…pain relief is a diagnostic finding — and appears to reduce the risk of a post injection flare. Lidocaine 10 mg/mL without adrenaline is used…

…a knee with a large effusion, 5–10 mL for smaller joints. Local anaesthesia of the skin and subcutis where needed, lidocaine 10 mg/mL…

…an iodine solution. Lidocaine 10 mg/mL without adrenaline for the block (adrenaline is safe in fingers and toes according to modern data, but there…

…Comment : : : : Lidocaine 10 mg/mL Rapid 1–2 hours The standard choice Lidocaine 10 mg/mL with adrenaline 5 µg/mL Rapid 2–6 hours…

…Anaesthetise the skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the wrist crease at an angle…

…Local anaesthetic: lidocaine 10 mg/mL, usually 5–10 mL, with a longer needle so that the periosteum can be infiltrated generously — it is the…

…sterile gown, sterile gloves and a large full body drape. Lidocaine 10 mg/mL for local anaesthesia, normal saline to flush all lumens, suture material…

…Local anaesthesia: lidocaine 10 mg/mL, a millilitre or two intracutaneously and along the needle track, with a fine needle. A manometer with a three…

…or a 50 mL syringe with a three way tap — intraosseous flow requires pressure ; gravity is not enough. Lidocaine 10 mg/mL to anaesthetise the…

…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…

…Local anaesthesia: lidocaine 10 mg/mL with adrenaline (epinephrine). Syringe, 27 G and 21 G needles. Irrigation fluid (NaCl 9 mg/mL) and a 20…

…ulcer, basal cell carcinoma) and vasculitis do occur. Wound debridement 1. Cleanse with lukewarm tap water or saline; showering the leg is a good option…

…or an iodine solution. Lidocaine 10 mg/mL with adrenaline 5 µg/mL (adrenaline gives a bloodless field and a longer duration; it is safe…

…preparation (chlorhexidine in alcohol 5 mg/mL), sterile gloves, fenestrated drape; full sterile attire for therapeutic drainage with an indwelling catheter. Lidocaine 10 mg/mL…

…auto injector and written instructions. Patients taking beta blockers may respond poorly to adrenaline. If there is no response, give glucagon 1–5 mg IV…

…pharynx with lidocaine spray and lubricate the electrode generously with lidocaine gel. 6. Introduce the electrode along the floor of the nose, parallel with the…

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

…then performed with preparedness for anaphylaxis. An untreated Addisonian crisis in progress: treat first, test later. Preparation and equipment Tetracosactide (Synacthen) 0.25 mg/mL…

…1 mg. Adverse effects Tachycardia. Flushing. Headache. Nausea. Vomiting. Caution Rarely used unless patient has a confirmed diagnosis of pheochromocytoma Treatment of hypertension associated with…

…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…

…with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long term corticosteroid treatment cannot increase their own cortisol production. Situation Action : : Fever, infection…

…transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and give by slow injection over 5…

…research has been devoted to it in recent years. Most cases (70%) of takotsubo cardiomyopathy occur in situations with extreme stress, such as car accidents…

…dose without troublesome adverse effects, give a further 8 mg intravenously , slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing weakness. 6…

…current creatinine with the eGFR, the weight, the age and the medication list. Always dilute morphine 10 mg/mL to 1 mg/mL (1 mL…

…Rapid sequence induction is used when intubation is required [1]. In salicylate poisoning, intubation with an inadequate minute ventilation can rapidly worsen the acidaemia and…

…Pathophysiology Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac…

…used to identify thin cap fibroatheroma, a plaque phenotype associated with subsequent major adverse cardiovascular events in observational studies. OCT OCT uses near infrared light…

…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 …

…T½ 1 min • May cause ventricular arrhythmias (dose dependent). • Prolonged use often causes headaches, tremors. • Effective if bradycardia is caused by beta blockers. Adrenaline (Epinephrine…

…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…

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

…infection and air pollution, but often no definite trigger can be identified [1,2]. Ask specifically about: Onset and time course. Increased dyspnoea compared with…

…high blood alcohol concentration, particularly in patients with marked tolerance. The most important measures in severe or complicated withdrawal are: 1. A benzodiazepine in a…

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

…get out the videolaryngoscope and plan B before you give the induction agent. Preparation and equipment Go through the equipment out loud with the team…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…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…

…clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have…

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

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

…intravenous bolus injections or as a constant dose infusion. Bolus regime : • 20 mg IV bolus over 2 minutes, followed by 20 to 80 mg every…

…plaque rupture is increased during infections). As noted by Bonow et al, it is also reasonable to believe that patients with heart failure are at…

…is considered causally responsible. This distinction is important because AKI after a contrast study frequently occurs in patients with several simultaneous renal insults. Infection, hypovolaemia…

…therapies requiring monthly or biweekly injections. Inclisiran is used as an adjunct to dietary measures and maximally tolerated statin therapy, with or without other LDL…

…non inferior to alteplase with respect to an excellent functional outcome, without an increased risk of symptomatic intracerebral haemorrhage or death [3]. Acute overview 1…

…times daily 1 g two to three times daily Pivmecillinam Dosed independently of renal function for a single course of treatment Trimethoprim 160 mg twice…

…next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain…

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

…Tonometry is contraindicated with suspected perforation or infection. Removal Proceed from the least to the most invasive technique. 1. Irrigate with sterile saline — loose particles…

…or long acting) Covers fasting glucose production Everyone with type 1 diabetes, always, including while fasting. Many with type 2 Mealtime insulin (rapid acting) Covers…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…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…

…or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic…

Cardiology Clinical medicine Definition and cardiovascular rationale Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible…

…muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting medications The SLCO1B1 rs4149056 polymorphism is associated with higher statin concentrations…

…pause. Position the patient semi recumbent with the chin slightly towards the chest — an extended neck directs the tube towards the larynx. Procedure 1. Inspect…

…life threatening ingestion of a highly toxic substance, where the patient arrives within about 1 hour (a liquid preparation) or 2 hours (tablets). With very…

…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)…

…course. An AST/ALT ratio 2 with moderately raised values suggests alcohol related liver disease; a ratio < 1 suggests steatohepatitis or viral hepatitis. An…