…select a safe disposition and diagnostic strategy. Only a minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5…

…abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination findings before the dose. A plan for…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…Condition Typical Pain Quality/Location Key Modifying Factors Associated Physical/Clinical Clues ACS/Myocardial Ischemia Substernal discomfort, pressure, tightness, or heaviness [7]. Worsens with exertion…

…established for these leads (please refer to ECG leads or Additional leads in acute myocardial infarction). Importance of performing ECG during ongoing chest pain It…

…diagnosis or identify a few likely diagnoses. The table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other…

…occur at a low level of exertion, or are associated with high event risk. The apparent differences between thresholds reflect different guideline frameworks and clinical…

…or pain on contact with water. A history of ear surgery in which the middle ear may be open (a mastoid cavity, mastoidectomy). An only…

…hypersensitivity to the preparations. Relative: Poorly controlled diabetes — expect a raised blood glucose for 2–5 days. Suspected or known tendon rupture. No response to…

…patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for EMS or bystanders…

…ones [5]. For acute clinical use the following simplification can be used: Grade Clinical picture Management : : : Mild allergic reaction Skin or mucosa only, stable breathing…

…movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than more slowly. The…

…adequate. For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia…

…with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or…

…helps explain the neurological manifestations of preeclampsia and the potential for stroke even at blood pressure levels that might otherwise be considered only moderately elevated…

…ischemic cascade describes the sequence of events during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques…

…at the first assessment, particularly in chest pain, back pain or suspected acute aortic syndrome. 5. Use the correct cuff size. A cuff that is…

…Chest pain or discomfort remains the cardinal symptom of CCS, but presentations are frequently non classical. Contemporary clinical populations include only a minority with symptoms…

…acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent symptoms. The ECG assessment remains necessary even…

…Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms…

…Intermittent claudication is exertional discomfort in a limb muscle that improves with rest. The symptom may be described as pain, aching, cramping, numbness or fatigue…

…with acute coronary syndrome (ACS) and confirmed by angiography or pathology. The Academic Research Consortium framework additionally distinguishes definite, probable, and possible stent thrombosis for…

…disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in asthma Contraindicated in impaired left ventricular function and together with an intravenous…

…a tendon injury, or after suturing over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture…

…often appropriate when very rapid or precise control is required, for example in acute aortic syndrome, marked neurological organ damage, or treatment with sodium nitroprusside…

…induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable. The benefit of…

…Paul A. et al. (2017): Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation. A Report from the American Society of Echocardiography Developed in Collaboration with…

…Clinically, UA is defined by one or more of the following patterns: Angina at rest, usually prolonged for more than 20 minutes. New onset severe…

…bradyarrhythmias or tachyarrhythmias, AV block, acute myocardial ischemia, old myocardial infarction, long QT, and bundle branch block. Cardiac monitoring is indicated for patients with a…

…only display ST depressions and/or T wave inversions. STE ACS (ST Elevation Acute Coronary Syndrome) & STEMI (ST Elevation Myocardial Infarction) Acute coronary syndromes with…

…to that seen in patients with STEMI. Moreover, the pain in acute pericarditis may also, as in STEMI, radiate to the neck, shoulders or back…

…women) and elderly individuals. Clinical characteristics and ECG changes in takotsubo cardiomyopathy The typical patient presents with severe chest pain, dyspnea and occasionally hemodynamic compromise…

…Examine the joint, locate the effusion and mark the puncture site with a pen or an indentation from a fingernail before cleaning the skin. 2…

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

…where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain, or when the volume limit is reached. Indications Diagnostic aspiration: a…

…angina include sudden symptom onset at rest or with minimal exertion, symptoms lasting at least 10 minutes unless treated immediately, severe chest pain or pressure…

…Those with possible ACS, a non diagnostic ECG, and normal initial troponin may be observed in a chest pain unit or another non intensive care…

…and symptoms SCAD generally presents as ACS. Symptoms may therefore include acute chest pain or chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy…

…diagnostic endpoint is a new or worsening regional wall motion abnormality (RWMA) during stress. A fixed abnormality that remains unchanged with stress generally indicates previous…

…Premature ventricular contractions in bigeminy. Two consecutive premature ventricular contractions are referred to as a pair or couplet. If 3 to 30 premature ventricular contractions…

…recent stroke or TIA in the vertebrobasilar territory. Retinal detachment. Relative: Marked cervical restriction of movement or pain — use the Semont manoeuvre or the side…

…with increasing frequency or severity; angina that awakens the patient from sleep. Patients receiving modified antiplatelet therapy require clinical surveillance for both recurrent ischemia and…

…these patients generally do not need hospital admission or intravenous treatment. Some patients with acute pain, anxiety, or distress have transient BP elevation that improves…

…not wait for troponin. If clinical suspicion persists despite an initially non diagnostic ECG, the ECG must be repeated, particularly with ongoing or recurrent pain …

…debridement 1. Cleanse with lukewarm tap water or saline; showering the leg is a good option. 2. Apply topical anaesthetic cream under occlusion for 30

…with or without pain, include sudden loss of consciousness, a confusional state, profound weakness, the appearance of an arrhythmia, evidence of peripheral embolism, or an…

…region but typically does not radiate below the umbilicus. Epigastric or subxiphoid pain may be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting…

…Indications Intermittent claudication, rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of a leg ulcer — compression in…

…maximum 0.5 mg For bradycardia with compromise Isoprenaline 0.02–0.15 µg/kg/min 0.02–0.1 µg/kg/min A bridge…

…pericarditis or endocarditis. Acute aortic dissection. Physical inability to perform the test safely. Relative: Condition Comment : : Left main stenosis Known — perform the test only on…

…A moistened cotton bud with a rolling movement can lift off a superficial body from the conjunctiva or the cornea. Never use a cotton bud…

…a long one for a high BMI), preferably warmed. Water based lubricant in a small quantity — it does not interfere with cytology or HPV testing…

…only monitoring and preparedness. Asystole with no electrical activity at all — pacing has no documented benefit there. Transcutaneous pacing: burns or wounds in the area…

Info This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment…

…Paul A. et al. (2017): Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation. A Report from the American Society of Echocardiography Developed in Collaboration with…

…which the heart cannot provide blood flow commensurate with the body’s requirements, or can do so only at the expense of abnormally high filling…

…Stable chest pain CCTA is recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of…

…for: Hemodynamic instability or cardiogenic shock. Clinical heart failure. Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with recurrent chest pain…

…Among patients referred for invasive angiography, ANOCA/INOCA is more frequent in women, affecting approximately 50–70% of women compared with 30–50% of men…

…initially selective or delayed approach into an indication for angiography and possible revascularization. Initial evaluation and risk stratification Clinical assessment Assessment begins with the clinical…