…strong suspicion of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients…

…Acute Care Surg 2016; 81:27 33 . Watts S, Smith JE, Gwyther R, Kirkman E. Closed chest compressions reduce survival in an animal model of…

…duration from the start to the end of the QRS complex. A short QRS complex implies that the ventricles are depolarized rapidly, which in turn…

…of evidence The pre hospital care of STEMI patients should be organized regionally (including all components from the emergency medical dispatch to catheterization laboratory) in…

…Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8. Document the ceiling of care and the…

…pre excitation (the ventricles are excited prematurely; refer to Figure 4, third panel). As illustrated in Figure 4 the initial depolarization of the ventricles is…

…an experienced practitioner in selected cases, but surgery is the standard. Dark skin: a risk of permanent hypopigmentation. Areas with poor circulation, above all the…

…Given in case of suspected digoxin intoxication. Table 4. Pharmacological treatment of acute bradycardia. Atropine Evidence: Class IIa recommendation Atropine is the first choice for…

…in practice overlap. Document the time of the suspicion of sepsis, the first dose of antibiotic, the cultures, the fluid bolus and the start of…

Procedurer Three of the commonest minor procedures in general practice concern the nails, and all three rest on the same foundation: an effective digital block…

…withdrawal carries a risk of rebound. The referring physician should have made this decision; document which applies. Nitroglycerin is continued; note it in the report…

…the prevention of atherothrombotic events in adult patients with acute coronary syndrome (ACS) or a prior heart attack and a high risk of developing an…

…wide or narrow complex tachycardia in which the mechanism needs to be documented before referral to an arrhythmia unit. Assessment of the effect of adenosine…

…on the clinical picture Moderate 6.0 to 6.4 mmol/L ECG and cardiac monitoring. Emergency treatment is often warranted, particularly in an acute…

…with the swallows. 6. Stop immediately in the event of coughing, stridor, cyanosis or marked breathlessness — withdraw the tube to the pharynx and start again…

…overdose. Tumour lysis syndrome appears as an indication in older protocols but is no longer routinely recommended — alkaline urine increases the precipitation of calcium phosphate…

…loading dose of an intravenous antiseizure drug If the seizure continues after adequate step 1 and step 2 Refractory status: contact anaesthesia, intensive care and…

…the test in: Condition Recommended delay : : Myocardial infarction or unstable angina 1 month Pneumothorax 1 month after resolution Pulmonary embolism, until anticoagulated and stable An…

…control of the bleeding has not yet been achieved. Penetrating torso injury with shock. A positive FAST scan in an unstable trauma patient. An unstable…

…overview Measure the plasma glucose immediately in everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour, collapse or an acute neurological…

…doses of an inhaled short acting β2 agonist, ipratropium in more severe attacks, and a systemic steroid given early [2,3]. Grading Grade the severity…

…start and can keep a patient alive until a transvenous lead is in place — but only if it is working, and the commonest source of…

…one with an eGFR of 50 and A1. Estimating renal function Formula Used for : : CKD EPI 2021 (creatinine) The first choice for eGFR in adults…

…smooth in ventricular tachycardia. SVT has a sharp start of the QRS complex. R wave duration ≥40 ms suggest ventricular tachycardia. Duration from start of…

…cells in the bundle of His (which possess automaticity) will not be reached by the atrial impulse and hence start discharging action potentials and an…

…floor of the nose in one smooth movement — never obliquely upwards towards the eye. 3. Expand it with 5–10 mL of saline through an…

…in which the bradycardia and reduced contractility of hypothermia are not tolerated. A decision to withhold further life sustaining treatment. Preparation and equipment Continuous core…

…the ECG gives the impression that repolarization starts earlier than normal in these patients. However, it is still unknown whether that is actually the case…

…stimulated in order to evoke an action potential. Upon stimulation, sodium (Na+) channels open which causes a rapid influx of sodium and depolarizes the cell…

…reach the ventricles. The physiological advantages of this configuration have been discussed in Chapter 1. Some individuals, however, possess an additional pathway between the atria…

…of NSTEMI and unstable angina is virtually equal and this explains why NSTEMI and unstable angina have traditionally been grouped. The chain of care in…

…Start non pharmacological treatment immediately , in parallel with the investigation. 8. Document the diagnosis and communicate it at every handover. Recognise it Core criteria Core…

…release tablet and an as required opioid at the same time. Opioids in abdominal pain of unclear cause do not delay the diagnosis and should…

…pain is one of the most common symptoms in the emergency department, as well as in primary health care. The cause (etiology) of chest pain…

…angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of…

…the inflammation and deposition of lipids progress, an atherosclerotic plaque forms in the wall of the artery. Such atherosclerotic plaques start building up early in…

…of these waves and intervals. The P wave, PR interval and PR segment ECG interpretation traditionally starts with an assessment of the P wave. The…

…in left bundle branch block (LBBB), which explains why paced QRS complexes are similar to the QRS morphology during LBBB. Stimulation in other regions of…

…waves. The ultrasound machine utilizes variations in the amplitude, frequency and timing of the reflected sound waves to create an image of the medium (tissue).

…the subendocardium of the left ventricle has the poorest prerequisites in case of ischemia. The infarction process starts in the subendocardium from where it spreads…

…diastole starts at the end of the T wave. Figure 2. Wiggers diagram showing pressure, volume, Doppler signal, ECG and AV valves during the cardiac…

…The cells of the sinus node have an intrinsic rate of depolarization at approximately 70 times per minute, which results in 70 contractions per minute…

…an ectopic focus may be located anywhere. If it is located near the atrioventricular node, activation of the atria will proceed in the opposite direction…

…near term prediction using smart devices and emerging technologies ( Marijon et al ). The stochastic nature (randomness) of sudden cardiac arrest is in some aspects similar…

…of the conduction system, the heart and the classical ECG waveforms. Figure 1 . The cardiac cycle starts when cells in the sinoatrial node discharge an…

…cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops acutely or subacutely…

…Acute Care Surg 2016;81:27 33. Watts S, Smith JE, Gwyther R, Kirkman E. Closed chest compressions reduce survival in an animal model of…

…away or the patient bleeds. In Sweden the treatment is usually managed from an anticoagulation clinic with dosing support, but whoever starts the drug is…

…amiodarone, or adrenaline (epinephrine). In the event of a cardiac arrest in a pregnant patient, immediate consultation with an obstetrician, neonatologist, and anesthesiologist is essential…

…seen after reperfusion in an occluded coronary artery. It also occurs as side effect of drugs, hypoxia, myocarditis and electrolyte disorders. Because the rate (60…

…node in Mobitz type 1 block can be viewed as a tendency to exhaust the conduction capacity. It starts with the successful conduction of an…

…to as an escape rhythm. In most cases, the escape rhythm originates in either of the following three structures (discussed in detail in Chapter 1…

…Acute Care Surg 2016; 81:27 33 . Watts S, Smith JE, Gwyther R, Kirkman E. Closed chest compressions reduce survival in an animal model of…

…perfusion, with an equal degree of hypoxia in all neurons. There is one fundamental difference between neurons and myocardium in the setting of hypoxia. Myocardium…

…in lower generated pressure and ultimately smaller stroke volume. Two dimensional (2D) and three dimensional (3D) echocardiography allows for the calculation of stroke volume. The…

…to be an interruption in the QRS complex and initiation of repolarization. However, no study to date has been able to demonstrate that the repolarization…

…occurs in diastole or the decompression phase during CPR). High aortic pressure and low right atrial pressure favor coronary blood flow. A CPP of approximately…

…starts to relax. The relaxation results in a rapid drop in ventricular pressure. Ventricular pressure drops below atrial pressure, which results in the opening of…

…a physical medium. This medium may consist of any matter, e.g air, water, metal, or tissue and fluids in the human body. Sound waves…

…can be counteracted with simultaneous administration of beta blockers). Effects Induces arteriolar vasodilation without effects on venous circulation. The reduction in systemic vascular resistance (SVR…