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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Pulmonary Embolism in Acute Exacerbations of COPD

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – Chronic Obstructive Pulmonary Disease, Exacerbations, HPC updates, pulmonary embolism
This systematic review shows a high rate of pulmonary embolism (PE) in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations. Symptoms of PE can overlap with those of acute exacerbations of chronic obstructive pulmonary disease (COPD) making the diagnosis…
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Fentanyl-Based Ventilator Sedation Decreased Ventilator Days in ICU Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – Fentanyl-Based Ventilator, HPC Blog Updates, HPC updates, ICU, intubation, mechanical ventilation, RASS, Richmond Agitation-Sedation Scale
Complications from long-term deep sedation and the lack of adequate pain control for mechanically ventilated intensive care unit (ICU) patients has resulted in the development of sedation protocols emphasizing pain control over sedation. These protocols use either remifentanyl or fentanyl.…
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MRSA antibiotics are overprescribed in patients hospitalized for community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – antibiotic stewardship, community-acquired pneumonia, HPC updates, mechanical ventilation, MRSA, pneumonia
Are MRSA Antibiotics Overprescribed for Community-Acquired Pneumonia? – NEJM Journal Watch Nearly 30% of hospitalized CAP patients received antibiotics for MRSA, even though fewer than 1% had MRSA-associated CAP. A recent multicenter, prospective, active-surveillance study of 2259 patients hospitalized with…
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Factors that influence Pleural Fluid pH after Thoracentesis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, medical procedures, Respiratory diseases, Thoracentesis
More Tags – chest tube, HPC updates, pleural fluid analysis, thoracentesis, tube thoracostomy
Pleural fluid pH is an important measure for determining the clinical management of pleural diseases. For example, a pleural fluid pH <7.2 in patients with suspected pleural infection should mandate the placement of a chest tube. However, pleural fluid pH…
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Obesity Hypoventilation Syndrome Is Associated with Serious Postoperative Respiratory Complications

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Respiratory diseases
More Tags – Bilevel noninvasive positive pressure ventilation, BiPAP, CPAP, HPC updates, Nocturnal continuous positive airway pressure, Obesity hypoventilation syndrome, Obstructive sleep apnea, OHS, OSA, Sleep-disordered breathing
Obesity hypoventilation syndrome (OHS) is defined by the triad of obesity (BMI >30 kg/m2), daytime hypoventilation (Paco2 >45 mm Hg), and sleep-disordered breathing in the absence of other causes of hypercapnia, such as severe obstructive lung disease, severe interstitial lung…
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Lower Oxygen Saturation Goals Are Safe in Mechanically Ventilated Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Medical General, medical procedures, Respiratory diseases
More Tags – Goal peripheral oxygen saturation, HPC updates, Oxygenation goals, PEEP, Positive end expiratory pressure
Targeting to 88%–92% did not cause harm. There is little data on ventilator weaning when it comes to oxygenation goals.  Many intensivists adjust the ventilator to maintain an oxygen saturation of at least 95% to buffer against desaturation.  However, there…
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Conservative Fluid Management Decreases Ventilator Days but not Mortality Compared with Liberal Fluid Management in ARDS

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, medical procedures, Respiratory diseases
More Tags – ARDS, Central venous pressure, Conservative fluid management, CVP, FACTT, FACTT Conservative, FACTT Liberal, FACTT Lite, Fluid and Catheter Treatment Trial, HPC updates, mechanical ventilation, Pulmonary artery occlusion pressure
A retrospective study compared the performance of Fluid and Catheter Treatment Trial (FACTT) Lite, FACTT Conservative, and FACTT Liberal. The prior FACTT demonstrated that conservative fluids is superior to liberal fluids for ARDS. A simplified conservative fluid protocol (FACTT Lite)…
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New Classification of ARDS Predicts Hospital Mortality

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – Acute respiratory distress syndrome, ARDS, HPC updates, mechanical ventilation
Presently, the mortality of patients in the hospital with acute respiratory distress syndrome (ARDS) is higher than 40%.  A sixteen month long observational study was conducted to determine if certain cutoff points of PaO2/FiO2 (less than or equal to 200…
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What Size Catheter Should I Use For Needle Decompression For a Tension Pneumothorax?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, medical procedures, Needle Decompression, Respiratory diseases, Traumatology
More Tags – chest tube, Chest wall thickness, HPC updates, Needle decompression catheter, Pleural space, Tension pneumothorax, tube thoracostomy
A recent meta-analysis of 13 studies that were investigating needle decompression compared data of sample size, mean chest wall thickness, and decompression success rates. The meta-analysis concluded that the needle decompression catheter should be at least 6.5 cm in length…
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Risk Factors for Difficult Ventilation with a Laryngeal mask Airway

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Laryngeal Mask Airway, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – Difficult LMA, HPC updates, laryngeal mask airway, LMA, PLAD Score, Predictive Laryngeal Mask Airway Difficulty Score, Risk Factors
Recently, a retrospective review of over 14,000 adult patients who underwent general anesthesia were assessed. A multivariable analysis was used to determine risk factors of difficult laryngeal mask airways (LMA). The following four risk factors were identified: male gender, age…
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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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New Recommendations for Evaluation of Patients with Suspected Acute Pulmonary Emboli

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures, Respiratory diseases
More Tags – D-dimer, HPC updates, pulmonary embolism, venous thromboembolism, VTE
The ACP CPG on the evaluation of patients with a suspected acute PE has the following primary recommendations: Use a validated clinical prediction rule to estimate pretest probability in patients with a possible acute PE (options include the Wells criteria…
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Predictors of failed intubations using video laryngoscopy such as failed Glidescope intubations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – airway management, direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, intubation, video laryngoscopy
In a study conducted at two academic medical centers, records showed that of 71,570 intubations 2,004 used Glidescope for airway management. Success rates and complications were documented in these Glidescope intubations. The overall success rate for Glidescope intubations was 97%.…
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Steroids are beneficial for hospitalized patients with community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – endotracheal intubation, HPC updates, intubation, mechanical ventilation, pneumonia, respiratory failure
A recent meta-analysis and systematic review of 13 randomized, placebo-controlled trials analyzed over 2000  patients hospitalized for CAP.  The analysis examined whether the addition of systemic corticosteroids doses (20–60 mg of prednisone or steroid equivalent) to empiric antibiotics was any better than…
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