…and the abscess sits somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

…rehabilitation possible, not an alternative to it. See the separate guide to joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff…

…ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into the media. The lesion may produce a localized medial haematoma and can…

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

…stiffness and accelerated medial calcification related to disturbed calcium–phosphate metabolism. Patients with advanced CKD are particularly vulnerable to structural cardiac abnormalities, HF and sudden…

…P1 (anterior or medial scallop), P2 (middle scallop), and P3 (posterior or lateral scallop). Figure 1. Anatomy of the mitral valve The leaflets are connected…

…brachial index (TBI). The digital arteries rarely calcify, which makes toe pressure the method of choice in diabetes and renal failure. A normal TBI is ≥

…joints). A 20–50 mL syringe for a knee with a large effusion, 5–10 mL for smaller joints. Local anaesthesia of the skin and…

…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…

…lies about 3–5 cm superior and medial to the anterior superior iliac spine and lateral to the lateral border of the rectus abdominis — this…

…done by using ECG changes to determine the affected area and subsequently the occluded coronary artery (culprit). Figure 1B. Detailed diagram of coronary artery segments…

…peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal clinical concern is cerebral embolism or haemodynamic compromise leading to transient ischaemic attack…

…patient (blue) and the corresponding high risk morph (red). Beyond the difference in R wave amplitude, note the slurred terminal portion of the R wave…

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…

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

…Lange Nielsen F. Congenital deaf mutism, functional heart disease with prolongation of the Q T interval and sudden death. Am Heart J 1957;54:59…

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…

…stopping statins. There are three main questions discussed in media, blogs and on social plattforms: Is high cholesterol a true cause of coronary artery disease?…

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…

…of the great medical inventions of the 20th century. Cardiac pacing has evolved from a hazardous experiment in the 1930s, to a routine, safe, and…

…requires comprehensive efforts and resources, ranging from continuously training laymen in the community to establishing advanced post resuscitation care. Since the majority of all sudden…

…for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept a diary. The set up and…

…which contrast media are injected selectively into the epicardial coronary arteries through a catheter advanced from a peripheral artery to the aortic root and coronary…

…anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast alone difficult. In patients with normal renal function, the occurrence of…

…NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical…

…height and weight. It is calculated by dividing body weight in kilograms by the square of height in meters. BMI is relevant for medical prognostication…

…myocardial infarction and at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment…

…appropriate intensity, with attention to the emergence of symptoms. Evaluation Before Rehabilitation Clinical assessment Rehabilitation begins with patient assessment and ongoing medical surveillance. The programme…

…PCI), or medical management. The standard post ACS regimen is DAPT for 12 months, generally consisting of low dose aspirin and a potent P2Y12 inhibitor…

…sharp or stabbing. Its location and radiation may reflect the segment of aorta involved, although the source material does not provide a detailed symptom to…

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

…patients require a mechanism based assessment rather than reassurance based solely on the absence of obstructive CAD. Evaluation and Physical Examination Clinical assessment The asses

…Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention…

…defects ECG Management and treatment of AV blocks (AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history …

…to tunica intima , tunica media , and tunica adventitia , respectively. Figure 1. Layers of the left ventricular wall, pericardium and ventricular cavity. The endocardium The endocardium…

…contrast media and recently stopped drugs. 8. Treat sepsis, bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and…

…Acute exacerbation of COPD with respiratory acidosis , that is, a pH below 7.35 and a PaCO₂ above 6.0 kPa despite optimal medical treatment…

…On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high after hip fracture, major surgery and…

…a raised filling pressure Marked respiratory variation in mitral and tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there…

…prolongation and torsade de pointes reported to the FDA in postmarketing studies. Anti androgen Cancer (Prostate) Abiraterone is an antiandrogen used in the treatment of…

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

…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…

…and angina related health status but does not reverse coronary atherosclerosis. Long term benefit therefore depends on the integration of revascularisation with guideline directed medical…

…manifestations that indicate particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed…

…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…

…first medical contact and interpreted within a target of 10 minutes. Prehospital ECG acquisition can shorten the time to diagnosis and facilitate triage of patients…

…medical and medication histories should specifically assess drugs or substances that may increase blood pressure. The source material does not provide an exhaustive list of…

…Definition and pathophysiology Spontaneous coronary artery dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall, usually through formation of…

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

…or pulseless VT (i.e. shockable), and the probability of survival is higher (since these arrhythmias can be defibrillated). Likewise, the later the ECG is…

…The discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades…

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

…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…

…characteristics and outcomes across the data sources for out of hospital cardiac arrest (OHCA) and in hospital cardiac arrest (IHCA). Age and sex The median…

…the T wave in lead aVL will be inverted and in some cases lead I will display a monophasic R wave instead of qR complex…

…under guideline directed medical therapy (GDMT). These patients must be managed as having HFrEF, as their underlying pathophysiology, trajectory, and risk of relapse upon GDMT…

…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…

…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…