…slowly over at least a minute; a rapid injection causes nausea and a fall in blood pressure without better analgesia. Flush the cannula before and…

…with an ECG in reality. Books that claim to make it "simple" can provide a quick entry point but fail to delve into the crucial…

…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…

…embolism, bleeding, stroke, etc.) as well as cases where the cause does not fall into the other categories. Trauma Cardiac arrest caused by violence, accidents…

…Torsades de Pointes in Long QT Syndrome) [1] . Underlying Etiologies The etiology of VT is broadly dichotomized into structural heart disease (SHD) and structurally normal…

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

…by a rise and/or fall in cTn with at least one value above the 99th percentile URL; and Clinical evidence of acute myocardial ischaemia …

…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…

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

…calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high dose salbutamol in…

…down into the larynx. The difficult airway rarely kills because the tube would not pass, but because the team keeps trying to intubate instead of…

…edges are held apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas. Superficial wounds with well…

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

…if possible, otherwise give IM with a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative…

…one third of patients with MINOCA may present with STEMI. Pathophysiology and causes MINOCA encompasses several distinct mechanisms. These may be broadly divided into coronary…

…target — the nasal cannula stays in place for days without anyone asking why, or the patient at risk of carbon dioxide retention is given 15…

…is held in slight abduction and external rotation, and the patient resists internal rotation. Check the axillary nerve: sensation over the lateral part of the…

…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…

…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…

…Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma…

…whereas isolated ST depression in a woman with a low pre test probability is usually a false positive. Indications Evaluation of chest pain with an…

…Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint…

…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…

…Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient's need for help matter more than…

…inspiratory fall in systemic systolic blood pressure, termed pulsus paradoxus. Tamponade is therefore characterized haemodynamically by elevation and near equalization of diastolic pressures in the…

…encompass 95 % of a healthy reference population, which means that one healthy value in twenty falls outside them . Order twelve tests in a healthy person…

…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…

…blood pressure response or ventricular arrhythmias. A fall in systolic blood pressure, particularly when accompanied by evidence of ischaemia, may indicate exercise induced global left…

…GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey…

…rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and Clinical evidence of acute myocardial…

…with the same risk as manifest hypertension. Non dipping: a nocturnal fall in pressure of < 10% of the daytime value; an independent risk marker…

…abrupt changes in blood pressure activate autonomic reflexes that influence the haemodynamic result. Reflex tachycardia is the rule after a rapid fall in blood pressure…

…complete in a minority Tachycardia, tachypnoea, cold periphery Almost always Pulsus paradoxus above 10 mmHg A fall in systolic blood pressure during inspiration; one of…

…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…

…brachial index (TBI). The digital arteries rarely calcify, which makes toe pressure the method of choice in diabetes and renal failure. A normal TBI is ≥

…rise in creatinine. Limitations of creatinine and urine output Creatinine is a late marker of function and may rise only after a substantial fall in…

…corrected in a controlled fashion, since too rapid a rise can cause osmotic demyelination syndrome [1,2]. Hyponatraemia is primarily a disorder of water balance…

…sequential systolic difference of 10 mmHg between the arms. Orthostatic hypotension: a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at…

…major surgery and intensive care [1,2]. The condition is associated with falls, aspiration, pressure sores, loss of function, longer length of stay, institutional care…

…congestion may be important mechanisms. Diuretics relieve the hemodynamic consequences of congestion by producing a negative sodium and water balance. They can reduce jugular venous…

…interaction between these acquired risks and age related cardiovascular remodeling contributes to the high incidence and prevalence of coronary and vascular disease in older adults…

…plugging. Expiratory flow limitation causes air trapping and dynamic hyperinflation. The consequences are increased work of breathing, exhaustion and, in the most severe cases, hypotension…

…included in randomized controlled trials. Moreover, trial participants who were described as frail generally had no more than mild frailty, limiting the applicability of trial…

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

…a ready made suspension or as a powder for suspension in water. A glass of water between doses of charcoal makes the drink more tolerable…

…volume to such an extent that chest compressions fail to generate stroke volumes. Consequently, addressing reversible causes of cardiac arrest becomes more critical than performing…

…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…

…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…

…10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine…

…wishes are properly established. Two things determine the outcome — that the confirmation of death is carried out in a formally unimpeachable way, and that the…

…Wallmuller C, Meron G, Kurkciyan I, et al. Causes of in hospital cardiac arrest and influence on outcome. Resuscitation 2012;83:120611. Wood S. Interactions…

…heart failure. In stable patients, it is advisable to add therapy with beta blocking agents before full target doses of ACE inhibitors are reached. Medication…

…central management principle is preservation of adequate right ventricular preload while supporting left ventricular performance and systemic circulation. Improvement in left ventricular function also lowers…

…current guideline recommendation class) appears in Section 6. Index Mechanism Advantages Limitations Key evidence Fractional Flow Reserve (FFR) Ratio of distal coronary pressure (Pd) to…

…haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage meeting the criteria for activation of the…

…treatment unnecessarily. 10. In unknown time of onset, wake up stroke or a late time window: perform advanced imaging according to the local protocol. 11…

…no risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the patient The right internal jugular vein is the first choice in most situations…

…cardiovascular risk falls within five years of stopping but may remain elevated thereafter. The overall health benefit is greater still when reductions in non cardiovascular…

…JE, Gwyther R, Kirkman E. Closed chest compressions reduce survival in an animal model of haemorrhageinduced traumatic cardiac arrest. Resuscitation 2019; 140:37 42. Endo…

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