Medical Education Symposium

First Author Information

Michael Joyce, MD, Assistant Professor, Virginia Commonwealth University, Emergency Medicine

Additional Author(s) Information

Jordan Tozer, MD Assistant Professor, Virginia Commonwealth University, Emergency Medicine

Lindsay Taylor, MD Assistant Professor, Virginia Commonwealth University, Emergency Medicine

Mike Vitto, DO, Assistant Professor, Virginia Commonwealth University, Emergency Medicine

David Evans, MD, Associate Professor, Virginia Commonwealth University, Emergency Medicine

Presentation Format

Oral

Type of Activity

Research

Original Presentation Date

2017

Date of Submission

May 2017

Abstract/Short Description

Point of care ultrasound is rapidly becoming the standard of care for many different clinical applications. The ACLS guidelines were recently updated to include ultrasound confirmation of endotracheal tube placement. While physicians sometimes utilize this in hospital, it is not commonly used in a pre-hospital setting. We proposed teaching this skill using a simulation approach including hands on teaching combined with simulation of pathology.

Purpose/Research Question

We propose to investigate the effectiveness of training air medics in ultrasound to assess endotracheal tube placement using simulation based learning. Currently, there is no training or formal education in place to train critical care paramedics in ultrasound, and on the job training is not feasible, as the instructor would have to be present at all times for when a learning situation arises. By moving the skills part of the instruction to simulation, it provides a way to give the basic ultrasound skills needed to apply to real clinical situations, such as ensuring endotracheal tube position after moving patients, after intubation, and in case of difficulty oxygenating or ventilating. Given the fact that physicians and residents can be easily trained in this skill as described in the literature, we feel this is a suitable method to train these learners. Our hypothesis is that we can effectively instruct air medics to ultrasound the neck and thorax to evaluate endotracheal tube location using simulators and hands on instruction.

Objectives

Determine if a simulation based approach is feasible for training of tracheal and lung ultrasound to critical care paramedics.

Assess ability for retention of knowledge using a post-test study protocol.

Survey participants on barriers to implementation of this technique into real world practice.

References

ACEP Board of Directors. (2016). ACEP Clinical Policy: Verification of Endotracheal Tube Placement. American College of Emergency Physicians.

Advanced Cardiac Life Support Guidelines, (2015).

Chou, E. H., Dickman, E., Tsou, P. Y., Tessaro, M., Tsai, Y. M., Ma, M. H., . . . Marshall, J. (2015). Ultrasonography for confirmation of endotracheal tube placement: a systematic review and meta-analysis. Resuscitation, 90, 97-103. doi:10.1016/j.resuscitation.2015.02.013

Chun, R., Kirkpatrick, A. W., Sirois, M., Sargasyn, A. E., Melton, S., Hamilton, D. R., & Dulchavsky, S. (2012). Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement. Prehospital and Disaster Medicine, 19(04), 366-369. doi:10.1017/s1049023x00002004

Das, S. K., Choupoo, N. S., Haldar, R., & Lahkar, A. (2015). Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis. Can J Anaesth, 62(4), 413-423. doi:10.1007/s12630-014-0301-z

Hoffmann, B., & Gullett, J. P. (2010). Emergency ultrasound for the detection of esophageal intubation. Acad Emerg Med, 17(4), 464-465. doi:10.1111/j.1553-2712.2010.00690.x

Milling, T. J., Jones, M., Khan, T., Tad-y, D., Melniker, L. A., Bove, J., . . . SchianodiCola, J. (2007). Transtracheal 2-d ultrasound for identification of esophageal intubation. J Emerg Med, 32(4), 409-414. doi:10.1016/j.jemermed.2006.08.022

Muslu, B., Sert, H., Kaya, A., Demircioglu, R. I., Gozdemir, M., Usta, B., & Boynukalin, K. S. (2011). Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients. J Ultrasound Med, 30(5), 671-676.

Park, S. C., Ryu, J. H., Yeom, S. R., Jeong, J. W., & Cho, S. J. (2009). Confirmation of endotracheal intubation by combined ultrasonographic methods in the Emergency Department. Emerg Med Australas, 21(4), 293-297. doi:10.1111/j.1742-6723.2009.01199.x

Singh, M., Chin, K. J., Chan, V. W., Wong, D. T., Prasad, G. A., & Yu, E. (2010). Use of sonography for airway assessment: an observational study. J Ultrasound Med, 29(1), 79-85.

Tejesh, C., Manjunath, A., Shivakumar, S., Vinayak, P., Yatish, B., & Geetha, C. (2016). Sonographic detection of tracheal or esophageal intubation: A cadaver study. Saudi J Anaesth, 10(3), 314-316. doi:10.4103/1658-354x.174922

Tonui, P. M., Nish, A. D., Smith, H. L., Letendre, P. V., & Portela, D. R. (2014). Ultrasound Imaging for Endotracheal Tube Repositioning During Percutaneous Tracheostomy in a Cadaver Model: A Potential Teaching Modality. The Ochsner Journal, 14(3), 335-338.

Werner, S. L., Smith, C. E., Goldstein, J. R., Jones, R. A., & Cydulka, R. K. (2007). Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement. Ann Emerg Med, 49(1), 75-80. doi:10.1016/j.annemergmed.2006.07.004

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