…and inhibits excitatory glutamate signalling, in part via NMDA receptors. With prolonged alcohol exposure the nervous system adapts through reduced GABA mediated inhibition and increased…

…compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A…

…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…

…airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always assess the severity clinically, whatever the DS CRB65 score. Urinary tract Diagnosis…

…and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly, COVID 19 has caused an unprecedented number of…

…mentioned below are discussed in detail in other chapters, to which links are provided throughout the text. Heart rate During the first week of life…

…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…

…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…

…of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular disease. Table 1. Etiologies in…

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

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

…Causes of acute pericarditis/myocarditis The most frequent cause of pericarditis is infections, in particular viral infections. This explains why pericarditis may affect individuals of…

…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…

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

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

…of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other…

…abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile…

…Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other circumstances that may affect…

…modification of loading, eccentric exercise, an NSAID, an orthosis — has not given a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound or other infection over…

…monthly or biweekly injections. Inclisiran is used as an adjunct to dietary measures and maximally tolerated statin therapy, with or without other LDL C lowering…

…In many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only…

…The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset…

…depth of the cavity and its distance to vessels. Contraindications and when to involve a surgeon The following locations must not be handled routinely in…

…eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of…

…degree of ischemia, parasympathetic and sympathetic tone) while others take months or years to develop (e.g. myocardial remodeling in heart failure or after myocardial…

…elevated levels of myocardial proteins. These proteins are cardiac troponins (henceforth referred to only as troponins). When elevated troponin levels are confirmed in patients with…

…Myocardial ischemia and infarction Pathological Q waves are evidence of myocardial infarction Myocardial infarction – particularly if extensive in size – typically manifests with pathological Q waves…

…is generally performed in order to evaluate ventricular function, since it may affect the choice of device therapy and also suggest whether other interventions (e…

…degree Mobitz type 2 AV block, third degree AV block). Sick sinus syndrome or symptomatic bradycardia in the absence of a pacemaker. Hypersensitivity to adenosine…

…of troponins in most normal persons. In 2017 it was possible to detect myocardial infarctions 100 times smaller than what was possible to detect in…

…8 years of age without meeting the criteria for RBBB or LBBB." These conduction delays may be observed after large myocardial infarctions, in which the…

…obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked…

…In the AV node, adenosine produces a transient, rate dependent prolongation of the A H interval, frequently manifesting as transient first , second , or third degree…

…the mechanism of an acute coronary syndrome (ACS), particularly when angiography shows no significant obstructive disease or when the culprit lesion is uncertain. In these…

…With very large quantities of an extremely toxic preparation, lavage can be discussed later. Lavage must never be performed routinely in poisoning — it rarely alters…

…and hyperkalemia. When bradycardia occurs in the context of inflammatory heart disease, it often reflects myocardial pathology that may also reduce myocardial contractility and cause…

…low gradient. Pathophysiology of aortic stenosis As aortic stenosis progresses, pressure conditions on the left side change dramatically, including in the left ventricle, left atrium…

Procedurer The result of a repair is determined before the first needle goes in. A wound that has not been irrigated clean, has not been…

…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…

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…

…An acute phase protein — a normal ferritin does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 % < 15 % indicates iron…

…anaesthesia. Placenta praevia or ruptured membranes in pregnancy — a speculum may be used, but not digital examination until the position of the placenta is known…

…A fracture of the bone to be punctured, or a major injury proximal to the puncture site. A joint prosthesis or orthopaedic metalwork in the…

…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…

…desired in conditions requiring afterload reduction. Time to onset of action 10 30 minutes. Duration of action <4 hours. Delivery IV or IM. Dose Injections…

…chloride available. Infection in the area to be biopsied. Hypersensitivity to local anaesthetics. Areas at high risk of unsightly or hypertrophic scars: the sternum, the…

…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…

…as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection in…

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

…mmHg ≤15 mmHg ≤2 Wood units The source material also presents a CpcPH threshold of PVR ≥3 Wood units in an overlapping clinical classification table…

…variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the…

…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…

…wishes are properly established. Two things determine the outcome — that the confirmation of death is carried out in a formally unimpeachable way, and that the…

…area of epithelium. 3. An embedded body: the patient is positioned at the slit lamp with the forehead against the band and the chin in…

…acromion . The injection site lies 2–3 fingerbreadths (about 5 cm) below the lower border of the acromion , in the middle of the muscle belly…

…caused by a dysregulated host response to infection. Clinically this usually corresponds to an acute increase in the SOFA score of at least 2 points…

…This discrepancy reflects, at least in part, the nocebo effect : negative expectations, contextual cues and attribution of pre existing symptoms to the medication. No single…

…illness and infection The insulin requirement rises, often despite a reduced food intake Insulin pump The patient manages the pump themselves where possible. In impaired…