…characterized by angiography. Standard gray scale IVUS demonstrates the principal vessel wall layers and allows quantitative measurements of: minimum and maximum lumen diameter; lumen area…

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

…the tube can pass through a fracture in the cribriform plate into the cranium Absolute Corrosive injury of the oesophagus or stomach after ingestion of…

…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…

…98:10511. Saarinen S, Nurmi J, Toivio T, et al. Does appropriate treatment of the primary underlying cause of PEA during resuscitation improve patients' su

…long for thick soft tissue and for the head of the humerus. A pressure bag or a 50 mL syringe with a three way tap…

…Choice of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and the descending…

…Procedure Insertion of the laryngeal mask 1. Check the mask, remove air from the cuff so that it is flat with a slightly upturned leading…

…spray and lubricate the electrode generously with lidocaine gel. 6. Introduce the electrode along the floor of the nose, parallel with the palate and straight…

…as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb…

…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…

…corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral epicondylitis the…

…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…

…due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and NSTE ACS . STE ACS is the acronym…

…of ST segment elevation (in untreated patients) is depicted in Figure 2 . As evident, such ST segment elevations are succeeded by gradual inversion of the…

…T½ 3 h. 50% renal elimination. • Typically the first choice of drug. • Effective in sinus bradycardia or AV node block. • Dose <0.5 mg may…

…two groups of three: leads I, II and III and leads aVR, aVL and aVF. Figure 1 shows the traditional presentation of 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…

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

…the suture is placed. The commonest cause of wound infection is retained contamination, not poor suture technique — and the commonest cause of permanent loss of…

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

…three sizes, a stylet or bougie taken out and shaped before induction , a syringe for the cuff, a cuff manometer. A laryngeal mask of the…

…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…

…of a healthy reference population, which means that one healthy value in twenty falls outside them . Order twelve tests in a healthy person and the…

…cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although…

…intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until…

…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…

…three dimensional (3D) echocardiography is the most revolutionary method, but it is not yet included in the standard protocol. The majority of examinations included in…

…include: palpation of peripheral pulses; auscultation for carotid, femoral, and abdominal bruits; bilateral brachial blood pressure measurement; cardiac auscultation; inspection of the legs and feet…

…IV plus 1.5 g for the first dose, then 1 g × 1 IV Clostridioides difficile, primary infection, low risk of recurrence vancomycin 125 mg …

…infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of the alcohol use disorder…

…the level of consciousness, the pupils, tone, clonus and seizures. Give glucose in hypoglycaemia and a benzodiazepine for toxicological seizures E Temperature, skin, smell, injection…

…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…

…given after the ingestion of a potentially toxic dose of a substance that binds to charcoal, when it can be given early and the patient…

…of technique Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma Excision with a 1–3 mm margin, down into the subcutis Never a shave — the…

…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…

…Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications Infection of the skin or soft tissues over the puncture site — use…

…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…

…the head and neck Fragile skin, poor healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection…

…the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of…

…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…

…ST segment depression or T wave inversion can occur without coronary artery disease. Proposed explanations in the source material include cardiac memory after abnormal ventricular…

…may clarify the mechanism of an acute coronary syndrome or guide percutaneous coronary intervention (PCI). ICA therefore has three principal roles: Defining the anatomical distribution…

…and hyperthyroidism; follow up and investigation of the cause of increased flow are appropriate. Exercise PH is defined by an mPAP/cardiac output slope greater…

…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…

…quoted as the threshold, but the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first…

…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…

…simpler to administer, since the whole dose is given as a bolus [1,2]. In a meta analysis of three phase 3 trials, tenecteplase was…

…the quick reference on inpatient insulin therapy Peptic ulcer A proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection…

…a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current…

…If the patient tolerates the test dose without troublesome adverse effects, give a further 8 mg intravenously , slowly. Rapid injection increases the risk of nicotinic…

…a soft globe — because a perforated eye must never be instrumented, have its pressure measured, or be palpated. Indications A sensation of something in the…

…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…

…5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis…

…repeated every three to five minutes to a total maximum of 3 mg . Doses below 0.5 mg can paradoxically worsen the bradycardia and must…

…of heart block, wheezing, and peripheral vasodilation, respectively. Pharmacokinetics and Administration Technique Adenosine is extensively and rapidly cleared from the plasma by cellular uptake into…