…the patient may experience hypoglycaemia like symptoms at a normal glucose. With frequent hypoglycaemia the warning symptoms may instead be absent until the glucose has…

…the only absolute indication, and always urgent. A large pericardial effusion with symptoms despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy…

…Contraindications Asthma and COPD. Adenosine has caused mild to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung…

…an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation…

…dyspnoea, wheeze or reduced exercise capacity. Suspected asthma or COPD — diagnosis and follow up. Risk groups: current or former smokers over 40 with respiratory symptoms…

…closed circumferential cast , and the patient must leave with clear information about the symptoms that should make them seek help immediately. Indications An undisplaced or…

…patient need not have fever, leucocytosis or a positive culture. Older people, the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms…

…Symptoms of acute pericarditis/myocarditis There are two forms of pericarditis: acute and chronic. This article will focus on the former, as it has implications…

…is therefore generally favoured within 14 days of symptom onset in the source material. Clinical Presentation and Symptoms Aortic dissection is an uncommon cause of…

…a COPD exacerbation with carbon dioxide retention for the latter. The treatment is also time limited by its very nature: a patient who has not…

…What usually goes wrong is not that the patient gets too little oxygen but that the prescription has no target — the nasal cannula stays in…

…dipstick in an older patient is difficult to interpret. Skin and soft tissue Diagnosis Agent Dose Duration : : : : Erysipelas phenoxymethylpenicillin 1 g × 3 (2 g × 3…

…and elevated catecholamine states. EAT typically has an abrupt onset, although a brief warm up phase lasting approximately 5 to 10 seconds may precede the…

…keeping the patient normothermic — but fever after cardiac arrest is harmful, it often arises spontaneously, and it must be actively prevented. The treatment has therefore…

…Do not intubate every patient routinely before endoscopy. Observational data do not show that prophylactic intubation reduces aspiration or mortality. It has on the contrary…

…Oxygen targets Aim for a saturation of 92–96 % in most patients, and 88–92 % where there is a risk of carbon dioxide retention (COPD…

…Use with caution in patients with asthma/chronic obstructive pulmonary disease (COPD). Dyspnea has been reported in patients treated with ticagrelor. Patients with a history…

…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…

…has been recorded at 27%, while for witnessed cardiac arrests, the survival rate stands at 73% (Podsiadlo et al.). A significant majority of these patients…

…it is the freeze–thaw–freeze cycle that causes cell death, not the cold alone. The temperature at the outer edge of the tissue is…

…atrophic, cold Dry, hyperkeratotic Pulses Palpable Weak or absent May be palpable despite ischaemia ABI 0.9 < 0.9 Often falsely high Contraindications to…

…also known as coronary artery disease, has been the number one killer worldwide since the 1960s. In 1948 the NHLBI initiated the Framingham Heart Study…

…or resulted from it. AF has important consequences beyond the arrhythmia itself. It may cause symptoms and impaired quality of life, contribute to heart failure…

…85%). Many patients appreciate the exercise test because it offers them an opportunity to evaluate their performance and symptoms under the supervision of their clinician…

Procedurer Warfarin has a narrow therapeutic index, a half life of several days and more than a hundred clinically relevant interactions. What determines whether the…

…substance that binds to charcoal, when it can be given early and the patient has an intact or a protected airway. The benefit is greatest…

…the management: is the patient unstable, how long has the fibrillation lasted, and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion…

Endokrinologi & metabolism Lathundar An inpatient has a different insulin sensitivity from at home: less food, more stress, often corticosteroids, often impaired renal function. Prescribe basal…

…International thresholds vary somewhat, but a PEF of 50 percent or less together with marked symptoms indicates a severe attack, while a PEF below 33…

…commonest error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal…

…a patient with a normal circulation and no symptoms requires no pacing, only monitoring and preparedness. Asystole with no electrical activity at all — pacing has…

…Moreover, the ultrasound system performs several calculates based on these parameters (e.g adjusting various dimensions/volumes to body surface area). Heart rate and blood…

…full vital signs, level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the patient has sepsis, septic shock, or a…

…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)…

…hypertrophic cardiomyopathy may display normal, or supranormal ejection fraction , despite manifest heart failure and severe symptoms. These individuals exhibit pronounced hypertrophy, resulting in a reduction…

…parameters that must be evaluated and the final result of the test depends on an integrated assessment of six components: Symptoms Exercise performance (functional capacity…

…getting up, medication intake, symptoms and any unusual activities. Interpretation A recording is acceptable if at least 70 % of the measurements are valid , with at…

…downstream procedures. In patients with a high probability, testing may add little diagnostic value and invasive coronary angiography may be more appropriate when symptoms, risk…

…coronary syndrome 80 g/L; a higher threshold may be considered individually in ongoing ischaemia Upper gastrointestinal bleeding that has been stabilised 70 g/L …

…objectively verifiable fatigable symptoms. Assessment of whether residual weakness in a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity…

…the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…

…and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually on a treadmill, while symptoms…

…of acute atherothrombosis. Type 3 MI: Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG changes, occurring before…

…change has developed over hours to days Fluctuating course Symptoms vary over the day and may appear temporarily to have resolved Inattention The patient loses…

…when the shock is delivered, and that the thromboembolic risk has been dealt with before the atria begin to contract again. An unsynchronised shock that…

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

…symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient who stops at a low workload with a fall in blood pressure is…

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

…rest and on movement . A patient who is pain free lying still but screams when turned has not finished being titrated. Expect an opioid naive…

Procedurer Cerumen should be removed when it causes symptoms or obscures the tympanic membrane — not routinely . The wax has a protective function, and the commonest…

…et al 1 ). Representative single beat morphs for a low risk patient (blue) and the corresponding high risk morph (red). Beyond the difference in R…

…CCS. General strategy For most patients, initial therapy consists of a beta blocker and/or a calcium channel blocker (CCB). If symptoms remain inadequately controlled…

…Clinical application and patient populations The evidence for anti inflammatory treatment in coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction…

…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…

…exertional dyspnoea. Patients may continue to have lifestyle limiting symptoms despite guideline directed medical therapy (GDMT), prompting consideration of revascularization. The likelihood that symptoms are…

…precapillary PH, partly because this value has been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk…

…myocardial ischaemic symptoms or equivalent presentations together with persistent ST segment elevation, or an equivalent electrocardiographic pattern, suggesting acute coronary occlusion. Most patients with this…

…health screening to assessment of symptoms after coronary artery bypass surgery. Traditionally, the most common indication for exercise stress testing has been the diagnostic evaluation…

…elderly individuals. Clinical characteristics and ECG changes in takotsubo cardiomyopathy The typical patient presents with severe chest pain, dyspnea and occasionally hemodynamic compromise. The ECG…

…0 mmol/L, and at lower values if the rise is rapid, the patient has symptoms, or the clinical risk is high [1,2]. 1…