Esmolol

Are they better? Are they worse? Are they in between? Did it not do anything? And to do that, the agents you choose are should in a perfect world be something fast on, fast off.

Think something like Esmolol potentially, right? Esmolol is a beta blocker, all right? So it's an AV nodal blocker, but it's fast on and fast off.

So if you guessed wrong and slowing them down makes them worse, you just turn it off and the Esmolol will work out their system very quickly, all right? Another thing we can do is diuresis for congestion.

So diuresis, giving them something like a loop diuretic, having them urinate off some of that fluid, or if they're not peeing, putting on renal replacement therapy.

This can reduce those pulmonary venous pressures and improve pulmonary edema.

Are they better? Are they worse? Are they in between? Did it not do anything? And to do that, the agent you choose should, in a perfect world, be something fast on, fast off.

Think something like esmolol potentially, right? Esmolol is a beta blocker, all right? So it's an AV nodal blocker, but it's fast on and fast off.

So if you guessed wrong and slowing them down makes them worse, you just turn it off and they, uh, the esmolol will work out their system very quickly, all right? Another thing we can do is diuresis for congestion.

So diuresis, giving them something like a loop diuretic, having them urinate off some of that fluid or if they're not peeing, you know, put them on renal replacement therapy.

Never flecainide in structural heart disease.

Esmolol if you must beat a block.

And remember, adenosine is diagnostic rather than therapeutic.

If there are adverse features, it's a synchronised shock, not a drug.

How do you control it?

You use intravenous beta blockers like Esmolol to drop their heart rate to around 60 beats per minute and vasodilators like nicardipine to drop their systolic pressure between 100 and 120.

If you don't control the hemodynamics, the sheer force of the blood can actually cause the aneurysm to rupture while you are trying to fix it.

Man, that's intense.