Hi, my name is Egon Zwets and I am a Emergency Physician from the Netherlands.
With the participants of the 1st MNSHA Masterclass (in cardiovascular and respiratory medicine) we decided to start this blog. In the future we would like you….our Dutch colleagues, but also colleagues from other countries to visit our blog and comment on the different posts.
Emergency Medicine is fairly new in the Netherlands. Just in this century (2000) we started with the training in Emergency Medicine and a lot has been achieved since then. But we still want to improve and starting a blog is an important step, we believe. Connection with the rest of the world means we can learn from one another!
In the following weeks we will start to post about different topics/cases/articles etc. I personally will start by looking at the ESC guideline on Acute (and Chronic) Heart Failure of 2012, written by The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology.
If you look at the guideline the treatment of AHF in patients with a good blood pressure is:
1.) Loop diuretics (nr. 1?)
3.) Morphine (Really???)
4.) NTG (after loop diuretics and morphine???)
5.) Consider NIV (Finally!)
Still I see doctors shouting for morphine and loop diuretics in patients coming in to the ED with AHF. A colleague of mine ones said: “If I come in with AHF give me morphine, I have seen it work!” But is this true or is this a case of WYSIATI? WYSIATI stands for “What You See Is All There Is” and it means that people can be so sure about their subjective disposition, that they are blind for other information. Doubt is being suppressed by our associative brain. (From the book: Think, Fast and Slow, by Daniel Kahneman, winner of the Nobel Price! I would recommend it to every doctor!) So,if you give both morphine, NTG and NIV….is it really the morphine working???
As you can see there is a lot to discuss with you about and I WILL START LOOKING AT MORPHINE IN AHF. This post will come soon! And maybe we can come up with a better approache to AHF in the end.
Until next time!