…for health care professionals. Contact the centre early in serious, unusual or unclear poisoning, with modified release preparations, mixed poisoning, pregnancy, children, a need for…

…benzodiazepine, aspiration, hypoventilation, circulatory failure or an anticipated need for anaesthesia. Consider a 12 lead ECG when the acute situation allows, particularly before fosphenytoin, or…

…all in diabetes. The severity of the symptoms and the patient's need for help matter more than a single measured value [2]. Level Plasma…

…continuous ECG monitoring and early assessment of the need for dialysis ECG changes or serious neuromuscular symptoms mean a high risk even if the plasma…

…or a need for a vasopressor After initial stabilisation Repeat the lactate if it was raised and follow the trend together with the clinical perfusion…

…impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer procedures…

…rising lactate or a worsening acidosis. An assessed need for at least 4 units of red cells within 1 hour. An actual requirement of more…

…specific context of perioperative care in patients with pulmonary arterial hypertension (PAH), progression of right heart failure may indicate the need for inodilator therapy. Furthermore…

…with relatives or physicians before contacting emergency services. These factors support the need for targeted public education, particularly among underserved groups and ethnic minority communities…

…book was at best poor. It is outdated, oversimplifies the concepts and basically lacks everything you need for clinical purposes. Regrettably, I cannot recommend this…

…only redefined: continuous core temperature measurement and a target value that must never be exceeded, during the first 72 hours for as long as the…

…few days. Principles Insulin component Function Who needs it : : : Basal insulin (intermediate or long acting) Covers fasting glucose production Everyone with type 1 diabetes, always…

…an inactive person becomes even modestly active, while additional activity continues to confer benefit with progressively smaller incremental effects. Some activity is preferable to none…

…personalized treatment decisions. The SYNTAX Score was created to address the need for a standardized method to evaluate the anatomical complexity of CAD, particularly in…

…the function. For example, there are functions that continuously reassess stimulation threshold in order to calibrate stimulations according to the excitability of the myocardium. Functions…

…is the patient unstable, how long has the fibrillation lasted, and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion, without delay…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…at that cause. With regards to medications, the clinical need must be reconsidered if bradycardia is a side effect of the medication. Often, the medication…

…from a previously low level can cause organ damage at lower values, for example in pregnancy, acute glomerular disease or scleroderma renal crisis [1,2]…

…septic shock, or a need for high dependency or intensive care 3 Take at least two sets of blood cultures from separate peripheral punctures. Also…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…vasodilators replicate the effects of exercise on coronary arteries, without the need for physical activity. Advantages of regadenoson over adenosine Regadenoson has advantages over adenosine…

…resting full cycle ratio [RFR], and related resting indices) simplified the procedure by removing the need for pharmacologic hyperemia, and angiography derived indices (quantitative flow…

CPR Time is the most critical factor for survival in cardiac arrest. Life saving interventions must be initiated momentarily to maximize the probability of survival…

…calculation relies on readily available clinical parameters, eliminating the need for more invasive and costly direct measurements of GFR. Limitations of MDRD eGFR Accuracy at…

…ear canal. A 30–60 mL syringe with a soft catheter and body temperature water for irrigation. Small children need help to keep still. Sedation…

…gas determines the need for ventilatory support . At the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea…

…with inotropic and vasopressor effects, and they often need to be combined in order to optimise or correct the haemodynamics. Most agents exert both vasopressor…

…a smaller number of older patients may need treatment to prevent one adverse cardiovascular outcome, the potential benefit for an individual patient may remain substantial…

…has a protective function, and the commonest complication of ear syringing is that someone syringes an ear that did not need syringing. The second commonest…

…CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin I to angiotensin II…

…current guidelines, laypeople do not need to perform the 3 rd assessment (reliable assessment of pulses requires training and experience). Thus, for laypeople, examinations 1…

…dysfunction and sick sinus syndrome Sinus node dysfunction is an umbrella term for conditions that either affect the automaticity of the sinoatrial node or block…

…the ECG leads and various lead systems, we need to clarify the difference between ECG leads and ECG electrodes . An electrode is a conductive pad…

…concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter…

…third trimester pregnancy, marked reflux. A need for high airway pressures, for example severe ARDS, marked obesity or a stiff chest wall. Glottic or subglottic…

…no imaging evidence of RV dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock or the need for ongoing cardiopulmonary resuscitation. Mechanical circulatory support…

…ischaemic risk, bleeding risk, need for anticoagulation, and whether coronary stents are present. Clinical objectives of therapy The main objectives of antiplatelet treatment after MI…

…clinical presentation, bleeding risk, the anticipated need for non cardiac surgery, procedural complexity, and the relative merits of PCI and coronary artery bypass grafting (CABG…

…and how PCI was performed. The need for non cardiac surgery. The presence of an indication for oral anticoagulation (OAC). Clinical context and treatment objectives…

…ultimately prevailed. The need for a standardized global definition led to early efforts by the World Health Organization in the mid 20th century, relying primarily…

…this score. A high HAS BLED score (≥3) indicates a need for closer clinical monitoring and aggressive modification of reversible risk factors (e.g., treating…

…a potential risk of serious morbidity or mortality, underscoring the need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and…

…of tendon xanthomas, corneal arcus and xanthelasma. Potential secondary causes of hypercholesterolaemia. The likelihood of a monogenic disorder and the need for family based screening

…and severity of underlying cardiovascular disease. Conduction disease and the need for pacemaker therapy may be more frequent in T2DM, although management follows the same…

…spontaneous circulation (ROSC). Stable ROSC is when spontaneous circulation is maintained for 20 consecutive minutes, without the need for chest compressions. ECMO is considered in…

…started in an opioid naive patient, or when a conversion between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain…

…with a known risk of bradycardia. Transvenous pacing is chosen when the need is more than brief: continuing pacing dependence, inadequate or unachievable transcutaneous capture…

…inadequate protective reflexes active major haematemesis severe agitation respiratory failure an anticipated difficult or prolonged endoscopic intervention a need for general anaesthesia for other reasons…

…for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal radiograph. Contraindications An open fracture or a wound that needs…

…determines the diagnosis, and it is asked of a patient who is haemodynamically stable enough for there to be time to ask it. Indications Wide…

…and a history of anaphylaxis — a relative contraindication; the test is then performed with preparedness for anaphylaxis. An untreated Addisonian crisis in progress: treat first…

…Contraindications There are no absolute contraindications. Take care in: Anticoagulant therapy — this rarely needs to be stopped for small biopsies, but have diathermy or aluminium…

…severe acute or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A recent echocardiographic examination should be…

…drug overdose, hypothermia, and hyperkalemia. For recurrent symptomatic bradycardia, temporary or permanent pacing may be required. However, transcutaneous pacing in the setting of cardiac arrest…

…pocket guide with a universal interpretation algorithm. These 22 pages includes all you need to perform methodological ECG interpretation. We recommend this approach as it…

…target organ damage. Although BP reduction is required, these patients generally do not need hospital admission or intravenous treatment. Some patients with acute pain, anxiety…

…Failure to rate adjust, which means that the pacemaker fails to adjust its rate according to haemodynamic needs. This is only relevant in rate responsive…

…required in established or suspected CAD The extent or location of ischaemia needs to be defined before revascularization Residual ischaemia must be assessed after initiation…