…Comment : : : Reticulocytes 20–100 ×10⁹/L Distinguishes a production defect from haemolysis or bleeding Ferritin 15–300 µg/L (women 10–150) An acute phase…

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

…indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with outflow tract obstruction Caution Tachyarrhythmia or bradyarrhythmia Rate…

…specific 99th percentile upper reference limit. It is classified as acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic…

…least two occasions, and preferably confirmation by home measurement or 24 hour recording — the thresholds for which are lower than for office measurement. Classification of…

…seizures, confusion, a change in behaviour, collapse or an acute neurological deficit. Hypoglycaemia can cause hemiparesis, aphasia and radiological changes resembling ischaemic stroke. Glucose measurement…

…full vital signs, level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the patient has sepsis, septic shock, or a…

…despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy. Tamponade is a clinical diagnosis supported by echocardiography: Finding Comment : : Hypotension, distended neck…

…Components of the HEMORR₂HAGES Score The acronym HEMORR₂HAGES represents the following parameters: H epatic or renal disease (1 point) E thanol abuse (1 point) M…

…with elevation of their diastolic pressures. Right sided filling becomes increasingly dependent on the fall in intrathoracic pressure during inspiration. The inspiratory increase in right…

…the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and/or fall of cTn values. However…

…initial STEMI management. The principal acute complications fall into two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure complications , including heart failure…

…ECG interpretation requires a comprehensive understanding of cardiovascular pathophysiology and electrocardiology. Unfortunately, numerous books and online resources fall into the trap of oversimplification. Physicians, nurses…

…upper reference limit (URL). It is considered acute when there is a rise and/or fall in cTn values. An elevated cTn alone does not…

…as well as cases where the cause does not fall into the other categories. Trauma Cardiac arrest caused by violence, accidents, burns, or other trauma…

…bicarbonate or blood gas, calcium, phosphate, glucose and a full blood count. 5. Take a urine dipstick and, where the cause is unclear or a…

…diary states when the patient fell asleep and got up. Holter ECG and longer rhythm monitoring Indications Palpitations, presyncope or syncope of suspected arrhythmic origin…

…normal or borderline resting ABI but typical claudication, the ankle pressure is measured immediately after treadmill walking or after repeated heel raises. A fall of…

…and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or does not fit the clinical picture. 4. Where possible…

…with inotropic and vasopressor effects, and they often need to be combined in order to optimise or correct the haemodynamics. Most agents exert both vasopressor…

…started in an opioid naive patient, or when a conversion between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain…

…mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis. It is characterized by prolonged angina…

…a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at 1 or 3 minutes after standing, following 5 minutes seated or…

…angina, impaired exercise capacity, an abnormal blood pressure response or ventricular arrhythmias. A fall in systolic blood pressure, particularly when accompanied by evidence of ischaemia…

…presence of myocardial necrosis. NSTEMI is confirmed by a typical rise and/or fall of high sensitivity cardiac troponin (hs cTn), with at least one…

…or underlying channelopathies (e.g., Torsades de Pointes in Long QT Syndrome) [1] . Underlying Etiologies The etiology of VT is broadly dichotomized into structural heart…

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

…movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than more slowly. The…

…Consequently, congestion may occur across the full range of left ventricular ejection fraction and may result from systolic dysfunction, diastolic dysfunction, or both. The clinical…

…10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine…

…or a haemoglobin below the applicable transfusion threshold (see below). Ongoing bleeding with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage…

…The two pathways DBD DCD : : : Full name Donation after death by neurological criteria (total brain infarction) Donation after circulatory death Starting point A ventilated patient…

…several non pharmacological measures at the same time, and use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and…

…hernia or visible abdominal wall collaterals (caput medusae) Puncture at least a few centimetres away from them Full bladder Have the patient void, or catheterise…

…monitoring, intravenous or intraosseous access, a targeted history At 5 minutes A full, adequate dose of a benzodiazepine About 10 minutes Repeat the benzodiazepine once…

…usually visible on plain films. Irrigation fluid: a copious volume of drinking quality tap water or sodium chloride 9 mg/mL. The volume matters more…

…pathophysiology Chronic kidney disease (CKD) is defined by abnormalities of renal structure or function that persist for more than 3 months and have health implications…

…fraction (HFmrEF) is a clinical syndrome defined by the combination of symptoms and/or signs of heart failure and a left ventricular ejection fraction (LVEF)…

…through the pulmonary circulation. Consequently, left ventricular filling falls and cardiac output may become markedly depressed. Right sided filling pressures—including central venous, right atrial…

…In heavy smokers, cardiovascular risk falls within five years of stopping but may remain elevated thereafter. The overall health benefit is greater still when reductions…

…resulting in obstruction. Central nervous system (CNS) injuries might cause apnea or hypoventilation. Respiratory conditions : Tension pneumothorax Drowning Airway obstruction Hanging Pneumonia High altitude sickness…

…and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level exceeding 4 mmol/l, commence an intravenous fluid resuscitation…

…mechanism. Sequential activation implies that the atria are activated first and they fill the ventricles with adequate volumes of blood before ventricular contraction commences. To…

…EAT, or atrial tachycardia) arises when an ectopic focus within the atria generates electrical impulses at a rate exceeding that of the sinoatrial (SA) node…

…iFR / RFR / Pd Pa / dPR) Resting Pd/Pa during the diastolic “wave free period” (iFR) or the lowest ratio across the full cardiac cycle (RFR)…

…is prolonged after a premature beat). This yields more time to fill the ventricles with blood (increased ventricular filling). Persons with premature beats might perceive…

…are also referred to as premature ventricular beats , premature ventricular contractions or just ventricular beats/contractions/complexes . These terms will be used interchangeably in this…

…bradycardia. The most important causes are as follows: Myocardial ischemia/infarction – Particularly ischemia or infarction located to the inferior wall of the left ventricle. This…

…compressions fail to generate stroke volumes. Consequently, addressing reversible causes of cardiac arrest becomes more critical than performing chest compressions. Hemorrhages, either manifesting externally or…

…Significance : : Inability to speak in full sentences Marked work of breathing Use of accessory respiratory muscles or paradoxical abdominal breathing Impending muscle fatigue Respiratory rate…

…attack : : : : Speech Full sentences Cannot complete a sentence in one breath Single words or unable to speak Position and behaviour Can lie down or sit…

…full blood count, electrolytes, creatinine, coagulation tests and troponin are taken in parallel but must not delay treatment in a patient without suspected coagulopathy or…

…drug, dosing, route of administration and criteria for intermediate care or intensive care. Time course after the last intake The times given are approximate. Symptoms…

…is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in…

…the needle may perforate into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position…

…and a large full body drape. Lidocaine 10 mg/mL for local anaesthesia, normal saline to flush all lumens, suture material or a securement device…

…preferably warmed. Water based lubricant in a small quantity — it does not interfere with cytology or HPV testing, but an excess can interfere with microbiological…

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

…vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption. Injection into an arm with a dialysis fistula. Preparation…

…needed around the clock. A continuous infusion or repeated doses, according to the local protocol Renal failure The insulin requirement falls . Reduce the dose and…