Which cirrhotic patients are at high risk for bleeding during hospital procedures?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Featured Procedure, Hospital Procedures, Lumbar Puncture, medical procedures, Paracentesis, Thoracentesis
More Tags – Bleed risk, central line, HPC updates, paracentesis, Procedures in Cirrhotic Patients, thoracentesis
How do we assess a cirrhotic patients bleed risk prior to a planned bedside procedure?  Can our standard platelet count and coagulation studies, prothrombin time (PT/INR) and partial thromboplastin time (aPTT), accurately predict bleed risk in cirrhotic patients?  The quick…
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IV Contrast CT Scans Do Not Significantly Increase the Risk of Acute Kidney Injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Hospital Procedures, medical procedures, Nephrology
More Tags – acute kidney injury, CT scan, featured, HPC updates
Researchers from the Mayo Clinic Rochester performed a retrospective study of data from 5758 adults with chronic kidney disease (CKD; stages 1−5) who underwent either noncontrast CT or iodixanol-enhanced contrast CT and who had pre- and post-CT serum creatinine measurements. All of…
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Steroids of No Benefit for Severe Alcoholic Hepatitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endocrinology, Featured, Gastrointestinal diseases, Hospital Procedures
More Tags – alcoholic hepatitis, hepatitis, HPC updates, steroids
Severe alcoholic hepatitis as defined by a Maddrey’s Discriminant Function [MDF] score, >32 can carry risk for 1-month mortality of greater than 50%. Current AASLD guidelines recommend corticosteroids (prednisolone 40 mg daily for 28 days) for patients with severe acute…
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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)…
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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),…
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Las Vegas Conference 2017

Hospital Procedure Consultants
More Articles – Events, Gastrointestinal diseases, Hospital Procedures, Medical General, Travel
More Tags – Bellagio, conference, hospitalist, HPC, Las Vegas, Miracle Mile Shops, Planet Hollywood, travel blog
Landed in Las Vegas for Our Conference at the Amazing Planet Hollywood Resort and Hotel. It was great to see all the familiar faces and many new ones from across the country. Enjoyed walking along the trendy shops and playing the…
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Antipyretics Do Not Change Mortality in Septic Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – HPC updates, nosocomial infections, sepsis
Fever is universally treated in the setting of infection in virtually all hospitals, but does treatment of fever improve outcomes in patients with sepsis? This meta-analysis of eight randomized trials (1507 patients) and six observational studies (2058 patients) that compared…
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Continuous Infusion of Beta-Lactam Antibiotics is Superior to Intermittent Dosing for Sepsis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – antibiotics, beta-lactam antibiotics, HPC updates, sepsis, septic shock
The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics.  Time-dependent antibiotics have increased bactericidal activity the…
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Think PE in Elderly Patients Hospitalized for Syncope

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures, Respiratory diseases
More Tags – CT pulmonary angiogram, D-dimer, HPC updates, pulmonary embolism, syncope, ventilation-perfusion lung scan
Although pulmonary embolism (PE) occasionally presents with syncope, patients with syncope are infrequently assessed for PE. This prospective study from Italy studied 560 elderly adults (mean age, 76) who were hospitalized for syncope. Those excluded from the study included patients…
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Elevated Cardiac Troponin Levels Are Not Always Due to Acute Coronary Syndromes

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hospital Procedures, Infections, Medical General, medical procedures, Respiratory diseases
More Tags – Aortic dissection, cardioversion, HPC updates, myocardial infarction, myocarditis, NSTEMI, pulmonary embolus, pulmonary hypertension, sepsis, stroke, troponin
Cardiac troponin assays have gone through a tremendous evolution since they were introduced into clinical labs in 1995 until the most recent ultra-sensitive assays became prevalent in 2007.  The original troponin T (TnT) and troponin I (TnI) assays had a…
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