…anticoagulants (rarely with antiplatelet agents). CHADS VASc predicts the risk of thromboembolism (stroke, TIA, systemic thromboembolism) in the next 12 months and the calculations apply…

…Includes factors like older age, reduced hemoglobin/hematocrit, bleeding history, insufficient kidney function, and treatment with antiplatelet agents. Research indicates that the ORBIT score may…

…the severity of the bleeding 7 Manage antiplatelet drugs according to their indication. Do not routinely stop aspirin given as secondary prevention 8 Contact the…

…concomitant antiplatelet therapy is genuinely indicated. The strongest established predictors of ischaemic stroke and systemic embolism are previous stroke or TIA and mitral stenosis. In…

…Given in case of suspected digoxin intoxication. Table 4. Pharmacological treatment of acute bradycardia. Atropine Evidence: Class IIa recommendation Atropine is the first choice for…

…oximetry Follow up of pH in, for example, ketoacidosis A venous sample is often sufficient if respiratory failure is not suspected Shock with a large…

…II, type 1 (Wencheback block) PR interval is gradually prolonged until one atrial impulse (P wave) is blocked in the AV node. Generally not. AV…

…is a clinical diagnosis. Treat as anaphylaxis in any of the following: 1. Acute onset of skin or mucosal symptoms , for example generalised urticaria, itching…

…in shock, rapidly progressive organ dysfunction, respiratory failure, impaired consciousness, or a need for a vasopressor After initial stabilisation Repeat the lactate if it was…

…complications calls for careful consideration of contraindications. Contraindications may be absolute or relative. Briefly, exercise stress testing must not be performed in the presence of…

…the dominant method for assessing left ventricular function (systolic function). It should be noted, however, that three dimensional (3D) echocardiography offers greater precision in the…

…be present in any bradycardia. Bradycardia may be present despite a high atrial rate (for example atrial fibrillation) if the block in the AV node…

…infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but should not delay reperfusion treatment…

Echocardiography Echocardiographic assessment of left ventricular diastolic function Methods for evaluating left ventricular diastolic function have evolved considerably in the past two decades. Currently recommended…

…This quick reference is intended primarily for adults and summarises the order in which measures are taken and the principles that are common to all…

…this compensates for the attenuation that occurs with increasing depth. TGC is adjusted using multiple controls that each represent a specific depth in the image…

…normal ferritin does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 % < 15 % indicates iron deficiency whatever the ferritin Vitamin…

…patient was preoxygenated, whether the difficulties were anticipated, whether the position and the equipment are in order, and whether there is an explicit plan for…

…in order to optimise or correct the haemodynamics. Most agents exert both vasopressor and inotropic effects (Figure 1). What follows is a quick reference for…

…in instances when the interface between compacted and noncompacted myocardium cannot be discerned. Scanning Maneuvers It is necessary to continuously adjust the transducer in order…

…but do not delay transfusion or control of the bleeding in order to obtain a central venous catheter. 4. Take samples for blood grouping and…

…certificates testify that you possess the necessary ECG skills required for clinical work. You must complete the ECG course in order to obtain your certificate…

…to the intensive care unit (ICU), coronary care unit (CCU), or catheterization laboratory. A 12 lead ECG must be obtained immediately after ROSC in order…

…after acute myocardial infarction in order to assess the presence of myocardial ischemia, evaluate angina pectoris, evaluate exercise performance, evaluate the effect of interventions and…

…pressure conditions in the heart. These techniques allow for the calculation of all clinically relevant hemodynamic parameters, with few exceptions. Prior to the Doppler era…

…proxy for peak oxygen uptake. This is discussed in detail below. The purpose of the exercise stress test is to induce cardiovascular stress in order…

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

…contiguous order from right anterior (V1) to left lateral (V6), but regrettably, the limb leads are not. Instead, the limb leads are displayed in two…

…who has not expressed opposition is presumed to have consented to donation. The person's wishes are established in this order: 1. The donation register…

…2 mmol/kg intravenously in symptomatic salicylate poisoning. For an adult this corresponds to the order of 100–200 mL of the 50 mg/mL…

…types in electrocardiology For the purpose of this discussion it is important to distinguish between two main types of cardiac cells: Conduction cells form the…

…additional electrodes in order to detect right ventricular infarction (leads V3R, V4R, V5R, V6R) and posterolateral infarction (leads V7, V8, V9). Criteria for ischemia/infarction…

…Older children may be asked to hold their breath, which leads to the cessation of sinus arrhythmia. Sinus pause Sinus pause also occurs in children…

…The amplitude of the normal P wave does not exceed 2.5 mm in any limb lead. Reference values for the P wave The negative…

…measuring dimensions. In order to obtain representative measurements, it is pivotal to align the M mode line such that it does not overestimate distances; e…

…as in Figure 1 . Any type of infarction may cause pathological R wave progression. However, the specificity for pathological R wave progression is considerably lower…

…are obtained with the patient in the supine position. In order to obtain the best possible image quality, patient safety and ergonomics for the operator…

…continuously in order to obtain a movie. The speed at which the images are updated is crucial for producing a high resolution movie. The rate…

…in cardiac arrest. In order for an infarction or ischemic episode to result in ventricular arrhythmia, it must coincide with other pro arrhythmogenic factors. The…

…follows after the exercise effort is terminated. Reliability as a function of workload In order for the exercise test to be reliable, the patient must…

…that the syringing is performed on a tympanic membrane that was already perforated. Indications Otoscopy: earache, hearing loss, ear discharge, dizziness, tinnitus, fever in a…

…with the antidotes. Material for immobilisation: a shoulder sling, a dorsal backslab, and a colleague to help. Analgesia and sedation The options, in ascending order…

…duration required are not established. The source material identifies chronic intake of approximately 60 g daily in males and 40 g daily in females as…

…was yesterday except that an electrical charge developed which fibrillated the heart. This electrical factor came and killed and disappeared and was not found in…

…very common in the population (discussed below). Study Figure 1 carefully . Figure 1. Types of ST segment elevations on ECG. Current guideline criteria for ischemic…

…give a positive result. A negative test does not exclude myasthenia gravis. Today the test plays a marginal role in Sweden. Edrophonium is available only…

…or thrombocytopenia Routine plasma or platelets are not needed — the INR does not predict bleeding risk in paracentesis. Follow the local protocol Ileus with distended…

…node and the AV node and is therefore ineffective — sometimes harmful — in infranodal block with wide QRS complexes; do not delay pacing in order to…

…optimize the function. For example, there are functions that continuously reassess stimulation threshold in order to calibrate stimulations according to the excitability of the myocardium…

…stimulated in order to evoke an action potential. Upon stimulation, sodium (Na+) channels open which causes a rapid influx of sodium and depolarizes the cell…

…repetition frequency in order to obtain accurate assessments of blood flow and myocardial movement. Figur 3A 3C. Nyquist's theorem and Nyquist limit The importance…

…stenoses must be graded in order to optimize management according to disease severity. The most important parameter, for grading of stenoses, is the opening area

…placed in beds located far away from physicians' and nurses' stations in order to not disturb the patients' rest. It was believed that the mere…

…of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for…

…older have been included in randomized controlled trials. Moreover, trial participants who were described as frail generally had no more than mild frailty, limiting the…

…Myocardial Infarction The ST segment elevation in acute pericarditis is typically diffuse, involving all leads except aVR and often V1, and does not correspond to…

…a class of oral agents initially developed for glucose lowering in type 2 diabetes mellitus (T2DM). The principal drugs identified in the source material are…

…according to the individual’s preferences, functional status and daily routine, because enjoyable and convenient activities are more likely to be maintained. For older adults…

…course, not on a single eGFR. Step 1: confirm the course and assess severity Establish the baseline Look for previous creatinine values in the record…

…and individual assessment. See the separate quick reference for dosing in impaired renal function. Respiratory tract Diagnosis Agent Dose Duration : : : : Pneumonia, non severe (DS CRB65…