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

Procedurer Emptying the stomach has gone from routine to exception. Activated charcoal — in Sweden usually called medicinal charcoal — is the first line measure in decontamination…

…tamponade is a life threatening clinical syndrome in which increased intrapericardial pressure compresses the heart and impairs ventricular filling. It generally results from accumulation of…

…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…

…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…

…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…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…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…

…schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation. Am Heart J . 2006;151(3):713 719. 2. Apostolakis S, Lane DA…

…ischaemic symptoms, haemodynamic instability or life threatening arrhythmias. Twelve to 48 hours after onset: routine primary PCI should be considered in otherwise stable patients. More…

…have an intact, thick fibrous cap but suffer from endothelial denudation. The local microenvironment is rich in hyaluronan, toll like receptor 2 (TLR2), and neutrophil…

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

…and health related quality of life substantially influence both cardiovascular risk and the balance between treatment benefit and harm. Prevention in the very elderly therefore…

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

…Life expectancy Patient priorities and preferences Patients who are fit and independent generally benefit from guideline directed blood pressure treatment similar to that used in…

…between regions — follow the local transfusion medicine regulations. In life threatening haemorrhage without a valid blood group, give group O RhD negative blood (always RhD…

…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…

…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…

…runs away or the patient bleeds. In Sweden the treatment is usually managed from an anticoagulation clinic with dosing support, but whoever starts the drug…

…Coimbra R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. Crit Care…

…ventilated patient who develops total brain infarction An intensive care patient in whom life sustaining treatment is withdrawn and total brain infarction is not expected…

…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 sinoatrial node discharges the first action potential, which spreads through the myocardium like a wavefront in water. Specific ion channels located on the cell…

…a syringe for the cuff in the models that have one, a cuff manometer. A videolaryngoscope with both a Macintosh like and a hyperangulated blade…

…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…

…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…

…myocardial injury, demonstrated by a rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and…

…1. Data from the Swedish Cardiopulmonary Resuscitation Registry (SCRR), showing presumed causes of out of hospital cardiac arrest in 130'000 cases ( Rawshani et al )…

…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…

…or measure at the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10…

…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…

…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…

…distinction supports a risk based approach because cardiovascular benefit from blood pressure reduction may also occur in selected people whose pressure is elevated but below…

…112 mmol/L may be relatively unaffected, while a rapid fall from 140 to 125 mmol/L can cause marked symptoms [4]. Grade Plasma sodium : …

…Step 1: confirm the course and assess severity Establish the baseline Look for previous creatinine values in the record, preferably from before the current illness.

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

…marked reduction in cell metabolism and thus prolongs survival. Myocardial stunning starts to normalize within minutes after the hypoxia is relieved. However, full recovery of…

…In the nationwide Swedish Registry for Cardiopulmonary Resuscitation, the 30 day survival for traumatic cardiac arrest is 2.5%. As per data from the registry…

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

…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…

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

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…

…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…

…less common in patients with inferoposterior left ventricular infarction, while infarction confined predominantly to the right ventricle is rare. The clinical spectrum extends from limited…

…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…

…initially in both arms if this can be done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic…

…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…

…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…

…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…

…concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS)…

…oriented (from base to apex) and yield a longitudinal shortening (Figure 1A), which means that the base is pulled towards the apex. Myocardial fibers in…

…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…

…from the most recent sample analysed for HPV. Invitations are sent up to and including the age of 70, and the last sample is in…

…than in HFpEF. The clinical population is heterogeneous because the HFmrEF range includes both patients with recovering systolic function and those with deterioration from a…

…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…

…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 with a fall in blood pressure is a high risk patient even with normal ST segments, whereas isolated ST depression in a woman with…

…hypertension: normal in the office but raised outside it — associated with the same risk as manifest hypertension. Non dipping: a nocturnal fall in pressure of…

…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…

…vasodilatation in the coronary, renal, cerebral and mesenteric vessels. Few Dopamine — intermediate dose Cardiogenic shock. Vasodilatory shock. Heart failure, acute or chronic. Bradycardia (second line…