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Computer simulation of CPR: Computer analysis of a simple electrical model of the circulation
ABSTRACTS
Pediatric Curriculum for Emergency Medicine Training Program JV Weigand, SM Asch / Department of Emergency Medicine, Akron City Hospital; Division of Emergency/Trauma Services, Children's Hospital Medical Center of Akron, Akron, Ohio Reviews of current emergency medicine residency programs repeatedly document deficiencies in the teaching and clinical experience of emergency pediatrics. To remedy this, a group of experienced teachers of emergency medicine and emergency pediatrics have jointly designed and pilot tested an integrated curriculum designed to operate within a 3-year emergency medicine residency. This integrated pediatric curriculum identifies educational objectives for training in pediatric emergencies and provides a specific plan for meeting these objectives with coordinated readings, laboratories, demonstrations, and intensive clinical encounters. The format also demonstrates how these methods may be utilized flexibly to capitalize on the particular strengths of individual emergency medical residencies and their trainees.
Emergency Pediatric Tracheotomies: A Usable Technique and Model for Instruction JH McLaughlin. KV Iserson / Section of Emergency Medicine.
Arizona Health Sciences Center. Tucson We have developed a reliable technique for emergency pediatric tracheotomy and a model for practicing the procedure. Because such emergency surgical access is rarely demanded of emergency physicians or pediatricians, few have the opportunity to become p r o f i c i e n t with this d r a m a t i c life-saving maneuver. Cricothyrotomy is precluded by the small size of the cricothyroid space in infants and small children, and the conventional tracheotomy technique requires considerable experience and operative equipment. Our technique uses basic equipment found in any ED: syringe, needle, scalpel, and endotracheal tube: It may be used to manage complete a~rway obstruction from edema or foreigu bOdies, facial or laryngeal fractures, laryngospasm or apnea with possible cervical spine injury. A finder needle and a salinefilled syringe are used to locate the small and poorly defined trachea. When the saline flows freely of when air bubbles enter the syringe, indicating entrance into the lumen, the needle is stabilized and a stabbing incision is made lateral to and against the needle. Using the knife handle to open the stoma, the needle is removed and a standard pediatric endotracheal tube is inserted. We have found the anesthetized kitten weighing 1,000-1,500 g to be a useful model for teaching and rehearsing this technique. This size cat has a tracheal diameter of 5.5-6.0 mm, which is equivalent to that of a child under 1 year of age. Adult cats in the 4,000 g range simulate well the older child. Teaching sessions involving emergency medicine faculty, residents, and medical students indicate that this method helps nonsurgeons to secure an adequate airway. The participants in the teaching sessions had no prior formal training in tracheotomies and varied experience with cricothyrotomy. Practice with this model greatly enhanced their confidence and skill. Experience using this model can enable emergency practitioners to become confident w i t h this method for emergency pediatric traeheotomy and to perform successfully in the critical situations when conservative airway management will not suffice.
0
Computer Simulation of CPR: Computer Analysis of a Simple Electrical Model of the Circulation
SA Meador/Department of Medicine, Emergency Medicine
Division, The Milton S Hershey Medical Center, The Pennsylvania State University, Hershey There have been n u m e r o u s attempts to model the cardio172/492
vascular system. Most have been concerned with the hemodynamic properties of blood flow with a beating heart. Recently work using a simple electrical model of the circulation to simulate the hemodynamics of cardiopulmonary resuscitation (CPR) has been published. This hard-wired circuit consists of the heart and great vessels modeled as a resistive-capacitive network, pressure as voltage, blbod flow as current, blood inertia as inductance; and vascular valves as diodes. Such a model is useful for examining the physiology of various methods and techniques of CPR administration. In this investigation, a general purpose circuit simulation program, SPICE Version 2G.1, was used to analyze previously published CPR models. With minor modifications, the program was able to reproduce fully the hard-wired circuit results. The program is very flexible, allowing for easy model modification and a wide range Of parameter values. In addition, the program offers the advantages of increased accuracy and low cost. Suggested future applications are for rapid evaluation of new CPR concepts.
1
Application of Microcomputers in the Emergency Department: Experience with a Computerized Logbook
SJ Januzik / Department of Emergency Medicine, Butterworth
Hospital, Grand Rapids, Michigan The JCAH regulations stipulate that every ED maintain a control register or logbook of the patients seen. Typically, logbooks consist of a handwritten record maintained by the ED clerical staff. The retrieval of logbook data is characteristically a slow and tedious task prone to error commensurate with the fatigue of the searcher. In addition, the medical records department must be able to retrieve patient information to satisfy physician requests, admissions lists, ED deaths, and long-term recordkeeping. Furthermore, the effectiveness of the logbook is highly dependent on the legibility of the handwriting. A computerized logbook has been developed for use on personal microcomputers utilizing an econOmical database management system. Each patient record consists of 17 fields, including basic identifying data, chief complaint, diagnosis, physicians involved, and disposition. The daily log of patients seen is a computer-generated printout containing nearly 4 times the number of patients per printed page as our handwritten 10g system. Our ED utilizes this information to generate data listings which would be too time consuming to obtain by conventional manual methods. It is now possible t o obtain listings of admissions, mortalities, daily radiographs, laboratory cultures, and physician patient lists. The log also may be transported on magnetic disk tO other personal computers for medical record uses. The system is a valuable resource in an emergency medicine residency, and allows our program to generate interesting case and radiograph listings. Research data can be obtained in a fraction of the amount of time and effort usually required by manual methods. The database is capable of searching or Sorting any record field, making it useful for quality assurance purposes. The advantage of an easy-to-use database management system in the ED permits any physician or staff member to obtain information on a 24-h basis without depending on hospital computer personnel.
2
Computer-Assisted Instruction in Trauma
RD Evans, S Brotman / Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania In an effort to improve education in trauma, a computer interactive program was developed for self-education and teaching. The program consists of Cases presented as patient management problems. Multiple choice answers are provided and a series of interactive loops is used to discuss both the correct and incorrect choices. Program branching is used to provide different outcomes
Annals of Emergency Medicine
14:5 May 1985
Pediatric Curriculum for Emergency Medicine Training Program JV Weigand, SM Asch / Department of Emergency Medicine, Akron City Hospital; Division of Emergency/Trauma Services, Children's Hospital Medical Center of Akron, Akron, Ohio Reviews of current emergency medicine residency programs repeatedly document deficiencies in the teaching and clinical experience of emergency pediatrics. To remedy this, a group of experienced teachers of emergency medicine and emergency pediatrics have jointly designed and pilot tested an integrated curriculum designed to operate within a 3-year emergency medicine residency. This integrated pediatric curriculum identifies educational objectives for training in pediatric emergencies and provides a specific plan for meeting these objectives with coordinated readings, laboratories, demonstrations, and intensive clinical encounters. The format also demonstrates how these methods may be utilized flexibly to capitalize on the particular strengths of individual emergency medical residencies and their trainees.
Emergency Pediatric Tracheotomies: A Usable Technique and Model for Instruction JH McLaughlin. KV Iserson / Section of Emergency Medicine.
Arizona Health Sciences Center. Tucson We have developed a reliable technique for emergency pediatric tracheotomy and a model for practicing the procedure. Because such emergency surgical access is rarely demanded of emergency physicians or pediatricians, few have the opportunity to become p r o f i c i e n t with this d r a m a t i c life-saving maneuver. Cricothyrotomy is precluded by the small size of the cricothyroid space in infants and small children, and the conventional tracheotomy technique requires considerable experience and operative equipment. Our technique uses basic equipment found in any ED: syringe, needle, scalpel, and endotracheal tube: It may be used to manage complete a~rway obstruction from edema or foreigu bOdies, facial or laryngeal fractures, laryngospasm or apnea with possible cervical spine injury. A finder needle and a salinefilled syringe are used to locate the small and poorly defined trachea. When the saline flows freely of when air bubbles enter the syringe, indicating entrance into the lumen, the needle is stabilized and a stabbing incision is made lateral to and against the needle. Using the knife handle to open the stoma, the needle is removed and a standard pediatric endotracheal tube is inserted. We have found the anesthetized kitten weighing 1,000-1,500 g to be a useful model for teaching and rehearsing this technique. This size cat has a tracheal diameter of 5.5-6.0 mm, which is equivalent to that of a child under 1 year of age. Adult cats in the 4,000 g range simulate well the older child. Teaching sessions involving emergency medicine faculty, residents, and medical students indicate that this method helps nonsurgeons to secure an adequate airway. The participants in the teaching sessions had no prior formal training in tracheotomies and varied experience with cricothyrotomy. Practice with this model greatly enhanced their confidence and skill. Experience using this model can enable emergency practitioners to become confident w i t h this method for emergency pediatric traeheotomy and to perform successfully in the critical situations when conservative airway management will not suffice.
0
Computer Simulation of CPR: Computer Analysis of a Simple Electrical Model of the Circulation
SA Meador/Department of Medicine, Emergency Medicine
Division, The Milton S Hershey Medical Center, The Pennsylvania State University, Hershey There have been n u m e r o u s attempts to model the cardio172/492
vascular system. Most have been concerned with the hemodynamic properties of blood flow with a beating heart. Recently work using a simple electrical model of the circulation to simulate the hemodynamics of cardiopulmonary resuscitation (CPR) has been published. This hard-wired circuit consists of the heart and great vessels modeled as a resistive-capacitive network, pressure as voltage, blbod flow as current, blood inertia as inductance; and vascular valves as diodes. Such a model is useful for examining the physiology of various methods and techniques of CPR administration. In this investigation, a general purpose circuit simulation program, SPICE Version 2G.1, was used to analyze previously published CPR models. With minor modifications, the program was able to reproduce fully the hard-wired circuit results. The program is very flexible, allowing for easy model modification and a wide range Of parameter values. In addition, the program offers the advantages of increased accuracy and low cost. Suggested future applications are for rapid evaluation of new CPR concepts.
1
Application of Microcomputers in the Emergency Department: Experience with a Computerized Logbook
SJ Januzik / Department of Emergency Medicine, Butterworth
Hospital, Grand Rapids, Michigan The JCAH regulations stipulate that every ED maintain a control register or logbook of the patients seen. Typically, logbooks consist of a handwritten record maintained by the ED clerical staff. The retrieval of logbook data is characteristically a slow and tedious task prone to error commensurate with the fatigue of the searcher. In addition, the medical records department must be able to retrieve patient information to satisfy physician requests, admissions lists, ED deaths, and long-term recordkeeping. Furthermore, the effectiveness of the logbook is highly dependent on the legibility of the handwriting. A computerized logbook has been developed for use on personal microcomputers utilizing an econOmical database management system. Each patient record consists of 17 fields, including basic identifying data, chief complaint, diagnosis, physicians involved, and disposition. The daily log of patients seen is a computer-generated printout containing nearly 4 times the number of patients per printed page as our handwritten 10g system. Our ED utilizes this information to generate data listings which would be too time consuming to obtain by conventional manual methods. It is now possible t o obtain listings of admissions, mortalities, daily radiographs, laboratory cultures, and physician patient lists. The log also may be transported on magnetic disk tO other personal computers for medical record uses. The system is a valuable resource in an emergency medicine residency, and allows our program to generate interesting case and radiograph listings. Research data can be obtained in a fraction of the amount of time and effort usually required by manual methods. The database is capable of searching or Sorting any record field, making it useful for quality assurance purposes. The advantage of an easy-to-use database management system in the ED permits any physician or staff member to obtain information on a 24-h basis without depending on hospital computer personnel.
2
Computer-Assisted Instruction in Trauma
RD Evans, S Brotman / Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania In an effort to improve education in trauma, a computer interactive program was developed for self-education and teaching. The program consists of Cases presented as patient management problems. Multiple choice answers are provided and a series of interactive loops is used to discuss both the correct and incorrect choices. Program branching is used to provide different outcomes
Annals of Emergency Medicine
14:5 May 1985