…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…

…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…

…even though incidence and prognosis vary widely between patient groups and care settings [2]. Practical first actions Do the following in parallel, not sequentially: 1…

…and the evidence for non traumatic bleeding is weaker [2,3,4]. Do the following immediately: 1. Call for help using the words massive haemorrhage …

…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…

…At least one of the following provides the required evidence of ischaemia: Symptoms compatible with myocardial ischaemia New ischaemic ECG changes Development of pathological Q…

…bradyarrhythmia, respiratory failure with severe hypoxaemia, severe anaemia, and hypotension or shock. Conversely, mechanisms that increase myocardial oxygen demand include sustained tachyarrhythmia and severe hypertension…

…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…

…using a needle due to reduced risk of injury. Thoracostomy should be performed promptly following needle decompression. Thoracostomy with drainage typically serves as a stabilizing…

…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…

…injuries to the mediastinum can cause tamponade. Post operative Complications : Post surgical complications following thoracic procedures can cause tamponade. Tamponade with swinging heart of the…

…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…

…inpatient : : Metformin Stop in acute kidney injury, hypoxia, shock, before contrast studies and before surgery. A risk of lactic acidosis SGLT2 inhibitor Stop in acute…

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

…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…

…effects for up to 2 weeks. The peak vasodilatory effect is observed between 2 4 days following the infusion. This delayed onset is attributable to…

…use in an emergency setting. The manual includes the following sections (click to navigate to the section): Classification of antiarrhythmic drugs. Classification of ventricular tachyarrhythmias…

…use in an emergency setting. The manual includes the following sections (click to navigate to the section): Classification of antiarrhythmic drugs. Classification of ventricular tachyarrhythmias…

…or sarcoidosis Other cardiac procedures Chemotherapeutic agents Catheter ablation Critical illness Defibrillator shocks Strenuous exercise Cardiac contusion The diagnosis should therefore distinguish isolated myocardial injury…

…corresponds to an acute increase in the SOFA score of at least 2 points. Septic shock is the subgroup that, despite the treatment of hypovolaemia…

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…

…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…

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…

…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…

…LAD) and left circumflex (LCx) arteries (Figure 1). Acute obstruction can lead to rapid hemodynamic deterioration, cardiogenic shock, malignant ventricular arrhythmias, or sudden cardiac death…

…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).

…normally 950–1150 mL/min Haemodynamic profiles in shock Type CO SVR CVP/PCWP ScvO₂ : : : : : : : : : Hypovolaemic ↓ ↑ ↓ ↓ Cardiogenic ↓ ↑ ↑ ↓…

…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…

…shock Haemoglobin, transfusion threshold 70 g/L 80 g/L in acute coronary syndrome See the circulatory and haemodynamic parameters for pressures, flows and shock…

…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…

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

…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…

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

…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…

…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…

…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…

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

…cardiac arrest, electrical or haemodynamic instability, and cardiogenic shock. ACS is distinct from myocardial infarction (MI). MI denotes cardiomyocyte necrosis occurring in the clinical setting…

…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…

…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…

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

…right ventricle is rare. The clinical spectrum extends from limited right ventricular dysfunction to severe right sided failure and cardiogenic shock. The haemodynamic disturbance results…

…risk is high, the diagnosis is uncertain, cardiogenic shock is present, or symptoms have been present for more than 2–3 hours. Patients with a…

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

…it becomes incomplete because the ventricles cannot expand normally. This leads to diastolic heart failure. The systolic function is usually unaffected, but the shock volume…

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

…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…

…ventilation and automatic external defibrillator (AED). Return of Spontaneous Circulation (ROSC) : Return of mechanical cardiac function resulting in circulation with pulse. Coronary perfusion pressure (CPP) …

…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…

…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…

…for example, ketoacidosis A venous sample is often sufficient if respiratory failure is not suspected Shock with a large arteriovenous difference Arterial sample, sometimes supplemented…

…6 years 0.15 mg · 6–12 years 0.3 mg · 12 years 0.5 mg (0.01 mg/kg) Adrenaline IV (only in shock…

…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…

…As for the intermediate dose, together with marked hypertension (caution during non selective beta blockade). Dobutamine Cardiogenic shock. Bradycardia (second line treatment). Stress testing (it…