…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…

…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…

…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…

…skin prick testing, a local anaesthetic weal, BCG Slow, local effect Contraindications Absolute: Infection, a wound, scar tissue, a tattoo or skin disease at the…

…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…

…analysers — check locally. Contraindications Peripheral venous cannula: Infection, burns or trauma at the puncture site. An arm with an arteriovenous fistula, previous axillary clearance or…

…coagulopathy or thrombocytopenia Relative Ongoing anticoagulant treatment — plan the aspiration for the trough level or pause the drug according to local practice Relative Skin infection…

…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…

…aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until…

…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…

…epinephrine . For anaphylaxis without cardiac arrest: Administer 0.5 mg epinephrine intramuscularly in the anterolateral thigh. If ineffective, repeat after 3 5 minutes. If intramuscular…

…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…

…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…

…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…

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

…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…

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

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

…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…

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

…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…