…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 larger , since a mask that is too small leaks and gives a poorer seal. Procedure Insertion of the laryngeal mask 1. Check the mask…

…5. Ask the patient to flex the head forward and swallow repeatedly , preferably with sips of water if swallowing is safe. Advance the tube in…

…a rising pCO₂ and respiratory acidosis, or a markedly increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection…

…arm abducted and the hand behind the head. All drains are inserted within the safe triangle (Figure 1). Outside it the risk of injuring the…

…in three lengths: short for children and slim limbs, medium for most adults, long for thick soft tissue and for the head of the humerus…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…gaze, or the number of seconds the patient can hold the head lifted off the couch. Filming before and during the test is helpful. A…

…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…

…levels who had underlying cardiovascular disease, of which 69.4% died. Guo et al also report a significant association between troponin T levels and C…

…pressure measured, or be palpated. Indications A sensation of something in the eye, watering, photophobia and redness after working with a grinder, a drill, a…

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

…injury will heal badly however neatly the suture is placed. The commonest cause of wound infection is retained contamination, not poor suture technique — and the…

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

…apical portion of the left ventricle is dilated (hence the term apical ballooning syndrome ). This syndrome was first descried in 1991 in Japan and the…

…held by the Swedish National Board of Health and Welfare, checked after the decision to withdraw treatment has been documented. 2. A donor card and…

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…TTE) examination and it is in line with guidelines issued by ASE, EACVI and BSE. External resources Guidelines from ASE (American Society of Echocardiography) Guidelines…

…inspection of the legs and feet. A systolic blood pressure difference between the arms exceeding 15 mmHg is associated with a 50% higher risk of…

…Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample…

…coagulopathy or thrombocytopenia (< 50 ×10⁹/L) — choose the subcutaneous route if possible, otherwise give IM with a fine needle and 5 minutes of compression…

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…

…of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are viral infection…

…bradycardia is caused by beta blockers. Adrenaline (Epinephrine) α and β agonist Infusion of 2–10 μg/min (titrate as needed). T½ 5 min…

…the most stable dressing, lowest risk of infection and thrombosis with prolonged dwell time Highest risk of pneumothorax, the vessel cannot be compressed after arterial…

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

…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…

…lack of lung tissue) and its impact on cardiac function. Clinically, patients may present with: Absent breath sounds on the affected side Crepitus Subcutaneous emphysema…

…0 mmol/L Triglycerides < 1.7 mmol/L 10 carries a risk of pancreatitis Cardiac markers and coagulation Test Reference Comment : : : High sensitivity troponin…

…respiratory infection with a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also include dementia, marked hearing loss and…

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

…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…

…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…

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

…in the posterior triangle of the neck, and the superficial nerves of the forearm and the dorsum of the hand. Preparation and equipment Chlorhexidine in…

…five years of stopping but may remain elevated thereafter. The overall health benefit is greater still when reductions in non cardiovascular morbidity and mortality are…

…hold the needle still, change the syringe and inject. The injection should go in easily. Resistance means the tip is in tissue, not in the…

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

…Clean the skin and apply the drape. Anaesthetise skin, subcutaneous tissue and then the periosteum at several points around the puncture site , and wait a…

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

…margins and a narrow neck. These findings may reflect plaque disruption or thrombus. A rounded or polypoid intraluminal mass and lesion haziness raise suspicion of…

…studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and…

…another CNS infection. Suspected inflammatory disease: multiple sclerosis, Guillain–Barré syndrome, autoimmune encephalitis. Meningeal carcinomatosis and CNS involvement in haematological malignancy. Investigation of dementia with…

…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…

…done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy…

…anaesthetic also improves the chance of success by counteracting vascular spasm. Pressure monitoring set: stiff, short tubing, a transducer, and a flush system with physiological…

…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…

…lactate, two sets of blood cultures, and a culture from the likely focus 0 to 15 min Ringer's acetate for hypotension or hypoperfusion, usually…

…or to resolution of the underlying cause. Contraindications Hypothermia with a body temperature below about 30 °C — the hypothermic myocardium is irritable and pacing can…

…that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go…

…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…

…adverse event rates similar to those with placebo, whereas approximately 10% of patients in registries and routine clinical practice report muscle symptoms. This discrepancy reflects…

…a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate…

…high risk of hypoglycaemia in a patient who is eating poorly. Consider stopping it GLP 1 receptor agonist It can cause nausea and delayed gastric…

…cent. An sPESI of 0 indicates low risk. Anticoagulation A DOAC is the first choice in pulmonary embolism without malignancy and without antiphospholipid syndrome. The…

…60 MHz. Their principal advantage is tissue penetration, generally allowing assessment several millimetres beyond the lumen and visualization of the external elastic membrane (EEM). IVUS…

…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…