…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…

…clip the hair — small cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum…

…mg/mL for local anaesthesia in the awake patient — the anaesthetic also improves the chance of success by counteracting vascular spasm. Pressure monitoring set: stiff…

…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…

…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…

…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…

…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…

…monitoring, complications and when thrombectomy should be considered. The doses and Swedish thresholds below are based on the national guideline for the management of reperfusion…

…schizoaffective disorder, HIV infection or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding…

…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…

…ECG monitoring and access to airway support. Indications Clinically suspected myasthenia gravis in a patient with clear, objectively verifiable fatigable symptoms. Assessment of whether residual…

…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…

…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…

…Intermediate–high Stable Yes Raised Admission with monitoring. Be prepared for rescue thrombolysis Intermediate–low Stable One of the two positive Admission Low Stable No…

…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…

…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…

…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…

…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…

…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…

…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…

…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 …

…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…

ECG Introduction to ECG interpretation Standard display of ECG leads in the 12 lead ECG Numerous conditions that can be diagnosed using the 12 lead…

…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…

…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 full thickness of the dermis, particularly over joints and in cosmetically sensitive areas. Superficial wounds with well apposed edges, abrasions and small wounds under…

…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…

…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

…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…

…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…

…small change in T4 produces a large change in TSH. During acute illness the TSH can be falsely low or high in the absence of…

…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…

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…

…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…

…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…

…small biopsies, but have diathermy or aluminium chloride available. Infection in the area to be biopsied. Hypersensitivity to local anaesthetics. Areas at high risk of…

…for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0.5–0.6 × 25 mm for small joints…

…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…

…smears immediately at the bedside from the first aspirate, which should be small — a few tenths of a millilitre, at most about 0.5 mL…

…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…

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

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…

…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…

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

…the rest. Support your working hand against the patient's zygoma or the bridge of the nose. 4. Approach tangentially from the periphery , never through…