…whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose colchicine as an adjunct to, rather than a replacement for…

…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…

…or FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an inadequate…

…non specific for SCD. Most people who die suddenly never had an ejection fraction measured before death, and among those who did, only a minority…

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

…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…

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

…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…

…85%). Many patients appreciate the exercise test because it offers them an opportunity to evaluate their performance and symptoms under the supervision of their clinician…

…Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG all come…

…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…

…An anticoagulant is given as soon as possible, but must not delay cardioversion in an unstable patient. Rate control in the stable patient Drug Situation…

…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…

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

…is defined as a plasma sodium below 135 mmol/L. The biochemical grade alone does not indicate how acute the condition is. A patient with…

…peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood gases are needed 3 Blood grouping and cross matching. Order red…

…preferably two lines in a bleeding patient. A transfusion set with a filter. Blood components must not be given through a set without a filter…

…which casting harms the patient are that it is too tight — the swelling comes after the injury, not before — and that an edge or a…

…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…

…severe hypoxaemia below 80 % (1 point), and the intubator not being an anaesthetist (1 point). A score of 3 or more indicates a difficult intubation…

…be preferred when available. Exercise ECG is not recommended as a rule out test in this group if those modalities are accessible. It may nevertheless…

…is not established. Myocarditis and takotsubo syndrome can produce myocardial injury and troponin elevation but are non ischaemic mimics rather than MINOCA when identified as…

…the patient's prescription, if it is clinically reasonable Give oxygen if the patient is hypoxaemic. Oxygen is not a treatment for dyspnoea as such…

…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…

…arms, an arm circumference too large for the available cuffs, and in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set…

…times daily See note Do not use Do not use Nitrofurantoin: as a general rule the drug is contraindicated at an eGFR <45 mL/min…

…haemodynamic instability — stabilise the patient first. Marked septal deviation towards the bleeding side (relative). Preparation and equipment Personal protective equipment (gloves, a visor, an apron)…

…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…

…Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind…

…sample therefore does not need to be repeated. Age Screening interval Test : : : 23–49 years Every five years HPV, with reflex cytology if HPV positive…

Procedurer Injection technique is treated as self evident and is therefore often done wrongly. The two commonest errors are that an intramuscular injection in fact…

…does not work, but the opening pressure cannot be measured in the sitting position . 2. Identify the level. Palpate both iliac crests and draw an…

…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…

…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…

…so as not to reduce a fracture dislocation or to miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with…

…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…

…started as soon as possible after ROSC and continued for at least 72 hours for as long as the unconsciousness persists. An awake patient who…

…Sweden. Warfarin is started today because there is a reason to reject a DOAC , not as the standard option. Contraindications Ongoing clinically significant bleeding. Pregnancy…

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

…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 may also reduce treatment inertia, in which patients remain on an inadequate single drug regimen for prolonged periods. The evidence supports improved blood pressure…

…still harbor significant metabolic risk. 3 For patients with a BMI below 35 kg/m², direct assessments such as waist circumference, waist to hip ratio…

…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…

…associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic PAH…

…regarded as a discrete disease; rather, it is an indicator of increased cardiovascular risk and a setting in which secondary hypertension is relatively common. Patients…

…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…

…infarct related artery is preferred; CABG is considered when PCI is not feasible or is unsuccessful. If neither PCI nor CABG is suitable or accessible,

…symptoms, the ECG and haemodynamics. Do not wait for troponin. If clinical suspicion persists despite an initially non diagnostic ECG, the ECG must be repeated…

…wasted patients, an apparently normal creatinine may therefore correspond to markedly impaired renal function [3]. Urine output can change before creatinine but is not a…

…of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with previous…

…not only in claudication, but before every compression treatment of a leg ulcer and as a risk marker in diabetes and known atherosclerotic disease. An…

…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…

…What usually ruins the examination is not the technique but the handling of the specimen — an aspirate that clots before the smears are made is…

…course to the superior vena cava, compressible if bleeding occurs, low risk of pneumothorax Uncomfortable for an awake patient, harder to keep the dressing clean…

…or an infusion Suspected adrenal crisis Give the corticosteroid immediately. Do not wait for laboratory results. Take a serum cortisol and ACTH first only if…