…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…

…chest radiograph alone belongs to an earlier era. The needle is inserted close to the upper border of the rib, never at the lower border…

…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…

…select a safe disposition and diagnostic strategy. Only a minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5…

…is pain free lying still but screams when turned has not finished being titrated. Expect an opioid naive adult to need 5–15 mg of…

…unstable pain: the onset takes 12 to 24 hours and the offset just as long. Breakthrough dose During ongoing opioid treatment: a breakthrough dose of…

…2], [5]. Localization: While often retrosternal, the pain may be localized to the left anterior chest and can radiate to the neck, shoulders, and arms…

…rare condition) In addition to these five conditions, there are numerous other causes of chest pain, but the other causes are either subacute or non…

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

…which lowers the heart rate. The parasympathetic activity also diminishes impulse transmission in the AV node. Thus, withdrawal of parasympathetic activity results in increased heart…

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…

…refractory to guideline directed medical therapy, occur at a low level of exertion, or are associated with high event risk. The apparent differences between thresholds…

…region. The time limit is not a guarantee. Where the stroke risk is high or the time of onset uncertain, choose the more cautious course…

…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…

…kills because the tube would not pass, but because the team keeps trying to intubate instead of changing the plan. The aim is always oxygenation…

…fluid collects in the left flank. Have the patient empty the bladder first. Procedure Choice of insertion site The left lower quadrant is the first…

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

…entity. The hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during circumstances with increased myocardial demand…

…entity. The hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during circumstances with increased myocardial demand…

…pain (angina). Myocardial perfusion imaging techniques, such as SPECT and PET, can detect perfusion abnormalities early in this sequence, before mechanical dysfunction ( i.e. left…

…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…

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

…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…

…A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior iliac spine is the standard…

…Retinal detachment. Relative: Marked cervical restriction of movement or pain — use the Semont manoeuvre or the side lying variant of the Dix–Hallpike test. Marked…

…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…

…burning, pelvic pain, dyspareunia. Cervical cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a…

…Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis…

…5 mg/mL: clean with 3–4 swabs in wide circles and let it dry for a couple of minutes before the needle is inserted…

…three to six months during ongoing compression therapy, and always in the event of new or increasing pain. Preparation and equipment Doppler for the ankle…

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

…clip the hair — small cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum…

…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…

…V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2…

…ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow…

…chest pain CCTA is recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of CAD…

…substantially lower concentrations than earlier generation assays. They can identify troponin concentrations in approximately 50–95% of healthy individuals, whereas sensitive, but not high sensitivity…

…beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the kidneys, retina, and…

…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…

…and Pathophysiology Posterior myocardial infarction is myocardial necrosis involving the posterior region of the left ventricle, usually as part of an inferoposterior or posterolateral infarction…

…minutes of standing to determine if orthostatic hypotension is present. High risk features on history include: New onset of chest discomfort, abdominal pain, shortness of…

…on the size of the thrombus and the plaque. The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow…

…These assays, referred to as high sensitive cardiac troponin, may actually detect the presence of troponins in most normal persons. In 2017 it was possible…

…coronary arteries originate from the aortic bulb ( Figure 1 ): The right coronary artery ( RCA ) originates on the right aspect of the aortic bulb. The left…

…inability to reach their maximal heart rate. Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity…

…and should be managed urgently. The risk of cardiogenic shock and cardiac arrest is high and pharmacological interventions are frequently futile. It is often necessary…

…to Patients with Chest Pain). As in patients with STEMI, those with NSTEMI and unstable angina are at considerable risk of developing life threatening ventricular…

…during the examination. Work related musculoskeletal disorders are a common cause of pain and sickness absence for ultrasound practitioners (Harrison et al). When performing emergency…

…The chest pain in acute pericarditis may be severe and the patient may also experience cold sweats, tachycardia and anxiety; all of which are common…

…In STEMI, a complete coronary artery occlusion leads to transmural ischemia, affecting a larger portion of the myocardium, thereby intensifying chest pain. In contrast, NSTEMI…

…Injection of contrast media into the ventricle will instead reveal that the apical portion of the left ventricle is dilated (hence the term apical ballooning…

…scalpel until pus appears. Take a culture from the wall of the cavity before irrigating. 5. Let the pus drain out. Empty it with gentle…

…Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas…

…while left sided and femoral insertions require longer ones — check the length in the set against the chosen side. An ultrasound machine with a high…

…proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period…

…Dark skin: a risk of permanent hypopigmentation. Areas with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes…

…3. Ocular movements in all directions; pain on upward gaze may suggest an orbital floor fracture. 4. Topical anaesthesia into the lower fornix. 5. Evert…