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Ideas for Skill Labs
pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


Hi everybody.

Do any of you have ideas on practicing/teaching using US for foreign body removal and/or I&D?  I have some ideas for things that might work (a piece of glass in a piece of meat, using a small water balloon to simulate an abscess, etc.), but they all seem clumsy.  I wasn't sure if some of you may have done it already and might be able to save me the trial and error with all of these ideas running around in my head.  

If you could share any experience you have with this (i.e. - if cadavers work, if certain cuts of meat work, if certain materials work better than others for FB or to simulate an abscess, if reasonably priced models are available, etc.), I would really appreciate it.

Michael Pallaci, DO, FACEP
Director, Emergency Medicine Residency Program
Grandview Medical Center
Dayton, OH
(614)288-4813
pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


I have used chicken breast and then inject them with yogurt to simulate an abscess cavity.  Meet with toothpicks or glass do a nice job simulating a foreign body.

HTH,

Rob

Robert Blankenship, MD, FACEP
Medical Director, Emergency Medicine
Chairman, Department of Medicine
St Vincent Fishers


pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


Paint balls from the skirmish type war games work great to simulate an abscess.  They have a nice wall, ultrasound well, and can even be aspirated.  I make a small incision into the side of a piece of thick meat and insert it.  Once aspirated you can just replace it with a new paint ball.  

As far as foreign bodies yes toothpicks and glass work well.  I also use sewing needles and pretty much any object a patient may step on.  During our introductory class I will often have a "mystery" item that the new residents must identify - golf tees, coins, or spent .22 shells are some I have tested them with in the past.

Kevin Roth, DO, FACOEP
Director, Emergency Medicine Ultrasound
Department of Emergency Medicine
Lehigh Valley Health Network
pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


Hi Michael,
 First choice: extra firm tofu. 2nd choice: boneless eye of round, about an inch thick.
 
Foreign bodies:
Sewing pins for metal.
Toothpicks for wood
Broken off plastic fork tines for plastic
Broken beer glass (purchased at Walmart or some other discount store).  Careful when you break the glass. You don't want to end up with a foreign body yourself!
 
Less success at finding an adequate abscess. We have used paint balls with mixed success.
 
Steve
 
Steve Socransky, MD, FRCPC
Course Director
The EDE 2 Course
www.ede2course.com
Sudbury, Ontario
pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


Use spam.  It is easy to insert foreign bodies into it and closes quite well without air interference.

Jared Marx


pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


All amazing ideas!  

If using firm tofu or spam, use small alligator tongs. Insert to desired depth via US. Open repeatedly in various directions to create a crypt. Follow this with a needle/syringe filled with yogurt (as Rob Blankenship recommended) to provide a MRSA like consistency.

Foreign bodies or broken bones, etc... Take gelatin, pore half, let cure partially, then imbed the bone or FB just before it is solid or lay on top. Wait till cured then pore the other half. It will create the most seamless models.

Thanks to all for the other great suggestions. I'll be using a few.

JJ

Jeremy N Johnson
DO, RDMS, FACEP
MAJ, MC, USA
EUS Fellowship Director
Madigan Army Medical Center, Fort Lewis, WA
Assoc. Prof. of Mil. & EM Med. USUHS, Bethesda , MD
Assoc. Prof. Emerg Med Baylor School of Medicine and Graduate School
eyesrusone@me.com
206-330-9203
pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


Gel wax, from a craft store for candles, holds up much better than Jello. When you need to remake the phantom, just reheat it, melt it, and pour it. Use the same method of pouring half, add the foreign body, then pour the rest. A broken stick of chalk works well as a bone. I've made an LP phantom using this method as well.                                   Michael Baker
pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


Not sure if he ever published it but one of the med students here came up with a model that used polenta-- the kind that looks like a sausage wrapped in plastic.Was cheap, didn't require extra preparation, and was a remarkably good mimic of soft tissue, he used it for vascular access but assume you could stick things in it.

Chris Moore
pererap
Posted: Friday, November 1, 2013
Joined: 8/31/2011
Posts: 231


Some fancier supermarkets sell chicken drumsticks in vacuum sealed plastic packages. You can break the bones with a hammer (hit hard to create a step off) and ultrasound straight through the plastic. Keeps everything pretty clean.

-Calvin Huang
pererap
Posted: Wednesday, November 13, 2013
Joined: 8/31/2011
Posts: 231


From Sachita Shah:                                                                                                       Not sure if you guys have seen this blog, but Kasia made it and it has a TON of homemade ultrasound phantom recipes for various scans that are quite entertaining- great photos and how to instructions.

http://meritus.kopernika.pl/homemade-tastes-better/
 
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