…of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of…

…Anaphylaxis is a clinical diagnosis. Treat as anaphylaxis in any of the following: 1. Acute onset of skin or mucosal symptoms , for example generalised urticaria…

…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…

…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…

…shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded…

…the following immediately: 1. Call for help using the words massive haemorrhage , and state the patient's location and identity, the presumed cause of bleeding…

…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…

… 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…

…manifestations of myocardial ischaemia following an acute gastrointestinal bleed or a sustained tachyarrhythmia. Symptoms of acute myocardial ischaemia are required for a formal diagnosis of…

…or cardiogenic shock. UA itself is defined by a recent change in the pattern of myocardial ischaemia rather than by a particular symptom intensity alone…

…Thoracostomy This method is generally deemed safer than using a needle due to reduced risk of injury. Thoracostomy should be performed promptly following needle decompression…

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

…cardiac massage in trauma shock. J Trauma 1989; 29:1430 3 . Jeffcoach DR, Gallegos JJ, Jesty SA, et al. Use of CPR in hemorrhagic shock…

…been changed, who is following it up and when. Sources American Diabetes Association, Standards of Care in Diabetes: diabetes care in the hospital. Endocrine Society…

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

…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…

…It reduces cardiac output and lower blood pressure. Cardiogenic shock may develop as a result of stunning. The systemic response to reperfusion and ischemia causes…

…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…

…for the management of ventricular tachyarrhythmias (VT, VF). It is primarily intended for use in an emergency setting. The manual includes the following sections (click…

…for the management of ventricular tachyarrhythmias (VT, VF). It is primarily intended for use in an emergency setting. The manual includes the following sections (click…

…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…

…health care exposure and the risk of resistant organisms 0 to 60 min Empirical intravenous antibiotics in septic shock or in certain or highly likely…

Critical care Myocardial ischemia and infarction Definition and Pathophysiology Cardiogenic shock is a state of inadequate tissue and end organ perfusion caused by cardiac insufficiency…

Arrhythmias and arrhythmology Procedurer Lathundar Electrical cardioversion is the delivery of a precisely regulated electrical shock to terminate a tachyarrhythmia, and it encompasses both synchronized…

…Avoids the vulnerable phase of the T wave There is no R wave to synchronise to; sync mode would block the shock entirely The patient…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…Duration of treatment: at least 3 months. Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence. Special situations Situation Comment : : Pregnancy Leg…

…cardiogenic shock, malignant ventricular arrhythmias, or sudden cardiac death. The resulting extensive ischemia causes immediate myocardial stunning (akinesia) and electrical instability. Fewer than 1% of…

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

…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…

…Always follow the local protocol for exact infusion rates, electrolyte concentrations and level of care. This quick reference is intended primarily for adults and summarises…

…about 7.20. Different targets apply when the intracranial pressure is raised: normocapnia (PaCO₂ 4.5–5.0 kPa) and avoidance of hypoxia, since hypercapnia…

…pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of…

…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…

…shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known stricture or tumour of the nose, pharynx or oesophagus. Oesophageal varices. Recent surgery of…

…arrest, shock, sepsis, major trauma, unconsciousness — until the saturation can be measured reliably. Conditions in which oxygen is given irrespective of the saturation (see below)…

…in mitral and tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute contraindications other than the…

…vein). Standby access in a patient at risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma…

…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…

…Assess the level of consciousness, the airway, the work of breathing, the peripheral perfusion and the signs of shock 2 Two large bore peripheral cannulae…

…with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual…

…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…

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

…formation is associated with poor short term prognosis, although early mortality is usually related to the extent of myocardial injury and its complications—shock, reinfarction…

…instability, cardiogenic shock, acute heart failure related to ongoing ischaemia, life threatening arrhythmias, and cardiac arrest after presentation are markers of very high risk. They…

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

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

…acute severe heart failure and cardiogenic shock. Identification of life threatening arrhythmias. Assessment for high risk mechanical complications. Determination of symptom onset time and anticipated…

…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…

…with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual…

…condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions are often futile. A transcutaneous pacemaker is often necessary…

…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…

…flow time : The duration (minutes) from start of CPR to ROSC or end of resuscitation attempts. Efficient CPR generates approximately 25% of normal cardiac output…

…only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac arrest often exhibit favorable neurological outcomes…

…continuous slow flush. Ultrasound with a high frequency linear probe when the pulse is weak, after previous failed attempts, or in children. A rolled towel…

…oximetry Follow up of pH in, for example, ketoacidosis A venous sample is often sufficient if respiratory failure is not suspected Shock with a large…

…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…

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

…line is necessary to achieve an optimal result. Overview of vasopressors and inotropes Vasoconstriction Vasodilatation Positive inotropy Phenylephrine Vasopressin Midodrine Noradrenaline Adrenaline, high dose Dopamine…