…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…

…and throat pain may point toward gastroesophageal reflux. Physical examination should include a speculum examination of the nose to look for excess mucoid or purulent…

…acute condition. Much research has been devoted to it in recent years. Most cases (70%) of takotsubo cardiomyopathy occur in situations with extreme stress, such…

…illness and, in some series, is reported in up to approximately one third of patients. Its absence therefore does not exclude the diagnosis. Findings suggesting…

…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…

…The absence of urticaria must therefore not be used to exclude the diagnosis [1]. Isolated urticaria, localised angio oedema or itching without compromise of the…

…to the arms, shoulders, neck, jaw, upper back, abdomen, or epigastrium. Dyspnoea, nausea, vomiting, diaphoresis, fatigue, faintness, and other symptoms may occur without chest pain…

…reconsider the pain mechanism instead of continuing to increase the dose. The level of sedation is scored on a four point scale: 0 fully awake…

…unstable pain: the onset takes 12 to 24 hours and the offset just as long. Breakthrough dose During ongoing opioid treatment: a breakthrough dose of…

…Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of chest pain, but the other causes are either subacute or…

…myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An…

…increases the venous return to the heart, which results in increased cardiac preload. The mechanisms are as follows: Sympathetic activity causes constriction of the veins…

…the injection has gone to the right place — immediate pain relief is a diagnostic finding — and appears to reduce the risk of a post injection…

…or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of obstructive coronary artery disease (CAD) before diagnostic testing…

…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…

…first. Procedure Choice of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and…

…patient resists internal rotation. Check the axillary nerve: sensation over the lateral part of the deltoid before and after the reduction , together with the distal…

…Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and…

…artery disease (CHD) are synonyms. These terms refer to symptomatic coronary atherosclerosis. Traditional classification of coronary artery disease Traditionally, coronary artery disease has been classified…

…artery disease (CHD) are synonyms. These terms refer to symptomatic coronary atherosclerosis. Traditional classification of coronary artery disease Traditionally, coronary artery disease has been classified…

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

…or recurrent pain [1,3,4]. This quick reference gives internationally established doses. Drug availability, thrombolysis regimens, renal function thresholds and the division of work…

…the other arm. 2. Ankle pressure. Place the cuff just above the malleoli, with its lower edge about 2 cm above the tip of the…

…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…

…test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so…

…treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest…

…is needed for the test to be conclusive. For assessment of function and prognosis, arrhythmia evaluation, known coronary artery disease and evaluation of treatment effect…

…a permanent part of the programme and is widely used — a woman who does not attend for a gynaecological examination, or who prefers to take…

…insufficient randomised evidence to determine which agent is best. The choice is therefore governed chiefly by the target organ damage, the pharmacology of the drug…

…An unclear arthritis, as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular…

…neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the ABI every three to…

…to the head and neck Fragile skin, poor healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of…

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

…cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the…

…instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction…

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

…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…

…Initial Clinical Context Chest pain or discomfort is the most common symptom initiating evaluation for ACS. Features that increase the likelihood of ACS include: Sudden…

…consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in acute stroke requires attention to the…

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

…and Pathophysiology Posterior myocardial infarction is myocardial necrosis involving the posterior region of the left ventricle, usually as part of an inferoposterior or posterolateral infarction…

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

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

…ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia. After this period…

…the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the other hand, appears to be similar…

…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…

…referred to as transmural ischemia). Yet, the pain caused by NSTEMI and unstable angina is considerable and most patients are therefore markedly affected. Other symptoms…

…during the examination. Work related musculoskeletal disorders are a common cause of pain and sickness absence for ultrasound practitioners (Harrison et al). When performing emergency…

…because they tend to accompany each other, the term perimyocarditis is often used. Image by Bruce Blausen, Blausen Gallery 2014. Causes of acute pericarditis/myocarditis…

…STEMI. In STEMI, a complete coronary artery occlusion leads to transmural ischemia, affecting a larger portion of the myocardium, thereby intensifying chest pain. In contrast…

…compartments Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue…

…Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood…

…36–54 hours The equivalences apply to the anti inflammatory effect. They say nothing about the mineralocorticoid effect or about suppression of the HPA axis…

…margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is…

…the lower fornix. 5. Evert the upper eyelid. Ask the patient to look down. Grasp the eyelashes, press gently downwards on the upper border of…

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

…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…

…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…

…universal definition of MI. Type 1 MI is generally related to an atherothrombotic event, whereas Types 2–5 MI have other mechanisms of myocardial ischaemia…