Care closer to home – a changing role for physicians

摘要

Editor – We are writing to express ourconcern at a misconception alluded to byCleland, Yassin and Khadjooi (Clin MedFebruary 2010 pp 59–64). The authorsstate that ‘patients with acute cardiogenicpulmonary oedema cannot lie flat so,unless the patient is ventilated, myocardialinfarction (MI) should be managed withthrombolysis, and unstable angina withjudicious doses of nitrates’.This is outdated advice. Primary percutaneouscoronary intervention can be carriedout in patients with pulmonaryoedema or cardiogenic shock – this is preciselythe treatment they need to givethem the best chance of survival, and itwould be wrong to deny them this becauseof a misunderstanding of what is technicallypossible.