…acute pancreatitis, alkalosis due to hyperventilation, rhabdomyolysis (particularly the initial phase), sepsis, malignancies with osteoblastic metastases, diminished calcium absorption and/or enhanced calcium excretion, chronic…

…must be taken into account). Known allergy to the preparation — rare; itching and urticaria are usually due to histamine release, not allergy. Concurrent MAO inhibitor…

…These age variations in heart rate are due to variations in the activity of the autonomic nervous system and changes in the automaticity of the…

…stroke volume and increased heart rate lead to increased cardiac output . Systolic blood pressure increases when cardiac output increases. Diastolic blood pressure is not affected…

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

…This is possible due to the small distance between the heart and the ultrasound transducer, and because less air filled lung tissue covers the heart…

…due to an arrhythmia or underlying cardiac disease. Relevant abnormalities include bradyarrhythmias or tachyarrhythmias, AV block, acute myocardial ischemia, old myocardial infarction, long QT, and…

…and occasionally pathological Q waves. Troponin levels are often mildly elevated. Hence, takotsubo cardiomyopathy cannot be differentiated from ST segment elevation myocardial infarction. Due to…

…will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and NSTE ACS …

…V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2…

…and throat pain may point toward gastroesophageal reflux. Physical examination should include a speculum examination of the nose to look for excess mucoid or purulent…

…are due to partial (incomplete) coronary artery occlusions , which implies that there remains residual blood flow in the artery. Moreover, management of NSTEMI and unstable…

…Indeed, ventricular tachycardia and ventricular fibrillation cause the vast majority of all deaths in the acute phase of STEMI. Death due to ventricular dysfunction, or…

…between myocardial oxygen supply and demand, which is not related to acute coronary atherothrombosis. By definition, acute atherothrombotic plaque disruption is not a feature of…

…pathological Q waves may be used to diagnose myocardial ischemia and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain…

…severe chest pain, diaphoresis, hypotension, pulmonary edema, malignant arrhythmias, and rapid progression to cardiogenic shock. Ventricular fibrillation or asystole may occur early due to the…

…stabilized. This usually takes 2 to 3 days and the patient must not have experienced chest pain during the last 12 hours before exercise. Patients…

…attack Syncope due to sinus arrest is referred to as Adam Stokes attack . Causes of sinoatrial arrest/pause High vagal tone is benign and the…

…and therefore the worse the prognosis. This does not always hold true. For example, in cardiac arrest due to pulmonary embolism the initial rhythm is…

…due to dyspnea is associated with a worse prognosis than termination due to chest pain. Leg fatigue Leg fatigue is particularly pronounced on bicycle, and…

…rather than a narrowly defined symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and may extend to the arms, shoulders…

…dose and lengthen the interval Liver failure A reduced dose and a longer interval for all opioids Obesity Dose according to effect, not according to…

…and can radiate to the neck, shoulders, and arms, sometimes following the trapezius ridge [2]. Distinguishing Features: Recognition may be aided by the pain not…

ECG Myocardial ischemia and infarction Approach to patients with chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms…

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

…the result meaningfully increases the likelihood of disease and can justify further investigation or treatment. Testing is therefore not an automatic response to chest pain…

…ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol…

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

…which is often associated with fracture and requires an orthopaedic surgeon. Dislocation of a native hip (as opposed to a prosthesis) — a high risk of…

…Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and…

…artery disease (CAD), frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity. The hallmark of stable…

…artery disease (CAD), frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity. The hallmark of stable…

…during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques, such as SPECT and PET, can detect…

…to 24 hours After failed fibrinolysis Immediate rescue PCI The 120 minute limit is a ceiling for the choice between primary PCI and fibrinolysis, not…

…condition to be serious [1]. Intramuscular adrenaline (epinephrine) is the first line treatment and must be given early when anaphylaxis is suspected. Do not wait…

…the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel…

…padding and the stockinette, right down to the skin — a cast split only through the plaster layer does not relieve the pressure. Common splints and…

…enough to proceed with urgent investigation , and a normal CT of the brain does not exclude an infarction in the posterior fossa. Preparation and equipment…

…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…

…Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with…

…sample when the HPV test is positive — the sample therefore does not need to be repeated. Age Screening interval Test : : : 23–49 years Every five…

…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…

…medially and slightly caudally, parallel to the posterior surface of the patella. The shoulder The patient sits with the arm hanging relaxed and slightly internally…

…compression applied to a limb with arterial insufficiency can cause necrosis and, in the worst case, amputation. The decisive step is therefore not the choice…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…throughout the respiratory cycle and where the lung does not come up against the probe on inspiration. 3. Measure the skin to pleura distance on…

…myocardial ischaemia or syncope — that has not responded to atropine: Complete heart block (third degree AV block) and second degree AV block Mobitz type 2…

…Ps”: Pain Paresthesia Pallor Pulselessness Poikilothermia, or coldness Paralysis Pain is often severe and is located distal to the arterial obstruction. Paresthesia, numbness and loss…

…Clinical Presentation and Indications CCTA is relevant to several clinical presentations. Stable chest pain CCTA is recommended as an initial test for diagnosing CAD in…

…not provide a detailed list of physical examination findings or a specific examination sequence. It does, however, emphasize that symptoms and vital signs contribute to…

…sufficient Severe elevation Acute HMOD Present Absent clinically Symptoms Often present and related to the affected organ May be absent or nonspecific Treatment setting Usually…

…particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from…

…elevation myocardial infarction to a percutaneous coronary intervention capable hospital. The initial ECG should be interpreted in conjunction with the clinical presentation and previous tracings…

…in diagnosing ischemia and infarction and guide appropriate management strategies. For instance, administering nitroglycerin to alleviate ischemic chest pain may lead to hemodynamic collapse in…

…fatigue and exercise intolerance to sudden cardiac arrest. The most common acute symptoms are dizziness (pre syncope), hypotension (chock), syncope, chest pain, heart failure and…

…able to separate pericarditis from ST elevation myocardial infarction (STEMI). This may not always be simple, because both conditions bring about severe chest pain and…

…fasciitis — pain that is disproportionately severe, a rapid course, skin discolouration, systemic upset — is an acute surgical emergency, not an abscess. Preparation and equipment No…

…titrated cautiously and the blood gas determines the need for ventilatory support . At the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient…

…Plus fluid and glucose Adrenal crisis: hypotension that does not respond to fluid, abdominal pain, vomiting, fever, hyponatraemia, hyperkalaemia, hypoglycaemia. Give hydrocortisone and an isotonic…

…on an irregular surface. Petroleum jelly around the lesion to protect the surrounding skin. Eye protection and gloves for the operator. Explain before treatment that…