…and tends to worsen when the patient lies flat or moves [2], [5]. Localization: While often retrosternal, the pain may be localized to the left…

…ECG changes in takotsubo cardiomyopathy The typical patient presents with severe chest pain, dyspnea and occasionally hemodynamic compromise. The ECG shows localized ST segment elevations…

…characterized by localized fibrinous pericarditis containing polymorphonuclear leukocytes. Important distinction from subacute cardiac rupture A post AMI pericardial effusion is not automatically attributable to Dressler…

…endings and afferent neural pathways in causing chronic refractory cough, akin to chronic neuropathic pain. This syndrome presents with a dry or minimally productive cough…

…plaque that penetrates through the internal elastic lamina into the media. The lesion may produce a localized medial haematoma and can progress to IMH, pseudoaneurysm…

ECG Myocardial ischemia and infarction Using the ECG to localize myocardial infarction and the coronary occlusion Determining the localization of myocardial infarction and ischemia, as…

…10 to 20 percent of anaphylactic reactions. The absence of urticaria must therefore not be used to exclude the diagnosis [1]. Isolated urticaria, localised angio…

…remains consequential, and historically 2–6% of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations…

…patient who is pain free lying still but screams when turned has not finished being titrated. Expect an opioid naive adult to need 5–15…

…hour to approximately 40–50 mg of oral morphine per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24…

…Ischemic chest pain is more easily provoked after a meal because food intake redistributes blood to the gastrointestinal tract which reduces blood availability in the…

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

…preload will lead to increased ventricular pressure and volume, which will, in turn, increase the stroke volume . This is explained by the Frank Starling mechanism…

…to joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff syndrome The subacromial space The best documented indication Greater trochanteric pain…

…and infarction Definition and clinical rationale Stable angina, or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of…

…ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol…

…often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the…

…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…

…and rostral ventrolateral areas of the medulla result in the blood pressure lowering effect. Effects Potent blood pressure lowering effect. Pain relief. Delivery IV, IM…

…syndromes (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity…

…syndrome (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity…

…ischemic cascade describes the sequence of events during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques…

…diagnostic ECG, the ECG must be repeated, particularly with ongoing or recurrent pain [1,3,4]. This quick reference gives internationally established doses. Drug availability…

…of myocardial infarction and stroke. Indications Intermittent claudication, rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of…

…to be treated conservatively. Immobilisation after reduction of a dislocation. Immobilisation of a ligament injury, a tendon injury, or after suturing over a joint. Pain…

…manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so, that are provoked by a change of position — turning over in bed, lying…

Procedurer The doses below apply to adults unless otherwise stated, and paediatric doses are given per kilogram with the stated maximum. Always check against the…

…is usually a false positive. Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and…

…patient is easier to examine. Indications Symptoms: bleeding outside menstruation, postmenopausal bleeding, discharge, itching, burning, pelvic pain, dyspareunia. Cervical cancer screening according to the national…

…drugs. Such treatment has not been shown to improve the prognosis and can cause hypotension, acute kidney injury, myocardial ischaemia or cerebral hypoperfusion. Pain, anxiety…

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

…cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the ABI every three to six months during…

…Contraindications Absolute contraindications to irrigation: A known or suspected perforation of the tympanic membrane — including a history of grommets, ear discharge or pain on contact…

…where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain, or when the volume limit is reached. Indications Diagnostic aspiration: a…

…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…

…criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of…

…remembered as the “six Ps”: Pain Paresthesia Pallor Pulselessness Poikilothermia, or coldness Paralysis Pain is often severe and is located distal to the arterial obstruction…

…Clinical Presentation and Indications CCTA is relevant to several clinical presentations. Stable chest pain CCTA is recommended as an initial test for diagnosing CAD in…

…longer serial intervals. Clinical Presentation and Initial Clinical Context Chest pain or discomfort is the most common symptom initiating evaluation for ACS. Features that increase…

…BP reduction is required, these patients generally do not need hospital admission or intravenous treatment. Some patients with acute pain, anxiety, or distress have transient…

…the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from ongoing myocardial ischaemia Haemodynamic instability or…

…acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent symptoms. The ECG assessment remains necessary even…

…after 3 minutes of standing to determine if orthostatic hypotension is present. High risk features on history include: New onset of chest discomfort, abdominal pain…

…the thrombus and the plaque. The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are…

…chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms. The diagnosis requires elevated levels of cardiac troponins. In addition to…

…stabilized. This usually takes 2 to 3 days and the patient must not have experienced chest pain during the last 12 hours before exercise. Patients…

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

…blood flow and thus more extensive myocardial ischemia (referred to as transmural ischemia). Yet, the pain caused by NSTEMI and unstable angina is considerable and…

…left lateral decubitus position. In this position, the heart comes closer to the thoracic wall, with less lung tissue covering the heart. Some images in…

…about severe chest pain and ST elevations on the ECG. However, as we will discuss below, it is actually rather straightforward to distinguish these two…

…Overview of management Click the diagram to enlarge. Chest pain (discomfort) is the hallmark symptom of myocardial ischemia and is particularly pronounced in patients experiencing…

…milk ducts, malignancy differential Surgeon or mammography Sole of the foot Deep compartments Orthopaedic surgeon Close to large vessels, in the groin or on the…

…and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an…

…does not respond to fluid, abdominal pain, vomiting, fever, hyponatraemia, hyperkalaemia, hypoglycaemia. Give hydrocortisone and an isotonic crystalloid. Exact doses according to the local protocol…

…with Raynaud's phenomenon. Preparation and equipment Liquid nitrogen in a flask (−196 °C) and a cryospray gun with interchangeable nozzles, or a cryoprobe for…

…glaucoma (tonometry). Contraindications Absolute contraindications to instrumental removal: Suspected penetrating injury or an intraocular foreign body — shield the eye with a rigid shield, give systemic…

…an arterial line should be considered. The blood pressure must not be dismissed as caused merely by pain or anxiety. These factors can affect the…

…or below 1.0 × 10⁹/L with an expected fall to below 0.5 × 10⁹/L within 48 hours Profound neutropenia A neutrophil count below…

…abdominal aortic diameter exceeds 3 cm. Most AAAs are located below the renal arteries and are related to atherosclerotic disease. At least 90% of AAAs…

…refers to the underlying coronary pathology, whereas “syndrome” describes its clinical expression. Clinical presentation and symptoms Clinical presentation is heterogeneous. Patients may have: Chest pain…