…care unit. Adenosine injection must be administered quickly (1 2 seconds), followed immediately by a rapid saline flush (use a three way tap system). Compatible…

…usually within 30 seconds. Doses higher than 18 mg are unlikely to revert a tachycardia and should not be used. Specific dosing adjustments are required…

…aminophylline Adenosine receptor antagonist, phosphodiesterase inhibitor. Exact mechanism is unknown. 100−200 mg slow iv injection. Rarely used. Glucagon Counteracts beta blockers. An antidote to…

…must be given before anything else. An antihistamine and a corticosteroid do not affect the acute course. Measure Adult Child : : : Adrenaline IM (1 mg/mL…

…which the mechanism needs to be documented before referral to an arrhythmia unit. Assessment of the effect of adenosine, which can be given during the…

…not provide specific details regarding the physical examination maneuvers for patients with bradycardia. Diagnostics Electrocardiography and Ambulatory Monitoring Because bradycardia and AV block can be…

…or valvular disease Recent (<48 hours) use of dipyridamole or dipyridamole containing medications Ingestion of caffeinated foods or beverages within 12 hours prior to testing

…For vaccination: adrenaline 1 mg/mL, an antihistamine, oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid…

…not be shorter than four weeks . Mix the corticosteroid and the lidocaine in the same syringe. The anaesthetic confirms that the injection has gone to…

…be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1…

…IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary. Continuous infusion: Start infusion at 0.1 mg/min and…

…spasm. The absence of obstructive CAD on ICA should therefore not automatically be interpreted as evidence that the patient’s symptoms are non cardiac. In…

…concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local…

…be given: hold the needle still, change the syringe and inject. The injection should go in easily. Resistance means the tip is in tissue, not…

…daily increased as required to up to 900 μg/day. Transdermal (one patch lasts for a week): • Catapress TTS 1 (0.1 mg/24hrs)…

…Due to their clinical presentation, these patients are immediately referred to angiography but no coronary artery occlusion can be identified. Injection of contrast media into…

…airway can be secured. Preparation and equipment Edrophonium 10 mg/mL, 1 mL (named patient product — order well in advance). Atropine 0.5 mg for…

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…not afterwards. A current creatinine with the eGFR, the weight, the age and the medication list. Always dilute morphine 10 mg/mL to 1 mg…

…recommended for neurological, respiratory or haemodynamic failure that cannot be corrected quickly. Rapid sequence induction is used when intubation is required [1]. In salicylate poisoning…

…plaque burden, and the dimensions of lesions that may not be fully characterized by angiography. Standard gray scale IVUS demonstrates the principal vessel wall layers…

…in endocarditis In 1973, it was the first time to describe how echocardiography (M mode) can be used to diagnose endocarditis. With 2D and later…

…infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met. The first hour Step Action : : 1…

…without being found. Indications A traumatic wound that gapes and cannot be expected to heal with good function or cosmesis without apposition. A wound that…

…change of treatment. Common precipitants are viral infection, bacterial infection and air pollution, but often no definite trigger can be identified [1,2]. Ask specifically…

…alcohol use disorder and planned follow up , not merely detoxification. Benzodiazepines reduce the severity of withdrawal and the risk of seizures and delirium [1,2…

…is still used in many units to assess the collateral circulation, but the test does not reliably predict ischaemic complications and should not decide the…

…is not a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in the skin overlying the puncture…

…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…

… used to guide antibiotic therapy Glucose and lipids Test Threshold Comment : : : Fasting plasma glucose 4.0–6.0 mmol/L ≥ 7.0 on two occasions…

…Working venous access, fluid and a vasopressor drawn up — push dose noradrenaline or phenylephrine must be ready before induction , not looked for afterwards. Monitoring: ECG…

…used as a triage test on the same liquid based sample when the HPV test is positive — the sample therefore does not need to be…

…when the opening pressure is to be measured. Four numbered sample tubes, and a light protected tube if spectrophotometry is to be performed. Procedure 1…

…which the middle ear may be open (a mastoid cavity, mastoidectomy). An only hearing ear. Relative (choose a manual technique or refer to ENT): Condition…

…intraosseous flow requires pressure ; gravity is not enough. Lidocaine 10 mg/mL to anaesthetise the marrow cavity in a conscious patient. Fixation material for the…

…but never below the ninth rib . Procedure Ultrasound localisation 1. Scan in the position in which the patient is to be punctured. Identify the diaphragm…

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

…aside time, coach actively, and do not accept a trace you would not be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea…

…Time to onset of action 10 30 minutes. Duration of action <4 hours. Delivery IV or IM. Dose Injections • IV: 10–40 mg every 4…

…2 to 4 hours Delivery IV Dose Can be given as repeated intravenous bolus injections or as a constant dose infusion. Bolus regime : • 20 mg…

…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…

…outcomes. The risk of death at 1 year is increased in comparison with patients with preserved renal function, although the association may not be causal…

…an important practical distinction from therapies requiring monthly or biweekly injections. Inclisiran is used as an adjunct to dietary measures and maximally tolerated statin therapy…

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

…death [3]. Acute overview 1. Activate the stroke call. 2. Establish the time of symptom onset or the time last known to be well. 3…

…not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the…

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

…gentamicin 5–7 mg/kg IV as a single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic…

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

…required, in addition to the mealtime dose Never stop basal insulin in a person with type 1 diabetes , not even before fasting or an investigation…

…infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics. 5. Biopsy any ulcer that has not…

…A D dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10…

…method determines what the pathologist can report. A shave biopsy of a pigmented lesion that turns out to be a melanoma can make the Breslow…

…must not be passed through the valve. The order of management in acute bradycardia Atropine is given in doses of 0.5–1 mg intravenously…

…threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left atrial size must also be considered…

…structured intervention should be used whenever smoking is identified. During encounters with smokers, “very brief advice” can initiate discussion and promote referral to formal cessation…

…ciclosporin, warfarin and grapefruit juice. Gemfibrozil should not be combined with statins because it alters statin absorption, hepatic uptake and disposition. Clinical presentation and symptoms…

…the lung. No tube may be used before its position has been verified by an approved method, and auscultation is not such a method. Indications…

…is given after the ingestion of a potentially toxic dose of a substance that binds to charcoal, when it can be given early and the…

…mg/mL for a planned large volume tap. A blood sample at the same time: serum albumin is mandatory in order to be able to…