Procedurer The insertion itself is rarely the difficult part — it is the confirmation of the position that determines whether the tube is safe. A misplaced…

…from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side, with the needle…

…compression. The reason compression nevertheless so often fails is that it is done wrongly: the patient pinches the nasal bone instead of the soft part…

…3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol production increases hepatic LDL receptor expression, thereby enhancing removal of…

Cardiology Neurology Definition and Pathophysiology Carotid artery stenosis is an atherosclerotic narrowing of the carotid arteries. It forms part of multisite artery disease, defined as…

ECG Introduction to ECG interpretation The normal T wave Assessment of the T wave represents a difficult but fundamental part of ECG interpretation. The normal…

…initial part shows QRS complexes with similar morphology as ECG 1, likely presenting a supraventricular rhythm. Three short bursts of ventricular tachycardia occur. ECG 3…

…aphasia and radiological changes resembling ischaemic stroke. Glucose measurement is therefore always part of the initial stroke assessment [1]. Treat immediately when there are symptoms…

…pathophysiology Chronic kidney disease (CKD) is defined by abnormalities of renal structure or function that persist for more than 3 months and have health implications…

…important indication and an emergency procedure . An unclear arthritis, as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or…

…3. Lancellotti, Patrizio; Tribouilloy, Christophe; Hagendorff, Andreas; Moura, Luis; Popescu, Bogdan A.; Agricola, Eustachio et al. (2010): European Association of Echocardiography recommendations for the assessment…

…segment depression in the inverted lead aVR). A notch is evident in the ascending part of the ST segment. A male patient (Figure 1) presented…

…is considerably better [3,5]. Pathophysiology Alcohol enhances inhibitory signalling via gamma aminobutyric acid, GABA, and inhibits excitatory glutamate signalling, in part via NMDA receptors…

…vasoconstriction, arrhythmia, intra aortic balloon pump. Assessment of stroke volume variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site…

…always RhD negative to women of childbearing age) while awaiting the result. Equipment A large bore peripheral cannula — at least 1.3 mm (green) for…

…Choice of site The posterior superior iliac spine is the standard site for both aspiration and biopsy in adults. Here the posterior part of the…

…much bicarbonate is given. Potassium replacement is not the management of a side effect; it is part of the treatment itself. Indications Salicylate poisoning with…

…retrograde (inverted) P waves, which can be located anywhere between the J point and the terminal part of the T wave. PR interval 0,22…

…in Figure 3. If an atria becomes enlarged (typically as a compensatory mechanism) its contribution to the P wave will be enhanced. Enlargement of the…

…volume (SV) should be placed between the leaflet tips (1–3 mm axial length of SV) and sweep speed is set to 50 mm/s…

…retrograde (inverted) P waves, which can be located anywhere between the J point and the terminal part of the T wave. PR interval 0,22…

…usually thickened and during systole leaflet doming appears. The proximal part of the pulmonary artery is frequently dilated. The maximum and mean pressure gradient is…

…AV) node are located in the atria and are not part of the ventricular conduction system. The AV node transitions into the bundle of His…

…first part of the formula (0.5 • D blood ) can be approximated to 4, meaning that Formula 2 can be rewritten as follows: Formula 3…

…tragus and the area behind the pinna before the otoscope is inserted — mastoid erythema and a protruding ear are not part of the tympanic membrane…

…myocardial segmentation for echocardiography and cardiac imaging Cardiovascular imaging modalities have developed rapidly in the past few decades. The repertoire of available methods includes echocardiography…

…without the presence of acute atherothrombosis. Type 3 MI: Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG…

…Tachycardia The classification of VT is fundamentally based on its duration, morphology, and hemodynamic consequences, which collectively dictate the urgency and modality of intervention [3] …

…deaths in patients without structural heart disease and is the leading cause of SCD in men under the age of 40 in endemic regions [3] …

…the hemodynamic significance of a coronary lesion, with anatomic and functional assessment discordant in a substantial minority of intermediate lesions. Over the past three decades…

…it will disappear, and the documentation is all that remains. 3. Pare down any hyperkeratosis with a scalpel; nitrogen does not penetrate thick keratin. 4…

…days, or shorter neutropenia with clinical risk factors International guidelines generally use a single temperature of 38.3 degrees as the threshold [4,5]. Some…

…fascicular block, the myocardium without fascicular supply will depend on impulses spreading from other parts of the ventricle (where the fascicle is intact). Figure 1…

…demonstrate that while the incidence of HFrEF has stabilized or slightly declined over the past two decades, the incidence of HFpEF continues to rise steeply…

…the traditional presentation of the 12 lead ECG. This presentation format is the standard in the United States, the United Kingdom, most parts of Europe…

…2 cm above the tip of the malleolus. 3. Dorsalis pedis artery — the signal is sought on the dorsum of the foot lateral to the…

…NSTEMI and a corresponding decrease in unstable angina in the past two decades (many of those who would previously have been classified as unstable angina…

…as side effect of drugs, hypoxia, myocarditis and electrolyte disorders. Because the rate (60–100 beats per minute) is on a par with the rate…

…promptly. Survival is around 70% when defibrillation is performed within 3 minutes of the collapse (Hessulf et al). In out of hospital cardiac arrest (OHCA)…

…optimal balance for deciding on ICD implantation, yielded a number needed to treat (NNT) of nine (95% CI: 6.3–13.6). References 1.Mazzanti…

…the optimal balance for deciding on ICD implantation, yielded a number needed to treat (NNT) of nine (95% CI: 6.3–13.6). References Mazzanti…

…tachycardia (VT). ECG 3 . Ventricular fibrillation (VF). ECG 4 . Ventricular fibrillation (VF). ECG 5 . Ventricular fibrillation (VF). ECG 6 . Delivery of shock, followed by asystole…

…resulting in reduced cardiac output and risk of hypoperfusion. Distinguishing AV block 2 and AV block 3 In case the distinction between second degree AV…

…3 year survival rate of 50% ( Eleid et al ). The cause of aortic stenosis displays marked geographical variations. In high income countries, the majority of…

…0,3 0,69 0,69 EROA (cm²) < 0,20 0,20 0,39 0,39 Jet size < 4cm² or < 20% of…

…if bradycardia is caused by beta blockers. Dobutamine β 1 agonist Infusion of 3−10 μg/kg/min. T½ 2 min Effective if inotropic…

…rhythm interrupted by polymorphic VT. ECG 2 . Polymorphic VT. ECG 3 . Polymorphic VT progresses to ventricular fibrillation (VF). ECG 4 . Polymorphic VT progresses to ventricular…

…relaxation (grade 1 dysfunction) Pseudonormal (grade 2 dysfunction) Reversible restrictive filling (grade 3 dysfunction) Irreversible restrictive filling (grade 4 dysfunction) E/A ratio 1–2…

…A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000 Oct…

…aortic diameter exceeds 3 cm. Most AAAs are located below the renal arteries and are related to atherosclerotic disease. At least 90% of AAAs larger…

…interrupted by ventricular tachycardia (VT). ECG 2 . Spontaneous termination of ventricular tachycardia (VT). ECG 3 . A single ventricular beat, followed by a three ventricular beats…

…2 . Polymorphic ventricular tachycardia. ECG 3 . Spontaneous termination of the ventricular tachycardia. ECG 4 . Recurrence and spontaneous termination of ventricular tachycardia. ECG 5 . Polymorphic ventricular…

…pressure suggests a low stroke volume Capillary refill < 3 s A simple and validated marker of perfusion Lactate < 1.6 mmol/L Clearance…

…3. Instil 10–20 mL of lidocaine gel into the urethra. Pinch the meatus closed and wait at least 3–5 minutes — the anaesthetic and…

…7 3.0–4.0 4.1–4.6 4.7–5.2 5.2 LA diameter/BSA, cm/m2 1.5–2.3 2…

…in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. In European heart journal cardiovascular Imaging 16 (3)…

…formula: MAP ≈ Diastolic Blood Pressure (DBP) + 1/3 × (Systolic Blood Pressure [SBP] – DBP) This formula accounts for the longer duration of diastole compared to systole…

…V6 (mm) 0–12 (5) 0.1–12 (5) 0.5–12 (5) 3–17 (8) 5–22 (12) 6–23 (14) 6–23 (13)…

…American Society of Echocardiography : official publication of the American Society of Echocardiography 16 (7), pp. 777–802. DOI: 10.1016/S0894 7317(03)00335 3…

…of vernakalant Vernakalant is dosed by body weight, with the maximum dose based upon 113 kg. Normal dilution: 4 mg/ml. Recommended initial dose: 3…