…much more common than upper extremity symptoms. The severity of symptoms should be described by their effect on walking distance, daily activities, work and independence…

…considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting with glucagon like peptide 1 receptor agonists (GLP 1 RAs) and…

…changes are extremely common in every population. For example, almost 80% of men display ST segment elevations that are not caused by ischemia and a…

…and a faster release kinetics. This may explain higher peak levels of cTnI compared with cTnT. Normal values (reference values) URL (upper reference limit) : The…

…myocardial cells and therefore myocardial troponins should not be detected in the blood. It should be noted, however, that current troponin assays are extremely sensitive…

…commonest cause of upper gastrointestinal bleeding, but the differential diagnosis includes oesophagitis, gastritis, a Mallory Weiss tear, a Dieulafoy lesion, angiodysplasia, malignancy and an aortoenteric…

…male and female Adult, male Adult, female Normal <440 ms <430 ms <450 ms Upper limit 440–460 ms 430–450 ms 450–470 ms…

Clinical medicine Emergency medicine Definition and pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that…

…presented in the parenthesis). Values without confidence interval are simply the 98 th percentile (i.e the upper reference limit). Age <1 day 1–3…

…symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and may extend to the arms, shoulders, neck, jaw, upper back, abdomen…

…pressure, and discomfort in the chest, arms, neck, jaw, upper back, and abdomen, as well as dyspnea and nausea (anginal equivalents) [7]. Clinicians must consider…

…troponin value above the assay specific 99th percentile upper reference limit. It is classified as acute when serial measurements demonstrate a rise and/or fall…

…presented in the parenthesis). Values without confidence interval are simply the 98 th percentile (i.e the upper reference limit). Age <1 day 1–3…

…evident, ventricular tachycardia may appear more polymorphic in one lead (the upper lead). ECG 2 . Although the signal in the upper lead appears very disorganized…

…alae nasi, upper lip) Venous drainage towards the cavernous sinus Surgeon or ENT; often antibiotics Palm, fingers, tendon sheaths Deep compartments and tendon sheaths, loss…

…free mass index 15–19 kg/m² 17–22 kg/m² Ideal and dosing weight Drug dosing often requires a weight other than the actual…

…back and arm supported, legs uncrossed, no conversation Cuff width ≥ 40% of the upper arm circumference — a cuff that is too narrow gives a falsely…

…added: transfusion saves no one whose bleeding is not stopped, and it is the time to haemorrhage control that determines the outcome. Indications Symptomatic anaemia…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

…A reservoir mask with a tight fitting seal, a separate nasal cannula for apnoeic oxygenation, a bag with a PEEP valve, and an oropharyngeal airway…

…50 × the upper limit of normal: paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis. The three are distinguished by the history and the…

…is inserted close to the upper border of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is stopped…

…fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression…

…however, incorporates overall cardiovascular risk, comorbidity and hypertension mediated organ damage (HMOD), rather than relying exclusively on the office pressure value. Blood pressure terminology Systolic…

…and ascends in a caudocranial direction along the interatrial septum. The left atrium is activated passively. The upper boundary of this circuit may be located…

…value above the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and/or fall of cTn…

…Evaluation and Physical Examination Patients with suspected ACS should undergo expedited emergency department assessment. The initial evaluation includes: Targeted medical history Physical examination Vital sign…

Cardiology Respiratory medicine Definition and Pathophysiology Pulmonary hypertension (PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise…

…above the assay specific 99th percentile upper reference limit (URL). It is considered acute when there is a rise and/or fall in cTn values…

…tongue, and uvula causing airway obstruction Cardiovascular: Hypotension Circulatory collapse culminating in cardiac arrest Anaphylaxis can develop without dermatological or upper airway manifestations. Anaphylactic cardiac…

…wave contour on ECG The normal P wave (Figure 1, upper panel) is typically smooth, symmetric and positive. The P wave in lead II may…

…electrodes more proximally (closer to the trunk): leg electrodes are placed proximally on the thighs and arm electrodes are placed proximally on the upper arm…

…upper normal limit is 220 msec (0.22 sec). If the PR interval is greater than 220 msec, first degree AV block is manifest and…

…after vascular surgery or endovascular intervention. Assessment of healing potential in ulcers and before deciding the level of amputation. Contraindications There are no absolute contraindications…

…day. Reassess the dose daily and follow creatinine. Underdosing in sepsis is more dangerous than exceeding the upper dose limit during the first 24 hours…

…upper gastrointestinal tract, ileus and ongoing upper gastrointestinal bleeding. Marked agitation or inability to cooperate. Copious secretions without an effective cough. Choice of method and…

…conflated. There is no absolute upper age limit. Suitability is determined organ by organ in consultation between the intensive care physician and the transplant service…

…Vertical, linear scratch marks suggest a foreign body under the upper eyelid. 7. Seidel's sign: apply fluorescein generously and look under blue light. A…

…reduce a fracture dislocation or to miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with known instability and a…

…hypokalaemia. Aim for a serum potassium in the upper normal range, around 4.0–4.5 mmol/L, and continue replacement throughout the treatment. This…

…and upper airway. Due to the risk of airway compromise, it represents a medical emergency. Evaluation and Physical Examination The evaluation of chronic cough in…

…The upper 99% limits of normal for corrected QT (QTc) values in the general population are 450 ms for men and 460 ms for women…

…other platelet pathways. The distinction between primary and secondary prevention is fundamental: Primary prevention refers to individuals without established atherosclerotic cardiovascular disease (ASCVD), coronary artery…

…in the epicardial arteries is a major pathological substrate, but ischaemia may also result from epicardial vasomotor abnormalities or structural and functional microvascular disease. Thus…

…cava (which returns blood from the head and upper limbs) also enters the right atrium. Oxygenated and deoxygenated blood is then mixed in the right…

…a reflection of right atrial depolarization and the second half is a reflection of left atrial depolarization. This is shown in Figure 3 (upper panel)…

…is defined by: cTn greater than 5 times the 99th percentile upper reference limit; and At least one of the following: New ischemic ECG changes…

Cardiology Pharmacology & dosing Definition and pathophysiology Statins inhibit 3 hydroxy 3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol…

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

…CCS) . This syndrome includes six clinical manifestations of coronary artery disease (discussed below). Moreover, prognostication, selection of diagnostic tests, and treatment strategies have been updated…

…the upper normal limit. Sinus tachycardia can exceed 240 beats/min in children. As in sinus rhythm, a P wave precedes every QRS complex and…

…cava (which returns blood from the head and upper limbs) also enters the right atrium. Oxygenated and deoxygenated blood is then mixed in the right…

…as long QT interval . The upper reference limit for QTc interval is 460 ms in males and 470 ms in females. QTc intervals exceeding these…

…value above the 99th percentile upper reference limit (URL) in the appropriate clinical context. Unstable Angina presents with clinical and/or electrocardiographic signs of myocardial…

Arrhythmias and arrhythmology ECG Sinoatrial block (SA block): from ECG to clinical management Sinoatrial (SA) block implies that the impulses discharged in the sinoatrial node…

…CCS) . This syndrome includes six clinical manifestations of coronary artery disease (discussed below). Moreover, prognostication, selection of diagnostic tests, and treatment strategies have been updated…

…interval and ride straight through the strip, without any relation to QRS complexes. P waves may occur on the ST T segment ( Figure 1 , upper…

…of an upper limit for ventricular compliance. The greater the left ventricular compliance, the less steep the slope of the EDPVR curve, and vice versa…