Joseph Esherick, M.D., FAAFP, FHM, Author at Hospital Procedures Consultants

Central Line Insertion and Associated Challenges

central line insertion

central line insertion

Joseph Esherick, M.D., FAAFP, FHM

January 30, 2023

More Articles – ACLS, central line placement, Featured, HPC Updates

More Tags – central line, Central line insertion, central line insertion course, hpc course, HPC updates, risk of central line insertion

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…

When Should You Stop Using Chest Tubes?

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…

Conscious Sedation. What It Is, When to Apply It, and the Latest Updates

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…

Dispelling Myths about Thoracentesis and Pleural Fluid Analysis

Joseph Esherick, M.D., FAAFP, FHM

October 25, 2022

More Articles – BNP, Chest Pain, CHF, diuretics, exudate, Featured, Heart failure, HPC Updates, pleural effusions, pleural fluid analysis, Pleural space, re-expansion pulmonary edema, Thoracentesis, transudate, Ultrasound-Guided Thoracentesis

More Tags – CHF, diuretics, exudate, featured, HPC updates, Light's criteria, pleural effusions, pleural fluid analysis, re-expansion pulmonary edema, thoracentesis, transudate

There 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…

What is the true complication rate for thoracentesis?

Joseph Esherick, M.D., FAAFP, FHM

October 25, 2022

More Articles – Featured Procedure, HPC Updates, pleural effusions, pleural fluid analysis, Pneumothorax, re-expansion pulmonary edema, Thoracentesis, ultrasound-guided procedures, Ultrasound-Guided Thoracentesis

More Tags – featured procedure, hemothorax, HPC updates, pneumothorax, re-expansion pulmonary edema, thoracentesis, thoracentesis complications, ultrasound-guided procedures

Thoracentesis 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…

Clinical Pearls for Airway Management of Morbidly Obese Patients

Joseph Esherick, M.D., FAAFP, FHM

August 23, 2022

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

More Tags – airway management, awake intubation, cricothyroidotomy, Difficult Intubation, featured, Glidescope intubation, ketamine, Ketofol, King tube airway, laryngeal mask airway, lorazepam, mechanical ventilation, midazolam, morbid obesity, paralytics, Propofol, video laryngoscopy

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…

Simulation Based Training for Central Venous Catheters

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…

Outpatient Management of A Spontaneous Pneumothorax

Joseph Esherick, M.D., FAAFP, FHM

July 2, 2022

More Articles – chest tubes, Featured Procedure, HPC Updates, Tube Thoracostomy

More Tags – chest tube, featured procedure, HPC updates, pneumothorax, tube thoracostomy

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…

Pearls about Chest Tube Management

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…

The Jury is Still Out on Whether Awake Prone Positioning in Non-intubated Patients with COVID-19 Pneumonia Decreases Mortality or Endotracheal Intubation

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…

Tricks of the Trade for Stylet-guided Endotracheal Intubations

Joseph Esherick, M.D., FAAFP, FHM

June 7, 2022

More Articles – Airway management, Endotracheal Intubation, Featured Procedure, HPC update, HPC Updates

More Tags – airway management, endotracheal intubation, featured procedure, HPC updates

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…

Maneuvers to Assess Fluid Responsiveness in Septic Shock or Vasodilatory Shock

Joseph Esherick, M.D., FAAFP, FHM

May 7, 2022

More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured, HPC Updates, Sepsis, Septic Shock, severe sepsis, shock

More Tags – Arterial Line, CVP, end-expiratory occlusion test, featured, passive leg raise, pulse pressure variability, sepsis, septic shock, shock, stroke volume variability, vasodilatory 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…

Do we really need to do a modified Allen’s Test before Radial Arterial Line Insertion?

Joseph Esherick, M.D., FAAFP, FHM

May 7, 2022

More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured Procedure, HPC Updates, Procedure Blog of the Week

More Tags – Allen's test, arterial line course, Arterial line placement, Arterial lines, featured procedure, HPC updates, radial arterial lines

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…

Dexmedetomidine and Propofol performed equally well for the sedation of mechanically ventilated patients with sepsis

Joseph Esherick, M.D., FAAFP, FHM

April 15, 2022

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

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,…

Protocolized Sedation is Recommended Over Usual Care for Mechanical Ventilation

Joseph Esherick, M.D., FAAFP, FHM

April 15, 2022

More Articles – Delirium, Featured Procedure, HPC Updates, Mechanical Ventilation, Protocolized Sedation, Sedation, Wake-up and Breath Protocol

More Tags – Delirium, featured procedure, HPC updates, mechanical ventilation, Protocolized Sedation, Sedation, Wake-up and Breath Protocol

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…