…patient who is clinically unwell must be managed as an emergency even at a lower temperature. Suspect neutropenia in anyone who has received cytotoxic chemotherapy…

…including pexelizumab, losmapimod and darapladib, failed to demonstrate clinical benefit in the settings studied. Clinical application and patient populations The evidence for anti inflammatory treatment…

…Presently, this treatment is confined to well equipped centers and is generally reserved for meticulously selected cases. Extracorporeal Life Support (ECLS) encompasses several extracorporeal systems…

…Adults with blood pressure ≥140/90 mmHg should receive both lifestyle and antihypertensive drug therapy. For grade 1 hypertension, pharmacological treatment has demonstrated cardiovascular benefit…

…and prevent its interaction with the hepatic LDL receptor. They lower LDL C by approximately 50–60%, including in patients receiving background statin therapy and…

…two treatment groups with respect to either the primary or secondary outcomes. Primary outcome events occurred in 49% of patients in the milrinone group and…

…near the ventricular cavity, and it may to some extent receive oxygen from the blood in the ventricular cavity. The right bundle branch then runs…

…major active metabolite. Both the parent drug and its metabolite accumulate extensively in various tissues, including the liver, lung, fat, and skin, with myocardial concentrations…

…examination Patients referred for echocardiography should receive information regarding the conduction of the examination. Some patient engagement is required to obtain all views and the…

…patient for 24 hours (including ECG monitoring). In all other situations, the underlying condition should be targeted and, if necessary, bradycardia should be treated (treatment…

…the course of treatment. Even transient, self terminating AF during ST elevation myocardial infarction may indicate an increased long term risk of stroke. In patients…

…stable patient Drug Situation Comment : : : Beta blocker (metoprolol) First choice in most cases The IV dose is titrated slowly. Caution in acute heart failure and…

…reserved for very serious poisonings in which the patient reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and…

…haemodynamic responses, arrhythmias and prognosis, with diagnostic interpretation reserved for appropriately selected patients. Pathophysiological basis Exercise progressively increases myocardial oxygen demand through increases in heart…

…most clinicians who encounter patients with pacemakers only have access to conventional surface ECGs. Being able to assess pacemaker function and perform troubleshooting should be…

…concurrent nephrotoxic drugs, including NSAIDs; and repeated or high volume contrast exposure. Patients with multiple myeloma and renal disease are particularly susceptible. The risk is…

…or heaviness [7]. Classically, it is initiated by exertion or stress and is relieved by rest or nitroglycerin [4], [6]. Presentation Nuances: While typical angina…

…to 24 hours for patients with risk factors; cardioversion between 24 and 48 hours without ongoing anticoagulation is then reserved for patients with a CHA₂DS₂…

…treatment that heals venous leg ulcers; everything else is supportive. But the same compression applied to a limb with arterial insufficiency can cause necrosis and…

…I C Angiography within 24 h is recommended if symptoms are completely relieved and ST segment elevation is completely normalized spontaneously or after nitroglycerin administration…

…ROSC), the midbrain may receive enough oxygen to preserve some pupillary reflex. Importantly, pupillary size and reactivity are influenced by factors beyond neural activity. Systemic…

…contractions leads to a marked reduction in cell metabolism and thus prolongs survival. Myocardial stunning starts to normalize within minutes after the hypoxia is relieved…

…blockers) without the risk of worsening the bradycardia. Persons with sick sinus syndrome should receive an artificial pacemaker to reduce symptoms and increase function. However…

…comparative evidence between prasugrel and ticagrelor is conflicting. A 12 month regimen remains the default for most patients with ACS, including those with NSTE ACS…

…by bradycardia. Most cases involve a mixed response of both hypotension and bradycardia. However, some patients exhibit a primary cardioinhibitory response with pronounced bradycardia. Most…

…apparent, and pseudo resistant hypertension The term resistant hypertension should be reserved for patients in whom the diagnosis has been carefully confirmed. Apparent resistant hypertension…

…a precisely regulated electrical shock to terminate a tachyarrhythmia, and it encompasses both synchronized cardioversion and defibrillation ; the key distinction is timing relative to the…

…many patients report less characteristic symptoms, while others present primarily with exertional dyspnoea. Symptoms should be characterized systematically, including: Onset and duration. Location and radiation…

…dysfunction, or both. The clinical consequences of extracellular volume expansion include elevated cardiac filling pressures, pulmonary congestion, systemic venous hypertension, and peripheral interstitial edema. These…

…the elderly also tend to have more atherosclerosis (both in frequency and severity) which may compensate for the inability to reach their maximal heart rate…

…course deviates from what was expected. The poison control centre is the authoritative local source for the current indication, dosing, sampling and duration of treatment…

…local protocol. Alternatives when there is a contraindication: catheter directed treatment or surgical embolectomy where available. A vasopressor (noradrenaline) and cautious fluid administration. Large fluid…

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

…channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia…

…delay inhaled treatment. 8. Reassess speech, work of breathing, level of consciousness and air entry repeatedly. 9. Measure PEF or FEV1 if the patient can…

…4. Where possible, take the plasma osmolality, urine osmolality and urine sodium before treatment. 5. With severe symptoms: give hypertonic saline immediately. Do not wait…

…the patient haemodynamically compromised, or are there signs of ongoing major bleeding? 2. Is there cirrhosis, or another strong suspicion of portal hypertension? Variceal and…

…planned transfusion in a patient without irregular red cell antibodies Serological crossmatch (MG test) Serological crossmatching between the recipient's plasma and the red cells…

…closed circumferential cast , and the patient must leave with clear information about the symptoms that should make them seek help immediately. Indications An undisplaced or…

…developed over hours to days Fluctuating course Symptoms vary over the day and may appear temporarily to have resolved Inattention The patient loses the thread…

…first attempt fails. Desaturation and unrecognised oesophageal intubation are the two mechanisms that kill patients during airway management , and both are predictable. Indications Inability to…

…the patient has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia, and no…

…ventilation. Home oxygen and the patient's usual saturation. Previous exacerbations and hospital admissions. Current inhaled treatment and adherence. Opioids, benzodiazepines and other sedating drugs…

…patients with a central cause. A normal routine neurological examination is therefore not sufficient to exclude stroke [3]. Step 1: classify by time course and…

…or a dialysis fistula in both arms, an arm circumference too large for the available cuffs, and in a patient who does not tolerate repeated…

…times daily Pivmecillinam Dosed independently of renal function for a single course of treatment Trimethoprim 160 mg twice daily 160 mg twice daily 160 mg…

…An unsecured airway or haemodynamic instability — stabilise the patient first. Marked septal deviation towards the bleeding side (relative). Preparation and equipment Personal protective equipment (gloves…

…before revascularisation. Evaluation of treatment effect in stable angina. Exercise induced arrhythmia or exercise induced syncope. Assessment of chronotropic function and pacemaker settings. Preoperative functional…

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

…a patient with a high BMI, and that the deltoid injection is placed too high — which causes the shoulder injury known as SIRVA. Both are…

…2. Identify the level. Palpate both iliac crests and draw an imaginary line between them. The line crosses the midline at approximately L4. Puncture at…

…Procedure 1. Inspect both nasal passages and choose the more patent one. Ask the patient about a previous nasal fracture or unilateral nasal obstruction. 2…

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

…the patient tenses up with pain, or because the operator pulls harder rather than more slowly. The neurovascular status must be documented before and after…

…points — follow the local instructions, but where the response is equivocal both are valuable. 7. Observe the patient throughout the test and for 15 minutes

…if the patient does not wake or if ongoing electrographic seizure activity is suspected Benzodiazepines are the established first line treatment. Intravenous lorazepam and diazepam…

…keeping the patient normothermic — but fever after cardiac arrest is harmful, it often arises spontaneously, and it must be actively prevented. The treatment has therefore…

…indication: LMWH at treatment dose in parallel. Procedure Initiation with a loading dose Used when a rapid effect is wanted and the patient is also…

…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…

…in selected patients. Treatment choices should be integrated with management of precipitating factors such as anaemia, uncontrolled hypertension, thyrotoxicosis, tachyarrhythmia, uncontrolled heart failure, and concomitant…