…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…

…and all bites on the hand. These are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis…

…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…

…the basis of percussion and a chest radiograph alone belongs to an earlier era. The needle is inserted close to the upper border of the…

…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…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…in renal failure, heart failure, a history of peptic ulcer, and old age Titrate according to the effect and the respiratory rate, not to a…

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

…threatening causes of chest pain: Ischemic heart disease : stable angina pectoris, unstable angina pectoris, acute myocardial infarction (AMI). Note that unstable angina pectoris and acute…

…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…

…the result meaningfully increases the likelihood of disease and can justify further investigation or treatment. Testing is therefore not an automatic response to chest pain…

…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…

…team keeps trying to intubate instead of changing the plan. The aim is always oxygenation, never intubation in itself — and every difficult airway algorithm is…

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

…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…

…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…

…still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior iliac spine is the standard site for both aspiration and…

…history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds…

…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…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]. Important exceptions Condition Overall strategy Common first choices : : : Acute…

…in wide circles and let it dry for a couple of minutes before the needle is inserted. Sterile gloves, sterile gauze, and a fenestrated drape…

…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…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…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…

…Capillary refill is delayed, and venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent…

…particularly those with stable chest pain, no previous diagnosis of CAD, and a low clinical likelihood of obstructive disease when good image quality is expected…

…heart failure, and end stage renal disease, may produce elevated troponin concentrations. The probability of MI increases continuously as the absolute hs cTn concentration rises…

…encephalopathy, acute heart failure, disseminated intravascular coagulation, and abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe hypertension without clinical evidence of acute…

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

…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…

…Exaggerated activation of a central reflex produces a stereotypic response: an initial increase in heart rate, followed by a drop in blood pressure, and finally…

…will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and NSTE ACS …

…however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia…

…LMCA is short and branches into the two arteries supplying the anterior and left side of the heart, as follows: The left anterior descending coronary…

…stages before and after revascularization procedures (PCI or coronary artery bypass grafting [CABG]). Stress testing is used to establish the diagnosis of ischemic heart disease…

…chest pain, heart failure and cardiac arrest. In cases with intermittent symptoms, it is important to establish a temporal correlation between symptoms and episodes of…

…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…

…to determine left and right in the obtained image. Figure 1 illustrates how the index marker is used for orientation. Figure 1. Orientation using the…

…the retrosternal chest pain in acute pericarditis is very similar to that in STEMI. The combination of retrosternal chest pain and ST elevation on ECG…

…larger portion of the myocardium, thereby intensifying chest pain. In contrast, NSTEMI and UA typically involve partial occlusions, resulting in subendocardial ischemia and comparatively milder…

…elevation is typically discrete and not on a par with the degree of left ventricular impairment. Pathophysiology of takotsubo cardiomyopathy (broken heart syndrome) This topic…

…anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to hurt even so. Offer…

…set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for…

…Catheter length: the right internal jugular vein requires the shortest catheter, while left sided and femoral insertions require longer ones — check the length in the…

…afternoon and evening. See the quick reference on inpatient insulin therapy Peptic ulcer A proton pump inhibitor with concomitant NSAID use or a history of…

…front , and this is why the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis…

…pressure measured, or be palpated. Indications A sensation of something in the eye, watering, photophobia and redness after working with a grinder, a drill, a…