…ventilation–perfusion matching, increased physiological dead space and the Haldane effect. It is therefore misleading to explain the whole phenomenon as abolition of the patie

…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…

…limit is not the clock but the degree of contamination, the depth and site of the wound, and how well the wound can be cleaned …

…of a central venous catheter insertion is decided before the needle goes in: the choice of site, the use of ultrasound throughout the puncture, and…

…and shaped before induction , a syringe for the cuff, a cuff manometer. A laryngeal mask of the correct size as a rescue airway, and surgical…

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…

…only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must…

…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…

…g × 3 IV Extensive furunculosis flucloxacillin 1 g × 3 10 days Wound infection flucloxacillin 1 g × 3 7 days Cat bite within 2 days phenoxymethylpenicillin…

…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…

…of 2, 3, 4 and 6 mm. A size 15 scalpel, a double edged razor blade or a flexible shave blade. Artery forceps, toothed surgical…

…separate guide to joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff syndrome The subacromial space The best documented indication Greater…

…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…

…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…

…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…

…standard site for both aspiration and biopsy in adults. Here the posterior part of the iliac crest is thick, red marrow is abundant, and the…

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

…and measure the ankle brachial index with Doppler. 4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and…

…done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy…

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

…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…

…pressure measured, or be palpated. Indications A sensation of something in the eye, watering, photophobia and redness after working with a grinder, a drill, a…

…a constriction that distorts the anatomy and tempts the operator to inject too high. 2. Palpate the acromion . The injection site lies 2–3 fingerbreadths …

…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…

…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…

…local protocol. Alternatives when there is a contraindication: catheter directed treatment or surgical embolectomy where available. A vasopressor (noradrenaline) and cautious fluid administration. Large fluid…

…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…

…bradycardia is caused by beta blockers. Adrenaline (Epinephrine) α and β agonist Infusion of 2–10 μg/min (titrate as needed). T½ 5 min…

…The test measures the ability of the adrenal cortex to respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether…

…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…

…the term perimyocarditis . Hemodynamic effects of pericardial effusion and cardiac tamponade Intrapericardial pressure increases as fluid accumulates in the pericardial space. Intrapericardial pressure may reach…

…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…

…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…

…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…

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

…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…

…clinical site of action—the coronary artery perfusing the AV node—before the drug is eliminated. A flush should immediately follow the bolus injection to…

…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…