Antibiotics in Sepsis: Is Early Always Better?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Arterial line, Central line, Emergency Procedures, Featured
More Tags – antibiotic stewardship, antibiotics, Arterial Line, central line, featured, sepsis, sepsis management, septic shock
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 – Cardiovascular diseases, Central line, Emergency Procedures, Featured, Intraosseous line, medical procedures
More Tags – EZ-IO, featured, HPC updates, intraosseous drill, intraosseous line, io line, Vascular access
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

Ultrasound-Guided Central Line Placement
Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central line, Events, Featured Procedure, medical procedures
More Tags – central venous catheter, featured procedure, HPC updates, Simulation Based Training; Central Line Training
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 – Emergency Procedures, Events, Featured Procedure, medical procedures, Paracentesis, RUSH Exam
More Tags – featured procedure, HPC updates, RUSH Exams
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, Emergency Procedures, Featured Procedure, medical procedures
More Tags – central line, central venous catheter, featured procedure, HPC updates, ultrasound, ultrasound-guided procedures
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, medical procedures, Paracentesis
More Tags – featured procedure, HPC updates, paracentesis, Ultrasound-Guided Paracentesis, ultrasound-guided procedures
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, Hospital Procedures, Infections, medical procedures
More Tags – Central Line; Central Venous Catheter; Septic Shock; Sepsis; Early Goal Directed Therapy; ProCESS, HPC updates
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 – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, Laryngeal Mask Airway, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, GlideScope, HPC updates, intubation, laryngeal mask airway, laryngoscopy
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 – Central line, Medical General
More Tags – point of care ultrasound; IVC ultrasound: volume responsiveness; fluid responsiveness; volume status
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 – Central line, medical procedures, Ultrasound-Guided Peripheral IV
More Tags – central line bundle, HPC updates, peripheral line, sterile technique, Ultrasound guided peripheral IV, ultrasound guided peripheral line, UTZ Guided IV
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 line, medical procedures
More Tags – Arterial lines, HPC updates, ultrasound-guided arterial lines, ultrasound-guided procedures
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 – Central line, Emergency Procedures, medical procedures, Ultrasound-Guided Peripheral IV
More Tags – Ultrasound-Guided Peripheral IV Insertion, ultrasound-guided procedures
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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