…Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood…

…outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections…

…Other microorganisms, generally, cause subacute endocarditis. Endocarditis can affect native (own) valves and valve prostheses. As always, foreign materials pose a high risk of infection…

…of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other…

…the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction…

…Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other circumstances that may affect…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

…modification of loading, eccentric exercise, an NSAID, an orthosis — has not given a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound or other infection over…

…of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast alone difficult. In patients with normal renal function, the occurrence of contrast…

…the threshold, but the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before…

…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…

…acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window…

…also shows the depth of the cavity and its distance to vessels. Contraindications and when to involve a surgeon The following locations must not be…

…eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of…

…multiorgan failure, infections, seizures and temperature management. The ICU is the preferred level of care for the absolute majority. The CCU may be suitable for…

…ECG must always be interpreted using a systematic approach in order to minimize the probability of missing significant abnormalities. The following parameters must be assessed…

…choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease, etc .) are warranted. Management of…

…Alternative route : Central venous administration of adenosine is suitable in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1…

…blood tests and other radiological examinations are most often required, in particular computed tomography (DT) and/or magnetic resonance imaging (MRI). Anatomy of the pericardium…

…cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction…

…not developed for routine coronary prevention because of fatal infections and high cost. Low dose methotrexate did not reduce cardiovascular outcomes, and several other agents…

…and lesion haziness raise suspicion of thrombus, although haziness is not specific. Intravascular imaging can identify plaque disruption, thrombus and other structural features that may…

…myocardial infarction. The chest pain in acute pericarditis may be severe and the patient may also experience cold sweats, tachycardia and anxiety; all of which…

…obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked…

…all other causes have been ruled out. Inappropriate sinus tachycardia is presumably more common than previously thought and the condition may hamper the quality of…

…before the drug is eliminated. A flush should immediately follow the bolus injection to ensure rapid delivery to the central circulation. If the drug is…

…required because blood causes strong backscatter of the light signal. Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…It may be broken, as in Figure 1 . Any type of infarction may cause pathological R wave progression. However, the specificity for pathological R wave…

…waves (Q wave infarction) Lead Definition of pathological Q wave Normal variants V2–V3 ≥0,02 s or QS complex None All other leads ≥0…

…the other hand, may only display ST depressions and/or T wave inversions. STE ACS (ST Elevation Acute Coronary Syndrome) & STEMI (ST Elevation Myocardial Infarction…

…Other cardiac procedures Chemotherapeutic agents Catheter ablation Critical illness Defibrillator shocks Strenuous exercise Cardiac contusion The diagnosis should therefore distinguish isolated myocardial injury from infarction…

…0.03 Other complications 0.28 Total major complications 1.70 In another large diagnostic catheterization analysis, mortality was approximately 0.2%, myocardial infarction approximately…

…from out of hospital cardiac arrest should not routinely undergo immediate angiography. A selective or delayed approach is recommended in this setting unless other findings…

ECG Myocardial ischemia and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes…

Cardiology Myocardial ischemia and infarction Definition and conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce…

…often female than patients with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional atherosclerotic risk factors…

…hypoperfusion reduces oxygen and nutrient delivery and, when severe or prolonged, produces multiorgan dysfunction and death. In the setting of ST elevation myocardial infarction (STEMI)…

Cardiology Interpreting myocardial perfusion SPECT images involves a systematic comparison of rest and stress images to assess myocardial ischemia and infarction. The key steps in…

Myocardial ischemia and infarction ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms…

…ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia. After this period…

…interventions intended to reduce recurrent infarction, ischaemic stroke, cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease…

…Other Differential Diagnoses ST segment elevations simulating acute ischemia or infarction may also occur in the following conditions [15]: Myocarditis Early repolarization patterns Left bundle…

…instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the catheterization laboratory are found to have complete LMCA occlusion, likely…

…from other branches of the same coronary artery or another coronary artery, will alleviate the ischemia, improve myocardial function and increase resistance to episodes of…

…hypertrophy). The following rules will distinguish the two conditions in the vast majority of cases: Right ventricular hypertrophy shifts the electrical axis to the right…

…ischemia and infarction Definition and Pathophysiology Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch…

…ACS), including ST Elevation Myocardial Infarction (STEMI) [1] . Historically viewed as a simple plumbing problem characterized by the gradual accumulation of inert cholesterol debris, modern…

…on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive…

…as STEMI (ST Elevation Myocardial Infarction) in terms of treatment and interventions. As discussed previously, STEMI is the result of a complete and proximal occlusion…

…can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation with inspiration, along with a pleural friction rub…

…with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an epicardial coronary artery…

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

…in the setting of LBBB. A patient with acute STEMI may therefore display a normal LBBB pattern. LBBB may be caused by ischemia/infarction : There…

…provided that other causes of right axis deviation have been excluded. Causes of left axis deviation Left bundle branch block. Left ventricular hypertrophy. Inferior infarction…

…provided that other causes of right axis deviation have been excluded. Causes of left axis deviation Left bundle branch block. Left ventricular hypertrophy. Inferior infarction…

…In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography…