…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…

…Needles: 21–25 G, 40 mm for subacromial and trochanteric injection; 25–27 G, 25 mm for the carpal tunnel, de Quervain's and trigger…

…respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether the result can be interpreted. What decides that is whether…

…2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary…

…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…

…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…

…drape for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0.5–0.6 × 25 mm for small…

…required to up to 900 μg/day. Transdermal (one patch lasts for a week): • Catapress TTS 1 (0.1 mg/24hrs). • Catapress TTS 2 …

…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…

…after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or increasing weakness, and give atropine. 8. Monitor for at…

…heated paper clip for trephination. Antibiotic ointment, a non adherent dressing, gauze. The digital block Anaesthetise from the dorsal aspect, one injection medial and one…

…started in an opioid naive patient, or when a conversion between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain…

…tone, clonus and seizures. Give glucose in hypoglycaemia and a benzodiazepine for toxicological seizures E Temperature, skin, smell, injection marks, medication patches and trauma. Remove…

…should not be used. Specific dosing adjustments are required in certain patient populations: Pediatric patients: For patients weighing less than 50 kg, the dosing should…

…Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement. OCT is particularly useful for: characterizing the surface of atheroma…

…Generally, adenosine is considered safe for patients with narrow complex tachycardia (NCT). Adenosine typically causes a short lasting second or third degree AV block which…

…also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease, etc .) are warranted. Management of AV blocks aims to restore…

…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…

…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…

…not been assessed for tendon and nerve injury will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained…

…than mild. 6. Assess the indication for antibiotics on the basis of sputum purulence, the other cardinal symptoms and the severity of the illness. 7…

…of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of…

…cardiac arrest. Repeated blood gases, for example during mechanical ventilation or severe metabolic derangement. Major surgery with expected blood loss or large volume shifts. Patients…

…Aspirate and biopsy answer different questions and do not replace one another: the aspirate shows cellular morphology and provides material for flow cytometry and genetics…

…not the subclavian. Thresholds for INR and platelet count before insertion differ between regions and departments — follow local protocol. Severe lung disease or a contralateral…

…7 nmol/L Electrolytes and renal function See the renal parameters for the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP <…

…light checked. Tubes in three sizes, a stylet or bougie taken out and shaped before induction , a syringe for the cuff, a cuff manometer. 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…

…The Swedish clinical care programme for bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even…

…dizziness attributable to a wax plug. The tympanic membrane cannot be inspected and the examination is needed for the diagnosis. Before audiometry or the fitting…

…medium for most adults, long for thick soft tissue and for the head of the humerus. A pressure bag or a 50 mL syringe with…

…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…

…parallel and must not wait for complete diagnostic certainty. Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection…

…of disease progression. Assessment of pulmonary involvement in systemic disease, for example rheumatoid arthritis or scleroderma, and during treatment with pulmonary toxic drugs. Contraindications Forced…

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

…minutes Duration of action 2 to 4 hours Delivery IV Dose Can be given as repeated intravenous bolus injections or as a constant dose infusion…

…cancer, etc – are the most important risk factors for poor outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms…

…temporal association is present; contrast induced AKI should be reserved for the smaller subgroup in which iodinated contrast is considered causally responsible. This distinction is…

…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…

…pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the emergency room: a very large or deep abscess, a markedly…

…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…

…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…

…in a formally unimpeachable way, and that the donor's organs are maintained physiologically for as long as the assessment takes. The task of the…

…or cefotaxime plus metronidazole 1 g × 3 IV plus 1.5 g for the first dose, then 1 g × 1 IV Clostridioides difficile, primary infection…

…the visual acuity before anything else is done. The second most important is to look for signs of perforation — Seidel's sign, an irregular pupil…

…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 :…

…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…

…Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the…

…Anticoagulant therapy — this rarely needs to be stopped for small biopsies, but have diathermy or aluminium chloride available. Infection in the area to be biopsied…

…pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis…

…principal haemodynamic definition uses PVR 2 Wood units. PVR is essential for identifying a precapillary pulmonary vascular component. PAWP is used to distinguish pulmonary venous…

…and may reduce cardiovascular risk within several years, although risk may remain higher than that of never smokers for a prolonged period. In heavy smokers…

…of many reported muscle symptoms remains uncertain. Randomized trials have shown muscle adverse event rates similar to those with placebo, whereas approximately 10% of patients…

Procedurer The insertion itself is rarely the difficult part — it is the confirmation of the position that determines whether the tube is safe. A misplaced…

…procedure reserved for very serious poisonings in which the patient reaches hospital early. The benefit of both methods falls steeply with the time since ingestion…

…25 G for the skin wheal and 21 G for the deeper layers. Diagnostic tap: 21–22 G needle, 20 mL and 50 mL syringes…

…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)…

…2–5 a mixed pattern. Orders of magnitude that direct the work up ALT 50 × the upper limit of normal: paracetamol poisoning, ischaemic hepatitis ("shock…

…particularly fatal infections, and because of cost. Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30…

…term outcomes. Patients with low flow low gradient aortic stenosis (discussed below) have a 3 year survival rate of 50% ( Eleid et al ). The cause…