…and the results must not be taken to mean that an electronic alert replaces clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with…

…own to declare the patient well. Clinical findings, the ECG and targeted concentration measurements carry more weight. Where serious poisoning is suspected, blood and urine…

…contaminated with the toxicant. Irrigate skin and eyes using saline solution (NaCl) if suspected of toxin exposure. Gastrointestinal lavage is infrequently employed due to aspiration…

…capacity. Suspected asthma or COPD — diagnosis and follow up. Risk groups: current or former smokers over 40 with respiratory symptoms, and occupational exposure to dust…

…oedema, together with at least one of the following: airway compromise respiratory compromise circulatory compromise severe gastrointestinal symptoms, particularly after exposure to a drug, insect…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…in parallel with drug treatment and transport planning [1,5]. Symptom duration Under 12 hours: reperfusion is indicated in persisting STEMI. 12 to 48 hours…

…contraindications to instrumental removal: Suspected penetrating injury or an intraocular foreign body — shield the eye with a rigid shield, give systemic antibiotics and contact an…

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

…contraindications to irrigation: A known or suspected perforation of the tympanic membrane — including a history of grommets, ear discharge or pain on contact with water…

…intraosseous access if intravenous access cannot be obtained quickly and parenteral treatment is needed. Prepare airway equipment and contact anaesthesia early with a prolonged seizure…

…with sterile water according to the volume printed on the catheter , usually 10 mL in adults. Do not use saline — the salt can crystallise and…

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

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

…division is clinically useful and is consistent with commonly used guidelines [1,3]. Level Plasma potassium Management : : : Mild 5.5 to 5.9 mmol/L…

…from the suspected focus, but avoid sampling that delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth…

…secondary prevention 8 Contact the endoscopist and the consultant on call early. In cirrhosis or suspected variceal bleeding, also contact a gastroenterologist with hepatology expertise…

…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…

…reduced eye contact Common and particularly easy to miss. May be misinterpreted as fatigue, depression or dementia Mixed Alternates between hypoactivity and hyperactivity Common on…

…are to be delivered. 2. Designate a team leader and one person responsible for recording the transfusions, the sampling, the incoming products and contact with…

…e applying an external electrical current that depolarizes cells in contact with the lead tip, and thus generate an action potential that will spread through…

…least equivalent to a liberal one in virtually every group studied. Transfuse one unit at a time and assess the effect clinically and with a…

…if possible, otherwise give IM with a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative…

…by contact between inflamed pericardial layers. It may have up to three components per cardiac cycle and is often best heard at end expiration with…

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

…Preparation and equipment A pulse oximeter, and the ability to take an arterial blood gas. An oxygen source with a flow meter, and equipment for…

…dislocation requiring operative treatment — contact an orthopaedic surgeon before attempting reduction. Posterior shoulder dislocation, which is often associated with fracture and requires an orthopaedic surgeon…

…V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2…

…of failure to capture is insufficient stimulus energy. Modern pacemakers have built in functions to calibrate the stimulus amplitude and width according to myocardial excitability…

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

…element The diagnosis and the donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury…

…Contact your national or regional poison control centre for advice on the treatment threshold and on whether haemodialysis should be considered. Rhabdomyolysis with marked elevation…

…ventricle with varying orientation. As explained below, this enables the ventricle to contract in several directions simultaneously. The subendocardium is the muscle layer closest to…

…The resulting glucosuria and natriuresis reduce proximal tubular workload, contract plasma volume and modestly lower blood pressure. Increased sodium delivery to the macula densa restores…

…The reader may wish to view the video lecture on The ST segment, J point, J 60 point and T wave to facilitate understanding of…

…and that the thromboembolic risk has been dealt with before the atria begin to contract again. An unsynchronised shock that happens to fall in the…

…half of the heart, it is important to familiarize yourself with the principles of hemodynamics and conditions prevailing on the right side. Echocardiography is the…

…well with the severity and extent of ischemia. In the setting of moderate ischemia, the myocardium becomes hypokinetic, meaning that the ischemic segments contract less…

…This is due to the high density of myocardium. It follows that myocardium generates reflections with high amplitude and low Doppler shift. To analyze reflections…

…Contact nephrology early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one…

…influx of sodium and depolarizes the cell. Contractile cells start to contract a few milliseconds after the start of the depolarization and they start relaxing…