SMLE key terms

A state in which tissue oxygen delivery falls below metabolic demand, producing cellular dysfunction. It is recognised by low blood pressure, fast pulse, cool or warm skin, reduced urine output and altered consciousness, and is classified as hypovolaemic, cardiogenic, distributive or obstructive.

Life-threatening organ dysfunction caused by a dysregulated host response to infection. Diagnosis requires suspected or confirmed infection plus evidence of organ dysfunction such as raised respiratory rate, low blood pressure, confusion or elevated lactate.

A product of anaerobic glucose metabolism measured in blood. Values rise when tissues are poorly perfused or when cells cannot use oxygen efficiently, so a raised level supports the diagnosis of shock and guides resuscitation.

A resting heart rate above the normal range for age, generally over 100 beats per minute in adults. It is a compensatory response to fever, pain, bleeding, dehydration or anxiety, and may also reflect a primary rhythm disorder.

A resting heart rate below the normal range, usually under 60 beats per minute in adults. It may be physiological in athletes or caused by drugs, hypothyroidism, raised intracranial pressure or conduction disease, and becomes dangerous when cardiac output falls.

Impaired conduction of electrical impulses from the atria to the ventricles, graded first, second and third degree. Complete block causes slow, unreliable ventricular rates with dizziness or syncope and often requires pacing.

A brief, self-limiting loss of consciousness caused by transient reduced cerebral blood flow, with spontaneous full recovery. It is distinguished from seizures by the absence of post-ictal confusion and by precipitating factors such as standing or pain.

A transient episode of abnormal electrical activity in the brain producing altered behaviour, movement, sensation or consciousness. Causes include epilepsy, hypoglycaemia, infection, head injury and drug withdrawal.

Continuous seizure activity lasting five minutes or more, or repeated seizures without recovery of consciousness between them. It is a medical emergency requiring airway support, glucose measurement, benzodiazepines and treatment of the underlying cause.

A scoring system from 3 to 15 that grades eye opening, verbal response and best motor response. It standardises the description of consciousness after head injury and other acute brain insults and guides airway decisions.

An abnormality in blood hydrogen ion concentration described by pH, partial pressure of carbon dioxide and bicarbonate. Primary problems are respiratory or metabolic, and compensation is assessed by comparing measured values with expected responses.

The difference between measured serum sodium and the sum of chloride and bicarbonate. A raised gap indicates accumulation of unmeasured acids such as ketones, lactate or toxins, and helps classify metabolic acidosis.

Serum potassium above the normal range, usually over 5.5 millimoles per litre. It causes muscle weakness and dangerous cardiac rhythm changes, particularly with renal failure, acidosis or drugs that impair potassium excretion.

A recording of the heart's electrical activity from surface electrodes. It identifies rhythm, rate, conduction intervals, ischaemia and electrolyte effects, and is essential in chest pain, palpitations and collapse.

Death of heart muscle caused by prolonged loss of blood supply, usually from coronary artery thrombosis. It presents with chest pain, sweating and nausea, and is confirmed by raised cardiac troponin and characteristic electrocardiographic changes.

A protein released from damaged heart muscle into the blood. High-sensitivity assays detect small amounts, and a rise or fall across serial samples supports the diagnosis of acute myocardial infarction.

A clinical pattern of fever or low temperature, fast pulse, fast breathing and abnormal white cell count. It signals widespread inflammation from infection, trauma, burns or pancreatitis but is not specific to any single cause.

The coordinated effort to use antimicrobials only when indicated, at the correct dose, route and duration. It aims to improve patient outcomes, reduce adverse effects and limit the emergence of resistant organisms.

Inflammation of the membranes covering the brain and spinal cord, usually from infection. Typical features are fever, severe headache, neck stiffness and photophobia; bacterial causes require urgent antibiotics and sometimes steroids.

Insertion of a needle into the spinal subarachnoid space to sample cerebrospinal fluid or give drugs. Fluid is analysed for cells, protein, glucose and organisms, and opening pressure can be measured.

A pregnancy-specific disorder of new hypertension after 20 weeks with proteinuria or other organ dysfunction. It threatens mother and fetus and can progress to seizures, liver and kidney injury, or placental abruption.

The occurrence of generalised seizures in a woman with preeclampsia, without another cause. It is an obstetric emergency requiring airway protection, magnesium sulphate and prompt delivery planning.

New raised blood pressure arising after 20 weeks of pregnancy without proteinuria or other organ involvement. It requires close monitoring because a proportion of cases later develop preeclampsia.

Excessive bleeding after childbirth, conventionally over 500 millilitres after vaginal birth or 1000 after caesarean. Causes are grouped as tone, trauma, tissue and thrombin abnormalities, and treatment begins with uterine massage and uterotonics.

Failure of the uterus to contract firmly after delivery, allowing continued bleeding from placental vessels. It is the commonest cause of postpartum haemorrhage and is managed with massage, oxytocin and other uterotonic drugs.

Infection of the genital tract or pelvis arising during or after childbirth. Fever, abdominal pain, offensive discharge and delayed uterine involution suggest the diagnosis, which requires cultures and prompt broad-spectrum antibiotics.

Yellow discolouration of skin and eyes in a newborn caused by raised bilirubin. It is common and usually physiological, but onset within 24 hours, rapid rise or prolonged course requires investigation for haemolysis, infection or biliary disease.

Permanent brain injury caused by bilirubin deposition in the basal ganglia of a jaundiced newborn. It is prevented by monitoring bilirubin levels and treating significant hyperbilirubinaemia with phototherapy or exchange transfusion.

Feeding an infant directly with human milk, ideally exclusively for the first six months. It provides nutrition, immune factors and bonding, and correct latch and positioning prevent most early feeding problems.

Inadequate physical growth in a child, shown by weight falling across growth centile lines over time. Causes include undernutrition, feeding difficulties, chronic illness and neglect, and assessment focuses on intake, growth charts and social circumstances.

A state of deficiency or imbalance in energy, protein or micronutrients that impairs body function. It is assessed by weight, height, body mass index, dietary history and biochemical markers, and increases complications of illness and surgery.

The coordinated management of a patient before, during and after surgery. It covers risk assessment, optimisation of comorbidity, anaesthetic planning, prevention of infection and thrombosis, and early recovery and rehabilitation.

Formation of thrombus in a vein with potential embolisation to the lungs, presenting as deep vein thrombosis or pulmonary embolism. Risk is increased by immobility, surgery, cancer and pregnancy, and is reduced by prophylaxis.

Obstruction of pulmonary arteries by material, usually thrombus from leg veins. It causes sudden breathlessness, chest pain, low oxygen saturation and sometimes collapse, and is confirmed by computed tomography angiography or other imaging.

Inflammation of the vermiform appendix, typically causing pain that migrates to the right lower abdomen with anorexia, nausea and tenderness. Untreated it can perforate, so surgical removal is the usual treatment.

Inflammation of the peritoneal lining, which may be infective or chemical. It produces severe abdominal pain, guarding and rigidity, and generalised bacterial peritonitis is a surgical emergency requiring resuscitation and source control.

An increase in the number of white blood cells above the reference range. It occurs in infection, inflammation, stress and leukaemia, and the differential count helps distinguish bacterial from other causes.

A persistent disorder of low mood or loss of interest lasting at least two weeks, with changes in sleep, appetite, energy, concentration and self-worth. Severity and suicide risk determine whether talking therapy, medication or urgent referral is needed.

A structured enquiry into thoughts, plans, intent, means and protective factors in a person who may harm themselves. It guides the level of observation, safety planning and referral, and should be documented clearly.

A toxic reaction to drugs that increase serotonin activity, causing agitation, tremor, clonus, sweating and fever. It is a clinical diagnosis and management includes stopping the drug, cooling and supportive care.