…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…

…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…

…KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in creatinine of at least 26…

…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…

…Pain may be absent, particularly in iatrogenic aortic injury. Iatrogenic lesions commonly follow cardiac surgery, coronary angiography or other invasive procedures, and affected patients may…

…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)…

…seizures and temperature management. The ICU is the preferred level of care for the absolute majority. The CCU may be suitable for stable (hemodynamically and…

…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…

…Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic…

…setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases. Other causes…

…pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk…

…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…

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

…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…

…Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand…

…UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis…

…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…

…with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional atherosclerotic risk factors. A substantial proportion present…

…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…

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

…Discontinue acetylsalicylic acid at the first sign of skin rash, mucosal lesions, or hypersensitivity. Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates…

…directed specifically at reperfusion injury have not generally demonstrated sufficient clinical benefit for routine use. No reflow may also occur in association with other procedural…

…of myocardial infarction. Cardiac troponin T and troponin I have emerged as the preferred biomarkers because they are extremely sensitive and specific for myocardial injury…

…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…

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

…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…

…Myocardial injury leads to release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated…

…Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of left ventricular hypertrophy or left…

…transmural ischemia. On the other hand, leads V1–V3 (occasionally V4) may detect the injury currents and present them as ST segment depressions. These depressions…

…with atrial fibrillation in the absence of an underlying structural cardiac explanation Early onset hypertension or cerebrovascular accident at a young age in the patient…

…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]…

…the opposite angle of observation. The injury currents are not strong enough to be detected on leads with opposite angle of observation. Other vectors may…

…in females or at least 15 drinks weekly in males, or binge drinking in either sex. Other definitions of unhealthy drinking include at least two…

…inflammation and other systemic influences. The severity of myocardial injury is determined not only by the epicardial obstruction but also by the vulnerability of the…

…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…

…and cardiovascular death — a patient with an eGFR of 70 and A3 is at higher risk than one with an eGFR of 50 and A1…

…resolution does not consistently permit identification of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well…

…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…

…Concussion, temporal bone injury, dissection, aminoglycoside toxicity, antiepileptic drugs, alcohol or sedatives Trauma and medication directed workup This corresponds to the principles of TiTrATE, in…

…platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation…

…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…

…vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the emergency room: a very large or deep abscess…

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

…drug concentration Gentamicin and other aminoglycosides A single dose initially. If treatment is continued, dosing is guided by drug concentration measurement. At a creatinine clearance…

…or unsecured airway in a patient with a reduced level of consciousness Gastric lavage Corrosive injury or suspected oesophageal perforation Gastric lavage Petroleum products Gastric…

…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…

…Acute myocardial infarction requires: Acute myocardial injury, demonstrated by a rise and/or fall in cardiac troponin with at least one value above the 99th…

…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…

…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…

…rhythm is shockable). This is explained by the fact that there are no means of determining what phase the patient is in. The three phases…

…been assessed for tendon and nerve injury will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained contamination…

…the need for more invasive and costly direct measurements of GFR. Limitations of MDRD eGFR Accuracy at Higher GFR Levels: The MDRD equation tends to…

…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…

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

…After about 30 minutes of continuous convulsive activity, t2, the risk of permanent neuronal injury increases. Treatment must therefore start at 5 minutes and be…

…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…

…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…