Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-23T09:54:29.731Z Has data issue: false hasContentIssue false
  • English
  • Français

Randomized Controlled Trial of Point-of-Care Ultrasound Education for the Recognition of Tension Pneumothorax by Paramedics in Prehospital Simulation

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  17 November 2020

Paul A. Khalil Open the ORCID record for Paul A. Khalil [Opens in a new window] ,
Andrew Merelman ,
John Riccio ,
Jodi Peterson ,
Ryan Shelton ,
Jeff Meyers ,
Tim Ketchmark ,
Emily Garneau ,
Stephanie Khalil  and
Genie Roosevelt
...Show all authors
Paul A. Khalil*
Affiliation:
Denver Health/University of Colorado, Department of Emergency Medicine, Denver, ColoradoUSA
Andrew Merelman
Affiliation:
Rocky Vista University College of Osteopathic Medicine, MS-3, Parker, ColoradoUSA
John Riccio
Affiliation:
South Metro Fire Rescue Authority, Centennial, ColoradoUSA
Jodi Peterson
Affiliation:
South Metro Fire Rescue Authority, Centennial, ColoradoUSA
Ryan Shelton
Affiliation:
South Metro Fire Rescue Authority, Centennial, ColoradoUSA
Jeff Meyers
Affiliation:
South Metro Fire Rescue Authority, Centennial, ColoradoUSA
Tim Ketchmark
Affiliation:
South Metro Fire Rescue Authority, Centennial, ColoradoUSA
Emily Garneau
Affiliation:
SonoSim, Denver, ColoradoUSA
Stephanie Khalil
Affiliation:
Independent Researcher
Genie Roosevelt
Affiliation:
Denver Health/University of Colorado, Department of Emergency Medicine, Denver, ColoradoUSA
Amanda Toney
Affiliation:
Denver Health/University of Colorado, Department of Emergency Medicine, Denver, ColoradoUSA Denver Health/University of Colorado, Pediatric Ultrasound Fellowship Director, Denver, ColoradoUSA
*
Correspondence: Paul A. Khalil, MD, 7006 Breakwater Pl, Louisville, Kentucky40059USA, E-mail: pkhalil3@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The primary goal of this study was to determine if ultrasound (US) use after brief point-of-care ultrasound (POCUS) training on cardiac and lung exams would result in more paramedics correctly identifying a tension pneumothorax (TPTX) during a simulation scenario.

Methods:

A randomized controlled, simulation-based trial of POCUS lung exam education investigating the ability of paramedics to correctly diagnose TPTX was performed. The US intervention group received a 30-minute cardiac and lung POCUS lecture followed by hands-on US training. The control group did not receive any POCUS training. Both groups participated in two scenarios: right unilateral TPTX and undifferentiated shock (no TPTX). In both scenarios, the patient continued to be hypoxemic after verified intubation with pulse oximetry of 86%-88% and hypotensive with a blood pressure of 70/50. Sirens were played at 65 decibels to mimic prehospital transport conditions. A simulation educator stated aloud the time diagnoses were made and procedures performed, which were recorded by the study investigator. Paramedics completed a pre-survey and post-survey.

Results:

Thirty paramedics were randomized to the control group; 30 paramedics were randomized to the US intervention group. Most paramedics had not received prior US training, had not previously performed a POCUS exam, and were uncomfortable with POCUS. Point-of-care US use was significantly higher in the US intervention group for both simulation cases (P <.001). A higher percentage of paramedics in the US intervention group arrived at the correct diagnosis (77%) for the TPTX case as compared to the control group (57%), although this difference was not significantly different (P = 0.1). There was no difference in the correct diagnosis between the control and US intervention groups for the undifferentiated shock case. On the post-survey, more paramedics in the US intervention group were comfortable with POCUS for evaluation of the lung and comfortable decompressing TPTX using POCUS (P <.001). Paramedics reported POCUS was within their scope of practice.

Conclusions:

Despite being novice POCUS users, the paramedics were more likely to correctly diagnose TPTX during simulation after a brief POCUS educational intervention. However, this difference was not statistically significant. Paramedics were comfortable using POCUS and felt its use improved their TPTX diagnostic skills.

Keywords

EMSpneumothoraxPOCUSsimulation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 1 , February 2021 , pp. 74 - 78
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Rojas, R, Wasserberger, J, Balasubramaniam, S. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. Ann Emerg Med. 1983;12(6):411-412.CrossRefGoogle ScholarPubMed
Fischer, H, Masel, H. Spontaneous pneumothorax and tension pneumothorax as causes of sudden death. Journal of Legal Medicine. 1978;81(3):223-226.Google ScholarPubMed
Galvagno, SM Jr, Nahmias, JT, Young, DA. Advanced Trauma Life Support update 2019: management and applications for adults and special populations. Anesthesiol Clin. 2019;37(1):13-32.CrossRefGoogle Scholar
Chen, SC, Markmann, JF, Kauder, DR, Schwab, CW. Hemopneumothorax missed by auscultation in penetrating chest injury. J Trauma. 1997;42(1):86-89.CrossRefGoogle ScholarPubMed
Brown, LH, Gough, JE, Bryan-Berg, DM, Hunt, RC. Assessment of breath sounds during ambulance transport. Ann Emerg Med. 1997;29(2):228-231.CrossRefGoogle ScholarPubMed
Ball, CG, Kirkpatrick, AW, Feliciano, DV. The occult pneumothorax: what have we learned? Can J Surg. 2009;52(5):E173-E179.Google ScholarPubMed
Blaivas, M, Lyon, M, Duggal, S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849.CrossRefGoogle Scholar
Alrajab, S, Youssef, AM, Akkus, NI, Caldito, G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013;17(5):R208.CrossRefGoogle Scholar
Szarpak, L, Mateo, RG, Marchese, G, et al. Ultrasonography as a tool for prehospital recognition of tension pneumothorax: preliminary data. Am J Emerg Med. 2016;34(7):1302-1303.CrossRefGoogle ScholarPubMed
Chin, EJ, Chan, CH, Mortazavi, R, et al. A pilot study examining the viability of a Prehospital Assessment with Ultrasound for Emergencies (PAUSE) protocol. J Emerg Med. 2013;44(1):142-149.CrossRefGoogle ScholarPubMed
Bhat, SR, Johnson, DA, Pierog, JE, Zaia, BE, Williams, SR, Gharahbaghian, L. Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): point-of-care ultrasound in Emergency Medical Services. West J Emerg Med. 2015;16(4):503-509.CrossRefGoogle ScholarPubMed
Ketelaars, R, Hoogerwerf, N, Scheffer, GJ. Prehospital chest ultrasound by a Dutch helicopter emergency medical service. J Emerg Med. 2013;44(4):811-817.CrossRefGoogle ScholarPubMed
Dawson, M, Mallin, M. Introduction to Bedside Ultrasound, Volumes 1 and 2. Lexington, Kentucky USA: Emergency Ultrasound Solutions; 2012.Google Scholar
American College of Emergency Physicians. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550-570.CrossRefGoogle Scholar
Soon, AW, Toney, AG, Stidham, T, Kendall, J, Roosevelt, G. Teaching point-of-care lung ultrasound to novice pediatric learners: web-based e-learning versus traditional classroom didactic. Pediatr Emerg Care. 2020;36(7):317-321.Google ScholarPubMed
Rykkje, A, Carlsen, JF, Nielsen, MB. Hand-held ultrasound devices compared with high-end ultrasound systems: a systematic review. Diagnostics (Basel). 2019;9(2):61.CrossRefGoogle ScholarPubMed
Lyon, M, Walton, P, Bhalla, V, Shiver, SA. Ultrasound detection of the sliding lung sign by prehospital critical care providers. Am J Emerg Med. 2012;30(3):485-488.CrossRefGoogle ScholarPubMed