New Oral Anticoagulants are as effective as Warfarin for VTE with less major bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures
More Tags – anticoagulation, DVT, HPC updates, PE, TSOAC, venous thromboembolism, VTE
The new direct target-specific oral anticoagulants (TSOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been compared with vitamin K antagonists (VKAs; warfarin and similar agents) for acute venous thromboembolism (VTE) in six recent phase III clinical trials encompassing more than 27,000…
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IV Contrast May Have Lower Risk of Contrast-Induced Nephropathy than Previously Suspected

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Nephrology
More Tags – acute kidney injury, AKI, contrast-induced nephropathy, HPC updates
In a recent retrospective study from Mayo Clinic, researchers demonstrated that intravenous contrast material was not associated with acute kidney injury (i.e., increase in serum creatinine level of ≥0.5 mg/dL) during the 72 hours after computed tomography (CT) of the…
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Alternative Diagnoses for VAP if BAL is Negative

Mechanical Ventilation for Intubated Patient
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, HPC updates, intubation, pneumonia, VAP
Among the 53% of patients with negative bronchoalveolar lavage results, alternative explanations for fever and for pulmonary infiltrates were established in 61% and 46%, respectively. Chest x-ray abnormalities, leukocytosis, purulent tracheal aspirate, or fever in a mechanically ventilated patient raise…
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Clinical Course after Episodes of Diverticulitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, medical procedures
More Tags – diverticulitis, HPC updates
In nonoperatively managed patients, ≈7% of patients had recurrent episodes, and 2% required emergency surgery during 4 years of follow-up. Some surgeons promote elective surgery after one or two episodes of uncomplicated diverticulitis to prevent recurrences that might require urgent…
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The absence of fever, elevated CRP and SIRS indicates 99.5% negative predictive value for excluding bacteremia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, Medical General, medical procedures
More Tags – bacteremia, elevated CRP, fever, HPC updates, SIRS, Systemic inflammatory response syndrome
A large cohort study out of Denmark examining over 17,000 ER visits by adults determined that the absence of all three criteria fever, elevated CRP and SIRS criteria had a 99.5% negative predictive value for excluding bacteremia. Fever, elevated CRP level,…
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Is oral contrast added to IV contrast necessary for the detection of acute appendicitis?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Medical General, medical procedures
More Tags – acute appendicitis, appendicitis, HPC updates, oral contrast, quality care, randomized trial
In three single-center, randomized trials, oral contrast — given in addition to intravenous (IV) contrast — did not improve the diagnostic accuracy of computed tomographic (CT) scanning for suspected appendicitis. To determine whether this conclusion is generally valid, researchers analyzed…
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Managing Patients with a Submassive Pulmonary Embolism (PE)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures, Respiratory diseases
More Tags – hemodynamic instability, HPC updates, massive PE, pulmonary, pulmonary embolism, submassive PE, thrombolysis
Guidelines recommend that patients with massive pulmonary embolism (PE) and hemodynamic instability be treated with thrombolysis (Circulation 2011; 123:1788). However, consensus is lacking on what to do in intermediate-risk patients (i.e., those who are hemodynamically stable but have right ventricular…
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Optimal Location for Needle Decompression For A Tension Pneumothorax

Hospital Procedure Consultants
More Articles – Central line, Emergency Procedures, medical procedures, Needle Decompression, Respiratory diseases, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – HPC updates, needle decompression, needle decompression 5th intercostal space, needle insertion, needle thoracostomy placement, obstructive shock, pneumothorax
Needle decompression location Traditionally, needle decompression for the emergent treatment of a tension pneumothorax is the second intercostal space in the mid-clavicular line.  This remains an option for needle insertion when you are treating a tension pneumothorax.  This insertion point…
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New trial refutes Epogen or liberal transfusions after traumatic brain injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – Brain injury, epogen, head trauma, HPC updates, neurological recovery, transfusions
A new randomized controlled trial refutes the theory that either Epogen or liberal transfusions will improve neurologic outcome in patients with traumatic brain injury. Head trauma occurs in 1.5 million Americans annually, at a cost of more than $56 billion. Erythropoietin…
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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…
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Does Cricoid Pressure Prevent Aspiration During Endotracheal Intubation?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, medical procedures, Respiratory diseases
More Tags – cricoid pressure, endotracheal intubation, Glidescope intubation, HPC updates, King tube airway, laryngeal mask airway, rapid sequence intubation
There has always been some controversy about the utility of applying cricoid pressure (aka Sellick Maneuver) during rapid sequence intubation for the purpose of preventing aspiration.  Theoretically, applying pressure on the cricoid cartilage posteriorly should occlude the esophagus against the…
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Inpatient vs outpatient treatment of acute DVT

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures
More Tags – Deep vein thrombosis, deep venous thrombosis, DVT, DVT treatment, HPC updates, treatment
Outpatient treatment of acute DVT is as safe as inpatient treatment in patient’s with an adequate home situation. Cohort study of 13,500 patients diagnosed with an acute lower extremity DVT and treated with either low molecular weight heparin or fondaparinux.…
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Should Endotracheal Intubation Become a Videogame?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, Laryngeal Mask Airway, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, GlideScope, HPC updates, intubation, laryngeal mask airway, laryngoscopy
Direct vs Video Laryngoscopy In 1878 William MacEwan first passed a tube into the trachea of an awake patient using his fingers as a guide.  Now health care providers routinely perform endotracheal intubation as a life saving intervention.  Despite over…
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