Summary:The purpose of this investigation was to determine if echocardiographic measures of ventricular structure and function ascribed to aerobic training might be an artifact of heart rate (HR) differences between trained and untrained subjects. Comparisons were made at rest, of 10 young, male, aerobically well-trained athletes [(V02)max 65>ml/kg/min] and 10 young, healthy controls [( VO2),,,<56ml/kg/min].Additionally, the echocardiographic responses to low (HR=80 beats/min) and moderate intensity (HR= 120 beats/min) supine cycling exercise were analyzed. Echocardiographic measures were made as described by Sahn et al. (1978). Results of echocardiographic comparisons between groups, both during supine rest and at a constant heart rate of 80 beats/min during supine cycling confirmed that athletes had significantly greater left ventricular mass (LV mass) and end-diastolic size per square meter of body surface area (p<0.05). When supine cycling loads were increased to elevate HR to 120 beats/min in groups of 7 athletes and 5 controls, athletes exhibited a progressive and significant (p<0.05) enlargement of left ventricular end-diastolic size (LVEDS), while left ventricular end-systolic size (LVESS) showed negligible change. The control group showed little change in LVEDS, but decreased LVESS significantly (p<0.05).Contractility measures, i.e., estimated ejection fraction (EF) and velocity of circumferential shortening (~c F ) increased in both groups in a similar manner. It was concluded that echocardiographic differences in ventricular structure and function observed between aerobically trained and untrained subjects are not an artifact of heart rate differences. Clearly, aerobic training results in increased LV mass and diastolic size which allows for further dilitation with supine exercise, Aerobic training does not appear to alter indices of myocardial contractility.
Audience: This simulation is intended for all levels of emergency medicine residents.Introduction: Syncope and near-syncope are very common presenting complaints to the emergency department. 1 There are several causes of syncope ranging from benign to life threatening. It is imperative that the emergency physician is able to evaluate and treat patients with undifferentiated syncope even with limited information. Approximately half of syncope cases can be differentiated by the presentation and clinical context. 1 In addition to a thorough history, an electrocardiogram (ECG) should be obtained on all patients presenting with syncope or near-syncope since it is non-invasive and cost effective in assessing cardiac causes of syncope. In this particular simulation, the cause of syncope is due to a hemorrhagic shock from a ruptured ectopic pregnancy.Educational Objectives: At the conclusion of this simulation, the learner will be able to:1. Review the initial management of syncope 2. Utilize laboratory and imaging techniques to diagnose a ruptured ectopic pregnancy.3. Demonstrate the ability to resuscitate and disposition an unstable ruptured ectopic pregnancy.Educational Methods: This simulation case was designed as a medium-to-high fidelity simulation scenario. It could also be altered and utilized as a practice oral board exam case. Research Methods:The quality of the simulation and educational content was evaluated by debriefing and verbal feedback that was obtained immediately after the case. Additionally, a survey was emailed to participants and observers of the case to provide qualitative feedback.Results: Post-simulation feedback from learners and observers was positive. Everyone present for the simulation felt that it was realistic and provided a unique opportunity to practice resuscitation skills.Discussion: Syncope and near-syncope are common presentations to the emergency department with multiple etiologies that range from cardiac, neurologic, neurocardiogenic, and orthostatic to unknown. It is SIMULATION 2 crucial that we diagnose and treat life-threatening causes of syncope rapidly and with limited information. In this case, the cause of syncope due to a ruptured ectopic pregnancy should be rapidly diagnosed with a thorough history and exam, urine pregnancy test, and a bedside abdominal ultrasound. Once the urine pregnancy test was resulted, ectopic pregnancy was the top differential diagnosis for each learner that participated. Initially, most learners only performed a transabdominal pelvic ultrasound of the pelvis, which is normal in the case. One learner performed a rapid ultrasound for shock and hypotension (RUSH) exam and was able to find free fluid in the right upper quadrant. Overall, this case and the debriefing topics were effective for learners at all levels.
Audience This simulation is intended for all levels of emergency medicine residents. Introduction Syncope and near-syncope are very common presenting complaints to the emergency department. 1 There are several causes of syncope ranging from benign to life threatening. It is imperative that the emergency physician is able to evaluate and treat patients with undifferentiated syncope even with limited information. Approximately half of syncope cases can be differentiated by the presentation and clinical context. 1 In addition to a thorough history, an electrocardiogram (ECG) should be obtained on all patients presenting with syncope or near-syncope since it is non-invasive and cost effective in assessing cardiac causes of syncope. In this particular simulation, the cause of syncope is due to a hemorrhagic shock from a ruptured ectopic pregnancy. Educational Objectives At the conclusion of this simulation, the learner will be able to: Review the initial management of syncope Utilize laboratory and imaging techniques to diagnose a ruptured ectopic pregnancy. Demonstrate the ability to resuscitate and disposition an unstable ruptured ectopic pregnancy. Educational Methods This simulation case was designed as a medium-to-high fidelity simulation scenario. It could also be altered and utilized as a practice oral board exam case. Research Methods The quality of the simulation and educational content was evaluated by debriefing and verbal feedback that was obtained immediately after the case. Additionally, a survey was emailed to participants and observers of the case to provide qualitative feedback. Results Post-simulation feedback from learners and observers was positive. Everyone present for the simulation felt that it was realistic and provided a unique opportunity to practice resuscitation skills. Discussion Syncope and near-syncope are common presentations to the emergency department with multiple etiologies that range from cardiac, neurologic, neurocardiogenic, and orthostatic to unknown. It is crucial that we diagnose and treat life-threatening causes of syncope rapidly and with limited information. In this case, the cause of syncope due to a ruptured ectopic pregnancy should be rapidly diagnosed with a thorough history and exam, urine pregnancy test, and a bedside abdominal ultrasound. Once the urine pregnancy test was resulted, ectopic pregnancy was the top differential diagnosis for each learner that participated. Initially, most learners only performed a transabdominal pelvic ultrasound of the pelvis, which is normal in the case. One learner performed a rapid ultrasound for shock and hypotension (RUSH) exam and was able to find free fluid in the right upper quadrant. Overall, this case and the debriefing topics wer...
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