…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…

…needles. An 18 G puncture needle, 7–9 cm (a spinal needle or the needle from a pericardiocentesis set), 10 mL and 20 mL syringes…

…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…

…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…

…the range printed on your own report. Haematology Test Reference Comment : : : Reticulocytes 20–100 ×10⁹/L Distinguishes a production defect from haemolysis or bleeding Ferritin…

…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…

…a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests from the suspected focus, but avoid…

…chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations arising from structural or functional abnormalities of the coronary arteries or coronary microcirculation…

…office SBP 120–139 mmHg or DBP 70–89 mmHg. This distinction supports a risk based approach because cardiovascular benefit from blood pressure reduction may…

…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…

…the cuff over a protective dressing, or measure at the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment:…

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

…trials, the field has transitioned from a predominantly pharmacological strategy to one that heavily integrates early catheter ablation and sophisticated device therapy [1] [2] . This…

…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…

…and screen and the serological crossmatch have a limited period of validity — usually about five days — because new antibodies can form after transfusion or pregnancy…

…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…

…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…

…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…

…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…

…to creatinine ratio (UACR) above 30 mg/g—or both. The eGFR is generally estimated from serum creatinine using the Chronic Kidney Disease Epidemiology Collaboration…

…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)…

…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…

…with the sinus P wave. The appearance depends on the location of the ectopic focus from which the impulse is discharged. If the impulse is…

…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…

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

…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…

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

…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…

…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…

…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…

…Lyon et al: Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of…

…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…

…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…

…taken from the sternum — the needle may perforate into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or…

…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…

…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…

…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…

…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…

…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…

…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…

…is most pronounced and extends towards the penumbra zone (the outermost and less ischemic area), which may receive oxygen from collateral vessels. In cardiac arrest…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…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 …

…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…

…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…

…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…

…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…

…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…

CPR The course from sudden cardiac arrest (SCA) to death follows a pathophysiological process that affects the effectiveness of the interventions. Numerous studies demonstrate that…