…hypertensive emergency requiring the most rapid BP response. The objective is to reduce aortic wall shear stress and rapidly lower systolic pressure. Renal and microvascular…

…in response to restenosis caused principally by neointimal hyperplasia. Contemporary DES combine a metallic scaffold, a polymeric or polymer free drug delivery system, and an…

…defined the victim's outcome: Neurological injury Myocardial dysfunction Systemic response to reperfusion and ischemia Effects of the underlying cause of cardiac arrest Neurological injuries…

…nearby, bystanders must respond immediately by summoning help (calling the emergency dispatch centre on the local emergency number) and initiate BLS (basic life support). BASIC…

…and lactate measurement. A meta analysis of emergency department alert systems found an association with lower mortality, but most of the evidence was observational and…

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

…sinus node dysfunction occur after tachyarrhythmia; the combination of tachyarrhythmia and sinus node dysfunction is referred to as tachy brady syndrome . Neurocardiogenic syndrome (which includes…

…symptoms and ECG recordings confirming a bradyarrhythmia. Potentially reversible causes should be pursued (Table 2). Figure 1. Management of acute bradycardia in the emergency setting…

…must go home with an adrenaline auto injector and written instructions. Patients taking beta blockers may respond poorly to adrenaline. If there is no response…

…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…

…hypertension and tachycardia are common during a generalised seizure. In prolonged status the initial sympathetic response can give way to hypotension, hypoxia, hypoglycaemia and circulatory…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Right ventricular infarction (RVI) is myocardial necrosis involving the right ventricle, most often occurring in association…

…blood pressure measurement. Resuscitation trolley with defibrillator, oxygen, suction and emergency drugs in the room. Staff with current CPR competence; a physician available. Patient preparation…

…markers of myocardial wall stress. They are released principally by ventricular cardiomyocytes in response to increased transmural stress and ventricular stretch. Atrial natriuretic peptide is…

…arrest cases, the correlation between the initial pupillary reflex (observed upon emergency department arrival) and the neurological status assessed at 30 days was evaluated. The…

…must be equipped with defibrillators and other emergency instruments. Personnel conducting the test must be formally trained to assess cardiovascular response, symptoms, and ECG changes…

…The severity of the symptoms governs the emergency treatment Severe symptoms The following symptoms indicate hyponatraemic encephalopathy and warrant immediate treatment in the absence of…

…The test measures the ability of the adrenal cortex to respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether…

…appropriate intensity, with attention to the emergence of symptoms. Evaluation Before Rehabilitation Clinical assessment Rehabilitation begins with patient assessment and ongoing medical surveillance. The programme…

…non STEMI (NSTEMI), and unstable angina (UA) has guided clinical decision making for decades but carries several limitations, most notably its reliance on ST segment…

…Plus fluid and glucose Adrenal crisis: hypotension that does not respond to fluid, abdominal pain, vomiting, fever, hyponatraemia, hyperkalaemia, hypoglycaemia. Give hydrocortisone and an isotonic…

…elective cardioversion. AVNRT and AVRT that respond to adenosine — try adenosine first in the stable patient. Sinus tachycardia and multifocal atrial tachycardia — treat the cause;…

…For laypeople, confirming absent or abnormal breathing is sufficient to alert the emergency service and commence CPR. Agonal breathing before apnea A cardiac arrest occurs…

…DW, Wickman LL, Swart GL. The hemodynamic and arterial blood gas response to asphyxiation: a canine model of pulseless electrical activity. Resuscitation 1995;30:16975…

Emergency medicine Myocardial ischemia and infarction Definition and Clinical Framework Chest pain is a broad clinical syndrome rather than a narrowly defined symptom. It includes…

…guide the choice of agent. Calcium channel blockers (CCB) Clevidipine Drug Clevidipine Brand names Cleviprex ® Indications Hypertension and hypertensive emergency. Treatment of postoperative hypertension…

…guide the choice of agent. Calcium channel blockers (CCB) Clevidipine Drug Clevidipine Brand names Cleviprex ® Indications Hypertension and hypertensive emergency. Treatment of postoperative hypertension…

…are several grading systems, and no grading replaces immediate clinical assessment. The updated international grading comprises five levels, with mild skin and mucosal reactions in…

…inpatient follow up depending on the clinical picture Moderate 6.0 to 6.4 mmol/L ECG and cardiac monitoring. Emergency treatment is often warranted…

…has become very low [4]. Sampling and measurement error A capillary glucose is sufficient to start emergency treatment, but abnormal or unexpected values should be…

…is the patient unstable, how long has the fibrillation lasted, and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion, without delay…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia…

Emergency medicine Lathundar Differential Diagnosis of Chest Pain: A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome…

Emergency medicine Myocardial ischemia and infarction Definition and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute myocardial infarction associated with a working diagnosis…

…and malperfusion are less frequent in type A IMH. IMH is classified anatomically according to the Stanford system: Type A IMH: involves the ascending aorta…

…immediate search for haemodynamic instability. This determines whether the patient has high risk PE and therefore requires an emergency management pathway. Patients without haemodynamic instability…

Cardiology Emergency medicine Procedurer Definition and Pathophysiology Cardiac tamponade is a life threatening clinical syndrome in which increased intrapericardial pressure compresses the heart and impairs…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

Clinical medicine Emergency medicine Definition and pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that…

Arrhythmias and arrhythmology Emergency medicine Pharmacology & dosing Definition and Pathophysiology Bradycardia encompasses a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within…

…rapid ventricular rate atrial fibrillation, marked anaemia, hypertensive emergency, heart failure, and end stage renal disease, may produce elevated troponin concentrations. The probability of MI…

…heavy sedation, surgery — and cardiac arrest. Contraindications There are no absolute contraindications in the emergency situation. Consider alternatives when: Intubation is not consistent with the…

Clevidipine Drug Clevidipine Brand names Cleviprex ® Indications Hypertension and hypertensive emergency. Treatment of postoperative hypertension. Mechanism of action Ultra short acting calcium channel blocker…

…with alpha blockade is necessary before administering labetalol (risk of elevating blood pressure in these settings). Labetalol doses and administration in hypertension (hypertensive crisis/emergency).

…Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency).

…reference This is a practical quick reference for emergency physicians in suspected acute ischaemic stroke. It covers time windows, indications and contraindications for intravenous thrombolysis…

…Fenoldopam Drug Fenoldopam Brand names Corlopam ® Indications Short term management of hypertension, including hypertensive emergency. Mechanism of action • Systemic Dopamine 1 (D1) receptor agonist…

…managed in an emergency department, an intensive care unit, a coronary care unit or another setting that allows frequent blood pressure measurement and continuous monitoring…

…hypertensive crisis/emergency Mechanism of action Clonidine is primarily a centrally acting alpha 2 agonist. Stimulation of alpha 2 adrenoceptors in the ventromedial and rostral…

Esmolol Drug Esmolol Brand names Brevibloc ® Indications Short term control of ventricular rate (including perioperative tachycardia) and hypertension (including hypertensive emergency, perioperative hypertension). Mechanism…

…not be given to pregnant women. • Should not be given to patients with Leber optic atrophy. Nitroprusside doses and administration in hypertension (hypertensive crisis/emergency).

…severe, a rapid course, skin discolouration, systemic upset — is an acute surgical emergency, not an abscess. Preparation and equipment No. 11 scalpel, curved haemostat, scissors…

…majority of cases, and the great majority of objects can be removed in general practice or in the emergency department with simple equipment. Two principles…

…the pressure, but emergency department studies show that raised values often persist after the visit and predict future hypertension and cardiovascular risk [3]. Questions that…

Info Antiarrhythmic drugs and management of ventricular tachycardia, ventricular fibrillation This manual presents recommendations for the management of ventricular tachyarrhythmias (VT, VF). It is primarily…

…duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left ventricular…

…and additionally severe hypertension (caution if patient on nonselective beta blockers). Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in…

…Flushing. Palpitations. Tolerance with prolonged use. Methemoglobinemia. Hypoxemia. Caution Proceed with caution in afterload dependent conditions. Nitroglycerin doses and administration in hypertension (hypertensive crisis/emergency).

…is a high quality emergency medicine blog covering a myriad of topics, primarily focusing on evidence based clinical topics, ECG cases, and high yield exam…

Cardiology Antiarrhythmic drugs and management of ventricular tachycardia, ventricular fibrillation This manual presents recommendations for the management of ventricular tachyarrhythmias (VT, VF). It is primarily…