Avoid Routine Proton Pump Inhibitor Therapy for Prophylaxis in Hospitalized Patients

Hospital Procedure Consultants
More Articles – Mechanical Ventilation, Medical General, medical procedures
More Tags – HPC updates, Prophylaxis
Avoid Routine Proton Pump Inhibitor Therapy for Prophylaxis in Hospitalized Patients Preface:  A retrospective study at a Boston hospital examined the effect of routine proton pump inhibitor therapy in hospitalized stroke patients.  No clear benefit was seen and multivariate analysis…
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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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Are Thienopyridines like Plavix Really Beneficial for Unstable Angina or NSTEMI?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Thoracentesis
More Tags – HPC updates, NSTEMI, Plavix, Thienopyridines, unstable angina
In a new meta-analysis, early management of non–ST-segment elevation myocardial infarctions with thienopyridines was not associated with significantly lower mortality and did not lower major adverse cardiovascular event rates for those eventually undergoing PCI. Current ACC/AHA guidelines support dual antiplatelet…
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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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