…not the subclavian. Thresholds for INR and platelet count before insertion differ between regions and departments — follow local protocol. Severe lung disease or a contralateral…

…with a high BMI, and that the deltoid injection is placed too high — which causes the shoulder injury known as SIRVA. Both are avoided with…

…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…

…sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0.5–0…

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

…effect of adenosine, which can be given during the recording and unmask the atrial activity. The investigation is diagnostic, not therapeutic. An unstable patient should…

…left side so that the fluid collects in the left flank. Have the patient empty the bladder first. Procedure Choice of insertion site The left…

…spasm. The absence of obstructive CAD on ICA should therefore not automatically be interpreted as evidence that the patient’s symptoms are non cardiac. In…

…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…

…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…

…on the hand. These are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis, often with antibiotic…

…the day of the test can therefore be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for…

…of thyroid disease; repeat it once the patient has recovered. Pitfalls Haemolysis raises the potassium, LDH and AST and lowers the haptoglobin. A tourniquet left…

…PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise from pulmonary vascular disease, left sided cardiac disease…

…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…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint or absent. Take cultures immediately, but never let sampling, imaging…

…Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks. Choice of vein and cannula size…

…out a possible donor on your own on grounds of age or medical history — contact the transplant coordinator and let the assessment be made there…

…scalpel until pus appears. Take a culture from the wall of the cavity before irrigating. 5. Let the pus drain out. Empty it with gentle…

…studies and evaluation of hemodynamic parameters. Hence, heart rate and blood pressure must also be noted. In summary, the following variables should be included in…

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

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 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…

…hemodynamic instability is a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions are often…

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…

…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…

…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…

…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…

…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…

…Thoracostomy This method is generally deemed safer than using a needle due to reduced risk of injury. Thoracostomy should be performed promptly following needle decompression…

…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…

…COPD. Adenosine has caused mild to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma…

…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…

…the aim should be a calm, mildly somnolent but rousable patient, while ventilation, circulation and underlying disease are monitored [3]. The management of complicated withdrawal…

…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…

…Clinical presentation and assessment Identifying tobacco exposure Every cardiovascular assessment should establish: Current smoking status. Cigarettes smoked per day. Duration of smoking and cumulative exposure…

…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…

…smears immediately at the bedside from the first aspirate, which should be small — a few tenths of a millilitre, at most about 0.5 mL…

…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…

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

…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…

…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…

…and when thrombectomy should be considered. The doses and Swedish thresholds below are based on the national guideline for the management of reperfusion treatment in…

…circulation, but the test does not reliably predict ischaemic complications and should not decide the matter on its own. Practice differs between regions and departments…

…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…

…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…

…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…

…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…

…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…

…or percutaneous coronary intervention. The preferred terminology is contrast associated AKI when temporal association is present; contrast induced AKI should be reserved for the smaller…

…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…

…a high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in…

…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…