…hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre…

…less ischemic area), which may receive oxygen from collateral vessels. In cardiac arrest, there is no cerebral perfusion, with an equal degree of hypoxia in…

…arrest and asystole represent severe manifestations of impulse generation or conduction failure. The pathophysiology of these events may stem from reversible causes, including hypovolemia, hypoxia…

…whereas fixed, dilated pupils can signal severe global ischemia or even herniation of the brain stem. Physiological Basis of the Pupillary Reflex in Cardiac Arrest…

…capillary glucose. 3. Exclude immediately treatable threats without delay: hypoxia, hypoglycaemia, circulatory failure, sepsis, stroke, intracranial haemorrhage, seizure, poisoning and severe withdrawal. 4. Establish whether…

…antihistamine for symptoms Anaphylaxis Objective airway, respiratory or circulatory compromise, or a rapidly progressive multisystem reaction Intramuscular adrenaline immediately Severe anaphylaxis Hypoxia, marked bronchospasm, stridor…

…a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest Drug Adult Child : : …

…agents. In the acute setting, bradyarrhythmic cardiac arrest or asystole may result from reversible systemic insults, including hypovolemia, hypoxia, cardiac tamponade, tension pneumothorax, preexisting acidosis…

…Clinically, patients may present with: Absent breath sounds on the affected side Crepitus Subcutaneous emphysema Hypotension Hypoxia Mediastinal shift, with potential tracheal deviation to the…

…following recommendations: Administer 100% oxygen at the maximum flow rate . Hypoxia can precipitate cardiac arrest in septic patients; timely oxygenation can potentially prevent circulatory collapse…

…Arrhythmias : Ventricular or supraventricular arrhythmias (bradyarrhythmia or tachyarrhythmia). Atrial or ventricular rupture : In severe cases, there can be a rupture of the atria or ventricles…

…bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be…

…kPa (200–300 mmHg) Moderate 13.3–26.6 kPa (100–200 mmHg) Severe ≤ 13.3 kPa (≤ 100 mmHg) See the intensive care parameters for…

…of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus plugging. Expiratory…

…reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not enough: fracture, renal colic, ischaemic pain, pancreatitis…

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…

Mitral valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation Vena contracta (cm) < 0,3 0,3 0,69 0,69 EROA (cm²…

Tricuspid valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation PISA radius < 0,6 0,6 0,9 0,9 Vena contracta (cm…

…consciousness. Focal neurological findings are uncommon in hypertensive encephalopathy and should prompt consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Ischemic cardiomyopathy is severe myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble…

…The severity of the symptoms governs the emergency treatment Severe symptoms The following symptoms indicate hyponatraemic encephalopathy and warrant immediate treatment in the absence of…

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

…particularly in patients with marked tolerance. The most important measures in severe or complicated withdrawal are: 1. A benzodiazepine in a sufficient and repeated dose…

Myocardial ischemia and infarction Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Post infarction mechanical complications are structural disruptions of acutely infarcted myocardium occurring most often during the first…

…MCS) considered as a bridge. Clinical Presentation and Symptoms Symptoms of STEMI The usual symptom is severe, prolonged ischemic discomfort. It is commonly described as…

…conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and, when prolonged or severe…

…and valvular function. Levosimendan drug is generally well tolerated. Severe adverse effects are less common. Levosimendan may be administered simultaneously with milrinone. The drugs can…

…exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or aortic aneurysm. Baseline ECG abnormalities rendering…

…Myocardial ischemia and infarction STEMI (ST Elevation Acute Myocardial Infarction): Epidemiology, Diagnosis (ECG), Criteria & Management Acute ST Elevation Myocardial Infarction (STEMI) is the most severe…

…arrhythmia, among others. Acute severe balance disturbance without nystagmus: HINTS does not apply. Assess gait and truncal stability and investigate for a central cause. Acute…

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

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

…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…

…departments — follow local protocol. Severe lung disease or a contralateral pneumothorax: avoid the subclavian and jugular routes on the healthy side, since a pneumothorax there…

… warm ischaemic time is the limiting factor The time critical element The diagnosis and the donor care The time from withdrawal of treatment to circulatory…

…a longer symptomatic course Consciousness Usually preserved, but may be impaired in severe DKA Cognitive impairment is more common, particularly at very high osmolality Blood…

…injury, recent cervical spine surgery, atlantoaxial instability, severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis, recent stroke or TIA in the vertebrobasilar territory. Retinal…

…Duration : : : : Pneumonia, non severe (DS CRB65 0–1) phenoxymethylpenicillin 1 g × 3 PO 5–7 days or benzylpenicillin 3 g × 3 IV Pneumonia, in chronic…

…48 hours, or ongoing unstable angina. Uncontrolled symptomatic arrhythmia. Symptomatic severe aortic stenosis. Decompensated heart failure. Acute pulmonary embolism or deep vein thrombosis. Acute myocarditis…

…nephrology early in anuria, in a dialysis patient, in severe acute kidney injury, in treatment failure or in ongoing massive potassium release. In cardiac arrest…

…marked reflux. A need for high airway pressures, for example severe ARDS, marked obesity or a stiff chest wall. Glottic or subglottic obstruction — the mask…

…Dry, necrotic, pale Variable, often deep Pain Moderate, relieved by elevation Severe, worse on elevation, better when dependent Often painless (neuropathy) Surrounding skin Hyperpigmentation, oedema…

…a strip of suture material or a drain Ingrown nail, severe or recurrent Partial nail avulsion, often with chemical matrix ablation A nail spicule that…

…retention — the commonest indication on a surgical ward. Decompression in severe vomiting where the stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery…

…venous access is not immediately available. Shock, severe trauma, burns or status epilepticus when peripheral access fails or is judged futile. Children in an emergency…

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

…fetal bleeding respectively). Marked liver failure with coagulopathy. Severe uncontrolled hypertension. Recent intracranial haemorrhage without a fresh assessment of benefit and risk. An inability to…

…who have low BSA or severe extra aortic features 45 mm • Patients who are undergoing aortic valve surgery • Patients with Marfan syndrome who have additional…

…Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA). Stroke Contraindications Cross reactivity: Do not administer to patients with a…

…<13 g/dL in men or <12 g/dL in women (3 points) Severe Renal Disease: Estimated glomerular filtration rate (eGFR) <30 mL/min or…

…with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension. Clevidipine doses and administration in hypertension.

…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…

…A PENICILLIN G BENZATHINE PENICILLIN G BENZATHINE Arrhythmia ar less Cardiac arrest severe INVEGA HAFYERA PALIPERIDONE PALMITATE paliperidone palmitate Arrhythmia wp most QT Prolongation moderate…

…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…

…Increased pulmonary blood flow. Ventricular arrhythmias Severe hypertension resulting in cerebrovascular hemorrhage Cardiac ischemia Sudden cardiac death Prolonged use may be cardiotoxic. Isoproterenol Bradycardia (first…

…Effective in pulmonary edema. Can produce severe hypotension. Time to onset of action 30 seconds to 1 minute Duration of action 1 to 10 minutes…

…<17 Tricuspid valve Tricuspid valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation PISA radius < 0,6 0,6 0,9 0,9…

…active substance or any excipient. Active bleeding. Previous intracranial hemorrhage. Severe liver impairment. Concurrent administration of ticagrelor with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin…

…myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis. It is characterized by prolonged angina at rest, usually lasting more than 20 minutes; new severe…