…acromion . The injection site lies 2–3 fingerbreadths (about 5 cm) below the lower border of the acromion , in the middle of the muscle belly…

…40 mg in tendinitis and epicondylitis . Higher doses than these add nothing documented but increase the risk of skin and fat atrophy. Lederspan states in…

…injection itself that determines whether the result can be interpreted. What decides that is whether the patient is taking a steroid that cross reacts in…

…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…

…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…

…The management is the opposite in each case. Equivalent doses Agent Equivalent glucocorticoid dose Mineralocorticoid effect Biological half life : : : : Hydrocortisone (cortisol) 20 mg Marked Short…

…Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications Infection of the skin or soft tissues over the puncture site — use…

…the medulla result in the blood pressure lowering effect. Effects Potent blood pressure lowering effect. Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV:…

…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…

…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…

…inspection of the nail bed, with suture of any nail bed laceration Contraindications There are no absolute contraindications, but be cautious and consider referral in…

…with sodium chloride) before intravenous titration. Half of all opioid dosing errors arise at the dilution step, and an undiluted syringe of 10 mg/mL…

…failure that cannot be corrected quickly. Rapid sequence induction is used when intubation is required [1]. In salicylate poisoning, intubation with an inadequate minute ventilation…

…required in certain patient populations: Pediatric patients: For patients weighing less than 50 kg, the dosing should be 0.05 to 0.3 mg/kg…

…thrombus, and implanted stents. The principal modalities used in the catheterization laboratory are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Unlike coronary angiography, which…

…is required in renal failure or renal replacement therapy. Pediatric patients Body weight < 50 kg: Initial dose: 0.05 to 0.1 mg/kg…

…first choice of drug. • Effective in sinus bradycardia or AV node block. • Dose <0.5 mg may worsen bradycardia and should not be given. • Relative…

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

Hematologi & onkologi Infektionssjukdomar Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation…

…usually visible on plain films. Irrigation fluid: a copious volume of drinking quality tap water or sodium chloride 9 mg/mL. The volume matters more…

…and sputum in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are viral infection, bacterial infection and…

…as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness…

…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…

…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…

…probe, a sterile probe cover and sterile gel. Chlorhexidine in alcohol 5 mg/mL for skin disinfection. Allow it to air dry completely before puncture…

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

…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…

…menstrual status, previous smear results and any previous conisation. Procedure Inspection The patient lies in the lithotomy position, well covered. Say what you are do

…neuroborreliosis, neurosyphilis or another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome, autoimmune encephalitis. Meningeal carcinomatosis and CNS involvement in haematological malignancy. Investigation…

…of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy: an otoscope with a charged battery and clean disposable specula in…

…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 —…

…mask, fenestrated drape. Chlorhexidine in alcohol 5 mg/mL. Local anaesthesia: lidocaine 10 mg/mL, 10–20 mL, a 25 G needle for the skin…

…dysfunction caused by a dysregulated host response to infection. Clinically this usually corresponds to an acute increase in the SOFA score of at least 2…

…smokers over 40 with respiratory symptoms, and occupational exposure to dust, gas or fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient…

…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…

…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…

…Infection, hypovolaemia, cardiac dysfunction, haemodynamic instability, anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast alone difficult. In patients with…

…up to 50–55% in guideline summaries. It also lowers non HDL C by up to approximately 50% and apolipoprotein B by approximately 20–40%…

…instead of injecting into it, and expect the procedure to hurt even so. Offer nitrous oxide, oral or intravenous analgesia, or procedural sedation in advance…

…Intravenous thrombolysis within 4.5 hours improves functional outcome in properly selected patients. Tenecteplase 0.25 mg/kg is a safe and effective alternative to…

…course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection…

…Untreated generalised infection, or certain transmissible agents according to the current transmission risk assessment. In DCD: patients in whom death must be confirmed after a…

…risk of recurrence vancomycin 125 mg × 4 PO 10 days Clostridioides difficile, high risk of recurrence fidaxomicin 200 mg × 2 PO 10 days In appendicitis…

Procedurer The single most important step in any eye injury is to measure and document the visual acuity before anything else is done. The second…

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

…both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic involvement. Relative: Condition Adaptation…

…dimer is raised in pregnancy, malignancy, infection, surgery, trauma and old age. A positive value is not a diagnosis. Risk grading in confirmed pulmonary embolism…

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

…for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must…

…and acquired factors may interact in its development. PAH may be idiopathic, heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV infection…

…syndrome, tobacco abstinence has been associated with reductions in reinfarction of approximately 30–40% and in death of approximately 35–45%. In chronic coronary syndrome…

…Statins inhibit 3 hydroxy 3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol production increases hepatic LDL receptor expression…

…insertion itself is rarely the difficult part — it is the confirmation of the position that determines whether the tube is safe. A misplaced tube in…

…or gastric surgery Gastric lavage Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning…

…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…

…have high risk occupations or participate in competitive athletics. In the context of Brugada syndrome (BrS), pharmacologic challenge with sodium channel blockers (ajmaline or flecainide…

…SMA, AMA, IgG subclasses, caeruloplasmin in people under 40, alpha 1 antitrypsin, TSH and coeliac serology , together with ultrasound of the liver and biliary tract…

…particularly fatal infections, and because of cost. Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30…

…heart disease is rare in high income countries, presumably because streptococcal infections are treated very liberally. Figure 1 shows the aortic valve in PSAX (parasternal…