Antimicrobial impregnated caps decrease the rate of catheter-related bloodstream infections

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Catheter-related bloodstream infections, Central line-associated bloodstream infections, central lines, central venous catheters, Device-related infections, HPC updates, Vascular access
The goal of zero device-related infections is what CMS desires for all hospitals, but is not a realistic goal.  Nevertheless, we can do everything in our power to minimize central line-associated bloodstream infections (CLABSIs).  We now can appreciate that the…
Read More

Bactrim or Septra and Spironolactone is a potentially deadly combination

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures
More Tags – Drug interactions, HPC updates, hyperkalemia, Sudden death
A Canadian team has performed a population-based case-control study in Ontario to determine whether this interaction might confer risk for sudden death, which can be triggered by hyperkalemia. During an 18-year period, 349 patients (age, ≥66) died suddenly while taking both…
Read More

The Benefits and Risks of Dual Antiplatelet Therapy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Events, Hematology, Hospital Procedures, medical procedures, Neurological diseases
More Tags – Antiplatelet therapy, coronary stent, HPC updates, major adverse cardiac events, PCI, percutaneous coronary intervention
The key points of dual antiplatelet therapy are that there is NO mortality benefit for DAPT vs ASA alone; there is a small but significant decrease in coronary stent thrombosis and major adverse cardiac events, but there is also an…
Read More

Survival to Hospital Discharge After Out-Of-Hospital Cardiac Arrest Is Increasing

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures, Needle Decompression
More Tags – ACLS, cardiac arrest survival, CPR, HPC updates
Previous investigations suggest that survival to hospital discharge following out-of-hospital cardiac arrest (OHCA) has remained stable (7%–8%) over the past 30 years. Recent recommendations regarding bystander and rescuer cardiopulmonary resuscitation (CPR) technique, post-resuscitation protocols, and regionalization of post-arrest care were…
Read More

Atrial fibrillation or atrial flutter rate or rhythm control during acute illness can cause adverse consequences

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – atrial fibrillation, atrial flutter, HPC updates, rate control rhythm control
What Should We Do About A-Fib/Flutter when There Is Another Acute Condition? Rapid atrial fibrillation or flutter (A-fib/flutter) can be managed by rate or rhythm control, but prior studies have focused on A-fib/flutter occurring in isolation. Now, investigators have retrospectively…
Read More

EEG

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – coma, EEG, electroencephalogram, HPC updates, minimally responsive state, persistent vegetative state
EEG in the Evaluation of Patients with Coma and Other Disorders of Consciousness The clinical evaluation of disorders of consciousness involves the challenge of distinguishing coma from vegetative state (VS) and from minimally conscious state (MCS). Recent neuroimaging studies have…
Read More

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…
Read More

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…
Read More

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…
Read More

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…
Read More

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…
Read More

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…
Read More

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…
Read More

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…
Read More

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.…
Read More