Rapid Influenza Diagnostic Tests Have High False Negative Rates

Patient Sleeping with Nurse in Mechanical Ventilation Cours
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Medical General, medical procedures, Respiratory diseases
More Tags – ARDS, featured, HPC updates, influenza
We are in the midst of an aggressive influenza season right now that should continue into March, so it is nice to review the testing accuracy of standard influenza point-of-care tests that are commonly used.  There are many Rapid Influenza Diagnostic…
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IV Contrast CT Scans Do Not Significantly Increase the Risk of Acute Kidney Injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Hospital Procedures, medical procedures, Nephrology
More Tags – acute kidney injury, CT scan, featured, HPC updates
Researchers from the Mayo Clinic Rochester performed a retrospective study of data from 5758 adults with chronic kidney disease (CKD; stages 1−5) who underwent either noncontrast CT or iodixanol-enhanced contrast CT and who had pre- and post-CT serum creatinine measurements. All of…
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King Tube Airways are Excellent Rescue Airways for Both EMS and Medical Personnel

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endotracheal Intubation, Featured Procedure, King Tube, Laryngeal Mask Airway, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – airway management, difficult airway management, HPC updates, intermediate airways, King tubes
King Tube Airways are Excellent Rescue Airways for Both EMS and Medical Personnel If you are faced with a patient who needs a secure airway and respiratory stabilization, I still believe that endotracheal intubation is the airway of choice.  Nevertheless,…
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Early Transexamic Acid Decreases Severe Bleeding in Major Trauma Patients or After Childbirth

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, Gastrointestinal diseases, Ginecology, medical procedures, Traumatology
More Tags – HPC updates, Major trauma, postpartum hemorrhage, TXA
Tranexamic acid (TXA) has been shown to decrease deaths from acute severe bleeding. To determine if time to treatment is associated with the effectiveness of TXA, these authors conducted a systematic review and only two trials met their criteria: the…
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Updated Guidelines on Acute Pancreatitis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Dermatology, Gastrointestinal diseases, Medical General, medical procedures
More Tags – Acute pancreatitis, Diagnosis, Epidemiology, HPC updates, Management
Acute pancreatitis (AP) has increased in the past decade and accounts for over 275,000 annual hospital admissions in the U.S. and estimated medical costs of $2.5 billion. Noteworthy points are as follows: Morbid obesity and DM 2 are independent risk…
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Non-rebreather Mask for Preoxygenation During Rapid Sequence Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, medical procedures, Respiratory diseases
More Tags – featured, HPC updates, intubation, preoxygenation, rapid sequence intubation
With flush-rate oxygen, a non-rebreather mask was at least as good as a bag-valve-mask ventilation for intubation preoxygenation. Many intubators using the rapid sequence intubation protocol use a bag-valve-mask (BVM) for preoxygenation. But in the absence of a good mask…
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How to Differentiate Pleural Effusion Exudates from Transudates

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, medical procedures, Paracentesis, Thoracentesis
More Tags – HPC updates, Pleural cholesterol, pleural effusion, pleural exudate, pleural transudate
How to Differentiate Pleural Effusion Exudates from Transudates Historically, Light’s criteria have been used to classify pleural effusions into transudates or exudates.  Light’s criteria were established by Dr. Richard Light in 1972.[1]  These criteria maximize sensitivity but have a lower…
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Iso-osmolar Contrast Rarely Causes Contrast-induced Nephropathy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Featured, medical procedures, Nephrology
More Tags – acute kidney injury, featured, HPC updates
Several studies in 2014 suggested that intravenous iodinated contrast use in computed tomography (CT) scanning was not associated with acute kidney injury.  Now, the Mayo Clinic has performed a retrospective study of data investigating 5758 adults with chronic kidney disease…
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New Two Probe Technique for Ultrasound-guided Paracentesis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, medical procedures, Paracentesis
More Tags – featured, HPC updates, paracentesis
A recent study of nearly 5,000 ultrasound-guided paracenteses concluded that the risk of major bleeding can be reduced if a two probe technique is used compared with a single probe approach.  The traditional single probe approach to ultrasound-guided paracentesis utilizes…
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Avoid Routine Lab Testing in Clinically Stable Hospitalized Adults

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Events, Featured, Hospital Procedures, medical procedures
More Tags – daily lab testing, featured, HPC updates
The Society of Hospital Medicine in collaboration with the Choosing Wisely organization has advocated against routine daily lab testing for hospitalized adults since September 2013.  At that time SHM wrote, “Hospitalized patients frequently have considerable volumes of blood drawn (phlebotomy)…
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Paracentesis: Do I Really Need the Ultrasound?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Featured, medical procedures, Paracentesis
More Tags – featured procedure, HPC updates, paracentesis, Ultrasound-Guided Paracentesis, ultrasound-guided procedures
In residency, I spent a great deal of time at the bedside assessing for shifting dullness in patients who may have had ascites.  Today, when I ask residents about shifting dullness, I often get blank stares.  “Why would I do…
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Troubleshooting Difficult Intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Endocrinology, Featured Procedure, King Tube, medical procedures, Respiratory diseases
More Tags – airway management, direct laryngoscopy, endotracheal intubation, endotracheal tubes, HPC updates, intubation
Have you ever been able to see the vocal cords during direct laryngoscopy but you weren’t able to pass the endotracheal tube cuff beyond the cords?  This occurs not too infrequently during endotracheal intubation and I am going to share…
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Open-Lung Recruitment Maneuvers Increased Mortality Compared with Standard PEEP titration for Moderate-Severe Acute Respiratory Distress Syndrome (ARDS)

Patient Sleeping with Nurse in Mechanical Ventilation Cours
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, Hospital Procedures, medical procedures, Respiratory diseases
More Tags – ARDS, featured, HPC updates, intubation, mechanical ventilation
There have been multiple strategies to determine the “optimal PEEP” in acute respiratory distress syndrome (ARDS).  One strategy is to perform a recruitment maneuver using an “Open Lung” approach and neuromuscular blockade (with pressures as high as 60 cm H2O),…
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