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

…than mast cell mediated, distinguishing it from classic allergic reactions. Clinical Presentation and Symptoms ACE Inhibitor Induced Cough ACE inhibitor induced cough occurs in 5…

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

…in place for days without anyone asking why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask…

…and the cell membranes collapse whereby cellular proteins are released into the circulation. It is possible to detect elevated levels of myocardial proteins in blood…

…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 cardiac cycle starts when cells in the sinoatrial node discharge an action potential that spreads as an electrical impulse through the atria and – via…

…studies in stroke, which differs pathophysiologically from cardiac arrest. In stroke, neuronal cell death begins in the central ischemic zone, where the ischemia is most…

…the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology…

…A corticosteroid must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in which septic arthritis must be…

…clinically unwell must be managed as an emergency even at a lower temperature. Suspect neutropenia in anyone who has received cytotoxic chemotherapy in the past…

…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…

…disease is the most common risk factor for PH. It produces postcapillary PH through elevation of left atrial and pulmonary venous pressure. In some patients…

…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…

…These mutations are located in genes encoding potassium and calcium channels of the outer cell membrane. Clinical presentation of Brugada syndrome Most patients are asymptomatic…

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

…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…

…crosses cell membranes relatively freely and therefore does not produce the same sustained shift of water [3]. Severity of DKA The classification helps in choosing…

…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…

…imaging demonstrates small intimal disruptions in approximately 20%–60% of cases. These disruptions may initiate or complicate the haematoma. IMH most frequently involves the descending…

…defined by its cardiovascular consequences. In 2015, high body mass index (BMI) was linked to approximately 4.0 million deaths worldwide, with more than two…

…advised in interpreting it without corroborating evidence of a coronary mechanism. The clinical context and the underlying mechanism of the oxygen supply/demand imbalance must…

…leadless pacemaker being the most promising improvement. 1 Given the wide use of pacemakers and the trend towards increased use of cardiac devices in general…

Cardiology SPECT vs. PET In SPECT (Single Photon Emission Computed Tomography), radiotracers emit gamma photons directly. These gamma rays are detected by gamma cameras to…

…in 50% ST segment return (i.e reduction of the ST segment elevation by 50%) within 60 minutes after administration of thrombolysis. Otherwise, one must…

…across the cells. Electrical potential differences arise as the electrical impulse travels through the heart. Electric potential difference is defined as a difference in electric…

…hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and mass…

…amyloidosis [8, 15]. AL Amyloidosis: This is a plasma cell dyscrasia in which abnormal plasma cells produce misfolded immunoglobulin light chains [8, 19]. Light chains…

…T segment and the rhythm is regular (in most cases). Idioventricular rhythm starts and terminates gradually. It occurs in other situations than does ventricular rhythm…

…by muscle mass, nutrition, drugs and fluid balance. Fluid administration can dilute the creatinine and mask the deterioration, while dehydration can concentrate it. In older…

…and dynamic hyperinflation. The consequences are increased work of breathing, exhaustion and, in the most severe cases, hypotension, pneumothorax and respiratory arrest [1]. The first…

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…

…pressure favor coronary blood flow. A CPP of approximately ≥ 15 mmHg is required to induce spontaneous electrical activity in myocardial cells. CPP below 15 mmHg…

…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 in this chapter because the phenomenon is frequently observed during arrhythmias. As previously discussed, all cardiac cells—both conduction and contractile cells—must undergo…

…particularly if spontaneous or diuretic induced, but it is absent in most diagnosed patients. Reliance on hypokalaemia alone therefore misses a substantial proportion of cases…

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…

…thick, rich in connective tissue and envelops the entire heart and the departures of the larger vessels. The visceral layer consists of mesothelian cells, collagen…

…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…

…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…

…impulses are occasionally discharged in the atrioventricular node or by cells near the node. The following must be noted: There are cells with pure automaticity…

…dissection or active major bleeding is not suspected. 6. Call the PCI service immediately in STEMI, a STEMI equivalent or very high risk NSTEMI. 7…

…surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go, adenosine activates potassium channels (IK.Ach, K.Ado) in a manner analogous…

…pulmonary artery pressure etc . The right atrium must then enlarge (hypertrophy) in order to manage to pump blood into the right ventricle. Right atrial enlargement …

…coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe form, known as no reflow, structural and functional…

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

…main principle behind artificial pacemakers; i.e applying an external electrical current that depolarizes cells in contact with the lead tip, and thus generate an…

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

…possess automaticity and thus pacemaker function. The intrinsic rate of depolarization in these cells is 60 beats per minute. The resulting P wave is morphologically…

…verapamil, diltiazem, amiodarone, clonidine) – These drugs affect the pacemaker cells in the sinoatrial node. They may also induce conduction defects (e.g. AV block). Increased…

…and contraindications have been excluded. CT angiography or transport planning must not delay treatment unnecessarily. 10. In unknown time of onset, wake up stroke or…

…calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high dose salbutamol in…

…called critical administration threshold and identifies rapid bleeding better than the retrospective definition of at least 10 units of red cells in 24 hours [5]…

…loss, plasma and red cells are lost simultaneously, which means the haemoglobin can be normal before fluid has redistributed or been given. In massive bleeding…

…indirectly as reciprocal abnormalities in the anterior precordial leads. Acute myocardial ischaemia alters the resting membrane potential and action potential duration of affected myocardial cells…

…Most of them are easy to use and require very little calculation. Sensitivity and specificity vary markedly, as discussed in detail in the articles on…

…diminishes the automaticity in the sinoatrial node (which lowers heart rate) and also slows conduction over the atrioventricular (AV) node. The most classical ECG finding…

…junctions in AV nodal cells), which allows for ventricular filling to complete prior to ventricular contraction. In contrast, contractile cells–and Purkinje fibers in particular…