…these patients are immediately referred to angiography but no coronary artery occlusion can be identified. Injection of contrast media into the ventricle will instead reveal…

…same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the…

…preferably with a local anaesthetic, and a decongestant nasal spray if the nasal passage is narrow. A 50–60 mL catheter syringe, a collection bag…

…emergency — but it should be changed or removed once the situation has stabilised. Preparation and equipment A central line set with a triple lumen catheter…

…mg/mL), sterile gloves, fenestrated drape; full sterile attire for therapeutic drainage with an indwelling catheter. Lidocaine 10 mg/mL, 5–10 mL, 25 G…

…insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb: marked peripheral arterial disease, Raynaud's phenomenon, thromboangiitis obliterans. An arm with…

…the head of the humerus. A pressure bag or a 50 mL syringe with a three way tap — intraosseous flow requires pressure ; gravity is not…

…risk of injury. Thoracostomy should be performed promptly following needle decompression. Thoracostomy with drainage typically serves as a stabilizing intervention. References Debehnke DJ, Hilander SJ…

…on the same side. A paretic limb — poorer absorption. Injection into an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there…

…laryngeal mask of the correct size plus one size above and one below. Second generation masks with a separate drainage channel (i gel, LMA Supreme…

…the gain so that the atrial deflections are clear without clipping. 4. Estimate the depth of insertion by measuring from the ala of the nose…

…tap. Therapeutic aspiration: a commercial aspiration set or a 6–8 F pigtail catheter, a drainage bag or a vacuum bottle. Drainage: a chest drain…

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…

…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…

…neutropenic fever is limited, but delayed antibiotics are associated with a worse outcome in sepsis and in several studies of neutropenic patients. In septic shock…

…respond to maximal ACTH stimulation, and it is rarely the injection itself that determines whether the result can be interpreted. What decides that is whether…

…in which the patient reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient…

…The patient sits with the arm hanging relaxed and slightly internally rotated. The posterior approach is preferable: it passes through muscle without major vessels or…

…in the Swedish medicines compendium (FASS) and in Swedish anaesthetic reviews as about 3–4 mg/kg without adrenaline and 7 mg/kg with adrenaline …

…2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary…

…arterial tree after selective intracoronary contrast injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site…

…infection and air pollution, but often no definite trigger can be identified [1,2]. Ask specifically about: Onset and time course. Increased dyspnoea compared with…

…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…

…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…

…the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP < 3 mg/L Rises within 6–8 h, half life about 19…

…with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long term corticosteroid treatment cannot increase their own cortisol production. Situation Action : : Fever, infection…

…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…

…Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample without a speculum…

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

…Nail avulsion and inspection of the nail bed, with suture of any nail bed laceration Contraindications There are no absolute contraindications, but be cautious and…

…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…

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

…aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until…

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

…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…

…among patients without evidence of myocardial injury (normal troponin I levels). Hence, troponin I was a strong predictor of survival in patients hospitalized with COVID…

…is considered causally responsible. This distinction is important because AKI after a contrast study frequently occurs in patients with several simultaneous renal insults. Infection, hypovolaemia…

…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…

…emergency department without contacting the appropriate specialty: Location Risk Management : : : Medial triangle of the face (nasal root, alae nasi, upper lip) Venous drainage towards the…

…trials, tenecteplase was non inferior to alteplase with respect to an excellent functional outcome, without an increased risk of symptomatic intracerebral haemorrhage or death [3]…

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

…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…

…the test dose without troublesome adverse effects, give a further 8 mg intravenously , slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing…

…severe piperacillin–tazobactam 4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline…

…The absence of a slit lamp — the cornea should not be instrumented without magnification. With a suspected chemical injury the priorities are reversed: irrigate first …

…to ketoacidosis within hours. Treatment with correction doses alone according to the glucose value, without basal insulin (a so called sliding scale), gives poorer control…

…index with Doppler. 4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical…

…and checked before the first intravenous dose is given. Oxygen with a mask and a bag available. The opioid drawn up in a 1 mL…

…around the clock for health care professionals. Contact the centre early in serious, unusual or unclear poisoning, with modified release preparations, mixed poisoning, pregnancy, children…

…bleeding risk with gastrointestinal and urogenital tumours Marked renal failure Low molecular weight heparin with dose adjustment, or warfarin Subsegmental pulmonary embolism without deep vein…

…A treatment resistant rash without a definite diagnosis. Choice of technique Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma Excision with a 1–3 mm…

…Pathophysiology Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac…

…effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias…

…In diabetes, carotid plaque prevalence correlates linearly with diabetes and carotid atherosclerosis tends to be more advanced than in people without diabetes. Carotid disease is…

…occult structural abnormality. IVUS IVUS generates images by transmitting ultrasound from an intracoronary catheter and recording echoes reflected from the vessel wall. Contemporary systems use…

…or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic…

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

…but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is a major modifiable driver of atherosclerosis and cardiovascular disease. Its relationship with…

…muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting medications The SLCO1B1 rs4149056 polymorphism is associated with higher statin concentrations…

…T wave inversion in myocardial ischemia Ischemia never causes isolated T wave inversions. It is a general misunderstanding that T wave inversions, without simultaneous ST…