…acromion , in the middle of the muscle belly, within the inverted triangle formed between the acromion and the lower tip of the muscle insertion. 3…

…inserted close to the upper border of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is stopped for…

…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…

…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…

…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…

…more severe and lower the seizure threshold [6]. This explains why a history of previous withdrawal seizures or delirium tremens is one of the strongest…

…endpoint. The cardiovascular benefits of cessation extend across primary and secondary prevention. Observational evidence indicates that cessation lowers the risk of peripheral artery disease, myocardial…

…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…

…roots of the cauda equina. If in doubt: choose a level lower, never higher. 3. Mark the puncture site, clean in wide circles and apply…

…course of the artery. 4. When pulsatile blood appears in the hub: lower the angle to close to the plane of the skin and advance…

…band and the chin in the rest. Support your working hand against the patient's zygoma or the bridge of the nose. 4. Approach tangentially…

…and lactate measurement. A meta analysis of emergency department alert systems found an association with lower mortality, but most of the evidence was observational and…

…Chinese and Malay patients, may have higher statin blood levels; lower starting doses are therefore appropriate. Drug interactions are particularly important. Inhibition of cytochrome P…

…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…

…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…

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

…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…

…heart rate, ECG. References Narula et al: Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiology.

…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…

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…

…individuals the infection may be severe and deadly. Importantly, COVID 19 has caused an unprecedented number of severe and deadly infections among young and apparently…

…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…

…passages and choose the more patent one. Ask the patient about a previous nasal fracture or unilateral nasal obstruction. 2. Measure the depth of insertion…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy…

…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…

…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…

…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…

…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…

…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…

…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…

…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…

…determine the outcome — that the confirmation of death is carried out in a formally unimpeachable way, and that the donor's organs are maintained physiologically…

…to 5–10 minutes after the injection . 7. Stop the test in the event of bradycardia, bronchospasm, marked salivation or increasing weakness, and give atropine…

…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…

…and reuptake into cells through a nucleoside transport system. Because of these highly efficient elimination pathways, adenosine has an extremely short elimination half life of…

…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…

…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…