Dispelling Myths about Thoracentesis and Pleural Fluid Analysis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Featured, medical procedures, Nephrology, Respiratory diseases, Thoracentesis
More Tags – CHF, diuretics, exudate, featured, HPC updates, Light's criteria, pleural effusions, pleural fluid analysis, re-expansion pulmonary edema, thoracentesis, transudate
There are two myths that have persisted about thoracentesis and pleural fluid analysis that must be dispelled. The first myth is that a large volume thoracentesis should not remove more than 1,500 mL fluid due to the risk of re-expansion…
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Clinical Pearls for Airway Management of Morbidly Obese Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, Featured, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – airway management, awake intubation, cricothyroidotomy, Difficult Intubation, featured, Glidescope intubation, ketamine, Ketofol, King tube airway, laryngeal mask airway, lorazepam, mechanical ventilation, midazolam, morbid obesity, paralytics, Propofol, video laryngoscopy
Morbidly obese patients can pose numerous challenges when it comes to airway management. Morbid obesity can make vascular access more difficult and you need good vascular access prior to any attempts at safe airway management. In addition, morbid obesity can…
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The Case for Simulation Based Training for Bedside Hospital Procedures

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Cardiovascular diseases, Emergency Procedures, Endotracheal Intubation, Events, FAST Exam, Featured, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Mechanical Ventilation, Medical General, medical procedures, Paracentesis, Thoracentesis
More Tags – E-FAST, featured, HPC updates, lumbar puncture, paracentesis, POCUS, RUSH Exams, Simulation Based Training; Central Line Training, simulation-based procedural training, thoracentesis, Vascular access
For decades the mantra for procedural education in medicine has been “see one-do one-teach one”.  Those of us who learned bedside procedures and point-of-care ultrasound by this model understand that this approach does not optimize safe and competent performance.   At…
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Pearls about Chest Tube Management

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Chest Tube, Featured, Thoracentesis
More Tags – air leak, chest tube placement, Chest tube removal, chest tubes, empyema, featured, hemothorax, HPC updates, parapneumonic effusion, pneumothorax, thoracentesis, tube thoracostomy
Chest tubes, or thoracostomy tubes, have been used since the fifth century BC when Hippocrates described the use of a hollow tin tube to drain fluid that was likely an empyema from his description.[i] Chest tubes started to be used…
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Antibiotics in Sepsis: Is Early Always Better?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Arterial line, Central line, Emergency Procedures, Featured
More Tags – antibiotic stewardship, antibiotics, Arterial Line, central line, featured, sepsis, sepsis management, septic shock
Timely administration of broad-spectrum antibiotics in septic patients saves lives.  Though this has been demonstrated in hundreds of clinical investigations over the last few decades, antibiotics remain the most controversial topic in the management of severe sepsis and septic shock. …
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The Jury is Still Out on Whether Awake Prone Positioning in Non-intubated Patients with COVID-19 Pneumonia Decreases Mortality or Endotracheal Intubation

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured, medical procedures, Respiratory diseases
More Tags – baritinib, COVID, COVID pneumonia, COVID-19, dexamethasone, endotracheal intubation, featured, HPC updates, intubation, remdesevir, respiratory failure, tociluzimab
COVID-19 pneumonia can be a frustrating infection to treat because we have limited medications that have proven benefit in moderate-severe infections. Patients with COVID-19 pneumonia who require up to 2L/min supplemental oxygen have at least moderate infection. Patients with severe…
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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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Dexmedetomidine and Propofol performed equally well for the sedation of mechanically ventilated patients with sepsis

Medical Professional Using Tablet in Mechanical Ventilation Course
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – ABCDEF bundle, CAM -ICU, Delirium, dexmedetomidine, featured, HPC updates, mechanical ventilation, Propofol, RASS, ventilator, ventilator sedation
The Society of Critical Care Medicine (SCCM) recommends that all mechanically ventilated patients receive analgesia, sedation, and delirium assessment and management while intubated. SCCM reinforced these principles in their 2018 clinical practice guideline on the prevention and management of pain,…
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Review of chest tube drainage of the pleural space

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Chest Tube, Featured, Procedural Sedation
More Tags – chest tube placement, Chest tube removal, chest tubes, featured, hemothorax, HPC updates, pigtail catheter placement, pleural effusions, pleurodesis, pneumothorax, re-expansion pulmonary edema, tube thoracostomy
This blog summarizes recommended management of chest tube drainage of the pleural space. The blog will cover the recommended size of chest tube for different indications, suggestions for chest tube insertion technique, methods to avoid chest tube complications and when…
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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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How to Prevent and Manage Malpositioned Central Lines

Right SCV-IJ case
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Events, Featured, Infections, Medical General, medical procedures
More Tags – central line, central line complications, Central line insertion, central line malpositioning, featured, femoral lines, HPC updates, IJ lines, Simulation Based Training; Central Line Training, subclavian lines
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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First Pass Success Rate is Better for Ultrasound-Guided Radial Artery Line Placement vs Palpation-Guided Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, Featured, medical procedures
More Tags – Arterial line insertion, Arterial lines, HPC updates, ultrasound-guided arterial lines
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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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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Recommendations for Invasive Hospital Procedures in Patients with Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Chest Tube, Featured, Gastrointestinal diseases, Hospital Procedures, Paracentesis, Thoracentesis
More Tags – Arterial line placement, central line placement, chest tube placement, cirrhosis, DIC, featured, HPC updates, hyperfibrinolysis, paracentesis, thoracentesis, tube thoracostomy
This blog aims to summarize the data available on how to safely perform invasive hospital procedures in patients with cirrhosis. Unfortunately, no prospective randomized controlled trials have been conducted to inform the practice of procedural medicine in cirrhotic patients. Therefore,…
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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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