…readings at home or on 24 hour recording. Masked hypertension: normal in the office but raised outside it — associated with the same risk as manifest…

…reduced level of consciousness, is having seizures or cannot swallow. 5. If there is no intravenous access, give glucagon and establish access at the same…

…of continuing to increase the dose. The level of sedation is scored on a four point scale: 0 fully awake, 1 drowsy but easily roused…

…signal is sought on the dorsum of the foot lateral to the extensor hallucis longus tendon. Measure in the same way as on the arm…

Procedurer Two things determine whether the procedure is safe: that synchronisation really is switched on when the shock is delivered, and that the thromboembolic risk…

…and on call physicians: recognise hypoactive delirium, stabilise the patient, work systematically through the possible causes, apply several non pharmacological measures at the same time…

…A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full sentences Marked work of breathing…

…speech, work of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus…

…The first hour Step Action : : 1 ABCDE, full vital signs, level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the…

…Full blood count. Plasma glucose before insulin. Creatine kinase in suspected rhabdomyolysis. Phosphate, urate and lactate dehydrogenase in suspected tumour lysis syndrome. A digoxin level…

…always Pulsus paradoxus above 10 mmHg A fall in systolic blood pressure during inspiration; one of the most useful signs Low voltage on the ECG…

…HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy…

…contracting at the same time the more efficient the pumping mechanism. Sequential activation implies that the atria are activated first and they fill the ventricles…

…discussion. A premature ventricular complex is recognized on the ECG as an abnormal and wide QRS complex occurring earlier than expected in the cardiac cycle…

…Cytology is used as a triage test on the same liquid based sample when the HPV test is positive — the sample therefore does not need…

…Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption…

…with elevation of their diastolic pressures. Right sided filling becomes increasingly dependent on the fall in intrathoracic pressure during inspiration. The inspiratory increase in right…

…diabetes. The single most dangerous prescribing decision on a ward. Not prescribing glucose measurement. Prescribe the measurement times at the same time as the insulin…

…the blood bank and, where needed, coagulation expertise at the same time [1]. Activate the local major haemorrhage protocol early. Protocols improve above all the…

…in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites —…

…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…

…circumferential shortening (Figure 1C). Left ventricular function depends on a complex interaction between the muscle fibers in these layers, which collectively produces a highly efficient…

…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…

…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…

…be considered. The doses and Swedish thresholds below are based on the national guideline for the management of reperfusion treatment in ischaemic stroke, Nationell arbetsgrupp…

…has an abrupt onset, although a brief warm up phase lasting approximately 5 to 10 seconds may precede the full tachycardia. It is characterized by…

…The two pathways DBD DCD : : : Full name Donation after death by neurological criteria (total brain infarction) Donation after circulatory death Starting point A ventilated patient…

…60–90 % For acute severe hypoxaemia. Fill the bag before applying the mask Venturi mask 2–15 L/min depending on the valve 24, 28…

…regarded as a series of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability…

…Intervention BLS or ACLS NNT to save 1 person Reference Early detection of cardiac arrest BLS 11 Berdowski et al Bystander CPR BLS 15 Hasselqvist…

…when interrogating witnesses, bystanders and health care professionals. The person may have some circulation despite circulatory collapse (e.g., with sustained ventricular tachycardia). Experimental and…

…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…

Njurmedicin Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine…

…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…

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

…the World Health Organization in the mid 20th century, relying primarily on electrocardiographic criteria for epidemiological purposes. With the advent of highly sensitive cardiac biomarkers…

…numerous books and online resources fall into the trap of oversimplification. Physicians, nurses, paramedics and physician assistants who rely on such books will realize their…

…this level with increased mortality. Contemporary management, however, incorporates overall cardiovascular risk, comorbidity and hypertension mediated organ damage (HMOD), rather than relying exclusively on the…

…Tachycardia: Classification, Underlying Etiologies, and Clinical Presentation Classification of Ventricular Tachycardia The classification of VT is fundamentally based on its duration, morphology, and hemodynamic consequences…

…without persistent ST segment elevation, accompanied by a rise and subsequent fall in cardiac specific troponin attributable to myocardial ischaemia. UA presents with compatible ischaemic…

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

…minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine, glucose…

…that bleeds because the edges are held apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas…

…decline in blood oxygen saturation ensues. Within 1 2 minutes, oxygen saturation falls to approximately 60%, leading to unconsciousness. The myocardium responds to hypoxia by…

…is prolonged after a premature beat). This yields more time to fill the ventricles with blood (increased ventricular filling). Persons with premature beats might perceive…

…Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol. An anticoagulant is given as soon as possible, but must…

…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…

…compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A…

…departments — follow local protocol. Severe lung disease or a contralateral pneumothorax: avoid the subclavian and jugular routes on the healthy side, since a pneumothorax there…

…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…

…kidney function declines and as albuminuria increases. When eGFR falls below approximately 60–75 mL/min/1.73 m², the probability of coronary artery disease…

…lead configuration when records are incomplete. A full device check should be available within the recommended interval before elective surgery. In the absence of malfunction…

…with plasma uric acid reduction of approximately 10% to 15% Possible effects on erythropoietin activity and erythropoiesis SGLT2 inhibition may also activate adenosine 5′ monophosphate…

…TdP is drug dependent, ranging between 1% and 8% for Class III antiarrhythmic agents depending on the specific drug and dosage [1]. Acute Management and…

…level exceeding 4 mmol/l, commence an intravenous fluid resuscitation using a crystalloid solution at a dose of 30 ml/kg. Should fluid resuscitation fail…

…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…

…compressions ineffective. For instance, a traumatic hemorrhage can deplete intravascular volume to such an extent that chest compressions fail to generate stroke volumes. Consequently, addressing…

…the "can't intubate, can't oxygenate" situation there are no contraindications — a laryngeal mask is inserted even with a full stomach. Preparation and equipment…

…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…

…levels of catecholamines. References A recent consensus document has been issued by the European Society for Cardiology: Lyon et al: Current state of knowledge on…