Peripheral Administration of Vasopressors and Their Safety

Joseph Esherick, M.D., FAAFP, FHM
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While vasopressors are typically administered through a central venous catheter (CVC), peripheral intravenous (PIV) administration is becoming more common in clinical practice. The safety of this administration method is now well-established and is a good alternative to CVC placement for…
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Brachial Arterial Catheterization and Its Low Risk of Complications

Radial arterial line training
Joseph Esherick, M.D., FAAFP, FHM
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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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When Should You Stop Using Chest Tubes?

Joseph Esherick, M.D., FAAFP, FHM
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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
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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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Conscious Sedation. What It Is, When to Apply It, and the Latest Updates

concious-sedation
Joseph Esherick, M.D., FAAFP, FHM
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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 sedation can recover more…
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Basic Emergency Procedures You Should Know

emergency procedures - small
Gabriela Delgado
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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?

Gabriela Delgado
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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

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Gabriela Delgado
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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, Featured, medical procedures, Nephrology, Respiratory diseases
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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
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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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The Case for Simulation Based Training for Bedside Hospital Procedures

Dr. Rick Rutherford, M.D., FAAFP
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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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Outpatient Management of A Spontaneous Pneumothorax

Joseph Esherick, M.D., FAAFP, FHM
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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
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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
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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 – Cardiovascular diseases, Featured, Infections, medical procedures
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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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