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…

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…

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

…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…

…cardiac arrest is 2.5%. As per data from the registry, only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest…

…pain and pain in the palliative phase. Severe breathlessness in the palliative phase (at lower doses than for pain). An opioid is rarely the right…

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

…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…

…Thus, optimal blood pressure is significantly lower than the current threshold for hypertension, and the current treatment target levels for patients with and without diabetes…

…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…

…each object appears whiter on the image. Increasing gain excessively results in lower resolution and difficulties discerning tissue borders. These are the main adjustments made…

…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…

…course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection…

…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…

…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…

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

…in ARVC are T wave inversion in V1–V3 (in the absence of right bundle branch block); virtually all patients display this. The epsilon wave…

…actual contraction but are also capable of transmitting the action potential, albeit at a much lower speed than the conduction cells. The terms contractile myocardium …

…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…

…rhythm is the normal rhythm of the heart. Sinus rhythm is the normal rhythm in all pediatric patients. Sinus rhythm is defined by the following…

…most commonly used formula. However, all above listed formulas were developed many decades ago and they have multiple drawbacks. For example, Bazett's formula is…

…after discharge of the impulse in the sinoatrial node. Lower tracing shows first degree sinoatrial block, in which the time interval from impulse discharge to…

…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…

…PVC) Premature atrial contractions (PAC) PACEMAKER RELATED Pacing with rapid ventricular response rate The incidence of tachycardia induced cardiomyopathy is 8–10% among patients with…

…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…

…angiographic reduction of coronary obstruction. Intensive lipid lowering improves endothelial function, lowers circulating high sensitivity C reactive protein, reduces thrombogenicity, and favourably modifies inflammatory and…

…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…

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…

…disease — a risk of osteomyelitis and poor healing. Check the ankle brachial index and the foot status before any procedure on a toe. Critical ischaemia…

…and arrhythmology ECG Diagnosis and management of narrow and wide complex tachycardia All clinically significant supraventricular and ventricular tachyarrhythmias have been reviewed in previous sections…

…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…

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

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

…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…

…early specialist involvement. DKA and HHS are dynamic conditions. Treatment must be guided by the clinical response and by repeated laboratory measurements, not by the…

…compression The ankle brachial index measured with Doppler determines whether compression may be applied at all, and if so at what pressure. Palpable foot pulses…

…the plasma glucose, a blood gas and an ECG all come before complete identification of the substance. Treatment of acute poisoning consists of four parallel…

…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 acute clinical event during the index procedure. Complete revascularization aims to treat all lesions producing myocardial ischaemia, either during the same procedure or through…

…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…