ABSTRACT
Introduction Geriatric hip fractures present a difficult challenge in the emergency department (ED) to achieve adequate analgesia. Opioid-sparing ultrasound-guided fascia iliaca compartment blocks (UFIB) have been shown to be both safe and effective in treating pain from hip fractures. In this study, we investigated the teachability of UFIB to emergency medicine (EM) residents using simulation models and also assessed if UFIB training increases its utility in the ED. Methods We created a UFIB model to simulate the procedure in a controlled environment. Sixteen residents from Loma Linda Emergency Medicine Residency participated in a pre-workshop survey and hands-on UFIB workshop. Comfort level in performing UFIB and confidence level in needle finding skills during UFIB were analyzed, plotted, and represented graphically. Results Comfort level in performing UFIB increased by approximately 50% (p < 0.01). Success rates also increased by 460% (p<0.05) after the workshop. However, the UFIB continued to be underutilized as 44% of respondents expressed that there is a "lack of time" to perform UFIB during their shifts. Conclusion A single one-hour workshop increased comfort level in performing UFIB and helped residents successfully achieve better pain control in patients with hip fractures. However, residents continued to refrain from using UFIB because it is too time-consuming.
ABSTRACT
The direct oral anticoagulants (DOACs) are the mainstay for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute venous thrombosis. They are attractive alternatives to warfarin because of their efficacy, ease of prescription and safety profile. The emergency department has gained expertise in the management of DOAC bleeding complications, but has been slower to adopt prescription decisions. Emergency clinicians are in a unique position to identify patients who are prescribed DOACs and are at high risk of impending bleeding. This is a practical guide for the emergency clinician on how to prescribe DOACs, the red flags for DOAC patients in the emergency department and advances in the treatment of bleeding.
