…technically correct performance is only half the task. The examination must be preceded by information about each step, take place with the patient's ongoing…

…chemistry & laboratory medicine Emergency medicine Myocardial ischemia and infarction Definition and Pathophysiological Basis High sensitivity cardiac troponin (hs cTn) assays detect circulating troponin released from…

…therefore requires individualized balancing of ischemic and bleeding hazards. High bleeding risk (HBR) should be assessed in a structured manner. Within the ARC HBR framework…

Initial Focus: High potency statin therapy is foundational unless contraindicated. Combination Therapy: Ezetimibe is the next step if LDL C targets are not met with…

Hydralazine Hydralazine is not preferred for hypertensive emergencies due to the high risk of reflex sympathetic stimulation. Drug Hydralazine Brand names Apresoline ®, Bidil ®…

…chemistry & laboratory medicine Definition and Pathophysiology Apolipoprotein B (apoB) and non high density lipoprotein cholesterol (non HDL C) are complementary measures of atherogenic lipoprotein burden…

…Mitral regurgitation Causes of mitral regurgitation The most common cause of mitral regurgitation in high income countries is age related degeneration of the valvular apparatus…

…hyperactivity Up to 5 to 7 days, sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness or after prolonged very high…

…< 120 and < 80 Normal 120–129 and/or 80–84 High normal 130–139 and/or 85–89 Grade 1 hypertension 140–159…

…recovery. A patient who stops at a low workload with a fall in blood pressure is a high risk patient even with normal ST segments…

…1. Expose the whole shoulder; rolling up a sleeve creates a constriction that distorts the anatomy and tempts the operator to inject too high. 2…

…a high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in…

…is incomplete: reduce the calculated equianalgesic dose by 25–50 per cent and titrate. At a high dose, in old age or in renal failure…

…disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2 60–89 Mildly reduced G3a 45–59 Mildly to moderately reduced G3b 30–44 Moderately…

…of atherothrombotic events in adult patients with acute coronary syndrome (ACS) or a prior heart attack and a high risk of developing an atherothrombotic event…

…of patients should undergo angiography within 24 hours, but high risk patients should be evaluated with angiography earlier. Guidelines recommend the use of validated risk…

…cardiac death: what the new Nature study shows Low risk (blue) versus high risk (red) ECG morphs in lead aVL (adapted from Obermeyer et al…

…recurrent clinical deterioration despite careful follow up and appropriate therapy. In this setting, the risk of sudden death and end stage heart failure is high…

…completely different. It took roughly 50 years for researchers to finally conclude that high cholesterol levels caused coronary artery disease and atherosclerosis in general. This…

…patients with a confirmed NSTEMI, patients with a working diagnosis of NSTE ACS and a high probability of unstable angina (UA), and patients whose initial…

…ECG cases, and high yield exam review. This is one of few EM blogs with up to date research discussions. EMcrit Superb website by Dr…

… sotagliflozin is a related dual SGLT1/SGLT2 inhibitor. SGLT2 is a high capacity, low affinity transporter situated in the S1 and S2 segments of the…

…world: What is the best ECG book? This question is far from trivial and the stakes are high; mastering ECG interpretation will frequently be a…

…acoustic shadowing. Reverberations artifacts Ultrasound waves can be reflected multiple times between dense structures ( i.e structures with high echogenicity). For each reflection, a portion…

…treatment, with a very low number needed to treat (NNT), indicating high effectiveness. Although BLS is primarily developed for out of hospital cardiac arrest (OHCA)…

…Respiratory conditions : Tension pneumothorax Drowning Airway obstruction Hanging Pneumonia High altitude sickness Aspiration Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes…

…and hypoperfusion manifesting as hypotension. The high mortality associated with sepsis underscores the critical importance of timely and appropriate interventions. In patients presenting with concurrent…

…In principle, all causes of pericarditis can result in constrictive pericarditis. In high income countries, idiopathic pericarditis, radiation to the pericardium and surgical interventions are…

…Dipyridamole, Regadenoson : Should be avoided in patients with active bronchospasm, severe hypotension, or high degree AV block. Caffeine and other methylxanthines, which antagonize adenosine receptors…

…of cardiovascular disease. It has been the number one killer in Western and high income countries for more than half a century, causing approximately 20…

…and should be managed urgently. The risk of cardiogenic shock and cardiac arrest is high and pharmacological interventions are frequently futile. It is often necessary…

…relaxation should proceed rapidly and the ventricle should expand substantially. This requires that the myocardium has high compliance , a term used to describe myocardial elasticity…

…NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical…

…lowered at each measurement, and not to talk. Otherwise ordinary activities, including work. No showering or bathing. A diary of going to bed, getting up…

Farmakologi & dosering Kardiologi Lathundar Three questions come up again and again on call: which dose, how long to interrupt treatment before a procedure, and how…

…develops over hours to days [1,2]. Six steps Step Question Practical interpretation : : : 1 Is the pH low or high? pH <7.35 is acidaemia…

…Atelectasis and postoperative hypoxaemia. Hypoxaemic failure where high flow nasal oxygen is insufficient and the carbon dioxide is normal. Bilevel NIV: Acute exacerbation of COPD…

…wards a substantial proportion of older patients are affected, and the incidence is particularly high after hip fracture, major surgery and intensive care [1,2…

…three components: diabetes or hyperglycaemia, ketosis and metabolic acidosis. A very high glucose value is no longer required [1]. Diabetic ketoacidosis, DKA Hyperosmolar hyperglycaemic state…

…present). High voltage (excessive amplitudes) is present if the S wave in V1 or V2 + the R wave in V5 is 35 mm. Q waves…

…the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked obstructive airways disease — relative; the…

…at lower values if the rise is rapid, the patient has symptoms, or the clinical risk is high [1,2]. 1. Perform an ABCDE assessment…

…high dose Adrenaline, low dose Dopamine, intermediate dose Isoproterenol Dopamine, low dose Dobutamine Levosimendan Amrinone Milrinone Nitroglycerin Nitroprusside Figure 1. The approximate position of each…

…completely. Relative contraindications: A high risk of aspiration: a non fasted patient, ileus, third trimester pregnancy, marked reflux. A need for high airway pressures, for…

…be palpable despite ischaemia ABI 0.9 < 0.9 Often falsely high Contraindications to compression The ankle brachial index measured with Doppler determines whether…

…cannot be established with spirometry alone, but is suspected when the FVC is low with a normal or high ratio. Reversibility: an increase in FEV₁…

…48 hours Profound neutropenia A neutrophil count below 0.1 × 10⁹/L An expected high risk course Neutropenia expected to last longer than 7 days…

…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…

…clinical picture are sufficient for a treatment decision. Systemic thrombolysis is the first line treatment in high risk embolism, unless there is an absolute contraindication…

…gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than…

…same time has a lactate above 2 mmol/L. This combination carries a high mortality [1,2]. Give antibiotics immediately and aim for administration within…

…injury — blood at the meatus, a perineal or scrotal haematoma, a high riding or impalpable prostate, a pelvic fracture, a straddle injury Relative Recent urethral…

…immunosuppression, and high dose corticosteroids. The time limit and the choice of closure strategy The classical limit of 6–8 hours for primary closure rests…

…The cornerstone of LQTS management involves lifestyle modifications, pharmacotherapy, and, in high risk cases, device implantation. Beta blockers, particularly non selective agents like nadolol and…

…The cornerstone of LQTS management involves lifestyle modifications, pharmacotherapy, and, in high risk cases, device implantation. Beta blockers, particularly non selective agents like nadolol and…

…of bleeding Low risk 0 3 0.8% Intermediate risk 4 2.6% High risk 5 or more 5.8% Interpretation of ATRIA risk score…

…BMI and cardiovascular outcomes High BMI is associated with several health conditions: Type 2 diabetes Hypertension Coronary artery disease Heart failure Dyslipidemia (including high LDL…

…Men Women Points Recommendation Evidence Recommendation Evidence 0 No treatment Low No treatment High 1 Oral anticoagulation (warfarin or NOAK 1 is considered for male…

…depends on plasma volume and plasma renin activity. Volume depletion and high plasma renin activity increase the effect of enalaprilat, and may cause severe hypotension…

…leeding history or predisposition L abile INR (International Normalized Ratio) E lderly (age 65 years) D rugs/alcohol concomitantly Each component is assigned 1 point…