…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…

…effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications Infection of the skin…

…before radiography. The longer a joint remains dislocated, the harder the reduction becomes and the greater the risk of chondral and neurovascular injury. Aim for…

…edges are held apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas. Superficial wounds with well…

…rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral epicondylitis the effect is in fact worse than…

…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…

…6% of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations The central pathophysiological concern in…

…and an undiluted syringe of 10 mg/mL makes small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the…

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…

…treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest…

…diagnosis, as the syndrome associated with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest…

…to chest pain. It is appropriate when the expected information is likely to change management. In patients with a very low probability of obstructive CAD…

…ACS). Aortic dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of chest pain, but the…

…Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the other hand, appears to be…

…for management of acute ischaemia. Those with possible ACS, a non diagnostic ECG, and normal initial troponin may be observed in a chest pain unit…

…return to the heart, which results in increased cardiac preload. The mechanisms are as follows: Sympathetic activity causes constriction of the veins, which increases the…

…denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction…

…paracentesis: Newly detected ascites — always. Every admission of a patient with known ascites. Clinical deterioration in a cirrhotic patient with ascites: fever, abdominal pain, encephalopathy…

…during the examination. Work related musculoskeletal disorders are a common cause of pain and sickness absence for ultrasound practitioners (Harrison et al). When performing emergency…

…TIA in the vertebrobasilar territory. Retinal detachment. Relative: Marked cervical restriction of movement or pain — use the Semont manoeuvre or the side lying variant of…

…isolated ST depression in a woman with a low pre test probability is usually a false positive. Indications Evaluation of chest pain with an intermediate…

…forehead against the band and the chin in the rest. Support your working hand against the patient's zygoma or the bridge of the nose…

…rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the…

…unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach…

…Inhaled and topical steroids in high doses can also cause systemic suppression. Corticosteroids mask fever and peritonitis. The abdomen of a patient on corticosteroids can…

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

…chest pain in acute pericarditis may be severe and the patient may also experience cold sweats, tachycardia and anxiety; all of which are common in…

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

…thrombosis in the treated area. The method is quick, cheap and requires no local anaesthetic — but it leaves no specimen . That makes the choice of…

…duration of effect, the dosing, the adverse effects and the important precautions. A hypertensive emergency is defined by a markedly raised blood pressure in combination…

…needle is placed in the wrong site, and too much is drained. Bedside ultrasound immediately before the puncture markedly reduces the risk of pneumothorax and…

…without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is…

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

…emerged, emphasizing the putative role of sensitized sensory nerve endings and afferent neural pathways in causing chronic refractory cough, akin to chronic neuropathic pain. This…

…chest pain) appear as the last event in the cascade. Thus, ischemic episodes may pass asymptomatically. Importance of heart rate during myocardial perfusion imaging It…

…rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of a leg ulcer — compression in arterial insufficiency can…

…affecting a larger portion of the myocardium, thereby intensifying chest pain. In contrast, NSTEMI and UA typically involve partial occlusions, resulting in subendocardial ischemia and…

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

…depth of the cavity and its distance to vessels. Contraindications and when to involve a surgeon The following locations must not be handled routinely in…

…three to six months during ongoing compression therapy, and always in the event of new or increasing pain. Preparation and equipment Doppler for the ankle…

…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…

…simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to the trapezius ridge is not seen in…

…the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol production increases hepatic LDL receptor expression, thereby enhancing removal of LDL particles from the circulation…

…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…

…branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for those wit

…elevated levels of myocardial proteins. These proteins are cardiac troponins (henceforth referred to only as troponins). When elevated troponin levels are confirmed in patients with…

…likely that the coming guidelines by the American Heart Association (AHA) and American College of Cardiology (ACC) will be in line with the European guidelines…

…ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms. The diagnosis requires elevated levels of cardiac troponins. In addition…

…to alleviate ischemic chest pain may lead to hemodynamic collapse in patients with right ventricular ischemia or infarction. Recognizing ECG signs of right ventricular involvement…

…P wave PR interval QRS complex ST segment T wave U wave QT (QTc) interval Pediatric and neonatal electrocardiograms differ markedly – in terms of rhythm…

…likely that the coming guidelines by the American Heart Association (AHA) and American College of Cardiology (ACC) will be in line with the European guidelines…

…Echocardiogram showing takotsubo cardiomyopathy in acute phase (A) and resolution phase (B). Note the apical ballooning of the apical portion fo the left ventricle (A…

…contrast agents, and accurately identifies abdominal aortic enlargement. Screening reduces aneurysm related mortality in populations with a high prevalence of AAA, particularly older male smoke

…to Patients with Chest Pain). As in patients with STEMI, those with NSTEMI and unstable angina are at considerable risk of developing life threatening ventricular…

…can affect the blood pressure in several ways. Monoamine oxidase inhibitors can cause a hypertensive crisis through interactions, while venlafaxine and higher doses of bupropion…

…NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8. Document the ceiling of care and the decision…

…severe abdominal pain or repeated vomiting after probable allergen exposure sudden hypotension or severe bronchospasm during anaesthesia, a drug infusion or the administration of contrast…

…burning, pelvic pain, dyspareunia. Cervical cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a…

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

…benzodiazepine) is considered. IIa C Cardiac arrest Management Recommendation Level of evidence Urgent angiography is indicated in patients exhibiting ST segment elevation. I B TTM…