…Maintenance dose : 5 mg once daily. Rationale: Patients in this age group have higher bleeding risk and increased exposure to the active metabolite of prasugrel…

…it is an indicator of increased cardiovascular risk and a setting in which secondary hypertension is relatively common. Patients presumed to have resistant hypertension should…

…what happens when the INR runs away or the patient bleeds. In Sweden the treatment is usually managed from an anticoagulation clinic with dosing support…

… an accelerating pattern, with increasing frequency or severity; angina that awakens the patient from sleep. Patients receiving modified antiplatelet therapy require clinical surveillance for both…

…uncommon unless the patient is receiving digoxin. The ventricular rate is regular, typically ranging from 100 to 250 beats per minute in atrial tachycardia and…

…also utilized for ventricular rate control in atrial fibrillation, particularly when other therapeutic options cannot be pursued. Patients receiving digoxin may present with symptoms of…

…For a patient who experiences a recurrent atherothrombotic event while receiving maximally tolerated statin therapy, an LDL C goal below 1.0 mmol/L (<40…

…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 patients who experience a recurrent atherothrombotic or cardiovascular event within 2 years while receiving maximally tolerated statin based treatment, an LDL C goal below…

…Clinicians should maintain a high index of suspicion for drug induced arrhythmias in patients receiving agents known to alter the electrical properties of the heart …

…nonfatal myocardial infarction, nonfatal stroke or coronary revascularization—occurred in 819 patients receiving bempedoic acid (11.7%) and 927 receiving placebo (13.3%). Bempedoic acid…

…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…

…limit escalation of beta blocker or CCB therapy. Nicorandil and trimetazidine are additional options in selected patients. Treatment choices should be integrated with management of…

…of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations The central pathophysiological concern in the…

…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…

…transient, self terminating AF during ST elevation myocardial infarction may indicate an increased long term risk of stroke. In patients with acute decompensated heart failure…

ECG Exercise stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar…

…Contact the centre early in serious, unusual or unclear poisoning, with modified release preparations, mixed poisoning, pregnancy, children, a need for an antidote or dialysis…

…or warfarin Subsegmental pulmonary embolism without deep vein thrombosis An individual assessment; in selected cases the patient can be observed without anticoagulation Red flags and…

…not delay cardioversion in an unstable patient. Rate control in the stable patient Drug Situation Comment : : : Beta blocker (metoprolol) First choice in most cases The…

Hematologi & onkologi Infektionssjukdomar Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation…

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…precipitate ventricular fibrillation. Prioritise rewarming. Bradycardia in a patient with a normal circulation and no symptoms requires no pacing, only monitoring and preparedness. Asystole with…

…normal or rising pCO₂ during an ongoing severe asthma attack is an alarm sign. Early in a severe attack the patient usually hyperventilates and the…

…is limited. In a patient with moderate symptoms the physician must judge the likelihood that the symptoms really are caused by the hyponatraemia. With severe…

…peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood gases are needed 3 Blood grouping and cross matching. Order red…

…unit is selected electronically against the blood group Standard for planned transfusion in a patient without irregular red cell antibodies Serological crossmatch (MG test) Serological…

…ways in which casting harms the patient are that it is too tight — the swelling comes after the injury, not before — and that an edge…

…the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for example…

…well the patient was preoxygenated, whether the difficulties were anticipated, whether the position and the equipment are in order, and whether there is an explicit…

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

…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)…

…presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's…

…examination, ECG, selective vascular imaging Traumatic or toxic syndrome Onset after trauma, a change in medication or an exposure Concussion, temporal bone injury, dissection, aminoglycoside…

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

…consider an alternative treatment In aminoglycoside treatment of obese patients, an adjusted body weight is used: adjusted weight = ideal weight + 0.4 x (actual…

…haemodynamic instability — stabilise the patient first. Marked septal deviation towards the bleeding side (relative). Preparation and equipment Personal protective equipment (gloves, a visor, an apron)…

…ST depression in a woman with a low pre test probability is usually a false positive. Indications Evaluation of chest pain with an intermediate pre…

…ileus or suspected perforation Gastric lavage An unprotected or unsecured airway in a patient with a reduced level of consciousness Gastric lavage Corrosive injury or…

…menstrual status, previous smear results and any previous conisation. Procedure Inspection The patient lies in the lithotomy position, well covered. Say what you are do

…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…

…how the patient is positioned, which needle is chosen, and that the tubes go to the right place. In suspected bacterial meningitis it is the…

…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…

…breathlessness in a patient who is not hypoxaemic. Breathlessness without hypoxaemia is not an indication for oxygen — look for the cause instead. Conditions in which…

…exceptions are an obvious recurrent dislocation in a patient with known instability and a low energy mechanism, and a neurovascularly threatened limb in which reduction…

…a relative contraindication; the test is then performed with preparedness for anaphylaxis. An untreated Addisonian crisis in progress: treat first, test later. Preparation and equipment…

…in adults is present with: an ongoing generalised tonic clonic seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the patient…

…active prevention of fever — defined as a temperature above about 37.7–37.8 °C — for at least 72 hours in patients who remain unconscious…

…those who did, only a minority had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no…

…1.5 mm All patients Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of…

…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…

…HbA1c) reduction, blood pressure, lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting…

…is therefore not an automatic response to chest pain. It is appropriate when the expected information is likely to change management. In patients with a…

…mmHg ≤15 mmHg ≤2 Wood units The source material also presents a CpcPH threshold of PVR ≥3 Wood units in an overlapping clinical classification table…

…precipitating factor is identifiable in up to one half of cases. Reported precipitants include vigorous physical activity, emotional stress, and an intercurrent medical or surgical…

…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…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…Is the patient hypovolaemic, adequately filled or fluid overloaded? 3. Is there, or is there approaching, an indication for dialysis? AKI occurs in about one…

…of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with previous…

…an ulcer, and where needed a photoplethysmograph and a toe cuff. Preparation: The patient must have rested lying down for at least 10 minutes in…