…tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not enough: fracture, renal colic, ischaemic pain, pancreatitis, major trauma. Postoperative pain…

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

…or no effect on myocardial contractility or conduction. Clevidipine reduces mean arterial blood pressure (MAP) by decreasing systemic vascular resistance (SVR). Clevidipine does not reduce…

…or no effect on myocardial contractility or conduction. Clevidipine reduces mean arterial blood pressure (MAP) by decreasing systemic vascular resistance (SVR). Clevidipine does not reduce…

…or no effect on myocardial contractility or conduction. Clevidipine reduces mean arterial blood pressure (MAP) by decreasing systemic vascular resistance (SVR). Clevidipine does not reduce…

…on a surgical ward. Decompression in severe vomiting where the stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery, according to local practice…

…in the entire chain. In massive haemorrhage a second problem is added: transfusion saves no one whose bleeding is not stopped, and it is the…

…aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart failure must be aspirated. Suspected empyema or complicated parapneumonic effusion…

…distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate stenting or other procedural intervention. The clinical…

…ms, is listed as a 'Normal ECG finding' and considered a normal variant in asymptomatic athletes with no significant family history, not requiring further evaluation…

…population measure that performs poorly at the level of the individual: it does not distinguish muscle from fat and takes no account of fat distribution…

…examination is not the technique but the handling of the specimen — an aspirate that clots before the smears are made is unusable, no matter how…

…not the cold alone. The temperature at the outer edge of the tissue is decisive: benign tissue requires about −25 °C for reliable cell death…

…sickle cell crisis. Contraindications There are no absolute contraindications in hypoxaemia. Take particular care in: A risk of hypercapnic respiratory failure — COPD, severe obesity with…

…in fact worse than no treatment at all at one year . The injection is therefore a tool to make rehabilitation possible, not an alternative to…

…complex. Brugada's algorithm If there is no RS complex in any chest lead (V1–V6) a diagnosis of ventricular tachycardia can be made. Otherwise…

…less cardiac failure severe Apretude CABOTEGRAVIR CABOTEGRAVIR SODIUM NA CLINICAL PHARMACOLOGY no QT interval is not prolonged Fulvestrant FULVESTRANT Fulvestrant NA no no AQUASOL A…

Hydralazine Hydralazine is not preferred for hypertensive emergencies due to the high risk of reflex sympathetic stimulation. Drug Hydralazine Brand names Apresoline ®, Bidil ®…

…or no thickening (<10%) 3 Dyskinesia Paradoxical thinning and/or outward directed motion during systole 4 Aneurysmatic Diastolic deformation 5 Recommended by the American Society…

…55 mg/dL): No change to the therapy. • If LDL C ≥ 1.4 mmol/L (55 mg/dL): • Add ezetimibe (if not already added earlier)…

…congestive heart failure. Angina pectoris. Hypertension, hypertensive crisis/emergency. Pulmonary hypertension. Blood pressure control. Mechanism of action Nitroglycerin provides nitric oxide (NO) that induces vasodilatation…

…Fatal outcomes are rare. Renal failure increases risk of cyanide toxicity. Cyanide toxicity requires doses 2 μg/kg/minute. Use the lowest possible dose…

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

…and Pathophysiology Angina with non obstructive coronary arteries (ANOCA) describes anginal symptoms in patients whose epicardial coronary arteries are normal or show no obstructive disease…

…These disorders require distinction from true MINOCA because their management is different. Takotsubo syndrome and myocarditis should not be classified as MINOCA when they are…

…no longer viewed merely as an electrical anomaly but as a progressive, complex atrial myopathy. For the practicing cardiologist, mastering the nuances of anticoagulation requires…

…failure ( Packer et al ) and 30% of people with diabetes ( Cavallari et al ). Organizational challenges in cardiac arrest Optimal management of sudden cardiac arrest requires…

…There are, however, no differences regarding the ECG grid. As in adults, the x axis represents time (the paper speed is typically 25 mm/s…

…Biological death usually occurs within minutes thereafter; survival is highly unlikely after 8–10 minutes of no flow (i.e. cardiac arrest without any circulation)…

…A sinoatrial arrest occurs when the sinoatrial node does not discharge an impulse for ≥2 seconds. Failure to discharge an impulse within <2 seconds is…

…serious condition because escape rhythms may (1) not occur, (2) occur transiently, or (3) occur but generate insufficient cardiac output. If no escape rhythm occurs…

…7. Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8. Document the ceiling of care and…

…renal failure, sleep apnoea). Suspected hypotension: dizziness, syncope, autonomic dysfunction, adverse drug effects. Wide variability between measurements. Hypertension in pregnancy. Contraindications There are no absolute…

…brachial index (TBI). The digital arteries rarely calcify, which makes toe pressure the method of choice in diabetes and renal failure. A normal TBI is ≥

…beta blocker Digoxin In heart failure or hypotension, or as an add on Slow onset. Dose reduction in renal failure and in old age Amiodarone…

…aortic dissection, acute renal failure, pre eclampsia) — intravenous treatment with a controlled reduction, as a rule no more than 25% during the first hour. The…

…whom death must be confirmed after a 20 minute no touch period, for example after poisoning, since this is not compatible with a DCD process…

…Children, pregnant women and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and…

…investigation , and a normal CT of the brain does not exclude an infarction in the posterior fossa. Preparation and equipment No special equipment is needed…

…wave There is no R wave to synchronise to; sync mode would block the shock entirely The patient Awake or sedated — requires sedation Unconscious In…

…Contraindications There are no absolute contraindications in the emergency situation. Consider alternatives when: Intubation is not consistent with the treatment plan — check any decision to…

…is often warranted, particularly in an acute rise, renal failure, symptoms or continued potassium administration Severe At least 6.5 mmol/L, or hyperkalaemic ECG…

…Availability in Sweden. Several of the drugs in this overview are not routinely marketed in Sweden and may require a named patient licence, among them…

…or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other precipitating factor…

Referensvärden "Liver function tests" mainly measure damage , not function. The tests that reflect the synthetic function of the liver are the prothrombin time (INR) , the…

…and inspection of the nail bed, with suture of any nail bed laceration Contraindications There are no absolute contraindications, but be cautious and consider referral…

…Avoid in renal failure, heart failure, a history of peptic ulcer, and old age Titrate according to the effect and the respiratory rate, not to…

…often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the…

…haemopericardium — these require surgery; pericardiocentesis is at best a bridge to it. A small (under 10 mm), loculated or purely posterior effusion with no safe…

…Lowering the body temperature to 33 °C has not been shown to improve survival or the neurological outcome compared with keeping the patient normothermic — but…

…or established renal failure. Without urine production there is no urine to alkalinise, and the sodium and volume load becomes pure harm. Dialysis is then…

Calculators CHA2DS2 VASc Score Calculator Congestive Heart Failure Hypertension Age = 75 years Diabetes Mellitus Stroke/TIA/TE Vascular disease Age 65 74 years Sex…

…Classified as QT prolonging drug in DrugBank. No data on QT prolongation or risk of torsade de pointes in PubMed. GnRH Antagonist Cancer (prostate) Synthetic…

…yet no reliable model currently exists for the long term prediction of sudden cardiac arrest. The constraint does not lie in therapy: implantable cardioverter defibrillators…

…anticoagulation, and possible reperfusion. The principal pathophysiological determinant of early adverse outcome is acute RV failure. In acute PE, obstruction of pulmonary blood flow increases…

…the suspected mechanism. No antianginal class has demonstrated consistent superiority for symptom relief in direct comparative studies, and combinations are frequently required. The central therapeutic…

…Selective serotonin reuptake inhibitors Patient selection Aspirin should not be prescribed routinely to individuals without established ASCVD. Selection requires simultaneous consideration of: Estimated cardiovascular risk…

…used in younger adults, whereas a markedly frail 65 year old may require the more cautious approach generally applied to older patients. Frailty is characterized…

…is 34,000 as of March 29, 2020 (Figure 1). There are no known effective treatments, although several randomized controlled trials are underway. Figure 1…

…and the broader atherosclerotic burden. Clinical Presentation and Symptoms Asymptomatic disease Many patients with carotid stenosis have no focal neurological symptoms. Asymptomatic disease may be…