…may occur even in the absence of pulmonary congestion. Patients may obtain relief by sitting forward. Other symptoms depend on the extent of reduction in…

…risk of cerebrovascular complications. Seizures in a patient with preeclampsia indicate eclampsia. Postpartum disease is clinically important. Hypertension is most frequent in women who had…

…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…

…A total of 500 cases of fatal myocardial infarction were examined. The authors reported that 60–70% of all cases had no myocardial disease or…

…reflex for predicting a poor neurological outcome was 68.8%. This implies that approximately one third of the patients who ultimately had a favorable neurological…

…detail. Symptom during exercise stress testing Perceived exertion The patient's perceived exertion is a way of estimating the intensity of the physical activity. It…

…vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS have more comorbidities and a higher…

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

…can keep a patient alive until a transvenous lead is in place — but only if it is working, and the commonest source of error is…

…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…

…describe the current pH of the blood. Acidosis and alkalosis , which describe processes that lower and raise pH respectively. A patient may therefore have both…

…Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint…

…recovery. A patient who stops at a low workload with a fall in blood pressure is a high risk patient even with normal ST segments…

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

…hypertension is elevated blood pressure attributable to a specific, identifiable underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension…

…not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an…

…in a patient without irregular red cell antibodies Serological crossmatch (MG test) Serological crossmatching between the recipient's plasma and the red cells of the…

…commonest of all dislocations. There is a hollow beneath the acromion, the arm is held in slight abduction and external rotation, and the patient resists…

…and the patient is also receiving LMWH, for example in newly diagnosed venous thromboembolism. 1. Check the INR before the first dose. A raised baseline…

…place, the electrodes come off, the patient has not kept a diary. The set up and the instructions decide whether the investigation will be usable…

…every compression treatment of a leg ulcer and as a risk marker in diabetes and known atherosclerotic disease. An ABI ≤ 0.90 is diagnostic of…

…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…

…A diagnosis of delirium is therefore the beginning of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation…

…more magnets constitute the same kind of urgency by a different mechanism. They attract one another through the tissue — even when they lie in separate…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…the patient Immediate assessment 1. Assess airway, breathing, circulation and level of consciousness. 2. Attach ECG, pulse oximetry and repeated blood pressure measurement when a…

…and a person designated to keep time and read out the number of attempts. Laryngeal mask sizes Size Patient weight Maximum cuff volume (air filled…

…that saves the patient — the puncture must never delay it. Indications Suspected meningitis or encephalitis. Suspected subarachnoid haemorrhage with a normal or non diagnostic CT…

…That question determines the diagnosis, and it is asked of a patient who is haemodynamically stable enough for there to be time to ask it…

…increments of 0.1 mg. Adverse effects Tachycardia. Flushing. Headache. Nausea. Vomiting. Caution Rarely used unless patient has a confirmed diagnosis of pheochromocytoma Treatment of…

…for every patient with isolated hypertension. Single Pill Combinations Fixed dose, single pill combinations are preferred whenever combination treatment is used. The number of prescribed…

…fifth of adults during a hospital episode in international studies and is linked to substantial mortality, even though incidence and prognosis vary widely between patient…

…A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior iliac spine is the standard…

…a consequence Medicinal charcoal Bowel obstruction, ileus or suspected perforation Gastric lavage An unprotected or unsecured airway in a patient with a reduced level of…

…the lower tip of the muscle insertion. 3. Stretch the skin with the thumb and index finger, or compress the muscle in a slim patient…

…fasting and surgery. A risk of euglycaemic ketoacidosis Sulfonylurea A high risk of hypoglycaemia in a patient who is eating poorly. Consider stopping it GLP…

…10 minutes. A maximum of two infusions can be given. Each infusion should be completed, even if the patient reverts to sinus rhythm. Th e…

…the magnitude of heart rate reduction. Ivabradine is also a reasonable consideration when a beta blocker cannot be tolerated or is contraindicated. In such patients…

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

…arrests, the survival rate stands at 73% (Podsiadlo et al.). A significant majority of these patients exhibit satisfactory neurological function upon discharge. Figure 1 . Expected…

…generate very minute or even invisible spikes (at least in some leads). Pacemaker stimulated beats display wide QRS complexes and a left bundle branch block…

…the ribs increase, providing larger windows for the ultrasound beam. The operator can sit on either side of the patient, depending on preferences. The operator…

…medicine since the presence of wall motion abnormalities in a patient with chest pain strongly suggests myocardial ischemia as the underlying cause of the symptoms…

…common to provide the patient with a permanent pacemaker to continue optimal medical treatment. Sick sinus syndrome (sinus node dysfunction), a common cause of brady

…10 minutes of the diagnosis, if symptom duration is under 12 hours and there is no contraindication After successful fibrinolysis Transfer directly to a PCI…

…wait for a complete diagnosis or for grading. Antihistamines, corticosteroids, inhaled bronchodilators and nebulised adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline…

…consider within 15 hours of the last dose. Andexanet alfa where available Low molecular weight heparin Protamine has only a partial effect Unfractionated heparin Protamine…

…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…

…mL/kg of 0.1 mg/mL), maximum 1 mg, every 3–5 min Amiodarone 300 mg IV after the 3rd defibrillation, a further 150…

…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…

…injury may be at greater immediate risk than a stable dialysis patient with a plasma potassium of 6.6 mmol/L and an unchanged ECG…

…Availability in Sweden. Several of the drugs in this overview are not routinely marketed in Sweden and may require a named patient licence, among them…

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

…after every dose, otherwise the dose does not arrive until the next flush. Assess the pain both at rest and on movement . A patient who…

…the patient's cheek so that the otoscope moves with the head if it moves. 4. Insert the speculum under vision, to a maximum of…

…products. Contrast medium for CT (this requires a large bore cannula in a suitable vein). Standby access in a patient at risk of rapid deterioration…

…hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1…

…elevated even when overt congestion is not apparent. Such a discrepancy should prompt consideration of an infiltrative cardiomyopathy within the appropriate clinical context. Several patient…

…should incorporate the estimated risk, risk enhancing factors and a clinician–patient discussion regarding the expected net benefit of therapy. Lifestyle modification is appropriate across…

…a few likely diagnoses. The table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of…