…myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial infarction. Participants received colchicine 0.5 mg once daily or placebo…

…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…

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

…level of risk Ask briefly and to the point: When did the deterioration begin, suddenly or over several days? Which drugs, and how many doses…

…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…

…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…

…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…

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

…Patients with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial…

…patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG all come before complete identification of…

…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…

…ventricular rate < 110/min is a sufficient initial target in most patients. Doses according to the local protocol and the Swedish medicines compendium (FASS…

…neutropenic fever is limited, but delayed antibiotics are associated with a worse outcome in sepsis and in several studies of neutropenic patients. In septic shock…

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…

…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…

…by the fact that the sickest patients are more often intubated [4]. Intubation is reasonable in: a reduced level of consciousness with inadequate protective reflexes…

…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…

…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…

…moderate pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be preferred when available. Exercise ECG is not recommended as a rule…

…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…

…hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8. Document the ceiling of care and the decision on intubation early. Initial assessment Confirm…

…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…

…not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the…

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

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…

…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 …

…be underestimated. Offer a chaperone according to local procedure; this is recommended for all examinations of the breasts, the genitalia and the rectum. Ask about…

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

…the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before the puncture Swedish…

…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…

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

…rotation, and the patient resists internal rotation. Check the axillary nerve: sensation over the lateral part of the deltoid before and after the reduction , together…

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

…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…

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

…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…

…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…

…also permit lower doses of each component, potentially limiting adverse effects and facilitating adherence. Treatment response, however, is heterogeneous, and some patients may benefit from…

…lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting with glucagon like peptide…

…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…

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

…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;…

…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…

…electrolytes, acid base status and the underlying cause. KDIGO recommends prompt investigation of reversible causes, continuing staging, and treatment directed at both the cause and…

…calm, mildly somnolent but rousable patient, while ventilation, circulation and underlying disease are monitored [3]. The management of complicated withdrawal varies between regions and units…

…needed more often than it is used — not only in claudication, but before every compression treatment of a leg ulcer and as a risk marker…

…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…

…never happens, and to make sure the catheter does not become the patient's next focus of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated…

…proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period…