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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Is oral contrast added to IV contrast necessary for the detection of acute appendicitis?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Medical General, medical procedures
More Tags – acute appendicitis, appendicitis, HPC updates, oral contrast, quality care, randomized trial
In three single-center, randomized trials, oral contrast — given in addition to intravenous (IV) contrast — did not improve the diagnostic accuracy of computed tomographic (CT) scanning for suspected appendicitis. To determine whether this conclusion is generally valid, researchers analyzed…
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Antiretroviral therapy recommended for all HIV-infected patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – antiretroviral, antiretroviral therapy, antiretroviral treatment, antiviral, antiviral society, HIV, HPC updates, infection
New guidelines from the International Antiviral Society recommend antiretroviral therapy for ALL HIV-infected patients Sponsoring Organization: International Antiviral Society–USA (IAS-USA) Target Population: Clinicians who treat HIV-infected patients Key Recommendations Antiretroviral therapy (ART) is recommended for all HIV-infected patients, including those with acute HIV infection—but…
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Assessment, Diagnosis, and Management of Childhood Concussions

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – childhood concussion, concussion, head trauma, HPC updates
Sponsoring Organization: Ontario Neurotrauma Foundation Target Population: Healthcare professionals and others who deal with concussion, including physicians, neuropsychologists, physical therapists, family, and schools/community sports organizations Background and Objective The panel used an evidence-based, systematic review to standardize diagnosis, assessment, and management of…
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Managing Patients with a Submassive Pulmonary Embolism (PE)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures, Respiratory diseases
More Tags – hemodynamic instability, HPC updates, massive PE, pulmonary, pulmonary embolism, submassive PE, thrombolysis
Guidelines recommend that patients with massive pulmonary embolism (PE) and hemodynamic instability be treated with thrombolysis (Circulation 2011; 123:1788). However, consensus is lacking on what to do in intermediate-risk patients (i.e., those who are hemodynamically stable but have right ventricular…
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Study Shows Interesting Results on Mild Hypothermia Treatment for Comatose Survivors

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Paracentesis
More Tags – cardiac arrest, comatose, HPC updates, hypothermia, mild hypothermia treatment, shockable rhythms
Mild hypothermia is standard of care for comatose survivors after cardiac arrest.  Now there is new evidence that survivors of PEA arrest do better neurologically compared with survivors of VF/VT arrests.  A retrospective, single-center study shows comatose survivors with shockable…
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New trial refutes Epogen or liberal transfusions after traumatic brain injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – Brain injury, epogen, head trauma, HPC updates, neurological recovery, transfusions
A new randomized controlled trial refutes the theory that either Epogen or liberal transfusions will improve neurologic outcome in patients with traumatic brain injury. Head trauma occurs in 1.5 million Americans annually, at a cost of more than $56 billion. Erythropoietin…
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Syntax trial results regarding PCI and CABG

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures, Neurological diseases
More Tags – CABG, cardiac surgery trial, Coronary artery bypass, HPC updates, left main disease, PCI, surgery, syntax
Results of the Syntax trial suggests that PCI and CABG have comparable results for most patients with left main disease. The results suggest that the all-cause mortality was lower with PCI vs CABG in patients with Syntax scores <=32, but…
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Does Cricoid Pressure Prevent Aspiration During Endotracheal Intubation?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, medical procedures, Respiratory diseases
More Tags – cricoid pressure, endotracheal intubation, Glidescope intubation, HPC updates, King tube airway, laryngeal mask airway, rapid sequence intubation
There has always been some controversy about the utility of applying cricoid pressure (aka Sellick Maneuver) during rapid sequence intubation for the purpose of preventing aspiration.  Theoretically, applying pressure on the cricoid cartilage posteriorly should occlude the esophagus against the…
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Inpatient vs outpatient treatment of acute DVT

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures
More Tags – Deep vein thrombosis, deep venous thrombosis, DVT, DVT treatment, HPC updates, treatment
Outpatient treatment of acute DVT is as safe as inpatient treatment in patient’s with an adequate home situation. Cohort study of 13,500 patients diagnosed with an acute lower extremity DVT and treated with either low molecular weight heparin or fondaparinux.…
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COPD Exacerbations: Low-dose vs High-dose Steriods

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Chest Tube, medical procedures, Respiratory diseases
More Tags – care quality, COPD, Exacerbations, high-dose, HPC updates, ICU, low-dose, steriods
Preface: Patients with COPD exacerbations requiring ICU admission did better with low-dose steroids vs high-dose steroids Cohort study of 17,239 patients with COPD exacerbations admitted to the ICU * ​1/3 required noninvasive ventilation * 15% were intubated * Virtually all…
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USPSTF on screening for abdominal aortic aneurysm

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – abdominal aortic aneurysm, HPC updates, screening, smoking, ultrasonography
The USPSTF continues to recommend screening primarily in 65- to 75-year-old men who have ever smoked. U.S. Preventive Services Task Force (USPSTF)​ Background Prevalence of abdominal aortic aneurysms (AAAs; defined by an aortic diameter of ≥3.0 cm) in adults older…
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MRI is useful to distinguish between residual clot versus acute recurrent DVT

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures
More Tags – compression ultrasound, D-dimer, DVT, HPC updates, MRI
Frequently the combination of a serum D-dimer level and compression ultrasound testing can differentiate between a residual venous clot and an acute recurrent DVT.  However, sometimes the results are equivocal and in these situations an MRI direct thrombus imaging can…
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Isolated free fluid on CT Imaging after Blunt Abdominal Trauma: Explore or Wait?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Traumatology
More Tags – abdominal trauma, HPC updates, Trauma CME
Patients with minimal free fluid and no abdominal tenderness can be observed, while patients with moderate-large amounts of free fluid and abdominal tenderness should undergo operative exploration. To determine if operative exploration or observation is the preferred management for hemodynamically…
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