…Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of patients with a central cause. A normal routine neurological examination…

…give information and obtain consent if the patient is awake, and scan the vessel with ultrasound before you drape — a thrombosed or non compressible vein…

…3. Support the head and lay the patient quickly into the supine position with the head extended approximately 20–30° below the horizontal, maintaining the…

…After prolonged hyperglycaemia the patient may experience hypoglycaemia like symptoms at a normal glucose. With frequent hypoglycaemia the warning symptoms may instead be absent until…

…stimulators, and other electronic equipment may also interfere with device function. The clinical consequences depend on the device, the patient's dependence on pacing, the…

…HEMORR₂HAGES with other bleeding risk assessment tools, notably ATRIA and HAS BLED: HAS BLED Score: In a study evaluating bleeding risk prediction in AF patients…

…the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no practical risk prediction tool currently exists. At the other end…

…of upper abdominal pain. An ECG recording costs approximately $10 (10€) and may reduce morbidity and mortality substantially in patients with acute coronary syndromes. Importantly…

…The nasal cannula, the simple mask and the reservoir mask deliver an FiO2 that varies with the patient's minute ventilation: a markedly hyperventilating pati

…cardiac index is cardiac output normalized to body surface area. The ultrasound system calculates body surface area using the patient's sex, weight and height…

…hypopigmentation. Areas with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes — the wound may not heal. Over…

…the prognosis. The patient must go to cardiothoracic surgery. In profound shock, very limited decompression may be considered in consultation with a cardiothoracic surgeon. Myocardial…

…with rupture, fewer than 5% of such lesions caused a clinical event during 3.4 years of follow up in a prospective study of patients…

…is managed according to the standard CPR algorithm, except that interventions to reoxygenate the patient is of paramount importance. In cardiac arrest due to asphyxia…

…from other fields (e.g. sepsis research) or physiological reasoning. Cardiac arrest care is advanced and should preferably only be conducted in specialized centers. Patients…

…in the other nostril, in the ears and in the mouth. Nose 1. Ask the patient to blow the nose gently. Clear mucus with suction…

…after a few minutes' rest, if the patient's condition allows. 7. With titratable intravenous treatment and an unstable course, an arterial line should be…

…preferred for coronary angiography and PCI because it is associated with fewer vascular and bleeding complications than femoral access. In patients with acute coronary syndrome…

…with or without other LDL C lowering drugs, when additional LDL C reduction is required, including in patients with atherosclerotic cardiovascular disease (ASCVD) or heterozygous…

…occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed or non obstructive coronary arteries, possible mechanisms include microvascular obstruction…

…in incorrect recordings. Patient data Gender, age, weight and height are required to evaluate the examination. Most echocardiographic parameters vary with age, gender and body…

…position, provided that the patient is able to assume this position. The subcostal and suprasternal windows are obtained with the patient in the supine position…

…or measure at the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10…

…effect. Duplicate therapy. Check that the patient is not simultaneously on a DOAC, low molecular weight heparin and an antiplatelet agent without an indication. Interactions…

…8% Interpretation of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist for patients with AF, including HAS BLED…

…treated in the same broad category as a patient with coronary artery disease when clinically appropriate. Other coronary anomalies Anomalous coronary origin and course can…

…clinical spectrum of ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present with cardiac arrest, electrical or haemodynamic instability…

…amiodarone, or adrenaline (epinephrine). In the event of a cardiac arrest in a pregnant patient, immediate consultation with an obstetrician, neonatologist, and anesthesiologist is essential…

…vagal tone does not necessitate treatment but it might be wise to observe the patient for 24 hours (including ECG monitoring). In all other situations…

…the risk of terminating the medication as compared with implanting a permanent pacemaker and continuing the treatment. Commonly, patients with bradycardia have a strong indication…

…ST T changes; the absence of such changes should lead to suspicion of ischemia (if the patient has symptoms consistent with ischemia). The same is…

…control in atrial fibrillation, particularly when other therapeutic options cannot be pursued. Patients receiving digoxin may present with symptoms of digitalis toxicity, which manifests across…

…categorised as myocardial injury. Clinical Presentation and Symptoms Patients with Type 2 MI frequently present with acute chest pain and troponin elevation. The clinical manifestation…

…benign to highly malignant, which is why expeditious management is warranted. Initial management includes assessing the patient's clinical status (symptoms, hemodynamics), ECG and risk…

…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…

…the initial dose should be reduced to 3 mg. Heart transplant patients: Due to denervation, which makes the sinus and AV nodes supersensitive to the…

…the absence of persistent ST segment elevation. This does not imply low risk: patients with NSTE ACS may have substantial myocardial ischaemia, dynamic ECG abnormalities…

…In contrast, patients with confirmed hypertension generally require BP lowering treatment without additional risk stratification for that treatment decision. Population to which SCORE2 and SCORE2…

ECG ECG leads and recording ECGs in pediatric patients (children) Principles of ECG leads, lead anatomy and electrical vectors have been discussed in the chapter…

…nasogastric tube. Warnings and Precautions Increased risk of bleeding, especially in patients with known elevated bleeding risk. Discontinuation of Ticagrelor should be avoided. If a…

…widely recognized and validated tool used to assess the one year risk of major bleeding in patients with atrial fibrillation (AF) who are taking anticoagulants…

…factor for stroke in AF patients. Evidence suggests that the increased stroke risk in women is more closely associated with other comorbidities and age rather…

…However, most clinicians who encounter patients with pacemakers only have access to conventional surface ECGs. Being able to assess pacemaker function and perform troubleshooting should…

…predictors of ischaemic stroke and systemic embolism are previous stroke or TIA and mitral stenosis. In patients with AF and previous ischaemic stroke treated wi

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

…Other symptoms – such as dyspnea, cold sweat, nausea, etc – are also common in NSTEMI and unstable angina (please refer to Approach to Patients with Chest…

…able to diagnose ventricular tachycardia. Causes of ventricular tachycardia Patients with ventricular tachycardia almost invariably have significant underlying heart disease. The most common causes are…

…uniform across the HFmrEF population. Some patients have a pathophysiological profile closer to HFrEF, whereas others have features overlapping with HFpEF, including abnormalities of LV…

…However, in cases of rapid AVNRT or in patients with underlying structural heart disease, the arrhythmia may result in symptoms indicative of reduced cardiac output…

…recent studies challenge these notions. Pathological Q waves may resolve in up to 30% of patients with inferior infarction. The amplitude of Q waves may…

…patients with total and proximal occlusions may present without ST segment elevations (which they should exhibit) due to rich collateral circulation in the ischemic area…

…pediatric patients. Sinus rhythm is defined by the following criteria: Regular rhythm with a ventricular rate within the age specific normal interval. P wave with…

…free wall rupture after infarction Anticoagulant associated bleeding Renal failure Systemic inflammatory disease Catheter based electrophysiological and structural cardiac procedures In patients with acute pericarditis…

…Patients with ARVC display frequent premature ventricular contractions (PVC), which may advance to monomorphic ventricular tachycardia (VT). Ventricular tachycardia in ARVC has LBBB morphology, with…

…there are no evidence based treatments for inappropriate sinus tachycardia, patients frequently benefit from obtaining a diagnosis, because it justifies their symptoms (treatment alternatives are…

…table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed above…

…for shortened regimens derives from selected populations, frequently with low or intermediate ischemic risk and under representation of patients with STEMI or other very high…