…stomach has gone from routine to exception. Activated charcoal — in Sweden usually called medicinal charcoal — is the first line measure in decontamination, and gastric lavage…

…age and pregnancy Procalcitonin < 0.25 µg/L Supports a bacterial aetiology; used to guide antibiotic therapy Glucose and lipids Test Threshold Comment : : : Fasting…

…collection with initially limited symptoms because the pericardium has had time to adapt. Hypotension and muffled heart sounds are important when present but are relatively…

…rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction. Cardiac troponin identifies injury to myocardial…

…tests, and versatile study tools. From basic cardiac physiology to the nuanced strategies of evidence based management, this book and course have been meticulously crafted…

…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…

…entity in itself and may arise from non ischaemic cardiac conditions (such as myocarditis) or non cardiac conditions (such as renal failure). To establish a…

…assessment and initiation of reperfusion therapy. The interval from treatment initiation to restoration of coronary flow. Early reperfusion, reduction of myocardial energy requirements and mitigation…

…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…

…The discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades…

…the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel…

…cognitive or physical impairment and needs help from another person Level 3 can occur even when the glucose has already begun to rise by the…

…from a central line if one is present 4 Take a full blood count with a differential, CRP, creatinine, electrolytes, liver function tests, glucose and…

…liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and to the left

…for major bleeding compared to HAS BLED. The C indices were 0.60 for HAS BLED, 0.55 for HEMORR₂HAGES, and 0.50 for ATRIA…

…the arms. Orthostatic hypotension: a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at 1 or 3 minutes after standing, following…

…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…

…or requiring termination earlier due to hemodynamic collapse [4] . Sustained VT is a medical emergency that universally warrants acute intervention and long term secondary prevention…

…rapid fall from 140 to 125 mmol/L can cause marked symptoms [4]. Grade Plasma sodium : : Mild 130 to 134 mmol/L Moderate 125 to…

…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…

…with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage…

…within 10 seconds (Fell et al, Houtkooper et al). The majority of ATP produced is utilized to fuel the contractile machinery and maintain ion channel…

…cancer and previous venous thromboembolism. A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full…

…according to the local protocol Renal failure The insulin requirement falls . Reduce the dose and measure more frequently Acute illness and infection The insulin requirement…

…appears as a P wave and QRS complex occurring earlier than expected ( Figure 1 ). The interval from the premature beat to the next sinus beat…

…to tissue requirements unless filling pressures are elevated. Consequently, congestion may occur across the full range of left ventricular ejection fraction and may result from…

…and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from…

…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…

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

…to 20 minutes at the latest Give a full loading dose of an intravenous antiseizure drug If the seizure continues after adequate step 1 and…

…burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other arrhythmias or conduction abnormalities…

…of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability. HFmrEF may therefore represent…

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

…populations, a distinct form of atrial tachycardia may occur due to embryological remnants within the atrial myocardium. These residual tissues, persisting from cardiac embryogenesis, are…

…and induces a delay to the next sinus beat (the RR interval is increased after a premature ventricular complex). This yields more time to fill…

…many instances. Cardiac tamponade : Tamponade in trauma patients is due to blood accumulation in the pericardial sack. This impairs atrial and ventricular filling, such that…

…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…

…must be preceded by information about each step, take place with the patient's ongoing consent, and be able to be stopped at any moment…

…rise. Often outpatient or brief inpatient follow up depending on the clinical picture Moderate 6.0 to 6.4 mmol/L ECG and cardiac monitoring…

…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…

…of the saturation Carbon monoxide poisoning. The pulse oximeter does not distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal value. Give 100 % oxygen on…

…risk and the risk of falls; anaemia and a known gastrointestinal source are investigated before starting. A referral or notification to the anticoagulation clinic, and…

…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…

…away from the device and with monopolar electrocautery below the umbilicus. Nevertheless, perioperative planning should be individualized according to the patient, device, procedure, and anticipated…

…and defibrillation should be performed within 180 seconds (for shockable rhythms) after confirmed cardiac arrest. If it is not feasible to provide effective CPR due…

…a dose of 30 ml/kg. Should fluid resuscitation fail to maintain a mean arterial pressure (MAP) above 65 mmHg, consider the initiation of vasopressor…

…that the atria are activated first and they fill the ventricles with adequate volumes of blood before ventricular contraction commences. To coordinate these two tasks…

…due to uncertainty in the recording of no flow and low flow times in registries. The uncertainty is often obvious when interrogating witnesses, bystanders and…

…radial, and circumferential contraction. Thus, methods such as ejection fraction may provide easily obtained parameters, but fail to provide important insights into left ventricular mechanics…

…and occasionally pathological Q waves. Troponin levels are often mildly elevated. Hence, takotsubo cardiomyopathy cannot be differentiated from ST segment elevation myocardial infarction. Due to…

…a sufficient initial target in most patients. Doses according to the local protocol and the Swedish medicines compendium (FASS). Rhythm control: the time limit before…

…5. Aspiration: advance the needle with the stylet in place perpendicular to the bone surface, angled slightly anteriorly and medially. Rotate under steady pressure until…

…ProSeal) are the first choice in emergencies, since they allow the stomach to be decompressed and tolerate higher pressures. Lubricant on the dorsal surface of…

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

…artery dissection (SCAD) Standard angiography may fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal…

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

…Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with…

…is used thereafter Two to three measurements one minute apart, taking the mean of the last two Orthostatic testing after 1 and 3 minutes of…

…renal disease and secondary hypertension, and lead to one dose being moved to the evening. The fall can only be calculated if the diary states…

…Nitroprusside Figure 1. The approximate position of each drug according to its vasoconstrictor effect (vertical axis) and its positive inotropic effect (horizontal axis). Grey =…