…alone is disputed and practice differs between units. Poisoning with other weak acids where the poison control centre recommends it, for example certain phenoxy acid…

…The diagnosis and the donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in…

…management of delirium in intensive care. Renal replacement therapy Absolute indications: refractory hyperkalaemia, refractory acidosis, refractory fluid overload, uraemic symptoms (pericarditis, encephalopathy) and certain poisonings…

…alkali) — it makes endoscopic assessment more difficult and causes vomiting Medicinal charcoal Petroleum products — vomiting with chemical pneumonitis as a consequence Medicinal charcoal Bowel obstruction…

…oxygen concentration is given irrespective of the saturation Carbon monoxide poisoning. The pulse oximeter does not distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal…

…ABCDE assessment and document the time of seizure onset, or the time the patient was last known to be well. Protect the patient from injury…

…cholestatic injury, and 2–5 a mixed pattern. Orders of magnitude that direct the work up ALT 50 × the upper limit of normal: paracetamol poisoning…

…Enteral nutrition and drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see…

…and release from an early cytosolic pool have all been associated with detectable troponin. High sensitivity assays may therefore identify a continuum of myocardial injury…

…Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in…

…many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The…

…eye injury is to measure and document the visual acuity before anything else is done. The second most important is to look for signs of…

…coronary occlusion and progress over time. Experimentally, necrosis advances from the subendocardium towards the subepicardium over several hours. The extent and tempo of injury are…

…ischaemic myocardial injury may coexist, and certain disease entities can span both categories; for example, acute heart failure may occur in the context of acute…

…cord injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against the skin, protects against the edges of…

…and that the deltoid injection is placed too high — which causes the shoulder injury known as SIRVA. Both are avoided with the right landmark and…

…nerve injury will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained contamination, not poor suture technique — and…

…medicine Definition and pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic…

…and death. The clinical consequences are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of…

…onset of the QRS complex. Nonrespiratory sinus arrhythmia may also be observed as a consequence of drug toxicity, such as digitalis excess. Biomarkers and Laboratory…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…particularly in iatrogenic aortic injury. Iatrogenic lesions commonly follow cardiac surgery, coronary angiography or other invasive procedures, and affected patients may be relatively painless compared…

…in other reports. It is more frequent in women and in patients presenting with NSTEMI than in those presenting with STEMI. Approximately one third of…

…effusion is substantial or when haemodynamic consequences develop. In patients with pericarditis complicated by constriction, symptoms and signs of right sided heart failure may predominate…

…The extent of myocardial injury is strongly influenced by total ischaemic time. This interval includes: The time from symptom onset to recognition and seeking medical…

…MI and acute coronary syndromes are commonly related to atherothrombotic events, myocardial ischaemia may also result from other mechanisms. Differential diagnoses and alternative causes of…

…history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds…

…ventilation. Inadequate ventilation with a rising pCO₂ and respiratory acidosis, or a markedly increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury…

…A patient with a plasma potassium of 6.2 mmol/L, new bradycardia and acute kidney injury may be at greater immediate risk than a…

…creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]. Important exceptions Condition Overall strategy Common first choices : : : Acute…

…morphine Morphine has an active renally excreted metabolite that causes late sedation and respiratory depression Marked liver failure A reduced dose of all of them…

…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…

…cannula in a large vein gives many times the flow of a fine needle, and collapsed veins mean that the fine needle is in addition…

…longer a joint remains dislocated, the harder the reduction becomes and the greater the risk of chondral and neurovascular injury. Aim for reduction within a…

…creatinine based value The mean of creatinine and cystatin C The most reliable in routine clinical practice Cockcroft–Gault Still used in certain dosing recommendations —…

…catheter is not easier to pass. With a difficult passage it is the shape of the tip and the technique that matter, not the calibre…

…to healthy populations or those with acute kidney injury. Influence of Muscle Mass and Diet: Serum creatinine levels, a key component of the MDRD equation…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS…

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

…peripheral artery to the aortic root and coronary ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides…

…injury must be coupled with clinical evidence of acute myocardial ischaemia. The Fourth Universal Definition classifies MI into five distinct subtypes based on pathophysiology and…

…analytical sensitivity improves diagnostic accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of myocardial injury…

…resolution does not consistently permit identification of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well…

…of infarction. Early thrombus formation is associated with poor short term prognosis, although early mortality is usually related to the extent of myocardial injury and…

…injury. The syndrome is therefore both a clinical risk factor cluster and a marker of broader metabolic dysfunction. Associated abnormalities may include increased apoB and…

…of dissection and impaired distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate stenting or other…

…Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather…

…produce major short and long term adverse consequences, including a substantially increased risk of periprocedural MI and death. Troponin elevation and myocardial injury Cardiac troponin…

…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…

…membrane potential and action potential duration of affected myocardial cells. The resulting voltage gradient between normal and ischaemic myocardium generates currents of injury that are…

…insufficiency, hepatic injury, thrombocytopenia, coagulopathy, cerebrovascular events, hepatic capsule rupture, placental abruption, disseminated intravascular coagulation, and multiple organ failure. In the absence of treatment, approximately…

…Reliance on hypokalaemia alone therefore misses a substantial proportion of cases. The cardiorenal and cerebrovascular consequences of unrecognized PA make early case detection clinically important…

…accounting for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral…

…also contributes to the extension and severity of ischemic injury. In its most severe form, known as no reflow, structural and functional impairments sustain vascular…

…inflammation and other systemic influences. The severity of myocardial injury is determined not only by the epicardial obstruction but also by the vulnerability of the…

…and no functional impairment to myositis with muscle inflammation and elevated CK. Rhabdomyolysis is a rare, severe form of muscle injury. The biological basis of…

…high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation, aggregation, and fibrin formation. Within a…

…pathophysiology of perioperative hypersensitivity and anaphylaxis: a narrative review. Br J Anaesth 2019; 123:e3849. Wallmuller C, Meron G, Kurkciyan I, et al. Causes of…

…No conversion formula (between troponin I and T) has been validated. The risk of interference with antibodies in the blood is higher for troponin I…