Role of Ultrasound in Lumbar Punctures

lumbar-punctures
Dr. Rick Rutherford, M.D., FAAFP
More 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
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For procedures involving lumbar punctures , sonographically guided lumbar punctures (SGLPs) have a higher propensity of being chosen when dealing with obese patients. This is based on findings of a randomized controlled trial conducted in 2007. The main takeaway from…
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The Case for Simulation Based Training for Bedside Hospital Procedures

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, E-FAST, emergency procedures, emergency procedures course, FAST exam, Featured, First-attempt success rate, hospital procedures, hospital procedures course, Hospitalist, HPC, HPC Conference, HPC Updates, Lumbar Puncture, medical procedures, medical procedures course, Paracentesis, paracentesis, POCUS, safety checklists, Simulation Based Training, Simulation-based procedural training, Thoracentesis, Ultrasound, Ultrasound for Pneumothorax, Ultrasound-Guided Central Line Insertion, Ultrasound-guided lumbar puncture, Ultrasound-Guided Lumbar Punctures, Ultrasound-Guided Paracentesis, ultrasound-guided procedures, Ultrasound-Guided Thoracentesis
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For decades the mantra for procedural education in medicine has been “see one-do one-teach one”.  Those of us who learned bedside procedures and point-of-care ultrasound by this model understand that this approach does not optimize safe and competent performance.   At…
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Antibiotics in Sepsis: Is Early Always Better?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – antibiotic stewardship, antibiotics, antimicrobial stewardship, 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, Featured, Sepsis, Septic Shock, severe sepsis, shock, Systemic inflammatory response syndrome
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Timely administration of broad-spectrum antibiotics in septic patients saves lives.  Though this has been demonstrated in hundreds of clinical investigations over the last few decades, antibiotics remain the most controversial topic in the management of severe sepsis and septic shock. …
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Intraosseous Lines: Expanding Indications

Dr. Rick Rutherford, M.D., FAAFP
More Articles – ACLS, Featured, HPC Updates, intraosseous line, IO line
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Intraosseous line use has increased significantly since the advent of the battery powered intraosseous drill.  In surveying providers at courses over the years, we have seen a steady rise in the number of providers with access to the intraosseous drill. …
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Simulation Based Training for Central Venous Catheters

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, central line placement, Central Venous Catheter, Featured Procedure, HPC Updates, procedures 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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Rapid Ultrasonography in Shock: A Lifesaving ED Tool

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Featured Procedure, HPC Updates, RUSH Exams
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Rapid Ultrasonography in Shock:  Is this really useful? Caring for patients with undifferentiated hypotension, causes anxiety for most health care providers.  This is natural.  Fear, however, must not lead to hesitation or poor decision-making.  Therapies chosen early in shock disproportionately…
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Ultrasound-guided Central Venous Access: Are Landmarks a Thing of the Past?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, central line placement, Central Venous Catheter, Featured Procedure, HPC Updates, Procedure Blog of the Week, Ultrasound-Guided Central Line Insertion, ultrasound-guided procedures
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Point-of-care ultrasound is one of the most rapidly evolving areas of medicine.  In addition to becoming the “stethoscope of the future” for bedside diagnostic evaluations, ultrasound has improved the safety and efficiency of a wide range of procedures.  The use…
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Paracentesis: Do I Really Need the Ultrasound?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Featured, HPC Updates, Paracentesis, Ultrasound-Guided Paracentesis, ultrasound-guided procedures
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In residency, I spent a great deal of time at the bedside assessing for shifting dullness in patients who may have had ascites.  Today, when I ask residents about shifting dullness, I often get blank stares.  “Why would I do…
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Early Goal Directed Therapy for Sepsis: No Longer?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, central line placement, Central Venous Catheter, HPC Updates, Procedure Blog of the Week, Sepsis, Septic Shock
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In 2001, the Rivers trial showed that Early Goal Directed Therapy for septic shock resulted in a 16% absolute mortality risk reduction1. In the treatment arm of this trial, septic patients with a lactate above 4 mmol/L or systolic blood…
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Should Endotracheal Intubation Become a Videogame?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Endotracheal Intubation, Glidescope Intubation, HPC Updates, Procedure Blog of the Week
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Direct vs Video Laryngoscopy In 1878 William MacEwan first passed a tube into the trachea of an awake patient using his fingers as a guide.  Now health care providers routinely perform endotracheal intubation as a life saving intervention.  Despite over…
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Can ultrasound predict volume responsiveness better than CVP?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Procedure Blog of the Week, RUSH Exams
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For decades we have relied on static measurements of volume status such as central venous pressure, pulmonary artery occlusion pressure and right ventricular end diastolic volume.  CVP has been shown to have little better than a coin toss chance of…
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Ultrasound Guided Peripheral IV and Sterile Technique

Dr. Rick Rutherford, M.D., FAAFP
More Articles – HPC Updates, Ultrasound-Guided Peripheral IV Insertion, ultrasound-guided procedures
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Is Aseptic Technique for Ultrasound Guided Peripheral Lines Enough? Widespread use of ultrasound guided peripheral intravenous catheters will reduce reliance on central lines, thus decreasing the central line device utilization ratios (DUR).  In theory and practice, high DURs correlate with…
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Ultrasound-Guided Radial Arterial Line

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Arterial Lines, HPC Updates, ultrasound-guided arterial lines, ultrasound-guided procedures
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Ultrasound for Radial Arterial Line?   Do I really need to use an ultrasound for radial arterial lines?  For years I have used ultrasound guidance for brachial and femoral arterial line placement because the risk associated with puncturing or lacerating…
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Ultrasound-Guided Peripheral IVs: An Alternative to Central Venous Catheters?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Ultrasound-Guided Peripheral IV Insertion, ultrasound-guided procedures
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One of the most common indications for placing a central venous catheter is “no IV access”.  I certainly have placed numerous central lines for this reason.  Unfortunately, this practice is not without consequences.  In addition to patient discomfort and mechanical…
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