…to a prosthesis) — a high risk of avascular necrosis of the femoral head and of vascular injury; always an orthopaedic surgeon, and usually general anaesthesia…

…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…

…Capillary refill is delayed, and venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent…

…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…

…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…

…muscle cells, leading to a white, platelet rich thrombus. Myocardial vulnerability, largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of…

…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…

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

…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…

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

…and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic aortic injury…

…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…

…in three lengths: short for children and slim limbs, medium for most adults, long for thick soft tissue and for the head of the humerus…

…to the evaluation of bradycardia. Treatment and Management, Including Acute and Long Term Strategies The initial approach to bradycardia management involves identifying and treating any…

…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…

…Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac arrest often exhibit favorable neurological outcomes ( Rawshani et al ). Traumatic cardiac arrests typically…

…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 combination of physiology, rate of bleeding, the pattern of injury or disease, the response to initial treatment and the expected continued bleeding matters more…

…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:…

…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…

…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…

…abnormality is inadequate distal perfusion in the absence of a major residual epicardial obstruction. No reflow is associated with serious short and long term outcomes…

…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…

…and that the donor's organs are maintained physiologically for as long as the assessment takes. The task of the health service is to give…

…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…

…a concurrent benzodiazepine or gabapentinoid, marked hypovolaemia, head injury with impaired consciousness, biliary tract disease. There is no contraindication to analgesia in the acute abdomen…

…Diabetes, immunosuppression A risk of necrotising otitis externa Anticoagulant treatment Bleeding into the ear canal Previous radiotherapy to the head and neck Fragile skin, poor…

…carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal value. Give 100 % oxygen on a reservoir mask — this markedly shortens the half life of carbon monoxide…