…with a high BMI, and that the deltoid injection is placed too high — which causes the shoulder injury known as SIRVA. Both are avoided with…

…may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of…

…or by the treatment. Indications A clinically or radiologically confirmed dislocation of the shoulder, elbow, finger, patella, jaw or hip prosthesis. A dislocation with neurovascular…

…any decision to limit treatment when time allows. There is complete upper airway obstruction where laryngoscopy will not succeed; plan for a surgical airway or…

…always weighs more heavily). A joint prosthesis: the aspiration must be performed by an orthopaedic surgeon under strictly sterile conditions. For corticosteroid injection there is…

Procedurer Cerumen should be removed when it causes symptoms or obscures the tympanic membrane — not routinely . The wax has a protective function, and the commonest…

…be biopsied. Hypersensitivity to local anaesthetics. Areas at high risk of unsightly or hypertrophic scars: the sternum, the shoulder, the jawline, the ears. Anatomically hazardous…

…Dressler syndrome. A pericardial effusion measuring more than 10 mm at end diastole after AMI should prompt investigation for possible subacute cardiac rupture, particularly when…

…pain is usually described as pressure, squeezing, or a crushing sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen…

…ischaemia, including severe oesophageal spasm and acid reflux. Clinical Presentation and Symptoms Characterising the presenting symptom The symptom should be classified as cardiac , possibly cardiac …

…or patients with diabetes [4]. Associated Findings: The sudden onset of symptoms coupled with diaphoresis should always raise concern for a cardiovascular cause [4]. 2…

…head can hang over the end. A pillow to place under the shoulders as an alternative to a hanging head. Frenzel goggles or video Frenzel…

…the chin on the chest, and the shoulders and hips stacked vertically. The back must be flexed like a bow — it is that flexion that…

…heaviness, or discomfort. Pain radiating to the neck, jaw, shoulders, back, or one or both arms. Indigestion or heartburn, particularly when associated with nausea or…

…Responsiveness : Does the victim respond to stimuli? Shake the victim by the shoulders and ask if the victim is awake. Breathing : Open the airway by…

…as in STEMI, radiate to the neck, shoulders or back. However, acute pericarditis is more likely if inspiration and supine position worsens the chest pain…

Procedurer A cast should hold the fracture still and do nothing else. The two ways in which casting harms the patient are that it is…

Info E resources you should bookmark Taming the SRU Drs Jeffery Hill, Ryan Lafollette and Bill Hinckley run this amazing website which includes everything from…

CPR A standard 12 lead ECG should be recorded in all patients after return of spontaneous circulation (ROSC). The purpose of a 12 lead ECG…

…commonest error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal…

…Flags Raising Suspicion of Cardiac Amyloidosis Demographic and Clinical Context Cardiac amyloidosis should be suspected in patients older than 65 years presenting with heart failure…

…identifiable underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension, with particular vigilance when the clinical history includes hypokalaemia…

…and childbirth All healthcare units capable of managing pregnant women in cardiac arrest should engage in specialized clinical training to manage cardiac arrest during pregnancy…

…coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the special challenges posed by some patient populations. The sensitivity, specificity…

…monitoring, complications and when thrombectomy should be considered. The doses and Swedish thresholds below are based on the national guideline for the management of reperfusion…

…logistics Management Recommendation Level of evidence The pre hospital care of STEMI patients should be organized regionally (including all components from the emergency medical dispatch…

…intervention (PCI). Contraindications Prasugrel should not be used in the following situations: Hypersensitivity to the active substance or any of the excipients. Active pathological bleeding…

…rhythm cannot be sinus rhythm. P wave may be biphasic (diphasic) in V1 (the negative deflection should be <1 mm). It may have a prominent…

…The higher the estimated risk, the earlier should angiography be performed. TIMI risk score for NSTEMI and unstable angina [calc_timi_nstemi] TIMI SCORE 30…

…reducing myocardial ischaemia and relieving anginal symptoms, while maintaining tolerability and adherence. Selection should be individualized according to blood pressure, heart rate, left ventricular function…

…temporal association is present; contrast induced AKI should be reserved for the smaller subgroup in which iodinated contrast is considered causally responsible. This distinction is…

…blood pressure reduction sufficient to reduce cardiovascular risk while preserving tolerability and daily function. Decisions should incorporate the confirmed blood pressure level, absolute cardiovascular risk…

…used for type 1 myocardial infarction are fulfilled. The temporal relationship to stent implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich…

…virtually always accompanied by impaired left ventricular systolic function. It should be noted that several types of cardiomyopathies ( e.g ischemic cardiomyopathy, tachycardia induced cardiomyopathy…

…changes and clinical implications is provided. The reader should already be familiar with the classification of acute coronary syndromes. Subsequent chapters will deal with ST…

…ventricular hypertrophy under normal loading conditions. Hypertrophic cardiomyopathy should not be confused with hypertrophy caused by increased loading conditions. Increased ventricular load is mostly caused…

…treatment of bradycardia (bradyarrhythmia) Acute bradycardia with hemodynamic instability Acute bradycardia with hemodynamic effects is a potentially life threatening condition and should be managed urgently…

…activation of the ventricular myocardium. The ventricles should be depolarized (activated) by impulses spreading through the left and right bundle branch, which branches out into…

…These estimates should be viewed as approximations due to the following: Registry data indicate that survival is possible with longer periods of no flow ( Rawshani…

…should be managed as STEMI (ST Elevation Myocardial Infarction) in terms of treatment and interventions. As discussed previously, STEMI is the result of a complete…

…interventions are time sensitive, and to maximize the likelihood of restoring spontaneous circulation, interventions should be adapted to the current phase. However, current guidelines do…

…definitively established as the cause of cardiac arrest, cardiopulmonary resuscitation (CPR) should be performed per standard guidelines. Cardiac arrests due to trauma are characterized by…

…of withdrawal and the risk of seizures and delirium [1,2]. In delirium tremens the aim should be a calm, mildly somnolent but rousable patient…

…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…

…no absolute contraindications. Refrain or modify in: Deep vein thrombosis in the leg — cuff compression should be avoided in the acute phase. A leg that…

…and in people under 18 years of age, where iso BMI or percentile charts should be used. Waist circumference Measure the waist between the lowest…

…assess the collateral circulation, but the test does not reliably predict ischaemic complications and should not decide the matter on its own. Practice differs between…

…latter. The treatment is also time limited by its very nature: a patient who has not responded within a couple of hours should be intubated…

…body reaching the stroma or deeper. The absence of a slit lamp — the cornea should not be instrumented without magnification. With a suspected chemical injury…

…observation [3,4]. A markedly raised blood pressure without acute target organ damage should not normally be lowered rapidly with intravenous drugs. Such treatment has…

…alone [2]. A markedly raised blood pressure without acute organ damage should as a rule not be lowered rapidly with intravenous drugs. Restart or optimise…

…stricture or a known diverticulum Relative Recent nasal or pharyngeal surgery Signs that should raise the suspicion of a base of skull fracture: periorbital bruising…

…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…

…Sepsis is a dynamic condition. Investigation and treatment must therefore proceed in parallel and must not wait for complete diagnostic certainty. Sepsis is defined as…

…nervous system. Contact your national or regional poison control centre for advice on the treatment threshold and on whether haemodialysis should be considered. Rhabdomyolysis with…

…are otherwise haemodynamically unstable. The benefit of its administration in these patients should be carefully balanced against the potential risks resulting from hypotension. • Withdrawal of…

…higher indicates high risk of major bleeding Note that a high HAS BLED score should not be used as a reason to withhold anticoagulation therapy…

…The desired time to action, contraindications and risk of adverse effects should guide the choice of agent. Calcium channel blockers (CCB) Clevidipine Drug Clevidipine Brand…

…Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency).

…dose: 3 μg/kg/minute. Maximum dose (10 μg/kg/minute) should never be used for mor than 10 minutes. Administer sodium thiosulfate …