…indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic…

…Contact technique with a cryoprobe gives a deeper and more controlled freeze on flat surfaces; spray technique is better on irregular surfaces and in the…

…forward. Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant…

…benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison…

…myocardium generates reflections with high amplitude and low Doppler shift. To analyze reflections from the myocardium, the ultrasound machine filters out all other reflected sound…

…Discuss with your national or regional poison control centre. An open flame or smoking in the room: a fire hazard. Preparation and equipment A pulse…

…Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as…

…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…

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

…The condition is associated with falls, aspiration, pressure sores, loss of function, longer length of stay, institutional care, readmission, cognitive decline and increased mortality [3…

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

…secondary prevention 8 Contact the endoscopist and the consultant on call early. In cirrhosis or suspected variceal bleeding, also contact a gastroenterologist with hepatology expertise…

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

…V3). IIa B In patients with inferior myocardial infarction, consider connecting V3R and V4R to detect concomitant right ventricular infarction. IIa B Routine blood sampling…

…intraosseous access if intravenous access cannot be obtained quickly and parenteral treatment is needed. Prepare airway equipment and contact anaesthesia early with a prolonged seizure…

…Older people, the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms. Findings that suggest acute organ dysfunction Organ or system Finding…

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

…poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An…

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

…2. Designate a team leader and one person responsible for recording the transfusions, the sampling, the incoming products and contact with the blood bank. 3…

…downwards and backwards in small children. 3. Rest your hand against the patient's cheek so that the otoscope moves with the head if it…

…e applying an external electrical current that depolarizes cells in contact with the lead tip, and thus generate an action potential that will spread through…

…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 …

…or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high dose salbutamol in marked hyperkalaemia if there is no contraindication. 5…

…Assess ventilation, airway protection, the expected course and the possibility of rapid reversal with an antidote. Intubation is recommended for neurological, respiratory or haemodynamic failure…

…fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression…

…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…

…the criteria for activation of the massive transfusion protocol. Plasma and platelets: in ongoing bleeding with coagulopathy, or as part of balanced transfusion in massive…

…organ preserving treatment is started, and a conversation conducted with time, clarity and respect is also what makes the decision hold afterwards. Organ preserving treatment …

…by contact between inflamed pericardial layers. It may have up to three components per cardiac cycle and is often best heard at end expiration with…

…medical contact and interpreted within a target of 10 minutes. Prehospital ECG acquisition can shorten the time to diagnosis and facilitate triage of patients with…

…centre, and activate the emergency medical response system using your local emergency number. Contact the nearest intensive care unit with expertise in toxicological emergencies. Antidote…

…dealt with before the atria begin to contract again. An unsynchronised shock that happens to fall in the T wave can precipitate ventricular fibrillation, and…

…normally concordant with the QRS complex, which means that a net positive QRS complex should be followed by a positive T wave and vice versa…

…assessing the right half of the heart, it is important to familiarize yourself with the principles of hemodynamics and conditions prevailing on the right side…

…sheets wrapping around the ventricle with varying orientation. This organization allows the left ventricle to contract in a highly sophisticated and effective way (Figure 1…

…myocardial infarction, stroke, heart failure, atrial fibrillation and peripheral artery disease. Prognosis is generally worse when diabetes coexists with these conditions. However, the cardiovascular effects…

…to the heart. The epicardium The outermost layer of the ventricular wall is the epicardium , which contains fibroelastic connective tissue, blood vessels, lymphatics and adipose…

…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…

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

…to the spread of an electrical current. All tissues and fluids surrounding the heart have an abundance of ions, enabling them to function as electrical…