…for treatment. Contraindications Absolute: Unstable cervical spine injury, recent cervical spine surgery, atlantoaxial instability, severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis, recent stroke…

…distal to the left subclavian artery. Penetrating atherosclerotic ulcer PAU is focal ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into…

…interval of several weeks, improvement with anti inflammatory treatment, and the tendency to recur all support an immunopathological mechanism. The precise cause, however, is not…

…of aorta involved, although the source material does not provide a detailed symptom to anatomy correlation. Pain may be absent, particularly in iatrogenic aortic injury…

…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…

…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…

…region of the left ventricle, usually as part of an inferoposterior or posterolateral infarction. Its recognition is clinically important because posterior infarction may not produce…

…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…

…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…

…The heart is rotated 30° to the left in the thorax. This positions the basal portion of the left lateral wall posteriorly in thorax (Figure…

…hypertension together promote left ventricular hypertrophy and kidney injury. The syndrome is therefore both a clinical risk factor cluster and a marker of broader metabolic…

…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…

…ST depression and does not evolve into pathologic Q waves [4]. Additionally, PR segment depression is a common and early electrocardiographic sign of acute pericarditis…

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

…left coronary artery is less common but more malignant than an anomalous right coronary artery. Anomalous origin of a coronary artery from the pulmonary artery…

…the conventional 12 lead ECG. These situations are as follows: Transmural ischemia located in the posterolateral portion of the left ventricle . Transmural ischemia located in…

…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…

…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…

…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…

…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…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

…if possible, otherwise give IM with a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative…

…the assessment takes. The task of the health service is to give effect to the deceased person's wishes, not to persuade anyone. This article…

…from the wall of the cavity before irrigating. 5. Let the pus drain out. Empty it with gentle pressure around the cavity, not by pressing…

…thrust is preferred if there is suspicion of cervical spine injury, in which scenario head tilt chin lift should only be used if other methods…

…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…

…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…

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

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

…of troponin elevation does not by itself establish the mechanism. Increased concentrations may result from acute coronary atherothrombosis, oxygen supply–demand imbalance, direct myocardial injury…

…otherwise stable patients. More than 48 hours after onset: routine PCI of an occluded infarct related artery is not recommended in stable, asymptomatic patients without…

…the association may not be causal. Renal dysfunction after PCI may reflect contrast associated injury, haemodynamic instability, cholesterol embolisation, or a combination of these mechanisms…

…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 …

…or initiation of ECMO. The syndrome was first described by Negovsky , who identified four processes that defined the victim's outcome: Neurological injury Myocardial dysfunction…

…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…

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

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

…hydrogen ions instead of potassium, and the urine stays acidic however much bicarbonate is given. Potassium replacement is not the management of a side effect…

…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…

…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…

…proteinuria when clinical symptoms or laboratory abnormalities indicate end organ injury. Eclampsia is the occurrence of new onset seizures or coma in a pregnant woman…

…commotio cordis, contusio cordis implies actual structural injury to the tissues. Manifestations of contusio cordis include: Arrhythmias : Ventricular or supraventricular arrhythmias (bradyarrhythmia or tachyarrhythmia). Atrial…

…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…

…acute aortic dissection, thrombosis of a graft or aneurysm, popliteal artery entrapment, trauma, phlegmasia cerulea dolens, ergotism, hypercoagulable states or iatrogenic vascular injury. Acute occlusion…

…Myocardial vulnerability, largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe form, known as…

…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…

…prognostic evaluation using two complementary domains: Indicators of acute PE severity , including clinical findings, RV dysfunction on imaging, and myocardial injury shown by laboratory testing…

…Troponin is a protein complex expressed in cardiac and skeletal muscle. The complex consists of troponin I (TnI) , troponin C (TnC) and troponin T (TnT…

…an overall assessment, not on a single threshold value. The combination of physiology, rate of bleeding, the pattern of injury or disease, the response to…

…ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia, and no obstructive stenosis in a major epicardial coronary artery. Non…

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

…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…

…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…

…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…

…altered shear stress and intimal injury promote atherosclerosis. The principal anatomical distributions are: Abdominal aorta and iliac arteries, involved in approximately 30% of symptomatic patients…

…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…