…or is removed by means of dialysis. Substance Antidot e Paracetamol (Acetaminophen) N Acetylcysteine Anticholinergics Physostigmine Anticoagulants (apixaban) Andexanet alpha Benzodiazepines Flumazenil The Black Widow…

…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…immunotherapies may require separate local protocols. Definition Criterion Practical definition : : Fever A single temperature of at least 38.3 degrees, or at least 38.0…

…Initial diagnosis of STEMI ECG Management Recommendation Level of evidence A 12 lead ECG should be interpreted immediately (within 10 minutes) at first medical contact…

…version 4 of 27 February 2024. The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence…

…but accounts for a minority of cases Hypoactive Lethargy, slow responses, reduced speech, immobility, poor food intake, reduced eye contact Common and particularly easy to…

Procedurer The single most important step in any eye injury is to measure and document the visual acuity before anything else is done. The second…

…The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional…

…the patient last passed urine. Contact intensive care in circulatory compromise, serious arrhythmia, marked QRS widening, a sine wave pattern, or a need for repeated…

…risk of blood contact. An alcohol or chlorhexidine swab. Let the skin dry completely before inserting the needle — alcohol carried in with the needle stings…

…products and contact with the blood bank. 3. Secure large bore access, or rapid central access, but do not delay transfusion or control of the…

…Diabetes, immunosuppression A risk of necrotising otitis externa Anticoagulant treatment Bleeding into the ear canal Previous radiotherapy to the head and neck Fragile skin, poor…

…oxygen on a reservoir mask — this markedly shortens the half life of carbon monoxide. Contact your national or regional poison control centre regarding hyperbaric treatment…

…immediately. Assess the level of consciousness, the pupils, tone, clonus and seizures. Give glucose in hypoglycaemia and a benzodiazepine for toxicological seizures E Temperature, skin…

…clinically or radiologically confirmed dislocation of the shoulder, elbow, finger, patella, jaw or hip prosthesis. A dislocation with neurovascular compromise or skin tenting — reduce promptly…

…intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until…

…cannot be obtained quickly and parenteral treatment is needed. Prepare airway equipment and contact anaesthesia early with a prolonged seizure, repeated doses of benzodiazepine, aspiration…

…fails routinely for one single reason: without normal potassium the urine cannot be alkalinised. The kidney then chooses to excrete hydrogen ions instead of potassium…

…impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer procedures…

ECG Principles of myocardial excitability Myocardium is excitable not only by action potentials originating in the sinus node, but also by external electrical stimuli that…

…9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded. 10. Contact nephrology early in severe, progressive or…

…Anaphylaxis is a rapidly developing systemic hypersensitivity reaction that can cause life threatening compromise of the airway, breathing or circulation. Skin symptoms may be absent…

…call coagulation service Always in parallel: mechanical control of bleeding, tranexamic acid where it is not contraindicated, and contact with the on call coagulation service…

…haemorrhage control) planned in advance. A history of a severe transfusion reaction: contact transfusion medicine before transfusing again. Preparation and equipment Compatibility testing Test What…

…experienced practitioner in selected cases, but surgery is the standard. Dark skin: a risk of permanent hypopigmentation. Areas with poor circulation, above all the lower…

…rule out a possible donor on your own on grounds of age or medical history — contact the transplant coordinator and let the assessment be made…

…A systolic blood pressure of 100 mmHg or less, a MAP below 65 mmHg, delayed capillary refill, cold or mottled skin Metabolism and perfusion A…

…the severity of the bleeding 7 Manage antiplatelet drugs according to their indication. Do not routinely stop aspirin given as secondary prevention 8 Contact the…

…ischemia and infarction Definition and pathophysiology Post infarction pericarditis encompasses two temporally and clinically distinct complications of acute myocardial infarction (AMI): Early infarct associated pericarditis …

…first medical contact and interpreted within a target of 10 minutes. Prehospital ECG acquisition can shorten the time to diagnosis and facilitate triage of patients…

…dislodgement, lead fracture or inadequate myocardial contact. It may also be due to the low amplitude (voltage) of the potentials generated by activated myocardium. Functional…

…position of the transducer. The ultrasound gel is important because it maximizes the contact surface between the transducer and the skin. Generous use of gel…

…of adequate anticoagulation before cardioversion — an INR ≥ 2.0 checked weekly on warfarin, or documented well managed DOAC therapy with no missed doses. A single…

…and pharmacological basis Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of oral agents initially developed for glucose lowering in type 2 diabetes mellitus …

…phase has a long duration which enables the majority of the ventricular myocardium to contract simultaneously. Since the membrane potential is relatively unchanged during the…

…contract in several directions simultaneously. The subendocardium is the muscle layer closest to the endocardium. The subendocardium has the poorest prerequisites in the case of…

…ventricle with varying orientation. This organization allows the left ventricle to contract in a highly sophisticated and effective way (Figure 1). Myocardial fibers adjacent to…

…Note that the leakage of sodium during the resting phase is called pacemaker potential . Figure 1. The action potential in the sinoatrial node and in…

…is capable of upregulating or downregulating metabolism (i.e contractility) according to oxygen supplies. Consequently, reduced oxygen supply would not result in ischemia, since the…

…myocardium to contract simultaneously. For this to be possible, the right leg must be intact. In the case ofblockade of the right bundle of His…

…the fact that cells in the apex contract as much as the cells in the basal parts. Since the apex is fixed and there are…