…symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and may extend to the arms, shoulders, neck, jaw, upper back, abdomen…

…back pain and selected cases of upper abdominal pain. An ECG recording costs approximately $10 (10€) and may reduce morbidity and mortality substantially in patients…

…with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest, arms, neck, jaw, upper back…

…jaw, back, upper abdomen, and left or right arm. Onset and evolution How do symptoms start (suddenly or gradually)? When did the patient first note…

…lower doses than for pain). An opioid is rarely the right choice in nociplastic or neuropathic pain, in chronic non cancer pain, or in headache…

…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…

…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…

…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…

…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…

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

…V4R to detect concomitant right ventricular infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase…

…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…

…stabbing or burning sensations may occur. Pain usually involves the central chest or epigastrium, may radiate to the arms, and less often to the abdomen…

…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…

…chest pain (30%) and dyspnea (10%). The major ECG findings in ARVC are T wave inversion in V1–V3 (in the absence of right bundle…

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

…Figure 1. Coronary artery anatomy in angiographic and computed tomography (CT) views. (A) Angiographic schematic showing the right coronary artery (RCA), left main coronary artery…

…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…

…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 Exercise stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar…

…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…

…more often than anything else. Record a resting ECG both supine and sitting, and resting blood pressure in both arms. Procedure 1. Exercise protocol: start…

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

…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…

…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…

…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…

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

…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…

…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…

…shows the most fluid, usually in the scapular line one to two intercostal spaces below the upper border of the fluid, but never below the…

…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…

…Arm pressure. Place the cuff on the upper arm. Locate the brachial signal in the antecubital fossa with the Doppler probe at 45–60° to…

…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…

…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…

…care or in the emergency department without contacting the appropriate specialty: Location Risk Management : : : Medial triangle of the face (nasal root, alae nasi, upper lip…

…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…

…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…

…The upper arm is held adducted against the trunk and the elbow is flexed to 90 degrees. The forearm is moved very slowly outwards in…

…in both arms. Cardiac auscultation. Pulmonary auscultation. Evaluation for heart failure. Assessment for circulatory compromise, haemodynamic instability, or electrical instability. Posterior infarction may occur in…

…and lasts longer. The pain usually involves the central portion of the chest or the epigastrium and occasionally radiates to the arms. Less common sites…

…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…

…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…

…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…

…NSTE ACS results in one of the following diagnoses: Non ST Elevation Myocardial Infarction (NSTEMI, non STEMI) , if troponin levels are above the upper threshold…

…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…

…positive in lead II (and also I and aVF). Arrhythmias Sinus tachycardia Sinus tachycardia exists if the heart rate is higher than the upper normal…

…NSTE ACS results in one of the following diagnoses: Non ST Elevation Myocardial Infarction (NSTEMI, non STEMI) , if troponin levels are above the upper threshold…

…common in women (70% are women) and elderly individuals. Clinical characteristics and ECG changes in takotsubo cardiomyopathy The typical patient presents with severe chest 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…

…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…