…Associated Findings: Exertional dyspnea, dizziness, and syncope may also occur [5]. Non Cardiac Causes Several non cardiac conditions can present with chest pain that requires…

…than 12 genetic mutations have been associated with the Brugada syndrome. These mutations are located in genes encoding potassium and calcium channels of the outer…

…presenting with acute chest pain ultimately have ACS; reported rates are generally 5–10%, although some series report 10–20%. Other life threatening cardiopulmonary conditions…

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

…form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation, aggregation, and fibrin formation…

…In addition, some patients present with severe LMCA stenosis exacerbated by other conditions, and these must also be recognized. Prompt identification of LMCA involvement is…

…performance and symptoms under the supervision of their clinician. Indeed, kinesiophobia (fear of exercising) is common after myocardial infarction and it is associated with poorer…

…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 nebulised adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is associated with more severe and more protracted reactions, biphasic courses and…

…with factors striving to lysate the thrombus (pro thrombolytic factors). The balance between pro thrombogenic and pro thrombolytic factors varies from one minute to another…

…patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed above. It is important that history taking and physical…

…greater in patients with diabetes mellitus and increases with age. STEMI may present as sudden onset breathlessness. Other less common presentations, with or without pain…

…particularly with ongoing or recurrent pain [1,3,4]. This quick reference gives internationally established doses. Drug availability, thrombolysis regimens, renal function thresholds and the…

…condition may occur especially in young women. Non coronary mechanisms that reduce oxygen supply include severe bradyarrhythmia, respiratory failure with severe hypoxaemia, severe anaemia, and…

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

…an intensive care unit, a coronary care unit or another setting that allows frequent blood pressure measurement and continuous monitoring. An arterial line is often…

…smoking, character of the pain. 2. Measure and trace the ulcer; photograph it with a ruler in the image. A reduction in size of 40…

…assessment should establish: The nature and stability of symptoms Exercise capacity The presence of active chest pain or other evidence of ongoing ischaemia Symptoms suggesting…

…be wise to observe the patient for 24 hours (including ECG monitoring). In all other situations, the underlying condition should be targeted and, if necessary…

…joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff syndrome The subacromial space The best documented indication Greater trochanteric pain syndrome…

…exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing the myocardial load), and vice…

…exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing the myocardial load), and vice…

…ST depressions and/or T wave inversions. Patients with NSTE ACS (NSTEMI, unstable angina), on the other hand, may only display ST depressions and/or…

…saturation : : Known COPD or another clear risk of hypercapnic respiratory failure 88 to 92 percent No risk of hypercapnia and a normal blood gas Usually…

…after a few minutes' rest, if the patient's condition allows. 7. With titratable intravenous treatment and an unstable course, an arterial line should be…

…osteoarthritis related joint disease. Contraindications Infection of the skin or soft tissues over the puncture site — use another approach or refrain. Bacteraemia without suspicion of…

…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…

…predict bleeding risk in paracentesis. Follow the local protocol Ileus with distended bowel loops Ultrasound guidance mandatory; choose another site Scars, hernia or visible abdominal…

…treatment. Cardiac and pulmonary complications Acute hypertension may precipitate myocardial ischemia or infarction, acute heart failure, or pulmonary oedema. Patients may present with chest pain…

…node and is therefore ineffective — sometimes harmful — in infranodal block with wide QRS complexes; do not delay pacing in order to try yet another dose…

…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…

…It is used in the acute vestibular syndrome — continuous vertigo with spontaneous nystagmus, nausea and difficulty walking that has lasted hours to days — to distinguish…

…coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality…

…or delayed approach is recommended in this setting unless other findings justify urgent intervention. Risk scores Several risk scores integrate clinical, ECG, and biomarker variables…

…Excessive fatigue. These non chest pain manifestations are reported more frequently in females, older adults and people with diabetes. Ischaemic heart disease may also present…

…nearly empty). In patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for…

…and afferent neural pathways in causing chronic refractory cough, akin to chronic neuropathic pain. This syndrome presents with a dry or minimally productive cough and…

…flow. Ischaemia initially produces pain and sensory disturbance. With progression, motor dysfunction develops, followed by profound anaesthesia, paralysis, muscle rigidity and ultimately major tissue loss…

…Epigastric or subxiphoid pain may be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense of impending doom When STEMI begins…

…patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected necrotising fasciitis — pain that…

…and neonatal electrocardiograms differ markedly – in terms of rhythm, morphology, normal findings, normal variants, etc – from adult electrocardiograms. It is crucial to be familiar with…

…Pain may be absent, particularly in iatrogenic aortic injury. Iatrogenic lesions commonly follow cardiac surgery, coronary angiography or other invasive procedures, and affected patients may…

…symptoms or ECG changes consistent with myocardial infarction/ischemia. Most patients, however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis…

…Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral regurgitation—predominant right ventricular (RV) infarction…

…Other symptoms – such as dyspnea, cold sweat, nausea, etc – are also common in NSTEMI and unstable angina (please refer to Approach to Patients with Chest…

…Other causes include immobilization, sarcoidosis, thyrotoxicosis, familial hypocalciuric hypercalcemia, Addison's disease, renal insufficiency, therapeutic interventions with tamoxifen or lithium, thiazide administration, and over supplementation…

…and note the pressure at which the signal returns. Repeat on the other arm. 2. Ankle pressure. Place the cuff just above the malleoli, with…

…front , and this is why the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis…

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

…myocardial oxygen demand and coronary blood supply, resulting in myocardial hypoperfusion or ischaemia. Ischaemia is commonly precipitated by exertion, emotional stress, or another form of…

…complexes are not preceded by P waves because the ectopic impulse originates in the ventricles and does not influence the atria (with exceptions discussed below)…

…monitoring and airway preparedness With procedural sedation, one person must manage the sedation and another the reduction . Check the fasting status, the ASA class and…

…limb and inform the patient. Backslab or circumferential cast A dorsal backslab or another half slab for a fresh injury, acute swelling, after reduction and…

…AAAs larger than 4 cm are associated with atherosclerotic pathology. AAA prevalence increases with age and is approximately five times higher in males than females…

…In patients with pericarditis complicated by constriction, symptoms and signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are…

…have no place in acute, unstable pain: the onset takes 12 to 24 hours and the offset just as long. Breakthrough dose During ongoing opioid…

…given for the pain, but the effect on the bowel must be taken into account). Known allergy to the preparation — rare; itching and urticaria are…

…or are associated with high event risk. The apparent differences between thresholds reflect different guideline frameworks and clinical pathways rather than a single universal classification…

…externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy: an otoscope with a charged battery and clean…

…of a patient with suspected syncope aims to determine whether the transient loss of consciousness was due to syncope, identify the cause, and assess the…