…determine afterwards whether a nerve injury was caused by the injury or by the treatment. Indications A clinically or radiologically confirmed dislocation of the shoulder…

…poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An…

…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…

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

…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…

…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…

…ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when…

…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…

…and Pathophysiology Myocardial injury Myocardial injury is a biochemical diagnosis defined by at least one cardiac troponin value above the assay specific 99th percentile upper…

…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…

…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…

…with at least one value above the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and…

…effectiveness of the interventions. Numerous studies demonstrate that the available interventions are time sensitive, and to maximize the likelihood of restoring spontaneous circulation, interventions should…

…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…

…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…

…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…

…Thoracostomy This method is generally deemed safer than using a needle due to reduced risk of injury. Thoracostomy should be performed promptly following needle decompression…

…on the upper border of the tarsal plate with a cotton bud, and at the same time fold the lid margin upwards and backwards towards…

…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…

…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…

…a large bore cannula in a suitable vein). Standby access in a patient at risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access…

…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…

…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…

…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…

…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…

…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…

…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…

…also contributes to the extension and severity of ischemic injury. In its most severe form, known as no reflow, structural and functional impairments sustain vascular…

…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…

…myocardial injury shown by laboratory testing. Comorbidity and aggravating conditions , which may worsen early prognosis even when haemodynamic status is initially preserved. Physical examination should…

…objective of decongestion is clinical euvolemia rather than an isolated numerical change in weight. Assessment should integrate the history, physical examination, laboratory data and diagnostic…

…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…

…and a faster release kinetics. This may explain higher peak levels of cTnI compared with cTnT. Normal values (reference values) URL (upper reference limit) : The…

…at the same time [1]. Activate the local major haemorrhage protocol early. Protocols improve above all the logistics, the communication and the simultaneous delivery of…

…suspected acute coronary syndrome. It should be obtained immediately at first medical contact and interpreted within a target of 10 minutes. Prehospital ECG acquisition can…

…supply and demand. The clinical history should therefore be examined for potential physiological or systemic stressors, with treatment directed at the precipitating condition. Myocardial and…

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

…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…

…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…

…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…

…much more common than upper extremity symptoms. The severity of symptoms should be described by their effect on walking distance, daily activities, work and independence…

…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…

…to endothelial injury [2] . The process initiates with endothelial dysfunction, a state provoked by systemic risk factors such as hypertension, hyperglycemia, smoking, and turbulent hemodynamic…

…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…

…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…

…symptoms should be distinguished from severe muscle injury. Myopathy is characterized by muscle symptoms accompanied by CK greater than 10 times the upper limit of…

…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…

…to the injury before the swelling develops. Procedure 1. Place the joint at the angle the treatment requires before the cast is applied, and hold…

…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…

…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…

…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

…and backwards along the superior wall of the ear canal , past the plug — not straight at it. The water should get behind the wax and…

…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…

…better alternative. Follow up At an eGFR below 60, or in the presence of albuminuria: check the potassium, calcium, phosphate, PTH, haemoglobin and bicarbonate , review…

…Methotrexate: NSAIDs inhibit tubular secretion of methotrexate, increasing plasma levels and risk of toxicity. Avoid combination with high dose methotrexate. Digoxin and lithium: Acetylsalicylic acid…

…of intervention. The assessment should also clarify: Whether AF is pre existing, newly detected, or newly developed during the acute illness The ventricular rate and…