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216 Medical Student Assessment of Point of Care Ultrasonography Training as Part of the Emergency Medicine Clerkship
Research Forum Abstracts Results: In total, 49 patients (mean age 46⫾23 years, mean BMI 28.1⫾7.5, 47% female) were enrolled. The DLS was present in 32.7% of all exams (n⫽16). There was no significant difference in BMI between DLS-positive and DLS-negative groups (26.9 [inter-quartile range 22.2-30.5] versus 28.8 [IQR 24.1-30.5]; p⫽0.18). However, there was a significant difference in age between DLS-positive and DLSnegative groups (54 years [IQR 31-73] versus 42 years [IQR 23-52]; p⬍0.05). In the DLS-positive cases, 56.3% had negative FAST exams for free fluid (false positives). There was a significant difference in the proportion of false-positive readings in the over-65 and under-65 subject groups (50% versus 8.8%, p⬍0.005); however, no significant differences were found for sex, height, or weight. When follow-up imaging was done (n⫽22), findings for free fluid were consistent with results from the FAST exam in 86% of cases. Conclusion: The double-line sign was a common finding in adult FAST exams. No significant relationship was found between BMI and false-positive DLS findings. However, a relationship was found between age and the prevalence of false-positive readings: false-positive DLS were more likely to be visualized for patients over 65. For this group, therefore, it is particularly important to verify the presence of free fluid in DLS-positive FAST exams using other confirmatory imaging. Ultrasonography training should address the implications of a positive DLS in FAST exams - especially in those under 65 - to improve patient care and avoid unnecessary costs.
216
Medical Student Assessment of Point of Care Ultrasonography Training as Part of the Emergency Medicine Clerkship
Favot M, Amponsah D, Manteuffel J/Henry Ford Hospital, Detroit, MI
Study Objectives: The purpose of this study was to evaluate whether or not 4th year medical students felt that dedicated point-of-care ultrasonography training was a useful addition to the standard emergency medicine clerkship curriculum. Methods: This was an 8-month prospective cohort study of medical students during an emergency medicine clerkship at a large urban academic medical center, from July 2011 to February 2012. A total of 40 medical students participated in the study, with an average of 5 students per month. As part of the standard 1-month emergency medicine clerkship, students were introduced to the Focused Assessment with Sonography for Trauma (FAST) exam, and ultrasonography-guided vascular access. They all completed a 2-hour ultrasonography didactic and hands-on session on live models and phantoms on day one of the elective. They also had 3-4 hours of individual dedicated scanning sessions with the ultrasonography fellow during the 1-month elective. They completed a 10-item multiple choice exam at the end of the rotation, and were surveyed via email one month after the rotation regarding their ultrasonography experience (figure 1). The investigators were aware of the chosen specialties of all the subjects. Results: 29/40 (72.5%) students completed the email survey. 14 (48.3%) of the students were applying to emergency medicine residencies, 5 (17.2%) to internal medicine, and 3 (10.3%) to family medicine. No other specialty had more than 2 prospective applicants amongst the students. Other specialties represented were surgery, radiology, neurology, anesthesiology and ophthalmology. 24/29 (82.8%) respondents said they had used ultrasonography during subsequent clinical rotations and 27/29 (93.1%) respondents said they foresaw using ultrasonography in some capacity during residency. Other themes that were frequently mentioned by the students in their responses were: finding the knowledge helpful on non-emergency medicine rotations (17/29, 58.6%), finding the scanning shift with the ultrasonography fellow highly valuable (16/29, 55.2%), getting to train on patients with actual pathology rather than models or volunteers (7/29, 24.1%) wanting more than 1 dedicated scanning shift (15/29, 51.7%) and also wanting bedside echocardiography to be a part of the curriculum (7/29, 24.1%) (table 1). There was a wide variation in the rotations the students mentioned using the ultrasonography skills they learned during the emergency medicine clerkship including CCU, PICU, OB, MICU, radiology, family medicine, internal medicine and surgery. Conclusions: Our study demonstrates that medical students find dedicated point-of-care ultrasonography training to be a useful adjunct to the emergency medicine clerkship curriculum, and that they feel the skills they acquire during this time will serve to benefit them on future clerkships and during residency training.
S78 Annals of Emergency Medicine
217
Midaxillary Option for Measuring IVC: Prospective Comparison of the Right Midaxillary and Subxiphoid IVC Measurements
Howard ZD, Gharahbaghian L, Steele BJ, Foy S, Williams SR/Stanford University, Stanford, CA
Study Objectives: Subxiphoid (SX) bedside ultrasonography measurements of the inferior vena cava (IVC) as a reflection of volume status and the variability of IVC diameter with anatomical location has been well described in the literature; however, trauma patients commonly have thoracoabdominal pathology that often limits this sonographic window. The right midaxillary (RMA) IVC view may offer a good alternative, obtained with the probe in the same window as the Morison’s pouch evaluation for the FAST exam and in many ultrasonography protocols for a patient in undifferentiated shock. The primary objective is to assess the accuracy of the RMA IVC view compared to the SX IVC view. Secondary objectives include evaluating emergency physicians’ ease of obtaining the RMA view, prior clinical judgment of volume status compared to each IVC view and whether a concurrent static versus dynamic trend of vital signs correlates with IVC volume status measurement. Methods: A prospective convenience sample of adult patients at a large urban academic Level-1 trauma center emergency department were enrolled over a 6-month period in 2011-2012. Emergency physicians trained in the protocol visualized the longitudinal IVC in in both SX and RMA windows. Measurements of maximal and minimal diameter located 2cm from the caval-atrial junction or diaphragm were recorded during passive respiration utilizing both 2D clips, still images and M-mode functionality. Sonosite M-Turbo systems were used exclusively for this study deemed exempt by the IRB. Euvolemia was defined by prior studies as an IVC diameter of 1.5-2.5cm with 50% or less respiratory variation in the SX view. Patients’ initial and concurrent vital signs, physician perceptions of volume status who were blinded to IVC measurement, and ease of obtaining the RMA views were noted in a random subset of cases. Mean and standard deviations of the measurements were compared using a paired t-test with scientific significance given to those with p values ⬍ 0.05.
Volume , . : October
216
Medical Student Assessment of Point of Care Ultrasonography Training as Part of the Emergency Medicine Clerkship
Favot M, Amponsah D, Manteuffel J/Henry Ford Hospital, Detroit, MI
Study Objectives: The purpose of this study was to evaluate whether or not 4th year medical students felt that dedicated point-of-care ultrasonography training was a useful addition to the standard emergency medicine clerkship curriculum. Methods: This was an 8-month prospective cohort study of medical students during an emergency medicine clerkship at a large urban academic medical center, from July 2011 to February 2012. A total of 40 medical students participated in the study, with an average of 5 students per month. As part of the standard 1-month emergency medicine clerkship, students were introduced to the Focused Assessment with Sonography for Trauma (FAST) exam, and ultrasonography-guided vascular access. They all completed a 2-hour ultrasonography didactic and hands-on session on live models and phantoms on day one of the elective. They also had 3-4 hours of individual dedicated scanning sessions with the ultrasonography fellow during the 1-month elective. They completed a 10-item multiple choice exam at the end of the rotation, and were surveyed via email one month after the rotation regarding their ultrasonography experience (figure 1). The investigators were aware of the chosen specialties of all the subjects. Results: 29/40 (72.5%) students completed the email survey. 14 (48.3%) of the students were applying to emergency medicine residencies, 5 (17.2%) to internal medicine, and 3 (10.3%) to family medicine. No other specialty had more than 2 prospective applicants amongst the students. Other specialties represented were surgery, radiology, neurology, anesthesiology and ophthalmology. 24/29 (82.8%) respondents said they had used ultrasonography during subsequent clinical rotations and 27/29 (93.1%) respondents said they foresaw using ultrasonography in some capacity during residency. Other themes that were frequently mentioned by the students in their responses were: finding the knowledge helpful on non-emergency medicine rotations (17/29, 58.6%), finding the scanning shift with the ultrasonography fellow highly valuable (16/29, 55.2%), getting to train on patients with actual pathology rather than models or volunteers (7/29, 24.1%) wanting more than 1 dedicated scanning shift (15/29, 51.7%) and also wanting bedside echocardiography to be a part of the curriculum (7/29, 24.1%) (table 1). There was a wide variation in the rotations the students mentioned using the ultrasonography skills they learned during the emergency medicine clerkship including CCU, PICU, OB, MICU, radiology, family medicine, internal medicine and surgery. Conclusions: Our study demonstrates that medical students find dedicated point-of-care ultrasonography training to be a useful adjunct to the emergency medicine clerkship curriculum, and that they feel the skills they acquire during this time will serve to benefit them on future clerkships and during residency training.
S78 Annals of Emergency Medicine
217
Midaxillary Option for Measuring IVC: Prospective Comparison of the Right Midaxillary and Subxiphoid IVC Measurements
Howard ZD, Gharahbaghian L, Steele BJ, Foy S, Williams SR/Stanford University, Stanford, CA
Study Objectives: Subxiphoid (SX) bedside ultrasonography measurements of the inferior vena cava (IVC) as a reflection of volume status and the variability of IVC diameter with anatomical location has been well described in the literature; however, trauma patients commonly have thoracoabdominal pathology that often limits this sonographic window. The right midaxillary (RMA) IVC view may offer a good alternative, obtained with the probe in the same window as the Morison’s pouch evaluation for the FAST exam and in many ultrasonography protocols for a patient in undifferentiated shock. The primary objective is to assess the accuracy of the RMA IVC view compared to the SX IVC view. Secondary objectives include evaluating emergency physicians’ ease of obtaining the RMA view, prior clinical judgment of volume status compared to each IVC view and whether a concurrent static versus dynamic trend of vital signs correlates with IVC volume status measurement. Methods: A prospective convenience sample of adult patients at a large urban academic Level-1 trauma center emergency department were enrolled over a 6-month period in 2011-2012. Emergency physicians trained in the protocol visualized the longitudinal IVC in in both SX and RMA windows. Measurements of maximal and minimal diameter located 2cm from the caval-atrial junction or diaphragm were recorded during passive respiration utilizing both 2D clips, still images and M-mode functionality. Sonosite M-Turbo systems were used exclusively for this study deemed exempt by the IRB. Euvolemia was defined by prior studies as an IVC diameter of 1.5-2.5cm with 50% or less respiratory variation in the SX view. Patients’ initial and concurrent vital signs, physician perceptions of volume status who were blinded to IVC measurement, and ease of obtaining the RMA views were noted in a random subset of cases. Mean and standard deviations of the measurements were compared using a paired t-test with scientific significance given to those with p values ⬍ 0.05.
Volume , . : October