Traditional teaching is that chest tubes placed to evacuate a pneumothorax should be directed anterior and superior and to evacuate fluid should be directed posterior and inferior. A recent study examined the effect of specific chest tube position on chest…
Read More
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…
Read More
Diagnostic lumbar punctures aid in the diagnosis of infections and diseases of the central nervous system. Life-threatening events from lumbar punctures are rare, but post–lumbar (dural) puncture headaches (PDPH) occur in 1% to 36% of patients, depending on the needle…
Read More
Safety checklists have been adopted by numerous industries to prevent errors and save lives.  Checklists have been used for decades by industries as diverse as the aviation industry, construction companies, and professional chefs to prevent mistakes.  In medicine, checklists have…
Read More
Historically, it was felt that a platelet count below 50,000 or an INR>1.5 was a contraindication to thoracentesis because of an increased bleeding risk.  These were arbitrary cut-offs that have since been challenged with newer kits and the use of…
Read More
Remember the Laryngeal Mask Airway When You Can’t Intubate! As a hospitalist who also works in the ICU, I am often the first responder to respiratory emergencies.  Frequently under these circumstances, you have a chaotic environment and a less than…
Read More
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…
Read More
King Tube Airways are Excellent Rescue Airways for Both EMS and Medical Personnel If you are faced with a patient who needs a secure airway and respiratory stabilization, I still believe that endotracheal intubation is the airway of choice.  Nevertheless,…
Read More
How to Differentiate Pleural Effusion Exudates from Transudates Historically, Light’s criteria have been used to classify pleural effusions into transudates or exudates.  Light’s criteria were established by Dr. Richard Light in 1972.[1]  These criteria maximize sensitivity but have a lower…
Read More
Have you ever been able to see the vocal cords during direct laryngoscopy but you weren’t able to pass the endotracheal tube cuff beyond the cords?  This occurs not too infrequently during endotracheal intubation and I am going to share…
Read More
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,…
Read More