…rather than lipid lowering. Other anti inflammatory strategies have produced less favourable results. Canakinumab, a monoclonal antibody directed against interleukin 1β, provided proof of…

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

…compared to conventional CPR in patients with refractory out of hospital cardiac arrest. Patients aged 18 to 70, who received bystander CPR and initially presented…

…nonpharmacological management should be actively implemented. Adults with blood pressure ≥140/90 mmHg should receive both lifestyle and antihypertensive drug therapy. For grade 1 hypertension…

…C by approximately 50–60%, including in patients receiving background statin therapy and in those unable to tolerate statins, provided that hepatic LDL receptor expression…

…be counteracted with simultaneous administration of norepinephrine. All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g. arterial line…

…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…

…and potential adverse effects, consideration should be given to initiating therapy with the patient hospitalized and monitored for at least several days. Intravenous Loading For…

…Cardiology) Preparations for the examination Patients referred for echocardiography should receive information regarding the conduction of the examination. Some patient engagement is required to obtain…

…be normal (QRS duration <0.12 s), because both bundle branches receive the impulse and spread it. If the impulse is discharged distal to the…

…indicated if the patient remains significantly decompensated, because recurrence is frequent while the precipitating haemodynamic and sympathetic abnormalities persist. Immediate cardioversion is reserved primarily for…

…though cardioversion will occur Target rate in the acute phase: a resting ventricular rate < 110/min is a sufficient initial target in most patients…

…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…

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

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

…0–2% in patients with an eGFR of 30–44 mL/min/1.73 m2 and up to 17% when eGFR is below 30 mL…

…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…

…Dry, necrotic, pale Variable, often deep Pain Moderate, relieved by elevation Severe, worse on elevation, better when dependent Often painless (neuropathy) Surrounding skin Hyperpigmentation, oedema…

…of STEMI patients should be organized regionally (including all components from the emergency medical dispatch to catheterization laboratory) in order to provide reperfusion therapy as…

…Various pharmaceutical agents, including epinephrine—administered to the vast majority of cardiac arrest patients—can induce such pupillary responses. In a comprehensive study by Javaudin…

…is most pronounced and extends towards the penumbra zone (the outermost and less ischemic area), which may receive oxygen from collateral vessels. In cardiac arrest…

…drug therapy as compared with implementing an artificial pacemaker in order to be able to continue drug therapy. It is very common that patients with…

…but it may be considered in selected patients with a high bleeding risk. Shorter approaches should therefore be reserved for circumstances in which bleeding concerns…

…branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for those wit

…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…

…defibrillation (unsynchronized shock) is reserved for ventricular fibrillation, where urgent reversion to sinus rhythm is required. The rationale for electrical therapy over drugs is that…

…particularly in patients with microvascular dysfunction or vasospasm. Angina associated with microvascular disease or vasomotor abnormalities may not be predictably exertional or relieved by rest…

…weight gain, peripheral edema, early satiety, abdominal distension and, in some patients, bendopnea. Congestion may also aggravate functional mitral regurgitation, ventricular dilatation, myocardial wall stress…

…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…

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…

…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…

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

Procedurer Transcutaneous pacing takes seconds to start and can keep a patient alive until a transvenous lead is in place — but only if it is…

…drugs, and how many doses, has the patient taken? Is the patient on an inhaled corticosteroid or other anti inflammatory treatment? Previous intensive care, intubati

…main clinical rule Two questions determine the initial management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2…

…hepatologi Akutsjukvård Lathundar Immediate orientation Two questions govern the initial management: 1. Is the patient haemodynamically compromised, or are there signs of ongoing major bleeding…

…each time Always, once per patient if no valid result exists Type and screen (BAS test) Blood group confirmation and antibody screening. If the screen…

…nothing else. The two ways in which casting harms the patient are that it is too tight — the swelling comes after the injury, not before…

…older adults: quick reference A quick reference for ward and on call physicians: recognise hypoactive delirium, stabilise the patient, work systematically through the possible causes…

…What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was preoxygenated…

…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)…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…and then selecting a targeted examination. The patient's description of the quality of the dizziness — rotatory vertigo, unsteadiness or faintness — discriminates poorly between dangerous…

…place, the electrodes come off, the patient has not kept a diary. The set up and the instructions decide whether the investigation will be usable…

…at an eGFR <45 mL/min. A short course (no more than 7 days) may be given to selected patients with an eGFR of 30…

…compression. The reason compression nevertheless so often fails is that it is done wrongly: the patient pinches the nasal bone instead of the soft part…

…Staff with current CPR competence; a physician available. Patient preparation: A light meal is permitted; no large meal, no coffee and no nicotine in the…

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…

…done wrongly. The two commonest errors are that an intramuscular injection in fact ends up subcutaneously in a patient with a high BMI, and that…

…needle itself. It is the decision whether to perform it now or after imaging, how the patient is positioned, which needle is chosen, and that…

…the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…

…What usually goes wrong is not that the patient gets too little oxygen but that the prescription has no target — the nasal cannula stays in…

…gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than…

…result can be interpreted. What decides that is whether the patient is taking a steroid that cross reacts in the cortisol assay, whether the samples…

…seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the patient regaining consciousness between them. Five minutes is the practical threshold…

…°C has not been shown to improve survival or the neurological outcome compared with keeping the patient normothermic — but fever after cardiac arrest is harmful…

…whether the treatment is safe is not the starting dose but the system around the patient : that the weekly dose is adjusted in small steps…

…in therapy: implantable cardioverter defibrillators (ICDs) are highly effective, terminating well over 99% of the ventricular arrhythmias they detect. It lies instead in patient selection…

…outcomes in CCS. General strategy For most patients, initial therapy consists of a beta blocker and/or a calcium channel blocker (CCB). If symptoms remain…