…classes. By acting on more than one pathophysiological pathway, combinations generally lower blood pressure more effectively than simply increasing the dose of a single drug…

…and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure <…

…received approval. In chronic coronary syndrome, the recommended LDL C objective is: LDL C <1.4 mmol/L (<55 mg/dL) , and A reduction of…

…most consistent contemporary role is therefore the assessment of functional capacity, symptoms, haemodynamic responses, arrhythmias and prognosis, with diagnostic interpretation reserved for appropriately selected patients…

…I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST…

…the patient's own clinic delay empirical antibiotics [1]. A practical target: give the first dose of broad spectrum antibiotics within 60 minutes of triage…

…myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial infarction. Participants received colchicine 0.5 mg once daily or placebo…

…compared to conventional CPR in patients with refractory out of hospital cardiac arrest. Patients aged 18 to 70, who received bystander CPR and initially presented…

…Hypotension can be counteracted with simultaneous administration of norepinephrine. All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g…

…infarction the prevalence of right and left bundle branch block on arrival ECG is 6% and 7%, respectively. A proportion of these patients have a…

…dosing schedule applicable to all patients; the regimen must be individualized based on the clinical situation and arrhythmia severity. Because of the drug's unusual…

…Cardiology) Preparations for the examination Patients referred for echocardiography should receive information regarding the conduction of the examination. Some patient engagement is required to obtain…

…of sinoatrial arrest/pause Sinus arrest/pause due to increased vagal tone does not necessitate treatment but it might be wise to observe the patient…

…In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during management of an acute illness…

…water between doses of charcoal makes the drink more tolerable. A kidney dish, a beaker or a straw, tissues, and an apron for the patient …

…than the base rate should inhibit the pacemaker. P waves The appearance of the P wave depends on where the atrial lead is fixed. Typically…

…to contrast alone difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with…

…2]. Summary of Pain Characteristics The following table synthesizes the key differential diagnoses and their characteristic pain patterns based on the provided context. Condition Typical…

…three weeks of adequate anticoagulation before cardioversion — an INR ≥ 2.0 checked weekly on warfarin, or documented well managed DOAC therapy with no missed doses…

…necrotic, pale Variable, often deep Pain Moderate, relieved by elevation Severe, worse on elevation, better when dependent Often painless (neuropathy) Surrounding skin Hyperpigmentation, oedema, lipodermatosclerosis…

…The specificity of absent pupillary reflex for predicting a poor neurological outcome was 68.8%. This implies that approximately one third of the patients who…

…area), which may receive oxygen from collateral vessels. In cardiac arrest, there is no cerebral perfusion, with an equal degree of hypoxia in all neurons…

…Symptomatic patients typically experience fatigue, dizziness, dyspnea, presyncope/syncope, or diminished exercise tolerance. Whenever such symptoms are associated with ECG evidence of sinus node dysfunction…

…most often aspirin. In selected patients, P2Y12 inhibitor monotherapy may be used as a de escalation strategy after a period of DAPT. The therapeutic objective…

…branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for those wit

…apparent, and pseudo resistant hypertension The term resistant hypertension should be reserved for patients in whom the diagnosis has been carefully confirmed. Apparent resistant hypertension…

…under monitored conditions, a controlled "dose" of electricity can immediately and safely restore sinus rhythm, obviating slow drug titration and rendering the supraventricular versus ventricular…

…The absence of chest pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may occur in patients with diabetes and autonomic neuropathy…

…whereas norepinephrine and/or inotropes are reserved for low output and hemodynamic instability. Evaluation and physical examination The objective of decongestion is clinical euvolemia rather…

…Patients with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial…

…the findings of the ambulance crew The stated dose is often unreliable and must never be used on its own to declare the patient well…

…Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the…

…albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a patient with known ascites. Clinical deterioration in a cirrhotic patient…

…a total maximum of 3 mg . Doses below 0.5 mg can paradoxically worsen the bradycardia and must be avoided. Atropine acts on the sinus…

… Which drugs, and how many doses, has the patient taken? Is the patient on an inhaled corticosteroid or other anti inflammatory treatment? Previous intensive care…

…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…

…bleeding, the decision to transfuse must therefore not be based on the haemoglobin alone [3]. The airway Do not intubate every patient routinely before endoscopy…

…in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage meeting the criteria for activation of the massive transfusion protocol…

…injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against the skin, protects against the edges of the…

…Delirium is common but often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high…

…A score of 3 or more indicates a difficult intubation — call for help and get out the videolaryngoscope and plan B before you give the…

…tomography (OCT) can reveal lesions that are not apparent on conventional angiography. Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation…

…8. Document the ceiling of care and the decision on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is…

…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…

…too large for the available cuffs, and in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set up and instructions Choose…

…At a creatinine clearance <20 mL/min, consider an alternative treatment In aminoglycoside treatment of obese patients, an adjusted body weight is used: adjusted weight…

…compression. The reason compression nevertheless so often fails is that it is done wrongly: the patient pinches the nasal bone instead of the soft part…

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

…used as a triage test on the same liquid based sample when the HPV test is positive — the sample therefore does not need to be…

…and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side…

…Procedure 1. Position the patient correctly. The lateral position with the back towards you, the knees drawn up, the chin on the chest, and the…

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

…L/min depending on the valve 24, 28, 31, 35, 40 or 50 % Gives a fixed, known FiO2 independently of the patient's breathing pattern…

…rotation, and the patient resists internal rotation. Check the axillary nerve: sensation over the lateral part of the deltoid before and after the reduction , together…

…to get through the day of the test can therefore be given dexamethasone. That is the practical key: the patient does not have to be…

…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…

…°C — for at least 72 hours in patients who remain unconscious. The evidence is insufficient to recommend for or against active cooling to 32–36…

…so that a dose change can reach the patient the same day the result arrives. 3. Reduce to 5 mg (two tablets) on days 1…

…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…

…acute coronary syndromes in patients with reduced left ventricular ejection fraction (LVEF). They are also recommended in patients within one year of MI and in…