…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…

…radiologically confirmed dislocation of the shoulder, elbow, finger, patella, jaw or hip prosthesis. A dislocation with neurovascular compromise or skin tenting — reduce promptly, before radiography…

…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…

…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…

…abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination findings before the dose. A plan for…

…Findings: The sudden onset of symptoms coupled with diaphoresis should always raise concern for a cardiovascular cause [4]. 2. Aortic Dissection Pain Characteristics: The classic…

…rare condition) In addition to these five conditions, there are numerous other causes of chest pain, but the other causes are either subacute or non…

…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…

…to chest pain. It is appropriate when the expected information is likely to change management. In patients with a very low probability of obstructive CAD…

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

…team, not in your head. Functioning suction within reach under the pillow or by the right shoulder. A reservoir mask with a tight fitting seal…

…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…

…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…

…the level of amputation. Contraindications There are no absolute contraindications. Refrain or modify in: Deep vein thrombosis in the leg — cuff compression should be avoided…

…smears immediately at the bedside from the first aspirate, which should be small — a few tenths of a millilitre, at most about 0.5 mL…

…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…

…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…

…with a low pre test probability is usually a false positive. Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery…

…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…

…dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit…

…slightly caudally, parallel to the posterior surface of the patella. The shoulder The patient sits with the arm hanging relaxed and slightly internally rotated. The…

…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…

…0 The time in therapeutic range (TTR) should exceed 70 % Venous thromboembolism 2.0–3.0 Overlap with low molecular weight heparin (LMWH) for at…

…concomitant right ventricular infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but should not…

…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…

…CCTA should be distinguished from coronary artery calcium (CAC) scoring. CAC imaging is a rapid, non contrast, low radiation CT examination that quantifies coronary calcification…

…segment elevation, immediate reperfusion assessment is required. Patients with NSTE ACS should be admitted for management of acute ischaemia. Those with possible ACS, a non…

…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…

…delay. In contrast, haemodynamically stable patients without ST segment elevation after successful resuscitation from out of hospital cardiac arrest should not routinely undergo immediate angiography…

…and facilitate triage of patients with suspected ST segment elevation myocardial infarction to a percutaneous coronary intervention capable hospital. The initial ECG should be interpreted…

…upright posture. Specific triggers are well recognized and include: Provoked fear, pain, anxiety, intense emotion, the sight of blood, unpleasant sights and odors, and orthostatic…

…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…

…with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms. The diagnosis requires elevated levels of cardiac troponins…

…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…

…kinesiophobia (fear of exercising) is common after myocardial infarction and it is associated with poorer survival. Patients with unstable angina pectoris with low risk (according…

…hemodynamic effects is a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock and cardiac arrest is high and pharmacological…

…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…

…operator should have an elbow rest, and also avoid bending the back during the examination. Work related musculoskeletal disorders are a common cause of pain…

…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…

…target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an arterial blood gas in respiratory compromise, low saturation…

…Internal jugular vein (right) Best ultrasound conditions, a straight course to the superior vena cava, compressible if bleeding occurs, low risk of pneumothorax Uncomfortable for…

…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…

…body reaching the stroma or deeper. The absence of a slit lamp — the cornea should not be instrumented without magnification. With a suspected chemical injury…