…transmission through the atrioventricular (AV) node, thereby interfering with the pathway that enables reentry tachyarrhythmias (AVNRT and AVRT). These arrhythmias rely on AV node transmission…

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

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…

…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…

…of the muscle belly, within the inverted triangle formed between the acromion and the lower tip of the muscle insertion. 3. Stretch the skin with…

…40 mm for subacromial and trochanteric injection; 25–27 G, 25 mm for the carpal tunnel, de Quervain's and trigger finger. Syringes of 3…

…related rise in cortisol. 3. Take the baseline sample : cortisol and plasma ACTH. The ACTH sample is taken before the injection and handled chilled. 4…

…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…

…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…

…• Catapress TTS 2 (0.2 mg/24hrs) • Catapress TTS 3 (0.3 mg/24hrs) Dosage in renal failure and renal replacement therapy: Dose as in…

…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…

…half of ocular myasthenia, thereafter MuSK and LRP4 antibodies) and on neurophysiology (repetitive nerve stimulation with a decrement ≥ 10 % at 3 Hz, sensitivity about 75…

…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…

…but easily roused, 2 sedated but rousable, 3 deeply sedated and not rousable. Sedation precedes respiratory depression and is the early warning sign. Choice of…

…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…

…strut coverage. OCT has limited tissue penetration, generally approximately 1–3 mm, and may not show the EEM through substantial plaque or calcium. Blood clearance…

…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…

…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…

…with a target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an arterial blood gas in respiratory compromise…

…while ventilation, circulation and underlying disease are monitored [3]. The management of complicated withdrawal varies between regions and units. Follow the local protocol for choice…

…compressible vessel. Allen's test is still used in many units to assess the collateral circulation, but the test does not reliably predict ischaemic complications…

…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…

…of 3 or more indicates a difficult intubation — call for help and get out the videolaryngoscope and plan B before you give the induction agent…

…Suspected subarachnoid haemorrhage with a normal or non diagnostic CT. Suspected neuroborreliosis, neurosyphilis or another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome…

…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…

…be given intravenously , at the same dose. Blood samples can be taken at insertion; a blood gas and electrolytes can be interpreted, but some laboratories…

…coagulopathy or thrombocytopenia Relative Ongoing anticoagulant treatment — plan the aspiration for the trough level or pause the drug according to local practice Relative Skin infection…

…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…

…humans and societies. The number of confirmed cases is approaching one million and the number of deaths is 34,000 as of March 29, 2020 …

…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…

…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…

…is given as a bolus [1,2]. In a meta analysis of three phase 3 trials, tenecteplase was non inferior to alteplase with respect to…

…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…

…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…

…1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always assess the severity…

…a fluid level in the anterior chamber, best seen with the patient sitting up. 3. Ocular movements in all directions; pain on upward gaze may…

…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…

…3. Palpate the pulses and measure the ankle brachial index with Doppler. 4. Culture only in the presence of clinical signs of infection — all chronic…

…own laboratory uses before applying it. The D dimer is raised in pregnancy, malignancy, infection, surgery, trauma and old age. A positive value is not…

…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…

…also presents a CpcPH threshold of PVR ≥3 Wood units in an overlapping clinical classification table; the principal haemodynamic definition uses PVR 2 Wood units…

…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…

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…

…in which the patient reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient…

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…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)…

…enzyme induction by alcohol or drugs and is often of no clinical significance. Synthetic function and prognosis Child–Pugh Parameter 1 point 2 points 3…

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

Echocardiography Aortic stenosis The aortic valve area is normally 3.0 to 4.0 cm 2 . Aortic stenosis is a progressive disease that leads to…