Delays to hospital inpatient admission in excess of five hours from arrival at an Emergency Department (ED) lead to a mortality rate of 8.71%. This increases by another 8% in cases where admission is delayed beyond six to eight hours. …
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What is conscious sedation? 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…
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A patient with a hemodynamically stable spontaneous pneumothorax can be managed as an outpatient using the placement of a small-bore pigtail catheter attached to a Heimlich valve.   As the Director of Medicine at a teaching hospital, I frequently encounter…
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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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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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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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The American College of Physicians (ACEP) has previously published guidelines in October 2013 about Procedural Sedation and Analgesia. In these guidelines, they provided Level B recommendations that state, “Do not delay procedural sedation in adults or pediatrics in the ED…
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Continuous Capnometry Should be Standard Practice for Moderate-Deep Procedural Sedation Continuous capnometry has been consistently proven to identify patients undergoing moderate-deep procedural sedation who have impaired ventilation well before hypoxia develops.  There have been at least 8 studies that have…
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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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Researchers assessed the incidence of sedation-related serious adverse events (SAEs) and risk factors for them in a prospective cohort study of children ≤18 years of age presenting to six Canadian pediatric emergency departments (EDs) and requiring sedation for painful procedures.…
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