Albert Einstein College of Medicine, USA; Metropolitan Hospital Center, Department of Emergency Medicine, USA.
NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA.
Am J Emerg Med. 2023 Sep;71:104-108. doi: 10.1016/j.ajem.2023.06.032. Epub 2023 Jun 19.
Traumatic epidural hematoma (EDH) with the potential to displace the brain tissue and increase intracranial pressure (ICP), is a life-threatening condition that requires emergent intervention. In rare circumstances, Emergency Physician (EP) may have to do skull trephination to reduce the ICP as a temporary measure.
To evaluate emergency medicine (EM) residents' comfort in performing emergency department (ED) burr holes and to assess their difficulties and evaluate comfort level before and after simulated EDH cases.
A 3D-printed skull, electrical and manual drills were used for the simulation. Subjective comfort level pre and post-procedure, as well as objective procedural skills and time to complete the drill, were recorded.
Twenty EM residents participated in the simulation study. The median time to perforate through the skull was 4 s for the electric drill and 10 s for the manual drill. A comfort level of 5 and above was reported by 12 participants for the manual drill and by 17 participants for the electric drill. Six participants had mild and 2 participants had moderate observed difficulty in handling the manual and electric drill. Most participants performed both procedures successfully with one attempt only. Three participants have an overall comfort level above 5 before the simulation and 13 participants had overall comfort level above 5 post-simulation.
The 3D-printed model assisted the ED burr hole simulation and the residents could perform the procedure with minimum difficulties.
外伤性硬脑膜外血肿（EDH）有可能移位脑组织并增加颅内压（ICP），是一种危及生命的状况，需要紧急干预。在极少数情况下，急诊医师（EP）可能需要进行颅骨环钻术以降低 ICP 作为临时措施。
评估急诊医学（EM）住院医师在进行急诊科（ED）颅骨环钻术方面的舒适度，并评估他们在模拟 EDH 病例前后的困难程度和舒适度。
使用 3D 打印颅骨、电钻和手动钻进行模拟。记录术前和术后的主观舒适度、客观手术技能和完成钻孔的时间。
20 名急诊住院医师参加了模拟研究。电钻穿孔颅骨的中位数时间为 4 秒，手动钻为 10 秒。12 名参与者对手动钻的舒适度评分为 5 分及以上，17 名参与者对电钻的舒适度评分为 5 分及以上。6 名参与者在处理手动和电钻时有轻微的困难，2 名参与者有中度的困难。大多数参与者只用一次尝试就成功完成了两项操作。3 名参与者在模拟前的整体舒适度评分高于 5 分，13 名参与者在模拟后的整体舒适度评分高于 5 分。
3D 打印模型辅助 ED 颅骨环钻术模拟，住院医师可以轻松完成该操作。
