Direct vs Video Laryngoscopy In 1878 William MacEwan first passed a tube into the trachea of an awake patient using his fingers as a guide.  Now health care providers routinely perform endotracheal intubation as a life saving intervention.  Despite over…
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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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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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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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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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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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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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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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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 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 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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For decades we have relied on static measurements of volume status such as central venous pressure, pulmonary artery occlusion pressure and right ventricular end diastolic volume.  CVP has been shown to have little better than a coin toss chance of…
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