KISA BİR EĞİTİM MODÜLÜ KULLANILARAK ACİL TIP ASİSTANLARI TARAFINDAN SOL VENTRIKÜL DUVAR HAREKET ANORMALLİKLERİNİN BELİRLENMESİ

Öz

Giriş: Duvar hareket anormalliklerinin acil servis hekimleri (ASH) tarafından değerlendirilmesi yeni bir konudur ve henüz acil ultrason kılavuzlarına dahil edilmemiştir. Bu çalışmanın amacı, kısa bir eğitim modülünün (STM) ASH'lerin duvar hareketi anormalliklerini tanıma becerisine katkısını değerlendirmektir. Gereç ve Yöntemler: Bu prospektif deneysel çalışma üçüncü basamak bir eğitim ve araştırma hastanesinin acil servisinde yürütülmüştür. Çalışmaya 1-3 yıllık mezuniyet sonrası eğitim programına dahil olan ASH'leri dahil edildi. Çalışma için otuz dakikalık duvar hareket hatası anormalliğini içeren video destekli kısa bir STM oluşturuldu. Normal ve duvar hareket kusuru patolojilerini içeren otuz soruluk bir test hazırlandı. Asistanlar eğitimden önce (ön test), eğitimden hemen sonra (son test) ve bir ay sonra (son test) olmak üzere üç teste tabi tutuldu ve testleri karşılaştırmak için ANOVA kullanıldı. Post-hoc analizlerde, istatistiksel anlamlılık değerini hesaplamak için Bonferroni testi kullanılmıştır (0.05/3=0.016), 0.016 değeri istatistiksel olarak anlamlı kabul edilmiştir. Bulgular: Çalışmaya 23 ASH dahil edilmiştir. Asistanlar eğitim öncesi ön testlerde 90 sorudan ortalama 50±12'sini, son testte 70±12'sini ve bir ay sonra 63±12'sini doğru yanıtlamıştır. Kısa eğitim modelinin asistanların duvar hareket kusurlarını tanıması üzerinde istatistiksel olarak anlamlı bir etkisi vardı (p<0.001). Post-hoc analizinde öntest ve son-test puanları arasında anlamlı bir fark vardı(p<0.001). Sonuç: Tüm duvar hareket kusurlarını ve normal duvar hareketini içeren 30 dakikalık kısa eğitim modeli, ASH'lerin duvar hareket anormalliklerini görsel olarak tanımaları için etkili bir eğitim yöntemi olarak bulundu.

Anahtar Kelimeler

• Hasta başı ultrason
• eğitim
• acil tıp
• odaklanmış kardiyak ultrason
• miyokard enfarktüsü

THE DETERMINATION OF LEFT VENTRICULAR WALL MOTION ABNORMALITY BY EMERGENCY MEDICINE RESIDENTS USING A BRIEF TRAINING MODULE

Öz

Introduction: Evaluation of wall motion abnormalities by emergency physicians (EP) is a new subject and has not yet been included in emergency ultrasound guidelines. This study aims to evaluate the contribution of a short training module (STM) to the ability of EPs to recognize wall motion abnormalities. Material and Methods: This prospective experimental study was conducted in the emergency department of a tertiary training and research hospital. EPs who were included in the 1-3-year postgraduate education program were included in the study. For the study, a short video-supported STM containing the thirty-minute wall motion error abnormality was created. A thirty-question test, including normal and wall motion defects, was prepared. The residents were subjected to three tests before the training (pre-test), immediately after the training (post-test), and one month after (final test). ANOVA was used to compare the tests. In post-hoc analyses, the Bonferroni test was used to calculate the statistical significance value (0.05/3=0.016), a value of 0.016 was considered statistically significant. Results: 23 EMRs were included in the study. The residents answered an average of 50±12 of 90 questions correctly in the pre-tests before the training, 70±12 questions in the post-test, and 63±12 questions one month later. The short training model had a statistically significant effect on residents' recognition of wall motion defects (p<0.001). There was a significant difference between pre-test and post-test scores in post-hoc analysis (p<0.001). Conclusion: The short 30-minute training model, which includes all wall motion defects and normal wall motion, was found to be an effective training method for EPs to visually recognize wall motion abnormalities

Anahtar Kelimeler

• Bedside ultrasound
• education
• emergency medicine
• focused cardiac ultrasoun
• myocardial infarction

Kaynakça

1. Mateer J, Plummer D, Heller M, Olson D, Jehle D, Overton D, Gussow L. Model curriculum for physician training in emergency ultrasonography. Ann Emerg Med. 1994 Jan;23(1):95-102. doi: 10.1016/s0196-0644(94)70014-1. PMID: 8273966.
2. Nazerian P, Vanni S, Volpicelli G, Gigli C, Zanobetti M, Bartolucci M, Ciavattone A, Lamorte A, Veltri A, Fabbri A, Grifoni S. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest. 2014 May;145(5):950-957. doi: 10.1378/chest.13-1087. PMID: 24092475.
3. Zengin S, Al B, Genc S, Yildirim C, Ercan S, Dogan M, Altunbas G. Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia. Am J Emerg Med. 2013 May;31(5):763-7. doi: 10.1016/j.ajem.2012.10.013. Epub 2013 Apr 17. PMID: 23602752.
4. Laursen CB, Sloth E, Lassen AT, Christensen Rd, Lambrechtsen J, Madsen PH, Henriksen DP, Davidsen JR, Rasmussen F. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med. 2014 Aug;2(8):638-46. doi: 10.1016/S2213-2600(14)70135-3. Epub 2014 Jul 3. PMID: 24998674.
5. Akhtar S, Theodoro D, Gaspari R, Tayal V, Sierzenski P, Lamantia J, Stahmer S, Raio C. Resident training in emergency ultrasound: consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors Conference. Acad Emerg Med. 2009 Dec;16 Suppl 2:S32-6. doi: 10.1111/j.1553-2712.2009.00589.x. PMID:20053207.
6. Kerwin C, Tommaso L, Kulstad E. A brief training module improves recognition of echocardiographic wall-motion abnormalities by emergency medicine physicians. Emerg Med Int. 2011;2011:483242. doi: 10.1155/2011/483242. Epub 2011 Jul 2. PMID: 22046540; PMCID: PMC3200256.
7. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-e228. doi: 10.1016/j.jacc.2014.09.017. Epub 2014 Sep 23. Erratum in: J Am Coll Cardiol. 2014 Dec 23;64(24):2713-4. Dosage error in article text. PMID: 25260718.
8. Kontos MC, Arrowood JA, Paulsen WH, Nixon JV. Early echocardiography can predict cardiac events in emergency department patients with chest pain. Ann Emerg Med. 1998 May;31(5):550-7. doi: 10.1016/s0196-0644(98)70200-8. PMID: 9581137.

9. Kontos MC. Role of Echocardiography in the Emergency Department for Identifying Patients with Myocardial Infarction and Ischemia. Echocardiography. 1999 Feb;16(2):193-205. doi: 10.1111/j.1540-8175.1999.tb00804.x. PMID: 11175141.
10. Buda AJ, Zotz RJ, Pace DP, Krause LC. Comparison of two-dimensional echocardiographic wall motion and wall thickening abnormalities in relation to the myocardium at risk. Am Heart J. 1986 Mar;111(3):587-92. doi: 10.1016/0002-8703(86)90068-2. PMID: 3953368.
11. Kaul S, Pandian NG, Gillam LD, Newell JB, Okada RD, Weyman AE. Contrast echocardiography in acute myocardial ischemia. III. An in vivo comparison of the extent of abnormal wall motion with the area at risk for necrosis. J Am Coll Cardiol. 1986 Feb;7(2):383-92. doi: 10.1016/s0735-1097(86)80509-5. PMID: 3944358.
12. Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med. 2002 Mar;9(3):186-93. doi: 10.1111/j.1553-2712.2002.tb00242.x. Erratum in: Acad Emerg Med 2002 Jun;9(6):642. PMID: 11874773.
13. Çelebi Yamanoğlu NG, Yamanoğlu A, Parlak İ, Pınar P, Tosun A, Erkuran B, Aydınok G, Torlak F. The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method? Am J Emerg Med. 2015 Mar;33(3):433-8. doi: 10.1016/j.ajem.2014.12.014. Epub 2014 Dec 18. PMID: 25616587.
14. Yamanoğlu A, Celebi Yamanoğlu NG, Sogut O. Male With Hypertension. Ann Emerg Med. 2016 Nov;68(5):e85-e86. doi: 10.1016/j.annemergmed.2016.04.030. PMID: 27772690.
15. Yamanoglu A, Celebi Yamanoglu NG, Evran T, Sogut O. How much can synthetic cannabinoid damage the heart? A case of cardiogenic shock following resistant ventricular fibrillation after synthetic cannabinoid use. J Clin Ultrasound. 2018 Nov;46(9):605-609. doi: 10.1002/jcu.22581. Epub 2018 Feb 26. PMID: 29479764.
16. Kontos MC, Arrowood JA, Paulsen WH, Nixon JV. Early echocardiography can predict cardiac events in emergency department patients with chest pain. Ann Emerg Med. 1998 May;31(5):550-7. doi: 10.1016/s0196-0644(98)70200-8. PMID: 9581137.