…emergency number. Contact the nearest intensive care unit with expertise in toxicological emergencies. Antidote Administer the specific antidote promptly upon suspicion of poisoning. Decontamination Disrobe…

…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…blood count or contact with the patient's own clinic delay empirical antibiotics [1]. A practical target: give the first dose of broad spectrum antibiotics…

…instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction…

…version 4 of 27 February 2024. The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence…

…but accounts for a minority of cases Hypoactive Lethargy, slow responses, reduced speech, immobility, poor food intake, reduced eye contact Common and particularly easy to…

…the visual acuity before anything else is done. The second most important is to look for signs of perforation — Seidel's sign, an irregular pupil…

…Contact your national or regional poison control centre before you decide, not afterwards. Indications Medicinal charcoal is given after the ingestion of a potentially toxic…

…or a very strong clinical suspicion. 3. Give intravenous calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells…

…a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An alcohol or chlorhexidine swab. Let the skin…

…products and contact with the blood bank. 3. Secure large bore access, or rapid central access, but do not delay transfusion or control of the…

…bearing skin. 5. Direct the jet upwards and backwards along the superior wall of the ear canal , past the plug — not straight at it. The…

…in hypoxaemia. Take particular care in: A risk of hypercapnic respiratory failure — COPD, severe obesity with hypoventilation, neuromuscular disease, marked chest wall deformity, severe bronchiectasis…

…a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation, chest movement and a blood gas…

…treatment — contact an orthopaedic surgeon before attempting reduction. Posterior shoulder dislocation, which is often associated with fracture and requires an orthopaedic surgeon. Dislocation of a…

…intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until…

…cannot be obtained quickly and parenteral treatment is needed. Prepare airway equipment and contact anaesthesia early with a prolonged seizure, repeated doses of benzodiazepine, aspiration…

…fold and at the same time reduces the passage of salicylate into the central nervous system. Contact your national or regional poison control centre for…

…impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer procedures…

…leads are introduced into one of the larger veins (typically the subclavian vein) and guided further down to the heart where they contact the endocardium…

…9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded. 10. Contact nephrology early in severe, progressive or…

…fluid and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise despite two adequate intramuscular doses of adrenaline and…

…call coagulation service Always in parallel: mechanical control of bleeding, tranexamic acid where it is not contraindicated, and contact with the on call coagulation service…

…haemorrhage control) planned in advance. A history of a severe transfusion reaction: contact transfusion medicine before transfusing again. Preparation and equipment Compatibility testing Test What…

…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…

…rule out a possible donor on your own on grounds of age or medical history — contact the transplant coordinator and let the assessment be made…

…urine output, respiration, chest findings, MAP and the response to every intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory…

…Give small boluses, for example 250 to 500 mL, with immediate reassessment of the blood pressure, pulse, peripheral perfusion, mental state and chest findings. Avoid

…Clinical presentation and symptoms The characteristic clinical syndrome consists of: Malaise Fever Pericardial or chest discomfort Leukocytosis Elevated erythrocyte sedimentation rate Pericardial effusion Pericardial pain…

…primarily in the context of suspected acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent symptoms…

…dislodgement, lead fracture or inadequate myocardial contact. It may also be due to the low amplitude (voltage) of the potentials generated by activated myocardium. Functional…

…chest wall, such that the distances between the ribs increase, providing larger windows for the ultrasound beam. The operator can sit on either side of…

…begin to contract again. An unsynchronised shock that happens to fall in the T wave can precipitate ventricular fibrillation, and cardioversion of fibrillation of unknown…

…and pharmacological basis Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of oral agents initially developed for glucose lowering in type 2 diabetes mellitus …

…onset of the T wave ( Figure 1 A ). The plateau phase has a long duration which enables the majority of the ventricular myocardium to contract…

…in arteries throughout the circulatory system (Figure 1). The ventricular wall consists of an inner lining (endocardium), a thick muscle layer (myocardium) and an outer…

…layer (mid wall) are oriented circularly around the short axis. Contraction in this layer results in radial shortening , meaning that the diameter of the ventricular…

…causes a rapid influx of sodium and depolarizes the cell. Contractile cells start to contract a few milliseconds after the start of the depolarization and…

…immediately display wall motion abnormalities. This is useful in emergency medicine since the presence of wall motion abnormalities in a patient with chest pain strongly…

…myocardium to contract simultaneously. For this to be possible, the right leg must be intact. In the case ofblockade of the right bundle of His…

…sound waves reflected from myocardium have high amplitude. This is due to the high density of myocardium. It follows that myocardium generates reflections with high…