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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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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Periprocedural Bleeding Risk for Thrombocytopenia, Coagulopathy, Antiplatelets and Anticoagulation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Chest Tube, Featured Procedure, Hematology, Lumbar Puncture, Medical General, medical procedures, Paracentesis, Thoracentesis
More Tags – anticoagulation, antiplatelets, central lines, chest tubes, coagulopathy, featured procedure, HPC updates, lumbar puncture, paracentesis, procedures, sir anticoagulation guidelines, sir guidelines anticoagulation, thoracentesis
This blog summarizes the 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures with regards to thrombocytopenia, coagulopathies, antiplatelets and anticoagulation.  The SIR guidelines are summarized as follows: Anticoagulation with heparin, LMWH, fondaparinux, argatroban, warfarin, DOAC, clopidogrel, ticagrelor…
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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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Informed Consent and Ethical Challenges During the COVID-19 Pandemic

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Hospital Procedures, Medical General, medical procedures, Respiratory diseases
More Tags – COVID, CPR, featured, HPC updates, Informed consent
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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Atraumatic Spinal Needles Significantly Decrease the Risk of Post-Dural Puncture Headaches or Spinal Headaches

Lumbar Puncture Training
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, Gastrointestinal diseases, Lumbar Puncture, Medical General, Oncology, Traumatology
More Tags – ATN, Atraumatic spinal needles, featured procedure, HPC updates, lumbar puncture, PDPH, post-dural puncture headache, TN, Traumatic needles
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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Why are Patients with Cirrhosis Readmitted to the Hospital?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, Gastrointestinal diseases, Hospital Procedures, Medical General, medical procedures
More Tags – Alcoholic liver disease, cirrhosis, featured procedure, HPC updates, Nonalcoholic liver disease, readmission
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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Where Should I Place My Central Line?

Ultrasound-Guided Central Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Featured, Medical General, medical procedures
More Tags – central lines, central venous catheters, featured, femoral lines, HPC updates, IJ lines, subclavian lines
The internal jugular or subclavian veins have fewer combined mechanical or infectious complications for central venous catheter insertions compared with femoral vein CVC placements.  Numerous organizations have proposed guidelines or central line bundles that have advocated preferential use of the…
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Summary of AASLD Practice Guidelines on Cirrhotic Ascites – Paracentesis Indicated for all Hospitalized Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Featured Procedure, Infections, Medical General, medical procedures, Paracentesis
More Tags – Cirrhotic ascites, featured procedure, Guidlelines, HPC updates, paracentesis, SBP, spontaneous bacterial peritonitis
According to AASLD Practice Guidelines, all patients with cirrhotic ascites admitted to the hospital should have a diagnostic paracentesis to rule out spontaneous bacterial peritonitis (SBP). Treatment of SBP requires cefotaxime plus albumin 1.5 gm/kg on the first day and…
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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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Risks for Post-Dural Puncture Headaches after Lumbar Puncture

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, Lumbar Puncture, Medical General, medical procedures, Paracentesis, Traumatology
More Tags – Headache, HPC updates, lumbar puncture, post-dural puncture headache, spinal headache
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…
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2018 Guidelines for Acute Ischemic Stroke Provides New Recommendations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Medical General, medical procedures
More Tags – featured, HPC updates, stroke
The 2018 AHA/ASA guidelines for the early management of acute ischemic stroke provides some important new evidence-based recommendations.  Some important new recommendations described in these guidelines include: The DAWN and DEFUSE 3 trials selected patients for mechanical thrombectomy within an extended time…
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Rapid Influenza Diagnostic Tests Have High False Negative Rates

Patient Sleeping with Nurse in Mechanical Ventilation Cours
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Medical General, medical procedures, Respiratory diseases
More Tags – ARDS, featured, HPC updates, influenza
We are in the midst of an aggressive influenza season right now that should continue into March, so it is nice to review the testing accuracy of standard influenza point-of-care tests that are commonly used.  There are many Rapid Influenza Diagnostic…
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