Ultrasound-Guided Thoracentesis is Probably Safe Even When Patients are Taking Clopidogrel (Plavix)

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Chest Tube, Hematology, King Tube, Medical General, medical procedures, Thoracentesis, Traumatology
More Tags – Clopidogrel, HPC updates, Plavix, Risks, Small-bore chest tube, thoracentesis
A prospective cohort single center study was conducted to analyze the risk associated with patients undergoing thoracentesis or small-bore chest tube placement while taking clopidogrel. Twenty-five patients taking clopidogrel gave consent to remain on the antiplatelet medication while undergoing thoracentesis…
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MRI Is Not Needed for Cervical Spine Clearance in Obtunded Blunt Trauma Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Laryngeal Mask Airway, medical procedures, Traumatology
More Tags – blunt trauma, C-spine clearance, cervical spine injury, head trauma, HPC updates
A systematic review found no significant missed injuries in obtunded blunt trauma patients who had normal CT imaging of their cervical spines. Given the significant morbidity and mortality associated with missed traumatic cervical spine injuries, patients in whom a reliable…
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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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Lumbar puncture characteristics of traumatic LP versus subarachnoid hemorrhage

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Lumbar Puncture, medical procedures, Traumatology
More Tags – HPC updates, lumbar puncture, subarachnoid hemorrhage, traumatic lumbar puncture
Differences between Traumatic LPs and SAH. How Traumatic lumbar punctures Impact Healthcare Decisions.How to Differentiate Traumatic Lumbar Punctures from Aneurysmal Subarachnoid Hemorrhage The diagnosis of subarachnoid hemorrhage (SAH) often requires lumbar puncture, however, in an estimated 10% to 30% of…
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Transexamic Acid Reduces Transfusions and Mortality in Major Bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Ginecology, Hospital Procedures, medical procedures, Traumatology
More Tags – HPC updates, transexamic acid, trauma
Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots). Now…
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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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Isolated free fluid on CT Imaging after Blunt Abdominal Trauma: Explore or Wait?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, medical procedures, Traumatology
More Tags – abdominal trauma, HPC updates, Trauma CME
Patients with minimal free fluid and no abdominal tenderness can be observed, while patients with moderate-large amounts of free fluid and abdominal tenderness should undergo operative exploration. To determine if operative exploration or observation is the preferred management for hemodynamically…
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Epidural steroid injections are ineffective for both sciatica and lumbar spinal stenosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Lumbar Puncture, medical procedures, Traumatology
More Tags – epidural steroid injections, HPC updates, lumbar spinal stenosis, sciatica
Two systematic reviews and meta-analyses have demonstrated no long-term benefit for back pain, leg pain, or disability using epidural steroid injections for either sciatica or lumbar spinal stenosis. The first systematic review and meta-analysis in 2012 analyzed 23 trials of…
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