…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 upper border of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain…

…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…

…Atherosclerotic and thromboembolic risk factors. Relevant predispositions, such as connective tissue disease. No single pain descriptor is diagnostic. The severity of pain also has limited…

…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…

…cause of the pain. Refer to The ischemic cascade for details. History taking in patients with chest pain (chest discomfort) HISTORY PARAMETER QUESTIONS COMMENTS Risk…

…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…

…injection has gone to the right place — immediate pain relief is a diagnostic finding — and appears to reduce the risk of a post injection flare…

…or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of obstructive coronary artery disease (CAD) before diagnostic testing…

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

…hyoid, 2 fingerbreadths from hyoid to the upper border of the thyroid cartilage M allampati Class III–IV indicates increased risk O bstruction/Obesity Stridor…

…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…

…ascites — always. Every admission of a patient with known ascites. Clinical deterioration in a cirrhotic patient with ascites: fever, abdominal pain, encephalopathy, rising creatinine, gastrointestinal…

…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…

…lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood…

…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…

…diagnostic of peripheral arterial disease and at the same time indicates a substantially increased risk of myocardial infarction and stroke. Indications Intermittent claudication, rest pain…

…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…

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

…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…

…Diabetes, immunosuppression A risk of necrotising otitis externa Anticoagulant treatment Bleeding into the ear canal Previous radiotherapy to the head and neck Fragile skin, poor…

…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…

…coagulopathy. Severe uncontrolled hypertension. Recent intracranial haemorrhage without a fresh assessment of benefit and risk. An inability to attend for sampling and follow up — relative…

…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…

…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…

…may produce elevated troponin concentrations. The probability of MI increases continuously as the absolute hs cTn concentration rises. Early absolute changes over 1 hour provide…

…titrated intravenous therapy when indicated Oral treatment and prompt follow up Main risk of management Overtreatment may impair autoregulation and cause ischemia Acute rapid reduction…

…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…

…the presence of ST segment elevations in the former. Refer to Figure 1, which illustrates the natural course of coronary artery disease, from risk factors…

…population. Troponin levels higher than the 99th percentile of a normal population are considered elevated (abnormal). Criteria for elevated troponins: serial measurements with a rising

…to alleviate ischemic chest pain may lead to hemodynamic collapse in patients with right ventricular ischemia or infarction. Recognizing ECG signs of right ventricular involvement…

…The sensitivity, specificity, risks, and results of the exercise test may be affected by patient characteristics. For example, exercising patients with ongoing myocardial ischemia may…

…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…

…handled routinely in primary care or in the emergency department without contacting the appropriate specialty: Location Risk Management : : : Medial triangle of the face (nasal root…

…Cyanosis or saturation below target despite oxygen Severe impairment of gas exchange Hypotension, cool peripheries or rising lactate Circulatory compromise or an alternative diagnosis Silent…

…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…

…according to the local protocol. Tapering after pharmacological treatment Duration and dose Risk of HPA suppression Tapering : : : < 3 weeks, at any dose Low Can…

…experienced practitioner in selected cases, but surgery is the standard. Dark skin: a risk of permanent hypopigmentation. Areas with poor circulation, above all the lower…

…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…