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

…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…

…4–4.0 mIU/L Free T4 12–22 pmol/L Free T3 3.1–6.8 pmol/L TSH is logarithmically related to T4 —…

…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…

…IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary. Continuous infusion: Start infusion at 0.1 mg/min and…

…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…

…Sterile gloves, sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0…

…week): • Catapress TTS 1 (0.1 mg/24hrs). • Catapress TTS 2 (0.2 mg/24hrs) • Catapress TTS 3 (0.3 mg/24hrs) Dosage in renal…

…octopus trap). Refer to Figure 1 and Figure 2. Figure 1. Echocardiogram showing takotsubo cardiomyopathy in acute phase (A) and resolution phase (B). Note the…

…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…

…point scale: 0 fully awake, 1 drowsy but easily roused, 2 sedated but rousable, 3 deeply sedated and not rousable. Sedation precedes respiratory depression and…

…for neurological, respiratory or haemodynamic failure that cannot be corrected quickly. Rapid sequence induction is used when intubation is required [1]. In salicylate poisoning, intubation…

…of these highly efficient elimination pathways, adenosine has an extremely short elimination half life of 1 to 6 seconds. Most of the drug's pharmacological…

…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…

Conduction defects ECG Management and treatment of AV blocks (AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical…

…high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular disease. Table 1…

…infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met. The first hour Step Action : : 1…

…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…

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

…1,2]. In delirium tremens the aim should be a calm, mildly somnolent but rousable patient, while ventilation, circulation and underlying disease are monitored [3…

…without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the wrist crease at an angle of 30–45 degrees , directed proximally along the course…

…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…

…anaesthetist (1 point). A score of 3 or more indicates a difficult intubation — call for help and get out the videolaryngoscope and plan B before…

…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…

…between regions. Common practice is correction at an INR above 1.5 and a platelet count below 50 × 10⁹/L before drain insertion, while diagnostic…

…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…

…surgery 1 month Neurosurgery or an intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection…

…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…

…societies. The number of confirmed cases is approaching one million and the number of deaths is 34,000 as of March 29, 2020 (Figure 1)…

…48 hours after exposure, with a peak at approximately 3–5 days and resolution within about 1 week in the usual course. Severe AKI requiring…

…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…

…simpler to administer, since the whole dose is given as a bolus [1,2]. In a meta analysis of three phase 3 trials, tenecteplase was…

…<15 : : : : : : Benzylpenicillin 1 3 g three times daily 1 3 g three times daily 1 3 g three times daily 1 3 g twice daily…

…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…

…days or benzylpenicillin 1–3 g × 3 IV Extensive furunculosis flucloxacillin 1 g × 3 10 days Wound infection flucloxacillin 1 g × 3 7 days Cat…

…10–21 mmHg). Tonometry is contraindicated with suspected perforation or infection. Removal Proceed from the least to the most invasive technique. 1. Irrigate with sterile…

…few days. Principles Insulin component Function Who needs it : : : Basal insulin (intermediate or long acting) Covers fasting glucose production Everyone with type 1 diabetes, always…

…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…

…of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3 Heart rate 100/min 1.5 Immobilisation ≥ 3 days or surgery in…

…a 1–3 mm margin, down into the subcutis Never a shave — the depth must be measurable Basal cell carcinoma, squamous cell carcinoma 3–4…

…benzodiazepine (midazolam or diazepam) is the commonest combination; propofol is used in units with airway expertise. Procedure 1. Dry the skin and shave where necessary…

…clinical classification comprises five groups: Group 1: Pulmonary arterial hypertension Group 2: PH due to left heart disease Group 3: PH due to chronic lung…

…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…

…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…

…Diagnostic paracentesis 1. Scan the left lower quadrant. Confirm at least 2–3 cm of free fluid depth with no bowel in the path of…

…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…

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

…income countries, presumably because streptococcal infections are treated very liberally. Figure 1 shows the aortic valve in PSAX (parasternal short axis view). Figure 1. The…