Nicholas J Stea

Interests

No activities entered.

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Adhikari, S. R., Stea, N., Drachman, M., & Acuña, J. (2020). Handheld ultrasound: Overcoming the challenge of difficult peripheral intravenous access in the emergency department. Journal of Ultrasound in Medicine.
• Acuña, J., Sorenson, J., Gades, A., Wyatt, R., Stea, N., Drachman, M., & Adhikari, S. (2020). Handheld Ultrasound: Overcoming the Challenge of Difficult Peripheral Intravenous Access in the Emergency Department. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 39(10), 1985-1991.
  More info

  The purpose of this study was to evaluate the performance of a handheld ultrasound device for difficult peripheral intravenous (PIV) access performed by nurses and paramedics in the emergency department (ED).
• Adhikari, S. R., Fan, H., Stea, N., Fiorello, A. B., Friedman, L., Irving, S., Acuna, J., Situ-LaCasse, E., Amini, R., & Stolz, L. A. (2018). Multimodular Ultrasound Orientation: Residents’ Confidence and Skill in Performing Point-of-care Ultrasound. Cureus, 10(11). doi:10.7759/cureus.3597
• Stolz, L. A., Amini, R., Situ-LaCasse, E., Acuña, J., Irving, S. C., Friedman, L., Fiorello, A. B., Stea, N., Fan, H., & Adhikari, S. (2018). Multimodular Ultrasound Orientation: Residents' Confidence and Skill in Performing Point-of-care Ultrasound. Cureus, 10(11), e3597.
  More info

  Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction. Results Over three years, 73 residents participated in this study. There was no significant difference in performance on the written test (p = 0.54) or the skills assessment (p = 0.16) between years. Performance on the written pre-test was not a predictor of performance on the skills test (R= 0.028; p = 0.19). Prior to training, residents were most confident in performing a focused assessment with sonography for trauma examination (median confidence 5.5 (interquartile range (IQR): 3 - 7) on a 10-point Likert scale where 1 represents low confidence and 10 represents high confidence). They reported the lowest confidence in performing a cardiac ultrasound (3 (IQR: 2 - 6)). Following training, residents reported increased confidence with all applications (p < 0.001). Eighty-five percent (confidence interval (CI): 73, 92) of residents agreed that the online ultrasound lectures effectively teach point-of-care ultrasound applications and 98% (CI: 88, 100) agreed that case-based interactive sessions helped them understand how ultrasound changes the management of acutely ill patients. Conclusions A written test of knowledge regarding the use of point-of-care ultrasound does not correlate with procedural skills at the start of residency, suggesting that teaching and evaluation of both types of skills are necessary. Following a multimodular introductory ultrasound course, residents showed increased confidence in performing the seven basic ultrasound applications. Residents reported that an asynchronous curriculum and case-based interactive sessions met the learning objectives and effectively taught point-of-care ultrasound applications.
• Jones, T., Stea, N., Stolz, U., & Adhikari, S. (2017). Ultrasound evaluation of saphenous vein for peripheral intravenous cannulation in adults. The journal of vascular access, 16(5), 418-21.
  More info

  The objective of this study was to investigate variables that may affect sonographic cannulation of great saphenous vein and determine the ideal location for ultrasound-guided saphenous vein cannulation in adult emergency department (ED) patients.
• Mohty, K. M., Cravens, M. G., Adamas-Rappaport, W. J., Amini-Shervin, B., Irving, S. C., Stea, N., Adhikari, S., & Amini, R. (2017). Cadaver-based Necrotizing Fasciitis Model for Medical Training. Cureus, 9(4), e1168.
  More info

  Necrotizing fasciitis is a devastating infectious disease process that is characterized by extensive soft tissue necrosis along deep fascial planes, systemic toxicity, and high mortality. Ultrasound imaging is a rapid and non-invasive tool that can be used to help make the diagnosis of necrotizing fasciitis by identifying several distinctive sonographic findings. The purpose of this study is to describe the construction of a realistic diagnostic training model for necrotizing fasciitis using fresh frozen cadavers and common, affordable materials. Presently, fresh non-embalmed cadavers have been used at medical institutions for various educational sessions including cadaver-based ultrasound training sessions. Details for the preparation and construction of a necrotizing fasciitis cadaver model are presented here. This paper shows that the images obtained from the cadaver model closely imitate the ultrasound appearance of fluid and gas seen in actual clinical cases of necrotizing fasciitis. Therefore, it can be concluded that this cadaver-based model produces high-quality sonographic images that simulate those found in true cases of necrotizing fasciitis and is ideal for demonstrating the sonographic findings of necrotizing fasciitis.
• Amini, R., Stolz, L. A., Breshears, E., Patanwala, A. E., Stea, N., Hawbaker, N., Thompson, M., Sanders, A. B., & Adhikari, S. (2016). Assessment of ultrasound-guided procedures in preclinical years. Internal and emergency medicine.
  More info

  Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students' procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p 
• Amini, R., Stolz, L. A., Kartchner, J. Z., Thompson, M., Stea, N., Hawbaker, N., Joshi, R., & Adhikari, S. (2016). Bedside echo for chest pain: an algorithm for education and assessment. Advances in medical education and practice, 7, 293-300.
  More info

  Goal-directed ultrasound protocols have been developed to facilitate efficiency, throughput, and patient care. Hands-on instruction and training workshops have been shown to positively impact ultrasound training.

Presentations

• Stea, N., & Friedman, L. (2015, October). Ultrasound-Guided Regional Anesthesia Lab. American College of Emergency Physicians Annual Meeting. Boston, MA.
  More info

  CoAuthors: Blaivas, Flavey, Herring, O'Brien, Thompson
• Stea, N., Amini, R., & Adhikari, S. R. (2015, May). Bedside Echo For Chest Pain: An Algorithm For Education and Assessment. Western Regional Meeting. Tucson, AZ.
• Stea, N., Amini, R., Stolz, L., & Adhikari, S. R. (2015, May). Bedside Echo For Chest Pain: An Algorithm For Education and Assessment; Society for Academic Emergency Medicine. Society for Academic Emergency Medicine. San Diego, CA.
• Stea, N., Falvey, D., Stolz, U., & Sakles, J. C. (2013, June). The impact of obesity on the first pass success rate of emergency department intubations. National Society of Academic Emergency Medicine Annual Meeting. Atlanta, GA.
• Stea, N., Falvey, D., Stolz, U., & Sakles, J. C. (2013, June). The impact of obesity on the first pass success rate of emergency department intubations. Western Society of Academic Emergency Medicine Annual Meeting. Long Beach, CA.
• Patel, J., Stea, N., Scheck, A. C., & Meuillet, E. J. (2004, February). Inhibition of Akt in combination with radiation therapy: a successful strategy depending on PTEN activity in human glioblastoma radiation biology and cancer: from molecular responses to the clinic. American Association for Cancer Research. Dana Point, CA.

Poster Presentations

• Keim, S. M., Tolby, N., Plitt, J., Min Simpkins, A. A., Ng, V., Berkman, M. R., Williams, C., Medina, T., Stea, N., Bradshaw, H. R., Situ-LaCasse, E. H., & Amini, R. (2023, November). Emergency Medicine Advising Program 2.0: An Innovative Approach to Medical Student Advising. Association of American Medical Colleges Learn Serve Lead. Seattle, WA: Association of American Medical Colleges.
• Stea, N., Kislin, K., Stadheim, C., Ambrad, A., Falsey, R. R., & Meuillet-May, E. J. (2013, July). ZD1839 (Iressa) radiosensitizes glioblastoma multiforme by altering patterns of gene expression in a time dependent manner. American Association for Cancer Research Annual Meeting. Washington, DC.