Iso-osmolar Contrast Rarely Causes Contrast-induced Nephropathy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, medical procedures, Nephrology
More Tags – acute kidney injury, featured, HPC updates
Several studies in 2014 suggested that intravenous iodinated contrast use in computed tomography (CT) scanning was not associated with acute kidney injury.  Now, the Mayo Clinic has performed a retrospective study of data investigating 5758 adults with chronic kidney disease…
Read More

New Two Probe Technique for Ultrasound-guided Paracentesis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, medical procedures, Paracentesis
More Tags – featured, HPC updates, paracentesis
A recent study of nearly 5,000 ultrasound-guided paracenteses concluded that the risk of major bleeding can be reduced if a two probe technique is used compared with a single probe approach.  The traditional single probe approach to ultrasound-guided paracentesis utilizes…
Read More

Avoid Routine Lab Testing in Clinically Stable Hospitalized Adults

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Events, Featured, Hospital Procedures, medical procedures
More Tags – daily lab testing, featured, HPC updates
The Society of Hospital Medicine in collaboration with the Choosing Wisely organization has advocated against routine daily lab testing for hospitalized adults since September 2013.  At that time SHM wrote, “Hospitalized patients frequently have considerable volumes of blood drawn (phlebotomy)…
Read More

Paracentesis: Do I Really Need the Ultrasound?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Featured, medical procedures, Paracentesis
More Tags – featured procedure, HPC updates, paracentesis, Ultrasound-Guided Paracentesis, ultrasound-guided procedures
In residency, I spent a great deal of time at the bedside assessing for shifting dullness in patients who may have had ascites.  Today, when I ask residents about shifting dullness, I often get blank stares.  “Why would I do…
Read More

Open-Lung Recruitment Maneuvers Increased Mortality Compared with Standard PEEP titration for Moderate-Severe Acute Respiratory Distress Syndrome (ARDS)

Patient Sleeping with Nurse in Mechanical Ventilation Cours
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Hospital Procedures, medical procedures, Respiratory diseases
More Tags – ARDS, featured, HPC updates, intubation, mechanical ventilation
There have been multiple strategies to determine the “optimal PEEP” in acute respiratory distress syndrome (ARDS).  One strategy is to perform a recruitment maneuver using an “Open Lung” approach and neuromuscular blockade (with pressures as high as 60 cm H2O),…
Read More

For Pediatric Procedural Sedation Ketamine Monotherapy Is the Safest Way to Go

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Mechanical Ventilation, medical procedures, Procedural Sedation
More Tags – HPC updates, procedural sedation
Researchers assessed the incidence of sedation-related serious adverse events (SAEs) and risk factors for them in a prospective cohort study of children ≤18 years of age presenting to six Canadian pediatric emergency departments (EDs) and requiring sedation for painful procedures.…
Read More