…everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour, collapse or an acute neurological deficit. Hypoglycaemia can cause hemiparesis, aphasia and…

…in the preceding hour. Remove socks and any compression stockings. Avoid measuring the arm pressure on the side with a dialysis fistula, lymphoedema after axillary…

…level of consciousness and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed…

…The following division is clinically useful and is consistent with commonly used guidelines [1,3]. Level Plasma potassium Management : : : Mild 5.5 to 5.9…

…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…

…readings at home or on 24 hour recording. Masked hypertension: normal in the office but raised outside it — associated with the same risk as manifest…

…laxative and an antiemetic prescribed at the same time as the opioid — not afterwards. A current creatinine with the eGFR, the weight, the age and…

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

…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…

…of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus plugging. Expiratory…

…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…

…with a 10.3% and 13% improvement compared with HEMORR₂HAGES and ATRIA, respectively (Apostolakis et al). ATRIA Score: The same study found that the ATRIA…

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

…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…

…some time between the ages of 64 and 70 depending on when the previous one was taken. A woman who has only been screened with…

…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…

…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…

…it can usually be continued Red flags and pitfalls Stopping basal insulin in type 1 diabetes. The single most dangerous prescribing decision on a ward…

…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…

…site Preparation and equipment Ultrasound with a curved array probe. Sterile preparation (chlorhexidine in alcohol 5 mg/mL), sterile gloves, fenestrated drape; full sterile attire…

…patient the same day the result arrives. 3. Reduce to 5 mg (two tablets) on days 1 and 2 in patients over 75, with a…

…sheets wrapping around the ventricle with varying orientation. This organization allows the left ventricle to contract in a highly sophisticated and effective way (Figure 1…

…μg/kg/min + ++++ + +++++ Intermediate dose dopamine activates β1, releases noradrenaline and thereby increases contractility and chronotropy, with a slight rise in SVR. Ventricular arrhythmias…

…fit and independent generally benefit from guideline directed blood pressure treatment similar to that used in younger adults, provided it is tolerated. Patients with functional…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…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…

…conversation conducted with time, clarity and respect is also what makes the decision hold afterwards. Organ preserving treatment — treatment given solely for the sake of…

…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…

…on average, resemble HFrEF more closely than HFpEF. Patients are more commonly male and younger than those with HFpEF and have a greater likelihood of…

…exist during the first few minutes from collapse. Table 1 shows the number needed to treat (NNT) for various interventions involved in BLS and ACLS…

…have some circulation despite circulatory collapse (e.g., with sustained ventricular tachycardia). Experimental and clinical understanding of hypoxic neuronal cell death stems largely from studies…

…the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with outflow tract…

…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…

…based on HbA1c. Albumin affects the total calcium — use the ionised calcium or correct for albumin. Biotin supplements interfere with many immunoassays, including troponin and…

…haemodynamic responses, arrhythmias and prognosis, with diagnostic interpretation reserved for appropriately selected patients. Pathophysiological basis Exercise progressively increases myocardial oxygen demand through increases in heart…

…be coupled with clinical evidence of acute myocardial ischaemia. The Fourth Universal Definition classifies MI into five distinct subtypes based on pathophysiology and clinical context…

…enriched with over 600 pages, engaging video lectures, challenging tests, and versatile study tools. From basic cardiac physiology to the nuanced strategies of evidence based…

…90 mmHg derives from epidemiological observations associating pressures above this level with increased mortality. Contemporary management, however, incorporates overall cardiovascular risk, comorbidity and hypertension mediated…

…with surviving bundles of myocytes that form the slow conducting isthmuses critical for re entry [6] . Non ischemic dilated cardiomyopathy (NICM), hypertrophic cardiomyopathy (HCM), and…

…accompanied by a rise and subsequent fall in cardiac specific troponin attributable to myocardial ischaemia. UA presents with compatible ischaemic symptoms but without cardiac specific…

…entirely on the presence of myocardial necrosis. NSTEMI is confirmed by a typical rise and/or fall of high sensitivity cardiac troponin (hs cTn), with…

…the more myocardium can be salvaged. Call the PCI service in parallel with drug treatment and transport planning [1,5]. Symptom duration Under 12 hours…

…painless and gives normal passive movement — test actively against resistance, tendon by tendon . With a glass injury: consider radiography, since glass is usually visible on…

…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…

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

…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…

…it is used : : : Blood grouping ABO and RhD typing. Requires two samples drawn on two separate occasions with a separate identity check each time Always…

…not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small 5–10 mL syringe…

…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…

…and chronic kidney disease (CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin…

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

…likelihood of clinically significant EMI is generally low, particularly with bipolar electrocautery performed away from the device and with monopolar electrocautery below the umbilicus. Nevertheless…

…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…

…a pivotal therapeutic target [4]: Beta Blockers : Administered to reduce adrenergic stimulation [4]. Sedation and Intubation : Along with anxiolytics, these measures minimize sympathetic surges [4]…

…levels . Elevated lactate is an indicator of tissue hypoperfusion and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level…

…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…

…As per data from the registry, only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac…

…Check the mask, remove air from the cuff so that it is flat with a slightly upturned leading edge, and lubricate the dorsal surface. 2…

…result from a mismatch between myocardial oxygen supply and demand. The clinical history should therefore be examined for potential physiological or systemic stressors, with treatment…

…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…