Procedurer Almost all the complications of pleural aspiration arise from two errors: the needle is placed in the wrong site, and too much is drained…

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…

…have all focused on measurements of blood flow. However, the Doppler effect can also be used to study myocardial motion. Myocardial motion during systole and…

…a central component of cardiovascular prevention and treatment. It is associated with lower cardiovascular and all cause mortality and with reduced incidence or burden of…

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

…their capital letters (Q, R, S), and small waves are referred to by their lower case letters (q, r, s). Figure 5 shows examples of…

…intrathoracic pressure decreases during inhalation, which lowers pressure in the pulmonary veins and left atrium; this facilitates blood flow from the pulmonary veins to the…

…on a single threshold value. The combination of physiology, rate of bleeding, the pattern of injury or disease, the response to initial treatment and the…

…function increases risk. Left Ventricular Ejection Fraction (LVEF) : Lower LVEF is associated with worse outcomes. Unprotected Left Main Disease : Increases complexity and risk. Peripheral Vascular…

…fraction. Enlargement of the left ventricle predisposes to atrial and ventricular arrhythmias. In advanced alcohol related cardiomyopathy, dilation may involve all four cardiac chambers. Associated…

…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…

…parameters. The Doppler effect The central principle to all hemodynamic calculations is the Doppler effect, which was discussed previously (see Doppler Effect and Doppler Echocardiography)…

…The greater the stenosis, the lower the level of myocardial workload required to elicit ischemia and symptoms. Angina pectoris: the hallmark of coronary artery disease…

…only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac arrest often exhibit favorable neurological outcomes…

…titration. Half of all opioid dosing errors arise at the dilution step, and an undiluted syringe of 10 mg/mL makes small adjustments impossible. Procedure…

…peripheral venous access often takes too long. Intraosseous access accepts all drugs, fluids and blood products that can be given intravenously , at the same dose…

…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…

…and mortality and improve quality of life. These approaches are discussed further below. Symptoms of atrial fibrillation Approximately 25% of all individuals with atrial fibrillation…

…Combination therapy with multiple antihypertensives is often necessary to normalize blood pressure. Management of hypertension requires careful consideration of other cardiovascular risk factors and coexisting…

…guidelines. As in all clinical emergencies, the airway, breathing, circulation, disability, exposure (ABCDE) approach is applicable in bradycardia (Figure 1). Cardiac output and blood pressure…

…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

…quantification of myocardial blood flow and assessment of coronary flow reserve. A single session can be used for performing both rest and stress images (Sogbein…

…the more time required for sound waves to travel back and forth, which results in lower pulse repetition frequency (fewer ultrasound pulses can be sent…

…perfusion, with an equal degree of hypoxia in all neurons. There is one fundamental difference between neurons and myocardium in the setting of hypoxia. Myocardium…

…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…

…clindamycin, metronidazole, moxifloxacin and fusidic acid. All have good absorption and are best given orally when gut function is intact. Oral vancomycin (only for C…

Procedurer The single most important step in any eye injury is to measure and document the visual acuity before anything else is done. The second…

…patients with symptomatic LV dysfunction, and all placebo controlled chronic HFrEF trials using neurohormonal antagonists have demonstrated a reduction in mortality. The absolute benefit is…

…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…

…lower than the risk among patients with Brugada syndrome. It follows that Brugada syndrome is a likely diagnosis in patients presenting with these symptoms and…

…a branch like morphology. As illustrated in Figure 2 all cardiac cells are connected, both electrically and mechanically, along their long axis. This cell architecture…

…away from the transducer will generate reflections with lower frequency. Doppler shift The Doppler effect is utilized to calculate velocity and direction of moving objects…

…in the majority of healthy pediatric patients. P waves precede all QRS complexes and the PR interval is constant. Although sinus arrhythmia can be pronounced…

…be used. Such QTc intervals are derived by all modern ECG machines and the formulas used are more precise than those listed above. It is…

…Lower tracing shows first degree sinoatrial block, in which the time interval from impulse discharge to atrial activation is prolonged and this cannot be discerned…

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

…preload, diminished stroke volume, and subsequently lower blood pressure and reduced organ perfusion. Left ventricular dilation occurs with ensuing decline inleft ventricular ejection fraction (LVEF)…

…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…

…does not increase ventilation at all . The backup rate is usually set at 12–16 breaths per minute. Regional protocols and the terminology used by…

…improves endothelial function, lowers circulating high sensitivity C reactive protein, reduces thrombogenicity, and favourably modifies inflammatory and collagen related components of atherosclerotic plaque. These effects…

…digoxin. Increased Vagus activity diminishes the automaticity in the sinoatrial node (which lowers heart rate) and also slows conduction over the atrioventricular (AV) node. The…

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…

…evident from the fact that the vast majority of all myocardial infarctions and episodes of myocardial ischemia, do not cause ventricular arrhythmias and cardiac arrest…

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…

…and all three rest on the same foundation: an effective digital block and a tourniquet . Without a bloodless field one works by feel, and by…

…tachycardia during physical activity, all tachycardias should be considered pathological and the task is to clarify the cause of the tachycardia. The cause may range…

…the pulmonary valve reveals regurgitant blood flow in the parasternal short axis view. Pressure gradient and pressure half time (PHT) are also estimated using continuous…

…for interpretation of ischemia. All available ECG criteria for acute myocardial infarction and ischemia are based on conventional 12 lead ECG. Established ECG criteria do…

ECG Myocardial ischemia and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes…

…not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be…

…plasma glucose Total calculated osmolality: 2 × plasma sodium + plasma glucose + plasma urea All concentrations are given in mmol/L and the result in mosm/kg…

…high Contraindications to compression The ankle brachial index measured with Doppler determines whether compression may be applied at all, and if so at what pressure…

…time, and whether the intake was single or repeated a modified release preparation or a combination product concurrent drugs, alcohol and illicit substances weight, age…

…relief and rarely alters the natural history of the disease. In lateral epicondylitis the effect is in fact worse than no treatment at all at…

…and anticipated adherence to antithrombotic therapy. Anatomical and functional completeness are not synonymous. Anatomically incomplete revascularization may nevertheless be functionally complete if all lesions causing…

…pages includes all you need to perform methodological ECG interpretation. We recommend this approach as it minimizes the risk of missing important abnormalities and also…