Avoid Routine Proton Pump Inhibitor Therapy for Prophylaxis in Hospitalized Patients

Hospital Procedure Consultants
More Articles – Mechanical Ventilation, Medical General, medical procedures
More Tags – HPC updates, Prophylaxis
Avoid Routine Proton Pump Inhibitor Therapy for Prophylaxis in Hospitalized Patients Preface:  A retrospective study at a Boston hospital examined the effect of routine proton pump inhibitor therapy in hospitalized stroke patients.  No clear benefit was seen and multivariate analysis…
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How to Reduce Recurrent Nephrolithiasis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Medical General, medical procedures, Nephrology, Paracentesis
More Tags – diuretics, HPC updates, kidney stones, nephrolithiasis, thiazides
Advise patients to drink at least 2 L daily; consider thiazide diuretics, citrate therapy and allopurinol for patients with “active” calcium stone formation. American College of Physicians (ACP) Key Recommendations Increased fluid intake to achieve 2 L of urine output daily…
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Are Thienopyridines like Plavix Really Beneficial for Unstable Angina or NSTEMI?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Thoracentesis
More Tags – HPC updates, NSTEMI, Plavix, Thienopyridines, unstable angina
In a new meta-analysis, early management of non–ST-segment elevation myocardial infarctions with thienopyridines was not associated with significantly lower mortality and did not lower major adverse cardiovascular event rates for those eventually undergoing PCI. Current ACC/AHA guidelines support dual antiplatelet…
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Summary of Updated Acute Ischemic Stroke guidelines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Medical General, medical procedures
More Tags – HPC updates, ischemic stroke, stroke, TPA
The American Heart Association/American Stroke Association has updated its comprehensive acute ischemic stroke care guidelines in 2013. The following is a summary of the most important new recommendations: Teleradiology networks are recommended for community hospitals that lack access to neurological…
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Pre-hospital cardiac arrest patients do best with supraglottic airway or BVM ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Endotracheal Intubation, King Tube, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – airway management, cardiac arrest, HPC updates, intubation, King tube, supraglottic airways
Cardiac arrest patients who were intubated had similar outcomes to those who had a supraglottic airway device (e.g., King tube) inserted in the pre-hospital setting. A literature review of 5 studies and over 300,000 patients with pre-hospital cardiac arrest demonstrated…
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Organisms That Cause Sepsis Are Changing, and Sepsis Management and Recognition Has Improved

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, Medical General, medical procedures
More Tags – HPC updates, ICU, quality care, sepsis, sepsis management, sepsis treatment
Preface: Nice summary of the changing pathogenic organisms causing severe sepsis.  This summary also displays how improved sepsis recognition and management has decreased mortality from 40% to 28% over the last decade. Mortality decreased from 40% to 28% overall. Although…
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New Study Suggests Continued Statin Use After ICH Improves Outcomes

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures, Neurological diseases
More Tags – HPC updates, ICU Quality Care, Intracerebral Hemorrhage, intracranial hemorrhage, Statins
Preface: The SPARCL trial made clinicians wary that high-dose statins may increase the risk of intracranial hemorrhage (ICH). This new observational study suggests that continued statin use after ICH appears to improve outcomes. The SPARCL trial (Stroke Prevention through Aggressive Reduction…
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New Study Identifies 7 Interventions to Decrease 30-day Readmission Rates

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures
More Tags – HPC updates, ICU, quality care, readmission rates, self-care, study
Preface: New study identifies 7 interventions to decrease the 30-day readmission rates.  The most effective interventions involved case workers and Improving patients ability to provide self-care at home. Study design: Meta-analysis. Setting: Forty-seven studies in multiple locations. Synopsis: This study evaluated…
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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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Study Shows Interesting Results on Mild Hypothermia Treatment for Comatose Survivors

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Paracentesis
More Tags – cardiac arrest, comatose, HPC updates, hypothermia, mild hypothermia treatment, shockable rhythms
Mild hypothermia is standard of care for comatose survivors after cardiac arrest.  Now there is new evidence that survivors of PEA arrest do better neurologically compared with survivors of VF/VT arrests.  A retrospective, single-center study shows comatose survivors with shockable…
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Can ultrasound predict volume responsiveness better than CVP?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central line, Medical General
More Tags – point of care ultrasound; IVC ultrasound: volume responsiveness; fluid responsiveness; volume status
For decades we have relied on static measurements of volume status such as central venous pressure, pulmonary artery occlusion pressure and right ventricular end diastolic volume.  CVP has been shown to have little better than a coin toss chance of…
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Massive Price Reduction on HPC Hospitalist and Emergency Procedures CME courses

Hospital Procedure Consultants
More Articles – Arterial line, Emergency Procedures, Medical General, Paracentesis, Thoracentesis
Early Registration Discount for ALL 2014 Hospitalist and Emergency Procedures CME courses is now $150 for physicians and $200 for nurse practitioners, physicians assistants, medical students, resident physicians, and military physicians Click Here for PDF version May 13, 2014 –…
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