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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Antibiotic duration for intra-abdominal infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures
More Tags – HPC updates, intra-abdominal infections, sepsis
In an open-label trial involving adults with complicated intra-abdominal infections at 23 centers in the U.S. and Canada, researchers have investigated whether fixed-duration antimicrobial therapy (4 days) after source control is as effective as the traditional strategy (antibiotic administration until 2 days…
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Lung ultrasound for diagnosis of pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – HPC updates, lung ultrasound, pneumonia, sepsis
Lung ultrasound can detect pneumothorax and pulmonary edema, but limited data exist to quantify its accuracy for diagnosing pneumonia. In a prospective study, investigators compared lung ultrasound to chest computed tomography (CT) and chest x-ray among adult patients presenting with…
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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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Transtracheal Ultrasound Can Confirm Endotracheal Intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Chest Tube, Emergency Procedures, Endotracheal Intubation, medical procedures
More Tags – endotracheal intubation, HPC updates, transtracheal ultrasound
In the emergency department (ED), colorimetric or quantitative capnography is the gold standard for confirmation of endotracheal tube placement. Capnography may be unreliable in patients with severe pulmonary obstruction, greatly reduced pulmonary circulation, or cardiac arrest. Transtracheal ultrasound imaging with…
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GlideScope VL Improves Success of Urgent Intubation by ICU Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, King Tube, medical procedures, Respiratory diseases
More Tags – direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, rapid sequence intubation
Use of video laryngoscopy (VL) results in improved glottic views, fewer intubation attempts, and higher intubation success in both operating room and emergency department (ED) patients. Less is known about performance characteristics of VL during urgent inpatient intubations performed in…
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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…
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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…
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The Bova Score Identifies Patients with Pulmonary Embolism at High Risk of Complications

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, Medical General, medical procedures, Respiratory diseases
More Tags – Bova score, HPC updates, pulmonary embolism, venous thromboembolism
Most patients with pulmonary embolism (PE) do well, and outpatient management is becoming more common. Predicting which patients will have complications would be valuable in order to triage patients for discharge or admission to a ward or intensive care unit…
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Perioperative Hyperglycemia Predicts Postoperative Complications only in Non-Diabetics

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endocrinology
More Tags – diabetes, HPC updates, hyperglycemia, perioperative complications
Perioperative Hyperglycemia Predicts Postoperative Complications only in Non-Diabetics Limited research has suggested that nondiabetic surgical patients who develop perioperative hyperglycemia are at above-average risk for postoperative complications. In this retrospective study, researchers examined the relation between perioperative glucose levels and…
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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…
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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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Prone Positioning Decreases Mortality in Severe ARDS

Mechanical Ventilation for Intubated Patient
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – ARDS, HPC updates, mechanical ventilation, prone positioning
Prone positioning has been in existence since 1974; however, the equipment and technique has now been refined and has proven to decrease mortality in severe ARDS.  Prone positioning decreases the amount of alveolar collapse and decreases V/Q mismatching in patients…
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Complications Common during Prehospital Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – HPC updates, Hypoxia, intubation
Preface:  This retrospective study examined physician performed prehospital intubations between 2008 and 2012 in Scottish aeromedical transport system.  Over 200 intubations were analyzed and 75% of the intubations were during inter facility transport and 25% at the scene.  There was…
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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…
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