…Some factors vary from second to second (e.g. degree of ischemia, parasympathetic and sympathetic tone) while others take months or years to develop (e…

…can spread from one cell to the next using this route. Figure 2 . Schematic illustration of the myocardial syncytium. Note the branched cell structure and…

…on a donor card, or through statements made to the next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour…

…home or ambulatory pressure. Office measurements provide only a limited representation of usual blood pressure and may be biased by the clinical environment. Out of…

…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…

…HPV positive The interval is counted from the most recent sample analysed for HPV. Invitations are sent up to and including the age of 70…

…why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off into a respiratory acidosis…

…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…

…that the efficacy of these interventions is much lower or uncertain. Indeed, the greatest opportunities for survival exist during the first few minutes from collapse…

…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…

…taken from the sternum — the needle may perforate into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or…

…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…

…Comment : : : Reticulocytes 20–100 ×10⁹/L Distinguishes a production defect from haemolysis or bleeding Ferritin 15–300 µg/L (women 10–150) An acute phase…

…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…

…rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and Clinical evidence of acute myocardial…

…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…

…MI results from acute coronary atherothrombosis. It is usually precipitated by disruption of an atherosclerotic plaque through rupture or erosion. The relative contributions of plaque…

…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…

…full vital signs, level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the patient has sepsis, septic shock, or a…

…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…

…of both hypovolaemia and venous congestion. 4. Take an urgent panel: creatinine, urea, sodium, potassium, bicarbonate or blood gas, calcium, phosphate, glucose and a full…

…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…

…needed around the clock. A continuous infusion or repeated doses, according to the local protocol Renal failure The insulin requirement falls . Reduce the dose and…

…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…

…environmental exposures are associated with continued or resumed smoking after the acute event and warrant particular attention. Cardiovascular benefits of cessation The principal benefits relevant…

…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…

…intravenous or intraosseous access, a targeted history At 5 minutes A full, adequate dose of a benzodiazepine About 10 minutes Repeat the benzodiazepine once if…

…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…

…remains fundamentally one of impaired cardiac performance, in which the heart cannot provide blood flow commensurate with the body’s requirements or can do so…

…The haemodynamic disturbance results from impaired right ventricular contraction and reduced forward flow through the pulmonary circulation. Consequently, left ventricular filling falls and cardiac output…

…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…

…done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy…

…the first choice, since it provides more elemental calcium per millilitre and can be given rapidly through secure intravenous or intraosseous access. Grading There is…

…haemostatic capacity, but it cannot compensate for an uncontrolled source of bleeding. Minimise the time to surgery, endoscopy, an obstetric procedure or angiographic intervention. Summon…

…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…

…or the effectiveness of longitudinal, radial, and circumferential contraction. Thus, methods such as ejection fraction may provide easily obtained parameters, but fail to provide important…

…or the time of onset uncertain, choose the more cautious course. Anticoagulation Assess the risk with CHA₂DS₂ VA (the sex category has been removed from…

…include: Degree of frailty, preferably using validated clinical tests Ability to perform activities of daily living Cognitive status Risk of falls Symptoms or history suggesting…

…absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial coronary vasospasm Coronary microvascular dysfunction Spontaneous coronary artery dissection (SCAD) Standard angiography may fail…

…phase of the T wave There is no R wave to synchronise to; sync mode would block the shock entirely The patient Awake or sedated…

…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…

…with the same risk as manifest hypertension. Non dipping: a nocturnal fall in pressure of < 10% of the daytime value; an independent risk marker…

…the patient fell asleep and got up. Holter ECG and longer rhythm monitoring Indications Palpitations, presyncope or syncope of suspected arrhythmic origin. Assessment of rate…

…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…