…injection in marked coagulopathy or thrombocytopenia (< 50 ×10⁹/L) — choose the subcutaneous route if possible, otherwise give IM with a fine needle and 5…

…to these superficial injections. Preparation and equipment Chlorhexidine in alcohol, an iodine solution or isopropyl alcohol. A depot glucocorticoid: triamcinolone hexacetonide (Lederspan 20 mg/mL)…

…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…

…in each case. Equivalent doses Agent Equivalent glucocorticoid dose Mineralocorticoid effect Biological half life : : : : Hydrocortisone (cortisol) 20 mg Marked Short, 8–12 hours Prednisolone 5…

…Preparation and equipment Chlorhexidine in alcohol 5 mg/mL: clean with 3–4 swabs in wide circles and let it dry for a couple of…

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

…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…

…turned has not finished being titrated. Expect an opioid naive adult to need 5–15 mg of morphine in total. If more than that is…

…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…

…events in observational studies. OCT OCT uses near infrared light rather than ultrasound. Its resolution is substantially higher than that of IVUS, approximately 5–20…

…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…

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

…is considerably better [3,5]. Pathophysiology Alcohol enhances inhibitory signalling via gamma aminobutyric acid, GABA, and inhibits excitatory glutamate signalling, in part via NMDA receptors…

…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…

…medication list. Chlorhexidine in alcohol, sterile gloves, fenestrated drape, sterile gauze. Local anaesthetic: lidocaine 10 mg/mL, usually 5–10 mL, with a longer needle…

…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…

…ng/L (< 300 in acute dyspnoea) A normal value effectively excludes heart failure D dimer < 0.5 mg/L FEU Age adjusted threshold…

…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…

…alligator forceps, a suction catheter (Frazier or Baron, 5 Fr). Cerumenolytics (docusate sodium, sodium bicarbonate drops, olive oil, carbamide peroxide) are instilled 15–30 minutes…

…that determines how quickly the volume reaches the patient. Preparation and equipment Cannulae in several sizes, a tourniquet, chlorhexidine in alcohol 5 mg/mL, gauze…

…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…

…to mean that an electronic alert replaces clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion…

…aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until…

…desired in conditions requiring afterload reduction. Time to onset of action 10 30 minutes. Duration of action <4 hours. Delivery IV or IM. Dose Injections…

…safe in patients with coronary artery disease since it does not increase heart rate, and reduces myocardial oxygen consumption. Time to onset of action: 5…

…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…

…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…

…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…

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

…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…

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

…3. Ocular movements in all directions; pain on upward gaze may suggest an orbital floor fracture. 4. Topical anaesthesia into the lower fornix. 5. Evert…

…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…

…deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic involvement. Relative: Condition Adaptation : : ABI 0.5–0.79 Reduced…

…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…

…passed through the valve. The order of management in acute bradycardia Atropine is given in doses of 0.5–1 mg intravenously, repeated every three…

…5: PH with unclear or multifactorial mechanisms PAH is a distinct and uncommon form of precapillary PH. It is defined haemodynamically by precapillary PH in…

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

…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…

…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…

…4745 patients within 30 days of myocardial infarction. Participants received colchicine 0.5 mg once daily or placebo. The primary composite outcome included cardiovascular death…

…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…