…tolerated guideline directed therapy, or when recurrent cardiovascular events occur despite such treatment. The trials did not establish a mortality benefit. Consequently, the decision to…

…backwards along the superior wall of the ear canal , past the plug — not straight at it. The water should get behind the wax and push…

…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…

…or unmeasurable Saturation on air Usually at least 92 percent May be below 92 percent Hypoxaemia despite oxygen Auscultation Wheeze with preserved air entry Marked…

…arrest. The constraint does not lie in therapy: implantable cardioverter defibrillators (ICDs) are highly effective, terminating well over 99% of the ventricular arrhythmias they detect…

…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…

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

…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…

…should not automatically be labelled type 2 myocardial infarction without further assessment. Clinical presentation and symptoms The clinical presentation is heterogeneous. AF may be well…

…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…

…associated thrombosis. Warfarin in antiphospholipid syndrome and in marked renal failure. Duration of treatment: at least 3 months. Extended treatment in unprovoked pulmonary embolism, a…

…blood count and creatinine when treatment is started, at follow up after one month, and at least annually thereafter, more often in impaired renal function…

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

…Scars, hernia or visible abdominal wall collaterals (caput medusae) Puncture at least a few centimetres away from them Full bladder Have the patient void, or…

…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…

…Definition : : Acute Documented development within less than 48 hours Chronic At least 48 hours Unknown Treated as chronic with respect to the correction limits The…

…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…

…the result. Equipment A large bore peripheral cannula — at least 1.3 mm (green) for rapid transfusion, preferably two lines in a bleeding patient. A…

…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…

…physicians: recognise hypoactive delirium, stabilise the patient, work systematically through the possible causes, apply several non pharmacological measures at the same time, and use drugs…

…depth Patient Internal diameter (mm) Depth at the teeth (cm) : : : Adult woman 7.0–7.5 21 Adult man 7.5–8.0 23 Child…

…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…

…present with NSTEMI, although STEMI occurs in approximately one third. Patients with MINOCA related STEMI generally do not have a prodrome before infarction. The clinical…

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

…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…

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

…may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min…

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

…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…

…menstrual status, previous smear results and any previous conisation. Procedure Inspection The patient lies in the lithotomy position, well covered. Say what you are do

…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…

…Procedure 1. Inspect both nasal passages and choose the more patent one. Ask the patient about a previous nasal fracture or unilateral nasal obstruction. 2…

…as one: with an indication, a route of administration and a target range for the saturation . What usually goes wrong is not that the patient…

…moved very slowly outwards in the horizontal plane , with pauses each time the patient tenses, until the joint slides back — usually at 70–110 deg

…a supraphysiological dose is tapered beforehand Prednisolone Stop at least 24 hours before Dexamethasone, betamethasone They do not cross react in the cortisol assay and…

…with: an ongoing generalised tonic clonic seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the patient regaining consciousness between them…

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

…0–3.0 Overlap with low molecular weight heparin (LMWH) for at least 5 days Mechanical aortic valve 2.5–3.5 Some centres use…

…after acute coronary syndromes in patients with reduced left ventricular ejection fraction (LVEF). They are also recommended in patients within one year of MI and…

…point. The diagnostic criteria require new ST elevation in at least two contiguous leads [8, 10]. The specific voltage thresholds vary based on patient age…

…and patient preferences. The source material describes hypertension using differing thresholds across international guidance. One framework defines confirmed hypertension as blood pressure consistently above 130…

…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 an automatic response to chest pain. It is appropriate when the expected information is likely to change management. In patients with a…

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

…The guideline framework does not use the terms “controlled resistant hypertension” for blood pressure at target on four or more drugs or “refractory hypertension” for…

…occurs at rest and lasts longer. The usual location is the central chest or epigastrium. Radiation may occur to one or both arms and less…

…whereas streptokinase is not fibrin specific and produces more extensive fibrinogen depletion. Successful fibrinolysis is generally accompanied by relief of ischaemic symptoms, at least 50%…

…asymptomatic patient is by contrast not recommended [1,5]. STEMI criteria and occlusion patterns on the ECG Classic ST elevation criteria New ST elevation at…

…injury is present when at least one of the following criteria is met [1]: A rise in creatinine of at least 26.5 µmol/L…

…Monitoring at the appropriate level of care , with readiness for respiratory support. 5. Treatment of the alcohol use disorder and planned follow up , not merely…

…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…

…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…

…syringes for the tube specimens. Glass slides, at least 6–10, plus spreader slides — laid out and labelled before the puncture begins . Specimen tubes: EDTA…

…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…

…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…