The HACOR Score can Predict Failure of Noninvasive Positive Pressure Ventilation or BiPAP

ICU Equipment and Nurse in Mechanical Ventilation Course
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, medical procedures, Respiratory diseases
More Tags – BiPAP, HACOR, HPC updates, noninvasive positive pressure ventilation, NPPV, Ventilation
Use of noninvasive positive pressure ventilation (NPPV) or BiPAP can temporarily support ventilation during initial treatment in some patients with respiratory failure. However, many patients fail NPPV and ultimately need intubation. Early intubation or close observation can benefit patients at…
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Ultrasound-Guided Lumbar Puncture More Successful than Traditional LP in Infants

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Lumbar Puncture, Medical General, medical procedures
More Tags – HPC updates, Infants, lumbar puncture, ultrasound, Ultrasound-guided lumbar puncture
Lumbar puncture (LP), commonly performed in infants to rule out meningitis, is often not successful in the hands of inexperienced operators. Investigators conducted a study of 128 infants younger than 6 months. They compared traditional LP to LP preceded by…
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Propofol vs Ketofol for Procedural Sedation in the ED

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Procedural Sedation
More Tags – HPC updates, Ketofol, procedural sedation, Propofol
In Australia, investigators analyzed 573 random adults from three emergency departments (EDs). These patients were to receive ketofol (a 1:1 mixture of ketamine and propofol) or propofol prior to a painful procedure. Initially, ketofol was administered intravenously at 0.25 mg/kg…
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Lidocaine or Amiodarone for Cardiac Arrest with a Shockable Rhythm?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures
More Tags – Amiodarone, cardiac arrest, Defibrillation, HPC updates, Lidocaine, Shockable Rhythm
After three defibrillation attempts, recommendations state that amiodarone or lidocaine may be considered for patients with cardiac arrest and persistent shockable rhythm.  A randomized, controlled trial was conducted and showed there was no significant difference between amiodarone and lidocaine and…
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Opinions on Euthanasia and Physician-Assisted Suicide

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures
More Tags – Euthanasia, HPC updates, Physician-Assisted Suicide
At the moment it is legal to practice euthanasia or physician-assisted suicide (PAS) in the following countries: Netherlands, Belgium, Luxembourg, Colombia, and Canada. PAS only (excludes euthanasia), is allowed in Switzerland and the following five U.S. states: Oregon, Washington, Montana,…
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Predictors of Difficult Intubation with Hypercurved Glidescope or C-MAC devices

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – C-MAC D-blade, Difficult Intubation, GlideScope, HPC updates, intubation, Videolaryngoscopy
Investigators have conducted a secondary analysis in order to identify predictors of difficult or prolonged intubation with hypercurved videolaryngoscopes. The analysis was of a randomized control trial of 1100 elective surgery patients. After anesthesia and neuromuscular blockade, these patients were…
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Guidelines for Imaging and Transfusion in Trauma

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Events, FAST Exam, Medical General, medical procedures, Traumatology
More Tags – FAST exam, Guidelines, HPC updates, National Institute for Health and Care Excellence, NICE, trauma
United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends the following as guidelines for imaging and transfusion in trauma: Key Recommendations Use CT early and liberally in adults with major trauma, even omitting plain films and the focused…
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CT Alone Can Clear the Cervical Spine in Intoxicated Patients with a Normal Neurological Exam

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Traumatology
More Tags – Computed tomography, CT scans, HPC updates, Magnetic resonance imaging, MRI, Spine Injury
The majority of intoxicated patients with a possible cervical spine injury remain in a cervical collar or undergo magnetic resonance imaging (MRI). This approach is preferred since computed tomography (CT) exams alone are insensitive for detecting ligamentous injuries. A study…
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Why are Patients with Cirrhosis Readmitted to the Hospital?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Hospital Procedures, Medical General, medical procedures
More Tags – Alcoholic liver disease, cirrhosis, HPC updates, Nonalcoholic liver disease, readmission
Patients diagnosed with cirrhosis are regularly admitted and readmitted to the hospital. Statistics show that the 90-day readmission rate is approximately 50%. A recent study analyzed the rate of readmission at 30-days and 90-days and the relevant causes among patients…
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When Should You Obtain Neuroimaging in Infants for Possible Abusive Head Trauma?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Respiratory diseases
More Tags – Abusive head trauma, AHT, Brain injury, HPC updates, Neuroimaging
Abusive head trauma (AHT) is extremely difficult to diagnose due to its unreliability and insensitive physical examination findings. A clinical prediction rule to identify subtle AHT was validated through a prospective multicenter study. Included in this study were well-appearing, afebrile…
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Pulmonary Embolism in Acute Exacerbations of COPD

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – Chronic Obstructive Pulmonary Disease, Exacerbations, HPC updates, pulmonary embolism
This systematic review shows a high rate of pulmonary embolism (PE) in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations. Symptoms of PE can overlap with those of acute exacerbations of chronic obstructive pulmonary disease (COPD) making the diagnosis…
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Fentanyl-Based Ventilator Sedation Decreased Ventilator Days in ICU Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – Fentanyl-Based Ventilator, HPC Blog Updates, HPC updates, ICU, intubation, mechanical ventilation, RASS, Richmond Agitation-Sedation Scale
Complications from long-term deep sedation and the lack of adequate pain control for mechanically ventilated intensive care unit (ICU) patients has resulted in the development of sedation protocols emphasizing pain control over sedation. These protocols use either remifentanyl or fentanyl.…
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MRSA antibiotics are overprescribed in patients hospitalized for community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – antibiotic stewardship, community-acquired pneumonia, HPC updates, mechanical ventilation, MRSA, pneumonia
Are MRSA Antibiotics Overprescribed for Community-Acquired Pneumonia? – NEJM Journal Watch Nearly 30% of hospitalized CAP patients received antibiotics for MRSA, even though fewer than 1% had MRSA-associated CAP. A recent multicenter, prospective, active-surveillance study of 2259 patients hospitalized with…
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How to Manage Patients with Atrial Fibrillation and Prior Intracranial Hemorrhage

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – atrial fibrillation, CHADS2-VASc score, HPC updates, intracranial hemorrhage
It has always been a therapeutic dilemma whether to anticoagulate patients with Afib and a history of prior intracranial hemorrhage (ICH).  This study used a Taiwanese national database to identify 12,917 patients with an ICH history and new AF and…
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Correction for CSF protein in traumatic lumbar punctures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Lumbar Puncture, medical procedures, Neurological diseases, Traumatology
More Tags – HPC updates, lumbar puncture, meningitis
Traumatic lumbar puncture (LP) is fairly common and occurs when the needle causes bleeding into the subarachnoid space. Introduction of peripheral red blood cells (RBCs) in cerebrospinal fluid (CSF) increases CSF protein levels, thereby complicating diagnosis of bacterial meningitis. This…
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