Enhancement of Cricothyroidotomy Education Using a Novel Technique: Cadaver Autografting.

BACKGROUND: Cricothyroidotomy is a lifesaving procedure required in up to 2% of emergent airways. Emergency medicine training programs frequently instruct this procedure via cadaver training, but cadaver cost and availability limit the opportunity for all trainees to perform the critical initial skin incision. Cadaver autografting is a novel way to simulate all steps of the procedure. OBJECTIVE: Our aim was to determine whether the technique of autografting cadaver tissue improves the experience of cricothyroidotomy simulation education for emergency medicine trainees. The investigators hypothesized that autografted cadaver tissue would be a useful adjunct. METHODS: In this prospective crossover study, volunteers were randomized to first perform cricothyroidotomy on previously incised native neck tissue or on autografted tissue, and then vice versa. The autograft consisted of cadaver iliotibial band covered with lateral thigh skin and subcutaneous tissue to simulate cricothyroid membrane and native anterior neck anatomy. Volunteer emergency medicine residents and sub-interns were included. Twenty-seven residents and nine students participated. Outcomes were evaluated via Likert scale. RESULTS: Thirty of 36 (83%) participants agreed or strongly agreed that they preferred cadaver autografting to the previously incised native tissue. Thirty-two of 36 (89%) agreed or strongly agreed that cadaver autografting was useful vs. 23 of 36 (64%) who answered similarly regarding previously incised native tissue (p = 0.001). Twenty-six of 36 (72%) were more comfortable with cricothyroidotomy in the emergency department after using cadaver autografting vs. 19 of 36 (53%) after using the native tissue (p = 0.003). CONCLUSIONS: Autografted cadaver tissue while simulating cricothyroidotomy was perceived to be a useful adjunct by the majority of participating emergency medicine trainees.

LGBTQ+ individuals are not explicitly represented in emergency medicine simulation curricula.

Background: Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior. Methods: We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher's Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior. Results: Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior. Conclusions: LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.

Adolescents Who Visit the Emergency Department Are More Likely to Make Unhealthy Dietary Choices: An Opportunity for Behavioral Intervention.

To identify health behaviors that may be amenable to brief screening and intervention among children in the emergency department (ED), we described the prevalence of health behaviors known to contribute to childhood obesity among middle school students who used the ED recently. Participants included 1590 5th, 7th, and 8th grade students who completed health surveys in 2011. Multivariate logistic regression was used to examine the association between health behaviors and ED use. Children who used the ED reported more unhealthy dietary behaviors, including greater consumption of energy-dense foods such as fried chicken, french fries, and ice cream (OR 1.20, 95% CI 1.06-1.37), fast food (OR 1.07, 95% CI 1.00-1.14) and sugar-sweetened beverages (OR 1.24, 95% CI 1.14-1.35). There was no association with fruit and vegetable consumption, physical activity, or screen time. Unhealthy dietary behaviors are associated with ED use in a low-resource urban population of middle school students.