…not on how wide the rim of fluid looks. With ultrasound guidance, the point at which the fluid lies most superficially is chosen and the…

…on a single eGFR. Step 1: confirm the course and assess severity Establish the baseline Look for previous creatinine values in the record, preferably from…

…the right atrium and right ventricle are compressed, with elevation of their diastolic pressures. Right sided filling becomes increasingly dependent on the fall in intrathoracic…

…with ATRIA and HAS BLED Scores Several studies have compared the predictive performance of HEMORR₂HAGES with other bleeding risk assessment tools, notably ATRIA and HAS…

…pathophysiology and electrocardiology. Unfortunately, numerous books and online resources fall into the trap of oversimplification. Physicians, nurses, paramedics and physician assistants who rely on such…

…from a central line if one is present 4 Take a full blood count with a differential, CRP, creatinine, electrolytes, liver function tests, glucose and…

…is generally related to an atherothrombotic event, whereas Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial…

…at which the signal disappears, deflate slowly (2 mmHg/s) and note the pressure at which the signal returns. Repeat on the other arm. 2…

…hypoglycaemia No defined threshold The patient has cognitive or physical impairment and needs help from another person Level 3 can occur even when the glucose…

…things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need…

…a premature ventricular contraction. Classification of premature ventricular contractions When every other beat on the ECG is a premature ventricular complex (PVC), the rhythm is…

…done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy…

…heart failure, atrial fibrillation, and other arrhythmias or conduction abnormalities. CKD also worsens the prognosis of established CVD. Mechanisms linking CKD to cardiovascular disease The…

…stimulators, and other electronic equipment may also interfere with device function. The clinical consequences depend on the device, the patient's dependence on pacing, the…

…skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A patient who cannot lie…

…The pulse oximeter does not distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal value. Give 100 % oxygen on a reservoir mask — this markedly shortens…

…depending on the ventricular response. The ECG in ectopic atrial rhythm and atrial tachycardia A regular rhythm with P waves that differ in contour from…

…or as an add on Slow onset. Dose reduction in renal failure and in old age Amiodarone In severe haemodynamic compromise where the above cannot…

…falls, and functional deterioration may have greater consequences in frail patients. Clinical Assessment Frailty and Functional Status Treatment decisions should not be based on age…

…fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal lesions that are not apparent on…

…used if other methods fail to open the airway. Figure 1. Methods to open the airway. No large study has compared oropharyngeal and nasopharyngeal airways…

…differs pathophysiologically from cardiac arrest. In stroke, neuronal cell death begins in the central ischemic zone, where the ischemia is most pronounced and extends towards…

…of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability. HFmrEF may therefore represent…

…will fall outside. The ranges below are guide values for adults. The method and the laboratory determine the range — always use the range printed on…

…a documented rise and/or fall of cTn values. However, myocardial injury alone is an entity in itself and may arise from non ischaemic cardiac…

…the arms. Orthostatic hypotension: a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at 1 or 3 minutes after standing, following…

…of myocytes that form the slow conducting isthmuses critical for re entry [6] . Non ischemic dilated cardiomyopathy (NICM), hypertrophic cardiomyopathy (HCM), and arrhythmogenic right ventricular…

…distinction between NSTEMI and UA hinges entirely on the presence of myocardial necrosis. NSTEMI is confirmed by a typical rise and/or fall of high…

…is in. The three phases following a sudden cardiac arrest were described by Weisfeldt and Becker (2002). Drawing on physiology, observational and experimental studies, they…

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

…different insulin sensitivity from at home: less food, more stress, often corticosteroids, often impaired renal function. Prescribe basal insulin, mealtime insulin and the correction dose…

…with the sinus P wave. The appearance depends on the location of the ectopic focus from which the impulse is discharged. If the impulse is…

…Scars, hernia or visible abdominal wall collaterals (caput medusae) Puncture at least a few centimetres away from them Full bladder Have the patient void, or…

…the limiting factor The time critical element The diagnosis and the donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive…

…Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample without a speculum…

…plasma and platelets. Observational data from trauma suggest a lower overall mortality after such protocols are introduced, although the effect on 24 hour mortality is…

…of falls; anaemia and a known gastrointestinal source are investigated before starting. A referral or notification to the anticoagulation clinic, and a decision on who…

…and the apex rotates counterclockwise. This rotating, or twisting, contraction is called circumferential shortening (Figure 1C). Left ventricular function depends on a complex interaction between…

…As per data from the registry, only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac…

…start treatment that eliminates potassium from the body. 6. Check the plasma potassium after about 1 hour and follow the plasma glucose closely for at…

…arrest and influence on outcome. Resuscitation 2012; 83:120611. Wang CH, Huang CH, Chang WT, et al. The effects of calcium and sodium bicarbonate on…

…mechanism. Sequential activation implies that the atria are activated first and they fill the ventricles with adequate volumes of blood before ventricular contraction commences. To…

…performed. Note that troponins may be elevated but the elevation is typically discrete and not on a par with the degree of left ventricular impairment…

…exceed 60 cmH₂O . Gel cuffed masks of the i gel type have no cuff to inflate and are chosen on weight alone. When in doubt…

…Left main stenosis Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment…

…patients with diabetes and anyone with dizziness Definitions White coat hypertension: a raised office reading but normal readings at home or on 24 hour recording…

…the procedure is safe: that synchronisation really is switched on when the shock is delivered, and that the thromboembolic risk has been dealt with before…

…test Definition and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually on a treadmill…

…but the effect on the bowel must be taken into account). Known allergy to the preparation — rare; itching and urticaria are usually due to histamine…

…autonomic reflexes that influence the haemodynamic result. Reflex tachycardia is the rule after a rapid fall in blood pressure. Drug Indications Dosing α1 β1 β2…

Akutsjukvård Psykiatri Lathundar Delirium in older adults: quick reference A quick reference for ward and on call physicians: recognise hypoactive delirium, stabilise the patient, work…

…and exclude dangerous differential diagnoses [1,2]. STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion…

…alone. Contraindications Primary closure must be avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on the hand. These…

…oxygen saturation falls to approximately 60%, leading to unconsciousness. The myocardium responds to hypoxia by downregulating metabolism and thus contractility (a consistent finding in acute…

…cap, mask, sterile gown, sterile gloves and a large full body drape. Lidocaine 10 mg/mL for local anaesthesia, normal saline to flush all lumens…

…previous axillary clearance on the same side. A paretic limb — poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection…

…Clinical Presentation and Symptoms The source material does not provide specific information on the clinical presentation and symptoms of the underlying conditions for which ACE…

…at initiation or during routine therapy. Potential clinically important complications and treatment related syndromes include: Hypovolaemia Falls and syncope, particularly in older adults Euglycaemic diabetic…

…approach focusing on rhythm stabilization, relief of triggers, and reduction of sympathetic drive [4]. Rhythm Stabilization In addition to defibrillation , several pharmacological and interventional alternatives…

… Which drugs, and how many doses, has the patient taken? Is the patient on an inhaled corticosteroid or other anti inflammatory treatment? Previous intensive care…