…in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption. Injection into an arm…

…Suspected or known tendon rupture. No response to previous injections at the same site. More than three injections at the same site within a year…

…treatment is given, and the test is performed later. Contraindications Known hypersensitivity to tetracosactide or ACTH. Marked atopic disease, particularly severe asthma and a history…

…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…

…significant obstructive CAD or when more than one potential culprit lesion is present. Clinical Indications Suspected Chronic Coronary Syndrome The decision to perform ICA is…

…s sick day rules) Vomiting or diarrhoea, unable to keep tablets down Parenteral hydrocortisone. The patient must have an emergency injection at home Acute illness…

…passes through muscle without major vessels or nerves, and the landmark — the posterior corner of the acromion — is easy to palpate even in a large…

…induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable. The benefit of…

…to it in recent years. Most cases (70%) of takotsubo cardiomyopathy occur in situations with extreme stress, such as car accidents, gun violence, threats, or…

…effect, 40 seconds to 5–10 minutes after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or increasing weakness…

…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…

…and urticaria are usually due to histamine release, not allergy. Concurrent MAO inhibitor, particularly with pethidine. Caution: untreated sleep apnoea, a concurrent benzodiazepine or gabapentinoid…

…estimated quantity the time, and whether the intake was single or repeated a modified release preparation or a combination product concurrent drugs, alcohol and illicit…

…12 mg or less successfully terminate 92% of supraventricular tachycardias (SVTs), usually within 30 seconds. Doses higher than 18 mg are unlikely to revert a…

…of gray scale IVUS include lower spatial resolution than OCT and imperfect discrimination between plaque components. Radiofrequency or virtual histology IVUS can provide additional information…

…Central venous administration of adenosine is suitable in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1 2 seconds)…

…etc .) are warranted. Management of AV blocks aims to restore atrioventricular conduction either pharmacologically or by means of artificial pacemakers. Both methods may be used…

…of infection. Vegetations can be found on the flaps and appear as moving masses. Mural vegetations are attached to the endocardium and, accordingly, less mobile…

…10⁹/L An expected high risk course Neutropenia expected to last longer than 7 days, or shorter neutropenia with clinical risk factors International guidelines generally…

…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…

…consciousness, or when NIV is being considered. 4. Give short acting bronchodilators. 5. Give a systemic corticosteroid if the exacerbation is more than mild. 6…

…5 to 7 days, sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness or after prolonged very high intake More than…

…as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb…

…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…

…body drape. Lidocaine 10 mg/mL for local anaesthesia, normal saline to flush all lumens, suture material or a securement device, transparent dressing. Monitoring throughout…

…homocysteine or methylmalonic acid Folate 7 nmol/L Electrolytes and renal function See the renal parameters for the eGFR stages and albuminuria. Inflammation and infection…

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

…cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although…

…blood cultures. For questions other than acute meningitis — an insidious onset, known malignancy, immunosuppression, papilloedema or new focal neurological signs — CT is performed first. Preparation…

…healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes…

…the old hole. Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks. Choice of vein…

…the aspiration for the trough level or pause the drug according to local practice Relative Skin infection, herpes zoster or burns over the puncture site…

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

…The manoeuvre ends when the volume increases by less than 0.025 L during the last second , or when the expiratory time has reached 15…

…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…

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

…of atherosclerotic plaque rupture is increased during infections). As noted by Bonow et al, it is also reasonable to believe that patients with heart failure…

…combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic injury because of its high blood flow…

…therapies requiring monthly or biweekly injections. Inclisiran is used as an adjunct to dietary measures and maximally tolerated statin therapy, with or without other LDL…

…rather than the emergency room: a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection…

…10. In unknown time of onset, wake up stroke or a late time window: perform advanced imaging according to the local protocol. 11. Document weight…

…in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be…

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

…infection flucloxacillin 1 g × 3 7 days Cat bite within 2 days phenoxymethylpenicillin 1 g × 3 10 days Cat bite after 2 days, close to…

…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…

…or repeated doses, according to the local protocol Renal failure The insulin requirement falls . Reduce the dose and measure more frequently Acute illness and infection…

…hyperkeratotic Pulses Palpable Weak or absent May be palpable despite ischaemia ABI 0.9 < 0.9 Often falsely high Contraindications to compression The ankle…

…contraindication. The agent and dose are according to the local protocol. Alternatives when there is a contraindication: catheter directed treatment or surgical embolectomy where available…

…4 mm punch from a lesion less than 48 hours old Also take a biopsy for immunofluorescence Panniculitis Excision or a deep punch down into…

…myocardial ischaemia or syncope — that has not responded to atropine: Complete heart block (third degree AV block) and second degree AV block Mobitz type 2…

…blood flow rather than pulmonary vascular disease. This state is termed unclassified PH. Potential explanations include congenital heart disease, liver disease, airway or lung disease…

…Exposure to second hand smoke. Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or…

…than 80 years Female sex Low body mass index Asian ancestry Previous muscle disease or a personal or family history of muscle disorders Acute infection…

…nasal fracture or unilateral nasal obstruction. 2. Measure the depth of insertion by laying the tube from the tip of the nose to the earlobe…

…Modified release preparations, anticholinergics, opioids and salicylate — where gastric emptying is delayed — may justify charcoal later, in some cases up to 6 hours or more…

…failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the…

…and extended monitoring exceeding 3 weeks is necessary, an implantable loop recorder is essential to accurately establish the diagnosis. Electrophysiology In patients with presyncope or…

…the suspicion to bone, pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs…

…adjunct to, rather than a replacement for, established secondary prevention treatment. Its potential role is greatest when cardiovascular risk remains high despite optimal or maximally…

…heart disease is a complication of rheumatic fever, which is caused by streptococcal infections (group A Streptococcus ). Rheumatic heart disease can occur at any age…