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…

…longer a joint remains dislocated, the harder the reduction becomes and the greater the risk of chondral and neurovascular injury. Aim for reduction within a…

…with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site bleeding, surgical repair, and blood transfusion with radial access. Radial access has…

…of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic aortic injury. In classic dissection, an intimal tear permits blood…

…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…

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

…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…

…brain death. The cause of brain injuries is anoxic cell death, continued dysfunction in cerebral blood flow (autoregulation) after ROSC and cerebral hypoperfusion. Myocardial dysfunction…

…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…

…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…

…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…

…sampling. Urinary catheter with hourly urine output measurement — the treatment cannot be guided without reliable measurement of urine output. Baseline tests: blood gas with electrolytes…

…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…

…or blood products. Contrast medium for CT (this requires a large bore cannula in a suitable vein). Standby access in a patient at risk of…

…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…

…in function. The severity of tissue injury depends on the site, duration and completeness of occlusion and on the adequacy of collateral blood flow. Ischaemia…

…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…

…entity requiring immediate reperfusion therapy. The pathophysiology of myocardial infarction injury involves the overlapping of vulnerable plaque and thrombogenic blood, which are critical determinants for…

…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…

…with expansion of both the intravascular and extravascular compartments. Heart failure is defined physiologically by the inability of the heart to provide blood flow appropriate…

…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…

…and T) has been validated. The risk of interference with antibodies in the blood is higher for troponin I (cTnI). Antibody interference is a rare…

…the pattern of injury or disease, the response to initial treatment and the expected continued bleeding matters more than an exact estimate of blood loss…

…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…

…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…

…or immediately after PCI. The clinical presentation depends on the extent of microvascular obstruction and the territory supplied by the treated vessel. Possible manifestations include…

…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]…

…isolation because myocardial injury is also encountered in non ACS cardiopulmonary disease. Patients with persistent or recurrent chest pain require repeat blood sampling even when…

…and reduced LV systolic function. The principal mechanisms are the combination of an abnormal thrombogenic endocardial surface and blood stasis. During the acute infarction phase…

…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…

…causing microvascular embolization (i.e occluding smaller vessels downstream). The thrombosis causes occlusion of the artery; blood flow may be partially or completely obstructed. Consequently…

…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…

…a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An alcohol or chlorhexidine swab. Let the skin…

…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…

…spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy: an otoscope with a charged battery and clean disposable specula…

…hyperoxia increases the risk of pulmonary toxicity. Keep the saturation in the lower part of the target range. Paraquat poisoning — oxygen worsens the lung injury…

…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…

…the efficacy of diuretics and antihypertensives. Risk of acute kidney injury increases when combined with ACE inhibitors. Corticosteroids and other NSAIDs: Increased risk of gastrointestinal…

…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…