…symptoms (SAMS). These range from diffuse myalgia with a normal CK and no functional impairment to myositis with muscle inflammation and elevated CK. Rhabdomyolysis is…

…Detect and characterize myocardial scar. Estimate the risk of major adverse cardiovascular events. Assess left ventricular volumes, regional wall motion, and ejection fraction using ECG…

…As always, foreign materials pose a high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18…

…emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint or absent. Take cultures immediately, but never let sampling, imaging…

…the samples are sent correctly. A corticosteroid must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in…

…will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained contamination, not poor suture technique — and the commonest…

…normal variation and requires a change of treatment. Common precipitants are viral infection, bacterial infection and air pollution, but often no definite trigger can be…

…as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness…

…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…

…low platelet counts, followed by compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow…

…make sure that never happens, and to make sure the catheter does not become the patient's next focus of infection. Indications Infusion of vesicant…

…the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP < 3 mg/L Rises within 6–8 h, half life about 19…

…infection or gastroenteritis at home Double or triple the oral daily dose during the days of illness (the patient's sick day rules) Vomiting or…

…work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring a…

…Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample without a speculum…

…arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An alcohol or chlorhexidine swab. Let…

…Suspected subarachnoid haemorrhage with a normal or non diagnostic CT. Suspected neuroborreliosis, neurosyphilis or another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome…

…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…

…1. Apply the tourniquet 10–15 cm proximal to the intended puncture site, let the arm hang, ask the patient to pump with the hand…

…radiograph alone belongs to an earlier era. The needle is inserted close to the upper border of the rib, never at the lower border where…

…wait for complete diagnostic certainty. Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection. Clinically this usually corresponds…

…a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint…

…gas or fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of…

…recommended — alkaline urine increases the precipitation of calcium phosphate. Contraindications Hypokalaemia — must be corrected first or in parallel; otherwise the treatment is ineffective. Hypocalcaemia , symptomatic…

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

…causally responsible. This distinction is important because AKI after a contrast study frequently occurs in patients with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction…

…of the natriuretic peptide A receptor. NT proBNP is an inactive cleavage product and has no direct biologic effect. BNP and NT proBNP have different…

…activity and cardiovascular benefit is curvilinear. The largest relative improvement occurs when an inactive person becomes even modestly active, while additional activity continues to confer…

…activated. Displacement of the tracheal tube. Cardiac arrest without adequate blood flow or ineffective compressions. While ETCO 2 is optimally measured in tracheal tubes, it…

…tongue, and uvula causing airway obstruction Cardiovascular: Hypotension Circulatory collapse culminating in cardiac arrest Anaphylaxis can develop without dermatological or upper airway manifestations. Anaphylactic cardiac…

…result in hemorrhage within the pericardium. Ventricular rupture : A transmural infarction can cause a rupture in the left ventricular free wall. Mediastinal trauma : Penetrating injuries…

…traumatic cardiac arrest often exhibit favorable neurological outcomes ( Rawshani et al ). Traumatic cardiac arrests typically result from mechanisms that render chest compressions ineffective. For instance…

…Management : : : Medial triangle of the face (nasal root, alae nasi, upper lip) Venous drainage towards the cavernous sinus Surgeon or ENT; often antibiotics Palm, fingers…

…6. Measure the blood pressure, initially in both arms if this can be done without losing time. 7. Perform urgent CT of the brain and…

…course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection…

…raised — the two decisions must never be conflated. There is no absolute upper age limit. Suitability is determined organ by organ in consultation between the…

…multifocal atrial tachycardia — treat the cause; cardioversion is ineffective. Known left atrial thrombus. A markedly enlarged left atrium, marked hyperthyroidism or an untreated underlying cause…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

…lid margin upwards and backwards towards the forehead. Double eversion is achieved by advancing the bud further downwards until the upper fornix is visible. 6…

…also does not bind every poison. With the following substances charcoal is ineffective and management is instead governed by the antidote, supportive treatment or dialysis:…

…failure The insulin requirement falls . Reduce the dose and measure more frequently Acute illness and infection The insulin requirement rises, often despite a reduced food…

…Septic phlebitis, ongoing soft tissue infection with systemic involvement. Relative: Condition Adaptation : : ABI 0.5–0.79 Reduced compression (20–30 mmHg) under vascular surgical…

…own laboratory uses before applying it. The D dimer is raised in pregnancy, malignancy, infection, surgery, trauma and old age. A positive value is not…

…stopped for small biopsies, but have diathermy or aluminium chloride available. Infection in the area to be biopsied. Hypersensitivity to local anaesthetics. Areas at high…

…pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein…

…pulmonary venous hypertension caused by left heart disease from pulmonary vascular disease. Although a PAWP of 12 mmHg represents the upper limit of normal in…

…schizoaffective disorder, HIV infection or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding…

…ingestion unless the ingested substance has the propensity to form bezoars or is a sustained release formulation. Note: activated charcoal is ineffective against alcohols, lithium…

…considered in patients with a high risk of recurrence. Electrical cardioversion is generally ineffective in the treatment of atrial tachycardia. Multifocal atrial tachycardia Figure 4…

…Figure 1 . Left panel : The association between compression depth and survival to hospital discharge ( Stiell et al ). Right panel : The association between compression rate and…