Articles tagged "Featured procedure"

Emergency Department Intubations Are Increasingly Successful

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

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.

Why are Patients with Cirrhosis Readmitted to the Hospital?

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

Top causes for hospital readmission in patients with cirrhosis were acute complications of cirrhosis (especially hepatic encephalopathy), substance abuse, and cancer complications.

Alternative Tests 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

The subclavian vein may be the preferred location over IJ and Femoral Locations for Central Line Placement

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

This prospective randomized study of complications related to central line location favors subclavian lines over internal jugular lines and femoral lines.

In plane ultrasound-guided central line placement is preferred over out-of-plane technique

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

A study from an urban EM residency program determined that in-plane ultrasound-guided central venous catheterization is superior to out-of-plane ultrasound-guided central line placement.

Video Laryngoscopy after Failed Intubation Attempt in the ER

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

After an initial failure, emergency department intubators were more successful with video laryngoscopy than with a direct laryngoscopy, regardless of which device was used initially.

Summary of AASLD Practice Guidelines on Cirrhotic Ascites - Paracentesis Indicated for all Hospitalized Patients

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

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).

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

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.