…stroke, meningitis and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or does not fit the clinical picture. 4…

…does not predict bleeding risk in paracentesis. Follow the local protocol Ileus with distended bowel loops Ultrasound guidance mandatory; choose another site Scars, hernia or…

…not to increase the dose. Contraindications Ongoing respiratory depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus…

…and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure <…

…A patient does not have to meet every criterion in a column. Clinical deterioration or a poor response to treatment carries more weight than a…

…of sinoatrial arrest/pause Sinus arrest/pause due to increased vagal tone does not necessitate treatment but it might be wise to observe the patient…

…cause life threatening compromise of the airway, breathing or circulation. Skin symptoms may be absent, and circulatory shock does not have to be present for…

…gap or delta ratio 6 Does the result fit the patient? If not, check the sample type, supplemental oxygen, sampling technique, air bubbles and analytical…

…plaque and can assess stenosis. A major limitation is that CAC does not measure total plaque burden or stenosis severity directly. A patient may have…

…Prognostic and risk stratification information Assessment of response to selected medical, revascularization, rehabilitation, ablative or surgical interventions The test does not define the structure or…

…type and screen and the serological crossmatch have a limited period of validity — usually about five days — because new antibodies can form after transfusion or…

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

…in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high dose salbutamol in marked…

…Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased…

…it will disappear, and the documentation is all that remains. 3. Pare down any hyperkeratosis with a scalpel; nitrogen does not penetrate thick keratin. 4…

…proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period…

…the patient to recite the months of the year backwards. A normal result does not exclude delirium, however, and an abnormal result is not specific…

…Contraindications The laryngeal mask is a compromise and does not protect the airway completely. Relative contraindications: A high risk of aspiration: a non fasted patient…

…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…

…medical and medication histories should specifically assess drugs or substances that may increase blood pressure. The source material does not provide an exhaustive list of…

…s morphology does not reliably establish that it will cause an acute event. A more clinically useful model considers both the plaque and the patient…

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

…Clinical Presentation and Symptoms The source material does not provide specific information on the clinical presentation and symptoms of the underlying conditions for which ACE…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

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

…and patients whose initial findings are less definitive. The defining electrocardiographic feature is the absence of persistent ST segment elevation. This does not imply low…

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

…whereas others have brief or asymptomatic episodes that are not detected during routine clinical assessment. The clinical burden of AF does not reliably predict stroke…

…Patients are predominantly older (frequently 65 years of age) and there is a strong female predominance. Women have a substantially higher lifetime risk of developing…

…both North American and European guidelines. However, a concave ST segment does not rule out ischemia, it merely reduces the probability of ischemia as the…

…ECG is a better marker of reperfusion than angiography itself. Studies have shown that angiographic blood flow does not always correlate with myocardial perfusion on…

…longer have a right of veto based on their own view . Their role is to convey what the deceased person themselves thought. This does not…

…does not fit the clinical picture, repeat the sample and send a venous plasma glucose, but do not delay treatment of a neurologically compromised patient…

…severity and manifestations of disease may differ substantially among carriers. Consequently, a normal examination or cardiac investigation at one point in time does not reliably…

…location of excess adiposity. 2 Clinical guidelines now emphasize that a BMI within the conventional "normal" range (up to 25 kg/m²) does not necessarily…

…V3 in patients with NSTE ACS/NSTEMI are almost invariably accompanied by ST segment depressions in other leads (particularly V5) and that is not consistent…

…the greater the probability that the rhythm has deteriorated into PEA or asystole, and therefore the worse the prognosis. This does not always hold true…

…Approximately 30% of all ischemic strokes are caused by cardiac embolism. This figure does not include paradoxical embolism (discussed below) and emboli from the proximal…

…almost 80% of men display ST segment elevations that are not caused by ischemia and a significant proportion have ST T changes caused by other…

…Ejection fraction is routinely examined at rest, which does not reveal the functional (maximum) capacity of the left ventricle, as this would require measuring the…

…ECG is 6% and 7%, respectively. A proportion of these patients have a new bundle branch block, which in the case of left bundle branch…

…does not apply in haemodynamic instability. Digitalis toxicity — a risk of refractory ventricular arrhythmias. Therapeutic digoxin levels, by contrast, are no obstacle. Untreated hypokalaemia or…

…during the illness and, in some series, is reported in up to approximately one third of patients. Its absence therefore does not exclude the diagnosis…

…did the patient first note the symptoms and how have the symptoms developed over time? In stable ischemic heart disease, symptoms are typically not present…

…fibrillation in patients with severe symptoms, provided that first line therapies have failed and the patient does not have structural heart disease or reduced left…

…time of onset when MRI is immediately available and does not delay treatment Saturation Give oxygen in hypoxia, not routinely to a normoxic patient Temperature…

…does not describe specific physical signs of CTO or a dedicated physical examination algorithm. Diagnostics Non invasive assessment of ischaemia and viability Objective evidence of…

…The proportion of painless or silent STEMIs is greater in patients with diabetes mellitus and increases with age. STEMI may present as sudden onset breathlessness…

…arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended…

…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…

…Patients with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose…

…life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment is safe is not the starting dose but…

…ECG does not exhibit ST segment elevations, but the condition should be managed as STEMI (ST Elevation Myocardial Infarction) in terms of treatment and interventions…

…occur in patients with a clinically unstable acute coronary syndrome, but the examination does not reliably establish or exclude the diagnosis. The ECG and serial…

…infarction and limb threatening complications. Among patients with established peripheral artery disease, those who stop smoking have approximately twice the five year survival of those…

…the patient is not simultaneously on a DOAC, low molecular weight heparin and an antiplatelet agent without an indication. Interactions: strong P gp or CYP3A4…

…time. Opioids in abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination findings before the dose…

…However, the term PSVT does not have any clinical relevance and it may lead to misunderstanding. Use of the term PSVT is therefore not recommended…

…worsening renal function does not necessarily indicate reduced cardiac output or impaired renal perfusion. Many patients have preserved cardiac output; increased venous and intra abdominal…

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