…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…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…

… the long term outcome is worse Medial epicondylitis At the flexor origin Avoid the ulnar nerve Carpal tunnel syndrome The carpal tunnel An acceptable bridge…

…the left subclavian artery. Penetrating atherosclerotic ulcer PAU is focal ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into the media…

…vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather than an isolated disorder of…

…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…

…papillary muscles via chordae tendineae (Figure 1). The anterolateral papillary muscle receives blood supply from the left anterior descending artery (LAD) and the left circumflex…

…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…

…a bloodless field one works by feel, and by feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : …

…segment (6) medial segment (7) apical segment (8) first diagonal branch (D1) (9) second diagonal branch (D2) (10) LCX = Left circumflex artery proximal segment…

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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…

…with patient assessment and ongoing medical surveillance. The programme should account for: The recent myocardial infarction and its clinical course Left ventricular function Residual ischaemic…

…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…

…medical attention due to chest discomfort or other symptoms that may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left…

…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…

…These layers are analogous to tunica intima , tunica media , and tunica adventitia , respectively. Figure 1. Layers of the left ventricular wall, pericardium and ventricular cavity…

…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…

…tissue injury. Skeletal muscle and nerves generally tolerate ischaemia for approximately 4–6 hours, making ALI a medical emergency in which prompt recognition, specialist assessment…

…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…

…stenosis Distal bifurcation involvement Coexisting multivessel disease The extent of jeopardized myocardium Left ventricular systolic function Diabetes and other comorbidities Anatomical complexity and completeness of…

…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…

ECG Myocardial ischemia and infarction Definition and Pathophysiology Posterior myocardial infarction is myocardial necrosis involving the posterior region of the left ventricle, usually as part…

…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…

…left posterior fascicular block is due to block in the posterior fascicle. Approximately 5–10% of all individuals have a third fascicle – the median or…

…clinical syndrome characterized by the cardinal symptoms and signs of heart failure (HF) in the presence of a left ventricular ejection fraction (LVEF) of ≥50%…

…specifically classified by the 2022 AHA/ACC/HFSA and 2021/2023 ESC guidelines as HF with a left ventricular ejection fraction (LVEF) of ≤40% [14…

…Medical Association (JAMA): [...] Of every 10 such victims, the heart in 6 or 7 showed no recent disease in coronary arteries or in heart muscle…