…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…

…atherosclerotic plaque disruption (rupture or erosion). The dynamic thrombotic component can vary in burden and may lead to distal coronary embolization, resulting in myocyte necrosis…

…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…

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

…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…

…Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in…

…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…

…due to uncertainty in the recording of no flow and low flow times in registries. The uncertainty is often obvious when interrogating witnesses, bystanders and…

…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…

…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…

…and defibrillation should be performed within 180 seconds (for shockable rhythms) after confirmed cardiac arrest. If it is not feasible to provide effective CPR due…

…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…

…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…

…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…

…collection with initially limited symptoms because the pericardium has had time to adapt. Hypotension and muffled heart sounds are important when present but are relatively…

…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…

…ESC) Evidence based management/treatment. These 9 aspects are all necessary to become confident in ECG interpretation and making clinical decisions using the ECG. Interestingly…

…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…

…can also be sought anterior to the lateral malleolus. Calculation: for each leg, the highest of the dorsalis pedis and posterior tibial pressures is divided…

…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…

…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…

…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…

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…

…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…

…is unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine, glucose, high sensitivity troponin and, where needed, coagulation tests…

…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…

…at retrieval Maintained up to retrieval Ceased; warm ischaemic time is the limiting factor The time critical element The diagnosis and the donor care The…

…example — may be enough to precipitate the condition [1,2]. Delirium is common but often missed. On medical and geriatric wards a substantial proportion of…

… 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…

…falls within five years of stopping but may remain elevated thereafter. The overall health benefit is greater still when reductions in non cardiovascular morbidity and…

…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…

…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…

…A large side to side difference may suggest aortic dissection CT of the brain Exclude intracerebral haemorrhage and assess early ischaemic changes CT angiography The…

…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…

…a sufficient initial target in most patients. Doses according to the local protocol and the Swedish medicines compendium (FASS). Rhythm control: the time limit before…

…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…