…is the first line treatment and must be given early when anaphylaxis is suspected. Do not wait for a complete diagnosis or for grading. Antihistamines…

…stenoses. Higher scores indicate more diffuse or technically complex disease and are associated with a greater relative advantage for CABG over PCI in multivessel disease…

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

…cardiogenic shock, researchers compared the effectiveness of milrinone and dobutamine . The primary composite outcome included in hospital mortality, resuscitated cardiac arrest, cardiac transplantation or mechanical…

…clinical setting Examples Acute coronary atherothrombosis Plaque disruption or erosion with thrombosis Reduced myocardial perfusion Coronary spasm, microvascular dysfunction, coronary embolism, coronary dissection, hypotension, shock…

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

…3 episodes of sustained VT, VF, or appropriate shocks from an ICD within 24 h. Classification of ventricular tachycardia (VT). ECG showing polymorphic ventricular tachycardia…

…3 episodes of sustained VT, VF, or appropriate shocks from an ICD within 24 h. Classification of ventricular tachycardia (VT). ECG showing polymorphic ventricular tachycardia…

…view), with the valve zoomed. The following parameters are evaluated: Can all three cusps be visualized, or is the valve bicuspid? Is there cusp prolapse…

…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…

…progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is…

…injury with shock. A positive FAST scan in an unstable trauma patient. An unstable pelvic fracture with circulatory compromise. A ruptured aortic aneurysm or another…

…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…

…For instance, a patient with stable CAD may present with clinical manifestations of myocardial ischaemia following an acute gastrointestinal bleed or a sustained tachyarrhythmia. Symptoms…

…of MI. Clinically, UA is defined by one or more of the following patterns: Angina at rest, usually prolonged for more than 20 minutes. New…

…air is substantial enough to compress the superior and inferior vena cava, impeding or halting venous return to the heart. In instances of tension pneumothorax…

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

…instability or a large area of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute…

…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…

…coronary care unit (CCU), or catheterization laboratory. A 12 lead ECG must be obtained immediately after ROSC in order to identify cases with ST segment…

…of the following: Symptoms of myocardial ischaemia. New ischaemic ECG changes. New pathological Q waves. Imaging evidence of new loss of viable myocardium or a…

…intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory failure, impaired consciousness, or a need for a vasopressor After initial…

…when severe or prolonged, produces multiorgan dysfunction and death. In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left…

…since a shock delivered asynchronously on the T wave during ventricular tachycardia can precipitate ventricular fibrillation, whereas a synchronized shock (timed to the QRS complex)…

…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…

…patients exhibit hypotension—often with a systolic blood pressure less than 90 mmHg—accompanied by signs of poor vital organ perfusion or frank shock states…

…systolic < 90 mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography…

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

…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).

…in a ventilated patient in sinus rhythm without spontaneous breathing, passive leg raising with an increase in stroke volume 10%, or inferior vena cava variability …

…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…

…Comment : : : MAP ≥ 65 mmHg 80–85 mmHg in chronic hypertension or when there are signs of inadequate perfusion Urine output 0.5 mL/kg/h…

…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…

…outcome in sepsis and in several studies of neutropenic patients. In septic shock, or where sepsis is highly likely, antibiotics must be given immediately [3]…

…are concealed. A recurrent unclear wide or narrow complex tachycardia in which the mechanism needs to be documented before referral to an arrhythmia unit. Assessment…

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

…tuberculosis or malignancy. Tamponade is a clinical diagnosis supported by echocardiography: Finding Comment : : Hypotension, distended neck veins, muffled heart sounds Beck's triad; complete in…

…In shock with collapsed vessels, the antecubital fossa or the external jugular vein are the vessels that can most often still be punctured — and ultrasound…

…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…

…and the signs of shock 2 Two large bore peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood gases are…

…Atrial or ventricular arrhythmias Bradycardia Peripheral (digital) ischemia Hypertension (especially nonselective β blocker patients) Prolonged use may be cardiotoxic. Epinephrine Shock (any) Cardiac arrest Bronchospasm…

…presentation to persistent chest discomfort, cardiac arrest, electrical or haemodynamic instability, and cardiogenic shock. ACS is distinct from myocardial infarction (MI). MI denotes cardiomyocyte necrosis…

…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…

…be diagnosed reliably by examination alone. Assessment should include evaluation for: Hemodynamic instability or cardiogenic shock. Clinical heart failure. Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia…

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

…may range from mild right ventricular impairment to cardiogenic shock. Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration…

…in the absence of persistent symptoms. Cardiogenic shock or haemodynamic instability warrants revascularization irrespective of the delay from symptom onset. PCI of the infarct related…

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

…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…

…Atrial or ventricular arrhythmias Bradycardia Peripheral (digital) ischemia Hypertension (especially nonselective β blocker patients) Prolonged use may be cardiotoxic. Epinephrine Shock (any) Cardiac arrest Bronchospasm…

…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…

…9 . Delivery of shock (red arrow), with subsequent asystole. ECG 10 . Recurrence of supraventricular complexes (red arrows). ECG 11 . Relapse of VF and new shock…

…ventricular tachycardia, and other tachyarrhythmias with discernible QRS complexes. Shockable rhythm : Tachyarrhythmias that can be treated with defibrillation (ventricular fibrillation) or cardioversion (ventricular tachycardia). Non…

…critical than performing chest compressions. Hemorrhages, either manifesting externally or concealed internally, account for approximately half of all traumatic cardiac arrests. In the absence of…

…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…

…develops over hours to days [1,2]. Six steps Step Question Practical interpretation : : : 1 Is the pH low or high? pH <7.35 is acidaemia…

…mg IV, a further 50 mg 1 mg/kg Magnesium 2 g (8 mmol) IV in torsades or hypomagnesaemia 25–50 mg/kg, maximum 2…

…after stabilisation or piperacillin–tazobactam 4 g × 4 IV plus gentamicin 5–7 mg/kg IV as a single dose Urosepsis with shock and suspected…

…renal, cerebral and mesenteric vessels. Few Dopamine — intermediate dose Cardiogenic shock. Vasodilatory shock. Heart failure, acute or chronic. Bradycardia (second line option). 3.0–10…