…activates vascular smooth muscle potassium channels to produce vasodilation. Although primarily defined by these mechanisms, levosimendan also exhibits some type 3 phosphodiesterase inhibitor (PDEI) activity…

…evidence of systemic venous congestion Blood pressure and evidence of hypotension Clinical evidence of low cardiac output or shock RVI may produce severe venous congestion…

…smoking and anticipated barriers to cessation. Exposure to second hand smoke. Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression…

…salicylate poisoning, intubation with an inadequate minute ventilation can rapidly worsen the acidaemia and increase the entry of salicylate into the central nervous system. Discuss…

…stenosis. Diagnostics Electrocardiogram and Cardiac Monitoring An ECG should be performed if there is suspicion of syncope due to an arrhythmia or underlying cardiac disease…

…gaze palsy — that can be assessed before and during the window of effect. The muscarinic effect may at the same time produce marked bradycardia and…

…careful monitoring, and shared decision making. Definition and Pathophysiology Aging related cardiovascular vulnerability Normal aging produces structural and functional cardiovascular changes that increase susceptibility to…

…is myocardial ischaemia caused by transient abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural…

…procedure, and anticipated electrical environment. Preoperative evaluation Establish the nature and function of the device The following should be determined before surgery: Device type: pacemaker…

…end stage renal disease, may produce elevated troponin concentrations. The probability of MI increases continuously as the absolute hs cTn concentration rises. Early absolute changes…

…closer monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with…

…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…

…VF or VT, survival is 30% in OHCA. If the initial rhythm is PEA (pulseless electrical activity), survival is 5% in OHCA. If the initial…

…monitoring should start immediately and a defibrillator must be ready. I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of…

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…

…pressure ECG monitoring D Disability AVPU: Alert Voice responsive Pain responsive Unresponsive Limb movements Pupillary light reflexes Blood glucose E Exposure Identify signs of heart…

…the investigation will be usable. Ambulatory blood pressure monitoring (ABPM) Indications Confirmation of newly detected hypertension — recommended before treatment is started . Suspected white coat hypertension…

…Anterior shoulder dislocation The commonest of all dislocations. There is a hollow beneath the acromion, the arm is held in slight abduction and external rotation…

…Discharge Management The STRONG HF trial demonstrated the safety and efficacy of an approach based on starting and titrating oral medical therapy for heart failure…

…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…

…Because of this prolonged terminal half life, achieving steady state concentration without a loading dose takes approximately 265 days. Interpatient variability mandates close clinical monitoring…

…category of elevated blood pressure, defined as office SBP 120–139 mmHg or DBP 70–89 mmHg. This distinction supports a risk based approach because…

…rescue PCI. For the purpose of assessing ST segment return, one should preferably use continuous ST segment monitoring. If monitoring equipment is not available, 12…

…dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous oxygen saturation. Repeated blood sampling during intensive care. Exhausted…

Procedurer What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was…

…continuous ECG monitoring and early assessment of the need for dialysis ECG changes or serious neuromuscular symptoms mean a high risk even if the plasma…

…known as t1. After about 30 minutes of continuous convulsive activity, t2, the risk of permanent neuronal injury increases. Treatment must therefore start at 5…

…of tachyarrhythmia, bradyarrhythmia or asystole. The tachyarrhythmias include ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). The bradyarrhythmias include all bradyarrhythmias, pulse less electrical activity…

…required. The rationale for electrical therapy over drugs is that, under monitored conditions, a controlled "dose" of electricity can immediately and safely restore sinus rhythm…

… one of the most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not exclude Diastolic collapse of the right atrium and…

…serum concentration. Alkalinisation increases renal elimination several fold and at the same time reduces the passage of salicylate into the central nervous system. Contact your…

…of ventilation, metabolic activity, and perfusion. Increased aerobic metabolism, perfusion, and ventilation result in a higher end tidal carbon dioxide level. Continuous ETCO 2 monitoring…

…obstruction of pulmonary blood flow increases RV pressure load and may impair RV filling and forward output. The resulting syndrome may progress to systemic congestion…

…part via NMDA receptors. With prolonged alcohol exposure the nervous system adapts through reduced GABA mediated inhibition and increased glutamatergic activity. When the alcohol level…

…about 7.20. Different targets apply when the intracranial pressure is raised: normocapnia (PaCO₂ 4.5–5.0 kPa) and avoidance of hypoxia, since hypercapnia…

…monitoring, complications and when thrombectomy should be considered. The doses and Swedish thresholds below are based on the national guideline for the management of reperfusion…

…careful monitoring and management of modifiable risk factors. The HAS BLED score has demonstrated moderate predictive abilities for bleeding risks in AF patients, regardless of…

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

…NIV are two different treatments with different physiology, and the commonest source of error is confusing them. CPAP delivers a constant pressure that recruits alveoli…

…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…

…recommended. Warfarin after individual assessment Rule of thumb for the monitoring interval: eGFR divided by 10 gives the number of months until the next check…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…be prescribed as one: with an indication, a route of administration and a target range for the saturation . What usually goes wrong is not that…

…Fluid and monitoring Use a balanced crystalloid in the first instance. Give small boluses, for example 250 to 500 mL, with immediate reassessment of the…

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

…systemic embolism. The contemporary understanding of AF has evolved significantly; it is no longer viewed merely as an electrical anomaly but as a progressive, complex…

…mg/mL for local anaesthesia in the awake patient — the anaesthetic also improves the chance of success by counteracting vascular spasm. Pressure monitoring set: stiff…

…anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia…

…dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit…

…lidocaine gel for the electrode. A glass of water with a straw, a vomit bowl, tissues, suction. Monitoring with ECG, blood pressure and saturation throughout…

…the first dose of antibiotic, the cultures, the fluid bolus and the start of the vasopressor. Time Action : : 0 to 5 min ABCDE, continuous monitoring…

…no symptoms requires no pacing, only monitoring and preparedness. Asystole with no electrical activity at all — pacing has no documented benefit there. Transcutaneous pacing: burns…

…ICD) is warranted. The HCM Risk SCD calculator is validated to estimate the 5 year risk of SCD in patients with HCM. What is the…

…Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and…

…duration of diastole compared to systole. Clinical utlility Monitoring MAP is essential for assessing adequate organ perfusion, especially in critically ill patients. A MAP of…

…maximally tolerated doses. The apparently uncontrolled office blood pressure must be confirmed using home blood pressure monitoring or ambulatory blood pressure monitoring. Other guideline formulations…

…Consequently, the absence of AF during intermittent monitoring is not sufficient evidence that thromboembolic risk is low. In the setting of acute coronary syndrome, AF…

…criteria for evaluating the success of TdP treatment or detailed step by step algorithms for alternative therapies when initial pharmacological approaches fail to suppress the…

…Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and…

…Intermediate–high Stable Yes Raised Admission with monitoring. Be prepared for rescue thrombolysis Intermediate–low Stable One of the two positive Admission Low Stable No…