…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…

…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…

…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…

…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…

…the next of kin no longer have a right of veto based on their own view . Their role is to convey what the deceased person…

…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…

…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…

…provoked by less exertion. Angina occurring after a recent myocardial infarction. UA belongs to the broader spectrum of acute coronary syndromes, which may present with…

…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…

…Assessment of whether residual weakness in a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and…

…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…

…treatment effect, the medication is continued — abrupt withdrawal carries a risk of rebound. The referring physician should have made this decision; document which applies. Nitroglycerin…

…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…

…12 to 48 hours: primary PCI should be considered even if symptoms have subsided, particularly with continuing ischaemia, heart failure, electrical instability or a large…

…not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has…

…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…

…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…

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…

…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…

…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…

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

…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…

…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…

…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…

…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…

…ABCDE assessment and document the time of seizure onset, or the time the patient was last known to be well. Protect the patient from injury…

…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 review the dose as the corticosteroid is tapered. The dose must come down in parallel, otherwise hypoglycaemia will follow. Discharge without a plan. Document…

…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…

…to the rectus sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a patient…

…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…

…individuals with a low pre test likelihood in whom a negative test may reduce the estimated likelihood sufficiently to defer further investigation. In patients with…

…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…

…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…

…moment. A trauma informed approach also improves the technical quality — a relaxed patient is easier to examine. Indications Symptoms: bleeding outside menstruation, postmenopausal bleeding, discharge…

…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…

…irrespective of the saturation (see below). Oxygen does not relieve breathlessness in a patient who is not hypoxaemic. Breathlessness without hypoxaemia is not an indication…

…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…