…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…

…is because it does not ensure complete drainage of the pericardium, and needles or catheters are at risk of bending or damage during chest compressions…

…haemodynamic consequences of the culprit lesion. Patients may present with ST segment elevation myocardial infarction (STEMI), non ST elevation ACS (NSTE ACS), or ACS complicated…

Echocardiography The standard transthoracic echocardiographic examination This chapter presents a sequential series of images that comprise a complete standard echocardiographic examination. The image views are…

…of the most popular ECG books and resources Recognizing that many visitors are interested in other books and online resources, we have plowed through more…

…is also constant. Atria and ventricles are depolarized separately. The ventricular rhythm is an escape rhythm arising in the AV node or bundle of His.

…a diagnosis of third degree AV block if the atrial and ventricular rate is equal and the P waves occur right before the QRS complexes…

Cardiology Clinical medicine Definition and cardiovascular rationale Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible…

…Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days…

…direction of the QRS complex The QRS complex can be classified as net positive or net negative, referring to its net direction. The QRS complex…

…needed. Intubate for a threatened airway, a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation…

…lactate, two sets of blood cultures, and a culture from the likely focus 0 to 15 min Ringer's acetate for hypotension or hypoperfusion, usually…

…necessary ECG skills required for clinical work. You must complete the ECG course in order to obtain your certificate. New ECG test will be added…

…partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically presents with ST segment depressions and/or T…

…ECG. These situations are as follows: Transmural ischemia located in the posterolateral portion of the left ventricle . Transmural ischemia located in the right ventricle . Both…

…for a complete diagnosis or for grading. Antihistamines, corticosteroids, inhaled bronchodilators and nebulised adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is…

…A score of 3 or more indicates a difficult intubation — call for help and get out the videolaryngoscope and plan B before you give the…

…5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document the…

…QRS complexes; do not delay pacing in order to try yet another dose. Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine…

…lesions with a visual diameter reduction of 50–70% may or may not produce ischaemia. Conversely, some lesions with apparently lesser narrowing are physiologically important…

…along with slurring or notching of the mid QRS in at least two left facing leads [7]. These stricter parameters correlate more closely with abnormal…

…that improve or resolve after reducing the dose or stopping therapy. It is divided clinically into: Complete intolerance: inability to tolerate any dose of any…

…A complete airway obstruction results in PEA and cardiac arrest within 8 minutes. Cardiac arrest as a result of asphyxia or hypoxia is managed according…

…in a cardiac arrest. For women beyond the 20 th week of pregnancy, or when the fundal height surpasses the umbilicus, the uterus should be…

…15% of cases). Clinically, patients present with severe chest pain, diaphoresis, hypotension, pulmonary edema, malignant arrhythmias, and rapid progression to cardiogenic shock. Ventricular fibrillation or…

…the transmission of impulses. Intense parasympathetic activity can result in a complete blockage of impulse conduction. If such blockage persists for 6 seconds or more…

…Infarction (NSTEMI) or unstable angina (UA), is attributed to the greater extent of ischemia present in STEMI. In STEMI, a complete coronary artery occlusion leads…

…of the T waves. These T waves are called post ischemic T waves and they indicate that the infarction process is more or less completed…

…features or an inadequate response. First line treatment is oxygen in hypoxaemia, repeated doses of an inhaled short acting β2 agonist, ipratropium in more severe…

…exact clock time of symptom onset or the time last known to be well NIHSS A complete score by a physician or nurse experienced in…

…interchangeable nozzles, or a cryoprobe for contact technique. Cotton buds for small lesions (these give a more superficial and less controllable depth of freeze). A…

…to 6 hours or more. Discuss this with the poison control centre. Gastric lavage is considered only after a life threatening ingestion of a highly…

…passed. An attempt can convert a partial rupture into a complete one. Contact the urologist or the surgeon on call for urethrography and suprapubic drainage…

…Warfarin has a narrow therapeutic index, a half life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment…

…by itself, establish the presence or haemodynamic significance of a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for…

…is present without anatomical or physiological criteria supporting revascularisation. Evaluation and Physical Examination Assessment should establish both clinical risk and the feasibility of complete revascularisation…

…location and complexity of coronary stenoses. Higher scores indicate more diffuse or technically complex disease and are associated with a greater relative advantage for CABG…

…Complete transection of a papillary muscle may cause immediately overwhelming MR. Partial rupture, often involving the tip or head of the muscle, more commonly produces…

…separate chapter discusses Long QT syndrome (LQTS). A complete list of drugs causing QT prolongation can be found here. Corrected QT intervals (QTc) can be…

…This evaluation should include a detailed history, thorough questioning of eyewitnesses, and a complete physical and neurologic examination. Blood pressure and heart rate should be…

…and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery. Ischemia will extend from the endocardium to the epicardium in the affected myocardial…

…causing microvascular embolization (i.e occluding smaller vessels downstream). The thrombosis causes occlusion of the artery; blood flow may be partially or completely obstructed. Consequently…

…the T wave in lead aVL will be inverted and in some cases lead I will display a monophasic R wave instead of qR complex…

…if the QRS complexes are wide there is a risk of distal block which may progress to more advanced block (second or third degree AV…

…can determine whether dysfunctional myocardium or myocardium supplied by a diseased vessel, is viable and could benefit from revascularization. Evaluating the success of revascularization : Myocardial…

…of sinus arrest (or any scenario in which atrial impulses do not reach the atrioventricular node), junctional escape rhythm may be life saving. During complete…

…T changes. Such ST T changes may mimic (simulate) or mask ischemia. Simulation of ischemia manifests as ST segment elevations in leads V1–V3, accompanied…

…hallmark of LBBB is the prolonged QRS duration. A QRS duration of 120 ms (0.12 s) or more is required to diagnose a complete…

…is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive myocardial ischemia (referred to…

…S wave or R wave. Fragmented QRS complexes are indications of previous myocardial infarction. There are imaging studies demonstrating that QRS fragmentation is more common…

…glide out of position due to the gel. One or two fingers may be placed gently on the skin to fix the position of the…

…Premature ventricular contractions in bigeminy. Two consecutive premature ventricular contractions are referred to as a pair or couplet. If 3 to 30 premature ventricular contractions…

…being followed by QRS complexes. This condition is further categorized into two distinct subtypes: type 1 (also known as Mobitz type 1 or Wenckebach block)…

…and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery. Ischemia will extend from the endocardium to the epicardium in the affected myocardial…

…The mitochondrial density allows for complete replenishment of ATP within 10 seconds (Fell et al, Houtkooper et al). The majority of ATP produced is utilized…

…ms). Increasing the number of ultrasound lines or image depth will reduce the frame rate since more time is required to complete each frame. Thus…

…seconds). The QRS complex is wide simply because the ectopic impulses that cause these rhythms spread partially or entirely outside of the ventricular conduction system…

…ml and administered over 10 minutes. A maximum of two infusions can be given. Each infusion should be completed, even if the patient reverts to…

…event of bradycardia, bronchospasm, marked salivation or increasing weakness, and give atropine. 8. Monitor for at least 30 minutes after the test has been completed…

…than a routine referral being made. Two or more magnets constitute the same kind of urgency by a different mechanism. They attract one another through…