…is high or the time of onset uncertain, choose the more cautious course. Anticoagulation Assess the risk with CHA₂DS₂ VA (the sex category has been…

…skin: a risk of permanent hypopigmentation. Areas with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes — the…

…a potential interaction, and that there is a ready made plan for what happens when the INR runs away or the patient bleeds. In Sweden…

…the documentation is insufficient; check more frequently. Warfarin is often preferable <15 or dialysis DOACs are not recommended. Warfarin after individual assessment Rule of thumb…

…risk of stroke and other thromboembolic events. Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients…

…the extent of ischemia. After revascularization procedures, stress testing is utilized to assess whether there is any residual ischemia or angina pectoris. Patients may undergo…

…coagulopathy, recent oesophageal or gastric surgery Gastric lavage Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern…

…and caution Active fever prevention has in practice no absolute contraindications. With active cooling to hypothermia , caution applies in: Ongoing uncontrolled bleeding or marked coagulopathy…

…Document what has been changed, who is following it up and when. Sources American Diabetes Association, Standards of Care in Diabetes: diabetes care in the…

…speech, work of breathing, level of consciousness and air entry repeatedly. 9. Measure PEF or FEV1 if the patient can manage it without delaying treatment…

…admission of a patient with known ascites. Clinical deterioration in a cirrhotic patient with ascites: fever, abdominal pain, encephalopathy, rising creatinine, gastrointestinal bleeding, leucocytosis or…

…a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that has not…

Echocardiography The echocardiographic examination The use of echocardiography has increased dramatically during the past few decades. Advances in echocardiography have been propelled by breakthroughs in…

…level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the patient has sepsis, septic shock, or a need for high…

…presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by…

…perfusion and the signs of shock 2 Two large bore peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood gases…

…or supranormal ejection fraction , despite manifest heart failure and severe symptoms. These individuals exhibit pronounced hypertrophy, resulting in a reduction of ventricular volume and subsequently…

…a fairly good estimate of the actual workload. The perceived exertion may be graded from 0 (none) to 10 (maximal exertion) or according to the…

…the patient fell asleep and got up. Holter ECG and longer rhythm monitoring Indications Palpitations, presyncope or syncope of suspected arrhythmic origin. Assessment of rate…

…probability is the clinician’s estimate of the probability that the patient has anatomically obstructive CAD before the result of a new test is known…

…ongoing bleeding with coagulopathy, or as part of balanced transfusion in massive haemorrhage. Transfusion thresholds in the stable, non bleeding patient Patient category Transfusion threshold…

…the event of bradycardia, bronchospasm, marked salivation or increasing weakness, and give atropine. 8. Monitor for at least 30 minutes after the test has been…

…of coughing, stridor, cyanosis or marked breathlessness — withdraw the tube to the pharynx and start again . If the tube emerges through the mouth it has…

…the prescription has no target — the nasal cannula stays in place for days without anyone asking why, or the patient at risk of carbon dioxide…

…at high risk of rupture, or determine whether ischaemia would occur at workloads greater than those achieved during testing. Exercise ECG has become less prominent…

…Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG changes, occurring before cTn values become available or abnormal…

…risk of hypercapnia has been assessed. 3. Take an arterial blood gas in respiratory compromise, low saturation, suspected carbon dioxide retention, reduced consciousness, or when…

…the cast has set, and document it. 10. Elevate the limb and inform the patient. Backslab or circumferential cast A dorsal backslab or another half…

…poisoning, withdrawal or several factors Inattention is central. A simple check is to ask the patient to recite the months of the year backwards. A…

…haemodynamic instability. Digitalis toxicity — a risk of refractory ventricular arrhythmias. Therapeutic digoxin levels, by contrast, are no obstacle. Untreated hypokalaemia or marked electrolyte disturbance; correct…

…acid on a pledget or as a solution has a good effect in anterior bleeding. Raise the chair so that the patient's nose is…

…angiography, myocardial perfusion scintigraphy, stress echocardiography) has greater diagnostic accuracy. Contraindications Absolute: Acute coronary syndrome within 48 hours, or ongoing unstable angina. Uncontrolled symptomatic arrhythmia…

…can be tested on urine or a self taken vaginal sample without a speculum. Routine gynaecological examination of asymptomatic women has not been shown to…

…of titration is abandoned — when a fixed dose is given without assessment, when a modified release preparation is started in an opioid naive patient, or…

…when it causes symptoms or obscures the tympanic membrane — not routinely . The wax has a protective function, and the commonest complication of ear syringing is…

…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…

…ICDs) are highly effective, terminating well over 99% of the ventricular arrhythmias they detect. It lies instead in patient selection. Because implantation entails appreciable cost…

…pressure, left ventricular dysfunction, contraindications, or intolerance limit escalation of beta blocker or CCB therapy. Nicorandil and trimetazidine are additional options in selected patients. Treatment…

…has principally involved two populations: Patients recently recovering from myocardial infarction or acute coronary syndrome. Patients with stable or chronic atherosclerotic coronary disease, many of…

…lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting with glucagon like peptide…

…left ventricular ejection fraction, procedural factors and anticipated outcomes. The supplied material does not describe specific physical signs of CTO or a dedicated physical examination…

…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…

…severity of ischaemia and whether infarction has occurred The extent and degree of myocardial involvement The anatomical territory, including anterior, inferoposterolateral or right ventricular involvement…

…Exercise stress testing has been used routinely for over 60 years to evaluate cardiopulmonary function and to diagnose cardiovascular disease. The value of exercise stress…

…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…

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

…if the patient can swallow safely. 4. Give intravenous glucose if the patient has a reduced level of consciousness, is having seizures or cannot swallow…

…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…

…of pain also has limited discriminatory value. Features suggesting myocardial ischaemia Ischaemic discomfort commonly: Is substernal and diffuse. Is described as pressure, tightness, heaviness, or…

…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…

…range of LVEF, and echocardiographic measurement is subject to meaningful variability. HFmrEF may therefore represent several clinically distinct trajectories: A patient whose LVEF has improved…

…suspicion of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with…

…prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel, a blood pressure cuff of the…

…An intensive care patient in whom a decision has been made to withdraw life sustaining treatment, in whom total brain infarction is not expected to…

…site — use another approach or refrain. Bacteraemia without suspicion of joint infection (relative; aspiration can seed a sterile joint). Marked coagulopathy or an anticoagulant at…

…of aspiration: a non fasted patient, ileus, third trimester pregnancy, marked reflux. A need for high airway pressures, for example severe ARDS, marked obesity or…

…early intervention and management. Standardization: Its widespread adoption has led to standardized reporting of eGFR in clinical laboratories, enhancing consistency in patient care. Non Invasiveness:…

…GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey…

…Patients with inflammatory rheumatic disease have a higher cardiovascular risk than the general population. This excess risk has been documented across a broad range of…

…signs of digoxin toxicity. Toxicity can manifest as sinus bradycardia or sinus arrest, atrioventricular (AV) node block, and junctional, fascicular, or ventricular tachyarrhythmias. Patients may…