…different vessel. Choice of site Vessel Advantages Disadvantages : : : Internal jugular vein (right) Best ultrasound conditions, a straight course to the superior vena cava, compressible if…

…to local practice Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk of…

…1. Connect the patient to the 12 lead ECG as usual and record a resting ECG of the arrhythmia before the electrode is inserted. 2…

…3 3 2 3 fingerbreadths of mouth opening, 3 fingerbreadths from chin to hyoid, 2 fingerbreadths from hyoid to the upper border of the thyroid…

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…

ECG Introduction to ECG interpretation 1. Which of the following ECG findings is typically considered a normal variant in asymptomatic athletes with no significant family…

…cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although…

…the ST segment to the T wave is smooth, as is the transition between phases 2 and 3 of the action potential ( Figure 1 A …

…into cells through a nucleoside transport system. Because of these highly efficient elimination pathways, adenosine has an extremely short elimination half life of 1 to…

…previous myocardial infarction). ECG examples of pre excitation (short PR interval, prolonged QRS duration, delta waves, secondary ST T abnormalities). Click to zoom. Atrioventricular reentrant …

…continuing to increase the dose. The level of sedation is scored on a four point scale: 0 fully awake, 1 drowsy but easily roused, 2…

…gradual loss of myocardium leads to ventricular dilation and right heart failure. Biventricular heart failure is less common. ECG in ARVC T wave inversion in…

…couple of minutes before the needle is inserted. Sterile gloves, sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1.2…

…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…

…catheter insertion) Underlying lung pathologies In cases of benign pneumothorax, positive pressure ventilation can precipitate a tension pneumothorax, leading to circulatory collapse. Diagnosis of a…

…Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks. Choice of vein and cannula size…

…paracentesis 1. Scan the left lower quadrant. Confirm at least 2–3 cm of free fluid depth with no bowel in the path of 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, remove…

…the hub: lower the angle to close to the plane of the skin and advance a further 1–2 mm so that the catheter tip…

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

…requires a change of treatment. Common precipitants are viral infection, bacterial infection and air pollution, but often no definite trigger can be identified [1,2]…

…outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections…

…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…

…to Figure 2 below). However, that type of normalization is much slower and it is explained by the gradual death (and thus the disappearance of…

…1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history (with emphasis on causes of AV blocks; please refer to…

…according to Figure 2 . Figure 2. The coordinate system presenting the limb leads in the frontal plane. This format of displaying the ECG leads is…

…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…

…high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular disease. Table 1…

…result of a repair is determined before the first needle goes in. A wound that has not been irrigated clean, has not been inspected to…

…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…

…Step Action : : 1 ABCDE, full vital signs, level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the patient has sepsis…

…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…

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

…age × 0.01 above 50 years INR 0.9–1.2 APTT 28–40 s Fibrinogen 2–4 g/L An acute phase protein Thyroid…

…glycopyrronium) 36–48 hours Smoking 1 hour Vigorous physical exertion 30 minutes A large meal 2 hours Withholding applies only to diagnostic spirometry with a…

…Central venous administration of adenosine is suitable in the intensive care unit or coronary care unit. Adenosine injection must be administered quickly (1 2 seconds)…

…for echocardiography should receive information regarding the conduction of the examination. Some patient engagement is required to obtain all views and the best possible image…

…3.1%. In contrast, within selected high risk populations, prevalence may be sufficiently high for targeted screening to be cost effective. For asymptomatic stenosis of…

…infection flucloxacillin 1 g × 3 7 days Cat bite within 2 days phenoxymethylpenicillin 1 g × 3 10 days Cat bite after 2 days, close to…

…not merely detoxification. Benzodiazepines reduce the severity of withdrawal and the risk of seizures and delirium [1,2]. In delirium tremens the aim should be…

…required [1]. In salicylate poisoning, intubation with an inadequate minute ventilation can rapidly worsen the acidaemia and increase the entry of salicylate into the central…

…particularly inverted T waves. Below follows a discussion which aims to clarify some of the common misunderstandings. All T waves are illustrated in Figure 18…

…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…

…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…

…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…

…to Figure 1 and Figure 2. Figure 1. Echocardiogram showing takotsubo cardiomyopathy in acute phase (A) and resolution phase (B). Note the apical ballooning of…

…Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury…

…adults. Here the posterior part of the iliac crest is thick, red marrow is abundant, and the distance to vessels and abdominal organs is large…

…1 ®, Duraclon ®, Kapvay ® Indications • Agitated delirium • Analgesia • Hypertension, hypertensive crisis/emergency Mechanism of action Clonidine is primarily a centrally acting alpha 2…

…injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS have more…

…selective intracoronary contrast injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to the aortic…

…classification comprises five groups: Group 1: Pulmonary arterial hypertension Group 2: PH due to left heart disease Group 3: PH due to chronic lung disease…

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

…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…

…in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics…

…death [3]. Acute overview 1. Activate the stroke call. 2. Establish the time of symptom onset or the time last known to be well. 3…

…use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric…

…1. The donation register held by the Swedish National Board of Health and Welfare, checked after the decision to withdraw treatment has been documented. 2…

…Procedure 1. Check the indication and contraindications, attach ECG monitoring and insert a venous cannula. 2. Document the baseline status of the chosen finding — measurement…

…suspected perforation or infection. Removal Proceed from the least to the most invasive technique. 1. Irrigate with sterile saline — loose particles often come away. 2…