…insulin therapy Peptic ulcer A proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high…

…frequently Acute illness and infection The insulin requirement rises, often despite a reduced food intake Insulin pump The patient manages the pump themselves where possible…

…Critical ischaemia. Immunosuppression. Suspicion of another diagnosis: gout, a felon (pulp abscess), herpetic whitlow ( never incise a herpetic whitlow ), subungual melanoma (a pigmented longitudinal nail…

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

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

…Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary. Continuous infusion…

…delay pacing in order to try yet another dose. Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice…

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

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

…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…

…a fracture in the cribriform plate into the cranium Absolute Corrosive injury of the oesophagus or stomach after ingestion of a caustic substance Absolute Choanal…

…shows the most fluid, usually in the scapular line one to two intercostal spaces below the upper border of the fluid, but never below 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…

…medium for most adults, long for thick soft tissue and for the head of the humerus. A pressure bag or a 50 mL syringe with…

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

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

…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…

…arrhythmia, intra aortic balloon pump. Assessment of stroke volume variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient…

…into the triangle between the index and middle fingers . The Z track technique for depot preparations and irritant drugs: pull the skin and subcutaneous tissue…

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…

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

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

…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 …

…infarction). Inversion of T waves indicates reperfusion The slow natural normalization of ST segment elevation (in untreated patients) is depicted in Figure 2 . As evident…

…from right anterior (V1) to left lateral (V6), but regrettably, the limb leads are not. Instead, the limb leads are displayed in two groups of…

…foreign materials pose a high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant…

…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…

…sample : cortisol and plasma ACTH. The ACTH sample is taken before the injection and handled chilled. 4. Inject 0.25 mg of tetracosactide intravenously , slowly…

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

…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

…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…

Referensvärden Reference ranges are statistical: by definition they encompass 95 % of a healthy reference population, which means that one healthy value in twenty falls outside…

…transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample without a speculum. Routine gynaecological examination of asymptomatic…

…Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also…

…Which of the following describes a 'Black athlete repolarization variant' considered a normal ECG finding? A: T wave inversion in leads V1 V3 in athletes…

…Alternative route : Central venous administration of adenosine is suitable in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1…

Echocardiography The echocardiographic examination The use of echocardiography has increased dramatically during the past few decades. Advances in echocardiography have been propelled by breakthroughs in…

…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…

…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…

…salicylate poisoning, intubation with an inadequate minute ventilation can rapidly worsen the acidaemia and increase the entry of salicylate into the central nervous system. Discuss…

…wave inversion means that the T wave is negative. The T wave is negative if its terminal portion is below the baseline, regardless of whether…

…with the poison control centre. Gastric lavage is considered only after a life threatening ingestion of a highly toxic substance, where the patient arrives within…

…Choice of technique Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma Excision with a 1–3 mm margin, down into the subcutis Never a shave…

…Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other circumstances that may affect…

…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…

…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…

…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…

…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…

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

…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…

…Although a PAWP of 12 mmHg represents the upper limit of normal in some assessments, a threshold of ≤15 mmHg remains the recommended criterion for…

…and aVL may occasionally display an isolated (single) T wave inversion. The term isolated implies that none of the neighboring leads display T wave inversions…

…the threshold, but the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before…

…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…

…to the next of kin. Since the change in the law in 2022, the next of kin no longer have a right of veto based…

…slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing weakness. 6. Assess the chosen finding continuously during the window of effect, 40…

…foreign body under the upper eyelid. 7. Seidel's sign: apply fluorescein generously and look under blue light. A dark stream of aqueous humour breaking…

…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…