…Due to a genetic mutation in the RYR1 receptor, resulting in persistent muscle contraction upon administration of halogenated anesthetic agents. As an idiosyncratic response to…

…0.4 0.8 2.1 Table 1. Survival in out of hospital cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ…

…the anterior axillary line. Thoracostomy This method is generally deemed safer than using a needle due to reduced risk of injury. Thoracostomy should be performed…

CPR Cardiac arrest due to trauma In cases of traumatic cardiac arrest, addressing reversible etiologies takes precedence over chest compressions. If trauma is not definitively…

Referensvärden Haemodynamic measurements become interpretable only when related to one another. A low blood pressure may be due to low flow, low vascular tone or…

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

…malignant arrhythmias, and rapid progression to cardiogenic shock. Ventricular fibrillation or asystole may occur early due to the massive ischemia. Complete LMCA occlusion is typically…

…Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in myocardial O 2 consumption) Regular : 2.0–20 μg/kg…

…crucial to distinguish Type 2 MI from acute and chronic myocardial injury. Myocardial injury is characterised by myocyte necrosis and troponin elevation due to mechanisms…

…Failure to increase cardiac output sufficiently will result in the following compilations: Pulmonary edema develops due to rising LAP and LVEDP. Cardiogenic shock develops if…

…challenging to drain using pericardiocentesis. In cases of cardiac tamponade, conventional chest compressions are ineffective. This is explained by the elevated intrapericardial pressure due to…

…Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in myocardial O 2 consumption) Regular : 2.0–20 μg/kg…

…the following criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical…

…cardiogenic shock, right ventricular free wall rupture and cardiac tamponade. The most common of these are hypotension, low cardiac output and sensitivity to drugs that…

…Asystole after shock. ECG 8 . Recurrence of supraventricular rhythm. ECG 9 . Supraventricular rhythm. Treatment of ventricular fibrillation Ventricular fibrillation is treated according to the resuscitation…

…output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to hypovolaemia, shock, obstruction or advanced renal injury…

…For example, in cardiac arrest due to pulmonary embolism the initial rhythm is typically PEA, which is explained by the fact that the embolus prevents…

…with other forms of ventricular tachycardia. Mechanisms of ventricular tachycardia Ventricular tachycardia (VT) may emerge due to increased/abnormal automaticity, re entry or triggered activity…

…a sudden heart rate decrease (e.g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with…

…a sudden heart rate decrease (e.g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with…

…Septic shock is the subgroup that, despite the treatment of hypovolaemia, requires a vasopressor to maintain a MAP of at least 65 mmHg and at…

…can extend injury beyond the initial ischemic zone and contributes to ventricular failure. Mechanisms of Shock The central consequence of extensive infarction is loss of…

…of the T wave There is no R wave to synchronise to; sync mode would block the shock entirely The patient Awake or sedated — requires…

…and cardiogenic shock can present de novo in pregnant women without pre existing heart disease, such as in peripartum cardiomyopathy, or secondary to known cardiac…

…or severe bronchospasm during anaesthesia, a drug infusion or the administration of contrast medium Skin symptoms are absent in approximately 10 to 20 percent of…

…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…

…The risk of cardiogenic shock and cardiac arrest is high and pharmacological interventions are frequently futile. It is often necessary to establish a transcutaneous pacemaker…

…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…

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

…principles that are common to all protocols. Children, pregnant women and patients with advanced renal failure, marked heart failure or circulatory shock require a specific…

…target ScvO₂ 70–80 % A low value suggests inadequate oxygen delivery Capillary refill < 3 s Equivalent to lactate guided resuscitation in septic shock Haemoglobin…

…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…

…septic shock, or where sepsis is highly likely, antibiotics must be given immediately [3]. This quick reference applies chiefly to adults with neutropenia related to…

…unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known stricture or tumour…

…range, or a PaO2 below 8 kPa on an arterial blood gas. Acute critical illness during initial stabilisation — cardiac arrest, shock, sepsis, major trauma, unconsciousness…

…can increase the bleeding and worsen the prognosis. The patient must go to cardiothoracic surgery. In profound shock, very limited decompression may be considered in…

…patient at risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma, burns or status epilepticus when…

…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…

…haemorrhage protocol in uncontrolled bleeding, shock or a rapid transfusion requirement 10 With impaired consciousness, an inability to protect the airway, or ongoing major haematemesis…

…to vital organs such as the brain and kidneys. Maintaining MAP within an optimal range is crucial in managing conditions like sepsis, trauma, and shock…

…in cardiac troponin. The spectrum ranges from symptom free presentation to persistent chest discomfort, cardiac arrest, electrical or haemodynamic instability, and cardiogenic shock. ACS is…

…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…

…its complications—shock, reinfarction, myocardial rupture, and ventricular tachyarrhythmia—rather than embolization itself. A thrombus may be: Mural: flattened, fixed, and closely adherent to the…

…outweigh its expected benefits. Haemodynamic and electrical status Haemodynamic instability, cardiogenic shock, acute heart failure related to ongoing ischaemia, life threatening arrhythmias, and cardiac arrest…

…left sided congestion—is an important clinical clue. Haemodynamic severity The presentation may range from mild right ventricular impairment to cardiogenic shock. Patients with hypotension…

…patient with symptoms of myocardial ischaemia. The immediate therapeutic objective is restoration of coronary blood flow to the infarct zone, thereby limiting infarct size and…

…and cardiogenic shock. Identification of life threatening arrhythmias. Assessment for high risk mechanical complications. Determination of symptom onset time and anticipated time to primary PCI…

…shock volume and ejection fraction (EF) may be reduced because the end diastolic volume of the ventricle (EDV) is reduced. Constrictive pericarditis also leads to…

…may be valuable if the diagnosis is uncertain. Echocardiography is generally performed in order to evaluate ventricular function, since it may affect the choice of…

…None ECG 1 . Sinus rhythm interrupted by rapid ventricular tachycardia (VT). ECG 2 . VT progressing to ventricular fibrillation. ECG 3 . Ventricular fibrillation, coarse (large amplitudes…

…shock (i.e. a shock delivered randomly, without considering the phase of the cardiac cycle) to terminate ventricular fibrillation. Cardioversion : Use of synchronized electric shock…

…hours: reperfusion is indicated in persisting STEMI. 12 to 48 hours: primary PCI should be considered even if symptoms have subsided, particularly with continuing ischaemia…

…to puncture. Sterile preparation with chlorhexidine in alcohol 5 mg/mL, sterile drape, sterile gloves, mask and cap. Lidocaine 10 mg/mL for local anaesthesia…

…respiratory disturbance, by contrast, develops over hours to days [1,2]. Six steps Step Question Practical interpretation : : : 1 Is the pH low or high? pH…

…kg) Adrenaline IV (only in shock, by experienced staff) 0.05–0.1 mg at a time, diluted to 0.1 mg/mL 1 µg…

…oral step down or piperacillin–tazobactam 4 g × 3 IV Urosepsis with shock cefotaxime 2 g × 3 IV Standard dose after stabilisation or piperacillin–tazobactam…

…and haemodynamic monitoring with ECG, a central venous catheter and an arterial line is necessary to achieve an optimal result. Overview of vasopressors and inotropes…

…to an infusion or injections Drugs for type 2 diabetes in inpatients Agent The acutely ill inpatient : : Metformin Stop in acute kidney injury, hypoxia, shock…

…cannot compensate for an uncontrolled source of bleeding. Minimise the time to surgery, endoscopy, an obstetric procedure or angiographic intervention. Summon anaesthesia, the operating specialty…

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…