Updated Guidelines on Acute Pancreatitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Dermatology, Gastrointestinal diseases, Medical General, medical procedures
More Tags – Acute pancreatitis, Diagnosis, Epidemiology, HPC updates, Management
Acute pancreatitis (AP) has increased in the past decade and accounts for over 275,000 annual hospital admissions in the U.S. and estimated medical costs of $2.5 billion. Noteworthy points are as follows: Morbid obesity and DM 2 are independent risk…
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Choosing Wisely Recommendations by American College of Emergency Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Nephrology, Respiratory diseases, Traumatology
More Tags – back pain, CT scans, HPC updates, nephrolithiasis, pulmonary embolus, sinusitis, syncope
Choosing Wisely is an initiative by the American Board of Internal Medicine that solicits evidence-based recommendations by other specialty associations to identify tests or procedures in their field which are unnecessary.  The following are a set of five recommendations that…
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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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Physicians Attire Can Contribute to the Unintentional Spread of Bacteria

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured Procedure, Medical General, medical procedures
More Tags – HPC updates, infection control, stethoscopes
Physicians and healthcare workers have long known that certain articles of clothing can act as fomites with the potential of spreading infection.  The best studied articles of clothing and equipment that can contribute to this spread include neckties, scarfs, stethoscopes,…
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New GOLD Guidelines for COPD Exacerbations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endocrinology, Mechanical Ventilation, Medical General, Respiratory diseases
More Tags – COPD, HPC updates, mechanical ventilation, noninvasive ventilation, procalcitonin, steroids
Beta2-agonists and anticholinergics are the initial bronchodilators Prednisone 1 mg/kg/day (up to 60 mg/day) or steroid equivalent for moderate-severe exacerbations x 5-7 days Antibiotics indicated for moderate-severe exacerbations with pulmonary infiltrate or sputum purulence –procalcitonin level >0.25 ng/mL supports antibiotic…
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Anticoagulation is Likely Beneficial for Portal Vein Thrombosis in Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Hematology, Medical General, medical procedures, Thoracentesis
More Tags – anticoagulation, cirrhosis, HPC updates, portal vein thrombosis
The optimal treatment of portal vein thrombosis in patients with cirrhosis has been a topic of debate for quite some time.  To this date there have been no large prospective, randomized controlled trials to help guide management in these patients. …
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A Low Peripheral Neutrophil-Lymphocyte Ratio Can Help to Exclude a Subarachnoid Hemorrhage

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, Medical General, medical procedures
More Tags – CT scan, Headache, HPC updates, subarachnoid hemorrhage
An elevated peripheral neutrophil-lymphocyte ratio is an indicator of inflammation. Investigators from a Turkish university hospital hypothesized that this ratio might differ in patients with subarachnoid hemorrhage (SAH) versus those with other headache syndromes. They performed a retrospective study of…
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2017 Consensus Guidelines on the Approach to Syncope in Adults and Children

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, Oncology, Respiratory diseases, Traumatology
More Tags – Aortic dissection, aortic stenosis, AV block, cancer, Cardiac ischemia, cardiac syncope, Cardiac tamponade, diabetes mellitus, GI bleed, heart block, Heart failure, HPC updates, Hypertrophic cardiomyopathy, pulmonary embolism, Severe prosthetic valve dysfunction, syncope, trauma
Key Recommendations 1). Initial evaluation Conduct physical exam, history (with careful attention to factors in Tables 1 & 2) and resting electrocardiogram (ECG) to identify a possible cause (see Tables 2 & 3). 2). Disposition from the emergency department (ED)…
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Extended cardiac monitoring is indicated for evaluation of cryptogenic strokes in elderly patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Medical General, medical procedures, Neurological diseases
More Tags – atrial fibrillation, cardiac monitoring, cryptogenic strokes, HPC updates, ischemic strokes, stroke
Prior studies have found that in patients with cryptogenic ischemic strokes, extended post-stroke cardiac monitoring detects intermittent atrial fibrillation (AF) in up to 20% of cases. Now, an industry-sponsored study from Germany randomized 400 patients all over 60 years old…
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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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When to Stop CPR for Out-of-Hospital Cardiac Arrest?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Hematology, Medical General, medical procedures
More Tags – cardiac arrest, CPR, HPC updates, out of hospital cardiac arrest, return of spontaneous circulation, ROSC
The Universal Termination of Resuscitation Guidelines suggest that resuscitation should be terminated if at least four rounds of CPR have occurred and the following three criteria are met: The arrest was NOT witnessed by emergency medical services (EMS) There has…
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To Intubate or Not Intubate During In-Hospital Codes?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Gastrointestinal diseases, Medical General, medical procedures, Respiratory diseases
More Tags – advanced airway, asystole, cardiac arrest, CPR, HPC updates, intubation, PEA, pulseless electrical activity, ROSC, ventricular fibrillation, ventricular tachycardia
The 2015 American Heart Association Advanced Cardiovascular Life Support guidelines deemphasizes advanced airway placement during the initial resuscitation. Out-of-hospital–arrest data suggest lower survival among patients who are intubated in the field.  Therefore, it is important to determine the importance of…
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Shock Index Predicts Increased Mortality Risk in General Emergency Department Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures
More Tags – emergency department triage, HPC updates, shock, shock index
The shock index — the ratio of heart rate to systolic blood pressure — is a new measure that may predict a poor outcome. Most of the studies using the shock index have been in trauma patients and those with…
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