…15 mg of morphine in total. If more than that is required without effect, reconsider the pain mechanism instead of continuing to increase the dose…

…pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis…

…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…

…a post injection flare. Lidocaine 10 mg/mL without adrenaline is used; larger volumes are needed subacromially and trochanterically to distribute the dose within the…

…Tetracosactide (Synacthen) 0.25 mg/mL, one ampoule. A peripheral venous cannula and a saline flush. A tube for serum or plasma cortisol according to…

…Delivery 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 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…

…surgeon under strictly sterile conditions. For corticosteroid injection there is an additional absolute contraindication: the slightest suspicion of septic arthritis. If the picture is unclear…

…by slow injection over 5 10 minutes. Dilute immediately before use. PO: Alternatives: Dixarit 25 μg tablets. Catapress 150 μg tablets. Dose: 75…

…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…

…for a few minutes. 5. If the patient tolerates the test dose without troublesome adverse effects, give a further 8 mg intravenously , slowly. Rapid injection…

…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…

…tone, clonus and seizures. Give glucose in hypoglycaemia and a benzodiazepine for toxicological seizures E Temperature, skin, smell, injection marks, medication patches and trauma. Remove…

…makes the sinus and AV nodes supersensitive to the drug, the initial dose should be reduced to 3 mg. Dipyridamole therapy: Dipyridamole is a nucleoside

…Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement. OCT is particularly useful for: characterizing the surface of atheroma…

…60 seconds before attempting a second dose. Second dose : 12 mg. Wait 60 seconds before attempting a third dose. Third dose : 12 or 16 mg…

…iv injection. Rarely used. Glucagon Counteracts beta blockers. An antidote to beta blockers. 2–10 mg bolus followed by 2–5 mg/h infusion Antidote…

…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…

…and high dose corticosteroids. The time limit and the choice of closure strategy The classical limit of 6–8 hours for primary closure rests on…

…than mild. 6. Assess the indication for antibiotics on the basis of sputum purulence, the other cardinal symptoms and the severity of the illness. 7…

…of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of…

…preparation with chlorhexidine in alcohol 5 mg/mL, sterile drape, sterile gloves, mask and cap. Lidocaine 10 mg/mL for local anaesthesia in the awake…

…Aspirate and biopsy answer different questions and do not replace one another: the aspirate shows cellular morphology and provides material for flow cytometry and genetics…

…become the patient's next focus of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous…

…function See the renal parameters for the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP < 3 mg/L Rises within 6…

…Working venous access, fluid and a vasopressor drawn up — push dose noradrenaline or phenylephrine must be ready before induction , not looked for afterwards. Monitoring: ECG…

…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…

…The Swedish clinical care programme for bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even…

…dizziness attributable to a wax plug. The tympanic membrane cannot be inspected and the examination is needed for the diagnosis. Before audiometry or the fitting…

…a tourniquet, chlorhexidine in alcohol 5 mg/mL, gauze, a transparent dressing, an extension set with a three way tap, and saline for flushing. An…

…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…

…and a culture from the likely focus 0 to 15 min Ringer's acetate for hypotension or hypoperfusion, usually 500 mL as a rapid bolus…

…of disease progression. Assessment of pulmonary involvement in systemic disease, for example rheumatoid arthritis or scleroderma, and during treatment with pulmonary toxic drugs. Contraindications Forced…

…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…

…hours Delivery IV Dose Can be given as repeated intravenous bolus injections or as a constant dose infusion. Bolus regime : • 20 mg IV bolus over…

…cancer, etc – are the most important risk factors for poor outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms…

…temporal association is present; contrast induced AKI should be reserved for the smaller subgroup in which iodinated contrast is considered causally responsible. This distinction is…

…inclisiran permits subcutaneous administration only twice yearly, an important practical distinction from therapies requiring monthly or biweekly injections. Inclisiran is used as an adjunct to…

…pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the emergency room: a very large or deep abscess, a markedly…

…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…

…only for C. difficile) is likewise dosed independently of renal function. Require drug concentration monitoring Drug Comment : : Vancomycin (intravenous) Loading dose by weight, maintenance dose…

…in a formally unimpeachable way, and that the donor's organs are maintained physiologically for as long as the assessment takes. The task of the…

…plus 1.5 g for the first dose, then 1 g × 1 IV Clostridioides difficile, primary infection, low risk of recurrence vancomycin 125 mg × 4…

…the visual acuity before anything else is done. The second most important is to look for signs of perforation — Seidel's sign, an irregular pupil…

…manages the pump themselves where possible. In impaired consciousness or DKA: remove the pump and change to an infusion or injections Drugs for type 2…

…Septic phlebitis, ongoing soft tissue infection with systemic involvement. Relative: Condition Adaptation : : ABI 0.5–0.79 Reduced compression (20–30 mmHg) under vascular surgical…

…for a treatment decision. Systemic thrombolysis is the first line treatment in high risk embolism, unless there is an absolute contraindication. The agent and dose…

…Anticoagulant therapy — this rarely needs to be stopped for small biopsies, but have diathermy or aluminium chloride available. Infection in the area to be biopsied…

…principal haemodynamic definition uses PVR 2 Wood units. PVR is essential for identifying a precapillary pulmonary vascular component. PAWP is used to distinguish pulmonary venous…

…and may reduce cardiovascular risk within several years, although risk may remain higher than that of never smokers for a prolonged period. In heavy smokers…

…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…

…not afterwards. Indications Medicinal charcoal is given after the ingestion of a potentially toxic dose of a substance that binds to charcoal, when it can…

…over the insertion site Change the puncture site Preparation and equipment Ultrasound with a curved array probe. Sterile preparation (chlorhexidine in alcohol 5 mg/mL…

…infusion of agents to stress the AV node and His Purkinje system, such as isoproterenol and/or procainamide. EPS with isoproterenol is also recommended for…

…A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance…

…of concept but was not developed for routine coronary prevention because of fatal infections and high cost. Low dose methotrexate did not reduce cardiovascular outcomes…

…heart disease is a complication of rheumatic fever, which is caused by streptococcal infections (group A Streptococcus ). Rheumatic heart disease can occur at any age…