…treated successfully in many instances. Cardiac tamponade : Tamponade in trauma patients is due to blood accumulation in the pericardial sack. This impairs atrial and ventricular…

…Wait 10 minutes — insufficient waiting time is the commonest reason for the patient finding the procedure painful. Test with a needle tip before you start…

… an accelerating pattern, with increasing frequency or severity; angina that awakens the patient from sleep. Patients receiving modified antiplatelet therapy require clinical surveillance for both…

…in association with an inferior left ventricular infarction. At least minor right ventricular necrosis is found in approximately one third of patients with inferior infarction…

…an early cytosolic pool have all been associated with detectable troponin. High sensitivity assays may therefore identify a continuum of myocardial injury ranging from minor…

…when appropriate, immediate percutaneous coronary intervention (PCI). Complications are uncommon, but their clinical spectrum ranges from transient arrhythmias and minor access site bleeding to myocardial…

…pathological intracranial findings. Patients with ACS undergoing PCI treated with prasugrel and ASA exhibited a higher risk of major and minor bleeding, as classified by…

…This has resulted in an increased prevalence of congenital heart disease in the general population, such that most clinicians will regularly encounter patients with CHD…

…B, Lane DA, Lip GYH. Comparison of bleeding risk scores in patients with atrial fibrillation: insights from the AFFIRM trial. J Intern Med . 2018;283…

…the explanation for the presentation. Clinical presentation and symptoms Patients typically present with symptoms suggestive of ACS and troponin elevation. The clinical and electrocardiographic manifestations…

…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…

…accuracy. Additionally, considering factors such as patient demographics, muscle mass, and clinical context is essential when interpreting eGFR results to ensure appropriate clinical decision making.

…Heart failure with an LVEF greater than 40%—comprising HFmrEF and HFpEF—accounts for approximately half of patients with symptomatic heart failure. These patients experience…

…elevation myocardial infarction may indicate an increased long term risk of stroke. In patients with acute decompensated heart failure, AF with rapid ventricular response is…

…and treatment of patients with acute coronary syndromes. Moreover, clinicians must clarify whether the ECG was recorded during chest pain, since an ECG without signs…

…interrogation and reprogramming are warranted in higher risk circumstances, particularly for pacing dependent patients, patients with CRT, and ICD recipients undergoing procedures likely to generate…

…contemporary definitions distinguish HFpEF from "Heart Failure with improved EF" (HFimpEF). HFimpEF refers to patients with a historical baseline LVEF ≤40% that has subsequently improved…

…Association (NYHA) classification. The source material specifically frames many pharmacological recommendations for patients with symptomatic NYHA class II–IV HFrEF. Advanced or refractory heart failure…

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

…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…

…molecular weight heparin with dose adjustment, or warfarin Subsegmental pulmonary embolism without deep vein thrombosis An individual assessment; in selected cases the patient can be…

…Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as…

…take place with the patient's ongoing consent, and be able to be stopped at any moment. A trauma informed approach also improves the technical…

…one: with an indication, a route of administration and a target range for the saturation . What usually goes wrong is not that the patient gets…

…not 48. The 2024 ESC guidelines and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors. Check…

…a patient who has not responded within a couple of hours should be intubated, not given another hour. Indications CPAP: Acute cardiogenic pulmonary oedema with…

…and trauma. Remove contaminated clothing and wash the skin after external exposure A low Glasgow Coma Scale is not on its own an absolute indication…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…other predictable error is forgetting that pacing hurts a great deal in a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension…

…the patient first. Marked septal deviation towards the bleeding side (relative). Preparation and equipment Personal protective equipment (gloves, a visor, an apron), suction with a…

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

…in STE ACS/STEMI. Note that a patient with STEMI may present during any of the phases illustrated in this figure, which is why it…

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

…symptoms or an unexpected sensor value, the glucose should therefore be checked with a capillary or venous measurement [5]. Treatment The awake patient who can…

…an arterial line if the patient is unstable or frequent blood gases are needed 3 Blood grouping and cross matching. Order red cells early with…

…Reperfusion therapy Management Recommendation Level of evidence Reperfusion is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent ST segment…

…other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular dysfunction and/or MVD. Nevertheless…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…substance, where the patient arrives within about 1 hour (a liquid preparation) or 2 hours (tablets). With very large quantities of an extremely toxic preparation…

…done wrongly. The two commonest errors are that an intramuscular injection in fact ends up subcutaneously in a patient with a high BMI, and that…

…the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…

…of the ST segment. A male patient (Figure 1) presented at age 36 years with an ECG showing deep and persistent, concave upward ST segment…

…In patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m2, an appropriately up titrated loop diuretic is necessary before resistant…

…every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an epicardial…

…infarction (STEMI) is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia…

…indication Marked anaemia Correct A resting ECG that makes ST interpretation impossible — left bundle branch block, paced rhythm, pre excitation, digitalis effect, marked LVH with…

…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…

…mechanisms may coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical context and the results of all relevant investigations. Haemodynamic definition At…

…possible image quality, patient safety and ergonomics for the operator, special examination tables are used. These tables are equipped with an opening (cutout), where the…

…unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach…

…mm (green) for rapid transfusion, preferably two lines in a bleeding patient. A transfusion set with a filter. Blood components must not be given through…

…the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for example…

…increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring…

…recording and unmask the atrial activity. The investigation is diagnostic, not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock…

…be taken to mean that an electronic alert replaces clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise…

…as long as the unconsciousness persists. An awake patient who obeys commands after ROSC needs no targeted temperature management, but must still be kept free…

…do the job, to reduce urethral trauma. The balloon is filled with sterile water according to the volume printed on the catheter , usually 10 mL…

…HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy…

…be used in selected patients with suspected chronic coronary syndrome when the result is expected to influence diagnostic strategy or management. Appropriate objectives include: Measuring…

…the "healthy" range can still harbor significant metabolic risk. 3 For patients with a BMI below 35 kg/m², direct assessments such as waist circumference…