…discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations The central pathophysiological concern in the emergency department…

…and infarction Definition and clinical rationale Stable angina, or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of…

…and lasts longer. The pain usually involves the central portion of the chest or the epigastrium and occasionally radiates to the arms. Less common sites…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

…Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with persistent…

…Nystagmus that is purely vertical, downbeating or direction changing Central cause Nystagmus without latency that does not fatigue Central cause New headache, neck pain, diplopia…

…2. Marked sinus bradycardia, sinus arrest, sick sinus syndrome with long pauses. Bradycardia in poisoning with a beta blocker, a calcium channel blocker or digitalis…

…assessment remain central. Diagnostic Strategy Initial 12 lead ECG The resting 12 lead ECG is the first line diagnostic test in suspected acute coronary syndrome…

…injury. Eclampsia is the occurrence of new onset seizures or coma in a pregnant woman with preeclampsia. HELLP syndrome—haemolysis, elevated liver enzymes or transaminases…

…of paramount importance. The primary concern in correcting hyponatremia is the prevention of osmotic demyelination syndrome (ODS), previously known as central pontine myelinolysis. Excessively rapid…

…Exercise stress test Evaluation of the exercise stress test (exercise ECG) The ECG reaction has always been a central component of the exercise stress test…

…increased ventricular contractility occur consistently. Exaggerated activation of a central reflex produces a stereotypic response: an initial increase in heart rate, followed by a drop…

…a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest Drug Adult Child : : …

…the site, duration and completeness of occlusion and on the adequacy of collateral blood flow. Ischaemia initially produces pain and sensory disturbance. With progression, motor…

…rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the…

…or crushing, although stabbing or burning sensations may occur. Pain usually involves the central chest or epigastrium, may radiate to the arms, and less often…

Procedurer What determines the outcome of a central venous catheter insertion is decided before the needle goes in: the choice of site, the use of…

Cardiology Pharmacology & dosing Definition and pathophysiology Congestion is a central expression of the heart failure syndrome and reflects excessive retention of sodium and water, with…

…and pathophysiology Lipid lowering therapy is a central component of cardiovascular prevention, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD), chronic coronary syndrome (CCS)…

…of atrial size 10 cm² or 40% of atrial size Jet orientation central variable excentric Pulmonary vein flow S dominant reduced S wave systolic flow…

…clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury. This classification is central to determining the intensity of monitoring, supportive treatment, anticoagulation, and…

…or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet activation and aggregation contribute importantly to arterial thrombus formation, recurrent coronary occlusion…

…with functional assessment. A central practical principle is that the visual severity of a stenosis does not reliably establish its haemodynamic importance. A lesion that…

…receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Aspirin irreversibly…

…undertaken to maintain or improve physical fitness. Regular physical activity is a central component of cardiovascular prevention and treatment. It is associated with lower cardiovascular…

…and is not determined solely by the apparent frequency or duration of documented episodes. The central therapeutic objective is prevention of thromboembolic complications, particularly stroke…

…Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes Neuromuscular diseases Anemia The natural course of asphyxia Should ventilation be entirely inhibited …

…not apply. Assess gait and truncal stability and investigate for a central cause. Acute vestibular syndrome is often caused by acute unilateral vestibulopathy, commonly called…

…and haemodynamic monitoring with ECG, a central venous catheter and an arterial line is necessary to achieve an optimal result. Overview of vasopressors and inotropes…

…bore access, or rapid central access, but do not delay transfusion or control of the bleeding in order to obtain a central venous catheter. 4…

…serum concentration. Alkalinisation increases renal elimination several fold and at the same time reduces the passage of salicylate into the central nervous system. Contact your…

…Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and…

…as described by the relationship: MAP = (CO × SVR) + Central Venous Pressure (CVP) This equation illustrates that MAP is determined by the volume of blood…

…infarction Pharmacology & dosing Definition and therapeutic objectives Antianginal therapy in chronic coronary syndrome (CCS) is directed primarily at reducing myocardial ischaemia and relieving anginal symptoms…

…to posteromedial inferior region of the right atrium. This circuit also relies on a central area of block, which encompasses both an anatomical barrier (the…

…affecting approximately 1 in 250,000–350,000 individuals. The lifelong exposure to high LDL C is central to the disease burden. In untreated HeFH…

…patients with reduced EF. Pathophysiology Abnormal ventricular relaxation and increased filling pressures The central hemodynamic abnormality in HFpEF is impaired diastolic function. The left ventricle…

…before resistant hypertension can be defined. The central physiological contributors include excess salt intake and salt and water retention, particularly when kidney function is impaired…

…Consequently, left ventricular filling falls and cardiac output may become markedly depressed. Right sided filling pressures—including central venous, right atrial, and right ventricular end…

…patients prior to sotalol initiation. Diagnostics Electrocardiography (ECG) Electrocardiographic monitoring is central to the safe initiation and maintenance of sotalol therapy. The drug prolongs the…

…for the selected treatment to restore flow. Early reperfusion is therefore the central priority of STEMI systems of care. Fibrinolysis promotes thrombus dissolution by converting…

…making rapid recognition, defibrillation capability and expedited reperfusion central to survival. Clinical Presentation and Symptoms The characteristic symptom prompting activation of the STEMI pathway is…

…episodes Iatrogenic events (e.g., during central venous catheter insertion) Underlying lung pathologies In cases of benign pneumothorax, positive pressure ventilation can precipitate a tension…

…discussed in this article. Metabolic equivalent (MET): measuring oxygen consumption Estimation of oxygen consumption is central to the assessment of exercise capacity. Metabolic equivalents (METs…

…uses to calculate various hemodynamic parameters. The Doppler effect The central principle to all hemodynamic calculations is the Doppler effect, which was discussed previously (see…

…Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and…

…arterial line, PiCCO, central venous catheter). The hemodynamic effects persist for 7–10 days after the end of infusion. Refer to Table 2 for a…

…In stroke, neuronal cell death begins in the central ischemic zone, where the ischemia is most pronounced and extends towards the penumbra zone (the outermost…

…begin before the blood alcohol concentration has reached zero, and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake…

…in marked shock or during high dose vasopressor treatment, when the radial trace may underestimate central pressure. The dorsalis pedis artery works but often shows…

…sometimes supplemented with a central venous sample Common approximate arterial reference ranges in adults are: pH 7.35 to 7.45 pCO₂ 4.7 to…

…use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and a clinical diagnosis, often described as acute brain failure…

…area < 0.05 0.05 0.59 0.59 Qualitative parameters Mild regurgitation Moderate regurgitation Severe regurgitation Jet area small variable large if central…

…a need for repeated calcium treatment. Urgent investigations As a rule, take: Plasma potassium as a central laboratory sample. A blood gas with pH, bicarbonate…

…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…

…MAP remains below 65 mmHg or the hypotension is marked. Do not wait for a central venous catheter Continuously Reassess the mental state, capillary refill…

…fan, paracetamol, cold infusions. A ventilator, an arterial line, a central venous catheter, ECG monitoring, blood gases. Drugs for sedation, analgesia and control of shivering…

…area < 0,05 0,05 0,59 0,59 Qualitative parameters Mild regurgitation Moderate regurgitation Severe regurgitation Jet area small variable large if central…

…indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndrome (ACS) or a prior heart attack and a high risk of…

…A flush should immediately follow the bolus injection to ensure rapid delivery to the central circulation. If the drug is injected into a central vein…