3 results
MP12: Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model
- B. Waterman, K. VanAarsen, M. Lewell, H. Tien, F. Myslik, M. Peddle, S. Doran
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, pp. S46-S47
- Print publication:
- May 2020
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Introduction: The FAST exam – Focused Assessment with Sonography in Trauma - is a rapid test using ultrasound to identify sonographic evidence of hemorrhage within the abdomen. In the prehospital setting, the information from a FAST examination can help triage patients, direct patients to the most appropriate facilities, assist with management strategies and potentially expedite time to definitive intervention. Few studies examine the accuracy of paramedic-only-performed FAST examinations. However, despite the potential benefits to the Canadian prehospital system, a potential barrier to implementation is the tremendous financial and operational burden if paramedics require prolonged ultrasound training courses. In this study, we conducted a double-blinded observational study comparing the accuracy of paramedic-performed FAST versus physician-performed tests on a sonographic Phantom, after a one-hour didactic training session. Methods: The interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model. The mannequin utilized in this study was a realistic model of a human torso where fluid could be injected into the abdomen to create a realistic ultrasound image of abdominal free fluid. Participants were required to scan the mannequin twice, once with 300 mL of fluid instilled and once with the abdomen free of fluid. Participants were blinded to the status of hemoperitoneum. The primary outcome of the study was accuracy rate of FAST examination by paramedics compared to emergency room physicians. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05. Total scan time was reported using means, standard deviations and 95% CIs and was compared between groups using standard t-test. Results: Fourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were ultrasound-naive whereas the emergency physicians had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups 85.6% and 87.5% (Δ1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively. Total scan time differed between groups but did not reach statistical significance. Paramedics took longer to complete the FAST examination with a mean (SD) time to complete the two scans of 10.35 (3.43) minutes compared to 7.34 (2.74) minutes for physicians, (Δ3.01 minutes 95%CI -0.97 to 7.00, p = 0.13). Conclusion: This study determined that critical care paramedics were able use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of ultrasound in prehospital programs to determine the most appropriate transport destination and aid in the triage of trauma patients while limiting the financial and logistical burden of ultrasound training.
P029: Requesting prescriptions in the emergency department: the patient, the request and the response
- L. Shepherd, M. Mucciaccio, K. VanAarsen
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, pp. S74-S75
- Print publication:
- May 2020
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Introduction: Patients presenting to the Emergency Department (ED) for the sole purpose of requesting prescriptions are problematic. Problematic for the patient, who may have a long wait to be seen and may leave dissatisfied. Problematic for the ED physician, who is in the business of episodic not comprehensive care and is diligently trying to avoid the misappropriation of medications. The primary objective of this study was to determine the characteristics of patients who present to the ED or Urgent Care Centre (UCC) requesting a prescription, the nature of these requests and the resulting action by the attending physician. The secondary objective was to determine the proportion of medication requests and responses that have potential street value. With this knowledge we may be better positioned to serve these patients and support physician decision-making. Methods: This was a single-centre, retrospective electronic chart review looking at all adult patients with a presenting complaint of medication request who attended a two-site tertiary ED or an Urgent Care Centre (UCC) in London, Ontario between April 1, 2014 and June 30, 2017. Data was tested for normality and analyzed using descriptive statistics. Results: A total of 1923 cases met the inclusion criteria. Cases were removed (n = 421) if it was unclear which prescription was requested or if a non-medication prescription or injection was requested. The patient median (IQR) age was 44 (32-54) with 58% being male and 55% having a family doctor. There were a total of 2261 prescriptions requested by 1502 patients. The top 3 most commonly requested classes of medications were opioids 433/1502 (28.8%), antidepressants/antipsychotics 371/1502 (24.7%) and benzodiazepines 252/1502 (16.8%). The median (IQR) wait time was 73 minutes (35-128). 298/1502 (19.8%) of patients received their requested prescription (opioids 12.7%; antidepressant/antipsychotic 55.3% and benzodiazepines 16.3%). 740/1502 (49.3%) of patients requested a medication that had street value. Of those, 118/740 (15.9%) received the requested medication. Conclusion: There is no “one size fits all” solution for the patient who presents to the ED requesting a prescription. The large number of requests for psychiatric medications suggests a service gap for mental health patients in the community. This data supports the need for comprehensive electronic medication records to guide physicians’ decisions.
LO38: Assessment of pain and provision of non-pharmacologic analgesia to children by prehospital providers in Southwestern Ontario: a cross-sectional study
- J. Teefy, H. Mustafa, N. Poonai, K. VanAarsen, A. Dukelow
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S21
- Print publication:
- May 2019
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Introduction: There is abundant evidence that in children, assessment and pharmacologic treatment of pain by prehospital providers is suboptimal. Most paediatric calls are performed by primary care paramedics who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. We sought to describe the proportion of children provided non-pharmacologic analgesia by prehospital providers. Methods: We reviewed all ambulance call reports (ACR) of children age 0-17 years with an acutely painful condition (headache, abdominal pain, possible fracture, head/ears/eyes/nose/throat pain, back pain, and unclassified pain) who were transported to the Children's Hospital, London Health Sciences Centre between 2008 and 2017. We excluded ACRs lacking data pertaining to the primary outcome. Data collection was recorded by two blinded assessors using a study-specific ExcelTM sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a hierarchical stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, documentation of pain score, and complaint. Results: Of 19782 ACRS, we report the preliminary results of 500 ACRs reviewed from Jan 1 to Feb 22, 2016. Of the 403 ACRs eligible for analysis, the median (IQR) age was 13 (8) years and 174 (43.2%) were females. 309/403 (76.7%) calls involved primary (as opposed to advanced) care paramedics. Pain assessments were performed in 171/403 (42.4%) calls, most commonly the 0-10 verbal numeric rating scale [128/171 (74.8%)] and the median (IQR) score was 7 (4) (n = 128). Non-pharmacologic analgesia was offered in 72/403 (17.9%) of calls, most commonly ice (37/72, 51%) and splint (29/72, 40%). In the multivariate model, significant predictors of non-pharmacologic analgesia included older age (OR 1.1; 95% CI: 1.1, 1.2; p = 0.01) and visible deformity (OR 8.2; 95% CI: 2.5, 30.2; p = 0.001). Sex (p = 0.62), documentation of pain score (p = 0.81), and complaint (p = 0.05) were not significant predictors. Conclusion: In this preliminary analysis, the provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers was suboptimal despite moderate to severe levels of pain. Less than half of patients had pain assessments documented. There is a clear need for education surrounding pain assessment and non-pharmacologic analgesic options in children among prehospital providers.