…oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25 mm 90° 1…

…21–25 G, 40 mm for subacromial and trochanteric injection; 25–27 G, 25 mm for the carpal tunnel, de Quervain's and trigger finger…

…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…

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

…coronary arterial tree after selective intracoronary contrast injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access…

…confused: replacement therapy in adrenal insufficiency (which must be increased under stress) and pharmacological anti inflammatory treatment (which must be tapered in a controlled fashion…

…to be given: hold the needle still, change the syringe and inject. The injection should go in easily. Resistance means the tip is in tissue…

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

…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…

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

…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…

…Practical points during titration: Give the injection slowly over at least a minute; a rapid injection causes nausea and a fall in blood pressure without…

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

…that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go…

…occult structural abnormality. IVUS IVUS generates images by transmitting ultrasound from an intracoronary catheter and recording echoes reflected from the vessel wall. Contemporary systems use…

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

…1, β 2 agonist Start infusion at 4 μg/min and titrate to desired result T½ 1 min • May cause ventricular arrhythmias (dose dependent)…

…of infection on the flap is called vegetation. As a rule, some kind of damage to native (own) valves is required to become vulnerable and…

…only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must…

…The commonest cause of wound infection is retained contamination, not poor suture technique — and the commonest cause of permanent loss of function is a tendon…

…are viral infection, bacterial infection and air pollution, but often no definite trigger can be identified [1,2]. Ask specifically about: Onset and time course…

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

…should be avoided — the collaterals are poor and the median nerve lies close by. Preparation and equipment Arterial catheter, usually 20 G in an adult…

…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…

…the most stable dressing, lowest risk of infection and thrombosis with prolonged dwell time Highest risk of pneumothorax, the vessel cannot be compressed after arterial…

…The method and the laboratory determine the range — always use the range printed on your own report. Haematology Test Reference Comment : : : Reticulocytes 20–100 ×10⁹…

…anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring a secured airway — transfer, heavy sedation, surgery — and cardiac arrest. Contraindications There…

…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…

…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…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…punctured — and ultrasound makes the deep forearm veins accessible to those who are experienced. Size Colour Approximate flow Typical use : : : : 14 G Orange 250–300…

…L before drain insertion, while diagnostic aspiration with a fine needle is tolerated at considerably worse values. Follow the local protocol. Preparation and equipment Ultrasound…

…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…

…respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also include dementia, marked hearing loss and…

…Induces arteriolar vasodilation without effects on venous circulation. The reduction in systemic vascular resistance (SVR) is rapid and may cause reflex sympathetic stimulation, including tachycardia…

…Postoperative hypertension. Mechanism of action Combined beta adrenergic and alpha adrenergic blocker with rapid onset of action. Labetalol has less antihypertensive efficacy as compared with…

…healthy individuals. Infections and the risk of acute coronary syndromes It is known that the risk of developing acute coronary syndromes increases during infections, including…

…with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction, haemodynamic instability, anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast…

…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…

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

…tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of renal function Doxycycline, erythromycin, clindamycin, metronidazole, moxifloxacin and fusidic…

…any retrieval: it begins when someone in the intensive care unit identifies a possible donor and the deceased person's own wishes are properly established…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

…loupe and a Wood's lamp. Oxybuprocaine or tetracaine drops (topical anaesthesia). Fluorescein strips. Sterile cotton buds. An eye spud or a 25–27 G…

…In impaired consciousness or DKA: remove the pump and change to an infusion or injections Drugs for type 2 diabetes in inpatients Agent The acutely…

…and measure the ankle brachial index with Doppler. 4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and…

…a pulse ≥ 110/min, a systolic blood pressure < 100 mmHg and a saturation < 90 per cent. An sPESI of 0 indicates low risk…

…mL (adrenaline gives a bloodless field and a longer duration; it is safe even on the fingers, toes, nose and ears), a 27 G needle…

…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…

…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…

…infection or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding cardiovascular effects and…

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

…Measure the depth of insertion by laying the tube from the tip of the nose to the earlobe and from there to the xiphoid process…

…reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your…

…the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin on the sample. Indications…

…system. The underlying pathophysiology varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral…

…Synthetic function and prognosis Child–Pugh Parameter 1 point 2 points 3 points : : : : Bilirubin (µmol/L) < 34 34–50 50 Albumin (g/L) 35…

…infarction and non fatal stroke. The clinical development of canakinumab for this indication did not continue because of safety concerns, particularly fatal infections, and because…

…by streptococcal infections (group A Streptococcus ). Rheumatic heart disease can occur at any age and multiple valve lesions are common (typically the aortic and mitral…