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

…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) should be performed per standard guidelines. Cardiac arrests due to trauma are characterized by very low survival rates. In the nationwide Swedish Registry for…

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…

…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…

…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…

…ischemia. The term transmural ischemia implies that the ischemia affects all wall layers – from endocardium to epicardium – in the myocardium affected by the occlusion. Transmural…

…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…

…late 1950s, 1960 and 1961 showed that VT could be terminated by delivering an electrical shock. This prompted physicians to construct coronary care units, in…

…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…

…which often converts at low energy and is difficult to terminate pharmacologically. Ectopic atrial tachycardia or SVT that has not been terminated by vagal manoeuvres…

…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…

…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…

…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…

…interrupted by ventricular tachycardia (VT). ECG 3 . Ventricular fibrillation (VF). ECG 4 . Ventricular fibrillation (VF). ECG 5 . Ventricular fibrillation (VF). ECG 6 . Delivery of shock…

…rhythm interrupted by polymorphic VT. ECG 2 . Polymorphic VT. ECG 3 . Polymorphic VT progresses to ventricular fibrillation (VF). ECG 4 . Polymorphic VT progresses to ventricular…

…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…

…paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis. The three are distinguished by the history and the speed of the course. An AST…

…occurs 7 to 14 days after a course of chemotherapy, but the timing varies considerably between regimens. Neutropenia can also be caused by haematological malignancy…

…most important thing is to swallow on command. A patient who understands the procedure tolerates it considerably better than one who is taken by surprise…

…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…

…children 24 G Yellow 15–20 mL/min Neonates and small children The flows apply to water by gravity according to the manufacturers' standard measurements…

…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…

…trauma, and shock, where perfusion may be compromised. Hemodynamic determinants of MAP Hemodynamically, MAP is influenced by cardiac output (CO) and systemic vascular resistance (SVR)…

…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…

…characterized by clinical low risk features, negative cardiac biomarkers, and no imaging evidence of RV dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock…

…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…

…reperfusion is strongly time dependent. The interval from symptom onset to reperfusion is determined by patient recognition and help seeking, pre hospital assessment and transport…

…of blood flow to the infarct related myocardial territory and limitation of infarct size. The extent of myocardial injury is strongly influenced by total ischaemic…

…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…

…etc .) are warranted. Management of AV blocks aims to restore atrioventricular conduction either pharmacologically or by means of artificial pacemakers. Both methods may be used…

…43 years History : None Medications : None ECG 1 . Sinus rhythm interrupted by rapid ventricular tachycardia (VT). ECG 2 . VT progressing to ventricular fibrillation. ECG 3 …

…collapse to initiation of CPR. During no flow there is no cerebral perfusion and brain damage progresses rapidly. Low flow : The circulation (perfusion) achieved by…

…shock, serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast…

…are routinely missed. The third thing to know by heart is that an arterial line must never be confused with a venous access. Indications Continuous…

…a primary metabolic disturbance within minutes by changing ventilation. Renal compensation for a primary respiratory disturbance, by contrast, develops over hours to days [1,2]…

…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…

…Aids to assessment The shock index is calculated as the heart rate divided by the systolic blood pressure. A value of around 0.9 to…

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…