Introduction The use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic. There is evidence of worldwide distribution of such devices, but some experts have warned of possible negative impacts of their use. The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department. Methods This was a randomized, crossover design study. Participants were randomized to intubate one of five airway scenarios with and without an aerosol box in place, with randomization of intubation sequence. The primary outcome was time to intubation. Secondary outcomes included number of intubation attempts, Cormack-Lehane view, percent of glottic opening, and resident physician perception of intubation difficulty. Results Forty-eight residents performed 96 intubations. Time to intubation was significantly longer with box use than without (mean 17 seconds [range 6–68 seconds] vs mean 10 seconds [range 5–40 seconds], p <0.001). Participants perceived intubation as being significantly more difficult with the aerosol box. There were no significant differences in the number of attempts or quality of view obtained. Conclusion Use of an aerosol box during difficult endotracheal intubation increases the time to intubation and perceived difficulty across a range of simulated ED patients.
Background:Emergency medicine clerkships are a required element of medical school programs. The optimal rotation structure is unknown, and in particular the number of clinical shifts required to achieve basic competency is unknown. In this analysis of one year of evaluations at an academic center, we assess the marginal utility of clinical shifts on competency, as assessed by historical preceptor milestone-based competency evaluations.The goal of the experiment is to observe the trend of passing rates throughout the course of an EM rotation using competencies including medical knowledge, data interpretation, and clinical judgement. The null hypothesis is that the percentage of students meeting the developmental milestones does not increase throughout the length of the clerkship. Methods:Clerkship evaluations of 200 students were retrospectively examined. A short form grading rubric was used to score students across eight developmental milestones. The average percentage of students meeting the developmental milestones were calculated and analyzed over the course of 14 shifts. A one-way ANOVA was used to compare the mean passing rates at different times of the clerkship. Results:The average percent of students achieving basic competency increased throughout the length of the clerkship, e.g. medical knowledge competency passing rates increased from 44.2% to 56.0%, first to last shifts respectively. Similar trends were observed in other competencies. The one-way ANOVA gave a p-value of less than 0.05; the null hypothesis was rejected. Conclusion/Potential Impact:The results can aid clerkship directors improve current grading rubrics to better assess student competency in their EM clerkships.
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