Do we really need to do a modified Allen’s Test before Radial Arterial Line Insertion?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Line, Arterial line insertion, Arterial line placement, Arterial Lines, Featured Procedure, HPC Updates, Procedure Blog of the Week
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It has long been Dogma that an abnormal modified Allen’s test is a contraindication to performing a radial arterial line in that arm.  The theory behind this is that the modified Allen’s test will identify patients who have insufficient collateral circulation…
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Simulation Based Training for Central Venous Catheters

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central Line, central line placement, Central Venous Catheter, Featured Procedure, HPC Updates, Procedure Blog of the Week, Simulation Based Training, Ultrasound-Guided Central Line Insertion
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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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Simulation Based Training Improves Airway Management Skills

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, Endotracheal Intubation, Featured Procedure, Glidescope Intubation, HPC Updates, Intubation, King Tube, Laryngeal Mask Airway, Procedure Blog of the Week
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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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Video laryngoscopy has a superior first pass success rate compared with direct laryngoscopy in the ICU

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, direct laryngoscopy, emergency procedures, Endotracheal Intubation, Featured Procedure, Glidescope Intubation, HPC Updates, Intubation, Procedure Blog of the Week, video laryngoscopy
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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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Ultrasound-guided Central Venous Access: Are Landmarks a Thing of the Past?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, central line placement, Central Venous Catheter, Featured Procedure, HPC Updates, Procedure Blog of the Week, Ultrasound-Guided Central Line Insertion, ultrasound-guided procedures
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Point-of-care ultrasound is one of the most rapidly evolving areas of medicine.  In addition to becoming the “stethoscope of the future” for bedside diagnostic evaluations, ultrasound has improved the safety and efficiency of a wide range of procedures.  The use…
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Troubleshooting Difficult Intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, Endotracheal Intubation, Featured Procedure, HPC Updates, Procedure Blog of the Week
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Have you ever been able to see the vocal cords during direct laryngoscopy but you weren’t able to pass the endotracheal tube cuff beyond the cords?  This occurs not too infrequently during endotracheal intubation and I am going to share…
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Optimal Location for Needle Decompression For A Tension Pneumothorax

Hospital Procedure Consultants
More Articles – HPC Updates, Needle Decompression, Procedure Blog of the Week
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Optimal Location for Needle Decompression For A Tension Pneumothorax Traditionally, needle decompression for the emergent treatment of a tension pneumothorax is the second intercostal space in the mid-clavicular line.  This remains an option for needle insertion when you are treating…
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Early Goal Directed Therapy for Sepsis: No Longer?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, central line placement, Central Venous Catheter, HPC Updates, Procedure Blog of the Week, Sepsis, Septic Shock
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In 2001, the Rivers trial showed that Early Goal Directed Therapy for septic shock resulted in a 16% absolute mortality risk reduction1. In the treatment arm of this trial, septic patients with a lactate above 4 mmol/L or systolic blood…
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Does Cricoid Pressure Prevent Aspiration During Endotracheal Intubation?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Airway management, Endotracheal Intubation, Glidescope Intubation, HPC Updates, intermediate airways, King Tube, Laryngeal Mask Airway, Procedure Blog of the Week
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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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Should Endotracheal Intubation Become a Videogame?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Endotracheal Intubation, Glidescope Intubation, HPC Updates, Procedure Blog of the Week
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Direct vs Video Laryngoscopy In 1878 William MacEwan first passed a tube into the trachea of an awake patient using his fingers as a guide.  Now health care providers routinely perform endotracheal intubation as a life saving intervention.  Despite over…
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MRI is useful to distinguish between residual clot versus acute recurrent DVT

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Deep venous thrombosis, HPC Updates, Procedure Blog of the Week, venous thromboembolism
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Frequently the combination of a serum D-dimer level and compression ultrasound testing can differentiate between a residual venous clot and an acute recurrent DVT.  However, sometimes the results are equivocal and in these situations an MRI direct thrombus imaging can…
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Isolated free fluid on CT Imaging after Blunt Abdominal Trauma: Explore or Wait?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – emergency procedures, HPC Updates, Procedure Blog of the Week, Trauma CME
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Patients with minimal free fluid and no abdominal tenderness can be observed, while patients with moderate-large amounts of free fluid and abdominal tenderness should undergo operative exploration. To determine if operative exploration or observation is the preferred management for hemodynamically…
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Continuous capnography beneficial during mechanical ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – HPC Updates, Mechanical Ventilation, Procedure Blog of the Week
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The American Association of Respiratory Care developed a clinical policy describing the benefit of continuous capnography during mechanical ventilation.  This policy statement recommends continuous capnometry during mechanical ventilation for a number of reasons:   1.  It confirms that the endotracheal…
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Noninvasive blood pressure monitoring not ready for prime time

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Lines, HPC Updates, Procedure Blog of the Week
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Noninvasive continuous arterial pressure monitoring using finger photoplethysmography is not quite ready for prime time.  This technology is comparable to cuff pressures, but this technology is far too variable compared with invasive arterial blood pressure monitoring using an arterial line.…
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Arterial Lines Do Cause Bloodstream Infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial Lines, HPC Updates, Procedure Blog of the Week
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Arterial lines are not completely benign.  They can definitely cause catheter-related bloodstream infections.  This study shows that arterial lines have a rate of bloodstream infection of about 1 in 1,000 catheter days.  Femoral arterial lines have a higher rate of…
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