Is this a cardiac patient or not?

[mobey]

your patient was in CHF. just needed alot of Lasix.

Care to explain how dehydrating, and depleting potassium in a CHF pt does any good?

[Quakefire]

Did you do any repeat 12-leads to see if there was any progression? What about reciprocal changes? Strangely just had a patient just like this, except he looked like crap too (bit younger too) We went the full cardiac route (well kinda he was allergic to morphine and one shot of nitro dropped his pressure 30 points) Our patient had upper abd/epigastric pain, with N/V ST elevation in V2, V3, V4 and was pale cool and clammy. Turned out as a GI bleed.

Cardiologist told us that the elevation was a result of the Lifepak 15 causing false elevation, and that on serial 12-leads there would be no progression. Can anyone comment on this?

[crotchitymedic1986]

Sure I will, read the chart and see what treatment the patient recieved, I bet my paycheck against yours that the pt was in CHF and got treated with Lasix. We can speculate all day, or go see what the truth was.

[mobey]

Sure I will, read the chart and see what treatment the patient recieved, I bet my paycheck against yours that the pt was in CHF and got treated with Lasix. We can speculate all day, or go see what the truth was.

Swing and a miss

The question was "Care to explain how dehydrating, and depleting potassium in a CHF pt does any good?"

It is unrealistic that I am going to fly to wherever this is, and ask a nurse to breech confidentiality to show me a chart, on the off chance the ER was as wrong as you are by treating CHF with high doses of Lasix.

So let me clarify, since my question was obvioustly worded in a manner that is too hard for you to interpret.

You said:

your patient was in CHF. just needed alot of Lasix.

My question to you is:

Care to EXPLAIN how dehydrating, and depleting potassium in ANY CHF pt does any good?

As you can see I caps'd the key words so it is easier to decipher the message I am attempting to deliver.

[Kiwiology]

Could be a GI bleed or an atypical MI .... did we ever find out what was wrong with this bloke?

[crotchitymedic1986]

You dont have to fly anywhere, the OP can tell us, and its not dehydrating the patient, it is draining an overload of fluid.

[tniuqs]

My question is:

Care to EXPLAIN how dehydrating, and depleting potassium in ANY CHF pt does any good?

This assists with the embalming process.

As you can see I caps'd the key words so it is easier to decipher the message I am attempting to deliver.

Bless you my son my eyes are getting weak and that helps

[mobey]

..... it is draining an overload of fluid.

I agree in the case of renal failure, where the pt is unable to expell fluid from the body, leading too circulatory overload.

CHF however is a "Failure of the heart to act as a forward pump".

CHF exacurbated pulmonary edema is not a fluid problem, it is a pump problem.

Hence the reason we use Nitro (reduce preload) and inotropes as first line treatment.

I will not even get into CPAP as it is far too complicated unless a solid foundation of knowledge is there.

[46Young]

your patient was in CHF. just needed alot of Lasix.

That's soooo 2005 (maybe years earlier for the more progressive depts). Our medical director actually went so far as to place lasix for APE as an OLMC option. Once we got CPAP, and double dosing of ntg for severe cases, and now nasal ETCO2 to help decide if a neb is appropriate for concrrent broncoconstriction, we started saving a lot of pts from getting tubed. Lasix just screws up their K+, and makes it that much more difficult for the hospital to correct. Really, most protocols call for 40 mg of lasix, or maybe 40 above their single dose (not daily total), up to 120 mg. The problem is, these are arbitrary amounts, given w/o knowledge of the pt's labs. How fast is a lasix going to work, anyway? Nowhere near as fast as aggressive ntg and CPAP, if appropriate. How effective is lasix in prehospital tx of APE? Not very, says numerous studies. Remember, we're not treating CHF. We're treating pulmonary edema with a cardiac etiology.

Sure I will, read the chart and see what treatment the patient recieved, I bet my paycheck against yours that the pt was in CHF and got treated with Lasix. We can speculate all day, or go see what the truth was.

What we need to do as far as prehospital treatment for the pt (maybe 15-45 minutes), and what the hospital does for the next 12, 24 hours or more are not necessarily the same.

[tniuqs]

and now nasal ETCO2 to help decide if a neb is appropriate for concrrent broncoconstriction

Ummm ... that is kinda stretching it, I don't think you wish debate that.

Ones Ears are far better at that diagnosis.

Remember, we're not treating CHF. We're treating pulmonary edema with a cardiac etiology.

Not really meaning to shred and the red wine did put things out of sequence, but could you expound on that a bit I am not following ?

Lasix has it place and really should not have a "drug" reputation persay. Lets not forget that one needs a mean b/p of at least 70 to 80 for whatever dosage of furosemide is needed to make that filter operational.

Quoting a MD I worked with a Dr. Marchashamer ... TO PEE IS TO BE.

In ICU we called dopamine "poor man's lasix" + inotropic and increases renal perfusion.

Did forget that even M/S has minor diuretic renal action useful in LVF.

Once we got CPAP

There was another tool in the bag sorry, my bad, I just felt compelled to finish that sentence.

What we need to do as far as prehospital treatment for the pt (maybe 15-45 minutes),(for others 2 to 3 hrs) and what the hospital does for the next 12, 24 hours or more are not necessarily the same.

Zactly ... not bad for a bucket head medic

Edited February 20, 2011 by tniuqs