Dispelling Myths about Thoracentesis and Pleural Fluid Analysis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Featured, medical procedures, Nephrology, Respiratory diseases, Thoracentesis
More Tags – CHF, diuretics, exudate, featured, HPC updates, Light's criteria, pleural effusions, pleural fluid analysis, re-expansion pulmonary edema, thoracentesis, transudate
There are two myths that have persisted about thoracentesis and pleural fluid analysis that must be dispelled. The first myth is that a large volume thoracentesis should not remove more than 1,500 mL fluid due to the risk of re-expansion…
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What is the true complication rate for thoracentesis?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures, Respiratory diseases, Thoracentesis
More Tags – featured procedure, hemothorax, HPC updates, pneumothorax, re-expansion pulmonary edema, thoracentesis, thoracentesis complications, ultrasound-guided procedures
Thoracentesis is one of the most common bedside procedures performed in U.S. hospitals.  There are about 173,000 thoracenteses performed each year in the U.S.  A systematic review and meta-analysis in 2010 concluded that thoracentesis-related pneumothorax occurs 6% of the time…
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Clinical Pearls for Airway Management of Morbidly Obese Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, Featured, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – airway management, awake intubation, cricothyroidotomy, Difficult Intubation, featured, Glidescope intubation, ketamine, Ketofol, King tube airway, laryngeal mask airway, lorazepam, mechanical ventilation, midazolam, morbid obesity, paralytics, Propofol, video laryngoscopy
Morbidly obese patients can pose numerous challenges when it comes to airway management. Morbid obesity can make vascular access more difficult and you need good vascular access prior to any attempts at safe airway management. In addition, morbid obesity can…
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Outpatient Management of A Spontaneous Pneumothorax

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Emergency Procedures, Featured Procedure, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – chest tube, featured procedure, HPC updates, pneumothorax, tube thoracostomy
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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The Jury is Still Out on Whether Awake Prone Positioning in Non-intubated Patients with COVID-19 Pneumonia Decreases Mortality or Endotracheal Intubation

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured, medical procedures, Respiratory diseases
More Tags – baritinib, COVID, COVID pneumonia, COVID-19, dexamethasone, endotracheal intubation, featured, HPC updates, intubation, remdesevir, respiratory failure, tociluzimab
COVID-19 pneumonia can be a frustrating infection to treat because we have limited medications that have proven benefit in moderate-severe infections. Patients with COVID-19 pneumonia who require up to 2L/min supplemental oxygen have at least moderate infection. Patients with severe…
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Tricks of the Trade for Stylet-guided Endotracheal Intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured Procedure, medical procedures, Respiratory diseases
More Tags – airway management, endotracheal intubation, featured procedure, HPC updates
Eschmann stylets, or Bougies, can assist the clinician with endotracheal intubation in difficult airway scenarios.  The stylet when properly placed can act to guide the endotracheal tube (ETT) into the trachea.  However, there are different troubleshooting techniques that once must…
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Dexmedetomidine and Propofol performed equally well for the sedation of mechanically ventilated patients with sepsis

Medical Professional Using Tablet in Mechanical Ventilation Course
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – ABCDEF bundle, CAM -ICU, Delirium, dexmedetomidine, featured, HPC updates, mechanical ventilation, Propofol, RASS, ventilator, ventilator sedation
The Society of Critical Care Medicine (SCCM) recommends that all mechanically ventilated patients receive analgesia, sedation, and delirium assessment and management while intubated. SCCM reinforced these principles in their 2018 clinical practice guideline on the prevention and management of pain,…
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Protocolized Sedation is Recommended Over Usual Care for Mechanical Ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – Delirium, featured procedure, HPC updates, mechanical ventilation, Protocolized Sedation, Sedation, Wake-up and Breath Protocol
A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effects of protocolized sedation in mechanically ventilated adult intensive care unit patients. Six randomized controlled trials and 1243 patients were studied. The results showed that protocolized…
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Airway Management Pearls to Optimize Your Chances of Securing an Airway

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Featured, Hospital Procedures, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – airway management, Bougie, delayed sequence intubation, difficult airway, endotracheal intubation, featured, HPC updates, intubation, King tube, LMA, mechanical ventilation, rapid sequence intubation
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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The Likelihood of a Difficult Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured Procedure, medical procedures, Respiratory diseases
More Tags – airway management, endotracheal intubation, featured procedure, HPC updates
A recent article in JAMA reviewed 62 high-quality articles to determine the clinical factors that can help to predict the patient with a difficult airway.  Airway management experts have devised different scoring systems and exam findings that can predict the…
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Procedural Competency in Academic Emergency Medicine Attending Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Emergency Procedures, Endotracheal Intubation, Featured, Intraosseous line, Lumbar Puncture, medical procedures, Paracentesis, Pericardiocentesis, Procedural Sedation, Respiratory diseases, Thoracentesis
More Tags – ACLS, chest tube placement, difficult airway management, endotracheal intubation, featured, HPC updates, intraosseous line placement, intubation, lumbar puncture, paracentesis, pericardiocentesis, procedural sedation, thoracentesis, tube thoracostomy
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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Simulation Based Training Improves Airway Management Skills

https://hospitalprocedures.org/endotracheal-intubation-course/
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Endotracheal Intubation, Featured Procedure, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Lumbar Puncture, Mechanical Ventilation, Medical General, medical procedures, Paracentesis, Respiratory diseases, Thoracentesis
More Tags – airway management, central lines, endotracheal intubation, Glidescope intubation, King tube, laryngeal mask airway, lumbar puncture, paracentesis, thoracentesis
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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Tips for Management and Bedside Procedures in Critically Ill Patients with COVID Pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Emergency Procedures, Endotracheal Intubation, Featured, Gastrointestinal diseases, Glidescope Intubation, Mechanical Ventilation, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – Arterial line insertion, asystole, cardiac arrest, Central line insertion, COVID pneumonia, CPR, featured, Glidescope intubation, HPC updates, intubation, mechanical ventilation, PEA, push dose pressors, video laryngoscopy
The SARS-COV-2 pandemic started in January 2020 and has decimated the majority of U.S. hospitals for the past 18 months. The impact of COVID-19 has not only affected available hospital beds, but has limited the ability of hospitals to perform…
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Airway Management in COVID-positive Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, Chest Tube, Endotracheal Intubation, Featured Procedure, Glidescope Intubation, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – airway management, COVID, featured procedure, HPC updates, intubation
A number of additional factors must be considered with airway management in COVID-positive patients. Hospital Procedures Consultants (HPC) can provide simulation-based training to prepare providers for airway management in COVID-positive patients. The first essential consideration is to place the patient into a…
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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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