…vasopressor and early source control. Sepsis is a dynamic condition. Investigation and treatment must therefore proceed in parallel and must not wait for complete diagnostic…

…without basal insulin (a so called sliding scale), gives poorer control and is not recommended as the sole regimen. Common situations Situation Management : : Fasting before…

…100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always assess…

…injection marks, medication patches and trauma. Remove contaminated clothing and wash the skin after external exposure A low Glasgow Coma Scale is not on its…

…ECG criteria for acute myocardial infarction and ischemia are based on conventional 12 lead ECG. Established ECG criteria do not apply to mathematicallyderived 12 lead…

…exception of beta blockers in selected patients after acute myocardial infarction (MI), antianginal drugs have not been shown to improve long term cardiovascular outcomes in…

…does not imply inevitable clinical disruption. Fewer than 5% of thin capped fibroatheromas have been identified as the source of an acute myocardial infarction during…

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

…Weight reduction and increased physical activity can improve metabolic control and exercise capacity, even when cardiovascular event reduction is not demonstrated in every intervention study…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…rate. Within the context of acute coronary syndromes, particularly ST elevation myocardial infarction (STEMI), ischemic injury can disrupt the conduction system at any level, producing…

…and coronary microvascular dysfunction. Women with RA were reported to have approximately twice the myocardial infarction risk of age matched controls. Cardiovascular events occur earlier…

…sex and blood pressure, affected patients have more frequent stroke, nonfatal myocardial infarction and atrial fibrillation, as well as greater cardiovascular mortality. Metabolic syndrome and…

…causing afferent arteriolar vasoconstriction and reducing glomerular hyperfiltration. The cardiovascular and renal effects extend beyond glycaemic control. Proposed mechanisms include: Reduction in glomerular hypertension and…

…Rhythm control, on the other hand, attempts to restore sinus rhythm by use of antiarrhythmic drugs. Randomized controlled trials have not demonstrated any clear difference…

…cardiac surgery: atrial fibrillation ≤3 days duration. Vernakalant does not convert atrial flutter to sinus rhythm. Vernakalant is only administered in a monitored clinical setting…

…coronary disease found fewer cardiovascular events with Mediterranean dietary interventions than with low fat control diets. In one trial of patients with previous myocardial infarction…

…can potentially be reversed if interventions are promptly instituted. In scenarios where an antidote is not available, it is essential to provide supportive care and…

…Infections are difficult to heal because the heart valves are not vascularized and therefore it is difficult for the immune system to reach the bacteria…

…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 samples are sent correctly. A corticosteroid must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in…

…The commonest cause of wound infection is retained contamination, not poor suture technique — and the commonest cause of permanent loss of function is a tendon…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness…

…Assessment of stroke volume variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand…

…is not a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in the skin overlying the puncture…

…insertion site. Thrombosis or known stenosis in the target vessel. Coagulopathy or ongoing anticoagulation: choose a compressible vessel (the internal jugular or femoral vein), not…

…L (women 10–150) An acute phase protein — a normal ferritin does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 %…

…use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric…

…Working venous access, fluid and a vasopressor drawn up — push dose noradrenaline or phenylephrine must be ready before induction , not looked for afterwards. Monitoring: ECG…

…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…

…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…

…care programme for bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even with a reduced…

…spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy: an otoscope with a charged battery and clean disposable specula…

…Blood samples can be taken at insertion; a blood gas and electrolytes can be interpreted, but some laboratories do not accept marrow blood in their…

…aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart failure must be aspirated. Suspected empyema or complicated parapneumonic effusion…

…bursitis first Injection is considered when 4–6 weeks of adequate conservative treatment — modification of loading, eccentric exercise, an NSAID, an orthosis — has not given…

…the eyes. Postpone the test in: Condition Recommended delay : : Myocardial infarction or unstable angina 1 month Pneumothorax 1 month after resolution Pulmonary embolism, until anticoagulated…

Cardiology Continous medical discussion: the ECG blog Infectious diseases Cardiovascular effects of COVID 19 Coronavirus disease 2019 (COVID 19) has caused a global public health…

…causally responsible. This distinction is important because AKI after a contrast study frequently occurs in patients with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction…

…not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy…

…does not delay treatment Saturation Give oxygen in hypoxia, not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing…

…and are given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller…

…made to withdraw life sustaining treatment, in whom total brain infarction is not expected to occur within a reasonable time, and in whom death is…

…or in the wind. Suspected corneal abrasion. A red eye where the diagnosis is not obvious. Suspected acute glaucoma (tonometry). Contraindications Absolute contraindications to instrumental…

…infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics. 5. Biopsy any ulcer that has not…

…malignancy, infection, surgery, trauma and old age. A positive value is not a diagnosis. Risk grading in confirmed pulmonary embolism Risk Haemodynamics Right ventricular strain…

…the subepidermal split. Choose the technique according to the diagnostic question, not according to what is quickest. Indications Suspected malignancy: basal cell carcinoma, squamous cell…

…infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must not be passed through the valve…

…used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction…

…In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is…

…muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting medications The…

…respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether the result can be interpreted. What decides that is whether…

…2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary…

Myocardial ischemia and infarction Procedurer Definition and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after…

…varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral, bacterial, protozoal, fungal, parasitic)…

…induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable. The benefit of…

…did not establish a mortality benefit. Consequently, the decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and possible infectious…

…heart disease is a complication of rheumatic fever, which is caused by streptococcal infections (group A Streptococcus ). Rheumatic heart disease can occur at any age…

…injuries, hemodynamic and respiratory instability, multiorgan failure, infections, seizures and temperature management. The ICU is the preferred level of care for the absolute majority. The…