…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…

…or blood products. Contrast medium for CT (this requires a large bore cannula in a suitable vein). Standby access in a patient at risk of…

…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…

…and endothelial or myocardial injury. Antithrombotic therapy may reduce embolization of thrombotic or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury…

…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…

…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…

…and the cell membranes collapse whereby cellular proteins are released into the circulation. It is possible to detect elevated levels of myocardial proteins in blood…

…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…

…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…

…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…

…ICU is the preferred level of care for the absolute majority. The CCU may be suitable for stable (hemodynamically and respiratory) and fully conscious patients…

…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…

…In acute PE, obstruction of pulmonary blood flow increases RV pressure load and may impair RV filling and forward output. The resulting syndrome may progress…

…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…

…With a suspected chemical injury the priorities are reversed: irrigate first , for at least 30 minutes, and measure the pH in the conjunctival sac before…

…about 30 minutes of continuous convulsive activity, t2, the risk of permanent neuronal injury increases. Treatment must therefore start at 5 minutes and be escalated…

…is part of the treatment itself. Indications Salicylate poisoning with symptoms or a rising serum concentration. Alkalinisation increases renal elimination several fold and at the…

…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…

…Cardiac troponin levels are extremely low in healthy subjects; the 99 th percentile is less than a few nanograms per liter of blood (typically <5…

…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…

…aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood pressure is often at least 180/120 mmHg, but no…

…repeat ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At first medical contact, assessment should occur concurrently with acquisition of the initial…

…why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off into a respiratory acidosis…

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

…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…

…specific marker of myocardial infarction (MI). MI requires both: Acute myocardial injury, demonstrated by a rising and/or falling troponin pattern with at least one…

…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…

…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…

…excreted metabolite that causes late sedation and respiratory depression Marked liver failure A reduced dose of all of them, at a longer interval All op

…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…

…compression The ankle brachial index measured with Doppler determines whether compression may be applied at all, and if so at what pressure. Palpable foot pulses…

…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…

…or at least four drinks for women or five for men on one occasion. Pharmacokinetics and pathophysiology Approximately 95% of ingested ethanol undergoes hepatic metabolism…

…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…

…be undertaken in bouts of at least 10 minutes; shorter episodes also contribute to health. Spreading activity across the week may reduce musculoskeletal injury risk…

…myocardial injury , demonstrated by a rise and/or fall in cTn with at least one value above the 99th percentile URL; and Clinical evidence of…

…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…

…levels. The mortality rate among patients with elevated troponin I was 51.2%, as compared with 4.5% among patients without evidence of myocardial injury…

…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 …

…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…

…The test presupposes that the patient has spontaneous nystagmus at the time of examination and that the examiner is experienced with the head impulse test…

…rate. Within the context of acute coronary syndromes, particularly ST elevation myocardial infarction (STEMI), ischemic injury can disrupt the conduction system at any level, producing…

…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…

…has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia, and no obstructive stenosis…

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