…it further. Starting doses in acute pain in an opioid naive adult Agent Route Starting dose Comment : : : : Morphine IV 2.5–5 mg, repeated after…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…affect the myocardium or major vessels. 1. Acute Coronary Syndrome (ACS) / Myocardial Ischemia Pain Characteristics: Typically presents as substernal discomfort, often described as pressure, tightness…

…select a safe disposition and diagnostic strategy. Only a minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5…

…patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based on symptoms, the ECG and haemodynamics. Do not wait…

…35 with raised pCO₂ Acute or acute on chronic hypercapnic respiratory failure Rapidly falling pH An urgent ventilatory problem Focal chest pain or unilaterally reduced…

…4. Measure the blood pressure in both arms at the first assessment, particularly in chest pain, back pain or suspected acute aortic syndrome. 5. Use…

…separate from MI. It refers to cardiac troponin release that does not fulfil the criteria for ischaemic myocardial infarction. It may be acute, when serial…

…tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not enough: fracture, renal colic, ischaemic pain, pancreatitis, major trauma. Postoperative pain…

…and Symptoms Acute chest and/or back pain is the predominant symptom of both IMH and PAU. PAU pain may resemble the abrupt pain of…

…acute myocardial infarction, which is then classified as NSTEMI (Non ST Elevation Myocardial Infarction). Patients with NSTE ACS who do not develop infarction are classified…

…infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but should not delay reperfusion treatment…

…Acute coronary syndromes cause symptoms already at rest. Stable ischemic heart disease does not cause symptoms at rest unless the stenosis is so grave that…

…may be used to diagnose myocardial ischemia and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…awake. Suspected necrotising fasciitis — pain that is disproportionately severe, a rapid course, skin discolouration, systemic upset — is an acute surgical emergency, not an abscess. Preparation…

…patient must not have experienced chest pain during the last 12 hours before exercise. Patients with unstable angina pectoris with high risk should not undergo…

…NSTEMI and unstable angina are different in one fundamental aspect: NSTEMI is by definition an acute myocardial infarction, whereas unstable angina is not an infarction …

…patients with acute pain, anxiety, or distress have transient BP elevation that improves when the precipitating state resolves. The distinction is therefore not based on…

…segment of aorta involved, although the source material does not provide a detailed symptom to anatomy correlation. Pain may be absent, particularly in iatrogenic aortic…

…acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to the trapezius ridge is not seen in STEMI and suggests pericarditis instead. Pain is…

…of objectively demonstrating peripheral arterial disease, and it is needed more often than it is used — not only in claudication, but before every compression treatment…

…A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness…

…the injury, not before — and that an edge or a fold presses on a bony prominence until the skin breaks down. An acute, fresh injury…

…never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in which septic arthritis must be distinguished from crystal…

…suggesting acute coronary occlusion. Most patients with this working diagnosis subsequently develop myocardial necrosis and cardiac troponin elevation, although not every patient with an initial…

…The underlying pathological mechanism is not restricted to a single lesion or process. Although Type 1 MI and acute coronary syndromes are commonly related to…

…abnormalities from chronic baseline findings, but comparison with an earlier tracing must not delay treatment when acute coronary occlusion is suspected. Standard ECG pattern suggesting…

…may not display the classic double lumen appearance. Clinical presentation and symptoms SCAD generally presents as ACS. Symptoms may therefore include acute chest pain or…

…2 MI frequently present with acute chest pain and troponin elevation. The clinical manifestation is typically driven by an acute stressor superimposed on the patient…

…Skin symptoms may be absent, and circulatory shock does not have to be present for the condition to be serious [1]. Intramuscular adrenaline (epinephrine) is…

…not a treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain…

…drugs. Such treatment has not been shown to improve the prognosis and can cause hypotension, acute kidney injury, myocardial ischaemia or cerebral hypoperfusion. Pain, anxiety…

…management of acute ischaemia. Those with possible ACS, a non diagnostic ECG, and normal initial troponin may be observed in a chest pain unit or…

…should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from ongoing myocardial ischaemia Haemodynamic…

…ischemia and infarction Definition and pathophysiology Post infarction pericarditis encompasses two temporally and clinically distinct complications of acute myocardial infarction (AMI): Early infarct associated pericarditis …

…pause. It commonly affects younger individuals who endure intense emotional stress, acute pain or other stimuli that increases vagal tone. In all other situations, sinus…

…flow limiting epicardial disease, and alternative causes should remain under consideration. Acute chest pain and suspected NSTE ACS CCTA may be used as an alternativ

…elevation myocardial infarction (STEMI). This may not always be simple, because both conditions bring about severe chest pain and ST elevations on the ECG. However…

…amputation. The decisive step is therefore not the choice of dressing but the ankle brachial index before the first bandage is applied . Indications Venous leg…

…not switched on — in second degree AV block Mobitz type 2, newly discovered complete heart block without current symptoms, alternating bundle branch block in acute…

…denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction…

…apical ballooning syndrome, stress induced cardiomyopathy) Takotsubo cardiomyopathy (broken heart syndrome) is a rather peculiar and certainly acute condition. Much research has been devoted to…

…corticosteroid abruptly after longer term treatment. Not giving a stress dose to a patient with adrenal insufficiency during acute illness. Confusing dexamethasone 0.75 mg…

…neck pain, diplopia, dysarthria, dysphagia, ataxia Posterior circulation stroke Unilateral hearing loss or tinnitus Ménière's disease, vestibular schwannoma, labyrinthitis Continuous vertigo that does not…

…Suspected corneal abrasion. A red eye where the diagnosis is not obvious. Suspected acute glaucoma (tonometry). Contraindications Absolute contraindications to instrumental removal: Suspected penetrating injury…

…or cold exposure. The absence of chest pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may occur in patients with diabetes…

…combination of an abnormal thrombogenic endocardial surface and blood stasis. During the acute infarction phase, endocardial inflammation and impaired regional contraction create conditions that favour…

…ventricular free wall, interventricular septum, or mitral valve apparatus. These lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss…

…or acute coronary occlusion. Stent thrombosis may occur within hours or days of implantation or many months to years later. Recurrent chest pain after STEMI…

…its etiology, severity (Table 2), and temporal onset. Distinguishing between acute and chronic hyponatremia, based on the rapidity of onset, is of paramount importance. The…

…all ischemic episodes are asymptomatic (refer to The Ischemic Cascade). Acute coronary syndromes occur when atherosclerotic plaques rupture or erode, leading to atherothrombosis and occlusion…

…and constitutes a medical emergency. Rupture may occur without preceding symptoms. Typical acute manifestations include severe pain, hypotension and abdominal tenderness. Leakage or rupture is…

…not be combined with statins because it alters statin absorption, hepatic uptake and disposition. Clinical presentation and symptoms Typical SAMS consists of: Symmetric muscle pain…

…pulmonary pressure, or haemodynamics Stress imaging is not recommended in patients undergoing urgent non cardiac surgery or those with an unstable clinical condition. In patients…

…is not an absolute rule. While it often holds true for cardiac arrests caused by chronic or acute ischemic heart disease, it is often not…

…fatigue and oedema. This definition does not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the…

…For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia, while…

…exercise intolerance to sudden cardiac arrest. The most common acute symptoms are dizziness (pre syncope), hypotension (chock), syncope, chest pain, heart failure and cardiac arrest…

…STEMI Example 12 ECG examples of acute STEMI (ST elevation myocardial infarction). Overview of management Click the diagram to enlarge. Chest pain (discomfort) is the…