Malpositioned central venous catheters occurs in about 7% of central line placements. A malpositioned central line is any central venous catheter where the tip is located anywhere other than the superior vena cava (SVC) for internal jugular lines or subclavian…
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In 2015 a meta-analysis found that when an ultrasound was used during a radial arterial catheter placement the first pass success rate improved. In the eleven trials that met inclusion criteria over 800 patients were enrolled. Compared to the palpation-guided…
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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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Informed consent can be challenging during “normal” times, but it has become increasingly complicated during the COVID-19 pandemic. The informed consent process ensures that a patient or their surrogate decision-maker understands the benefits, potential risks and any alternatives of a…
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Traditionally, it was felt that the INR had to be less than 1.5 and platelets had to be at least 50,000/µL to perform most bedside procedures. With more clinical evidence, we now know that low-risk bedside procedures can be performed…
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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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Complicated parapneumonic effusions frequently represent pleural space infections. Approximately 1 in 7 cases of pneumonia have an associated parapneumonic effusion (PPE) on chest x-ray. Most of these effusions are small and usually resolve spontaneously with prompt antibiotic administration. However, moderate-to-large…
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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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A recent cohort study using the Danish nationwide medical registry demonstrates that the incidence of a spinal or epidural hematoma from lumbar punctures in patients with pre-existing thrombocytopenia (Platelets<150 K) or coagulopathy (INR>1.4 or aPTT>39 seconds) is not significantly higher…
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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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Class 1 evidence to inform decisions about the safety of lumbar punctures in patients with a coagulopathy are lacking. The only guidance we have regarding the safety of lumbar punctures is based on clinical guidance from organizations such as the…
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