…distress Organic material (peas, beans) The same day — it swells when moist Sharp objects The same day Plastic bead, stone, toy Within a day or…

…Objects moving away from the transducer will generate reflections with lower frequency. Doppler shift The Doppler effect is utilized to calculate velocity and direction of…

…a physical medium. This medium may consist of any matter, e.g air, water, metal, or tissue and fluids in the human body. Sound waves…

…accompany other ischemic ST T changes. They may occur in both NSTEMI and STEMI. QTc prolongation The QT (QTc) interval may be prolonged, shortened or…

…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…

…treatment with ticagrelor. Caution is advised for patients with hyperuricemia or gout. Use of ticagrelor is discouraged in patients with uric acid nephropathy. Thrombotic Thrombocytopenic…

…from: Incomplete penetrance of a variant inherited from a parent. A de novo variant. Less commonly, autosomal recessive inheritance. X linked or other non autosomal…

…and the magnitude of LDL C reduction. Thus, even a modest absolute reduction may be clinically important in individuals at high or very high risk…

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

…lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood…

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

…NSAIDs). Other contraindications: Hemophilia. Thrombocytopenia. Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…LDL C in many studies, although the relative advantage of apoB over non HDL C or standard lipid testing remains unsettled. In a large population…

…aggregation. Because aspirin affects only one pathway of platelet activation, its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The…

…operative assessment, or evaluation of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of severe asymptomatic stenosis is low, screening has…

…and other symptoms may occur without chest pain and should be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around…

…example, high HDL cholesterol levels appears to be beneficial, whereas triglyceride levels seem to be of little or no importance for atherosclerosis. When discussing atherosclerosis…

…from selected populations, frequently with low or intermediate ischemic risk and under representation of patients with STEMI or other very high risk features. Noninferiority studies…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment of coronary…

…a manifestation of systemic arterial disease rather than an isolated disorder of the lower limbs. Patients frequently have concomitant coronary, cerebrovascular or other peripheral arterial…

…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…

…hours, or days. In the vast majority of cases, the re entry circuit in atrial flutter is located in the right atrium and it typically…

…cancel each other out. However, the ECG may show features characteristic of biventricular hypertrophy. Biventricular hypertrophy ECG In case the ECG or other examinations suggest…

…of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or…

…1). This is possible by using two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves…

…designed to identify ischemic areas of the myocardium by highlighting regions with reduced blood flow. Radiotracers for SPECT Technetium 99m (Sestamibi or Tetrofosmin): With a…

…Other vectors may interfere with the injury currents, and inhibit them from being detected by leads with opposite angles of observation. The electrocardiographic natural course…

…features of third degree AV block On the ECG P waves have no relation to the QRS complexes. The QRS complexes may be normal or…

…in oedema and ascites, and in people under 18 years of age, where iso BMI or percentile charts should be used. Waist circumference Measure the…

…The other DOACs are possible according to FASS, but the documentation is insufficient; check more frequently. Warfarin is often preferable <15 or dialysis DOACs are…

…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…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is…

…sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked obstructive airways disease — relative; the risk of bronchospasm is real…

…4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline 200 mg × 1…

…Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit, a coronary care unit or another setting that…

…can swallow safely. 4. Give intravenous glucose if the patient has a reduced level of consciousness, is having seizures or cannot swallow. 5. If there…

…5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document the…

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

…abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile…

…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…

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

…to try yet another dose. Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace…

…at the same time reduces the passage of salicylate into the central nervous system. Contact your national or regional poison control centre for advice on…

…or additional risk factors 55 mm (ascending aorta, aortic arch) All individuals 60 mm (descending aorta) All individuals Risk factors : previous dissection, family history of…

…4 2.6% High risk 5 or more 5.8% Interpretation of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment…

…chadsva] The CHA₂DS₂ VA score has superseded the CHA₂DS₂ VASc score. As of 2025, it is recommended to use the CHA₂DS₂ VA score for stroke…

…maximum score of 9. The score takes into account various risk factors that contribute to bleeding risk, including uncontrolled hypertension, impaired renal or liver function…

…in balancing estimating the risks of bleeding. Components of the HEMORR₂HAGES Score The acronym HEMORR₂HAGES represents the following parameters: H epatic or renal disease (1…

…5% to 30% of patients taking these agents. The cough is characteristically nonproductive and dry. Patients may describe a persistent tickle or sensitivity in the…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease, active cancer, and other conditions incorporated into validated…

…fluid ounces of 40% distilled spirits. Habitual heavy consumption is defined in the source material as at least eight drinks weekly in females or at…

…mellitus and other adverse influences disturb these functions. The resulting endothelial dysfunction promotes inappropriate vasoconstriction, adhesion of circulating cells, inflammatory cell entry into the intima…

…newly detected for the first time, or newly developed during management of an acute illness. The clinical relationship between AF and acute deterioration is often…

…and increased vulnerability to adverse outcomes. It is dynamic and may improve or worsen with illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity…

…and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly, COVID 19 has caused an unprecedented number of…

…used to classify 10 year risk as follows: Risk category 10 year risk of fatal or non fatal CVD Low <2% Moderate ≥2% to <10%…