Catheter-directed thrombolysis for DVT potentially has equivalent mortality rates when compared with systemic anticoagulation alone.

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures
More Tags – catheter-directed thrombolysis, Deep vein thrombosis, HPC updates, post-thrombotic syndrome
Previous trials have shown that catheter-directed thrombolysis (CDT) for proximal deep vein thrombosis has a lower rate of post-thrombotic syndrome compared with systemic anticoagulation alone.  However, a new retrospective cohort study shows that the mortality rates are equivalent and the rates of transfusion,…
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Is oral contrast added to IV contrast necessary for the detection of acute appendicitis?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Medical General, medical procedures
More Tags – acute appendicitis, appendicitis, HPC updates, oral contrast, quality care, randomized trial
In three single-center, randomized trials, oral contrast — given in addition to intravenous (IV) contrast — did not improve the diagnostic accuracy of computed tomographic (CT) scanning for suspected appendicitis. To determine whether this conclusion is generally valid, researchers analyzed…
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Antiretroviral therapy recommended for all HIV-infected patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – antiretroviral, antiretroviral therapy, antiretroviral treatment, antiviral, antiviral society, HIV, HPC updates, infection
New guidelines from the International Antiviral Society recommend antiretroviral therapy for ALL HIV-infected patients Sponsoring Organization: International Antiviral Society–USA (IAS-USA) Target Population: Clinicians who treat HIV-infected patients Key Recommendations Antiretroviral therapy (ART) is recommended for all HIV-infected patients, including those with acute HIV infection—but…
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Assessment, Diagnosis, and Management of Childhood Concussions

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – childhood concussion, concussion, head trauma, HPC updates
Sponsoring Organization: Ontario Neurotrauma Foundation Target Population: Healthcare professionals and others who deal with concussion, including physicians, neuropsychologists, physical therapists, family, and schools/community sports organizations Background and Objective The panel used an evidence-based, systematic review to standardize diagnosis, assessment, and management of…
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Managing Patients with a Submassive Pulmonary Embolism (PE)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures, Respiratory diseases
More Tags – hemodynamic instability, HPC updates, massive PE, pulmonary, pulmonary embolism, submassive PE, thrombolysis
Guidelines recommend that patients with massive pulmonary embolism (PE) and hemodynamic instability be treated with thrombolysis (Circulation 2011; 123:1788). However, consensus is lacking on what to do in intermediate-risk patients (i.e., those who are hemodynamically stable but have right ventricular…
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Study Shows Interesting Results on Mild Hypothermia Treatment for Comatose Survivors

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Paracentesis
More Tags – cardiac arrest, comatose, HPC updates, hypothermia, mild hypothermia treatment, shockable rhythms
Mild hypothermia is standard of care for comatose survivors after cardiac arrest.  Now there is new evidence that survivors of PEA arrest do better neurologically compared with survivors of VF/VT arrests.  A retrospective, single-center study shows comatose survivors with shockable…
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Optimal Location for Needle Decompression For A Tension Pneumothorax

Hospital Procedure Consultants
More Articles – Central line, Emergency Procedures, medical procedures, Needle Decompression, Respiratory diseases, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – HPC updates, needle decompression, needle decompression 5th intercostal space, needle insertion, needle thoracostomy placement, obstructive shock, pneumothorax
Needle decompression location Traditionally, needle decompression for the emergent treatment of a tension pneumothorax is the second intercostal space in the mid-clavicular line.  This remains an option for needle insertion when you are treating a tension pneumothorax.  This insertion point…
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