…thumb and index finger, or compress the muscle in a slim patient. 4. Insert the needle perpendicularly , quickly and firmly, to its full length. 5…

…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…

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

…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…

…upper reference limit (URL). It is considered acute when there is a rise and/or fall in cTn values. An elevated cTn alone does not…

…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…

…Shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) are mostly due to acute myocardial ischemia or myocardial infarction, and in these cases, the likelihood of ROSC…

…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…

…Position the head in the sniffing position if the neck may be moved. 3. Ensure that the patient is sufficiently deeply sedated or relaxed — a…

…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…

…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…

…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…

…has no target — the nasal cannula stays in place for days without anyone asking why, or the patient at risk of carbon dioxide retention is…

…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…

…myocardium, or simply myocardial cell, refer to this cell type, and these terms are used interchangeably. Cardiac cell architecture In contrast to skeletal muscle, cardiac…

…that 98 out of 100 cases had full recovery. More recent studies has reported mortality rates reaching 4%. ECG in takotsubo cardiomyopathy (broken heart syndrome…

…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…

…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…

…rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the…

…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…

…but abnormal or unexpected values should be confirmed with a laboratory analysed plasma glucose when the situation allows. Glucose meters are less reliable in the…

…threatening clinical syndrome in which increased intrapericardial pressure compresses the heart and impairs ventricular filling. It generally results from accumulation of pericardial fluid, blood, or…

…haemolysis or bleeding Ferritin 15–300 µg/L (women 10–150) An acute phase protein — a normal ferritin does not exclude iron deficiency in 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 of…

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

…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…

…or several mechanisms acting simultaneously. Acute myocardial infarction Acute myocardial infarction requires: Acute myocardial injury, demonstrated by a rise and/or fall in cardiac troponin…

…standing in older patients, patients with diabetes and anyone with dizziness Definitions White coat hypertension: a raised office reading but normal readings at home or…

…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…

…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…

…axillary clearance or a recently inserted venous port. Procedure 1. Arm pressure. Place the cuff on the upper arm. Locate the brachial signal in the…

…time course. 2. Measure the urine output. Perform a bladder scan in oliguria, anuria or unexplained AKI. 3. Assess the circulation and volume status, including…

…not to normalise the plasma sodium. Chronic or minimally symptomatic hyponatraemia must be corrected in a controlled fashion, since too rapid a rise can cause…

…a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at 1 or 3 minutes after standing, following 5 minutes seated or…

…several non pharmacological measures at the same time, and use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and…

…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…

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

…attack : : : : Speech Full sentences Cannot complete a sentence in one breath Single words or unable to speak Position and behaviour Can lie down or sit…

…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…

…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…

…confirming the position. For gastric lavage: a wide bore orogastric tube (Ch 28–32 in an adult), a funnel or a lavage system, lukewarm fluid…

…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…

…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…

…treatment Convulsive status epilepticus in adults is present with: an ongoing generalised tonic clonic seizure lasting at least 5 minutes, or repeated generalised tonic clonic…

…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…

…service. Contraindications An expressed refusal by the deceased — in the donation register, on a donor card, or through statements made to the next of kin…

…injuries : Direct trauma can cause airway injuries, resulting in obstruction. Central nervous system (CNS) injuries might cause apnea or hypoventilation. Respiratory conditions : Tension pneumothorax Drowning…

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

…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…

…or a haemoglobin below the applicable transfusion threshold (see below). Ongoing bleeding with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage…

…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…

…and a large full body drape. Lidocaine 10 mg/mL for local anaesthesia, normal saline to flush all lumens, suture material or a securement device…

…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…

…following recommendations: Administer 100% oxygen at the maximum flow rate . Hypoxia can precipitate cardiac arrest in septic patients; timely oxygenation can potentially prevent circulatory collapse…

…is prolonged after a premature beat). This yields more time to fill the ventricles with blood (increased ventricular filling). Persons with premature beats might perceive…