…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…

…marker of function and may rise only after a substantial fall in glomerular filtration. The value is affected by muscle mass, nutrition, drugs and fluid…

…myositis with muscle inflammation and elevated CK. Rhabdomyolysis is a rare, severe form of muscle injury. The biological basis of many reported muscle symptoms remains…

…are components of the myocardial contractile apparatus and are expressed predominantly in cardiac muscle. Troponin I is highly specific for myocardial injury. Interpretation of troponin…

…are cardiac specific isoforms of troponin and these are abbreviated cTnI, cTnT, and cTnC. The isoforms cTnI and cTnT are specific to cardiac muscle cells…

…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…

…perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow. The resulting ischaemia threatens skeletal muscle and peripheral…

…endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection with or without intramural haematoma. Spontaneous coronary…

…and less often to the abdomen, back, lower jaw, neck, or occipital region. It typically occurs at rest, lasts longer than ordinary angina, and does…

…portion of the chest or the epigastrium and occasionally radiates to the arms. Less common sites of radiation include the abdomen, back, lower jaw, and…

…C based eGFR With an atypical muscle mass, or to confirm a creatinine based value The mean of creatinine and cystatin C The most reliable…

…entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather than an isolated disorder of the lower limbs. Patients…

…relatives of patients with PA Patients with hypokalaemia may develop weakness, muscle cramps or, in severe cases, periodic paralysis. Nevertheless, many patients are normokalaemic and…

…and degradation. Histologically, a vulnerable plaque is defined by a fibrous cap thickness of less than 65 μm, heavy macrophage infiltration, sparse smooth muscle…

…the acromion and the lower tip of the muscle insertion. 3. Stretch the skin with the thumb and index finger, or compress the muscle in…

…75–150 minutes per week of vigorous intensity aerobic activity; or An equivalent combination of moderate and vigorous intensity activity. Muscle strengthening exercise should additionally…

…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 bleeding complications than femoral access. In patients with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site bleeding, surgical repair, and…

…back or abdominal pain. Pain may be described as ripping, tearing, sharp or stabbing. Its location and radiation may reflect the segment of aorta involved…

…The extent of myocardial injury is strongly influenced by total ischaemic time. This interval includes: The time from symptom onset to recognition and seeking medical…

…many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The…

…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)…

…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…

…cardiac arrest is witnessed and the rhythm is shockable). This is explained by the fact that there are no means of determining what phase the…

…the victim's outcome: Neurological injury Myocardial dysfunction Systemic response to reperfusion and ischemia Effects of the underlying cause of cardiac arrest Neurological injuries may…

…cause of permanent loss of function is a tendon injury that was sutured over without being found. Indications A traumatic wound that gapes and cannot…

…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…

…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…

…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…

…control centre for advice on the treatment threshold and on whether haemodialysis should be considered. Rhabdomyolysis with marked elevation of CK and threatened kidney injury…

…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…

…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…

…cannula in a large vein gives many times the flow of a fine needle, and collapsed veins mean that the fine needle is in addition…

…and hyperkalemia. For recurrent symptomatic bradycardia, temporary or permanent pacing may be required. However, transcutaneous pacing in the setting of cardiac arrest has not demonstrated…

…injury. The syndrome is therefore both a clinical risk factor cluster and a marker of broader metabolic dysfunction. Associated abnormalities may include increased apoB and…

…insufficiency, hepatic injury, thrombocytopenia, coagulopathy, cerebrovascular events, hepatic capsule rupture, placental abruption, disseminated intravascular coagulation, and multiple organ failure. In the absence of treatment, approximately…

…only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac arrest often exhibit favorable neurological outcomes…

…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…

…medicine Definition and pathophysiology Acute pulmonary embolism (PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury…

…persistent organ injury Consider mechanical circulatory support Refractory advanced disease Consider palliative care Right ventricular failure is characterized by increased right atrial and right ventricular…

…after infarction and is usually transient. Late post acute myocardial infarction pericarditis , traditionally termed Dressler syndrome , which is a manifestation of post cardiac injury syndrome…

…the communication and the simultaneous delivery of red cells, plasma and platelets. Observational data from trauma suggest a lower overall mortality after such protocols are…

…membrane potential and action potential duration of affected myocardial cells. The resulting voltage gradient between normal and ischaemic myocardium generates currents of injury that are…

…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:…

…longer episodes, a lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI…

…in hypertensive encephalopathy and should prompt consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in…

…Stent implantation Manipulation of friable SVG lesions Embolic debris obstructs the distal microcirculation and may be accompanied by microvascular constriction and endothelial or myocardial injury…

…evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI), in which myocardial ischaemia is accompanied by cardiomyocyte necrosis and…

…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…

…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…

…biomarkers because they are extremely sensitive and specific for myocardial injury. Elevated levels of cardiac troponins is firm evidence of myocardial necrosis (i.e infarction…

…ligament injury, a tendon injury, or after suturing over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a…

…The diagnosis and the donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in…

…creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]. Important exceptions Condition Overall strategy Common first choices : : : Acute…

…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…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…risk of hypercapnic respiratory failure — COPD, severe obesity with hypoventilation, neuromuscular disease, marked chest wall deformity, severe bronchiectasis and cystic fibrosis. Here a lower target…