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Browsing by Author "Saltarelli, Nicholas"
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Item Establishing a Low-Resource Simulation Emergency Medicine Curriculum in Nepal(Association of American Medical Colleges, 2020-07-15) Wang, Alfred; Saltarelli, Nicholas; Cooper, Dylan; Amatya, Yogendra; House, Darlene R.; Emergency Medicine, School of MedicineIntroduction High-fidelity medical simulation is widely used in emergency medicine training because it mirrors the fast-paced environment of the emergency department (ED). However, simulation is not common in emergency medicine training programs in lower-resourced countries as cost, availability of resources, and faculty experience are potential limitations. We initiated a simulation curriculum in a low-resource environment. Methods We created a simulation lab for medical officers and students on their emergency medicine rotation at a teaching hospital in Patan, Nepal, with 48,000 ED patient visits per year. We set up a simulation lab consisting of a room with one manikin, an intubation trainer, and a projector displaying a simulation cardiac monitor. In this environment, we ran a total of eight cases over 4 simulation days. Debriefing was done at the end of each case. At the end of the curriculum, an electronic survey was delivered to the medical officers to seek improvement for future cases. Results All eight cases were well received, and learners appreciated the safe learning space and teamwork. Of note, the first simulation case that was run (the airway lab) was more difficult for learners due to lack of experience. Survey feedback included improving the debriefing content and adding further procedural skills training. Discussion Simulation is a valuable experience for learners in any environment. Although resources may be limited abroad, a sustainable simulation lab can be constructed and potItem Tension pneumothorax: Lateral needle decompression(Elsevier, 2018) Welch, Julie L.; Saltarelli, Nicholas; Emergency Medicine, School of MedicineA 37 yo man presented to the ED with sudden onset of left sided chest pain and dyspnea after lifting a box. On physical examination the patient was hypotensive (86/55), tachycardiac (HR 125), hypoxic (88%), diaphoretic, with diminished left sided breath sounds. A portable chest x-ray revealed a large left tension pneumothorax with rightward tracheal deviation and mediastinal shift. (Image 1) The patient was placed on oxygen and an emergent needle decompression thoracostomy was performed. A 14-gauge needle was placed into the lateral 4th intercostal space at the mid-axillary line with immediate return of air and improvement in vital signs and symptoms. The needle was then used as a guide for placement of a percutaneous chest tube via the Seldinger technique. (Total procedure time was < 4 min.) A chest x-ray showed re-expansion of the left lung with the chest tube. (Image 2) The patient was admitted to the pulmonary service in stable condition.