…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…

…LCx supplies the posterior descending artery (PDA) in a left dominant circulation (i.e. 10 15% of cases). Clinically, patients present with severe chest pain…

…from apical windows. The patient's left arm should be placed under the patient's head. This stretches in the chest wall, such that the…

…Repeat on the left side. A positive test in the posterior canal is characterised by: A latency of 1–5 seconds before the nystagmus begins…

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

…avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on the hand. These are as a rule left open…

…to involve a surgeon The following locations must not be handled routinely in primary care or in the emergency department without contacting the appropriate specialty:…

…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…

…the left ventricle takes the shape of that octopus trap). Refer to Figure 1 and Figure 2. Figure 1. Echocardiogram showing takotsubo cardiomyopathy in acute…

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…

…2], [5]. Localization: While often retrosternal, the pain may be localized to the left anterior chest and can radiate to the neck, shoulders, and arms…

…The table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed…

…Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with recurrent chest pain and hemodynamic compromise after MI, mechanical complications should be considered. Transthoracic echocardiography (TTE…

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…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…

…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…

…pain (angina). Myocardial perfusion imaging techniques, such as SPECT and PET, can detect perfusion abnormalities early in this sequence, before mechanical dysfunction ( i.e. left…

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

…blood pressure in combination with new or progressive acute target organ damage. Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular…

…clip the hair — small cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum…

…dysfunction and death. In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately…

…myocardial ischaemia and to estimate prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure…

…PDA is supplied by the left circumflex coronary artery (LCX). Right dominant system is by far the most common anatomy, occurring in 90% of all…

…resulting in permanent wall motion abnormalities. Figure 1. Standardized myocardial segmentation and nomenclature for echocardiography. The left ventricle is divided into 17 segments for 2D…

…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…

…material does not provide a detailed symptom to anatomy correlation. Pain may be absent, particularly in iatrogenic aortic injury. Iatrogenic lesions commonly follow cardiac surgery…

…recurrent chest pain, pulmonary congestion, a new cardiac murmur, or jugular venous distension in the days after MI should prompt immediate consideration of a mechanical…

…chest pain or chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy, the clinical presentation of ACS is generally similar to that in non…

…left ventricular hypertrophy. In patients with stable known or presumed CAD, an acute stressor—such as an acute gastrointestinal bleed causing a precipitous drop in…

…back pain is the predominant symptom of both IMH and PAU. PAU pain may resemble the abrupt pain of classic aortic dissection. Symptom onset in…

…in the morning within several hours of awakening has been described. Atypical and painless presentations Pain is not universal. Painless STEMI is more frequent in…

…from the lungs to the left ventricle, which therefore contracts without pre load (the ventricle is empty or nearly empty). In patients with an initial…

…up and leans forward. Pain may be retrosternal or left precordial and can radiate to the neck, arms, or left shoulder. It may occasionally be…

…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…

…Pharmacology & dosing Definition and pathophysiology Heart failure is a clinical syndrome in which the heart cannot provide blood flow commensurate with the body’s requirements…

…spray technique is better on irregular surfaces and in the scalp. Complications Complication Frequency and comment : : Pain during thawing The rule rather than the exception…

…postmenopausal bleeding, discharge, itching, burning, pelvic pain, dyspareunia. Cervical cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of…

…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…

…with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations The central pathophysiological concern in the emergency department is…

…small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at least a minute; a rapid…

…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…

…is generally preferred to exclude obstructive CAD. Intermediate or high probability: above 15% in the chest pain pathway. Either CCTA or functional imaging is appropriate…

…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…

…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…

…Exercise induces physiological changes such as increased ventilation, coronary vasodilation, increase in blood pressure, etc . The purpose of such changes is simply to enable 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…

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

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

…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…

…life produces more marked suppression. Stress dosing in known adrenal insufficiency A patient with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long…

…For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia, while…

…as in STEMI, radiate to the neck, shoulders or back. However, acute pericarditis is more likely if inspiration and supine position worsens the chest pain…

Procedurer Almost all the complications of pleural aspiration arise from two errors: the needle is placed in the wrong site, and too much is drained…

…blood pressure lowering effect. Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml…

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

…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…

…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…

…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…

…movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than more slowly. The…

…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…