The role of an academic emergency department in advancing equity and justice

Landry, Alden; Brown, Ivan W.; Blomkalns, Andra L.; Wolfe, Richard E.

doi:10.1111/acem.14164

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…The videoscopic view may be better than that afforded by standard direct laryngoscopy 105 – 107 and may 108 – 111 or may not 112 be significantly better than that afforded by direct eye-to-glottis viewing with the same video laryngoscope. Higher first-pass 105 , 113 and overall 105 , 114 success rates have been reported with Mac-VL than with DL. As with DL, once a view of the glottis is obtained, tracheal tube delivery tends to be straightforward.…”

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 93%

“… 117 First pass tracheal intubation success with HA-VL is frequently higher than with DL. 113 Tracheal intubation with HA-VL requires use of a stylet 118 or other adjunct and for the inexperienced airway manager, may be more challenging or take longer than with DL. 119 , 120 This can occur despite good glottic visualization.…”

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 99%

“… 141 Nevertheless, compared with DL, the first-attempt and overall success rates of tracheal intubation using VL (Mac-VL or HA-VL) are rarely worse, and are often better. 105 , 113 , 114 , 142 – 153 …”

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 99%

“…In addition, there may be lower complication rates with VL, including fewer occurrences of esophageal intubation. 52 , 113 , 144 – 147 , 156 – 159 The use of VL also enables a “shared mental model”, helping to increase engagement of all airway team members. On balance, and resources allowing, the CAFG recommends the routine primary use of VL with an appropriate blade type for all tracheal intubations.…”

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 99%

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Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. Findings and key recommendations Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider “exit strategy” options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a “cannot ventilate, cannot oxygenate” emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as “airway lead” to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.

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Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 93%

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 99%

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 99%

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 99%

See 2 more Smart Citations

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…14 Departments must review patient complaints as a source of potential disparities that may not be apparent through traditional measurements of quality and address racism and other forms of bias that patients experience during their ED course. 15 This level of integration of health equity into all functions of a department requires consistent leadership, complemented by financial support and academic rigor seen in other spaces in the practice of medicine.…”

Section: Patient P Opul Ati On: Equ It Y In Patient C Arementioning

confidence: 99%

Call to action in academic emergency medicine: Going beyond the appreciation of diversity, equity, and inclusion to true practice

Landry

Boatright

Smith

2021

AEM Education and Training

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Racial disparities in emergency medicine: Implementation of a novel educational module in the emergency medicine clerkship

Ellis

Landry

Darling

et al. 2023

AEM Education and Training

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Objectives: Despite decades of literature recognizing racial disparities (RDs) in emergency medicine (EM), published curricula dedicated to addressing them are sparse.We present details of our novel RD curriculum for EM clerkships and its educational outcomes. Methods:We created a 30-min interactive didactic module on the topic designed for third-and fourth-year medical students enrolled in our EM clerkships. Through a modified Delphi process, education faculty and content experts in RD developed a 10-question multiple-choice test of knowledge on RD that the students completed immediately prior to and 2 weeks following the activity. Students also completed a Likert-style learner satisfaction survey. Median pre-and posttest scores were compared using a paired Wilcoxon signed-rank test and presented using medians and 95% confidence intervals (CIs). Satisfaction survey responses were dichotomized into favorable and neutral/not favorable.Results: For the 36 students who completed the module, the median pretest score was 40% (95% CI 36%-50%) and the posttest score was 70% (95% CI 60%-70%) with a p-value of <0.001. Thirty-five of the 36 students improved on the posttest with a mean increase of 24.2% (95% CI 20.2-28.2). The satisfaction survey also showed a positive response, with at least 83% of participants responding favorably to all statements (overall mean favorable response 93%, 95% CI 90%-96%). ConclusionsThis EM-based module on RD led to improvement in students' knowledge on the topic and positive reception by participants. This is a feasible option for educating students in EM on the topic of RD. of 5 | RACIAL DISPARITIES IN EMERGENCY MEDICINE NEED FOR INNOVATIONRacial disparities (RDs) in health care outcomes due to racism and provider bias is well documented in the literature. Despite this, progress across a multitude of key health metrics has been lacking over the past two decades. 1 Widespread education on the topic in medical training is needed to address this problem. To date, there is no established, standardized curriculum for students in emergency medicine (EM) to address the numerous RDs in this patient population and potential biases that exist in this learner group. BACKG ROU N DRDs in the emergency department (ED) are ubiquitous. For instance, Black patients are less likely than their White counterparts to receive pain medicine, 2-5 be triaged appropriately, 6,7 and receive basic testing for chest pain. 3 In addition, Black patients are more likely to be accused of child abuse, 8 be physically restrained, 9,10 get questioned about drug use, and undergo drug testing. 11The National Academy of Medicine, in their 2003 landmark report "Unequal Treatment," lauded education as a primary means to address these RDs. 12 This sentiment has been consistently reinforced in literature. [13][14][15] Studies have demonstrated a substantial need for education in the medical student population. One investigation found that half of White medical students had misconceptions regarding race including the belief Black p...

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The role of an academic emergency department in advancing equity and justice

Cited by 7 publications

References 22 publications

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Call to action in academic emergency medicine: Going beyond the appreciation of diversity, equity, and inclusion to true practice

Racial disparities in emergency medicine: Implementation of a novel educational module in the emergency medicine clerkship

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