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…
Read MoreSimulation-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…
Read MoreDoes 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…
Read MoreIt 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…
Read MoreHave 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…
Read MoreVideo 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…
Read MoreOptimal 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…
Read MoreIn 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…
Read MoreThere 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…
Read MoreMore Articles – Endotracheal Intubation, Glidescope Intubation, HPC Updates, Procedure Blog of the Week
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…
Read MoreMore Articles – Deep venous thrombosis, HPC Updates, Procedure Blog of the Week, venous thromboembolism
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…
Read MorePatients 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…
Read MoreThe 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…
Read MoreNoninvasive 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.…
Read MoreArterial 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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