…increases. The autonomic nervous system is the first system to react to exercise. It does so by withdrawing parasympathetic activity and increasing sympathetic activity. This…

…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…

…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…

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

…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…

…crucial to distinguish Type 2 MI from acute and chronic myocardial injury. Myocardial injury is characterised by myocyte necrosis and troponin elevation due to mechanisms…

…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…

…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…

…This pain is thought to result from right ventricular ischemia that develops during physical exertion [5]. Associated Findings: Exertional dyspnea, dizziness, and syncope may also…

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…

…often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the…

…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…

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

…or new onset marked weakness rapidly progressive symptoms from several organ systems severe abdominal pain or repeated vomiting after probable allergen exposure sudden hypotension or…

…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…

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

…Turn the head 45° to the right. 3. Support the head and lay the patient quickly into the supine position with the head extended approximately…

…No drug has been shown to improve the neurological outcome in cardiac arrest. High quality compressions with minimal interruptions and early defibrillation are what determine…

…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…

…Routine gynaecological examination of asymptomatic women has not been shown to improve outcomes and is not part of the screening programme — screening consists of the…

…shown to improve the prognosis and can cause hypotension, acute kidney injury, myocardial ischaemia or cerebral hypoperfusion. Pain, anxiety, urinary retention, hypoxia, drug withdrawal and…

…important indication and an emergency procedure . An unclear arthritis, as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or…

…pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the ABI every three to six months during ongoing compression therapy, and…

…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…

…needle is inserted close to the upper border of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is…

…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…

…with persistent or recurrent chest pain require repeat blood sampling even when an accelerated algorithm has already been initiated. Evaluation and Physical Examination Patients with…

…benefit Clinical Presentation and Symptoms Symptoms depend on the organ system involved. Possible manifestations include headache, visual disturbance, chest pain, dyspnoea, dizziness, and neurological deficits…

…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…

…it shows the coronary arteries and their relation to the ECG leads. Note that Figure 1 is a right dominant system (i.e PDA is…

…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…

…a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to hurt even so. Offer nitrous oxide…

…level of consciousness and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed…

…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…