…the leads. External causes are less common and include electrolyte disorders, metabolic disorders, hypoxemia, antiarrhythmic drugs, or electromagnetic disturbance caused by other machines/devices. Below…

…contact, attach continuous rhythm monitoring, secure intravenous access, assess the circulation and the bleeding risk, and exclude dangerous differential diagnoses [1,2]. STEMI and other…

…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…

…intestinal transit. Coffee ground vomiting is less specific than fresh haematemesis and can also be seen when the bleeding is slow or has stopped. The…

…any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded. 10. Contact nephrology…

…possible due to the small distance between the heart and the ultrasound transducer, and because less air filled lung tissue covers the heart. In adults…

…three hours. The evidence for an absolute one hour requirement is clearest in septic shock and less certain in sepsis without shock [3,4]. The…

…abdominal or thoracic surgery 1 month Neurosurgery or an intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An…

…Give a full loading dose of an intravenous antiseizure drug If the seizure continues after adequate step 1 and step 2 Refractory status: contact anaesthesia…

…or as a substitute for mobilisation and bladder training. Contraindications Type Condition : : Absolute Suspected urethral injury — blood at the meatus, a perineal or scrotal haematoma…

…lying supine, or swallowing and typically improves when the patient sits up and leans forward. Pain may be retrosternal or left precordial and can radiate…

…Leas V7–V9 : should display a positive T wave. ST segment changes are typically accompanied by T wave changes Because phase 2 and phase 3…

…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

…the typical local signs of inflammation may be faint or absent. Take cultures immediately, but never let sampling, imaging, the blood count or contact with…

…Initial diagnosis of STEMI ECG Management Recommendation Level of evidence A 12 lead ECG should be interpreted immediately (within 10 minutes) at first medical contact…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…4. Establish whether the condition is new or clearly worse than baseline. Contact relatives, home care services, the residential care home or the previous care…

…or an intraocular foreign body — shield the eye with a rigid shield, give systemic antibiotics and contact an ophthalmologist urgently . A positive Seidel's sign…

…since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison control centre before you decide, not afterwards. Indications Medicinal…

…plasma glucose closely for at least 6 hours after insulin. 7. Contact nephrology early in anuria, in a dialysis patient, in severe acute kidney injury…

…as SIRVA. Both are avoided with the right landmark and the right needle length. Indications Route Typical drugs Absorption : : : Intramuscular (IM) Vaccines, depot antipsychotics, hydroxocobalamin…

…leader and one person responsible for recording the transfusions, the sampling, the incoming products and contact with the blood bank. 3. Secure large bore access…

…the tympanic membrane — including a history of grommets, ear discharge or pain on contact with water. A history of ear surgery in which the middle…

…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…

…centre , which in most countries is staffed around the clock for health care professionals. Contact the centre early in serious, unusual or unclear poisoning, with…

…injury. Aim for reduction within a few hours. Contraindications A fracture dislocation requiring operative treatment — contact an orthopaedic surgeon before attempting reduction. Posterior shoulder dislocation…

…nervous system. Contact your national or regional poison control centre for advice on the treatment threshold and on whether haemodialysis should be considered. Rhabdomyolysis with…

…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…

…a known or probable allergen , even if skin symptoms are absent [1,4]. Typical warning symptoms are: hoarseness, stridor, swelling of the tongue or throat…

…rivaroxaban and edoxaban. Check every 6 months 15 30 Dabigatran contraindicated. The other DOACs are possible according to FASS, but the documentation is insufficient; check…

…contact transfusion medicine before transfusing again. Preparation and equipment Compatibility testing Test What it involves When it is used : : : Blood grouping ABO and RhD typing…

…next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain…

…prompt repeat ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At first medical contact, assessment should occur concurrently with acquisition of the…

…frozen plasma Prothrombin complex concentrate Actions in suspected poisoning and cardiac arrest Promptly contact the closest intensive care unit (ICU) possessing expertise in toxicological management…

…when the shock is delivered, and that the thromboembolic risk has been dealt with before the atria begin to contract again. An unsynchronised shock that…

…pharmacological basis Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of oral agents initially developed for glucose lowering in type 2 diabetes mellitus (T2DM)…

…orientation. As explained below, this enables the ventricle to contract in several directions simultaneously. The subendocardium is the muscle layer closest to the endocardium. The…

…ventricle with varying orientation. This organization allows the left ventricle to contract in a highly sophisticated and effective way (Figure 1). Myocardial fibers adjacent to…

…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…

…or pulmonic stenosis. Heart rate . Synchronicity : Optimal contraction requires the majority of all ventricular myocardium to contract simultaneously. For this to be possible, the right…

…shift. To analyze reflections from the myocardium, the ultrasound machine filters out all other reflected sound waves, such that only those representing myocardium are recorded…