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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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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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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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…
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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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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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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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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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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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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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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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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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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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