…low platelet counts, followed by compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow…

…and, in the most severe cases, hypotension, pneumothorax and respiratory arrest [1]. The first few minutes 1. Sit the patient up and minimise physical exertion…

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…but some laboratories do not accept marrow blood in their analysers — check locally. Contraindications Peripheral venous cannula: Infection, burns or trauma at the puncture site…

…subjects, the echocardiographic evaluation in pediatric patients requires a different approach, with more emphasis on the heart position in the thorax, the atrial situs viscerum…

…stretches in the chest wall, such that the distances between the ribs increase, providing larger windows for the ultrasound beam. The operator can sit on…

Procedurer Almost all the complications of pleural aspiration arise from two errors: the needle is placed in the wrong site, and too much is drained…

Procedurer What determines the outcome of a central venous catheter insertion is decided before the needle goes in: the choice of site, the use of…

…and the abscess sits somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face…

…attacks of vertigo, seconds to a minute or so, that are provoked by a change of position — turning over in bed, lying down, standing up…

…graft; in such cases, clinical manifestations may be less dramatic despite a sudden deterioration in function. The severity of tissue injury depends on the site…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…vascular and bleeding complications than femoral access. In patients with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site bleeding, surgical repair…

…in its inhibition of the Na+ K+ ATPase, the enzymatic equivalent of the cellular sodium pump. Digoxin binds reversibly to a specific high affinity site…

…a tattoo or skin disease at the injection site. Known hypersensitivity to the preparation. Intramuscular injection in marked coagulopathy or thrombocytopenia (< 50 ×10⁹/L…

…Cellulitis, a skin wound or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the adjacent joint…

…24 hours is accepted in Swedish practice. The limit is not the clock but the degree of contamination, the depth and site of the wound…

…docs Dr Casey Parker's site covers a wide range of topics. The archive is loaded with great articles which physicians should be interested in…

…cauda equina. If in doubt: choose a level lower, never higher. 3. Mark the puncture site, clean in wide circles and apply the drape. 4…

…the pacemaker current (If) in sinus node cells, accompanied by a decrease in Vmax. Consequently, shifts in the pacemaker site within the sinus node and…

…Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb: marked peripheral arterial disease, Raynaud…

…Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications Infection of the skin or soft tissues over the puncture site — use…

…mask sits above the obstruction and solves nothing. A mouth opening below about 2 cm. Extensive pharyngeal pathology: tumour, abscess, marked swelling, previous radiotherapy. In…

…else is supportive. But the same compression applied to a limb with arterial insufficiency can cause necrosis and, in the worst case, amputation. The decisive…

…for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must…

…injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to the aortic root, engaging the…

…when the report arrives. Procedure Punch biopsy 1. Mark the biopsy site. In an inflammatory dermatosis: the active edge , not the burnt out centre. 2…

…Whether electrosurgery or diathermy will be used. Whether monopolar or bipolar electrocautery is planned. The operative site in relation to the pulse generator and the

…T in lead I). Situs inversus. Left posterior fascicular block is diagnosed when the axis is between 90° and 180° with rS complex in I…

…T in lead I). Situs inversus. Left posterior fascicular block is diagnosed when the axis is between 90° and 180° with rS complex in I…

…ear discharge, dizziness, tinnitus, fever in a child without an obvious focus, and before every ear syringing. Removal of cerumen: Hearing loss, a blocked sensation…

…collapse in a tamponaded patient , since positive airway pressure further reduces the venous return. Procedure Choice of access The ultrasound, not tradition, determines the site…

…procedure must not then be started. Radiography before reduction A radiograph is taken before reduction in a first time dislocation , so as not to reduce…

…test. At follow up during ongoing treatment, the test is performed on the usual medication — note this in the report. Record the height without shoes…

…cardiovascular interventions. Dressler syndrome now occurs in fewer than 1% of AMI cases and is seen predominantly after larger infarctions and/or delayed reperfusion. Its…

…5% of such lesions caused a clinical event during 3.4 years of follow up in a prospective study of patients with acute coronary syndrome…

…a good effect in anterior bleeding. Raise the chair so that the patient's nose is at your eye level. The patient sits upright and…

Myocardial ischemia and infarction Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form…

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 most serious dosing errors arise at the dilution step, not in the choice of dose. Paediatric doses are calculated on actual body weight unless…

…to approximately 40–50 mg of oral morphine per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24 hours…

…Reported relative effects include: Approximately 11% reduction in cardiovascular events in a meta analysis of primary prevention trials involving individuals with an estimated 10 year…

…agonists (GLP 1 RAs) and evolving into multi receptor agonists, has unleashed a new paradigm in cardiometabolic medicine. These therapies are revolutionizing public health strategies…

Echocardiography Ultrasound artifacts The following artifacts are common in ultrasound imaging: The ultrasound image displays non existing structures. The ultrasound image does not display existing…

…of cardiac arrest patients—can induce such pupillary responses. In a comprehensive study by Javaudin et al., involving more than 11,000 cardiac arrest cases…

…Romhilt Este's score system Points Any of the following: R or S in any limb lead ≥20 mm S V1 or S V2 ≥30…

…infarction (STEMI) and non ST segment elevation myocardial infarction (Non STEMI, NSTEMI) in detail. Although myocardial ischemia may affect every aspect of the ECG – from…

…At a creatinine clearance <20 mL/min, consider an alternative treatment In aminoglycoside treatment of obese patients, an adjusted body weight is used: adjusted weight…

…Within a day or so Unilateral, foul smelling nasal discharge in a small child is a foreign body until proven otherwise. Contraindications Absolute: that you…

…a fixed dose is given without assessment, when a modified release preparation is started in an opioid naive patient, or when a conversion between drugs…

…VF). It is primarily intended for use in an emergency setting. The manual includes the following sections (click to navigate to the section): Classification of…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…decompensation, whereas acute illness and increased sympathetic drive may promote AF. In DHF, ventricular rate may decrease as dyspnoea improves and sympathetic activation subsides, making…

…level, producing atrioventricular (AV) or intraventricular blocks. Isolated sinus bradycardia in the early hours following infarction may be associated with hemodynamic compromise. More broadly, bradyarrhythmic…