…to initial rhythm If the initial rhythm is VF or VT, survival is 30% in OHCA. If the initial rhythm is PEA (pulseless electrical activity)…

…pulseless electrical activity (PEA), and asystole can all occur in one patient. The typical depiction of sudden cardiac death as a gradual transition from sinus…

…blocker, a calcium channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive…

…may progress to hemodynamic instability, presenting as shock or cardiac arrest manifesting as bradyarrhythmic arrest, asystole, or pulseless electrical activity (PEA). Evaluation and Physical Examination…

…pacing may rarely result in pacing during ventricular repolarization and provoke ventricular tachycardia or ventricular fibrillation. The likelihood of clinically significant EMI is generally low…

…propofol, or etomidate), routine blood pressure and oximetry monitoring, availability of atropine, isoproterenol, or transcutaneous pacing for post shock bradycardia, and use of biphasic defibrillators …

…of both thromboembolic and hemorrhagic risks. The diagnostic prerequisite for clinical AF remains the documentation of the arrhythmia via a standard 12 lead ECG or…

…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…

Arrhythmias and arrhythmology Pharmacology & dosing Definition and Pathophysiology Sotalol is a nonselective beta adrenoceptor blocker devoid of intrinsic sympathomimetic activity that also prolongs cardiac repolarization…

…Phase 0 : Indicates the beginning of the next inspiration. Normal ETCO 2 : 38 mmHg (5 kPa) or 5%. Monitoring ETCO 2 aids in: Assessing ventilation…

…medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction. acute heart failure recurrent dynamic ST segment or T wave changes…

…Cardiac output and blood pressure, rather than ECG, are the strongest predictors of adverse outcomes. Non acute or asymptomatic bradycardia Non acute bradycardia is a…

…Alternative modalities — cardiac MRI, long term ambulatory monitoring, electrophysiological study, PET, SPECT, genetic profiling — add information but are too costly or invasive to screen a…

…neurological outcome compared with keeping the patient normothermic — but fever after cardiac arrest is harmful, it often arises spontaneously, and it must be actively prevented…

…days as necessary. Supplemental infusions of 150 mg over 10 minutes can be utilized for breakthrough ventricular tachycardia (VT) or ventricular fibrillation (VF). IV infusions…

…or a reassessment of treatment strategies. References O’Mahony C, Jichi F, Pavlou M, et al. A novel clinical risk prediction model for sudden cardiac…

…cardiac monitoring at a plasma potassium above 6.0 mmol/L, and at lower values if the rise is rapid, the patient has symptoms, or…

…A score of 3 or more indicates a difficult intubation — call for help and get out the videolaryngoscope and plan B before you give the…

…anaesthesia, normal saline to flush all lumens, suture material or a securement device, transparent dressing. Monitoring throughout the procedure: ECG, pulse oximetry and blood pressure…

…monitoring, intravenous or intraosseous access, a targeted history At 5 minutes A full, adequate dose of a benzodiazepine About 10 minutes Repeat the benzodiazepine once…

…cardiac biomarkers. Intermediate low risk PE includes stable patients who are not low risk but have either RV dysfunction or elevated biomarkers, or neither of…

…unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of…

…peripartum cardiomyopathy, or secondary to known cardiac conditions; in these patients, symptoms may be challenging to differentiate from normal physiological changes of pregnancy. Evaluation and…

…unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of…

…Intervention Monitoring : Assess residual shunts after device closure or surgery. Differentiating Pathologies : Helps differentiate cardiac vs. non cardiac causes of symptoms like dyspnea or failure…

…or cardiac arrest — intubate. Inability to protect the airway: a reduced level of consciousness not attributable to hypercapnia, marked swallowing difficulty, vomiting. Haemodynamic instability or…

…or vascular tone can significantly impact MAP, reflecting the dynamic interplay between cardiac function and vascular resistance. Advantages of measuring MAP over systolic blood pressure…

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

…possible or known plaques, or stenosis. Diagnostics Electrocardiogram and Cardiac Monitoring An ECG should be performed if there is suspicion of syncope due to an…

…why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off into a respiratory acidosis…

…cardiac examination is usually normal when the patient is not experiencing ischaemia. A minority of patients have clinical evidence of systemic vasospasm, particularly migraine or…

…low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to guide therapy. Diagnostics Electrocardiography…

…be confused with a venous access. Indications Continuous blood pressure monitoring in haemodynamic instability or during ongoing vasoactive treatment. Conditions in which blood pressure must…

…cardiac or pulmonary disease, a pulse ≥ 110/min, a systolic blood pressure < 100 mmHg and a saturation < 90 per cent. An sPESI of…

…Stellate ganglion block (SGB) or cardiac surgical sympathetic denervation can be performed to mechanically reduce sympathetic output [4]. Evaluation of Treatment and Alternatives for Drug…

…got up. Holter ECG and longer rhythm monitoring Indications Palpitations, presyncope or syncope of suspected arrhythmic origin. Assessment of rate control in atrial fibrillation. Suspected…

…compromise or skin tenting — reduce promptly, before radiography. The longer a joint remains dislocated, the harder the reduction becomes and the greater the risk of…

…or electrophysiology in relation to ACE inhibitor therapy. Biomarkers and Laboratory Findings Monitoring renal function and potassium is a critical component of ACE inhibitor therapy…

…a few seconds of myocardial electrical activity and there is a chance that ischemic episodes are missed. Indeed, studies (with continuous ST segment monitoring) show…

…disappearance of Korotkoff sounds; if sounds persist, the fourth Korotkoff sound is used. Office blood pressure: blood pressure measured in a clinical setting, manually or…

…inversion of the T waves. These T waves are called post ischemic T waves and they indicate that the infarction process is more or less…

…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…

…conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic alkalosis or an arterial pH above…

…preferably before or at the same time as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at…

…MAP ≥ 65 mmHg 80–85 mmHg in chronic hypertension or when there are signs of inadequate perfusion Urine output 0.5 mL/kg/h Lactate…

…increased risk of symptomatic intracerebral haemorrhage or death [3]. Acute overview 1. Activate the stroke call. 2. Establish the time of symptom onset or the…

…maximum score of 9. The score takes into account various risk factors that contribute to bleeding risk, including uncontrolled hypertension, impaired renal or liver function…

…electrical instability or a large area of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or…

…environmental exposures are associated with continued or resumed smoking after the acute event and warrant particular attention. Cardiovascular benefits of cessation The principal benefits relevant…

…Contraindications Ongoing respiratory depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given…

…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…

…indication and contraindications, attach ECG monitoring and insert a venous cannula. 2. Document the baseline status of the chosen finding — measurement, photograph or video. 3…

…can swallow safely. 4. Give intravenous glucose if the patient has a reduced level of consciousness, is having seizures or cannot swallow. 5. If there…

…perfusion and the signs of shock 2 Two large bore peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood gases…

…and quality of life may be equally important therapeutic objectives. Evidence from randomized trials is often less applicable to very frail or multimorbid patients because…

…region. The time limit is not a guarantee. Where the stroke risk is high or the time of onset uncertain, choose the more cautious course…

…Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit, a coronary care unit or another setting that…

…electrocardiographic and haemodynamic monitoring with ECG, a central venous catheter and an arterial line is necessary to achieve an optimal result. Overview of vasopressors and…

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

…atrial activity. The investigation is diagnostic, not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary…