…the head of the humerus. A pressure bag or a 50 mL syringe with a three way tap — intraosseous flow requires pressure ; gravity is not…

…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…

…standard CPR, as per guidelines). Contusio cordis Contusio cordis refers to a contusion of the myocardium, greater vessels or valves, due to a direct, non…

…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…

…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…

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

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

…by the gradual accumulation of inert cholesterol debris, modern vascular biology has redefined atherosclerosis as a dynamic, immune mediated fibroproliferative response to endothelial injury [2]…

…may include systemic arterial embolic manifestations. The source material does not provide a detailed catalogue of specific embolic syndromes. Clinical suspicion should be heightened after…

…output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to hypovolaemia, shock, obstruction or advanced renal injury…

…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…

…femoral head and of vascular injury; always an orthopaedic surgeon, and usually general anaesthesia. An open dislocation. Inadequate analgesia or sedation — the procedure must not…

…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…

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

…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…

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

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

…elevated blood pressure and impaired glucose regulation. Diagnosis is based on the coexistence of defined clinical and laboratory components; the diagnostic criteria themselves are not…

…and equipment Go through the equipment out loud with the team, not in your head. Functioning suction within reach under the pillow or by the…

…in function. The severity of tissue injury depends on the site, duration and completeness of occlusion and on the adequacy of collateral blood flow. Ischaemia…

…as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand, which is not related to acute coronary…

…classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury. This classification is central to determining the intensity of…

…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…

…The absence of a slit lamp — the cornea should not be instrumented without magnification. With a suspected chemical injury the priorities are reversed: irrigate first…

…the time of seizure onset, or the time the patient was last known to be well. Protect the patient from injury. Do not restrain the…

…sampling. Urinary catheter with hourly urine output measurement — the treatment cannot be guided without reliable measurement of urine output. Baseline tests: blood gas with electrolytes…

…diuretic treatment has not been shown formally to reduce heart failure mortality; its established role is symptom relief and prevention of recurrent congestion and hospitalization…

…apparent organ injury to severe multisystem disease. Severe features include: Severe hypertension, defined as blood pressure ≥160/110 mmHg Headache that does not respond to…

…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…

…and T) has been validated. The risk of interference with antibodies in the blood is higher for troponin I (cTnI). Antibody interference is a rare…

…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…

…grading must not be used mechanically. A patient with a plasma potassium of 6.2 mmol/L, new bradycardia and acute kidney injury may be…

…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…

…posterior infarction should not be regarded as an isolated electrocardiographic pattern in every case; it may represent the posterior component of a broader infarct territory…

…a route of administration and a target range for the saturation . What usually goes wrong is not that the patient gets too little oxygen but…

…recent MI. Myocardial injury is separate from MI. It refers to cardiac troponin release that does not fulfil the criteria for ischaemic myocardial infarction. It…

…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…

…ACS). Cardiac troponin is a marker of myocardial injury, not a disease specific marker of myocardial infarction (MI). MI requires both: Acute myocardial injury, demonstrated…

…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…

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

…release, not allergy. Concurrent MAO inhibitor, particularly with pethidine. Caution: untreated sleep apnoea, a concurrent benzodiazepine or gabapentinoid, marked hypovolaemia, head injury with impaired consciousness…

…urethral injury is suspected. Indications Acute urinary retention. Chronic urinary retention with renal impairment or a large residual volume. A need for accurate measurement of…

…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…

…worse when the patient moves the head is therefore not evidence of BPPV. Step 2: decide whether HINTS may be used HINTS stands for Head

…with exercise. Chronic myocardial injury Long term heavy consumption can produce a cardiomyopathy, although the exact exposure threshold and duration required are not established. The…

…injury, accelerates atherosclerosis, increases myocardial oxygen demand, and may worsen ischemia in patients with obstructive coronary disease. It is also the most prevalent antecedent of…

…not be undertaken in bouts of at least 10 minutes; shorter episodes also contribute to health. Spreading activity across the week may reduce musculoskeletal injury…

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

…is classified as acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous…

…al, JAMA Cardiology (2020). Guo et al reported that 27.8% (52 of 187 patients) had myocardial injury, defined as elevated troponin T levels (TnT)…

…Universal Definition of Myocardial Infarction Consensus Documents, with the Fourth Universal Definition published in 2018. A fundamental prerequisite for diagnosing any MI is myocardial injury…

…and to maximize the likelihood of restoring spontaneous circulation, interventions should be adapted to the current phase. However, current guidelines do not consider this fact …

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

…proceed with urgent investigation , and a normal CT of the brain does not exclude an infarction in the posterior fossa. Preparation and equipment No special…

…be observed as a consequence of drug toxicity, such as digitalis excess. Biomarkers and Laboratory Findings The source material does not provide information on biomarkers…

…for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see the separate text on gastric lavage). The tube is not, however…

…points, not aims in themselves. Almost all of them have proved to work better as ranges to stay within than as figures to strive for…

…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…

…management is different. Takotsubo syndrome and myocarditis should not be classified as MINOCA when they are established as the explanation for the presentation. Clinical presentation…

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