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

…of hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary…

…50 percent or less together with marked symptoms indicates a severe attack, while a PEF below 33 percent or signs of ventilatory failure means life…

…in old age or in renal failure, reduce it further. Starting doses in acute pain in an opioid naive adult Agent Route Starting dose Comment…

…with thrombosis; other cases result from spasm, microvascular dysfunction, embolism, dissection, hypotension or shock, respiratory failure, severe anaemia, sustained bradyarrhythmia, tachyarrhythmia, or severe hypertension with…

…hypoxia, or sleep disordered breathing Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease Group 5: PH with unclear or multifactorial mechanisms…

…and presence of high risk arrhythmias on ECG guides the management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia…

…ischemia or infarction, acute heart failure, or pulmonary oedema. Patients may present with chest pain, severe breathlessness, hypoxaemia, rales, or respiratory distress. In patients with…

…respiratory failure with severe hypoxaemia, severe anaemia, and hypotension or shock. Conversely, mechanisms that increase myocardial oxygen demand include sustained tachyarrhythmia and severe hypertension, with…

…respiratory or haemodynamic failure that cannot be corrected quickly. Rapid sequence induction is used when intubation is required [1]. In salicylate poisoning, intubation with an…

…A failure to improve function is a reason to taper off, not to increase the dose. Contraindications Ongoing respiratory depression, or untreated severe respiratory failure…

…hypoxaemia. Hypoxaemic failure where high flow nasal oxygen is insufficient and the carbon dioxide is normal. Bilevel NIV: Acute exacerbation of COPD with respiratory acidosis …

…Scale below 8 Vomiting together with clear neurological impairment Respiratory failure or respiratory arrest Clinical signs of raised intracranial pressure or impending herniation Moderately severe…

…Contraindications There are no absolute contraindications in hypoxaemia. Take particular care in: A risk of hypercapnic respiratory failure — COPD, severe obesity with hypoventilation, neuromuscular disease…

…Examples Acute coronary atherothrombosis Plaque disruption or erosion with thrombosis Reduced myocardial perfusion Coronary spasm, microvascular dysfunction, coronary embolism, coronary dissection, hypotension, shock, respiratory failure…

…infected with COVID 19. Moreover, there may also be an increased risk of myocarditis, given the similarities between COVID 19 and MERS (Middle East Respiratory…

…the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms. Findings that suggest acute organ dysfunction Organ or system Finding : : CNS New…

…including acute pancreatitis, alkalosis due to hyperventilation, rhabdomyolysis (particularly the initial phase), sepsis, malignancies with osteoblastic metastases, diminished calcium absorption and/or enhanced calcium excretion…

…of hypoxia and respiratory failure. In placebo controlled trials, respiratory depression was no more common — and sometimes less common — after a benzodiazepine than with continued…

…a reduced level of consciousness with inadequate protective reflexes active major haematemesis severe agitation respiratory failure an anticipated difficult or prolonged endoscopic intervention a need…

…cardiac arrests caused by chronic or acute ischemic heart disease, it is often not true in other circumstances (e.g. pulmonary embolism, trauma, respiratory causes…

…arrest within 8 minutes. Cardiac arrest as a result of asphyxia or hypoxia is managed according to the standard CPR algorithm, except that interventions to…

…with mild skin and mucosal reactions in the lower grades and marked airway, respiratory or circulatory compromise in the higher ones [5]. For acute clinical…

…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…

…acute coronary syndrome (NSTE ACS) in patients with a low to intermediate likelihood of CAD when cardiac troponin and/or the ECG is normal or…

…wave or misplaced electrode). Lead III occasionally displays a large isolated Q wave; this is called a respiratory Q wave, because its amplitude varies with…

…of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of…

…progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is…

…non inferior to alteplase with respect to an excellent functional outcome, without an increased risk of symptomatic intracerebral haemorrhage or death [3]. Acute overview 1…

…lasts, and whether anything actually triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus…

…abdominal aortic aneurysm. Clinical Presentation and Symptoms Acute chest and/or back pain is the predominant symptom of both IMH and PAU. PAU pain may…

…and with or without an acute rise in cardiac troponin. The spectrum ranges from symptom free presentation to persistent chest discomfort, cardiac arrest, electrical or…

…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…

…right ventricular hypertrophy (RVH) from posterior acute ischemia. Both these conditions cause ST segment depressions in V1–V3 along with large R waves ( Figure 2…

…Williams classification (Table 1). Agents in bold text are commonly used to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification…

…the presence of substantial pre existing CKD, particularly when congestive heart failure or other causes of ischaemic AKI coexist. Risk assessment Patient related risk factors…

…reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting…

…with NSTE ACS (NSTEMI, unstable angina), on the other hand, may only display ST depressions and/or T wave inversions. STE ACS (ST Elevation Acute…

…Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms…

…Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med 2021; 385:516 525 Indications Severe left ventricular failure, acute or chronic…

…deposition, culminating in a partially or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non…

…ST segment elevation in acute myocardial ischemia ST segment elevations with straight (horizontal, upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia …

…markedly raised blood pressure without acute organ damage should as a rule not be lowered rapidly with intravenous drugs. Restart or optimise oral treatment and…

…threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction. acute heart failure recurrent dynamic ST segment or T wave changes, particularly with intermittent…

…failure, acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when the coronary artery is completely occluded and is particularly associated with…

…Clinical context and treatment objectives DAPT is used in two principal settings: After ACS , whether managed medically or with revascularization. After elective PCI for CCS …

…V9). Criteria for ischemia/infarction have been established for these leads (please refer to ECG leads or Additional leads in acute myocardial infarction). Importance of…

…Myocardial ischemia and infarction Factors that modify infarct size and the natural course in acute myocardial infarction (AMI) The traditional distinction between NSTE ACS (NSTEMI…

…or obscure acute myocardial ischemia and infarction, creating significant diagnostic challenges. These complexities led researchers to study patients presenting with LBBB and suspected acute myocardial…

…muscle damage or inflammation may result in elevated cTnT levels. Although both troponin T and I may be chronically elevated in patients with renal failure…

…Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy. Dosage Acute myocardial infarction: Initial…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

…flat. Lead V1 : Inverted or flat T wave is rather common, particularly in women. The T wave inversion is concordant with the QRS complex. Leas…

ECG Myocardial ischemia and infarction Acute myocardial infarction (AMI) always affects the left ventricle Myocardial infarction is virtually synonymous with left ventricular infarction . All myocardial…

…recovering from myocardial infarction or acute coronary syndrome. Patients with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome…

…and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms or signs, with or without electrocardiographic…

…After revascularization procedures, stress testing is utilized to assess whether there is any residual ischemia or angina pectoris. Patients may undergo repeated stress tests to…

…grouped. The chain of care in NSTEMI and unstable angina Management of patients with acute coronary syndromes is permeated by the mantra time is myocardium…