…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…

…tract. This process is not dose dependent. Similarly, angioedema occurring in the setting of ACE inhibitor therapy is bradykinin mediated rather than mast cell mediated…

…A transfusion set with a filter. Blood components must not be given through a set without a filter. Sodium chloride 9 mg/mL for flushing

…must be prescribed as one: with an indication, a route of administration and a target range for the saturation . What usually goes wrong is not…

…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…

…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…

…ECG) To ensure effective cardiac pumping function, the atria and the ventricles must be activated rapidly and sequentially. Rapid activation is important in order to…

…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…

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

…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…

…caused by haematological malignancy, stem cell transplantation, immunosuppressive drugs, radiotherapy, bone marrow failure and certain targeted cancer treatments. Fever is not obligatory Hypothermia, new confusion…

…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…

…The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left atrial size must also be…

…e currents generated by tissues that the electrode is not connected to). Also, external signals from electronics (cell phones, computers, etc) must also be ignored…

…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…

…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…

…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…

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

… one of the most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not exclude Diastolic collapse of the right atrium and…

…IMH than in classic type A dissection. PAU often differs clinically from classic dissection in that most patients do not have aortic regurgitation, pulse deficits…

…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…

…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…

…and Internet connected devices. Additional breakthroughs have been achieved in recent years, with the leadless pacemaker being the most promising improvement. 1 Given the wide…

…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…

…must consider rescue PCI. For the purpose of assessing ST segment return, one should preferably use continuous ST segment monitoring. If monitoring equipment is not…

…leads with similar angles must display similar ECG curves (diagrams). For some purposes (e.g. diagnosis of some arrhythmias) it is not always necessary to…

…water soluble and readily crosses cell membranes, allowing distribution throughout water containing tissues, including the myocardium. Its effects therefore depend not only on dose but…

…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…

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

…2,3]. Grading Grade the severity by the most serious finding. A patient does not have to meet every criterion in a column. Clinical deterioration…

…Sepsis is a dynamic condition. Investigation and treatment must therefore proceed in parallel and must not wait for complete diagnostic certainty. Sepsis is defined as…

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…

…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…

…it should not be considered abnormal. On the other hand, sinus bradycardia developing during physical exercise is considered abnormal, because heart rate must increase during…

…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…

…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…

…at least not under normal circumstances. However, impulses are occasionally discharged in the atrioventricular node or by cells near the node. The following must be…

…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…

…does not show that the P wave in lead II might actually be slightly asymmetric by having two humps. This is often (but not always…

…tends to occur in vessels with little or no lipid core, rich proteoglycans, and many smooth muscle cells, leading to a white, platelet rich thrombus…

…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…

…Myocardium is excitable not only by action potentials originating in the sinus node, but also by external electrical stimuli that drive the cells to threshold…

…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…

…Cells near the atrioventricular node: The atrioventricular node does not possess automaticity, but cells surrounding it do. These cells are capable of generating an escape…

…carotid sinus [baroreceptor] stimulation). It is common to discover SB in healthy young individuals who are not well trained. This is also a normal finding…

…9. Give thrombolysis as soon as haemorrhage and contraindications have been excluded. CT angiography or transport planning must not delay treatment unnecessarily. 10. In unknown…

…dangerous than a corresponding stable chronic value [4]. The grading must not be used mechanically. A patient with a plasma potassium of 6.2 mmol…

…least 10 units of red cells in 24 hours [5]. A continuing transfusion requirement while definitive control of the bleeding has not yet been achieved…

…to their indication. Do not routinely stop aspirin given as secondary prevention 8 Contact the endoscopist and the consultant on call early. In cirrhosis or…

…abnormalities from chronic baseline findings, but comparison with an earlier tracing must not delay treatment when acute coronary occlusion is suspected. Standard ECG pattern suggesting…

…QRS duration Hypertrophy may cause a slight prolongation of the QRS duration because it takes longer to depolarize the large ventricular mass. It does not…

…ventricles. This increases the automaticity in cells with natural automaticity but it may also provoke abnormal automaticity in cells that normally do not exhibit automaticity…

…some impulses are completely blocked, such that not all P waves are followed by QRS complexes. Second degree AV block is subdivided into the following…