…administer to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications…

…system. The underlying pathophysiology varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral…

…outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections…

…between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of action Colchicine Colchicine appears to exert several anti inflammatory…

…to a complex fibroatheroma. Smooth muscle cells (SMCs) migrate from the tunica media into the intima, driven by platelet derived growth factor (PDGF) and other…

…contribute to both microvascular and epicardial vasomotor disorders. Endothelial activation can promote the release of adhesion molecules, inflammatory cytokines, and vasoconstricting mediators, producing abnormal vascular…

…zone and contributes to ventricular failure. Mechanisms of Shock The central consequence of extensive infarction is loss of contractile myocardium, with reduced cardiac output and…

…of cardiovascular risk reduction was considered similar to that achieved with statins for a comparable absolute degree of LDL C lowering. Diabetes and glycaemic outcomes…

…Trauma Cardiac surgery and other iatrogenic cardiovascular procedures Acute aortic disease, particularly ascending or type A aortic dissection Myocardial free wall rupture after infarction Anticoagulant…

…consumption Natriuresis and diuresis Reduction in plasma volume, preload and afterload Lower left ventricular wall stress Reduced sympathetic nervous system activity Improvement in cardiac metabolic…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…lead to death ( Stone, Libby et al. ). As the atherosclerotic plaque increases in size, it bulges into the artery lumen and causes stenosis (reduction of…

…nonsteroidal anti inflammatory drugs Corticosteroid therapy Other antiplatelet or antithrombotic drugs Selective serotonin reuptake inhibitors Patient selection Aspirin should not be prescribed routinely to individuals…

…confused: replacement therapy in adrenal insufficiency (which must be increased under stress) and pharmacological anti inflammatory treatment (which must be tapered in a controlled fashion)…

…report. A shave biopsy of a pigmented lesion that turns out to be a melanoma can make the Breslow thickness unmeasurable and staging therefore impossible…

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

…neuroborreliosis, neurosyphilis or another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome, autoimmune encephalitis. Meningeal carcinomatosis and CNS involvement in haematological malignancy. Investigation…

…heart sounds and jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction sounds, tachycardia, tachypnea, weakened peripheral pulses, edema, cyanosis. Cardiac tamponade is…

…survival. It includes diagnosis of post cardiac arrest syndrome (PCAS), optimization of ventilation, oxygenation, hemodynamics, antiischemic treatment, temperature treatment, treatment of seizures, and infections. However…

…weeks. The pathogenesis is presumed to be immune mediated. Pericardial injury, necrosis, bleeding, or pleural incision may expose cardiac antigens and initiate an inflammatory response…

Introduction to Coronary Atherosclerosis, Plaques, Atherothrombosis Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by…

…with RA were reported to have approximately twice the myocardial infarction risk of age matched controls. Cardiovascular events occur earlier, and approximately half of premature…

…segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), myocardial infarction, and repeat target lesion revascularization…

… vascular inflammation; progression of calcific aortic stenosis; enhancement of a prothrombotic state. Its atherogenic and inflammatory effects may be mediated partly by oxidized phospholipids carried…

…injury leads to release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated troponin…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…parallel and must not wait for complete diagnostic certainty. Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection…

…zero, and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake Common clinical picture : : 4 to 12 hours Tremor…

…according to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and…

…compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A…

…Suction and oxygen to hand. The patient sits leaning forward with the arms on a table for diagnostic and therapeutic aspiration; for drain insertion the…

…praecordium to the left of the sternum, the other on the back between the left scapula and the spine. The anterolateral position also works and…

…compartments Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue…

…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…

…the eyelids, conjunctiva, cornea and anterior chamber. Note the pupil size, shape and reaction to light. A teardrop shaped or peaked pupil suggests perforation. Look…

…an antihistamine, oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25 mm…

…Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks. Choice of vein and cannula size…

…renal insults. Infection, hypovolaemia, cardiac dysfunction, haemodynamic instability, anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast alone difficult. In…

…C reduction, including modulation of inflammation, oxidative stress, endothelial function, plaque stability, thrombogenic responses and immune activity. Statin intolerance refers to adverse effects attributed to…

…by an mPAP/cardiac output slope greater than 3 mmHg/L/min from rest to exercise. This response is age dependent and may rarely occur…

…in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics…

…infection or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding cardiovascular effects and…

…unless there is an absolute contraindication. The agent and dose are according to the local protocol. Alternatives when there is a contraindication: catheter directed treatment…

…patients with valve prostheses or other cardiac devices (pacemaker, CRT, ICD). In addition to staphylococcus aureus , hemolytic streptococci and pneumococci cause acute endocarditis. Other microorganisms…

…management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb: marked peripheral arterial disease…

…only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must…

…Mix the corticosteroid and the lidocaine in the same syringe. The anaesthetic confirms that the injection has gone to the right place — immediate pain relief…

…be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze or reduced exercise capacity. Suspected asthma or COPD — diagnosis and follow up…

…without being found. Indications A traumatic wound that gapes and cannot be expected to heal with good function or cosmesis without apposition. A wound that…

…6. Assess the indication for antibiotics on the basis of sputum purulence, the other cardinal symptoms and the severity of the illness. 7. Start NIV…

…technique is designed to make sure that never happens, and to make sure the catheter does not become the patient's next focus of infection…

…mmol/L Triglycerides < 1.7 mmol/L 10 carries a risk of pancreatitis Cardiac markers and coagulation Test Reference Comment : : : High sensitivity troponin T…

…intravenous) Loading dose by weight, maintenance dose by renal function and drug concentration Gentamicin and other aminoglycosides A single dose initially. If treatment is continued…

…develops total brain infarction An intensive care patient in whom life sustaining treatment is withdrawn and total brain infarction is not expected to occur Death…

…anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring a secured airway — transfer, heavy sedation, surgery — and cardiac arrest. Contraindications There…

…In impaired consciousness or DKA: remove the pump and change to an infusion or injections Drugs for type 2 diabetes in inpatients Agent The acutely…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

…selective intracoronary contrast injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to the aortic…

…Due to this rapid clearance, adenosine must be administered as a rapid intravenous bolus. Unlike many other intravenous medications where rapid boluses risk hemodynamic instability…

…generally performed in order to evaluate ventricular function, since it may affect the choice of device therapy and also suggest whether other interventions (e.g…