Accuracy of Urine Electrolytes to Assess Etiology of Acute kidney injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, medical procedures, Nephrology
More Tags – acute glomerulonephritis, acute interstitial nephritis, acute kidney injury, acute tubular necrosis, diuretics, HPC updates, prerenal azotemia
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…
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Elevated Cardiac Troponin Levels Are Not Always Due to Acute Coronary Syndromes

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hospital Procedures, Infections, Medical General, medical procedures, Respiratory diseases
More Tags – Aortic dissection, cardioversion, HPC updates, myocardial infarction, myocarditis, NSTEMI, pulmonary embolus, pulmonary hypertension, sepsis, stroke, troponin
Cardiac troponin assays have gone through a tremendous evolution since they were introduced into clinical labs in 1995 until the most recent ultra-sensitive assays became prevalent in 2007.  The original troponin T (TnT) and troponin I (TnI) assays had a…
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Continuous-Infusion Beta-Lactam Antibiotics is Superior to Intermittent Dosing in Septic Patients?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, Medical General, medical procedures
More Tags – beta-lactam antibiotics, critical illness, HPC updates, sepsis, septic shock, severe sepsis
The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics which depend on maintaining drug concentrations above…
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Pulmonary Embolism Is Common in Elderly Patients Hospitalized for Syncope

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, Medical General, medical procedures, Respiratory diseases
More Tags – D-dimer, HPC updates, pulmonary embolism, syncope, venous thromboembolism, Wells score
Although pulmonary embolism (PE) occasionally presents with syncope, patients with syncope are infrequently assessed for PE. In this prospective study from Italy, researchers determined the prevalence of PE in 560 elderly adults (mean age, 76) who were hospitalized for their…
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The HACOR Score can Predict Failure of Noninvasive Positive Pressure Ventilation or BiPAP

ICU Equipment and Nurse in Mechanical Ventilation Course
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, medical procedures, Respiratory diseases
More Tags – BiPAP, HACOR, HPC updates, noninvasive positive pressure ventilation, NPPV, Ventilation
Use of noninvasive positive pressure ventilation (NPPV) or BiPAP can temporarily support ventilation during initial treatment in some patients with respiratory failure. However, many patients fail NPPV and ultimately need intubation. Early intubation or close observation can benefit patients at…
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Ultrasound-Guided Lumbar Puncture More Successful than Traditional LP in Infants

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Lumbar Puncture, Medical General, medical procedures
More Tags – HPC updates, Infants, lumbar puncture, ultrasound, Ultrasound-guided lumbar puncture
Lumbar puncture (LP), commonly performed in infants to rule out meningitis, is often not successful in the hands of inexperienced operators. Investigators conducted a study of 128 infants younger than 6 months. They compared traditional LP to LP preceded by…
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Propofol vs Ketofol for Procedural Sedation in the ED

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Procedural Sedation
More Tags – HPC updates, Ketofol, procedural sedation, Propofol
In Australia, investigators analyzed 573 random adults from three emergency departments (EDs). These patients were to receive ketofol (a 1:1 mixture of ketamine and propofol) or propofol prior to a painful procedure. Initially, ketofol was administered intravenously at 0.25 mg/kg…
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Lidocaine or Amiodarone for Cardiac Arrest with a Shockable Rhythm?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures
More Tags – Amiodarone, cardiac arrest, Defibrillation, HPC updates, Lidocaine, Shockable Rhythm
After three defibrillation attempts, recommendations state that amiodarone or lidocaine may be considered for patients with cardiac arrest and persistent shockable rhythm.  A randomized, controlled trial was conducted and showed there was no significant difference between amiodarone and lidocaine and…
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Opinions on Euthanasia and Physician-Assisted Suicide

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures
More Tags – Euthanasia, HPC updates, Physician-Assisted Suicide
At the moment it is legal to practice euthanasia or physician-assisted suicide (PAS) in the following countries: Netherlands, Belgium, Luxembourg, Colombia, and Canada. PAS only (excludes euthanasia), is allowed in Switzerland and the following five U.S. states: Oregon, Washington, Montana,…
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Predictors of Difficult Intubation with Hypercurved Glidescope or C-MAC devices

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – C-MAC D-blade, Difficult Intubation, GlideScope, HPC updates, intubation, Videolaryngoscopy
Investigators have conducted a secondary analysis in order to identify predictors of difficult or prolonged intubation with hypercurved videolaryngoscopes. The analysis was of a randomized control trial of 1100 elective surgery patients. After anesthesia and neuromuscular blockade, these patients were…
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Guidelines for Imaging and Transfusion in Trauma

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Events, FAST Exam, Medical General, medical procedures, Traumatology
More Tags – FAST exam, Guidelines, HPC updates, National Institute for Health and Care Excellence, NICE, trauma
United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends the following as guidelines for imaging and transfusion in trauma: Key Recommendations Use CT early and liberally in adults with major trauma, even omitting plain films and the focused…
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CT Alone Can Clear the Cervical Spine in Intoxicated Patients with a Normal Neurological Exam

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Traumatology
More Tags – Computed tomography, CT scans, HPC updates, Magnetic resonance imaging, MRI, Spine Injury
The majority of intoxicated patients with a possible cervical spine injury remain in a cervical collar or undergo magnetic resonance imaging (MRI). This approach is preferred since computed tomography (CT) exams alone are insensitive for detecting ligamentous injuries. A study…
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Why are Patients with Cirrhosis Readmitted to the Hospital?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Hospital Procedures, Medical General, medical procedures
More Tags – Alcoholic liver disease, cirrhosis, HPC updates, Nonalcoholic liver disease, readmission
Patients diagnosed with cirrhosis are regularly admitted and readmitted to the hospital. Statistics show that the 90-day readmission rate is approximately 50%. A recent study analyzed the rate of readmission at 30-days and 90-days and the relevant causes among patients…
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When Should You Obtain Neuroimaging in Infants for Possible Abusive Head Trauma?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Respiratory diseases
More Tags – Abusive head trauma, AHT, Brain injury, HPC updates, Neuroimaging
Abusive head trauma (AHT) is extremely difficult to diagnose due to its unreliability and insensitive physical examination findings. A clinical prediction rule to identify subtle AHT was validated through a prospective multicenter study. Included in this study were well-appearing, afebrile…
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Pulmonary Embolism in Acute Exacerbations of COPD

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – Chronic Obstructive Pulmonary Disease, Exacerbations, HPC updates, pulmonary embolism
This systematic review shows a high rate of pulmonary embolism (PE) in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations. Symptoms of PE can overlap with those of acute exacerbations of chronic obstructive pulmonary disease (COPD) making the diagnosis…
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