…including acute responders and non responders. Left heart disease is the most common risk factor for PH. It produces postcapillary PH through elevation of left…

…commonest cause of upper gastrointestinal bleeding, but the differential diagnosis includes oesophagitis, gastritis, a Mallory Weiss tear, a Dieulafoy lesion, angiodysplasia, malignancy and an aortoenteric…

…rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and Clinical evidence of acute myocardial…

…investigations. The emergency differential also reflects distinct mechanisms of acute cardiopulmonary disease: Pulmonary embolism and spontaneous pneumothorax may produce abrupt chest pain and respiratory distress…

…insufficient and the carbon dioxide is normal. Bilevel NIV: Acute exacerbation of COPD with respiratory acidosis , that is, a pH below 7.35 and a…

Clinical medicine Emergency medicine Definition and pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that…

…and selected cases of upper abdominal pain. An ECG recording costs approximately $10 (10€) and may reduce morbidity and mortality substantially in patients with acute…

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

…ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI), and ST Elevation Myocardial Infarction (STEMI…

…et al, Twerenbold et al) Kinetics Troponin T (cTnT) and troponin I (cTnI) increase 2 3 hours after the onset of acute myocardial infarction. The…

…present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation with inspiration, along with a pleural friction rub, helps differentiate…

…laboratory medicine Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia…

…falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage meeting the criteria for activation of the massive…

…upper limit of normal: paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis. The three are distinguished by the history and the speed of…

…above the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and/or fall of cTn values…

…percentile upper reference limit; and Evidence that the injury is caused by myocardial ischaemia. Accordingly, acute troponin elevation without evidence of ischaemia represents acute myocardial…

…upper lip) Venous drainage towards the cavernous sinus Surgeon or ENT; often antibiotics Palm, fingers, tendon sheaths Deep compartments and tendon sheaths, loss of function…

…brachial index (TBI). The digital arteries rarely calcify, which makes toe pressure the method of choice in diabetes and renal failure. A normal TBI is ≥

…most common cause of misclassification. Five minutes' seated rest, back and arm supported, legs uncrossed, no conversation Cuff width ≥ 40% of the upper arm circumference…

…foreign body under the upper eyelid. 7. Seidel's sign: apply fluorescein generously and look under blue light. A dark stream of aqueous humour breaking…

…post ACS or post revascularization states, and heart failure of ischaemic or cardiometabolic origin. Major clinical presentations The principal outpatient presentations include: Reproducible stress induced…

…the absence of a flow limiting epicardial stenosis. It is associated particularly with intervention on degenerated saphenous vein grafts, rotational atherectomy, and acute MI procedures…

…numerous other causes of chest pain, but the other causes are either subacute or non acute. The history taking must be systematic and accurate because…

…are blocked sporadically (without any Wenckebach phenomenon). The pauses between the visible beats are always multiples of the normal P P interval (Figure 3). Typically…

…tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of renal function Doxycycline, erythromycin, clindamycin, metronidazole, moxifloxacin and fusidic…

…when multiple modifiable and non modifiable risk factors converge. The electrophysiological mechanism underlying TdP involves prolonged ventricular repolarisation, which allows for the recovery of time…

…ancestry Previous muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not…

…the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for ventilatory…

…Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in…

…of breathing, exhaustion and, in the most severe cases, hypotension, pneumothorax and respiratory arrest [1]. The first few minutes 1. Sit the patient up and…

…suggest aortic dissection CT of the brain Exclude intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify…

…present, neurological examination, gait and truncal stability Acute balance syndrome Acute persistent unsteadiness or ataxia without clear spontaneous nystagmus Cerebellar or brainstem infarction, intoxication, Wernicke…

…Pathophysiology Acute aortic syndromes comprise classic aortic dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Aortic dissection accounts for approximately 80%–90% of acute…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…on: Blood pressure and evidence of hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or…

Myocardial ischemia and infarction ECG Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the…

…signs of overdose. Sedation precedes respiratory depression; monitor it. Naloxone is titrated to spontaneous breathing, not to wakefulness. It has a short half life, and…

…treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects on multiple cardiac…

Adapted from AHA, ACC and ESC guidelines.

…many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The…

…is defined by acute coronary artery occlusion causing transmural ischemia and requiring urgent reperfusion, even in the absence of classic ST elevation. Multiple studies have…

…a classification of acute coronary syndromes and myocardial infarctions. The reader should study this chart carefully. Figure 1. Flowchart showing the natural course of coronary…

…the concurrent use of beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe acute or chronic…

…These ST segment depressions are mirror images of the ST segment elevations, and they are seen in leads with a roughly opposite angle to the…

…of bupropion, among others, can raise the blood pressure. Serotonin syndrome can also cause autonomic instability and hypertension [4]. Step 2: look systematically for acute…

…the absence of ST segment elevation, primary PCI is indicated in patients with symptoms suggestive of acute myocardial infarction and at least one of the…

…haemodynamically unstable patients, evaluation must also consider acute severe mitral regurgitation, mechanical complications, and ischaemia related ventricular failure as potential causes of shock. Patients with…

…to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Aspirin irreversibly inhibits cyclooxygenase and thereby suppresses…

…that it will cause an acute event. A more clinically useful model considers both the plaque and the patient. Multiple potentially high risk plaques may…

…and STE ACS (STEMI) is slightly simplified. In reality, the course in acute myocardial infarction (AMI) is modified by several factors. The most important of…

…arise when facing a patient with left bundle branch block (LBBB) and symptoms of ischemia follows: Left bundle branch block (LBBB) can mimic acute STEMI …

…the efficacy of diuretics and antihypertensives. Risk of acute kidney injury increases when combined with ACE inhibitors. Corticosteroids and other NSAIDs: Increased risk of gastrointestinal…

…Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks. Choice of vein and cannula size…

…be familiar with the classification of acute coronary syndromes. Subsequent chapters will deal with ST segment elevation myocardial infarction (STEMI) and non ST segment elevation…

…Management of acute bradycardia in the emergency setting. Parameter Assessment A Airway Voice Breath sounds B Breathing Respiratory rate (12–20 / min) Chest wall movements…

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