Articles tagged "HPC updates"

Open-Lung Recruitment Maneuvers Increased Mortality Compared with Standard PEEP titration for Moderate-Severe Acute Respiratory Distress Syndrome (ARDS)

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

Open Lung recruitment maneuvers using PEEP titration based on respiratory system compliance increased mortality compared with ARDSNet PEEP titration in moderate-severe ARDS.

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.

Drones Deliver AEDs Faster than Ambulances in Out-of Hospital Cardiac Arrests

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

A shock from an automated external defibrillators can save lives in cardiac arrests from ventricular fibrillation or ventricular tachycardia if delivered early. Drones might be a solution to get an AED to cardiac arrest victims especially in rural America.

Blood Cultures are Not Recommended for Most Non-Severe Cases of UTI, Cellulitis, or Pneumonia

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

Blood cultures rarely change empiric antibiotic management and can lead to unnecessary increased costs and length of stays for patients admitted for non-severe cases of urinary tract infections, community-acquired pneumonias and cellulitis

Anticoagulation is Likely Beneficial for Portal Vein Thrombosis in Cirrhosis

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

This meta-analysis shows higher portal vein recanalization, lower cirrhosis progression, and no excess bleeding risk with anticoagulant treatment for portal vein thrombosis in patients with cirrhosis.

Higher Baseline Serum Creatinine Increases Mortality for Hospitalized Patients with Cirrhosis

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

This study showed that a rise in serum creatinine (SCr) of 0.7 mg/mL from baseline had 68% sensitivity and 80% specificity for predicting 30-day mortality in hospitalized patients with cirrhosis. This level of acute kidney injury (AKI) also doubled the chance of mortality within 30 days compared with cirrhotic patients without AKI.

A Negative High-Sensitivity Troponin and Reassuring EKG Can Rule out Acute MI

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

This meta-analysis demonstrates that a negative high-sensitivity cardiac troponin measured at least 3 hours after symptom onset in association with an EKG with no evidence of ischemia or injury can effectively rule out an acute myocardial infarction (AMI).

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.

2017 Consensus Guidelines on the Approach to Syncope in Adults and Children

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

2017 consensus syncope guidelines from American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS), in collaboration with the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine, and endorsed by the Pediatric and Congenital Electrophysiology Society

Extended cardiac monitoring is indicated for evaluation of cryptogenic strokes in elderly patients

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

Extended cardiac rhythm monitoring, repeated three times in 6 months, significantly increased detection of paroxysmal atrial fibrillation in elderly patients with cryptogenic strokes.

Antimicrobial Stewardship Recommends Shorter Duration of Antibiotics for Community-Acquired Pneumonia and Healthcare-Associated Pneumonia

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

Many physicians prescribe antibiotics for a much longer duration than guideline recommendations to treat community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP).

Misdiagnosed Cellulitis Increases Unnecessary Hospital Admissions and Antibiotic Use

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

In this retrospective study, 30% of patients hospitalized and treated for cellulitis were misdiagnosed.

When to Stop CPR for Out-of-Hospital Cardiac Arrest?

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

This study of out-of-hospital cardiac arrest (OHCA) showed that resuscitation efforts should continue and patients should be transported to the hospital if there is ROSC (return of spontaneous circulation), a shock has been delivered, or if EMS witnessed the arrest.

To Intubate or Not Intubate During In-Hospital Codes?

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

This observational study suggests that intubation during inpatient cardiac arrest was associated with worse outcomes.

Summary of Sepsis and Septic Shock Treatment in 2017

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

The 2016 Surviving Sepsis Guidelines have just been released and summarize the current international guidelines for the management of patients with sepsis and septic shock

Accuracy of Urine Electrolytes to Assess Etiology of Acute kidney injury

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

Both the fractional excretion of sodium (FENa) and the fractional excretion of urea (FEUrea) have an established role as part of the work-up for determining if acute kidney injury (AKI) is due to a prerenal or intrarenal cause. Although both the FENa and FEUrea are helpful, they both have their limitations.

Elevated Cardiac Troponin Levels Are Not Always Due to Acute Coronary Syndromes

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

High-sensitivity troponin assays have improved the sensitivity of the test but the specificity for acute coronary syndromes (ACS) has decreased over time.

Continuous-Infusion Beta-Lactam Antibiotics is Superior to Intermittent Dosing in Septic Patients?

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

This meta-analysis demonstrates that continuous infusion beta-lactam antibiotics compared with traditional intermittent antibiotic dosing lowers 30-day mortality in septic patients.

Predictors of Difficult Intubation with Hypercurved Glidescope or C-MAC devices

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

In a study of controlled intubations in the OR using acute-angled videolaryngoscopes, “sniffing” head position, reduced mouth opening, and attending intubators were associated with prolonged intubation times.

Guidelines for Imaging and Transfusion in Trauma

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

New NICE guideline recommend early, whole-body computed tomography for adults with major trauma; for trauma with suspected hemorrhage, use blood and tranexamic acid (TXA) instead of crystalloid for treatment.

CT Alone Can Clear the Cervical Spine in Intoxicated Patients with a Normal Neurological Exam

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

Modern CT scans of the cervical spine alone is sufficient to rule out significant C-spine injury in patients without focal neurological deficits, even when they are intoxicated.

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.

When Should You Obtain Neuroimaging in Infants for Possible Abusive Head Trauma?

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

Abusive head trauma (AHT) is difficult to diagnose because history is unreliable and physical exam findings are insensitive. Now a new Pittsburgh Infant Brain Injury Score has been validated to help determine which infants should undergo neuroimaging for possible AHT.

MRSA antibiotics are overprescribed in patients hospitalized for community-acquired pneumonia

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

Empiric antibiotics that cover methicillin-resistant staph aureus (MRSA) are overprescribed for adults admitted to the hospital for community-acquired pneumonia (CAP).

How to Manage Patients with Atrial Fibrillation and Prior Intracranial Hemorrhage

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

Patients with AF and prior ICH should undergo warfarin anticoagulation if they have valvular AF or non-valvular AF and a CHADS2-VASc score of 6 or more. On the other hand, patients with AF, diabetes and vascular disease but have a CHADS2-VASc score of 5 or less should probably have no antithrombotic therapy due to a high risk of recurrent ICH.

Best practice for Treatment of Patients Hospitalized for Community-Acquired Pneumonia

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

Early administration of antibiotics within 8 hours and use of objective criteria to transition from intravenous to oral therapy when patients reach clinical stability is best practice for patients hospitalized for community-acquired pneumonia (CAP).

Chronic corticosteroid use increases the risk of some infections

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

This large cohort study documents the degree to which chronic corticosteroids increase certain types of infections

The Risk that Chest Pain Represents Acute Coronary Syndrome

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

Chest pain is a leading cause of ED admissions and hospital admissions. This meta-analysis isolates certain risk factors and prognostic scoring systems that are best at predicting whether chest pain represents ACS

Obesity Hypoventilation Syndrome Is Associated with Serious Postoperative Respiratory Complications

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

Obesity hypoventilation syndrome (OHS) is associated with a high incidence of postoperative respiratory failure. OHS is often detected by preoperative hypercapnia in obese patients.

Lower Oxygen Saturation Goals Are Safe in Mechanically Ventilated Patients

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

This study randomized 104 ventilated patients into two arms: a conservative strategy arm with a goal peripheral oxygen saturation of 88%–92% and a liberal strategy with a goal peripheral oxygen saturation of >95%.

Conservative Fluid Management Decreases Ventilator Days but not Mortality Compared with Liberal Fluid Management in ARDS

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

A retrospective study compared the performance of Fluid and Catheter Treatment Trial (FACTT) Lite, FACTT Conservative, and FACTT Liberal.

First Pass Success Rate is Better for Ultrasound-Guided Radial Artery Line Placement vs Palpation-Guided Placement

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

Ultrasound-guided technique showed significant improvement in the first-attempt success rate. Adults and pediatric patients both benefit from the ultrasound-guided technique.

Atraumatic Spinal Needles Significantly Decrease the Risk of Post-Dural Puncture Headaches or Spinal Headaches

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

Atraumatic spinal needles reduce the incidence and severity of post-dural puncture headaches, or spinal headaches, compared with traumatic spinal needles.

New Classification of ARDS Predicts Hospital Mortality

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

Hospital mortality increases steadily as the severity of acute respiratory distress syndrome (ARDS) increases. Presently, the mortality of patients in the hospital with ARDS is higher than 40%.

Which Patients with Cirrhotic Ascites Admitted to the Hospital Need a Paracentesis?

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).

What Size Catheter Should I Use For Needle Decompression For a Tension Pneumothorax?

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

Needle decompression catheter should be at least 6.5 cm in length to ensure that 95% of patients would have penetration into the pleural space.

Risk Factors for Difficult Ventilation with a Laryngeal mask Airway

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

Using the PLAD Score can help clinicians take certain precautions in treatment plans, such as having alternate airway options available, to help reduce morbidity and mortality rates.

Serum Procalcitonin Can Help to Differentiate CHF from Pneumonia in ED Patients Complaining of Dyspnea

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

Two studies suggest that a serum procalcitonin level of 0.10-ng/mL or higher suggests pneumonia over heart failure as the cause of acute dyspnea in ED patients requiring hospitalization.

A Modified Allen’s Test is Not Needed Prior to Radial Artery Catheter Placement

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

Two recent trials confirm that an abnormal modified Allen's test does not preclude radial artery catheter placement.

Consensus Recommendations on Diagnostic Approach to Chest Pain in the Emergency Department

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

A multidisciplinary group from 13 major organizations provides consensus recommendations on the appropriate radiologic imaging guidelines for four clinical scenarios presenting as chest pain in the ED.

An Update on the Treatment of Venous Thromboembolic Disease

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

Every four years the American College of Chest Physicians (ACCP) disseminates a new set of guidelines on the evaluation and management of venous thromboembolic disease (VTE).

Ultrasound-Guided Thoracentesis is Probably Safe Even When Patients are Taking Clopidogrel (Plavix)

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

A prospective cohort single center study was conducted to analyze the risk associated with patients undergoing thoracentesis or small-bore chest tube placement while taking clopidogrel.

Essential to Administer Antibiotics Immediately if Bacterial Meningitis is Suspected

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

The amendment of the Swedish guidelines to remove impaired mental status as a contraindication for lumbar punctures without prior CT scan led to more favorable outcomes.

Updated International Guidelines for Post–Cardiac Arrest Care

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

The European Resuscitation Council and the European Society of Intensive Care Medicine have collaborated to produce these post-resuscitation care guidelines

MRI Is Not Needed for Cervical Spine Clearance in Obtunded Blunt Trauma Patients

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

For blunt trauma patients who are not evaluable because of depressed level of consciousness, an MRI is not needed if the CT scan of the C-spine is normal.

Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

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

Many clinicians admit that they do not follow CDC guidelines for arterial catheter insertion even though the rate of bloodstream infections is similar between central lines and arterial lines.

Antimicrobial impregnated caps decrease the rate of catheter-related bloodstream infections

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

Antimicrobial impregnated caps on IV ports reduce the incidence of central line-associated bloodstream infections in a high-risk cancer unit

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.

New Recommendations for Evaluation of Patients with Suspected Acute Pulmonary Emboli

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

The American College of Physicians has just released clinical practice guidelines on how to evaluate patients with a suspected acute PE.

Steroids are beneficial for hospitalized patients with community-acquired pneumonia

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

Steroids appear to decrease mortality, need for mechanical ventilation, ARDS, and hospital length of stay for patients admitted for community-acquired pneumonia (CAP).

Managing Patients with a Submassive Pulmonary Embolism (PE)

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

It is unequivocal that systemic thrombolysis is indicated for massive PE associated with obstructive shock. What is less clear is how to manage the patients with a submassive PE. This meta-analysis concludes that thrombolysis is associated with a lower all-cause mortality but an increased risk of major bleeding including intracranial hemorrhage.