When Should You Stop Using Chest Tubes?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Emergency Procedures, Events, Featured, King Tube, Medical General, medical procedures
More Tags – central line placement, chest tube placement, E-FAST, featured procedure, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, POCUS, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access
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…
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Role of Ultrasound in Lumbar Punctures

lumbar-punctures
Dr. Rick Rutherford, M.D., FAAFP
More Articles – Cardiovascular diseases, Emergency Procedures, Events, Featured, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Medical General, medical procedures, Ultrasound-Guided Peripheral IV
More Tags – central line placement, chest tube placement, E-FAST, featured, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, POCUS, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access
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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Conscious Sedation. What It Is, When to Apply It, and the Latest Updates

concious-sedation
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Emergency Procedures, Endotracheal Intubation, Events, Hospital Procedures, King Tube, Laryngeal Mask Airway, Medical General, medical procedures, Procedural Sedation
More Tags – central line placement, chest tube placement, E-FAST, featured procedure, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, POCUS, RUSH Exams, sedation procedure, thoracentesis, tube thoracostomy, Vascular access
What is conscious sedation? 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…
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Basic Emergency Procedures You Should Know

emergency procedures - small
Dr. Rick Rutherford, M.D., FAAFP
More Articles – Arterial line, Cardiovascular diseases, Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, Events, FAST Exam, Intraosseous line, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Mechanical Ventilation, Medical General, medical procedures, Needle Decompression, Paracentesis, Procedural Sedation, RUSH Exam, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – central line placement, chest tube placement, E-FAST, emergency medicine procedures, er procedures, featured procedure, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, POCUS, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access
Physicians, physician associates (PAs), and nurse practitioners (NPs) need to be adept in a range of essential medical emergency procedures that they must perform in an inpatient settings. These bedside procedures are accomplished readily, but only if you have the…
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Live CME Course vs Online CME Course. Which One to Choose?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, Events, FAST Exam, Intraosseous line, King Tube, Lumbar Puncture, Medical General, medical procedures, Paracentesis, RUSH Exam, Thoracentesis
More Tags – central line placement, chest tube placement, E-FAST, featured, HPC updates, intraosseous line placement, intubation, live cme, lumbar puncture, paracentesis, POCUS, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access
A Continuing Medical Education (CME) Course is designed for doctors, nurses, nurse practitioners, physician associates and other healthcare professionals who want to learn more about certain topics in medicine.  The primary goal of CME is to improve the quality of…
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Looking To Work in the ER? Here Are Its Benefits, Challenges, and What To Expect

emergency
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, Events, FAST Exam, Featured, Intraosseous line, King Tube, Lumbar Puncture, medical procedures, Paracentesis, RUSH Exam, Thoracentesis
More Tags – central line placement, E-FAST, featured, HPC updates, intubation, lumbar puncture, paracentesis, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access, working in an emergency room
The emergency room (ER) is an essential area of any hospital because it often deals with life-and-death situations. How medical personnel respond significantly affects the prognosis of patients who are in need of urgent care.  As a medical professional, experience…
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Dispelling Myths about Thoracentesis and Pleural Fluid Analysis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Featured, medical procedures, Nephrology, Respiratory diseases, 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…
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What is the true complication rate for thoracentesis?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures, Respiratory diseases, 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…
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Clinical Pearls for Airway Management of Morbidly Obese Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, Featured, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
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…
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The Case for Simulation Based Training for Bedside Hospital Procedures

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Cardiovascular diseases, Emergency Procedures, Endotracheal Intubation, Events, FAST Exam, Featured, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Mechanical Ventilation, Medical General, medical procedures, Paracentesis, Thoracentesis
More Tags – E-FAST, featured, HPC updates, lumbar puncture, paracentesis, POCUS, RUSH Exams, Simulation Based Training; Central Line Training, simulation-based procedural training, thoracentesis, Vascular access
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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Simulation Based Training for Central Venous Catheters

Ultrasound-Guided Central Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Events, Featured Procedure, medical procedures
More Tags – central line, Central line insertion, central line placement, 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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Outpatient Management of A Spontaneous Pneumothorax

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Emergency Procedures, Featured Procedure, medical procedures, Procedural Sedation, Respiratory diseases
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…
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Pearls about Chest Tube Management

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Chest Tube, Featured, Thoracentesis
More Tags – air leak, chest tube placement, Chest tube removal, chest tubes, empyema, featured, hemothorax, HPC updates, parapneumonic effusion, pneumothorax, thoracentesis, tube thoracostomy
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…
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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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