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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com


Update from the K-Hole: Ketamine in the ED

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lunes, 6 de agosto de 2018

Heart Failure Myths (Part II)

emDocs - August 6, 2018 - Author: Long B.  Edited by: Koyfman A
"Key Points:
  • A variety of misconceptions are present concerning the ED evaluation and management of AHF.
  • Patients with hypertensive pulmonary edema require nitroglycerin and NIPPV. Diuretics before these therapies can be harmful.
  • Diuretics can be beneficial in patients with more subacute decompensation and systemic volume overload.
  • Nitroglycerin in bolus doses is safe and can reduce need for ICU admission. It probably does not improve mortality.
  • Morphine can be harmful; you have safer options to reduce preload and afterload (nitroglycerin and NIPPV).
  • Disposition is a complex decision, but combining assessment of patient hemodynamic status, ability to follow up, lab markers/ECG, and risk stratification toolsmay allow patient discharge."