…wherever in the screening interval the patient happens to be — a recently taken normal smear is no reason to refrain from investigating postmenopausal bleeding or…

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

…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…

…or several mechanisms acting simultaneously. Acute myocardial infarction Acute myocardial infarction requires: Acute myocardial injury, demonstrated by a rise and/or fall in cardiac troponin…

…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…

…electrical or haemodynamic instability, and cardiogenic shock. ACS is distinct from myocardial infarction (MI). MI denotes cardiomyocyte necrosis occurring in the clinical setting of acute…

…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…

…is an acute myocardial infarction associated with a working diagnosis of persistent ST segment elevation or an accepted equivalent in the setting of ischaemic symptoms…

…injury from infarction caused by acute ischaemia. Acute myocardial infarction Acute MI requires both: Acute myocardial injury , demonstrated by a rise and/or fall in…

…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…

…axillary clearance or a recently inserted venous port. Procedure 1. Arm pressure. Place the cuff on the upper arm. Locate the brachial signal in the…

…severe hypoglycaemia No defined threshold The patient has cognitive or physical impairment and needs help from another person Level 3 can occur even when the…

…a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests from the suspected focus, but avoid…

…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…

…guide clinicians in balancing estimating the risks of bleeding. Components of the HEMORR₂HAGES Score The acronym HEMORR₂HAGES represents the following parameters: H epatic or renal…

…mmHg or DBP 70–89 mmHg. This distinction supports a risk based approach because cardiovascular benefit from blood pressure reduction may also occur in selected…

…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…

…secondary prevention strategies. By Morphology: Monomorphic VT (MMVT): Characterized by a uniform QRS morphology from beat to beat in each electrocardiographic lead. MMVT strongly indicates…

…not to normalise the plasma sodium. Chronic or minimally symptomatic hyponatraemia must be corrected in a controlled fashion, since too rapid a rise can cause…

…time course. 2. Measure the urine output. Perform a bladder scan in oliguria, anuria or unexplained AKI. 3. Assess the circulation and volume status, including…

…confirming the position. For gastric lavage: a wide bore orogastric tube (Ch 28–32 in an adult), a funnel or a lavage system, lukewarm fluid…

…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…

…the delay from collapse to defibrillation is substantially longer. The median time to arrival of the EMS is 10 to 15 minutes in Europe and…

…Significance : : Inability to speak in full sentences Marked work of breathing Use of accessory respiratory muscles or paradoxical abdominal breathing Impending muscle fatigue Respiratory rate…

…insulin at lunch and dinner in the first instance. Measure the glucose before every meal and at bedtime Enteral or parenteral nutrition Insulin is needed…

…in the opposite direction and thus generate a negative (retrograde) P wave (Figure 2). Thus, the P wave morphology of premature atrial beats differs from…

…Consequently, congestion may occur across the full range of left ventricular ejection fraction and may result from systolic dysfunction, diastolic dysfunction, or both. The clinical…

…smokers for a prolonged period. In heavy smokers, cardiovascular risk falls within five years of stopping but may remain elevated thereafter. The overall health benefit…

…from them Full bladder Have the patient void, or catheterise, before puncture Pregnancy, previous extensive abdominal surgery Ultrasound guidance; choose a new site if in…

…donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain infarction…

…from seizure onset Action : : 0 to 5 minutes ABCDE, start timing, glucose, monitoring, intravenous or intraosseous access, a targeted history At 5 minutes A full…

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

…renal, thyroid or hepatic disease may produce a similar symptom complex; in the absence of cardiac dysfunction, these conditions do not fulfil the definition of…

…severity The presentation may range from mild right ventricular impairment to cardiogenic shock. Patients with hypotension, marked low output, or persistent severe symptoms require close…

…approximately 5 to 10 seconds may precede the full tachycardia. It is characterized by short, rapid bursts of atrial activity. In the majority of cases…

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

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

…full blood count, electrolytes, creatinine, coagulation tests and troponin are taken in parallel but must not delay treatment in a patient without suspected coagulopathy or…

…Add high dose salbutamol in marked hyperkalaemia if there is no contraindication. 5. At the same time, start treatment that eliminates potassium from the body…

…pressure. A value of around 0.9 to 1.0 or higher in an adult trauma patient suggests significant hypovolaemia and an increased transfusion requirement…

…the lung injury. Discuss with your national or regional poison control centre. An open flame or smoking in the room: a fire hazard. Preparation and…

…what happens when the INR runs away or the patient bleeds. In Sweden the treatment is usually managed from an anticoagulation clinic with dosing support…

…important therapeutic objectives. Evidence from randomized trials is often less applicable to very frail or multimorbid patients because these groups have historically been underrepresented. Consequently…

…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…

…few minutes from collapse. Table 1 shows the number needed to treat (NNT) for various interventions involved in BLS and ACLS. Intervention BLS or ACLS…

…following recommendations: Administer 100% oxygen at the maximum flow rate . Hypoxia can precipitate cardiac arrest in septic patients; timely oxygenation can potentially prevent circulatory collapse…

…These cells form bundles of fibers that act as electrical cords that spread the action potential rapidly and sequentially to contractile myocardium in the atria…

…Shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) are mostly due to acute myocardial ischemia or myocardial infarction, and in these cases, the likelihood of ROSC…

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

…during systole showing apical ballooning akinesis with basal hyperkinesis in a characteristic takotsubo ventricle. Studies from the US and Japan has estimated that up to…

…the full blood count and creatinine when treatment is started, at follow up after one month, and at least annually thereafter, more often in impaired…

…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…

…air from the cuff so that it is flat with a slightly upturned leading edge, and lubricate the dorsal surface. 2. Position the head in…

…or impaired autonomic compensation limits tolerability. Evidence Base and Its Limitations Few adults aged 85 years or older have been included in randomized controlled trials…

…MINOCA may result from a mismatch between myocardial oxygen supply and demand. The clinical history should therefore be examined for potential physiological or systemic stressors…

…atria begin to contract again. An unsynchronised shock that happens to fall in the T wave can precipitate ventricular fibrillation, and cardioversion of fibrillation of…

…workload controlled resistance; 12 lead ECG with continuous recording; automated or manual blood pressure measurement. Resuscitation trolley with defibrillator, oxygen, suction and emergency drugs in…

…a raised office reading but normal readings at home or on 24 hour recording. Masked hypertension: normal in the office but raised outside it — associated…

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

…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…