…is predominantly observed in older patients with heavily calcified, tortuous vessels [2] . Regardless of the initiating mechanism, the exposure of thrombogenic material triggers a rapid…

…seen predominantly after larger infarctions and/or delayed reperfusion. Its typical onset is 1–2 weeks after AMI, although descriptions of the syndrome include a…

…presentation of ACS is generally similar to that in non pregnant patients, although symptoms may be atypical. Pregnant patients with SCAD may have a more…

…form of statin therapy after systematic reassessment and rechallenge. The principal manifestation is statin associated muscle symptoms (SAMS). These range from diffuse myalgia with a…

…severe piperacillin–tazobactam 4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline…

…bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even with a reduced level of consciousness…

…foreign materials pose a high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant…

…attributed to the pericardium: The pericardium serves as a barrier to infections. The pericardium reduces friction between the ventricles and surrounding structures of the mediastinum…

…by a biologically active process. Risk factors for calcification overlap with risk factors for coronary heart disease (atherosclerosis). The average age at diagnosis of aortic…

…Continous medical discussion: the ECG blog Infectious diseases Cardiovascular effects of COVID 19 Coronavirus disease 2019 (COVID 19) has caused a global public health crisis…

…and medications : A wide range of diseases and medications may cause sinus tachycardia; e.g congestive heart failure, lung disease (e.g COPD), fever, infections…

…In patients with previous myocardial infarction and residual inflammation, defined by hsCRP ≥2 mg/L, it produced a modest reduction in a composite of cardiovascular…

…and ischemia causes a state similar to SIRS (systemic inflammatory response syndrome) with risk of disseminated intravascular coagulation, hypotension, impaired vasoregulation, etc. With regard to…

…disorders frequently present with presyncope or syncope. Diagnosing transient or paroxysmal AV block in these individuals can be challenging. A high suspicion of intermittent infrahisian…

…which acts as a lubricant that prevents friction during ventricular contraction and relaxation. Pericardial effusion is the presence of an abnormal amount of fluid in…

…cause of pericarditis is infections, in particular viral infections. This explains why pericarditis may affect individuals of all ages. However, a wide range of local…

…of the heart. Sinus rhythm is the normal rhythm in all pediatric patients. Sinus rhythm is defined by the following criteria: Regular rhythm with a…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

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

…or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis or a positive culture…

…alcohol 5 mg/mL: clean with 3–4 swabs in wide circles and let it dry for a couple of minutes before the needle is…

…With a glass injury: consider radiography, since glass is usually visible on plain films. Irrigation fluid: a copious volume of drinking quality tap water or…

…clean with a tracheostomy or copious secretions Subclavian vein Most comfortable for the patient, the most stable dressing, lowest risk of infection and thrombosis with…

…nausea and delayed gastric emptying. Bear this in mind before sedation and endoscopy DPP 4 inhibitor A low risk of hypoglycaemia; it can usually be…

…produces a dose dependent reduction in PCSK9 and LDL C. Across clinical studies, LDL C reductions have generally been approximately 50%, with reported reductions of…

…identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window, or when thrombectomy…

…or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical context and the…

…ankle brachial index with Doppler. 4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken…

…of the hand. Preparation and equipment Chlorhexidine in alcohol or an iodine solution. Lidocaine 10 mg/mL with adrenaline 5 µg/mL (adrenaline gives a…

…bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is chosen when the need…

…4.0–6.0 mmol/L ≥ 7.0 on two occasions establishes a diagnosis of diabetes HbA1c < 42 mmol/mol 42–47 = prediabetes…

…care Intermediate–high Stable Yes Raised Admission with monitoring. Be prepared for rescue thrombolysis Intermediate–low Stable One of the two positive Admission Low Stable…

…in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are viral infection, bacterial infection and air pollution…

…with a relatively clear level of consciousness and preserved orientation 12 to 48 hours Withdrawal seizures, usually generalised tonic clonic and sometimes several within a…

…skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the wrist crease at an angle of 30…

…A paretic limb — poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of…

…spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy: an otoscope with a charged battery and clean disposable specula…

…thick soft tissue and for the head of the humerus. A pressure bag or a 50 mL syringe with a three way tap — intraosseous flow…

…in death of approximately 35–45%. In chronic coronary syndrome, cessation has been associated with a 36% reduction in premature mortality compared with continued smoking…

…Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also…

…to the next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection…

…local practice Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk of pneumothorax…

…ulcer A proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a…

…10 minutes Duration of action 2 to 4 hours Delivery IV Dose Can be given as repeated intravenous bolus injections or as a constant dose…

…of the face or perianally. Indications Fluctuant, tender, erythematous and indurated swelling in the skin or subcutis. Pilonidal abscess, hidradenitis abscess and paronychia with a…

…usually 5–10 mL, with a longer needle so that the periosteum can be infiltrated generously — it is the periosteum that hurts, not the skin…

…work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring a…

…Grasp the eyelashes, press gently downwards on the upper border of the tarsal plate with a cotton bud, and at the same time fold the…

…renal vasculature or collecting system. With iodinated contrast, the observed renal dysfunction may therefore reflect a combination of: direct tubular toxicity; renal haemodynamic disturbance and…

…A short course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary…

…1930s, to a routine, safe, and sophisticated treatment used worldwide. Artificial pacemakers have benefitted immensely from advances in engineering, notably with the advent of transistors…

…dose without troublesome adverse effects, give a further 8 mg intravenously , slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing weakness. 6…

…at twice as great a risk of all cause death and cardiovascular death, compared to patients without such disturbances, including those with RBBB and LBBB…

…patient has a confirmed diagnosis of pheochromocytoma Treatment of hypertension associated with pheochromocytoma; treatment of dermal necrosis after extravasation of drugs with á adrenergic effects…

…synonymous with left ventricular infarction . All myocardial infarctions affect the left ventricle. Right ventricular infarction is uncommon but may occur if there is a proximal…

…patients with a very high clinical likelihood of obstructive CAD, defined in the source material as greater than 85%, particularly when one or more of…

…The risk of circulatory collapse is highest with AV block 2 Mobitz type 2 and AV block 3. The only treatment with a class I…

…ballooning akinesis with basal hyperkinesis in a characteristic takotsubo ventricle. Studies from the US and Japan has estimated that up to 2% of patients referred…

…Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a relative contraindication; the test is then performed with preparedness for anaphylaxis. An untreated…

…clinical site of action—the coronary artery perfusing the AV node—before the drug is eliminated. A flush should immediately follow the bolus injection to…