…is chiefly short term Lateral epicondylitis At the extensor origin Consider withholding it; the long term outcome is worse Medial epicondylitis At the flexor origin…

…somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face or perianally. Indications Fluctuant…

…with post thrombotic syndrome. Differential diagnosis Feature Venous ulcer Arterial ulcer Diabetic foot ulcer : : : : Site Gaiter area, above the medial malleolus Toes, heel, lateral malleolus…

…Intramural haematoma IMH is haemorrhage within the aortic media without an identifiable communication between the aortic lumen and the haematoma and without a visible intimal…

…large and medium sized arteries. Pathological features include plaque formation with calcium deposition, medial thinning, destruction of muscular and elastic tissue, fragmentation of the internal…

…In CKD, additional mechanisms include vascular stiffness and accelerated medial calcification related to disturbed calcium–phosphate metabolism. Patients with advanced CKD are particularly vulnerable to…

…annular circumference. The posterior leaflet generally has two distinct indentations which divide it into three scallops, P1 (anterior or medial scallop), P2 (middle scallop), and…

…hallucis longus tendon. Measure in the same way as on the arm. 4. Posterior tibial artery — behind the medial malleolus. Measure. 5. Repeat on the…

…highest accuracy for palpation guided aspiration. Press the fluid from the medial towards the lateral side with your free hand. The needle is inserted directed…

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…The site lies about 3–5 cm superior and medial to the anterior superior iliac spine and lateral to the lateral border of the rectus…

…Left main coronary artery (5) LAD = left anterior descending artery: proximal segment (6) medial segment (7) apical segment (8) first diagonal branch (D1) (9)…

Continous medical discussion: the ECG blog ECG A deep learning ECG biomarker for sudden cardiac death: what the new Nature study shows Low risk (blue…

Continous medical discussion: the ECG blog ECG Early repolarization pattern: confused J points, notches and slurs I once had the privilige of attending a lecture…

Continous medical discussion: the ECG blog Myocardial ischemia and infarction Myocardial ischemia The definition of ischemia may appear trivial but it is actually a very…

Continous medical discussion: the ECG blog ECG The best ECG book is not the one making it simple In the thrilling and ever evolving field…

Arrhythmias and arrhythmology Continous medical discussion: the ECG blog Genetic and miscellaneous conditions A novel potentially life threatening cardiac arrhythmia syndrome identified with ECG The…

Cardiology Continous medical discussion: the ECG blog Infectious diseases Cardiovascular effects of COVID 19 Coronavirus disease 2019 (COVID 19) has caused a global public health…

Cardiology Continous medical discussion: the ECG blog Coronary artery disease: On LDL cholesterol, dietary fat & statins You are probably aware that ischemic heart disease, also…

Cardiology Continous medical discussion: the ECG blog Endocrinology & metabolism Cardiovascular medicine is currently witnessing a paradigm shift. For decades, the management of type 2 diabetes…

ECG The artificial pacemaker is one of the great medical inventions of the 20th century. Cardiac pacing has evolved from a hazardous experiment in the…

CPR Hearts too good to die In 1961 the Journal of the American Medical Association (JAMA) published an article titled Hearts too good to die…

…interpreted as specialist investigations. Both fail more often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off…

…and scope Coronary angiography is an invasive fluoroscopic procedure in which contrast media are injected selectively into the epicardial coronary arteries through a catheter advanced…

Cardiology Nephrology Definition and terminology Contrast associated acute kidney injury is an acute deterioration in renal function occurring after exposure to iodinated contrast media, particularly…

…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…body weight in kilograms by the square of height in meters. BMI is relevant for medical prognostication as it serves as a quick, low cost…

…Initial diagnosis of STEMI ECG Management Recommendation Level of evidence A 12 lead ECG should be interpreted immediately (within 10 minutes) at first medical contact…

…education, psychosocial support, vocational guidance, medical surveillance, and appropriate pharmacological treatment. After myocardial infarction, rehabilitation aims to: Restore and improve functional capacity Reduce disability and…

…events after coronary angiography, percutaneous coronary intervention (PCI), or medical management. The standard post ACS regimen is DAPT for 12 months, generally consisting of low…

…traumatic aortic injury. In classic dissection, an intimal tear permits blood to enter the diseased aortic media. Blood then propagates along the wall, creating a…

…practice guidelines for emergency medicine (and prehospital medicine). This is high quality medical education simply. Life in the Fast Lane Australian site with one of…

…to established reversible myocardial ischaemia in either of two settings: Obstructive coronary artery disease (CAD) that cannot be controlled despite escalation of antianginal medical therapy…

…chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or other symptoms that may be caused…

…AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history (with emphasis on causes of AV blocks; please…

…endocardium), a thick muscle layer (myocardium) and an outer lining (epicardium). These layers are analogous to tunica intima , tunica media , and tunica adventitia , respectively. Figure…

…is suspected. 7. Review all medication, including over the counter preparations, herbal remedies, contrast media and recently stopped drugs. 8. Treat sepsis, bleeding, shock, hypoxia…

…acidosis , that is, a pH below 7.35 and a PaCO₂ above 6.0 kPa despite optimal medical treatment with bronchodilators, steroids and controlled oxygen…

…Delirium is common but often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high…

…the only absolute indication, and always urgent. A large pericardial effusion with symptoms despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy…

…Medical conditions Category Condition Congenital conditions Jervell and Lange Nielsen syndrome Romano Ward syndrome Idiopathic congenital long QT syndrome (LQTS) Metabolic disorders Hypokalemia Hypomagnesemia Hypocalcemia…

…generally tolerate ischaemia for approximately 4–6 hours, making ALI a medical emergency in which prompt recognition, specialist assessment and restoration of perfusion are essential…

…to exercise Detection of exercise induced arrhythmias Identification of exercise related ST segment changes Prognostic and risk stratification information Assessment of response to selected medical…

…not reverse coronary atherosclerosis. Long term benefit therefore depends on the integration of revascularisation with guideline directed medical therapy and secondary prevention. Clinical Presentation and…

…should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from ongoing myocardial ischaemia Haemodynamic…

…underlying coronary atherosclerotic process. Their clinical effects therefore occur within the broader framework of guideline directed medical therapy and secondary prevention. PCI treats focal stenotic…

…or chest pain equivalent symptoms. The ECG assessment remains necessary even when symptoms have improved by the time of medical evaluation, because transient or evolving…

…symptoms, or medical histories should undergo appropriate screening for secondary hypertension. The initial clinical assessment should establish: Whether hypertension is genuinely present Factors that may…

…approximately 40–50 years. Hormonal influences, including oestrogen and progesterone related structural changes in the coronary media. The early postpartum period, when marked hormonal changes…

…myocardial injury is strongly influenced by total ischaemic time. This interval includes: The time from symptom onset to recognition and seeking medical assistance. Prehospital assessment…

…In out of hospital cardiac arrest (OHCA) the initial rhythm is recorded by the EMS (emergency medical service) team upon their arrival at the scene…

…arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes cardiac arrest caused by heart disease, other medical conditions (pulmonary embolism, bleeding…

…includes surgery, catheter interventions, and medical therapies. Adults with congenital heart disease are mostly managed in GUCH clinics (Grown Up Congenital Heart disease). Prevalence of…

…be fatal. Approximately 500 Swedes are affected annually by endocarditis and the median age of 70 years at the onset of the disease. Approximately 12…

…and in hospital cardiac arrest (IHCA). Age and sex The median age in OHCA is 70 years in Sweden, 66 years in Europe (EuReCA) and…

…fascicle. Approximately 5–10% of all individuals have a third fascicle – the median or centroseptal fascicle – which gives off Purkinje fibers to the interventricular septum…

…HFimpEF). HFimpEF refers to patients with a historical baseline LVEF ≤40% that has subsequently improved to 40% under guideline directed medical therapy (GDMT). These patients…

…Data from the TRED HF trial demonstrated that withdrawal of guideline directed medical therapy (GDMT) in these patients leads to a high rate of relapse…

…80 years. This was expressed in 1961 by Beck et al in the Journal of American Medical Association (JAMA): [...] Of every 10 such victims, the…