Extended cardiac monitoring is indicated for evaluation of cryptogenic strokes in elderly patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Medical General, medical procedures, Neurological diseases
More Tags – atrial fibrillation, cardiac monitoring, cryptogenic strokes, HPC updates, ischemic strokes, stroke
Prior studies have found that in patients with cryptogenic ischemic strokes, extended post-stroke cardiac monitoring detects intermittent atrial fibrillation (AF) in up to 20% of cases. Now, an industry-sponsored study from Germany randomized 400 patients all over 60 years old…
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When Should You Obtain Neuroimaging in Infants for Possible Abusive Head Trauma?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Respiratory diseases
More Tags – Abusive head trauma, AHT, Brain injury, HPC updates, Neuroimaging
Abusive head trauma (AHT) is extremely difficult to diagnose due to its unreliability and insensitive physical examination findings. A clinical prediction rule to identify subtle AHT was validated through a prospective multicenter study. Included in this study were well-appearing, afebrile…
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Correction for CSF protein in traumatic lumbar punctures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Lumbar Puncture, medical procedures, Neurological diseases, Traumatology
More Tags – HPC updates, lumbar puncture, meningitis
Traumatic lumbar puncture (LP) is fairly common and occurs when the needle causes bleeding into the subarachnoid space. Introduction of peripheral red blood cells (RBCs) in cerebrospinal fluid (CSF) increases CSF protein levels, thereby complicating diagnosis of bacterial meningitis. This…
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Differences in Intracerebral Hemorrhage Between Warfarin and New Oral Anticoagulants

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Laryngeal Mask Airway, medical procedures, Neurological diseases
More Tags – HPC updates, ICH, Intracerebral Hemorrhage, New Oral Anticoagulants, NOACs
In prior randomized trials, the incidence of intracerebral hemorrhage (ICH) was significantly lower with the new oral anticoagulants (NOACs) than with warfarin (Blood 2014; 124:1968).  However, it remains unclear if clinical outcomes are similar when ICH does occur with different…
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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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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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How Important Is the “Golden Hour” After Trauma?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – HPC updates, trauma, traumatic brain injury, traumatic shock
Traditional dogma teaches that it is crucial for trauma patients to reach the hospital and be treated within 1 hour of injury (the “golden hour”). Investigators reviewed data from a large trauma registry to determine outcomes for two cohorts of…
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The Benefits and Risks of Dual Antiplatelet Therapy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Events, Hematology, Hospital Procedures, medical procedures, Neurological diseases
More Tags – Antiplatelet therapy, coronary stent, HPC updates, major adverse cardiac events, PCI, percutaneous coronary intervention
The key points of dual antiplatelet therapy are that there is NO mortality benefit for DAPT vs ASA alone; there is a small but significant decrease in coronary stent thrombosis and major adverse cardiac events, but there is also an…
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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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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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New trial refutes Epogen or liberal transfusions after traumatic brain injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – Brain injury, epogen, head trauma, HPC updates, neurological recovery, transfusions
A new randomized controlled trial refutes the theory that either Epogen or liberal transfusions will improve neurologic outcome in patients with traumatic brain injury. Head trauma occurs in 1.5 million Americans annually, at a cost of more than $56 billion. Erythropoietin…
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Syntax trial results regarding PCI and CABG

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Emergency Procedures, medical procedures, Neurological diseases
More Tags – CABG, cardiac surgery trial, Coronary artery bypass, HPC updates, left main disease, PCI, surgery, syntax
Results of the Syntax trial suggests that PCI and CABG have comparable results for most patients with left main disease. The results suggest that the all-cause mortality was lower with PCI vs CABG in patients with Syntax scores <=32, but…
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