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

…normally need investigation on the basis of an isolated, asymptomatic low sensor reading alone. Symptoms Autonomic symptoms Early warning symptoms are due to sympathetic activation…

…The cuff at heart level Measure in both arms at the first visit; a difference 15 mmHg suggests vascular disease, and the arm with the…

…signal is sought on the dorsum of the foot lateral to the extensor hallucis longus tendon. Measure in the same way as on the arm…

…digoxin levels, by contrast, are no obstacle. Untreated hypokalaemia or marked electrolyte disturbance; correct these first before elective cardioversion. AVNRT and AVRT that respond to…

…ward and on call physicians: recognise hypoactive delirium, stabilise the patient, work systematically through the possible causes, apply several non pharmacological measures at the same…

…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…

…about to stop breathing. Diminishing wheeze means improvement only if air entry, speech, work of breathing, level of consciousness and PEF improve at the same…

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

…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…

…the same probe as for echocardiography) and a sterile probe cover. Continuous ECG, blood pressure and saturation monitoring; a defibrillator to hand. Sterile gown and…

…al). ATRIA Score: The same study found that the ATRIA score had a lower predictive performance for major bleeding compared to HAS BLED. The C…

…contracting at the same time the more efficient the pumping mechanism. Sequential activation implies that the atria are activated first and they fill the ventricles…

…If every third beat is a PVC, it is referred to as PVC in trigeminy . Similarly, there can be quadrigeminy and so on. Figure 3…

…as a triage test on the same liquid based sample when the HPV test is positive — the sample therefore does not need to be repeated…

…needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same…

…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…

…prescribing decision on a ward. Not prescribing glucose measurement. Prescribe the measurement times at the same time as the insulin. Giving mealtime insulin to a…

…not on a single threshold value. The combination of physiology, rate of bleeding, the pattern of injury or disease, the response to initial treatment and…

…whereas the caecum on the right is mobile and often gas filled. The site lies about 3–5 cm superior and medial to the anterior…

…can reach the patient the same day the result arrives. 3. Reduce to 5 mg (two tablets) on days 1 and 2 in patients over…

…radial, and circumferential contraction. Thus, methods such as ejection fraction may provide easily obtained parameters, but fail to provide important insights into left ventricular mechanics…

…Nitroprusside Figure 1. The approximate position of each drug according to its vasoconstrictor effect (vertical axis) and its positive inotropic effect (horizontal axis). Grey =…

…and Functional Status Treatment decisions should not be based on age alone. Assessment should include: Degree of frailty, preferably using validated clinical tests Ability to…

…in properly selected patients. Tenecteplase 0.25 mg/kg is a safe and effective alternative to alteplase and is simpler to administer, since the whole…

…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…

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

…headache. High flow oxygen on a reservoir mask is the first line treatment during an attack and aborts most attacks within 15–20 minutes. An…

…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…

…and defibrillation should be performed within 180 seconds (for shockable rhythms) after confirmed cardiac arrest. If it is not feasible to provide effective CPR due…

…due to uncertainty in the recording of no flow and low flow times in registries. The uncertainty is often obvious when interrogating witnesses, bystanders and…

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

…Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in…

… used to guide antibiotic therapy Glucose and lipids Test Threshold Comment : : : Fasting plasma glucose 4.0–6.0 mmol/L ≥ 7.0 on two occasions…

…to influence diagnostic strategy or management. Appropriate objectives include: Measuring exercise tolerance Determining whether symptoms are reproduced by exertion Assessing the relationship between symptoms and…

…The Fourth Universal Definition classifies MI into five distinct subtypes based on pathophysiology and clinical context: Type 1 MI: Caused by atherothrombotic coronary artery disease…

…ECG books (according to Amazon and Google Shop). A number of online resources are also reviewed. Our recommendations below are based on how well each…

…this level with increased mortality. Contemporary management, however, incorporates overall cardiovascular risk, comorbidity and hypertension mediated organ damage (HMOD), rather than relying exclusively on the…

…or requiring termination earlier due to hemodynamic collapse [4] . Sustained VT is a medical emergency that universally warrants acute intervention and long term secondary prevention…

…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…

…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…

…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…

…and on the face and scalp — where the blood supply is good and a scar is stigmatising — up to about 24 hours is accepted in…

…cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ, Hilander SJ, Dobler DW, Wickman LL, Swart GL. The hemodynamic and arterial blood…

…most cases, the premature atrial impulse is conducted to the ventricles, which results in ventricular depolarization and the appearance of a QRS complex. Because the…

…ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol…

…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…

…5. Aspiration: advance the needle with the stylet in place perpendicular to the bone surface, angled slightly anteriorly and medially. Rotate under steady pressure until…

…disinfection. Allow it to air dry completely before puncture. Maximal barrier precautions: cap, mask, sterile gown, sterile gloves and a large full body drape. Lidocaine…

…specific information on the clinical presentation and symptoms of the underlying conditions for which ACE inhibitors are prescribed. Evaluation and Physical Examination Prior to initiating…

…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…

…Whether electrosurgery or diathermy will be used. Whether monopolar or bipolar electrocautery is planned. The operative site in relation to the pulse generator and the

…body weight and haemoglobin A1c Increased uricosuria, with plasma uric acid reduction of approximately 10% to 15% Possible effects on erythropoietin activity and erythropoiesis SGLT2…

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

…a dose of 30 ml/kg. Should fluid resuscitation fail to maintain a mean arterial pressure (MAP) above 65 mmHg, consider the initiation of vasopressor…

…within 10 seconds (Fell et al, Houtkooper et al). The majority of ATP produced is utilized to fuel the contractile machinery and maintain ion channel…

…many instances. Cardiac tamponade : Tamponade in trauma patients is due to blood accumulation in the pericardial sack. This impairs atrial and ventricular filling, such that…

…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…

…and occasionally pathological Q waves. Troponin levels are often mildly elevated. Hence, takotsubo cardiomyopathy cannot be differentiated from ST segment elevation myocardial infarction. Due to…