Clinical Pearls for Airway Management of Morbidly Obese Patients

Joseph Esherick, M.D., FAAFP, FHM
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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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Simulation Based Training Improves Airway Management Skills

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Featured Procedure, Gastrointestinal diseases, Medical General, medical procedures, Respiratory diseases
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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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Recommendations for Invasive Hospital Procedures in Patients with Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
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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 – Cardiovascular diseases, Featured, Gastrointestinal diseases, Medical General, medical procedures, Respiratory diseases
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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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Video laryngoscopy has a superior first pass success rate compared with direct laryngoscopy in the ICU

Joseph Esherick, M.D., FAAFP, FHM
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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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Atraumatic Spinal Needles Significantly Decrease the Risk of Post-Dural Puncture Headaches or Spinal Headaches

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, Gastrointestinal diseases, Medical General, Oncology, Traumatology
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According to recent studies, atraumatic needles (ATN) reduce the rate of post-dural puncture headache (PDPH) when compared to traumatic needles (TN – or bevel-tip needles such as Quincke needles) (27% vs 60%).  Also, the mean duration of PDPH from ATN…
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Emergency Department Intubations Are Increasingly Successful

Joseph Esherick, M.D., FAAFP, FHM
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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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Which cirrhotic patients are at high risk for bleeding during hospital procedures?

Joseph Esherick, M.D., FAAFP, FHM
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This blog will offer some expert recommendations to help guide the safety of hospital procedures at different platelet and coagulation profiles.  Unfortunately, there are no strong evidence-based guidelines for hospital procedures dedicated to the study of patients with decompensated cirrhosis.…
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Why are Patients with Cirrhosis Readmitted to the Hospital?

Joseph Esherick, M.D., FAAFP, FHM
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Patients diagnosed with cirrhosis are regularly admitted and readmitted to the hospital. Statistics show that the 90-day readmission rate is approximately 50%. A recent study analyzed the rate of readmission at 30-days and 90-days and the relevant causes among patients…
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Review of the Management of Hepatic Hydrothorax

Joseph Esherick, M.D., FAAFP, FHM
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This blog summarizes a recent update reviewing current management recommendations for hepatic hydrothorax (HH).  Hepatic hydrothorax is a complication of decompensated cirrhosis with portal hypertension.  Sixty percent of patients accumulate both ascitic fluid and pleural fluid as a result of portal…
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Summary of EASL Guidelines on Ascites, SBP and HRS Management in Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Gastrointestinal diseases, Infections, medical procedures
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This blog summarizes the recent European Association for the Study of the Liver (EASL) guidelines on the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS) in patients with cirrhosis. Cirrhotic ascites occurs as a consequence of portal…
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Emergency Department Intubations Are Increasingly Successful

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, Gastrointestinal diseases, medical procedures, Respiratory diseases
More Tags – , , , ,
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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Early Transexamic Acid Decreases Severe Bleeding in Major Trauma Patients or After Childbirth

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Gastrointestinal diseases, Ginecology, medical procedures, Traumatology
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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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Steroids of No Benefit for Severe Alcoholic Hepatitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endocrinology, Featured, Gastrointestinal diseases
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Severe alcoholic hepatitis as defined by a Maddrey’s Discriminant Function [MDF] score, >32 can carry risk for 1-month mortality of greater than 50%. Current AASLD guidelines recommend corticosteroids (prednisolone 40 mg daily for 28 days) for patients with severe acute…
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Updated Guidelines on Acute Pancreatitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Dermatology, Gastrointestinal diseases, Medical General, medical procedures
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Acute pancreatitis (AP) has increased in the past decade and accounts for over 275,000 annual hospital admissions in the U.S. and estimated medical costs of $2.5 billion. Noteworthy points are as follows: Morbid obesity and DM 2 are independent risk…
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