…still used in many units to assess the collateral circulation, but the test does not reliably predict ischaemic complications and should not decide the matter…

…a new cardiac murmur, or jugular venous distension in the days after MI should prompt immediate consideration of a mechanical complication. Clinical deterioration may be…

…in the presence of a tamponade, chest compressions have limited efficacy. Furthermore, administering large tidal volumes might inadvertently elevate intrathoracic pressures, additionally compromising venous return…

Echocardiography Cardiac thromboembolism Thromboembolism is a leading cause of death worldwide (1). Emboli originating in the atria, left atrial appendage (LAA), ventricles, valves, and proximal…

…epilepticus in adults is present with: an ongoing generalised tonic clonic seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the…

…of complications calls for careful consideration of contraindications. Contraindications may be absolute or relative. Briefly, exercise stress testing must not be performed in the presence…

…prolonged, produces multiorgan dysfunction and death. In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction…

…In particular, it cannot distinguish adipose tissue from lean mass. Waist circumference and the waist to hip ratio provide additional information about visceral adiposity and…

…venous oxygen saturation. Repeated blood sampling during intensive care. Exhausted peripheral venous access during prolonged intravenous therapy. The need for central access is not in…

…the only one that will go in. The rule that saves time is simple: two attempts or 90 seconds — then go intraosseous. Indications Peripheral venous…

…heals venous leg ulcers; everything else is supportive. But the same compression applied to a limb with arterial insufficiency can cause necrosis and, in the…

…estimated that 10 million cases of venous thromboembolism occur globally every year ( Raskob et al ). The incidence of pulmonary embolism has increased in recent decades…

…blockers). Effects Induces arteriolar vasodilation without effects on venous circulation. The reduction in systemic vascular resistance (SVR) is rapid and may cause reflex sympathetic stimulation…

…hyperkalemia and hypokalemia can induce life threatening arrhythmias and cardiac arrest, with hyperkalemia being the most prevalent electrolyte disturbance observed in cardiac arrest scenarios. Hypocalcemia…

…using a venous cannula Can be executed in a pre hospital setting. A large venous cannula, preferably ≥7 cm, should be utilized. The cannula is…

…or in the emergency department without contacting the appropriate specialty: Location Risk Management : : : Medial triangle of the face (nasal root, alae nasi, upper lip) Venous…

…Perform a bladder scan in oliguria, anuria or unexplained AKI. 3. Assess the circulation and volume status, including signs of both hypovolaemia and venous congestion…

…require a higher target Doses in venous thromboembolism Treatment doses in deep vein thrombosis and pulmonary embolism differ from the atrial fibrillation doses and include…

…The condition occurs above all in: treatment with SGLT2 inhibitors pregnancy prolonged fasting or a very low carbohydrate intake excessive alcohol consumption vomiting or othe

…a venous plasma glucose, but do not delay treatment of a neurologically compromised patient. Continuous glucose monitoring reflects interstitial glucose and lags behind the blood…

…in the emergency department, the intensive care or coronary care unit, and the operating theatre. Careful electrocardiographic and haemodynamic monitoring with ECG, a central venous…

…access, or rapid central access, but do not delay transfusion or control of the bleeding in order to obtain a central venous catheter. 4. Take…

…Comment : : : Atrial fibrillation 2.0–3.0 The time in therapeutic range (TTR) should exceed 70 % Venous thromboembolism 2.0–3.0 Overlap with low…

…on the venous capacitance vessels. Hence, Clevidipine reduces blood pressure without affecting cardiac filling pressures. • Clevidipine is more effective than nitroglycerin, nitroprusside, and nicardipine in…

…on the venous capacitance vessels. Hence, Clevidipine reduces blood pressure without affecting cardiac filling pressures. • Clevidipine is more effective than nitroglycerin, nitroprusside, and nicardipine in…

…Central Venous Pressure (CVP) This equation illustrates that MAP is determined by the volume of blood the heart pumps and the resistance encountered in the…

…increasing frequency of hospitalizations and visits for heart failure without disease recognition in the 3 years preceding diagnosis is also a notable red flag [8…

…and near equalization of diastolic pressures in the cardiac chambers, with chamber pressures approaching intrapericardial pressure. The jugular venous waveform typically has a prominent x…

…Behçet disease can cause both arterial and venous thrombosis. In SLE, renal artery involvement may contribute to difficult to control hypertension. The cardiovascular consequences of

…and occurs in more than 90% of patients presenting with the syndrome. Its severity and temporal pattern vary considerably. Symptoms of systemic venous congestion include…

…aortic pressure minus coronary venous pressure In routine clinical practice, coronary venous pressure is generally assumed to be zero, yielding the simplified ratio of mean…

…The left ventricle may have apparently preserved global systolic emptying while exhibiting impaired relaxation, increased passive stiffness, or both. Consequently, relatively small increases in venous…

…and calcific aortic valve stenosis. Lp(a) is not associated with venous thromboembolism in prospective epidemiological studies. Its biological effects appear to differ from those…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…disease is the most common risk factor for PH. It produces postcapillary PH through elevation of left atrial and pulmonary venous pressure. In some patients…

…venous distension Kussmaul’s sign Hepatomegaly Hypotension, which may or may not be present Markedly reduced cardiac output in severe cases Cardiogenic shock in the…

…reflex response to posture, venous pooling, or external stimuli. The underlying pathophysiology is rooted in autonomic dysregulation within a structurally normal heart. During an episode…

…arrest in a pregnant patient, immediate consultation with an obstetrician, neonatologist, and anesthesiologist is essential. Figure 1 . When a pregnant woman is supine, the uterus…

…A rapid increase in preload (e.g by increasing venous return to the heart in supine position) leads to an immediate increase in ejection fraction…

…At 30 days, 20% of those in the extracorporeal CPR group and 16% in the conventional CPR group had a favorable neurologic outcome. This difference…

…on the venous capacitance vessels. Hence, Clevidipine reduces blood pressure without affecting cardiac filling pressures. • Clevidipine is more effective than nitroglycerin, nitroprusside, and nicardipine in…

…factors, which influence cardiac function primarily by affecting ventricular function, include blood pressure, venous return, pulmonary gas exchange efficiency, the concentration of catecholamines, angiotensin, hemoglobin…

…3 Important study: Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock (N Engl J Med 2021; 385:516 525) In a randomized…

…and previous venous thromboembolism. A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full sentences…

…impending respiratory arrest. A venous blood gas can give useful information about pH and the trend in carbon dioxide, but in critical illness, marked hypoxaemia…

…inserted venous port. Procedure 1. Arm pressure. Place the cuff on the upper arm. Locate the brachial signal in the antecubital fossa with the Doppler…

…acidosis or alkalosis in a haemodynamically stable patient A venous blood gas is often sufficient as the first sample Precise pCO₂ in suspected ventilatory failure…

…Assessment of whether residual weakness in a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and…

…newborn 3.0–3.5 6 + weight in kg Always have one size smaller to hand. The cuff is inflated to 20–30 cmH₂O measured…

…3. Insert a peripheral venous cannula. 4. Measure the blood pressure in both arms at the first assessment, particularly in chest pain, back pain or…

…small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at least a minute; a rapid…

…collapse in a tamponaded patient , since positive airway pressure further reduces the venous return. Procedure Choice of access The ultrasound, not tradition, determines the site…

…Anticoagulation A DOAC is the first choice in pulmonary embolism without malignancy and without antiphospholipid syndrome. The doses in venous thromboembolism include an initial high…

…in septic shock, or when sepsis is judged certain or highly likely. With possible sepsis without shock, a rapid targeted assessment is made. If the…

…Insert a venous cannula. Wait a few minutes — the venepuncture itself can cause a stress related rise in cortisol. 3. Take the baseline sample : cortisol…

…shock. Already marked hypothermia from another cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated…

…for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must…

…measurement — the treatment cannot be guided without reliable measurement of urine output. Baseline tests: blood gas with electrolytes, sodium, potassium, ionised calcium, creatinine, CK in…

…an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow. The resulting ischaemia…

…Specific dosing adjustments are required in certain patient populations: Pediatric patients: For patients weighing less than 50 kg, the dosing should be 0.05 to…