Arrhythmias and arrhythmology Critical care Definition and pathophysiology Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and…

…lymphoedema or a dialysis fistula in both arms, an arm circumference too large for the available cuffs, and in a patient who does not tolerate…

…acidaemia and increase the entry of salicylate into the central nervous system. Discuss the case early with the poison control centre and with anaesthesia or…

…varies between regions and units. Follow the local protocol for choice of drug, dosing, route of administration and criteria for intermediate care or intensive care…

…or while swelling is progressing. Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel the pressure sore. Preparation and equipment…

…vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER…

…vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER…

…can form after transfusion or pregnancy. Check the validity before ordering blood ; an expired type and screen discovered when the patient is already bleeding costs…

…or warfarin Subsegmental pulmonary embolism without deep vein thrombosis An individual assessment; in selected cases the patient can be observed without anticoagulation Red flags and…

…intensive care facilities, and, where available, cardiothoracic and advanced haemodynamic support services. When fibrinolysis is indicated Fibrinolysis is indicated when: STEMI is diagnosed or strongly…

…sepsis research) or physiological reasoning. Cardiac arrest care is advanced and should preferably only be conducted in specialized centers. Patients who are not in specialized…

…the time of examination and that the examiner is experienced with the head impulse test; performed on the wrong patient or by an inexperienced examiner…

…7.3 and bicarbonate ≥ 15 mmol/L Hyperosmolality Not required Effective osmolality 300 mosm/kg or total osmolality 320 mosm/kg Typical patient Often type…

…clinical care requires diagnostic and treatment thresholds. The 2024 European guideline defines hypertension as an office systolic blood pressure (SBP) of ≥140 mmHg or diastolic…

…16 and EPAP 6–8 cmH₂O Increase the EPAP against obstruction, the IPAP against hypercapnia SpO₂ 88–92% Hypoxaemic failure without hypercapnia CPAP or high…

…is associated with a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical histories should undergo appropriate screening…

…hypoxic cardiac arrest : Trauma and injuries : Direct trauma can cause airway injuries, resulting in obstruction. Central nervous system (CNS) injuries might cause apnea or hypoventilation…

…argue for the operating theatre rather than the emergency room: a very large or deep abscess, a markedly unwell patient with fever and systemic upset…

…heterogeneous, and some patients may benefit from a more individualized selection strategy. When to Initiate Pharmacological Treatment Lifestyle intervention is an essential component of care…

…1% of patients. It manifests as localized, transient swelling of the subcutaneous or submucosal tissues, most frequently involving the face, lips, tongue, and upper airway…

…the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms. Findings that suggest acute organ dysfunction Organ or system Finding : : CNS New…

…principles of treatment The patient should be managed in an emergency department, an intensive care unit, a coronary care unit or another setting that allows…

…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…

…of any physiological index; lesion specific and largely independent of resting hemodynamics; guideline reference standard. Requires pressure wire + vasodilator (cost, time, patient discomfort); falsely normal…

…if the patient does not wake or if ongoing electrographic seizure activity is suspected Benzodiazepines are the established first line treatment. Intravenous lorazepam and diazepam…

…in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed above. It is important that history taking and…

…why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off into a respiratory acidosis…

…is essential to provide supportive care and maintain vital functions artificially until the substance undergoes renal elimination, hepatic elimination or is removed by means of…

…and is also applicable after acute coronary syndrome, percutaneous coronary intervention, or cardiac surgery. The post infarction patient may experience: Reduced exercise tolerance Physical deconditioning…

…care [1,2]. The condition is associated with falls, aspiration, pressure sores, loss of function, longer length of stay, institutional care, readmission, cognitive decline and…

…in patients with acute coronary syndromes. Importantly, the ECG findings dictate the management of acute coronary syndromes. Hence, an ECG must be performed and interpreted…

…PEF or FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an…

…pregnant women, patients after allogeneic stem cell transplantation and patients treated with CAR T cells or other advanced immunotherapies may require separate local protocols. Definition…

…A referral or notification to the anticoagulation clinic, and a decision on who will dose during the first week. Written patient information: the Waran booklet…

…decision whether to perform it now or after imaging, how the patient is positioned, which needle is chosen, and that the tubes go to the…

…technique). The patient lies supine or sits. The upper arm is held adducted against the trunk and the elbow is flexed to 90 degrees. The…

…the intensive care physician and the transplant service. Contraindications An expressed refusal by the deceased — in the donation register, on a donor card, or through…

…rheumatoid arthritis, ankylosing spondylitis MACOCHA is validated for the intensive care patient and totals 12 points: Mallampati III–IV (5 points), obstructive sleep apnoea syndrome…

…of care and the decision on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is an acute or subacute…

…continuous core temperature measurement and a target value that must never be exceeded, during the first 72 hours for as long as the patient remains…

…widely between patient groups and care settings [2]. Practical first actions Do the following in parallel, not sequentially: 1. Check previous creatinine values and establish…

…collapse or impaired consciousness Adrenaline, oxygen, intravenous access, fluid and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise…

…the subclavian and jugular routes on the healthy side, since a pneumothorax there would be poorly tolerated. A patient who cannot lie flat or cannot…

…Skin and soft tissue Diagnosis Agent Dose Duration : : : : Erysipelas phenoxymethylpenicillin 1 g × 3 (2 g × 3 if weight 90 kg) 10 days or benzylpenicillin 1…

…output and ask when the patient last passed urine. Contact intensive care in circulatory compromise, serious arrhythmia, marked QRS widening, a sine wave pattern, or…

…pump The patient manages the pump themselves where possible. In impaired consciousness or DKA: remove the pump and change to an infusion or injections Drugs…

…lactate is an indicator of tissue hypoperfusion and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level exceeding 4…

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

…developed which fibrillated the heart. This electrical factor came and killed and disappeared and was not found in the dead heart. The cause of death…

…CKD), facilitating early intervention and management. Standardization: Its widespread adoption has led to standardized reporting of eGFR in clinical laboratories, enhancing consistency in patient care…

…in patients with symptoms suggestive of acute myocardial infarction and at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent or…

…presenting to an emergency department or contacting primary care first. If ischaemic discomfort persists, emergency medical services should be called. Patients who have been prescribed…

…infrahisian block should be maintained, particularly in older patients and those exhibiting a bundle branch block (BBB) or an intraventricular conduction defect. In severe cases…

…congestion. In pregnant patients presenting with suspected acute heart failure, urgent hospital admission and referral to an expert centre with advanced heart failure care capabilities…

…pool, numerous macrophages or foam cells, and a thin fibrous cap. Disruption of the cap exposes the lipid core and extracellular matrix to circulating blood…

…The syndrome is characterized by a rather peculiar ECG and the patients experience syncope, life threatening ventricular arrhythmias, cardiac arrest, or even sudden cardiac death…

…vasopressor and inotropic effects (Figure 1). What follows is a quick reference for their use in the emergency department, the intensive care or coronary care…

…or cardiometabolic abnormalities make LDL C an incomplete representation of atherogenic burden. Clinical Presentation and Symptoms ApoB elevation and increased non HDL C are laboratory…

…Nevertheless, many patients are normokalaemic and have no distinctive symptoms attributable to aldosterone excess. Cardiovascular complications may dominate the presentation or emerge during evaluation. These…

…In contrast, plaque erosion tends to occur in vessels with little or no lipid core, rich proteoglycans, and many smooth muscle cells, leading to a…