…15%–20%, substantially exceeding those seen with native vessel PCI. Mechanisms The principal mechanism is distal embolization of atheromatous and thrombotic material. Plaque or thrombus…

…from the vessel lumen by a fibrous cap. The LRNC is a highly toxic, pro thrombotic milieu composed of extracellular cholesterol crystals, apoptotic and necrotic…

…of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic aortic injury. In classic dissection, an intimal tear permits blood…

…therapy. The pathophysiology of myocardial infarction injury involves the overlapping of vulnerable plaque and thrombogenic blood, which are critical determinants for infarction occurrence and extension…

…downstream, causing microvascular embolization (i.e occluding smaller vessels downstream). The thrombosis causes occlusion of the artery; blood flow may be partially or completely obstructed…

…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…

…reversible causes of traumatic cardiac arrest ( Salomone et al ): Hypovolemia : Hypovolemic shock is common in both penetrating and blunt force trauma. Loss of blood volume…

…Blood and colloids flow more slowly, and every additional length of tubing, every tap and every filter reduces the flow further — it is the whole…

…an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An alcohol or chlorhexidine swab…

…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…

…objective is restoration of blood flow to the infarct related myocardial territory and limitation of infarct size. The extent of myocardial injury is strongly influenced…

…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…

…with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site bleeding, surgical repair, and blood transfusion with radial access. Radial access has…

…effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic injury because of its high blood flow and…

…brain death. The cause of brain injuries is anoxic cell death, continued dysfunction in cerebral blood flow (autoregulation) after ROSC and cerebral hypoperfusion. Myocardial dysfunction…

…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…

…Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the kidneys, retina, and brain…

…dyslipidaemia, elevated blood pressure and impaired glucose regulation. Diagnosis is based on the coexistence of defined clinical and laboratory components; the diagnostic criteria themselves are…

…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…

…of tissue injury depends on the site, duration and completeness of occlusion and on the adequacy of collateral blood flow. Ischaemia initially produces pain and…

…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…

…Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease, active cancer, and other conditions…

…DW, Wickman LL, Swart GL. The hemodynamic and arterial blood gas response to asphyxiation: a canine model of pulseless electrical activity. Resuscitation 1995; 30:16975…

…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…

…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…

…guided without reliable measurement of urine output. Baseline tests: blood gas with electrolytes, sodium, potassium, ionised calcium, creatinine, CK in rhabdomyolysis, and salicylate concentration in…

…blood flow appropriate to tissue requirements unless filling pressures are elevated. Consequently, congestion may occur across the full range of left ventricular ejection fraction and…

…This helps explain the neurological manifestations of preeclampsia and the potential for stroke even at blood pressure levels that might otherwise be considered only moderately…

…the pattern of injury or disease, the response to initial treatment and the expected continued bleeding matters more than an exact estimate of blood loss…

…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 …

…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…

…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…

…Condition Overall strategy Common first choices : : : Acute aortic syndrome Immediate rate control and rapid reduction of the systolic blood pressure towards 100 to 120 mmHg…

…both alternative diagnoses and high risk features of acute coronary syndrome. The physical examination should include: Assessment of all major peripheral pulses. Blood pressure measurement…

…concentration washes nitrogen out of the pleural air and speeds resorption. Other conditions in which high flow oxygen is given irrespective of the saturation according…

…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…

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

…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…

…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…

…Chinese and Malay patients, may have higher statin blood levels; lower starting doses are therefore appropriate. Drug interactions are particularly important. Inhibition of cytochrome P…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…workload is heavy, or as a substitute for mobilisation and bladder training. Contraindications Type Condition : : Absolute Suspected urethral injury — blood at the meatus, a perineal…

…closer monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with…

…Concussion, temporal bone injury, dissection, aminoglycoside toxicity, antiepileptic drugs, alcohol or sedatives Trauma and medication directed workup This corresponds to the principles of TiTrATE, in…

…drinking in either sex. Other definitions of unhealthy drinking include at least two drinks daily in women or three in men, or at least four…

…70% of older adults presenting with myocardial infarction, stroke, acute aortic syndromes, or heart failure have preexisting hypertension. The relationship between blood pressure and outcome…

…Assessment Before Prescription Physical activity should be assessed and prescribed using the components of: Frequency Intensity Time or duration Type Progression The prescription should be…

…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…

…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…

…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…

…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…

…are no means of determining what phase the patient is in. The three phases following a sudden cardiac arrest were described by Weisfeldt and Becker …

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

…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…

…setting of cardiac arrest, it is essential to reconfirm the rhythm in two leads if possible to distinguish true bradyarrhythmic or asystolic arrest from other…

…5. Ask the patient to flex the head forward and swallow repeatedly , preferably with sips of water if swallowing is safe. Advance the tube in…

…about 7.20. Different targets apply when the intracranial pressure is raised: normocapnia (PaCO₂ 4.5–5.0 kPa) and avoidance of hypoxia, since hypercapnia…

…which is a manifestation of post cardiac injury syndrome (PCIS). PCIS is an umbrella term that also includes post pericardiotomy syndrome and post traumatic pericarditis…

…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…

…liver injury is the commonest cause Isolated bilirubin Unconjugated, the others normal Gilbert's syndrome, haemolysis The R value = (ALT / upper limit of normal…