…as well as cases where the cause does not fall into the other categories. Trauma Cardiac arrest caused by violence, accidents, burns, or other trauma…

…mechanism. Sequential activation implies that the atria are activated first and they fill the ventricles with adequate volumes of blood before ventricular contraction commences. To…

…or through statements made to the next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a…

…Out of office measurement is consequently central to diagnosis and long term management. Clinical presentation and symptoms The source material does not describe the typical…

…complications fall into two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure complications , including heart failure and cardiogenic shock. Most out of…

…must then not be carried out. Vaginismus or marked anxiety — plan for extra time, a smaller speculum, possibly a local anaesthetic gel, or examination under…

…possible oxygen concentration is given irrespective of the saturation Carbon monoxide poisoning. The pulse oximeter does not distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely…

…out of 100 cases had full recovery. More recent studies has reported mortality rates reaching 4%. ECG in takotsubo cardiomyopathy (broken heart syndrome) 80% of…

…tube) or coagulopathy (risk of bleeding). An advanced airway (tracheal tube, supraglottic airway) should be established as early as possible. Airway management should not interrupt…

…Deasy C, Bray J, Smith K, et al. Hanging Associated out of hospital cardiac arrests in Melbourne, Australia. Emerg Med 2013; 30:3842. Luna GK…

…What usually ruins the examination is not the technique but the handling of the specimen — an aspirate that clots before the smears are made is…

…neuromuscular blockers, and a person designated to keep time and read out the number of attempts. Laryngeal mask sizes Size Patient weight Maximum cuff volume…

…In out of hospital cardiac arrest (OHCA), the delay from collapse to defibrillation is substantially longer. The median time to arrival of the EMS is…

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

…It generally results from accumulation of pericardial fluid, blood, or, less commonly, a mass. Tamponade occurs when intrapericardial pressure equals or exceeds right atrial pressure…

…acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction…

…book? This question is far from trivial and the stakes are high; mastering ECG interpretation will frequently be a matter of life and death. ECG…

…chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations arising from structural or functional abnormalities of the coronary arteries or coronary microcirculation…

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

…thrombus by angiography or autopsy, except in type 2 and type 3 MI. A diagnosis of MI should not be made solely from an abnormal…

…normal or borderline resting ABI but typical claudication, the ankle pressure is measured immediately after treadmill walking or after repeated heel raises. A fall of…

…can swallow safely. 4. Give intravenous glucose if the patient has a reduced level of consciousness, is having seizures or cannot swallow. 5. If there…

…is not obligatory Hypothermia, new confusion, tachypnoea, hypotension, rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of infection…

…most superficially, where the distance from the skin is shortest, and where no liver, lung or vessel lies in the path of the needle. Access…

…Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation. Am Heart J . 2006;151…

…UA hinges entirely on the presence of myocardial necrosis. NSTEMI is confirmed by a typical rise and/or fall of high sensitivity cardiac troponin (hs…

…by dense collagenous scar, interspersed with surviving bundles of myocytes that form the slow conducting isthmuses critical for re entry [6] . Non ischemic dilated cardiomyopathy…

…patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from 140 to 125 mmol/L can…

…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…

…The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional…

…and screen and the serological crossmatch have a limited period of validity — usually about five days — because new antibodies can form after transfusion or pregnancy…

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

…Never stop basal insulin in a person with type 1 diabetes , not even before fasting or an investigation. Stopping it leads to ketoacidosis within hours…

…Because the impulse enters the ventricles through the bundle of His (which means that both bundle branches will conduct the impulse to each respective ventricle…

…across the full range of left ventricular ejection fraction and may result from systolic dysfunction, diastolic dysfunction, or both. The clinical consequences of extracellular volume…

…is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is a major modifiable driver of…

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

…the time of seizure onset, or the time the patient was last known to be well. Protect the patient from injury. Do not restrain the…

…and pathophysiology Chronic kidney disease (CKD) is defined by abnormalities of renal structure or function that persist for more than 3 months and have health…

…classification is clinically useful but should not be regarded as a series of completely discrete diseases. Heart failure extends across the full range of LVEF…

…by manifestations of severe right ventricular failure. Typical findings include: Jugular venous distension Kussmaul’s sign Hepatomegaly Hypotension, which may or may not be present…

…at a rate exceeding that of the sinoatrial (SA) node. This enhanced atrial activity is most commonly attributable to abnormal automaticity or re entry mechanisms…

…impulse discharged from an ectopic focus in the ventricles will spread abnormally (because the impulse did not enter the ventricles through the bundle of His…

…Hypoxia is common in traumatic cardiac arrest and can arise from a range of injuries. Any trauma impairing ventilation or gas exchange can cause hypoxia…

…aphasia, hemianopia or hand paresis in a person of working age Blood pressure Measure initially in both arms if this does not delay reperfusion treatment…

…do not delay treatment when there are ECG changes, circulatory compromise or a very strong clinical suspicion. 3. Give intravenous calcium in the presence of…

…bore access, or rapid central access, but do not delay transfusion or control of the bleeding in order to obtain a central venous catheter. 4…

…An assessment of bleeding risk and the risk of falls; anaemia and a known gastrointestinal source are investigated before starting. A referral or notification to…

…and quality of life may be equally important therapeutic objectives. Evidence from randomized trials is often less applicable to very frail or multimorbid patients because…

…provoke ventricular tachycardia or ventricular fibrillation. The likelihood of clinically significant EMI is generally low, particularly with bipolar electrocautery performed away from the device and…

…area), which may receive oxygen from collateral vessels. In cardiac arrest, there is no cerebral perfusion, with an equal degree of hypoxia in all neurons…

…g ejection fraction (EF), fractional sorting (FS), etc — do not elucidate regional variations in contractile function, or the effectiveness of longitudinal, radial, and circumferential contraction…

…your own region. The time limit is not a guarantee. Where the stroke risk is high or the time of onset uncertain, choose the more…

…limiting the applicability of trial findings to people with substantial functional impairment, multimorbidity, or limited life expectancy. Available randomized evidence has not demonstrated that frailty…

…tomography (OCT) can reveal lesions that are not apparent on conventional angiography. Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation…

…does not apply in haemodynamic instability. Digitalis toxicity — a risk of refractory ventricular arrhythmias. Therapeutic digoxin levels, by contrast, are no obstacle. Untreated hypokalaemia or…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

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

…lowered at each measurement, and not to talk. Otherwise ordinary activities, including work. No showering or bathing. A diary of going to bed, getting up…

…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…