January 6, 2020

Background: Although the standard positioning for intubation is supine in the sniffing position, there has been recent literature in the past decade that elevating the head of the bed to 25 to 30 degrees may be a preferable setup for direct laryngoscopy due to improved laryngeal view and reduced airway complications. These studies have been conducted in multiple settings and patient populations including the prehospital setting, the emergency department, and the operating room (for elective cases). Additionally, video-assisted laryngoscopy has been a relatively recent innovation in airway management: the first video laryngoscope produced commercially became available in 2001. Similarly, this technology has been studied in multiple settings including in the emergency department and in the operating room. Both head-elevated direct laryngoscopy and video-assisted laryngoscopy have been studied with a variety of outcomes including first-pass success rate, time to intubation, and mortality rates. However, despite video-assisted laryngoscopy becoming increasingly ubiquitous, its limitations include a high cost and the possibility of components becoming damaged. Both of these innovations in intubation—video-assisted laryngoscopy and elevating the head of the bed—remain debated within the field of emergency medicine.

September 30, 2019

Background: Chest pain is a common chief complaint the Emergency Department, and the differential diagnosis includes life-threatening conditions from several organ systems including cardiac, pulmonary, and gastrointestinal, in addition to more benign etiologies. Historically, despite most patients not having acute coronary syndrome, there is still a high rate of medical admissions in patients with chest pain. The advent of accelerated diagnostic protocols has aided in guiding clinicians with decision making and disposition of these patients. This study aimed to address the question of whether or not an emergency medicine physician’s clinical gestalt would be sufficient to rule in or rule out acute coronary syndrome (ACS). Several studies have addressed this question with conflicting results. Given the high morbidity and mortality of acute coronary syndrome, emergency medicine physicians focus their clinical decision making on decreasing type II errors, i.e., false negatives. In clinical practice, this means having a low rule-out rate based on physician gestalt; in other words, most patients with chest pain presenting to the Emergency Department will have testing including an EKG and troponin level even for patients for whom the physicians have a low clinical suspicion for ACS.