…the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra…

…the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia…

…intraluminal pressure. Coronary blood flow is also influenced by sympathetic and parasympathetic influences; sympathetic stimulation leads to vasoconstriction through the release of norepinephrine, while parasympathetic…

…the onset of myocardial infarction. This is utilized in clinical practice by detecting troponins in patients with suspected acute coronary syndromes. Several manufacturers have developed…

…acute coronary syndromes are commonly related to atherothrombotic events, myocardial ischaemia may also result from other mechanisms. Differential diagnoses and alternative causes of troponin release…

…promote the release of adhesion molecules, inflammatory cytokines, and vasoconstricting mediators, producing abnormal vascular responses and potentially increasing the future risk of obstructive coronary disease…

…restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form of arterial hyperplastic disease arising after percutaneous coronary intervention (PCI)…

…which results in thrombus formation (Figure 1). Disruption of an atherosclerotic plaque may also release atherosclerotic debris downstream, causing microvascular embolization (i.e occluding smaller…

…The central pathophysiological concern in the emergency department is myocardial ischaemia caused by an acute coronary process. Myocardial injury leads to release of cardiac troponin…

…infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased concentrations may result from acute coronary atherothrombosis, oxygen supply–demand imbalance…

…and Pathophysiological Basis High sensitivity cardiac troponin (hs cTn) assays detect circulating troponin released from injured cardiomyocytes at substantially lower concentrations than earlier generation assays…

…1). What follows is a quick reference for their use in the emergency department, the intensive care or coronary care unit, and the operating theatre…

…Endothelial dysfunction, increased vascular stiffness, impaired coronary circulation, vascular calcification and myocardial fibrosis further accelerate cardiovascular and renal injury. Adipokine imbalance contributes to insulin resistance…

…preparations: in practice within about 1 hour. Tablets and solid preparations: up to about 2 hours. Modified release preparations, anticholinergics, opioids and salicylate — where gastric…

…a dialysis patient, in severe acute kidney injury, in treatment failure or in ongoing massive potassium release. In cardiac arrest with suspected hyperkalaemia, advanced life…

…a fixed dose is given without assessment, when a modified release preparation is started in an opioid naive patient, or when a conversion between drugs…

…around the clock for health care professionals. Contact the centre early in serious, unusual or unclear poisoning, with modified release preparations, mixed poisoning, pregnancy, children…

…markers of myocardial wall stress. They are released principally by ventricular cardiomyocytes in response to increased transmural stress and ventricular stretch. Atrial natriuretic peptide is…

…and subcutaneous tissue 2–3 cm to one side, inject, wait 10 seconds, withdraw the needle and release the skin. The displaced track prevents the

…modified release preparation before the daily requirement is known. Duplication. Check that the patient is not already on an opioid patch, a modified release tablet…

…if more than one hour has elapsed post ingestion unless the ingested substance has the propensity to form bezoars or is a sustained release formulation…

…the skin perpendicular to the skin tension lines with the thumb and index finger — the biopsy defect then becomes oval when the skin is released…

…pupillary reflex. Importantly, pupillary size and reactivity are influenced by factors beyond neural activity. Systemic catecholamines released or administered during resuscitation can affect pupil to