…management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2. Is the hyponatraemia acute or chronic? Severe symptoms…

…by intraluminal thrombosis or haemorrhage into the plaque through the disrupted surface. Type 2 MI: Attributed to an imbalance between myocardial oxygen supply and demand…

…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…

…itching and urticaria are usually due to histamine release, not allergy. Concurrent MAO inhibitor, particularly with pethidine. Caution: untreated sleep apnoea, a concurrent benzodiazepine or…

…meal or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other precipitating…

…30 seconds or requiring termination earlier due to hemodynamic collapse [4] . Sustained VT is a medical emergency that universally warrants acute intervention and long term…

…progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is…

…cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ, Hilander SJ, Dobler DW, Wickman LL, Swart GL. The hemodynamic and arterial blood…

…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…

…mostly due to acute myocardial ischemia or myocardial infarction, and in these cases, the likelihood of ROSC is higher as compared to other etiologies and…

…is often omitted in clinical practice, and these arrhythmias are commonly referred to simply as atrial tachycardia or atrial rhythm, depending on the ventricular response…

…infarction. Sinus Node Dysfunction (SND) – Sinus node dysfunction implies that the cells of the sinoatrial node are defective and fail to generate electrical impulses. Side…

…and occasionally pathological Q waves. Troponin levels are often mildly elevated. Hence, takotsubo cardiomyopathy cannot be differentiated from ST segment elevation myocardial infarction. Due to…

…used if other methods fail to open the airway. Figure 1. Methods to open the airway. No large study has compared oropharyngeal and nasopharyngeal airways…

…related to T4 — a small change in T4 produces a large change in TSH. During acute illness the TSH can be falsely low or high…

…Elective or subacute: Symptomatic persistent atrial fibrillation where rhythm control is the aim. Atrial flutter, which often converts at low energy and is difficult to…

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

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

…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…

…neutropenia related to cancer treatment. Children, pregnant women, patients after allogeneic stem cell transplantation and patients treated with CAR T cells or other advanced immunotherapies…

…liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and to the left

…to guide clinicians in balancing estimating the risks of bleeding. Components of the HEMORR₂HAGES Score The acronym HEMORR₂HAGES represents the following parameters: H epatic or…

…Other symptoms depend on the extent of reduction in cardiac output and arterial pressure and may include: Chest discomfort Fatigue Weakness Presyncope or syncope Exercise…

…The principal acute complications fall into two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure complications , including heart failure and cardiogenic shock…

…interested in other books and online resources, we have plowed through more than 30 of the most popular ECG books (according to Amazon and Google…

…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…

…recorder Contraindications None. Practical obstacles are skin disease or allergy to the electrode gel, and marked body hair that cannot be shaved. Set up 1…

…a manual manometer, plastic film or a dressing to protect an ulcer, and where needed a photoplethysmograph and a toe cuff. Preparation: The patient must…

…are several synthetic and endogenous agents with inotropic and vasopressor effects, and they often need to be combined in order to optimise or correct the…

…a transient and reversible mismatch between myocardial oxygen demand and blood supply, generally during exertion, emotional stress, or another stressor. Manifestations include angina, other chest…

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

…to influence diagnostic strategy or management. Appropriate objectives include: Measuring exercise tolerance Determining whether symptoms are reproduced by exertion Assessing the relationship between symptoms and…

…The distinction between NSTEMI and UA hinges entirely on the presence of myocardial necrosis. NSTEMI is confirmed by a typical rise and/or fall of…

…anticholinergics, opioids and salicylate — where gastric emptying is delayed — may justify charcoal later, in some cases up to 6 hours or more. Discuss this with…

…with an effect equivalent to sedation and fewer adverse effects Digital nerve block The standard in finger dislocation Procedural sedation Propofol, ketamine or a combination…

…flow appropriate to tissue requirements unless filling pressures are elevated. Consequently, congestion may occur across the full range of left ventricular ejection fraction and may…

…2 to 24 hours After failed fibrinolysis Immediate rescue PCI The 120 minute limit is a ceiling for the choice between primary PCI and fibrinolysis…

…and it is the time to haemorrhage control that determines the outcome. Indications Symptomatic anaemia, or a haemoglobin below the applicable transfusion threshold (see below…

…physician and the transplant service. Contraindications An expressed refusal by the deceased — in the donation register, on a donor card, or through statements made to…

…depression or dementia Mixed Alternates between hypoactivity and hyperactivity Common on repeated assessment over the day It is wrong to assume that hyperactive delirium is…

…20 mL and 50 mL syringes. Therapeutic drainage: a commercial paracentesis set or a catheter over needle, 16–18 G, connected to tubing and a…

…the initial sympathetic response can give way to hypotension, hypoxia, hypoglycaemia and circulatory failure [5]. Plasma glucose immediately Check the capillary or venous glucose i

…without being found. Indications A traumatic wound that gapes and cannot be expected to heal with good function or cosmesis without apposition. A wound that…

…burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other arrhythmias or conduction abnormalities…

…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…

…mild right ventricular impairment to cardiogenic shock. Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic…

…for smoking and anticipated barriers to cessation. Exposure to second hand smoke. Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation…

…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…

…is important to distinguish between two main types of cardiac cells: Conduction cells form the fiber networks that sprout into the myocardium and disseminate the…

…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…

…most cases, the premature atrial impulse is conducted to the ventricles, which results in ventricular depolarization and the appearance of a QRS complex. Because the…

…be quadrigeminy and so on. Figure 3. Premature ventricular contractions in bigeminy. Two consecutive premature ventricular contractions are referred to as a pair or couplet…

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

…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…

…intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology…

…withdrawal varies between regions and units. Follow the local protocol for choice of drug, dosing, route of administration and criteria for intermediate care or intensive…

…preferred to warfarin except in a mechanical valve prosthesis and in moderate to severe mitral stenosis, where warfarin applies. Apixaban is often preferred, among other…

…obesity or when the supine position is necessary. After previous punctures: change side, and avoid irradiated fields. Preparation and equipment Informed consent, current full blood…

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

…urine or a self taken vaginal sample without a speculum. Routine gynaecological examination of asymptomatic women has not been shown to improve outcomes and is…