…Cellulitis, a skin wound or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the adjacent joint…

…used for type 1 myocardial infarction are fulfilled. The temporal relationship to stent implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich…

…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…

…release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated troponin, so biomarker interpretation…

…herpes zoster pain are other considerations when assessing chest pain [2]. Autoimmune/Malignancy: A history suggesting an autoimmune disorder or known malignancy may suggest specific…

…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…

…with long pauses. Bradycardia in poisoning with a beta blocker, a calcium channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during…

…of the nine parameters listed above. Many of the diagnoses mentioned below are discussed in detail in other chapters, to which links are provided throughout…

…individuals who endure intense emotional stress, acute pain or other stimuli that increases vagal tone. In all other situations, sinus arrest/pause should be considered…

…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…

…UA presents with compatible ischaemic symptoms but without cardiac specific troponin elevation above the 99th percentile. The clinical presentation should not be interpreted in isolation…

…syndrome are fairly specific to the disorder, provided that the clinical characteristics are in line with the disorder. There are however other disorders that may…

…ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or other…

…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…

…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…

…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…

…spot, in three minutes, without drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The…

…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…

…sputum purulence, the other cardinal symptoms and the severity of the illness. 7. Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive…

…and they tend to accompany each other. Therefore, the term perimyocarditis is often used in clinical practice (this article will use all three terms interchangeably…

…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…

Kardiologi Akutsjukvård Intensivvård Lathundar Clinical use This overview is a quick reference to the intravenous antihypertensive drugs used in a hypertensive emergency. It summarises the…

…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…

…of the aorta or arteries supplying the limbs. In adults over 40 years of age, atherosclerosis is the predominant cause. Other mechanisms include thrombosis, embolism…

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

…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…

…tendon. Measure in the same way as on the arm. 4. Posterior tibial artery — behind the medial malleolus. Measure. 5. Repeat on the other leg…

…rhythm ( Thorén et al ). The initial rhythm has immense significance for survival in cardiac arrest, regardless of all other circumstances. The initial rhythm is an…

…in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the…

…monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis…

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

…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…

…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…

…Reduced exercise tolerance. Excessive fatigue. These non chest pain manifestations are reported more frequently in females, older adults and people with diabetes. Ischaemic heart disease…

…occur when atherosclerotic plaques disrupt, resulting in the activation of thrombocytes and coagulation factors causing the formation of a thrombus. Such a thrombus can cause…

…managed as a distinct clinical entity. The hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during…

…managed as a distinct clinical entity. The hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during…

…a window of opportunity for reperfusion. In addition, some patients present with severe LMCA stenosis exacerbated by other conditions, and these must also be recognized…

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

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

…anatomy correlation. Pain may be absent, particularly in iatrogenic aortic injury. Iatrogenic lesions commonly follow cardiac surgery, coronary angiography or other invasive procedures, and affected…

…not routinely undergo immediate angiography. A selective or delayed approach is recommended in this setting unless other findings justify urgent intervention. Risk scores Several risk…

…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…

…establish: The nature and stability of symptoms Exercise capacity The presence of active chest pain or other evidence of ongoing ischaemia Symptoms suggesting haemodynamic compromise…

…and thyroid surgeries, as well as medications and agents such as bisphosphonates, calcitonin, citrate (from transfusions), phenytoin, phosphate, and foscarnet, among others. ECG in hypoc

…pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may occur in patients with diabetes and autonomic neuropathy, as well as in…

…ventricular contractions When every other beat on the ECG is a premature ventricular complex (PVC), the rhythm is referred to as PVC in bigeminy ( Figure…

…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…

…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…

…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…

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

…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…

…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…

…with a fluid level in the anterior chamber, best seen with the patient sitting up. 3. Ocular movements in all directions; pain on upward gaze…

…a tendon injury, or after suturing over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture…

…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…

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…