…Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS…

…Patients with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial…

…the findings of the ambulance crew The stated dose is often unreliable and must never be used on its own to declare the patient well…

…A D dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10…

…ventricular rate < 110/min is a sufficient initial target in most patients. Doses according to the local protocol and the Swedish medicines compendium (FASS)…

…the suspected focus, but avoid sampling that delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth, throat…

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

…self adhesive multifunction pads. A separate three lead ECG cable connected to the patient — the device senses the rhythm through the cable, not through the…

…the silent one. A patient who has become calm, quiet in the chest and stopped struggling may be about to stop breathing. Diminishing wheeze means…

…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…

…bleeding, the decision to transfuse must therefore not be based on the haemoglobin alone [3]. The airway Do not intubate every patient routinely before endoscopy…

Procedurer The most serious transfusion accidents rarely stem from laboratory errors but from the wrong blood being given to the wrong patient — a mislabelled tube…

…the patient must leave with clear information about the symptoms that should make them seek help immediately. Indications An undisplaced or reduced fracture to be…

…a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for example — may be enough to precipitate the…

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

…a low pre test likelihood in whom a negative test may reduce the estimated likelihood sufficiently to defer further investigation. In patients with established CAD…

…according to the population and diagnostic criteria. MINOCA accounts for approximately 1–14% of ACS presentations in different series and approximately 5–10% of patients…

…Concomitant cardiac disease Oxygen targets Patient Initial target saturation : : Known COPD or another clear risk of hypercapnic respiratory failure 88 to 92 percent No risk…

…HINTS, Dix Hallpike and the Epley manoeuvre, since otherwise these examinations are easily applied to the wrong patient or misinterpreted [4]. Trigger or merely aggravation…

…and in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set up and instructions Choose the cuff according to arm circumference…

…short course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract…

…not backwards. Procedure Step 1 — compression Have the patient blow out the clot. The pinch is applied to the lower third of the nose, the…

…Acute aortic dissection. Physical inability to perform the test safely. Relative: Condition Comment : : Left main stenosis Known — perform the test only on a clear indication…

…toxic dose of a substance that binds to charcoal, when it can be given early and the patient has an intact or a protected airway…

…reason to refrain from investigating postmenopausal bleeding or a visible cervical lesion. Contraindications There are no absolute contraindications, but refrain or adapt in: The patient…

…mL, an antihistamine, oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25 G, 25…

…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…

…is expected. 5. Ask the patient to flex the head forward and swallow repeatedly , preferably with sips of water if swallowing is safe. Advance the…

…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…

… the patient cooperates Intra articular local anaesthesia Lidocaine into the glenohumeral joint in shoulder dislocation, with an effect equivalent to sedation and fewer adverse effects…

…and are often the very question at issue A patient who needs steroid cover simply to get through the day of the test can therefore…

…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…

…threshold is always behind. Indications A patient who remains unconscious (with no meaningful response to speech) after the return of spontaneous circulation , whether the arrest…

…reach the patient the same day the result arrives. 3. Reduce to 5 mg (two tablets) on days 1 and 2 in patients over 75…

…lies instead in patient selection. Because implantation entails appreciable cost and procedural risk, the risk benefit balance depends almost entirely on the capacity to identify…

…should be individualized according to blood pressure, heart rate, left ventricular function, comorbidities, concomitant medications, potential drug interactions, the presumed mechanism of ischaemia, patient preferences…

…10]: Patient Demographic Lead Group ST Elevation Threshold at J Point Men under 40 years V2 to V3 Greater than or equal to 2.5…

…adherence, although prospective outcome trials have not directly established that upfront combination therapy is superior to upfront monotherapy for every patient with isolated hypertension. Single…

…significant metabolic risk. 3 For patients with a BMI below 35 kg/m², direct assessments such as waist circumference, waist to hip ratio, or dual…

…imaging finding; it can refine the decision to test and may identify patients who require preventive therapy even when functional testing is normal. Probability categories…

…mechanisms may coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical context and the results of all relevant investigations. Haemodynamic definition At…

…the initiating disorder. Earlier diagnosis is associated with a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical…

…obstruction of an epicardial coronary artery. A vulnerable atherosclerotic plaque and thrombogenic blood interact to initiate and extend thrombosis. Plaque vulnerability is influenced by inflammation…

…reperfusion is strongly time dependent. The interval from symptom onset to reperfusion is determined by patient recognition and help seeking, pre hospital assessment and transport…

…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…

…1]. Three questions must be answered immediately: 1. Is there obstruction to urine flow? 2. Is the patient hypovolaemic, adequately filled or fluid overloaded? 3…

…cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with previous complicated withdrawal [4]. Untreated delirium…

…plastic film or a dressing to protect an ulcer, and where needed a photoplethysmograph and a toe cuff. Preparation: The patient must have rested lying…

…raise pH respectively. A patient may therefore have both an acidosis and an alkalosis at the same time despite a normal pH. The lungs compensate…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…a straight course to the superior vena cava, compressible if bleeding occurs, low risk of pneumothorax Uncomfortable for an awake patient, harder to keep the…

…corticosteroid abruptly after longer term treatment. Not giving a stress dose to a patient with adrenal insufficiency during acute illness. Confusing dexamethasone 0.75 mg…

…latter. The treatment is also time limited by its very nature: a patient who has not responded within a couple of hours should be intubated…

…the donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain…

…the order in which measures are taken and the principles that are common to all protocols. Children, pregnant women and patients with advanced renal failure…

…in millimetres, the time to diplopia on upward gaze, or the number of seconds the patient can hold the head lifted off the couch. Filming…

…correct these first before elective cardioversion. AVNRT and AVRT that respond to adenosine — try adenosine first in the stable patient. Sinus tachycardia and multifocal atrial…

…5. Evert the upper eyelid. Ask the patient to look down. Grasp the eyelashes, press gently downwards on the upper border of the tarsal plate…

…ears and in the mouth. Nose 1. Ask the patient to blow the nose gently. Clear mucus with suction without pushing the object backwards. 2…

…0 mmol/L, and at lower values if the rise is rapid, the patient has symptoms, or the clinical risk is high [1,2]. 1…