…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…

…COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial infarction. Participants received colchicine 0.5 mg once daily or placebo. The primary…

…ECLS) emerges as the sole therapeutic alternative for such situations. Presently, this treatment is confined to well equipped centers and is generally reserved for meticulously…

…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…

…Indications PCSK9 inhibitors are used as additional lipid lowering therapy in patients whose LDL C remains above the recommended goal despite maximally tolerated statin therapy…

…All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g. arterial line, PiCCO, central venous catheter). The hemodynamic effects…

…off any Purkinje fibers during its course through the interventricular septum. It starts to branch off at the anterior papillary muscle's origin. The interventricular…

…even in patients with left ventricular dysfunction, though those with depressed ejection fraction should receive it with great caution due to the risk of hypotension…

…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…

…discharging impulses until the sinoatrial node recovers and starts discharging. Less than 3 consecutive beats (or from a latent pacemaker (or any other ectopic focus…

…the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during management of an acute illness. The…

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

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

…most consistent contemporary role is therefore the assessment of functional capacity, symptoms, haemodynamic responses, arrhythmias and prognosis, with diagnostic interpretation reserved for appropriately selected patients…

…which enables the clinician to examine intracardiac ECGs at any time. However, most clinicians who encounter patients with pacemakers only have access to conventional surface…

…to contrast alone difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with…

…or stress and is relieved by rest or nitroglycerin [4], [6]. Presentation Nuances: While typical angina is defined by these characteristics, the presentation can be…

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

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

…24/7 without delay. I B Patients transferred to PCI centres can bypass the emergency department to undergo primary PCI without delay. I B Ambulance…

…maintained (for example, high quality cardiopulmonary resuscitation or partial ROSC), the midbrain may receive enough oxygen to preserve some pupillary reflex. Importantly, pupillary size and…

…without any circulation). These estimates should be viewed as approximations due to the following: Registry data indicate that survival is possible with longer periods of…

…syndrome should receive an artificial pacemaker to reduce symptoms and increase function. However, it should be noted that any bradycardia originating in the sinoatrial node…

…In selected patients, P2Y12 inhibitor monotherapy may be used as a de escalation strategy after a period of DAPT. The therapeutic objective is to reduce…

…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…

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

…cardiometabolic cause is suspected. Selected asymptomatic individuals in whom coronary disease is detected incidentally or during cardiovascular risk assessment. The mechanisms overlap clinically. Microvascular angina…

…whereas norepinephrine and/or inotropes are reserved for low output and hemodynamic instability. Evaluation and physical examination The objective of decongestion is clinical euvolemia rather…

…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…

… in selected cases the patient can be observed without anticoagulation Red flags and pitfalls A normal saturation and a normal ECG do not exclude pulmonary…

…tap. A blood sample at the same time: serum albumin is mandatory in order to be able to calculate the SAAG. The patient lies supine…

…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…

…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…

…the same time exclude other acute causes, for example hypoglycaemia, poisoning, stroke, meningitis and a postictal state. 3. Check a repeat plasma sodium if the…

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

…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…

…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…

…physicians: recognise hypoactive delirium, stabilise the patient, work systematically through the possible causes, apply several non pharmacological measures at the same time, and use drugs…

…unrecognised oesophageal intubation are the two mechanisms that kill patients during airway management , and both are predictable. Indications Inability to protect the airway: reduced level…

…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)…

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

…by first establishing the time course and precipitating circumstances , and then selecting a targeted examination. The patient's description of the quality of the dizziness …

…20 % during the night. Pattern Nocturnal fall Comment : : : Dipper 10–20 % Normal Non dipper < 10 % Independent risk marker Reverse dipper ≤ 0 %, night time pressure…

…to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect…

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

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

…refrain or adapt in: The patient does not consent — the examination must then not be carried out. Vaginismus or marked anxiety — plan for extra time…

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

…and that the tubes go to the right place. In suspected bacterial meningitis it is the time to antibiotics that saves the patient — the puncture…

…Ask the patient to flex the head forward and swallow repeatedly , preferably with sips of water if swallowing is safe. Advance the tube in time…

…headache. High flow oxygen on a reservoir mask is the first line treatment during an attack and aborts most attacks within 15–20 minutes. An…

…force. The methods that work best exploit time, gravity and slow movement; those that fail usually do so because the patient tenses up with pain…

…of these time points — follow the local instructions, but where the response is equivocal both are valuable. 7. Observe the patient throughout the test and…

…the time of seizure onset, or the time the patient was last known to be well. Protect the patient from injury. Do not restrain the…

…during the first 72 hours for as long as the patient remains unconscious. The evidence Trial Question Result : : : TTM (2013) 33 °C versus 36 °C…

…taken at the same time each day, usually in the evening so that a dose change can reach the patient the same day the result…

…99% of the ventricular arrhythmias they detect. It lies instead in patient selection. Because implantation entails appreciable cost and procedural risk, the risk benefit balance…

…is reasonable, although the optimal initial combination strategy remains uncertain. A beta blocker combined with a dihydropyridine CCB is appropriate for many patients. Long acting…