…conventional hypertension threshold. The traditional diagnostic threshold of 140/90 mmHg derives from epidemiological observations associating pressures above this level with increased mortality. Contemporary management…

…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…

…causes of cardiac arrest according to the Utstein protocol. Figure 1. Data from the Swedish Cardiopulmonary Resuscitation Registry (SCRR), showing presumed causes of out of…

…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…

…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…

…time critical element The diagnosis and the donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe…

…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…

…distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal value. Give 100 % oxygen on a reservoir mask — this markedly shortens the half life of carbon…

…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…

…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…

…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…

…6. Make the smears immediately at the bedside from the first aspirate, which should be small — a few tenths of a millilitre, at most about…

…Reference ranges are statistical: by definition they encompass 95 % of a healthy reference population, which means that one healthy value in twenty falls outside them …

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

…the injury resulted from acute myocardial ischaemia. Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does…

…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…

…lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI is diagnosed when…

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

…Experimentally, necrosis advances from the subendocardium towards the subepicardium over several hours. The extent and tempo of injury are influenced by collateral flow, myocardial oxygen…

…the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel, a blood pressure cuff of the correct…

Endokrinologi & metabolism Akutsjukvård Lathundar Emergency overview Measure the plasma glucose immediately in everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour…

…two sets of blood cultures from separate peripheral punctures. Also culture from a central line if one is present 4 Take a full blood count…

…Almost always Pulsus paradoxus above 10 mmHg A fall in systolic blood pressure during inspiration; one of the most useful signs Low voltage on the…

…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…

…The transition from a quiescent plaque to a highly thrombogenic surface occurs via three primary mechanisms: Plaque Rupture: Accounting for 60 70% of ACS presentations…

…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…

…in which the patient reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient…

…but from the wrong blood being given to the wrong patient — a mislabelled tube, or an identity check performed at the nurses' station instead of…

…Akutsjukvård Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the…

Endokrinologi & metabolism Lathundar An inpatient has a different insulin sensitivity from at home: less food, more stress, often corticosteroids, often impaired renal function. Prescribe basal…

…with the sinus P wave. The appearance depends on the location of the ectopic focus from which the impulse is discharged. If the impulse is…

…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…

…reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is a major modifiable driver of atherosclerosis and cardiovascular disease…

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

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

…When eGFR falls below approximately 60–75 mL/min/1.73 m², the probability of coronary artery disease (CAD) increases in an approximately linear manner…

…of LVEF, and echocardiographic measurement is subject to meaningful variability. HFmrEF may therefore represent several clinically distinct trajectories: A patient whose LVEF has improved from…

…range from mild right ventricular impairment to cardiogenic shock. Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of…

…there is a risk of developing tachycardia induced cardiomyopathy. In pediatric populations, a distinct form of atrial tachycardia may occur due to embryological remnants within…

…more time to fill the ventricles with blood (increased ventricular filling). The person with premature beats might perceive this as palpitations, because of the stronger…

…As per data from the registry, only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac…

…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…

…or a very strong clinical suspicion. 3. Give intravenous calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells…

…a full blood count, INR, APTT and fibrinogen. 7. Give tranexamic acid where it is indicated. 8. Proceed in parallel to definitive control of the…

…drugs, herbal remedies and supplements. An assessment of bleeding risk and the risk of falls; anaemia and a known gastrointestinal source are investigated before starting…

…Preservation of mobility, cognition, independence, functional capacity, and quality of life may be equally important therapeutic objectives. Evidence from randomized trials is often less applicable…

…records are incomplete. A full device check should be available within the recommended interval before elective surgery. In the absence of malfunction, a pacemaker should…

…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…

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

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

…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…

…An unsynchronised shock that happens to fall in the T wave can precipitate ventricular fibrillation, and cardioversion of fibrillation of unknown duration without anticoagulation can…

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…

…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…

…line is necessary to achieve an optimal result. Overview of vasopressors and inotropes Vasoconstriction Vasodilatation Positive inotropy Phenylephrine Vasopressin Midodrine Noradrenaline Adrenaline, high dose Dopamine…