…never happens, and to make sure the catheter does not become the patient's next focus of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated…

…bradycardia is caused by beta blockers. Adrenaline (Epinephrine) α and β agonist Infusion of 2–10 μg/min (titrate as needed). T½ 5 min…

…Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is…

…to 15 minutes as necessary. Continuous infusion: Start infusion at 0.1 mg/min and increase in increments of 0.1 mg. Adverse effects Tachycardia…

…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…

…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…

…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…

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

…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…

…subcutaneous tissue and then the periosteum at several points around the puncture site , and wait a few minutes. 4. Make a small skin incision with…

…5. Ask the patient to flex the head forward and swallow repeatedly , preferably with sips of water if swallowing is safe. Advance the tube in…

…arm abducted and the hand behind the head. All drains are inserted within the safe triangle (Figure 1). Outside it the risk of injuring the…

…lack of lung tissue) and its impact on cardiac function. Clinically, patients may present with: Absent breath sounds on the affected side Crepitus Subcutaneous emphysema…

…in three lengths: short for children and slim limbs, medium for most adults, long for thick soft tissue and for the head of the humerus…

…Procedure Choice of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and the…

…the larger , since a mask that is too small leaks and gives a poorer seal. Procedure Insertion of the laryngeal mask 1. Check the mask…

…mouthful of water and hold it. Advance the electrode at the very moment the patient swallows — the pharyngeal muscles then guide the tip into the…

…anaesthetic also improves the chance of success by counteracting vascular spasm. Pressure monitoring set: stiff, short tubing, a transducer, and a flush system with physiological…

…poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are viral infection…

…individuals the infection may be severe and deadly. Importantly, COVID 19 has caused an unprecedented number of severe and deadly infections among young and apparently…

…will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and NSTE ACS …

…elevations are succeeded by gradual inversion of the T waves. These T waves are called post ischemic T waves and they indicate that the infarction…

…This format of displaying the ECG leads is referred to as the Cabrera format and it has been the existing standard in Sweden for over…

…Endocarditis implies that a bacterial infection engages the heart valves and this is a serious condition. The focus of infection on the flap is called…

…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…

…The test measures the ability of the adrenal cortex to respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether…

…a rising pCO₂ and respiratory acidosis, or a markedly increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection…

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

…coronary or valvular disease Recent (<48 hours) use of dipyridamole or dipyridamole containing medications Ingestion of caffeinated foods or beverages within 12 hours prior to…

…0 mmol/L Triglycerides < 1.7 mmol/L 10 carries a risk of pancreatitis Cardiac markers and coagulation Test Reference Comment : : : High sensitivity troponin…

…Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on…

…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…

…elevation followed by T wave inversion in leads V1 V4 in black athletes. C: PR interval <120 ms with a delta wave and wide QRS (…

…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…

…heart rate, ECG. References Narula et al: Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiology.

…inspection of the legs and feet. A systolic blood pressure difference between the arms exceeding 15 mmHg is associated with a 50% higher risk of…

…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…

…of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of…

…the acidaemia and increase the entry of salicylate into the central nervous system. Discuss the case early with the poison control centre and with anaesthesia…

…T waves are seen after periods of ischemia, after infarction and after successful reperfusion (PCI). Post ischemic T wave inversion is caused by abnormal repolarization…

…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…

…in the posterior triangle of the neck, and the superficial nerves of the forearm and the dorsum of the hand. Preparation and equipment Chlorhexidine in…

…five years of stopping but may remain elevated thereafter. The overall health benefit is greater still when reductions in non cardiovascular morbidity and mortality are…

…hold the needle still, change the syringe and inject. The injection should go in easily. Resistance means the tip is in tissue, not in the…

…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…

…Diabetes, immunosuppression A risk of necrotising otitis externa Anticoagulant treatment Bleeding into the ear canal Previous radiotherapy to the head and neck Fragile skin, poor…

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

…the first time, or newly developed during management of an acute illness. The clinical relationship between AF and acute deterioration is often bidirectional. AF with…

…margins and a narrow neck. These findings may reflect plaque disruption or thrombus. A rounded or polypoid intraluminal mass and lesion haziness raise suspicion of…

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

…of T wave inversion. Myocardial ischemia may also present with flat T waves, which are defined as T waves with an amplitude between +1 and…

…another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome, autoimmune encephalitis. Meningeal carcinomatosis and CNS involvement in haematological malignancy. Investigation of dementia with…

…failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic involvement…

…done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy…

…determine the outcome — that the confirmation of death is carried out in a formally unimpeachable way, and that the donor's organs are maintained physiologically…

…gaze, or the number of seconds the patient can hold the head lifted off the couch. Filming before and during the test is helpful. A…

…pressure measured, or be palpated. Indications A sensation of something in the eye, watering, photophobia and redness after working with a grinder, a drill, a…

…lactate, two sets of blood cultures, and a culture from the likely focus 0 to 15 min Ringer's acetate for hypotension or hypoperfusion, usually…