…in decompensated heart failure (DHF). In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during…

…Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the special challenges…

…stabilise the patient, work systematically through the possible causes, apply several non pharmacological measures at the same time, and use drugs only in severe agitation…

…rising pCO₂ during an ongoing severe asthma attack is an alarm sign. Early in a severe attack the patient usually hyperventilates and the pCO₂ is…

…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…

…continued, dosing is guided by drug concentration measurement. At a creatinine clearance <20 mL/min, consider an alternative treatment In aminoglycoside treatment of obese patients…

…including in different nostrils) Immediately — pressure necrosis across the septum A live insect As soon as possible — kill it first; the patient is in great…

…cardiovascular events per 1000 patient years, compared with 15.0 per 1000 patient years in age matched controls without autoimmune disease. The greatest risks were…

…Romhilt Este's score system Points Any of the following: R or S in any limb lead ≥20 mm S V1 or S V2 ≥30…

…12 years 0.5 mg (0.01 mg/kg) Adrenaline IV (only in shock, by experienced staff) 0.05–0.1 mg at a time…

…small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at least a minute; a rapid…

…that the patient is not already on an opioid patch, a modified release tablet and an as required opioid at the same time. Opioids in…

…peripheral artery disease. Secondary prevention concerns patients with established vascular disease, in whom aspirin has a substantially more favourable benefit–risk profile. Aspirin is not…

…of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations The central pathophysiological concern in the…

…to the left atrial appendage, although competing mechanisms such as large artery atherosclerosis and small vessel disease may also contribute to stroke in patients with…

…any cold or damp textiles. Administer cardiopulmonary resuscitation (CPR) following standard protocols, emphasizing concurrent rapid rewarming of the patient. Consider extracorporeal membrane oxygenation (ECMO) in…

…of cost. Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial infarction. Participants…

…goal. For statin intolerant patients, ezetimibe may be used initially. If LDL C remains above target, bempedoic acid is recommended in the relevant guideline setting…

…expertise in toxicological emergencies. Antidote Administer the specific antidote promptly upon suspicion of poisoning. Decontamination Disrobe the patient of any attire possibly contaminated with the…

…that a patient with STEMI may present during any of the phases illustrated in this figure, which is why it should be studied in detail…

…blood flow in the myocardium, simply because ST T changes directly reflect myocardial perfusion. ST segment return is particularly important to assess in patients treated…

…depression. Sinus tachycardia. Refer to Figure 1 . Figure 1. Electrical alternans in patient with cardiac tamponade. The ECG shows varying QRS and T wave amplitudes.

…to the endocardium, again, in its final third. The right bundle branch does not give off any Purkinje fibers during its course through the interventricular…

…GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey…

…associations, emphasizing that the three measures are closely related in many patients. The practical distinction is that: LDL C estimates cholesterol within LDL particles. Non…

…patient may remain substantial. At the same time, adverse effects such as hypotension, syncope, falls, and functional deterioration may have greater consequences in frail patients…

…infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the infarct related artery…

…The test is particularly relevant when the decision to initiate or intensify preventive therapy is uncertain. Prevention guidelines support its use in selected individuals at…

…in carefully selected patients with high ischemic risk and low bleeding risk. These strategies are intended primarily to reduce bleeding rather than to replace the…

…and the severity and manifestations of disease may differ substantially among carriers. Consequently, a normal examination or cardiac investigation at one point in time does…

…cardiomyopathy within the appropriate clinical context. Several patient related factors influence interpretation. Natriuretic peptide concentrations generally increase with age and are higher in patients with…

…In ACS complicated by cardiogenic shock, multivessel disease is present in approximately 80% of patients. Evaluation and clinical assessment Clinical factors influencing treatment selection The…

…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…

…in the size of the thrombus. This means that a patient who experienced chest pain at home may be asymptomatic during the assessment in the…

…to study patients presenting with LBBB and suspected acute myocardial infarction (AMI) by referring them for urgent reperfusion therapy, which at the time was primarily…

…be repeated at 2 6 weeks intervals, or more frequently, as individually appropriate. 3 Important study: Milrinone as Compared with Dobutamine in the Treatment of…

…physiological) ST segment depressions occur during physical exercise. These ST segment depressions have an upsloping ST segment. The depression in the J 60 point is…

…be considered. The immediate clinical categories include: Non cardiac diagnosis Chronic stable angina Possible ACS Definite ACS In patients with ST segment elevation, immediate reperfusion…

…tap. A blood sample at the same time: serum albumin is mandatory in order to be able to calculate the SAAG. The patient lies supine…

…onkologi Infektionssjukdomar Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may…

…but some laboratories do not accept marrow blood in their analysers — check locally. Contraindications Peripheral venous cannula: Infection, burns or trauma at the puncture site…

…potassium into the cells with insulin and glucose. Add high dose salbutamol in marked hyperkalaemia if there is no contraindication. 5. At the same time…

…Patients with extensive subcutaneous fat require harder pressure. Orientation index marker All ultrasound transducers have an index marker, which is used for orienting in the…

…equal. Check against a manual measurement and document the difference. Programme measurements every 20 minutes during the day and every 30 minutes at night , or…

…Bradycardia in a patient with a normal circulation and no symptoms requires no pacing, only monitoring and preparedness. Asystole with no electrical activity at all…

…reduced absorption and, in selected cases, enhanced elimination. For many poisonings, well delivered supportive treatment matters more than the antidote [1,2]. Telephone your national…

Procedurer Catheterisation is straightforward in most patients and dangerous in a few. The male urethra is about 25 cm long with two curves and a…

…in adults is present with: an ongoing generalised tonic clonic seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the patient…

…Limitations of MDRD eGFR Accuracy at Higher GFR Levels: The MDRD equation tends to underestimate GFR in individuals with near normal or mildly reduced kidney…

…anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia…

…in which the patient reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient…

…progression By periodically recalculating the SCD risk, clinicians can monitor changes in a patient's condition over time. For instance, an increase in left atrial…

…circumferential cast in a fresh injury, before surgery, or while swelling is progressing. Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does…

…alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient who stops at a low…

…acuity in each eye separately , with the patient's usual glasses and then through a pinhole. This is done before any drops. 2. Inspect the…

…for hypotension in young, pregnant or previously athletic patients. Beta blockade, a pacemaker and autonomic neuropathy can at the same time mask the expected tachycardia…

… 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…

…The central therapeutic aim is symptom control rather than modification of long term cardiovascular outcomes. With the important exception of beta blockers in selected patients…

…chronic coronary syndrome Exercise ECG may be used in selected patients with suspected chronic coronary syndrome when the result is expected to influence diagnostic strategy…

…A standard 12 lead ECG should be recorded in all patients after return of spontaneous circulation (ROSC). The purpose of a 12 lead ECG is…