…MRI is immediately available and does not delay treatment Saturation Give oxygen in hypoxia, not routinely to a normoxic patient Temperature Treat fever and look…

…seizures coma The symptom threshold varies. After prolonged hyperglycaemia the patient may experience hypoglycaemia like symptoms at a normal glucose. With frequent hypoglycaemia the warning…

…with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes — the wound may not heal. Over superficial nerves…

…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…

…A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from 140 to 125 mmol/L…

…the patient's coldness can mimic post mortem conditions. Therefore, a meticulous assessment of vital signs is crucial. Exceptionally high survival rates have been documented…

…recommendations are not restricted to patients with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the documented ischaemic…

…stable patient. Transfusion given solely to reach a laboratory value without a clinical question. A patient who declines blood transfusion. The decision must be documented…

…drugs predisposing to bleeding and alcohol use. A high bleeding risk score should prompt correction of modifiable risk factors and closer surveillance; it does not…

…remains consequential, and historically 2–6% of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations…

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

…patient in whom a decision has been made to withdraw life sustaining treatment, in whom total brain infarction is not expected to occur within a…

…is titrated to spontaneous breathing, not to wakefulness. It has a short half life, and the patient must be monitored afterwards. Starting a modified release…

…prior anticoagulation. The 2024 ESC guidelines and several Swedish clinical knowledge support documents have tightened the threshold to 24 hours for patients with risk factors;…

…pathological mechanism is not restricted to a single lesion or process. Although Type 1 MI and acute coronary syndromes are commonly related to atherothrombotic events…

…or episodic and may not follow a classical pattern of stable exertional angina. Vasospastic angina should be suspected when patients have repetitive episodes of rest…

…do not already have a condition conferring sufficiently high cardiovascular risk. They should not be applied as the principal risk tool in people with: Documented…

…eyelid. Ask the patient to look down. Grasp the eyelashes, press gently downwards on the upper border of the tarsal plate with a cotton bud…

…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…

…appear temporarily to have resolved Inattention The patient loses the thread, is easily distracted or cannot follow a simple instruction Altered awareness The patient is…

…residual weakness in a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific:…

…The patient need not have fever, leucocytosis or a positive culture. Older people, the immunosuppressed and patients with renal or hepatic failure can have subtle…

…in the patient on anticoagulants; see the acute stroke quick reference. Stopping the drug and forgetting to restart it after the procedure. Document the restart…

…lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood…

…patients referred to PCI with a suspicion of STE ACS/STEMI, actually have takotsubo. Previous studies reported that 98 out of 100 cases had full…

…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…

…A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full sentences Marked work of breathing…

…1. Connect the patient to the 12 lead ECG as usual and record a resting ECG of the arrhythmia before the electrode is inserted. 2…

…also time limited by its very nature: a patient who has not responded within a couple of hours should be intubated, not given another hour…

…the patient has not kept a diary. The set up and the instructions decide whether the investigation will be usable. Ambulatory blood pressure monitoring (ABPM…

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

…0 × 10⁹/L with an expected fall to below 0.5 × 10⁹/L within 48 hours Profound neutropenia A neutrophil count below 0.1 × 10⁹…

…available material does not establish a significant increase in late morbidity or mortality attributable to these events. Clinical presentation and symptoms Most patients with stent…

…on a ward. Not prescribing glucose measurement. Prescribe the measurement times at the same time as the insulin. Giving mealtime insulin to a patient who…

…and document the time of seizure onset, or the time the patient was last known to be well. Protect the patient from injury. Do not…

…the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and/or fall of cTn values. However…

…adequate. For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia…

…9 As above. Very high Oral anticoagulation (warfarin or NOAC) is recommended for all female patients with a score of 3 or more. Very high…

…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…

…usually takes 2 to 3 days and the patient must not have experienced chest pain during the last 12 hours before exercise. Patients with unstable…

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…

…have tightened the former 48 hour rule for patients with risk factors. Check what applies in your own region. The time limit is not a…

…a few centimetres away from them Full bladder Have the patient void, or catheterise, before puncture Pregnancy, previous extensive abdominal surgery Ultrasound guidance; choose a…

…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…

…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…

…check any decision to limit treatment when time allows. There is complete upper airway obstruction where laryngoscopy will not succeed; plan for a surgical airway…

…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…

…A substantial proportion present with NSTEMI, although STEMI occurs in approximately one third. Patients with MINOCA related STEMI generally do not have a prodrome before…

…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 mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be…

…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…

…binds to charcoal, when it can be given early and the patient has an intact or a protected airway. The benefit is greatest within the…

…let the patient empty her bladder — a full bladder makes bimanual palpation difficult and causes prolapse to be underestimated. Offer a chaperone according to local…

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

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

…paper with a scale that discriminates within the acidic range — ordinary litmus paper that only shows acid or alkaline is not sufficient. A fixation dressing…

…Oxygen does not relieve breathlessness in a patient who is not hypoxaemic. Breathlessness without hypoxaemia is not an indication for oxygen — look for the cause…

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

…cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated. A decision to withhold further life…