…pull the skin and subcutaneous tissue 2–3 cm to one side, inject, wait 10 seconds, withdraw the needle and release the skin. The displaced…

…that is the posterior superior iliac spine. Mark it. 3. Clean the skin and apply the drape. Anaesthetise skin, subcutaneous tissue and then the periosteum…

…an inflammatory dermatosis: the active edge , not the burnt out centre. 2. Clean the skin and infiltrate the anaesthetic intradermally and subcutaneously until a weal…

…the fluid bolus and the start of the vasopressor. Time Action : : 0 to 5 min ABCDE, continuous monitoring, activate the sepsis pathway according to local…

…to local practice Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk of…

…Local anaesthesia works poorly in inflamed tissue — the acidic environment inactivates the anaesthetic. Place a field block in healthy skin around the abscess instead of…

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

…the dressing clean with a tracheostomy or copious secretions Subclavian vein Most comfortable for the patient, the most stable dressing, lowest risk of infection and…

…at normal concentrations; be cautious nonetheless in known peripheral vascular disease and follow local practice. Inject through the wound edge , not through intact skin — it

…joints. Local anaesthesia of the skin and subcutis where needed, lidocaine 10 mg/mL. Sample tubes: an EDTA tube for the cell count and crystals…

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

…corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral epicondylitis the…

…mask and cap. Lidocaine 10 mg/mL for local anaesthesia in the awake patient — the anaesthetic also improves the chance of success by counteracting vascular…

…soft to pass through the skin on its own. Local anaesthesia: lidocaine 10 mg/mL, a millilitre or two intracutaneously and along the needle track…

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

…of rebound. The referring physician should have made this decision; document which applies. Nitroglycerin is continued; note it in the report. Shaving and careful skin…

…and lies most superficially, where the distance from the skin is shortest, and where no liver, lung or vessel lies in the path of the…

…cm of free fluid depth with no bowel in the path of the needle and measure the skin to peritoneum distance. 2. Mark the site…

…the toxicant. Irrigate skin and eyes using saline solution (NaCl) if suspected of toxin exposure. Gastrointestinal lavage is infrequently employed due to aspiration risks and…

…Follow the local protocol for choice of drug, dosing, route of administration and criteria for intermediate care or intensive care. Time course after the last…

…to the national programme. Checking an intrauterine device or a pessary. Assessment of prolapse. Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea…

…according to the local protocol. Alternatives when there is a contraindication: catheter directed treatment or surgical embolectomy where available. A vasopressor (noradrenaline) and cautious fluid…

…of a healthy reference population, which means that one healthy value in twenty falls outside them . Order twelve tests in a healthy person and the…

…version 4 of 27 February 2024. The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence…

…or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric symptoms…

…according to the local protocol Renal failure The insulin requirement falls . Reduce the dose and measure more frequently Acute illness and infection The insulin requirement…

…numerous local and systemic disorders. Accumulation of fluid in the pericardial space may lead to increased intrapericardial pressure, which in turn affects ventricular relaxation (and…

…at 30 minutes and at 60 minutes . Some laboratories accept one of these time points — follow the local instructions, but where the response is equivocal…

…of local and systemic conditions may cause pericarditis. The most common causes are as follows: Rheumatoid arthritis (RA) Systemic Lupus Erythematosus (SLE) Acute myocardial infarction…

…within the plaque and tissue factor bearing microparticles contribute to activation of coagulation. Plaque rupture is typically associated with a fibrin rich, red thrombus. The…

…subendothelial matrix components, notably tissue factor and collagen, to the circulating blood [3] . Plaque Erosion: Responsible for up to 30% of ACS cases, plaque erosion…

…While dyspnea is the cardinal symptom, chest pain can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation…

…potential drug interactions, the presumed mechanism of ischaemia, patient preferences, local availability, and cost. The pathophysiological substrate of angina may differ between patients. Myocardial ischaemia…

…PCI and stent implantation produce local vascular injury and initiate a sustained inflammatory and reparative response. Proliferation and accumulation of tissue within the stent progressively…

…Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment of coronary complexity The SYNTAX score…

…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…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…programs) and local level (e.g. EMS protocols, in hospital protocols, etc) is necessary to improve outcomes in out of hospital cardiac arrest (OHCA) and…

…pharmacological stress Local expertise and adequate echocardiographic facilities are available Risk stratification is required in established or suspected CAD The extent or location of ischaemia…

…coronary artery. Anomalous origin of a coronary artery from the pulmonary artery can result in reduced coronary oxygen content, coronary steal, and myocardial ischaemia. Coronary…

…follow the local protocol for exact infusion rates, electrolyte concentrations and level of care. This quick reference is intended primarily for adults and summarises the…

…the treated area. The method is quick, cheap and requires no local anaesthetic — but it leaves no specimen . That makes the choice of lesion the…

…treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest…

…treadmill The choice of exercise equipment and protocol depends mainly on local traditions. The treadmill and cycle ergometer (bicycle) are the most frequently used test…

…division of work between the ambulance service, the emergency department and the PCI laboratory may differ between Swedish regions. Always follow the local PCI and…

…INR and weight) plus vitamin K 10 mg IV Dabigatran Idarucizumab (Praxbind) Apixaban, rivaroxaban, edoxaban Prothrombin complex concentrate, consider within 15 hours of the last…

…ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol…

…the soft part , and held continuously for at least 10 minutes without letting go to look. Compression can be preceded by a dose of decongestant…

…Activate the local major haemorrhage protocol early. Protocols improve above all the logistics, the communication and the simultaneous delivery of red cells, plasma and platelets…

…but local choices of drug, formulations and infusion rates may differ. Always follow the current hospital protocol and check the strength and the maximum infusion…

…von Willebrand factor, and increased thrombin generation. The clinical consequence of this triad is severe: cardioembolic strokes associated with AF are typically larger, present with…

…Assess the esponse and repeat administration as clinically indicated. Measure serum lactate levels . Elevated lactate is an indicator of tissue hypoperfusion and can guide resuscitative…

…in the heart. These conditions may be ranked according to their embolic potential. Conditions with high embolic potential entail a high risk of embolism and…

…of the individual donor unit When irregular antibodies have been demonstrated, when the screening result is unclear, and otherwise according to local protocol Both the…

…vary; follow the local setting instructions for the device available on the unit. Preparation and equipment A device capable of both CPAP and bilevel ventilation…

…is to ask the patient to recite the months of the year backwards. A normal result does not exclude delirium, however, and an abnormal result…

…Two or more magnets constitute the same kind of urgency by a different mechanism. They attract one another through the tissue — even when they lie…

…Check the local formulary, the licensing status, the concentration, the dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should…

…oxygen and a bag available. Drugs for procedural sedation and analgesia according to local practice and the guidelines of the Swedish Society of Anaesthesiology and…

…hospitals , and the local care programme applies. In practice the cooling device is set to a target of around 37.0–37.5 °C , that…