…patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination must be preceded…

…infections, such as viral, bacterial, and tuberculous infections. Post pericardiotomy syndrome. Acute transmural myocardial infarction. Rupture of the free ventricular wall. Neoplasms (particularly breast and…

…abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected…

…dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period before…

…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…

…the autonomic nervous system and changes in the automaticity of the sinoatrial node. Rhythm Normal rhythm A rhythm is defined as three consecutive beats with…

…a result of stunning. The systemic response to reperfusion and ischemia causes a state similar to SIRS (systemic inflammatory response syndrome) with risk of disseminated…

…endocarditis. With 2D and later 3D ultrasound, the technology has been greatly refined. Similarly, the development of transesophageal echocardiography (TEE) has been extremely valuable. Echocardiography…

…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…

…colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of action Colchicine Colchicine…

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

…viral infections. This explains why pericarditis may affect individuals of all ages. However, a wide range of local and systemic conditions may cause pericarditis. The…

…and nervousness. This is due to altered tone in the autonomic nervous system, with increased sympathetic input (leading to stimulation of beta adrenergic receptors) and…

…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…

…according to type of stenosis. The patients with low flow (stroke volume index <35 ml/m²) and low gradient (<40 mmHg) displayed the worst prognosis…

…Do the following early: 1. Assess airway, work of breathing, level of consciousness and circulation. 2. Give controlled oxygen with a target of 88 to…

…of every tendon crossing the wound. A tendon injury can be painless and gives normal passive movement — test actively against resistance, tendon by tendon . With…

…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…

…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…

…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…

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

…of a healthy reference population, which means that one healthy value in twenty falls outside them . Order twelve tests in a healthy person and the…

…long for thick soft tissue and for the head of the humerus. A pressure bag or a 50 mL syringe with a three way tap…

…intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until…

…infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of the alcohol use disorder…

…with simultaneous administration of beta blockers). Effects Induces arteriolar vasodilation without effects on venous circulation. The reduction in systemic vascular resistance (SVR) is rapid and…

…nerves of the forearm and the dorsum of the hand. Preparation and equipment Chlorhexidine in alcohol or an iodine solution. Lidocaine 10 mg/mL with…

…and appears to reduce the risk of a post injection flare. Lidocaine 10 mg/mL without adrenaline is used; larger volumes are needed subacromially and…

…Hypertensive emergency, including in pregnancy. Postoperative hypertension. Mechanism of action Combined beta adrenergic and alpha adrenergic blocker with rapid onset of action. Labetalol has less…

…reduce the adherence barriers associated with more frequent injectable therapy, although the clinical importance of improved adherence remains dependent on sustained follow up and administration…

…and cardiovascular disease. Its relationship with cardiovascular risk is nonlinear: even light smoking carries a substantial proportion of the excess ischaemic heart disease risk associated…

…50 mL syringe for a knee with a large effusion, 5–10 mL for smaller joints. Local anaesthesia of the skin and subcutis where needed…

…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…

…the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of…

…associated, or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among patients with…

…the diagnosis. 3. Palpate the pulses and measure the ankle brachial index with Doppler. 4. Culture only in the presence of clinical signs of infection…

…version 4 of 27 February 2024. The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence…

…makes the artery harder to palpate. Procedure Catheter over needle (direct technique) 1. Palpate the course of the artery with two fingertips and note the…

…afternoon and evening. See the quick reference on inpatient insulin therapy Peptic ulcer A proton pump inhibitor with concomitant NSAID use or a history of…

…to the next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection…

…Indications A sensation of something in the eye, watering, photophobia and redness after working with a grinder, a drill, a lawnmower, or in the wind…

…coagulopathy or thrombocytopenia (< 50 ×10⁹/L) — choose the subcutaneous route if possible, otherwise give IM with a fine needle and 5 minutes of compression…

…and the results must not be taken to mean that an electronic alert replaces clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with…

…and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is chosen when the need is more than brief: continuing pacing dependence…

…the complication remains associated with post procedural morbidity and mortality. Pathophysiology The precise mechanism of contrast induced AKI is incompletely defined. In many cases, the…

…Vitamin D deficiency Concomitant interacting medications The SLCO1B1 rs4149056 polymorphism is associated with higher statin concentrations and may increase the risk of simvastatin related myopathy…

…inpatients Agent The acutely ill inpatient : : Metformin Stop in acute kidney injury, hypoxia, shock, before contrast studies and before surgery. A risk of lactic acidosis…

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

…to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect…

…evident from the fact that the vast majority of all myocardial infarctions and episodes of myocardial ischemia, do not cause ventricular arrhythmias and cardiac arrest…

…partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically presents with ST segment depressions and/or T…

…V1 V2 and R/S ratio ≥1 with concordant positive T wave in absence of conduction defect. R/S ratio 1 implies that the R…

…connective tissue and a very high density of capillaries. The muscle fibers are organized into several sheets that wrap around the ventricle with varying orientation…

…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…

…the 1930s, to a routine, safe, and sophisticated treatment used worldwide. Artificial pacemakers have benefitted immensely from advances in engineering, notably with the advent of…

…Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a relative contraindication; the test is then performed with preparedness for anaphylaxis. An untreated…

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

…diagnosis of pheochromocytoma Treatment of hypertension associated with pheochromocytoma; treatment of dermal necrosis after extravasation of drugs with á adrenergic effects. Phentolamine doses and administration…

…of Valsalva is associated with increased sudden death risk, particularly in individuals younger than 35 years during or after vigorous exercise. Anomalous origin of the…

…Syndrome]); blocking AV node conduction may result in accelerated transmission of atrial impulses to the ventricles and thus ventricular fibrillation and cardiac arrest. High degree…