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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Simulation Based Training for Central Venous Catheters

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central Line, central line placement, Central Venous Catheter, Featured Procedure, HPC Updates, Procedure Blog of the Week, Simulation Based 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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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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Procedural Competency in Academic Emergency Medicine Attending Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – ACLS, advanced airway, Airway management, Central line insertion, central line placement, central lines, chest tube placement, cricothyroidotomy, difficult airway, difficult airway management, Endotracheal Intubation, Featured, HPC Updates, Intubation, Lumbar Puncture, Paracentesis, paracentesis, Procedural Sedation, Simulation Based Training, Simulation-based procedural training, Thoracentesis, Tube Thoracostomy
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A recent article summarizes a cross-sectional survey aimed at determining the processes in place to assess the procedural competency of academic emergency medicine attendings.[i] The survey was sent to the 39 ACGME-accredited Emergency Medicine programs in the U.S. and had…
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Simulation Based Training Improves Airway Management Skills

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, Endotracheal Intubation, Featured Procedure, Glidescope Intubation, HPC Updates, Intubation, King Tube, Laryngeal Mask Airway, Procedure Blog of the Week
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Simulation-based procedural training has been shown to improve procedural competence, safety, operator confidence and most importantly patient safety for every bedside procedure studied.  Now, a new systematic review and meta-analysis confirms that simulation-based training in airway management improves procedural competence…
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Periprocedural Bleeding Risk for Thrombocytopenia, Coagulopathy, Antiplatelets and Anticoagulation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, antiplatelets, central lines, Chest tube, chest tubes, coagulopathy, Featured Procedure, HPC Updates, Lumbar Puncture, Paracentesis, procedures, Thoracentesis
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This blog summarizes the 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures with regards to thrombocytopenia, coagulopathies, antiplatelets and anticoagulation.  The SIR guidelines are summarized as follows: Anticoagulation with heparin, LMWH, fondaparinux, argatroban, warfarin, DOAC, clopidogrel, ticagrelor…
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Recommendations for Invasive Hospital Procedures in Patients with Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – acute kidney injury, Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Central Line, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, Chest tube, chest tube placement, Cirrhosis, Featured, hospital procedures, HPC Updates, Paracentesis, paracentesis, Procedures in Cirrhotic Patients, Radial Artery Catheterization, Sepsis, Small-bore chest tube, Spontaneous bacterial peritonitis, Thoracentesis, thrombocytopenia, transexamic acid, Tube Thoracostomy, ultrasound-guided arterial lines, Ultrasound-Guided Central Line Insertion, Ultrasound-Guided Paracentesis, Ultrasound-guided radial artery line placement, Ultrasound-Guided Thoracentesis
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This blog aims to summarize the data available on how to safely perform invasive hospital procedures in patients with cirrhosis. Unfortunately, no prospective randomized controlled trials have been conducted to inform the practice of procedural medicine in cirrhotic patients. Therefore,…
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Tips for Management and Bedside Procedures in Critically Ill Patients with COVID Pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Acute respiratory distress syndrome, advanced airway, Airway management, ARDS, Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, asystole, Cardiac Arrest, cardiac arrest survival, Central Line, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, COVID, CPR, difficult airway, difficult airway management, Difficult Intubation, emergent intubation, Endotracheal Intubation, Featured, Glidescope Intubation, hospital procedures, hospital procedures course, HPC Conference, HPC Updates, ICU, Intubation, Mechanical Ventilation, PEA, preoxygenation, prone positioning, pulseless electrical activity, Radial Artery Catheterization, respiratory failure, Simulation Based Training, Simulation-based procedural training, ultrasound-guided arterial lines, Ultrasound-Guided Central Line Insertion, video laryngoscopy, Videolaryngoscopy
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The SARS-COV-2 pandemic started in January 2020 and has decimated the majority of U.S. hospitals for the past 18 months. The impact of COVID-19 has not only affected available hospital beds, but has limited the ability of hospitals to perform…
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Airway Management in COVID-positive Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, COVID, Featured Procedure, HPC Updates, Intubation
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A number of additional factors must be considered with airway management in COVID-positive patients. Hospital Procedures Consultants (HPC) can provide simulation-based training to prepare providers for airway management in COVID-positive patients. The first essential consideration is to place the patient into a…
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Informed Consent and Ethical Challenges During the COVID-19 Pandemic

Joseph Esherick, M.D., FAAFP, FHM
More Articles – COVID, CPAP, CPR, emergent intubation, Endotracheal Intubation, Featured, HPC Updates, Informed consent, noninvasive ventilation, NPPV
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Informed consent can be challenging during “normal” times, but it has become increasingly complicated during the COVID-19 pandemic. The informed consent process ensures that a patient or their surrogate decision-maker understands the benefits, potential risks and any alternatives of a…
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Safety of Thoracentesis and Tube Thoracostomy in Patients with Uncorrected Coagulopathies

Tube Thoracostomy Insertion
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulants and Procedures, Anticoagulation, Antiplatelet therapy, antiplatelets, Chest tube, chest tube placement, chest tubes, coagulopathy, Featured, HPC Updates, Thoracentesis
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Traditionally, it was felt that the INR had to be less than 1.5 and platelets had to be at least 50,000/µL to perform most bedside procedures. With more clinical evidence, we now know that low-risk bedside procedures can be performed…
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Thoracentesis-Associated Pneumothorax is Rare when Performed by Procedural Experts Using Ultrasound Guidance

Thoracentesis Course
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, HPC Updates, Pneumothorax, Thoracentesis, Ultrasound-Guided Thoracentesis
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Original studies of ultrasound-guided thoracentesis concluded a 2% risk of pneumothorax. A recent single center study of 9320 thoracenteses over 12 years all by procedural experts had pneumothorax rate of 0.6%. This same study also demonstrated a very low incidence…
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