…diastolic pressure and pulse pressure with minimal effect on CO. Minimal chronotropic effect. Increases coronary blood flow. Atrial or ventricular arrhythmias Bradycardia Peripheral (digital) ischemia…

…adults with congenital heart disease. Initiation Strategies Because of its ability to significantly prolong the QT interval and cause torsades de pointes or provoke severe…

…diastolic pressure and pulse pressure with minimal effect on CO. Minimal chronotropic effect. Increases coronary blood flow. Atrial or ventricular arrhythmias Bradycardia Peripheral (digital) ischemia…

…derivatives or heparin—except low dose heparin). Patients with gastrointestinal disorders. Patients with severe kidney disease (glomerular filtration rate < 30 mL/min). Patients with…

…to tetracosactide or ACTH. Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a relative contraindication; the test is then performed with preparedness…

…difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with chronic kidney disease…

…is limited. Ivabradine alone or combined with a beta blocker should be considered in symptomatic patients. This is a class IIa, level B recommendation. Combination…

…is more severe, and lasts longer. The pain usually involves the central portion of the chest or the epigastrium and occasionally radiates to the arms…

…and with several patient and treatment related factors: Age older than 80 years Female sex Low body mass index Asian ancestry Previous muscle disease or…

…with demonstrated cardiovascular effects. Diabetes may also contribute to arrhythmogenesis through diabetic neuropathy and adverse metabolic effects, independently of coexisting CAD, previous myocardial infarction or…

…entire heart. Severe symptoms occur at 7 mmol/L or higher. Causes of hyperkalaemia Severe hyperkalemia is usually the result of several interacting factors, such…

…whereas a severe appearing lesion may not produce demonstrable ischaemia. Functional assessment with pressure or flow measurements, intravascular imaging, or fractional flow reserve derived from…

…in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or pharmacological…

…10 minutes unless promptly treated Severe chest pain, pressure, or discomfort An accelerating pattern of angina, with increasing frequency or severity Symptoms that awaken the…

…Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to…

…when prolonged or severe, myocardial necrosis. It most commonly reflects atherothrombosis: disruption of an atherosclerotic plaque followed by platelet activation and coagulation, with formation of…

…with or without extension into the arch or descending aorta. Stanford type B: does not involve the ascending aorta and includes dissections involving the arch…

…Auscultation Wheeze with preserved air entry Marked wheeze or reduced air entry Silent or nearly silent chest pCO₂ Low Usually low Normal or raised Other…

…naive adult with normal renal function Morphine The reference drug, with the greatest experience eGFR 30–60 Morphine at half the dose, or oxycodone Morphine…

Pulmonary valve regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep…

…wave systolic flow reversal, Qualitative parameters Mild regurgiation Moderate regurgitation Severe regurgitation Mitral valve apparatus normal or mildly abnormal often abnormal abnormal, possibly flail CW…

…Moderate regurgitation Severe regurgitation Coaptation defect mild moderate severe Size right ventricle normal normal or enlarged enlarged Size right atrium normal normal or enlarged enlarged…

…hypertensive encephalopathy and should prompt consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in acute…

…cardiomyopathy is severe myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble primary dilated cardiomyopathy, particularly when angina or a previous…

…treatment. 5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document…

…of cardiac troponins. In addition to elevated troponins, the patient must display either symptoms or ECG changes consistent with myocardial infarction/ischemia. Most patients, however…

…particularly after previous severe episodes, with concurrent physical illness or after prolonged very high intake More than 90 percent of withdrawal seizures occur within 48…

…several non pharmacological measures at the same time, and use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and…

…When clinically significant, it may present with chronic angina, an anginal equivalent or exertional dyspnoea. Patients may continue to have lifestyle limiting symptoms despite guideline…

…with NSTEMI. The timing of VSR, free wall rupture, and papillary muscle rupture is characteristically bimodal. Events may occur within the first 24 hours or…

…or transcatheter intervention, with temporary mechanical circulatory support (MCS) considered as a bridge. Clinical Presentation and Symptoms Symptoms of STEMI The usual symptom is severe…

…workload. Levosimendan is used in severe acute or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A…

…are contraindicated in patients with bronchospastic lung disease, or a history of significant reactive airway disease. Contraindications also include second degree or third degree AV…

…severity of symptoms in STEMI patients, compared to those with Non ST Elevation Myocardial Infarction (NSTEMI) or unstable angina (UA), is attributed to the greater…

…focal neurological findings are absent in roughly half of patients with a central cause. A normal routine neurological examination is therefore not sufficient to exclude…

…or for grading. Antihistamines, corticosteroids, inhaled bronchodilators and nebulised adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is associated with more severe…

…Repeated blood gases, for example during mechanical ventilation or severe metabolic derangement. Major surgery with expected blood loss or large volume shifts. Patients in whom…

…patients with risk factors. Check what applies in your own region. The time limit is not a guarantee. Where the stroke risk is high or…

…Contraindications Severe coagulopathy or ongoing anticoagulation — correct this first . Thrombocytopenia, by contrast, is not a contraindication; the specimen may be taken even at very low…

…low risk of pneumothorax Uncomfortable for an awake patient, harder to keep the dressing clean with a tracheostomy or copious secretions Subclavian vein Most comfortable…

…from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain infarction is judged possible during…

…with DKA dose insulin, while the osmolality is corrected cautiously [1,3]. Euglycaemic DKA Euglycaemic DKA means ketosis and metabolic acidosis despite a normal or…

…wrong patient or by an inexperienced examiner it is unreliable. A single central feature is enough to proceed with urgent investigation , and a normal CT…

…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…

…severe piperacillin–tazobactam 4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline…

…is a high risk patient even with normal ST segments, whereas isolated ST depression in a woman with a low pre test probability is usually…

…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…

…coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood…

…deeply sedated or relaxed — a half awake patient coughs, clenches the jaw and develops laryngospasm . 4. Open the mouth, introduce the mask with the aperture…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

…Splinting with a cotton wisp Ingrown nail with moderate inflammation Splinting with a strip of suture material or a drain Ingrown nail, severe or recurrent…

…with a local anaesthetic, and a decongestant nasal spray if the nasal passage is narrow. A 50–60 mL catheter syringe, a collection bag or…

…the head of the humerus. A pressure bag or a 50 mL syringe with a three way tap — intraosseous flow requires pressure ; gravity is not…

…TTR) should exceed 70 % Venous thromboembolism 2.0–3.0 Overlap with low molecular weight heparin (LMWH) for at least 5 days Mechanical aortic valve…

…Turner syndrome 40 mm • Patients with mutations in TGFBR1, TGFBR2 or Loes Dietz syndrome, who have low BSA or severe extra aortic features 45 mm …

…Low risk 0 3 0.8% Intermediate risk 4 2.6% High risk 5 or more 5.8% Interpretation of ATRIA risk score. Comparison with…

…failure. Caution • Used cautiously in patients with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension…

…Caution • Clonidine may induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable…

…less Myocardial infarction severe CAPASTAT SULFATE CAPREOMYCIN capreomycin sulfate NA no no INFED IRON DEXTRAN IRON DEXTRAN Mixed ar less patients with pre existing cardiovascular…

…depletion and high plasma renin activity increase the effect of enalaprilat, and may cause severe hypotension. Time to onset of action 15 to 30 minutes…