…thrombolysis within 4.5 hours improves functional outcome in properly selected patients. Tenecteplase 0.25 mg/kg is a safe and effective alternative to alteplase…

…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…

…is to be expected, that the area will be red and weeping for a week or so, and that hypopigmentation may be permanent. Document the…

…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…

…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…

…neurovascular status must be documented before and after every attempt at reduction — otherwise it is impossible to determine afterwards whether a nerve injury was caused…

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

…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…

…Evaluation and risk assessment The evaluation of a patient with AF who may require anticoagulation should establish: Whether AF is clinical or device detected subclinical…

…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;…

…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…

…Presentation and Symptoms The clinical spectrum of ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present with cardiac arrest…

…occur in up to 70% of patients undergoing invasive coronary angiography, while approximately 25% of these patients have documented ischaemia. Among patients referred for invasive…

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

…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…

…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…

…effect appears within less than a minute and has gone after 5–10 minutes. That makes the test useful only if you have selected an…

…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…

…stenosis Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy…

…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…

…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…

…response to every intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory failure, impaired consciousness, or a need for a…

Procedurer Transcutaneous pacing takes seconds to start and can keep a patient alive until a transvenous lead is in place — but only if it is…

…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…

…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…

…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…

…latter. The treatment is also time limited by its very nature: a patient who has not responded within a couple of hours should be intubated…

…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…

…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…

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

…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…

…and document it. 10. Elevate the limb and inform the patient. Backslab or circumferential cast A dorsal backslab or another half slab for a fresh…

…2 at the same time By about 10 to 20 minutes at the latest Give a full loading dose of an intravenous antiseizure drug If…

…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…

…Never stop basal insulin in a person with type 1 diabetes , not even before fasting or an investigation. Stopping it leads to ketoacidosis within hours…

…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…

…urea and a blood gas with lactate 5 Give crystalloid in small boluses with frequent reassessment. Give blood according to the circulatory response and the…

…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…

…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…

…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]…

…A short course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary…

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

…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…

…thumb and index finger, or compress the muscle in a slim patient. 4. Insert the needle perpendicularly , quickly and firmly, to its full length. 5…

…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…

…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…

…the patient then rebreathes carbon dioxide from the mask Mask with a reservoir 10–15 L/min 60–90 % For acute severe hypoxaemia. Fill the…

…suppression and are often the very question at issue A patient who needs steroid cover simply to get through the day of the test can…

…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…