…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…

…pain relief is a diagnostic finding — and appears to reduce the risk of a post injection flare. Lidocaine 10 mg/mL without adrenaline is used…

…given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1. Schedule…

…onset of action 1 to 2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg every 5…

…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…

…use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric…

…the samples are sent correctly. A corticosteroid must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in…

…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…

…dose without troublesome adverse effects, give a further 8 mg intravenously , slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing weakness. 6…

…and note the time. It must not stay on for longer than 20–30 minutes. Procedure Paronychia — incision and drainage 1. A digital block if…

…not afterwards. A current creatinine with the eGFR, the weight, the age and the medication list. Always dilute morphine 10 mg/mL to 1 mg…

…injection marks, medication patches and trauma. Remove contaminated clothing and wash the skin after external exposure A low Glasgow Coma Scale is not on its…

…usually within 30 seconds. Doses higher than 18 mg are unlikely to revert a tachycardia and should not be used. Specific dosing adjustments are required…

…OCT has limited tissue penetration, generally approximately 1–3 mm, and may not show the EEM through substantial plaque or calcium. Blood clearance is required…

…in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1 2 seconds), followed immediately by a rapid saline flush …

…Dose <0.5 mg may worsen bradycardia and should not be given. • Relative contraindications are ileus, glaucoma. Isoprenaline / Isoproterenol α 1, α 2, β 1…

…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…

…infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met. The first hour Step Action : : 1…

…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…

…change of treatment. Common precipitants are viral infection, bacterial infection and air pollution, but often no definite trigger can be identified [1,2]. Ask specifically…

…planned follow up , not merely detoxification. Benzodiazepines reduce the severity of withdrawal and the risk of seizures and delirium [1,2]. In delirium tremens the…

…Greater extension makes the artery harder to palpate. Procedure Catheter over needle (direct technique) 1. Palpate the course of the artery with two fingertips and…

…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…

…insertion site. Thrombosis or known stenosis in the target vessel. Coagulopathy or ongoing anticoagulation: choose a compressible vessel (the internal jugular or femoral vein), not…

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

…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…

…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…

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

…intraosseous flow requires pressure ; gravity is not enough. Lidocaine 10 mg/mL to anaesthetise the marrow cavity in a conscious patient. Fixation material for the…

…between regions. Common practice is correction at an INR above 1.5 and a platelet count below 50 × 10⁹/L before drain insertion, while diagnostic…

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

…surgery 1 month Neurosurgery or an intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection…

…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)…

…outcomes. The risk of death at 1 year is increased in comparison with patients with preserved renal function, although the association may not be causal…

…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…

…not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy…

…mg/kg is a safe and effective alternative to alteplase and is simpler to administer, since the whole dose is given as a bolus [1…

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

…a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current…

…gentamicin 5–7 mg/kg IV as a single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic…

…10–21 mmHg). Tonometry is contraindicated with suspected perforation or infection. Removal Proceed from the least to the most invasive technique. 1. Irrigate with sterile…

…required, in addition to the mealtime dose Never stop basal insulin in a person with type 1 diabetes , not even before fasting or an investigation…

…infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics. 5. Biopsy any ulcer that has not…

…malignancy, infection, surgery, trauma and old age. A positive value is not a diagnosis. Risk grading in confirmed pulmonary embolism Risk Haemodynamics Right ventricular strain…

…when the report arrives. Procedure Punch biopsy 1. Mark the biopsy site. In an inflammatory dermatosis: the active edge , not the burnt out centre. 2…

…must not be passed through the valve. The order of management in acute bradycardia Atropine is given in doses of 0.5–1 mg intravenously…

…used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction…

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

…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…

…the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison control centre before you decide, not afterwards…

…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…

…varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral, bacterial, protozoal, fungal, parasitic)…

…most often enzyme induction by alcohol or drugs and is often of no clinical significance. Synthetic function and prognosis Child–Pugh Parameter 1 point 2…

…antibody directed against interleukin 1β, provided proof of concept but was not developed for routine coronary prevention because of fatal infections and high cost…

…income countries, presumably because streptococcal infections are treated very liberally. Figure 1 shows the aortic valve in PSAX (parasternal short axis view). Figure 1. The…