…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…

…safe triangle (Figure 1). Outside it the risk of injuring the diaphragm, liver, spleen or internal thoracic artery increases. For diagnostic aspiration the point chosen…

…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…

…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…

…is often indicative of a noncardiac source [4]. 3. Pneumonia with Pleurisy Pain Characteristics: Pleuritic pain is a common presentation [2]. 4. Other Systemic/Local…

…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…

…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…

…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…

…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…

…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…

…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…

…the dorsum of the foot lateral to the extensor hallucis longus tendon. Measure in the same way as on the arm. 4. Posterior tibial artery …

…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…

…arthritis of the neck. Symptomatic carotid stenosis, recent stroke or TIA in the vertebrobasilar territory. Retinal detachment. Relative: Marked cervical restriction of movement or pain…

…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…

…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…

…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…

…of very high risk. They require immediate escalation because the priority is to identify and treat an obstructive coronary lesion without avoidable delay. In contrast…

…with acute chest pain or chest pain equivalent symptoms. The ECG assessment remains necessary even when symptoms have improved by the time of medical evaluation…

…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…

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

…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…

…on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive…

…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…

…refers to inflammation of the myocardial (muscle) tissue. However, it is often difficult to differentiate pericarditis and myocarditis, and they tend to accompany each other…

…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…

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

…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…