…a sharps bin. For vaccination: adrenaline 1 mg/mL, an antihistamine, oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume…

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…

…a non selective alpha adrenergic blocker. Phentolamine reduces blood pressure while increasing catecholamine activity. Effects Primarily causes afterload reduction. Time to onset of action 1…

…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…

…have an emergency injection at home Acute illness, trauma, surgery Parenteral hydrocortisone, at a dose according to the local protocol. Usually a bolus followed by…

…a couple of minutes before the needle is inserted. Sterile gloves, sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1…

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

…for a kind of octopus trap (the left ventricle takes the shape of that octopus trap). Refer to Figure 1 and Figure 2. Figure 1…

…under monitoring in a setting where the airway can be secured. Preparation and equipment Edrophonium 10 mg/mL, 1 mL (named patient product — order well…

…not stay on for longer than 20–30 minutes. Procedure Paronychia — incision and drainage 1. A digital block if the abscess is more than superficia

…increase the dose. The level of sedation is scored on a four point scale: 0 fully awake, 1 drowsy but easily roused, 2 sedated but…

…a targeted antidote, reduced absorption and, in selected cases, enhanced elimination. For many poisonings, well delivered supportive treatment matters more than the antidote [1,2…

…cells through a nucleoside transport system. Because of these highly efficient elimination pathways, adenosine has an extremely short elimination half life of 1 to 6…

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

…please refer to Management of acute bradycardia. A summary of the treatments is provided below. Figure 1. Management of acute bradycardia in the emergency setting…

…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…

…count or contact with the patient's own clinic delay empirical antibiotics [1]. A practical target: give the first dose of broad spectrum antibiotics within…

…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…

…requires a change of treatment. Common precipitants are viral infection, bacterial infection and air pollution, but often no definite trigger can be identified [1,2…

…with marked tolerance. The most important measures in severe or complicated withdrawal are: 1. A benzodiazepine in a sufficient and repeated dose , titrated against clinical…

…angle to close to the plane of the skin and advance a further 1–2 mm so that the catheter tip also lies in the…

…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…

…specific — follow the local 0/1 hour protocol NT proBNP < 125 ng/L (< 300 in acute dyspnoea) A normal value effectively excludes heart…

…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…

…Procedure Otoscopy 1. Inspect the outer ear, the tragus and the area behind the pinna before the otoscope is inserted — mastoid erythema and a protruding…

…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…

…at an INR above 1.5 and a platelet count below 50 × 10⁹/L before drain insertion, while diagnostic aspiration with a fine needle is…

…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…

…Dose Injections • IV: 10–40 mg every 4–6 hours • IM: 10–20 mg every 4–6 hours. Infusion • Afterload reduction : Start infusion at 1…

…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…

…Continous medical discussion: the ECG blog Infectious diseases Cardiovascular effects of COVID 19 Coronavirus disease 2019 (COVID 19) has caused a global public health crisis…

…rate Reported estimates include a rate of approximately 0–2% in patients with an eGFR of 30–44 mL/min/1.73 m2 and up…

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…

…1 g three times daily 1 g three times daily 1 g two to three times daily Pivmecillinam Dosed independently of renal function for a…

…before any retrieval: it begins when someone in the intensive care unit identifies a possible donor and the deceased person's own wishes are properly…

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

…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…

…sole regimen. Common situations Situation Management : : Fasting before an investigation, type 1 Continue basal insulin, often at a somewhat reduced dose. Withhold mealtime insulin. Monitor…

…boot), or a class 2–3 compression stocking. Tape measure for ankle circumference — this governs the choice of material and bandaging technique. Procedure Assessment 1…

…malignancy 1 Two level interpretation: ≤ 4 points means pulmonary embolism unlikely, 4 points means pulmonary embolism likely. Probability Next step : : Unlikely D dimer. A negative…

…lesion, suspected melanoma Excision with a 1–3 mm margin, down into the subcutis Never a shave — the depth must be measurable Basal cell carcinoma…

…opioid (morphine or fentanyl) combined with a benzodiazepine (midazolam or diazepam) is the commonest combination; propofol is used in units with airway expertise. Procedure 1…

…2 mmHg/L/min may help identify a postcapillary mechanism. Clinical classification The clinical classification comprises five groups: Group 1: Pulmonary arterial hypertension Group 2…

…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…

…mass index Asian ancestry Previous muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D…

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…

…is considered only after a life threatening ingestion of a highly toxic substance, where the patient arrives within about 1 hour (a liquid preparation) or…

…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)…

…most often enzyme induction by alcohol or drugs and is often of no clinical significance. Synthetic function and prognosis Child–Pugh Parameter 1 point 2…

…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…