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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.