…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…

…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…

…risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma, burns or status epilepticus when peripheral access…

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

…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…

…marked elevation of CK and threatened kidney injury, as an adjunct to the decisive measure: early and generous fluid administration. The benefit of alkalinisation over…

…or both. The clinical consequences of extracellular volume expansion include elevated cardiac filling pressures, pulmonary congestion, systemic venous hypertension, and peripheral interstitial edema. These abnormalities…

…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…

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

…peripheral vasoconstriction, impaired consciousness, a rising lactate or a worsening acidosis. An assessed need for at least 4 units of red cells within 1 hour…

…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…

…associated with lower cardiovascular and all cause mortality and with reduced incidence or burden of hypertension, type 2 diabetes, coronary disease, stroke, peripheral arterial disease…

…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…

…with advancing age. Presentations without pain may include: Sudden breathlessness Syncope or sudden loss of consciousness Confusion Profound weakness An arrhythmia Peripheral embolism An ot

…heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have often described a J shaped association between…

…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…

…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…

Njurmedicin Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine…

…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…

…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…

…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…

…ischaemic ECG changes. The distinction between myocardial injury and type 2 infarction is particularly important. Type 2 infarction requires clinical evidence of ischaemia; an elevated…

…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…

…exposures may contribute to tubular injury, making attribution to contrast alone difficult. In patients with normal renal function, the occurrence of contrast induced AKI is…

…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…

…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…

…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…

…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…

…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…

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

…bradycardia and acute kidney injury may be at greater immediate risk than a stable dialysis patient with a plasma potassium of 6.6 mmol/L…

…of rhythm disturbances characterized by an inappropriately slow heart rate. Within the context of acute coronary syndromes, particularly ST elevation myocardial infarction (STEMI), ischemic injury…

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

…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…

…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…

…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…

…of skull fracture or a marked midfacial fracture — the tube can pass through a fracture in the cribriform plate into the cranium Absolute Corrosive injury…

…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…

…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…

…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…

…traditionally termed Dressler syndrome , which is a manifestation of post cardiac injury syndrome (PCIS). PCIS is an umbrella term that also includes post pericardiotomy syndrome…

…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…

…in which the patient has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia…

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

…with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations arising from structural or functional abnormalities of the…

…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…

…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…

…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…

…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]…

…and Evidence that the injury is caused by myocardial ischaemia. Accordingly, acute troponin elevation without evidence of ischaemia represents acute myocardial injury rather than MI…

…hours of infarction. Early thrombus formation is associated with poor short term prognosis, although early mortality is usually related to the extent of myocardial injury…

…Rhabdomyolysis is a rare, severe form of muscle injury. The biological basis of many reported muscle symptoms remains uncertain. Randomized trials have shown muscle adverse…

…cord injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against the skin, protects against the edges of…

…donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain infarction…

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

…with a high BMI, and that the deltoid injection is placed too high — which causes the shoulder injury known as SIRVA. Both are avoided with…

…is given. The serious incidents almost always arise when the principle of titration is abandoned — when a fixed dose is given without assessment, when a…