Ultrasound-guided Central Venous Access: Are Landmarks a Thing of the Past?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central line, Emergency Procedures, Featured Procedure, medical procedures
More Tags – central line, central venous catheter, featured procedure, HPC updates, ultrasound, ultrasound-guided procedures
Point-of-care ultrasound is one of the most rapidly evolving areas of medicine.  In addition to becoming the “stethoscope of the future” for bedside diagnostic evaluations, ultrasound has improved the safety and efficiency of a wide range of procedures.  The use…
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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, 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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Ultrasound-guided Tube Thoracostomy Improves Optimal Insertion Site Selection

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Emergency Procedures, Featured, medical procedures
More Tags – chest tube, featured, HPC updates, tube thoracostomy, ultrasound
The optimal insertion site for tube thoracostomy is at the mid-axillary line in the triangle of safety.  This avoids any major nerves or arteries aside from the intercostal vessels.  Ultrasound-guided localization of this site performed better than palpation. In semi-elective…
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Performing Procedures on Patients Who Take Dabigatran, Rivaroxaban, and Apixaban

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured Procedure, Hematology, Lumbar Puncture, medical procedures
More Tags – anticoagulation, bedside procedures, HPC updates, invasive procedures, Oral anticoagulants
Over the past several years, there has been a dramatic increase in the use of the new oral anticoagulants (Dabigatran, Rivaroxaban, and Apixaban).  The popularity of these medications stems not only from aggressive pharmaceutical monitoring to physicians and to the…
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2018 Guidelines for Acute Ischemic Stroke Provides New Recommendations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Medical General, medical procedures
More Tags – featured, HPC updates, stroke
The 2018 AHA/ASA guidelines for the early management of acute ischemic stroke provides some important new evidence-based recommendations.  Some important new recommendations described in these guidelines include: The DAWN and DEFUSE 3 trials selected patients for mechanical thrombectomy within an extended time…
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Rapid Influenza Diagnostic Tests Have High False Negative Rates

Patient Sleeping with Nurse in Mechanical Ventilation Cours
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Medical General, medical procedures, Respiratory diseases
More Tags – ARDS, featured, HPC updates, influenza
We are in the midst of an aggressive influenza season right now that should continue into March, so it is nice to review the testing accuracy of standard influenza point-of-care tests that are commonly used.  There are many Rapid Influenza Diagnostic…
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Early Transexamic Acid Decreases Severe Bleeding in Major Trauma Patients or After Childbirth

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Gastrointestinal diseases, Ginecology, medical procedures, Traumatology
More Tags – HPC updates, Major trauma, postpartum hemorrhage, TXA
Tranexamic acid (TXA) has been shown to decrease deaths from acute severe bleeding. To determine if time to treatment is associated with the effectiveness of TXA, these authors conducted a systematic review and only two trials met their criteria: the…
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Non-rebreather Mask for Preoxygenation During Rapid Sequence Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, medical procedures, Respiratory diseases
More Tags – featured, HPC updates, intubation, preoxygenation, rapid sequence intubation
With flush-rate oxygen, a non-rebreather mask was at least as good as a bag-valve-mask ventilation for intubation preoxygenation. Many intubators using the rapid sequence intubation protocol use a bag-valve-mask (BVM) for preoxygenation. But in the absence of a good mask…
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Iso-osmolar Contrast Rarely Causes Contrast-induced Nephropathy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, medical procedures, Nephrology
More Tags – acute kidney injury, featured, HPC updates
Several studies in 2014 suggested that intravenous iodinated contrast use in computed tomography (CT) scanning was not associated with acute kidney injury.  Now, the Mayo Clinic has performed a retrospective study of data investigating 5758 adults with chronic kidney disease…
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Ultrasound Has Utility for Fracture Management

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Traumatology
More Tags – fracture reduction, fractures, HPC updates, ultrasound
There have been a few studies that have demonstrated that bedside ultrasound has a high sensitivity and specificity for fracture diagnosis. Researchers in Italy compared the accuracy of US to that of plain radiography (the gold standard) in 204 children…
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For Pediatric Procedural Sedation Ketamine Monotherapy Is the Safest Way to Go

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Mechanical Ventilation, medical procedures, Procedural Sedation
More Tags – HPC updates, procedural sedation
Researchers assessed the incidence of sedation-related serious adverse events (SAEs) and risk factors for them in a prospective cohort study of children ≤18 years of age presenting to six Canadian pediatric emergency departments (EDs) and requiring sedation for painful procedures.…
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Choosing Wisely Recommendations by American College of Emergency Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Nephrology, Respiratory diseases, Traumatology
More Tags – back pain, CT scans, HPC updates, nephrolithiasis, pulmonary embolus, sinusitis, syncope
Choosing Wisely is an initiative by the American Board of Internal Medicine that solicits evidence-based recommendations by other specialty associations to identify tests or procedures in their field which are unnecessary.  The following are a set of five recommendations that…
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Physicians Attire Can Contribute to the Unintentional Spread of Bacteria

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured Procedure, Medical General, medical procedures
More Tags – HPC updates, infection control, stethoscopes
Physicians and healthcare workers have long known that certain articles of clothing can act as fomites with the potential of spreading infection.  The best studied articles of clothing and equipment that can contribute to this spread include neckties, scarfs, stethoscopes,…
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