…question. A patient who declines blood transfusion. The decision must be documented and alternatives (iron, tranexamic acid, cell salvage, haemorrhage control) planned in advance. A…

…severe, myocardial necrosis. It most commonly reflects atherothrombosis: disruption of an atherosclerotic plaque followed by platelet activation and coagulation, with formation of an intraluminal thrombus…

…the atria and the ventricles must be activated rapidly and sequentially. Rapid activation is important in order to activate as much myocardium simultaneously as possible…

…cells The contractile cells, unlike cells of the sinoatrial node, display a true resting potential (phase 4), which is around –90 mV. These cells must…

…Additional breakthroughs have been achieved in recent years, with the leadless pacemaker being the most promising improvement. 1 Given the wide use of pacemakers and…

…In 2015, high body mass index (BMI) was linked to approximately 4.0 million deaths worldwide, with more than two thirds—roughly 67%—of these…

…sodium loading. It is the most common form of secondary hypertension. Aldosterone acts principally through the mineralocorticoid receptor (MR). After entering target cells, it binds…

…positive and smooth wave. It is small because the atria make a relatively small muscle mass. If the rhythm is sinus rhythm (i.e under…

…injury. In its most severe form, known as no reflow, structural and functional impairments sustain vascular obstruction. Endothelial dysfunction triggers leukocyte and platelet activation, while…

…The desmosome is a component of the intercalated disc that connects myocardial cells mechanically and electrically. Most mutations are inherited in an autosomal dominant manner…

…or other ectopic focus) are referred to as an escape rhythm. In most cases, the escape rhythm originates in either of the following three structures…

…parallel to definitive control of the bleeding. Activate the protocol in Activation must be based on an overall assessment, not on a single threshold value…

…dependent. Similarly, angioedema occurring in the setting of ACE inhibitor therapy is bradykinin mediated rather than mast cell mediated, distinguishing it from classic allergic reactions…

Procedurer Oxygen is a drug and must be prescribed as one: with an indication, a route of administration and a target range for the saturation…

…by the fact that there is no (or very little) turnover of myocardial cells and therefore myocardial troponins should not be detected in the blood…

…neuronal cell death begins in the central ischemic zone, where the ischemia is most pronounced and extends towards the penumbra zone (the outermost and less…

…made is unusable, no matter how well the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or…

…moment the spray starts. Let the tissue thaw completely between cycles — it is the freeze–thaw–freeze cycle that causes cell death, not the cold…

…always weighs more heavily). A joint prosthesis: the aspiration must be performed by an orthopaedic surgeon under strictly sterile conditions. For corticosteroid injection there is…

…or where sepsis is highly likely, antibiotics must be given immediately [3]. This quick reference applies chiefly to adults with neutropenia related to cancer treatment…

…into the subcutis Never a shave — the depth must be measurable Basal cell carcinoma, squamous cell carcinoma 3–4 mm punch or shave Diagnostic biopsy…

…cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic PAH, including acute responders and non responders. Left heart disease is the most…

…Also, external signals from electronics (cell phones, computers, etc) must also be ignored. The atrial lead is therefore set to record signals with an amplitude…

…genes encoding potassium and calcium channels of the outer cell membrane. Clinical presentation of Brugada syndrome Most patients are asymptomatic until the age of 20…

…or catheterization laboratory. A 12 lead ECG must be obtained immediately after ROSC in order to identify cases with ST segment elevations, which demand urgent…

…DKA and HHS are dynamic conditions. Treatment must be guided by the clinical response and by repeated laboratory measurements, not by the values on admission…

…With ultrasound guidance, the point at which the fluid lies most superficially is chosen and the needle is followed all the way in, which has…

…These disruptions may initiate or complicate the haematoma. IMH most frequently involves the descending thoracic aorta, which is affected in approximately 60%–70% of cases…

…without plaque rupture, coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous…

…be suitable for quantifying myocardial blood flow, its uptake by the myocardium must closely correlate with actual blood flow. An ideal tracer exhibits high extraction…

…60 minutes after administration of thrombolysis. Otherwise, one must consider rescue PCI. For the purpose of assessing ST segment return, one should preferably use continuous…

…electrical events but from different angles. This means that ECG leads with similar angles must display similar ECG curves (diagrams). For some purposes (e.g…

…to moderate concentrations and first order kinetics at higher concentrations. Ethanol is water soluble and readily crosses cell membranes, allowing distribution throughout water containing tissues…

…19]. It is currently considered the most frequent form of CA worldwide [15]. Clinical Presentation and Course Both AL and ATTR CA typically present as…

…Indeed, any cell type in the ventricles may cause ventricular arrhythmias. Definitions and ECG criteria for ventricular rhythm and idioventricular rhythm Ventricular rhythm exists if…

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…

Lungmedicin Akutsjukvård Lathundar Immediate management The most dangerous asthma attack is the silent one. A patient who has become calm, quiet in the chest and…

Infektionssjukdomar Akutsjukvård Lathundar Purpose and scope A quick reference for the doctor on call faced with suspected sepsis in adults: rapid recognition, microbiological sampling, empirical…

Procedurer Catheterisation is straightforward in most patients and dangerous in a few. The male urethra is about 25 cm long with two curves and a…

CPR This chapter will introduce the most common and essential terms used in resuscitation science, providing a foundation for understanding subsequent chapters. SCA (Sudden Cardiac…

…wave. Because of the long duration of the plateau phase most contractile cells are in this phase at the same time (more or less). Moreover…

…discussed, all cardiac cells—both conduction and contractile cells—must undergo rapid repolarization to ensure they are excitable when the next action potential occurs. If…

Arrhythmias and arrhythmology ECG Mechanisms of cardiac arrhythmias: from automaticity to re entry This section introduces the most common arrhythmias encountered in clinical practice, beginning…

…diseases: effusion and tamponade A long series of conditions can affect the pericardium (pericardium). The most common of these are acute pericarditis (perimyocarditis), constrictive pericarditis…

…Briefly, exercise stress testing must not be performed in the presence of absolute contraindications. Relative contraindications call for an individualized assessment of the risks; if…

…by middle age, most persons have some degree of atherosclerosis in the coronary arteries. Advanced atherosclerotic plaques contain inflammatory cells, smooth muscle cells, extracellular matrix…

…or by cells near the node. The following must be noted: There are cells with pure automaticity around the atrioventricular node. These cells are capable…

…must not delay reperfusion. 5. Give aspirin if acute coronary syndrome is likely and aortic dissection or active major bleeding is not suspected. 6. Call…

…Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells…

…cTnT, and cTnC. The isoforms cTnI and cTnT are specific to cardiac muscle cells. Cardiac troponin levels are extremely low in healthy subjects; the 99…

…This function of the pacemaker is referred to as sensing . Most pacemakers use two leads; one in the right atrium and one in the right…

…In reality, the course in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications, are as follows…

…bradycardia. The most important causes are as follows: Myocardial ischemia/infarction – Particularly ischemia or infarction located to the inferior wall of the left ventricle. This…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high dose salbutamol in marked hyperkalaemia if there is no contraindication. 5…

…or frequent blood gases are needed 3 Blood grouping and cross matching. Order red cells early with ongoing major bleeding 4 Tests: haemoglobin, platelet count…

…in the anterior precordial leads. Acute myocardial ischaemia alters the resting membrane potential and action potential duration of affected myocardial cells. The resulting voltage gradient…

…and algorithms have been developed over the years. Most of them are easy to use and require very little calculation. Sensitivity and specificity vary markedly…

…digoxin may cause life threatening arrhythmias, every healthcare provider must be able to recognize common digoxin ECG changes and arrhythmias. Digoxin effects on cardiac function…

…the ventricles to exhibit any electrical—and consequently mechanical—activity, an escape rhythm must originate from an ectopic focus located distal to the block. Thir