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Despite the rapid expansion of online educational resources for emergency medicine, barriers remain to their effective use by emergency physicians and trainees. This article expands on previous descriptions of techniques to aggregate online educational resources, outlining four strategies to help learners navigate, evaluate, and contribute online. These strategies include 1) cultivating digital mentors, 2) browsing the most popular free open access medical education (FOAM) websites, 3) using critical appraisal tools developed for FOAM, and 4) contributing new online content.
The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice. We propose that new types of scholars are emerging to moderate the changing landscape of knowledge translation: 1) critical clinicians who critically appraise research in the same way that lay reviewers critique restaurants; 2) translational teachers adept with these new technologies who will work with researchers to disseminate their findings effectively; and 3) interactive investigators who engage with clinicians to ensure that their findings resonate and are applied at the bedside. The development of these scholars could build on the promise of evidence-based medicine by enhancing the appraisal and translation of research in practice.
This chapter discusses the management of airway. Oxygenation is the primary concern in airway management. As hemoglobin and oxygen bind cooperatively, desaturation is slow above SpO2 90%. Below 90%, hemoglobin molecules quickly lose bound oxygen, and critical hypoxia can occur in seconds. Due to the technical aspects of pulse oximetry, there is a lag of up to 2 minutes in the measured SpO2. Therefore, reading in the 80-90% range may indicate that the actual SpO2 is much lower. Laryngoscopy should be abandoned when SpO2 reads 90% in order for the patient to be reoxygenated. The goal of preoxygenation is not merely to achieve a SpO2 of 100%, but also to de-nitrogenate the lungs, completely filling the lungs with oxygen to act as an oxygen reservoir during laryngoscopy. Principles of laryngoscopy are identical for direct and video laryngoscopy, with the exception of different positioning.