…primary PCI if the total expected time is 120 minutes or less If PCI cannot be performed within 120 minutes Fibrinolysis within 10 minutes of…

…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…

…The manoeuvre ends when the volume increases by less than 0.025 L during the last second , or when the expiratory time has reached 15…

…Prepare airway equipment and contact anaesthesia early with a prolonged seizure, repeated doses of benzodiazepine, aspiration, hypoventilation, circulatory failure or an anticipated need for 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…

…partial rupture into a complete one. Contact the urologist or the surgeon on call for urethrography and suprapubic drainage. Preparation and equipment A sterile catheterisation…

…This may be due to lead dislodgement, lead fracture or inadequate myocardial contact. It may also be due to the low amplitude (voltage) of the…

…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…

…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…

…V1 : Inverted or flat T wave is rather common, particularly in women. The T wave inversion is concordant with the QRS complex. Leas V7–V9…

…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

…of inflammation may be faint or absent. Take cultures immediately, but never let sampling, imaging, the blood count or contact with the patient's own…

…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…

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

…reduced eye contact Common and particularly easy to miss. May be misinterpreted as fatigue, depression or dementia Mixed Alternates between hypoactivity and hyperactivity Common on…

…instrumental removal: Suspected penetrating injury or an intraocular foreign body — shield the eye with a rigid shield, give systemic antibiotics and contact an ophthalmologist urgently …

…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…

…7. Contact nephrology early in anuria, in a dialysis patient, in severe acute kidney injury, in treatment failure or in ongoing massive potassium release. In…

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

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

…contraindications to irrigation: A known or suspected perforation of the tympanic membrane — including a history of grommets, ear discharge or pain on contact with water…

…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…

…Telephone your national or regional poison control centre , which in most countries is staffed around the clock for health care professionals. Contact the centre early…

…so because the patient tenses up with pain, or because the operator pulls harder rather than more slowly. The neurovascular status must be documented before…

…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…

…collapse or impaired consciousness Adrenaline, oxygen, intravenous access, fluid and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise…

… check more frequently. Warfarin is often preferable <15 or dialysis DOACs are not recommended. Warfarin after individual assessment Rule of thumb for the monitoring interval…

…wrong patient — a mislabelled tube, or an identity check performed at the nurses' station instead of at the bedside. The check against the patient's…

…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…

…coronary syndrome. Recurrent or persistent symptoms should prompt repeat ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At first medical contact, assessment…

…Contact expertise Contact your national or regional poison control centre, and activate the emergency medical response system using your local emergency number. Contact the nearest…

…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…

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

…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…