Epidural steroid injections are ineffective for both sciatica and lumbar spinal stenosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Lumbar Puncture, medical procedures, Traumatology
More Tags – epidural steroid injections, HPC updates, lumbar spinal stenosis, sciatica
Two systematic reviews and meta-analyses have demonstrated no long-term benefit for back pain, leg pain, or disability using epidural steroid injections for either sciatica or lumbar spinal stenosis. The first systematic review and meta-analysis in 2012 analyzed 23 trials of…
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Review on pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – HPC updates, intubation, mechanical ventilation, pneumonia
This is an excellent review on the diagnosis, triage, and management of both community-acquired pneumonia and healthcare-associated pneumonia (HCAP).  This review also contains important information about clinical scoring tools to know which patients require admission, which patients require ICU care,…
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Azithromycin to prevent COPD Exacerbations or not?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Respiratory diseases
More Tags – COPD, COPD exacerbations, HPC updates
This is a nice review on azithromycin to prevent chronic obstructive pulmonary disease exacerbations (COPD exacerbations). A recent Cochrane analysis and a retrospective VA study were both found that continuous azithromycin use decreased the incidence of COPD exacerbations in patients…
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Continuous capnography beneficial during mechanical ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Chest Tube, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – capnography, Capnometry, HPC updates, mechanical ventilation
The American Association of Respiratory Care developed a clinical policy describing the benefit of continuous capnography during mechanical ventilation.  This policy statement recommends continuous capnometry during mechanical ventilation for a number of reasons:   1.  It confirms that the endotracheal…
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Noninvasive blood pressure monitoring not ready for prime time

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, medical procedures
More Tags – Arterial Line, HPC updates
Noninvasive continuous arterial pressure monitoring using finger photoplethysmography is not quite ready for prime time.  This technology is comparable to cuff pressures, but this technology is far too variable compared with invasive arterial blood pressure monitoring using an arterial line.…
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Arterial Lines Do Cause Bloodstream Infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Infections, medical procedures
More Tags – Arterial lines, bloodstream infections, HPC updates, Vascular access
Arterial lines are not completely benign.  They can definitely cause catheter-related bloodstream infections.  This study shows that arterial lines have a rate of bloodstream infection of about 1 in 1,000 catheter days.  Femoral arterial lines have a higher rate of…
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Procedural Sedation and Analgesia in the ED

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Procedural Sedation
More Tags – capnography, conscious sedation, HPC updates, procedural sedation
The American College of Emergency Physicians (ACEP) just published a new clinical policy on procedural sedation and analgesia in the emergency department, which revised the previous policy from 2005.1  Procedural sedation (conscious sedation) is extremely common in the ED and…
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What is All the Fuss about Auto-PEEP?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – Auto-PEEP, hemodynamic monitoring, HPC updates, mechanical ventilation, ventilator
Lungs normally empty by passive recoil and the pressure in the alveoli at end-expiration is the intrinsic positive end-expiratory pressure (PEEP).  During spontaneous respirations and with normal lungs, the PEEP is equal to atmospheric pressure.  On a ventilator, auto-PEEP occurs…
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Informed Consent Discussion for Bedside Procedures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures
More Tags – bedside procedures, decision-making capacity, HPC updates, Informed consent
I am frequently asked by my residents, “What elements are needed for informed consent?”  The first place to start is the definition of informed consent.  Applebaum defined informed consent as “the process by which the treating health care provider discloses…
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Ultrasound is More Sensitive Than Chest X-ray for Detection of a Pneumothorax

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Chest Tube, Emergency Procedures, FAST Exam, Medical General, medical procedures, Respiratory diseases
More Tags – E-FAST, HPC updates, pneumothorax, POCUS
Pneumothoraces are a common problem in the ER and the ICU.  The traditional screening test for a pneumothorax in the hospital is the chest radiograph; however, chest radiographs are not very sensitive in the setting of trauma and in ventilated…
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Simulation-Based Procedural Training Improves Job & Patient Satisfaction

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, Chest Tube, Emergency Procedures, medical procedures, Paracentesis
More Tags – HPC updates
Are you a hospitalist who would like to incorporate procedures into your practice but don’t feel competent or confident in your skills?  Are you a hospitalist who does procedures so infrequently that you feel more comfortable referring your patients to…
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