➡️ Diuretics may not be the preferred initial therapy for those patients with vascular failure, who are often euvolemic, or those with cardiogenic shock, who are often hypovolemic.
3/
➡️ In these patients, the emergency provider should first optimize preload and afterload reduction with the use of noninvasive positive pressure ventilation (NPPV), nitrates, or inotropes as indicated.
4/
➡️ Early use of NPPV significantly reduces rates of intubation and inhospital mortality.
➡️ NPPV decreases preload and afterload by increasing intrathoracic pressure.
5/
➡️ Nitrates should be administered early and rapidly to maximize preload and afterload reduction.
➡️ At low doses, nitrates dilate the venous system and reduce preload.
➡️ At higher doses, nitrates produce arterial dilation with resultant afterload reduction.
6/
➡️ Sodium nitroprusside is an alternative that may be useful in patient’s refractory to nitroglycerin therapy
➡️ For patients presenting with pulmonary edema secondary to cardiogenic shock, an inotrope such as dobutamine should be initiated to improve cardiac output.
7/
➡️ Recent data suggest worse outcomes with the use of morphine for cardiogenic pulmonary edema.
➡️ Diuretic administration should follow the use of more rapidly acting preload and afterload reducing therapies, particularly if there is little suspicion of volume overload.
➡️ Acids cause coagulative necrosis, which results in a self-limiting burn pattern
➡️ Alkaline materials induce liquefactive necrosis with diffusion into deeper layers of the injured mucosa. Even low concentrations of alkaline ingestion can cause extensive injury.
3/
➡️ Caustic Ingestion can provoke injury from the mouth, the airway, down through the esophagus to the small intestine.
➡️ Long-term complications can lead to strictures and an increased risk of esophageal cancer.
➡️ Boerhaave syndrome is a spontaneous rupture of the esophagus from barotrauma related to retching or any sudden increase in intraabdominal pressure against a closed glottis.
➡️ Boerhaave syndrome should be suspected in any patient who presents with retrosternal chest pain, neck pain, or epigastric pain, especially if it began after an episode of severe retching or bearing down against a closed glottis (weight lifting, defecation, childbirth, etc)
➡️ Additional critical diagnoses to consider that can be detected with ECG:
👉Ventricular Preexcitation (WPW)
👉Brugada syndrome
👉Long or short QT syndromes
👉Hypertrophic Cardiomyopathy
👉Arrhythmogenic right ventricular dysplasia
👉Catecholaminergic polymorphic VT
3/
➡️ Ventricular Preexcitation (WPW)
👉 PR segment < 120 ms
👉 QRS complex > 110 ms
👉 Slurred upstroke of the initial part of the R wave (delta wave)
➖ Type A: delta wave in all precordial leads, R > S in lead V1
➖ Type B: negative delta waves in leads V1 and V2