…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…

…Venturi mask with a set of valves, and a high flow nasal cannula where available. Bag mask equipment for a patient who is not breathing…

…V3). IIa B In patients with inferior myocardial infarction, consider connecting V3R and V4R to detect concomitant right ventricular infarction. IIa B Routine blood sampling…

…needed and start anaesthetic treatment with EEG After clinical cessation of the seizure Assess the recovery of consciousness. Urgent EEG if the patient does not…

…and fibrinolysis, not an acceptable routine target. The shorter the ischaemic time, the more myocardium can be salvaged. Call the PCI service in parallel with…

…A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met…

…The patient need not have fever, leucocytosis or a positive culture. Older people, the immunosuppressed and patients with renal or hepatic failure can have subtle…

…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…

…with the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison control centre before you decide, not…

…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…

…distant objects). These concepts have been discussed in detail previously. The gain is regulated with TGC and gain control , as discussed earlier. The gain must…

…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…

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

…the tympanic membrane — including a history of grommets, ear discharge or pain on contact with water. A history of ear surgery in which the middle…

…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…

…The condition is associated with falls, aspiration, pressure sores, loss of function, longer length of stay, institutional care, readmission, cognitive decline and increased mortality [3…

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

…secure intravenous access and record an ECG. 2. Confirm the potassium with a repeat sample, but do not delay treatment when there are ECG changes…

…is not on its own an absolute indication for intubation. Assess ventilation, airway protection, the expected course and the possibility of rapid reversal with an…

…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…

…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…

…fluid and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise despite two adequate intramuscular doses of adrenaline and…

…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…

…to their indication. Do not routinely stop aspirin given as secondary prevention 8 Contact the endoscopist and the consultant on call early. In cirrhosis or…

…Ongoing bleeding with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss…

…to the next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection…

…weeks, improvement with anti inflammatory treatment, and the tendency to recur all support an immunopathological mechanism. The precise cause, however, is not fully established. At…

…and previous tracings when available. A prior ECG can help distinguish new abnormalities from chronic baseline findings, but comparison with an earlier tracing must not…

…and ECG Conventional surface ECG can reveal the following types of pacemaker dysfunction: Failure to capture (FTC) , which means that the pacemaker stimulations do not…

…centre, and activate the emergency medical response system using your local emergency number. Contact the nearest intensive care unit with expertise in toxicological emergencies. Antidote…

…it will disappear, and the documentation is all that remains. 3. Pare down any hyperkeratosis with a scalpel; nitrogen does not penetrate thick keratin. 4…

…dealt with before the atria begin to contract again. An unsynchronised shock that happens to fall in the T wave can precipitate ventricular fibrillation, and…

…normally concordant with the QRS complex, which means that a net positive QRS complex should be followed by a positive T wave and vice versa…

…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…

…sheets wrapping around the ventricle with varying orientation. This organization allows the left ventricle to contract in a highly sophisticated and effective way (Figure 1…

…fibrillation and peripheral artery disease. Prognosis is generally worse when diabetes coexists with these conditions. However, the cardiovascular effects of SGLT2 inhibitors are not explained…

…connective tissue and a very high density of capillaries. The muscle fibers are organized into several sheets that wrap around the ventricle with varying orientation…

…pericardium and connective tissue. Therefore the apex does not move much during the cardiac cycle, despite the fact that cells in the apex contract as…

…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…

…Management is governed not by the creatinine value alone but by the course, urine output, volume status, electrolytes, acid base status and the underlying cause…

…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…