Lower Oxygen Saturation Goals Are Safe in Mechanically Ventilated Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Respiratory diseases
More Tags – Goal peripheral oxygen saturation, HPC updates, Oxygenation goals, PEEP, Positive end expiratory pressure
Targeting to 88%–92% did not cause harm. There is little data on ventilator weaning when it comes to oxygenation goals.  Many intensivists adjust the ventilator to maintain an oxygen saturation of at least 95% to buffer against desaturation.  However, there…
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Fondaparinux appears to be superior to enoxaparin for patients with an NSTEMI

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – Anti-coagulant, HPC updates, Non–ST-segment elevation myocardial infarction, NSTEMI
The anti-Xa anticoagulant lowers bleeding and death rates in a routine clinical care setting. In patients with non–ST-segment elevation myocardial infarction (NSTEMI), the factor Xa inhibitor fondaparinux was noninferior to enoxaparin in reducing ischemic outcomes in the OASIS-5 study. In…
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Differences in Intracerebral Hemorrhage Between Warfarin and New Oral Anticoagulants

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Laryngeal Mask Airway, medical procedures, Neurological diseases
More Tags – HPC updates, ICH, Intracerebral Hemorrhage, New Oral Anticoagulants, NOACs
In prior randomized trials, the incidence of intracerebral hemorrhage (ICH) was significantly lower with the new oral anticoagulants (NOACs) than with warfarin (Blood 2014; 124:1968).  However, it remains unclear if clinical outcomes are similar when ICH does occur with different…
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The Insertion Site for a Thoracentesis Should not be Close to the Spine

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Thoracentesis
More Tags – Catheter, Guidelines, HPC updates, Saftey techniques, thoracentesis, Ultrasound-guided thoracentesis
Recent studies have determined the best technique for improving the safety of thoracentesis. The patient should be sitting as upright as possible. Then, ultrasound the posterior back and locate a catheter insertion point at least 6 cm lateral to the…
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Conservative Fluid Management Decreases Ventilator Days but not Mortality Compared with Liberal Fluid Management in ARDS

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, medical procedures, Respiratory diseases
More Tags – ARDS, Central venous pressure, Conservative fluid management, CVP, FACTT, FACTT Conservative, FACTT Liberal, FACTT Lite, Fluid and Catheter Treatment Trial, HPC updates, mechanical ventilation, Pulmonary artery occlusion pressure
A retrospective study compared the performance of Fluid and Catheter Treatment Trial (FACTT) Lite, FACTT Conservative, and FACTT Liberal. The prior FACTT demonstrated that conservative fluids is superior to liberal fluids for ARDS. A simplified conservative fluid protocol (FACTT Lite)…
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