…drain insertion the supine position is used with the arm abducted and the hand behind the head. All drains are inserted within the safe triangle…

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…

…myocardium generates reflections with high amplitude and low Doppler shift. To analyze reflections from the myocardium, the ultrasound machine filters out all other reflected sound…

…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…

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

…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…

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

…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 distinct transition from ST segment to T wave and lower T wave amplitude. The T wave should be concordant with the QRS complex…

…from the sound source, will instead be reflected with a lower frequency than the sound waves emitted from the sound source. The difference in frequency…

…infarction Coronary artery disease (ischemic heart disease) Coronary artery disease, which is synonymous with ischemic heart disease, is the most common form of cardiovascular disease…

…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…

…mL (1 mL made up to 10 mL with sodium chloride) before intravenous titration. Half of all opioid dosing errors arise at the dilution step…

…the hand is suitable for finer cannulae. Avoid the lower limb in adults. In shock with collapsed vessels, the antecubital fossa or the external jugular…

…Corrected QT Interval (QTc interval) The QT interval varies inversely with heart rate; it shortens at higher heart rates and lengthens at lower heart rates…

…fibrillation Approximately 25% of all individuals with atrial fibrillation are asymptomatic (they have no symptoms). In such individuals, screening with ECG may reveal atrial fibrillation…

…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…

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

…specific region of the image, whereas shifting focus simply adjusts the location (along the ultrasound beam) with the best resolution. If the ultrasound image is…

…fixed immediately after administration. Radiotracers with higher levels of redistribution can move from areas of higher concentration to regions with lower concentration, for reasons other…

…Therefore, emitted sound waves can be associated with reflected sound waves, making it possible to determine the distance of the reflector ( i.e the structure…

…several times lower, regardless of etiology, if the initial rhythm is asystole or PEA. Most current protocols for ECMO exclude patients presenting with asystole or…

…block: ECG criteria, clinical characteristics and management This chapter discusses third degree AV block, which is synonymous with AV dissociation, complete AV block, AV block…

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

…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…

…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…

…communities. Late presentation is clinically important: Within 12 hours of symptom onset: reperfusion therapy is recommended for all patients with a working diagnosis of STEMI…

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

…the ventricles with adequate volumes of blood before ventricular contraction commences. To coordinate these two tasks, the heart has an electrical conduction system composed of…

…and reflect them at a higher frequency. Objects moving away from the transducer will generate reflections with lower frequency. Doppler shift The Doppler effect is…

…autonomic nervous system and changes in the automaticity of the sinoatrial node. Rhythm Normal rhythm A rhythm is defined as three consecutive beats with identical…

…all above listed formulas were developed many decades ago and they have multiple drawbacks. For example, Bazett's formula is only suitable in adults with…

…the surface ECG. Intracardiac electrodes – with the placement of electrodes against the sinoatrial node – are necessary to diagnose first and third degree sinoatrial block. However…

…The chain of care in acute STEMI Optimal care for patients with STEMI requires a well coordinated system involving both prehospital and hospital based services…

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

…administered simultaneously with milrinone. The drugs can also be given sequentially. Hypotension can be counteracted with simultaneous administration of norepinephrine. All patients with severe acute…

…pressure and thereby increases ventilation and lowers the carbon dioxide. Pulmonary oedema calls for the former, a COPD exacerbation with carbon dioxide retention for the…

…until outpatient follow up. High intensity statin treatment is recommended for all patients with ACS to reduce major adverse cardiovascular events. Therapy should preferably begin…

…which lowers heart rate) and also slows conduction over the atrioventricular (AV) node. The most classical ECG finding is generalized ST segment depressions with curved…

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…

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

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…

…in: Diabetes with neuropathy or peripheral arterial disease — a risk of osteomyelitis and poor healing. Check the ankle brachial index and the foot status before…

…which is synonymous with tachyarrhythmia. Except for sinus tachycardia during physical activity, all tachycardias should be considered pathological and the task is to clarify the…

…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…

…Comparison with previous ECG recordings The ECG must be compared to previous ECG recordings if such are available. ST T changes are extremely common in…

…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…

…The condition occurs above all in: treatment with SGLT2 inhibitors pregnancy prolonged fasting or a very low carbohydrate intake excessive alcohol consumption vomiting or othe

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

…salicylate poisoning, intubation with an inadequate minute ventilation can rapidly worsen the acidaemia and increase the entry of salicylate into the central nervous system. Discuss…

…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…

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

…detrimental. We have therefore compiled a pocket guide with a universal interpretation algorithm. These 22 pages includes all you need to perform methodological ECG interpretation…