…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…

…the plaque through the disrupted surface. Type 2 MI: Attributed to an imbalance between myocardial oxygen supply and demand, without the presence of acute atherothrombosis…

…The discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades…

…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…

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

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

…hospital episode in international studies and is linked to substantial mortality, even though incidence and prognosis vary widely between patient groups and care settings [2…

…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…

…many instances. Cardiac tamponade : Tamponade in trauma patients is due to blood accumulation in the pericardial sack. This impairs atrial and ventricular filling, such that…

…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…

…all other cases aligns with the approach used for atrial fibrillation and atrial flutter. Beta blockers, digoxin, and calcium channel blockers may be used to…

…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…

…age and pregnancy Procalcitonin < 0.25 µg/L Supports a bacterial aetiology; used to guide antibiotic therapy Glucose and lipids Test Threshold Comment : : : Fasting…

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

…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…

…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…

…is used thereafter Two to three measurements one minute apart, taking the mean of the last two Orthostatic testing after 1 and 3 minutes of…

…glucose and lactate. Add a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests from the…

…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

…for major bleeding compared to HAS BLED. The C indices were 0.60 for HAS BLED, 0.55 for HEMORR₂HAGES, and 0.50 for ATRIA…

…associations include: Idiopathic or viral pericarditis Malignant pericardial disease Tuberculosis Purulent or bacterial pericarditis Trauma Cardiac surgery and other iatrogenic cardiovascular procedures Acute aortic disease…

…presenting feature. The source material emphasizes that patients and families should be educated to recognize chest discomfort or dyspnoea as potentially indicating myocardial infarction, particularly…

…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…

…renal disease and secondary hypertension, and lead to one dose being moved to the evening. The fall can only be calculated if the diary states…

…at which the signal disappears, deflate slowly (2 mmHg/s) and note the pressure at which the signal returns. Repeat on the other arm. 2…

…Nitroprusside Figure 1. The approximate position of each drug according to its vasoconstrictor effect (vertical axis) and its positive inotropic effect (horizontal axis). Grey =…

…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…

…a sequential systolic difference of 10 mmHg between the arms. Orthostatic hypotension: a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP…

…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…

…has gone from routine to exception. Activated charcoal — in Sweden usually called medicinal charcoal — is the first line measure in decontamination, and gastric lavage is…

…work best exploit time, gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator…

…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…

…with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage…

…Swedish law and practice; the legal framework, the consent model and the time limits differ between countries. The two pathways DBD DCD : : : Full name Donation…

…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…

… full sterile attire for therapeutic drainage with an indwelling catheter. Lidocaine 10 mg/mL, 5–10 mL, 25 G for the skin wheal and 21…

…to 20 minutes at the latest Give a full loading dose of an intravenous antiseizure drug If the seizure continues after adequate step 1 and…

…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…

…hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete…

…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…

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

…cancer and previous venous thromboembolism. A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full…

…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…

…zero, and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake Common clinical picture : : 4 to 12 hours Tremor…

…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…

…5. Aspiration: advance the needle with the stylet in place perpendicular to the bone surface, angled slightly anteriorly and medially. Rotate under steady pressure until…

…disinfection. Allow it to air dry completely before puncture. Maximal barrier precautions: cap, mask, sterile gown, sterile gloves and a large full body drape. Lidocaine…

…mycoplasma and a wet mount. Gloves, gauze swabs, a sheet to cover the patient. Before the examination: let the patient empty her bladder — a full…