…pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis…

…descried in 1991 in Japan and the authors termed it takotsubo , which is the Japanese word for a kind of octopus trap (the left ventricle…

…collection bag or suction, and a clamp. pH indicator paper with a scale that discriminates within the acidic range — ordinary litmus paper that only shows…

…central venous catheter insertion is decided before the needle goes in: the choice of site, the use of ultrasound throughout the puncture, and maintaining maximal…

…attire for therapeutic drainage with an indwelling catheter. Lidocaine 10 mg/mL, 5–10 mL, 25 G for the skin wheal and 21 G for…

…the catheter tip also lies in the lumen. 5. Hold the needle still and advance the catheter over the needle. It should slide in without…

…of a fine needle, and collapsed veins mean that the fine needle is in addition the only one that will go in. The rule that…

…episodes Iatrogenic events (e.g., during central venous catheter insertion) Underlying lung pathologies In cases of benign pneumothorax, positive pressure ventilation can precipitate a tension…

…Intramuscular injection in marked coagulopathy or thrombocytopenia (< 50 ×10⁹/L) — choose the subcutaneous route if possible, otherwise give IM with a fine needle and…

…you are doing. Indications The laryngeal mask: A rescue airway when intubation has failed and bag mask ventilation is difficult or inadequate. The primary airway…

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

…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…

…duration of effect. Lidocaine 10 mg/mL without adrenaline , 2–5 mL. Needles: 21–25 G, 40 mm for subacromial and trochanteric injection; 25–27…

…of infection on the flap is called vegetation. As a rule, some kind of damage to native (own) valves is required to become vulnerable and…

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

…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…

…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…

Procedurer A monoarthritis is septic until proven otherwise, and the only thing that proves otherwise is the synovial fluid. The aspiration is technically simple — what…

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

…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…

…Definition and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after selective intracoronary contrast injection under…

…Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8. Document the ceiling of care and the…

…3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the appropriate level of care , with readiness for respiratory support…

…low platelet counts, followed by compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow…

…acid Folate 7 nmol/L Electrolytes and renal function See the renal parameters for the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment :…

…Take a serum cortisol and ACTH first only if this does not delay treatment. Plus fluid and glucose Adrenal crisis: hypotension that does not respond…

…anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring a secured airway — transfer, heavy sedation, surgery — and cardiac arrest. Contraindications There…

…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…

…the opening pressure in suspected idiopathic intracranial hypertension. Therapeutic drainage in idiopathic intracranial hypertension and in assessment before shunt surgery. Contraindications Clinical signs of herniation —…

…Acute paronychia with fluctuance or visible pus Incision and drainage Acute paronychia without pus formation Antibiotics and soaks alone Ingrown nail with mild inflammation Splinting…

…discharge, dizziness, tinnitus, fever in a child without an obvious focus, and before every ear syringing. Removal of cerumen: Hearing loss, a blocked sensation, itching…

…three hours. The evidence for an absolute one hour requirement is clearest in septic shock and less certain in sepsis without shock [3,4]. The…

Procedurer Spirometry is the only investigation that distinguishes obstructive from restrictive impairment of lung function, and COPD cannot be diagnosed without it . The quality of…

…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…

…disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly…

…with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction, haemodynamic instability, anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast…

…of ST segment elevations Rapid T wave inversion Normalization (return) of ST segment elevations Successful reperfusion results in rapid and marked normalization (return) of ST…

…not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy…

…and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has been assessed The plasma glucose is normally the only…

…tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of renal function Doxycycline, erythromycin, clindamycin, metronidazole, moxifloxacin and fusidic…

…any retrieval: it begins when someone in the intensive care unit identifies a possible donor and the deceased person's own wishes are properly established…

…appears within less than a minute and has gone after 5–10 minutes. That makes the test useful only if you have selected an objectively…

…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…

…not be instrumented without magnification. With a suspected chemical injury the priorities are reversed: irrigate first , for at least 30 minutes, and measure the pH…

…the glucose value, without basal insulin (a so called sliding scale), gives poorer control and is not recommended as the sole regimen. Common situations Situation…

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

…a minute; a rapid injection causes nausea and a fall in blood pressure without better analgesia. Flush the cannula before and after every dose, otherwise…

…glucose in hypoglycaemia and a benzodiazepine for toxicological seizures E Temperature, skin, smell, injection marks, medication patches and trauma. Remove contaminated clothing and wash the…

…observed without anticoagulation Red flags and pitfalls A normal saturation and a normal ECG do not exclude pulmonary embolism. Syncope may be the only symptom…

…report. A shave biopsy of a pigmented lesion that turns out to be a melanoma can make the Breslow thickness unmeasurable and staging therefore impossible…

…A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go, adenosine activates potassium channels (IK.Ach…

…is water soluble and readily crosses cell membranes, allowing distribution throughout water containing tissues, including the myocardium. Its effects therefore depend not only on dose…

…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…

…and acquired factors may interact in its development. PAH may be idiopathic, heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV infection…

…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 (…

…infection or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding cardiovascular effects and…

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

…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…