Dispelling Myths about Thoracentesis and Pleural Fluid Analysis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Featured, medical procedures, Nephrology, Respiratory diseases, Thoracentesis
More Tags – CHF, diuretics, exudate, featured, HPC updates, Light's criteria, pleural effusions, pleural fluid analysis, re-expansion pulmonary edema, thoracentesis, transudate
There are two myths that have persisted about thoracentesis and pleural fluid analysis that must be dispelled. The first myth is that a large volume thoracentesis should not remove more than 1,500 mL fluid due to the risk of re-expansion…
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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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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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Choosing Wisely Recommendations by American College of Emergency Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Nephrology, Respiratory diseases, Traumatology
More Tags – back pain, CT scans, HPC updates, nephrolithiasis, pulmonary embolus, sinusitis, syncope
Choosing Wisely is an initiative by the American Board of Internal Medicine that solicits evidence-based recommendations by other specialty associations to identify tests or procedures in their field which are unnecessary.  The following are a set of five recommendations that…
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Blood Cultures are Not Recommended for Most Non-Severe Cases of UTI, Cellulitis, or Pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Dermatology, Emergency Procedures, Infections, medical procedures, Nephrology, Respiratory diseases
More Tags – bacteremia, cellulitis, community-acquired pneumonia, HPC updates, pneumonia, UTI
In many hospitals, blood cultures have become a reflexive habit for patients presenting to the ER with any suspected infection.  This was, in part, due to the inappropriate addition of routine blood cultures as a core measure in 2001 by…
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Higher Baseline Serum Creatinine Increases Mortality for Hospitalized Patients with Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, medical procedures, Nephrology, Paracentesis
More Tags – acute kidney injury, cirrhosis, HPC updates
The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by more than 50% in <48 h from a stable value within 3 months. North…
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Accuracy of Urine Electrolytes to Assess Etiology of Acute kidney injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, medical procedures, Nephrology
More Tags – acute glomerulonephritis, acute interstitial nephritis, acute kidney injury, acute tubular necrosis, diuretics, HPC updates, prerenal azotemia
Both the fractional excretion of sodium (FENa) and the fractional excretion of urea (FEUrea) have an established role as part of the work-up for determining if acute kidney injury (AKI) is due to a prerenal or intrarenal cause. Although both…
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Serum Procalcitonin Can Help to Differentiate CHF from Pneumonia in ED Patients Complaining of Dyspnea

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, medical procedures, Nephrology, Respiratory diseases
More Tags – BNP, CHF, dyspnea in ER, Heart failure, HPC updates, pneumonia, procalcitonin
Previous trials have investigated the use of B-type natriuretic peptide (BNP) to assess patients with dyspnea in the ED. The sentinel trial was the BNP (Breathe Not Properly) trial that evaluated nearly 800 patients presenting to the ED with complaints…
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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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