The "double eights mask brace" improves the fit and protection of a basic surgical mask amidst COVID-19 pandemic.

STUDY OBJECTIVE: The COVID-19 pandemic has resulted in widespread shortages of personal protective equipment, including N95 respirators. Although basic surgical facemasks are more commonly available, their efficacy is limited due primarily to their poor face seal. This pilot study examined the impact of a rubber band mask brace on a basic surgical mask, as determined by quantitative fit testing. METHODS: Subjects wearing a basic surgical facemask and the rubber band mask brace underwent quantitative fit testing using machinery designed to certify N95 mask fit. Subjects were tested with the brace anchored behind their ears, with a paperclip behind the head, and on the side knobs of their face shields. The primary outcome measure was whether the subject passed the quantitative fit test at or above the Occupational Safety and Health Administration (OSHA)-verified standard for N95 masks. RESULTS: Subjects (n = 11) were 54.5% female, with a median height of 70 inches (interquartile range [IQR] = 68-74), weight of 170 pounds (IQR = 145-215), and body mass index (BMI) of 24.6 (IQR = 22.2-27.2), and encompassing 5 distinct N95 mask fit types. We found that 45%, 100%, and 100% of subjects passed the quantitative fit test when the brace was anchored behind the ears, with a paperclip and on a face shield, respectively. CONCLUSION: Of the 11 subjects included in the analysis, across a range of body habitus and N95 mask fit types, all passed the quantitative fit test when the mask brace was anchored on either face shield or with a paperclip. This data suggests that although the brace does not create an N95 equivalent in terms of filtration, it would offer improved protection from airborne viruses when worn with a basic surgical mask.

Calculated decisions: Canadian C-spine rule.

A review of the uses and evidence for the Canadian C-spine rule, which can be used to clinically clear cervical spine fracture without imaging.

Calculated decisions: NEXUS criteria for c-spine imaging.

A review of the uses and evidence for the NEXUS criteria for C-spine imaging, which are used to clear patients from cervical spine fracture clinically, without imaging.

Calculated decisions: modified Rankin Scale for neurologic disability.

A review of the uses and evidence for the modified Rankin Scale, which measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability.

Calculated decisions: NIH Stroke Scale/Score (NIHSS).

A review of the uses and evidence for the National Institutes of Health Scale/Score, which is used to quantify stroke severity.

Calculated decisions: Alberta Stroke Program Early CT Score (ASPECTS).

A review of the uses and evidence for the Alberta Stroke Program Early CT Score, which determines middle cerebral artery stroke severity using available computed tomography data.

Calculated Decisions: Alberta stroke program early ct score (ASPECTS).

The ASPECTS determines middle cerebral artery stroke severity using available computed tomography data.

Calculated Decisions: NIH stroke scale/score (NIHSS).

The NIH Scale/Score is used to quantify stroke severity.

Calculated decisions:NEXUS criteria for c-spine imaging.

The NEXUS criteria for C-spine imaging clear patients from cervical spine fracture clinically, without imaging.

Calculated decisions: Canadian c-spine rule.

The Canadian C-spine rule clinically clears cervical spine fracture without imaging.

Calculated decisions: Canadian CT head injury/trauma rule.

The Canadian CT Head Rule was developed to help physicians determine which patients with minor head injury need head CT imaging.

Clinical Policy: Critical Issues Related to Opioids in Adult Patients Presenting to the Emergency Department.

This clinical policy from the American College of Emergency Physicians addresses key issues in opioid management in adult patients presenting to the emergency department. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In adult patients experiencing opioid withdrawal, is emergency department-administered buprenorphine as effective for the management of opioid withdrawal compared with alternative management strategies? (2) In adult patients experiencing an acute painful condition, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms? (3) In adult patients with an acute exacerbation of noncancer chronic pain, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms? (4) In adult patients with an acute episode of pain being discharged from the emergency department, do the harms of a short concomitant course of opioids and muscle relaxants/sedative-hypnotics outweigh the benefits? Evidence was graded and recommendations were made based on the strength of the available data.

Calculated Decisions: National Institutes of Health Stroke Scale (NIHSS)

The NIHSS is used to quantify the severity of ischemic stroke.

Calculated Decisions: Modified Rankin Scale (mRS) for Neurologic Disability

The modified Rankin Scale (mRS) for neurologic disability measures the degree of disability or dependence in the daily activities of people who have suffered a stroke.

Calculated Decisions: Alberta Stroke Program Early CT Score (ASPECTS)

The Alberta Stroke Program Early CT Score (ASPECTS) assesses the severity of middle cerebral artery stroke using available computed tomography data.

Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline.

The American College of Emergency Physicians (ACEP) organized a multidisciplinary effort to create a clinical practice guideline specific to unscheduled, time-sensitive procedural sedation, which differs in important ways from scheduled, elective procedural sedation. The purpose of this guideline is to serve as a resource for practitioners who perform unscheduled procedural sedation regardless of location or patient age. This document outlines the underlying background and rationale, and issues relating to staffing, practice, and quality improvement.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2016.

OBJECTIVES: The objectives were to critically appraise the emergency medicine (EM) medical education literature published in 2016 and review the highest-quality quantitative and qualitative studies. METHODS: A search of the English language literature in 2016 querying MEDLINE, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified 510 papers related to medical education in EM. Two reviewers independently screened all of the publications using previously established exclusion criteria. The 25 top-scoring quantitative studies based on methodology and all six qualitative studies were scored by all reviewers using selected scoring criteria that have been adapted from previous installments. The top-scoring articles were highlighted and trends in medical education research were described. RESULTS: Seventy-five manuscripts met inclusion criteria and were scored. Eleven quantitative and one qualitative papers were the highest scoring and are summarized in this article. CONCLUSION: This annual critical appraisal series highlights the best EM education research articles published in 2016.