Drones Deliver AEDs Faster than Ambulances in Out-of Hospital Cardiac Arrests

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – automated external defibrillators, cardiac arrest, HPC updates, ventricular fibrillation, ventricular tachycardia
Out-of-hospital cardiac arrests (OHCA) have a survival rate of only 8-10%.  The most critical factors for patient survival is the early administration of good bystander CPR and early defibrillation in shockable rhythms.  Currently, defibrillators are transported to OHCA victims only…
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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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Safe Ways to Rule Out Pulmonary Embolism without Using a CT Pulmonary Angiogram

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures, Respiratory diseases
More Tags – D-dimer, deep venous thrombosis, HPC updates, pulmonary embolism
Pulmonary embolism (PE) is one of the most difficult to diagnose and potentially fatal disorders in medicine.  Because of this, CT pulmonary angiograms (CTPA) are over utilized so as to not miss this potentially fatal problem.  There are three ways…
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Septic Cancer Patients May Have A Decreased Mortality Using a Liberal Versus a Restrictive Transfusion Threshold

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, Oncology
More Tags – cancer, HPC updates, sepsis, transfusion
There is now very convincing evidence to support a restrictive transfusion threshold — hemoglobin, <7 g/dL — for most critically ill patients that is supported by guidelines from the American Association of Blood Banks and the TRICC and FOCUS trials. …
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A Negative High-Sensitivity Troponin and Reassuring EKG Can Rule out Acute MI

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures, Traumatology
More Tags – acute coronary syndrome, acute myocardial infarction, chest pain, HPC updates
One of the more common presenting complaints to an ED is the adult presenting with chest pain.  In addition, one of the most common reasons for admission to a hospitalist service is the “Chest pain rule out MI” admitting diagnosis.…
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A Low Peripheral Neutrophil-Lymphocyte Ratio Can Help to Exclude a Subarachnoid Hemorrhage

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, Medical General, medical procedures
More Tags – CT scan, Headache, HPC updates, subarachnoid hemorrhage
An elevated peripheral neutrophil-lymphocyte ratio is an indicator of inflammation. Investigators from a Turkish university hospital hypothesized that this ratio might differ in patients with subarachnoid hemorrhage (SAH) versus those with other headache syndromes. They performed a retrospective study of…
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2017 Consensus Guidelines on the Approach to Syncope in Adults and Children

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, Oncology, Respiratory diseases, Traumatology
More Tags – Aortic dissection, aortic stenosis, AV block, cancer, Cardiac ischemia, cardiac syncope, Cardiac tamponade, diabetes mellitus, GI bleed, heart block, Heart failure, HPC updates, Hypertrophic cardiomyopathy, pulmonary embolism, Severe prosthetic valve dysfunction, syncope, trauma
Key Recommendations 1). Initial evaluation Conduct physical exam, history (with careful attention to factors in Tables 1 & 2) and resting electrocardiogram (ECG) to identify a possible cause (see Tables 2 & 3). 2). Disposition from the emergency department (ED)…
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Semi-upright vs Supine Position for Emergency Intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, medical procedures, Respiratory diseases
More Tags – emergent intubation, endotracheal intubation, HPC updates, intubation, rapid sequence intubation
Prior studies have suggested that patients should be intubated emergently in an upright, head-forward position rather than in the traditional supine position.  This is especially true for intubations of morbidly obese patients where it is known that pre-oxygenation and intubation in…
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Antimicrobial Stewardship Recommends Shorter Duration of Antibiotics for Community-Acquired Pneumonia and Healthcare-Associated Pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – antibiotic stewardship, antimicrobial stewardship, CAP, community-acquired pneumonia, HCAP, healthcare-associate pneumonia, HPC updates, pneumonia
The Infectious Diseases Society of America (IDSA) guidelines remain the gold standard guidelines for infectious disease problems.  The IDSA recommends treating patients with community-acquired pneumonia (CAP) for 5 days and it recommends treating those with healthcare-associated pneumonia (HCAP) for 7-8…
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Misdiagnosed Cellulitis Increases Unnecessary Hospital Admissions and Antibiotic Use

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Dermatology, Emergency Procedures, Gastrointestinal diseases, Hematology, Infections, medical procedures
More Tags – cellulitis, contact dermatitis, gout or pseudogout, HPC updates, skin infection, venous stasis dermatitis, venous thrombosis
There are multiple noninfectious medical disorders that mimic cellulits.  In this retrospective study, researchers focused on misdiagnosis of cellulitis in 259 patients hospitalized with presumed diagnoses of lower extremity cellulitis at a Boston teaching hospital. Patients with complicating factors (e.g.,…
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When to Stop CPR for Out-of-Hospital Cardiac Arrest?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Hematology, Medical General, medical procedures
More Tags – cardiac arrest, CPR, HPC updates, out of hospital cardiac arrest, return of spontaneous circulation, ROSC
The Universal Termination of Resuscitation Guidelines suggest that resuscitation should be terminated if at least four rounds of CPR have occurred and the following three criteria are met: The arrest was NOT witnessed by emergency medical services (EMS) There has…
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To Intubate or Not Intubate During In-Hospital Codes?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Gastrointestinal diseases, Medical General, medical procedures, Respiratory diseases
More Tags – advanced airway, asystole, cardiac arrest, CPR, HPC updates, intubation, PEA, pulseless electrical activity, ROSC, ventricular fibrillation, ventricular tachycardia
The 2015 American Heart Association Advanced Cardiovascular Life Support guidelines deemphasizes advanced airway placement during the initial resuscitation. Out-of-hospital–arrest data suggest lower survival among patients who are intubated in the field.  Therefore, it is important to determine the importance of…
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Shock Index Predicts Increased Mortality Risk in General Emergency Department Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures
More Tags – emergency department triage, HPC updates, shock, shock index
The shock index — the ratio of heart rate to systolic blood pressure — is a new measure that may predict a poor outcome. Most of the studies using the shock index have been in trauma patients and those with…
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Continuous-Infusion Beta-Lactam Antibiotics is Superior to Intermittent Dosing in Septic Patients?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, Medical General, medical procedures
More Tags – beta-lactam antibiotics, critical illness, HPC updates, sepsis, septic shock, severe sepsis
The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics which depend on maintaining drug concentrations above…
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Pulmonary Embolism Is Common in Elderly Patients Hospitalized for Syncope

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, Medical General, medical procedures, Respiratory diseases
More Tags – D-dimer, HPC updates, pulmonary embolism, syncope, venous thromboembolism, Wells score
Although pulmonary embolism (PE) occasionally presents with syncope, patients with syncope are infrequently assessed for PE. In this prospective study from Italy, researchers determined the prevalence of PE in 560 elderly adults (mean age, 76) who were hospitalized for their…
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