…among the frailer participants enrolled in trials. In contrast, observational studies have sometimes suggested that lower blood pressure may be harmful in significantly frail patients…

…of cost. Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial infarction. Participants…

…643 cases of out of hospital cardiac arrest in the ROC PRIMED trial. These patients were enrolled in a randomized trial that evaluated the efficacy…

…compared to patients without such disturbances, including those with RBBB and LBBB. This was reported in the Coronary Heart Disease Study,1 which enrolled 10…

…In patients with acute decompensated heart failure, AF with rapid ventricular response is particularly important. Cardioversion is generally not immediately indicated if the patient remains…

ECG Exercise stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar…

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…

…dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10 micrograms/L …

…and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors. Check what applies in your own region…

Hematologi & onkologi Infektionssjukdomar Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation…

…bladder Have the patient void, or catheterise, before puncture Pregnancy, previous extensive abdominal surgery Ultrasound guidance; choose a new site if in doubt Cellulitis over…

…precipitate ventricular fibrillation. Prioritise rewarming. Bradycardia in a patient with a normal circulation and no symptoms requires no pacing, only monitoring and preparedness. Asystole with…

…asthma attack is an alarm sign. Early in a severe attack the patient usually hyperventilates and the pCO₂ is low. A normal pCO₂ may therefore…

…is limited. In a patient with moderate symptoms the physician must judge the likelihood that the symptoms really are caused by the hyponatraemia. With severe…

…are influenced by the fact that the sickest patients are more often intubated [4]. Intubation is reasonable in: a reduced level of consciousness with inadequate…

…unit is selected electronically against the blood group Standard for planned transfusion in a patient without irregular red cell antibodies Serological crossmatch (MG test) Serological…

…nothing else. The two ways in which casting harms the patient are that it is too tight — the swelling comes after the injury, not before…

…the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for example…

…fibreoptic intubation. A difficult airway is anticipated in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the right course, not RSI…

…exercise duration, workload or metabolic equivalents, is among the strongest predictors of mortality in patients with cardiovascular disease after accounting for age. Chronotropic response, blood…

…concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS)…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of patients with a central cause. A normal routine neurological examination…

…often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept a diary…

…At a creatinine clearance <20 mL/min, consider an alternative treatment In aminoglycoside treatment of obese patients, an adjusted body weight is used: adjusted weight…

…a good effect in anterior bleeding. Raise the chair so that the patient's nose is at your eye level. The patient sits upright and…

…physician available. Patient preparation: A light meal is permitted; no large meal, no coffee and no nicotine in the preceding 2–3 hours. Comfortable clothing…

…ileus or suspected perforation Gastric lavage An unprotected or unsecured airway in a patient with a reduced level of consciousness Gastric lavage Corrosive injury or…

…menstrual status, previous smear results and any previous conisation. Procedure Inspection The patient lies in the lithotomy position, well covered. Say what you are do

…done wrongly. The two commonest errors are that an intramuscular injection in fact ends up subcutaneously in a patient with a high BMI, and that…

…how the patient is positioned, which needle is chosen, and that the tubes go to the right place. In suspected bacterial meningitis it is the…

…and drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see the separate…

…is not that the patient gets too little oxygen but that the prescription has no target — the nasal cannula stays in place for days without…

…oxide Rapid onset and offset; the patient cooperates Intra articular local anaesthesia Lidocaine into the glenohumeral joint in shoulder dislocation, with an effect equivalent to…

…result can be interpreted. What decides that is whether the patient is taking a steroid that cross reacts in the cortisol assay, whether the samples…

…in adults is present with: an ongoing generalised tonic clonic seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the patient…

…active prevention of fever — defined as a temperature above about 37.7–37.8 °C — for at least 72 hours in patients who remain unconscious…

…plan for what happens when the INR runs away or the patient bleeds. In Sweden the treatment is usually managed from an anticoagulation clinic with…

…those who did, only a minority had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no…

…limit escalation of beta blocker or CCB therapy. Nicorandil and trimetazidine are additional options in selected patients. Treatment choices should be integrated with management of…

…1.5 mm All patients Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of…

…is recommended. European guidance gives this strategy a Class I recommendation with Level B evidence in patients with blood pressure ≥140/90 mmHg, with important…

…HbA1c) reduction, blood pressure, lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting…

…In patients with a very low probability of obstructive CAD, testing may generate false positive results and unnecessary downstream procedures. In patients with a high…

…most common risk factor for PH. It produces postcapillary PH through elevation of left atrial and pulmonary venous pressure. In some patients, chronic postcapillary pr

…the aorta and renovascular disease are important non endocrine causes, particularly in patients with resistant hypertension. Dietary sodium and potassium abnormalities and commonly used over…

…while cardiomyocyte swelling, interstitial oedema and tissue inflammation produce extravascular compression. In the most severe form, termed no reflow, structural and functional microvascular impairment persists…

…infarction (STEMI) is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…Is the patient hypovolaemic, adequately filled or fluid overloaded? 3. Is there, or is there approaching, an indication for dialysis? AKI occurs in about one…

…cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with previous complicated withdrawal [4]. Untreated delirium…

…Preparation: The patient must have rested lying down for at least 10 minutes in a room at a comfortable temperature — a cold foot gives falsely…

…acidosis or alkalosis in a haemodynamically stable patient A venous blood gas is often sufficient as the first sample Precise pCO₂ in suspected ventilatory failure…

…pressure dressing. Procedure 1. Place the patient in the lateral position with the knees drawn up , or prone with a pillow under the pelvis. The…

…artery — everything in the technique is designed to make sure that never happens, and to make sure the catheter does not become the patient's…

…life produces more marked suppression. Stress dosing in known adrenal insufficiency A patient with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long…

…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…

…the current transmission risk assessment. In DCD: patients in whom death must be confirmed after a 20 minute no touch period, for example after poisoning…

…mosm/kg or total osmolality 320 mosm/kg Typical patient Often type 1 diabetes, but also occurs in type 2 diabetes Usually type 2 diabetes…

…the size of the ptosis in millimetres, the time to diplopia on upward gaze, or the number of seconds the patient can hold the head…