…ventricle to contract in several directions simultaneously. The subendocardium is the muscle layer closest to the endocardium. The subendocardium has the poorest prerequisites in the…

…this layer results in a twisting (rotating) motion of the entire left ventricle. Basal segments rotate clockwise, and the apex rotates counterclockwise. This rotating, or…

…anticholinergics, opioids and salicylate — where gastric emptying is delayed — may justify charcoal later, in some cases up to 6 hours or more. Discuss this with…

…be saved early for later targeted analysis. Initial monitoring and investigations Investigation Comment : : Plasma glucose Taken immediately and repeated in impaired consciousness, or with insulin…

…rasping, or grating sound produced by contact between inflamed pericardial layers. It may have up to three components per cardiac cycle and is often best…

…anticoagulation can cause a stroke hours to weeks later. Everything else in the procedure is routine. Synchronised cardioversion or unsynchronised defibrillation Synchronised cardioversion Unsynchronised defibrillation …

…during the cardiac cycle, despite the fact that cells in the apex contract as much as the cells in the basal parts. Since the apex…

…6. Call the PCI service immediately in STEMI, a STEMI equivalent or very high risk NSTEMI. 7. Document symptom onset, first medical contact, the diagnostic…

…needed 9 Contact the haematologist or oncologist. Contact an infectious diseases physician early in a high risk course, in instability, with resistance problems, or with…

…medical contact. I B ECG monitoring should start immediately and a defibrillator must be ready. I B Consider connecting leads V7, V8 and V9 in…

…early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with…

…several non pharmacological measures at the same time, and use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and…

…on the slit lamp, or a hand held device (iCare, Tono Pen). Procedure Systematic examination 1. Visual acuity in each eye separately , with the patient…

…passed urine. Contact intensive care in circulatory compromise, serious arrhythmia, marked QRS widening, a sine wave pattern, or a need for repeated calcium treatment. Urgent…

…a risk of blood contact. An alcohol or chlorhexidine swab. Let the skin dry completely before inserting the needle — alcohol carried in with the needle…

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

…grommets, ear discharge or pain on contact with water. A history of ear surgery in which the middle ear may be open (a mastoid cavity…

…a reservoir mask — this markedly shortens the half life of carbon monoxide. Contact your national or regional poison control centre regarding hyperbaric treatment. Cluster headache…

…flexed to 90 degrees. The forearm is moved very slowly outwards in the horizontal plane , with pauses each time the patient tenses, until the joint…

…volume increases by less than 0.025 L during the last second , or when the expiratory time has reached 15 seconds. In 2019 ATS/ERS…

…treatment Convulsive status epilepticus in adults is present with: an ongoing generalised tonic clonic seizure lasting at least 5 minutes, or repeated generalised tonic clonic…

…creatinine, CK in rhabdomyolysis, and salicylate concentration in poisoning. Procedure 1. Contact your national or regional poison control centre in poisoning before treatment is started…

…complete one. Contact the urologist or the surgeon on call for urethrography and suprapubic drainage. Preparation and equipment A sterile catheterisation pack, sterile gloves, chlorhexidine…

…main principle behind artificial pacemakers; i.e applying an external electrical current that depolarizes cells in contact with the lead tip, and thus generate an…

…10. Contact nephrology early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least…

…compromise in the higher ones [5]. For acute clinical use the following simplification can be used: Grade Clinical picture Management : : : Mild allergic reaction Skin or…

…concomitant verapamil or increased bleeding risk Warfarin Individual, target INR 2.0 3.0 A mechanical valve may require a higher target Doses in venous…

…Contraindications Anaemia that can be corrected with iron, B12 or folate in a stable patient. Transfusion given solely to reach a laboratory value without a…

…phenomenon. Preparation and equipment Liquid nitrogen in a flask (−196 °C) and a cryospray gun with interchangeable nozzles, or a cryoprobe for contact technique. Cotton…

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

…to every intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory failure, impaired consciousness, or a need for a vasopressor…

…coffee ground vomiting or melaena. Haematochezia can occur in massive upper bleeding with rapid intestinal transit. Coffee ground vomiting is less specific than fresh haematemesis…

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

…are associated with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less common and include electrolyte disorders…

…inconclusive evidence. However, in cases of iron, lithium, or potassium intoxication where lavage might prove beneficial, the procedure should be conducted post intubation. Avoid lavage…

…the child in the supine position. This is possible due to the small distance between the heart and the ultrasound transducer, and because less air…

…Clinical benefits have been demonstrated in several overlapping populations: T2DM with established cardiovascular disease or high cardiovascular risk T2DM with chronic kidney disease Heart failure…

…the ventricular myocardium to contract simultaneously. Since the membrane potential is relatively unchanged during the plateau phase, the potential differences in the myocardium will be…

…by a repolarization (recovery). The action potential occurs in all cardiac cells but its appearance varies depending on cell type. During de and repolarization ions…

…well with the severity and extent of ischemia. In the setting of moderate ischemia, the myocardium becomes hypokinetic, meaning that the ischemic segments contract less

…may increase in, for example, pulmonary hypertension or pulmonic stenosis. Heart rate . Synchronicity : Optimal contraction requires the majority of all ventricular myocardium to contract simultaneously…