…reduced level of consciousness, is having seizures or cannot swallow. 5. If there is no intravenous access, give glucagon and establish access at the same…

…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…

…without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8. Document the ceiling of care and the decision on…

…At the same time, start treatment that eliminates potassium from the body. 6. Check the plasma potassium after about 1 hour and follow the plasma…

…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…

…mmHg and a diastolic pressure < 70 mmHg on treatment — the benefit plateaus and adverse effects increase. Hypertensive crisis Hypertensive urgency: markedly raised pressure without…

…that is required without effect, reconsider the pain mechanism instead of continuing to increase the dose. The level of sedation is scored on a four…

…things determine whether the procedure is safe: that synchronisation really is switched on when the shock is delivered, and that the thromboembolic risk has been…

…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…

…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…

…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…

…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…

…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…

…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…

…Give 7.5 mg (three 2.5 mg tablets) on day 1 and day 2 . The doses are taken at the same time each day…

…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…

…and its positive inotropic effect (horizontal axis). Grey = pure vasopressors, orange = phosphodiesterase inhibitors, blue/turquoise = calcium sensitisers and a beta agonist without…

…the same time, adverse effects such as hypotension, syncope, falls, and functional deterioration may have greater consequences in frail patients. Clinical Assessment Frailty and Functional…

…arms if this can be done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to 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…

…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…

…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…

…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…

…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…

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

…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…

…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…

…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…

…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…

…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…

…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…

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

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

…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…

…without apposition. A wound that bleeds because the edges are held apart. A wound through the full thickness of the dermis, particularly over joints and…

…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…

…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…

…long has the fibrillation lasted, and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…level exceeding 4 mmol/l, commence an intravenous fluid resuscitation using a crystalloid solution at a dose of 30 ml/kg. Should fluid resuscitation fail…

…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…

…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…

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