…in selected cases, but surgery is the standard. Dark skin: a risk of permanent hypopigmentation. Areas with poor circulation, above all the lower leg in…

…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…

…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…

…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…

…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…

…or lower jaw. Discomfort may extend superiorly as far as the occipital region but typically does not radiate below the umbilicus. Epigastric or subxiphoid pain…

…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…

…up. 3. Ocular movements in all directions; pain on upward gaze may suggest an orbital floor fracture. 4. Topical anaesthesia into the lower fornix. 5…

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…

…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…

…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…

…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…

…symptoms. 4. Blood pressure every second minute and on symptoms. 5. Ask actively about chest pain, breathlessness and leg fatigue; have the patient rate exertion

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…which results in the complete stop of blood flow and thus more extensive myocardial ischemia (referred to as transmural ischemia). Yet, the pain caused by…

…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…

…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…

…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…

…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…

…after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications…

…Surgeon or mammography Sole of the foot Deep compartments Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding, vascular injury…

…is known. Recent gynaecological surgery. Preparation and equipment An examination couch with leg supports, and good, directable lighting. Specula in several sizes (small, medium, large…

…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…

…breathlessness in the palliative phase (at lower doses than for pain). An opioid is rarely the right choice in nociplastic or neuropathic pain, in chronic…

…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…

…inability to reach their maximal heart rate. Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity…

…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…

…Parasympathetic stimulation reduces the automaticity in the sinoatrial node, which lowers the heart rate. The parasympathetic activity also diminishes impulse transmission in the AV node…

…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…

…Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available…

…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…

…of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain, or when the…

…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…

…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…

…by the EMS. Specificity : The specificity is relatively lower at 53%, highlighting challenges in distinguishing STEMI from conditions that mimic its presentation. Positive Predictive Value…

…in that case add toe pressure measurement. Absolute: ABI < 0.5 or toe pressure < 30 mmHg. Decompensated heart failure — compression of both legs…

…gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than…

…back, lower jaw, and neck. The pain may radiate as high as the occipital area but does not radiate below the umbilicus. It is often…