…main clinical rule Two questions determine the initial management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2…

…delayed, partly due to autopsy studies demonstrating an absence of coronary thrombi in a significant proportion of deceased patients. Historically referred to as coronary thrombosis…

…does not fall into the other categories. Trauma Cardiac arrest caused by violence, accidents, burns, or other trauma. Drowning Cardiac arrest due to drowning Electrocution…

…on the bowel must be taken into account). Known allergy to the preparation — rare; itching and urticaria are usually due to histamine release, not allergy…

…alert value < 3.9 mmol/L but at least 3.0 mmol/L Prompt action is needed to prevent a further fall Level 2…

…fraction (LVEF). Sustained VT: Defined as VT lasting longer than 30 seconds or requiring termination earlier due to hemodynamic collapse [4] . Sustained VT is a…

…to markedly impaired renal function [3]. Urine output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to…

…0.4 0.8 2.1 Table 1. Survival in out of hospital cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ…

CPR Cardiac arrest due to trauma In cases of traumatic cardiac arrest, addressing reversible etiologies takes precedence over chest compressions. If trauma is not definitively…

…These estimates should be viewed as approximations due to the following: Registry data indicate that survival is possible with longer periods of no flow ( Rawshani…

…induced cardiomyopathy. In pediatric populations, a distinct form of atrial tachycardia may occur due to embryological remnants within the atrial myocardium. These residual tissues, persisting…

…in the following circumstances: During sleep . Well trained individuals display SB at rest due to high vagal tone. These individuals have developed a highly efficient…

…referred to PCI with a suspicion of STE ACS/STEMI, actually have takotsubo. Previous studies reported that 98 out of 100 cases had full recovery…

…which scenario head tilt chin lift should only be used if other methods fail to open the airway. Figure 1. Methods to open the airway…

… used to guide antibiotic therapy Glucose and lipids Test Threshold Comment : : : Fasting plasma glucose 4.0–6.0 mmol/L ≥ 7.0 on two occasions…

…certain and argue against elective cardioversion. Anticoagulation before cardioversion After cardioversion the atrium does not regain its mechanical function until days to weeks have passed…

…Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with…

…and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction. Cardiac troponin identifies injury to myocardial cells…

…mmHg suggests vascular disease, and the arm with the higher reading is used thereafter Two to three measurements one minute apart, taking the mean of…

…or below 1.0 × 10⁹/L with an expected fall to below 0.5 × 10⁹/L within 48 hours Profound neutropenia A neutrophil count below…

…tachypnoea, cold periphery Almost always Pulsus paradoxus above 10 mmHg A fall in systolic blood pressure during inspiration; one of the most useful signs Low…

…CYP2C9 variants) (1 point) E xcessive fall risk (1 point) S troke (1 point) HEMORR₂HAGES Score Risk category Incidence of major bleeding (per 100 patient…

…death. The volume required to produce tamponade depends principally on the rate of accumulation and the compliance of the pericardium. Rapid accumulation may cause tamponade…

…of ischaemic symptoms. The immediate pathophysiological objective is restoration of blood flow to the infarct related myocardial territory and limitation of infarct size. The extent…

…Books that claim to make it "simple" can provide a quick entry point but fail to delve into the crucial depths needed for clinical practice…

…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…

…and lead to one dose being moved to the evening. The fall can only be calculated if the diary states when the patient fell asleep…

Procedurer The ankle brachial index is the cheapest and most accessible method of objectively demonstrating peripheral arterial disease, and it is needed more often than…

…and haemodynamic monitoring with ECG, a central venous catheter and an arterial line is necessary to achieve an optimal result. Overview of vasopressors and inotropes…

…without persistent ST segment elevation, accompanied by a rise and subsequent fall in cardiac specific troponin attributable to myocardial ischaemia. UA presents with compatible ischaemic…

…the arms. Orthostatic hypotension: a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at 1 or 3 minutes after standing, following…

…suspected chronic coronary syndrome when the result is expected to influence diagnostic strategy or management. Appropriate objectives include: Measuring exercise tolerance Determining whether symptoms are…

Introduction to Coronary Atherosclerosis, Plaques, Atherothrombosis Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by…

Procedurer Emptying the stomach has gone from routine to exception. Activated charcoal — in Sweden usually called medicinal charcoal — is the first line measure in decontamination…

…lies supine or sits. The upper arm is held adducted against the trunk and the elbow is flexed to 90 degrees. The forearm is moved…

…of the heart to provide blood flow appropriate to tissue requirements unless filling pressures are elevated. Consequently, congestion may occur across the full range of…

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

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

…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…

…deprivation, urinary retention or a new sedative drug, for example — may be enough to precipitate the condition [1,2]. Delirium is common but often missed…

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

…from seizure onset Action : : 0 to 5 minutes ABCDE, start timing, glucose, monitoring, intravenous or intraosseous access, a targeted history At 5 minutes A full…

…expected to heal with good function or cosmesis without apposition. A wound that bleeds because the edges are held apart. A wound through the full…

…1.73 m², excess urinary albumin excretion—typically a spot urinary albumin to creatinine ratio (UACR) above 30 mg/g—or both. The eGFR is…

…of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability. HFmrEF may therefore represent…

…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 cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is…

…a dose of 30 ml/kg. Should fluid resuscitation fail to maintain a mean arterial pressure (MAP) above 65 mmHg, consider the initiation of vasopressor…

…that the atria are activated first and they fill the ventricles with adequate volumes of blood before ventricular contraction commences. To coordinate these two tasks…

…reserve (FFR), have been validated against outcomes and shown to outperform visual angiographic guidance in selecting lesions for percutaneous coronary intervention (PCI). Non hyperemic pressure…

…induces a delay to the next sinus beat (the RR interval is prolonged after a premature beat). This yields more time to fill the ventricles…

…a delay to the next sinus beat (the RR interval is increased after a premature ventricular complex). This yields more time to fill the ventricles…

…Signs of a serious condition Finding Significance : : Inability to speak in full sentences Marked work of breathing Use of accessory respiratory muscles or paradoxical abdominal…

…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…

…overview 1. Activate the stroke call. 2. Establish the time of symptom onset or the time last known to be well. 3. Assess airway, breathing…

…important measures in severe or complicated withdrawal are: 1. A benzodiazepine in a sufficient and repeated dose , titrated against clinical effect. 2. Parenteral thiamine early …

…Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol. An anticoagulant is given as soon as possible, but must…

…red marrow is abundant, and the distance to vessels and abdominal organs is large. The sternum may be used for aspiration when the iliac crest…

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

…sheet to cover the patient. Before the examination: let the patient empty her bladder — a full bladder makes bimanual palpation difficult and causes prolapse to…