Development of a Novel Ultrasound-guided Peritonsillar Abscess Model for Simulation Training

Abstract

IntroductionPeritonsillar abscess (PTA) is the most common deep space infection of the head and neck presenting to emergency departments.1 No commercial PTA task trainer exists for simulation training. Thus, resident physicians often perform their first PTA needle aspiration in the clinical setting, knowing that carotid artery puncture and hemorrhage are serious and devastating complications. While several low-fidelity PTA task trainers have been previously described, none allow for ultrasound image acquisition.6–9 We sought to create a cost-effective and realistic task trainer that allows trainees to acquire both diagnostic ultrasound and needle aspiration skills while draining a peritonsillar abscess.MethodsWe built the task trainer with low-cost, replaceable, and easily cleanable materials. A damaged airway headskin was repurposed to build the model. A mesh wire cylinder attached to a wooden base was fashioned to provide infrastructure. PTAs were simulated with a water and lotion solution inside a water balloon that was glued to the bottom of a paper cup. The balloon was fully submerged with ordnance gelatin to facilitate ultrasound image acquisition, and an asymmetric soft palate and deviated uvula were painted on top after setting. PTA cups were replaced after use. We spent eight hours constructing three task trainers and used 50 PTA cups for a total cost <$110.ResultsForty-six emergency medicine (EM) residents performed PTA needle aspirations using the task trainers and were asked to rate ultrasound image realism, task trainer realism, and trainer ease of use on a five-point visual analog scale, with five being very realistic and easy. Sixteen of 46 (35%) residents completed the survey and reported that ultrasound images were representative of real PTAs (mean 3.41). They found the model realistic (mean 3.73) and easy to use (mean 4.08). Residents rated their comfort with the drainage procedure as 2.07 before and 3.64 after practicing on the trainer.ConclusionThis low-cost, easy-to-construct simulator allows for ultrasound image acquisition while performing PTA needle aspirations and is the first reported of its kind. Educators from EM and otolaryngology can use this model to educate inexperienced trainees, thus ultimately improving patient safety in the clinical setting.

Management of Peritonsillar Abscess Within a Local Emergency Department: A Quality Analysis Study

“…This highlights the underutilization of ultrasound for diagnosis and treatment. Training utilizing ultrasound for PTA drainage has been found to increase a resident's comfort level with PTA management [ 11 ]. The ED at the institution is the primary location for a large Emergency Medicine residency program.…”

“…Medical therapy has been shown to be equally effective to drainage and resulted in fewer sick days in some patients, lower opioid usage, and decreased soreness [ 1 ]. However, I&D exhibits a success rate of 93-95%, and is a relatively inexpensive and simple procedure, making it the most common treatment approach [ 11 , 12 ]. Therefore, the primary objective of this study was to evaluate how a local hospital network’s EDs compared to generally accepted guidelines regarding the diagnosis and management of potential PTAs with respect to attempted drainage, appropriate antimicrobial therapy, and outpatient management.…”

Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence

“…Pre- and post-training surveys demonstrated significant improvements in comfort with the donning/doffing and tracheostomy protocols, underscoring the importance of simulation and rehearsal when planning such implementations. Previous authors have used similar models to assess otolaryngologist comfort pre/post simulation, and found that otolaryngologists are more likely to accurately predict their pre-intervention knowledge than are primary care providers [ 18 , 19 ]. In addition, decay in knowledge and comfort appears to occur more slowly in otolaryngology providers, when topics are within their field of practice.…”

A novel training simulator for portable ultrasound identification of incorrect newborn endotracheal tube placement – observational diagnostic accuracy study protocol

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