…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…

…and the commonest complication of ear syringing is that someone syringes an ear that did not need syringing. The second commonest is that the syringing…

…negative T waves) do not affect the management of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile…

…systemic steroid given early [2,3]. Grading Grade the severity by the most serious finding. A patient does not have to meet every criterion in…

…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…

…1000 patient years, compared with 15.0 per 1000 patient years in age matched controls without autoimmune disease. The greatest risks were reported with systemic…

…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…

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

…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…

…Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the special challenges…

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…

…to the local protocol. An anticoagulant is given as soon as possible, but must not delay cardioversion in an unstable patient. Rate control in the…

…targeted cancer treatments. Fever is not obligatory Hypothermia, new confusion, tachypnoea, hypotension, rigors, abdominal pain or a rapid deterioration in general condition may be the…

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…

…In massive bleeding, the decision to transfuse must therefore not be based on the haemoglobin alone [3]. The airway Do not intubate every patient routinely…

…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…

…cast in a fresh injury, before surgery, or while swelling is progressing. Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not…

…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…

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

…not confined to the ECG. Ischaemia may also produce angina, impaired exercise capacity, an abnormal blood pressure response or ventricular arrhythmias. A fall in systolic…

…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…

…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…

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

…a dialysis fistula in both arms, an arm circumference too large for the available cuffs, and in a patient who does not tolerate repeated compression…

…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…

…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…

…patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind every poison. With the…

…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…

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

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

…drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see the separate text…

…patient who is not breathing adequately. Choosing a system System Flow Approximate FiO2 Comment : : : : Nasal cannula 1–6 L/min 24–44 % Comfortable; 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…

…the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1. Schedule the test in the…

…Do not restrain the limbs and do not put anything in the mouth. Suction the mouth as needed and place the patient in the recovery…

…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…

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

…uncomplicated acute coronary syndrome when LVEF is 40% is not definitive. Observational studies have yielded conflicting results, and the appropriate duration of therapy in p

…Myocardial Infarction The ST segment elevation in acute pericarditis is typically diffuse, involving all leads except aVR and often V1, and does not correspond to…

…dose combination therapy generally produces faster and more consistent blood pressure reduction than monotherapy. It may also reduce treatment inertia, in which patients remain on…

…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…

…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…

…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…

…of secondary hypertension cases. Coarctation of the aorta and renovascular disease are important non endocrine causes, particularly in patients with resistant hypertension. Dietary sodium and…

…the symptoms generally do not resolve simply with cessation of activity, unlike typical exertional angina. A precipitating factor is identifiable in up to one half…

…as soon as possible, with a target of less than 10 minutes from STEMI diagnosis to the fibrinolytic bolus. In suitable systems, pre hospital fibrinolysis…

…infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI criteria and occlusion patterns on the ECG Classic…

…between patient groups and care settings [2]. Practical first actions Do the following in parallel, not sequentially: 1. Check previous creatinine values and establish the…

…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…

…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…

…The differences increase in severe circulatory failure and marked respiratory failure [3,4]. Question Appropriate sample : : Metabolic acidosis or alkalosis in a haemodynamically stable patient…

…is not a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in the skin overlying the puncture…

…artery — everything in the technique is designed to make sure that never happens, and to make sure the catheter does not become the patient's…

…Inhaled and topical steroids in high doses can also cause systemic suppression. Corticosteroids mask fever and peritonitis. The abdomen of a patient on corticosteroids can…