Neurologi Akutsjukvård Lathundar About this quick reference This is a practical quick reference for emergency physicians in suspected acute ischaemic stroke. It covers time windows…

…to haemorrhage control that determines the outcome. Indications Symptomatic anaemia, or a haemoglobin below the applicable transfusion threshold (see below). Ongoing bleeding with haemodynamic compromise…

…in type 2 diabetes Usually type 2 diabetes, older age and a longer symptomatic course Consciousness Usually preserved, but may be impaired in severe DKA…

…cervical spine surgery, atlantoaxial instability, severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis, recent stroke or TIA in the vertebrobasilar territory. Retinal detachment. Relative:…

…Unstable monomorphic VT with a pulse. Pre excitation with atrial fibrillation and a very rapid ventricular rate. Elective or subacute: Symptomatic persistent atrial fibrillation where…

…Comment : : Left main stenosis Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual…

…symptomatic hyponatraemia must be corrected in a controlled fashion, since too rapid a rise can cause osmotic demyelination syndrome [1,2]. Hyponatraemia is primarily a…

…Haemarthrosis after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease…

…a symptomatic or large pneumothorax, recurrent malignant effusion (often combined with pleurodesis), and in chest trauma and postoperatively. Emergency needle decompression: a clinical suspicion of…

…symptomatic salicylate poisoning. For an adult this corresponds to the order of 100–200 mL of the 50 mg/mL solution. 6. Continue with a…

…referred to as sinus node dysfunction (SND). If a person with ECG signs of SND is symptomatic, the condition is classified as sick sinus syndrome…

…consistently shown benefit for patients with symptomatic LV dysfunction, and all placebo controlled chronic HFrEF trials using neurohormonal antagonists have demonstrated a reduction in mortality…

…for approximately half of patients with symptomatic HF. The distinction is clinically useful but not absolute. Ejection fraction is a continuous variable and echocardiographic measurement…

…In such patients, it may be considered in symptomatic patients with LVEF ≤35%, sinus rhythm and a resting heart rate ≥70 beats/min, provided that…

…presentation and symptoms Asymptomatic and atypical disease Fewer than half of patients with PAD have typical symptoms. Many have impaired walking or a slow gait…

…frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity. The hallmark of stable coronary artery disease…

…and arrhythmias caused by digoxin were discussed previously. Below follows a rather detailed declaration of ECG changes, arrhythmias and conduction defects that occur due to…

…factors (see Risk factors below). A significant proportion of cases with pulmonary embolism require thrombolysis to dissolve the occlusion. Administration of thrombolysis requires careful consideration…

…sinus node dysfunction The causes have been discussed in each respective article. A rehearsal follows. Reversible causes of sinus node dysfunction Age related degenerative disease …

…frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity. The hallmark of stable coronary artery disease…

Info A comprehensive list of conditions and drugs that may prolong the QT interval, and cause torsade de pointes (TdP) and long QT syndrome (LQTS…

…asymptomatic and are identified either during routine abdominal examination or incidentally on imaging performed for another indication. When palpable, an AAA may present as a…

…haemorrhage within the aortic media without an identifiable communication between the aortic lumen and the haematoma and without a visible intimal flap or false lumen…

…setting. Beta blockers Mechanism and clinical role Beta blockers reduce myocardial oxygen demand and provide symptomatic relief by lowering heart rate and limiting adrenergic stimulation…

…or ambulatory pressure. Office measurements provide only a limited representation of usual blood pressure and may be biased by the clinical environment. Out of office…

Arrhythmias and arrhythmology Emergency medicine Pharmacology & dosing Definition and Pathophysiology Bradycardia encompasses a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within…

…sufficiently high for targeted screening to be cost effective. For asymptomatic stenosis of at least 70%, the reported 5 year ipsilateral stroke risk is 14…

…a large meal, emotional upset, or cold exposure. The absence of chest pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may…

Cardiology Pharmacology & dosing Definition and pathophysiology Heart failure is a clinical syndrome in which the heart cannot provide blood flow commensurate with the body’s…

…secondary to a low cardiac output. Its primary clinical utility in contemporary practice is late line therapy for patients who remain profoundly symptomatic despite optimal…

…for approximately half of patients with symptomatic heart failure. These patients experience substantial morbidity and mortality, despite often having a considerable burden of non cardiac…

Cardiology Pharmacology & dosing Definition and Therapeutic Rationale Hypertension is a major risk factor for atherosclerotic cardiovascular disease and contributes to microvascular and macrovascular complications. It…

…stented segment or at its margins. Angiographic restenosis has traditionally been described as a follow up diameter stenosis exceeding 50%, whereas clinical restenosis refers to…

…be paroxysmal, extended ambulatory monitoring is often required to capture symptomatic events. A typical 24 to 48 hour Holter monitor is frequently insufficient. Monitors that…

…to patients with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the documented ischaemic burden. In chronic coronary…

…dosing Definition and Pathophysiology Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a hepatic protein that regulates the availability of the low density lipoprotein receptor …

…prevention. PCI treats focal stenotic segments, whereas CABG provides a bypass beyond diseased segments. The latter may also protect against future proximal disease progression, while…

…probability is the clinician’s estimate of the probability that the patient has anatomically obstructive CAD before the result of a new test is known…

Arrhythmias and arrhythmology Pharmacology & dosing Definition and pathophysiology Atrial fibrillation (AF) is a major independent risk factor for thromboembolism, including ischaemic stroke. This risk applies…

…2 AV block, third degree AV block). Sick sinus syndrome or symptomatic bradycardia in the absence of a pacemaker. Hypersensitivity to adenosine. Administration Normal route…

…in most Western populations. Individuals with bicuspid aortic valves may develop symptomatic aortic stenosis already at the age of 60 years. Bicuspid aortic valves also…

…Cardiomyopathy / Dysplasia (ARVC, ARVD) Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is considered a genetic cardiomyopathy that predominantly affects the right ventricle. ARVC is defined by the…

…referred to as sinus node dysfunction (SND). If a person with ECG signs of SND is symptomatic, the condition is classified as sick sinus syndrome…

…with low to moderate risk of CAD. In patients with a high to very high risk of CAD, invasive coronary angiography is the first line…

…management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia, it is fundamental to establish a temporal correlation between the…

…may become symptomatic already at 2.5 cm 2 . A normal mitral valve has an area of 4 to 6 cm 2 . A valve area…

…toward them. A permanent pacemaker is generally indicated when reversible causes are absent and the patient is symptomatic or at risk of developing symptoms. The…

…haemodynamics, not the volume of fluid. A litre that has accumulated slowly can be asymptomatic, while 150 mL collected over an hour causes tamponade. The…

…the following ECG findings is typically considered a normal variant in asymptomatic athletes with no significant family history? A: Mobitz Type II 2nd AV block…

…on the coronary arteries. The tumors can be asymptomatic for a long time and be detected randomly when investigating other conditions. More dramatic onset of…

…can be tested on urine or a self taken vaginal sample without a speculum. Routine gynaecological examination of asymptomatic women has not been shown to…

…long standing hypertension and a rightward shifted autoregulation [1,3]. The term hypertensive urgency is best avoided. It implies that an asymptomatic rise in blood…

…and APS. Some patient groups have a two to three fold greater prevalence of asymptomatic atherosclerotic cardiovascular disease (ASCVD) than the general population. The evidence…

…particularly regarding the risk stratification of asymptomatic patients, the prognostic utility of electrophysiological studies (EPS), and the transition from a purely device based management strategy…

Arrhythmias and arrhythmology ECG Genetic and miscellaneous conditions Brugada syndrome: A life threatening arrhythmia with unknown prevalence Pedro Brugada and his two brothers, Josep and…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…5–7 mg/kg IV as a single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria…

…3]. A healthy person without diabetes therefore does not normally need investigation on the basis of an isolated, asymptomatic low sensor reading alone. Symptoms Autonomic…

…I C A routine primary PCI strategy should be considered in patients presenting late (12–48 h) after symptom onset. IIa B In asymptomatic patients…

…are available. Further diagnostic imaging solely because calcified plaque is present in an asymptomatic individual is not supported by the available evidence described here. Systematic…