…is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption. Injection into…

…not be shorter than four weeks . Mix the corticosteroid and the lidocaine in the same syringe. The anaesthetic confirms that the injection has gone to…

…up of known HPA suppression to determine whether replacement can be stopped. The test is not the first line investigation in a suspected acute crisis…

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

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

…of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric symptoms Sleep disturbance, hypomania…

…must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in which septic arthritis must be distinguished from…

…of its administration in these patients should be carefully balanced against the potential risks resulting from hypotension. • Withdrawal of clonidine may lead to rebound hypertension…

…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…

…continuously during the window of effect, 40 seconds to 5–10 minutes after the injection . 7. Stop the test in the event of bradycardia, bronchospasm…

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…injection causes nausea and a fall in blood pressure without better analgesia. Flush the cannula before and after every dose, otherwise the dose does not…

Akutsjukvård Lathundar Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG…

…nodal block lasting up to a few seconds. His Purkinje conduction is generally unaffected directly. Adenosine does not typically affect conduction in normal accessory pathways…

…Virtual histology IVUS has also been used to identify thin cap fibroatheroma, a plaque phenotype associated with subsequent major adverse cardiovascular events in observational studies…

…Syndrome]); blocking AV node conduction may result in accelerated transmission of atrial impulses to the ventricles and thus ventricular fibrillation and cardiac arrest. High degree…

…may be valuable if the diagnosis is uncertain. Echocardiography is generally performed in order to evaluate ventricular function, since it may affect the choice of…

…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…

…is not obligatory Hypothermia, new confusion, tachypnoea, hypotension, rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of infection…

…through a 20 mL syringe and a large bore needle. Chlorhexidine in alcohol to the skin around the wound — not into the wound. Sterile gloves…

…Signs of a serious condition Finding Significance : : Inability to speak in full sentences Marked work of breathing Use of accessory respiratory muscles or paradoxical abdominal…

…not merely detoxification. Benzodiazepines reduce the severity of withdrawal and the risk of seizures and delirium [1,2]. In delirium tremens the aim should be…

…management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb: marked peripheral arterial disease…

…is not a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in the skin overlying the puncture…

…The need for central access is not in itself an indication for emergency insertion in an unstable situation: intraosseous access or a large bore peripheral…

…10–150) An acute phase protein — a normal ferritin does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 % < 15…

…and plan B before you give the induction agent. Preparation and equipment Go through the equipment out loud with the team, not in your head…

…to improve outcomes and is not part of the screening programme — screening consists of the smear, not of the examination itself. Cervical cancer screening in…

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

…Recurrent otitis externa in which the wax retains moisture. Contraindications Absolute contraindications to irrigation: A known or suspected perforation of the tympanic membrane — including a…

…samples can be taken at insertion; a blood gas and electrolytes can be interpreted, but some laboratories do not accept marrow blood in their analysers —…

…shows the most fluid, usually in the scapular line one to two intercostal spaces below the upper border of the fluid, but never below the…

…parallel and must not wait for complete diagnostic certainty. Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection…

…symptoms, and occupational exposure to dust, gas or fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow…

…desired in conditions requiring afterload reduction. Time to onset of action 10 30 minutes. Duration of action <4 hours. Delivery IV or IM. Dose Injections…

…Labetalol is safe in patients with coronary artery disease since it does not increase heart rate, and reduces myocardial oxygen consumption. Time to onset of…

…to precipitate acute coronary events during infections: An acute coronary event may be triggered by increased myocardial demand during the infection. Systemic inflammation results in…

…frequently occurs in patients with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction, haemodynamic instability, anaemia and other nephrotoxic exposures may contribute to tubular injury…

…an important practical distinction from therapies requiring monthly or biweekly injections. Inclisiran is used as an adjunct to dietary measures and maximally tolerated statin therapy…

…anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to hurt even so. Offer…

…does not delay treatment Saturation Give oxygen in hypoxia, not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing…

…2026 and are given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or…

…types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current transmission risk assessment. In DCD: patients in whom death…

…and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin and soft tissue Diagnosis Agent…

…or in the wind. Suspected corneal abrasion. A red eye where the diagnosis is not obvious. Suspected acute glaucoma (tonometry). Contraindications Absolute contraindications to instrumental…

…Never stop basal insulin in a person with type 1 diabetes , not even before fasting or an investigation. Stopping it leads to ketoacidosis within hours…

…compression applied to a limb with arterial insufficiency can cause necrosis and, in the worst case, amputation. The decisive step is therefore not the choice…

…A D dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10…

…and you are in the subcutis. 5. Lift the specimen gently with a needle tip or fine forceps applied to its edge , not by gripping…

…Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that has not responded to atropine: Complete…

…rest to exercise. This response is age dependent and may rarely occur in healthy people older than 60 years. The abnormal slope does not itself…

…products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking…

…This discrepancy reflects, at least in part, the nocebo effect : negative expectations, contextual cues and attribution of pre existing symptoms to the medication. No single…

…surgical ward. Decompression in severe vomiting where the stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery, according to local practice. Enteral nutrition…

…an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind every poison…

…deterioration. The procedure itself is straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and…

…an implantable loop recorder is essential to accurately establish the diagnosis. Electrophysiology In patients with presyncope or syncope—especially older individuals with BBB or intraventricular…

…shifts the suspicion to bone, pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or…

…dose methotrexate did not reduce cardiovascular outcomes, and several other agents, including pexelizumab, losmapimod and darapladib, failed to demonstrate clinical benefit in the settings studied…

…elevated risk of developing aortic stenosis. The prevalence of bicuspid aortic valves is 1% to 2% in most Western populations. Individuals with bicuspid aortic valves…