…the injection has gone to the right place — immediate pain relief is a diagnostic finding — and appears to reduce the risk of a post injection…

…deltoid injection is placed too high — which causes the shoulder injury known as SIRVA. Both are avoided with the right landmark and the right needle…

…team, not in your head. Functioning suction within reach under the pillow or by the right shoulder. A reservoir mask with a tight fitting seal…

…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…

…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…

…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…

…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…

…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…

…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…

…infection, surgery, trauma and old age. A positive value is not a diagnosis. Risk grading in confirmed pulmonary embolism Risk Haemodynamics Right ventricular strain (echo…

…to the next of kin. Since the change in the law in 2022, the next of kin no longer have a right of veto based…

…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…

…External resources Guidelines from ASE (American Society of Echocardiography) Guidelines from ESC (European Society for Cardiology) Preparations for the examination Patients referred for echocardiography should…

…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…

…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…

…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…

…edges are held apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas. Superficial wounds with well…

…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…

…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…

…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…

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…

…question): A fracture of the bone to be punctured, or a major injury proximal to the puncture site. A joint prosthesis or orthopaedic metalwork 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…

…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…

…injection marks, medication patches and trauma. Remove contaminated clothing and wash the skin after external exposure A low Glasgow Coma Scale is not on its…

…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…

…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…

…or soft tissues over the puncture site — use another approach or refrain. Bacteraemia without suspicion of joint infection (relative; aspiration can seed a sterile joint)…

…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…

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

…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…

…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…

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…

…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…

…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…

…aortic balloon pump. Assessment of stroke volume variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation…

…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…

…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…

…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…

…bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is chosen when the need…

…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…

…temporal association is present; contrast induced AKI should be reserved for the smaller subgroup in which iodinated contrast is considered causally responsible. This distinction is…

…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…

…somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face or perianally. Indications Fluctuant…

…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…

…lumen and visualization of the external elastic membrane (EEM). IVUS is consequently useful for determining vessel size, plaque burden, and the dimensions of lesions that…

…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…