…and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact…

…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…

…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…

…Discuss with your national or regional poison control centre. An open flame or smoking in the room: a fire hazard. Preparation and equipment A pulse…

…malfunction are associated with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less common and include electrolyte…

…Contact technique with a cryoprobe gives a deeper and more controlled freeze on flat surfaces; spray technique is better on irregular surfaces and in the…

…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…

…Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as…

…Poisoning with other weak acids where the poison control centre recommends it, for example certain phenoxy acid herbicides (2,4 D, MCPA) and methotrexate overdose…

…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…

…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…

…myocardium generates reflections with high amplitude and low Doppler shift. To analyze reflections from the myocardium, the ultrasound machine filters out all other reflected sound…

…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…

…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…

…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…

…Older people, the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms. Findings that suggest acute organ dysfunction Organ or system Finding…

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

…poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An…

…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…

…2. Designate a team leader and one person responsible for recording the transfusions, the sampling, the incoming products and contact with the blood bank. 3…

…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…

…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 …

…or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high dose salbutamol in marked hyperkalaemia if there is no contraindication. 5…

…Assess ventilation, airway protection, the expected course and the possibility of rapid reversal with an antidote. Intubation is recommended for neurological, respiratory or haemodynamic failure…

…fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression…

…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…

…the criteria for activation of the massive transfusion protocol. Plasma and platelets: in ongoing bleeding with coagulopathy, or as part of balanced transfusion in massive…

…organ preserving treatment is started, and a conversation conducted with time, clarity and respect is also what makes the decision hold afterwards. Organ preserving treatment …

…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…

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

…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…

…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…

…with chloride following passively down the resulting electrochemical gradient. By inhibiting SGLT2, these drugs produce coupled sodium and glucose loss in approximately a 1:1…

…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…

…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…

…and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded. 10. Contact…

…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…