…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…

…potential occurs in all cardiac cells but its appearance varies depending on cell type. During de and repolarization ions (Na + [sodium], K + [potassium] and Ca…

…However, the l isomer is responsible for virtually all of the beta blocking activity. Sotalol does not block alpha adrenoceptors and lacks sodium channel blocking…

…electrophysiological standpoint), whereas others may be life threatening. The most common and clinically most relevant electrolyte imbalances concern potassium, calcium and magnesium. Note that some…

…6. Perform an ECG in hyperkalaemia or where a rapid rise in potassium is suspected. 7. Review all medication, including over the counter preparations, herbal…

…sure the catheter does not become the patient's next focus of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition…

…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…

…be counteracted with simultaneous administration of norepinephrine. All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g. arterial line…

…prior knowledge is required. Note that the terms unipolar leads and bipolar leads are not recommended because all ECG leads are bipolar, since they compare…

…with resistant hypertension. Dietary sodium and potassium abnormalities and commonly used over the counter medicines may also contribute to apparent treatment resistance. The diagnosis is…

…associated with the Brugada syndrome. These mutations are located in genes encoding potassium and calcium channels of the outer cell membrane. Clinical presentation of Brugada…

…heart rate. The positive inotropic effect is due to the inhibition of the sodium potassium adenosine triphosphatase (NaK ATPase) in the ventricular myocardium. Inhibition of…

…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…

…N terminal pro B type natriuretic peptide (NT proBNP) values, potassium concentrations, and estimated glomerular filtration rate (eGFR) should be assessed during follow up visits…

…point depression). The reason for such electrical potential difference is that not all ventricular myocardial cells will finish their action potential simultaneously. Myocardial cells which…

…consensus report by MacFarlane et al it was noted that roughly 5% to 13% of all individuals in a Western population display early repolarization pattern…

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…

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…

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…

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…

…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…

…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…

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…

…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…

…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…

…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…

…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…

…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…

…quick reference is intended primarily for adults and summarises the order in which measures are taken and the principles that are common to all protocols…

…dressing but the ankle brachial index before the first bandage is applied . Indications Venous leg ulcer — about 70% of all leg ulcers. Chronic venous oedema…

…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…

…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…

…of the Electrical Axis The heart's electrical axis represents the net vectoral sum of all active electrical wavefronts at any given point in time…

…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…

…discussed, all cardiac cells—both conduction and contractile cells—must undergo rapid repolarization to ensure they are excitable when the next action potential occurs. If…

…or asystole. The tachyarrhythmias include ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). The bradyarrhythmias include all bradyarrhythmias, pulse less electrical activity (PEA), and asystole…

…clinical features, mechanisms, ECG & management Atrioventricular nodal reentrant tachycardia (AVNRT) is a common tachyarrhythmia observed across all age groups, from children to the elderly, and…

…If many sample volumes are placed along several Doppler lines, then all velocities in the area can be presented with colors. The brighter the color…

…threshold will evoke an action potential, which will subsequently propagate to neighboring cells and ultimately depolarize all connected myocardium. This is the main principle behind…

…regularly encounter patients with CHD. Approximately 95% of all incident cases of congenital heart disease reach adulthood ( Mandalenakis et al ). The largest leap in survival…

…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…

…cases of fatal myocardial infarction were examined. The authors reported that 60–70% of all cases had no myocardial disease or acute coronary syndrome. Indeed…

…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…

…ventricular mass. Most formulas are simple mathematical equations, included in all ultrasound systems, and assume that the geometry of the left ventricle is normal. Figure…

…the structures to be studied. The image will display all structures along that line over time (the x axis displays time). Since M mode only…

…the underlying mechanisms of cardiac arrhythmias. While a detailed understanding of these mechanisms is not essential for all clinicians, it is reasonable to acquire an…

…the same phenomenon. Sinus arrhythmia fulfill all criteria for sinus rhythm except from the fact that the rhythm is slightly irregular ( Figure 1 ). This is…

…12.0 ± 1.0 18.2 ± 1.9 18.1 ± 1.7 All 11.7 ± 1.0 11.6 ± 1.0 17.0 ± 1.9…

…off. The defibrillator finds no stable R wave, and in sync mode no shock at all is then delivered while the patient deteriorates. Indications Emergency…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…1]. Activate the local major haemorrhage protocol early. Protocols improve above all the logistics, the communication and the simultaneous delivery of red cells, plasma and…

…With ultrasound guidance, the point at which the fluid lies most superficially is chosen and the needle is followed all the way in, which has…

…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…

…before attempting Relative A known urethral stricture Relative Acute prostatitis or urethritis Relative Latex allergy (choose an all silicone catheter) Where urethral injury is suspected…

…avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on the hand. These are as a rule left open…