Original studies of ultrasound-guided thoracentesis concluded a 2% risk of pneumothorax. A recent single center study of 9320 thoracenteses over 12 years all by procedural experts had pneumothorax rate of 0.6%. This same study also demonstrated a very low incidence…
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Complicated parapneumonic effusions frequently represent pleural space infections. Approximately 1 in 7 cases of pneumonia have an associated parapneumonic effusion (PPE) on chest x-ray. Most of these effusions are small and usually resolve spontaneously with prompt antibiotic administration. However, moderate-to-large…
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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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Emergency department (ED) intubation is constantly evolving, with new devices, techniques, and medications being frequently adopted. To evaluate temporal trends, National Emergency Airway Registry (NEAR) investigators analyzed registry data on ED intubations at 13 large hospitals in the U.S., Canada,…
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A historical myth in procedural medicine is the operator should limit removal of pleural fluid to 1.5 L during thoracentesis because of the risk of re-expansion pulmonary edema or pneumothorax.  New evidence supports safety of large volume thoracentesis until no…
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Video Laryngoscopy Is Superior to Direct Laryngoscopy for Failed Intubation Attempts in the ER Although video laryngoscopy has repeatedly been shown to be superior to direct laryngoscopy, there has not yet been any specific directive instructing emergency department (ED) intubators…
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The Difficult Airway Society (DAS) has recently published new guidelines for awake tracheal intubation (ATI) in adults.  When performed correctly, ATI has a favorable safety profile for patients with an anticipated difficult airway.  The guidelines cover the indications for ATI,…
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Emergency department (ED) intubation is constantly evolving, with new devices, techniques, and medications being frequently adopted. To evaluate temporal trends, National Emergency Airway Registry (NEAR) investigators analyzed registry data on ED intubations at 13 large hospitals in the U.S., Canada,…
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Patients may have anatomically difficult airways or physiologically difficult airways.  Both anatomical and physiological factors can lead to peri-intubation complications.  My goal for this blog is to describe the factors that may contribute to an anatomically difficult airway and clinical…
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Remember the Laryngeal Mask Airway When You Can’t Intubate! As a hospitalist who also works in the ICU, I am often the first responder to respiratory emergencies.  Frequently under these circumstances, you have a chaotic environment and a less than…
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We are in the midst of an aggressive influenza season right now that should continue into March, so it is nice to review the testing accuracy of standard influenza point-of-care tests that are commonly used.  There are many Rapid Influenza Diagnostic…
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King Tube Airways are Excellent Rescue Airways for Both EMS and Medical Personnel If you are faced with a patient who needs a secure airway and respiratory stabilization, I still believe that endotracheal intubation is the airway of choice.  Nevertheless,…
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With flush-rate oxygen, a non-rebreather mask was at least as good as a bag-valve-mask ventilation for intubation preoxygenation. Many intubators using the rapid sequence intubation protocol use a bag-valve-mask (BVM) for preoxygenation. But in the absence of a good mask…
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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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There have been multiple strategies to determine the “optimal PEEP” in acute respiratory distress syndrome (ARDS).  One strategy is to perform a recruitment maneuver using an “Open Lung” approach and neuromuscular blockade (with pressures as high as 60 cm H2O),…
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