The Bova Score Identifies Patients with Pulmonary Embolism at High Risk of Complications

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, Medical General, medical procedures, Respiratory diseases
More Tags – Bova score, HPC updates, pulmonary embolism, venous thromboembolism
Most patients with pulmonary embolism (PE) do well, and outpatient management is becoming more common. Predicting which patients will have complications would be valuable in order to triage patients for discharge or admission to a ward or intensive care unit…
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Perioperative Hyperglycemia Predicts Postoperative Complications only in Non-Diabetics

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endocrinology
More Tags – diabetes, HPC updates, hyperglycemia, perioperative complications
Perioperative Hyperglycemia Predicts Postoperative Complications only in Non-Diabetics Limited research has suggested that nondiabetic surgical patients who develop perioperative hyperglycemia are at above-average risk for postoperative complications. In this retrospective study, researchers examined the relation between perioperative glucose levels and…
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Atrial fibrillation or atrial flutter rate or rhythm control during acute illness can cause adverse consequences

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – atrial fibrillation, atrial flutter, HPC updates, rate control rhythm control
What Should We Do About A-Fib/Flutter when There Is Another Acute Condition? Rapid atrial fibrillation or flutter (A-fib/flutter) can be managed by rate or rhythm control, but prior studies have focused on A-fib/flutter occurring in isolation. Now, investigators have retrospectively…
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Noninvasive Ventilation is Extremely Effective for Severe COPD Exacerbations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – BiPAP, COPD exacerbations, HPC updates, intubation, mechanical ventilation, noninvasive ventilation
Based on meta-analysis of randomized, controlled trials, noninvasive positive pressure ventilation (NPPV) is the only intervention that improves mortality in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). However, many patients who are eligible for this intervention go…
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The clinical characteristics of acute encephalitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Lumbar Puncture, Mechanical Ventilation, medical procedures
More Tags – autoimmune encephalitis, encephalitis, HPC updates, paraneoplastic encephalitis, viral encephalitis
In a review of 198 cases, the principal etiologies were viral infection and autoimmune disease; outcomes were good in about 50%. Due to its relatively low incidence, acute encephalitis remains poorly studied. To better define the etiology, clinical presentation, and…
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Ultrasound-guided radial arterial line placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Emergency Procedures, medical procedures
More Tags – Arterial line placement, HPC updates, ultrasound-guided arterial lines
Radial artery catheters are frequently placed in the emergency department (ED) and intensive care unit (ICU) for hemodynamic monitoring and arterial blood gas analysis. A number of small studies have compared ultrasound-guided placement of radial artery catheters to traditional placement…
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Prone Positioning Decreases Mortality in Severe ARDS

Mechanical Ventilation for Intubated Patient
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – ARDS, HPC updates, mechanical ventilation, prone positioning
Prone positioning has been in existence since 1974; however, the equipment and technique has now been refined and has proven to decrease mortality in severe ARDS.  Prone positioning decreases the amount of alveolar collapse and decreases V/Q mismatching in patients…
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Choosing Wisely Recommendations by the CCSC

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – choosing wisely, HPC updates, mechanical ventilation, parenteral nutrition, transfusions
CHOOSING WISELY RECOMMENDATIONS FROM THE CRITICAL CARE SOCIETIES COLLABORATIVE 1. Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions. Many diagnostic studies (including chest radiographs, arterial blood gases, blood chemistries…
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EEG

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – coma, EEG, electroencephalogram, HPC updates, minimally responsive state, persistent vegetative state
EEG in the Evaluation of Patients with Coma and Other Disorders of Consciousness The clinical evaluation of disorders of consciousness involves the challenge of distinguishing coma from vegetative state (VS) and from minimally conscious state (MCS). Recent neuroimaging studies have…
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Complications Common during Prehospital Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – HPC updates, Hypoxia, intubation
Preface:  This retrospective study examined physician performed prehospital intubations between 2008 and 2012 in Scottish aeromedical transport system.  Over 200 intubations were analyzed and 75% of the intubations were during inter facility transport and 25% at the scene.  There was…
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No role for routine carotid doppler ultrasounds to screen for carotid artery stenosis prior to noncardiac surgery

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – Carotid Artery Stenosis, HPC updates
No role for routine carotid doppler ultrasounds to screen for carotid artery stenosis prior to noncardiac surgery Preface:  Carotid artery doppler ultrasound scans are frequently ordered prior to noncardiac surgery to decrease the chance of a perioperative stroke.  The assumption…
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Steroids beneficial in refractory septic shock

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – HPC updates, septic shock
Steroids beneficial in refractory septic shock Preface:  This multi-center observational study of over 1,800 patients examined whether low-dose steroids (<80 mg prednisone equivalents) was superior to placebo for patients in septic shock.  There results showed that there was a slight…
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New Oral Anticoagulants are as effective as Warfarin for VTE with less major bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures
More Tags – anticoagulation, DVT, HPC updates, PE, TSOAC, venous thromboembolism, VTE
The new direct target-specific oral anticoagulants (TSOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been compared with vitamin K antagonists (VKAs; warfarin and similar agents) for acute venous thromboembolism (VTE) in six recent phase III clinical trials encompassing more than 27,000…
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IV Contrast May Have Lower Risk of Contrast-Induced Nephropathy than Previously Suspected

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Nephrology
More Tags – acute kidney injury, AKI, contrast-induced nephropathy, HPC updates
In a recent retrospective study from Mayo Clinic, researchers demonstrated that intravenous contrast material was not associated with acute kidney injury (i.e., increase in serum creatinine level of ≥0.5 mg/dL) during the 72 hours after computed tomography (CT) of the…
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How to Reduce Recurrent Nephrolithiasis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Medical General, medical procedures, Nephrology, Paracentesis
More Tags – diuretics, HPC updates, kidney stones, nephrolithiasis, thiazides
Advise patients to drink at least 2 L daily; consider thiazide diuretics, citrate therapy and allopurinol for patients with “active” calcium stone formation. American College of Physicians (ACP) Key Recommendations Increased fluid intake to achieve 2 L of urine output daily…
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