…used — a woman who does not attend for a gynaecological examination, or who prefers to take the sample herself, is given a vaginal self sampling…

…reduction is not demonstrated in every intervention study. Cardiovascular Risk Assessment Screening for cardiovascular and kidney disease All patients with diabetes should be assessed for:…

…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…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly…

…green) for rapid transfusion, preferably two lines in a bleeding patient. A transfusion set with a filter. Blood components must not be given through a…

…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…

…long term risk of stroke. In patients with acute decompensated heart failure, AF with rapid ventricular response is particularly important. Cardioversion is generally not immediately…

…needed. Intubate for a threatened airway, a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation…

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

…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…

…not with force. The methods that work best exploit time, gravity and slow movement; those that fail usually do so because the patient tenses up…

…oral or intravenous analgesia, or procedural sedation in advance. Inadequate analgesia is the commonest reason for an incompletely performed drainage. Procedure 1. Locate the centre…

…a suitable vein). Standby access in a patient at risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock…

…Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the…

…hours, not 48. The 2024 ESC guidelines and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors…

…for example hypoglycaemia, poisoning, stroke, meningitis and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or does not fit…

…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…

…Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against…

…outcome in sepsis and in several studies of neutropenic patients. In septic shock, or where sepsis is highly likely, antibiotics must be given immediately [3]…

…A fall in systolic blood pressure during inspiration; one of the most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not…

…target value that must never be exceeded, during the first 72 hours for as long as the patient remains unconscious. The evidence Trial Question Result …

…more often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept a…

…cannula stays in place for days without anyone asking why, or the patient at risk of carbon dioxide retention is given 15 litres on a…

…for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense of impending doom When STEMI begins during exertion, the symptoms generally do not…

…if the patient is hypoxaemic. Oxygen is not a treatment for dyspnoea as such and must not be given uncontrolled simply because the patient feels…

… 2. Is the patient hypovolaemic, adequately filled or fluid overloaded? 3. Is there, or is there approaching, an indication for dialysis? AKI occurs in about…

…2025/2026 and are given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger…

…not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for example — may be…

…not looked for afterwards. Monitoring: ECG, pulse oximetry and blood pressure at short intervals. Tube size and depth Patient Internal diameter (mm) Depth at the…

…the pressure, but emergency department studies show that raised values often persist after the visit and predict future hypertension and cardiovascular risk [3]. Questions that…

…choose a manual technique or refer to ENT): Condition Reason : : Diabetes, immunosuppression A risk of necrotising otitis externa Anticoagulant treatment Bleeding into the ear canal…

…given. In massive bleeding, the decision to transfuse must therefore not be based on the haemoglobin alone [3]. The airway Do not intubate every patient…

…first choice in Sweden. Warfarin is started today because there is a reason to reject a DOAC , not as the standard option. Contraindications Ongoing clinically…

…Detecting exercise induced arrhythmias Evaluating the blood pressure response Refining risk stratification and prognosis For patients with low or moderate pre test likelihood of obstructive…

…atherosclerotic risk factors. A substantial proportion present with NSTEMI, although STEMI occurs in approximately one third. Patients with MINOCA related STEMI generally do not have…

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

…test can therefore be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be…

…is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left atrial size must also be considered. Patients…

…worse when the patient moves the head is therefore not evidence of BPPV. Step 2: decide whether HINTS may be used HINTS stands for Head

…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…

…the patient blow out the clot. The pinch is applied to the lower third of the nose, the soft part , and held continuously for at…

…harm the patient through aspiration. Contact your national or regional poison control centre before you decide, not afterwards. Indications Medicinal charcoal is given after the…

…for dialysis ECG changes or serious neuromuscular symptoms mean a high risk even if the plasma potassium is below 6.5 mmol/L. Conversely, patients…

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

…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…

…the puncture, and antibiotics and a corticosteroid are then given immediately after blood cultures. For questions other than acute meningitis — an insidious onset, known malignancy…

…not empty. Intraoperatively and postoperatively after major abdominal surgery, according to local practice. Enteral nutrition and drug administration when the patient cannot swallow safely, for…

…Show for yourself what a maximal blow looks like. The patient sits upright with both feet on the floor and must not lean forward during…

…kg should not be given within 24 hours. If conversion to sinus rhythm is not successful, blood pressure and ECG should be observed for an…

…patients after acute myocardial infarction (MI), antianginal drugs have not been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients…

…Angiography also provides limited information about plaque composition, vulnerability and the risk of future plaque rupture. Anatomical severity versus functional significance The physiological effect of…

…asymptomatic individual is not supported by the available evidence described here. Systematic screening of the general population for cardiovascular risk factors has not been shown…

…acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction…

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

…considered in every patient with newly diagnosed or referred hypertension, with particular vigilance when the clinical history includes hypokalaemia. Endocrine disorders account for many secondary…

…bleeding risk is high, the diagnosis is uncertain, cardiogenic shock is present, or symptoms have been present for more than 2–3 hours. Patients with…

…factor for thromboembolism, including ischaemic stroke. This risk applies across the clinical patterns of AF—paroxysmal, persistent, long standing persistent and permanent—and is not…

…beta blockers actually increase chronotropic competency in patients with heart failure, despite their negative chronotropic effect. Among persons who do not suffer from heart failure…

…ventricular hypertrophy under normal loading conditions. Hypertrophic cardiomyopathy should not be confused with hypertrophy caused by increased loading conditions. Increased ventricular load is mostly caused…