Summary of Updated Acute Ischemic Stroke guidelines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Medical General, medical procedures
More Tags – HPC updates, ischemic stroke, stroke, TPA
The American Heart Association/American Stroke Association has updated its comprehensive acute ischemic stroke care guidelines in 2013. The following is a summary of the most important new recommendations: Teleradiology networks are recommended for community hospitals that lack access to neurological…
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Pre-hospital cardiac arrest patients do best with supraglottic airway or BVM ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Endotracheal Intubation, King Tube, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – airway management, cardiac arrest, HPC updates, intubation, King tube, supraglottic airways
Cardiac arrest patients who were intubated had similar outcomes to those who had a supraglottic airway device (e.g., King tube) inserted in the pre-hospital setting. A literature review of 5 studies and over 300,000 patients with pre-hospital cardiac arrest demonstrated…
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Transexamic Acid Reduces Transfusions and Mortality in Major Bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Ginecology, Hospital Procedures, medical procedures, Traumatology
More Tags – HPC updates, transexamic acid, trauma
Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots). Now…
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Direct-Acting Oral Anticoagulants Have a Lower Mortality than Warfarin for Nonvalvular Afib

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Hospital Procedures, medical procedures
More Tags – anticoagulation, atrial fibrillation, HPC updates
Compared with warfarin, the new agents significantly reduced all-cause and vascular mortality. The new direct-acting oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been found to be noninferior to vitamin K antagonists in clinical trials of stroke prevention in…
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Alternative Diagnoses for VAP if BAL is Negative

Mechanical Ventilation for Intubated Patient
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, HPC updates, intubation, pneumonia, VAP
Among the 53% of patients with negative bronchoalveolar lavage results, alternative explanations for fever and for pulmonary infiltrates were established in 61% and 46%, respectively. Chest x-ray abnormalities, leukocytosis, purulent tracheal aspirate, or fever in a mechanically ventilated patient raise…
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Organisms That Cause Sepsis Are Changing, and Sepsis Management and Recognition Has Improved

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, Medical General, medical procedures
More Tags – HPC updates, ICU, quality care, sepsis, sepsis management, sepsis treatment
Preface: Nice summary of the changing pathogenic organisms causing severe sepsis.  This summary also displays how improved sepsis recognition and management has decreased mortality from 40% to 28% over the last decade. Mortality decreased from 40% to 28% overall. Although…
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New Study Suggests Continued Statin Use After ICH Improves Outcomes

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures, Neurological diseases
More Tags – HPC updates, ICU Quality Care, Intracerebral Hemorrhage, intracranial hemorrhage, Statins
Preface: The SPARCL trial made clinicians wary that high-dose statins may increase the risk of intracranial hemorrhage (ICH). This new observational study suggests that continued statin use after ICH appears to improve outcomes. The SPARCL trial (Stroke Prevention through Aggressive Reduction…
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New Study Identifies 7 Interventions to Decrease 30-day Readmission Rates

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures
More Tags – HPC updates, ICU, quality care, readmission rates, self-care, study
Preface: New study identifies 7 interventions to decrease the 30-day readmission rates.  The most effective interventions involved case workers and Improving patients ability to provide self-care at home. Study design: Meta-analysis. Setting: Forty-seven studies in multiple locations. Synopsis: This study evaluated…
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Clinical Course after Episodes of Diverticulitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, medical procedures
More Tags – diverticulitis, HPC updates
In nonoperatively managed patients, ≈7% of patients had recurrent episodes, and 2% required emergency surgery during 4 years of follow-up. Some surgeons promote elective surgery after one or two episodes of uncomplicated diverticulitis to prevent recurrences that might require urgent…
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The absence of fever, elevated CRP and SIRS indicates 99.5% negative predictive value for excluding bacteremia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, Medical General, medical procedures
More Tags – bacteremia, elevated CRP, fever, HPC updates, SIRS, Systemic inflammatory response syndrome
A large cohort study out of Denmark examining over 17,000 ER visits by adults determined that the absence of all three criteria fever, elevated CRP and SIRS criteria had a 99.5% negative predictive value for excluding bacteremia. Fever, elevated CRP level,…
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High risk for postoperative adverse cardiovascular events during the first 9 months after stroke

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Events, Hospital Procedures, medical procedures
More Tags – adverse cardiovascular events, cardiovascular, HPC updates, ischemic stroke
Risk for postoperative adverse cardiovascular events was especially high during the first 9 months after stroke. If possible, you should wait at least 9 months and preferably 12 months after an ischemic stroke to undergo elective non cardiac surgery. Stroke…
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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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