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

…or neuropathic pain, in chronic non cancer pain, or in headache. A failure to improve function is a reason to taper off, not to increase…

…opioid at the same time. Opioids in abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination…

…by the pain not being relieved by rest or nitroglycerin, and by exacerbation with deep inspiration or movement [5]. 4. Pulmonary Embolism (PE) Pain Characteristics…

…during ongoing chest pain if the opportunity is given. An ECG without ischemic ST T changes when recording during chest pain is not consistent with…

…does not cause symptoms at rest unless the stenosis is so grave that myocardial oxygen demands cannot be satisfied even at rest. Ischemic chest pain…

…Diastolic blood pressure is not affected by changes in cardiac output. Hence, diastolic blood pressure is not affected by exercise (occasionally it may even drop…

Procedurer A dislocation is reduced with muscle relaxation, not with force. The methods that work best exploit time, gravity and slow movement; those that fail…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and peritonism…

…awake. Suspected necrotising fasciitis — pain that is disproportionately severe, a rapid course, skin discolouration, systemic upset — is an acute surgical emergency, not an abscess. Preparation…

…the tympanic membrane — including a history of grommets, ear discharge or pain on contact with water. A history of ear surgery in which the middle…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…disease and can justify further investigation or treatment. Testing is therefore not an automatic response to chest pain. It is appropriate when the expected information…

…of objectively demonstrating peripheral arterial disease, and it is needed more often than it is used — not only in claudication, but before every compression treatment…

…an arterial line should be considered. The blood pressure must not be dismissed as caused merely by pain or anxiety. These factors can affect the…

…Skin symptoms may be absent, and circulatory shock does not have to be present for the condition to be serious [1]. Intramuscular adrenaline (epinephrine) is…

…the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema…

…comes after the injury, not before — and that an edge or a fold presses on a bony prominence until the skin breaks down. An acute…

…not a treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain…

…the samples are sent correctly. A corticosteroid must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in…

…amputation. The decisive step is therefore not the choice of dressing but the ankle brachial index before the first bandage is applied . Indications Venous leg…

…and rostral ventrolateral areas of the medulla result in the blood pressure lowering effect. Effects Potent blood pressure lowering effect. Pain relief. Delivery IV, IM…

…should not be interpreted in isolation because myocardial injury is also encountered in non ACS cardiopulmonary disease. Patients with persistent or recurrent chest pain require…

…or posterolateral infarction. Its recognition is clinically important because posterior infarction may not produce conventional ST segment elevation in the standard 12 lead ECG. Instead…

…sinoatrial pause (sinus pause/arrest): ECG characteristics & clinical implications A sinoatrial arrest occurs when the sinoatrial node does not discharge an impulse for ≥2 seconds…

…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…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…leaves no specimen . That makes the choice of lesion the critical point: never freeze anything whose diagnosis you have not established. Indications Lesion Freeze time…

…neck pain, diplopia, dysarthria, dysphagia, ataxia Posterior circulation stroke Unilateral hearing loss or tinnitus Ménière's disease, vestibular schwannoma, labyrinthitis Continuous vertigo that does not…

…postmenopausal bleeding, discharge, itching, burning, pelvic pain, dyspareunia. Cervical cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of…

…drugs. Such treatment has not been shown to improve the prognosis and can cause hypotension, acute kidney injury, myocardial ischaemia or cerebral hypoperfusion. Pain, anxiety…

…chest pain, or when the volume limit is reached. Indications Diagnostic aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by…

…expertise. Procedure 1. Dry the skin and shave where necessary. Do not clip the hair — small cuts cause burning pain. 2. Position the pads, preferably…

…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…

…an important first line investigation for selected patients with suspected coronary artery disease (CAD), particularly those with stable chest pain, no previous diagnosis of CAD…

…patients with acute pain, anxiety, or distress have transient BP elevation that improves when the precipitating state resolves. The distinction is therefore not based on…

…the absence of persistent ST segment elevation. This does not imply low risk: patients with NSTE ACS may have substantial myocardial ischaemia, dynamic ECG abnormalities…

…extend superiorly as far as the occipital region but typically does not radiate below the umbilicus. Epigastric or subxiphoid pain may be mistaken for indigestion…

…categorised as myocardial injury. Clinical Presentation and Symptoms Patients with Type 2 MI frequently present with acute chest pain and troponin elevation. The clinical manifestation…

…which is then classified as NSTEMI (Non ST Elevation Myocardial Infarction). Patients with NSTE ACS who do not develop infarction are classified as unstable angina…

…patient must not have experienced chest pain during the last 12 hours before exercise. Patients with unstable angina pectoris with high risk should not undergo…

…elevation myocardial infarction (STEMI). This may not always be simple, because both conditions bring about severe chest pain and ST elevations on the ECG. However…

…and ACTH first only if this does not delay treatment. Plus fluid and glucose Adrenal crisis: hypotension that does not respond to fluid, abdominal pain…

…or in the wind. Suspected corneal abrasion. A red eye where the diagnosis is not obvious. Suspected acute glaucoma (tonometry). Contraindications Absolute contraindications to instrumental…

…is inhibited, the resulting accumulation of these peptides irritates afferent neural pathways in the respiratory tract. This process is not dose dependent. Similarly, angioedema occurring…

…injury is separate from MI. It refers to cardiac troponin release that does not fulfil the criteria for ischaemic myocardial infarction. It may be acute…

…or cold exposure. The absence of chest pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may occur in patients with diabetes…

…least one major criterion or two minor criteria. The source material does not provide the individual ARC HBR criteria. Modification of antiplatelet therapy may involve:…

…segment of aorta involved, although the source material does not provide a detailed symptom to anatomy correlation. Pain may be absent, particularly in iatrogenic aortic…

…Extreme obesity ≥40 III Extremely high BMI is useful for screening and population level risk estimation, but it does not characterize body composition, fat distribution…

…mechanism. The precise cause, however, is not fully established. At pathological examination, Dressler syndrome is generally characterized by localized fibrinous pericarditis containing polymorphonuclear leukocytes. Important…

…venous haemodynamics. Neuromodulation of cardiac pain signalling. Experimental angiogenic or regenerative strategies. The syndrome is clinically important not only because of persistent symptoms, but also…

…without an elevation in cardiac troponin. The underlying pathological mechanism is not restricted to a single lesion or process. Although Type 1 MI and acute…

…may be used to diagnose myocardial ischemia and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea…

…has become increasingly clear in the past few decades that atherosclerosis is not caused by the passive deposition of lipids into the coronary artery walls…

…ischemia). Yet, the pain caused by NSTEMI and unstable angina is considerable and most patients are therefore markedly affected. Other symptoms – such as dyspnea, cold…

…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…

…Fever is not obligatory Hypothermia, new confusion, tachypnoea, hypotension, rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of…

…does not exclude AAA. Plain abdominal radiography has limited sensitivity. A calcified aneurysmal outline may be visible, but approximately one quarter of aneurysms are not…