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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Maneuvers to Assess Fluid Responsiveness in Septic Shock or Vasodilatory Shock

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured, HPC Updates, Sepsis, Septic Shock, severe sepsis, shock
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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…
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Do we really need to do a modified Allen’s Test before Radial Arterial Line Insertion?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured Procedure, HPC Updates, Procedure Blog of the Week
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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…
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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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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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Which cirrhotic patients are at high risk for bleeding during hospital procedures?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line placement, central line placement, chest tubes, Cirrhosis, Featured, HPC Updates, Lumbar Puncture, Paracentesis, Thoracentesis, Tube Thoracostomy
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This blog will offer some expert recommendations to help guide the safety of hospital procedures at different platelet and coagulation profiles.  Unfortunately, there are no strong evidence-based guidelines for hospital procedures dedicated to the study of patients with decompensated cirrhosis.…
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Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line insertion, Arterial line placement, Arterial line-associated bloodstream infections, Catheter-related bloodstream infections, central line associated bloodstream infections, Central line insertion, Device-related infections, HPC Updates, Vascular access
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Arterial line-associated bloodstream infections occur at rate of 0.9-3.4 infections per thousand catheter-days. This rate of infections is similar to the risk of central line-associated bloodstream infections (CLABSIs). The CDC guidelines for arterial line placement recommend the use of chlorhexidine…
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Ultrasound-guided radial arterial line placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line placement, HPC Updates, ultrasound-guided arterial lines
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Radial artery catheters are frequently placed in the emergency department (ED) and intensive care unit (ICU) for hemodynamic monitoring and arterial blood gas analysis. A number of small studies have compared ultrasound-guided placement of radial artery catheters to traditional placement…
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