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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Safety of Thoracentesis and Tube Thoracostomy in Patients with Uncorrected Coagulopathies

Tube Thoracostomy Insertion Procedure
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Chest Tube, Endotracheal Intubation, Featured, Hematology, medical procedures, Thoracentesis
More Tags – anticoagulation, antiplatelets, chest tube placement, coagulopathy, featured, HPC updates, thoracentesis, tube thoracostomy
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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Thoracentesis-Associated Pneumothorax is Rare when Performed by Procedural Experts Using Ultrasound Guidance

Thoracentesis Course
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Featured Procedure, medical procedures, Respiratory diseases, Thoracentesis
More Tags – featured procedure, HPC updates, pneumothorax, thoracentesis, Ultrasound-guided thoracentesis
Original studies of ultrasound-guided thoracentesis concluded a 2% risk of pneumothorax. A recent single center study of 9320 thoracenteses over 12 years all by procedural experts had pneumothorax rate of 0.6%. This same study also demonstrated a very low incidence…
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How to Place a Chest Tube in a Safe and Humane Fashion

Hospital Procedure Consultants
More Articles – Cardiovascular diseases, Chest Tube, Featured Procedure, King Tube, medical procedures, Procedural Sedation
More Tags – chest tube, featured procedure, HPC updates, procedural sedation, tube thoracostomy
Chest tube placement, or tube thoracostomy, can be an anxiety-provoking procedure for both the patient AND the operator.  It can also be a very gratifying procedure for the operator when performed successfully and without patient discomfort. Here are a few…
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Management of Pleural Infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Chest Tube, Featured, Infections, King Tube, medical procedures, Respiratory diseases, Thoracentesis
More Tags – chest tube, empyema, featured, HPC updates, parapneumonic effusion, pleural effusion, thoracentesis, tube thoracostomy
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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Video laryngoscopy has a superior first pass success rate compared with direct laryngoscopy in the ICU

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Featured Procedure, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – airway management, direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, intubation, video laryngoscopy
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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Incidence of Spinal Hematoma from Lumbar Punctures in Patients with a Coagulopathy or Thrombocytopenia

Lumbar Puncture CME
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Hematology, Lumbar Puncture, medical procedures
More Tags – coagulopathy, epidural hematoma, featured, HPC updates, lumbar puncture, thrombocytopenia
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 Lines Placed Using the EZ-IO Device Can Be Safely Maintained for Up to 48 hours

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Featured Procedure, Intraosseous line, medical procedures
More Tags – EZ-IO, featured procedure, HPC updates, intraosseous drill, intraosseous line, io line, Vascular access
Intraosseous vascular access using the EZ-IO device is a wonderful option for emergency access in the hospital or pre-hospital setting. Intraosseous lines are easy to place with proper training and can serve as emergency vascular access during cardiac arrest or…
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Intraosseous Lines: Expanding Indications

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Cardiovascular diseases, Central line, Emergency Procedures, Featured, Intraosseous line, medical procedures
More Tags – EZ-IO, featured, HPC updates, intraosseous drill, intraosseous line, io line, Vascular access
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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Risk of Epidural Hematoma from Lumbar Puncture in Patients with a Coagulopathy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Hematology, Lumbar Puncture, medical procedures
More Tags – coagulopathy, epidural hematoma, featured, HPC updates, lumbar puncture, thrombocytopenia
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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Simulation Based Training for Central Venous Catheters

Ultrasound-Guided Central Line Placement
Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central line, Events, Featured Procedure, medical procedures
More Tags – central venous catheter, featured procedure, HPC updates, Simulation Based Training; Central Line Training
Does Simulation Based Training Improve Central Line Success Rates? Simulation-based procedural training has become increasingly popular in academic medical centers and among medical trainees.  Limited data has suggested that simulation based training improves success rates and safety, but evidence has…
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Rapid Ultrasonography in Shock: A Lifesaving ED Tool

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Emergency Procedures, Events, Featured Procedure, medical procedures, Paracentesis, RUSH Exam
More Tags – featured procedure, HPC updates, RUSH Exams
Rapid Ultrasonography in Shock:  Is this really useful? Caring for patients with undifferentiated hypotension, causes anxiety for most health care providers.  This is natural.  Fear, however, must not lead to hesitation or poor decision-making.  Therapies chosen early in shock disproportionately…
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Emergency Department Intubations Are Increasingly Successful

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured Procedure, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, featured procedure, Glidescope intubation, HPC updates, intubation, video laryngoscopy
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
More Articles – Arterial line, Cardiovascular diseases, Central line, Featured, Gastrointestinal diseases, Hospital Procedures, Lumbar Puncture, medical procedures, Paracentesis, Ultrasound-Guided Peripheral IV
More Tags – Arterial line placement, central line placement, chest tubes, cirrhosis, featured, HPC updates, lumbar puncture, paracentesis, thoracentesis, tube thoracostomy
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
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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