…wrong move — in the hand, in the medial triangle of the face or perianally. Indications Fluctuant, tender, erythematous and indurated swelling in the skin or…

…2. Clean and let it dry. Do not palpate the puncture site again with an unsterile hand. 3. Insert the needle in one movement, aspirating…

…alone. Contraindications Primary closure must be avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on the hand. These…

…slit lamp with the forehead against the band and the chin in the rest. Support your working hand against the patient's zygoma or the…

…very small or loculated effusion — consider image guided puncture in the radiology department The thresholds for the INR and the platelet count vary between regions…

…testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the other hand, appears to be similar. Exercise stress testing and revascularization …

…canal : pull the pinna upwards and backwards in adults, downwards and backwards in small children. 3. Rest your hand against the patient's cheek so…

…acute pain or other stimuli that increases vagal tone. In all other situations, sinus arrest/pause should be considered abnormal, and the following differential diagnoses…

…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 …

…in a reduction of coronary blood flow and this causes subendocardial ischemia (i.e ischemia that only affects the subendocardium). STEMI, on the other hand…

…remains consequential, and historically 2–6% of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations…

…is useful in practice: An examination couch that can be approached from all sides and on which the patient's head can hang over the…

…new onset seizures or coma in a pregnant woman with preeclampsia. HELLP syndrome—haemolysis, elevated liver enzymes or transaminases, and thrombocytopenia—is generally regarded as…

…ST elevation in lead aVR was relatively uncommon (7%). Patients with greater ST elevation in aVR had higher crude in hospital and 6 month mortality…

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

…hard exertion A healthy person can still go on, but he or she really has to push him or herself. It feels very heavy, and…

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

…titration in acute severe pain Practical points during titration: Give the injection slowly over at least a minute; a rapid injection causes nausea and a…

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

…therapy and Opioid therapy in severe pain. Cardiac arrest Drug Adult Child : : : Adrenaline 1 mg IV/IO every 3–5 min. In asystole and PEA…

…chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest, arms, neck, jaw, upper back, and abdomen, as well as dyspnea and…

…chest pain pathway. Testing is optional and may be selected according to clinical judgement. Low to moderate probability: greater than 5% to 50% in the…

…symptoms in clinical practice and it is fundamental to be able to differentiate benign from serious etiologies. Therefore, when encountering a patient with chest pain…

…ECG, and normal initial troponin may be observed in a chest pain unit or another non intensive care setting while serial testing is completed. Diagnostic…

…blood pressure increases during exercise. The increase in cardiac output during moderate exercise is the result of increased stroke volume and increased heart rate. However…

…In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography…

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

…reduced when studying distant objects). These concepts have been discussed in detail previously. The gain is regulated with TGC and gain control , as discussed earlier…

…the corticosteroid and the lidocaine in the same syringe. The anaesthetic confirms that the injection has gone to the right place — immediate pain relief is…

…Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and symptoms in known heart disease…

…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…

…Overview Acute coronary syndrome comprises STEMI, NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG…

…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…

…confused: replacement therapy in adrenal insufficiency (which must be increased under stress) and pharmacological anti inflammatory treatment (which must be tapered in a controlled fashion…

…abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia, while sensory and motor function remain preserved. The duration and progression of…

…pain in acute pericarditis may also, as in STEMI, radiate to the neck, shoulders or back. However, acute pericarditis is more likely if inspiration and…

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

…deeper and more controlled freeze on flat surfaces; spray technique is better on irregular surfaces and in the scalp. Complications Complication Frequency and comment : : Pain…

…principle, not a universal target. Chronic hypertension shifts autoregulation in the brain and kidneys towards higher pressures. Too rapid a normalisation can therefore cause cerebral…

…used in units with airway expertise. Procedure 1. Dry the skin and shave where necessary. Do not clip the hair — small cuts cause burning pain…

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

…to chronic neuropathic pain. This syndrome presents with a dry or minimally productive cough and a tickle or sensitivity in the throat, and is made…

…perfusion abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques, such as SPECT and PET, can detect perfusion abnormalities early in this…

…arterial disease and at the same time indicates a substantially increased risk of myocardial infarction and stroke. Indications Intermittent claudication, rest pain in the foot…

…the myocardium, thereby intensifying chest pain. In contrast, NSTEMI and UA typically involve partial occlusions, resulting in subendocardial ischemia and comparatively milder symptoms. For the…

…bridging; myocardial metabolic abnormalities; and abnormal pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis…

…ongoing compression therapy, and always in the event of new or increasing pain. Preparation and equipment Doppler for the ankle brachial index, blood pressure cuff…

…block The standard in finger dislocation Procedural sedation Propofol, ketamine or a combination. It requires a fasting history, two people, full monitoring and airway preparedness…

…infarction primarily in the context of suspected acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent…

…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…

Cardiology Pharmacology & dosing Definition and pathophysiology Statins inhibit 3 hydroxy 3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol…

…Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand…

…The underlying pathophysiology is rooted in autonomic dysregulation within a structurally normal heart. During an episode, decreased cardiac output and a potential paradoxical vasodilation with…

…suspected coronary artery disease (i.e CCS). The new guidelines are based on data derived from studies conducted mainly in North America and Europe. Moreover…

…Upon such damage, the plaque exposes highly thrombogenic materials which activate circulating platelets and coagulation factors, which results in thrombus formation (Figure 1). Disruption of…

…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…

…QRS complex and the P wave is positive in lead II. Sinus tachycardia is always considered pathological and the underlying cause must be investigated. Pain…

…disease (i.e. CCS). The new guidelines are based on data derived from studies conducted mainly in North America and Europe. Moreover, the guideline committee…

…Expansion may produce pain in the abdomen, chest, lower back or scrotum. Aneurysmal pain is clinically important because it may herald rupture and constitutes a…

…new organ damage in which immediate, controlled blood pressure lowering can limit the damage. The choice of drug, the target pressure and the rate of…