…sepsis without shock, a rapid targeted assessment is made. If the suspicion persists, antibiotics must be given within three hours. The evidence for an absolute…

…elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases. Other causes include acute mechanical…

…availability of atropine, isoproterenol, or transcutaneous pacing for post shock bradycardia, and use of biphasic defibrillators , which are standard due to superior efficacy over monophasic…

…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…

…of right heart failure may indicate the need for inodilator therapy. Furthermore, acute heart failure and cardiogenic shock can present de novo in pregnant women…

…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…

…Stable No Normal Anticoagulation. Outpatient management may be considered The sPESI (simplified Pulmonary Embolism Severity Index) gives 1 point each for age 80 years, cancer…

…LAD) and left circumflex (LCx) arteries (Figure 1). Acute obstruction can lead to rapid hemodynamic deterioration, cardiogenic shock, malignant ventricular arrhythmias, or sudden cardiac death…

…and should be managed urgently. The risk of cardiogenic shock and cardiac arrest is high and pharmacological interventions are frequently futile. It is often necessary…

…5 . Ventricular fibrillation (VF). ECG 6 . Delivery of shock, followed by asystole. ECG 7 . Asystole after shock. ECG 8 . Recurrence of supraventricular rhythm. ECG 9…

…fibrillation (VF). ECG 4 . Polymorphic VT progresses to ventricular fibrillation (VF). ECG 5 . Ventricular fibrillation (VF). ECG 6 . Delivery of shock during ventricular fibrillation (VF).

…normally 950–1150 mL/min Haemodynamic profiles in shock Type CO SVR CVP/PCWP ScvO₂ : : : : : : : : : Hypovolaemic ↓ ↑ ↓ ↓ Cardiogenic ↓ ↑ ↑ ↓…

…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…

…shock Haemoglobin, transfusion threshold 70 g/L 80 g/L in acute coronary syndrome See the circulatory and haemodynamic parameters for pressures, flows and shock…

…50 × the upper limit of normal: paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis. The three are distinguished by the history and the…

…sepsis, septic shock, or a need for high dependency or intensive care 3 Take at least two sets of blood cultures from separate peripheral punctures…

…determines the diagnosis, and it is asked of a patient who is haemodynamically stable enough for there to be time to ask it. Indications Wide…

…be prescribed as one: with an indication, a route of administration and a target range for the saturation . What usually goes wrong is not that…

…no safe route for puncture — surgical drainage or pericardiotomy instead. Relative: uncorrected coagulopathy, thrombocytopenia and ongoing anticoagulant treatment. In tamponade with shock the coagulation is…

…is flexed. The dorsum of the hand is suitable for finer cannulae. Avoid the lower limb in adults. In shock with collapsed vessels, the antecubital…

…that pacing hurts a great deal in a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure…

…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…

…nonselective β blocker) Tolerance after a few days Norepinephrine Shock (any) Hypotension (any) 0.01–3.0 μg/kg/min Safe for peripheral use +++++ …

…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…

…no imaging evidence of RV dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock or the need for ongoing cardiopulmonary resuscitation. Mechanical circulatory support…

…thrombus is often asymptomatic and cannot be diagnosed reliably by examination alone. Assessment should include evaluation for: Hemodynamic instability or cardiogenic shock. Clinical heart failure…

…failure presumed to result from ongoing myocardial ischaemia Haemodynamic instability or cardiogenic shock Life threatening arrhythmias or cardiac arrest after presentation Mechanical complications of myocardial…

…for Kussmaul’s sign Hepatomegaly as evidence of systemic venous congestion Blood pressure and evidence of hypotension Clinical evidence of low cardiac output or shock…

…the diagnosis is uncertain, cardiogenic shock is present, or symptoms have been present for more than 2–3 hours. Patients with a working diagnosis of…

…lead ECG. Assessment for haemodynamic instability, acute severe heart failure and cardiogenic shock. Identification of life threatening arrhythmias. Assessment for high risk mechanical complications. Determination…

…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…

…edema develops due to rising LAP and LVEDP. Cardiogenic shock develops if the cardiac output is insufficient. Aortic regurgitation may cause myocardial ischemia because cardiac…

…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…

…nonselective β blocker) Tolerance after a few days Norepinephrine Shock (any) Hypotension (any) 0.01–3.0 μg/kg/min Safe for peripheral use +++++ …

…also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease, etc .) are warranted. Management of AV blocks aims to restore…

CPR Each recording presents two leads recorded simultaneously. Sex : Male Age : 43 years History : None Medications : None ECG 1 . Sinus rhythm interrupted by rapid ventricular…

…introduce the most common and essential terms used in resuscitation science, providing a foundation for understanding subsequent chapters. SCA (Sudden Cardiac Arrest) : Sudden and unexpected…

…each implicated in roughly 10% of cases. Potentially reversible causes of traumatic cardiac arrest ( Salomone et al ): Hypovolemia : Hypovolemic shock is common in both penetrating…

…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…

…or is there approaching, an indication for dialysis? AKI occurs in about one fifth of adults during a hospital episode in international studies and is…

…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…

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

…not a treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain…

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

…marked rise in SVR. As for the intermediate dose, together with marked hypertension (caution during non selective beta blockade). Dobutamine Cardiogenic shock. Bradycardia (second line…

…in the hospital. Endocrine Society clinical practice guideline on the management of hyperglycaemia in hospitalised adults. The summary of product characteristics for each insulin preparation.

…Transfusion restores circulating volume, oxygen transport and haemostatic capacity, but it cannot compensate for an uncontrolled source of bleeding. Minimise the time to surgery, endoscopy…

…toxic shock D Plasma glucose immediately. Assess the level of consciousness, the pupils, tone, clonus and seizures. Give glucose in hypoglycaemia and a benzodiazepine for…

…target value that must never be exceeded, during the first 72 hours for as long as the patient remains unconscious. The evidence Trial Question Result …

Info This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment…

…At the other end, roughly two thirds of ICDs implanted for reduced LVEF never deliver an appropriate shock, so the false positive burden is substantial…

…and may include: Chest discomfort Fatigue Weakness Presyncope or syncope Exercise intolerance Symptoms of shock in advanced cases The presentation may be abrupt or subacute…

…additional non infarct related lesions. Culprit only revascularization treats the artery responsible for the acute clinical event during the index procedure. Complete revascularization aims to…

…ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when…

…regurgitation, coronary malperfusion, myocardial ischaemia, heart failure, shock and cerebral or visceral malperfusion. Type B disease may produce rupture, renal, mesenteric or limb malperfusion, spinal…

…In severe cases, bradycardia may progress to hemodynamic instability, presenting as shock or cardiac arrest manifesting as bradyarrhythmic arrest, asystole, or pulseless electrical activity (PEA…

…contractile apparatus and are expressed predominantly in cardiac muscle. Troponin I is highly specific for myocardial injury. Interpretation of troponin T is more complex because…

…on degenerated saphenous vein grafts (SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction. In SVG PCI, slow flow or no reflow rates may…

…heart failure or cardiogenic shock. In chronic coronary disease, the principal symptomatic indication for revascularization is angina that remains refractory despite medical therapy when significant…