…of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are viral infection…

…outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections…

…some kind of damage to native (own) valves is required to become vulnerable and contaminated by bacteria . Infections are difficult to heal because the heart…

…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 most stable dressing, lowest risk of infection and thrombosis with prolonged dwell time Highest risk of pneumothorax, the vessel cannot be compressed after arterial…

…a rising pCO₂ and respiratory acidosis, or a markedly increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection…

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…

…a suspected infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met. The first hour Step…

…0 mmol/L Triglycerides < 1.7 mmol/L 10 carries a risk of pancreatitis Cardiac markers and coagulation Test Reference Comment : : : High sensitivity troponin…

…Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample…

…Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks. Choice of vein and cannula size…

…respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also include dementia, marked hearing loss and…

…IV plus 1.5 g for the first dose, then 1 g × 1 IV Clostridioides difficile, primary infection, low risk of recurrence vancomycin 125 mg ×…

…of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of…

…report. A shave biopsy of a pigmented lesion that turns out to be a melanoma can make the Breslow thickness unmeasurable and staging therefore impossible…

…A risk of rupture; use sparingly Prepatellar and olecranon bursitis The bursa Exclude septic bursitis first Injection is considered when 4–6 weeks of adequate…

…recurrent infarction and limb threatening complications. Among patients with established peripheral artery disease, those who stop smoking have approximately twice the five year survival of…

…for a couple of minutes before the needle is inserted. Sterile gloves, sterile gauze, and a fenestrated drape for injection. A needle of 0.8…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…the stylet and aspirate. 6. Make the smears immediately at the bedside from the first aspirate, which should be small — a few tenths of a…

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

…the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before the puncture Swedish…

…necrosis and, in the worst case, amputation. The decisive step is therefore not the choice of dressing but the ankle brachial index before the first…

…the monitoring and management of intracranial haemorrhage and angioedema. First of all Measure Comment : : Plasma glucose Hypoglycaemia can mimic stroke. Measure immediately and correct marked…

…regions and departments; a palpable ulnar pulse and a warm, well perfused hand carry more weight. Choice of vessel The radial artery is the first…

…proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period…

…total brain infarction is not expected to occur within a reasonable time, and in whom death is judged likely within 180 minutes of treatment being…

…reversed: irrigate first , for at least 30 minutes, and measure the pH in the conjunctival sac before anything else is done. Preparation and equipment A…

…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…

…shock and less certain in sepsis without shock [3,4]. The first hour, in order The measures should in practice overlap. Document the time of…

…without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is…

…with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction, haemodynamic instability, anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast…

…adverse event rates similar to those with placebo, whereas approximately 10% of patients in registries and routine clinical practice report muscle symptoms. This discrepancy reflects…

…anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to hurt even so. Offer…

…In impaired consciousness or DKA: remove the pump and change to an infusion or injections Drugs for type 2 diabetes in inpatients Agent The acutely…

…< 100 mmHg and a saturation < 90 per cent. An sPESI of 0 indicates low risk. Anticoagulation A DOAC is the first choice in…

…tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of renal function Doxycycline, erythromycin, clindamycin, metronidazole, moxifloxacin and fusidic…

…considered pathological and the underlying cause must be investigated. Pain, infections, medications, fever, hypovolemia, dehydration, anemia, hyperthyroidism and myocarditis are common etiologies. Treatment of the…

…treatment of seizures, and infections. However, the underlying evidence for many of the recommendations is based on few randomized trials and the evidence is often…

…• Typically the first choice of drug. • Effective in sinus bradycardia or AV node block. • Dose <0.5 mg may worsen bradycardia and should not be…

…and a history of anaphylaxis — a relative contraindication; the test is then performed with preparedness for anaphylaxis. An untreated Addisonian crisis in progress: treat first…

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary. Continuous infusion: Start infusion at 0.1 mg/min and increase…

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

…myocardial infarction. Rupture of the free ventricular wall. Neoplasms (particularly breast and lung cancer). Inflammatory conditions, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and…

…level of consciousness, the pupils, tone, clonus and seizures. Give glucose in hypoglycaemia and a benzodiazepine for toxicological seizures E Temperature, skin, smell, injection marks…

…to infections. The pericardium reduces friction between the ventricles and surrounding structures of the mediastinum. Friction is reduced because the fluid in the pericardial sac…

…apical portion of the left ventricle is dilated (hence the term apical ballooning syndrome ). This syndrome was first descried in 1991 in Japan and the…

…the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of action Colchicine Colchicine appears to exert several…

…transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and give by slow injection over 5…

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…

…A high suspicion of intermittent infrahisian block should be maintained, particularly in older patients and those exhibiting a bundle branch block (BBB) or an intraventricular…

…of local and systemic conditions may cause pericarditis. The most common causes are as follows: Rheumatoid arthritis (RA) Systemic Lupus Erythematosus (SLE) Acute myocardial infarction…

…range of diseases and medications may cause sinus tachycardia; e.g congestive heart failure, lung disease (e.g COPD), fever, infections, anemia, myocardial ischemia/infarction…

…to 5–10 minutes after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or increasing weakness, and give atropine…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go…

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

…characterized by angiography. Standard gray scale IVUS demonstrates the principal vessel wall layers and allows quantitative measurements of: minimum and maximum lumen diameter; lumen area…

ECG Myocardial ischemia and infarction Classification, diagnosis and definitions of acute coronary syndromes (ACS) and acute myocardial infarction (AMI) Acute coronary syndromes occur when atherosclerotic…