…lack of lung tissue) and its impact on cardiac function. Clinically, patients may present with: Absent breath sounds on the affected side Crepitus Subcutaneous emphysema…

…in three lengths: short for children and slim limbs, medium for most adults, long for thick soft tissue and for the head of the humerus…

…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…

…passages and choose the more patent one. Ask the patient about a previous nasal fracture or unilateral nasal obstruction. 2. Measure the depth of insertion…

…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…

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

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

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

…hold the needle still, change the syringe and inject. The injection should go in easily. Resistance means the tip is in tissue, not in the…

…Clean the skin and apply the drape. Anaesthetise skin, subcutaneous tissue and then the periosteum at several points around the puncture site , and wait a…

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

…60 MHz. Their principal advantage is tissue penetration, generally allowing assessment several millimetres beyond the lumen and visualization of the external elastic membrane (EEM). IVUS…

…inflamed tissue — the acidic environment inactivates the anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect…

…reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your…

…may be subclinical. Progressive dilation can subsequently impair left ventricular ejection fraction. Enlargement of the left ventricle predisposes to atrial and ventricular arrhythmias. In advanced…

…the shortest catheter, while left sided and femoral insertions require longer ones — check the length in the set against the chosen side. An ultrasound machine…

…arm abducted and the hand behind the head. All drains are inserted within the safe triangle (Figure 1). Outside it the risk of injuring the…

…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…

…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…

…Practice differs between regions and departments; a palpable ulnar pulse and a warm, well perfused hand carry more weight. Choice of vessel The radial artery…

…of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are viral infection…

…individuals the infection may be severe and deadly. Importantly, COVID 19 has caused an unprecedented number of severe and deadly infections among young and apparently…

…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 …

…elevations are succeeded by gradual inversion of the T waves. These T waves are called post ischemic T waves and they indicate that the infarction…

…bradycardia is caused by beta blockers. Adrenaline (Epinephrine) α and β agonist Infusion of 2–10 μg/min (titrate as needed). T½ 5 min…

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

…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 test measures the ability of the adrenal cortex to respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether…

…a rising pCO₂ and respiratory acidosis, or a markedly increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection…

…the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction…

…Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary. Continuous infusion: Start infusion at 0.1 mg/min and increase…

…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…

…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…

…Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample…

…respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also include dementia, marked hearing loss and…

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

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

…heart rate, ECG. References Narula et al: Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiology.

…inspection of the legs and feet. A systolic blood pressure difference between the arms exceeding 15 mmHg is associated with a 50% higher risk of…

…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…

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

…T waves are seen after periods of ischemia, after infarction and after successful reperfusion (PCI). Post ischemic T wave inversion is caused by abnormal repolarization…

…in the posterior triangle of the neck, and the superficial nerves of the forearm and the dorsum of the hand. Preparation and equipment Chlorhexidine in…

…to second hand smoke. Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other…

…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…

…5 cm into the ear canal, not beyond the hair bearing skin. 5. Direct the jet upwards and backwards along the superior wall of the…

…transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and give by slow injection over 5…

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

…intermediate non left main coronary stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed or…

…of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left…

…of T wave inversion. Myocardial ischemia may also present with flat T waves, which are defined as T waves with an amplitude between +1 and…

…another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome, autoimmune encephalitis. Meningeal carcinomatosis and CNS involvement in haematological malignancy. Investigation of dementia with…

…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…

…determine the outcome — that the confirmation of death is carried out in a formally unimpeachable way, and that the donor's organs are maintained physiologically…

…to 5–10 minutes after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or increasing weakness, and give atropine…

…forehead against the band and the chin in the rest. Support your working hand against the patient's zygoma or the bridge of the nose…

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