…report. A shave biopsy of a pigmented lesion that turns out to be a melanoma can make the Breslow thickness unmeasurable and staging therefore impossible…

…which needle is chosen, and that the tubes go to the right place. In suspected bacterial meningitis it is the time to antibiotics that saves…

…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…

…do not always correspond. Visual estimation of luminal narrowing may therefore be insufficient when deciding whether an intermediate lesion should be revascularized. Coronary pressure assessment…

…reaches the planned margin around the lesion. Start timing at that point. 7. Allow complete thawing — the thaw time should be at least as long…

…MINOCA is not a definitive disease diagnosis. It is a descriptive and provisional classification that should trigger further investigation. The underlying mechanism may be coronary…

…management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality, as well as limb complications. Atherosclerotic lesions generally…

…and its treatment options have been addressed. ANOCA/INOCA should not be labelled refractory before further diagnostic evaluation. The underlying endotype must first be defined…

…anterior descending and left circumflex arteries The number of additional diseased vessels Lesion morphology and technical feasibility of PCI The likely completeness of revascularisation with…

…coronary lesion without avoidable delay. In contrast, haemodynamically stable patients without ST segment elevation after successful resuscitation from out of hospital cardiac arrest should not…

…after ST elevation myocardial infarction (STEMI). The principal lesions are: Ventricular septal rupture (VSR), producing an acute left to right shunt. Ventricular free wall rupture…

…without an elevation in cardiac troponin. The underlying pathological mechanism is not restricted to a single lesion or process. Although Type 1 MI and acute…

…taken. A woman who has only been screened with cytology should be offered an HPV tested sample without waiting for the next routine invitation. Self…

…therapy. Anatomical and functional completeness are not synonymous. Anatomically incomplete revascularization may nevertheless be functionally complete if all lesions causing ischaemia have been treated. Conversely…

…also be associated with early death after cardiac transplantation. Myocardial bridging is not itself an atherosclerotic lesion, but it may cause local coronary injury over…

…Rheumatic fever. Endocarditis. Heart surgery (can cause permanent bradycardia). Hypothyroidism. Medullar lesion. Increased intracranial pressure. General hypoxia. Autonomic nervous system Neurocardiogenic syncope. Carotid Sinus Hypersensitivity…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…be dislodged by: Balloon inflation Atherectomy Stent implantation Manipulation of friable SVG lesions Embolic debris obstructs the distal microcirculation and may be accompanied by microvascular…

…CAD), in non obstructive coronary arteries, or in patients with intermediate lesions that do not produce physiologically significant flow limitation. The mechanisms are incompletely defined…

…of sinus node dysfunction Age related degenerative disease (fibrosis) Myocardial ischemia/infarction Lesions due to heart surgery Myocarditis Collagen disease Amyloidosis Risk of supraventricular tachyarrhythmia …

…injection is placed too high — which causes the shoulder injury known as SIRVA. Both are avoided with the right landmark and the right needle length…

…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…

…afterwards whether a nerve injury was caused by the injury or by the treatment. Indications A clinically or radiologically confirmed dislocation of the shoulder, elbow…

…team, not in your head. Functioning suction within reach under the pillow or by the right shoulder. A reservoir mask with a tight fitting seal…

…injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0.5–0.6 × 25 mm for small joints (wrist…

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…

…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…

…the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, and left or right arm. Onset and evolution How do symptoms start…

…Radiation to both arms or shoulders has a particularly strong association with myocardial infarction in the cited clinical data, although right arm radiation has not…

…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…

…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…

…requirement for antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity…

…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…

…concomitant right ventricular infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but should not…

…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…

…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…

…exhibit ST segment elevations, but the condition should be managed as STEMI (ST Elevation Myocardial Infarction) in terms of treatment and interventions. As discussed previously…

…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…