…days without anyone asking why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off…

…world: What is the best ECG book? This question is far from trivial and the stakes are high; mastering ECG interpretation will frequently be a…

…specific 99th percentile upper reference limit. It is classified as acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic…

…and tamponade even without a large circumferential effusion. Causes Tamponade shares the causes of pericardial effusion. Important clinical associations include: Idiopathic or viral pericarditis Malignant…

…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…

…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…

…is diagnosed when typical ischaemic symptoms occur without persistent ST segment elevation, accompanied by a rise and subsequent fall in cardiac specific troponin attributable to…

…are complementary objectives of initial STEMI management. The principal acute complications fall into two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure…

…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…

…Components of the HEMORR₂HAGES Score The acronym HEMORR₂HAGES represents the following parameters: H epatic or renal disease (1 point) E thanol abuse (1 point) M…

…office SBP 120–139 mmHg or DBP 70–89 mmHg. This distinction supports a risk based approach because cardiovascular benefit from blood pressure reduction may…

…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 a rise and/or fall in cTn values. An elevated cTn alone does not establish MI, because myocardial injury may occur without myocardial ischaemia…

…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 : …

…the cuff over a protective dressing, or measure at the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment:…

…needles. An 18 G puncture needle, 7–9 cm (a spinal needle or the needle from a pericardiocentesis set), 10 mL and 20 mL syringes…

…trials, the field has transitioned from a predominantly pharmacological strategy to one that heavily integrates early catheter ablation and sophisticated device therapy [1] [2] . This…

…bicarbonate or blood gas, calcium, phosphate, glucose and a full blood count. 5. Take a urine dipstick and, where the cause is unclear or a…

…presence of myocardial necrosis. NSTEMI is confirmed by a typical rise and/or fall of high sensitivity cardiac troponin (hs cTn), with at least one…

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

…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…

…before fasting or an investigation. Stopping it leads to ketoacidosis within hours. Treatment with correction doses alone according to the glucose value, without basal insulin…

…to creatinine ratio (UACR) above 30 mg/g—or both. The eGFR is generally estimated from serum creatinine using the Chronic Kidney Disease Epidemiology Collaboration…

…Structural or functional cardiac abnormality Evidence such as increased left atrial size, left ventricular hypertrophy or abnormal LV filling supports the diagnosis Unlike HFpEF, objective…

…EAT) most commonly occurs in individuals with underlying structural or electrical heart disease. Less frequently, it may also present in individuals without identifiable cardiac disease…

…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…

…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…

…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…

…atrial contraction (premature atrial beat / complex) A premature atrial contraction is produced by an impulse discharged from an ectopic focus located anywhere in the atria…

…are also referred to as premature ventricular beats , premature ventricular contractions or just ventricular beats/contractions/complexes . These terms will be used interchangeably in this…

…uncontrolled source of bleeding. Minimise the time to surgery, endoscopy, an obstetric procedure or angiographic intervention. Summon anaesthesia, the operating specialty, the blood bank and…

…a patient who has little or no reliable intrinsic rhythm may develop prolonged pauses. Pacing dependent patients therefore require protection against inhibition during the period…

…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…

…In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is…

…are often mildly elevated. Hence, takotsubo cardiomyopathy cannot be differentiated from ST segment elevation myocardial infarction. Due to their clinical presentation, these patients are immediately…

…compressions fail to generate stroke volumes. Consequently, addressing reversible causes of cardiac arrest becomes more critical than performing chest compressions. Hemorrhages, either manifesting externally or…

…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…

…The two pathways DBD DCD : : : Full name Donation after death by neurological criteria (total brain infarction) Donation after circulatory death Starting point A ventilated patient…

…Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample without a speculum…

…at lower values if the rise is rapid, the patient has symptoms, or the clinical risk is high [1,2]. 1. Perform an ABCDE assessment…

…bioprosthetic valve, the first 3 months 2.0–3.0 Thereafter usually an antiplatelet drug or nothing Preparation and equipment INR, full blood count, creatinine…

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

…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…

…and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level exceeding 4 mmol/l, commence an intravenous fluid resuscitation…

…fail to provide important insights into left ventricular mechanics. Regional differences in contractile function are of utmost importance, particularly in the setting of (confirmed or…

…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…

…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…

…single most important tool when intubation fails, since it restores oxygenation without requiring a view down into the larynx. The difficult airway rarely kills because…

…Ability to perform activities of daily living Cognitive status Risk of falls Symptoms or history suggesting orthostatic hypotension Multimorbidity Polypharmacy and overall therapeutic burden Life…

…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…

…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…

CPR Neurons are exceptionally vulnerable to hypoxia and anoxia ( Casas et al ). In cardiac arrest without chest compressions (i.e. if cerebral perfusion ceases), irreversible…

CPR The course from sudden cardiac arrest (SCA) to death follows a pathophysiological process that affects the effectiveness of the interventions. Numerous studies demonstrate that…

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

…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…

…least two occasions, and preferably confirmation by home measurement or 24 hour recording — the thresholds for which are lower than for office measurement. Classification of…

…specialist investigations. Both fail more often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient…

…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…