…or transaminases, and thrombocytopenia—is generally regarded as a severe preeclamptic phenotype or variant. Pathophysiology The precise mechanism of preeclampsia remains incompletely established. Proposed contributors…

…acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood pressure is often at least 180/120 mmHg, but no absolute threshold…

…Pregnancy, gestational week and recent delivery. Pre eclampsia can present postpartum. Known hypertension and current antihypertensive treatment. Missed doses or abrupt withdrawal of a beta…

…This pre test probability is the clinician’s estimate of the probability that the patient has anatomically obstructive CAD before the result of a new…

Cardiology Emergency medicine Definition and Pathophysiology A hypertensive emergency is severe blood pressure elevation accompanied by acute hypertension mediated target organ damage (HMOD). The European…

…rupture with acute severe mitral regurgitation—predominant right ventricular (RV) infarction, cardiac rupture with tamponade, and less common causes such as severe pre existing valvular…

…Preoperative functional assessment before major surgery. At a low pre test probability most positive results are false positives; at a high probability a negative test…

…MAP) by decreasing systemic vascular resistance (SVR). Clevidipine does not reduce cardiac filling pressure (pre load), since it has no effects on the venous capacitance…

…while cardiomyocyte swelling, interstitial oedema and tissue inflammation produce extravascular compression. In the most severe form, termed no reflow, structural and functional microvascular impairment persists…

…and elevated CK. Rhabdomyolysis is a rare, severe form of muscle injury. The biological basis of many reported muscle symptoms remains uncertain. Randomized trials have…

…Dose reduction in renal failure and in old age Amiodarone In severe haemodynamic compromise where the above cannot be used It also has a rhythm…

…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…

…MAP) by decreasing systemic vascular resistance (SVR). Clevidipine does not reduce cardiac filling pressure (pre load), since it has no effects on the venous capacitance…

…constitutes a major clinical problem. It can manifest as an increase in the frequency of a pre existing arrhythmia, the sustenance of a previously non…

…DUS), pre operative assessment, or evaluation of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of severe asymptomatic stenosis is low…

…with potential tracheal deviation to the opposite side Distended jugular veins Management Decompression using a venous cannula Can be executed in a pre hospital setting…

…MAP) by decreasing systemic vascular resistance (SVR). Clevidipine does not reduce cardiac filling pressure (pre load), since it has no effects on the venous capacitance…

…week in the usual course. Severe AKI requiring dialysis is uncommon except in the presence of substantial pre existing CKD, particularly when congestive heart failure…

…in older patients and those exhibiting a bundle branch block (BBB) or an intraventricular conduction defect. In severe cases, bradycardia may progress to hemodynamic instability…

…or location of inducible ischaemia. It is particularly appropriate when: The pre test likelihood of obstructive CAD is moderate or high, generally greater than 15…

…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…

…is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not enough: fracture, renal colic…

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…

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…

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

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…

…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…

…reported prevalence ranging from 18% to 52%. They frequently occur in patients with severe coronary artery disease, defined in the source material as stenosis greater…

…and cardiac tamponade. Papillary muscle rupture, producing acute severe mitral regurgitation (MR). These complications result from transmural myocardial necrosis and subsequent tissue disruption. Infarct expansion…

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

…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…

…Diagnosis (ECG), Criteria & Management Acute ST Elevation Myocardial Infarction (STEMI) is the most severe manifestation of coronary artery disease. This chapter deals with the pathophysiology…

…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…

…adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is associated with more severe and more protracted reactions, biphasic courses and fatal outcome…

…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…

…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…

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

…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…

…manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so, that are provoked by a change of position — turning over in bed, lying…

…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 : : …

…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…

…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…

…patient, ileus, third trimester pregnancy, marked reflux. A need for high airway pressures, for example severe ARDS, marked obesity or a stiff chest wall. Glottic…

…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…

…only one that will go in. The rule that saves time is simple: two attempts or 90 seconds — then go intraosseous. Indications Peripheral venous cannula:…

…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…

…significant bleeding. Pregnancy in the first trimester and close to delivery (embryopathy and fetal bleeding respectively). Marked liver failure with coagulopathy. Severe uncontrolled hypertension. Recent…

…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…

…Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy. Dosage Acute myocardial infarction: Initial loading dose: 300–500 mg…

…<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…

…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…

…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…

…and additionally severe hypertension (caution if patient on nonselective beta blockers). Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in…