…those who did, only a minority had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no…

…whether the patient is clinically unstable, identify life threatening diagnoses rapidly, and select a safe disposition and diagnostic strategy. Only a minority of patients presenting…

…novo after delivery. New onset postpartum preeclampsia is increasingly recognized as a significant cause of maternal morbidity and mortality during the postpartum period. Maternal and…

…Myocardial Infarction Ticagrelor 60 mg twice daily is the recommended dose for extended treatment for patients who had a heart attack at least a year…

…because the pericardium has had time to adapt. Hypotension and muffled heart sounds are important when present but are relatively insensitive findings. Some patients with…

…with the patient fasting or having had a light breakfast according to local practice. Let the patient rest lying down or sitting for at least…

…in AF patients, the HAS BLED score demonstrated superior predictive performance compared to both HEMORR₂HAGES and ATRIA. The HAS BLED score had the highest net…

…during the stressful circumstances surrounding a sudden cardiac arrest, uncertainty may arise with regard to no flow time, low flow time, patient preferences, patient background…

…ECG changes were stable over a period of 30 years. The ST segment depressions were accentuated during exercise. The patient developed atrial fibrillation at 55…

…trial participants who were described as frail generally had no more than mild frailty, limiting the applicability of trial findings to people with substantial functional…

…or low flow periods. Under such circumstances, the efficacy of compressions and defibrillation diminishes considerably. Extracorporeal Life Support (ECLS) emerges as the sole therapeutic alternative…

…these patients are immediately referred to angiography but no coronary artery occlusion can be identified. Injection of contrast media into the ventricle will instead reveal…

…for urgent reperfusion therapy, which at the time was primarily fibrinolysis (Wilner et al.). Their findings revealed that a substantial number of these patients had…

…third of the patients who ultimately had a favorable neurological recovery exhibited an abnormal pupillary reflex upon initial examination. Notably, 31.2% of patients discharged…

…in the SYNTAX trial, patients with high scores had significantly higher mortality and MACE rates compared to those with low scores. Monitor Quality of Care…

…instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the catheterization laboratory are found to have complete LMCA occlusion, likely…

…as prognostic markers during the disease course. In summary, the risk of severe disease and death is several times higher in patients with cardiovascular diseas

…In patients with atherosclerotic vascular disease or familial hypercholesterolaemia, addition of bempedoic acid to statin therapy reduced LDL C by approximately 16.5%; the reduction…

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…

…85%). Many patients appreciate the exercise test because it offers them an opportunity to evaluate their performance and symptoms under the supervision of their clinician…

…poison control centre , which in most countries is staffed around the clock for health care professionals. Contact the centre early in serious, unusual or unclear…

… in selected cases the patient can be observed without anticoagulation Red flags and pitfalls A normal saturation and a normal ECG do not exclude pulmonary…

…to the local protocol. An anticoagulant is given as soon as possible, but must not delay cardioversion in an unstable patient. Rate control in the…

…general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected…

Procedurer The commonest error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often…

…and can keep a patient alive until a transvenous lead is in place — but only if it is working, and the commonest source of error…

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

…The biochemical grade alone does not indicate how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be…

Gastroenterologi & hepatologi Akutsjukvård Lathundar Immediate orientation Two questions govern the initial management: 1. Is the patient haemodynamically compromised, or are there signs of ongoing major…

…Transfusion thresholds in the stable, non bleeding patient Patient category Transfusion threshold (Hb) : : Most stable adult inpatients, including intensive care 70 g/L Known cardiovascular…

…care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against the…

…proportion of older patients are affected, and the incidence is particularly high after hip fracture, major surgery and intensive care [1,2]. The condition is…

…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…

…a patient performs progressively increasing external work, usually on a treadmill, while symptoms, a 12 lead ECG, heart rate and blood pressure are monitored. The…

…concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS)…

…oedema. Previous hypercapnia, NIV or invasive ventilation. Home oxygen and the patient's usual saturation. Previous exacerbations and hospital admissions. Current inhaled treatment and adherence…

…movement that merely worsens dizziness that is already ongoing . A patient with BPPV is usually relatively free of symptoms between the brief attacks. Lying down…

…during the day and every 30 minutes at night , or alternatively every 15 and every 30 minutes respectively. Instruct the patient to stop, keep the…

…to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect…

…nasal fracture (absolute). An unsecured airway or haemodynamic instability — stabilise the patient first. Marked septal deviation towards the bleeding side (relative). Preparation and equipment Personal…

…symptoms. 4. Blood pressure every second minute and on symptoms. 5. Ask actively about chest pain, breathlessness and leg fatigue; have the patient rate exertion

…this with the poison control centre. Gastric lavage is considered only after a life threatening ingestion of a highly toxic substance, where the patient arrives…

…For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination must…

…a slim patient. 4. Insert the needle perpendicularly , quickly and firmly, to its full length. 5. Aspiration is not needed for vaccination in the deltoid…

…instability — stabilise the patient first. CT before the puncture Swedish practice differs here from several international guidelines. The Swedish clinical care programme for bacterial CNS…

…drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see the separate text…

…headache. High flow oxygen on a reservoir mask is the first line treatment during an attack and aborts most attacks within 15–20 minutes. An…

…miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with known instability and a low energy mechanism, and a neurovascularly…

…treatment with EEG After clinical cessation of the seizure Assess the recovery of consciousness. Urgent EEG if the patient does not wake or if ongoing…

…during the first 72 hours for as long as the patient remains unconscious. The evidence Trial Question Result : : : TTM (2013) 33 °C versus 36 °C…

…documentation or have only weak evidence. Venous thromboembolism when a DOAC cannot be used (interactions, cost, adherence, pregnancy after the first trimester under specialist care)…

…is reasonable, although the optimal initial combination strategy remains uncertain. A beta blocker combined with a dihydropyridine CCB is appropriate for many patients. Long acting…

…5 mm All patients Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of left…

…treatment inertia, in which patients remain on an inadequate single drug regimen for prolonged periods. The evidence supports improved blood pressure control and adherence, although…

…lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting with glucagon like peptide…

…chest pain. It is appropriate when the expected information is likely to change management. In patients with a very low probability of obstructive CAD, testing…

…used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction…

…underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension, with particular vigilance when the clinical history includes hypokalaemia. Endocrine…

…Nausea and vomiting Anxiety A sense of impending doom When STEMI begins during exertion, the symptoms generally do not resolve simply with cessation of activity…

…the diagnosis is uncertain, cardiogenic shock is present, or symptoms have been present for more than 2–3 hours. Patients with a working diagnosis of…