…Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An alcohol or…

…More than three injections at the same site within a year. The Achilles tendon and the patellar tendon — do not inject into or beside them…

…respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether the result can be interpreted. What decides that is whether…

…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…

…injection at home Acute illness, trauma, surgery Parenteral hydrocortisone, at a dose according to the local protocol. Usually a bolus followed by repeated doses or…

…site — use another approach or refrain. Bacteraemia without suspicion of joint infection (relative; aspiration can seed a sterile joint). Marked coagulopathy or an anticoagulant at…

…induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable. The benefit of…

…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…

…effect, 40 seconds to 5–10 minutes after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or increasing weakness…

…Electrocautery or a heated paper clip for trephination. Antibiotic ointment, a non adherent dressing, gauze. The digital block Anaesthetise from the dorsal aspect, one injection…

…when a modified release preparation is started in an opioid naive patient, or when a conversion between drugs is made without reduction for incomplete cross…

…estimated quantity the time, and whether the intake was single or repeated a modified release preparation or a combination product concurrent drugs, alcohol and illicit…

…transient first , second , or third degree AV nodal block lasting up to a few seconds. His Purkinje conduction is generally unaffected directly. Adenosine does not…

…plaque or calcium. Blood clearance is required because blood causes strong backscatter of the light signal. Imaging is therefore typically performed during contrast injection or…

…Central venous administration of adenosine is suitable in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1 2 seconds)…

…etc .) are warranted. Management of AV blocks aims to restore atrioventricular conduction either pharmacologically or by means of artificial pacemakers. Both methods may be used…

…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…

…a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint or absent. Take cultures immediately…

…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…

…in respiratory compromise, low saturation, suspected carbon dioxide retention, reduced consciousness, or when NIV is being considered. 4. Give short acting bronchodilators. 5. Give a…

…Parenteral thiamine early , preferably before or at the same time as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance…

…Assessment of stroke volume variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand…

…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 infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other…

…homocysteine or methylmalonic acid Folate 7 nmol/L Electrolytes and renal function See the renal parameters for the eGFR stages and albuminuria. Inflammation and infection…

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

…device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a…

…treatment or marked coagulopathy. A platelet count below 50 × 10⁹/L is often quoted as the threshold, but the threshold varies between regions. Infection of…

…healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes…

…the past 24 hours — the fluid leaks out through the old hole. Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative)…

…the aspiration for the trough level or pause the drug according to local practice Relative Skin infection, herpes zoster or burns over the puncture site…

…sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis or a…

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

…<4 hours. Delivery IV or IM. Dose Injections • IV: 10–40 mg every 4–6 hours • IM: 10–20 mg every 4–6 hours. Infusion…

…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…

…in increased levels of circulating pro inflammatory cytokines that may cause plaque rupture (i.e the risk of atherosclerotic plaque rupture is increased during infections)…

…particularly during cardiovascular angiography, computed tomography, or percutaneous coronary intervention. The preferred terminology is contrast associated AKI when temporal association is present; contrast induced AKI…

…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…

…rather than the emergency room: a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection…

…to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has been assessed…

…not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the…

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

…7 days or doxycycline 200 mg × 1 on day 1, then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime…

…acute glaucoma is suspected (normal 10–21 mmHg). Tonometry is contraindicated with suspected perforation or infection. Removal Proceed from the least to the most invasive…

…infection The insulin requirement rises, often despite a reduced food intake Insulin pump The patient manages the pump themselves where possible. In impaired consciousness or…

…hyperkeratotic Pulses Palpable Weak or absent May be palpable despite ischaemia ABI 0.9 < 0.9 Often falsely high Contraindications to compression The ankle…

…Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence. Special situations Situation Comment : : Pregnancy Leg ultrasound first. CT pulmonary angiography or lung…

…have diathermy or aluminium chloride available. Infection in the area to be biopsied. Hypersensitivity to local anaesthetics. Areas at high risk of unsightly or hypertrophic…

…myocardial ischaemia or syncope — that has not responded to atropine: Complete heart block (third degree AV block) and second degree AV block Mobitz type 2…

…PAH may be idiopathic, heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also…

…electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other circumstances that may affect cessation or treatment…

…index Asian ancestry Previous muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency…

…Ask the patient about a previous nasal fracture or unilateral nasal obstruction. 2. Measure the depth of insertion by laying the tube from the tip…

…falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison control centre before you…

…renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to…

…and extended monitoring exceeding 3 weeks is necessary, an implantable loop recorder is essential to accurately establish the diagnosis. Electrophysiology In patients with presyncope or…

…pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of…

…reduce this residual risk without necessarily altering lipid concentrations, blood pressure or other conventional risk factors. Colchicine is an established anti inflammatory drug that may…

…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…