…as an add on Slow onset. Dose reduction in renal failure and in old age Amiodarone In severe haemodynamic compromise where the above cannot be…

…to the anticoagulation clinic, and a decision on who will dose during the first week. Written patient information: the Waran booklet (the Swedish warfarin patient…

…the value of echocardiographic examination depends on the pre test probability, which is the probability that the patient actually has endocarditis (this the probability should…

…Patient preference and the balance of risk and benefit determine whether treatment is initiated. High 3 9 As above. Very high Oral anticoagulation (warfarin or…

…monitoring. The onset of action depends on the route of administration. Intravenous (IV) amiodarone generally acts within 1 to 2 hours. Oral onset is delayed…

…infection or gastroenteritis at home Double or triple the oral daily dose during the days of illness (the patient's sick day rules) Vomiting or…

…bacteriuria. The exceptions are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin…

…difficulties that prevent the patient from cooperating. Suspected base of skull fracture or marked coagulopathy argues against the nasal route; the oral route may then…

…1 % suggests a prerenal cause, above 2 % acute tubular necrosis — but the value is unreliable during diuretic therapy, where a fractional excretion of urea below…

…not cross react in the cortisol assay and can be given as steroid cover during the test Oestrogen and the combined oral contraceptive These raise…

…Early Post Discharge Management The STRONG HF trial demonstrated the safety and efficacy of an approach based on starting and titrating oral medical therapy for…

… the type of revascularization; stent related risk; whether long term oral anticoagulation is required; tolerance of treatment during the initial months. Patients with HBR are…

…Duplication. Check that the patient is not already on an opioid patch, a modified release tablet and an as required opioid at the same time…

…abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected…

…However, the cardiovascular effects of SGLT2 inhibitors are not explained simply by their effects on haemoglobin A1c. Clinical benefits have been demonstrated in several overlapping…

…patients with acute pain, anxiety, or distress have transient BP elevation that improves when the precipitating state resolves. The distinction is therefore not based on…

…Route : Oral. Prasugrel can be taken with or without food. Administering a 60 mg loading dose on an empty stomach may provide the fastest onset…

…J, Toivio T, et al. Does appropriate treatment of the primary underlying cause of PEA during resuscitation improve patients’ survival? Resuscitation 2012;83:81922. Mroczek…

…and on symptoms. 4. Blood pressure every second minute and on symptoms. 5. Ask actively about chest pain, breathlessness and leg fatigue; have the patient…

…85%). Many patients appreciate the exercise test because it offers them an opportunity to evaluate their performance and symptoms under the supervision of their clinician…

…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…

…the condition [1,2]. Delirium is common but often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the…

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

…pressure during inspiration; one of the most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not exclude Diastolic collapse of the…

…adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly unstable. Transcutaneous pacing Equipment A defibrillator with a…

…Infektionssjukdomar Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be…

…to the rectus sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a patient…

…and the findings of the ambulance crew The stated dose is often unreliable and must never be used on its own to declare the patient…

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

…point. The diagnostic criteria require new ST elevation in at least two contiguous leads [8, 10]. The specific voltage thresholds vary based on patient age…

…the patient are that it is too tight — the swelling comes after the injury, not before — and that an edge or a fold presses on…

…then reserved for patients with a CHA₂DS₂ VA score of 0–1. Check what applies in your own region. Duration above the threshold or unknown…

Infektionssjukdomar Akutsjukvård Lathundar Purpose and scope A quick reference for the doctor on call faced with suspected sepsis in adults: rapid recognition, microbiological sampling, empirical…

…a patient performs progressively increasing external work, usually on a treadmill, while symptoms, a 12 lead ECG, heart rate and blood pressure are monitored. The…

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

…or low flow periods. Under such circumstances, the efficacy of compressions and defibrillation diminishes considerably. Extracorporeal Life Support (ECLS) emerges as the sole therapeutic alternative…

…rising pCO₂ during an ongoing severe asthma attack is an alarm sign. Early in a severe attack the patient usually hyperventilates and the pCO₂ is…

…not intubate every patient routinely before endoscopy. Observational data do not show that prophylactic intubation reduces aspiration or mortality. It has on the contrary been…

…focusing primarily on hemoglobin A1c (HbA1c) reduction, blood pressure, lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence…

…nerve and the superior gluteal artery are avoided. The patient lies on their side with the knee slightly flexed. Place the palm on the greater…

…cancer and previous venous thromboembolism. A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full…

…the validity before ordering blood ; an expired type and screen discovered when the patient is already bleeding costs precious time. Exact validity periods and the…

…For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination must…

…12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in inpatients. Hypoglycaemia on the ward is…

…disease — a risk of osteomyelitis and poor healing. Check the ankle brachial index and the foot status before any procedure on a toe. Critical ischaemia…

…when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see the separate text on gastric…

…why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off into a respiratory acidosis…

…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…

…root morphology. Age stratified formulas help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of aortic root dilation. Key…

…Lip GY. Performance of the HEMORR₂HAGES, ATRIA, and HAS BLED bleeding risk prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS study. J…

…lies instead in patient selection. Because implantation entails appreciable cost and procedural risk, the risk benefit balance depends almost entirely on the capacity to identify…

…ECG Definition and Pathophysiology Atrial flutter is defined by a macroreentrant atrial circuit, which manifests on the electrocardiogram (ECG) as organized, continuous atrial electrical activity…

…treatment inertia, in which patients remain on an inadequate single drug regimen for prolonged periods. The evidence supports improved blood pressure control and adherence, although…

…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)…

…dedicated testing, or a qualitative assessment of CAC on a non gated chest CT, can modify the estimated likelihood of atherosclerotic obstructive CAD. CAC is…

…Nausea and vomiting Anxiety A sense of impending doom When STEMI begins during exertion, the symptoms generally do not resolve simply with cessation of activity…

…and ventricular arrhythmias is greater in patients on digoxin or verapamil, although this is not an established drug interaction. The half life of adenosine is…

…ecotdense masses on valves should lead to suspicion of endocarditis (the masses are vegetations). The risk of endocarditis is especially high for patients with valve…

…ST depressions and/or T wave inversions. Patients with NSTE ACS (NSTEMI, unstable angina), on the other hand, may only display ST depressions and/or…

…in the size of the thrombus. This means that a patient who experienced chest pain at home may be asymptomatic during the assessment in the…