tag:blogger.com,1999:blog-4505990433916682663.post3966419526952833314..comments2024-03-13T02:04:31.476-04:00Comments on Paramedicine 101: Differential Dx: Tachypnea Part 4Adam Thompson, EMT-Phttp://www.blogger.com/profile/18107359165856983910noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4505990433916682663.post-20046851393265873152010-08-13T01:53:16.783-04:002010-08-13T01:53:16.783-04:00Many thanks for the information, now I will not co...Many thanks for the information, now I will not commit such error.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-33318956646872370822009-08-26T19:59:10.304-04:002009-08-26T19:59:10.304-04:00Craig,
You are asking about a generic version of ...Craig,<br /><br />You are asking about a generic version of Viagra. Probably just to drop some spam into the comments. This is not really an emergency drug, although the emergency may be in the eye of the beholder. <br /><br />If you take this, or any other erectile dysfunction drug, it would not be a good idea to follow it with NTG. NTG is a very effective drug for pulmonary edema.<br /><br />The drugs appear to have a combined effect that is dramatic and may cause you blood pressure to drop to dangerous levels, perhaps as low as zero.<br /><br />Most important - <b>Do not buy drugs on the internet</b>. You have no real oversight of the manufacture of what you buy. The ingredients might not be what you are trying to buy.Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-47532362247248251002009-08-26T19:42:58.909-04:002009-08-26T19:42:58.909-04:00I suffered a pulmonary edema so if I buy some Kam...I suffered a pulmonary edema so if I buy some <a href="http://www.safemeds.com/viagra/kamagra.html" rel="nofollow">Kamagra Online</a><br />can any tell me if this is a little risky ?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-7489703219919530662009-05-17T08:23:00.000-04:002009-05-17T08:23:00.000-04:00It's okay shaggy, you should see my posts before I...It's okay shaggy, you should see my posts before I proof-read them.<br /><br />"I think it would be unlikely for a patient to develop pulmonary edema from RV infarct"<br /><br />Correct, but most RVIs are not isolated to the RV. I have had one patient in cardiogenic shock in my short career. You're right, it's not very common at all.Adam Thompson, EMT-Phttps://www.blogger.com/profile/18107359165856983910noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-47741532669504067462009-05-16T23:01:00.000-04:002009-05-16T23:01:00.000-04:00Thanks for pointing out the "ICP". I am so used to...Thanks for pointing out the "ICP". I am so used to discussing ICP when teaching about TBIs and Cushing's Triad, that when I rant on in the middle of the night discussing ITP, I write ICP instead. Yes, you would think even subconsciously I should be able to differentiate the brain from the chest. But not all of us are blessed with an above average IQ like some other folks (ahem-like you, Tom, and others).<br /><br />I did not consider to mention the effects of CPAP/PEEP on RV infarct when discussing treatment of respiratory distress from ADHF, but it is a great point to bring up. The effects are very similar to giving NTG. In fact we had a crew bottom out a BP the other day with CPAP. I suspect the patient was suffering from pneumonia and was initially normotensive, but the medic thought the patient was in CHF because she had a history of it. <br /><br />Anyway, yes, if there is ST elevation in the inferior leads, and the pressure is even normotensive, I would be carefull to use CPAP unless I checked RV4 and R/O an RCA occlusion. Very good point, but I think it would be unlikely for a patient to develop pulmonary edema from RV infarct, and cardiogenic shock is usually not something commonly seen by EMS as it is in a CCU.Shaggyhttps://www.blogger.com/profile/10687847155700323439noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-91980961205597104742009-05-13T08:46:00.000-04:002009-05-13T08:46:00.000-04:00I think you accidently stated "ICP" instead of ITP...I think you accidently stated "ICP" instead of ITP a few times. No biggy. Good comment though. This is also an important thing to remember in consideration of AMI patients. If your patient shows increased ST elevation or a sudden and unstable drop in BP, you may want to consider removing the CPAP. <br /><br />If they are having a RV infarct, their condition may deteriorate with the use of CPAP.Adam Thompson, EMT-Phttps://www.blogger.com/profile/18107359165856983910noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-46190044526840916712009-05-13T06:30:00.000-04:002009-05-13T06:30:00.000-04:00I just wanted to add a little note about CPAP and ...I just wanted to add a little note about CPAP and PEEP in the treatment of Acute Decompensated Heart Failure in relation to preload and afterload. <br />As we know, when alveolar pressure is above atmosmospheric pressure, air flows out, and with the inverse, with negative alveolar pressure, air flows from higher pressure outside to the lungs. The negative pressure draws it in. The same premise holds true for the negative pressure of the right ventricle. The right ventricle is very reliant on Intrathoracic Pressure (ITP). With negative pressure, such as at the beginning of the inspiratory phase, causes a vacuum in the right side of the heart, drawing more blood in and subsequently increasing right ventricular (RV)filling. <br />Now with the opposite effect, with increased ITP, there is a DECREASED RV preload. CPAP and PEEP increase the ICP, thus decreasing RV preload and by impairing systemic vascular return. It also increases RV afterload for many reasons that cannot be explained by the consensus of physiologists.<br /><br />We know that increasing ICP reduces PVR by counteracting hypoxic pulmonary vasoconstriction. PEEP and CPAP "opens" collapsed alveoli, increasing alveolar pO2, therefore, hypoxic pulmonary vasoconstriction will be reduced. This then increases RV ejection (to the lungs).<br /><br />Now with the return to the heart from the lungs: A decrease in systemic venous return and, thus, right preload, will result in decreased pulmonary venous return, and left preload because the two ventricles pump together. Not only that, blood flow returning from the lungs is regulated by ITP as well as its stress on the flow. Though PEEP/CPAp increases the intravascular hydrostatic pressure in the alveolar vessels, it increases the interstitial space pressure and forces much of the fluid out through the lymphatic system.<br /><br />Left ventricular (LV) pumping is dependant on LV preload, LV contractility and the pressure against which the left ventricle ejects (afterload), as we know. And yet, cardiac output is better, for many reasons most cannot agree on. One thing that is agreed upon is the elevated ITP from PEEP or CPAP puts a higher pressure than the rest of the circulation (which is at atm), decreasing the force necessary to eject the blood from the LV. This all leads to a slight decrease in BP while maintaining CO. Can we see why now hypotension and relative hypovolemia can be contra-indications to PEEP and CPAP?<br /><br />So, in a nutshell, CPAP and PEEP when the patient is on a vent, can decrease preload as well as the Nitrates and ACE inhibitors. If this was too detailed, in which it actually was not, remember that as medics, we are healthcare professionals and should understand a moderate amount of pathophysiology and the physiological affects of our treatments.Shaggyhttps://www.blogger.com/profile/10687847155700323439noreply@blogger.com