…The trials did not establish a mortality benefit. Consequently, the decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and…

…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…

…someone syringes an ear that did not need syringing. The second commonest is that the syringing is performed on a tympanic membrane that was already…

…do not affect the management of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead to…

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

…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…

…Some patient groups have a two to three fold greater prevalence of asymptomatic atherosclerotic cardiovascular disease (ASCVD) than the general population. The evidence for premature…

…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…

…delaying time to treatment. History taking, physical examination, ECG and laboratory tests are the cornerstones of management of patients with chest pain. A 12 lead…

…issued a consensus statement (refer to MacFarlane et al) and in 2016 Patton et al did likewise (refer to Patton et al). Surprisingly, the definition…

…to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS have more comorbidities and a…

…4 to 6 days after acute myocardial infarction. Moreover, early exercise tests should not be maximal, which means that the clinician must set a lower…

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…

…A D dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10…

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

…neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met. 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…

…ECG cable connected to the patient — the device senses the rhythm through the cable, not through the pads. A pulse oximeter, a blood pressure cuff…

…Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2. Is the hyponatraemia acute or chronic? Severe symptoms require immediate…

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

…rarely the right measure. Contraindications Anaemia that can be corrected with iron, B12 or folate in a stable patient. Transfusion given solely to reach a…

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

…central. A simple check is to ask the patient to recite the months of the year backwards. A normal result does not exclude delirium, however…

…patients during airway management , and both are predictable. Indications Inability to protect the airway: reduced level of consciousness, loss of pharyngeal reflexes, vomiting with a…

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

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

…subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are…

…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]…

…in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set up and instructions Choose the cuff according to arm circumference ; a…

…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…

…check the pharynx — blood running down into the pharynx means that the bleeding is not controlled. Petroleum jelly gauze often gives better pressure but requires…

…oxygen, suction and emergency drugs in the room. Staff with current CPR competence; a physician available. Patient preparation: A light meal is permitted; no large…

…you decide, not afterwards. Indications Medicinal charcoal is given after the ingestion of a potentially toxic dose of a substance that binds to charcoal, when…

…triage requires a cervical sample. Screening is for the asymptomatic. Symptoms must be investigated wherever in the screening interval the patient happens to be — a…

…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…

…is the time to antibiotics that saves the patient — the puncture must never delay it. Indications Suspected meningitis or encephalitis. Suspected subarachnoid haemorrhage with a…

…major abdominal surgery, according to local practice. Enteral nutrition and drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of…

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

…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…

…with the patient fasting or having had a light breakfast according to local practice. Let the patient rest lying down or sitting for at least…

…or the time the patient was last known to be well. Protect the patient from injury. Do not restrain the limbs and do not put…

…Indications A patient who remains unconscious (with no meaningful response to speech) after the return of spontaneous circulation , whether the arrest occurred in or out…

…a DOAC is the first choice in Sweden. Warfarin is started today because there is a reason to reject a DOAC , not as the standard…

…tailored to the suspected mechanism. No antianginal class has demonstrated consistent superiority for symptom relief in direct comparative studies, and combinations are frequently required. The…

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

…heterogeneous, and some patients may benefit from a more individualized selection strategy. When to Initiate Pharmacological Treatment Lifestyle intervention is an essential component of care…

…a BMI within the conventional "normal" range (up to 25 kg/m²) does not necessarily equate to optimal cardiovascular health. 2 Evidence suggests that a…

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

…used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction…

…Patients presumed to have resistant hypertension should undergo a structured assessment and be referred to a specialized centre because the work up may require expertise…

…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…

…by patient recognition and help seeking, pre hospital assessment and transport, diagnostic and treatment delays, and the time required for the selected treatment to restore…

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

…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…

…and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake Common clinical picture : : 4 to 12 hours Tremor, sweating…

…needed a photoplethysmograph and a toe cuff. Preparation: The patient must have rested lying down for at least 10 minutes in a room at a…

…Abnormal Abnormal A compensated simple disorder, or two opposing primary disorders It is therefore not enough to ask which of the pCO₂ and the HCO₃…

…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…

…The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter…

…slowly Months to years Marked A slow taper, often over months. Consider an ACTH test before stopping During and after the taper the patient must…