…documents have tightened the threshold to 24 hours for patients with risk factors; cardioversion between 24 and 48 hours without ongoing anticoagulation is then reserved…

…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…

…main clinical rule Two questions determine the initial management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2…

…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…

…prior stroke, bleeding tendency or previous bleeding, labile international normalized ratio (INR), older age, drugs predisposing to bleeding and alcohol use. A high bleeding risk…

…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…

…Consent and the law Swedish law is based on presumed consent : a person who has not expressed opposition is presumed to have consented to donation…

…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…

…therefore be checked with a capillary or venous measurement [5]. Treatment The awake patient who can swallow safely Give 15 to 20 g of rapid…

…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…

…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…

…major bleeding is not suspected. 6. Call the PCI service immediately in STEMI, a STEMI equivalent or very high risk NSTEMI. 7. Document symptom onset…

…by the finding that 75% of patients have increased plasma levels of catecholamines. References A recent consensus document has been issued by the European Society…

…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…

…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…

…hypercapnia and a normal blood gas Usually 94 to 98 percent An individually documented target prescription, for example in chronic hypercapnia Follow the patient's…

…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…

…of consciousness not attributable to hypercapnia, marked swallowing difficulty, vomiting. Haemodynamic instability or a life threatening arrhythmia. Undrained pneumothorax. Facial trauma, facial burns or recent…

…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…

…saw, protective sheeting Hot water gives faster setting and more heat production — a risk of burns Document the distal neurovascular status before casting : sensation, motor…

…the suspected focus, but avoid sampling that delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth, throat…

…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…

…World Heart Federation (WHF) collaborated to redefine MI using a biochemical and clinical approach. This culminated in the Universal Definition of Myocardial Infarction Consensus Documents…

…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…

…Mellitus (1 point) S: Prior Stroke or TIA or thromboembolism (2 points) V: Vascular disease (1 point) A: Age 65 to 74 years (1 point…

…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…

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…

…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…

…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…

…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…

…measure in decontamination, and gastric lavage is today a rare procedure reserved for very serious poisonings in which the patient reaches hospital early. The benefit…

…used as a triage test on the same liquid based sample when the HPV test is positive — the sample therefore does not need to be…

…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…

…indication on a surgical ward. Decompression in severe vomiting where the stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery, according to local…

…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…