…of a PCSK9 inhibitor. Place in lipid lowering therapy General treatment sequence High intensity statin therapy remains the foundation of lipid lowering treatment for patients…

…drugs have not been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients, initial therapy consists of a beta blocker…

…is generally: High intensity statin therapy at the highest tolerated dose. Addition of ezetimibe if the LDL C target is not achieved. Addition of a…

…mortality due to stopping statins. There are three main questions discussed in media, blogs and on social plattforms: Is high cholesterol a true cause of…

…the patient from sleep. Patients receiving modified antiplatelet therapy require clinical surveillance for both recurrent ischemia and bleeding. The source material does not specify a…

…rising potassium is usually more dangerous than a corresponding stable chronic value [4]. The grading must not be used mechanically. A patient with a plasma…

…Syncope is particularly important as a marker of potentially severe disease. The presence of haemodynamic instability places the patient in the high risk category and…

…be tailored to the patient's needs. Programming is done through an external device that communicates wirelessly with the pacemaker. A wide range of settings…

…to initiate or intensify preventive therapy is uncertain. Prevention guidelines support its use in selected individuals at intermediate risk, rather than as a universal population…

…Patients with manifest clinical disease are at high risk of progression and generally require all appropriate evidence based measures, including drug treatment and therapeutic lifestyle…

…as unexplained dyspnea on exertion, RAD demonstrates a high predictive value for the condition [9]. Furthermore, RAD is frequently observed in adult patients with severe…

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

…and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high after hip fracture, major surgery and intensive care …

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

…Repeated blood sampling during intensive care. Exhausted peripheral venous access during prolonged intravenous therapy. The need for central access is not in itself an indication…

…Remove contaminated clothing and wash the skin after external exposure A low Glasgow Coma Scale is not on its own an absolute indication for intubation…

…Not prescribing glucose measurement. Prescribe the measurement times at the same time as the insulin. Giving mealtime insulin to a patient who is not eating…

…based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia. The immediate therapeutic objective is restoration…

…lasts a few seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin…

…if gastrointestinal perforation or obstruction is suspected. If the patient is intubated, administer activated charcoal through a gastric tube at a dose of 0.5…

…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…

…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…

…before exercise. Patients with unstable angina pectoris with high risk should not undergo exercise stress tests; these patients should be referred to angiography instead. Exercise…

…a set of valves, and a high flow nasal cannula where available. Bag mask equipment for a patient who is not breathing adequately. Choosing a…

…patients with hepatic cirrhosis — creatinine based eGFR substantially overestimates renal function. Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2…

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

…Cytology is used as a triage test on the same liquid based sample when the HPV test is positive — the sample therefore does not need…

…is the probability that the patient actually has endocarditis (this the probability should be estimated before echocardiography is performed). Among patients with a very high…

…failure is high, and assessment for advanced therapies may be required. Evaluation and physical examination Assessment begins by establishing that the patient has a clinical…

…A catheter is not, however, indicated for incontinence as the sole reason, for convenience where the workload is heavy, or as a substitute for mobilisation…

…Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually on a treadmill, while symptoms, a 12 lead…

…the muscle in a slim patient. 4. Insert the needle perpendicularly , quickly and firmly, to its full length. 5. Aspiration is not needed for vaccination…

…for patients with risk factors. Check what applies in your own region. The time limit is not a guarantee. Where the stroke risk is high…

…Palpable foot pulses are not an acceptable substitute, and in patients with diabetes or renal failure the index may be falsely normal because of medial…

…represent a more favorable profile, as the upper limit of the "healthy" range can still harbor significant metabolic risk. 3 For patients with a BMI…

…Contraindications The laryngeal mask is a compromise and does not protect the airway completely. Relative contraindications: A high risk of aspiration: a non fasted patient…

…conduction. Clinical Presentation and Symptoms Patients with atrial flutter typically present with symptoms related to high ventricular rates and the loss of the atrial kick…

…patients with ANOCA/INOCA, symptoms may persist despite non obstructive coronary anatomy. Such patients require a mechanism based assessment rather than reassurance based solely on…

…available material does not establish a significant increase in late morbidity or mortality attributable to these events. Clinical presentation and symptoms Most patients with stent…

…Pathophysiology Stress echocardiography is a functional cardiac imaging technique used primarily to identify inducible myocardial ischaemia and to estimate prognosis in patients with suspected or…

…value. A normal INR and a normal APTT do not exclude DOAC effect. Duplicate therapy. Check that the patient is not simultaneously on a DOAC…

…for a superficial, compressible vessel. Allen's test is still used in many units to assess the collateral circulation, but the test does not reliably…

…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…

…The patient sits leaning forward with the arms on a table for diagnostic and therapeutic aspiration; for drain insertion the supine position is used with…

…anticipated effect of the result on management. ICA with available coronary pressure assessment is recommended in patients with a very high clinical likelihood of obstructive…

…anion gap, is there a further metabolic disturbance? Calculate the delta gap or delta ratio 6 Does the result fit the patient? If not, check…

…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…

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

…the haptoglobin. A tourniquet left on during sampling raises the potassium, calcium and proteins. Fasting is required for triglycerides but not for cholesterol, nor for…

…unlikely to revert a tachycardia and should not be used. Specific dosing adjustments are required in certain patient populations: Pediatric patients: For patients weighing less…

…Starting a modified release preparation before the daily requirement is known. Duplication. Check that the patient is not already on an opioid patch, a modified…

…among high risk patients. The strategy may, however, increase peri procedural complications and bleeding. Clinical presentation The available source material does not provide a detailed…

…of follow up in a prospective study of patients with acute coronary syndrome. Thus, an individual plaque’s morphology does not reliably establish that it…

…the sinoatrial node does not discharge an impulse for ≥2 seconds. Failure to discharge an impulse within <2 seconds is defined as a sinoatrial pause…

…while a left main coronary stenosis of at least 50% is considered significant. These thresholds describe luminal narrowing, not necessarily the physiological effect of the…

…as high as the occipital area but does not radiate below the umbilicus. It is often accompanied by sweating, nausea, vomiting, anxiety, and a sense…

…and other therapies have failed. Patients with structural heart disease or reduced left ventricular function are not eligible. Effects of propafenone and flecainide on ECG…

…Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms…

…high flow oxygen therapy (100% FiO2) should be provided to maintain arterial oxygen saturation levels above 95%. Given the young age of these patients and…

…three components: diabetes or hyperglycaemia, ketosis and metabolic acidosis. A very high glucose value is no longer required [1]. Diabetic ketoacidosis, DKA Hyperosmolar hyperglycaemic state…