…Severe sepsis and septic shock. Already marked hypothermia from another cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of…

…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…

…acute, when serial troponin values show a dynamic change, or chronic, when troponin elevation persists without such a change. Myocarditis, sepsis, takotsubo cardiomyopathy, valvular disease…

…below 8 kPa on an arterial blood gas. Acute critical illness during initial stabilisation — cardiac arrest, shock, sepsis, major trauma, unconsciousness — until the saturation can…

…with severe hypoxaemia, severe anaemia, and hypotension or shock. Conversely, mechanisms that increase myocardial oxygen demand include sustained tachyarrhythmia and severe hypertension, with or without…

…of sepsis induced cardiac arrest, consider the following recommendations: Administer 100% oxygen at the maximum flow rate . Hypoxia can precipitate cardiac arrest in septic patients…

…Acute pancreatitis, pancreas surgery, alkalosis (hyperventilation), rhabdomyolysis, septicemia (sepsis), osteolytic cancer metastases, abnormal calcium absorption (gastrointestinal) and resorption (from primary urine), renal failure, small bowel…

…herbal remedies, contrast media and recently stopped drugs. 8. Treat sepsis, bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the…

…nausea, vomiting, muscle cramps, apathy, confusion, impaired reflexes. Severe <115 mmol/L Seizures, coma, respiratory arrest, brainstem herniation and death. Table 2. Grading of hyponatremia…

…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…

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

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…

…abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe hypertension without clinical evidence of acute, ongoing target organ damage. Although BP reduction is…

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…

…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…

…muscle rupture Papillary muscle rupture causes abrupt severe MR. Its typical presentation is: Sudden severe dyspnoea. Acute pulmonary oedema. Hypotension. Progressive heart failure. Cardiogenic shock…

…causes such as severe pre existing valvular disease or excessive beta blocker or calcium channel blocker exposure. The incidence of cardiogenic shock complicating STEMI has…

…dissection, hypotension or shock, respiratory failure, severe anaemia, sustained bradyarrhythmia, tachyarrhythmia, or severe hypertension with or without left ventricular hypertrophy. Among patients with NSTE ACS…

…Cardiogenic Shock. N Engl J Med 2021; 385:516 525 Indications Severe left ventricular failure, acute or chronic. Severe biventricular failure, acute or chronic. Severe…

…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…

…Spontaneous attacks without a clear trigger: consider vestibular migraine, Ménière's disease, TIA and arrhythmia, among others. Acute severe balance disturbance without nystagmus: HINTS does…

…Skin symptoms may be absent, and circulatory shock does not have to be present for the condition to be serious [1]. Intramuscular adrenaline (epinephrine) is…

…easy to trust too much. Two errors make the reading useless without anyone noticing: the transducer is at the wrong height , and the system is…

…anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia…

…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…

…the use of ultrasound throughout the puncture, and maintaining maximal barrier precautions without shortcuts. The most common serious error is dilating a vessel that turns…

…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…

…and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and HHS are dynamic…

…that can be cured on the spot, in three minutes, without drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the…

…second attempt). Vasoactive infusions Drug Dose range Primary effect Used in : : : : Noradrenaline 0.05–0.5 µg/kg/min α₁ — vasoconstriction Septic and distributive shock

…dosering Lathundar The doses below are taken from the recommendations of Strama Stockholm for the empirical antibiotic treatment of adults in hospital and in residential…

…only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with outflow tract obstruction Caution…

…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…

…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…

…single most important tool when intubation fails, since it restores oxygenation without requiring a view down into the larynx. The difficult airway rarely kills because…

…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…

…same foundation: an effective digital block and a tourniquet . Without a bloodless field one works by feel, and by feel nail spicules are left behind —…

…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…

…Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma, burns or status epilepticus when peripheral access fails or is judged…

…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…

…Marked liver failure with coagulopathy. Severe uncontrolled hypertension. Recent intracranial haemorrhage without a fresh assessment of benefit and risk. An inability to attend for sampling…

…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…

…Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy. Dosage Acute myocardial infarction: Initial…

…<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…

…has no effects on the venous capacitance vessels. Hence, Clevidipine reduces blood pressure without affecting cardiac filling pressures. • Clevidipine is more effective than nitroglycerin, nitroprusside…

…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…

…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…

…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…

…muscle rigidity and ultimately major tissue loss. Reperfusion after severe or prolonged ischaemia may be accompanied by rhabdomyolysis, with potential renal failure and increased mortality…

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