Arun Nagdev

Author(s): Brewer, Jonathan; Nagdev, Arun

Acute pain is one of the most frequent, and yet one of the most challenging, complaints physicians encounter in the emergency department (ED). Currently, opioids are one of several pain medications given for acute pain, but given the long-term side effects and potential for abuse, alternative pain regimens are sought. Ultrasound-guided nerve blocks (UGNB) can provide quick and sufficient pain control and therefore can be considered a component of a physician’s multimodal pain plan in the ED. As UGNB are more widely implemented at the point of care, guidelines are needed to assist emergency providers to acquire the skill necessary to incorporate them into their acute pain management.

Point-of-care ultrasound (POCUS) enables physicians to make critical diagnosis and treatment decisions at the bedside. However, access to and expertise with this technology remain limited in Peru. Establishing longitudinal POCUS educational curriculums in remote, low-resource settings can be challenging due to geographical distances, encumbering the ability to provide ongoing hands-on support. Previously described educational interventions have focused on training individual users on clinical applications of POCUS, rather than training physicians how to teach POCUS, thereby limiting scalability and sustainable impact. We therefore describe our experiences establishing the first ultrasound fellowship curriculum in Peru, which incorporates tele-ultrasonography to circumvent traditional geographical barriers.

We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis(hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision.The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-careultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture.Patient underwent successful emergent mitral valve replacement after initial resuscitative efforts andintraaortic balloon pump placement.