…adult electrocardiograms. It is crucial to be familiar with normal findings, normal variants, and pathology in neonates, infants and during the childhood years. Below follows…

…general (circumferential) or localized to a specific area. The effusion itself may consist of serous fluid (transudate), protein rich fluid (exudate) to pure blood (exudate…

…extended monitoring exceeding 3 weeks is necessary, an implantable loop recorder is essential to accurately establish the diagnosis. Electrophysiology In patients with presyncope or syncope…

…blocker, a calcium channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive…

…Comment : : : High sensitivity troponin T < 14 ng/L The decision thresholds are assay specific — follow the local 0/1 hour protocol NT proBNP <…

…a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific: motor neurone disease…

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

…Specific dosing adjustments are required in certain patient populations: Pediatric patients: For patients weighing less than 50 kg, the dosing should be 0.05 to…

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

…the preparations. Relative: Poorly controlled diabetes — expect a raised blood glucose for 2–5 days. Suspected or known tendon rupture. No response to previous injections…

…bacteriuria. The exceptions are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin…

…up of the foci of infection. Vegetations can be found on the flaps and appear as moving masses. Mural vegetations are attached to the endocardium…

…or cannot be advanced. An introducer for the atraumatic needle — it is too soft to pass through the skin on its own. Local anaesthesia: lidocaine…

…disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly…

…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…

…caused by streptococcal infections (group A Streptococcus ). Rheumatic heart disease can occur at any age and multiple valve lesions are common (typically the aortic and…

…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…

…depression. Sinus tachycardia. Refer to Figure 1 . Figure 1. Electrical alternans in patient with cardiac tamponade. The ECG shows varying QRS and T wave amplitudes.

…Erythematosus (SLE) Acute myocardial infarction (AMI) Post infarction (including Dressler syndrome) Uremia Radiation to the heart Trauma Tuberculousis Neoplasms (cancer) Post cardiac surgery (hemorrhagic pericarditis)…

…crucial task is to distinguish three types of sinus tachycardia. These types differ fundamentally in terms of pathophysiology, prognosis, and treatment. The types of sinus…

…but avoid sampling that delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth, throat, skin, perianal region…

…corticosteroid is to be given: hold the needle still, change the syringe and inject. The injection should go in easily. Resistance means the tip is…

…a repair is determined before the first needle goes in. A wound that has not been irrigated clean, has not been inspected to its depth…

…and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an…

…and preserved orientation 12 to 48 hours Withdrawal seizures, usually generalised tonic clonic and sometimes several within a short period 24 to 72 hours Increasing…

…management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb: marked peripheral arterial disease…

…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…

…technique is designed to make sure that never happens, and to make sure the catheter does not become the patient's next focus of infection…

…of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric symptoms Sleep disturbance, hypomania…

…6 + weight in kg Always have one size smaller to hand. The cuff is inflated to 20–30 cmH₂O measured with a manometer — a higher…

…cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although…

…in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption. Injection into an arm…

…the head and neck Fragile skin, poor healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection…

…leaks out through the old hole. Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks…

…plan the aspiration for the trough level or pause the drug according to local practice Relative Skin infection, herpes zoster or burns over the puncture…

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

…reference values (GLI 2012 is the standard). Patient preparation — given with the appointment letter: Drug or habit Period to be withheld before the test : : Short…

Hydralazine Hydralazine is not preferred for hypertensive emergencies due to the high risk of reflex sympathetic stimulation. Drug Hydralazine Brand names Apresoline ®, Bidil ®…

…repeated intravenous bolus injections or as a constant dose infusion. Bolus regime : • 20 mg IV bolus over 2 minutes, followed by 20 to 80 mg…

…renal function occurring after exposure to iodinated contrast media, particularly during cardiovascular angiography, computed tomography, or percutaneous coronary intervention. The preferred terminology is contrast associated…

…ACS), the early post event period is particularly vulnerable, and delayed intensification of lipid lowering therapy may leave patients exposed to avoidable risk. Contemporary guidance…

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

…not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has…

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

…tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current transmission risk assessment. In DCD: patients in whom…

…is suspected (normal 10–21 mmHg). Tonometry is contraindicated with suspected perforation or infection. Removal Proceed from the least to the most invasive technique. 1…

…consciousness or DKA: remove the pump and change to an infusion or injections Drugs for type 2 diabetes in inpatients Agent The acutely ill inpatient …

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

…scintigraphy according to local procedure. Low molecular weight heparin, not a DOAC Active cancer A DOAC or low molecular weight heparin. Consider the bleeding risk…

…rarely needs to be stopped for small biopsies, but have diathermy or aluminium chloride available. Infection in the area to be biopsied. Hypersensitivity to local…

…such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic PAH, including acute responders…

…smokers for a prolonged period. In heavy smokers, cardiovascular risk falls within five years of stopping but may remain elevated thereafter. The overall health benefit…

…and no functional impairment to myositis with muscle inflammation and elevated CK. Rhabdomyolysis is a rare, severe form of muscle injury. The biological basis of…

…is one of the great medical inventions of the 20th century. Cardiac pacing has evolved from a hazardous experiment in the 1930s, to a routine…

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

…Time to onset of action 1 to 2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg…

…the left ventricle is subdivided into 4 walls: inferior , anterior , lateral and septal wall ( Figure 2 below). An inferior myocardial infarction refers to an infarction…

…of the medulla result in the blood pressure lowering effect. Effects Potent blood pressure lowering effect. Pain relief. Delivery IV, IM, PO, transdermal Dose Injection…

…seen predominantly after larger infarctions and/or delayed reperfusion. Its typical onset is 1–2 weeks after AMI, although descriptions of the syndrome include a…

…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…