…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…

…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…

…always Pulsus paradoxus above 10 mmHg A fall in systolic blood pressure during inspiration; one of the most useful signs Low voltage on the ECG…

…bicarbonate or blood gas, calcium, phosphate, glucose and a full blood count. 5. Take a urine dipstick and, where the cause is unclear or a…

…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…

…above the threshold or unknown: at least three weeks of adequate anticoagulation before cardioversion — an INR ≥ 2.0 checked weekly on warfarin, or documented well…

…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…

…with elevation of their diastolic pressures. Right sided filling becomes increasingly dependent on the fall in intrathoracic pressure during inspiration. The inspiratory increase in right…

…full vital signs, level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the patient has sepsis, septic shock, or a…

…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…

…the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and/or fall of cTn values. However…

…numerous books and online resources fall into the trap of oversimplification. Physicians, nurses, paramedics and physician assistants who rely on such books will realize their…

…No smoking or coffee in the preceding hour. Remove socks and any compression stockings. Avoid measuring the arm pressure on the side with a dialysis…

…rapid changes. Pressure on the sensor, for example during sleep, can give falsely low values. When there are symptoms or an unexpected sensor value, the…

…started in an opioid naive patient, or when a conversion between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain…

…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…

…Tachycardia: Classification, Underlying Etiologies, and Clinical Presentation Classification of Ventricular Tachycardia The classification of VT is fundamentally based on its duration, morphology, and hemodynamic consequences…

…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…

…mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis. It is characterized by prolonged angina…

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

…hypoactivity and hyperactivity Common on repeated assessment over the day It is wrong to assume that hyperactive delirium is always detected, or that hypoactive delirium…

…be quadrigeminy and so on. Figure 3. Premature ventricular contractions in bigeminy. Two consecutive premature ventricular contractions are referred to as a pair or couplet…

…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…

…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…

…Hypoglycaemia on the ward is more dangerous than moderate hyperglycaemia over a few days. Principles Insulin component Function Who needs it : : : Basal insulin (intermediate or…

…hernia or visible abdominal wall collaterals (caput medusae) Puncture at least a few centimetres away from them Full bladder Have the patient void, or catheterise…

…radiography, since glass is usually visible on plain films. Irrigation fluid: a copious volume of drinking quality tap water or sodium chloride 9 mg/mL…

…resulting in obstruction. Central nervous system (CNS) injuries might cause apnea or hypoventilation. Respiratory conditions : Tension pneumothorax Drowning Airway obstruction Hanging Pneumonia High altitude sickness…

…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…

…and the decision on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of…

…in impaired left ventricular function and together with an intravenous beta blocker Digoxin In heart failure or hypotension, or as an add on Slow onset…

…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…

…obesity or when the supine position is necessary. After previous punctures: change side, and avoid irradiated fields. Preparation and equipment Informed consent, current full blood…

…subclavian and jugular routes on the healthy side, since a pneumothorax there would be poorly tolerated. A patient who cannot lie flat or cannot cooperate …

…device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a…

…Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption…

…be based on an overall assessment, not on a single threshold value. The combination of physiology, rate of bleeding, the pattern of injury or disease…

…Fill the bag before applying the mask Venturi mask 2–15 L/min depending on the valve 24, 28, 31, 35, 40 or 50 % Gives…

…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…

…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…

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

…fraction (HFmrEF) is a clinical syndrome defined by the combination of symptoms and/or signs of heart failure and a left ventricular ejection fraction (LVEF)…

…and cardiac resynchronization therapy (CRT) devices. Implantable loop recorders are diagnostic devices rather than pacing or defibrillation systems, but their stored data may also be…

…simply by their effects on haemoglobin A1c. Clinical benefits have been demonstrated in several overlapping populations: T2DM with established cardiovascular disease or high cardiovascular risk…

…initial pharmacological approaches fail to suppress the arrhythmia. However, the context indicates that if pharmacological therapy is inadequate, escalation to catheter ablation or mechanical circulatory…

…and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level exceeding 4 mmol/l, commence an intravenous fluid resuscitation…

…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…

…in clinical practice, and these arrhythmias are commonly referred to simply as atrial tachycardia or atrial rhythm, depending on the ventricular response. The ECG in…

…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…

…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…

…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…

…Saturation on air Usually at least 92 percent May be below 92 percent Hypoxaemia despite oxygen Auscultation Wheeze with preserved air entry Marked wheeze or…

…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…

…you are doing. Indications The laryngeal mask: A rescue airway when intubation has failed and bag mask ventilation is difficult or inadequate. The primary airway…

…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…

…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 (OHCA) ACLS is performed by paramedics, nurses or physicians, depending on the design of the pre hospital system. ACLS involves placing an advanced airway…

…However, full recovery of contractility may take hours to days. It is generally stated that myocardium resists 20 minutes of severe hypoxia before cell death…

…STEMI, actually have takotsubo. Previous studies reported that 98 out of 100 cases had full recovery. More recent studies has reported mortality rates reaching 4%…