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Cardiology 1. Acute Pulmonary Oedema ICU / RESUS ☆ ▸ Casualty: breathless, orthopnoea, rales, JVD, S3 gallop, bilateral pitting oedema; prior MI/HTN
ABCDE Sit upright; oxygen only if SpO₂ <90% (target ≥90%) — routine high-flow O₂ not indicated; IV access + monitoring; GTN + IV furosemide; start CPAP/BiPAP early if SpO₂ <90% or RR >25 despite O₂; treat arrhythmia/ischaemia.
Sit upright + Oxygen only if SpO₂ <90% (target ≥90%); routine high-flow O₂ not indicated; continuous oximeter
✓ Initial orders: Furosemide 40 mg IV + Nitroglycerin (paste/IV) + O₂ if SpO₂ <90%; CXR, ECG, ABG. Natriuretic peptides aid diagnosis when uncertain (rule-out BNP <100, NT-proBNP <300 pg/mL) — but never delay treatment to wait for them in florid pulmonary oedema. Morphine no longer routine
✓ Move clock 15–30 min: if urine made → improving. If NOT → check response at 2 h (urine output / spot urine Na); if inadequate, double the IV dose — do not redose blindly; recheck vitals q15–30 min
✓ First test: ECG → if arrhythmia (VT/AFib/flutter) causing it → immediate synchronized cardioversion
✓ Still not responding to preload reduction: add IV nitroglycerin; consult cardiology + critical care (CCS)
✓ Max preload Rx + persistent hypoxia → ICU: Persistent hypoxia despite NIV → intubation. Inotropes (dobutamine) only if SBP <90 mm Hg WITH hypoperfusion; norepinephrine if shock
✓ Order set Sit up; O₂ only if SpO₂ <90% IV furosemide GTN (paste/IV/infusion) ECG + troponin CXR portable ABG/VBG U&E, BNP/NT-proBNP (rule-out <100 / <300 pg/mL) Monitor 0 min O₂, furosemide, nitrate; ECG, ABG 15–30 min Urine output + vitals; re-dose loop if no urine 1 h Reassess oxygenation; escalate NIV → intubation if failing; dobutamine only if SBP <90 + hypoperfusion 2–6 h Fluid balance, electrolytes, response Escalate / ICU Persistent hypoxia despite max preload reduction Needs inotrope/vasopressor (only if SBP <90 mm Hg with hypoperfusion) NIV (CPAP/BiPAP) failure Rising PaCO₂ / exhaustion → intubate Cardiogenic shock Criteria Admit All acute pulmonary oedema
ICU Refractory hypoxia, shock, or NIV failure
Intubate Exhaustion, ↓GCS, or refractory hypoxaemia despite NIV
Ventilate Failing oxygenation on max NIV
Vasopressors Cardiogenic shock — noradrenaline ± inotrope
Discharge Euvolaemic on oral therapy, SpO₂ stable on air, cause addressed, HF meds started + follow-up
Never Call cardiology early, but start treatment yourself — do not wait for them Key Most patients respond to preload reduction alone. Loop alt if furosemide absent = bumetanide/torsemide. Start CPAP/BiPAP early if SpO₂ <90% or RR >25 despite O₂ — early therapy, not last rescue. Early bedside echo (immediate if shock/arrest); identify precipitant. Urine catheter + strict fluid balance; daily weights. VTE thromboprophylaxis (LMWH) unless contraindicated. Initiate/up-titrate GDMT before discharge (STRONG-HF, Class I-B); in-hospital SGLT2 inhibitor start is supported (EMPULSE). Acetazolamide 500 mg IV daily may augment decongestion (ADVOR). Clinical detail — differentials, red flags, pitfalls, disposition Red flags SpO₂ <90% on max therapy Rising PaCO₂/exhaustion Hypotension/shock Differentials Pneumonia ARDS PE COPD exacerbation Common mistakes Excess fluids Relying on BNP when picture is obvious Delaying NIV Disposition & follow-up Improve → ward + HF workup; refractory/hypoxic → HDU/ICU.
Discharge package Medications Loop diuretic; start/continue HF therapy (ACEi/ARNI, β-blocker, MRA, SGLT2i)
Follow-up HF clinic 1–2 wk; echo if new
Lifestyle Daily weights, fluid/salt restriction
Warning symptoms Worsening breathlessness, weight gain >2 kg in 2 days, ankle swelling, chest pain
💊 Treatment detail — doses & preparation Furosemide IV loop diuretic
Dose 40–80 mg IV slow push; if on home furosemide give ≥1–2.5× the oral dose IV (DOSE); infusion 5–40 mg/h in refractory congestion
Preparation 20 mg/2 mL ampoule undiluted over 2–5 min (ototoxic if fast); infusion 250 mg in 50 mL NS via pump
Monitor Urine output, K⁺, Mg²⁺, creatinine, volume status; check response at 2 h (urine output / spot urine Na); do not redose blindly
Glyceryl trinitrate (nitroglycerin) IV/SL vasodilator
Dose SL 400 mcg spray/tablet; IV 10–200 mcg/min infusion
Preparation 50 mg in 250 mL D5W (200 mcg/mL) in glass bottle/non-PVC set; start 10 mcg/min, titrate q5 min
Monitor Only if SBP >110 mm Hg; avoid with PDE5 inhibitors, RV infarction, severe aortic stenosis; BP, headache; tolerance after 24 h — nitrate-free interval
0.9% Sodium chloride crystalloid
Dose Fluids are NOT routine in cardiogenic pulmonary oedema — avoid IV fluids unless true hypovolemia (e.g., RV infarct, over-diuresis); consider fluid restriction 1.5–2 L/day in dilutional hyponatraemia
Preparation 500/1000 mL bags; add KCl only after urine output confirmed
Monitor Daily weights + strict fluid balance; reassess volume status — excess fluids worsen pulmonary oedema
Dobutamine inotrope
Dose 2.5–10 mcg/kg/min IV infusion
Preparation 250 mg in 250 mL D5W/NS (1 mg/mL) via pump; central line preferred
Monitor HR, arrhythmias, urine output; vasodilates — combine with noradrenaline if hypotensive
📖 ESC Acute & Chronic Heart Failure Reviewed July 2026
2. Congestive Heart Failure (chronic, systolic) EMERGENCY ☆ ▸ Ambulatory: exertional dyspnoea, orthopnoea, PND, S4, apical murmur→axilla, oedema; long-standing HTN
Initial orders: ECG, CXR, transthoracic echo (only way to tell systolic vs diastolic; EF low = systolic)
✓ Start — 4 pillars (mortality benefit): ARNI (sacubitril-valsartan) or ACE-inhibitor/ARB + β-blocker (metoprolol succinate/carvedilol/bisoprolol) + SGLT2 inhibitor (dapagliflozin/empagliflozin) + MRA (spironolactone/eplerenone)
✓ Congestion / fluid overload → loop diuretic (furosemide) titrated to symptoms
✓ Still symptomatic → add Digoxin — ↓ symptoms & hospitalizations, does NOT ↓ mortality
✓ Still symptomatic + wide QRS → Biventricular pacemaker (CRT). EF <35% → ICD (↓ mortality, not symptoms) — despite ≥3 months of optimal GDMT (and >40 days post-MI)
✓ Order set ECG CXR Echo (EF) U&E, BNP Ferritin/TSAT, TFT, HbA1c Criteria Admit Decompensation, hypotension, or worsening renal function
ICU Cardiogenic shock / needing inotropes
Vasopressors Low-output shock despite optimisation
Discharge Euvolaemic, stable renal function/K⁺, on optimised oral therapy, weights + follow-up arranged
Never Combine ACE inhibitor with ARB (no benefit, ↑ harm) Order a cardiology consult on a single-answer CHF question Key Mortality ↓: ACEi/ARB, β-blocker, spironolactone/eplerenone (SGLT2i now added). HFpEF (preserved EF): SGLT2 inhibitor is Class 2a to reduce HF hospitalizations (empagliflozin 10 mg OD — EMPEROR-Preserved; dapagliflozin — DELIVER); manage congestion with diuretics and treat comorbidities (HTN, AF). Non-DHP CCB: avoid in HFrEF. Clinical detail — differentials, red flags, pitfalls, disposition Red flags Rest dyspnoea Hypotension Worsening renal function on up-titration Differentials COPD Renal/hepatic oedema Constrictive pericarditis Anaemia Common mistakes Under-dosing the 4 pillars Stopping ACEi for mild Cr rise NSAIDs Disposition & follow-up Optimise 4 pillars; HF clinic follow-up 1–2 wk; daily weights.
Discharge package Medications Optimised 4 pillars + diuretic for symptoms
Follow-up HF nurse/clinic; repeat U&E after titration
Vaccination Influenza + pneumococcal
Lifestyle Salt/fluid limits, daily weights, exercise as tolerated
Warning symptoms Increasing breathlessness, oedema, weight gain, dizziness, palpitations
💊 Treatment detail — doses & preparation Sacubitril/valsartan (ARNI) HF pillar
Dose Start 24/26 mg BD (49/51 if tolerated), double q2–4 wk to 97/103 mg BD
Preparation Fixed-combination tablets 24/26, 49/51, 97/103 mg
Monitor 36-h ACEi washout before starting (angioedema); BP, K⁺, creatinine
Bisoprolol β-blocker (HF)
Dose Start 1.25 mg OD, double every 2 wk to target 10 mg OD
Preparation 1.25/2.5/5/10 mg tablets; take same time daily
Monitor HR, BP, HF symptoms — titrate slowly
Spironolactone MRA
Dose 25–50 mg OD (HF); 100–400 mg/day (hyperaldosteronism)
Preparation 25/50/100 mg tablets
Monitor K⁺, creatinine at 3 d + 1 wk; gynaecomastia (eplerenone alternative)
Dapagliflozin SGLT2 inhibitor
Dose 10 mg OD (HF ± diabetes)
Preparation 10 mg tablets
Monitor Sick-day rules (hold when fasting/surgery), euglycaemic DKA, genital infections, eGFR
Furosemide PO loop diuretic
Dose 20–80 mg OD/BD, titrate to dry weight
Preparation 20/40/500 mg tablets; take morning/midday
Monitor Daily weight, K⁺, renal function
📖 ESC / ACC-AHA Heart Failure Reviewed July 2026
3. Acute Coronary Syndrome ICU / RESUS ☆ ▸ Casualty: crushing substernal chest pain; risk factors (HTN, smoking, dyslipidaemia)
ABCDE Oxygen only if SpO₂ <90% (not routine); IV access, continuous ECG; aspirin + 2nd antiplatelet; analgesia; activate reperfusion.
Calculators: qtc
Initial orders: ECG (≤10 min) + Troponin; Aspirin 162–325 mg chewed immediately, then 75–100 mg daily + Nitroglycerin SL (morphine only for refractory pain — not routine)
✓ Add 2nd antiplatelet: ticagrelor or prasugrel preferred over clopidogrel — DAPT unless high bleeding risk or on oral anticoagulation (then individualize)
✓ Give also: β-blocker (metoprolol) — avoid if cardiogenic shock, acute HF, bradycardia, hypotension, or high-grade AV block; ACE inhibitor; high-intensity statin (atorvastatin 80 mg or rosuvastatin 20–40 mg); anticoagulation in both STEMI and NSTEMI — agent per reperfusion strategy (UFH with PCI/fibrinolysis; enoxaparin/fondaparinux in NSTEMI)
✓ STEMI — reperfuse: Primary PCI preferred: FMC-to-device ≤90 min (≤120 min if transfer needed). If not achievable → fibrinolysis (tenecteplase preferred) up to 12 h from onset, door/FMC-to-needle ≤30 min, then routine angiography 2–24 h (pharmacoinvasive)
✓ Fibrinolysis only for: STEMI (or true STEMI-equivalent — Sgarbossa/modified Sgarbossa criteria with clinical correlation in LBBB/paced rhythm) — NOT for NSTEMI. New LBBB alone is NOT an automatic STEMI equivalent.
✓ Decision tree STEMI criteria (incl. Sgarbossa if LBBB/paced)?
Yes PCI available within 120 min?
Yes Primary PCI (door-to-balloon <90 min)
No Thrombolysis ≤12 h (door-to-needle <30 min), then transfer for PCI
No NSTEMI/UA pathway: dual antiplatelet + anticoagulant; risk-stratify (GRACE) → early angiography
Order set ECG ≤10 min Troponin (serial) Aspirin 162–325 mg chewed + 2nd antiplatelet U&E, FBC, glucose, lipids CXR Reperfusion pathway (PCI/lysis) Monitor 0 min ECG + troponin; dual antiplatelet; reperfusion decision 10 min Door-to-ECG done; activate cath lab if STEMI 90 min Target door-to-balloon (PCI) 3–6 h Repeat troponin; telemetry 24 h Echo (EF), lipids, secondary prevention Escalate / ICU Ongoing ischaemia / cardiogenic shock Sustained VT/VF or high-grade block Mechanical complication (acute MR, VSD, rupture) Killip III–IV / pulmonary oedema Criteria Admit All ACS
ICU Cardiogenic shock, malignant arrhythmia, mechanical complication
Intubate Cardiac arrest / severe pulmonary oedema
Vasopressors Cardiogenic shock (consider mechanical support)
Transfuse Hospitalized AMI: transfusion to ~10 g/dL reasonable (2025 ACS guideline 2b, MINT; AABB 2025) — not restrictive 7–8
Discharge Reperfused/pain-free, no arrhythmia, EF assessed, secondary prevention + rehab
Never Give thrombolytics for NSTEMI Delay aspirin — give immediately, chewed Key High-sensitivity troponin is the preferred biomarker — 0/1-h or 0/2-h rule-out algorithms; myoglobin/CK-MB no longer routine (CK-MB only for suspected reinfarction). Posterior ECG V7–V9 when posterior MI suspected; right-sided ECG V3R–V4R in inferior STEMI. Radial access preferred for PCI. Immediate bedside echo if shock or mechanical complication (papillary muscle rupture, VSD, free-wall rupture). NSTEMI risk-tiered angiography (<2 h very-high-risk, ≤24 h high-risk). Clinical detail — differentials, red flags, pitfalls, disposition Red flags Ongoing pain Hypotension/shock New murmur Malignant arrhythmia Differentials Aortic dissection PE Pericarditis GORD/musculoskeletal Common mistakes Thrombolysis for NSTEMI Delaying aspirin Missing posterior/RV MI Disposition & follow-up CCU/monitored bed; echo, secondary prevention, cardiac rehab.
Discharge package Medications Dual antiplatelet, high-intensity statin, β-blocker, ACEi; colchicine 0.5 mg daily may be considered (2b)
Follow-up Cardiology + echo; cardiac rehab
Vaccination Influenza
Lifestyle Smoking cessation, diet, activity per rehab
Warning symptoms Recurrent chest pain, breathlessness, syncope
💊 Treatment detail — doses & preparation Aspirin antiplatelet
Dose ACS: 162–325 mg chewed immediately, then 75–100 mg daily. PV/stroke prevention: 75 mg OD
Preparation 300 mg dispersible (chew/dissolve for loading); 75 mg enteric-coated maintenance
Monitor Bleeding, dyspepsia; avoid in viral illness in children
Ticagrelor P2Y12 inhibitor
Dose Load 180 mg PO, then 90 mg BD
Preparation 90 mg tablets (crushable for NG)
Monitor Avoid in prior intracranial haemorrhage/active bleeding; may cause dyspnoea, bradyarrhythmia; bleeding; avoid with strong CYP3A4 inhibitors
Clopidogrel P2Y12 inhibitor
Dose Load 300–600 mg PO, then 75 mg OD
Preparation 75/300 mg tablets
Monitor Bleeding; CYP2C19 poor metabolisers — consider ticagrelor
Unfractionated heparin IV anticoagulant
Dose UFH 60 U/kg (max 4000 U) bolus, then 12 U/kg/h (max 1000 U/h), titrate aPTT 1.5–2.5× — ACS dosing (the 80/18 regimen is for VTE)
Preparation 25,000 U in 250 mL NS (100 U/mL) via pump
Monitor aPTT q6h, platelets day 3–14 (HIT)
Glyceryl trinitrate (nitroglycerin) IV/SL vasodilator
Dose SL 400 mcg spray/tablet; IV 10–200 mcg/min infusion
Preparation 50 mg in 250 mL D5W (200 mcg/mL) in glass bottle/non-PVC set; start 10 mcg/min, titrate q5 min
Monitor BP, headache; tolerance after 24 h — nitrate-free interval
Atorvastatin statin
Dose High-intensity: atorvastatin 80 mg OD post-ACS (or rosuvastatin 20–40 mg)
Preparation 10/20/40/80 mg tablets, any time of day
Monitor LFTs baseline, muscle symptoms; target LDL reduction ≥50%
📖 ESC ACS / ACC-AHA Reviewed July 2026
4. Aortic Stenosis URGENT ☆ ▸ Elderly: exertional dyspnoea, syncope, angina; crescendo-decrescendo systolic murmur 2nd R ICS → carotids; louder on squatting, softer with Valsalva
Bedside maneuvers → then Echocardiogram (diagnostic: valve area, gradient, LVH)
✓ Symptomatic severe AS → Aortic Valve Replacement (surgical AVR or TAVR) — before LV dilation
✓ Valve choice: bioprosthetic preferred in elderly (no lifelong warfarin); mechanical needs INR 2–3
✓ Order set Echo (gradient, valve area, EF) ECG CXR Coronary angiography pre-op Criteria Admit Syncope, heart failure, or ACS-like presentation
ICU Haemodynamic instability peri-procedure
Discharge Symptoms controlled and valve intervention plan in place
Never Give diuretics / nitrates / vasodilators — ↓ LV filling → syncope/arrest Use balloon valvuloplasty (valve re-stenoses quickly) Key No medical therapy prolongs survival — replacement is the answer once symptomatic. Clinical detail — differentials, red flags, pitfalls, disposition Red flags Syncope Angina Heart failure — all mark severe symptomatic AS Differentials HOCM Mitral regurgitation Aortic sclerosis Common mistakes Vasodilators/diuretics dropping preload Delaying valve referral Disposition & follow-up Symptomatic severe → prompt surgical/TAVR referral.
Discharge package Medications Treat comorbid HTN cautiously; avoid excess vasodilators
Follow-up Cardiology; timing of valve intervention
Warning symptoms Exertional syncope, angina, breathlessness
💊 Treatment detail — doses & preparation Vasodilator caution safety
Dose Avoid nitrates/ACEi in severe AS (fixed output — precipitous hypotension)
Preparation —
Monitor Echo gradient + BP tolerance before any afterload reduction
Aortic valve replacement definitive
Dose SAVR (young/low-risk) or TAVR (older/high-risk) once symptomatic severe
Preparation Pre-op: echo, CT annulus sizing, coronary assessment
Monitor Watch for heart block post-TAVR
📖 ESC/EACTS Valvular Heart Disease Reviewed July 2026
5. Mitral Stenosis URGENT ☆ ▸ Rheumatic fever in childhood (common in India): dyspnoea, haemoptysis, AF; diastolic rumble + opening snap, loud S1 at apex
Diagnostic: Echocardiogram (valve area, calcification)
✓ Rate control: Metoprolol (↑ diastolic filling time); diuretic for congestion; AF in rheumatic MS → anticoagulate with warfarin (INR 2–3) — DOACs contraindicated (INVICTUS)
✓ Definitive: Balloon valvuloplasty (safe in pregnancy) → surgical repair/replacement if unsuitable
✓ Order set Echo ECG (AF/LA enlargement) CXR Anticoagulate if AF — warfarin (INR 2–3); DOACs NOT indicated in rheumatic MS (INVICTUS) Criteria Admit Decompensation, new AF, haemoptysis
Discharge Rate-controlled, anticoagulated with warfarin if AF, valvuloplasty referral
Key Worsens with tachycardia/pregnancy (less diastolic filling time). AF with moderate–severe rheumatic MS → vitamin-K antagonist (warfarin, INR 2–3). DOACs are contraindicated in rheumatic MS (2020 ACC/AHA VHD Class 1; INVICTUS). Clinical detail — differentials, red flags, pitfalls, disposition Red flags Haemoptysis New AF with instability Pregnancy decompensation Differentials Left atrial myxoma Cor triatriatum Pulmonary HTN other cause Common mistakes Tachycardia worsening filling Missing rheumatic history Disposition & follow-up Balloon valvuloplasty referral; endocarditis awareness.
Discharge package Medications Rate control; anticoagulation if AF
Follow-up Cardiology; valvuloplasty planning
Warning symptoms Breathlessness, haemoptysis, palpitations
💊 Treatment detail — doses & preparation Metoprolol β-blocker
Dose IV 2.5–5 mg q5 min ×3; PO 25–100 mg BD (succinate OD for HF)
Preparation IV 1 mg/mL ampoule undiluted, slow push; PO immediate- vs extended-release not interchangeable mg-for-schedule
Monitor HR, BP; avoid in decompensated HF/asthma/high-grade block
Furosemide PO loop diuretic
Dose 20–80 mg OD/BD, titrate to dry weight
Preparation 20/40/500 mg tablets; take morning/midday
Monitor Daily weight, K⁺, renal function
Digoxin cardiac glycoside
Dose Load 500 mcg PO/IV ×2, 6 h apart, then 62.5–250 mcg OD (lower in elderly/CKD)
Preparation PO tablets/elixir; IV 250 mcg/mL dilute in 50 mL NS over ≥10 min
Monitor Level 6 h post-dose (target 0.5–0.9), K⁺, Mg²⁺, renal function, toxicity signs
Warfarin VKA anticoagulant
Dose Load 5 mg OD ×2 d then INR-guided; target INR 2–3 (valves may differ)
Preparation 0.5/1/3/5 mg tablets — colour-coded
Monitor INR q2–3 d until stable; diet consistency, interactions (amiodarone, antibiotics)
📖 ESC/EACTS Valvular Heart Disease Reviewed July 2026
6. Atrial Fibrillation EMERGENCY ☆ ▸ Irregularly irregular pulse, no P waves, rapid rate
Calculators: chads hasbled
Unstable (chest pain, CHF, ↓SBP, confusion) → Immediate synchronized cardioversion (AF/AFL: begin at 200 J biphasic)
✓ Stable → rate control (or early rhythm control): β-blocker (metoprolol) OR CCB (diltiazem/verapamil) OR digoxin. Early rhythm control (within 12 months of diagnosis) reduces cardiovascular outcomes in selected patients (EAST-AFNET 4, Class 2a); catheter ablation is Class 1 first-line rhythm control in selected patients (younger, few comorbidities, HFrEF)
✓ Anticoagulate by CHA₂DS₂-VASc: men ≥1 / women ≥2 → consider; men ≥2 / women ≥3 → DOAC (apixaban/rivaroxaban/dabigatran) preferred over warfarin. Aspirin NOT recommended for stroke prevention
✓ Decision tree Haemodynamically unstable (chest pain, CHF, ↓BP, ↓GCS)?
Yes Immediate synchronised cardioversion
No Onset <48 h or anticoagulated/TEE clear?
Yes Rate control; cardiovert if chosen; start anticoagulation by CHA₂DS₂-VASc
No Rate control + anticoagulate ≥3 wk before elective cardioversion (or TEE-guided)
Order set ECG U&E, Mg, TFT Troponin if ischaemic Echo Rate control + anticoagulation decision Criteria Admit Instability, ischaemia, or heart failure from AF
ICU Refractory instability needing cardioversion/support
Discharge Rate controlled, anticoagulation decided (CHA₂DS₂-VASc), reversible causes addressed
Never Anticoagulate for AF <48 h before cardioversion without TEE Chemically convert before controlling rate Key Early rhythm control (≤12 months of diagnosis) reduces cardiovascular outcomes in selected patients (EAST-AFNET 4); rate control remains appropriate for many. Catheter ablation is Class 1 first-line rhythm control in selected patients; LAA occlusion (Class 2a) if long-term anticoagulation contraindicated. Pre-excited AF (WPW + AF) → procainamide or ibutilide; avoid AV-nodal blockers (see case 7). Clinical detail — differentials, red flags, pitfalls, disposition Red flags Hypotension/chest pain/CHF → cardiovert Pre-excited AF Differentials Atrial flutter MAT Frequent ectopy Common mistakes Aspirin for stroke prevention AV-nodal blockers in WPW Cardioverting >48 h without anticoagulation/TEE Disposition & follow-up Rate control, CHA₂DS₂-VASc-based anticoagulation, outpatient rhythm review.
Discharge package Medications Rate control; anticoagulation per CHA₂DS₂-VASc
Follow-up Review rhythm/rate; anticoagulation monitoring
Lifestyle Alcohol moderation, treat OSA, BP control
Warning symptoms Palpitations with chest pain/syncope, bleeding on anticoagulant
💊 Treatment detail — doses & preparation Metoprolol β-blocker
Dose IV 2.5–5 mg q5 min ×3; PO 25–100 mg BD (succinate OD for HF)
Preparation IV 1 mg/mL ampoule undiluted, slow push; PO immediate- vs extended-release not interchangeable mg-for-schedule
Monitor HR, BP; avoid in decompensated HF/asthma/high-grade block
Diltiazem non-DHP CCB
Dose IV 0.25 mg/kg over 2 min, then 5–15 mg/h; PO 60–120 mg TDS (MR OD available)
Preparation IV 25 mg in 5 mL undiluted or in 100 mL NS; infusion 125 mg in 500 mL NS
Monitor HR, BP, AV block; avoid in HFrEF/WPW
Digoxin cardiac glycoside
Dose Load 500 mcg PO/IV ×2, 6 h apart, then 62.5–250 mcg OD (lower in elderly/CKD)
Preparation PO tablets/elixir; IV 250 mcg/mL dilute in 50 mL NS over ≥10 min
Monitor Level 6 h post-dose (target 0.5–0.9), K⁺, Mg²⁺, renal function, toxicity signs
Apixaban DOAC (anti-Xa)
Dose 5 mg BD (2.5 mg BD if ≥2 of: age ≥80, weight ≤60 kg, Cr ≥133). PE/DVT: 10 mg BD ×7 d then 5 mg BD
Preparation 2.5/5 mg tablets (crushable)
Monitor Bleeding, renal function; no routine monitoring
Amiodarone IV antiarrhythmic
Dose Arrest: 300 mg IV/IO bolus (then 150 mg). Stable: 150 mg over 10 min, then 1 mg/min ×6 h, 0.5 mg/min ×18 h
Preparation Bolus 300 mg in 20–50 mL D5W; infusion 900 mg in 500 mL D5W (glass/non-PVC)
Monitor QT, LFTs, thyroid; long half-life — interacts with warfarin/digoxin
📖 ESC / ACC-AHA-HRS Atrial Fibrillation Reviewed July 2026
7. SVT / VT / WPW ICU / RESUS ☆ ▸ SVT: narrow, regular, fast. VT: wide. WPW: delta wave, short PR
ABCDE Assess stability; unstable → synchronised DCCV (pulseless VT → defibrillate); correct electrolytes.
Calculators: qtc
Check first: Ca, Mg, K, O2 levels (low levels provoke arrhythmia)
✓ SVT (stable): Vagal / carotid massage → Adenosine 6 mg → 12 mg IV push → if fails, diltiazem/verapamil IV bolus
✓ VT (stable, normal BP): IV procainamide or amiodarone 150 mg IV over 10 min (co-equal — PROCAMIO favored procainamide; sotalol removed from 2025 AHA algorithm)
✓ VT unstable / hypotension → synchronized cardioversion (narrow-complex 100 J; monomorphic VT 100 J; AF/AFL 200 J; polymorphic VT → unsynchronized defibrillation dose); pulseless → defibrillate
✓ WPW with AF: Procainamide 20–50 mg/min IV (best)
✓ Decision tree Pulse present?
Yes Haemodynamically stable?
Yes Narrow complex (SVT)?
Yes Vagal → adenosine → AV-nodal blocker
No VT: procainamide or amiodarone (avoid AV-nodal blockers if WPW)
No Synchronised cardioversion
No Defibrillate + ALS (pulseless VT/VF)
Order set ECG (12-lead) + rhythm strip K⁺, Mg, Ca Continuous monitoring Pads on Criteria Admit Sustained/haemodynamically significant arrhythmia
ICU Recurrent VT/instability, post-arrest
Intubate Post-arrest / peri-arrest
Discharge Rhythm controlled, electrolytes corrected, EP referral
Never Give AV-nodal blockers (adenosine, digoxin, β-blocker, verapamil) in WPW+AF → VF Transfer an unstable patient elsewhere Key Ablation is curative for recurrent SVT/WPW. Clinical detail — differentials, red flags, pitfalls, disposition Red flags Instability → synchronised DCCV Pulseless VT → defibrillate Differentials Sinus tachycardia AF/flutter with aberrancy Artefact Common mistakes AV-nodal blockers in WPW+AF Treating VT as SVT Disposition & follow-up EP referral; consider ablation/ICD.
Discharge package Medications As indicated; avoid AV-nodal blockers in WPW
Follow-up Electrophysiology; consider ablation/ICD
Warning symptoms Palpitations with syncope, chest pain
💊 Treatment detail — doses & preparation Adenosine antiarrhythmic
Dose 6 mg rapid IV push → 12 mg → 12 mg if no response
Preparation Push undiluted (3 mg/mL) fast via proximal port, immediate 20 mL flush, raise arm
Monitor Transient asystole/flushing expected; avoid in WPW+AF, asthma caution
Diltiazem non-DHP CCB
Dose IV 0.25 mg/kg over 2 min, then 5–15 mg/h; PO 60–120 mg TDS (MR OD available)
Preparation IV 25 mg in 5 mL undiluted or in 100 mL NS; infusion 125 mg in 500 mL NS
Monitor HR, BP, AV block; avoid in HFrEF/WPW
Amiodarone IV antiarrhythmic
Dose Arrest: 300 mg IV/IO bolus (then 150 mg). Stable: 150 mg over 10 min, then 1 mg/min ×6 h, 0.5 mg/min ×18 h
Preparation Bolus 300 mg in 20–50 mL D5W; infusion 900 mg in 500 mL D5W (glass/non-PVC)
Monitor QT, LFTs, thyroid; long half-life — interacts with warfarin/digoxin
Procainamide IV class Ia antiarrhythmic
Dose Stable monomorphic VT or WPW+AF: 20–50 mg/min IV until arrhythmia suppressed, hypotension, QRS widens >50%, or max 17 mg/kg; then 1–4 mg/min
Preparation 100 mg/mL vial; infuse via pump with continuous ECG + BP monitoring
Monitor Hypotension, QRS/QT widening; avoid in prolonged QT/HFrEF caution; co-equal with amiodarone for stable VT (2025 AHA)
Magnesium sulfate IV electrolyte/antiarrhythmic
Dose Torsades: 2 g over 10–15 min. Asthma: 2 g over 20 min. Eclampsia: 4 g load then 1 g/h
Preparation 2 g in 100 mL NS via pump; eclampsia 4 g in 100–200 mL
Monitor Reflexes/RR if high doses (toxicity), Mg²⁺ level, renal function
📖 ESC / AHA-ACC-HRS Arrhythmias Reviewed July 2026
8. Pericardial Tamponade ICU / RESUS ☆ ▸ Hypotension + ↑JVP + muffled sounds (Beck); pulsus paradoxus >10 mmHg; electrical alternans; effusion/post-MI
ABCDE O₂, IV fluids to bridge; urgent echo; pericardiocentesis without delay if unstable.
Temporize: Normal saline boluses IV to raise BP (recheck after each bolus)
✓ Definitive — do NOT wait for echo/cath: Pericardiocentesis (removing even ~50 mL restores filling)
✓ Decision tree Haemodynamically unstable?
Yes IV fluids to bridge → urgent pericardiocentesis (don't wait for imaging)
No Echo to confirm; monitored pericardiocentesis; treat cause
Order set Urgent echo ECG (electrical alternans) IV fluids Prepare pericardiocentesis Escalate / ICU Haemodynamic collapse Emergent pericardiocentesis Recurrent effusion → window Criteria Admit All tamponade
ICU Peri/post-drainage monitoring, recurrence
Vasopressors Bridge only until drainage
Discharge Effusion drained, cause treated, no re-accumulation on echo
Never Give diuretics/vasodilators — worsens filling Key Earliest echo sign = diastolic RA/RV collapse. Clinical detail — differentials, red flags, pitfalls, disposition Red flags Beck triad Pulsus paradoxus Haemodynamic collapse Differentials Tension pneumothorax Massive PE RV infarct Constrictive pericarditis Common mistakes Diuretics/vasodilators Waiting for imaging before draining unstable patient Disposition & follow-up Drain; treat cause; monitor for re-accumulation.
Discharge package Medications Treat underlying cause (e.g., colchicine/NSAID if pericarditic)
Follow-up Repeat echo for re-accumulation
Warning symptoms Breathlessness, chest pain, dizziness
💊 Treatment detail — doses & preparation 0.9% Sodium chloride crystalloid
Dose Bolus 500 mL over 15–30 min, reassess; maintenance 1–1.5 mL/kg/h
Preparation 500/1000 mL bags; add KCl only after urine output confirmed
Monitor Hyperchloraemic acidosis with large volumes — prefer balanced (LR) for resuscitation
Noradrenaline (norepinephrine) vasopressor
Dose 0.05–1 mcg/kg/min IV infusion, titrate to MAP ≥65
Preparation 4 mg in 250 mL D5W or NS (16 mcg/mL) via infusion pump; central line preferred — proximal peripheral vein acceptable short-term
Monitor Continuous invasive MAP; check limb perfusion, urine output; wean gradually, never stop abruptly
Pericardiocentesis definitive
Dose Echo-guided needle drainage — removing even 50 mL restores filling
Preparation Subxiphoid approach, echo guidance, monitor on
Monitor Watch for re-accumulation; send fluid for cytology/culture
📖 ESC Pericardial Diseases Reviewed July 2026
9. Complete Heart Block ICU / RESUS ☆ ▸ AV dissociation, bradycardia, syncope, cannon a-waves
ABCDE Monitor + pads; atropine; transcutaneous pacing if unstable; treat reversible causes.
Symptomatic bradycardia: Atropine 1 mg IV every 3–5 min (max 3 mg)
✓ If atropine insufficient → Transcutaneous pacing
✓ Definitive → Permanent pacemaker
✓ Decision tree Adverse signs (shock, syncope, ischaemia, HF)?
Yes Responds to atropine?
Yes Observe; identify reversible cause; plan pacing
No Transcutaneous pacing → transvenous → permanent pacemaker
No Monitor; permanent pacemaker for high-grade/symptomatic block
Order set ECG Continuous monitoring Atropine ready Transcutaneous pacing pads K⁺, drug review, troponin Criteria Admit All symptomatic/high-grade block
ICU Unstable awaiting pacing
Discharge Paced (temporary→permanent), reversible causes excluded
Never Delay transcutaneous pacing while escalating drugs in unstable bradycardia — drugs are a bridge only Key Atropine blocks ACh at SA/AV node → ↑ rate; often fails in infranodal block → pace. Atropine ineffective → dopamine infusion 5–20 mcg/kg/min or epinephrine infusion 2–10 mcg/min are equal second-line alternatives to pacing (2025 AHA); temporary transvenous pacing reasonable (Class 2a) for persistent unstable bradycardia. Clinical detail — differentials, red flags, pitfalls, disposition Red flags Syncope Haemodynamic instability Wide escape/asystole pauses Differentials High-grade AV block Sinus arrest Drug/electrolyte cause Common mistakes Relying on drugs alone when pacing is indicated Missing reversible cause (drugs, ↑K⁺, ischaemia) Disposition & follow-up Pacing → permanent pacemaker.
Discharge package Medications Review AV-blocking drugs
Follow-up Pacemaker clinic
Warning symptoms Syncope, dizziness, device-site issues
💊 Treatment detail — doses & preparation Atropine antimuscarinic
Dose Bradycardia: 1 mg IV q3–5 min (max 3 mg). Organophosphate: 1–2 mg IV bolus, double q5 min until secretions dry, then infusion 10–20% of loading dose/h
Preparation 1 mg/mL ampoule undiluted; organophosphate needs many mg — stock 10+ ampoules
Monitor HR, secretions, pupils (not a target in OP); tachycardia, urinary retention
Adrenaline infusion vasopressor/inotrope
Dose 0.05–1 mcg/kg/min IV infusion, titrate to effect
Preparation 4 mg in 250 mL D5W/NS (16 mcg/mL) via pump; central access for prolonged use
Monitor Tachycardia, arrhythmia, lactate rise; invasive MAP
Pacing definitive
Dose Transcutaneous pads NOW if unstable → transvenous wire → permanent pacemaker
Preparation Pads front-back, start 60–80 bpm, increase mA until capture
Monitor Check mechanical capture by pulse, not just ECG
📖 ESC Pacing / ACC-AHA Bradycardia Reviewed July 2026
10. Mitral Regurgitation URGENT ☆ ▸ Holosystolic murmur at apex → axilla, soft S1
Confirms it: Echocardiogram
✓ Chronic primary MR (normotensive, preserved LV): Vasodilators NOT indicated (2020 ACC/AHA COR 3 No Benefit) — treat hypertension if present; vasodilators/HF GDMT are for secondary (functional) MR
✓ Severe / symptomatic / ↓EF → Valve repair or replacement; transcatheter edge-to-edge repair (MitraClip) if prohibitive surgical risk (2a), or secondary MR despite GDMT (COAPT)
✓ Acute (papillary muscle rupture post-MI) → emergency surgery + afterload reduction/IABP
✓ Order set Echo (severity, EF) ECG CXR Criteria Admit Acute severe MR / pulmonary oedema
ICU Acute papillary rupture — pre-op support
Vasopressors Bridge with afterload reduction/IABP
Discharge Stable, surveillance or surgical plan
Clinical detail — differentials, red flags, pitfalls, disposition Red flags Acute severe (papillary rupture) with oedema/shock Differentials Aortic stenosis (radiation) VSD Tricuspid regurgitation Common mistakes Missing acute MR post-MI Delaying surgery in severe symptomatic MR Disposition & follow-up Chronic primary MR → surveillance + treat hypertension; severe/symptomatic → surgery (TEER if prohibitive risk).
Discharge package Medications No routine vasodilators in primary MR (treat hypertension); HF GDMT for secondary MR
Follow-up Cardiology + serial echo
Warning symptoms Breathlessness, palpitations, oedema
💊 Treatment detail — doses & preparation Enalapril ACE inhibitor
Dose Start 2.5–5 mg BD, titrate to 10–20 mg BD
Preparation 2.5/5/10/20 mg tablets
Monitor Creatinine + K⁺ at 1–2 wk; cough/angioedema
Furosemide PO loop diuretic
Dose 20–80 mg OD/BD, titrate to dry weight
Preparation 20/40/500 mg tablets; take morning/midday
Monitor Daily weight, K⁺, renal function
Valve surgery definitive
Dose Repair preferred over replacement for severe symptomatic MR
Preparation Pre-op echo + coronary angiography
Monitor Post-op warfarin (mechanical) or antiplatelet (tissue/repair)
📖 ESC/EACTS Valvular Heart Disease Reviewed July 2026
11. Peripheral Arterial Disease STABLE ☆ ▸ Claudication, ↓ pulses, shiny hairless skin; smoker
First test: ABI <0.9 = disease (<0.6 severe)
✓ Confirms it: Angiography — only before revascularization, not to diagnose
✓ Treat: Smoking cessation (counsel) + high-intensity statin + rivaroxaban 2.5 mg BD combined with low-dose aspirin (Class 1, 2024 ACC/AHA PAD GL; clopidogrel 75 mg alone is a reasonable antiplatelet alternative); cilostazol for claudication
✓ Severe/critical ischaemia → Revascularization / bypass
✓ Order set ABI Doppler Lipids, HbA1c Foot exam Criteria Admit Critical limb / acute limb ischaemia
ICU Post-revascularisation instability
Discharge Risk factors addressed, revascularisation plan, wound care
Key Cilostazol contraindicated in heart failure. Rivaroxaban 2.5 mg BD + low-dose aspirin is Class 1 to reduce MACE and limb events in PAD (2024 ACC/AHA; COMPASS/VOYAGER). Clinical detail — differentials, red flags, pitfalls, disposition Red flags Rest pain Ulcer/gangrene Sudden cold pulseless limb (acute ischaemia) Differentials Spinal stenosis Venous claudication Arthritis Common mistakes Angiography before non-invasive testing Missing critical limb ischaemia Disposition & follow-up Risk-factor control, supervised exercise; vascular referral if critical.
Discharge package Medications Rivaroxaban 2.5 mg BD + aspirin 75 mg + high-intensity statin; cilostazol for claudication
Follow-up Vascular; supervised exercise
Vaccination —
Lifestyle Smoking cessation essential; foot care
Warning symptoms Rest pain, non-healing ulcer, sudden cold pale limb
💊 Treatment detail — doses & preparation Aspirin antiplatelet
Dose ACS: 150–325 mg chewed once, then 75 mg OD. PV/stroke prevention: 75 mg OD
Preparation 300 mg dispersible (chew/dissolve for loading); 75 mg enteric-coated maintenance
Monitor Bleeding, dyspepsia; avoid in viral illness in children
Clopidogrel P2Y12 inhibitor
Dose Load 300–600 mg PO, then 75 mg OD
Preparation 75/300 mg tablets
Monitor Bleeding; CYP2C19 poor metabolisers — consider ticagrelor
Atorvastatin statin
Dose 20–80 mg OD (post-ACS 80 mg)
Preparation 10/20/40/80 mg tablets, any time of day
Monitor LFTs baseline, muscle symptoms; target LDL reduction ≥50%
Cilostazol PDE3 inhibitor
Dose 100 mg BD (50 mg with CYP3A4/2C19 inhibitors)
Preparation 50/100 mg tablets, 30 min before food
Monitor Avoid in heart failure; headache, palpitations
📖 ESC Peripheral Arterial Disease Reviewed July 2026
Transient LOC with spontaneous recovery
First, for everyone: ECG + Telemetry + orthostatic vitals + glucose (90% of syncope mortality is cardiac)
✓ Next: Echocardiogram (structural). Head CT low-yield unless focal/trauma
✓ Recurrent, benign features → Tilt-table (vasovagal)
✓ Order set ECG Lying/standing BP Glucose Telemetry Echo if structural suspicion Criteria Admit Cardiac syncope, abnormal ECG, or high-risk features
ICU Malignant arrhythmia
Discharge Benign (vasovagal/orthostatic) cause, normal ECG, safety-netting
Key Exertional syncope → AS/HCM. Sudden, no prodrome → arrhythmia. Clinical detail — differentials, red flags, pitfalls, disposition Red flags Exertional syncope No prodrome Family history sudden death Abnormal ECG Differentials Vasovagal Orthostatic Arrhythmia Seizure AS/HOCM/PE Common mistakes Over-ordering head CT Discharging cardiac syncope Disposition & follow-up Cardiac features → admit/monitor; benign → reassure + safety advice.
Discharge package Medications Review culprit drugs
Follow-up Cardiology if cardiac features
Lifestyle Hydration/salt for vasovagal; driving advice
Warning symptoms Exertional syncope, palpitations, injury
💊 Treatment detail — doses & preparation Fludrocortisone mineralocorticoid
Dose 50–200 mcg OD
Preparation 100 mcg tablets
Monitor BP, K⁺, oedema
Midodrine α1-agonist
Dose 2.5–10 mg TDS (last dose before 6 pm)
Preparation 2.5/5 mg tablets
Monitor Supine hypertension, urinary retention
Cardiac syncope work-up safety
Dose Telemetry + echo first — treat the cause, not the symptom
Preparation —
Monitor Driving restrictions until cause addressed
📖 ESC Syncope Reviewed July 2026
2
Hematology 1. Sickle Cell Crisis EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Autoimmune Hemolysis URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. G6PD Deficiency URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Paroxysmal Nocturnal Hemoglobinuria URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
5. HUS / TTP ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
6. Immune Thrombocytopenic Purpura URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
7. Clotting Factor Deficiency (Hemophilia) URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
8. Thrombophilia / DVT / HIT URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Endocrinology 1. Diabetic Ketoacidosis ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Hyperosmolar Hyperglycaemic State (HHS) EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Hypoglycaemia (Severe, Inpatient) EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Adrenal Crisis ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Neurology 1. Stroke (Ischaemic) ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Myasthenia Gravis EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Subarachnoid Haemorrhage ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Guillain-Barré Syndrome EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
5. Meningitis (Bacterial) ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
6. Head Trauma — Subdural Hematoma EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Gastroenterology 1. Gastrointestinal Bleeding ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Inflammatory Bowel Disease URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Acute Pancreatitis EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Decompensated Cirrhosis (Ascites, SBP, Encephalopathy) EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Nephrology 1. Acute Kidney Injury — Prerenal URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Acute Tubular Necrosis (incl. Rhabdomyolysis) EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Nephrotic Syndrome (Membranous) URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. End-Stage Renal Failure / Dialysis URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
6. Central Diabetes Insipidus EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
7. Hyperkalaemia / Tumour Lysis ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Pulmonary 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Pneumonia (CAP) EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Pneumocystis (PCP) Pneumonia EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
6. Pulmonary Embolus EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Rheumatology 1. Systemic Lupus Erythematosus URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Septic Arthritis (Acute Hot Joint) EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Oncology 1. Multiple Myeloma URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Tumour Lysis Syndrome EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Febrile Neutropenia EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Hypercalcaemia of Malignancy URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Infectious Disease 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Endocarditis EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Pyelonephritis EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
5. Infectious Diarrhea URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
7. Dengue with Warning Signs EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Emergency / Toxicology 1. Tricyclic Antidepressant Overdose ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Paracetamol Overdose URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Aspirin / Salicylate Overdose ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Carbon Monoxide Poisoning ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
5. Ethylene Glycol / Methanol ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
6. Organophosphate Poisoning ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
7. Snakebite Envenomation ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
8. Digoxin Toxicity ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
9. Drowning / Hypothermia ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
10. Neuroleptic Malignant Syndrome ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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Critical Care / ICU 1. Sepsis & Septic Shock ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Undifferentiated Shock & Vasopressor Guide ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Anaphylaxis ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Acute Respiratory Failure — Initial Ventilator Setup ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
6. Status Epilepticus ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
7. Aortic Dissection ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
8. Hypertensive Emergency ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
9. Cardiac Arrest & Post-ROSC Care ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
10. Acute Liver Failure ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
13
Miscellaneous 1. Invasive Fungal Infection in the ICU ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
2. Clostridioides difficile and ICU Diarrhoea URGENT ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
3. Coagulopathy in the Bleeding Patient ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
4. Rheumatological Emergencies EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
5. The Transplant Patient with Fever EMERGENCY ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
6. Thyroid Storm and Myxoedema Coma ICU / RESUS ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
7. Device-Associated Infection Prevention Bundles STABLE ☆ ▸ 🔒 This case opens with a referral from any ICU Decoded member, or by applying with your registration. Get access
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