Summary of Sepsis and Septic Shock Treatment in 2017

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Hematology, Infections, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – ARDS, Arterial lines, central lines, hemodynamic monitoring, HPC updates, mechanical ventilation, sepsis, septic shock, vasopressors
Definitions Presumed source with SIRS criteria = infection Infection with life-threatening organ dysfunction = sepsis Sepsis refractory to intravenous fluid challenge = septic shock Treatment of sepsis or septic shock Draw blood cultures x 2 Analyze any fluid that may…
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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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Differences in Intracerebral Hemorrhage Between Warfarin and New Oral Anticoagulants

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Laryngeal Mask Airway, medical procedures, Neurological diseases
More Tags – HPC updates, ICH, Intracerebral Hemorrhage, New Oral Anticoagulants, NOACs
In prior randomized trials, the incidence of intracerebral hemorrhage (ICH) was significantly lower with the new oral anticoagulants (NOACs) than with warfarin (Blood 2014; 124:1968).  However, it remains unclear if clinical outcomes are similar when ICH does occur with different…
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An Update on the Treatment of Venous Thromboembolic Disease

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Hospital Procedures, Medical General, Oncology
More Tags – anticoagulation, cancer, Deep vein thrombosis, DVT, HPC updates, Updated guidelines, Venous Thromboembolic Disease, VTD
Every four years the American College of Chest Physicians (ACCP) disseminates a new set of guidelines on the evaluation and management of venous thromboembolic disease (VTE). The ACCP just released its updated guidelines for the treatment of VTE and I…
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Ultrasound-Guided Thoracentesis is Probably Safe Even When Patients are Taking Clopidogrel (Plavix)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Hematology, King Tube, Medical General, medical procedures, Thoracentesis, Traumatology
More Tags – Clopidogrel, HPC updates, Plavix, Risks, Small-bore chest tube, thoracentesis
A prospective cohort single center study was conducted to analyze the risk associated with patients undergoing thoracentesis or small-bore chest tube placement while taking clopidogrel. Twenty-five patients taking clopidogrel gave consent to remain on the antiplatelet medication while undergoing thoracentesis…
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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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New Recommendations for Evaluation of Patients with Suspected Acute Pulmonary Emboli

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures, Respiratory diseases
More Tags – D-dimer, HPC updates, pulmonary embolism, venous thromboembolism, VTE
The ACP CPG on the evaluation of patients with a suspected acute PE has the following primary recommendations: Use a validated clinical prediction rule to estimate pretest probability in patients with a possible acute PE (options include the Wells criteria…
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Lumbar puncture characteristics of traumatic LP versus subarachnoid hemorrhage

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Lumbar Puncture, medical procedures, Traumatology
More Tags – HPC updates, lumbar puncture, subarachnoid hemorrhage, traumatic lumbar puncture
Differences between Traumatic LPs and SAH. How Traumatic lumbar punctures Impact Healthcare Decisions.How to Differentiate Traumatic Lumbar Punctures from Aneurysmal Subarachnoid Hemorrhage The diagnosis of subarachnoid hemorrhage (SAH) often requires lumbar puncture, however, in an estimated 10% to 30% of…
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The Benefits and Risks of Dual Antiplatelet Therapy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Events, Hematology, Hospital Procedures, medical procedures, Neurological diseases
More Tags – Antiplatelet therapy, coronary stent, HPC updates, major adverse cardiac events, PCI, percutaneous coronary intervention
The key points of dual antiplatelet therapy are that there is NO mortality benefit for DAPT vs ASA alone; there is a small but significant decrease in coronary stent thrombosis and major adverse cardiac events, but there is also an…
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Hepatic Encephalopathy with Acute Decompensated Cirrhosis and Acute-on- Chronic Liver Failure

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Hematology, Hospital Procedures, medical procedures
More Tags – cirrhosis, GI bleeding, hepatic encephalopathy, HPC updates
Hepatic encephalopathy (HE) is one of the major complications of cirrhosis, and recent evidence suggests that hospitalized cirrhotic HE patients with acute decompensation and, especially, acute-on-chronic liver failure (ACLF) have extremely poor outcomes. The current review article discusses the pathophysiology…
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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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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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Direct-Acting Oral Anticoagulants Have a Lower Mortality than Warfarin for Nonvalvular Afib

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Hospital Procedures, medical procedures
More Tags – anticoagulation, atrial fibrillation, HPC updates
Compared with warfarin, the new agents significantly reduced all-cause and vascular mortality. The new direct-acting oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been found to be noninferior to vitamin K antagonists in clinical trials of stroke prevention in…
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Catheter-directed thrombolysis for DVT potentially has equivalent mortality rates when compared with systemic anticoagulation alone.

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures
More Tags – catheter-directed thrombolysis, Deep vein thrombosis, HPC updates, post-thrombotic syndrome
Previous trials have shown that catheter-directed thrombolysis (CDT) for proximal deep vein thrombosis has a lower rate of post-thrombotic syndrome compared with systemic anticoagulation alone.  However, a new retrospective cohort study shows that the mortality rates are equivalent and the rates of transfusion,…
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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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