…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…

…Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk of pneumothorax; ultrasound guidance…

…mechanisms of acute cardiopulmonary disease: Pulmonary embolism and spontaneous pneumothorax may produce abrupt chest pain and respiratory distress. Aortic dissection may cause sudden severe pain…

…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…

…of pain exacerbation with inspiration, along with a pleural friction rub, helps differentiate it from angina pectoris [5]. 5. Pulmonary Hypertension Pain Characteristics: Severe pulmonary…

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

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…

…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…

…refractory to guideline directed medical therapy, occur at a low level of exertion, or are associated with high event risk. The apparent differences between thresholds…

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

…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…

…or recurrent pain [1,3,4]. This quick reference gives internationally established doses. Drug availability, thrombolysis regimens, renal function thresholds and the division of work…

…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…

…of myocardial infarction and stroke. Indications Intermittent claudication, rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of…

…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…

…far enough forward that the head will extend beyond the end of the couch when laid down. 2. Turn the head 45° to the right…

…thrombosis (coronary or pulmonary), tension pneumothorax. No drug has been shown to improve the neurological outcome in cardiac arrest. High quality compressions with minimal interruptions…

…Uncontrolled symptomatic arrhythmia. Symptomatic severe aortic stenosis. Decompensated heart failure. Acute pulmonary embolism or deep vein thrombosis. Acute myocarditis, pericarditis or endocarditis. Acute aortic dissection…

…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…

…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…

…V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2…

…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…

…than earlier generation assays. They can identify troponin concentrations in approximately 50–95% of healthy individuals, whereas sensitive, but not high sensitivity, assays detect troponin…

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

…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…

…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…

…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…

…These assays, referred to as high sensitive cardiac troponin, may actually detect the presence of troponins in most normal persons. In 2017 it was possible…

…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…

…must not have experienced chest pain during the last 12 hours before exercise. Patients with unstable angina pectoris with high risk should not undergo exercise…

…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…

…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…

…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…

…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…

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

…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…

…proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period…

…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…