…without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is…

…Monomorphic VT : VT with constant QRS morphology. Polymorphic VT : VT with beat to beat variations in QRS morphology. Bidirectional VT : VT with alternating QRS axis…

…common (regardless of heart rate) among persons with heart disease. Alternating block (right and left bundle branch block alternating from one beat to another) is…

…Monomorphic VT : VT with constant QRS morphology. Polymorphic VT : VT with beat to beat variations in QRS morphology. Bidirectional VT : VT with alternating QRS axis…

…there is atrioventricular conduction, these rhythms typically compete which is seen on the ECG with sinus rhythm alternating with accelerated ventricular rhythm. As mentioned in…

…year . The injection is therefore a tool to make rehabilitation possible, not an alternative to it. See the separate guide to joint aspiration and injection…

…exceeding 200 beats per minute. While ECG appearances with flutter like patterns are predominantly caused by macroreentrant circuits, microreentry remains a possible alternative mechanism. Conversely…

…acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window…

…below apply to adults unless otherwise stated, and paediatric doses are given per kilogram with the stated maximum. Always check against the local guideline and…

…ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is…

…is also an alternative to invasive coronary angiography (ICA) for excluding non ST segment elevation acute coronary syndrome (NSTE ACS) in patients with a low…

…follow cardiac surgery, coronary angiography or other invasive procedures, and affected patients may be relatively painless compared with those with spontaneous dissection. Clinical manifestations may…

…Management Definition and Clinical Characteristics Torsades de pointes (TdP) represents a multifactorial clinical entity typically associated with drug induced long QT syndrome (DI LQTS) [1]…

…atherothrombotic events, myocardial ischaemia may also result from other mechanisms. Differential diagnoses and alternative causes of troponin release must therefore be considered throughout assessment. Coronary…

…such circumstances, the efficacy of compressions and defibrillation diminishes considerably. Extracorporeal Life Support (ECLS) emerges as the sole therapeutic alternative for such situations. Presently, this…

…ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is…

…lactate Circulatory compromise or an alternative diagnosis Silent or nearly silent chest Very severe airflow obstruction pH below 7.35 with raised pCO₂ Acute or…

…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…

…of treatment response and measurement of residual disease (MRD). Fever of unknown origin or suspected granulomatous disease with marrow involvement. Work up of unexplained iron…

…drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre…

…half of ocular myasthenia, thereafter MuSK and LRP4 antibodies) and on neurophysiology (repetitive nerve stimulation with a decrement ≥ 10 % at 3 Hz, sensitivity about 75…

…managed DOAC therapy with no missed doses. A single missed DOAC dose makes the pretreatment inadequate and the cardioversion must be postponed. Alternative when more…

…is an alternative but lies closer to the brachial plexus and the vessels. The elbow The elbow is flexed to 90 degrees with the palm…

…must never delay it. Indications Suspected meningitis or encephalitis. Suspected subarachnoid haemorrhage with a normal or non diagnostic CT. Suspected neuroborreliosis, neurosyphilis or another CNS…

…commonest error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…renal function Formula Used for : : CKD EPI 2021 (creatinine) The first choice for eGFR in adults Cystatin C based eGFR With an atypical muscle mass…

…after pituitary surgery or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment. A basal morning cortisol in the grey…

…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…

…critical, especially in individuals with near normal kidney function, alternative equations like the Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation may offer improved accuracy…

…s formula. Note that a QTc interval 480 is always considered pathological. For patients with bundle branch blocks, the corresponding figure is 500 ms. The…

…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…

…the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no practical risk prediction tool currently exists. At the other end…

…in a patient taking an ACE inhibitor should begin with a comprehensive history and physical examination. Clinicians should inquire about historical clues suggesting alternative etiologies…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…approximately 20–50%. Their greater analytical sensitivity improves diagnostic accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is…

…injury have not generally demonstrated sufficient clinical benefit for routine use. No reflow may also occur in association with other procedural complications, including distal embolization…

…C remains above the recommended goal despite maximally tolerated statin therapy, generally with ezetimibe where appropriate. Established clinical atherosclerotic cardiovascular disease (ASCVD) and FH are…

…arteries. It frequently coexists with left main coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous…

…occur concurrently with acquisition of the initial ECG. Evaluation includes prompt measurement of vital signs and a focused examination directed toward both alternative diagnoses and…

…contraindication) . Irregular wide complex tachycardia is most often due to atrial fibrillation with wide QRS complexes due to bundle branch blocks or other conduction defects…

…supraglottic airway is a reasonable alternative if a tracheal tube cannot be established. Nasopharyngeal airways may cause complications in patients with skull fractures (risk of…

…beginning with 500 ml of normal saline over 5 10 minutes, adjusting based on response. If hypotension persists despite fluid and epinephrine administration, consider alternative…