…ischaemia and presumed new ischaemic ECG changes. The distinction between myocardial injury and type 2 infarction is particularly important. Type 2 infarction requires clinical evidence…

Njurmedicin Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine…

Cardiology Nephrology Definition and terminology Contrast associated acute kidney injury is an acute deterioration in renal function occurring after exposure to iodinated contrast media, particularly…

Procedurer The single most important step in any eye injury is to measure and document the visual acuity before anything else is done. The second…

Clinical chemistry & laboratory medicine Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute…

…Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand…

…pulses and capillary refill. Check the skin, and remove rings and jewellery distal to the injury before the swelling develops. Procedure 1. Place the joint…

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

…to its depth, and has not been assessed for tendon and nerve injury will heal badly however neatly the suture is placed. The commonest cause…

…exceed available blood flow. The resulting ischaemia threatens skeletal muscle and peripheral nerves and may progress rapidly to irreversible tissue injury. Skeletal muscle and nerves…

…status, clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury. This classification is central to determining the intensity of monitoring, supportive treatment, anticoagulation…

…coronary syndromes, particularly ST elevation myocardial infarction (STEMI), ischemic injury can disrupt the conduction system at any level, producing atrioventricular (AV) or intraventricular blocks. Isolated…

…organ injury is decisive. The pathophysiology reflects failure of vascular autoregulation during a rapid or severe rise in BP. This may produce acute injury in…

…alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic aortic injury. In classic dissection, an intimal tear permits blood to enter the diseased aortic…

…of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia, and no obstructive stenosis in a major…

…traditionally termed Dressler syndrome , which is a manifestation of post cardiac injury syndrome (PCIS). PCIS is an umbrella term that also includes post pericardiotomy syndrome…

…myocardial territory and limitation of infarct size. The extent of myocardial injury is strongly influenced by total ischaemic time. This interval includes: The time from…

…myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI…

…of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain infarction is judged possible during ongoing ventilation …

…used for diagnosis, and the barbecue roll or the Gufoni manoeuvre for treatment. Contraindications Absolute: Unstable cervical spine injury, recent cervical spine surgery, atlantoaxial instability…

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

…nephrology early in anuria, in a dialysis patient, in severe acute kidney injury, in treatment failure or in ongoing massive potassium release. In cardiac arrest…

…coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood…

…Comment : : : Intracranial pressure (ICP) < 22 mmHg The treatment threshold in traumatic brain injury Cerebral perfusion pressure (CPP) 60–70 mmHg CPP = MAP − ICP…

…tumour, primary biliary cholangitis, drugs Mixed Both raised Drug induced liver injury is the commonest cause Isolated bilirubin Unconjugated, the others normal Gilbert's syndrome…

…through a fracture in the cribriform plate into the cranium Absolute Corrosive injury of the oesophagus or stomach after ingestion of a caustic substance Absolute…

…a concurrent benzodiazepine or gabapentinoid, marked hypovolaemia, head injury with impaired consciousness, biliary tract disease. There is no contraindication to analgesia in the acute abdomen…

…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…

…A fracture of the bone to be punctured, or a major injury proximal to the puncture site. A joint prosthesis or orthopaedic metalwork in the…

…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…

…and very large people. Acute kidney injury (KDIGO) Stage Creatinine Urine output : : : 1 A rise ≥ 26 µmol/L in 48 h, or 1.5–1…

…convulsive activity, t2, the risk of permanent neuronal injury increases. Treatment must therefore start at 5 minutes and be escalated without unnecessary pauses [1]. The…

…threshold and on whether haemodialysis should be considered. Rhabdomyolysis with marked elevation of CK and threatened kidney injury, as an adjunct to the decisive measure…

…separate the safe catheterisation from the harmful one: never forcing against resistance, and never catheterising urethrally when urethral injury is suspected. Indications Acute urinary retention…

…primarily consisting of individuals with CKD, limiting its accuracy when applied to healthy populations or those with acute kidney injury. Influence of Muscle Mass and…

…mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis. It is characterized by prolonged angina…

…increase the risk of stroke and other thromboembolic events. Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the…

…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…

…stroke, coronary perforation, haemodynamic collapse, acute kidney injury, and death. The risk profile differs between diagnostic angiography and PCI, and is strongly influenced by the…

…To establish a diagnosis of MI, acute myocardial injury must be coupled with clinical evidence of acute myocardial ischaemia. The Fourth Universal Definition classifies MI…

…hs cTn measurements. Troponin results should not be interpreted in isolation because myocardial injury is also encountered in non ACS cardiopulmonary disease. Patients with persistent…

…of ISR is neointimal hyperplasia following vessel wall injury. PCI and stent implantation produce local vascular injury and initiate a sustained inflammatory and reparative response…

…formation is associated with poor short term prognosis, although early mortality is usually related to the extent of myocardial injury and its complications—shock, reinfarction…

…with progression, hyperglycaemia and pancreatic β cell dysfunction. These abnormalities initiate self perpetuating metabolic and inflammatory pathways that injure the vasculature, heart and kidneys. Advanced…

…or myocardial injury. Antithrombotic therapy may reduce embolization of thrombotic or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury have not…

…branch points, where disturbed flow, altered shear stress and intimal injury promote atherosclerosis. The principal anatomical distributions are: Abdominal aorta and iliac arteries, involved in…

…the criteria for type 1 MI. Procedural myocardial injury may also occur without satisfying the diagnostic threshold for periprocedural MI. This distinction is clinically important…

…or the inferobasal wall. Transmural ischemia located in this area yields an injury current (ST vector) directed towards the back, where there is no exploring…

…cells. The resulting voltage gradient between normal and ischaemic myocardium generates currents of injury that are expressed on the surface ECG as ST segment displacement…

…creatinine ratio ≥0.3. Preeclampsia may nevertheless be diagnosed without proteinuria when clinical symptoms or laboratory abnormalities indicate end organ injury. Eclampsia is the occurrence…

…neurons and other tissues. This distribution helps explain why PA produces cardiovascular injury beyond its effects on blood pressure and potassium balance. The principal sporadic…

…zone. Coronary Occlusion and Myocardial Injury STEMI generally results from abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery…

…entity requiring immediate reperfusion therapy. The pathophysiology of myocardial infarction injury involves the overlapping of vulnerable plaque and thrombogenic blood, which are critical determinants for…

…influences. The severity of myocardial injury is determined not only by the epicardial obstruction but also by the vulnerability of the myocardium and coronary microcirculation…

…and elevated CK. Rhabdomyolysis is a rare, severe form of muscle injury. The biological basis of many reported muscle symptoms remains uncertain. Randomized trials have…

…platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation…

…the anterior axillary line. Thoracostomy This method is generally deemed safer than using a needle due to reduced risk of injury. Thoracostomy should be performed…

…troponin T (cTNT). The following differences exist between troponin I and T: An increase in troponin I (cTnI) is only seen in myocardial injury. Hence…

…debris, modern vascular biology has redefined atherosclerosis as a dynamic, immune mediated fibroproliferative response to endothelial injury [2] . The process initiates with endothelial dysfunction, a…

…hypoxia, and reperfusion injury. Myocardial oxygen demand Myocardium can only function under aerobic conditions (oxygen is required for ATP synthesis [ATP is the primary energy…