Early Paracentesis in Patients Admitted With Cirrhotic Ascites

refractory ascites
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, medical procedures, Paracentesis
More Tags – Cirrhotic ascites, cirrhotic symptoms, Early Paracentesis, featured, paracentesis
Cirrhosis refers to a chronic liver disease that causes the liver’s normal architecture to change. It leads to scarring, the formation of fibrous tissue, and fluid (ascites) in the abdomen. Some cases may require invasive hospital procedures. Ascites is cirrhosis’…
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Simulation Based Training for Central Venous Catheters

Ultrasound-Guided Central Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Events, Featured Procedure, medical procedures
More Tags – central line, Central line insertion, central line placement, central venous catheter, featured procedure, HPC updates, Simulation Based Training; Central Line Training
Does Simulation Based Training Improve Central Line Success Rates? Simulation-based procedural training has become increasingly popular in academic medical centers and among medical trainees.  Limited data has suggested that simulation based training improves success rates and safety, but evidence has…
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Outpatient Management of A Spontaneous Pneumothorax

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Emergency Procedures, Featured Procedure, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – chest tube, featured procedure, HPC updates, pneumothorax, tube thoracostomy
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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Tricks of the Trade for Stylet-guided Endotracheal Intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured Procedure, medical procedures, Respiratory diseases
More Tags – airway management, endotracheal intubation, featured procedure, HPC updates
Eschmann stylets, or Bougies, can assist the clinician with endotracheal intubation in difficult airway scenarios.  The stylet when properly placed can act to guide the endotracheal tube (ETT) into the trachea.  However, there are different troubleshooting techniques that once must…
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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 test arterial line, Allen's test, allen's test arterial line, arterial line course, Arterial line placement, Arterial lines, featured procedure, HPC updates, modified allen test, modified allen's test, 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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Protocolized Sedation is Recommended Over Usual Care for Mechanical Ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – Delirium, featured procedure, HPC updates, mechanical ventilation, Protocolized Sedation, Sedation, Wake-up and Breath Protocol
A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effects of protocolized sedation in mechanically ventilated adult intensive care unit patients. Six randomized controlled trials and 1243 patients were studied. The results showed that protocolized…
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The Likelihood of a Difficult Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured Procedure, medical procedures, Respiratory diseases
More Tags – airway management, endotracheal intubation, featured procedure, HPC updates
A recent article in JAMA reviewed 62 high-quality articles to determine the clinical factors that can help to predict the patient with a difficult airway.  Airway management experts have devised different scoring systems and exam findings that can predict the…
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Simulation Based Training Improves Airway Management Skills

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Endotracheal Intubation, Featured Procedure, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Mechanical Ventilation, Medical General, medical procedures, Paracentesis, Respiratory diseases, Thoracentesis
More Tags – airway management, central lines, endotracheal intubation, Glidescope intubation, King tube, laryngeal mask airway, lumbar puncture, paracentesis, thoracentesis
Simulation-based procedural training has been shown to improve procedural competence, safety, operator confidence and most importantly patient safety for every bedside procedure studied.  Now, a new systematic review and meta-analysis confirms that simulation-based training in airway management improves procedural competence…
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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, sir anticoagulation guidelines, sir guidelines anticoagulation, 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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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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Thoracentesis-Associated Pneumothorax is Rare when Performed by Procedural Experts Using Ultrasound Guidance

Thoracentesis Course
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Featured Procedure, medical procedures, Respiratory diseases, Thoracentesis
More Tags – featured procedure, HPC updates, pneumothorax, thoracentesis, Ultrasound-guided thoracentesis
Original studies of ultrasound-guided thoracentesis concluded a 2% risk of pneumothorax. A recent single center study of 9320 thoracenteses over 12 years all by procedural experts had pneumothorax rate of 0.6%. This same study also demonstrated a very low incidence…
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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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How to Place a Chest Tube in a Safe and Humane Fashion

Hospital Procedure Consultants
More Articles – Cardiovascular diseases, Chest Tube, Featured Procedure, King Tube, medical procedures, Procedural Sedation
More Tags – chest tube, featured procedure, HPC updates, procedural sedation, tube thoracostomy
Chest tube placement, or tube thoracostomy, can be an anxiety-provoking procedure for both the patient AND the operator.  It can also be a very gratifying procedure for the operator when performed successfully and without patient discomfort. Here are a few…
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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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