…or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment. A basal morning cortisol in the grey zone. A morning…

…risk of hypoglycaemia; it can usually be continued Red flags and pitfalls Stopping basal insulin in type 1 diabetes. The single most dangerous prescribing decision…

…or a very strong clinical suspicion. 3. Give intravenous calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells…

…driver of sudden cardiac death (SCD) and a major cause of morbidity in patients with structural heart disease, VT necessitates a nuanced, multidisciplinary approach to…

…thrombolysis regimens, renal function thresholds and the division of work between the ambulance service, the emergency department and the PCI laboratory may differ between Swedish…

…syndromes (NSTE ACS). The division into STE ACS and NSTE ACS has profound implications for management and treatment of patients with acute coronary syndromes. Moreover…

…8. Document the ceiling of care and the decision on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is…

…for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when appropriate, immediate percutaneous coronary intervention (PCI…

…chemistry & laboratory medicine Definition and Pathophysiology B type natriuretic peptide (BNP) and N terminal pro BNP (NT proBNP) are circulating markers of myocardial wall stress…

…and proposes an integrated decision pathway for physiology guided revascularization. Overview: Comparison of Physiological Indices The table below summarizes the four index families discussed in…

…The decision to transfer the patient to the ICU or CCU depends on the system of care and patient status. The absolute majority of patients…

…modify the estimated likelihood of atherosclerotic obstructive CAD. CAC is therefore not merely an incidental imaging finding; it can refine the decision to test and…

…identification of acute coronary occlusion (Al Zaiti et al, 2023). The proposed transition from the traditional STEMI/NSTEMI/UA classification to the OMI/NOMI approach…

Procedurer What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was…

…whereas contemporary decision making increasingly combines anatomical imaging with functional assessment. A central practical principle is that the visual severity of a stenosis does not…

…disease and evaluation of treatment effect, the medication is continued — abrupt withdrawal carries a risk of rebound. The referring physician should have made this decision…

[calc_mdrd] The Modification of Diet in Renal Disease (MDRD) equation for estimating the Glomerular Filtration Rate (eGFR) is: eGFR = 175 × (Scr)^ 1…

…the presence of concomitant risk factors. In contrast, patients with confirmed hypertension generally require BP lowering treatment without additional risk stratification for that treatment decision…

…carries a risk of pancreatitis Cardiac markers and coagulation Test Reference Comment : : : High sensitivity troponin T < 14 ng/L The decision thresholds are assay…

…to adults in sinus rhythm, recorded at a paper speed of 50 mm/s with 1 mV = 10 mm. At 50 mm/s a…

…a lumbar puncture is rarely the needle itself. It is the decision whether to perform it now or after imaging, how the patient is positioned…

…risk of falls; anaemia and a known gastrointestinal source are investigated before starting. A referral or notification to the anticoagulation clinic, and a decision on…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…and the decision to initiate CPR is often ambiguous. Since the risk of attempting CPR is extremely low and the potentially catastrophic consequences of wrongfully…

…a blood gas the treatment cannot be guided. A decision on the level of care and on whether intubation is appropriate, documented before treatment begins…

…and respect is also what makes the decision hold afterwards. Organ preserving treatment — treatment given solely for the sake of the donation — may continue for…

…a reduced level of consciousness with inadequate protective reflexes active major haematemesis severe agitation respiratory failure an anticipated difficult or prolonged endoscopic intervention a need…

…calc_timi_nstemi] TIMI SCORE 30 days mortality 30 days acute MI Probability of revascularization 0 1 1,2% 2,3% 1,2% 2 1…

…functional capacity, and health related quality of life substantially influence both cardiovascular risk and the balance between treatment benefit and harm. Prevention in the very…

…the inherent risks of iatrogenic hemorrhage. ECG recordings of atrial fibrillation. Click to enlarge. Risk Stratification: Stroke and Bleeding Assessment The decision to initiate oral…

…The decision must be documented and alternatives (iron, tranexamic acid, cell salvage, haemorrhage control) planned in advance. A history of a severe transfusion reaction: contact…

…do it. Otherwise the echocardiographic findings plus the clinical picture are sufficient for a treatment decision. Systemic thrombolysis is the first line treatment in high…

…and routine follow up is usually sufficient. Shared decision making The calculator provides a quantitative estimate of SCD risk, which facilitates informed discussions between clinicians…

…s predictive accuracy. The SYNTAX Score remains a cornerstone in the management of complex CAD, providing a structured approach to revascularization strategy. While it has…

…A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000 Oct…

…despite appropriately titrated medical therapy should prompt consideration of coronary angiography and possible revascularization. Revascularization may be selected for symptom relief after shared decision making…

…decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of…

…by itself, establish the presence or haemodynamic significance of a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for…

…hypertensive encephalopathy and should prompt consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in acute…

…forms part of shared clinical decision making. Pathophysiological and Diagnostic Considerations Angiographic severity and physiological severity do not always correspond. Visual estimation of luminal narrowing…

…is moderate or near a treatment decision threshold. Failure to account for a high Lp(a) level may lead to substantial underestimation of cardiovascular risk…

…patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated. A decision to withhold further life sustaining treatment. Preparation…

…than percutaneous coronary intervention (PCI). A CTO may be discovered incidentally during diagnostic angiography. Collateral vessels may maintain distal perfusion and permit visualization of the…