…aim is to relieve the cerebral oedema quickly, not to normalise the plasma sodium. Chronic or minimally symptomatic hyponatraemia must be corrected in a controlled…

…there is a documented rise and/or fall of cTn values. However, myocardial injury alone is an entity in itself and may arise from non…

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

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

…does not normally need investigation on the basis of an isolated, asymptomatic low sensor reading alone. Symptoms Autonomic symptoms Early warning symptoms are due to…

…disease or reduced left ventricular ejection fraction (LVEF). Sustained VT: Defined as VT lasting longer than 30 seconds or requiring termination earlier due to hemodynamic…

…output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to hypovolaemia, shock, obstruction or advanced renal injury…

…or hypoxia is managed according to the standard CPR algorithm, except that interventions to reoxygenate the patient is of paramount importance. In cardiac arrest due…

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

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

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

…ischemia or infarction located to the inferior wall of the left ventricle. This type of bradycardia is due to diminished automaticity (pacemaker function) in the…

…to it in recent years. Most cases (70%) of takotsubo cardiomyopathy occur in situations with extreme stress, such as car accidents, gun violence, threats, or…

…advanced and costly than the interventions available in BLS, the number needed to treat (NNT) for the ACLS specific interventions is much higher or uncertain…

…haemolysis or bleeding Ferritin 15–300 µg/L (women 10–150) An acute phase protein — a normal ferritin does not exclude iron deficiency in the…

…unknown or excessive duration without adequate anticoagulation or exclusion of thrombus — the most important relative contraindication to elective cardioversion. It does not apply in haemodynamic…

…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…

…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…

…hypertension is not made on a single reading. It requires repeated measurements on at least two occasions, and preferably confirmation by home measurement or 24…

…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…

…A fall in systolic blood pressure during inspiration; one of the most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not…

…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…

…threatening clinical syndrome in which increased intrapericardial pressure compresses the heart and impairs ventricular filling. It generally results from accumulation of pericardial fluid, blood, or…

…related artery is not recommended in stable, asymptomatic patients without severe ischaemia. Evaluation and Physical Examination The initial evaluation should be structured to establish a…

…few real world examples of the conditions, or provided too few tests to result in any clinical proficiency. The best ECG books and the most…

…URL). It is considered acute when there is a rise and/or fall in cTn values. An elevated cTn alone does not establish MI, because…

…and in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set up and instructions Choose the cuff according to arm circumference…

…signal is sought on the dorsum of the foot lateral to the extensor hallucis longus tendon. Measure in the same way as on the arm…

…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…

…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…

…is consequently central to diagnosis and long term management. Clinical presentation and symptoms The source material does not describe the typical symptoms or symptom burden…

…is not confined to the ECG. Ischaemia may also produce angina, impaired exercise capacity, an abnormal blood pressure response or ventricular arrhythmias. A fall in…

…and/or fall of high sensitivity cardiac troponin (hs cTn), with at least one value above the 99th percentile upper reference limit (URL) in the…

…where gastric emptying is delayed — may justify charcoal later, in some cases up to 6 hours or more. Discuss this with the poison control centre…

…so as not to reduce a fracture dislocation or to miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with…

…However, diuretic treatment has not been shown formally to reduce heart failure mortality; its established role is symptom relief and prevention of recurrent congestion and…

…arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended…

…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…

…types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current transmission risk assessment. In DCD: patients in whom death…

…delirium with a structured instrument , for example the 4AT or the CAM according to local protocol. 6. Look for several concurrent causes. In older patients…

…does not predict bleeding risk in paracentesis. Follow the local protocol Ileus with distended bowel loops Ultrasound guidance mandatory; choose another site Scars, hernia or…

…In parallel with the drug treatment Resuscitation, investigation and drug treatment must proceed simultaneously. Do not wait for laboratory results, CT or EEG before the…

…through a 20 mL syringe and a large bore needle. Chlorhexidine in alcohol to the skin around the wound — not into the wound. Sterile gloves…

…is transmitted to the renal veins and can reduce GFR. Conversely, a rise in creatinine during effective decongestion and overall clinical improvement does not necessarily…

…not be regarded as a series of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to…

…which may or may not be present Markedly reduced cardiac output in severe cases Cardiogenic shock in the most advanced presentations The symptoms of RVI…

…The principal benefits relevant to clinical cardiology include: Clinical setting or outcome Reported benefit of cessation Cardiovascular disease overall Substantial reduction in cardiovascular events 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…

…myocardium, or simply myocardial cell, refer to this cell type, and these terms are used interchangeably. Cardiac cell architecture In contrast to skeletal muscle, cardiac…

…shown to outperform visual angiographic guidance in selecting lesions for percutaneous coronary intervention (PCI). Non hyperemic pressure ratios (instantaneous wave free ratio [iFR], resting full…

…will be similar to the normal P wave. If the impulse is discharged near the atrioventricular node, the atria will be depolarized in the opposite…

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

…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…

…A patient does not have to meet every criterion in a column. Clinical deterioration or a poor response to treatment carries more weight than a…

…last known to be well NIHSS A complete score by a physician or nurse experienced in stroke Functional impact A low NIHSS does not exclude…

…suspicion of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with…

…Check what applies in your own region. The time limit is not a guarantee. Where the stroke risk is high or the time of onset…

…into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position is necessary. After previous…

…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…

…of the programme and is widely used — a woman who does not attend for a gynaecological examination, or who prefers to take the sample herself…