…in parallel with drug treatment and transport planning [1,5]. Symptom duration Under 12 hours: reperfusion is indicated in persisting STEMI. 12 to 48 hours…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…to the table above. 9. Check that the whole lesion, including the margin, has turned white. Contact technique with a cryoprobe gives a deeper and…

…Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as…

…secondary prevention 8 Contact the endoscopist and the consultant on call early. In cirrhosis or suspected variceal bleeding, also contact a gastroenterologist with hepatology expertise…

…benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison…

…reduced eye contact Common and particularly easy to miss. May be misinterpreted as fatigue, depression or dementia Mixed Alternates between hypoactivity and hyperactivity Common on…

…discuss with the on call coagulation service Always in parallel: mechanical control of bleeding, tranexamic acid where it is not contraindicated, and contact with the…

…air and speeds resorption. Other conditions in which high flow oxygen is given irrespective of the saturation according to international guidelines are decompression sickness and…

…of failure to capture is insufficient stimulus energy. Modern pacemakers have built in functions to calibrate the stimulus amplitude and width according to myocardial excitability…

…to alkalinise, and the sodium and volume load becomes pure harm. Dialysis is then the way forward. Heart failure, pulmonary oedema and other conditions with…

…myocardium generates reflections with high amplitude and low Doppler shift. To analyze reflections from the myocardium, the ultrasound machine filters out all other reflected sound…

…Contact nephrology early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one…

…of the R waves. This is believed to be due to delayed (and thus electrically unopposed) depolarization in the ischemic area. Fragmented QRS complex The…

…level of consciousness and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed…

…administration of ticagrelor with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, nefazodone, ritonavir, and atazanavir) can lead to a significant increase in exposure to ticagrelor…

…risk of transmitting the relevant variant to each child. However, other inheritance patterns, de novo variants, incomplete penetrance and variable phenotypic expression complicate risk prediction…

…in addition to LDL and other apoB containing particles. Cardiovascular risk categories Primary prevention For adults aged 40–75 years without diabetes and with LDL…

…Table 1: Myocardial and ECG reaction in various settings with ischemia or increased workload STATUS OF CORONARY ARTERY SETTING EFFECT ECG REACTION Normal coronary artery…

…Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute…

…administer to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications…

…in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet activation and aggregation contribute importantly to arterial…

…used. Risk in these circumstances appears to track more closely with apoB. Discordantly high apoB is especially associated with metabolic syndrome and mildly elevated triglycerides…

…relatively limited compared with agents that inhibit other platelet pathways. The distinction between primary and secondary prevention is fundamental: Primary prevention refers to individuals without…

…two vascular beds. Carotid disease therefore commonly coexists with coronary artery disease (CAD), peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal…

…the chest and may extend to the arms, shoulders, neck, jaw, upper back, abdomen, or epigastrium. Dyspnoea, nausea, vomiting, diaphoresis, fatigue, faintness, and other symptoms…

…Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction…

…acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI…

…in hypertensive encephalopathy and should prompt consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in…

…with left main coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and…

…sedentary behaviour and loss of independence. Identification of PAD also provides an opportunity to recognise atherosclerosis in other arterial territories and to initiate secondary prevention…

…with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption…

…in the US and many other countries, a 2:1 block will be difficult to discern because the flutter wave may fuse with the preceding…

…ECG has low sensitivity with respect to detecting biventricular hypertrophy. This is because the strong and oppositely directed forces tend to cancel each other out…

…myocardial electrical activity and there is a chance that ischemic episodes are missed. Indeed, studies (with continuous ST segment monitoring) show that 60% to 75%…

…The principles of continuous wave Doppler and pulsed wave Doppler. The disadvantage of continuous wave Doppler is that it is not possible to determine where…

…annihilate each other, producing two gamma photons emitted in opposite directions. PET scanners detect these gamma rays to construct images with high spatial and temporal…

…not strong enough to be detected on leads with opposite angle of observation. Other vectors may interfere with the injury currents, and inhibit them from…

…synonymous with AV dissociation, complete AV block, AV block III and AV block 3. In third degree AV block, no atrial impulses are conducted to…

…lowest rib and the iliac crest, at the end of expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement…

…and myeloma. Suspected bone marrow metastasis. Assessment of treatment response and measurement of residual disease (MRD). Fever of unknown origin or suspected granulomatous disease with…

…with a high frequency linear probe, a sterile probe cover and sterile gel. Chlorhexidine in alcohol 5 mg/mL for skin disinfection. Allow it to…

…be performed without atropine, ECG monitoring and access to airway support. Indications Clinically suspected myasthenia gravis in a patient with clear, objectively verifiable fatigable symptoms…

…single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period…

…organ damage should not normally be lowered rapidly with intravenous drugs. Such treatment has not been shown to improve the prognosis and can cause hypotension…

…meal or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other precipitating…

…least 48 hours Unknown Treated as chronic with respect to the correction limits The brain adapts to prolonged hypotonicity by extruding electrolytes and organic osmolytes…

…suspicion to bone, pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and…

…absolute contraindications other than the conditions in which the procedure is the wrong treatment : Aortic dissection with haemopericardium — drainage can increase the bleeding and worsen…

…or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the adjacent joint. Known hypersensitivity to the…

…Transcutaneous pacing Equipment A defibrillator with a pacing function and self adhesive multifunction pads. A separate three lead ECG cable connected to the patient — the…

[calc_aorta] Sinus of Valsalva (SOV) and Aortic Root Assessment The sinus of Valsalva diameter (SOVd) is a critical measurement in evaluating aortic root morphology…

…for major bleeding compared to ATRIA. ORBIT: Includes factors like older age, reduced hemoglobin/hematocrit, bleeding history, insufficient kidney function, and treatment with antiplatelet agents…

…is more closely associated with other comorbidities and age rather than sex alone. Consequently, the CHA₂DS₂ VA score was developed to provide a more accurate…

…BLED score is a widely recognized and validated tool used to assess the one year risk of major bleeding in patients with atrial fibrillation (AF)…

…to both HEMORR₂HAGES and ATRIA. The HAS BLED score had the highest net reclassification improvement for predicting clinically relevant bleeding, with a 10.3% and…

…and relies on the temporal association of the cough with the medication. Specific diagnostic criteria for cough hypersensitivity syndrome are lacking; the diagnosis is suspected…

…and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations…

…and the Hestia criteria, are used to assess clinical risk. These instruments incorporate haemodynamic and respiratory variables such as tachycardia and hypoxaemia, together with age…

…oxygen consumption associated with exercise. Chronic myocardial injury Long term heavy consumption can produce a cardiomyopathy, although the exact exposure threshold and duration required are…