…the clinical picture. A 24 hour urine collection for electrolytes can be used to quantify sodium and potassium intake, preferably while the patient is receiving…

…effect is wanted and the patient is also receiving LMWH, for example in newly diagnosed venous thromboembolism. 1. Check the INR before the first dose…

… 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…

…followed by a QRS complex; atrioventricular block is uncommon unless the patient is receiving digoxin. The ventricular rate is regular, typically ranging from 100 to…

…Diagnostics Electrocardiography and Electrophysiology Electrocardiographic evaluation of patients receiving digoxin reveals specific electrophysiologic profiles. Digoxin's autonomic actions largely slow the sinus node discharge rate…

…appropriate first line pharmacological option when a patient is unable to tolerate any statin regimen. The treatment sequence for patients with chronic coronary syndrome is:…

…equivalent who were receiving statins, inclisiran produced a further reduction in LDL C of approximately 50%. The effect was consistent in patients with and without…

…In treatment naïve patients unlikely to achieve the LDL C goal with statin therapy alone, initiation of high intensity statin plus ezetimibe during hospitalization should…

…UA/NSTEMI patients undergoing coronary angiography within 48 hours of hospital admission, the loading dose should be administered at the time of PCI. Patients should…

…index of suspicion for drug induced arrhythmias in patients receiving agents known to alter the electrical properties of the heart (inducing QRS or QT prolongation…

…The composite major adverse cardiovascular outcome—cardiovascular death, nonfatal myocardial infarction, nonfatal stroke or coronary revascularization—occurred in 819 patients receiving bempedoic acid (11.7…

…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…

…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…

…ischaemia. A focused history should establish: Quality of the discomfort. Location and radiation. Onset and temporal pattern. Duration and recurrence. Provoking and relieving factors. Associated…

…clinical populations include only a minority with symptoms having all of the traditional aggravating and relieving characteristics of angina; many patients report less characteristic symptoms…

…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…

…estimating the extent of ischemia. After revascularization procedures, stress testing is utilized to assess whether there is any residual ischemia or angina pectoris. Patients may…

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…

…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…

…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…

…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…

…urine measurement. Sudden polyuria is a warning sign of impending overcorrection. Grading Hyponatraemia is defined as a plasma sodium below 135 mmol/L. The biochemical…

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…

…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…

…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…

…blood pressure measurement. Resuscitation trolley with defibrillator, oxygen, suction and emergency drugs in the room. Staff with current CPR competence; a physician available. Patient preparation…

…which the patient reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through…

…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…

…temperature measurement and a target value that must never be exceeded, during the first 72 hours for as long as the patient remains unconscious. The…

…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…

…equal to 2 mm Women (any age) V2 to V3 Greater than or equal to 1.5 mm All patients Other leads Greater than or…

…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…

…lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting with glucagon like peptide…

…chest pain. It is appropriate when the expected information is likely to change management. In patients with a very low probability of obstructive CAD, testing…

…used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction…

…or surgical illness. Events may occur at any time, although clustering in the morning within several hours of awakening has been described. Atypical and painless…

…is determined by patient recognition and help seeking, pre hospital assessment and transport, diagnostic and treatment delays, and the time required for the selected treatment…

…lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood…

…patient groups and care settings [2]. Practical first actions Do the following in parallel, not sequentially: 1. Check previous creatinine values and establish the time…

…in patients with previous complicated withdrawal [4]. Untreated delirium tremens has historically carried a high mortality. With modern sedation, supportive treatment and treatment of the…

…Preparation: The patient must have rested lying down for at least 10 minutes in a room at a comfortable temperature — a cold foot gives falsely…