Clinical Pearls for Airway Management of Morbidly Obese Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – advanced airway, Airway management, awake intubation, cricothyroidotomy, difficult airway, difficult airway management, Difficult Intubation, Difficult LMA, direct laryngoscopy, emergent intubation, Endotracheal Intubation, Featured, GlideScope, Glidescope Intubation, HPC Updates, intermediate airways, Intubation, Ketofol, Laryngeal Mask Airway, laryngoscopy, LMA, Mechanical Ventilation, Propofol, supraglottic airway, Vascular access, Ventilation, video laryngoscopy, Videolaryngoscopy
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Morbidly obese patients can pose numerous challenges when it comes to airway management. Morbid obesity can make vascular access more difficult and you need good vascular access prior to any attempts at safe airway management. In addition, morbid obesity can…
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Simulation Based Training for Central Venous Catheters

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central Line, central line complications, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, Featured Procedure, HPC Updates, Procedure Blog of the Week, Simulation Based Training, Simulation-based procedural training, Ultrasound-Guided Central Line Insertion
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Does Simulation Based Training Improve Central Line Success Rates? Simulation-based procedural training has become increasingly popular in academic medical centers and among medical trainees.  Limited data has suggested that simulation based training improves success rates and safety, but evidence has…
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Outpatient Management of A Spontaneous Pneumothorax

Joseph Esherick, M.D., FAAFP, FHM
More Articles – chest tubes, Featured Procedure, HPC Updates, Tube Thoracostomy
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A patient with a hemodynamically stable spontaneous pneumothorax can be managed as an outpatient using the placement of a small-bore pigtail catheter attached to a Heimlich valve.   As the Director of Medicine at a teaching hospital, I frequently encounter…
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Pearls about Chest Tube Management

Joseph Esherick, M.D., FAAFP, FHM
More Articles – blunt trauma, Chest Pain, Chest tube, chest tube placement, chest tube position, Chest tube removal, chest tube size, chest tubes, emergency procedures, empyema, Featured, hospital procedures, HPC Updates, parapneumonic effusion, pleural effusions, pleural fluid analysis, pneumonia, Pneumothorax, POCUS, Prophylaxis, Small-bore chest tube, Thoracentesis, thrombolysis, Tube Thoracostomy, Ultrasound-Guided Thoracentesis
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Chest tubes, or thoracostomy tubes, have been used since the fifth century BC when Hippocrates described the use of a hollow tin tube to drain fluid that was likely an empyema from his description.[i] Chest tubes started to be used…
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The Jury is Still Out on Whether Awake Prone Positioning in Non-intubated Patients with COVID-19 Pneumonia Decreases Mortality or Endotracheal Intubation

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Acute respiratory distress syndrome, Airway management, Anti-coagulant, ARDS, Bilevel noninvasive positive pressure ventilation, BiPAP, corticosteroids, COVID, CPAP, Endotracheal Intubation, Featured, HPC Updates, Mechanical Ventilation, noninvasive positive pressure ventilation, noninvasive ventilation, NPPV, respiratory failure
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COVID-19 pneumonia can be a frustrating infection to treat because we have limited medications that have proven benefit in moderate-severe infections. Patients with COVID-19 pneumonia who require up to 2L/min supplemental oxygen have at least moderate infection. Patients with severe…
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Tricks of the Trade for Stylet-guided Endotracheal Intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, Endotracheal Intubation, Featured Procedure, HPC update, HPC Updates
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Eschmann stylets, or Bougies, can assist the clinician with endotracheal intubation in difficult airway scenarios.  The stylet when properly placed can act to guide the endotracheal tube (ETT) into the trachea.  However, there are different troubleshooting techniques that once must…
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Maneuvers to Assess Fluid Responsiveness in Septic Shock or Vasodilatory Shock

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured, HPC Updates, Sepsis, Septic Shock, severe sepsis, shock
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Aggressive fluid administration is a hallmark of septic shock management and has been espoused by the Surviving Sepsis Campaign and is a part of the CMS SEP-1 sepsis bundle. The sepsis bundle includes administration of 30 ml/kg crystalloid bolus (LR…
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Do we really need to do a modified Allen’s Test before Radial Arterial Line Insertion?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured Procedure, HPC Updates, Procedure Blog of the Week
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It has long been Dogma that an abnormal modified Allen’s test is a contraindication to performing a radial arterial line in that arm.  The theory behind this is that the modified Allen’s test will identify patients who have insufficient collateral circulation…
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Dexmedetomidine and Propofol performed equally well for the sedation of mechanically ventilated patients with sepsis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – BLOG OF THE WEEK, Delirium, Featured, Fentanyl-Based Ventilator, HPC Updates, Mechanical Ventilation, RASS, Richmond Agitation-Sedation Scale, Sedation, Sepsis, Septic Shock, severe sepsis, Ventilation, Wake-up and Breath Protocol
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The Society of Critical Care Medicine (SCCM) recommends that all mechanically ventilated patients receive analgesia, sedation, and delirium assessment and management while intubated. SCCM reinforced these principles in their 2018 clinical practice guideline on the prevention and management of pain,…
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Protocolized Sedation is Recommended Over Usual Care for Mechanical Ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Delirium, Featured Procedure, HPC Updates, Mechanical Ventilation, Protocolized Sedation, Sedation, Wake-up and Breath Protocol
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A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effects of protocolized sedation in mechanically ventilated adult intensive care unit patients. Six randomized controlled trials and 1243 patients were studied. The results showed that protocolized…
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Review of chest tube drainage of the pleural space

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulants and Procedures, Anticoagulation, Antiplatelet therapy, antiplatelets, Chest tube, chest tube placement, chest tube position, Chest tube removal, chest tube size, chest tubes, Featured, HPC update, HPC Updates, Plavix, pleural effusions, Pleural space, Pneumothorax, POCUS, re-expansion pulmonary edema, Small-bore chest tube, Tension pneumothorax, Thienopyridines, thrombocytopenia, Tube Thoracostomy
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This blog summarizes recommended management of chest tube drainage of the pleural space. The blog will cover the recommended size of chest tube for different indications, suggestions for chest tube insertion technique, methods to avoid chest tube complications and when…
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Airway Management Pearls to Optimize Your Chances of Securing an Airway

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – advanced airway, Airway management, difficult airway, difficult airway management, Difficult Intubation, direct laryngoscopy, emergency procedures, emergency procedures course, emergent intubation, Endotracheal Intubation, Featured, Glidescope Intubation, hospital procedures, hospital procedures course, HPC Updates, Hypoxia, Intubation, King Tube, Laryngeal Mask Airway, LMA, Mechanical Ventilation, medical procedures, medical procedures course, preoxygenation, rapid sequence intubation, respiratory failure, supraglottic airway, supraglottic airways, surgical airway, video laryngoscopy, Videolaryngoscopy
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TOP TEN AIRWAY MANAGEMENT PEARLS TO OPTIMIZE YOUR CHANCES OF SECURING AN AIRWAY Develop a difficult airway management plan Huddle with your nurse and respiratory therapist in advance to alert everybody what plan A/B/C/D are for the patient If plan…
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The Likelihood of a Difficult Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, difficult airway, Endotracheal Intubation, Featured Procedure, HPC Updates
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A recent article in JAMA reviewed 62 high-quality articles to determine the clinical factors that can help to predict the patient with a difficult airway.  Airway management experts have devised different scoring systems and exam findings that can predict the…
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How to Prevent and Manage Malpositioned Central Lines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central Line, central line complications, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, Featured, femoral lines, HPC Updates, IJ lines, internal jugular line, subclavian line
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Malpositioned central venous catheters occurs in about 7% of central line placements. A malpositioned central line is any central venous catheter where the tip is located anywhere other than the superior vena cava (SVC) for internal jugular lines or subclavian…
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First Pass Success Rate is Better for Ultrasound-Guided Radial Artery Line Placement vs Palpation-Guided Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured, HPC Updates, ultrasound-guided arterial lines
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In 2015 a meta-analysis found that when an ultrasound was used during a radial arterial catheter placement the first pass success rate improved. In the eleven trials that met inclusion criteria over 800 patients were enrolled. Compared to the palpation-guided…
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