…death, and among those who did, only a minority had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF…

…instilled 15–30 minutes before the procedure, or over a few days at home for a hard plug. Have the patient lie with the ear…

…urgent coronary angiography with the intent of performing PCI. The COACT, PEARL and TOMAHAWK trials studied patients with ROSC who did not display ST segment…

…Clinical assessment History that affects the level of risk Ask briefly and to the point: When did the deterioration begin, suddenly or over several days…

…and because of cost. Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial…

…factors such as smoking, family history of premature coronary disease, hypertension and hypercholesterolaemia did not fully explain the excess coronary risk. Rheumatoid arthritis RA is…

…in the fifth decade of life in several family members. Imaging studies did not reveal structural cardiac abnormalities, nor coronary artery disease. Another male patient…

…are the cornerstones of management of patients with chest pain. A 12 lead ECG recording must be registered and interpreted within 10 minutes of arrival…

…did not eliminate it. Angiographic restenosis—defined in the source material as follow up diameter stenosis greater than 50%—occurred in 20–30% of patients…

…absolute risk Readers not familiar with the terms absolute and relative risk may be confused by the previous paragraph. The absolute risk of an event…

…of stroke. In patients with acute decompensated heart failure, AF with rapid ventricular response is particularly important. Cardioversion is generally not immediately indicated if the…

…evaluate the effect of interventions and medications, and prognosticate survival. However, exercise stress testing must not be performed within 4 to 6 days after acute…

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…

…in selected cases the patient can be observed without anticoagulation Red flags and pitfalls A normal saturation and a normal ECG do not exclude pulmonary…

…a DOAC is given at an eGFR 30 mL/min. At an eGFR of 15–30 mL/min the documentation is inadequate and closer monitoring…

…with the patient's own clinic delay empirical antibiotics [1]. A practical target: give the first dose of broad spectrum antibiotics within 60 minutes of…

…in the left flank. Have the patient empty the bladder first. Procedure Choice of insertion site The left lower quadrant is the first choice : the…

…is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly unstable…

…The biochemical grade alone does not indicate how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be…

…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…

…in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage meeting the criteria for activation of the massive transfusion protocol…

…injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against the skin, protects against the edges of the…

…A diagnosis of delirium is therefore the beginning of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation…

…anticipated in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the right course, not RSI. Assess the airway first LEMON for…

…most consistent contemporary role is therefore the assessment of functional capacity, symptoms, haemodynamic responses, arrhythmias and prognosis, with diagnostic interpretation reserved for appropriately selected patients…

…tomography (OCT) can reveal lesions that are not apparent on conventional angiography. Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation…

…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…

…but is not their actual trigger. The fact that continuous dizziness becomes worse when the patient moves the head is therefore not evidence of BPPV…

…every 15 and every 30 minutes respectively. Instruct the patient to stop, keep the arm still and lowered at each measurement, and not to talk…

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

…not backwards. Procedure Step 1 — compression Have the patient blow out the clot. The pinch is applied to the lower third of the nose, the…

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…

…of a highly toxic substance, where the patient arrives within about 1 hour (a liquid preparation) or 2 hours (tablets). With very large quantities of…

…examinations of the breasts, the genitalia and the rectum. Ask about pregnancy, menstrual status, previous smear results and any previous conisation. Procedure Inspection The patient…

…and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side…

…suspected bacterial meningitis — not even with a reduced level of consciousness, focal neurological signs or seizures — because the delay costs more than the scan contributes…

…is not sufficient. A fixation dressing for the nose, a vomit bowl, tissues, and a glass of water with a straw if the patient is…

…given irrespective of the saturation (see below). Oxygen does not relieve breathlessness in a patient who is not hypoxaemic. Breathlessness without hypoxaemia is not an…

…head and of vascular injury; always an orthopaedic surgeon, and usually general anaesthesia. An open dislocation. Inadequate analgesia or sedation — the procedure must not then…

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

…with EEG After clinical cessation of the seizure Assess the recovery of consciousness. Urgent EEG if the patient does not wake or if ongoing electrographic…

…shock. Already marked hypothermia from another cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated…

…of several days and more than a hundred clinically relevant interactions. What determines whether the treatment is safe is not the starting dose but the…

…in patients within one year of MI and in those with LVEF ≤50% in the cited North American guideline discussion. By contrast, the benefit of…

…is the presence of prominent reciprocal ST depression [4]. Furthermore, ischemic ST elevations follow a predictable evolutionary pattern, typically followed within hours to days by…

…be initiated concurrently. In patients with a confirmed indication for treatment but blood pressure in the range of 120–139/70–89 mmHg, concomitant indications…

…location of excess adiposity. 2 Clinical guidelines now emphasize that a BMI within the conventional "normal" range (up to 25 kg/m²) does not necessarily…

…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…

…precapillary PH, partly because this value has been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk…

…Cure is not universal, however. Delayed recognition may permit vascular remodelling and renal impairment to develop, leaving persistent hypertension despite correction of the initiating disorder…

…any time, although clustering in the morning within several hours of awakening has been described. Atypical and painless presentations Pain is not universal. Painless STEMI…

…support capable of acquiring and transmitting a 12 lead ECG and obtaining medical authorization. Fibrinolysis reduces mortality in patients with STEMI, with the greatest benefit…

…2. Obtain a 12 lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4…

…criterion gives the higher stage. A patient can thus be stage 3 by urine output despite a less marked rise in creatinine. Limitations of creatinine…

…in patients with previous complicated withdrawal [4]. Untreated delirium tremens has historically carried a high mortality. With modern sedation, supportive treatment and treatment of the…

…prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel, a blood pressure cuff of the…

…can often be used for an initial assessment of pH and the metabolic component, but it should not be regarded as fully interchangeable with an…

…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…

…the technique is designed to make sure that never happens, and to make sure the catheter does not become the patient's next focus of…

…infection or gastroenteritis at home Double or triple the oral daily dose during the days of illness (the patient's sick day rules) Vomiting or…