According to AASLD Practice Guidelines, all patients with cirrhotic ascites admitted to the hospital should have a diagnostic paracentesis to rule out spontaneous bacterial peritonitis (SBP).
The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891 This technique utilizes the...
Ultrasound has improved the safety and efficiency of a wide range of procedures including ultrasound-guided central line insertion
First-pass ED intubation success increased from 80% in 2002 to 86% in 2012, with concomitant increases in the use of video laryngoscopy and rocuronium.
When a chest tube was inserted in a pleural space, secondary interventions were not necessary. Also, there is no significant difference between using a small or large chest tube in the setting of chest trauma.
The standard tests to assess bleed risk do not accurately predict bleed risk in cirrhotic patients during bedside procedures.
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 with direct laryngoscopy, endotracheal intubation, video laryngoscopy, laryngeal mask airway insertion, and King tube airway insertion.
Balancing patient safety with trainee experience presents an ongoing challenge in medicine. Simulation based training has been proposed as a tool to improve the safety of bedside procedures, but has not been rigorously studied. This metaanalysis reviews the evidence available and evaluates whether simulation based training improves success rates for central venous catheter placement.
The drawback to these new oral anticoagulants is that there is no true antidote that can reverse the anticoagulant activity in the event that a patient develops a major hemorrhage or if they require emergency surgery or have a need for an invasive bedside procedure.
Patients' being in a seated position during the procedure showed a trend to increased frequency of headaches both immediately and 24 hours after puncture. Also, removal of CSF volumes above 30 mL increased the risk of immediate post-procedure headaches.
Safety checklists have been adopted by numerous industries to prevent errors and save lives. Checklists have been used for decades by...
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 optimal environment to intubate a patient.
Rapid Ultrasonography in Shock: Is this really useful? Caring for patients with undifferentiated hypotension, causes anxiety for most health...
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.
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...
Intraosseous line use has increased since the advent of the EZ-IO and is becoming the procedure of choice in unstable patients without venous access.
This is further support that a pre-procedure modified Allen’s test is not a reliable predictor of ischemic complications for radial arterial line insertion and an abnormal Allen’s test should not be a contraindication to placing a radial arterial line.
This meta-analysis analyzed 20 studies and nearly 3,500 patients. The study found that, on the average, a pleural cholesterol level of 55 mg/L or more had an 88% sensitivity, 96% specificity and positive likelihood ratio for an exudate of 20.3. On the other hand, a pleural cholesterol level below 55 mg/L has a negative likelihood ratio of 0.12 suggesting a transudate. In addition a pleural fluid/serum cholesterol ratio of 0.3 or more has 94% sensitivity and 87% specificity for a pleural exudate. A P/S cholesterol ratio less than 0.3 has a negative likelihood ratio of 0.07.3
Chest tube placement, or tube thoracostomy, can be an anxiety-provoking procedure for both the patient AND the operator. It can also be a...
In residency, I spent a great deal of time at the bedside assessing for shifting dullness in patients who may have had ascites. Today, when I...
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 a trick for this.
Protocolized sedation compared with usual care led to decreased mortality, decreased ICU length of stay, decreased hospital length of stay, and decreased tracheostomy rates.
As a third year medical student at a busy trauma center, one of my jobs was to hold a bag of saline connected to the trauma victim’s abdomen...
Video laryngoscopy has a superior first pass success rate and lower rate of difficult intubations and esophageal intubations compared with direct laryngoscopy for ICU intubations.
Many articles of clinician clothing can become colonized with bacteria and act as fomites spreading bacteria between patients.
