…transported from the venous circulation to the arterial circulation, e.g via a persistent foramen ovale (PFO), which enables blood flow from the right to…

…as atrial septal defects (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA). Echocardiography provides a non invasive, accessible method to calculate this ratio…

…diagnostic angiography. Collateral vessels may maintain distal perfusion and permit visualization of the vessel beyond the occlusion when the patent donor artery is injected. The…

…the ST segment is normalized within one hour, and this confirms that the coronary artery flow is patent. The rapid ST segment return is explained…

…the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…

…syndromes (ACS) and is also a common tachyarrhythmia requiring treatment in decompensated heart failure (DHF). In the critically ill patient, AF may be pre existing…

…stabilized. This usually takes 2 to 3 days and the patient must not have experienced chest pain during the last 12 hours before exercise. Patients…

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…

…Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the…

…but must not delay cardioversion in an unstable patient. Rate control in the stable patient Drug Situation Comment : : : Beta blocker (metoprolol) First choice in most…

Hematologi & onkologi Infektionssjukdomar Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation…

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

Procedurer Transcutaneous pacing takes seconds to start and can keep a patient alive until a transvenous lead is in place — but only if it is…

…management The most dangerous asthma attack is the silent one. A patient who has become calm, quiet in the chest and stopped struggling may be…

…main clinical rule Two questions determine the initial management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2…

…hepatologi Akutsjukvård Lathundar Immediate orientation Two questions govern the initial management: 1. Is the patient haemodynamically compromised, or are there signs of ongoing major bleeding…

…each time Always, once per patient if no valid result exists Type and screen (BAS test) Blood group confirmation and antibody screening. If the screen…

…nothing else. The two ways in which casting harms the patient are that it is too tight — the swelling comes after the injury, not before…

…older adults: quick reference A quick reference for ward and on call physicians: recognise hypoactive delirium, stabilise the patient, work systematically through the possible causes…

…What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was preoxygenated…

ECG Exercise stress test Definition and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually…

…concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS)…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…and then selecting a targeted examination. The patient's description of the quality of the dizziness — rotatory vertigo, unsteadiness or faintness — discriminates poorly between dangerous…

…place, the electrodes come off, the patient has not kept a diary. The set up and the instructions decide whether the investigation will be usable…

…who are markedly larger or smaller than average. Higher doses may be required in the critically ill patient. Intravenous antibiotics Drug eGFR 90 60 89…

…compression. The reason compression nevertheless so often fails is that it is done wrongly: the patient pinches the nasal bone instead of the soft part…

…Staff with current CPR competence; a physician available. Patient preparation: A light meal is permitted; no large meal, no coffee and no nicotine in the…

…substance that binds to charcoal, when it can be given early and the patient has an intact or a protected airway. The benefit is greatest…

…Symptoms must be investigated wherever in the screening interval the patient happens to be — a recently taken normal smear is no reason to refrain from…

…done wrongly. The two commonest errors are that an intramuscular injection in fact ends up subcutaneously in a patient with a high BMI, and that…

…needle itself. It is the decision whether to perform it now or after imaging, how the patient is positioned, which needle is chosen, and that…

…What usually goes wrong is not that the patient gets too little oxygen but that the prescription has no target — the nasal cannula stays in…

…gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than…

…result can be interpreted. What decides that is whether the patient is taking a steroid that cross reacts in the cortisol assay, whether the samples…

…seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the patient regaining consciousness between them. Five minutes is the practical threshold…

…°C has not been shown to improve survival or the neurological outcome compared with keeping the patient normothermic — but fever after cardiac arrest is harmful…

…whether the treatment is safe is not the starting dose but the system around the patient : that the weekly dose is adjusted in small steps…

…in the ventromedial and rostral ventrolateral areas of the medulla result in the blood pressure lowering effect. Effects Potent blood pressure lowering effect. Pain relief…

…et al 1 ). Representative single beat morphs for a low risk patient (blue) and the corresponding high risk morph (red). Beyond the difference in R…

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

…The specific voltage thresholds vary based on patient age, sex, and lead location, as detailed below [8, 10]: Patient Demographic Lead Group ST Elevation Threshold…

…It is frequently clinically silent, which promotes both patient and clinician inertia and contributes to inadequate long term control. The treatment objective is individualized blood…

…HbA1c) reduction, blood pressure, lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting…

…test probability is the clinician’s estimate of the probability that the patient has anatomically obstructive CAD before the result of a new test is…

…mechanisms may coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical context and the results of all relevant investigations. Haemodynamic definition At…

…identifiable underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension, with particular vigilance when the clinical history includes hypokalaemia…

…necrosis and cardiac troponin elevation, although not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually…

…infarction (STEMI) is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia…

…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…

…questions must be answered immediately: 1. Is there obstruction to urine flow? 2. Is the patient hypovolaemic, adequately filled or fluid overloaded? 3. Is there…

…and delirium [1,2]. In delirium tremens the aim should be a calm, mildly somnolent but rousable patient, while ventilation, circulation and underlying disease are…

…or measure at the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10…

…raise pH respectively. A patient may therefore have both an acidosis and an alkalosis at the same time despite a normal pH. The lungs compensate…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…make sure that never happens, and to make sure the catheter does not become the patient's next focus of infection. Indications Infusion of vesicant…

…life produces more marked suppression. Stress dosing in known adrenal insufficiency A patient with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long…

…latter. The treatment is also time limited by its very nature: a patient who has not responded within a couple of hours should be intubated…

…Donation after circulatory death Starting point A ventilated patient who develops total brain infarction An intensive care patient in whom life sustaining treatment is withdrawn…

…and bicarbonate ≥ 15 mmol/L Hyperosmolality Not required Effective osmolality 300 mosm/kg or total osmolality 320 mosm/kg Typical patient Often type 1 diabetes…