The next post is written by one of my great assistants, who is really an EKG-nerd! I hope you like it! Please respond if you have any comments and myself (Egon) and Iwan will take a look at it!
Have a look at this EKG. Go on, you know you want to!
What is the rhythm and what would be your treatment ?
At first glance it looked like an AVNRT (atrioventricular nodal reentrant tachycardia) to me and I had adenosine drawn up. But let’s be a good boy and follow the diagnostic tree from the ESC guidelines:
Anybody any other suggestions?
Hereby as promised the post about morphine in acute heart failure.
Morphine has been considered a central drug in the treatment of pulmonary oedema for a long time. It is believed to cause venodilatation, peripheral venous pooling, reduction of pulmonary congestion and is thought to be a powerful anxiolytic. Most of these believes appears to be based on small studies, which were published during the era when there few alternatives.
In vivo experiments has shown peripheral dilatation, (1,2) probably due to histamine receptors rather that the opiate receptors (3), and a decrease in systemic vascular resistance (2). Furthermore peripheral pooling in the splanchnic region has been found. The splanchnic vascular resistance dropped by 16% after admission of morphine (4).
Next to this scientific evidence there is the strong subjective believe of a lot of doctors that it improves the short-term patient apprearance, which is another big reason we still use it, I think.
A large retrospective study from 2008 (5) looked at the outcome of patients treated with and without morphine for decompensated heart failure. Continue reading
I was discussing this with one the SEH doc’s from either AMC or VU… don’t remember.
But maybe the artikels mentioned in this blog might convince the trauma surgens??
If I do a rectal exam in a trauma patient I always do it while the patient is being logrolled… anybody follows the advise of this blogger?
Hierbij mijn handletselboek. Ik leg uit in de inleiding wat ik er graag mee zou willen. Ik zou het heel erg leuk vinden als mensen mij hun eigen bijdragen/ inzichten/ opmerkingen/ fotorapportages en dergelijk zouden sturen!
Sietske de Klerk