Role of Ultrasound in Lumbar Punctures

lumbar-punctures
Dr. Rick Rutherford, M.D., FAAFP
More Articles – Cardiovascular diseases, Emergency Procedures, Events, Featured, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Medical General, medical procedures, Ultrasound-Guided Peripheral IV
More Tags – central line placement, chest tube placement, E-FAST, featured, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, POCUS, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access
For procedures involving lumbar punctures , sonographically guided lumbar punctures (SGLPs) have a higher propensity of being chosen when dealing with obese patients. This is based on findings of a randomized controlled trial conducted in 2007. The main takeaway from…
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Conscious Sedation. What It Is, When to Apply It, and the Latest Updates

concious-sedation
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Emergency Procedures, Endotracheal Intubation, Events, Hospital Procedures, King Tube, Laryngeal Mask Airway, Medical General, medical procedures, Procedural Sedation
More Tags – central line placement, chest tube placement, E-FAST, featured procedure, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, POCUS, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access
Conscious sedation, also known as procedural sedation, is a common practice in emergency departments for patients undergoing painful or anxiety-provoking procedures.  It is intended as a less invasive method. Generally, those who undergo this type of sedation can recover more…
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Basic Emergency Procedures You Should Know

emergency procedures - small
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, Events, FAST Exam, Intraosseous line, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Mechanical Ventilation, Medical General, medical procedures, Needle Decompression, Paracentesis, Procedural Sedation, RUSH Exam, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – central line placement, chest tube placement, E-FAST, featured procedure, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, POCUS, RUSH Exams, thoracentesis, tube thoracostomy, Vascular access
Physicians, physician associates (PAs), and nurse practitioners (NPs) need to be adept in a range of essential medical emergency procedures that they must perform in an inpatient settings. These bedside procedures are accomplished readily, but only if you have the…
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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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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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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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Summary of Difficult Airway Management in COVID-19 Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Featured, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation
More Tags – awake intubation, COVID-19, difficult airway management, Difficult Intubation, endotracheal intubation, featured, HPC updates, intubation, video laryngoscopy
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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Predictors of and Pearls for Difficult Airway Management

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – cricothyroidotomy, difficult airway management, endotracheal intubation, featured, HPC updates, intubation, King tube, laryngeal mask airway, supraglottic airway, surgical airway
Patients may have anatomically difficult airways or physiologically difficult airways.  Both anatomical and physiological factors can lead to peri-intubation complications.  My goal for this blog is to describe the factors that may contribute to an anatomically difficult airway and clinical…
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Remember the Laryngeal Mask Airway When You Can’t Intubate!

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured Procedure, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – featured procedure, HPC updates, intermediate airways, laryngeal mask airway
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…
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King Tube Airways are Excellent Rescue Airways for Both EMS and Medical Personnel

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured Procedure, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – airway management, difficult airway management, HPC updates, intermediate airways, King tubes
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,…
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Differences in Intracerebral Hemorrhage Between Warfarin and New Oral Anticoagulants

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Laryngeal Mask Airway, medical procedures, Neurological diseases
More Tags – HPC updates, ICH, Intracerebral Hemorrhage, New Oral Anticoagulants, NOACs
In prior randomized trials, the incidence of intracerebral hemorrhage (ICH) was significantly lower with the new oral anticoagulants (NOACs) than with warfarin (Blood 2014; 124:1968).  However, it remains unclear if clinical outcomes are similar when ICH does occur with different…
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Risk Factors for Difficult Ventilation with a Laryngeal mask Airway

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Laryngeal Mask Airway, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – Difficult LMA, HPC updates, laryngeal mask airway, LMA, PLAD Score, Predictive Laryngeal Mask Airway Difficulty Score, Risk Factors
Recently, a retrospective review of over 14,000 adult patients who underwent general anesthesia were assessed. A multivariable analysis was used to determine risk factors of difficult laryngeal mask airways (LMA). The following four risk factors were identified: male gender, age…
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MRI Is Not Needed for Cervical Spine Clearance in Obtunded Blunt Trauma Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Laryngeal Mask Airway, medical procedures, Traumatology
More Tags – blunt trauma, C-spine clearance, cervical spine injury, head trauma, HPC updates
A systematic review found no significant missed injuries in obtunded blunt trauma patients who had normal CT imaging of their cervical spines. Given the significant morbidity and mortality associated with missed traumatic cervical spine injuries, patients in whom a reliable…
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Does Cricoid Pressure Prevent Aspiration During Endotracheal Intubation?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, medical procedures, Respiratory diseases
More Tags – cricoid pressure, endotracheal intubation, Glidescope intubation, HPC updates, King tube airway, laryngeal mask airway, rapid sequence intubation
There has always been some controversy about the utility of applying cricoid pressure (aka Sellick Maneuver) during rapid sequence intubation for the purpose of preventing aspiration.  Theoretically, applying pressure on the cricoid cartilage posteriorly should occlude the esophagus against the…
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