…gives way — the cortex has then been passed. Remove the stylet and aspirate. 6. Make the smears immediately at the bedside from the first aspirate…

…in diagnostics. A patient who exhibits an ecotdense mass entrenched in the endocardium with impaired mobility (for example, after myocardial infarction), most likely has a…

…whether AF initiated the deterioration or resulted from it. AF has important consequences beyond the arrhythmia itself. It may cause symptoms and impaired quality of…

…grafting [CABG]). Stress testing is used to establish the diagnosis of ischemic heart disease as well as estimating the extent of ischemia. After revascularization procedures…

…with a loading dose Used when a rapid effect is wanted and the patient is also receiving LMWH, for example in newly diagnosed venous thromboembolism…

…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…

…VA (the sex category has been removed from the Swedish recommendation). Score Recommendation : : 0 No anticoagulant 1 Consider an oral anticoagulant, particularly at age ≥ 65…

…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…

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…

…management The most dangerous asthma attack is the silent one. A patient who has become calm, quiet in the chest and stopped struggling may be…

…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…

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…

…2 Assess whether the patient has sepsis, septic shock, or a need for high dependency or intensive care 3 Take at least two sets of…

…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)…

…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…

…fraction (EF) For several decades, ejection fraction (EF) has been the dominating method for assessing left ventricular systolic function. Ejection fraction is simple to calculate…

…Exercise stress test Evaluation of the exercise stress test (exercise ECG) The ECG reaction has always been a central component of the exercise stress test…

…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…

…coronary artery disease (CAD) before diagnostic testing. This pre test probability is the clinician’s estimate of the probability that the patient has anatomically obstructive…

…Upper gastrointestinal bleeding that has been stabilised 70 g/L — a more liberal strategy gives worse outcomes A restrictive strategy is at least equivalent to…

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

…The resistance at the posterior pharyngeal wall after about 10–15 cm is expected. 5. Ask the patient to flex the head forward and swallow…

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

…occur at workloads greater than those achieved during testing. Exercise ECG has become less prominent as a primary diagnostic test for obstructive coronary artery disease…

…A fundamental prerequisite for diagnosing any MI is myocardial injury, defined by an elevated cardiac troponin (cTn) value with at least one value above the…

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

…1. Place the joint at the angle the treatment requires before the cast is applied, and hold that position until the cast has set. 2…

…older patients delirium is often multifactorial. 7. Start non pharmacological treatment immediately , in parallel with the investigation. 8. Document the diagnosis and communicate it at…

…SVT that has not been terminated by vagal manoeuvres, adenosine or rate controlling drugs. New onset fibrillation of certain duration below the threshold at which…

…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…

…false positives; at a high probability a negative test adds little. Imaging (coronary CT angiography, myocardial perfusion scintigraphy, stress echocardiography) has greater diagnostic accuracy. Contraindications…

…patient's ongoing consent, and be able to be stopped at any moment. A trauma informed approach also improves the technical quality — a relaxed patient…

…biliary tract disease. There is no contraindication to analgesia in the acute abdomen . The notion that an opioid masks the diagnosis has been disproved — withholding…

…procedure, or over a few days at home for a hard plug. Have the patient lie with the ear uppermost for 5 minutes after instillation…

…and a vasopressor prepared. The patient is positioned semi recumbent, at 30–45 degrees — the fluid then collects anteriorly and inferiorly, which makes it easier…

…the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no practical risk prediction tool currently exists. At the other end…

…patients. Treatment choices should be integrated with management of precipitating factors such as anaemia, uncontrolled hypertension, thyrotoxicosis, tachyarrhythmia, uncontrolled heart failure, and concomitant valvular disease…

…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…

…is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography…

…coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical context and the results of all relevant investigations. Haemodynamic definition At rest, PH…

…Most patients with this working diagnosis subsequently develop myocardial necrosis and cardiac troponin elevation, although not every patient with an initial STEMI pattern has myocardial…

…coronary artery bypass surgery. Traditionally, the most common indication for exercise stress testing has been the diagnostic evaluation of coronary artery disease. However, current guidelines …

…Therefore, these patients must be managed as STE ACS/STEMI until angiography has been performed. Note that troponins may be elevated but the elevation is…

…start cardiac monitoring at a plasma potassium above 6.0 mmol/L, and at lower values if the rise is rapid, the patient has symptoms…

…and establish access at the same time. 6. Measure the glucose again after 10 to 15 minutes and repeat treatment until the patient has recovered…

…Vomiting. Caution Rarely used unless patient has a confirmed diagnosis of pheochromocytoma Treatment of hypertension associated with pheochromocytoma; treatment of dermal necrosis after extravasation of…

…Relevant predispositions, such as connective tissue disease. No single pain descriptor is diagnostic. The severity of pain also has limited discriminatory value. Features suggesting myocardial…

…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…

…A patient whose LVEF has improved from a previous value below 40%. A patient whose LVEF has declined from a previous value of at least…

…the aim should be a calm, mildly somnolent but rousable patient, while ventilation, circulation and underlying disease are monitored [3]. The management of complicated withdrawal…

…marker in diabetes and known atherosclerotic disease. An ABI ≤ 0.90 is diagnostic of peripheral arterial disease and at the same time indicates a substantially…

…during ongoing ventilation (DBD). An intensive care patient in whom a decision has been made to withdraw life sustaining treatment, in whom total brain infarction…

…The knee The patient lies supine with the leg extended and the quadriceps relaxed. The superolateral approach has the highest accuracy for palpation guided aspiration…

…ventilating is not experienced in intubation. Planned anaesthesia for short procedures in a fasted patient at low risk of aspiration. A conduit for fibreoptically assisted…

…disease (CKD), facilitating early intervention and management. Standardization: Its widespread adoption has led to standardized reporting of eGFR in clinical laboratories, enhancing consistency in patient…

…the HEMORR₂HAGES, ATRIA, and HAS BLED bleeding risk prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS study. J Am Coll Cardiol . 2012…

…inflammatory disease. Epidemiology and disease specific patterns Patients with inflammatory rheumatic disease have a higher cardiovascular risk than the general population. This excess risk has…

…disease, hypothyroidism, and amyloidosis. Furthermore, ongoing ischemia, hypomagnesemia, and moderate to severe renal impairment increase the likelihood of digitalis intoxication even at therapeutic doses. Diagnostics…