Alternative Diagnoses for VAP if BAL is Negative

Mechanical Ventilation for Intubated Patient
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, HPC updates, intubation, pneumonia, VAP
Among the 53% of patients with negative bronchoalveolar lavage results, alternative explanations for fever and for pulmonary infiltrates were established in 61% and 46%, respectively. Chest x-ray abnormalities, leukocytosis, purulent tracheal aspirate, or fever in a mechanically ventilated patient raise…
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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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Clinical Course after Episodes of Diverticulitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Gastrointestinal diseases, medical procedures
More Tags – diverticulitis, HPC updates
In nonoperatively managed patients, ≈7% of patients had recurrent episodes, and 2% required emergency surgery during 4 years of follow-up. Some surgeons promote elective surgery after one or two episodes of uncomplicated diverticulitis to prevent recurrences that might require urgent…
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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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High risk for postoperative adverse cardiovascular events during the first 9 months after stroke

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Events, Hospital Procedures, medical procedures
More Tags – adverse cardiovascular events, cardiovascular, HPC updates, ischemic stroke
Risk for postoperative adverse cardiovascular events was especially high during the first 9 months after stroke. If possible, you should wait at least 9 months and preferably 12 months after an ischemic stroke to undergo elective non cardiac surgery. Stroke…
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Catheter-directed thrombolysis for DVT potentially has equivalent mortality rates when compared with systemic anticoagulation alone.

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures
More Tags – catheter-directed thrombolysis, Deep vein thrombosis, HPC updates, post-thrombotic syndrome
Previous trials have shown that catheter-directed thrombolysis (CDT) for proximal deep vein thrombosis has a lower rate of post-thrombotic syndrome compared with systemic anticoagulation alone.  However, a new retrospective cohort study shows that the mortality rates are equivalent and the rates of transfusion,…
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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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Antiretroviral therapy recommended for all HIV-infected patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – antiretroviral, antiretroviral therapy, antiretroviral treatment, antiviral, antiviral society, HIV, HPC updates, infection
New guidelines from the International Antiviral Society recommend antiretroviral therapy for ALL HIV-infected patients Sponsoring Organization: International Antiviral Society–USA (IAS-USA) Target Population: Clinicians who treat HIV-infected patients Key Recommendations Antiretroviral therapy (ART) is recommended for all HIV-infected patients, including those with acute HIV infection—but…
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Assessment, Diagnosis, and Management of Childhood Concussions

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – childhood concussion, concussion, head trauma, HPC updates
Sponsoring Organization: Ontario Neurotrauma Foundation Target Population: Healthcare professionals and others who deal with concussion, including physicians, neuropsychologists, physical therapists, family, and schools/community sports organizations Background and Objective The panel used an evidence-based, systematic review to standardize diagnosis, assessment, and management of…
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Managing Patients with a Submassive Pulmonary Embolism (PE)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, medical procedures, Respiratory diseases
More Tags – hemodynamic instability, HPC updates, massive PE, pulmonary, pulmonary embolism, submassive PE, thrombolysis
Guidelines recommend that patients with massive pulmonary embolism (PE) and hemodynamic instability be treated with thrombolysis (Circulation 2011; 123:1788). However, consensus is lacking on what to do in intermediate-risk patients (i.e., those who are hemodynamically stable but have right ventricular…
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