Mediterranean Journal of Emergency Medicine & Acute Care

Introduction: Simulation is used by many medical specialties, throughout the world, as an effective educational adjunct to clinical learning experiences. There is limited prospective research to support the use of table-top, low fidelity, simulation experiences as a suitable replacement for traditional lecture-based modalities in the context of undergraduate emergency medical education. We designed, implemented and evaluated sections of a table-top simulation-based curriculum for fourth year medical students participating in the department’s advanced emergency medicine clerkship. Methods: A prospective, randomized, cross over study comparing lecture-based learning activities to an experimental table-top simulation exercises based on a primary outcome objective, considering the quantitative acquisition of clinical knowledge, and a secondary outcome looking at the results of survey data, considering student perspectives on learning experience. Four student cohorts participated in the study, each spending one month in the department’s advanced emergency medicine medical student elective.Results: Medical knowledge learning outcomes did not show a significant improvement in the experimental modality when compared to the traditional format. Likert scale survey data showed, with statistical significance (P<.05), that students preferred the simulation modality over the traditional lectures finding it to be more interactive, and a more effective format for teaching medical knowledge and applicable clinical information. Conclusion: Findings showed, with statistical significance, that students preferred this learning modality but that more research would be needed to further evaluate our findings of improved learning outcomes. Further research should be pursued to characterize this modality’s benefit, as compared to traditional small group lecture and high-fidelity simulation modalities, in order to evaluate its possible effectiveness for furthering the development of undergraduate emergency medicine education in the future.

Introduction: Sudden cardiac arrest accounts for 5% to 10% of deaths among children. Survival following out-of-hospital cardiac arrest depends on quick recognition, early cardiopulmonary resuscitation (CPR) and defibrillation. In Lebanon, the survival rate of children following such arrests is low (16.7%). Consequently, this study assesses availability of automated external defibrillators (AED) and CPR/AED training in Lebanese schools.

Methods: This is a cross-sectional phone-based survey study conducted using a randomized sample of 175 private, private-free and public schools - representative of all of the country regions.

Results: Among surveyed schools, 99 responded with a complete participation (56.6% response rate). Most surveyed schools were public. 28% had at least one individual who underwent CPR or/and AED training, and only 2 schools had an AED. 4 schools reported a history of SCA, 3 of them were confirmed dead, and those 4 schools did not have an AED. The main perceived barriers for not having an AED included lack of recommendations and regulations implementing such programs at schools (24.7%), no previous cardiac arrest cases at the school (22.7%) and absence of support from authorities (21.6%). Moreover, 86.9% of participant schools were interested in CPR/AED training and 89% found it essential.

Conclusion: The results of the study suggest that Lebanese schools are affected by the lack of sufficient legislations and requirements for SCA. This calls for promotion of basic life support training, as well as large-scale evaluation for emergency preparedness.

Patellar tendon rupture and patellar apex rupture are established complications in patients with end stage kidney disease, however, little to no literature describes bilateral patellar avulsion. This is a case presentation of bilateral knee avulsion due to bilateral patellar tendon rupture at the level of the apexes in a patient with end stage kidney disease on dialysis. A 52 year old female presented to the emergency department for low energy traumatic event. On physical exam patient had bilateral patella alta with limited range of motion. On imaging, bilateral knee MRI was diagnostic of bilateral avulsion of patellar apexes. In light of the clinical and radiological findings, patient was admitted for surgical repair, in which a free tendon graft was placed. Post operation radiography showed good patellar placement and fixation. Upon discharge, patient was allowed partial weight bearing for the first 6 weeks, followed by full weight bearing. 1 year post surgery, patient was pain free and able to ambulate comfortably. We conclude that, patellar apex avulsion should be suspected in patients with renal dysfunction presenting for unilateral or bilateral chronic knee pain even if no severe mechanism of injury was present.