…down into the larynx. The difficult airway rarely kills because the tube would not pass, but because the team keeps trying to intubate instead of…

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

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…

…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…

…transient, self terminating AF during ST elevation myocardial infarction may indicate an increased long term risk of stroke. In patients with acute decompensated heart failure…

…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…

…tap, and saline for flushing. An intraosseous drill system with needles in three lengths: short for children and slim limbs, medium for most adults, long…

…also improves the chance of success by counteracting vascular spasm. Pressure monitoring set: stiff, short tubing, a transducer, and a flush system with physiological saline…

…Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early: 1. Assess airway, work of breathing…

…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…

…kg Body weight 50 kg: Adult dosage. Adverse effects Adverse effects typically persist <10 seconds due to the short half life of adenosine. Anxiety Chestpain…

…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…

…clear level of consciousness and preserved orientation 12 to 48 hours Withdrawal seizures, usually generalised tonic clonic and sometimes several within a short period 24…

…hyperacute T waves seen in the very early phase of myocardial ischemia. Hyperacute T waves are broad based, high and symmetric. Their duration is short…

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

…will start where the accessory pathway inserts into the ventricle, and the impulse will spread slowly because it will propagate outside of the conduction system…

…a short expected survival, a high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol…

…Decompensated heart failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with…

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

…A short course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary…

…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…

…is reached. Indications Diagnostic aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart failure must be aspirated. Suspected empyema…

…to the heart. In instances of tension pneumothorax, the accumulated pressure can shift the entire mediastinum, manifesting externally as a laryngeal displacement. Etiologies of tension…

…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…

…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…

…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…

…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 …

…discussed previously in this article. Briefly, accelerated ventricular rhythm (also called idioventricular rhythm) is a benign ventricular rhythm with a heart rate of 60–10

…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…

…The coordinate system presenting the limb leads in the frontal plane. This format of displaying the ECG leads is referred to as the Cabrera format…

…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…

…Endocarditis implies that a bacterial infection engages the heart valves and this is a serious condition. The focus of infection on the flap is called…

…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…

…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…

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…

…If the heart rate is greater than 100 beats/min, repeating the ECG after a longer resting period is advised. 4. Which of the following…

…External resources Guidelines from ASE (American Society of Echocardiography) Guidelines from ESC (European Society for Cardiology) Preparations for the examination Patients referred for echocardiography should…

…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…

…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…

…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…

…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…

…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…

…been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection…

…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…

…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…

…The assessment of medical suitability is made by the transplant team. Never rule out a possible donor on your own on grounds of age or…

…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…