…use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric…

…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…

…malignancy, infection, surgery, trauma and old age. A positive value is not a diagnosis. Risk grading in confirmed pulmonary embolism Risk Haemodynamics Right ventricular strain…

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

…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…

…A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met…

…Currently, opioid overdose stands as a predominant etiological factor for cardiac arrest within this demographic on a global scale. Numerous substances possess the potential to…

…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…

…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…

…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…

…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…

…and non fatal stroke. The clinical development of canakinumab for this indication did not continue because of safety concerns, particularly fatal infections, and because of…

…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…

…suggesting current or recent cerebral ischaemia; known CAD, PAD, or other atherosclerotic disease; diabetes and other cardiovascular risk factors; smoking, hypertension, hypercholesterolaemia, and sedentary behaviour…

…oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25 mm 90° 1…

…bursitis first Injection is considered when 4–6 weeks of adequate conservative treatment — modification of loading, eccentric exercise, an NSAID, an orthosis — has not given…

…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…

…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…

…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…

…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…

…loosened or avulsed nail plate, or a damaged nail fold edge Nail avulsion and inspection of the nail bed, with suture of any nail bed…

…injection causes nausea and a fall in blood pressure without better analgesia. Flush the cannula before and after every dose, otherwise the dose does not…

…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…

…to a few seconds. His Purkinje conduction is generally unaffected directly. Adenosine does not typically affect conduction in normal accessory pathways. However, conduction may be…

…plaque burden, and the dimensions of lesions that may not be fully characterized by angiography. Standard gray scale IVUS demonstrates the principal vessel wall layers…

…arrhythmias is greater in patients on digoxin or verapamil, although this is not an established drug interaction. The half life of adenosine is 8 seconds…

…drug. • Effective in sinus bradycardia or AV node block. • Dose <0.5 mg may worsen bradycardia and should not be given. • Relative contraindications are ileus…

…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…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…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…

…is not a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in the skin overlying the puncture…

…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…

…L (women 10–150) An acute phase protein — a normal ferritin does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 %…

…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…

…Blood samples can be taken at insertion; a blood gas and electrolytes can be interpreted, but some laboratories do not accept marrow blood in their…

…aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart failure must be aspirated. Suspected empyema or complicated parapneumonic effusion…

…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…

…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…

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

…efficacy as compared with nicardipine. Labetalol is safe in patients with coronary artery disease since it does not increase heart rate, and reduces myocardial oxygen…

…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…

…does not delay treatment Saturation Give oxygen in hypoxia, not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing…

…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…

…or in the wind. Suspected corneal abrasion. A red eye where the diagnosis is not obvious. Suspected acute glaucoma (tonometry). Contraindications Absolute contraindications to instrumental…

…Never stop basal insulin in a person with type 1 diabetes , not even before fasting or an investigation. Stopping it leads to ketoacidosis within hours…

…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…

…the subepidermal split. Choose the technique according to the diagnostic question, not according to what is quickest. Indications Suspected malignancy: basal cell carcinoma, squamous cell…

…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…

…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…

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…

…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…