…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…

…of titration is abandoned — when a fixed dose is given without assessment, when a modified release preparation is started in an opioid naive patient, or…

…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…

…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…

…or underlying channelopathies (e.g., Torsades de Pointes in Long QT Syndrome) [1] . Underlying Etiologies The etiology of VT is broadly dichotomized into structural heart…

…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…

…compromise or a very strong clinical suspicion. 3. Give intravenous calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the…

…usually visible on plain films. Irrigation fluid: a copious volume of drinking quality tap water or sodium chloride 9 mg/mL. The volume matters more…

…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…

…the lower tip of the muscle insertion. 3. Stretch the skin with the thumb and index finger, or compress the muscle in a slim patient…

…stenosis in a major epicardial coronary artery. Non obstructive disease is generally defined as the absence of a stenosis of 50% or more in any…

…Keep the saturation in the lower part of the target range. Paraquat poisoning — oxygen worsens the lung injury. Discuss with your national or regional poison…

…nerve block The standard in finger dislocation Procedural sedation Propofol, ketamine or a combination. It requires a fasting history, two people, full monitoring and airway…

…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…

…cases (70%) of takotsubo cardiomyopathy occur in situations with extreme stress, such as car accidents, gun violence, threats, or any situation in which the individual…

…the needle may perforate into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position…

…after myocardial infarction or before revascularisation. Evaluation of treatment effect in stable angina. Exercise induced arrhythmia or exercise induced syncope. Assessment of chronotropic function and…

…60 minutes of triage or arrival. This is supported by international guidelines on neutropenic fever [2]. The direct evidence for exactly one hour in neutropenic…

…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…

…Measure the plasma glucose immediately in everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour, collapse or an acute neurological deficit…

…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…

…exercise capacity, an abnormal blood pressure response or ventricular arrhythmias. A fall in systolic blood pressure, particularly when accompanied by evidence of ischaemia, may indicate…

…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…

…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…

…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…

…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…

…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…

…normal or borderline resting ABI but typical claudication, the ankle pressure is measured immediately after treadmill walking or after repeated heel raises. A fall of…

…adequately filled or fluid overloaded? 3. Is there, or is there approaching, an indication for dialysis? AKI occurs in about one fifth of adults during…

…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…

…difference of 10 mmHg between the arms. Orthostatic hypotension: a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at 1 or…

…therefore the beginning of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new…

…change in weight. Assessment should integrate the history, physical examination, laboratory data and diagnostic testing. Examination for congestion Useful bedside indicators of persistent or improving…

…treatment benefit and harm. Prevention in the very elderly therefore extends beyond reducing myocardial infarction, stroke, heart failure, or cardiovascular death. Preservation of mobility, cognition…

…Important interpretation of the blood gas A normal or rising pCO₂ during an ongoing severe asthma attack is an alarm sign. Early in a severe…

…common in later life. These changes contribute to the complexity of defining an appropriate treatment target, particularly when a lower DBP, orthostatic hypotension, or impaired…

…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…

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

…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…

…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…

…intravenous or intraosseous access, a targeted history At 5 minutes A full, adequate dose of a benzodiazepine About 10 minutes Repeat the benzodiazepine once if…

…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…

…deceased — in the donation register, on a donor card, or through statements made to the next of kin. Active malignancy with a risk of transmission…

…A complete airway obstruction results in PEA and cardiac arrest within 8 minutes. Cardiac arrest as a result of asphyxia or hypoxia is managed according…

…or electrophysiology in relation to ACE inhibitor therapy. Biomarkers and Laboratory Findings Monitoring renal function and potassium is a critical component of ACE inhibitor therapy…

…which may or may not be present Markedly reduced cardiac output in severe cases Cardiogenic shock in the most advanced presentations The symptoms of RVI…

…iFR) or the lowest ratio across the full cardiac cycle (RFR); no vasodilator. Cutoff ≤ 0.89. No hyperemic agent — faster, cheaper, better tolerated; validated in…

…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…

…experienced in stroke Functional impact A low NIHSS does not exclude a disabling deficit, for example aphasia, hemianopia or hand paresis in a person of…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…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…