Articles in "featured procedure"

Does chest tube location or size matter for tube thoracostomy in trauma patients?

by Joseph Esherick, M.D., FAAFP, FHM

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.

Which cirrhotic patients are at high risk for bleeding during hospital procedures?

by Joseph Esherick, M.D., FAAFP, FHM

The standard tests to assess bleed risk do not accurately predict bleed risk in cirrhotic patients during bedside procedures.

Simulation Based Training Improves Airway Management Skills

by Joseph Esherick, M.D., FAAFP, FHM

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.

Simulation Based Training for Central Venous Catheters

by Rick Rutherford, M.D., FAAFP

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.

Performing Procedures on Patients Who Take Dabigatran, Rivaroxaban, and Apixaban

by Joseph Esherick, M.D., FAAFP, FHM

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.

Risks for Post-Dural Puncture Headaches after Lumbar Puncture

by Joseph Esherick, M.D., FAAFP, FHM

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.

Remember the Laryngeal Mask Airway When You Can’t Intubate!

by Joseph Esherick, M.D., FAAFP, FHM

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.

Bedside Ultrasound Increases the Success Rate for Difficult Lumbar Punctures

by Joseph Esherick, M.D., FAAFP, FHM

The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891 This technique utilizes the...

Ultrasound-guided Central Venous Access: Are Landmarks a Thing of the Past?

by Rick Rutherford, M.D., FAAFP

Ultrasound has improved the safety and efficiency of a wide range of procedures including ultrasound-guided central line insertion

Do we really need to do a modified Allen’s Test before Radial Arterial Line Insertion?

by Joseph Esherick, M.D., FAAFP, FHM

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.

How to Differentiate Pleural Effusion Exudates from Transudates

by Joseph Esherick, M.D., FAAFP, FHM

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

Troubleshooting Difficult Intubations

by Joseph Esherick, M.D., FAAFP, FHM

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 is Recommended Over Usual Care for Mechanical Ventilation

by Joseph Esherick, M.D., FAAFP, FHM

Protocolized sedation compared with usual care led to decreased mortality, decreased ICU length of stay, decreased hospital length of stay, and decreased tracheostomy rates.

Video laryngoscopy has a superior first pass success rate compared with direct laryngoscopy in the ICU

by Joseph Esherick, M.D., FAAFP, FHM

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.