Pre-oxygenation: Implications in emergency airway management.

Transient oxygen desaturation during emergency department intubation is an event with potentially devastating consequences. Pre-oxygenation is an important means of increasing a patient's oxygen reserve and duration of safe apnea prior to intubation. In the emergent setting, important modifications to pre-oxygenation techniques need to be considered to best manage critically ill patients. In this review, we discuss recent updates in pre-oxygenation techniques and evaluate the evidence supporting both commonly used and newly emerging techniques for pre-oxygenation, assessing nature and level of illness, the best delivery method of oxygen, using delayed sequence intubation in patients who cannot tolerate non-invasive pre-oxygenation and using apneic oxygenation via nasal cannula and non-rebreather mask during intubation.

Implementation of the resident exposure to nursing and administration curriculum.

OBJECTIVES: Clinical competence is an essential component of the practice of emergency medicine (EM), but a well-rounded physician must gain appreciation and understanding of the many nonclinical aspects of EM, including emergency department (ED) throughput, operational metrics, financial principles, policies and procedures, interaction with nursing, and patient experience. While most residency programs include an administrative component, the majority are during the final year of training. We designed and piloted the Resident Exposure To Nursing and Administration (RETNA) curriculum for postgraduate year one (PGY-1) residents during orientation. The curriculum included a lecture, departmental tour with operational focus, and nurse shadowing experience, which were completed prior to their first clinical shift. We hypothesized that residents would view this favorably and advocate for formal adoption of the RETNA curriculum. Furthermore, we anticipated that the curriculum would improve relationships between residents and nursing. METHODS: The three-component RETNA curriculum was piloted at an urban, academic center, with 14 PGY-1 residents per class, to two PGY-1 classes over a two-year period. Surveys were used to assess the resident perception of each component of the curriculum. Quantitative survey results were compared year over year using an unpaired t-test. Qualitative comments were also recorded and analyzed for content. Nursing evaluation scores of PGY-1 residents were used to independently analyze the impact of the curriculum on nurse-resident interactions. RESULTS: The overall survey response rate was 82%. There was no statistically significant difference between the responses recorded in 2019 versus 2020 (p < 0.05). All PGY-1s, with one exception, agreed or strongly agreed that a similar session should be included in future orientations. Of the respondents, 88% thought that the lecture on ED flow was educational and 91% agreed that the nurse shadowing shift was a valuable learning experience. All subjective survey responses were positive, and all three components of the curriculum, ED flow, nursing workflow, and patient experience, were mentioned in the comments. Nurse-resident relationships improved after implementation of the curriculum. CONCLUSION: The overwhelmingly positive feedback we received on this curriculum has led to the adoption of the RETNA curriculum as a core component for future EM orientations at the study institution. Introducing trainees to ED administration and nursing early in residency has few drawbacks and many potential benefits. As such, we advocate for further study and adoption of similar curricula to enhance and supplement existing postgraduate EM resident education.