…non pregnant adult of normal weight, and individual assessment. See the separate quick reference for dosing in impaired renal function. Respiratory tract Diagnosis Agent Dose…

…events during infections: An acute coronary event may be triggered by increased myocardial demand during the infection. Systemic inflammation results in increased levels of circulating…

…increased intrapericardial pressure, which in turn affects ventricular relaxation (and thus ventricular filling). This may even lead to compression of the ventricles during diastole; cardiac…

…in older children because they have a lower heart rate. Older children may be asked to hold their breath, which leads to the cessation of…

…managed in the ICU. Post resuscitation care requires expertise and resources to diagnose, monitor and manage neurological injuries, hemodynamic and respiratory instability, multiorgan failure, infections…

…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…

…is 1% to 2% in most Western populations. Individuals with bicuspid aortic valves may develop symptomatic aortic stenosis already at the age of 60 years…

…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…

…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…

…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…

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

…involvement, and atrioventricular block (AVB) may indicate septal involvement in the inflammatory process. A broad spectrum of pharmacologic agents can induce bradycardia or conduction disorders…

…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…

…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…

…response to infection. Clinically this usually corresponds to an acute increase in the SOFA score of at least 2 points. Septic shock is the subgroup…

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…

…controlled. Contraindications In life threatening conditions all contraindications are relative — but they govern which site is chosen. Infection, burns or trauma over the insertion site…

…in three sizes, a stylet or bougie taken out and shaped before induction , a syringe for the cuff, a cuff manometer. A laryngeal mask of…

…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…

…Assessment of pulmonary involvement in systemic disease, for example rheumatoid arthritis or scleroderma, and during treatment with pulmonary toxic drugs. Contraindications Forced expiration raises the…

…needles in three lengths: short for children and slim limbs, medium for most adults, long for thick soft tissue and for the head of the…

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

…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…

…Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint…

…a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current…

…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…

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

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

…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…

…approximately twice the five year survival of those who continue. After acute coronary syndrome, tobacco abstinence has been associated with reductions in reinfarction of approximately…

…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…

…in patients with previous complicated withdrawal [4]. Untreated delirium tremens has historically carried a high mortality. With modern sedation, supportive treatment and treatment of the…

…a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in the skin overlying the puncture site. Previous…

…The D dimer is raised in pregnancy, malignancy, infection, surgery, trauma and old age. A positive value is not a diagnosis. Risk grading in confirmed…

…does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 % < 15 % indicates iron deficiency whatever the ferritin Vitamin B12 150…

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

…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…

…malignancy differential Surgeon or mammography Sole of the foot Deep compartments Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding…

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

…PCSK9. The prolonged intracellular effect of inclisiran permits subcutaneous administration only twice yearly, an important practical distinction from therapies requiring monthly or biweekly injections. Inclisiran…

…whereas approximately 10% of patients in registries and routine clinical practice report muscle symptoms. This discrepancy reflects, at least in part, the nocebo effect : negative…

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

…or multifactorial mechanisms PAH is a distinct and uncommon form of precapillary PH. It is defined haemodynamically by precapillary PH in the absence of CTEPH…

…initially in both arms if this does not delay reperfusion treatment. A large side to side difference may suggest aortic dissection CT of the brain…

…Inhaled and topical steroids in high doses can also cause systemic suppression. Corticosteroids mask fever and peritonitis. The abdomen of a patient on corticosteroids can…

…branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is chosen when the need is…

…to contrast alone difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with…

…A low risk of hypoglycaemia; it can usually be continued Red flags and pitfalls Stopping basal insulin in type 1 diabetes. The single most dangerous…

…closest to the endocardium. The subendocardium has the poorest prerequisites in the case of myocardial ischemia. All myocardial infarctions affect the subendocardium (hence the term…

…and occlude. Many acute myocardial infarctions arise from lesions that previously obstructed less than 50% of the lumen. Assessment of total coronary disease burden, including…

…e.g. myocardial remodeling in heart failure or after myocardial infarction). Ventricular arrhythmias are easier to induce in the presence of arrhythmogenic substrates. A substrate…

…definitions of acute coronary syndromes (ACS) and acute myocardial infarction (AMI) Acute coronary syndromes occur when atherosclerotic plaques disrupt, resulting in the activation of thrombocytes…

…All myocardial infarctions affect the left ventricle. Right ventricular infarction is uncommon but may occur if there is a proximal occlusion in the right coronary…

…notions. Pathological Q waves may resolve in up to 30% of patients with inferior infarction. The amplitude of Q waves may also diminish over time…

…50% renal elimination. • Typically the first choice of drug. • Effective in sinus bradycardia or AV node block. • Dose <0.5 mg may worsen bradycardia and…

ECG The artificial pacemaker is one of the great medical inventions of the 20th century. Cardiac pacing has evolved from a hazardous experiment in the…

…Suspected secondary adrenal insufficiency in pituitary disease, after pituitary surgery or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment…

…inspection of the nail bed, with suture of any nail bed laceration Contraindications There are no absolute contraindications, but be cautious and consider referral in…

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

…a ready made suspension or as a powder for suspension in water. A glass of water between doses of charcoal makes the drink more tolerable…