New Classification of ARDS Predicts Hospital Mortality

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – Acute respiratory distress syndrome, ARDS, HPC updates, mechanical ventilation
Presently, the mortality of patients in the hospital with acute respiratory distress syndrome (ARDS) is higher than 40%.  A sixteen month long observational study was conducted to determine if certain cutoff points of PaO2/FiO2 (less than or equal to 200…
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What Size Catheter Should I Use For Needle Decompression For a Tension Pneumothorax?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, medical procedures, Needle Decompression, Respiratory diseases, Traumatology
More Tags – chest tube, Chest wall thickness, HPC updates, Needle decompression catheter, Pleural space, Tension pneumothorax, tube thoracostomy
A recent meta-analysis of 13 studies that were investigating needle decompression compared data of sample size, mean chest wall thickness, and decompression success rates. The meta-analysis concluded that the needle decompression catheter should be at least 6.5 cm in length…
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Differences Between Lumbar Punctures in Children Vs Lumbar Punctures in Adults

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Lumbar Puncture, Medical General, medical procedures
More Tags – CSF Lactate Level, HPC updates, lumbar puncture, Pediatric Lumbar Puncture
Pediatric lumbar punctures can have much higher success rates when proper positioning and technique are emphasized. The position should be the lateral decubitus position with hips flexed, but the neck does not need to be flexed. The spinal cord ends…
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Risk Factors for Difficult Ventilation with a Laryngeal mask Airway

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Laryngeal Mask Airway, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – Difficult LMA, HPC updates, laryngeal mask airway, LMA, PLAD Score, Predictive Laryngeal Mask Airway Difficulty Score, Risk Factors
Recently, a retrospective review of over 14,000 adult patients who underwent general anesthesia were assessed. A multivariable analysis was used to determine risk factors of difficult laryngeal mask airways (LMA). The following four risk factors were identified: male gender, age…
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Serum Procalcitonin Can Help to Differentiate CHF from Pneumonia in ED Patients Complaining of Dyspnea

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures, Nephrology, Respiratory diseases
More Tags – BNP, CHF, dyspnea in ER, Heart failure, HPC updates, pneumonia, procalcitonin
Previous trials have investigated the use of B-type natriuretic peptide (BNP) to assess patients with dyspnea in the ED. The sentinel trial was the BNP (Breathe Not Properly) trial that evaluated nearly 800 patients presenting to the ED with complaints…
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A Modified Allen’s Test is Not Needed Prior to Radial Artery Catheter Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Events, Medical General, medical procedures
More Tags – Allen's test, Handgrip Strength Test, HPC updates, Radial Artery Catheterization, Thumb Capillary Lactate, Thumb Plethysmography, Ulnar Frame Count
A study was executed to decipher the best cut-off point for a positive Allen’s test. Ninety-three hands of 47 patients undergoing coronary artery bypass surgery were screened. The average age of the patients was 63.3 years. Independent observers examined these…
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Consensus Recommendations on Diagnostic Approach to Chest Pain in the Emergency Department

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures, Traumatology
More Tags – acute coronary syndrome, chest pain, ECG, Emergency Department, HPC updates, Suspected Acute Aortic Syndromes
Target Audience: Emergency clinicians Background: A multidisciplinary group of emergency physicians, radiologists, cardiologists, and others has developed appropriateness criteria for the use of imaging to help inform clinicians for four clinical scenarios presenting as chest pain in the ED. Key…
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An Update on the Treatment of Venous Thromboembolic Disease

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Hospital Procedures, Medical General, Oncology
More Tags – anticoagulation, cancer, Deep vein thrombosis, DVT, HPC updates, Updated guidelines, Venous Thromboembolic Disease, VTD
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). The ACCP just released its updated guidelines for the treatment of VTE and I…
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Ultrasound-Guided Thoracentesis is Probably Safe Even When Patients are Taking Clopidogrel (Plavix)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Hematology, King Tube, Medical General, medical procedures, Thoracentesis, Traumatology
More Tags – Clopidogrel, HPC updates, Plavix, Risks, Small-bore chest tube, thoracentesis
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. Twenty-five patients taking clopidogrel gave consent to remain on the antiplatelet medication while undergoing thoracentesis…
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Essential to Administer Antibiotics Immediately if Bacterial Meningitis is Suspected

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Infections, Lumbar Puncture, Medical General, medical procedures, Neurological diseases
More Tags – Acute Bacterial Meningitis, CT scan, Guidelines, HPC updates, lumbar puncture
Prior to the revised Swedish lumbar puncture guideline, a CT scan was often performed prior to lumbar puncture when acute bacterial meningitis was suspected. Taking the time to perform a CT scan of the head before lumbar puncture delays treatment…
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Updated International Guidelines for Post–Cardiac Arrest Care

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Chest Tube, Emergency Procedures, Hematology, Medical General, medical procedures
More Tags – cardiac arrest, coronary angiography, HPC updates, percutaneous coronary intervention, post-cardiac arrest care, return of spontaneous circulation, ROSC, vasopressors
These guidelines are for physicians who care for patients with return of spontaneous circulation (ROSC) after cardiac arrest, including emergency physicians, critical care physicians, and cardiologists These guidelines update the 2010 International Liaison Committee on Resuscitation guidelines for patients with…
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MRI Is Not Needed for Cervical Spine Clearance in Obtunded Blunt Trauma Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Laryngeal Mask Airway, medical procedures, Traumatology
More Tags – blunt trauma, C-spine clearance, cervical spine injury, head trauma, HPC updates
A systematic review found no significant missed injuries in obtunded blunt trauma patients who had normal CT imaging of their cervical spines. Given the significant morbidity and mortality associated with missed traumatic cervical spine injuries, patients in whom a reliable…
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Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Arterial line insertion, Arterial line placement, Arterial line-associated bloodstream infections, Catheter-related bloodstream infections, Central line insertion, Central line-associated bloodstream infections, Device-related infections, HPC updates, Vascular access
Arterial line-associated bloodstream infections occur at rate of 0.9-3.4 infections per thousand catheter-days. This rate of infections is similar to the risk of central line-associated bloodstream infections (CLABSIs). The CDC guidelines for arterial line placement recommend the use of chlorhexidine…
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Antimicrobial impregnated caps decrease the rate of catheter-related bloodstream infections

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Catheter-related bloodstream infections, Central line-associated bloodstream infections, central lines, central venous catheters, Device-related infections, HPC updates, Vascular access
The goal of zero device-related infections is what CMS desires for all hospitals, but is not a realistic goal.  Nevertheless, we can do everything in our power to minimize central line-associated bloodstream infections (CLABSIs).  We now can appreciate that the…
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New Recommendations for Evaluation of Patients with Suspected Acute Pulmonary Emboli

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures, Respiratory diseases
More Tags – D-dimer, HPC updates, pulmonary embolism, venous thromboembolism, VTE
The ACP CPG on the evaluation of patients with a suspected acute PE has the following primary recommendations: Use a validated clinical prediction rule to estimate pretest probability in patients with a possible acute PE (options include the Wells criteria…
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