A primer on proning in the emergency department.

Historically, the prone position was used almost exclusively in the ICU for patients suffering from refractory hypoxemia due to acute respiratory distress syndrome (ARDS). Amidst the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, however, this technique has been increasingly utilized in settings outside of the ICU, particularly in the emergency department. With emerging evidence that patients diagnosed with COVID-19 who are not intubated and mechanically ventilated may benefit from the prone position, this strategy should not be isolated to only those with critical illness. This is a review of the pertinent physiology and evidence supporting prone positioning along with a step-by-step guide meant to familiarize those who are not already comfortable with the maneuver. Placing a patient in the prone position helps to improve ventilation-perfusion matching, dorsal lung recruitment, and ultimately gas exchange. Evidence also suggests there is improved oxygenation in both mechanically ventilated patients and those who are awake and spontaneously breathing, further reinforcing the utility of the prone position in non-ICU settings. Given present concerns about resource limitations because of the pandemic, prone positioning has especially demonstrable value as a technique to delay or even prevent intubation. Patients who are able to self-prone should be directed into the ''swimmer's position'' and then placed in reverse Trendelenburg position if further oxygenation is needed. If a mechanically ventilated patient is to be placed in the prone position, specific precautions should be taken to ensure the patient's safety and to prevent any unwanted sequelae of prone positioning.

Mock Oral Board Examinations via Web-based Video Teleconferencing in the Era of COVID-19.

Owing to infection control measures necessitated by the COVID-19 pandemic, many educational didactic components within residency programs have needed to adapt to virtual formats. We describe and evaluate the transition of an in-person mock oral board certification examination to an entirely virtual format. Oral board cases consisting of two single cases and one triple case were adapted to a virtual format using a Web-based video teleconferencing platform. Faculty examiners underwent 20-minute training sessions prior to the examination. Both resident examinees and faculty examiners completed postexamination surveys. The system usability scale (SUS) was used to assess the usability of the new format by the faculty examiners. Fifteen resident examinees completed the mock virtual oral board examination with eight faculty examiners. All faculty members completed the postexamination survey. The mean (±SD) SUS score was 90.6 (±11.5) out of a maximum of 100. Eleven of 15 (73%) resident examinees completed the postexamination survey. All respondents agreed or strongly agreed that examiner instructions were easy to understand and that examiners were adept at using the Web-based platform. Some technical issues were encountered including audio difficulties for some examiners. Respondents were split regarding personal preference for virtual or in-person mock oral board formats. Utilizing video teleconferencing software to provide a virtual, Web-based alternative to in-person mock oral board examination was feasible, and the virtual format was shown to have high usability despite minimal training time for experienced faculty examiners.