Rasheed Mustafa N, Coleman Keel E, Fortuna Timothy J
Virginia Tech Carilion School of Medicine, Department of Emergency Medicine, Roanoke, VA.
J Educ Teach Emerg Med. 2020 Jan 15;5(1):I1-I9. doi: 10.21980/J86G9P. eCollection 2020 Jan.
This low-cost peritonsillar abscess model is intended for the education of emergency medicine and otolaryngology residents and advanced care practitioners of all training levels.
With incidence rates as high as 124 per 100,000 in the 14-21 age range, peritonsillar abscesses (PTA) are one of the more common head and neck soft tissue infections encountered in the emergency department.1 Peritonsillar abscesses can present to the emergency department in critically ill patients with the dangers of airway compromise and further local spreading. Emergency medicine (EM) residents need practice to properly identify and to minimize procedural complications such as perforation of nearby vessels, aspiration pneumonitis, and airway compromise. A major tool used in the emergency department that can help prevent complications is the use of ultrasound, which the Accreditation Council for Graduate Medical Education (ACGME) requires residents to become proficient at.2 Historically, computed tomography (CT) scanning to diagnose along with blind drainage has been the method of choice. With a sensitivity of 95.2%, intraoral ultrasound can minimize both radiation and procedure related complications.3 The current simulators available come at significant capital expenditure and do not provide high-fidelity ultrasound experience. Here we design and implement a low-cost trainer for residents to use ultrasound to diagnose and drain a PTA.
By the end of this instructional session learners should be able to: 1) identify and discuss the indications, contraindications, and complications associated with peritonsillar abscesses, 2) properly identify and measure a PTA through ultrasound, and 3) competently perform ultrasound-guided peritonsillar abscess drainage on a simulator and remove fluid.
This PTA model utilizes task trainers designed from Styrofoam wig heads. An airway was modeled using readily available wood shop tools and balloons filled with a fluid mixture containing coconut lotion, water, and fragrance beads, which were inserted into the airway. This unique mixture within the balloons creates a realistic echogenicity of an abscess with loculations. With emergency medicine clinical faculty guidance and the use of ultrasound, learners are able to identify a peritonsillar abscess and subsequently demonstrate drainage of fluid with a needle and syringe.
This PTA model was tested with a group of 36 emergency medicine residents. Optional, anonymous post surveys were completed by 17 residents. A 5-point Likert Scale was used to assess utility of this model.
The majority of users agreed the model provides a realistic image of the disease for diagnosis by ultrasound with a score of 3.6 and felt more comfortable identifying and draining peritonsillar abscesses with scores of 3.7 and 3.6 respectively. Learners' surveys revealed the session was useful and improved their knowledge with both scoring 3.8. No critical feedback was given by learners or instructors. The efficacy of the content was assessed by evaluators observing proper ultrasound, procedure set up, and drainage of PTA.
This inexpensive model to expose residents to proper PTA drainage was effective considering learners' high response to post-procedure survey scales. The results of our pilot implementation showed this model has utility in teaching ultrasound guided identification and drainage of PTA's. With minimal build and optimized instruction time, we can improve residents' comfort in performing this procedure and allow for important simulation experience in a safe, controlled environment.
Simulation, emergency medicine, peritonsillar abscess, otolaryngology.
这种低成本的扁桃体周围脓肿模型旨在用于培训急诊医学和耳鼻喉科住院医师以及各级高级护理从业者。
在14至21岁年龄段，扁桃体周围脓肿（PTA）的发病率高达每10万人中有124例，是急诊科较为常见的头颈部软组织感染之一。1扁桃体周围脓肿可能出现在危重症患者中，存在气道受损和进一步局部扩散的风险。急诊医学（EM）住院医师需要通过实践来正确识别并尽量减少诸如附近血管穿孔、吸入性肺炎和气道受损等操作并发症。急诊科用于预防并发症的一种主要工具是超声检查，毕业后医学教育认证委员会（ACGME）要求住院医师熟练掌握此项技能。2从历史上看，计算机断层扫描（CT）扫描用于诊断并结合盲目引流一直是首选方法。口腔内超声的敏感性为95.2%，可将辐射和与操作相关的并发症降至最低。3目前可用的模拟器成本高昂，且无法提供高保真的超声体验。在此，我们设计并制作了一种低成本的培训工具，供住院医师用于通过超声诊断和引流扁桃体周围脓肿。
在本教学课程结束时，学习者应能够：1）识别并讨论与扁桃体周围脓肿相关的适应证、禁忌证和并发症；2）通过超声正确识别并测量扁桃体周围脓肿；3）在模拟器上熟练进行超声引导下的扁桃体周围脓肿引流并排出液体。
这种扁桃体周围脓肿模型使用由泡沫塑料假发头制作的任务训练器。气道使用现成的木工工具和装有由椰子乳液、水和香珠组成的混合液体的气球进行模拟，将气球插入气道。气球内这种独特的混合物产生了带有分隔的脓肿的逼真回声。在急诊医学临床教员的指导下并使用超声，学习者能够识别扁桃体周围脓肿，并随后用针和注射器演示液体引流。
该扁桃体周围脓肿模型在一组36名急诊医学住院医师中进行了测试。17名住院医师完成了可选的匿名课后调查。使用5点李克特量表来评估该模型的效用。
大多数用户认为该模型通过超声为疾病诊断提供了逼真的图像，评分为3.6，并且在识别和引流扁桃体周围脓肿时分别感觉更有信心，评分为3.7和3.6。学习者的调查显示该课程很有用，并且在知识提升方面评分均为3.8。学习者和教员均未给出关键反馈。内容的有效性由评估人员通过观察正确的超声检查、操作设置和扁桃体周围脓肿引流来评估。
考虑到学习者对课后调查问卷的高反馈率，这种让住院医师接触正确的扁桃体周围脓肿引流方法的廉价模型是有效的。我们初步实施的结果表明，该模型在教授超声引导下识别和引流扁桃体周围脓肿方面具有效用。通过最少的制作和优化的教学时间，我们可以提高住院医师进行该操作的信心，并在安全、可控的环境中提供重要的模拟体验。
模拟、急诊医学、扁桃体周围脓肿、耳鼻喉科。
