Procedurer The insertion itself is rarely the difficult part — it is the confirmation of the position that determines whether the tube is safe. A misplaced…

…pressures, for example severe ARDS, marked obesity or a stiff chest wall. Glottic or subglottic obstruction — the mask sits above the obstruction and solves nothing…

…a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation, chest movement and a blood gas…

…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…

…is the standard site for both aspiration and biopsy in adults. Here the posterior part of the iliac crest is thick, red marrow is abundant…

…the upper border of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain…

…oxygen Severe impairment of gas exchange Hypotension, cool peripheries or rising lactate Circulatory compromise or an alternative diagnosis Silent or nearly silent chest Very severe…

…Etiologies of tension pneumothorax include: Traumatic injuries (blunt force, lacerations, gunshot wounds) Asthmatic episodes Iatrogenic events (e.g., during central venous catheter insertion) Underlying lung…

…working, and the commonest source of error is believing that it is. Twitching of the chest muscles and spikes on the screen mean nothing. Capture…

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

…range of about 15–40 Hz , and adjust the gain so that the atrial deflections are clear without clipping. 4. Estimate the depth of insertion…

…caused by a dysregulated host response to infection. Clinically this usually corresponds to an acute increase in the SOFA score of at least 2 points…

…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…

…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…

…and it provides adequate opportunities for rhythm diagnostics, as well as detection of T waves and R waves. It is essential that T waves and…

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

…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…

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…

…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…

…condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions are often futile. A transcutaneous pacemaker is often necessary…

…never happens, and to make sure the catheter does not become the patient's next focus of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated…

…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…

…been assessed for tendon and nerve injury will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained contamination…

…sample : cortisol and plasma ACTH. The ACTH sample is taken before the injection and handled chilled. 4. Inject 0.25 mg of tetracosactide intravenously , slowly…

…What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was preoxygenated…

…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…

Referensvärden Reference ranges are statistical: by definition they encompass 95 % of a healthy reference population, which means that one healthy value in twenty falls outside…

…times the flow of a fine needle, and collapsed veins mean that the fine needle is in addition the only one that will go in…

…Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also…

…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…

…primary infection, low risk of recurrence vancomycin 125 mg × 4 PO 10 days Clostridioides difficile, high risk of recurrence fidaxomicin 200 mg × 2 PO 10…

…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…

…chloride available. Infection in the area to be biopsied. Hypersensitivity to local anaesthetics. Areas at high risk of unsightly or hypertrophic scars: the sternum, 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…

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

…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…

…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…

…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…

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

Cardiology Respiratory medicine Definition and Pathophysiology Pulmonary hypertension (PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise…

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

…overview 1. Activate the stroke call. 2. Establish the time of symptom onset or the time last known to be well. 3. Assess airway, breathing…

…ulnar pulse and a warm, well perfused hand carry more weight. Choice of vessel The radial artery is the first choice : superficial, easy to compress…

…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…

…to the next of kin. Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection…

…slowly. Rapid injection increases the risk of nicotinic effects with paradoxically increasing weakness. 6. Assess the chosen finding continuously during the window of effect, 40…

…the rest. Support your working hand against the patient's zygoma or the bridge of the nose. 4. Approach tangentially from the periphery , never through…

…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…

…clinical site of action—the coronary artery perfusing the AV node—before the drug is eliminated. A flush should immediately follow the bolus injection to…

…In patients undergoing percutaneous coronary intervention, even mild baseline renal dysfunction is associated with worse outcomes. The risk of death at 1 year is increased…

…ancestry Previous muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting…

…cavity with a no. 11 scalpel until pus appears. Take a culture from the wall of the cavity before irrigating. 5. Let the pus drain…

…hypoglycaemia will follow. Discharge without a plan. Document what has been changed, who is following it up and when. Sources American Diabetes Association, Standards of…

…The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3 Heart rate…

…value of these techniques rests on their ability to characterize the anatomy responsible for a stenosis, define plaque morphology, identify occult lesions, and optimize percutaneous…

…eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of…