…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…

…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…

…Sterile gloves, sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0…

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

…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…

…a further 8 mg intravenously , slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing weakness. 6. Assess the chosen finding continuously during…

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

…of 10 mg/mL makes small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at…

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

…before the drug is eliminated. A flush should immediately follow the bolus injection to ensure rapid delivery to the central circulation. If the drug is…

…backscatter of the light signal. Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement. OCT is particularly useful for…

…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 …

…minutes, maximum 3 mg IV. T½ 3 h. 50% renal elimination. • Typically the first choice of drug. • Effective in sinus bradycardia or AV node block…

…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…

…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…

…Assessment of stroke volume variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand…

…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…

Procedurer What determines the outcome of a central venous catheter insertion is decided before the needle goes in: the choice of site, the use of…

…ferritin does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 % < 15 % indicates iron deficiency whatever the ferritin Vitamin B12…

…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…

…A platelet count below 50 × 10⁹/L is often quoted as the threshold, but the threshold varies between regions. Infection of the skin over the…

…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…

…bag or a 50 mL syringe with a three way tap — intraosseous flow requires pressure ; gravity is not enough. Lidocaine 10 mg/mL to anaesthetise…

…for the deeper layers. Diagnostic aspiration: a 21 G (green) or 22 G needle, a 50 mL syringe, a three way tap. Therapeutic aspiration: a…

…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…

…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…

…Delivery IV or IM. Dose Injections • IV: 10–40 mg every 4–6 hours • IM: 10–20 mg every 4–6 hours. Infusion • Afterload reduction…

…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…

…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)…

…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…

…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…

…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…

…to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has been assessed…

…patients with an eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect is lost…

…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…

…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…

…Sterile cotton buds. An eye spud or a 25–27 G needle on a 2 mL syringe as a handle. A low speed rust ring…

…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…

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

…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…

…heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among…

…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…

…muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting medications The…

…local anaesthetic, and a decongestant nasal spray if the nasal passage is narrow. A 50–60 mL catheter syringe, a collection bag or suction, and…

…patient — charcoal stains everything black. For administration by tube: a gastric tube and a 50–60 mL catheter syringe, and equipment for confirming the position…

…over the insertion site Change the puncture site Preparation and equipment Ultrasound with a curved array probe. Sterile preparation (chlorhexidine in alcohol 5 mg/mL)…

…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…

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

…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…