…Other anti inflammatory strategies have produced less favourable results. Canakinumab, a monoclonal antibody directed against interleukin 1β, provided proof of concept but was not…

…membrane — not routinely . The wax has a protective function, and the commonest complication of ear syringing is that someone syringes an ear that did not…

…TOMAHAWK trials studied patients with ROSC who did not display ST segment elevations and randomized them to urgent angiography. These trials did not show any…

…the severity by the most serious finding. A patient does not have to meet every criterion in a column. Clinical deterioration or a poor response…

…term prediction of sudden cardiac arrest. The constraint does not lie in therapy: implantable cardioverter defibrillators (ICDs) are highly effective, terminating well over 99% of…

…family history of premature coronary disease, hypertension and hypercholesterolaemia did not fully explain the excess coronary risk. Rheumatoid arthritis RA is associated with increased carotid…

…life in several family members. Imaging studies did not reveal structural cardiac abnormalities, nor coronary artery disease. Another male patient, with similar ST segment changes…

…When did the patient first note the symptoms and how have the symptoms developed over time? In stable ischemic heart disease, symptoms are typically not…

…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…

…than normal in these patients. However, it is still unknown whether that is actually the case; i.e repolarization may actually not start earlier than…

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

…before exercise. Patients with unstable angina pectoris with high risk should not undergo exercise stress tests; these patients should be referred to angiography instead. Exercise…

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…

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

…tightened the former 48 hour rule for patients with risk factors. Check what applies in your own region. The time limit is not a guarantee…

…neutropenic patient who is clinically unwell must be managed as an emergency even at a lower temperature. Suspect neutropenia in anyone who has received cytotoxic…

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…

…adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly unstable. Transcutaneous pacing Equipment A defibrillator with a…

…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…

…must therefore not be based on the haemoglobin alone [3]. The airway Do not intubate every patient routinely before endoscopy. Observational data do not show…

…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…

…Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against…

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

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

…patients with low or moderate pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be preferred when available. Exercise ECG is not…

…STEMI occurs in approximately one third. Patients with MINOCA related STEMI generally do not have a prodrome before infarction. The clinical presentation may also reflect…

…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…

…findings are absent in roughly half of patients with a central cause. A normal routine neurological examination is therefore not sufficient to exclude stroke [3…

…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…

…2026 and are given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or…

…Raise the chair so that the patient's nose is at your eye level. The patient sits upright and tilts the head forwards , not backwards…

…lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient…

…since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison control centre before you decide, not afterwards. Indications Medicinal…

…are no absolute contraindications, but refrain or adapt in: The patient does not consent — the examination must then not be carried out. Vaginismus or marked…

…muscle in a slim patient. 4. Insert the needle perpendicularly , quickly and firmly, to its full length. 5. Aspiration is not needed for vaccination in…

…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…

…stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery, according to local practice. Enteral nutrition and drug administration when the patient cannot swallow…

…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…

…not with force. The methods that work best exploit time, gravity and slow movement; those that fail usually do so because the patient tenses up…

…be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1…

…consciousness. Urgent EEG if the patient does not wake or if ongoing electrographic seizure activity is suspected Benzodiazepines are the established first line treatment. Intravenous…

…the patient normothermic — but fever after cardiac arrest is harmful, it often arises spontaneously, and it must be actively prevented. The treatment has therefore not…

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

…antianginal drugs have not been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients, initial therapy consists of a beta…

…V2 to V3 Greater than or equal to 1.5 mm All patients Other leads Greater than or equal to 1 mm These criteria for…

…or very old or frail patients who may not tolerate rapid blood pressure reduction. Initial Combination Therapy General Strategy For most adults with confirmed hypertension…

…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…

…is therefore not merely an incidental imaging finding; it can refine the decision to test and may identify patients who require preventive therapy even when…

…is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left atrial size must also be considered. Patients…

…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…

…Most patients with this working diagnosis subsequently develop myocardial necrosis and cardiac troponin elevation, although not every patient with an initial STEMI pattern has myocardial…

…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…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…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…

…can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked tolerance. The most important measures in severe or complicated withdrawal…

…of objectively demonstrating peripheral arterial disease, and it is needed more often than it is used — not only in claudication, but before every compression treatment…

…there a further metabolic disturbance? Calculate the delta gap or delta ratio 6 Does the result fit the patient? If not, check the sample type…

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…

…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…

…Two situations are often confused: replacement therapy in adrenal insufficiency (which must be increased under stress) and pharmacological anti inflammatory treatment (which must be tapered…