Choosing Wisely Recommendations by the CCSC

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – choosing wisely, HPC updates, mechanical ventilation, parenteral nutrition, transfusions
CHOOSING WISELY RECOMMENDATIONS FROM THE CRITICAL CARE SOCIETIES COLLABORATIVE 1. Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions. Many diagnostic studies (including chest radiographs, arterial blood gases, blood chemistries…
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EEG

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – coma, EEG, electroencephalogram, HPC updates, minimally responsive state, persistent vegetative state
EEG in the Evaluation of Patients with Coma and Other Disorders of Consciousness The clinical evaluation of disorders of consciousness involves the challenge of distinguishing coma from vegetative state (VS) and from minimally conscious state (MCS). Recent neuroimaging studies have…
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Nutrition in Acute Pancreatitis: Have We Come Full Circle?

Hospital Procedure Consultants
More Articles – Gastrointestinal diseases, Mechanical Ventilation, medical procedures
More Tags – HPC updates, Pancreatitis
Nutrition in Acute Pancreatitis: Have We Come Full Circle? Preface:  This randomized controlled trial demonstrated that early tube feeding is not superior to delayed initiation of oral feeds in patients with severe acute pancreatitis. Study: Current guidelines recommend early use…
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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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Complications Common during Prehospital Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – HPC updates, Hypoxia, intubation
Preface:  This retrospective study examined physician performed prehospital intubations between 2008 and 2012 in Scottish aeromedical transport system.  Over 200 intubations were analyzed and 75% of the intubations were during inter facility transport and 25% at the scene.  There was…
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No role for routine carotid doppler ultrasounds to screen for carotid artery stenosis prior to noncardiac surgery

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures
More Tags – Carotid Artery Stenosis, HPC updates
No role for routine carotid doppler ultrasounds to screen for carotid artery stenosis prior to noncardiac surgery Preface:  Carotid artery doppler ultrasound scans are frequently ordered prior to noncardiac surgery to decrease the chance of a perioperative stroke.  The assumption…
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Steroids beneficial in refractory septic shock

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – HPC updates, septic shock
Steroids beneficial in refractory septic shock Preface:  This multi-center observational study of over 1,800 patients examined whether low-dose steroids (<80 mg prednisone equivalents) was superior to placebo for patients in septic shock.  There results showed that there was a slight…
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New Oral Anticoagulants are as effective as Warfarin for VTE with less major bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures
More Tags – anticoagulation, DVT, HPC updates, PE, TSOAC, venous thromboembolism, VTE
The new direct target-specific oral anticoagulants (TSOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been compared with vitamin K antagonists (VKAs; warfarin and similar agents) for acute venous thromboembolism (VTE) in six recent phase III clinical trials encompassing more than 27,000…
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IV Contrast May Have Lower Risk of Contrast-Induced Nephropathy than Previously Suspected

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Nephrology
More Tags – acute kidney injury, AKI, contrast-induced nephropathy, HPC updates
In a recent retrospective study from Mayo Clinic, researchers demonstrated that intravenous contrast material was not associated with acute kidney injury (i.e., increase in serum creatinine level of ≥0.5 mg/dL) during the 72 hours after computed tomography (CT) of the…
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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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Transexamic Acid Reduces Transfusions and Mortality in Major Bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Ginecology, Hospital Procedures, medical procedures, Traumatology
More Tags – HPC updates, transexamic acid, trauma
Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots). Now…
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Direct-Acting Oral Anticoagulants Have a Lower Mortality than Warfarin for Nonvalvular Afib

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Hospital Procedures, medical procedures
More Tags – anticoagulation, atrial fibrillation, HPC updates
Compared with warfarin, the new agents significantly reduced all-cause and vascular mortality. The new direct-acting oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been found to be noninferior to vitamin K antagonists in clinical trials of stroke prevention in…
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