VENTRICULAR TACHYCARDIA Overview of approach to ventricular tachycardia EKG Features of VT • If patient is hemodynamically stable, take a deep breath and get a 12-lead EKG! Leads of choice to analyze: V1-2 and 6 for bundle branch morphology; I and F for axis EKG findings suggestive of VT: 1) AV dissociation/VA block with Wenckebach: “cherchez le p” and try to march them out usi
Erectile dysfunction clinicErectile Dysfunction Clinic
Delivering the best in care
UHB is a no smoking Trust
To see all of our current patient information leaﬂets please visit www.uhb.nhs.uk/patient-information-leaﬂets.htm Erectile Dysfunction (ED) is the persistent inability to get or maintain an erection that is sufﬁcient for successful sexual intercourse.
ED effects approximately half of all men between the ages of 40-70. ED can have many causes that are either physical (within the body) or psychological (related to mind). • venous leakage of blood away from penis Psychological causes may include anxiety, depression, relationship problems, and stress.
Your healthcare practitioner will discuss with you your individual case and what may be contributing towards your ED.
ED can have a signiﬁcant impact on your quality of life and currently there is no known cure for ED. However there are treatments available, which may be able to provide you with a good quality erection to have satisfactory sexual intercourse.
The healthcare practitioner will ask you some questions to assess your erections. Blood tests will be taken and you will be given a physical examination.
The healthcare practitioner will discuss treatment options, and in some cases shown to you, in clinic.
Of course you may refuse to have any part of the assessment carried out. The healthcare practitioner may not be able to assess your symptoms fully or recommend the most beneﬁcial treatment to you, without being able to gain all of the information.
The symptoms of ED may be helped by making lifestyle changes which can reduce risk factors which make you more at risk from getting ED. These changes may also have an impact on improving your general health.
Your treatment options will depend on the ﬁndings of the healthcare practitioner. If your ED is caused by an underlying medical condition, it may be necessary to treat the condition ﬁrst, before treating the ED. If a hormonal problem is identiﬁed, it may be necessary to refer you to an endocrinologist. An endocrinologist is a specialist in the treatment of hormonal conditions.
There are 4 different treatments available for erectile dysfunction. • Tablets taken prior to intercourse (VIAGRA, CIALIS and • A pellet of medication that goes into your urethra (water pipe) called MUSE (medicated urethral system for erection) • Injections that go directly into the penis called CAVERJECT • Vacuum suction devices - an external plastic tube placed over the penis. When activated it creates a vacuum that allows the penis to ﬁll with blood. To keep the penis erect a rubber constriction band is placed on the penis during intercourse Viagra – This is available in different strengths, and your
healthcare practitioner will discuss this with you. Viagra needs
to be taken at least 30 to 60 minutes prior to sexual intercourse,
and lasts for around 8 hours.
Cialis – This is available in different strengths, which can change
how you take this medication. One type of Cialis is taken in
the same way as Viagra, at least 30 minutes prior to sexual
intercourse, but each tablet may be effective for a maximum of
36 hours. Another type of Cialis is taken on a daily basis.
Levitra – This is available in different strengths and also needs
to be taken at least 30 minutes prior to sexual intercourse.
Manufacturer recommendations are that it lasts around 8 hours.
These tablets work through sexual stimulation and therefore you need to be aroused in order for them to become effective. The type of tablet that may be best suited to individual need, will be discussed by your healthcare practitioner at your appointment.
Side effects from tablets may affect some people and not
others. How you will be affected is unknown until you have
tried the tablets. Below is a list of the most reported side
effects in our clinics:
The active drug in MUSE and CAVERJECT is Alprostadil. This is a man-made hormone which stimulates blood ﬂow to the penis.
You will be taught how to use these treatments at your appointment, by your healthcare practitioner, and it may take between 1 and 8 weeks, to establish you on a dose which is effective. Alprostadil will usually produce an erection within 15 minutes and how long it lasts can vary from patient to patient.
The side effects of Alprostidil again vary depending on the route of administration but include: • reactions at the site of the injection, such as swelling MUSE – is a pellet of medication that goes into your urethra
CAVERJECT – is an injection that goes directly into the penis.
Both of these treatments need to be tried within the clinic
setting and cannot be prescribed by your GP until the dose of
medication has been determined and your technique in using
these treatments has been assessed as being safe.
If a vacuum suction device is appropriate for you, your healthcare practitioner will arrange a further appointment for you with the product specialist. They will show you how these devices work. You can try a device to see what effect you get before deciding to order one. These devices can cost around £150, therefore we want you to be completely happy with the outcome prior to purchase (if you are entitled to a prescription on the NHS then these pumps are prescribed by your GP and you would only pay the prescription charge, if this applies to you).
The Department of Health guidelines state that unless patients have one of the following conditions, then they must pay for their ED treatments. Your GP and healthcare practitioner cannot change these national guidelines.
• Renal failure treated by dialysis or transplant • Patients who were taking treatments for ED prior to 14 Once you are happy with a treatment option, your healthcare practitioner will write to your GP asking him to provide you with a prescription. If you do not meet the requirements to receive free prescriptions, this prescription is commonly known as a ‘Private Prescription’. When you take this to a pharmacy, they will know that you are required to pay the full cost of the prescription. If you do meet the requirements then you will receive a prescription in the usual manner.
How much will I have to pay for treatments? Each treatment will have a different cost and will also change over time. The current average costs will be discussed with you, by your healthcare practitioner.
Advanced Nurse Practitioner
Telephone: 0121 672 7843
Urology Clinical Nurse Specialist
Telephone: 0121 627 2284
Mr Subramonian Secretary
Telephone: 0121 371 5737
The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit www.uhb.nhs.uk/health-talks.htm or call 0121 371 4957.
Queen Elizabeth Hospital Birmingham
Author: Kelly Calame Date: August 2012 Review date: August 2014
Date:02/02/2010 URL: http://www.thehindu.com/2010/02/02/stories/2010020253070300.htm Plan to link Then Pennaiyar and Cheyyaru sent to Centre for nod Sathanur reservoir opened up for irrigation Food Minister opens sluice gates of pickup dam Water will be released in six instalments Tiruvannamalai: A project has been drafted to link the Then Pennaiyar with the Cheyyaru at a