…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…

…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…

…pain, or when the volume limit is reached. Indications Diagnostic aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart…

…and other symptoms may occur without chest pain and should be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around…

…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…

…PO According to the preparation Avoid in renal failure, heart failure, a history of peptic ulcer, and old age Titrate according to the effect and…

…The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than chest pain itself…

…to these five conditions, there are numerous other causes of chest pain, but the other causes are either subacute or non acute. The history taking…

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

…Starling mechanism is amplified by the positive inotropic effects of the sympathetic stimulation. Increased stroke volume and increased heart rate lead to increased cardiac output …

…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…

…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…

…first. Procedure Choice of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and…

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

…it very likely that the coming guidelines by the American Heart Association (AHA) and American College of Cardiology (ACC) will be in line with the…

…it very likely that the coming guidelines by the American Heart Association (AHA) and American College of Cardiology (ACC) will be in line with the…

…chest pain) appear as the last event in the cascade. Thus, ischemic episodes may pass asymptomatically. Importance of heart rate during myocardial perfusion imaging It…

…arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended…

…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…

…the other arm. 2. Ankle pressure. Place the cuff just above the malleoli, with its lower edge about 2 cm above the tip of the…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…the side lying variant of the Dix–Hallpike test. Marked obesity or spinal disease that makes positioning impossible. Severe angina, heart failure or recent myocardial…

…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…

…organ damage. Isolated malignant retinopathy without other acute organ damage can often be treated more cautiously with oral drugs under careful observation [3,4]. A…

…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…

…monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis…

…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…

…cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the…

…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…

…or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction. acute heart failure recurrent dynamic…

…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…

…distribution of coronary stenosis. Modern cardiac CT can acquire a three dimensional cardiac dataset within approximately 5–15 seconds, with submillimetre spatial resolution. Iodinated contrast…

…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…

…of vascular autoregulation during a rapid or severe rise in BP. This may produce acute injury in the brain, retina, heart, aorta, kidneys, or other…

…high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from ongoing…

…The physical examination should include: Assessment of all major peripheral pulses. Blood pressure measurement in both arms. Cardiac auscultation. Pulmonary auscultation. Evaluation for heart failure…

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

…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…

…ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia. After this period…

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

…maximal heart rate. Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the other hand…

…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…

…in a reduction of coronary blood flow and this causes subendocardial ischemia (i.e ischemia that only affects the subendocardium). STEMI, on the other hand…

…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…

…and clinical features The pericardium is a double walled sac in which the heart and the roots of the great vessels are contained (Figure 1)…

…artery occlusion leads to transmural ischemia, affecting a larger portion of the myocardium, thereby intensifying chest pain. In contrast, NSTEMI and UA typically involve partial…

…broken heart syndrome) is a rather peculiar and certainly acute condition. Much research has been devoted to it in recent years. Most cases (70%) of…

…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…

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

…different position or a different vessel. Choice of site Vessel Advantages Disadvantages : : : Internal jugular vein (right) Best ultrasound conditions, a straight course to the superior…

…apply to the anti inflammatory effect. They say nothing about the mineralocorticoid effect or about suppression of the HPA axis, where a long half life…

…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…