…nothing documented but increase the risk of skin and fat atrophy. Lederspan states in addition that the dosing interval should not be shorter than four…

…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…

…Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An ECG recording…

…Procedure Anterior shoulder dislocation The commonest of all dislocations. There is a hollow beneath the acromion, the arm is held in slight abduction and external…

Procedurer What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was…

…slightly caudally, parallel to the posterior surface of the patella. The shoulder The patient sits with the arm hanging relaxed and slightly internally rotated. The…

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

…at high risk of unsightly or hypertrophic scars: the sternum, the shoulder, the jawline, the ears. Anatomically hazardous areas: the branches of the facial nerve…

…ischemia and infarction Definition and pathophysiology Post infarction pericarditis encompasses two temporally and clinically distinct complications of acute myocardial infarction (AMI): Early infarct associated pericarditis …

…chest pain the primary task is to exclude or verify the following potentially life threatening causes of chest pain: Ischemic heart disease : stable angina pectoris…

…other symptoms may occur without chest pain and should be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around three…

…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…

…to place under the shoulders as an alternative to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus can otherwise…

…the threshold, but the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before…

…neck, jaw, shoulders, back, or one or both arms. Indigestion or heartburn, particularly when associated with nausea or vomiting. Persistent shortness of breath. Weakness, dizziness…

…indicating high effectiveness. Although BLS is primarily developed for out of hospital cardiac arrest (OHCA), it can be used in any setting until advanced cardiac…

…and clinical features The pericardium is a double walled sac in which the heart and the roots of the great vessels are contained (Figure 1)…

…that should make them seek help immediately. Indications An undisplaced or reduced fracture to be treated conservatively. Immobilisation after reduction of a dislocation. Immobilisation of…

…physicians should be interested in. Updates occur frequently. Nuemblog A residents blog with superb, and expanding, content. Beautifully presented and highly relevant for many of…

…elevation myocardial infarction (STEMI). Stable patients with ROSC presenting with ST elevations should undergo urgent coronary angiography with the intent of performing PCI. The COACT…

…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…

…90 mmHg. Screening is particularly pertinent in the presence of hypokalaemia or treatment resistance. Hypokalaemia should not be permitted when assessing dietary electrolyte intake, because…

…the uterus should be manually displaced to the woman's left side (Figure 1). Additional offloading of the vena cava can be accomplished using a…

…revascularized individuals Clinicians should be familiar with the special challenges posed by some patient populations. The sensitivity, specificity, risks, and results of the exercise test…

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

…monitoring should start immediately and a defibrillator must be ready. I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of…

…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…

…complex; (3) the P wave is positive in lead II and (4) the PR interval is constant. Causes of bradycardia : sinus bradycardia, sinoatrial block, sinoatrial…

…high risk patients should be evaluated with angiography earlier. Guidelines recommend the use of validated risk models to estimate the risk of acute myocardial infarction…

…adherence. Selection should be individualized according to blood pressure, heart rate, left ventricular function, comorbidities, concomitant medications, potential drug interactions, the presumed mechanism of ischaemia…

…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 targets should therefore be individualized within the applicable guideline framework. Combination therapy is based on the complementary mechanisms of drugs from different classes…

…to stent implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich because they form under high shear conditions. Disruption of an atherosclerotic…

…Ischemic cardiomyopathy should be suspected if there is significant stenosis ( 75% luminal obstruction) of the left main coronary artery (LAD) or 2 epicardial coronary arteries…

…should be flat and on the same level as the baseline (recall that the baseline is the level of the PR segment). Refer to Figure…

…Figure 1 ). Although the ventricular volume is reduced by concentric hypertrophy, it may still be normal when compared to reference values. Figure 1. Types of…

…recordings confirming a bradyarrhythmia. Potentially reversible causes should be pursued (Table 2). Figure 1. Management of acute bradycardia in the emergency setting. Parameter Assessment A…

…ventricle. Disturbance in ventricular relaxation results in the disruption of pressure conditions in the left ventricle. Ventricular pressure should drop rapidly and substantially during diastole…

…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…

…of STEMI. However, there are situations with transmural ischemia that do not yield ST elevations. It is important to recognize these situations since they should…

…effectiveness of the interventions. Numerous studies demonstrate that the available interventions are time sensitive, and to maximize the likelihood of restoring spontaneous circulation, interventions should…

…chest compressions. If trauma is not definitively established as the cause of cardiac arrest, cardiopulmonary resuscitation (CPR) should be performed per standard guidelines. Cardiac arrests…

…the aim should be a calm, mildly somnolent but rousable patient, while ventilation, circulation and underlying disease are monitored [3]. The management of complicated withdrawal…

…When should anaphylaxis be suspected? Anaphylaxis is a clinical diagnosis. Treat as anaphylaxis in any of the following: 1. Acute onset of skin or mucosal…

…the level of amputation. Contraindications There are no absolute contraindications. Refrain or modify in: Deep vein thrombosis in the leg — cuff compression should be avoided…

…22 above 70 years, and reduced food intake together form the basis of most screening instruments and should prompt a nutritional assessment. See also unintentional…

…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…

…within a couple of hours should be intubated, not given another hour. Indications CPAP: Acute cardiogenic pulmonary oedema with hypoxaemia and marked work of breathing …

…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…

…dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit…

…not by the blood pressure figure alone [2]. A markedly raised blood pressure without acute organ damage should as a rule not be lowered rapidly…

…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…

…patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known stricture or tumour of…

…first hour, in order The measures should in practice overlap. Document the time of the suspicion of sepsis, the first dose of antibiotic, the cultures…

…control centre for advice on the treatment threshold and on whether haemodialysis should be considered. Rhabdomyolysis with marked elevation of CK and threatened kidney injury…

…The benefit of its administration in these patients should be carefully balanced against the potential risks resulting from hypotension. • Withdrawal of clonidine may lead to…

…of 2 suggests moderate risk A score of 3 or higher indicates high risk of major bleeding Note that a high HAS BLED score should…

…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).