…the right atrium and right ventricle are compressed, with elevation of their diastolic pressures. Right sided filling becomes increasingly dependent on the fall in intrathoracic…

…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…

…lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI is diagnosed when…

…distinction between NSTEMI and UA hinges entirely on the presence of myocardial necrosis. NSTEMI is confirmed by a typical rise and/or fall of high…

…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…

…on a single eGFR. Step 1: confirm the course and assess severity Establish the baseline Look for previous creatinine values in the record, preferably from…

…not on how wide the rim of fluid looks. With ultrasound guidance, the point at which the fluid lies most superficially is chosen and the…

…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…

…universally warrants acute intervention and long term secondary prevention strategies. By Morphology: Monomorphic VT (MMVT): Characterized by a uniform QRS morphology from beat to beat…

…pathophysiology and electrocardiology. Unfortunately, numerous books and online resources fall into the trap of oversimplification. Physicians, nurses, paramedics and physician assistants who rely on such…

…will fall outside. The ranges below are guide values for adults. The method and the laboratory determine the range — always use the range printed on…

…HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy…

…hypoglycaemia No defined threshold The patient has cognitive or physical impairment and needs help from another person Level 3 can occur even when the glucose…

…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…

…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…

Arrhythmias and arrhythmology ECG Premature atrial contraction (premature atrial beat / complex) A premature atrial contraction is produced by an impulse discharged from an ectopic focus…

…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…

…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…

…plasma and platelets. Observational data from trauma suggest a lower overall mortality after such protocols are introduced, although the effect on 24 hour mortality is…

…and abdominal organs is large. The sternum may be used for aspiration when the iliac crest is inaccessible, but biopsy must never be taken from…

…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…

…and the apex rotates counterclockwise. This rotating, or twisting, contraction is called circumferential shortening (Figure 1C). Left ventricular function depends on a complex interaction between…

…exceed 60 cmH₂O . Gel cuffed masks of the i gel type have no cuff to inflate and are chosen on weight alone. When in doubt…

…fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal lesions that are not apparent on…

…arrest is highly dependent on the initial rhythm (first recorded rhythm). The initial rhythm is a marker of several crucial events and factors: Cause of…

…falls, and functional deterioration may have greater consequences in frail patients. Clinical Assessment Frailty and Functional Status Treatment decisions should not be based on age…

…PVC, it is referred to as PVC in trigeminy . Similarly, there can be quadrigeminy and so on. Figure 3. Premature ventricular contractions in bigeminy. Two…

…repolarization and provoke ventricular tachycardia or ventricular fibrillation. The likelihood of clinically significant EMI is generally low, particularly with bipolar electrocautery performed away from the…

…depending on the ventricular response. The ECG in ectopic atrial rhythm and atrial tachycardia A regular rhythm with P waves that differ in contour from…

…is in. The three phases following a sudden cardiac arrest were described by Weisfeldt and Becker (2002). Drawing on physiology, observational and experimental studies, they…

…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…

…Abnormal urinalysis or renal imaging Risk of progression rises with proteinuria and depends on cause 2 60 mL/min/1.73 m² Abnormal urinalysis or…

…performed. Note that troponins may be elevated but the elevation is typically discrete and not on a par with the degree of left ventricular impairment…

…different insulin sensitivity from at home: less food, more stress, often corticosteroids, often impaired renal function. Prescribe basal insulin, mealtime insulin and the correction dose…

…The pulse oximeter does not distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal value. Give 100 % oxygen on a reservoir mask — this markedly shortens…

…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…

…if other methods fail to open the airway. Figure 1. Methods to open the airway. No large study has compared oropharyngeal and nasopharyngeal airways in…

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

…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…

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

…arrest and influence on outcome. Resuscitation 2012; 83:120611. Wang CH, Huang CH, Chang WT, et al. The effects of calcium and sodium bicarbonate on…

…or as an add on Slow onset. Dose reduction in renal failure and in old age Amiodarone In severe haemodynamic compromise where the above cannot…

…and glucose. Add high dose salbutamol in marked hyperkalaemia if there is no contraindication. 5. At the same time, start treatment that eliminates potassium from…

…reverse cardiac arrest and survivors of traumatic cardiac arrest often exhibit favorable neurological outcomes ( Rawshani et al ). Traumatic cardiac arrests typically result from mechanisms that…

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

…test Definition and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually on a treadmill…

…autonomic reflexes that influence the haemodynamic result. Reflex tachycardia is the rule after a rapid fall in blood pressure. Drug Indications Dosing α1 β1 β2…

…patients with diabetes and anyone with dizziness Definitions White coat hypertension: a raised office reading but normal readings at home or on 24 hour recording…

…the procedure is safe: that synchronisation really is switched on when the shock is delivered, and that the thromboembolic risk has been dealt with before…

…but the effect on the bowel must be taken into account). Known allergy to the preparation — rare; itching and urticaria are usually due to histamine…

…oxygen saturation falls to approximately 60%, leading to unconsciousness. The myocardium responds to hypoxia by downregulating metabolism and thus contractility (a consistent finding in acute…

…approach focusing on rhythm stabilization, relief of triggers, and reduction of sympathetic drive [4]. Rhythm Stabilization In addition to defibrillation , several pharmacological and interventional alternatives…

…Clinical Presentation and Symptoms The source material does not provide specific information on the clinical presentation and symptoms of the underlying conditions for which ACE…

…at initiation or during routine therapy. Potential clinically important complications and treatment related syndromes include: Hypovolaemia Falls and syncope, particularly in older adults Euglycaemic diabetic…

…is unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine, glucose, high sensitivity troponin and, where needed, coagulation tests…

…previous axillary clearance on the same side. A paretic limb — poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection…

Akutsjukvård Psykiatri Lathundar Delirium in older adults: quick reference A quick reference for ward and on call physicians: recognise hypoactive delirium, stabilise the patient, work…

…alone. Contraindications Primary closure must be avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on the hand. These…

…cap, mask, sterile gown, sterile gloves and a large full body drape. Lidocaine 10 mg/mL for local anaesthesia, normal saline to flush all lumens…

…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…