…patient does not consent — the examination must then not be carried out. Vaginismus or marked anxiety — plan for extra time, a smaller speculum, possibly a…

…cardiovascular disease, including PAD Conversely, patients with CVD should be screened systematically for diabetes because undiagnosed T2DM is common and has major therapeutic and prognosti

…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…

…patient — the device senses the rhythm through the cable, not through the pads. A pulse oximeter, a blood pressure cuff, and an arterial line for…

…If the screen is negative, a unit is selected electronically against the blood group Standard for planned transfusion in a patient without irregular red cell…

…Moreover, early exercise tests should not be maximal, which means that the clinician must set a lower goal regarding workload (e.g. reaching 70% of…

…also a common tachyarrhythmia requiring treatment in decompensated heart failure (DHF). In the critically ill patient, AF may be pre existing, newly detected for the…

Akutsjukvård Lathundar Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG…

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…

…lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient…

…so as not to reduce a fracture dislocation or to miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with…

…situations that argue for the operating theatre rather than the emergency room: a very large or deep abscess, a markedly unwell patient with fever and…

…pressure ; gravity is not enough. Lidocaine 10 mg/mL to anaesthetise the marrow cavity in a conscious patient. Fixation material for the intraosseous needle. Procedure…

…A D dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10…

…tightened the former 48 hour rule for patients with risk factors. Check what applies in your own region. The time limit is not a guarantee…

…not wait for a complete work up of the cause or for imaging. 6. Document the starting time, the baseline plasma sodium, the target for…

…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…

…in a fresh injury, before surgery, or while swelling is progressing. Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel…

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

…can precipitate circulatory collapse in a tamponaded patient , since positive airway pressure further reduces the venous return. Procedure Choice of access The ultrasound, not tradition…

…cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated. A decision to withhold further life…

…arms, an arm circumference too large for the available cuffs, and in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set…

…a route of administration and a target range for the saturation . What usually goes wrong is not that the patient gets too little oxygen but…

…does not radiate below the umbilicus. Epigastric or subxiphoid pain may be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense…

…Follow the patient's prescription, if it is clinically reasonable Give oxygen if the patient is hypoxaemic. Oxygen is not a treatment for dyspnoea as…

…anuria for at least 12 hours Use whichever criterion gives the higher stage. A patient can thus be stage 3 by urine output despite a…

…for a single course of treatment Trimethoprim 160 mg twice daily 160 mg twice daily 160 mg twice daily 100 mg twice daily Do not…

…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…

…in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the right course, not RSI. Assess the airway first LEMON for a…

…coronary and renal perfusion, particularly in patients with long standing hypertension and a rightward shifted autoregulation [1,3]. The term hypertensive urgency is best avoided…

…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…

…after the endoscopy. Fluid and monitoring Use a balanced crystalloid in the first instance. Give small boluses, for example 250 to 500 mL, with immediate…

…and the patient is also receiving LMWH, for example in newly diagnosed venous thromboembolism. 1. Check the INR before the first dose. A raised baseline…

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

…and myocarditis should not be classified as MINOCA when they are established as the explanation for the presentation. Clinical presentation and symptoms Patients typically present…

…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…

…be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1…

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

…among others. Acute severe balance disturbance without nystagmus: HINTS does not apply. Assess gait and truncal stability and investigate for a central cause. Acute vestibular…

…or a dressing to protect an ulcer, and where needed a photoplethysmograph and a toe cuff. Preparation: The patient must have rested lying down for…

…pressure , rolling it, for 4–5 seconds until a grey eschar forms. Start peripheral to the bleeding point and work inwards towards the centre. 4…

…measure in decontamination, and gastric lavage is today a rare procedure reserved for very serious poisonings in which the patient reaches hospital early. The benefit…

…1 hour and follow the plasma glucose closely for at least 6 hours after insulin. 7. Contact nephrology early in anuria, in a dialysis patient…

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

…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…

…care programme for bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even with a reduced…

…is not sufficient. A fixation dressing for the nose, a vomit bowl, tissues, and a glass of water with a straw if the patient is…

…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…

…days duration. Vernakalant does not convert atrial flutter to sinus rhythm. Vernakalant is only administered in a monitored clinical setting appropriate for cardioversion. Administration of…

…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…

…but account for a substantial proportion of sudden cardiac death in young athletes. Clinically, they may be categorized according to whether they are: Not associated…

…incidentally identified on a chest CT performed for another indication can also contribute to risk assessment. Visual reporting of coronary calcification using four categories—none…

…Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased…

…therefore not an automatic response to chest pain. It is appropriate when the expected information is likely to change management. In patients with a very…

…with a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical histories should undergo appropriate screening for secondary…

…although older patients also have more contraindications and a greater risk of bleeding and myocardial rupture. Late presentation For patients presenting more than 12 hours…

…drugs predisposing to bleeding and alcohol use. A high bleeding risk score should prompt correction of modifiable risk factors and closer surveillance; it does 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…

…is inversely related to age, such that the younger the patient presenting with hypertrophy, the more likely a genetic etiology. The genetic mechanisms underlying hypertrophic…