Central line insertion can be a complicated process that requires proper training to minimize procedural risks. One of its most important aspects is the proper positioning of the patient during the procedure to ensure safety and success. Patients may also…
Read MoreMore Articles – Airway management, Central Line, central line placement, chest tube placement, E-FAST, Endotracheal Intubation, FAST exam, Featured, hospital procedures course, HPC Updates, Intubation, Lumbar Puncture, medical procedures course, paracentesis, POCUS, RUSH Exams, Thoracentesis, Tube Thoracostomy
Thoracostomy or the insertion of chest tubes (CTs) is a frequent procedure in clinical practices. After inserting chest tubes in the patient’s pleural cavity, they become a route for administering antibiotics, sclerosing agents, fibrinolytics, and saline. Meanwhile, indwelling pleural catheters…
Read MoreMore Articles – Airway management, Central Line, central line placement, chest tube placement, E-FAST, Endotracheal Intubation, FAST exam, Featured Procedure, hospital procedures course, HPC Updates, Intubation, Lumbar Puncture, medical procedures course, paracentesis, POCUS, RUSH Exams, Thoracentesis, Tube Thoracostomy
Conscious sedation, also known as procedural sedation, is a common practice in emergency departments for patients undergoing painful or anxiety-provoking procedures. It is intended as a less invasive method. Generally, those who undergo this type of sedation can recover more…
Read MoreThere are two myths that have persisted about thoracentesis and pleural fluid analysis that must be dispelled. The first myth is that a large volume thoracentesis should not remove more than 1,500 mL fluid due to the risk of re-expansion…
Read MoreThoracentesis is one of the most common bedside procedures performed in U.S. hospitals. There are about 173,000 thoracenteses performed each year in the U.S. A systematic review and meta-analysis in 2010 concluded that thoracentesis-related pneumothorax occurs 6% of the time…
Read MoreMore 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
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…
Read MoreMore 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
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…
Read MoreA 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…
Read MoreMore 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
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…
Read MoreMore 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
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…
Read MoreEschmann 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…
Read MoreMore Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured, HPC Updates, Sepsis, Septic Shock, severe sepsis, shock
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…
Read MoreIt 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…
Read MoreMore 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
More Tags – ABCDEF bundle, CAM -ICU, Delirium, dexmedetomidine, featured, HPC updates, mechanical ventilation, Propofol, RASS, ventilator, ventilator sedation
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,…
Read MoreA 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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