Steroids in COPD Exacerbation – No Role for High-Dose Steroids

Ben Scheribel
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – COPD, COPD exacerbations, HPC updates, respiratory failure
Researchers evaluated 17,239 patients (77% older than 60; 31% tobacco users) with COPD exacerbations who were admitted to ICUs at 473 U.S. hospitals. Nearly one third of patients received noninvasive ventilation; 15% were intubated. Almost all patients received antibiotics and…
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Lung ultrasound for diagnosis of pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – HPC updates, lung ultrasound, pneumonia, sepsis
Lung ultrasound can detect pneumothorax and pulmonary edema, but limited data exist to quantify its accuracy for diagnosing pneumonia. In a prospective study, investigators compared lung ultrasound to chest computed tomography (CT) and chest x-ray among adult patients presenting with…
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GlideScope VL Improves Success of Urgent Intubation by ICU Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, King Tube, medical procedures, Respiratory diseases
More Tags – direct laryngoscopy, endotracheal intubation, Glidescope intubation, HPC updates, rapid sequence intubation
Use of video laryngoscopy (VL) results in improved glottic views, fewer intubation attempts, and higher intubation success in both operating room and emergency department (ED) patients. Less is known about performance characteristics of VL during urgent inpatient intubations performed in…
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The Bova Score Identifies Patients with Pulmonary Embolism at High Risk of Complications

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Hematology, Medical General, medical procedures, Respiratory diseases
More Tags – Bova score, HPC updates, pulmonary embolism, venous thromboembolism
Most patients with pulmonary embolism (PE) do well, and outpatient management is becoming more common. Predicting which patients will have complications would be valuable in order to triage patients for discharge or admission to a ward or intensive care unit…
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Noninvasive Ventilation is Extremely Effective for Severe COPD Exacerbations

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – BiPAP, COPD exacerbations, HPC updates, intubation, mechanical ventilation, noninvasive ventilation
Based on meta-analysis of randomized, controlled trials, noninvasive positive pressure ventilation (NPPV) is the only intervention that improves mortality in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). However, many patients who are eligible for this intervention go…
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Prone Positioning Decreases Mortality in Severe ARDS

Mechanical Ventilation for Intubated Patient
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Respiratory diseases
More Tags – ARDS, HPC updates, mechanical ventilation, prone positioning
Prone positioning has been in existence since 1974; however, the equipment and technique has now been refined and has proven to decrease mortality in severe ARDS.  Prone positioning decreases the amount of alveolar collapse and decreases V/Q mismatching in patients…
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Choosing Wisely Recommendations by the CCSC

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – choosing wisely, HPC updates, mechanical ventilation, parenteral nutrition, transfusions
CHOOSING WISELY RECOMMENDATIONS FROM THE CRITICAL CARE SOCIETIES COLLABORATIVE 1. Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions. Many diagnostic studies (including chest radiographs, arterial blood gases, blood chemistries…
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EEG

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Procedural Sedation, Respiratory diseases
More Tags – coma, EEG, electroencephalogram, HPC updates, minimally responsive state, persistent vegetative state
EEG in the Evaluation of Patients with Coma and Other Disorders of Consciousness The clinical evaluation of disorders of consciousness involves the challenge of distinguishing coma from vegetative state (VS) and from minimally conscious state (MCS). Recent neuroimaging studies have…
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Complications Common during Prehospital Intubation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Glidescope Intubation, medical procedures, Respiratory diseases
More Tags – HPC updates, Hypoxia, intubation
Preface:  This retrospective study examined physician performed prehospital intubations between 2008 and 2012 in Scottish aeromedical transport system.  Over 200 intubations were analyzed and 75% of the intubations were during inter facility transport and 25% at the scene.  There was…
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Pre-hospital cardiac arrest patients do best with supraglottic airway or BVM ventilation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Endotracheal Intubation, King Tube, Mechanical Ventilation, Medical General, medical procedures, Respiratory diseases
More Tags – airway management, cardiac arrest, HPC updates, intubation, King tube, supraglottic airways
Cardiac arrest patients who were intubated had similar outcomes to those who had a supraglottic airway device (e.g., King tube) inserted in the pre-hospital setting. A literature review of 5 studies and over 300,000 patients with pre-hospital cardiac arrest demonstrated…
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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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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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Optimal Location for Needle Decompression For A Tension Pneumothorax

Hospital Procedure Consultants
More Articles – Central line, Emergency Procedures, medical procedures, Needle Decompression, Respiratory diseases, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – HPC updates, needle decompression, needle decompression 5th intercostal space, needle insertion, needle thoracostomy placement, obstructive shock, pneumothorax
Needle decompression location Traditionally, needle decompression for the emergent treatment of a tension pneumothorax is the second intercostal space in the mid-clavicular line.  This remains an option for needle insertion when you are treating a tension pneumothorax.  This insertion point…
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Does Cricoid Pressure Prevent Aspiration During Endotracheal Intubation?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Endotracheal Intubation, Gastrointestinal diseases, Glidescope Intubation, King Tube, Laryngeal Mask Airway, medical procedures, Respiratory diseases
More Tags – cricoid pressure, endotracheal intubation, Glidescope intubation, HPC updates, King tube airway, laryngeal mask airway, rapid sequence intubation
There has always been some controversy about the utility of applying cricoid pressure (aka Sellick Maneuver) during rapid sequence intubation for the purpose of preventing aspiration.  Theoretically, applying pressure on the cricoid cartilage posteriorly should occlude the esophagus against the…
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