…acute clinical use the following simplification can be used: Grade Clinical picture Management : : : Mild allergic reaction Skin or mucosa only, stable breathing and circulation Observation…

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

…a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock and cardiac arrest is high and pharmacological interventions are frequently…

…Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in…

…adult trauma patient suggests significant hypovolaemia and an increased transfusion requirement. Pregnancy, medication and arrhythmia affect its interpretation. The shock index must never replace clinical…

…average arterial pressure and is a better indicator of organ perfusion. In clinical settings, MAP is often preferred over SBP for the following reasons: Indicator…

… and Clinical evidence of acute myocardial ischaemia. At least one of the following provides the required evidence of ischaemia: Symptoms compatible with myocardial ischaemia New…

…severe anaemia, and hypotension or shock. Conversely, mechanisms that increase myocardial oxygen demand include sustained tachyarrhythmia and severe hypertension, with or without left ventricular hypertrophy…

…necrosis and cardiac troponin release meeting the criteria of the universal definition of MI. Clinically, UA is defined by one or more of the following…

…absence of sounds on the affected side. Ultrasonography can reveal pneumothorax (highlighted by a lack of lung tissue) and its impact on cardiac function. Clinically…

…and cardiac arrest, standard cardiopulmonary resuscitation (CPR) protocols are followed. Moreover, for optimal management in the context of sepsis induced cardiac arrest, consider the following…

CPR Tamponade and cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops…

…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…

…Discharge without a plan. Document what has been changed, who is following it up and when. Sources American Diabetes Association, Standards of Care in Diabetes…

…symptoms suggestive of acute myocardial infarction and at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain…

…by cardiogenic shock, multivessel disease is present in approximately 80% of patients. Evaluation and clinical assessment Clinical factors influencing treatment selection The following characteristics favour…

…from hemodynamic failure and multiorgan dysfunction. 10% die from recurrent arrhythmias. To monitor and evaluate the victim after ROSC, the following modalities and investigations are…

…525) In a randomized, double blind study involving 192 patients with cardiogenic shock, researchers compared the effectiveness of milrinone and dobutamine . The primary composite outcome…

Info Antiarrhythmic drugs and management of ventricular tachycardia, ventricular fibrillation This manual presents recommendations for the management of ventricular tachyarrhythmias (VT, VF). It is primarily…

Cardiology Antiarrhythmic drugs and management of ventricular tachycardia, ventricular fibrillation This manual presents recommendations for the management of ventricular tachyarrhythmias (VT, VF). It is primarily…

…99th percentile URL; and Clinical evidence of acute myocardial ischaemia , demonstrated by at least one of the following: Symptoms of myocardial ischaemia. New ischaemic ECG…

…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…

…and less common causes such as severe pre existing valvular disease or excessive beta blocker or calcium channel blocker exposure. The incidence of cardiogenic shock…

…paroxysmal supraventricular tachycardia, and hemodynamically compromising ventricular tachycardia, while defibrillation (unsynchronized shock) is reserved for ventricular fibrillation, where urgent reversion to sinus rhythm is required…

…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…

…therapy. Furthermore, acute heart failure and cardiogenic shock can present de novo in pregnant women without pre existing heart disease, such as in peripartum cardiomyopathy…

…Swedish medicines compendium (FASS) and the local protocol. Low molecular weight heparin is the first choice in pregnancy and an alternative in cancer associated thrombosis…

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

…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).

…↑ ↓ Vital signs and measures of perfusion Parameter Normal Comment : : : Heart rate 50–100/min MAP 70–105 mmHg Target ≥ 65 mmHg in shock…

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

…in acute coronary syndrome See the circulatory and haemodynamic parameters for pressures, flows and shock profiles. Acid–base and electrolytes in intensive care Neurological monitoring…

…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…

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

…recording and unmask the atrial activity. The investigation is diagnostic, not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock…

…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…

…In profound shock, very limited decompression may be considered in consultation with a cardiothoracic surgeon. Myocardial rupture after myocardial infarction, and traumatic haemopericardium — these require…

…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…

…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…

…chronotropy and mild increase in SVR. Ventricular arrhythmias Myocardial ischemia Tissue ischemia (high doses or extravasation) Dopamine high dose Cardiogenic shock Vasodilatory shock Heart failure…

…and cardiogenic shock. ACS is distinct from myocardial infarction (MI). MI denotes cardiomyocyte necrosis occurring in the clinical setting of acute myocardial ischaemia and is…

…shock or the need for ongoing cardiopulmonary resuscitation. Mechanical circulatory support, including extracorporeal membrane oxygenation (ECMO), may be required in this setting. Clinical presentation and…

…or cardiogenic shock. Clinical heart failure. Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with recurrent chest pain and hemodynamic compromise…

…Haemodynamic and electrical status Haemodynamic instability, cardiogenic shock, acute heart failure related to ongoing ischaemia, life threatening arrhythmias, and cardiac arrest after presentation are markers…

…right ventricular impairment to cardiogenic shock. Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment…

…at opening the occluded coronary artery and is advantageous when fibrinolysis is contraindicated, bleeding risk is high, the diagnosis is uncertain, cardiogenic shock is present…

…failure complications , including heart failure and cardiogenic shock. Most out of hospital deaths occur early and are commonly related to ventricular fibrillation. More than half…

…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…

…chronotropy and mild increase in SVR. Ventricular arrhythmias Myocardial ischemia Tissue ischemia (high doses or extravasation) Dopamine high dose Cardiogenic shock Vasodilatory shock Heart failure…

…instability is a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions are often futile…

…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…

…of synchronized electric shock (i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias with…

…of cases. Potentially reversible causes of traumatic cardiac arrest ( Salomone et al ): Hypovolemia : Hypovolemic shock is common in both penetrating and blunt force trauma. Loss…

…the palmar arches and the lowest complication rate. The femoral artery is the second choice and is often the best in marked shock or during…

…or a mixed metabolic and respiratory acidosis if the pCO₂ is not low enough High Low Normal or low Respiratory alkalosis High High High Metabolic…

…second attempt). Vasoactive infusions Drug Dose range Primary effect Used in : : : : Noradrenaline 0.05–0.5 µg/kg/min α₁ — vasoconstriction Septic and distributive shock

…dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period before…

…and chronotropy, with a slight rise in SVR. Ventricular arrhythmias. Myocardial ischaemia. Tissue ischaemia (high doses or extravasation). Dopamine — high dose Cardiogenic shock. Vasodilatory shock…