…surgeon. Dislocation of a native hip (as opposed to a prosthesis) — a high risk of avascular necrosis of the femoral head and of vascular injury…

…of function is a tendon injury that was sutured over without being found. Indications A traumatic wound that gapes and cannot be expected to heal…

…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…

…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…

…remains consequential, and historically 2–6% of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations…

…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…

…per cent and titrate. At a high dose, in old age or in renal failure, reduce it further. Starting doses in acute pain in an…

…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…

…threatening causes of chest pain: Ischemic heart disease : stable angina pectoris, unstable angina pectoris, acute myocardial infarction (AMI). Note that unstable angina pectoris and acute…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…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…

…most persuasive when the initial probability is high enough that the result meaningfully increases the likelihood of disease and can justify further investigation or treatment…

…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…

…Contraindications The laryngeal mask is a compromise and does not protect the airway completely. Relative contraindications: A high risk of aspiration: a non fasted patient…

…should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration…

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

…degree of coronary atherosclerosis. Risk factors for atherosclerosis (e.g smoking, hypertension, diabetes, hyperlipidemia [particularly high LDL cholesterol], etc ) accelerate the atherosclerotic process and increase…

…degree of coronary atherosclerosis. Risk factors for atherosclerosis (e.g smoking, hypertension, diabetes, hyperlipidemia [particularly high LDL cholesterol], etc ) accelerate the atherosclerotic process and increase…

…sequence of events during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques, such as SPECT and…

…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…

…reaction that can cause life threatening compromise of the airway, breathing or circulation. Skin symptoms may be absent, and circulatory shock does not have to…

…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…

…The test presupposes that the patient has spontaneous nystagmus at the time of examination and that the examiner is experienced with the head impulse test…

…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…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…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…

…ongoing compression therapy, and always in the event of new or increasing pain. Preparation and equipment Doppler for the ankle brachial index, blood pressure cuff…

…the head and neck Fragile skin, poor healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection…

…or to resolution of the underlying cause. Contraindications Hypothermia with a body temperature below about 30 °C — the hypothermic myocardium is irritable and pacing can…

…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…

…start immediately and a defibrillator must be ready. I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of posterior acute…

…presentation and symptoms Symptoms commonly develop rapidly, often within an hour of arterial occlusion. The classic clinical constellation is remembered as the “six Ps”: Pain…

…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 NSTEMI. It does identify several clinical manifestations that indicate particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain…

…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…

…long QT, and bundle branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is…

…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 …

…and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of…

…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…

…days and the patient must not have experienced chest pain during the last 12 hours before exercise. Patients with unstable angina pectoris with high risk…

…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…

…complete stop of blood flow and thus more extensive myocardial ischemia (referred to as transmural ischemia). Yet, the pain caused by NSTEMI and unstable angina…

…is held at the tip, using the thumb and the forefinger, while remaining fingers stabilize the grip. The transducer tends to glide out of position…

…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…

…to be capable of recognizing STEMI using 12 lead ECG. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EMS personnel…

…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…

…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…

…dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous oxygen saturation. Repeated blood sampling during intensive care. Exhausted…

…and more marked HPA suppression. Inhaled and topical steroids in high doses can also cause systemic suppression. Corticosteroids mask fever and peritonitis. The abdomen of…

…not heal. Over superficial nerves (the lateral aspects of the fingers, the ulnar groove, the neck of the fibula). The eyelid margins, the cartilage of…

…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…