A Modified Allen’s Test is Not Needed Prior to Radial Artery Catheter Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Events, Medical General, medical procedures
More Tags – Allen's test, Handgrip Strength Test, HPC updates, Radial Artery Catheterization, Thumb Capillary Lactate, Thumb Plethysmography, Ulnar Frame Count
A study was executed to decipher the best cut-off point for a positive Allen’s test. Ninety-three hands of 47 patients undergoing coronary artery bypass surgery were screened. The average age of the patients was 63.3 years. Independent observers examined these…
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Consensus Recommendations on Diagnostic Approach to Chest Pain in the Emergency Department

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures, Traumatology
More Tags – acute coronary syndrome, chest pain, ECG, Emergency Department, HPC updates, Suspected Acute Aortic Syndromes
Target Audience: Emergency clinicians Background: A multidisciplinary group of emergency physicians, radiologists, cardiologists, and others has developed appropriateness criteria for the use of imaging to help inform clinicians for four clinical scenarios presenting as chest pain in the ED. Key…
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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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Essential to Administer Antibiotics Immediately if Bacterial Meningitis is Suspected

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Infections, Lumbar Puncture, Medical General, medical procedures, Neurological diseases
More Tags – Acute Bacterial Meningitis, CT scan, Guidelines, HPC updates, lumbar puncture
Prior to the revised Swedish lumbar puncture guideline, a CT scan was often performed prior to lumbar puncture when acute bacterial meningitis was suspected. Taking the time to perform a CT scan of the head before lumbar puncture delays treatment…
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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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MRI Is Not Needed for Cervical Spine Clearance in Obtunded Blunt Trauma Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Laryngeal Mask Airway, medical procedures, Traumatology
More Tags – blunt trauma, C-spine clearance, cervical spine injury, head trauma, HPC updates
A systematic review found no significant missed injuries in obtunded blunt trauma patients who had normal CT imaging of their cervical spines. Given the significant morbidity and mortality associated with missed traumatic cervical spine injuries, patients in whom a reliable…
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Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Arterial line insertion, Arterial line placement, Arterial line-associated bloodstream infections, Catheter-related bloodstream infections, Central line insertion, Central line-associated bloodstream infections, Device-related infections, HPC updates, Vascular access
Arterial line-associated bloodstream infections occur at rate of 0.9-3.4 infections per thousand catheter-days. This rate of infections is similar to the risk of central line-associated bloodstream infections (CLABSIs). The CDC guidelines for arterial line placement recommend the use of chlorhexidine…
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Antimicrobial impregnated caps decrease the rate of catheter-related bloodstream infections

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Catheter-related bloodstream infections, Central line-associated bloodstream infections, central lines, central venous catheters, Device-related infections, HPC updates, Vascular access
The goal of zero device-related infections is what CMS desires for all hospitals, but is not a realistic goal.  Nevertheless, we can do everything in our power to minimize central line-associated bloodstream infections (CLABSIs).  We now can appreciate that the…
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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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Predictors of failed intubations using video laryngoscopy such as failed Glidescope intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – airway management, direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, intubation, video laryngoscopy
In a study conducted at two academic medical centers, records showed that of 71,570 intubations 2,004 used Glidescope for airway management. Success rates and complications were documented in these Glidescope intubations. The overall success rate for Glidescope intubations was 97%.…
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Steroids are beneficial for hospitalized patients with community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, HPC updates, intubation, mechanical ventilation, pneumonia, respiratory failure
A recent meta-analysis and systematic review of 13 randomized, placebo-controlled trials analyzed over 2000  patients hospitalized for CAP.  The analysis examined whether the addition of systemic corticosteroids doses (20–60 mg of prednisone or steroid equivalent) to empiric antibiotics was any better than…
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Earlier Lumbar Puncture for Suspected Acute Bacterial Meningitis Leads to Better Outcomes

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Lumbar Puncture, medical procedures, Neurological diseases
More Tags – bacterial meningitis, HPC updates, lumbar puncture, meningitis
Although adult bacterial meningitis (ABM) is rare, the outcomes can be devastating. An area of controversy concerns when to perform lumbar puncture (LP). Because of the possibility of brain herniation, it has been recommended that cerebral computed tomography (CT) be…
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Steroids in COPD Exacerbation – No Role for High-Dose Steroids

Ben Scheribel
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – COPD, COPD exacerbations, HPC updates, respiratory failure
Researchers evaluated 17,239 patients (77% older than 60; 31% tobacco users) with COPD exacerbations who were admitted to ICUs at 473 U.S. hospitals. Nearly one third of patients received noninvasive ventilation; 15% were intubated. Almost all patients received antibiotics and…
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Antibiotic duration for intra-abdominal infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures
More Tags – HPC updates, intra-abdominal infections, sepsis
In an open-label trial involving adults with complicated intra-abdominal infections at 23 centers in the U.S. and Canada, researchers have investigated whether fixed-duration antimicrobial therapy (4 days) after source control is as effective as the traditional strategy (antibiotic administration until 2 days…
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Lung ultrasound for diagnosis of pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – HPC updates, lung ultrasound, pneumonia, sepsis
Lung ultrasound can detect pneumothorax and pulmonary edema, but limited data exist to quantify its accuracy for diagnosing pneumonia. In a prospective study, investigators compared lung ultrasound to chest computed tomography (CT) and chest x-ray among adult patients presenting with…
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