…in impaired left ventricular function and together with an intravenous beta blocker Digoxin In heart failure or hypotension, or as an add on Slow onset…

…tablets) on days 1 and 2 in patients over 75, with a weight below 60 kg, heart failure, hepatic impairment, malnutrition, concurrent amiodarone or known…

…onset of the disease. Approximately 12% die within 30 days, compared to the 30 day mortality of STEMI (ST segment elevation infarction) , which is about…

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

…on the route of administration. Intravenous (IV) amiodarone generally acts within 1 to 2 hours. Oral onset is delayed, typically requiring 2 to 3 days…

…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…

…7 days Cat bite within 2 days phenoxymethylpenicillin 1 g × 3 10 days Cat bite after 2 days, close to a joint or on the…

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

…list (metformin, NSAIDs, RAAS blockade, gabapentin, direct oral anticoagulants) and refer to nephrology at an eGFR < 30, with rapid deterioration, or with A3 albuminuria.

…steroids Note them on the request form — they can themselves cause HPA suppression and are often the very question at issue A patient who needs…

…and efficacy of an approach based on starting and titrating oral medical therapy for heart failure within 2 days before anticipated hospital discharge and in…

…angina. The initial clinical distinction depends on symptoms, serial electrocardiography, and cardiac troponin findings. The default treatment after ACS, whether or not PCI is performed…

…in renal failure Ketobemidone IV 2.5–5 mg Oral bioavailability about 35 per cent Paracetamol PO or IV 1 g × 4 The basic analgesic…

…in the skin or subcutis. Pilonidal abscess, hidradenitis abscess and paronychia with a collection of pus. Persistent painful induration after a few days of antibiotics…

…simply by their effects on haemoglobin A1c. Clinical benefits have been demonstrated in several overlapping populations: T2DM with established cardiovascular disease or high cardiovascular risk…

…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…

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

…6°C (97.7 99.7°F). It arises when heat production or acquisition surpasses the body's capacity for heat elimination. Hyperthermia can induce an inflammatory…

…pericarditis or endocarditis. Acute aortic dissection. Physical inability to perform the test safely. Relative: Condition Comment : : Left main stenosis Known — perform the test only on…

…and prognosticate survival. However, exercise stress testing must not be performed within 4 to 6 days after acute myocardial infarction. Moreover, early exercise tests should…

…µmol/L within 48 hours. A rise in creatinine to at least 1.5 times baseline, known or presumed to have occurred within 7 days…

…often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high after hip fracture, major…

…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…

…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…

…deal in a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that…

…before a blood count is available. The nadir often occurs 7 to 14 days after a course of chemotherapy, but the timing varies considerably between…

…artery, which runs on the posterior aspect of the rectus muscle along its lateral border and is the commonest source of serious bleeding after paracentesis…

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

…its own thresholds in the patient on anticoagulants; see the acute stroke quick reference. Stopping the drug and forgetting to restart it after the procedure…

…typically followed within hours to days by evolving T wave inversions and often by the development of Q waves in the same lead distribution [15…

…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…

…wave to synchronise to; sync mode would block the shock entirely The patient Awake or sedated — requires sedation Unconscious In polymorphic VT, sync must be…

…intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory failure, impaired consciousness, or a need for a vasopressor After initial…

…by exercise duration, workload or metabolic equivalents, is among the strongest predictors of mortality in patients with cardiovascular disease after accounting for age. Chronotropic response…

…infarction (STEMI) is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia…

…70, who received bystander CPR and initially presented with a ventricular arrhythmia without return of spontaneous circulation within 15 minutes, were included. At 30 days…

…suddenly or over several days? Which drugs, and how many doses, has the patient taken? Is the patient on an inhaled corticosteroid or other anti…

…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…

…or to identify the precise location of excess adiposity. 2 Clinical guidelines now emphasize that a BMI within the conventional "normal" range (up to 25…

…Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on the same side. A paretic limb — poorer absorption…

…and the decision on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of…

…days — because new antibodies can form after transfusion or pregnancy. Check the validity before ordering blood ; an expired type and screen discovered when the patient…

…screening interval the patient happens to be — a recently taken normal smear is no reason to refrain from investigating postmenopausal bleeding or a visible cervical…

…Hypoglycaemia on the ward is more dangerous than moderate hyperglycaemia over a few days. Principles Insulin component Function Who needs it : : : Basal insulin (intermediate or…

…Apply the tourniquet only after the block has taken effect, and note the time. It must not stay on for longer than 20–30 minutes…

…obstruction or gastric retention — the commonest indication on a surgical ward. Decompression in severe vomiting where the stomach does not empty. Intraoperatively and postoperatively after…

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

…in chest trauma and postoperatively. Emergency needle decompression: a clinical suspicion of tension pneumothorax in a haemodynamically or respiratorily unstable patient. Contraindications In tension pneumothorax…

…Threshold for surgery Relevant patient category 27.5 mm/m 2 Turner syndrome 40 mm • Patients with mutations in TGFBR1, TGFBR2 or Loes Dietz syndrome…

…HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy…

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

…typical flutter. Furthermore, typical flutter frequently emerges in patients undergoing pharmacological treatment for AF with class IC drugs or amiodarone. In these instances, the flutter…

…It may also reduce treatment inertia, in which patients remain on an inadequate single drug regimen for prolonged periods. The evidence supports improved blood pressure…

…intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal lesions that are not apparent on conventional angiography. Coronary vasomotor disorders…

…A quantitative CAC score from dedicated testing, or a qualitative assessment of CAC on a non gated chest CT, can modify the estimated likelihood of…

…The electrocardiographic appearance depends on several interacting factors: The stage of the ischaemic process: acute, evolving or chronic The severity of ischaemia and whether infarction…

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

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

…The occlusion may be complete or partial, depending on the size of the thrombus and the plaque. The patient will experience severe chest pain due…

…syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or other symptoms that may be…