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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Airway Management Pearls to Optimize Your Chances of Securing an Airway

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Featured, Hospital Procedures, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – airway management, Bougie, delayed sequence intubation, difficult airway, endotracheal intubation, featured, HPC updates, intubation, King tube, LMA, mechanical ventilation, rapid sequence intubation
TOP TEN AIRWAY MANAGEMENT PEARLS TO OPTIMIZE YOUR CHANCES OF SECURING AN AIRWAY Develop a difficult airway management plan Huddle with your nurse and respiratory therapist in advance to alert everybody what plan A/B/C/D are for the patient If plan…
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Procedural Competency in Academic Emergency Medicine Attending Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Emergency Procedures, Endotracheal Intubation, Featured, Intraosseous line, Lumbar Puncture, medical procedures, Paracentesis, Pericardiocentesis, Procedural Sedation, Respiratory diseases, Thoracentesis
More Tags – ACLS, chest tube placement, difficult airway management, endotracheal intubation, featured, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, pericardiocentesis, procedural sedation, thoracentesis, tube thoracostomy
A recent article summarizes a cross-sectional survey aimed at determining the processes in place to assess the procedural competency of academic emergency medicine attendings.[i] The survey was sent to the 39 ACGME-accredited Emergency Medicine programs in the U.S. and had…
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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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Pediatric Procedural Sedation is Safe for Emergency Department Procedures without Fasting

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Procedural Sedation
More Tags – conscious sedation, featured, HPC updates, procedural sedation, Sedation
The American College of Physicians (ACEP) has previously published guidelines in October 2013 about Procedural Sedation and Analgesia. In these guidelines, they provided Level B recommendations that state, “Do not delay procedural sedation in adults or pediatrics in the ED…
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Continuous Capnometry Should be Standard Practice for Moderate-Deep Procedural Sedation

Hospital Procedure Consultants
More Articles – Emergency Procedures, Featured Procedure, Procedural Sedation
More Tags – Capnometry, conscious sedation, featured procedure, HPC updates, procedural sedation, Sedation
Continuous Capnometry Should be Standard Practice for Moderate-Deep Procedural Sedation Continuous capnometry has been consistently proven to identify patients undergoing moderate-deep procedural sedation who have impaired ventilation well before hypoxia develops.  There have been at least 8 studies that have…
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Summary of Difficult Airway Management in COVID-19 Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Featured, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation
More Tags – awake intubation, COVID-19, difficult airway management, Difficult Intubation, endotracheal intubation, featured, HPC updates, intubation, video laryngoscopy
The Society of Airway Management recently issued guidelines for Difficult Airway Management in COVID-19 patients.  The SARS CoV-2 (COVID-19) virus is extremely contagious via respiratory droplets and therefore extra precautions are needed for airway management in severe COVID-19 infection.  Airway…
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Video laryngoscopy has a superior first pass success rate compared with direct laryngoscopy in the ICU

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Featured Procedure, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – airway management, direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, intubation, video laryngoscopy
Video laryngoscopy is superior to direct laryngoscopy for emergency intubations in the ICU. A recent meta-analysis based on nine trials evaluated 2,133 ICU patients and concluded that video laryngoscopy (VL) has a higher first pass success rate compared to direct…
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Intraosseous Lines Placed Using the EZ-IO Device Can Be Safely Maintained for Up to 48 hours

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Featured Procedure, Intraosseous line, medical procedures
More Tags – EZ-IO, featured procedure, HPC updates, intraosseous drill, intraosseous line, io line, Vascular access
Intraosseous vascular access using the EZ-IO device is a wonderful option for emergency access in the hospital or pre-hospital setting. Intraosseous lines are easy to place with proper training and can serve as emergency vascular access during cardiac arrest or…
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Intraosseous Lines: Expanding Indications

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Cardiovascular diseases, Central line, Emergency Procedures, Featured, Intraosseous line, medical procedures
More Tags – EZ-IO, featured, HPC updates, intraosseous drill, intraosseous line, io line, Vascular access
Intraosseous line use has increased significantly since the advent of the battery powered intraosseous drill.  In surveying providers at courses over the years, we have seen a steady rise in the number of providers with access to the intraosseous drill. …
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Rapid Ultrasonography in Shock: A Lifesaving ED Tool

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Emergency Procedures, Events, Featured Procedure, medical procedures, Paracentesis, RUSH Exam
More Tags – featured procedure, HPC updates, RUSH Exams
Rapid Ultrasonography in Shock:  Is this really useful? Caring for patients with undifferentiated hypotension, causes anxiety for most health care providers.  This is natural.  Fear, however, must not lead to hesitation or poor decision-making.  Therapies chosen early in shock disproportionately…
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In-person Procedural Education in the Era of COVID19

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Chest Tube, Emergency Procedures, Featured, Glidescope Intubation, Lumbar Puncture, Paracentesis, Thoracentesis
More Tags – chest tube placement, emergency procedures course, featured, hospital procedures course, HPC updates, intubation, lumbar puncture, medical procedures course, paracentesis, POCUS, thoracentesis, Vascular access
Medical procedural education in the era of COVID19 is still best conducted via HANDS-ON simulation-based procedural training. Procedural skills can NOT be attained via remote education, but in-person training must be conducted safely. There are many topics and skills that can be successfully be taught online,…
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Emergency Department Intubations Are Increasingly Successful

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured Procedure, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, featured procedure, Glidescope intubation, HPC updates, intubation, video laryngoscopy
Emergency department (ED) intubation is constantly evolving, with new devices, techniques, and medications being frequently adopted. To evaluate temporal trends, National Emergency Airway Registry (NEAR) investigators analyzed registry data on ED intubations at 13 large hospitals in the U.S., Canada,…
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Video Laryngoscopy after Failed Intubation Attempt in the ER

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured Procedure, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – direct laryngoscopy, featured procedure, HPC updates, intubation, video laryngoscopy
Video Laryngoscopy Is Superior to Direct Laryngoscopy for Failed Intubation Attempts in the ER Although video laryngoscopy has repeatedly been shown to be superior to direct laryngoscopy, there has not yet been any specific directive instructing emergency department (ED) intubators…
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Bedside Ultrasound Increases the Success Rate for Difficult Lumbar Punctures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured Procedure, Lumbar Puncture, medical procedures
More Tags – featured procedure, HPC updates, lumbar puncture, Ultrasound-Guided Lumbar Punctures, ultrasound-guided procedures
The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891[1]This technique utilizes the iliac crest and the posterior lumbar spinous processes to determine the optimal sites for spinal needle introduction in either the L3-4 or…
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