…principal roles: Defining the anatomical distribution and severity of epicardial coronary artery disease (CAD). Assessing the haemodynamic significance of lesions whose angiographic severity is uncertain…

…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…

…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…

Procedurer Almost all the complications of pleural aspiration arise from two errors: the needle is placed in the wrong site, and too much is drained…

…animal model of haemorrhageinduced traumatic cardiac arrest. Resuscitation 2019; 140:37 42. Endo A, Kojima M, Hong ZJ, Otomo Y, Coimbra R. Open chest versus…

…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…

…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…

…between two sizes in an adult: choose the larger , since a mask that is too small leaks and gives a poorer seal. Procedure Insertion of…

…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…

…extension makes the artery harder to palpate. Procedure Catheter over needle (direct technique) 1. Palpate the course of the artery with two fingertips and note…

…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…

Lungmedicin Akutsjukvård Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and…

…the risk of developing acute coronary syndromes increases during infections, including influenza (6–9). Two mechanisms have been proposed to precipitate acute coronary events during…

…Figure 1. Flowchart showing the natural course of coronary artery disease and classification of acute coronary syndromes into STEMI, NSTEMI and unstable angina using ECG…

…and this confirms that the coronary artery flow is patent. The rapid ST segment return is explained by rapid normalization of myocardial cell membrane potentials…

…choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease, etc .) are warranted. Management of…

…displayed in two groups of three: leads I, II and III and leads aVR, aVL and aVF. Figure 1 shows the traditional presentation of the…

…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…

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

…in alcohol to the skin around the wound — not into the wound. Sterile gloves, a fenestrated drape, toothed forceps, a needle holder, scissors, artery forceps…

…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…

…septic shock, or a need for high dependency or intensive care 3 Take at least two sets of blood cultures from separate peripheral punctures. Also…

…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…

…myocardial perfusion imaging Diagnosis of coronary artery disease (CAD) : Myocardial perfusion imaging can confirm or rule out CAD in patients with symptoms suggestive of CAD…

…4.0–6.0 mmol/L ≥ 7.0 on two occasions establishes a diagnosis of diabetes HbA1c < 42 mmol/mol 42–47 = prediabetes…

…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…

…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…

…included in the standard protocol. The majority of examinations included in the standard protocol are performed using two dimensional (2D) imaging. Some measurements are still…

…arteries. It forms part of multisite artery disease, defined as atherosclerosis affecting at least two vascular beds. Carotid disease therefore commonly coexists with coronary artery…

…primary infection, low risk of recurrence vancomycin 125 mg × 4 PO 10 days Clostridioides difficile, high risk of recurrence fidaxomicin 200 mg × 2 PO 10…

…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…

…in a coronary artery occurs (then of course, the ST segment will be elevated). T wave inversion (inverted / negative T waves) T wave inversion means…

…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…

…smoking After acute coronary syndrome Reinfarction reduced by approximately 30–40%; death reduced by approximately 35–45% Peripheral artery disease Lower risk of progression to…

…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…

…but no coronary artery occlusion can be identified. Injection of contrast media into the ventricle will instead reveal that the apical portion of the left…

…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…

…What usually ruins the examination is not the technique but the handling of the specimen — an aspirate that clots before the smears are made is…

…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…

…ischaemic electrocardiographic changes during rapid AF. ST segment depression or T wave inversion can occur without coronary artery disease. Proposed explanations in the source material…

Cardiology Respiratory medicine Definition and Pathophysiology Pulmonary hypertension (PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise…

…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…

…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…

…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…

…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…

…wishes are properly established. Two things determine the outcome — that the confirmation of death is carried out in a formally unimpeachable way, and that the…

…Two people: one who injects and monitors, one who assesses and documents muscle function. Define the outcome measure before the test. Measure the size of…

…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…

…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…

…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…

…dependent torsades de pointes. Standby pacing — pads applied but the device not switched on — in second degree AV block Mobitz type 2, newly discovered complete…

…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…

…associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have…