…longer corticosteroid treatment Risk Action : : Osteoporosis Calcium and vitamin D. A bisphosphonate with longer treatment and risk factors, according to the guideline Hyperglycaemia Glucose measurement…

…generalised infection, or certain transmissible agents according to the current transmission risk assessment. In DCD: patients in whom death must be confirmed after a 20…

…Duration of treatment: at least 3 months. Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence. Special situations Situation Comment : : Pregnancy Leg…

…and acquired factors may interact in its development. PAH may be idiopathic, heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV infection…

…As always, foreign materials pose a high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18…

…days, or shorter neutropenia with clinical risk factors International guidelines generally use a single temperature of 38.3 degrees as the threshold [4,5]. Some…

…if more than one hour has elapsed post ingestion unless the ingested substance has the propensity to form bezoars or is a sustained release formulation…

…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…

…when several predisposing factors coexist, rather than being determined by contrast exposure in isolation. Estimated glomerular filtration rate Reported estimates include a rate of approximately…

…step down or gentamicin 4.5 mg/kg IV as a single dose Urosepsis with complicating factors cefotaxime 1 g × 3 IV 10–14 days…

…and treatment related factors: Age older than 80 years Female sex Low body mass index Asian ancestry Previous muscle disease or a personal or family…

…a monoclonal antibody directed against interleukin 1β, provided proof of concept but was not developed for routine coronary prevention because of fatal infections and…

…cause of aortic stenosis. Rheumatic heart disease is a complication of rheumatic fever, which is caused by streptococcal infections (group A Streptococcus ). Rheumatic heart disease…

… inspection of the legs and feet. A systolic blood pressure difference between the arms exceeding 15 mmHg is associated with a 50% higher risk of…

…Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25 mm 90° 1–2 mL Deltoid, BMI 35 or a large arm…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…is rarely the injection itself that determines whether the result can be interpreted. What decides that is whether the patient is taking a steroid that…

…®, Rogitine ® Indications Hypertensive crisis. Mechanism of action Phentolamine is a non selective alpha adrenergic blocker. Phentolamine reduces blood pressure while increasing catecholamine activity…

…tree after selective intracoronary contrast injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to…

…conditions. For corticosteroid injection there is an additional absolute contraindication: the slightest suspicion of septic arthritis. If the picture is unclear — aspirate, send a culture…

…delirium • Analgesia • Hypertension, hypertensive crisis/emergency Mechanism of action Clonidine is primarily a centrally acting alpha 2 agonist. Stimulation of alpha 2 adrenoceptors in the…

…apical ballooning syndrome, stress induced cardiomyopathy) Takotsubo cardiomyopathy (broken heart syndrome) is a rather peculiar and certainly acute condition. Much research has been devoted to…

…for a few minutes. 5. If the patient tolerates the test dose without troublesome adverse effects, give a further 8 mg intravenously , slowly. Rapid injection…

…injection medial and one lateral to the base of the phalanx, 2–3 mL on each side, with the needle tip directed volarly until a…

…points during titration: Give the injection slowly over at least a minute; a rapid injection causes nausea and a fall in blood pressure without better…

…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…

…A flush should immediately follow the bolus injection to ensure rapid delivery to the central circulation. If the drug is injected into a central vein…

…Unlike coronary angiography, which produces a two dimensional luminogram and has limited specificity for plaque and vessel wall pathology, intravascular imaging provides cross sectional and…

…care unit. Adenosine injection must be administered quickly (1 2 seconds), followed immediately by a rapid saline flush (use a three way tap system). Compatible…

…AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history (with emphasis on causes of AV blocks; please…

…cause of wound infection is retained contamination, not poor suture technique — and the commonest cause of permanent loss of function is a tendon injury that…

…in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are viral infection, bacterial infection and air pollution…

…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…

…for dialysis. Previous vascular surgery in the area. Coagulopathy and thrombolytic treatment are relative contraindications and are an argument for a superficial, compressible vessel. Allen…

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

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…

…the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP < 3 mg/L Rises within 6–8 h, half life about 19…

…airway obstruction: inhalation injury, anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring a secured airway — transfer, heavy sedation, surgery — and…

…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…

…for bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even with a reduced level of…

…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…

…at the same dose. Blood samples can be taken at insertion; a blood gas and electrolytes can be interpreted, but some laboratories do not accept…

…according to local practice Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk…

…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…

…aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated…

…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…

Cardiology Pharmacology & dosing Definition and therapeutic rationale Inclisiran is a liver directed small interfering RNA (siRNA) designed to reduce production of proprotein convertase subtilisin/kexin…

…acidic environment inactivates the anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to…

…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…

…two to three times daily Pivmecillinam Dosed independently of renal function for a single course of treatment Trimethoprim 160 mg twice daily 160 mg twice…

…or infection. Removal Proceed from the least to the most invasive technique. 1. Irrigate with sterile saline — loose particles often come away. 2. A moistened…

…the dose and measure more frequently Acute illness and infection The insulin requirement rises, often despite a reduced food intake Insulin pump The patient manages…

…Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to…

…from the active edge, not from the centre Include epidermis and dermis Bullous dermatosis Two biopsies: one from a fresh blister (routine), one from perilesional…

…the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis…

…In chronic coronary syndrome, cessation has been associated with a 36% reduction in premature mortality compared with continued smoking. Cessation also improves vascular health and…

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…

…not afterwards. Indications Medicinal charcoal is given after the ingestion of a potentially toxic dose of a substance that binds to charcoal, when it can…

…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…