…a combination of: direct tubular toxicity; renal haemodynamic disturbance and ischaemia; pre existing or concurrent hypovolaemia; cardiac dysfunction or haemodynamic instability; and additional nephrotoxic exposures…

…the nocebo effect : negative expectations, contextual cues and attribution of pre existing symptoms to the medication. No single diagnostic test can distinguish a pharmacological SAMS…

…patients on digoxin or verapamil, although this is not an established drug interaction. The half life of adenosine is 8 seconds. Adverse effects are therefore…

…Figure 1. Flow chart for the investigation of suspected endocarditis. Vegetations Vegetations are ecotate masses made up of the foci of infection. Vegetations can be…

…its development. PAH may be idiopathic, heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The…

…Etiologies of tension pneumothorax include: Traumatic injuries (blunt force, lacerations, gunshot wounds) Asthmatic episodes Iatrogenic events (e.g., during central venous catheter insertion) Underlying lung…

…should include: palpation of peripheral pulses; auscultation for carotid, femoral, and abdominal bruits; bilateral brachial blood pressure measurement; cardiac auscultation; inspection of the legs and…

…infusion of agents to stress the AV node and His Purkinje system, such as isoproterenol and/or procainamide. EPS with isoproterenol is also recommended for…

…of the correct size, a sharps bin. For vaccination: adrenaline 1 mg/mL, an antihistamine, oxygen, and the ability to lay the patient down. Injection…

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

…T½ 3 h. 50% renal elimination. • Typically the first choice of drug. • Effective in sinus bradycardia or AV node block. • Dose <0.5 mg may…

…Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a relative contraindication; the test is then performed with preparedness for anaphylaxis. An untreated…

…or a damaged nail fold edge Nail avulsion and inspection of the nail bed, with suture of any nail bed laceration Contraindications There are no…

Phentolamine Drug Phentolamine Brand names Oraverse ®, Rogitine ® Indications Hypertensive crisis. Mechanism of action Phentolamine is a non selective alpha adrenergic blocker. Phentolamine reduces…

…level of consciousness, the pupils, tone, clonus and seizures. Give glucose in hypoglycaemia and a benzodiazepine for toxicological seizures E Temperature, skin, smell, injection marks…

…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…

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

…to complement ICA, particularly for intermediate non left main coronary stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with…

…surgeon under strictly sterile conditions. For corticosteroid injection there is an additional absolute contraindication: the slightest suspicion of septic arthritis. If the picture is unclear…

…proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period…

…after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or increasing weakness, and give atropine. 8. Monitor for at…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…clinical site of action—the coronary artery perfusing the AV node—before the drug is eliminated. A flush should immediately follow the bolus injection to…

…Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement. OCT is particularly useful for: characterizing the surface of atheroma…

…COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for ventilatory support …

…cancer, etc – are the most important risk factors for poor outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms…

…not been assessed for tendon and nerve injury will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained…

…become the patient's next focus of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous…

…bougie taken out and shaped before induction , a syringe for the cuff, a cuff manometer. A laryngeal mask of the correct size as a rescue…

…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…

…infectious diseases physician early in a high risk course, in instability, with resistance problems, or with suspected fungal infection 10 Document the times of triag

…7 nmol/L Electrolytes and renal function See the renal parameters for the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP <…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…but the cannula kinks when the arm is flexed. The dorsum of the hand is suitable for finer cannulae. Avoid the lower limb in adults…

…occupational exposure to dust, gas or fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow up of…

…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…

…management of complicated withdrawal varies between regions and units. Follow the local protocol for choice of drug, dosing, route of administration and criteria for intermediate…

…not preferred for hypertensive emergencies due to the high risk of reflex sympathetic stimulation. Drug Hydralazine Brand names Apresoline ®, Bidil ® Mechanism of action…

…chloride available. Infection in the area to be biopsied. Hypersensitivity to local anaesthetics. Areas at high risk of unsightly or hypertrophic scars: the sternum, the…

Labetalol Drug Labetalol Brand names Trandate ® Indications Mycoardial ischemia. Hypertension. Hypertensive emergency, including in pregnancy. Postoperative hypertension. Mechanism of action Combined beta adrenergic and…

…lowering strategy: Dietary and lifestyle interventions form the foundation of treatment. Statins are the preferred first line pharmacological therapy for patients at increased ASCVD risk…

…Exposure to second hand smoke. Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or…

…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…

…still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior iliac spine is the standard site for both aspiration and…

…for bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even with a reduced level of…

…4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only…

…not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has…

…cap. Lidocaine 10 mg/mL for local anaesthesia in the awake patient — the anaesthetic also improves the chance of success by counteracting vascular spasm. Pressure…

…that the confirmation of death is carried out in a formally unimpeachable way, and that the donor's organs are maintained physiologically for as long…

…the visual acuity before anything else is done. The second most important is to look for signs of perforation — Seidel's sign, an irregular pupil…

…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…

…pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis…

…acidic environment inactivates the anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to…

…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 :…

…Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the…

…Oral vancomycin (only for C. difficile) is likewise dosed independently of renal function. Require drug concentration monitoring Drug Comment : : Vancomycin (intravenous) Loading dose by weight…

…Pain, infections, medications, fever, hypovolemia, dehydration, anemia, hyperthyroidism and myocarditis are common etiologies. Treatment of the underlying cause should resolve the sinus tachycardia. Sinus arrhythmia…

…infections, seizures and temperature management. The ICU is the preferred level of care for the absolute majority. The CCU may be suitable for stable (hemodynamically…

…oxygen is required for ATP synthesis [ATP is the primary energy source in all cells]). The heart consumes approximately 30 kilograms of ATP per day…

…Enteral nutrition and drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see…