…vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption. Injection into an arm with a dialysis fistula. Preparation…

…of the fascia on the calcaneus A risk of rupture; use sparingly Prepatellar and olecranon bursitis The bursa Exclude septic bursitis first Injection is considered…

…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 Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric symptoms Sleep disturbance, hypomania, confusion. Commonest early on…

…surgeon under strictly sterile conditions. For corticosteroid injection there is an additional absolute contraindication: the slightest suspicion of septic arthritis. If the picture is unclear…

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

…the European Society for Cardiology: Lyon et al: Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of…

…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…

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

…Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain, but the effect on the bowel must be taken into account)…

…Remove contaminated clothing and wash the skin after external exposure A low Glasgow Coma Scale is not on its own an absolute indication for intubation…

…Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells…

…for plaque and vessel wall pathology, intravascular imaging provides cross sectional and longitudinal information about the artery. The clinical value of these techniques rests on…

…rely on AV node transmission. By disrupting this transmission, the reentry and hence, the arrhythmia may be terminated. Generally, adenosine is considered safe for patients…

…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…

…chart for the investigation of suspected endocarditis. Vegetations Vegetations are ecotate masses made up of the foci of infection. Vegetations can be found on the…

…or arrival. This is supported by international guidelines on neutropenic fever [2]. The direct evidence for exactly one hour in neutropenic fever is limited, but…

…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…

…in many units to assess the collateral circulation, but the test does not reliably predict ischaemic complications and should not decide the matter on its…

…followed by compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other…

…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…

…The ranges below are guide values for adults. The method and the laboratory determine the range — always use the range printed on your own report…

…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…

…that did not need syringing. The second commonest is that the syringing is performed on a tympanic membrane that was already perforated. Indications Otoscopy: earache…

…18 G Green 90–100 mL/min Blood transfusion, contrast medium 20 G Pink 55–65 mL/min The standard for most adults 22 G…

…patient sits leaning forward with the arms on a table for diagnostic and therapeutic aspiration; for drain insertion the supine position is used with the…

Infektionssjukdomar Akutsjukvård Lathundar Purpose and scope A quick reference for the doctor on call faced with suspected sepsis in adults: rapid recognition, microbiological sampling, empirical…

…Show for yourself what a maximal blow looks like. The patient sits upright with both feet on the floor and must not lean forward during…

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…

…in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the…

…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…

…COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline 200 mg × 1 on day 1, then 100 mg ×…

…with a syringe for irrigation. An eye shield (never a pressure dressing when perforation is suspected). A tonometer: an applanation tonometer on the slit lamp…

…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 :…

…necrotic, pale Variable, often deep Pain Moderate, relieved by elevation Severe, worse on elevation, better when dependent Often painless (neuropathy) Surrounding skin Hyperpigmentation, oedema, lipodermatosclerosis…

…criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3 Heart rate 100/min…

…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…

…PVR ≥3 Wood units in an overlapping clinical classification table; the principal haemodynamic definition uses PVR 2 Wood units. PVR is essential for identifying a…

…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…

…LDL particles from the circulation. Statins also reduce production of apoB 100 containing lipoproteins and exert effects beyond LDL C reduction, including modulation of inflammation…

…cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see the separate text on gastric lavage). The tube…

…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…

…the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin on the sample. Indications…

…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)…

…A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance…

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

…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…