…Sepsis is a dynamic condition. Investigation and treatment must therefore proceed in parallel and must not wait for complete diagnostic certainty. Sepsis is defined as…

Critical care Myocardial ischemia and infarction Definition and Pathophysiology Cardiogenic shock is a state of inadequate tissue and end organ perfusion caused by cardiac insufficiency…

Referensvärden The values below are starting points, not aims in themselves. Almost all of them have proved to work better as ranges to stay within…

Referensvärden "Liver function tests" mainly measure damage , not function. The tests that reflect the synthetic function of the liver are the prothrombin time (INR) , the…

…vein). Standby access in a patient at risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma…

…thrombocytopenia and ongoing anticoagulant treatment. In tamponade with shock the coagulation is corrected in parallel with the procedure, not before it. Preparation and equipment Ultrasound…

Akutsjukvård Lathundar Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG…

…lateral) does not affect success, but active compression of the pads lowers defibrillation thresholds and improves success, and maximum fixed energy shocks outperform low escalating…

…addressing reversible etiologies takes precedence over chest compressions. If trauma is not definitively established as the cause of cardiac arrest, cardiopulmonary resuscitation (CPR) should be…

…function [3]. Urine output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to hypovolaemia, shock, obstruction or…

…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…

…What usually goes wrong is not that the patient gets too little oxygen but that the prescription has no target — the nasal cannula stays in…

…septic shock. Already marked hypothermia from another cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…wave to synchronise to; sync mode would block the shock entirely The patient Awake or sedated — requires sedation Unconscious In polymorphic VT, sync must be…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…bradyarrhythmia, respiratory failure with severe hypoxaemia, severe anaemia, and hypotension or shock. Conversely, mechanisms that increase myocardial oxygen demand include sustained tachyarrhythmia and severe hypertension…

…without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not affected by the concurrent use of beta blockers. The vasodilating effect reduces preload…

…STEMI) without ST segment elevations on 12 lead ECG This chapter covers situations in which the 12 lead ECG does not exhibit ST segment elevations…

…for example, ketoacidosis A venous sample is often sufficient if respiratory failure is not suspected Shock with a large arteriovenous difference Arterial sample, sometimes supplemented…

…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…

…and most serious dosing errors arise at the dilution step, not in the choice of dose. Paediatric doses are calculated on actual body weight unless…

…activity. The investigation is diagnostic, not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema…

…shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that has not responded to atropine: Complete heart block (third degree AV block) and second degree…

…MAP within an optimal range is crucial in managing conditions like sepsis, trauma, and shock, where perfusion may be compromised. Hemodynamic determinants of MAP Hemodynamically…

…cardiac arrest, electrical or haemodynamic instability, and cardiogenic shock. ACS is distinct from myocardial infarction (MI). MI denotes cardiomyocyte necrosis occurring in the clinical setting…

Cardiology Emergency medicine Definition and pathophysiology Acute pulmonary embolism (PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and…

…is classified as acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous…

…benefit. An early invasive strategy is not recommended when the risks of revascularization outweigh its expected benefits. Haemodynamic and electrical status Haemodynamic instability, cardiogenic shock…

…which may or may not be present Markedly reduced cardiac output in severe cases Cardiogenic shock in the most advanced presentations The symptoms of RVI…

…related artery is not recommended when presentation is more than 48 hours after symptom onset in the absence of persistent symptoms. Cardiogenic shock or haemodynamic…

…Relapse of VF and new shock. ECG 12 . Sinus rhythm. ECG 13 . Recurring VT. ECG 14 . Sinus rhythm, with ST segment elevations not seen previously.

…Relapse of VF and new shock. ECG 12 . Sinus rhythm. ECG 13 . Ventricular tachycardia. ECG 14 . Sinus rhythm, with ST segment elevations not seen previously…

…based on symptoms, the ECG and haemodynamics. Do not wait for troponin. If clinical suspicion persists despite an initially non diagnostic ECG, the ECG must…

…complication rate. The femoral artery is the second choice and is often the best in marked shock or during high dose vasopressor treatment, when the…

…Never stop basal insulin in a person with type 1 diabetes , not even before fasting or an investigation. Stopping it leads to ketoacidosis within hours…

…hours [5]. A continuing transfusion requirement while definitive control of the bleeding has not yet been achieved. Penetrating torso injury with shock. A positive FAST…

…antibiotics are associated with a worse outcome in sepsis and in several studies of neutropenic patients. In septic shock, or where sepsis is highly likely…

…the work of breathing, the peripheral perfusion and the signs of shock 2 Two large bore peripheral cannulae. Consider an arterial line if the patient…

…infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but should not delay reperfusion treatment…

…term prediction of sudden cardiac arrest. The constraint does not lie in therapy: implantable cardioverter defibrillators (ICDs) are highly effective, terminating well over 99% of…

…absent or markedly reduced y descent. The clinical impact depends not only on effusion volume but also on the rate of fluid accumulation, pericardial distensibility…

…and anticipated adherence to antithrombotic therapy. Anatomical and functional completeness are not synonymous. Anatomically incomplete revascularization may nevertheless be functionally complete if all lesions causing…

…intimal tear or flap. AAS is classified anatomically according to involvement of the ascending aorta: Stanford type A: involves the ascending aorta, with or without…

…formation is associated with poor short term prognosis, although early mortality is usually related to the extent of myocardial injury and its complications—shock, reinfarction…

…or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury have not generally demonstrated sufficient clinical benefit for routine use. No reflow…

…also protect against future proximal disease progression, while stents do not prevent the development of new proximal atherosclerosis. The choice between procedures therefore depends on…

…Mechanical or pump failure complications , including heart failure and cardiogenic shock. Most out of hospital deaths occur early and are commonly related to ventricular fibrillation…

…recurrent chest discomfort. Haemodynamic instability. Electrical instability or arrhythmia. Heart failure. Cardiogenic shock. Recent myocardial infarction. Important alternative diagnoses. Physical examination findings are not s

…Thus, an individual plaque’s morphology does not reliably establish that it will cause an acute event. A more clinically useful model considers both the…

…arrest care is advanced and should preferably only be conducted in specialized centers. Patients who are not in specialized cardiac arrest centers should, if feasible…

…usually unaffected, but the shock volume and ejection fraction (EF) may be reduced because the end diastolic volume of the ventricle (EDV) is reduced. Constrictive…

…condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions are often futile. A transcutaneous pacemaker is often necessary…

…5–7 mg/kg IV as a single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria…

…as shock or cardiac arrest manifesting as bradyarrhythmic arrest, asystole, or pulseless electrical activity (PEA). Evaluation and Physical Examination The source material does not provide…

…has deteriorated into PEA or asystole, and therefore the worse the prognosis. This does not always hold true. For example, in cardiac arrest due to…

…is generally considered less effective than thoracotomy. This is because it does not ensure complete drainage of the pericardium, and needles or catheters are at…

…of sudden cardiac arrest. Idiopathic ventricular tachycardia (IVT) Ventricular tachycardia may be classified as idiopathic if no cause can be identified. Idiopathic ventricular tachycardia has…

…been out of stock for a long period — check local availability. Betamethasone (Betapred 4 mg/mL) is water soluble and short acting, not a depot…

…is a rise and/or fall in cTn values. An elevated cTn alone does not establish MI, because myocardial injury may occur without myocardial ischaemia…