…a hand held device (iCare, Tono Pen). Procedure Systematic examination 1. Visual acuity in each eye separately , with the patient's usual glasses and then…

…toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel, a…

…a slightly upturned leading edge, and lubricate the dorsal surface. 2. Position the head in the sniffing position if the neck may be moved. 3…

…waves. The transducer is held with one hand and its position and angle are adjusted to send ultrasound waves through structures to be visualized. Ultrasound…

…that bleeds because the edges are held apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas…

…skin and advance a further 1–2 mm so that the catheter tip also lies in the lumen. 5. Hold the needle still and advance…

…canal Previous radiotherapy to the head and neck Fragile skin, poor healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa…

…a table for diagnostic and therapeutic aspiration; for drain insertion the supine position is used with the arm abducted and the hand behind the head…

…and the intubator not being an anaesthetist (1 point). A score of 3 or more indicates a difficult intubation — call for help and get out…

…oxygen and complete equipment for intubation and ventilation must be to hand before the lavage begins. The head of the trolley must be able to…

…your hand to press the remaining fluid down. 5. If a corticosteroid is to be given: hold the needle still, change the syringe and inject…

…is expected. 5. Ask the patient to flex the head forward and swallow repeatedly , preferably with sips of water if swallowing is safe. Advance the…

…the tourniquet 10–15 cm proximal to the intended puncture site, let the arm hang, ask the patient to pump with the hand, and pa

…useful in practice: An examination couch that can be approached from all sides and on which the patient's head can hang over the end…

…medicine Definition and cardiovascular rationale Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled…

…on the other hand, are much less likely to be caused by ischemia ( Figure 1 B ). This is noted in both North American and European…

…wrong move — in the hand, in the medial triangle of the face or perianally. Indications Fluctuant, tender, erythematous and indurated swelling in the skin or…

…poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An…

…the P wave vector, and the exploring electrode is located in front of the P wave vector ( Figure 2, right hand side). This article is…

…transmural ischemia. On the other hand, leads V1–V3 (occasionally V4) may detect the injury currents and present them as ST segment depressions. These depressions…

…In STE ACS, on the other hand, the ST segment depressions are secondary findings and the primary findings are the ST segment elevations. As explained…

…intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology…

…most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not exclude Diastolic collapse of the right atrium and right ventricle The…

…Photograph and draw in the site before the local anaesthetic is given — the anaesthetic can make a subtle lesion hard to find again, and it…

…et al 1 ). Representative single beat morphs for a low risk patient (blue) and the corresponding high risk morph (red). Beyond the difference in R…

…with low risk of recurrence. Atrial fibrillation in other circumstances (particularly those listed above) is usually a progressive disease. Complications of atrial fibrillation and available…

…ST depressions and/or T wave inversions. Patients with NSTE ACS (NSTEMI, unstable angina), on the other hand, may only display ST depressions and/or…

…the other hand, appears to be similar. Exercise stress testing and revascularization (PCI, CABG) Stress testing is commonly performed at various stages before and after…

…the sinoatrial node) is a common finding in athletes and during sleep; in these scenarios, it should not be considered abnormal. On the other hand…

…in a reduction of coronary blood flow and this causes subendocardial ischemia (i.e ischemia that only affects the subendocardium). STEMI, on the other hand…

…other stimuli that increases vagal tone. In all other situations, sinus arrest/pause should be considered abnormal, and the following differential diagnoses are at hand…

…transmural ischemia. On the other hand, leads V1–V3 (occasionally V4) may detect the injury currents and present them as ST segment depressions. These depressions…

…with regards to measuring ventricular dimensions, trabeculae and papillary muscles are considered part of the left ventricular cavity. Other dimensions– including atrial dimensions, mitral annulus…

…leads, as the diagnosis can often be established by examining fewer leads. On the other hand, for the purpose of diagnosing morphological changes (e.g…

…confused J points, notches and slurs I once had the privilige of attending a lecture given by professor Salim Yusuf of McMaster University. Professor Yusuf…

…can be hard to find in older women. Two things separate the safe catheterisation from the harmful one: never forcing against resistance, and never catheterising…

…and the decision to initiate CPR is often ambiguous. Since the risk of attempting CPR is extremely low and the potentially catastrophic consequences of wrongfully…

…HAS BLED, 0.55 for HEMORR₂HAGES, and 0.50 for ATRIA, indicating that HAS BLED had better discrimination ability (Apostolakis et al). Overall, the HAS…

…and repeat revascularization. For example, in the SYNTAX trial, patients with high scores had significantly higher mortality and MACE rates compared to those with low…

…administration, warnings, precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for…

…reverse causality, and the association of arterial stiffness with both low DBP and increased mortality. Older adults have a higher absolute cardiovascular risk than younger…

…Other life threatening cardiopulmonary conditions account for approximately 5% of presentations in some populations. Despite this relatively low prevalence, missed myocardial infarction remains consequential, and…

…the drug prolongs atrial and ventricular refractoriness, extends the A H and QT intervals, and increases sinus cycle length. Clinical Presentation and Symptoms The source…

…bilateral pupillary constriction (a brisk reflex), whereas low light causes dilation. This reflex is highly sensitive to brainstem integrity and cerebral perfusion. During cardiac arrest…

…In addition, some patients present with severe LMCA stenosis exacerbated by other conditions, and these must also be recognized. Prompt identification of LMCA involvement is…

…The anatomy of the nail apparatus The terminology is hard to follow without a picture, and several of the steps below refer to structures that…

…the morning, preferably starting between 08:00 and 09:00 , with the patient fasting or having had a light breakfast according to local practice. Let…

…father and uncle, with similar ST segment changes, were diagnosed with atrial fibrillation in their 60s. The father had repeated episodes of ventricular tachycardia and…

…participants had type 2 diabetes. Over a median follow up of 40.6 months, the time averaged LDL C difference between bempedoic acid and placebo…

…associations include: Idiopathic or viral pericarditis Malignant pericardial disease Tuberculosis Purulent or bacterial pericarditis Trauma Cardiac surgery and other iatrogenic cardiovascular procedures Acute aortic disease…

…levels who had underlying cardiovascular disease, of which 69.4% died. Guo et al also report a significant association between troponin T levels and C…

…conditions like osteoarthritis and obstructive sleep apnea primarily reflect the extent of weight loss, the reductions in hard cardiovascular outcomes (MI, stroke) and metabolic liver…

Cardiology Definition and pathophysiology Low density lipoprotein cholesterol (LDL C) is the principal therapeutic target in lipid management because LDL and other apolipoprotein B containing…

…elevated liver enzymes or transaminases, and thrombocytopenia—is generally regarded as a severe preeclamptic phenotype or variant. Pathophysiology The precise mechanism of preeclampsia remains incompletely…

…ECG education. Review of the most popular ECG books and resources Recognizing that many visitors are interested in other books and online resources, we have…

…arrest. Within the context of pregnancy, hypovolemia and other etiologies of hypotension remain the predominant causes of cardiac arrest. Should cardiac arrest occur postpartum, hemorrhage…

…hard exertion A healthy person can still go on, but he or she really has to push him or herself. It feels very heavy, and…

…g. pulmonary embolism) or in case of long no flow or low flow periods. Under such circumstances, the efficacy of compressions and defibrillation diminishes considerably…

…Their findings revealed that a substantial number of these patients had complete coronary artery occlusions, and outcomes improved when they were treated as acute STEMI…

…term apical ballooning syndrome ). This syndrome was first descried in 1991 in Japan and the authors termed it takotsubo , which is the Japanese word for…