…The patient lies on their side with the knee slightly flexed. Place the palm on the greater trochanter with the index finger towards the anterior…

…support above the expiratory pressure and thereby increases ventilation and lowers the carbon dioxide. Pulmonary oedema calls for the former, a COPD exacerbation with carbon…

…to adults in sinus rhythm, recorded at a paper speed of 50 mm/s with 1 mV = 10 mm. At 50 mm/s a…

…access. Grading There is no entirely uniform international grading. The following division is clinically useful and is consistent with commonly used guidelines [1,3]. Level…

…single blood pressure value does not define a hypertensive emergency. Even a blood pressure above 220/120 mmHg can occur without acute organ damage. Conversely…

…Treatment • No prior treatment, low dose, or low intensity lipid lowering therapy: • Start high potency, high dose statin therapy (Class I recommendation). • Immediate combination with…

…with a 95% confidence interval of 0.72–0.95 and an absolute risk reduction of 2.4%. There was no statistical evidence that glycaemic…

…1.73 m², excess urinary albumin excretion—typically a spot urinary albumin to creatinine ratio (UACR) above 30 mg/g—or both. The eGFR is…

…myocardial injury, demonstrated by a rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and…

…T wave amplitude is highest in V2–V3. The amplitude diminishes with increasing age. As noted above, the transition from the ST segment to the…

…more common). The prevalence of atrial fibrillation correlates strongly with age. Approximately 10% of individuals aged 80 years and above have atrial fibrillation, whereas the…

…creatinine ≥133 µmol/L Rivaroxaban 20 mg once daily with food 15 mg once daily at eGFR 15 49 mL/min Edoxaban 60 mg once…

…Anticoagulation Assess the risk with CHA₂DS₂ VA (the sex category has been removed from the Swedish recommendation). Score Recommendation : : 0 No anticoagulant 1 Consider an…

Endokrinologi & metabolism Akutsjukvård Lathundar Emergency overview Measure the plasma glucose immediately in everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour…

…< 20 kPa (150 mmHg), and permissive hypercapnia as long as the pH stays above about 7.20. Different targets apply when the intracranial pressure…

…the "can't intubate, can't oxygenate" situation there are no contraindications — a laryngeal mask is inserted even with a full stomach. Preparation and equipment…

…After deep vein thrombosis with post thrombotic syndrome. Differential diagnosis Feature Venous ulcer Arterial ulcer Diabetic foot ulcer : : : : Site Gaiter area, above the medial malleolus…

…1]. Activate the local major haemorrhage protocol early. Protocols improve above all the logistics, the communication and the simultaneous delivery of red cells, plasma and…

…posterior effusion with no safe route for puncture — surgical drainage or pericardiotomy instead. Relative: uncorrected coagulopathy, thrombocytopenia and ongoing anticoagulant treatment. In tamponade with shock…

Infektionssjukdomar Akutsjukvård Lathundar Purpose and scope A quick reference for the doctor on call faced with suspected sepsis in adults: rapid recognition, microbiological sampling, empirical…

…after pituitary surgery or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment. A basal morning cortisol in the grey…

…threshold is always behind. Indications A patient who remains unconscious (with no meaningful response to speech) after the return of spontaneous circulation , whether the arrest…

…BMI and cardiovascular outcomes High BMI is associated with several health conditions: Type 2 diabetes Hypertension Coronary artery disease Heart failure Dyslipidemia (including high LDL…

…et al. (2003): Recommendations for evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography. In Journal of the American Society…

…conventional hypertension threshold. The traditional diagnostic threshold of 140/90 mmHg derives from epidemiological observations associating pressures above this level with increased mortality. Contemporary management…

…myocardial injury, defined by an elevated cardiac troponin (cTn) value with at least one value above the 99th percentile upper reference limit (URL). The injury…

…myocardial injury, demonstrated by a rising and/or falling troponin pattern with at least one value above the assay specific 99th percentile upper reference limit;…

…younger individuals with low short term risk, lifetime benefit should be considered and discussed. Where blood pressure is more than 20/10 mmHg above the…

…adiposity and may correlate more closely with outcomes than BMI, particularly in women. For European populations, waist circumference above 94 cm in men or 80…

…as additional lipid lowering therapy in patients whose LDL C remains above the recommended goal despite maximally tolerated statin therapy, generally with ezetimibe where appropriate…

…directed towards the back, where there is no exploring electrode (in the 12 lead ECG) that can present the ST segment elevations ( Figure 1 ). Thus…

…above goal despite three or more antihypertensive drugs from different classes at maximally tolerated doses, including a diuretic appropriate for kidney function. In patients with…

…The amplitude of the waveform recorded in any given lead correlates directly with the projection of the heart vector onto that specific lead vector [3…

…Acute myocardial injury , demonstrated by a rise and/or fall in cTn with at least one value above the 99th percentile URL; and Clinical evidence…

…table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed above…

…the tachyarrhythmia originates above the ventricles, ventricular depolarization proceeds normally via the His Purkinje system, and in most cases, there is no significant hemodynamic compromise…

…and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level exceeding 4 mmol/l, commence an intravenous fluid resuscitation…

…with rate 500 ml/h). Cold shower. Ice packs. Heat stroke ( 40°C) Neurological symptoms, confusion, convulsion, tachycardia, hypotension, coma. As above but with lower temperatures…

…In such instances, favorable neurological outcomes are possible even with prolonged periods of no blood flow, due to the reduced metabolic rate that accompanies declining…

…atrium. Recall that velocities (flows) directed away from the transducer are displayed below the baseline and velocities towards the transducer are displayed above the baseline…

…normal findings, normal variants, etc – from adult electrocardiograms. It is crucial to be familiar with normal findings, normal variants, and pathology in neonates, infants and…

…or no visible P wave. The QRS complex is generally normal, unless there is concomitant intraventricular conduction disturbance. Figure 1 (below) displays two ECGs with…

…to determine the direction of the rotation. With 2 observations per cycle, it appears that there is no rotation. This example illustrates the significance of…

…1. Ventricular rhythm. One exception to the rule above should be noted. If an ectopic focus arises in or near the bundle of His, the…

…air pollution, but often no definite trigger can be identified [1,2]. Ask specifically about: Onset and time course. Increased dyspnoea compared with usual. Increased…

…least 10 minutes in a room at a comfortable temperature — a cold foot gives falsely low pressures. No smoking or coffee in the preceding hour…

…population measure that performs poorly at the level of the individual: it does not distinguish muscle from fat and takes no account of fat distribution…

…0.5 mg/L FEU Age adjusted threshold: age × 0.01 above 50 years INR 0.9–1.2 APTT 28–40 s Fibrinogen 2…

…above all in the afternoon and evening. See the quick reference on inpatient insulin therapy Peptic ulcer A proton pump inhibitor with concomitant NSAID use…

…indicated according to the table above. 9. Check that the whole lesion, including the margin, has turned white. Contact technique with a cryoprobe gives a…

…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

…INR ≥ 2.0 checked weekly on warfarin, or documented well managed DOAC therapy with no missed doses. A single missed DOAC dose makes the pretreatment…

…glucose : : Most inpatients 6–10 mmol/L Frail older people, a short expected survival, a high risk of hypoglycaemia 8–12 mmol/L The critically…

…crisis. Contraindications There are no absolute contraindications in hypoxaemia. Take particular care in: A risk of hypercapnic respiratory failure — COPD, severe obesity with hypoventilation, neuromuscular…

…correction at an INR above 1.5 and a platelet count below 50 × 10⁹/L before drain insertion, while diagnostic aspiration with a fine needle…

…renal function Formula Used for : : CKD EPI 2021 (creatinine) The first choice for eGFR in adults Cystatin C based eGFR With an atypical muscle mass…

…conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic alkalosis or an arterial pH above…

…tachycardia (VT) from supraventricular tachycardia (SVT) with wide QRS complex. Brugada's algorithm If there is no RS complex in any chest lead (V1–V6…

…is initiated. High No treatment High 2 Oral anticoagulation (warfarin or NOAC) is recommended for all male patients with scores of 2 or more. Very…

…headedness, or loss of consciousness. No symptoms at the time of assessment. Ongoing chest discomfort with electrical or haemodynamic instability. Cardiac arrest or cardiogenic shock…