…atrial flutter. As compared with several other supraventricular tachyarrhythmias, atrial flutter does not occur among otherwise healthy individuals. Atrial flutter causes characteristic ECG changes, as…

…a person with ECG signs of SND is symptomatic, the condition is classified as sick sinus syndrome (SSS) . Causes of tachycardia (tachyarrhythmia) with narrow QRS…

…management is different. Takotsubo syndrome and myocarditis should not be classified as MINOCA when they are established as the explanation for the presentation. Clinical presentation…

…a person with ECG signs of SND is symptomatic, the condition is classified as sick sinus syndrome (SSS) . Causes of tachycardia (tachyarrhythmia) with narrow QRS…

…not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy…

…at the dilution step, not in the choice of dose. Paediatric doses are calculated on actual body weight unless otherwise stated. When the weight of…

…the samples are sent correctly. A corticosteroid must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in…

Procedurer A dislocation is reduced with muscle relaxation, not with force. The methods that work best exploit time, gravity and slow movement; those that fail…

…more complex. Older adults, often defined in cardiovascular practice as those older than 75 years, are not a homogeneous population: biological age, frailty, multimorbidity, sarcopenia…

…from children to the elderly, and frequently occurs in otherwise healthy individuals. The arrhythmia is characterized by its abrupt onset and termination and typically presents…

…the patient to stop, keep the arm still and lowered at each measurement, and not to talk. Otherwise ordinary activities, including work. No showering or…

…foreign body until proven otherwise. Contraindications Absolute: that you cannot see the object, or cannot reach it with the instruments available. Do not then try …

…if possible, otherwise give IM with a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative…

…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…

…do it. Otherwise the echocardiographic findings plus the clinical picture are sufficient for a treatment decision. Systemic thrombolysis is the first line treatment in high…

…simple — bicarbonate and a look at the urine dipstick — but it fails routinely for one single reason: without normal potassium the urine cannot be alkalinised…

…induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable. The benefit of…

…age, may not be fully captured by conventional risk scores and may be the first clinically important manifestation of an otherwise unrecognized inflammatory disease. Epidemiology…

…Extreme obesity ≥40 III Extremely high BMI is useful for screening and population level risk estimation, but it does not characterize body composition, fat distribution…

…geometry must be normal. There must not be regional differences in contractile function. Otherwise, the point of measurement may not be representative. Ventricular activation must…

…may be a pathological finding in some cases. Sinus arrhythmia is not a normal finding among older individuals. In that scenario it might be explained…

…guidelines assert that the ST segment must be either downsloping or horizontal. Otherwise, ischemia is unlikely to be the cause of the ST segment depression…

…triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner…

…single most important safety measure in the entire chain. In massive haemorrhage a second problem is added: transfusion saves no one whose bleeding is not…

…A single central feature is enough to proceed with urgent investigation , and a normal CT of the brain does not exclude an infarction in the…

…basal insulin in type 1 diabetes. The single most dangerous prescribing decision on a ward. Not prescribing glucose measurement. Prescribe the measurement times at the…

…Flush the cannula before and after every dose, otherwise the dose does not arrive until the next flush. Assess the pain both at rest and…

…5 mm over 6 months. Such growth may justify consideration of repair at a smaller diameter than would otherwise be used. Women have growth rates…

…atrial fibrillation. Consequently, alcohol should not be initiated as a cardiovascular preventive strategy. A drink equivalent contains approximately 12–14 g of ethanol. Representative quantities…

…descriptions report rates of approximately 5–10%, while fewer than 5% of otherwise normal angiograms demonstrate bridging. The wide range reflects differences in ascertainment and…

…versa ( Figure 17 ). Otherwise there is discordance (opposite directions of QRS and T) which might be due to pathology. A negative T wave is also…

…the deviation of the electrical axis. The QRS duration is slightly prolonged but does not reach 0.12 s. Block in the anterior fascicle causes…

…as it does not represent a true conduction block but rather a delay in the propagation of electrical impulses from the atria to the ventricles…

…reperfusion than angiography itself. Studies have shown that angiographic blood flow does not always correlate with myocardial perfusion on the microvascular level. This is presumably…

…helps explain the neurological manifestations of preeclampsia and the potential for stroke even at blood pressure levels that might otherwise be considered only moderately elevated…

…be considered in otherwise stable patients. More than 48 hours after onset: routine PCI of an occluded infarct related artery is not recommended in stable…

…greater resolution. PRF must be high in order to assess the velocity and direction of blood flow, otherwise, the calculations will be uncertain. This is…

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

Referensvärden A diagnosis of hypertension is not made on a single reading. It requires repeated measurements on at least two occasions, and preferably confirmation by…

Referensvärden The values below are starting points, not aims in themselves. Almost all of them have proved to work better as ranges to stay within…

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…

Procedurer The commonest error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

Akutsjukvård Lathundar Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG…

Procedurer Aspirate and biopsy answer different questions and do not replace one another: the aspirate shows cellular morphology and provides material for flow cytometry and…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

Procedurer Pericardiocentesis is performed on the basis of the haemodynamics, not the volume of fluid. A litre that has accumulated slowly can be asymptomatic, while…

ECG Principles of myocardial excitability Myocardium is excitable not only by action potentials originating in the sinus node, but also by external electrical stimuli that…

…tragus and the area behind the pinna before the otoscope is inserted — mastoid erythema and a protruding ear are not part of the tympanic membrane…

Info The ECG shows AV block III (complete heart block). P waves are not related to QRS. PP interval is constant, but independent of RR…

Continous medical discussion: the ECG blog ECG The best ECG book is not the one making it simple In the thrilling and ever evolving field…

Arrhythmias and arrhythmology ECG Aberrant ventricular conduction (aberrancy, aberration) Aberrant conduction is not a mechanism of arrhythmia; it is a ventricular conduction disturbance . It is…

…and clinical decisions should therefore be based on the whole course, not on a single eGFR. Step 1: confirm the course and assess severity Establish…

…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…

…distinction that determines management is: is there acute hypertension mediated organ damage or not? A single blood pressure value does not define a hypertensive emergency…

…age, height and ethnicity — not against absolute figures. Since 2022 the z score with a lower limit of normal at z = −1.64 (the…

…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…

…contamination, not poor suture technique — and the commonest cause of permanent loss of function is a tendon injury that was sutured over without being found…

…therapy is foundational unless contraindicated. Combination Therapy: Ezetimibe is the next step if LDL C targets are not met with statins alone. PCSK9 Inhibitors: Added…

…ultrasound imaging: The ultrasound image displays non existing structures. The ultrasound image does not display existing structures. The ultrasound image misrepresents the echogenicity of structures…