…evaluation of patients receiving digoxin reveals specific electrophysiologic profiles. Digoxin's autonomic actions largely slow the sinus node discharge rate, shorten atrial refractoriness, and prolong…

…effect is wanted and the patient is also receiving LMWH, for example in newly diagnosed venous thromboembolism. 1. Check the INR before the first dose…

…patients receiving agents known to alter the electrical properties of the heart (inducing QRS or QT prolongation) or causing electrolyte abnormalities, such as thiazide and…

…dL), and at least a 50% reduction from baseline. For a patient who experiences a recurrent atherothrombotic event while receiving maximally tolerated statin therapy, an…

…and lipoprotein(a) are variable or modest. In phase III studies involving patients with ASCVD or at least one ASCVD risk equivalent who were receiving…

… and A reduction of at least 50% from baseline. In patients who experience a recurrent atherothrombotic or cardiovascular event within 2 years while receiving maximally…

…24 hour urine collection for electrolytes can be used to quantify sodium and potassium intake, preferably while the patient is receiving a stable diuretic dose…

…increasing frequency or severity; angina that awakens the patient from sleep. Patients receiving modified antiplatelet therapy require clinical surveillance for both recurrent ischemia and bleeding…

…unless the patient is receiving digoxin. The ventricular rate is regular, typically ranging from 100 to 250 beats per minute in atrial tachycardia and less…

…Patients receiving medications that increase bleeding risk, including oral anticoagulants, clopidogrel, NSAIDs, or fibrinolytics. For patients with active bleeding requiring reversal of prasugrel's pharmacological…

…nonfatal myocardial infarction, nonfatal stroke or coronary revascularization—occurred in 819 patients receiving bempedoic acid (11.7%) and 927 receiving placebo (13.3%). Bempedoic acid…

…when the target remains unmet despite maximally tolerated statin therapy and ezetimibe. For patients with a recurrent atherothrombotic event while receiving maximally tolerated statin therapy…

…patients, initial therapy consists of a beta blocker and/or a calcium channel blocker (CCB). If symptoms remain inadequately controlled, treatment should be reassessed and…

…and radiation. Onset and temporal pattern. Duration and recurrence. Provoking and relieving factors. Associated symptoms. Similarity to previous documented angina or myocardial infarction. Atherosclerotic and…

…Quality and intensity. Precipitating factors, including exertion, emotional stress, meals, or exposure to cold. Relieving factors, including rest or medication. Time of day and temporal…

…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…

…to TIMI score or similar) may undergo stress testing when their clinical condition is stabilized. This usually takes 2 to 3 days and the patient…

…the formulation and the estimated quantity the time, and whether the intake was single or repeated a modified release preparation or a combination product concurrent…

…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…

…metoprolol) First choice in most cases The IV dose is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem…

…antibiotics are associated with a worse outcome in sepsis and in several studies of neutropenic patients. In septic shock, or where sepsis is highly likely…

…sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a patient with known ascites…

…an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly unstable. Transcutaneous pacing Equipment…

…the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an inadequate response. First line…

…of the cause or for imaging. 6. Document the starting time, the baseline plasma sodium, the target for the first few hours, and the maximum…

…peripheral perfusion and the signs of shock 2 Two large bore peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood…

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

…and the patient must leave with clear information about the symptoms that should make them seek help immediately. Indications An undisplaced or reduced fracture to…

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

…in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the right course, not RSI. Assess the airway first LEMON for a…

…between symptoms and ECG changes Detecting exercise induced arrhythmias Evaluating the blood pressure response Refining risk stratification and prognosis For patients with low or moderate…

…intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal lesions that are not apparent on conventional angiography. Coronary vasomotor disorders…

…targets Patient Initial target saturation : : Known COPD or another clear risk of hypercapnic respiratory failure 88 to 92 percent No risk of hypercapnia and a…

…is managed most safely by first establishing the time course and precipitating circumstances , and then selecting a targeted examination. The patient's description of the…

…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…

…2026 and are given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or…

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

…blood pressure response, heart rate response, arrhythmias and recovery. A patient who stops at a low workload with a fall in blood pressure is a…

…charcoal, when it can be given early and the patient has an intact or a protected airway. The benefit is greatest within the first hour…

…refrain or adapt in: The patient does not consent — the examination must then not be carried out. Vaginismus or marked anxiety — plan for extra time…

…muscle. With a 25 mm needle the dose ends up subcutaneously, which gives a poorer immune response and more local reaction. Procedure Intramuscular — deltoid 1…

…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…

…the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first feed then becomes a direct instillation into the…

…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…

…work best exploit time, gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator…

…these time points — follow the local instructions, but where the response is equivocal both are valuable. 7. Observe the patient throughout the test and for…

…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…

…with no meaningful response to speech) after the return of spontaneous circulation , whether the arrest occurred in or out of hospital and whatever the initial…

…et al 1 ). Representative single beat morphs for a low risk patient (blue) and the corresponding high risk morph (red). Beyond the difference in R…

…10]: Patient Demographic Lead Group ST Elevation Threshold at J Point Men under 40 years V2 to V3 Greater than or equal to 2.5…

…component, potentially limiting adverse effects and facilitating adherence. Treatment response, however, is heterogeneous, and some patients may benefit from a more individualized selection strategy. When…

…utility is frequently limited by its inability to distinguish between muscle mass and various fat depots, or to identify the precise location of excess adiposity…

…the result meaningfully increases the likelihood of disease and can justify further investigation or treatment. Testing is therefore not an automatic response to chest pain…

…or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic…

…emotional stress, and an intercurrent medical or surgical illness. Events may occur at any time, although clustering in the morning within several hours of awakening…

…and preserving myocardial function. The benefit of reperfusion is strongly time dependent. The interval from symptom onset to reperfusion is determined by patient recognition and…

…or very high risk NSTEMI. 7. Document symptom onset, first medical contact, the diagnostic ECG, the reperfusion decision, thrombolysis and PCI wire crossing. Exact times…

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

…benzodiazepine in a sufficient and repeated dose , titrated against clinical effect. 2. Parenteral thiamine early , preferably before or at the same time as carbohydrate administration…

…or measure at the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10…