UMEM Educational Pearls - By Kerith Joseph

Summary

Objective:
The study aimed to determine how a brief educational intervention could enable emergency medicine (EM) residents to use point-of-care ultrasound (POCUS) effectively to diagnose and manage shoulder dislocations in the emergency department (ED).

Methods:

Conducted at an academic teaching hospital in Miami, Florida.

Twenty EM residents (PGY1–PGY4) with no prior shoulder ultrasound training participated.

Residents received <1 hour of in-service training, including a short lecture, video instruction, and hands-on practice using a Sonosite M-Turbo ultrasound device.

Over one year (2016–2017), residents prospectively enrolled 78 adult patients with suspected shoulder dislocation.

POCUS findings were compared with x-rays (the gold standard) for accuracy.

Time to diagnosis and reduction confirmation were recorded.

Results:

55 of 78 patients were diagnosed with dislocation; 53 anterior, 1 posterior, 1 inferior.

POCUS achieved 100% sensitivity and specificity for diagnosing and confirming successful reductions compared to x-ray.

Ultrasound results were available ~22 minutes faster for diagnosis and ~27 minutes faster for reduction confirmation than x-rays (p < 0.0001).

Residents across all training years performed equally well.

POCUS also identified 14 fractures (12 confirmed by x-ray, 2 seen only on ultrasound).

Discussion:

A short educational session enabled residents to accurately use POCUS for shoulder dislocation diagnosis and management.

POCUS reduced diagnostic time, avoided radiation exposure, and may improve ED workflow and patient comfort.

Findings support including shoulder ultrasound as a core component of EM training, filling a current gap in national ultrasound education guidelines.

Limitations:

Convenience sample and single-center design.

Some selection bias and inherent limitations of POCUS-based studies.

Conclusion:

Emergency medicine residents can learn to diagnose and manage shoulder dislocations with excellent accuracy after brief ultrasound training. POCUS should be integrated into EM residency curricula as a core skill for musculoskeletal emergencies.

Summary:
This study evaluated whether the line-of-sight approach improves the speed and accuracy of ultrasound-guided needle placement into the subdeltoid bursa among novice operators, compared to the side approach. A secondary aim was to assess the usefulness of the APPLES mnemonic (Angle, Position, Perpendicular, Line up, Entry, Sweep) as a teaching aid.

Methods:
Medical students and residents were randomized to perform the procedure using both approaches in a crossover design. Two blinded reviewers measured procedure time, and participants completed a survey on their preferences and perceptions of APPLES. Statistical tests (paired t test, McNemar test) compared performance time and accuracy.

Results:

The line-of-sight approach significantly reduced procedure time (mean 14.4 s vs. 18.6 s; P = .00029).

Participants were more likely to hit the target within 30 s using the line-of-sight approach (P = .035).

72.7% preferred the line-of-sight approach.

88.2% found the APPLES mnemonic helpful.

Conclusions:
The operator’s positioning plays a key role in ultrasound-guided procedures. The line-of-sight approach improves both speed and accuracy for novice users, and the APPLES mnemonic is a valuable educational tool for teaching these techniques.

Kerith Joseph MD, RMSK

Clinical Associate Professor

University of Maryland School of Medicine

Baltimore Veterans Affairs Medical Center, Emergency Department