As the nature of work becomes more complex, teams have become necessary to ensure effective functioning within organizations. The healthcare industry is no exception. As such, the prevalence of training interventions designed to optimize teamwork in this industry has increased substantially over the last 10 years (Weaver, Dy, & Rosen, 2014). Using Kirkpatrick's (1956, 1996) training evaluation framework, we conducted a meta-analytic examination of healthcare team training to quantify its effectiveness and understand the conditions under which it is most successful. Results demonstrate that healthcare team training improves each of Kirkpatrick's criteria (reactions, learning, transfer, results; d = .37 to .89). Second, findings indicate that healthcare team training is largely robust to trainee composition, training strategy, and characteristics of the work environment, with the only exception being the reduced effectiveness of team training programs that involve feedback. As a tertiary goal, we proposed and found empirical support for a sequential model of healthcare team training where team training affects results via learning, which leads to transfer, which increases results. We find support for this sequential model in the healthcare industry (i.e., the current meta-analysis) and in training across all industries (i.e., using meta-analytic estimates from Arthur, Bennett, Edens, & Bell, 2003), suggesting the sequential benefits of training are not unique to medical teams. Ultimately, this meta-analysis supports the expanded use of team training and points toward recommendations for optimizing its effectiveness within healthcare settings. (PsycINFO Database Record

Saving lives: A meta-analysis of team training in healthcare.

This is the first scientific statement from the American Heart Association on maternal resuscitation. This document will provide readers with up-to-date and comprehensive information, guidelines, and recommendations for all aspects of maternal resuscitation. Maternal resuscitation is an acute event that involves many subspecialties and allied health providers; this document will be relevant to all healthcare providers who are involved in resuscitation and specifically maternal resuscitation.

Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association.

Systematic review of coaching to enhance surgeons' operative performance

Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.

/pdf/clinical-review-special-populations-critical-illness-and-1i00cjyr4g.pdf

Clinical review: Special populations - critical illness and pregnancy

Introduction: ACE inhibitors are first-line therapy in patients with chronic kidney disease (CKD) The main adverse effects of ACE inhibitors are hypotension, renal function impairment and hyperkalemiaAreas covered: This paper reviews evidence from clinical studies regarding adverse effects of ACE inhibitors in patients with CKD The safety aspects of ACE inhibitors are discussed in relation to their pharmacological action, drug–drug interactions, drug–diet interaction, precautions needed in certain clinical conditions and other adverse effectsExpert opinion: The main adverse effects of ACE inhibitors follow from their interaction with renin-angiotensin-aldosterone system (RAAS)-activity and volume depletion This interaction can be turned into clinical benefit and increase efficacy of ACE inhibitors by reduction in dietary sodium or adding diuretics Dual RAAS-blockade is no longer advocated in patients with CKD because of the safety issues, and combination of ACE inhibitors with moderate reduction in 

Safety of ACE inhibitor therapies in patients with chronic kidney disease

Cardiopulmonary arrest in pregnancy is rare occurring in 1 in 30,000 pregnancies. When it does occur, it is important for a clinician to be familiar with the features peculiar to the pregnant state. Knowledge of the anatomic and physiologic changes of pregnancy is helpful in the treatment and diagnosis. Although the main focus should be on the mother, it should not be forgotten that there is another potential life at stake. Resuscitation of the mother is performed in the same manner as in any other patient, except for a few minor adjustments because of the changes of pregnancy. The specialties of obstetrics and neonatology should be involved early in the process to ensure appropriate treatment of both mother and the newborn. This article will explore the changes that occur in pregnancy and their impact on treatment. The common causes of maternal cardiac arrest will be discussed briefly.

/pdf/cardiac-arrest-and-pregnancy-23o6ryw0hb.pdf

Cardiac arrest and pregnancy.

Introduction: Poor teamwork leads to preventable medical errors, and thus negatively impacts medical care. One way to improve teamwork is training. A multimodality team training program was designed to impact the attitudes and behavior of first-year residents who will encounter medical situations in the trauma room. The training program included low-fidelity role plays, lectures, and high-fidelity simulation with feedback. Materials and Methods: The training program was a one-day workshop that was conducted twice, once for each of the two groups over two days at the beginning of the academic year in July. A total of 41 first-year interns (10 Emergency Medicine and 31 Surgery) were recruited for participation. Participants completed a Situational judgment test (SJT) on trauma teamwork before training. The training began with a low-fidelity simulation that served as an icebreaker to team concepts. Subsequently, a lecture with discussion provided key points regarding teamwork in the trauma room. A high-fidelity simulation then allowed participation in one of four trauma room scenarios with medical expert debriefing. The course concluded with a course summary and an assessment of participant attitudes regarding training along with a second administration of SJT. Results: Participant reactions to the training were positive overall. Results of SJT showed a positive effect for team training in three of the four possible comparisons. Conclusion: The program was well received by the residents. Results suggest that a comprehensive training approach using role play, lecture, and simulation can positively affect behavioral choices for teamwork in the trauma room.

Teamwork in the trauma room evaluation of a multimodal team training program

Angiotensin converting enzyme inhibitor ACEI-induced angioedema of the intestine is a rare occurrence and often unrecognized complication of ACEI. We present a case of a 45-year-old Hispanic female with angioedema of the small bowel progressing to facial and oral pharyngeal angioedema. Patients are typically middle-aged females on ACEI therapy who present to the emergency department with abdominal pain, nausea, vomiting, and diarrhea. This is a diagnosis of exclusion, and physicians must have a high index of suspicion to make the diagnosis. Symptoms typically resolve within 24–48 hours after ACE inhibitor withdrawal. Recognizing these signs and symptoms, and discontinuing the medication, can save a patient from unnecessary, costly, and invasive procedures.

https://downloads.hindawi.com/journals/crim/2010/690695.pdf

ACE Inhibitor-Induced Angioedema of the Bowel

Traumatic extrathoracic lung herniation is an extremely rare and poorly described complication of blunt trauma. Diagnosis has been limited to computed tomographic imaging, which takes both time and requires the patient to leave the emergency department (ED). Focused assessment with sonography in trauma has become routine in the evaluation of blunt trauma in the ED before obtaining computed tomographic imaging. We report a case on use of the extended focused assessment with sonography in trauma examination in aiding the immediate diagnosis of traumatic extrathoracic lung herniation in blunt trauma. Use of the extended focused assessment with sonography in trauma routinely as part of the primary survey in blunt trauma can hasten the diagnosis of traumatic lung herniation, thereby expediting interventions and disposition of the blunt trauma patient. Traumatic extrathoracic lung herniation is a poorly described entity, having been reported less than 300 times in the literature since the injury was first described 5 centuries ago [1]. Cervical, thoracic, and diaphragmatic lung hernias have been described and defined, and these can be congenital or acquired [2,3]. Blunt trauma and motor vehicle accidents appear to be causingmost lung herniations based on case reports [2,4]. Certain preexisting conditions, including chest wall weakness or atrophy and hyperinflation syndromes, can increase the likelihood of traumatic or spontaneous lung herniation [5]. A 33-year-old man presented to the emergency department after being struck by a motor vehicle while driving his motorized scooter. He sustained blunt trauma to the left chest. On arrival, he was tachycardic and tachypneic with a SpO2 of 92% on room air. He endorsed dyspnea and left chest wall tenderness to palpation but without deformities, ecchymoses, or crepitus to the area. Extended focused assessment with sonography in trauma (eFAST) was remarkable for a left pulmonary defect, specifically the lack of an echogenic pleural line between rib spaces (Fig. 1). At the time of eFAST, the etiology of the pulmonary defect was uncertain. Chest x-ray (CXR) revealed radiodensity in the left perihilar region, left sternoclavicular joint dislocation, and superior displacement of the left clavicle. Radiodensity was thought to represent pulmonary contusion. ☆ Meetings: None. ☆☆ Grants: None. ★ Conflicts of interest: None. ★★ Author contributions: None. 0735-6757/$ – see front matter. Published by Elsevier Inc. The patient's SpO2 improved to 99% after placement on nonrebreather; however, he continued to endorse significant left chest pain, worse with palpation. A stat computed tomography (CT) was obtained and showed a large left-sided lung herniation through the anterior chest wall via dislocation of the sternoclavicular and first costosternal joints (Fig. 2). Subcutaneous emphysema was noted in the midline, transcending up the neck, and within the chest wall musculature. On return from CT, the patient continued to endorse dyspnea and chest pain, requiring continued use of the nonrebreather to maintain oxygen saturations greater than 92%. Based on continued tachycardia, tachypnea, and oxygen requirements, the patient was intubated. Once in the operating room, trauma surgery repaired the left chest wall defect, andmeshwas placed over area of lung herniation. Dislocations were repaired by orthopedics. Diagnosis of extrathoracic lung herniation has been difficult and was limited before the common use of CT [4]. CXR rarely adequately demonstrates lung herniation although can raise suspicion if joint dislocations or focal increased lung densities are noted [4,6]. To our knowledge, emergency ultrasound has not previously been used to aid in the diagnosis of traumatic lung herniation. The eFAST has a higher sensitivity than CXR in identifying hemothoraces and pneumothoraces, with CXR missing an estimated 30% to 40% of pneumothorax cases [7]. Although the sensitivity is comparable to CT, the eFAST has the advantage of being immediately available, portable, can be readily used in unstable patients, requires no radiation, and can be used quickly for patient re-evaluation [7]. Pulmonary injuries often require immediate intervention in the trauma patient, and these live-saving procedures should not be postponed while awaiting CT imaging. This case demonstrates that use of the eFAST in blunt trauma patients can be used to aid in the diagnosis of traumatic lung herniation. The rarity of traumatic lung herniations limits the availability of ultrasound images, which can be used for teaching pathologic diagnoses. We were able to determine that pulmonary pathology existed, which was neither a pneumothorax nor hemothorax by noting the lack of an echogenic pleural line between rib spaces, demarcated as pleural gap in Fig. 1. This pleural gap contained a hypoechoic structure suggestive of pulmonary parenchyma, continuous with the underlying hypoechoic area where pulmonary parenchyma normally lies. Normal hyperechoic pleural lines were noted on superior and inferior edges of the rib spaces, with pleural gap between ribs. The combination of a normal sliding lung sign superiorly and inferiorly, normal seashore sign throughout lung fields, and the apparent tip of the lung entering the intercostal space on inspiration in the pleural gap, we determined lung pathology Fig. 1. Extended FAST image of left lung showing pleural gap (left) and of right lung showing pleural line between ribs (right). Images are taken at second intercostal space. Fig. 2. Axial CT image showing left-sided lung hernia. 633.e2 Case Report / American Journal of Emergency Medicine 31 (2013) 633.e1–633.e2 existed, which we had not previously encountered on eFAST. With stronger evidence-based eFAST diagnosis during the primary survey, the patient may have gone directly to the operating room without delay for CT imaging. Surgical repair of lung herniations has been the mainstay of treatment [4,6,8]. Proficient use of emergency ultrasound, specifically the eFAST, will aid in the rapid diagnosis and disposition of pulmonary injuries requiring immediate intervention. Stacey Marlow MD Tabitha Campbell MD Ashley Davis BS Hershel R. Patel BS Department of Emergency Medicine University of South Florida at Tampa General Hospital

Emergency ultrasound in the diagnosis of traumatic extrathoracic lung herniation.

/pdf/ace-inhibitor-inducedangioedema-of-the-bowel-1ryqdcfdog.pdf

ACE Inhibitor-InducedAngioedema of the Bowel

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