…should be utilized. The cannula is inserted into the 4th or 5th intercostal space along the anterior axillary line. Thoracostomy This method is generally deemed…

…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…

…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…

…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…

…machine. Lidocaine spray for the pharynx and lidocaine gel for the electrode. A glass of water with a straw, a vomit bowl, tissues, suction. Monitoring…

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…

…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…

…loosened or avulsed nail plate, or a damaged nail fold edge Nail avulsion and inspection of the nail bed, with suture of any nail bed…

…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…

…cardiomyopathy that predominantly affects the right ventricle. ARVC is defined by the gradual loss of myocardial cells, which are replaced by fat and fibrous tissue…

…disease. Contraindications Infection of the skin or soft tissues over the puncture site — use another approach or refrain. Bacteraemia without suspicion of joint infection (relative…

…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…

…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…

…required because blood causes strong backscatter of the light signal. Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement…

…rather than the emergency room: a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection…

…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…

…fluid ounces of 40% distilled spirits. Habitual heavy consumption is defined in the source material as at least eight drinks weekly in females or at…

…clean with a tracheostomy or copious secretions Subclavian vein Most comfortable for the patient, the most stable dressing, lowest risk of infection and thrombosis with…

…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…

…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…

…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…

…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…

…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…

…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…

…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 …

…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…

…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…

…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…

…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…

…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…

…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…

…in V6 with QRS duration <120 ms) D: Profound sinus bradycardia (<30 beats/min or sinus pauses ≥3 s) Explanation: Incomplete Right Bundle Branch Block…

…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…

…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…

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

…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…

… 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…

…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…

…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…

…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…

…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…

…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…

…Assessing the haemodynamic significance of lesions whose angiographic severity is uncertain. Supporting decisions regarding revascularization and, in selected patients, identifying microvascular or vasomotor coronary disorders…

…total obliteration of affected vessels. Genetic, molecular, and acquired factors may interact in its development. PAH may be idiopathic, heritable, drug associated, or associated with…

…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…

…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…

…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…

…window of effect, 40 seconds to 5–10 minutes after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or…

…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…

…of titration is abandoned — when a fixed dose is given without assessment, when a modified release preparation is started in an opioid naive patient, or…