…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…

…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…

…and toes. Pain that is worse at night or when the limb is horizontal. Improvement when the leg is placed in a dependent position. With…

…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…

…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…

…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…

…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…

…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…

…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…

…defines the condition. A rapid rise in blood pressure can cause serious organ damage even at lower levels, particularly in pregnancy [1,2]. Malignant hypertension…

…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…

…Conversely, a rapid rise in blood pressure from a previously low level can cause organ damage at lower values, for example in pregnancy, acute glomerular…

…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…

…revascularization, while avoiding unnecessary procedural complications and bleeding in those at lower risk or in whom the hazards of revascularization outweigh its potential benefit. A…

…severe chest pain or pressure, and an accelerating pattern. An accelerating pattern includes increasingly frequent or severe episodes, longer episodes, a lower threshold for provocation…

…in men or 80 cm in women is considered indicative of obesity or excess abdominal adiposity. Ethnic specific thresholds are lower or otherwise modified in…

…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…

…Statins inhibit 3 hydroxy 3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol production increases hepatic LDL receptor expression…

…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…

…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…

…five levels, with mild skin and mucosal reactions in the lower grades and marked airway, respiratory or circulatory compromise in the higher ones [5]. For…

…syncope, chest pain, heart failure and cardiac arrest. In cases with intermittent symptoms, it is important to establish a temporal correlation between symptoms and episodes…

…chest pain, dyspnoea, dizziness, and neurological deficits. Neurological involvement Hypertensive encephalopathy may present with somnolence, lethargy, tonic–clonic seizures, cortical blindness, and, in advanced cases…

…Stable chest pain CCTA is recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of…

…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…

…may occur. Pain usually involves the central chest or epigastrium, may radiate to the arms, and less often to the abdomen, back, lower jaw, neck…

…tends to manifest in young adults and the most common symptoms are palpitations (prevalence 40%), syncope (30%), sudden cardiac death (15%), atypical chest pain (30…

…for hypertension. However, coronary artery disease remains the number one killer in most regions worldwide ( Tsao et al .). The New England Journal of Medicine, 1812…

…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…

…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…

…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…

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…

…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…

…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…

…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…

…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…

…s left arm should be placed under the patient's head. This stretches in the chest wall, such that the distances between the ribs increase…

…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…

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

…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

…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…

…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…

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

…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…

…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…

…or electrical alterations are evident. Subjective symptoms (i.e. chest pain) appear as the last event in the cascade. Thus, ischemic episodes may pass asymptomatically…

…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…

…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…

…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…

…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…

…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…

…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…

…vasovagal syncope is reported to occur in over 40% of females and 30% of males due to a lack of effective reflex response to posture…