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This edition of the Emergency Medicine Journal has ‘something for everyone’ (as always), and at least one article that will be of interest to everyone (I think). The two main themes in this edition are ‘the difficult airway’ and Paediatric Emergency Medicine. However, we begin this Primary Survey by talking about gender.
Gender differences in Emergency Medicine
Two articles look at gender disparity in Emergency Medicine (EM). A short report by Partiali et al looks at the proportion of female speakers, and the length of time these speakers are given to deliver their talks, at a major EM academic conference. Although both proportion and ‘speaking-time’ are increasing over the period reviewed, there remains a large gender difference. In the paper by Parsons et al, the worldwide difference in academic representation between the genders is discussed, and is especially interesting given the fact that more females matriculate from medical school in both the USA (since 2017) and the UK (since 1996–7). The authors then go on to look at gender differences in medical leadership in EM in the USA. The discrepancy revealed in this paper will, unfortunately, be unsurprising.
Whilst writing this ‘Primary Survey’ my bedtime reading is a novel by the late-Victorian writer George Gissing, who in many of his novels explored the position of women in the late nineteenth century. One of the characters opines “Woman is still enslaved, though men nowadays think it necessary to disguise it.” Having read these two articles it may be that the medical profession has evolved little in this regard over the last 150 years.
The difficult airway
Three papers in this edition look at difficult airways and their management. In a paper from Japan by Takahashi et al, there is a review of a database from a large observational study on emergency airway management. This has revealed an increase in major (but not minor) adverse events in the older population undergoing emergency intubation, largely due to post-intubation hypotension. From the Helicopter Emergency Medical Service in London, there is a 20 year review of emergency cricothyroidotomy which reveals a very low rate of requirement for surgical airways in the pre-hospital environmentWhen performed, it is often due to blood in the airway preventing laryngoscopy. Gaffar et al have looked at trauma CT scans and calculated the average cricothyroid membrane depth, and factors associated with a greater depth. Some of these factors might be surprising, however these ought to be considered by those preparing to perform an emergency surgical airway.
Paediatric Emergency Medicine
There are several papers looking at issues in Paediatric Emergency Medicine. The results from a Paediatric Emergency registry in Nicaragua (reviewed in Bressan et al) is sobering, and the use of point-of-care EEG in an ED (described by Simma et al) in intriguing.
Two further papers particularly catch the eye. The Editors Choice this month is a paper looking at the likely cervical spine imaging in a Paediatric population, when using three different clinical decision rules (CDRs) (Philips et al). There were large differences between cervical spine injury rates and imaging rates. However the use of CDRs would have increased the rate of imaging. The second paper is the short report by Cameron et al, highlighting the dangers of travel cups to children; of interest to all of those who use them.
Other articles of interest
The problem of pre-hospital ‘missed stroke’ is considered in the systematic review by Jones et al, and reading this paper reveals the challenges faced by clinicians ‘in the field’. The clinical impact of this, and the potential for improving sensitivity of tools to identify stroke pre-hospital is discussed.
Two original research papers relating to COVID-19 are of interest. Lyall and Lone look at the effect on non-COVID admissions during the first lockdown in Scotland, while Bertaina et al look at non-invasive ventilation in acute respiratory failure due to COVID-19.
And the article I think will be of interest to everyone? This is the Best Evidence topic report on homemade or cloth facemasks as a preventative measure for respiratory virus transmission- an evidence review on a topic that, is affecting all our lives.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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