…infection and air pollution, but often no definite trigger can be identified [1,2]. Ask specifically about: Onset and time course. Increased dyspnoea compared with…

…risk of atherosclerotic plaque rupture is increased during infections). As noted by Bonow et al, it is also reasonable to believe that patients with heart…

…foreign materials pose a high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant…

…apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas. Superficial wounds with well apposed edges, abrasions…

…clean with a tracheostomy or copious secretions Subclavian vein Most comfortable for the patient, the most stable dressing, lowest risk of infection and thrombosis with…

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

…local practice Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk of pneumothorax…

…neutropenic fever is limited, but delayed antibiotics are associated with a worse outcome in sepsis and in several studies of neutropenic patients. In septic shock…

Referensvärden Reference ranges are statistical: by definition they encompass 95 % of a healthy reference population, which means that one healthy value in twenty falls outside…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…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…

…Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also…

…severe piperacillin–tazobactam 4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline…

…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…

…without a definite diagnosis. Choice of technique Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma Excision with a 1–3 mm margin, down into the…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…adverse environmental exposures are associated with continued or resumed smoking after the acute event and warrant particular attention. Cardiovascular benefits of cessation The principal benefits…

…surgeon under strictly sterile conditions. For corticosteroid injection there is an additional absolute contraindication: the slightest suspicion of septic arthritis. If the picture is unclear…

…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…

…Assessment of treatment response and measurement of residual disease (MRD). Fever of unknown origin or suspected granulomatous disease with marrow involvement. Work up of unexplained…

…obliteration of affected vessels. Genetic, molecular, and acquired factors may interact in its development. PAH may be idiopathic, heritable, drug associated, or associated with conditions…

…CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome, autoimmune encephalitis. Meningeal carcinomatosis and CNS involvement in haematological malignancy. Investigation of dementia with biomarkers…

…failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic involvement…

…acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window…

…insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb: marked peripheral arterial disease, Raynaud's phenomenon, thromboangiitis obliterans. An arm with…

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

…time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain infarction is judged possible…

…Grasp the eyelashes, press gently downwards on the upper border of the tarsal plate with a cotton bud, and at the same time fold the…

…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…

…clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have…

…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…

…baseline renal dysfunction is associated with worse outcomes. The risk of death at 1 year is increased in comparison with patients with preserved renal function…

…history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting medications The SLCO1B1 rs4149056 polymorphism is associated with higher…

…triangle of the face or perianally. Indications Fluctuant, tender, erythematous and indurated swelling in the skin or subcutis. Pilonidal abscess, hidradenitis abscess and paronychia with…

…a high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in…

…the first choice in pregnancy and an alternative in cancer associated thrombosis. Warfarin in antiphospholipid syndrome and in marked renal failure. Duration of treatment: at…

…course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection…

…electrocardiograms differ markedly – in terms of rhythm, morphology, normal findings, normal variants, etc – from adult electrocardiograms. It is crucial to be familiar with normal findings…

…multiorgan failure, infections, seizures and temperature management. The ICU is the preferred level of care for the absolute majority. The CCU may be suitable for…

…currently the only treatment with class I recommendation according to European (ESC) and North American (AHA, ACC) guidelines. For details regarding the management of bradycardia…

…after pituitary surgery or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment. A basal morning cortisol in the grey…

…of the haematoma A subungual haematoma with a split, loosened or avulsed nail plate, or a damaged nail fold edge Nail avulsion and inspection of…

…patient has a confirmed diagnosis of pheochromocytoma Treatment of hypertension associated with pheochromocytoma; treatment of dermal necrosis after extravasation of drugs with á adrenergic effects…

…names : Adenocor Mechanism of action Adenosine works by slowing down the impulse transmission through the atrioventricular (AV) node, thereby interfering with the pathway that enables…

…electrical amplitude – is the ECG hallmark of cardiac tamponade. Causes of pericardial effusion and cardiac tamponade The most common cause of pericardial effusion is infections…

…possibility of rapid reversal with an antidote. Intubation is recommended for neurological, respiratory or haemodynamic failure that cannot be corrected quickly. Rapid sequence induction is…

…attributed to the pericardium: The pericardium serves as a barrier to infections. The pericardium reduces friction between the ventricles and surrounding structures of the mediastinum…

…research has been devoted to it in recent years. Most cases (70%) of takotsubo cardiomyopathy occur in situations with extreme stress, such as car accidents…

…In patients with previous myocardial infarction and residual inflammation, defined by hsCRP ≥2 mg/L, it produced a modest reduction in a composite of cardiovascular…

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

…stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed or non obstructive coronary arteries, possible…

…include the infusion of agents to stress the AV node and His Purkinje system, such as isoproterenol and/or procainamide. EPS with isoproterenol is also…

…myocardial infarction. The chest pain in acute pericarditis may be severe and the patient may also experience cold sweats, tachycardia and anxiety; all of which…

…infections, anemia, myocardial ischemia/infarction, pulmonary embolism, pheochromocytoma, hyperthyroidism, hypovolemia, pharmacological substances (alcohol, amphetamine, coffee, anticholinergic drugs, beta adrenergic agonists). In all of these conditions…

…slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing weakness. 6. Assess the chosen finding continuously during the window of effect, 40…

…undiluted syringe of 10 mg/mL makes small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly…

…Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells…

…Prognosis in aortic stenosis according to type of stenosis. The patients with low flow (stroke volume index <35 ml/m²) and low gradient (<40 mmHg…

…used to identify thin cap fibroatheroma, a plaque phenotype associated with subsequent major adverse cardiovascular events in observational studies. OCT OCT uses near infrared light…

…Myocardial Infarction) Acute coronary syndromes with significant ST segment elevations are classified as STE ACS . Virtually all cases of STE ACS lead to myocardial infarction…