…action is needed to prevent a further fall Level 2, clinically significant < 3.0 mmol/L A seriously low glucose; immediate treatment is required…

Akutsjukvård Lathundar Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG…

…patients you need to treat to save one. If an intervention has an NNT of 10, then 10 people must be treated to save 1…

…COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for ventilatory support …

…unstable patient Hypotension (systolic < 90 mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism…

Akutsjukvård Kirurgi & trauma Lathundar Immediate management In massive haemorrhage it is rapid control of the bleeding that determines the outcome. Transfusion restores circulating volume, oxygen…

…where sepsis is highly likely, antibiotics must be given immediately [3]. This quick reference applies chiefly to adults with neutropenia related to cancer treatment. Children…

…with a soft catheter and body temperature water for irrigation. Small children need help to keep still. Sedation is usually better than physical restraint — ketamine…

…the response to every intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory failure, impaired consciousness, or a need for…

…the initial sympathetic response can give way to hypotension, hypoxia, hypoglycaemia and circulatory failure [5]. Plasma glucose immediately Check the capillary or venous glucose i

…are often the very question at issue A patient who needs steroid cover simply to get through the day of the test can therefore be…

…a normal radiograph. Contraindications An open fracture or a wound that needs to be inspected — use a windowed splint or external fixation. Established or impending…

…Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that has not responded to atropine…

…balanced crystalloid in the first instance. Give small boluses, for example 250 to 500 mL, with immediate reassessment of the blood pressure, pulse, peripheral perfusion…

…patient unstable, how long has the fibrillation lasted, and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any…

…no imaging evidence of RV dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock or the need for ongoing cardiopulmonary resuscitation. Mechanical circulatory support…

…onset time and anticipated time to primary PCI. Patients with STEMI should be monitored in a setting capable of continuous rhythm surveillance and immediate res

…crisis [1,2]. A hypertensive emergency means a markedly raised blood pressure together with ongoing or new organ damage in which immediate, controlled blood pressure…

…the circulation. ECMO use during cardiac arrest (referred to as ECPR [extracorporeal CPR] ) requires the immediate establishment of veno arterial ECMO (VA ECMO) . A peripheral…

…Both, however, need rapid assessment and an active treatment plan. Initial assessment and sampling Immediate measures Assess airway, breathing and circulation. Attach continuous ECG monitoring…

…pocket guide with a universal interpretation algorithm. These 22 pages includes all you need to perform methodological ECG interpretation. We recommend this approach as it…

ECG Introduction to ECG interpretation The ECG leads Before discussing the ECG leads and various lead systems, we need to clarify the difference between ECG…

…vasodilators replicate the effects of exercise on coronary arteries, without the need for physical activity. Advantages of regadenoson over adenosine Regadenoson has advantages over adenosine…

…with inotropic and vasopressor effects, and they often need to be combined in order to optimise or correct the haemodynamics. Most agents exert both vasopressor…

…need for anticoagulation, and whether coronary stents are present. Clinical objectives of therapy The main objectives of antiplatelet treatment after MI are to: prevent recurrent…

…as a triage test on the same liquid based sample when the HPV test is positive — the sample therefore does not need to be repeated…

…to optimize the dose of diuretic first. However, clinicians may need to reduce the dose of diuretic during the initiation of an ACE inhibitor to…

…radial artery. According to current guidelines, laypeople do not need to perform the 3 rd assessment (reliable assessment of pulses requires training and experience). Thus…

…to need 5–15 mg of morphine in total. If more than that is required without effect, reconsider the pain mechanism instead of continuing to…

…concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter…

…kills because the tube would not pass, but because the team keeps trying to intubate instead of changing the plan. The aim is always oxygenation…

…has a protective function, and the commonest complication of ear syringing is that someone syringes an ear that did not need syringing. The second commonest…

…only 3–5 cm and almost straight, but the meatus can be hard to find in older women. Two things separate the safe catheterisation from…

…characteristics to predict clinical outcomes and aid in personalized treatment decisions. The SYNTAX Score was created to address the need for a standardized method to…

…range of lesions amenable to PCI. Stent selection must nevertheless be integrated with lesion anatomy, clinical presentation, bleeding risk, the anticipated need for non cardiac…

…receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Aspirin irreversibly…

…Historically referred to as coronary thrombosis, the term myocardial infarction ultimately prevailed. The need for a standardized global definition led to early efforts by the…

…2 days each week. Activities need not be undertaken in bouts of at least 10 minutes; shorter episodes also contribute to health. Spreading activity across…

…condition. It is associated with a two to four fold increase in lifetime cardiovascular disease (CVD) risk and approximately doubles cardiovascular risk on average. Its…

…reserve (FFR), have been validated against outcomes and shown to outperform visual angiographic guidance in selecting lesions for percutaneous coronary intervention (PCI). Non hyperemic pressure…

…Thus, although a smaller number of older patients may need treatment to prevent one adverse cardiovascular outcome, the potential benefit for an individual patient may…

…the need for more invasive and costly direct measurements of GFR. Limitations of MDRD eGFR Accuracy at Higher GFR Levels: The MDRD equation tends to…

…target organ damage. Although BP reduction is required, these patients generally do not need hospital admission or intravenous treatment. Some patients with acute pain, anxiety…

…the source material, it is utilised alongside inotropes in acute heart failure to support systemic blood pressure through its infusion rate parameters. Clinical Presentation and…

…driver of global cardiovascular morbidity and mortality, primarily due to its association with ischemic stroke and systemic embolism. The contemporary understanding of AF has evolved…

…a potential risk of serious morbidity or mortality, underscoring the need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and…

…be targeted at that cause. With regards to medications, the clinical need must be reconsidered if bradycardia is a side effect of the medication. Often…

…well trained athletes) need not be treated. When in doubt whether the bradycardia is physiological, it is useful to perform a Holter ECG (ambulatory recording…

…proteins in the hepatic LDL receptor pathway. Reduced cellular uptake and clearance of LDL leads to increased circulating LDL C. The principal genetic mechanisms involve:…

…tests, and versatile study tools. From basic cardiac physiology to the nuanced strategies of evidence based management, this book and course have been meticulously crafted…

…and the local care programme applies. In practice the cooling device is set to a target of around 37.0–37.5 °C , that is…

…waves. Undersensing may lead to overpacing . Failure to rate adjust, which means that the pacemaker fails to adjust its rate according to haemodynamic needs. This…

…pacemaker software includes pre programmed algorithms and settings, which can be tailored to the patient's needs. Programming is done through an external device that…

…rarely needs to be stopped for small biopsies, but have diathermy or aluminium chloride available. Infection in the area to be biopsied. Hypersensitivity to local…

…required in established or suspected CAD The extent or location of ischaemia needs to be defined before revascularization Residual ischaemia must be assessed after initiation…

…are concealed. A recurrent unclear wide or narrow complex tachycardia in which the mechanism needs to be documented before referral to an arrhythmia unit. Assessment…

…high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in inpatients…

…Long term pharmacological management of chronic sinus bradycardia with a pacemaker is usually not necessary unless sinus rates are too slow to meet physiologic needs…

…for acute severe heart failure. A recent echocardiographic examination should be available or performed urgently to evaluate ventricular and valvular function. Levosimendan drug is generally…