How Hospitals Can Tap into the Power of Emergency Medicine PAs

emergency medicine PA
Dr. Rick Rutherford, M.D., FAAFP
More Articles – Arterial line, Central line, Emergency Procedures, Endotracheal Intubation, FAST Exam, Featured, Lumbar Puncture, Medical General, Paracentesis, Procedural Sedation, Thoracentesis
More Tags – emergency medicine PA
Delays to hospital inpatient admission in excess of five hours from arrival at an Emergency Department (ED) lead to a mortality rate of 8.71%. This increases by another 8% in cases where admission is delayed beyond six to eight hours. …
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Brachial Arterial Catheterization and Its Low Risk of Complications

Radial arterial line training
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Emergency Procedures, Featured
More Tags – artery catheterization, Brachial arterial catheterization, main brachial artery
Brachial arterial catheterization is widely chosen for constant blood pressure and hemodynamic monitoring in critically ill patients. It provides real-time measurements of physiologic parameters with a very low incidence of associated risks or complications. In this article, we will revisit…
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Basic Emergency Procedures You Should Know

emergency procedures - small
Joseph Esherick, M.D., FAAFP, FHM
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, 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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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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Maneuvers to Assess Fluid Responsiveness in Septic Shock or Vasodilatory Shock

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Emergency Procedures, Featured, Infections, Mechanical Ventilation, medical procedures
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…
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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, Featured Procedure, medical procedures
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…
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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, Central line, Featured, medical procedures
More Tags – Arterial line insertion, Arterial lines, HPC updates, ultrasound-guided arterial lines
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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Periprocedural Bleeding Risk for Thrombocytopenia, Coagulopathy, Antiplatelets and Anticoagulation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Chest Tube, Featured Procedure, Hematology, Lumbar Puncture, Medical General, medical procedures, Paracentesis, Thoracentesis
More Tags – anticoagulation, antiplatelets, central lines, chest tubes, coagulopathy, featured procedure, HPC updates, lumbar puncture, paracentesis, procedures, thoracentesis
This blog summarizes the 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures with regards to thrombocytopenia, coagulopathies, antiplatelets and anticoagulation.  The SIR guidelines are summarized as follows: Anticoagulation with heparin, LMWH, fondaparinux, argatroban, warfarin, DOAC, clopidogrel, ticagrelor…
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Recommendations for Invasive Hospital Procedures in Patients with Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Chest Tube, Featured, Gastrointestinal diseases, Hospital Procedures, Paracentesis, Thoracentesis
More Tags – Arterial line placement, central line placement, chest tube placement, cirrhosis, DIC, featured, HPC updates, hyperfibrinolysis, paracentesis, thoracentesis, tube thoracostomy
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 – Arterial line, Cardiovascular diseases, Central line, Emergency Procedures, Endotracheal Intubation, Featured, Gastrointestinal diseases, Glidescope Intubation, Mechanical Ventilation, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – Arterial line insertion, asystole, cardiac arrest, Central line insertion, COVID pneumonia, CPR, featured, Glidescope intubation, HPC updates, intubation, mechanical ventilation, PEA, push dose pressors, video laryngoscopy
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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Airway Management in COVID-positive Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, Chest Tube, Endotracheal Intubation, Featured Procedure, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – airway management, COVID, featured procedure, HPC updates, intubation
A number of additional factors must be considered with airway management in COVID-positive patients. Hospital Procedures Consultants (HPC) can provide simulation-based training to prepare providers for airway management in COVID-positive patients. The first essential consideration is to place the patient into a…
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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, Cardiovascular diseases, Central line, Featured, Gastrointestinal diseases, Hospital Procedures, Lumbar Puncture, medical procedures, Paracentesis, Ultrasound-Guided Peripheral IV
More Tags – Arterial line placement, central line placement, chest tubes, cirrhosis, featured, HPC updates, lumbar puncture, paracentesis, thoracentesis, tube thoracostomy
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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In plane ultrasound-guided central line placement is preferred over out-of-plane technique

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, medical procedures
More Tags – central line, HPC updates, internal jugular line, subclavian line, ultrasound-guided procedures
A study from an urban EM residency program determined that in-plane ultrasound-guided central venous catheterization is superior to out-of-plane ultrasound-guided central line placement. This study was only a single center study that was a randomized crossover study of ER residents…
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Updated Guidelines on Acute Pancreatitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Dermatology, Gastrointestinal diseases, Medical General, medical procedures
More Tags – Acute pancreatitis, Diagnosis, Epidemiology, HPC updates, Management
Acute pancreatitis (AP) has increased in the past decade and accounts for over 275,000 annual hospital admissions in the U.S. and estimated medical costs of $2.5 billion. Noteworthy points are as follows: Morbid obesity and DM 2 are independent risk…
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