…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…

…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…

…oxygen requirement, a saturation below 93 per cent on air, or a falling PaO2 Circulation A systolic blood pressure of 100 mmHg or less, a…

…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…

…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…

…a straddle injury Relative Recent urethral or prostatic surgery — contact a urologist before attempting Relative A known urethral stricture Relative Acute prostatitis or urethritis Relative…

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

…a postrenal cause cannot confidently be excluded. 10. Contact nephrology early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute…

…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…

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

…Figure 1 A ). The plateau phase has a long duration which enables the majority of the ventricular myocardium to contract simultaneously. Since the membrane potential…

…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

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

…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…

…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…

…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…

…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…

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

…parallel: mechanical control of bleeding, tranexamic acid where it is not contraindicated, and contact with the on call coagulation service. Send samples for INR, APTT…

…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…

…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…

…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…

…The resulting glucosuria and natriuresis reduce proximal tubular workload, contract plasma volume and modestly lower blood pressure. Increased sodium delivery to the macula densa restores…

…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…

…Contractile cells start to contract a few milliseconds after the start of the depolarization and they start relaxing a few milliseconds after the repolarization is…

…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…

…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…