…beginning of the next inspiration. Normal ETCO 2 : 38 mmHg (5 kPa) or 5%. Monitoring ETCO 2 aids in: Assessing ventilation quality. Determining ventilation rate…

…reduced consciousness or marked stillness Respiratory rate Under 25 per minute At least 25 per minute A falling rate, bradypnoea or apnoea Pulse Under 110…

…A respiratory rate of at least 22/min, increased work of breathing, a new oxygen requirement, a saturation below 93 per cent on air, or…

…needed. Intubate for a threatened airway, a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation…

…gas is needed mainly when concomitant respiratory failure or an exact assessment of oxygenation requires it [3]. Calculation of osmolality Use the same formula throughout…

…for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of CAD Characteristics suggesting that good quality imaging is achievable It…

…or an intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of…

…of the chosen finding — measurement, photograph or video. 3. Give atropine 0.5 mg intravenously (alternatively glycopyrronium 0.2 mg) to reduce the risk of…

…level of consciousness Coma Marked drowsiness, for example a Glasgow Coma Scale below 8 Vomiting together with clear neurological impairment Respiratory failure or respiratory arrest…

…specific 99th percentile upper reference limit. It is classified as acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic…

…or ambulatory pressure. Masked hypertension: office pressure below the hypertension threshold but hypertensive home or ambulatory pressure. Office measurements provide only a limited representation of…

…across the mitral valve using pulsed Doppler. Estimating left ventricular filling pressure via e' . Measurement of deceleration time (DT) . Diastolic function can be estimated from…

…and parasympathetic influences; sympathetic stimulation leads to vasoconstriction through the release of norepinephrine, while parasympathetic activation can cause vasodilation via acetylcholine release. These mechanisms collectively…

…with its most common waveforms. Important intervals and points of measurement are depicted. ECG interpretation requires knowledge of these waves and intervals. The P wave…

…high Lp(a) level may lead to substantial underestimation of cardiovascular risk. Conversely, Lp(a) measurement provides limited additional reclassification beyond currently recommended global risk…

…or supranormal ejection fraction , despite manifest heart failure and severe symptoms. These individuals exhibit pronounced hypertrophy, resulting in a reduction of ventricular volume and subsequently…

…25% Normal FS, 2D measurement 18% Advantages of fractional shortening If ventricular geometry is normal and there are no regional wall motion abnormalities, then fractional…

…this chapter, you will learn the physiological basis of all ECG waves and how to determine whether the ECG is normal or abnormal. Although heart…

…2 ) This formula is excellent for measuring pressure gradients across small openings, such as the valves. Importantly, in the setting of valvular stenosis or regurgitation…

…measurement in evaluating aortic root morphology. Age stratified formulas help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of…

…than for office measurement. Classification of office blood pressure Category Systolic Diastolic : : : : : Optimal < 120 and < 80 Normal 120–129 and/or 80–84…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…LVOT to improve the accuracy of the measurement. Flow velocity in LVOT : Velocity is measured in apical four chamber view (4C) or five chamber view …

…with a braked, workload controlled resistance; 12 lead ECG with continuous recording; automated or manual blood pressure measurement. Resuscitation trolley with defibrillator, oxygen, suction and…

…e.g left ventricular diameter, are evaluated in several views in order to assess the reliability and reproducibility of the measurements. The parasternal and apical…

…Insert a urinary catheter and start hourly urine output measurement. 5. Give a bolus of sodium bicarbonate 1–2 mmol/kg intravenously in symptomatic salicylate…

…in oedema and ascites, and in people under 18 years of age, where iso BMI or percentile charts should be used. Waist circumference Measure the…

…checked with a capillary or venous measurement [5]. Treatment The awake patient who can swallow safely Give 15 to 20 g of rapid acting carbohydrate…

…be questioned specifically about neurological symptoms during the preceding 6 months. Those with symptoms suggestive of TIA or stroke require neurological consultation and, when appropriate…

…quantify the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs). This measurement is pivotal in diagnosing and managing congenital or acquired cardiac…

…How to measure the QT interval Measurement of the QT interval may be difficult due to T wave changes. Causes of prolonged QTc duration Antiarrhythmics …

…cardiovascular societies, defines HF as a clinical syndrome corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [3] . Within…

…types of heart failure: HFPEF , HFmrEF and HFREF . This classification is based primarily on the measurement of left ventricular ejection fraction (LVEF). The majority of…

…types of heart failure: HFPEF , HFmrEF and HFREF . This classification is based primarily on the measurement of left ventricular ejection fraction (LVEF). The majority of…

…the LVEF measurement is reliable. Nevertheless, these findings increase diagnostic confidence. The presence of symptoms alone is insufficient. Anaemia and pulmonary, renal, thyroid or hepatic…

…can be determined since the speed of ultrasound is constant in the body. The investigator specifies where the measurement should be performed by moving the…

…myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma. Suspected bone marrow metastasis. Assessment of treatment response and measurement of residual…

…primarily in the context of suspected acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent symptoms…

…using pulsed wave Doppler and measurement of the diameter. Cardiac output (CO) Cardiac output is the product of stroke volume (SV) and heart rate (HR)…

…still and lowered at each measurement, and not to talk. Otherwise ordinary activities, including work. No showering or bathing. A diary of going to bed…

Echocardiography Tissue Doppler (Tissue Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the Doppler effect can also…

…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…

…may be falsely normal because of medial sclerosis — in that case add toe pressure measurement. Absolute: ABI < 0.5 or toe pressure < 30…

…at a rate appropriate to tissue requirements unless filling pressures are elevated. The syndrome is therefore defined by symptoms and signs of congestion or impaired…

…enabling depolarization and repolarization, and between cells via gap junctions, facilitating the propagation of depolarization across the cells. Electrical potential differences arise as the electrical…

…in haematological malignancy. Investigation of dementia with biomarkers (amyloid, tau, phospho tau). Measurement of the opening pressure in suspected idiopathic intracranial hypertension. Therapeutic drainage in…

…retention. Chronic urinary retention with renal impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient…

…1. (A) Flow velocity increases as a liquid approach a circular opening. The flow profile gradually assumes the shape of a hemisphere with multiple layers…

…or dialysis DOACs are not recommended. Warfarin after individual assessment Rule of thumb for the monitoring interval: eGFR divided by 10 gives the number of…

…loss or large volume shifts. Patients in whom non invasive measurement is unreliable: marked obesity, pronounced vasoconstriction, arrhythmia, intra aortic balloon pump. Assessment of stroke…

…↓ or normal ↑ or normal Obstructive (tamponade, PE) ↓ ↑ ↑ ↓ Vital signs and measures of perfusion Parameter Normal Comment : : : Heart rate 50…

…wide or narrow complex tachycardia in which the mechanism needs to be documented before referral to an arrhythmia unit. Assessment of the effect of adenosine…

…contractility of hypothermia are not tolerated. A decision to withhold further life sustaining treatment. Preparation and equipment Continuous core temperature measurement. An oesophageal probe or…

…ECG Initial hs cTn measurement Continuous cardiac monitoring The source material does not provide a detailed list of physical examination findings or a specific examination…

…by adjusting the QT interval for the heart rate, and the resulting QT interval is referred to as corrected QT interval, or simply QTc interval…

…apply to the anti inflammatory effect. They say nothing about the mineralocorticoid effect or about suppression of the HPA axis, where a long half life…

…or new organ damage in which immediate, controlled blood pressure lowering can limit the damage. The choice of drug, the target pressure and the rate…

…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…

…consideration of treatable contributors, such as underlying comorbidities, supervised muscle strengthening physiotherapy, exercise, and coordination and balance training. Orthostatic Blood Pressure Measurement Before starting or…

… or An undiagnosed secondary cause of hypertension. White coat hypertension must be excluded with out of office measurements. Objective assessment of adherence may be undertaken…