…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…

…a potent P2Y12 inhibitor to clopidogrel; reducing the dose of prasugrel; extending DAPT beyond 12 months in carefully selected patients with high ischemic risk and…

…mg/dL) to reduce cardiovascular risk. 1. Assess Prior Treatment • No prior treatment, low dose, or low intensity lipid lowering therapy: • Start high potency, high…

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

…varies according to particle size and composition. As a result, apoB and cholesterol measures may be discordant. A patient may have: Relatively high apoB despite…

…regurgitation in high income countries is age related degeneration of the valvular apparatus. Age related degeneration affects 2% of the population and leads to gradual…

…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…

…a sharps bin. For vaccination: adrenaline 1 mg/mL, an antihistamine, oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume…

…eating Correction dose (rapid acting) Corrects a currently high value As required, in addition to the mealtime dose Never stop basal insulin in a person…

…hour to approximately 40–50 mg of oral morphine per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24…

…The absolute GFR (mL/min) must be used for dosing, not the value normalised to body surface area — the difference is substantial in very small…

…patients treated with ticagrelor. Patients with a history of ischemic stroke can be treated with ticagrelor for up to 12 months. Use with caution in…

…but high risk patients should be evaluated with angiography earlier. Guidelines recommend the use of validated risk models to estimate the risk of acute myocardial…

…linked to national death certificates and electronic health records, and asked whether it could isolate a clinically actionable high risk group for SCD — one defined…

…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…

…of very high risk. They require immediate escalation because the priority is to identify and treat an obstructive coronary lesion without avoidable delay. In contrast…

…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…

…principal drugs identified in the source material are canagliflozin, dapagliflozin and empagliflozin; sotagliflozin is a related dual SGLT1/SGLT2 inhibitor. SGLT2 is a high capacity…

…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…

…structures have very high echogenicity (e.g skeleton, calcifications, mechanical heart valves) and reflect virtually all sound waves, leaving too few waves to explore the…

…BLS is an exceptionally effective treatment, with a very low number needed to treat (NNT), indicating high effectiveness. Although BLS is primarily developed for out…

…interventions to reoxygenate the patient is of paramount importance. In cardiac arrest due to asphyxia, the probability of return of spontaneous circulation (ROSC) is high…

…resuscitation using a crystalloid solution at a dose of 30 ml/kg. Should fluid resuscitation fail to maintain a mean arterial pressure (MAP) above 65…

…constrictive pericarditis. In high income countries, idiopathic pericarditis, radiation to the pericardium and surgical interventions are the most common causes of constrictive pericarditis. Of these…

…recommended as the initial study in patients with low to moderate risk of CAD. In patients with a high to very high risk of CAD…

…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…

…Junctional rhythm First degree AV block Second degree AV block Mobitz type 1 (Wenckebach block) Pauses up to 4 seconds in patients with atrial fibrillation…

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

…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…

…tolerate repeated compression (for example marked thrombocytopenia). Set up and instructions Choose the cuff according to arm circumference ; a cuff that is too narrow overestimates…

…eGFR <15 mL/min) at least 96 hours should have elapsed since the last dose before an invasive procedure. Exact intervals according to the local…

…respiratory disturbance, by contrast, develops over hours to days [1,2]. Six steps Step Question Practical interpretation : : : 1 Is the pH low or high? pH…

…88–92% Hypoxaemic failure without hypercapnia CPAP or high flow nasal oxygen 5–10 cmH₂O According to oxygenation requirement SpO₂ 92–96% The pressure support…

…every population. Hypoactive delirium is, however, consistently underdiagnosed, and several studies have linked the subtype to high mortality, particularly in intensive care [5]. Suspect hypoactive

…severe DKA Cognitive impairment is more common, particularly at very high osmolality Blood ketones are preferable to urine ketones. The principal ketone body in DKA…

…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…

…Edrophonium 10 mg/mL, 1 mL (named patient product — order well in advance). Atropine 0.5 mg for premedication, plus further atropine drawn up in…

…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…

…necessary to achieve an optimal result. Overview of vasopressors and inotropes Vasoconstriction Vasodilatation Positive inotropy Phenylephrine Vasopressin Midodrine Noradrenaline Adrenaline, high dose Dopamine, high dose…

…mL 4 50–70 kg 30 mL 5 70–100 kg 40 mL 6 over 100 kg 50 mL The volumes are maxima — inflate to…

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

…z score with a lower limit of normal at z = −1.64 (the fifth percentile) has been recommended in preference to fixed percentage thresholds…

…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…

…resorption. Other conditions in which high flow oxygen is given irrespective of the saturation according to international guidelines are decompression sickness and sickle cell crisis…

…is the first line treatment in high risk embolism, unless there is an absolute contraindication. The agent and dose are according to the local protocol…

…surgeon. Dislocation of a native hip (as opposed to a prosthesis) — a high risk of avascular necrosis of the femoral head and of vascular injury…

…usually 500 mL as a rapid bolus, and a smaller bolus where the risk of fluid overload is high 0 to 30 min Clinical assessment…

…The material determines how long the catheter may stay: all silicone and latex with a hydrogel or silicone elastomer coating may remain for up to…

…suture material, scissors, dressings. Local anaesthesia Agent Onset Duration Comment : : : : Lidocaine 10 mg/mL Rapid 1–2 hours The standard choice Lidocaine 10 mg/mL…

…leading to delayed repolarization and an increased risk of life threatening arrhythmic events. The cornerstone of LQTS management involves lifestyle modifications, pharmacotherapy, and, in high…

…leading to delayed repolarization and an increased risk of life threatening arrhythmic events. The cornerstone of LQTS management involves lifestyle modifications, pharmacotherapy, and, in high…

…Factors in Atrial Fibrillation) Bleeding Risk Score is a clinical tool designed to estimate the risk of major bleeding in patients with atrial fibrillation (AF…

…Underweight : Less than 18.5 Normal weight : 18.5 to 24.9 Overweight : 25 to 29.9 Obese : 30 and above Limitations of BMI Despite…

…currently the most widely used model. The aim of CHADS VASc is to identify patients at high risk of stroke, TIA or systemic thromboembolism and…

…depletion and high plasma renin activity increase the effect of enalaprilat, and may cause severe hypotension. Time to onset of action 15 to 30 minutes…

…or higher indicates high risk of major bleeding Note that a high HAS BLED score should not be used as a reason to withhold anticoagulation…

…The HCM Risk SCD score aims to identify individuals with a high risk of SCD and determine whether an implantable cardioverter defibrillator (ICD) is warranted…