…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…

…Definite ACS In patients with ST segment elevation, immediate reperfusion assessment is required. Patients with NSTE ACS should be admitted for management of acute ischaemia…

…In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during management of an acute illness…

…acute myocardial infarction in order to assess the presence of myocardial ischemia, evaluate angina pectoris, evaluate exercise performance, evaluate the effect of interventions and medications…

…what was expected. The poison control centre is the authoritative local source for the current indication, dosing, sampling and duration of treatment. International guidelines must…

…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…

…not 48. The 2024 ESC guidelines and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors. Check…

…whether the patient has sepsis, septic shock, or a need for high dependency or intensive care 3 Take at least two sets of blood cultures…

…can keep a patient alive until a transvenous lead is in place — but only if it is working, and the commonest source of error is…

…Do not wait for the blood gas result before starting treatment. Clinical assessment History that affects the level of risk Ask briefly and to the…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…level of consciousness with inadequate protective reflexes active major haematemesis severe agitation respiratory failure an anticipated difficult or prolonged endoscopic intervention a need for general…

…a unit is selected electronically against the blood group Standard for planned transfusion in a patient without irregular red cell antibodies Serological crossmatch (MG test…

…over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal radiograph. Contraindications An…

…of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for…

…rheumatoid arthritis, ankylosing spondylitis MACOCHA is validated for the intensive care patient and totals 12 points: Mallampati III–IV (5 points), obstructive sleep apnoea syndrome…

…exercise induced arrhythmias Evaluating the blood pressure response Refining risk stratification and prognosis For patients with low or moderate pre test likelihood of obstructive CAD…

…MINOCA accounts for approximately 1–14% of ACS presentations in different series and approximately 5–10% of patients presenting with myocardial infarction in other reports…

…of hypercapnia and a normal blood gas Usually 94 to 98 percent An individually documented target prescription, for example in chronic hypercapnia Follow the patient…

…worse when the patient moves the head is therefore not evidence of BPPV. Step 2: decide whether HINTS may be used HINTS stands for Head

…fail more often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept…

…course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection…

…the patient blow out the clot. The pinch is applied to the lower third of the nose, the soft part , and held continuously for at…

…is needed for the test to be conclusive. For assessment of function and prognosis, arrhythmia evaluation, known coronary artery disease and evaluation of treatment effect…

…water between doses of charcoal makes the drink more tolerable. A kidney dish, a beaker or a straw, tissues, and an apron for the patient —…

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…

…syringe of the correct size, a sharps bin. For vaccination: adrenaline 1 mg/mL, an antihistamine, oxygen, and the ability to lay the patient down…

…instability — stabilise the patient first. CT before the puncture Swedish practice differs here from several international guidelines. The Swedish clinical care programme for bacterial CNS…

…Enteral nutrition and drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see…

…Venturi mask with a set of valves, and a high flow nasal cannula where available. Bag mask equipment for a patient who is not breathing…

…remains dislocated, the harder the reduction becomes and the greater the risk of chondral and neurovascular injury. Aim for reduction within a few hours. Contraindications…

…day of the test can therefore be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the…

…without the patient regaining consciousness between them. Five minutes is the practical threshold for treatment, known as t1. After about 30 minutes of continuous convulsive…

…the active prevention of fever — defined as a temperature above about 37.7–37.8 °C — for at least 72 hours in patients who remain…

…with a loading dose Used when a rapid effect is wanted and the patient is also receiving LMWH, for example in newly diagnosed venous thromboembolism…

…had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no practical risk prediction tool currently exists…

…outcomes in CCS. General strategy For most patients, initial therapy consists of a beta blocker and/or a calcium channel blocker (CCB). If symptoms remain…

…mm All patients Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of left ventricular…

…monotherapy for every patient with isolated hypertension. Single Pill Combinations Fixed dose, single pill combinations are preferred whenever combination treatment is used. The number of…

…profile, as the upper limit of the "healthy" range can still harbor significant metabolic risk. 3 For patients with a BMI below 35 kg/m²…

…likelihood of atherosclerotic obstructive CAD. CAC is therefore not merely an incidental imaging finding; it can refine the decision to test and may identify patients…

…been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection…

…a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical histories should undergo appropriate screening for secondary hypertension…

…not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an…

…myocardial rupture. Late presentation For patients presenting more than 12 hours after symptom onset, PPCI is recommended when there are: ongoing symptoms suggestive of 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…

…patient hypovolaemic, adequately filled or fluid overloaded? 3. Is there, or is there approaching, an indication for dialysis? AKI occurs in about one fifth of…

…patient, while ventilation, circulation and underlying disease are monitored [3]. The management of complicated withdrawal varies between regions and units. Follow the local protocol for…

…Preparation: The patient must have rested lying down for at least 10 minutes in a room at a comfortable temperature — a cold foot gives falsely…

…a gradient or PaO₂/FiO₂ Arterial blood gas COHb or MetHb Arterial or venous sample with co oximetry Follow up of pH in, for example…

…A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior iliac spine is the standard…

…risk of pneumothorax Uncomfortable for an awake patient, harder to keep the dressing clean with a tracheostomy or copious secretions Subclavian vein Most comfortable for…

…test before stopping During and after the taper the patient must be informed about the stress dosing rules and about the symptoms of adrenal insufficiency…

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

…that the donor's organs are maintained physiologically for as long as the assessment takes. The task of the health service is to give effect…

…for adults and summarises the order in which measures are taken and the principles that are common to all protocols. Children, pregnant women and patients…

…2 mg of edrophonium intravenously as a test dose . Observe pulse, blood pressure and muscle strength for a few minutes. 5. If the patient tolerates…

…for patients with risk factors; cardioversion between 24 and 48 hours without ongoing anticoagulation is then reserved for patients with a CHA₂DS₂ VA score of…

…the visual acuity before anything else is done. The second most important is to look for signs of perforation — Seidel's sign, an irregular pupil…

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