…as acute brain failure. It is precipitated by somatic illness, drugs, poisoning, withdrawal, surgery or several concurrent factors. A diagnosis of delirium is therefore the…

…L Stupor or coma may occur Mixed picture of DKA and HHS Overlap is common. Treat as mixed DKA and HHS if the patient has…

…days, or shorter neutropenia with clinical risk factors International guidelines generally use a single temperature of 38.3 degrees as the threshold [4,5]. Some…

…a risk of permanent hypopigmentation. Areas with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes — the wound…

…otherwise stated. When the weight of a child aged 1–10 years is unknown: estimate it as (age in years + 4) × 2 kg , but use…

…microvascular dysfunction, or combinations of these mechanisms. Drug selection can therefore be tailored to the suspected mechanism. No antianginal class has demonstrated consistent superiority for…

…Acute transmural myocardial infarction. Rupture of the free ventricular wall. Neoplasms (particularly breast and lung cancer). Inflammatory conditions, such as rheumatoid arthritis, systemic lupus erythematosus…

…conclusive if the achieved workload is sufficient to provoke symptoms/signs that are not noticeable during rest. As a rule of thumb, the patient must…

…lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood…

…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…

…before or at the same time as carbohydrate administration. 3. Rapid identification of seizures, delirium tremens, infection, trauma and metabolic disturbance. 4. Monitoring at the…

…hours should have elapsed since the last dose before an invasive procedure. Exact intervals according to the local protocol or the on call coagulation service…

…or hypotension, or as an add on Slow onset. Dose reduction in renal failure and in old age Amiodarone In severe haemodynamic compromise where the…

…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…

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

…bowl. Local anaesthesia and vasoconstriction: lidocaine 4 % with oxymetazoline 0.5 % (or xylometazoline) on cotton pledgets. Cautery: silver nitrate sticks; electrocautery as a second choice…

…and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side…

…value As required, in addition to the mealtime dose Never stop basal insulin in a person with type 1 diabetes , not even before fasting or…

…The shock index is calculated as the heart rate divided by the systolic blood pressure. A value of around 0.9 to 1.0 or…

…12) of polyurethane or silicone for nutrition, since it causes less mucosal irritation with longer term use. A water soluble lubricant, preferably with a local…

…Follow the local protocol Ileus with distended bowel loops Ultrasound guidance mandatory; choose another site Scars, hernia or visible abdominal wall collaterals (caput medusae) Puncture…

…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…

…the airway, the pharyngeal reflexes, vomiting and secretions. Suction and give oxygen as needed. Intubate for a threatened airway, a marked risk of aspiration, or…

…signs of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3 Heart rate 100/min 1.5 Immobilisation ≥ 3 days or surgery…

…s acetate for hypotension or hypoperfusion, usually 500 mL as a rapid bolus, and a smaller bolus where the risk of fluid overload is high…

…the drug treatment Resuscitation, investigation and drug treatment must proceed simultaneously. Do not wait for laboratory results, CT or EEG before the first dose of…

…oxidative stress and immune activation progressively alter the local vascular environment. The extracellular matrix is an active component of lesion development rather than merely a…

…Pathophysiology Neointimal hyperplasia The principal mechanism of ISR is neointimal hyperplasia following vessel wall injury. PCI and stent implantation produce local vascular injury and initiate…

…local expertise and operator or institutional experience Assessment of coronary complexity The SYNTAX score is used to characterize coronary anatomical complexity. It incorporates the number…

…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…

…dissection. Coronary embolism of cardiac or non cardiac origin. Oxygen supply–demand mismatch, including demand related events in the presence of fixed coronary disease. More…

…12 lead ECG or a single lead ECG tracing lasting ≥30 seconds, characterized by irregularly irregular R R intervals and the absence of distinct P…

…Vasopressin Prioritize the collection of blood cultures to identify potential pathogens and guide antimicrobial therapy. Administer broad spectrum antibiotics in accordance with local clinical guidelines…

…when a cerebral artery is occluded due to local atherothrombosis or occlusion due to embolization. Approximately 30% of all ischemic strokes are caused by cardiac…

…deposition, culminating in a partially or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non…

…enough — as a rule of thumb, along the whole length of the abscess or at least half its diameter. Too small an incision is the…

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

…haemorrhage meeting the criteria for activation of the massive transfusion protocol. Plasma and platelets: in ongoing bleeding with coagulopathy, or as part of balanced transfusion…

…scalpel for the skin incision, sterile dressings, pressure dressing. Procedure 1. Place the patient in the lateral position with the knees drawn up , or prone…

…the TSH can be falsely low or high in the absence of thyroid disease; repeat it once the patient has recovered. Pitfalls Haemolysis raises the…

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

…is 8–12 minutes — a shorter test gives insufficient information, a longer one is limited by local muscle fatigue rather than by the heart. 2…

…tips of various sizes. A balloon catheter (a 5–6 Fr Fogarty or a Katz extractor). A local anaesthetic with a vasoconstrictor for the nose…

…anaesthesia. Placenta praevia or ruptured membranes in pregnancy — a speculum may be used, but not digital examination until the position of the placenta is known…

…Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit, a coronary care unit or another setting that…

…An unclear arthritis, as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular…

…or marked coagulopathy. A platelet count below 50 × 10⁹/L is often quoted as the threshold, but the threshold varies between regions. Infection of the…

…mL for local anaesthesia, 25 G and 21 G needles. An 18 G puncture needle, 7–9 cm (a spinal needle or the needle from…

…or sedation — the procedure must not then be started. Radiography before reduction A radiograph is taken before reduction in a first time dislocation , so as…

…Known hypersensitivity to tetracosactide or ACTH. Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a relative contraindication; the test is then performed…

…pot of 4 % formalin, and for immunofluorescence Michel's medium or saline according to local procedure. Photograph and draw in the site before the local…

…of loading, eccentric exercise, an NSAID, an orthosis — has not given a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound or other infection over the…

…or out of hospital and whatever the initial rhythm. It applies to both shockable and non shockable initial rhythms. It is started as soon as…

…support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly…

…the renal function and the severity of the bleeding 7 Manage antiplatelet drugs according to their indication. Do not routinely stop aspirin given as secondary…

…overdose. Tumour lysis syndrome appears as an indication in older protocols but is no longer routinely recommended — alkaline urine increases the precipitation of calcium phosphate…

…Instillation therapy and contrast studies of the urinary tract. Wound healing with a sacral pressure sore or extensive perineal wounds where urinary leakage prevents healing…

…must be avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on the hand. These are as a rule…

…amplify the abnormality through increased myocardial contractility and heart rate. Coronary compression and a Venturi or “suction” effect have been proposed as mechanisms of inducible…

…suggesting an autoimmune disorder or known malignancy may suggest specific, nonidiopathic etiologies [2]. Summary of Pain Characteristics The following table synthesizes the key differential diagnoses…