…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…

…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…

…affect the myocardium or major vessels. 1. Acute Coronary Syndrome (ACS) / Myocardial Ischemia Pain Characteristics: Typically presents as substernal discomfort, often described as pressure, tightness…

…coronary syndromes (ACS). Aortic dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of chest pain…

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…

…basic principles of exercise physiology is essential to conduct and evaluate the exercise stress test. Exercise induces physiological changes such as increased ventilation, coronary vasodilation…

…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…

…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…

…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…

…paracentesis: Newly detected ascites — always. Every admission of a patient with known ascites. Clinical deterioration in a cirrhotic patient with ascites: fever, abdominal pain, encephalopathy…

…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…

…least 85% of the age adjusted MHR. Heller et al. demonstrated the following, among patients with known coronary artery disease: Achieving 85% of age adjusted…

…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…

…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…

…cause necrosis. Screening in diabetes of 10 years' duration, or in diabetes with age 50 years. Risk assessment in known coronary or cerebrovascular disease. Follow…

…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…

…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…

…Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit, a coronary care unit or another setting that…

…effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications Infection of the skin…

…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…

…states or iatrogenic vascular injury. Acute occlusion may also occur in an artery with established collateral circulation, particularly an occluded bypass graft; in such cases…

…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…

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

…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…

…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…

…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…

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

…leads. Localization of myocardial infarction / ischemia is done by using ECG changes to determine the affected area and subsequently the occluded coronary artery (culprit). Figure…

…or coronary artery bypass grafting [CABG]). Stress testing is used to establish the diagnosis of ischemic heart disease as well as estimating the extent of…

…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…

…than the pain in acute STEMI. This is explained by the fact that NSTEMI and unstable angina are caused by 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…

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

…Among them are coronary artery vasospasm, dysfunctional capillary function and catecholamine toxicity. The latter theory is corroborated by the finding that 75% of patients have…

…somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face or perianally. Indications Fluctuant…

…pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early: 1. Assess airway, work of breathing, level of consciousness and circulation…

…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…

…margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is…

…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…