…ventricular tachycardia, which may degenerate into ventricular fibrillation at any age. Exercise, or any other activity causing adrenergic stimulation, increase the risk of syncope, ventricular…

…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…

…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…

…nerve stimulation with a decrement ≥ 10 % at 3 Hz, sensitivity about 75 %; single fibre EMG about 95 %). Contraindications Known hypersensitivity to edrophonium. Mechanical obstruction of…

…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…

…Catheter length: the right internal jugular vein requires the shortest catheter, while left sided and femoral insertions require longer ones — check the length in the…

…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…

…safe triangle (Figure 1). Outside it the risk of injuring the diaphragm, liver, spleen or internal thoracic artery increases. For diagnostic aspiration the point chosen…

…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…

…left side so that the fluid collects in the left flank. Have the patient empty the bladder first. Procedure Choice of insertion site The left…

…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…

…base of skull fracture or marked coagulopathy argues against the nasal route; the oral route may then be considered. Preparation and equipment A 12 lead…

…and a warm, well perfused hand carry more weight. Choice of vessel The radial artery is the first choice : superficial, easy to compress, with a…

…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…

…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…

…in the leads with the highest ST segment elevation. Figure 2. The electrocardiographic natural course in STEMI (ST elevation myocardial infarction). Inversion of T waves…

…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…

…V1) to left lateral (V6), but regrettably, the limb leads are not. Instead, the limb leads are displayed in two groups of three: leads I…

…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…

…on the hand. These are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis, often with antibiotic…

…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…

…emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint or absent. Take cultures immediately, but never let sampling, imaging…

…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…

…disability that precludes safe and adequate testing Relative contraindications Known obstructive left main coronary artery stenosis Moderate to severe aortic stenosis with uncertain relation to…

…of thyroid disease; repeat it once the patient has recovered. Pitfalls Haemolysis raises the potassium, LDH and AST and lowers the haptoglobin. A tourniquet left…

…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…

…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…

…ST segment elevation followed by T wave inversion in leads V1 V4 in black athletes. C: PR interval <120 ms with a delta wave and…

…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…

…12 lead ECG is not required; limb lead II is sufficient and it provides adequate opportunities for rhythm diagnostics, as well as detection of T…

…family history, particularly in the broader assessment of peripheral arterial and aortic disease; planned surgery, especially carotid endarterectomy (CEA), coronary artery bypass grafting (CABG), or…

…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…

…misunderstood, particularly in the setting of ischemia. Normal T wave inversion An isolated (single) T wave inversion in lead V1 is common and normal. It…

…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…

…coronary syndrome Reinfarction reduced by approximately 30–40%; death reduced by approximately 35–45% Peripheral artery disease Lower risk of progression to chronic limb threat

…circles and let it dry for a couple of minutes before the needle is inserted. Sterile gloves, sterile gauze, and a fenestrated drape for injection…

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

…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…

…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…

…to complement ICA, particularly for intermediate non left main coronary stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with…

…PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise from pulmonary vascular disease, left sided cardiac disease…

…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…

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

…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…

…out a possible donor on your own on grounds of age or medical history — contact the transplant coordinator and let the assessment be made there…

…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…

…excreted metabolite that causes late sedation and respiratory depression Marked liver failure A reduced dose of all of them, at a longer interval All op

…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…

…infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must not be passed through the valve…