…in ongoing bleeding with coagulopathy, or as part of balanced transfusion in massive haemorrhage. Transfusion thresholds in the stable, non bleeding patient Patient category Transfusion…

…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…

…spinal needle or the needle from a pericardiocentesis set), 10 mL and 20 mL syringes, a three way tap. A Seldinger set with a guidewire…

…then reserved for patients with a CHA₂DS₂ VA score of 0–1. Check what applies in your own region. Duration above the threshold or unknown:…

…Haemodynamic or electrical instability in advanced or acute presentations Left main disease may be clinically silent, and revascularisation recommendations are not restricted to patients with…

…patients with risk factors. Check what applies in your own region. The time limit is not a guarantee. Where the stroke risk is high or…

…and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level exceeding 4 mmol/l, commence an intravenous fluid resuscitation…

…for chest compressions. ECMO is considered in individuals who can survive with satisfactory quality of life if the circulation is temporarily supported by ECMO. Furthermore…

…electronic alert replaces clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient…

…Asystole with no electrical activity at all — pacing has no documented benefit there. Transcutaneous pacing: burns or wounds in the area where the pads would…

…typical flutter. Furthermore, typical flutter frequently emerges in patients undergoing pharmacological treatment for AF with class IC drugs or amiodarone. In these instances, the flutter…

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

…in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or pharmacological…

…with the patient in the supine position. Parasternal Windows PLAX Parasternal Long Axis view The parasternal long axis view (PLAX) is located on the left…

…the lungs to the left ventricle, which therefore contracts without pre load (the ventricle is empty or nearly empty). In patients with an initial shockable…

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

…that aggravate or cause bradycardia (e.g. beta blockers in heart failure). In such scenarios, it is very common to provide the patient with a…

…electrical cardioversion preferred. Evaluation and risk assessment The evaluation of a patient with AF who may require anticoagulation should establish: Whether AF is clinical or…

…low risk: patients with NSTE ACS may have substantial myocardial ischaemia, dynamic ECG abnormalities, myocardial necrosis, haemodynamic deterioration, heart failure, malignant arrhythmias, or mechanical complications…

…might wonder what the probability is that the patient actually has NSTE ACS (NSTEMI) since they present with ST segment depressions on the 12 lead…

…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…

…worsen with inspiration, coughing, lying supine, or swallowing and typically improves when the patient sits up and leans forward. Pain may be retrosternal or left…

…a sudden and random electrical event. An excerpt from the article follows: [...] Of every 10 such victims, the heart in 6 or 7 showed no…

…or sudden cardiac death. The resulting extensive ischemia causes immediate myocardial stunning (akinesia) and electrical instability. Fewer than 1% of patients with ST elevation myocardial…

…Evaluating the Electrical Axis Evaluating the electrical axis is highly useful in several distinct clinical scenarios: Suspected Pulmonary Hypertension: In patients presenting with symptoms like…

…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…

…lead anatomy and electrical vectors have been discussed in the chapter The ECG Leads. Acquisition of ECGs in pediatric patients is slightly different from adults…

…sequence, before mechanical dysfunction ( i.e. left ventricular systolic or diastolic dysfunction) or electrical changes (ST T changes on ECG) become apparent. In contrast, modalities…

…Coimbra R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. Crit Care…

…or electrical instability. Posterior infarction may occur in patients with a clinically unstable acute coronary syndrome, but the examination does not reliably establish or exclude…

…tachycardia Patients with ventricular tachycardia almost invariably have significant underlying heart disease. The most common causes are coronary heart disease (acute coronary syndromes or ischemic…

…of anaphylactic cardiac arrests present with pulseless electrical activity (PEA) as the initial rhythm, while the remainder manifest ventricular fibrillation (VF) or asystole ( Ebo et…

…Identification of life threatening arrhythmias. Assessment for high risk mechanical complications. Determination of symptom onset time and anticipated time to primary PCI. Patients with STEMI…

…cardiovascular medicine. As a primary driver of sudden cardiac death (SCD) and a major cause of morbidity in patients with structural heart disease, VT necessitates…

…the right precordial leads—and a propensity for life threatening polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients with structurally normal hearts [2] …

…the sinoatrial node discharges electrical impulses at a higher frequency than normal. Similar to sinus rhythm, the rhythm is regular with a positive P wave…

…circumstances with non shockable rhythm or with prolonged periods of VF (fine VF resistant to defibrillations), the purpose of CPR is to induce myocardial electrical…

…Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol associated hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left…

…R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life of life hospital arrival upon arrival: a retrospective multicenter study…

…Coimbra R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. Crit Care…

…1. ECG changes in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). The electrical vector of the left ventricle is enhanced in LVH, which…

…or a hand held device (iCare, Tono Pen). Procedure Systematic examination 1. Visual acuity in each eye separately , with the patient's usual glasses and…

…function) Several echocardiographic measurements are available to assess left ventricular systolic function. These methods elucidate slightly different aspects of systolic function and their combined use…

…in Figure 1. The ultrasound system automatically calculates RWT (Relative Weight Thickness), provided that the patient's weight, height and sex are entered. RWT is…

…Implications of left bundle branch block in myocardial ischemia and infarction A summary of the issues that arise when facing a patient with left bundle…

…For patients with LBBB and a left ventricular ejection fraction (LVEF) $< 35%$, the implantation of a defibrillator or a CRT D is indicated…

…for: Hemodynamic instability or cardiogenic shock. Clinical heart failure. Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with recurrent chest pain…

…infarction and it is associated with poorer survival. Patients with unstable angina pectoris with low risk (according to TIMI score or similar) may undergo stress…

…instability. Evaluation and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These…

Akutsjukvård Lathundar Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG…

…to ask it. Indications Wide complex tachycardia where ventricular tachycardia must be distinguished from supraventricular tachycardia with bundle branch block or aberrancy. Narrow complex tachycardia…

…The patient lies supine, preferably with slight rotation towards the left side so that the fluid collects in the left flank. Have the patient empty…

…what happens when the INR runs away or the patient bleeds. In Sweden the treatment is usually managed from an anticoagulation clinic with dosing support…

…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…

…utmost importance, particularly in the setting of (confirmed or suspected) myocardial ischemia. As a clear example, consider a patient with ischemic heart disease, who has…

Akutsjukvård Lathundar Basic principle Anaphylaxis is a rapidly developing systemic hypersensitivity reaction that can cause life threatening compromise of the airway, breathing or circulation. Skin…

…a patient's condition over time. For instance, an increase in left atrial size or the development of NSVT may warrant closer surveillance or a…

…decade of life in several family members. Imaging studies did not reveal structural cardiac abnormalities, nor coronary artery disease. Another male patient, with similar ST…

…in patients with heart failure with reduced ejection fraction (HFrEF) and coronary artery disease (CAD), and after acute coronary syndromes in patients with reduced left…

…The classification also recognizes vasoreactivity subgroups among patients with idiopathic PAH, including acute responders and non responders. Left heart disease is the most common risk…