Updated Guidelines on Acute Pancreatitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Dermatology, Gastrointestinal diseases, Medical General, medical procedures
More Tags – Acute pancreatitis, Diagnosis, Epidemiology, HPC updates, Management
Acute pancreatitis (AP) has increased in the past decade and accounts for over 275,000 annual hospital admissions in the U.S. and estimated medical costs of $2.5 billion. Noteworthy points are as follows: Morbid obesity and DM 2 are independent risk…
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Blood Cultures are Not Recommended for Most Non-Severe Cases of UTI, Cellulitis, or Pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Dermatology, Emergency Procedures, Infections, medical procedures, Nephrology, Respiratory diseases
More Tags – bacteremia, cellulitis, community-acquired pneumonia, HPC updates, pneumonia, UTI
In many hospitals, blood cultures have become a reflexive habit for patients presenting to the ER with any suspected infection.  This was, in part, due to the inappropriate addition of routine blood cultures as a core measure in 2001 by…
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Summary of Sepsis and Septic Shock Treatment in 2017

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Hematology, Infections, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – ARDS, Arterial lines, central lines, hemodynamic monitoring, HPC updates, mechanical ventilation, sepsis, septic shock, vasopressors
Definitions Presumed source with SIRS criteria = infection Infection with life-threatening organ dysfunction = sepsis Sepsis refractory to intravenous fluid challenge = septic shock Treatment of sepsis or septic shock Draw blood cultures x 2 Analyze any fluid that may…
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Guidelines for Imaging and Transfusion in Trauma

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Events, FAST Exam, Medical General, medical procedures, Traumatology
More Tags – FAST exam, Guidelines, HPC updates, National Institute for Health and Care Excellence, NICE, trauma
United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends the following as guidelines for imaging and transfusion in trauma: Key Recommendations Use CT early and liberally in adults with major trauma, even omitting plain films and the focused…
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First Pass Success Rate is Better for Ultrasound-Guided Radial Artery Line Placement vs Palpation-Guided Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, medical procedures
More Tags – Arterial Line, First-attempt success rate, HPC updates, Palpation-guided placement, Ultrasound-guided radial artery line placement
In 2015 a meta-analysis found that when an ultrasound was used during a radial arterial catheter placement the first pass success rate improved. In the eleven trials that met inclusion criteria over 800 patients were enrolled. Compared to the palpation-guided…
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A Modified Allen’s Test is Not Needed Prior to Radial Artery Catheter Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Events, Medical General, medical procedures
More Tags – Allen's test, Handgrip Strength Test, HPC updates, Radial Artery Catheterization, Thumb Capillary Lactate, Thumb Plethysmography, Ulnar Frame Count
A study was executed to decipher the best cut-off point for a positive Allen’s test. Ninety-three hands of 47 patients undergoing coronary artery bypass surgery were screened. The average age of the patients was 63.3 years. Independent observers examined these…
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Consensus Recommendations on Diagnostic Approach to Chest Pain in the Emergency Department

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures, Traumatology
More Tags – acute coronary syndrome, chest pain, ECG, Emergency Department, HPC updates, Suspected Acute Aortic Syndromes
Target Audience: Emergency clinicians Background: A multidisciplinary group of emergency physicians, radiologists, cardiologists, and others has developed appropriateness criteria for the use of imaging to help inform clinicians for four clinical scenarios presenting as chest pain in the ED. Key…
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Updated International Guidelines for Post–Cardiac Arrest Care

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Chest Tube, Emergency Procedures, Hematology, Medical General, medical procedures
More Tags – cardiac arrest, coronary angiography, HPC updates, percutaneous coronary intervention, post-cardiac arrest care, return of spontaneous circulation, ROSC, vasopressors
These guidelines are for physicians who care for patients with return of spontaneous circulation (ROSC) after cardiac arrest, including emergency physicians, critical care physicians, and cardiologists These guidelines update the 2010 International Liaison Committee on Resuscitation guidelines for patients with…
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Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Arterial line insertion, Arterial line placement, Arterial line-associated bloodstream infections, Catheter-related bloodstream infections, Central line insertion, Central line-associated bloodstream infections, Device-related infections, HPC updates, Vascular access
Arterial line-associated bloodstream infections occur at rate of 0.9-3.4 infections per thousand catheter-days. This rate of infections is similar to the risk of central line-associated bloodstream infections (CLABSIs). The CDC guidelines for arterial line placement recommend the use of chlorhexidine…
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The Reasons Hospitalists Should Learn Hospital Procedures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, FAST Exam, Glidescope Intubation, Hospital Procedures, King Tube, Lumbar Puncture, Medical General, medical procedures, Needle Decompression, Paracentesis, RUSH Exam, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – emergency procedures, hospital procedures, HPC updates, medical procedures, simulation-based procedural training
Hospitalists are in the ideal position to perform bedside procedures on their patients. They know every aspect about their patients and have had the opportunity to develop a good rapport and the trust of their patients. So, why are they…
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Ultrasound-guided radial arterial line placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Emergency Procedures, medical procedures
More Tags – Arterial line placement, HPC updates, ultrasound-guided arterial lines
Radial artery catheters are frequently placed in the emergency department (ED) and intensive care unit (ICU) for hemodynamic monitoring and arterial blood gas analysis. A number of small studies have compared ultrasound-guided placement of radial artery catheters to traditional placement…
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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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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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Massive Price Reduction on HPC Hospitalist and Emergency Procedures CME courses

Hospital Procedure Consultants
More Articles – Arterial line, Emergency Procedures, Medical General, Paracentesis, Thoracentesis
Early Registration Discount for ALL 2014 Hospitalist and Emergency Procedures CME courses is now $150 for physicians and $200 for nurse practitioners, physicians assistants, medical students, resident physicians, and military physicians Click Here for PDF version May 13, 2014 –…
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