…Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and give by slow injection over 5 10…

…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…

…Infections are difficult to heal because the heart valves are not vascularized and therefore it is difficult for the immune system to reach the bacteria…

…planned follow up , not merely detoxification. Benzodiazepines reduce the severity of withdrawal and the risk of seizures and delirium [1,2]. In delirium tremens the…

…apixaban) Andexanet alpha Benzodiazepines Flumazenil The Black Widow, Spider Bett Lactrodectus antivenom Botulism (botulinum toxin) Botulism Ininum antitoxin Beta blocker Glucagon IV Calcium flow inhibitor …

…AMA, IgG subclasses, caeruloplasmin in people under 40, alpha 1 antitrypsin, TSH and coeliac serology , together with ultrasound of the liver and biliary tract . Go…

…bolus injections or as a constant dose infusion. Bolus regime : • 20 mg IV bolus over 2 minutes, followed by 20 to 80 mg every 10…

…the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25 mm 90° 1–2 mL Deltoid, BMI 35 or…

…pain relief is a diagnostic finding — and appears to reduce the risk of a post injection flare. Lidocaine 10 mg/mL without adrenaline is used…

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

…and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after selective intracoronary contrast injection under fluoroscopy…

…therapy Peptic ulcer A proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses…

…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…

…Injection of contrast media into the ventricle will instead reveal that the apical portion of the left ventricle is dilated (hence the term apical ballooning…

…withdrawing the cholinesterase inhibitor, under monitoring in a setting where the airway can be secured. Preparation and equipment Edrophonium 10 mg/mL, 1 mL (named…

…and note the time. It must not stay on for longer than 20–30 minutes. Procedure Paronychia — incision and drainage 1. A digital block if…

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

…injection marks, medication patches and trauma. Remove contaminated clothing and wash the skin after external exposure A low Glasgow Coma Scale is not on its…

…A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go, adenosine activates potassium channels (IK.Ach…

…OCT has limited tissue penetration, generally approximately 1–3 mm, and may not show the EEM through substantial plaque or calcium. Blood clearance is required…

…in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1 2 seconds), followed immediately by a rapid saline flush …

…phosphodiesterase inhibitor. Exact mechanism is unknown. 100−200 mg slow iv injection. Rarely used. Glucagon Counteracts beta blockers. An antidote to beta blockers. 2–10…

…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…

…The commonest cause of wound infection is retained contamination, not poor suture technique — and the commonest cause of permanent loss of function is a tendon…

…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…

…cap. Lidocaine 10 mg/mL for local anaesthesia in the awake patient — the anaesthetic also improves the chance of success by counteracting vascular spasm. Pressure…

…not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small 5–10 mL syringe…

…insertion site. Thrombosis or known stenosis in the target vessel. Coagulopathy or ongoing anticoagulation: choose a compressible vessel (the internal jugular or femoral vein), not…

…left on during sampling raises the potassium, calcium and proteins. Fasting is required for triglycerides but not for cholesterol, nor for glucose when the diagnosis…

…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…

…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…

…care programme for bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even with a reduced…

…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…

…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…

…between regions. Common practice is correction at an INR above 1.5 and a platelet count below 50 × 10⁹/L before drain insertion, while diagnostic…

…5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis…

…surgery 1 month Neurosurgery or an intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection…

…Dose Injections • IV: 10–40 mg every 4–6 hours • IM: 10–20 mg every 4–6 hours. Infusion • Afterload reduction : Start infusion at 1…

…in increased levels of circulating pro inflammatory cytokines that may cause plaque rupture (i.e the risk of atherosclerotic plaque rupture is increased during infections)…

…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…

…inclisiran permits subcutaneous administration only twice yearly, an important practical distinction from therapies requiring monthly or biweekly injections. Inclisiran is used as an adjunct to…

…not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy…

…as soon as haemorrhage and contraindications have been excluded. CT angiography or transport planning must not delay treatment unnecessarily. 10. In unknown time of onset…

…and are given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller…

…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…

…first dose, then 1 g × 1 IV Clostridioides difficile, primary infection, low risk of recurrence vancomycin 125 mg × 4 PO 10 days Clostridioides difficile, high…

…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…

…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…

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

…when the report arrives. Procedure Punch biopsy 1. Mark the biopsy site. In an inflammatory dermatosis: the active edge , not the burnt out centre. 2…

…infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must not be passed through the valve…

…used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction…

…In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is…

…adverse event rates similar to those with placebo, whereas approximately 10% of patients in registries and routine clinical practice report muscle symptoms. This discrepancy reflects…

…straight backwards, not upwards towards the bridge of the nose. The resistance at the posterior pharyngeal wall after about 10–15 cm is expected. 5…

…the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison control centre before you decide, not afterwards…

Procedurer The commonest error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often…

…varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral, bacterial, protozoal, fungal, parasitic)…

…antibody directed against interleukin 1β, provided proof of concept but was not developed for routine coronary prevention because of fatal infections and high cost…