Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Diversity, equity, and inclusion (DEI) in health care fosters many positive outcomes including improved patient care. DEI initiatives are often created by or require buy-in from departmental leaders with low DEI literacy. Book clubs are one way to develop DEI literacy. The purpose of this paper is to describe how leaders in the department of emergency medicine (DEM) process the information gained from reading a DEI book through discussion in a book club setting and explore how participation enhances their DEI literacy and fosters self-reflection. ⋯ By addressing privilege and systemic inequities through the reflective practice and dialogue of a book club, participants demonstrated a growing commitment and perceived readiness to advancing inclusive practices within medicine.
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Emergency tracheal intubation is associated with a risk of clinical adverse events, including the risk of first-attempt failure. Induction agents usually include a sedative and a neuromuscular blocking agent (i.e., paralytic). Whether the order of administration (i.e., sedative vs. paralytic given first) is associated with first-attempt failure or adverse events is unknown. ⋯ In this Bayesian analysis a paralytic-first drug sequence was associated with reduced first-attempt failure during emergency tracheal intubation.
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In patients with a high clinical probability of pulmonary embolism (PE), the high prevalence can lower the D-dimer negative predictive value and increase the risk of diagnostic failure. It is therefore recommended that these high-risk patients should undergo chest imaging without D-dimer testing although no evidence supports this recommendation. ⋯ In this study, ruling out PE in high-risk patients based on D-dimer below the age-adjusted threshold was safe, with no missed PE. However, the large CI of the primary endpoint precludes a definitive conclusion.