ABSTRACT
Ultrasound identification of soft tissue pathology is a useful skill for the emergency physician, but it requires practice and familiarity to be effective. Given its rising popularity in the Emergency Department, regional anesthesia is another essential skill that requires practice. Realistic models can help create procedural confidence and accuracy. Since entry-level professional-grade models can be cost-prohibitive, the development of simple and affordable models for teaching is valuable for emergency provider education, especially in resource-limited settings. Other inexpensive models have been produced and discussed in ultrasound; literature; however, no models have yet been designed for the replication of several different modalities in a single model. We developed and successfully tested a meat phantom model utilizing materials available at a local grocery store that can be quickly assembled in a short amount of time with minimal effort. This low-cost, easy-to-make phantom accurately replicates human tissue and pathology and is ideal for learners to practice several skill sets at once.
ABSTRACT
INTRODUCTION: Ketorolac is useful in acute pain management to avoid opiate-related complications; however, some surgeons fear associated acute kidney injury (AKI) and bleeding despite a paucity of literature on ketorolac use in trauma patients. We hypothesized that our institution's use of intravenous ketorolac for rib fracture pain management did not increase the incidence of bleeding or AKI. METHODS: Rib fracture patients aged 15 years and above admitted between January 2016-June 2018 were identified in our trauma registry along with frequency of bleeding events. AKI was defined as ≥ 1.5x increase in serum creatinine from baseline measured on the second day of admission (after 24 hours of resuscitation) or an increase of ≥ .3 mg/dL over a 48-hour period. Patients receiving ketorolac were compared to patients with no ketorolac use. RESULTS: Two cohorts of 199 control and 205 ketorolac patients were found to be similar in age, gender, admission systolic blood pressure (SBP), injury severity score, intravenous radiocontrast received, and transfusion requirements. Analysis revealed no difference in frequency of AKI using both definitions (8% vs. 7.3%, P = .79) and (19.6% vs. 15.1%, P = .24), respectively, or bleeding events (2.5% vs. 0%, P = .03). Logistic regression demonstrated that ketorolac use was not an independent predictor for AKI but age and admission SBP < 90 were. CONCLUSION: Use of ketorolac in this cohort of trauma patients with rib fractures did not increase the incidence of AKI or bleeding events.
