An Introductory Point-of-Care Ultrasound Curriculum for an Anesthesiology Residency Program.

Introduction: The use of point-of-care ultrasound (POCUS) is a growing trend in the field of anesthesiology. However, formal POCUS curriculums are still not widely implemented in residency programs. As the Accreditation Council for Graduate Medical Education and the American Board of Anesthesiology have both incorporated POCUS into their educational aims and expectations for graduates, we recognized the need for a formal POCUS curriculum for our residency program. We developed and implemented a comprehensive 3-week POCUS curriculum for our first-year anesthesiology residents (CA1s) in the latter half of their academic year. Methods: Twenty CA1s participated in this educational activity. The POCUS curriculum spanned seven topics and was given in weekly 2-hour sessions over the course of 3 weeks. Each session was designed with the first hour consisting of a traditional lecture-based presentation followed by live hands-on practice. A pretest on POCUS knowledge was given to every resident before the curriculum, and a posttest and survey were administered afterwards. Results: Every CA1 showed an improvement in their posttest scores. The median scores of the pretest and posttest were 49% and 75%, respectively. Survey results were positive, with all of the CA1s agreeing that the POCUS educational materials were appropriate to their level of training and that their POCUS knowledge and technical skills improved after the curriculum. Discussion: We have shown that our formal POCUS curriculum improved anesthesiology residents' knowledge as well as resulting in positive views on the implementation of this intervention.

Early versus delayed fixation of isolated closed femur fractures in an urban trauma center.

The use of intramedullary rods is accepted as the gold standard for treatment of closed femur fractures. Early fixation of these fractures has been shown to be beneficial in the multiply-injured patient. This retrospective review was undertaken to examine the isolated femur fractures in an urban trauma center over a six-year period. Of the 76 patients included in the study, 42 underwent early fixation (less than 48 hours after injury) and 34 had delayed fixation (more than 48 hours after injury). There was no statistical difference in postoperative complications between the two groups. Fixation performed within 48 hours did not seem to decrease morbidity when compared to fixation performed after 48 hours. Length of stay and hospital costs were increased with delayed fixation.

Treatment of isolated type I open fractures: is emergent operative debridement necessary?

A retrospective review was done of treatment of isolated Type I open fractures. Ninety-one patients with isolated Type I open fractures were included in the study. Patients with multiple injuries, gunshot wounds, hand injuries, compartment syndromes, intraarticular fractures, or higher type open fractures were excluded. All patients received antibiotics and were followed up until fracture union. The patients' charts were reviewed for the type of fracture, mechanism of injury, type of treatment, length of hospital stay, and complications encountered, especially infections. There was a 0% incidence of infection in all patients. Only one patient received operative debridement within 12 hours. A prospective randomized study of the treatment of Type I open fractures is needed to determine whether immediate operative debridement is necessary to prevent infection. Immediate operative debridement may not be necessary in the isolated, low-energy Type I open fracture with stable fracture patterns.