…pulses. This is accomplished by using the same piezoelectric crystals to send and analyze sound waves. The crystals alternate rapidly between sending and analyzing ultrasound…

…therefore heterogeneous. Irreversibly scarred regions may alternate with viable segments that are dysfunctional because of repeated ischemic episodes or chronic reductions in perfusion. The amount…

…depression or dementia Mixed Alternates between hypoactivity and hyperactivity Common on repeated assessment over the day It is wrong to assume that hyperactive delirium is…

ECG Genetic and miscellaneous conditions Eletrical alternans: an ECG sign of pericardial effusion and cardiac tamponade The pericardial space (cavity) always contains a small amount…

…into or beside them. Anticoagulant treatment is not a contraindication to these superficial injections. Preparation and equipment Chlorhexidine in alcohol, an iodine solution or isopropyl…

…beats per minute. While ECG appearances with flutter like patterns are predominantly caused by macroreentrant circuits, microreentry remains a possible alternative mechanism. Conversely, certain macroreentrant…

…in properly selected patients. Tenecteplase 0.25 mg/kg is a safe and effective alternative to alteplase and is simpler to administer, since the whole…

…mg Lidocaine (alternative) 100 mg IV, a further 50 mg 1 mg/kg Magnesium 2 g (8 mmol) IV in torsades or hypomagnesaemia 25–50…

…despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy. Tamponade is a clinical diagnosis supported by echocardiography: Finding Comment : : Hypotension, distended neck…

…ischemia (high doses or extravasation) Dopamine high dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) High…

…present but stenosis is minimal or mild, symptoms are also unlikely to be caused by flow limiting epicardial disease, and alternative causes should remain under…

…propagates along the wall, creating a true lumen and a false lumen separated by an intimal flap. Propagation may be antegrade or, less commonly, retrograde…

…formal criteria for evaluating the success of TdP treatment or detailed step by step algorithms for alternative therapies when initial pharmacological approaches fail to suppress…

…and alternative causes of troponin release must therefore be considered throughout assessment. Coronary disease is most commonly related to atheromatous plaque producing progressive narrowing or…

…or low flow periods. Under such circumstances, the efficacy of compressions and defibrillation diminishes considerably. Extracorporeal Life Support (ECLS) emerges as the sole therapeutic alternative…

…ischemia (high doses or extravasation) Dopamine high dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) High…

…on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and…

…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…

…line alternative in marked obesity or when the supine position is necessary. After previous punctures: change side, and avoid irradiated fields. Preparation and equipment Informed…

…A pillow to place under the shoulders as an alternative to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus…

…if you have selected an objectively measurable finding in advance — usually ptosis or fatigable gaze palsy — that can be assessed before and during the window…

…the procedure is routine. Synchronised cardioversion or unsynchronised defibrillation Synchronised cardioversion Unsynchronised defibrillation : : : Rhythm An organised rhythm with discernible QRS complexes: atrial fibrillation, atrial flutter…

…Preparation and equipment Chlorhexidine in alcohol 5 mg/mL: clean with 3–4 swabs in wide circles and let it dry for a couple of…

…immunosuppression, papilloedema or new focal neurological signs — CT is performed first. Preparation and equipment Informed consent, coagulation status and an up to date medication list…

…often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the…

…Low molecular weight heparin with dose adjustment, or warfarin Subsegmental pulmonary embolism without deep vein thrombosis An individual assessment; in selected cases the patient can…

…excretion of urea below 35 % is a better alternative. Follow up At an eGFR below 60, or in the presence of albuminuria: check the potassium…

…Preparation and equipment Tetracosactide (Synacthen) 0.25 mg/mL, one ampoule. A peripheral venous cannula and a saline flush. A tube for serum or plasma…

…without being found. Indications A traumatic wound that gapes and cannot be expected to heal with good function or cosmesis without apposition. A wound that…

…Williams classification (Table 1). Agents in bold text are commonly used to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification…

…In cases where precise GFR assessment is critical, especially in individuals with near normal kidney function, alternative equations like the Chronic Kidney Disease Epidemiology Collaboration…

…the Framingham Heart Study, this linear correction formula adjusts the QT interval based on heart rate without involving square or cube roots. It has been…

…standardized method to evaluate the anatomical complexity of CAD, particularly in patients with multivessel disease or left main coronary artery disease . It integrates multiple variables…

…Alternative modalities — cardiac MRI, long term ambulatory monitoring, electrophysiological study, PET, SPECT, genetic profiling — add information but are too costly or invasive to screen a…

…lacking; the diagnosis is suspected when alternative etiologies are excluded by diagnostic testing or failed therapeutic trials. If alternative causes of cough are suspected, specific…

…inhibitor monotherapy. Clopidogrel Clopidogrel 75 mg once daily is an established alternative to aspirin. In patients with previous MI, stroke, or peripheral arterial disease, clopidogrel…

…assessment 12 lead ECG Initial hs cTn measurement Continuous cardiac monitoring The source material does not provide a detailed list of physical examination findings or…

…distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate stenting or other procedural intervention. The clinical…

…specified by the guideline. PCSK9 inhibitors are also relevant in statin intolerant patients who remain above goal despite alternative lipid lowering therapy. Evolocumab and alirocumab…

…Patient preferences, local expertise and operator or institutional experience Assessment of coronary complexity The SYNTAX score is used to characterize coronary anatomical complexity. It incorporates…

…cardiovascular interventions. Dressler syndrome now occurs in fewer than 1% of AMI cases and is seen predominantly after larger infarctions and/or delayed reperfusion. Its…

…Evaluation for heart failure. Assessment for circulatory compromise, haemodynamic instability, or electrical instability. Posterior infarction may occur in patients with a clinically unstable acute coronary…

…Peripheral intravenous (IV). Alternative route : Central venous administration of adenosine is suitable in the intensive care unit or coronary care unit. Adenosine injection must be…

…be delivered by virtually anyone, advanced cardiopulmonary resuscitation (ACLS) is provided by healthcare professionals with the skills and equipment required. Although ACLS is more advanced…

…Williams classification (Table 1). Agents in bold text are commonly used to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification…

…pulseless electrical activity (PEA) as the initial rhythm, while the remainder manifest ventricular fibrillation (VF) or asystole ( Ebo et al ). Clinical manifestations of anaphylaxis Nervousness…