The Dark Truth About the Creepy Beak Mask

During the Black Death of the 14th to 17th centuries, plague doctors became a haunting symbol of the pandemic. These physicians donned long, beaked masks that seemed macabre by today’s standards, but they were an early attempt at personal protective equipment. The beaks were not for intimidation; they were filled with a mix of aromatic herbs, spices, and flowers, such as lavender, rosemary, and mint. Physicians believed that "miasma," or bad air, caused disease, and the herbs in the beak acted as a filter, purifying the air they breathed. While ineffective against Yersinia pestis, the bacteria responsible for the plague, the masks did provide some psychological comfort to both the doctors and their patients.

The full plague doctor outfit was equally dramatic, featuring a waxed cloak, gloves, and a wide-brimmed hat, which were intended to shield the wearer from "contaminated" air or physical contact. These outfits made the doctors appear almost otherworldly, heightening fear rather than providing reassurance. Despite their rudimentary understanding of germ theory, plague doctors inadvertently reduced exposure to fleas—the true carriers of the plague—thanks to their covered clothing. The eerie aesthetic of the plague doctor persists in modern pop culture, a chilling reminder of humanity’s desperate measures in the face of disease.

Now, lets get on to the 92nd edition of the newsletter...

Never Apologize To A Consultant

Swami and I got togetehr to talk about calling consults. We talked about those potentially difficult 2 AM calls and how to turn them into productive and professional interactions. We talked about ensuring the consultant's full attention before proceeding, to leading with the critical information that matters most (like leading with "gunshot wound to the abdomen" rather than meandering through irrelevant medical history). We also emphasize a crucial mindset shift: never apologize for making the consult, as it undermines your position and the legitimate need for specialist input. The full video a must-watch for anyone working in a clinical setting and who wants to master the art of consultation.

Watch the full video here and leave a comment.

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Intubating the Neuro Patient

In this episode, Dr. Danya Khoujah unpacks the complexities of intubating neurologically injured patients, recorded live at ResusX: ReUnion. From pre-intubation steps like head-of-bed elevation and fentanyl premedication to choosing the right induction agents, she provides a clear roadmap for managing these critical scenarios. Dr. Khoujah emphasizes avoiding secondary injury, managing ICP, and optimizing patient outcomes. Whether you’re dealing with traumatic brain injuries, strokes, or seizures, this episode is full of practical, evidence-based tips to elevate your practice in emergency and critical care medicine.

1. Check out this video now and watch the entire ResusX: ReUnion conference for more content from Danya and our other all-star faculty!

 Watch the Video Now!

A New X / Twitter Competitor? 

Like it or not social Media in medicine is here to stay. It all started many years ago on a little platform called Twitter, that later became X. Medical professionals flocked to this platform to post education and create a community for discussion. Twitter was also the birthplace for FOAMed (Free Open Access Medical Education). The education was flowing for years on Twitter until it became X...then things started getting a little weird. The algorithm no longer favors medical education, there are lots of ads, and frankly it's not the academic place it used to be. Despite multiple educators have attempted to resuscitate the medical education on X while others have fled. And while I've personally been active on other platforms, such as Instagram, TikTok, YouTube...these are technically image and video apps and don't support the text base education that educators enjoy.

Enter Blue Sky an application that feels very reminiscent for the old Twitter. It's much more friendly network and more collaborative for conversation education. Although it's relatively new, it's meded user base has grownsignificantly, likely secondary to the frustrations associated with X. I recently made the jump over there and found it to be very warm, welcoming, and filled with a wealth of collegial conversation. I recommend you check it out and if you like the content I post on other platforms you can follow me here.

Bougie or Bust? The Truth About First-Pass Success

Ever wonder if you should reach for a bougie or stylet on your next intubation? A fresh systematic review and meta-analysis involving over 9,000 patients has shed some new light on this age-old debate. The results? Bougie use does appear to improve first-pass success rates, but there's more to the story than just the numbers. While the overall benefit was modest (showing an 11% relative improvement in first-attempt success), the real magic happened in cases with poor glottic views, where the bougie nearly doubled the chances of first-pass success. However, it's worth noting that these wins came with a small trade-off – slightly longer intubation times (up to 13 seconds in ED settings) and a minor uptick in intubation-related injuries.

What makes this review particularly interesting is its broad scope, pulling data from diverse clinical settings including EDs, ICUs, and ORs. Remember the BEAM trial that had everyone excited about bougies back in 2018? Well, their impressive 98% first-attempt success rate wasn't quite replicated in the larger BOUGIE trial, highlighting an important point: success with any airway tool largely depends on who's wielding it. This review helps reconcile these seemingly conflicting results by showing us that while bougies can be game-changers in difficult airways, their advantage might be less pronounced in routine cases with good views.

Key Take-Home Points:

• Bougies show their true value in difficult airways with poor glottic views, offering a 60% higher success rate in Cormack-Lehane grade III/IV views
• The learning curve matters – centers with more bougie experience generally showed better outcomes, suggesting regular practice is key
• While bougies might take a few extra seconds to use, they don't significantly increase complications like hypoxemia or esophageal intubations
• A pragmatic approach would be having both bougie and stylet readily available, rather than committing to a one-size-fits-all strategy

For a more detailed analysis and discussion of the study's implications for medical education, check out the full blog post here.

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