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

…to local protocol. Potassium chloride for infusion. Urine dipstick with a pH scale, or urine pH measurement on a blood gas analyser. Blood gas equipment…

…the bridge of the nose. The resistance at the posterior pharyngeal wall after about 10–15 cm is expected. 5. Ask the patient to flex…

…due to histamine release, not allergy. Concurrent MAO inhibitor, particularly with pethidine. Caution: untreated sleep apnoea, a concurrent benzodiazepine or gabapentinoid, marked hypovolaemia, head injury…

…a high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in…

…output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to hypovolaemia, shock, obstruction or advanced renal injury…

…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…

…to detect fractures that have occurred or been unmasked. Preparation and equipment An examination couch that can be lowered, preferably allowing the prone position. Monitoring…

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

…of aorta involved, although the source material does not provide a detailed symptom to anatomy correlation. Pain may be absent, particularly in iatrogenic aortic injury…

…may therefore identify a continuum of myocardial injury ranging from minor or reversible injury to extensive necrosis. Causes of myocardial injury Important causes include: Mechanism…

…limitation of infarct size. The extent of myocardial injury is strongly influenced by total ischaemic time. This interval includes: The time from symptom onset to…

…the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic injury because of its high blood…

…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)…

…as renal failure). To establish a diagnosis of MI, acute myocardial injury must be coupled with clinical evidence of acute myocardial ischaemia. The Fourth Universal…

…to defibrillate immediately if cardiac arrest is witnessed and the rhythm is shockable). This is explained by the fact that there are no means of…

…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…

…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…

…cuff, a cuff manometer. A laryngeal mask of the correct size as a rescue airway, and surgical airway equipment (a size 10 scalpel, a bougie…

…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…

…risk of permanent neuronal injury increases. Treatment must therefore start at 5 minutes and be escalated without unnecessary pauses [1]. The aims are, simultaneously, to…

…enough to proceed with urgent investigation , and a normal CT of the brain does not exclude an infarction in the posterior fossa. Preparation and equipment…

…continuous ECG monitoring and early assessment of the need for dialysis ECG changes or serious neuromuscular symptoms mean a high risk even if the plasma…

…access (absolute, for the bone in question): A fracture of the bone to be punctured, or a major injury proximal to the puncture site. A…

…of drug toxicity, such as digitalis excess. Biomarkers and Laboratory Findings The source material does not provide information on biomarkers or laboratory findings specific to…

…stiffness, impaired coronary circulation, vascular calcification and myocardial fibrosis further accelerate cardiovascular and renal injury. Adipokine imbalance contributes to insulin resistance, β cell failure, endothelial…

…100 cases of preeclampsia may progress to eclampsia. Clinical presentation and symptoms The clinical spectrum ranges from hypertension without apparent organ injury to severe multisystem…

…an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand, which is not related to acute coronary atherothrombosis…

…due to a direct, non penetrating traumatic blow to the chest. Unlike commotio cordis, contusio cordis implies actual structural injury to the tissues. Manifestations of…

…ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow…

…extend injury beyond the initial ischemic zone and contributes to ventricular failure. Mechanisms of Shock The central consequence of extensive infarction is loss of contractile…

…tissue inflammation promote extravascular compression, exacerbating myocardial injury. Clinical Presentation and Symptoms In up to one half of STEMI cases, a precipitating factor such as…

…electrolytes in intensive care Neurological monitoring Parameter Target Comment : : : Intracranial pressure (ICP) < 22 mmHg The treatment threshold in traumatic brain injury Cerebral perfusion pressure …

…and myocardial injury. This classification is central to determining the intensity of monitoring, supportive treatment, anticoagulation, and possible reperfusion. The principal pathophysiological determinant of early…

…formally to reduce heart failure mortality; its established role is symptom relief and prevention of recurrent congestion and hospitalization. Clinical presentation and symptoms Symptoms of…

…of post cardiac injury syndrome (PCIS). PCIS is an umbrella term that also includes post pericardiotomy syndrome and post traumatic pericarditis, including cases related to…

…consists of troponin I (TnI) , troponin C (TnC) and troponin T (TnT) , which enable the interaction between actin and myosin and are therefore fundamental to…

…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…

…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…

…myocardial injury and troponin elevation but are non ischaemic mimics rather than MINOCA when identified as the final diagnosis. Reported prevalence varies according to the…

…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…

…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…

…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]…

…a detailed list of physical examination findings or a specific examination sequence. It does, however, emphasize that symptoms and vital signs contribute to initial triage…

…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…

…form of muscle injury. The biological basis of many reported muscle symptoms remains uncertain. Randomized trials have shown muscle adverse event rates similar to those…

…two decades (many of those who would previously have been classified as unstable angina are now classified as NSTEMI due to the sensitive troponin assays…

…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…

…Condition Overall strategy Common first choices : : : Acute aortic syndrome Immediate rate control and rapid reduction of the systolic blood pressure towards 100 to 120 mmHg…

…if possible, otherwise give IM with a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative…

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

…positive airway pressure and washes out dead space. It requires special equipment and monitoring The nasal cannula, the simple mask and the reservoir mask deliver…

…Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2 60–89 Mildly reduced G3a 45–59 Mildly to moderately reduced…

…binding to plasma albumin, but the therapeutic effect remains unchanged. Sulfonylureas: Salicylates may potentiate the hypoglycemic effect of sulfonylureas, possibly due to reduced binding to…