Introduction Barrier enclosure devices were introduced to protect against infectious disease transmission during aerosol generating medical procedures (AGMP). Recent discussion in the medical community has led to new designs and adoption despite limited evidence. A scoping review was conducted to characterize devices being used and their performance. Methods We conducted a scoping review of formal databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus), grey literature, and hand-searched relevant journals. Forward and reverse citation searching was completed on included articles. Article/full-text screening and data extraction was performed by two independent reviewers. Studies were categorized by publication type, device category, intended medical use, and outcomes (efficacy – ability to contain particles; efficiency – time to complete AGMP; and usability – user experience). Results Searches identified 6489 studies and 123 met criteria for inclusion (k = 0.81 title/abstract, k = 0.77 full-text). Most articles were published in 2020 (98%, n = 120) as letters/commentaries (58%, n = 71). Box systems represented 42% ( n = 52) of systems described, while plastic sheet systems accounted for 54% ( n = 66). The majority were used for airway management (67%, n = 83). Only half of articles described outcome measures (54%, n = 67); 82% ( n = 55) reporting efficacy, 39% ( n = 26) on usability, and 15% ( n = 10) on efficiency. Efficacy of devices in containing aerosols was limited and frequently dependent on use of suction devices. Conclusions While use of various barrier enclosure devices has become widespread during this pandemic, objective data of efficacy, efficiency, and usability is limited. Further controlled studies are required before adoption into routine clinical practice.

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Pediatric respiratory illnesses are a huge burden to emergency departments worldwide. This article reviews the latest evidence in the epidemiology, assessment, management, and disposition of children presenting to the emergency department with asthma, croup, bronchiolitis, and pneumonia.

The combination of a brief education-based intervention and a computerized FF was more effective than education alone in reducing solitary BC collection in our ED in this time series study. FFs can be a powerful tool in modifying behaviors and processes in the clinical setting.

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Ordering and protocolling CT scans after-hours from the emergency department (ED) at our institution previously required discussion between the ED physician and radiology resident, which led to workflow inefficiency. Our intervention consisted of creating an electronic list of CT requests that radiology residents would monitor. Radiology protocolled straightforward requests and contacted the ordering physician for more details when required. We aimed to improve workflow efficiency, increase provider satisfaction and reduce CT turnaround time without significantly affecting CT utilisation. Plan-do-study-act cycles were used to plan and evaluate the intervention. The intervention was initiated on weekday evenings and then expanded to weekend hours after an interim analysis. Qualitative outcomes were measured via electronic survey, and quantitative outcomes were collected from administrative data and analysed via control charts and other statistical methods. Survey response was high from ED physicians (76%, n=82/108) and radiology residents (79%, n=30/38). After the intervention, the majority of ED staff and radiology residents perceived improved workflow efficiency (96.3%, 73.3%), radiology residents noted a subjective decrease in disruptions (83.3%) and most ED staff felt that scans were performed more quickly (84.1%). Radiology residents received fewer pages per shift, adjusted for scan volume. There was a reduction in time from order entry to protocol on weekday shifts only, with no statistically significant effect on time from order entry to scan. Segmented regression analysis demonstrated a background increase in utilisation over time (0.7–2.0 CT/100 ED visits/year, p<0.0005), but the intervention itself did not contribute to an overall increase in CT utilisation. In conclusion, our intervention led to improved perceived workflow efficiency and reduced pages. Scans were protocoled more quickly on weekdays, but turnaround times were otherwise not significantly affected by the intervention. Background CT utilisation increased over time, but this increase was not attributable to our intervention.

Introduction Medical institutions are using barrier enclosure devices during intubation procedures and other aerosol-generating medical procedures without evidence of their effectiveness or usability, potentially compromising patient care, and provider safety. Our objective was to determine the degree of protection offered by these devices and explore other usability factors for two popular barrier systems. Methods A simulated trial comparing an intubation box, a frame and plastic tarp system, and unprotected intubation was performed in an academic emergency department. Ten emergency physicians were recruited to participate. Our primary outcome was the degree of contamination from secretions measured by average surface area exposed to phosphorescent material. Secondary outcomes included: laryngoscopy time and time to barrier application, unsuccessful intubation attempts, and usability ratings for each system. Descriptive statistics were reported for all variables of interest and a linear mixed model was used to analyze contamination and laryngoscopy time. Usability was captured through electronic questionnaires using a five-point Likert scale. Results Contamination was more prevalent with the box, compared to the frame and tarp, and no device, however, this did not achieve statistical significance (13.2% versus 8.1% versus 12.2%, P = 0.17). A barrier system delayed intubation when compared to using no system (no system = 24.4 s [95% CI 17.3–27.5], frame = 54.4 s [95% CI 13.8–95.0], box = 33.8 s [95% CI 21.4–46.1], P = 0.02). In assessing usability, 30% of users preferred the use of a box barrier, 40% of users preferred the frame, and 30% would not use either in future intubation. Conclusions Compared to no barrier protection, an intubation box enclosure offers limited additional protection. A frame and tarp system reduces exposure at the expense of visibility and operator comfort. Finally, barrier systems do not appear to have a clinically significant impact on airway management.

Background The ketogenic (“keto”) diet has been gaining more attention lately in the medical literature and the lay media as a potentially effective method for weight control and management of type 2 diabetes. Though rare, there have been case reports of serious side effects. Here, we present a peculiar case of pancreatitis presumably associated with the ketogenic diet. Case presentation A 35-year-old man on a calorie-restricted ketogenic diet presented to the emergency department with weekly abdominal pain on Monday mornings, each time after dietary indiscretions (“cheat days”) on the weekend. It was found that he had a clinical presentation consistent with acute pancreatitis with no associated alcohol use, hypertriglyceridemia, pancreatic obstruction, or other anatomic abnormalities. The patient’s symptoms resolved with conservative management and progressive reintroduction of a standard diet. Conclusion This case indicates that the ketogenic diet could lower the threshold for acute pancreatitis, and that an episodic stressor may trigger an acute attack in the absence of traditional risk factors.