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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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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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, 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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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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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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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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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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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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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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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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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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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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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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This blog summarizes recommended management of chest tube drainage of the pleural space. The blog will cover the recommended size of chest tube for different indications, suggestions for chest tube insertion technique, methods to avoid chest tube complications and when…
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