…anaesthesia, normal saline to flush all lumens, suture material or a securement device, transparent dressing. Monitoring throughout the procedure: ECG, pulse oximetry and blood pressure…

…to try yet another dose. Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace…

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

…lidocaine gel for the electrode. A glass of water with a straw, a vomit bowl, tissues, suction. Monitoring with ECG, blood pressure and saturation throughout…

…gradual inversion of the T waves. These T waves are called post ischemic T waves and they indicate that the infarction process is more or…

…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…

…preferably before or at the same time as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at…

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

…aphasia, hemianopia or hand paresis in a person of working age Blood pressure Measure initially in both arms if this does not delay reperfusion treatment…

…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…

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

…indication and contraindications, attach ECG monitoring and insert a venous cannula. 2. Document the baseline status of the chosen finding — measurement, photograph or video. 3…

…sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis or a…

…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…

…signs of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3 Heart rate 100/min 1.5 Immobilisation ≥ 3 days or surgery…

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

…cribriform plate into the cranium Absolute Corrosive injury of the oesophagus or stomach after ingestion of a caustic substance Absolute Choanal atresia or an occluded…

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

…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…

…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…

…renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to…

…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…

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

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…

…risk of hypercapnia has been assessed. 3. Take an arterial blood gas in respiratory compromise, low saturation, suspected carbon dioxide retention, reduced consciousness, or when…

…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…

…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…

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

…facilitates ECG interpretation (e.g. interpretation of myocardial ischemia and electrical axis). All modern ECG machines can present either aVR or –aVR; we recommend that …

…feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : : Acute paronychia with fluctuance or visible pus Incision and…

…common agent. These streptococci most often originate from the oral cavity and affect heart valves that have some kind of damage, change or degeneration. Endocarditis…

…usually visible on plain films. Irrigation fluid: a copious volume of drinking quality tap water or sodium chloride 9 mg/mL. The volume matters more…

…insufficiency in pituitary disease, after pituitary surgery or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment. A basal morning…

…rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the…

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

…a large change in TSH. During acute illness the TSH can be falsely low or high in the absence of thyroid disease; repeat it once…

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

…or an intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of…

…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…

…COPD. Adenosine has caused mild to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma…

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…

…be questioned specifically about neurological symptoms during the preceding 6 months. Those with symptoms suggestive of TIA or stroke require neurological consultation and, when appropriate…

…4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline 200 mg × 1…

… However, T wave inversions that are accompanied by ST segment deviation (either depression or elevation) is representative of ischemia (but in that scenario, it is…

…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…

…have diathermy or aluminium chloride available. Infection in the area to be biopsied. Hypersensitivity to local anaesthetics. Areas at high risk of unsightly or hypertrophic…

…as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection 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…

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

…the needle may perforate into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position…

…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…

…and whether left ventricular systolic function is depressed or preserved Whether hypotension is present Whether an accessory pathway is suspected, particularly before administration of digoxin…

…Left ventricular dysfunction suggesting extensive obstructive CAD. A high risk result on non invasive testing. Symptoms that are strongly suggestive of obstructive CAD. Uncertain or…

…from pulmonary vascular disease, left sided cardiac disease, chronic lung disease or hypoxia, chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms…

…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…

…treatment or marked coagulopathy. A platelet count below 50 × 10⁹/L is often quoted as the threshold, but the threshold varies between regions. Infection of…

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

…next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain…

…acute glaucoma is suspected (normal 10–21 mmHg). Tonometry is contraindicated with suspected perforation or infection. Removal Proceed from the least to the most invasive…