…never at the lower border where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain, or when the volume limit is…

Procedurer Almost all nosebleeds arise from Kiesselbach's plexus on the anterior septum and stop with correctly performed compression. The reason compression nevertheless so often…

Echocardiography Tissue Doppler (Tissue Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the Doppler effect can also…

…cardiovascular prevention and treatment. It is associated with lower cardiovascular and all cause mortality and with reduced incidence or burden of hypertension, type 2 diabetes…

…Myocardial infarction is virtually synonymous with left ventricular infarction . All myocardial infarctions affect the left ventricle. Right ventricular infarction is uncommon but may occur if…

…regardless of the appearance of the QRS complex. All positive waves are referred to as R waves. The first positive wave is simply an "R…

…the result of chronic inflammation of the pericardium. In principle, all causes of pericarditis can result in constrictive pericarditis. In high income countries, idiopathic pericarditis…

…improve above all the logistics, the communication and the simultaneous delivery of red cells, plasma and platelets. Observational data from trauma suggest a lower overall…

…Creatinine Clearance : Reduced renal function increases risk. Left Ventricular Ejection Fraction (LVEF) : Lower LVEF is associated with worse outcomes. Unprotected Left Main Disease : Increases complexity…

…duration , sex , and genetically influenced effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with…

…those at lower risk or in whom the hazards of revascularization outweigh its potential benefit. A routine invasive strategy does not reduce all cause mortality…

…a more symmetrical T wave, a more distinct transition from ST segment to T wave and lower T wave amplitude. The T wave should be…

…volumes, and pressure conditions in the heart. These techniques allow for the calculation of all clinically relevant hemodynamic parameters, with few exceptions. Prior to the…

…income countries for more than half a century, causing approximately 20% of all deaths in these regions. Mortality rates and case fatality in coronary artery…

…chest compressions. Hemorrhages, either manifesting externally or concealed internally, account for approximately half of all traumatic cardiac arrests. In the absence of evident hemorrhage, potential…

…at lower doses than for pain). An opioid is rarely the right choice in nociplastic or neuropathic pain, in chronic non cancer pain, or in…

…Avoid the lower limb in adults. In shock with collapsed vessels, the antecubital fossa or the external jugular vein are the vessels that can most…

…The QT interval varies inversely with heart rate; it shortens at higher heart rates and lengthens at lower heart rates. To account for this variability…

…population is 1.0% to 1.5%. The crude prevalence is lower in non Western countries, primarily due to the younger age composition in those…

…systolic blood pressure 140 mm Hg or diastolic blood pressure 80 mm Hg or higher. • Approximately 50% of all cardiovascular events attributable to hypertension occur…

…the only treatment with class I recommendation according to European (ESC) and North American (AHA, ACC) guidelines. As in all clinical emergencies, the airway, breathing…

…the one examines is located. One can choose to place one or more focus (multiple focus lowers the image update rate). The direction and foc

…ischemia, seen in multivessel disease, exists when all coronary arteries are equally compromised, leading to uniform perfusion that may appear deceptively normal on SPECT. Detecting…

…pulsed wave Doppler sends and analyses sound waves sequentially. The ultrasound machine is programmed to ignore all signals, except those reflected from a certain depth…

…there is no cerebral perfusion, with an equal degree of hypoxia in all neurons. There is one fundamental difference between neurons and myocardium in the…

…Importantly, for the ventricles to have any electrical (and thus pumping) activity at all, an escape rhythm must arise in an ectopic focus (located distal…

…with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes — the wound may not heal. Over superficial nerves…

…not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the…

…up. 3. Ocular movements in all directions; pain on upward gaze may suggest an orbital floor fracture. 4. Topical anaesthesia into the lower fornix. 5…

…CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin I to angiotensin II…

…Black race, lower socioeconomic or uninsured status, a history of angina or diabetes, and consultation with relatives or physicians before contacting emergency services. These factors…

…cardiac arrest, or even sudden cardiac death. The Brugada brothers also noted that the syndrome – which was named the Brugada syndrome – appeared to be hereditary…

…the action potential, albeit at a much lower speed than the conduction cells. The terms contractile myocardium , myocardium, or simply myocardial cell, refer to this…

…round and have an irregular surface, the reflected sound waves are scattered in all directions (Figure 2). Although only a fraction of the sound waves…

…variations in heart rate are due to variations in the activity of the autonomic nervous system and changes in the automaticity of the sinoatrial node…

…during physical exertion). Therefore, to judge whether the QT interval is normal or not, one must adjust for the current heart rate. This is done…

…Sinoatrial (SA) block implies that the impulses discharged in the sinoatrial node are either not conducted to the atria or are so with a delay…

…tachycardia and ventricular fibrillation cause the vast majority of all deaths in the acute phase of STEMI. Death due to ventricular dysfunction, or mechanical complications…

…excellent, with the vast majority of patients recovering completely after restoration of sinus rhythm (or any other rhythm with normal ventricular rate and activation). Recovery…

…increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not affected by the concurrent use…

…unloads the heart, whereas bilevel NIV delivers pressure support above the expiratory pressure and thereby increases ventilation and lowers the carbon dioxide. Pulmonary oedema calls…

…already taking low or moderate intensity statins should have treatment intensified. The 2025 ACS guideline recommendations include: High intensity statin therapy for all patients with…

…hypokalemia. Arrhythmias caused by digoxin Digoxin may cause virtually all known arrhythmias. However, none of the ECG changes or arrhythmias are unique to digoxin. One…

All patients with NSTE ACS (NSTEMI or unstable angina) are treated similarly with respect to anti ischemic and anti thrombotic drugs. Management must, however, be…

CPR Cardiac arrest during pregnancy and childbirth All healthcare units capable of managing pregnant women in cardiac arrest should engage in specialized clinical training to…

CPR It is commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being…

CPR A standard 12 lead ECG should be recorded in all patients after return of spontaneous circulation (ROSC). The purpose of a 12 lead ECG…

…aims in themselves. Almost all of them have proved to work better as ranges to stay within than as figures to strive for. Ventilation In…

…general practice concern the nails, and all three rest on the same foundation: an effective digital block and a tourniquet . Without a bloodless field one…

…in the ventricles will result in wide QRS complexes because the impulse will spread entirely or partly outside of the conduction system (which is slow)…

…pulmonic) regurgitation Pulmonary regurgitation is also called pulmonic regurgitation . The majority of all adults exhibit a small pulmonary regurgitation, which is considered a normal finding…

…pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or other symptoms that may be caused by…

…source. ATP is produced by metabolizing carbohydrates (glucose), fats or proteins, whichever is available. ATP fuels all cellular functions, such as contraction and relaxation. Increasing…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…principles that are common to all protocols. Children, pregnant women and patients with advanced renal failure, marked heart failure or circulatory shock require a specific…

…applied at all, and if so at what pressure. Palpable foot pulses are not an acceptable substitute, and in patients with diabetes or renal failure…

…increase the entry of salicylate into the central nervous system. Discuss the case early with the poison control centre and with anaesthesia or intensive care…

…history of the disease. In lateral epicondylitis the effect is in fact worse than no treatment at all at one year . The injection is therefore…

…the index procedure. Complete revascularization aims to treat all lesions producing myocardial ischaemia, either during the same procedure or through staged intervention. The rationale for…

…pocket guide with a universal interpretation algorithm. These 22 pages includes all you need to perform methodological ECG interpretation. We recommend this approach as it…