…the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25 mm 90° 1–2 mL Deltoid, BMI 35 or…

…duration of effect. Lidocaine 10 mg/mL without adrenaline , 2–5 mL. Needles: 21–25 G, 40 mm for subacromial and trochanteric injection; 25–27…

…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…

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

…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…

…infection or gastroenteritis at home Double or triple the oral daily dose during the days of illness (the patient's sick day rules) Vomiting or…

…Sterile gloves, sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0…

…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…

…premedication, plus further atropine drawn up in a syringe as a standby dose. Glycopyrronium (Robinul) 0.2 mg is an alternative premedication. Peripheral venous cannula…

…from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side, with the needle…

…of 10 mg/mL makes small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at…

…enhanced elimination. For many poisonings, well delivered supportive treatment matters more than the antidote [1,2]. Telephone your national or regional poison control centre , which…

…before the drug is eliminated. A flush should immediately follow the bolus injection to ensure rapid delivery to the central circulation. If the drug is…

…backscatter of the light signal. Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement. OCT is particularly useful for…

…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 …

…2–5 mg/h infusion Antidote to beta blockers. Calcium Counteracts calcium channel blockers (CCB). Antidote to CCBs. 10 ml calcium 0.2 mmol/ml…

…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…

…Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint…

…Lidocaine 10 mg/mL with adrenaline 5 µg/mL Rapid 2–6 hours A bloodless field, less bleeding Mepivacaine 10 mg/mL Rapid Somewhat longer…

…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…

…clinical effect. 2. Parenteral thiamine early , preferably before or at the same time as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma…

…to close to the plane of the skin and advance a further 1–2 mm so that the catheter tip also lies in the lumen…

…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…

Procedurer What determines the outcome of a central venous catheter insertion is decided before the needle goes in: the choice of site, the use of…

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

…work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring a…

…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…

…Suspected subarachnoid haemorrhage with a normal or non diagnostic CT. Suspected neuroborreliosis, neurosyphilis or another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome…

…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…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

…coagulopathy or thrombocytopenia Relative Ongoing anticoagulant treatment — plan the aspiration for the trough level or pause the drug according to local practice Relative Skin infection…

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

…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…

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

…IV Dose Can be given as repeated intravenous bolus injections or as a constant dose infusion. Bolus regime : • 20 mg IV bolus over 2 minutes…

…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)…

…0–2% in patients with an eGFR of 30–44 mL/min/1.73 m2 and up to 17% when eGFR is below 30 mL…

…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…

…abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected…

…to alteplase and is simpler to administer, since the whole dose is given as a bolus [1,2]. In a meta analysis of three phase…

…patients with an eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect is lost…

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

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

…Sterile cotton buds. An eye spud or a 25–27 G needle on a 2 mL syringe as a handle. A low speed rust ring…

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

…Septic phlebitis, ongoing soft tissue infection with systemic involvement. Relative: Condition Adaptation : : ABI 0.5–0.79 Reduced compression (20–30 mmHg) under vascular surgical…

…own laboratory uses before applying it. The D dimer is raised in pregnancy, malignancy, infection, surgery, trauma and old age. A positive value is not…

…toes, nose and ears), a 27 G needle, a 2–5 mL syringe. Punches of 2, 3, 4 and 6 mm. A size 15 scalpel…

…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…

…Wood units in an overlapping clinical classification table; the principal haemodynamic definition uses PVR 2 Wood units. PVR is essential for identifying a precapillary pulmonary…

…Clinical presentation and assessment Identifying tobacco exposure Every cardiovascular assessment should establish: Current smoking status. Cigarettes smoked per day. Duration of smoking and cumulative exposure…

…LDL particles from the circulation. Statins also reduce production of apoB 100 containing lipoproteins and exert effects beyond LDL C reduction, including modulation of inflammation…

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

…after a life threatening ingestion of a highly toxic substance, where the patient arrives within about 1 hour (a liquid preparation) or 2 hours (tablets…

…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)…

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

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

Echocardiography Aortic stenosis The aortic valve area is normally 3.0 to 4.0 cm 2 . Aortic stenosis is a progressive disease that leads to…