NEPI. Discussion Forum

457 Norad in sepsis with venous ulcers [ Emergency Medicine ]

on the flip side - the low pressures will kill the patients now... so if put in a corner i would probably follow the egdt protocol, maximize cvp and initiate dopamine (over preference to norad) in this patient, see if it helps. I did not find major contraindics to dopa in venous ulcers.
Finally if there is no resort an amputation may need to be done, under a leg block, considering that the blood pressure is too low for safe anesthesia, and then you could eventually initiate norad too...

456 Norad in sepsis with venous ulcers [ Emergency Medicine ]

I am attaching a couple of links to access articles on pentoxyphylline
http://ccforum.com/content/2/S1/P017
http://summaries.cochrane.org/CD004205/pentoxifylline-for-treatment-of-sepsis-and-necrotizing-enterocolitis-in-neonates
http://apps.who.int/rhl/newborn/reviews/cd004205/en/index.html

455 Norad in sepsis with venous ulcers [ Emergency Medicine ]

An option may be pentoxyphylline.
It is a drug that is used to improve peripheral oxygenation in neonatal sepsis - enterocolitis etc.
However at the same time, there are studies that have documented its benefit in treatment of venous ulcers also.
Haven't seen any studies mentioning this use in venous ulcers but could be worth a search and try !

454 Norad in sepsis with venous ulcers [ Emergency Medicine ]

A morbid obese with venous ulcers in sepsis septic shock, can norad be given or be substituted with other ionotropes!! source of sepsis are the venous ulcers itself
Norad works by peripheral vasoconstriction and can worsen the venous ulcers . So I tried searching literature for any alternatives. Any suggestions .

Kind regards

453 Furosemide vs Nitrate [ Clinical case discussions ]

Why not CPAP???(ofcourse after MI is excluded)

452 Furosemide vs Nitrate [ Clinical case discussions ]

Frusemide still.................I thought the world is moving on to new modailites.

Would not give frusemide as firstline to some who could be already dry as bone/??Vasculopath with knackered kidneys(I think most of the patients will have either of these two)
It is my personal choice though.

And the Jury is still out on which is the best(no difference in mortality i think)

451 Furosemide vs Nitrate [ Clinical case discussions ]

Furosemide is supposed to decrease preload with an immediate direct vascular action. Then has a delayed affect due to diuresis.
Takes seconds to break an ampoule and inject.

NTG is used to bridge the gap in between. Using well titrated infusion. But takes a few minutes to load onto infuser pumps.

Furosemide is first choice!

Would first consider NTG only if sublingual spray available.

450 'foreign' trained and returned - have they a role in Indian Em or are they mere show-offs [ Emergency Medicine ]

I am quoting the below statement from my previous post in Feb 2008.
[url]http://www.emergencymedicine.in/nepi/forum/viewthread.php?thread_id=9[/url]
_____________________________________

I dont want to imagine an institute or organization or people who have no understanding of EM to govern the specialty. (This is highly possible in a country like ours where politics rule). I dread the day when MD and DNB recognizes EM and opens the program in all colleges. Who are the people who will teach the PG students. There aren't sufficient EM trained physicians today. I hate the situation when an anesthetist or cardiologist or orthopedician starts teaching students about EM and trauma management.
______________________________________

Looks like this is exactly what is happening now.

By the way, you must be MD/MS qualified AND working in a medical college hospital to enter the FACET training.

Read Tintinalli, Take some MCQs and attend workshops. Yes, you become qualified EM Faculty.
Do you really believe that somebody can teach EM after getting certified like this, without quality EM experience which is supervised in a well established EM department.

The FACET program is not a new concept. Symbiosis Institute Pune, Annamalai University Chennai and Apollo Hospitals had started this kind of certification back in early 2000. But they failed miserably because the doctors who underwent this kind of certification could not handle real-time emergency patients. They were as good as glorified CMOs. As far as I know, there is hardly any demand for such training in India. Our hospital stopped this program in 2005.

Since FACET is a requirement in Medical College Hospitals, your training and experience can be put to good use in the academic emergency departments of private sector hospitals (which comprises of 80% of healthcare delivery in India). It will only take a short while for people to realize who teaches EM better. Don't worry!

-Imron

449 'foreign' trained and returned - have they a role in Indian Em or are they mere show-offs [ Emergency Medicine ]

I can sense some what over protective market strategy in that comment.

Ground reality in India (for EM)

Short cut to EM Physician/Trainer in India (get fellowship as well)
http://www.facetindia.org
Read Tintinalli, Take some MCQ exams and attend workshops. Looks good, I am keen to get it as well.

Sorry to gloat, but just a bit worried about the way EM is going in India.Hopefully we will have some wisdom prevailing over in the near future.

448 Furosemide vs Nitrate [ Clinical case discussions ]

Back to the same old age old question - Is it furosemide or nitrates (GTN) that you'd reach for in a patient with acute heart failure? Agreed that both these drugs have some role but which is the first drug of choice?