Ultrasound-Guided Lumbar Puncture More Successful than Traditional LP in Infants

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Lumbar Puncture, Medical General, medical procedures
More Tags – HPC updates, Infants, lumbar puncture, ultrasound, Ultrasound-guided lumbar puncture
Lumbar puncture (LP), commonly performed in infants to rule out meningitis, is often not successful in the hands of inexperienced operators. Investigators conducted a study of 128 infants younger than 6 months. They compared traditional LP to LP preceded by…
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Propofol vs Ketofol for Procedural Sedation in the ED

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Procedural Sedation
More Tags – HPC updates, Ketofol, procedural sedation, Propofol
In Australia, investigators analyzed 573 random adults from three emergency departments (EDs). These patients were to receive ketofol (a 1:1 mixture of ketamine and propofol) or propofol prior to a painful procedure. Initially, ketofol was administered intravenously at 0.25 mg/kg…
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Lidocaine or Amiodarone for Cardiac Arrest with a Shockable Rhythm?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures
More Tags – Amiodarone, cardiac arrest, Defibrillation, HPC updates, Lidocaine, Shockable Rhythm
After three defibrillation attempts, recommendations state that amiodarone or lidocaine may be considered for patients with cardiac arrest and persistent shockable rhythm.  A randomized, controlled trial was conducted and showed there was no significant difference between amiodarone and lidocaine and…
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Predictors of Difficult Intubation with Hypercurved Glidescope or C-MAC devices

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – C-MAC D-blade, Difficult Intubation, GlideScope, HPC updates, intubation, Videolaryngoscopy
Investigators have conducted a secondary analysis in order to identify predictors of difficult or prolonged intubation with hypercurved videolaryngoscopes. The analysis was of a randomized control trial of 1100 elective surgery patients. After anesthesia and neuromuscular blockade, these patients were…
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CT Alone Can Clear the Cervical Spine in Intoxicated Patients with a Normal Neurological Exam

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Traumatology
More Tags – Computed tomography, CT scans, HPC updates, Magnetic resonance imaging, MRI, Spine Injury
The majority of intoxicated patients with a possible cervical spine injury remain in a cervical collar or undergo magnetic resonance imaging (MRI). This approach is preferred since computed tomography (CT) exams alone are insensitive for detecting ligamentous injuries. A study…
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Pulmonary Embolism in Acute Exacerbations of COPD

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – Chronic Obstructive Pulmonary Disease, Exacerbations, HPC updates, pulmonary embolism
This systematic review shows a high rate of pulmonary embolism (PE) in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations. Symptoms of PE can overlap with those of acute exacerbations of chronic obstructive pulmonary disease (COPD) making the diagnosis…
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MRSA antibiotics are overprescribed in patients hospitalized for community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – antibiotic stewardship, community-acquired pneumonia, HPC updates, mechanical ventilation, MRSA, pneumonia
Are MRSA Antibiotics Overprescribed for Community-Acquired Pneumonia? – NEJM Journal Watch Nearly 30% of hospitalized CAP patients received antibiotics for MRSA, even though fewer than 1% had MRSA-associated CAP. A recent multicenter, prospective, active-surveillance study of 2259 patients hospitalized with…
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How to Manage Patients with Atrial Fibrillation and Prior Intracranial Hemorrhage

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – atrial fibrillation, CHADS2-VASc score, HPC updates, intracranial hemorrhage
It has always been a therapeutic dilemma whether to anticoagulate patients with Afib and a history of prior intracranial hemorrhage (ICH).  This study used a Taiwanese national database to identify 12,917 patients with an ICH history and new AF and…
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Correction for CSF protein in traumatic lumbar punctures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Lumbar Puncture, medical procedures, Neurological diseases, Traumatology
More Tags – HPC updates, lumbar puncture, meningitis
Traumatic lumbar puncture (LP) is fairly common and occurs when the needle causes bleeding into the subarachnoid space. Introduction of peripheral red blood cells (RBCs) in cerebrospinal fluid (CSF) increases CSF protein levels, thereby complicating diagnosis of bacterial meningitis. This…
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Chronic corticosteroid use increases the risk of some infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Dermatology, Emergency Procedures, Endocrinology, Ginecology, Infections, Traumatology
More Tags – bloodstream infections, candidiasis, corticosteroids, HPC updates, respiratory tract infections, steroids, zoster
This population-based cohort study between 2000 and 2012 from the UK’s Health Improvement Network database compared diagnoses between 275,000 adults who had been prescribed corticosteroids and 626,000 who had not been prescribed corticosteroids.  The query was whether corticosteroid recipients had…
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Obesity Hypoventilation Syndrome Is Associated with Serious Postoperative Respiratory Complications

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Respiratory diseases
More Tags – Bilevel noninvasive positive pressure ventilation, BiPAP, CPAP, HPC updates, Nocturnal continuous positive airway pressure, Obesity hypoventilation syndrome, Obstructive sleep apnea, OHS, OSA, Sleep-disordered breathing
Obesity hypoventilation syndrome (OHS) is defined by the triad of obesity (BMI >30 kg/m2), daytime hypoventilation (Paco2 >45 mm Hg), and sleep-disordered breathing in the absence of other causes of hypercapnia, such as severe obstructive lung disease, severe interstitial lung…
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Lower Oxygen Saturation Goals Are Safe in Mechanically Ventilated Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Respiratory diseases
More Tags – Goal peripheral oxygen saturation, HPC updates, Oxygenation goals, PEEP, Positive end expiratory pressure
Targeting to 88%–92% did not cause harm. There is little data on ventilator weaning when it comes to oxygenation goals.  Many intensivists adjust the ventilator to maintain an oxygen saturation of at least 95% to buffer against desaturation.  However, there…
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Fondaparinux appears to be superior to enoxaparin for patients with an NSTEMI

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – Anti-coagulant, HPC updates, Non–ST-segment elevation myocardial infarction, NSTEMI
The anti-Xa anticoagulant lowers bleeding and death rates in a routine clinical care setting. In patients with non–ST-segment elevation myocardial infarction (NSTEMI), the factor Xa inhibitor fondaparinux was noninferior to enoxaparin in reducing ischemic outcomes in the OASIS-5 study. In…
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Serum Procalcitonin Can Help to Differentiate CHF from Pneumonia in ED Patients Complaining of Dyspnea

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures, Nephrology, Respiratory diseases
More Tags – BNP, CHF, dyspnea in ER, Heart failure, HPC updates, pneumonia, procalcitonin
Previous trials have investigated the use of B-type natriuretic peptide (BNP) to assess patients with dyspnea in the ED. The sentinel trial was the BNP (Breathe Not Properly) trial that evaluated nearly 800 patients presenting to the ED with complaints…
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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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