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Author(s): Lahham, Shadi; Smith, Taylaur; Baker, Jessa; Purdy, Amanda; Frumin, Erica; Winners, Bret; Wilson, Sean P; Gari, Abdulatif; Fox, John C | Abstract: BACKGROUND:Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks. METHODS:This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device. RESULTS:Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10 (40%) of the participants preferred the Blue Phantom model, while 10 (40%) preferred the homemade gelatin model and 5 (20%) preferred the homemade tofu model. After cost awareness, the majority, 18 (72%) preferred the gelatin model. CONCLUSION:The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.

Medical Teacher r P Fo In-flight Medical Emergencies: Creation of a Novel Simulation Based Medical Student Curriculum Manuscript Categories: Date Submitted by the Author: Draft Letters n/a ev Complete List of Authors: Medical Teacher r-R Manuscript ID: ee Journal: w ie Katzer, Robert; University of California, Irvine School of Medicine, Emergency Medicine Frumin, Erica; University of California, Irvine School of Medicine, Emergency Medicine Silverman, Danielle; Cambridge Health Alliance, Emergency Medicine Koenig, Kristi; University of California, Irvine School of Medicine, Emergency Medicine Schultz, Carl; University of California, Irvine School of Medicine, Emergency Medicine Education environment < Curriculum, General < Curriculum, Medical education research < Management, Undergraduate < Phase of education, Medicine < Profession ly On Keywords: E-Mail: medicalteacher@dundee.ac.uk URL: http://mc.manuscriptcentral.com/CMTE

Introduction: The accurate diagnosis of elevated intracranial pressure (eICP) in the emergent setting is a critical determination that presents significant challenges. Several studies show correlation of sonographic optic nerve sheath diameter (ONSD) to eICP, while others show high inter-observer variability or marginal performance with less experienced sonographers. The objective of our study is to assess the ability of bedside ultrasound measurement of ONSD to identify the presence of eICP when performed by a single experienced sonographer. We hypothesize that ONSD measurement is sensitive and specific for detecting eICP and can be correlated with values obtained by external ventricular device (EVD). Methods: This was a prospective blinded observational study conducted in a neurocritical care unit of a level 1 trauma center. ONSD measurement was performed on a convenience sample of 27 adult patients who required placement of an invasive intracranial monitor as part of their clinical care. One certified sonographer/physician performed all ultrasounds within 24 hours of placement of EVD. The sonographer was blinded to the ICP recorded by invasive monitor at the time of the scan. A mean ONSD value of ≥5.2 mm was taken as positive. Results: The sonographer performed 27 ocular ultrasounds on individual patients. Six (22%) of these patients had eICP (EVD measurement of >20 mmHg). Spearman rank correlation coefficient of ONSD and ICP was 0.408 (p=0.03), demonstrating a moderate positive correlation. A ROC curve was created to determine the optimal cut off value to distinguish an eICP greater than 20 mmHg. The area under the receiver operator characteristic curve was 0.8712 (95% confidence interval [CI]=0.67 to 0.96). ONSD ≥5.2 mm was a good predictor of eICP (>20 mmHg) with a sensitivity of 83.3% (95% CI=35.9% to 99.6%) and specificity of 100% (95% CI=84.6% to 100%). Conclusion: While the study suggests ONSD measurements performed by a single skilled operator may be both sensitive and specific for detecting eICP, confirmation in a much larger sample is needed. Ocular ultrasound may provide additional non-invasive means of assessing eICP . [West J Emerg Med. 2014;15(2):217–220.]