>At the Medical Emergencies course at UCL this
year....
>Aimed more at SHOs and no input at
> all
> from A&E guys somewhat bizarrely, but Ii learned
> loads)
>
Bristol based one day Medical Emergencies courses are
run mainly by ED Consultants. Latest ones were
advertised in the BMJ a couple of weeks ago. Run by
Paul Younge ED Consultant at Frenchay
([log in to unmask]).
Agree nitrates not frusemide. CPAP is excellent is
these patients too.
Steve Meek
--- Adrian Fogarty <[log in to unmask]> wrote:
> I'd be careful of adopting Webb's ideas about LVF
> for use in an emergent
> setting. I heard him speak a few times and I get the
> idea he sees only the
> really bad ones that end up in his unit. I tend to
> think of LVF as a
> respiratory emergency, not cardiac, despite the
> name. These patients present
> in severe respiratory distress; tachypnoeic, hypoxic
> and hypercarbic, yet
> they have normal or elevated blood pressure. They
> generally don't need
> inotropes, but they are very vasoconstricted, so
> yes, we do use GTN but very
> little else for these patients. Most are not
> hypervolaemic so frusemide
> makes little sense. Most never get near an ITU, so
> beware of letting an
> intensivist teach you how to manage emergencies such
> as this in your A&E
> department!
>
> Adrian Fogarty
>
> ----- Original Message -----
> From: <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, September 25, 2002 7:11 PM
> Subject: Re: Acute LVF and Inotropes
>
>
> >
> > I hear some chaps in London have given up on all
> > inotropes but Adren and then
> > use GTN to off load in acute LVF or is thisjust
> hear
> > say (note no apostrophe)
> >
> > Cheers
> > Peter Cutting
>
> Pete,
> You're right.
> At the Medical Emergencies course at UCL this year
> Andrew Webb (physician intensivist at UCH) told us
> he
> used Epi alone, although others using Dob then Epi.
> It
> was the general feeling against any use of frusemide
> I
> found most interesting, as our intensivists seem to
> love buckets of the stuff.
>
> (NB the course is excellent value if you get the
> chance
> - £170 for the weekend, comes with free Ox Hdbk
> Critical Care. Aimed more at SHOs and no input at
> all
> from A&E guys somewhat bizarrely, but Ii learned
> loads)
>
> Cheers!
> Giles.
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