Morris Kharasch

Epistaxis simulator: an innovative design.

Introduction: This article provides directions for creating a cost-effective epistaxis simulator using an existing CPR Trainer and expired medical supplies. Methods: An epistaxis simulator was created and presented to attending Emergency Medicine physician-educators at Evanston Northwestern Healthcare as an adjunct for procedural training. The materials and methods for making the nosebleed simulator are outlined in this article. Results: We created an epistaxis model utilizing an older CPR Trainer, i.v. tubing, and a bag of normal saline. The model provided realistic epistaxis. This simulator is able to simulate a nosebleed’s response to proper positioning of nasal packing by creating hemostasis. Conclusions: Existing task trainers can be modified to provide learners with novel features that can expand the number of simulated clinical conditions.

Physiological Stress Responses of Emergency Medicine Residents During an Immersive Medical Simulation Scenario

igh-fidelity simulation is now considered a standard educational tool in any residency training programs. The Accreditation Council for Gradate Medical Education Residency Review Committee for Emergency edicine now allows procedural skills completed in a simulated envionment to count toward their overall procedural exposure during esidency training. The rationale is that these simulated experiences rovide a level of training realistic enough to allow the patient to perform etter in an actual patient experience. Research has also shown that roficiency demonstrated in simulated settings can translate accurately nto patient care and improve patient safety. Measuring the learner’s subjective experience, as compared to the real linical environment, is a challenge in the simulation environment. roponents of immersive medical simulation claim that participating in a cenario provides an emotional response that causes the trainees to espond to the situation as if it were real. This emotional response is onsidered an important factor contributing to the simulation’s effectiveess in embedding the experience in the learner’s memory. We attempted o objectively measure the learner’s physiological heart rate and blood ressure response to stress encountered in an immersive medical simuation involving a critically ill patient.

Resident response to integration of simulation-based education into emergency medicine conference.

OBJECTIVES Utilization of simulation-based training has become increasingly prevalent in residency training. The authors compared emergency medicine (EM) resident feedback for simulation sessions to traditional lectures from an EM residency didactic program. METHODS The authors performed a retrospective review of all written EM conference evaluations over a 29-month period. Evaluation questions were scored on a 1-9 Likert scale. RESULTS Lectures and simulation accounted for 77.6 and 22.4% of the conferences, respectively. Scored means (+/-standard deviations [SDs]) were as follows: overall, lecture 7.97 +/- 0.74 versus simulation 8.373 +/- 0.44 (p < 0.01); Question 1, lecture 7.97 +/- 0.74 versus simulation 8.40 +/- 0.43 (p < 0.005); Question 2, lecture 7.92 +/- 0.74 versus simulation 8.34 +/- 0.48 (p < 0.01); Question 3, lecture 8.01 +/- 0.77 versus simulation 8.26 +/- 0.51 (p < 0.15); and Question 4, lecture 8.00 +/- 0.75 versus simulation 8.42 +/- 0.46 (p < 0.01). There was no longitudinal decay of scores. CONCLUSIONS Emergency medicine residents scored simulation-based sessions higher than traditional lectures. The scores over time suggest that this preference for simulation can be sustainable long term. Residents perceive simulation as more desirable teaching method compared to the traditional lecture format.

Evaluation of the patient with closed head trauma : An evidence based approach

This article approaches the subject of closed head trauma from the time-sensitive vantage point of the emergency physician. As the clinical scenario unfolds, he or she constantly evaluates the need for diagnostic tests as information is received from paramedics, nurses, and the history and physical examination. This article provides a synopsis and a critique of original clinical trials to aid the emergency physician in making an evidence based decision.

An innovative and inexpensive model for teaching cricothyrotomy.

Cricothyrotomy is considered an integral procedure in the practice of emergency medicine. The Accreditation Council for Graduate Medical Education requires residents in emergency medicine to demonstrate proficiency in this skill, but because cricothyrotomy is rarely encountered in the clinical setting, alternative methods to teach this high-stakes procedure become an important curricular component in residency training. We present an innovative and inexpensive method for teaching cricothyrotomy using animal trachea and synthetic skin.

Assessing the accreditation council for graduate medical education requirement for temporary cardiac pacing procedural competency through simulation.

Purpose: The Accreditation Council for Graduate Medical Education (ACGME) guidelines recommend that residents perform 6 cardiac pacing attempts during residency training, while making no distinction between transcutaneous pacing (TCP) or transvenous pacing (TVP). This study seeks to enhance and validate emergency medicine residency curricula by assessing and measuring the minimum number of performances for TCP and TVP through simulation for procedural competency. Methods: In 2009–2010, 36 residents were invited to the simulation laboratory to participate in individual procedural training sessions. The residents each rotated through the 2 following partial-task training stations staffed by faculty members: (1) TVP and (2) TCP. Using the process of deliberate practice, the procedures were repeated until the faculty members had determined procedural competency defined as 2 completions without error via a preset checklist. Results: Residents required a mean (SD) of 3.11 (0.56) attempts and a median of 3 attempts to successfully perform TCP and a mean (SD) of 5.25 (0.94) attempts and a median of 6 attempts to successfully perform TVP. Learners required a mean (SD) total number of 8.39 (1.09) attempts and a median of 9 attempts to achieve competency at cardiac pacing. No resident required more than 5 attempts to achieve competency in TCP; no resident required more than 6 attempts to achieve competency in TVP. Conclusions: When measuring TVP alone, the number of attempts to achieve competency are comparable with that of the ACGME guidelines. When accounting for both TCP and TVP, the number of attempts required to achieve competency is greater than those delineated by the ACGME guidelines. The results of this trial warrant continuation and reproduction on a larger scale to revisit the ACGME guidelines.

Neonatal resuscitation guidelines

The following guidelines apply to infants in perinatal transition from intrauterine to extrauterine life as well as those that have concluded perinatal transition but require resuscitation during the early weeks to months of life. The goal of this article is to outline the most recent consensus guidelines for neonatal resuscitation and to summarize the level of evidence for the steps that constitute these guidelines. Nearly 1 in 10 newborns need some basic resuscitative measures to aid breathing at birth, but fewer than 1 in 100 require major resuscitations. Practitioners can rapidly assess the need for neonatal resuscitation by observing 3 vital characteristics of the birth:

Simulation applications in emergency medical services.

rehospital emergency medical services (EMS) play an important role n the initial stabilization and transport of critically ill patients daily round the world. In the USA, there are an estimated 840,000 ertified first responders and, of these, there are greater than 192,000 MS providers. These individuals work for a variety of governmental nd private organizations such as fire departments, private companies, olunteers, hospitals, and third-party providers. All states require a rained and certified EMS responder to provide emergency medical are in the event of a weapons of mass destruction (WMD) incident nd the administration of antidotes as dictated by region. As a esponse to September 11, comprehensive competency-based curricula or terrorism preparedness have been created. The hallmark of an expertly trained EMS provider is the ability to ecognize rapidly and treat immediate life threats, initiate timely ommunication with receiving facilities to prepare them for patient rrival, and execute proper protocols in the event of a disaster or mass asualty. EMS providers require a unique skill set to deal effectively ith the complexities of the scope of their practice. They are under ignificant time pressure to triage and initiate treatment for unstable atients. This requires clear thinking and poise. They must be able to hink flexibly and cope with an array of environmental factors articular to the scene. Additionally, they need to be able to work ffectively while maintaining situational awareness of dangers to their ersonal safety. Finally, they need to maintain vigilance and be repared to react to the possibility that their scene response is otentially related to a mass casualty or disaster that they have never

High-Fidelity Simulation—Emergency Medicine

igh-fidelity simulation (HFS) has become an essential tool for training any health care providers in virtually every field of medicine. The rimary benefit of using HFS as an educational and evaluative tool is that earners can practice medical decision-making and procedural skills on imulated patients in an environment where the risk of error will not harm n actual patient. These technologies and the educational constructs esigned around their use were developed to practice skills without ncurring risk. Medicine followed precedents set by model high reliability rganizations such the military with its war games exercises, the aeropace industry with flight training of pilots and astronauts, and the nuclear ower industry to train personnel to deal effectively and resiliently in rises situations. Bridging the gap between other industries and mediine, Gaba and DeAnda pioneered the use of simulation in anesthesia to rain anesthesiologists. Their report described the creation of a compreensive anesthesia simulation environment that re-created an operating oom. Appropriate monitoring equipment was included as was a realistic ntubation/thorax mannequin, which allowed for the formulation of ealistic problems within the operating room. Built on Gaba’s work in the 1980s, the subspecialty of anesthesia was he first to adopt it as an educational tool within the field of medicine. he first study regarding training in emergency medicine occurred in 999 and emphasized airway training. This advanced airway course used imulation to teach rapid sequence intubation skills as well as how to anage problems during rapid sequence intubation. The idea of using HFS to limit human error and improve safety was nitially introduced by the airlines and National Aeronautics and Space dministration as a Crew Resource Management (CRM) Curriculum. It as then used to create an Anesthesia Crisis Resource Management

Innovative Simulation Training Models

Maximilian Hoffman, Morgan Krey, Margaret Iwanicki, Jordon Cooper, Sasha Jones, Peggy Ochoa, RNC-OB, MS, Pam Aitchison, RN, Jin-cheng Zhao, MD, MS, Morris Kharasch, MD, FACEP, and Ernest E. Wang, MD, FACEP imulation now plays a major role in health care education and training. n the last decade, medical simulation experts have delineated the features f and methods for using simulation to facilitate effective learning in the ealth care setting. Each year, simulationists find new procedures and kills to teach using simulation. However, partial task training models for any procedures remain unavailable. We describe several synthetic and rganic models that can be created for simulation-based training puroses.