…With a glass injury: consider radiography, since glass is usually visible on plain films. Irrigation fluid: a copious volume of drinking quality tap water or…

…Plain abdominal radiography has limited sensitivity. A calcified aneurysmal outline may be visible, but approximately one quarter of aneurysms are not calcified and therefore cannot…

…promptly, before radiography. The longer a joint remains dislocated, the harder the reduction becomes and the greater the risk of chondral and neurovascular injury. Aim…

…the basis of percussion and a chest radiograph alone belongs to an earlier era. The needle is inserted close to the upper border of the…

…over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal radiograph. Contraindications An…

…and other symptoms may occur without chest pain and should be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…50 mg of oral morphine per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24 hours and the offset…

…and a history of pain exacerbation with inspiration, along with a pleural friction rub, helps differentiate it from angina pectoris [5]. 5. Pulmonary Hypertension Pain…

…presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed above. It is important that history taking and physical examination…

…myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An…

…intensity of exercise increases. The autonomic nervous system is the first system to react to exercise. It does so by withdrawing parasympathetic activity and increasing…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…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…

…in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes…

…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…

…team keeps trying to intubate instead of changing the plan. The aim is always oxygenation, never intubation in itself — and every difficult airway algorithm is…

…empty bladder and is rarely used in large volume ascites. Diagnostic paracentesis 1. Scan the left lower quadrant. Confirm at least 2–3 cm of…

…Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and…

…exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing the myocardial load), and vice…

…exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing the myocardial load), and vice…

…contrast, modalities like echocardiography and ECG typically identify ischemia at later stages, when functional or electrical alterations are evident. Subjective symptoms (i.e. chest pain…

…or recurrent pain [1,3,4]. This quick reference gives internationally established doses. Drug availability, thrombolysis regimens, renal function thresholds and the division of work…

…abdominal pain or repeated vomiting after probable allergen exposure sudden hypotension or severe bronchospasm during anaesthesia, a drug infusion or the administration of contrast medium…

…of myocardial infarction and stroke. Indications Intermittent claudication, rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of…

…still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior iliac spine is the standard site for both aspiration and…

…history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds…

…treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest…

…Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and symptoms in known heart disease…

…bladder makes bimanual palpation difficult and causes prolapse to be underestimated. Offer a chaperone according to local procedure; this is recommended for all examinations of…

…creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]. Important exceptions Condition Overall strategy Common first choices : : : Acute…

…important indication and an emergency procedure . An unclear arthritis, as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or…

…monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the…

…Warfarin has a narrow therapeutic index, a half life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment…

…suggestive of acute myocardial infarction and at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory…

…Capillary refill is delayed, and venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent…

…particularly those with stable chest pain, no previous diagnosis of CAD, and a low clinical likelihood of obstructive disease when good image quality is expected…

…Presentation and Initial Clinical Context Chest pain or discomfort is the most common symptom initiating evaluation for ACS. Features that increase the likelihood of ACS…

…with chest pain, severe breathlessness, hypoxaemia, rales, or respiratory distress. In patients with HFpEF, acute hypertension is a frequent trigger of decompensation and may produce…

…of very high risk. They require immediate escalation because the priority is to identify and treat an obstructive coronary lesion without avoidable delay. In contrast…

…primarily in the context of suspected acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent symptoms…

…posture. Specific triggers are well recognized and include: Provoked fear, pain, anxiety, intense emotion, the sight of blood, unpleasant sights and odors, and orthostatic stress…

…will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and NSTE ACS …

…however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia…

…is done by using ECG changes to determine the affected area and subsequently the occluded coronary artery (culprit). Figure 1B. Detailed diagram of coronary artery…

…utilized to assess whether there is any residual ischemia or angina pectoris. Patients may undergo repeated stress tests to assess symptoms and signs of ischemia.

…chest pain, heart failure and cardiac arrest. In cases with intermittent symptoms, it is important to establish a temporal correlation between symptoms and episodes of…

…on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive…

…and also avoid bending the back during the examination. Work related musculoskeletal disorders are a common cause of pain and sickness absence for ultrasound practitioners…

…the retrosternal chest pain in acute pericarditis is very similar to that in STEMI. The combination of retrosternal chest pain and ST elevation on ECG…

…larger portion of the myocardium, thereby intensifying chest pain. In contrast, NSTEMI and UA typically involve partial occlusions, resulting in subendocardial ischemia and comparatively milder…

…apical portion of the left ventricle is dilated (hence the term apical ballooning syndrome ). This syndrome was first descried in 1991 in Japan and the…

…anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to hurt even so. Offer…

…set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…afternoon and evening. See the quick reference on inpatient insulin therapy Peptic ulcer A proton pump inhibitor with concomitant NSAID use or a history of…

…front , and this is why the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis…

…pressure measured, or be palpated. Indications A sensation of something in the eye, watering, photophobia and redness after working with a grinder, a drill, a…