…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…

…stopped for coughing, chest pain, or when the volume limit is reached. Indications Diagnostic aspiration: a new pleural effusion of unclear cause. An effusion not…

…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…

…Despite this relatively low prevalence, missed myocardial infarction remains consequential, and historically 2–6% of patients discharged with presumed non ischaemic chest pain were subsequently…

…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…

…analgesic; always give it in parallel unless contraindicated NSAID PO According to the preparation Avoid in renal failure, heart failure, a history of peptic ulcer…

…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…

…node. Thus, withdrawal of parasympathetic activity results in increased heart rate and increased impulse transmission across the AV node. Sympathetic fibers innervate the entire heart…

…G, 25 mm for the carpal tunnel, de Quervain's and trigger finger. Syringes of 3, 5 and 10 mL, artery forceps, gauze, a dressing…

…to chest pain. It is appropriate when the expected information is likely to change management. In patients with a very low probability of obstructive CAD…

…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…

…ventilating is not experienced in intubation. Planned anaesthesia for short procedures in a fasted patient at low risk of aspiration. A conduit for fibreoptically assisted…

…diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration. The procedure itself…

…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…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…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…

…brachial index (TBI). The digital arteries rarely calcify, which makes toe pressure the method of choice in diabetes and renal failure. A normal TBI is ≥

…up of unexplained iron, B12 or folate deficiency when blood tests are insufficient. Contraindications Severe coagulopathy or ongoing anticoagulation — correct this first . Thrombocytopenia, by contrast…

…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…

…a low pre test probability is usually a false positive. Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery 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…

…cerebral, coronary or renal ischaemia. Neurological status, urine output, creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]…

…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…

…I C Pain Titrated i.v. opioids. IIa C Anxiety Tranquillizer (e.g benzodiazepine) is considered. IIa C Cardiac arrest Management Recommendation Level of evidence…

…claudication, accompanied by moderate pain or paresthesia, while sensory and motor function remain preserved. The duration and progression of symptoms should be documented carefully. Longer…

…with suspected coronary artery disease (CAD), particularly those with stable chest pain, no previous diagnosis of CAD, and a low clinical likelihood of obstructive disease…

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

…disseminated intravascular coagulation, and abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe hypertension without clinical evidence of acute, ongoing target organ damage…

…The defining electrocardiographic feature is the absence of persistent ST segment elevation. This does not imply low risk: patients with NSTE ACS may have substantial…

…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…

…abdominal pain, shortness of breath, or headache Syncope during exertion or while supine Sudden onset of palpitations followed by syncope Severe coronary artery or structural…

…1. Flowchart showing the natural course of coronary artery disease and classification of acute coronary syndromes into STEMI, NSTEMI and unstable angina using ECG criteria…

…myocardial infarction is the most severe complication of coronary artery disease. The most common initiating mechanism is rupture or erosion of a vulnerable (unstable) atherosclerotic…

…is supplied by the left circumflex coronary artery (LCX). Right dominant system is by far the most common anatomy, occurring in 90% of all individuals…

…kinesiophobia (fear of exercising) is common after myocardial infarction and it is associated with poorer survival. Patients with unstable angina pectoris with low risk (according…

…ECG monitoring D Disability AVPU: Alert Voice responsive Pain responsive Unresponsive Limb movements Pupillary light reflexes Blood glucose E Exposure Identify signs of heart failure…

…30 days if left untreated. Moreover, the pathophysiology of NSTEMI and unstable angina is very similar: both are due to partial (incomplete) coronary artery occlusions …

…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…

…no coronary artery occlusion can be identified. Injection of contrast media into the ventricle will instead reveal that the apical portion of the left ventricle…

…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…

…target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an arterial blood gas in respiratory compromise, low saturation…

…compressible if bleeding occurs, low risk of pneumothorax Uncomfortable for an awake patient, harder to keep the dressing clean with a tracheostomy or copious secretions…

…Risk of HPA suppression Tapering : : : < 3 weeks, at any dose Low Can be stopped straight away 3 weeks, prednisolone < 5 mg/day Low…

…moment the spray starts. Let the tissue thaw completely between cycles — it is the freeze–thaw–freeze cycle that causes cell death, not the cold…

…the visual acuity before anything else is done. The second most important is to look for signs of perforation — Seidel's sign, an irregular pupil…