…GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey…

…B, Lane DA, Lip GYH. Comparison of bleeding risk scores in patients with atrial fibrillation: insights from the AFFIRM trial. J Intern Med . 2018;283…

…HAS BLED score should not be used as a reason to withhold anticoagulation therapy. Instead, it serves as a tool to identify patients who may…

…tool designed to assess stroke risk in patients with non valvular atrial fibrillation (AF). It is a modification of the widely used CHA₂DS₂ VASc score…

…Hence, heart rate and blood pressure must also be noted. In summary, the following variables should be included in the survey: personal identification, age, sex…

…course of treatment. Even transient, self terminating AF during ST elevation myocardial infarction may indicate an increased long term risk of stroke. In patients with…

…score or similar) may undergo stress testing when their clinical condition is stabilized. This usually takes 2 to 3 days and the patient must not…

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…

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

…Assess the risk with CHA₂DS₂ VA (the sex category has been removed from the Swedish recommendation). Score Recommendation : : 0 No anticoagulant 1 Consider an oral…

…malignancy, stem cell transplantation, immunosuppressive drugs, radiotherapy, bone marrow failure and certain targeted cancer treatments. Fever is not obligatory Hypothermia, new confusion, tachypnoea, hypotension, rigors…

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

…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…

…A patient does not have to meet every criterion in a column. Clinical deterioration or a poor response to treatment carries more weight than a…

…hypotonic hyponatraemia, however, treatment must not be delayed [1,3]. Severe symptoms: treat immediately Hypertonic sodium chloride Give hypertonic saline 30 mg/mL, 3 per…

…compromise a rapidly falling haemoglobin after fluid treatment has been started a continuing transfusion requirement. A normal haemoglobin early on does not exclude major bleeding…

…preferably two lines in a bleeding patient. A transfusion set with a filter. Blood components must not be given through a set without a filter…

…Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against…

…6. Look for several concurrent causes. In older patients delirium is often multifactorial. 7. Start non pharmacological treatment immediately , in parallel with the investigation. 8…

…intubation. A difficult airway is anticipated in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the right course, not RSI. Assess…

…patients with low or moderate pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be preferred when available. Exercise ECG is not…

…result from a mismatch between myocardial oxygen supply and demand. The clinical history should therefore be examined for potential physiological or systemic stressors, with treatment…

…hypercapnia Follow the patient's prescription, if it is clinically reasonable Give oxygen if the patient is hypoxaemic. Oxygen is not a treatment for dyspnoea…

…findings are absent in roughly half of patients with a central cause. A normal routine neurological examination is therefore not sufficient to exclude stroke [3…

…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 a creatinine clearance <20 mL/min, consider an alternative treatment In aminoglycoside treatment of obese patients, an adjusted body weight is used: adjusted weight…

…has been done properly. Indications Ongoing epistaxis that has not stopped spontaneously. Recurrent bleeding from a visible vessel on the septum (cautery). Continued bleeding despite…

…lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient…

…has no place in the modern treatment of poisoning. Charcoal also does not bind every poison. With the following substances charcoal is ineffective and management…

…refrain from investigating postmenopausal bleeding or a visible cervical lesion. Contraindications There are no absolute contraindications, but refrain or adapt in: The patient does not…

…a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative: Lymphoedema or previous axillary clearance on…

…the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before the puncture Swedish practice differs here from several international guidelines. The Swedish clinical…

…stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery, according to local practice. Enteral nutrition and drug administration when the patient cannot swallow…

…of the saturation Carbon monoxide poisoning. The pulse oximeter does not distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal value. Give 100 % oxygen on…

…not with force. The methods that work best exploit time, gravity and slow movement; those that fail usually do so because the patient tenses up…

…be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1…

…consciousness. Urgent EEG if the patient does not wake or if ongoing electrographic seizure activity is suspected Benzodiazepines are the established first line treatment. Intravenous…

…the patient normothermic — but fever after cardiac arrest is harmful, it often arises spontaneously, and it must be actively prevented. The treatment has therefore not…

…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…

…ECG morphs in lead aVL (adapted from Obermeyer et al 1 ). Representative single beat morphs for a low risk patient (blue) and the corresponding high…

…patients after acute myocardial infarction (MI), antianginal drugs have not been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients…

…V2 to V3 Greater than or equal to 1.5 mm All patients Other leads Greater than or equal to 1 mm These criteria for…

…or frail patients who may not tolerate rapid blood pressure reduction. Initial Combination Therapy General Strategy For most adults with confirmed hypertension, initial treatment with…

…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…

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

…in healthy people older than 60 years. The abnormal slope does not itself distinguish precapillary from postcapillary disease. A PAWP/cardiac output slope greater than…

…90 mmHg. Screening is particularly pertinent in the presence of hypokalaemia or treatment resistance. Hypokalaemia should not be permitted when assessing dietary electrolyte intake, because…

…Most patients with this working diagnosis subsequently develop myocardial necrosis and cardiac troponin elevation, although not every patient with an initial STEMI pattern has myocardial…

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

…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…

…even though incidence and prognosis vary widely between patient groups and care settings [2]. Practical first actions Do the following in parallel, not sequentially: 1…

…5. Treatment of the alcohol use disorder and planned follow up , not merely detoxification. Benzodiazepines reduce the severity of withdrawal and the risk of seizures…

…or measure at the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10…

…there a further metabolic disturbance? Calculate the delta gap or delta ratio 6 Does the result fit the patient? If not, check the sample type…

Procedurer Aspirate and biopsy answer different questions and do not replace one another: the aspirate shows cellular morphology and provides material for flow cytometry and…

…make sure that never happens, and to make sure the catheter does not become the patient's next focus of infection. Indications Infusion of vesicant…

…flags and pitfalls Stopping a corticosteroid abruptly after longer term treatment. Not giving a stress dose to a patient with adrenal insufficiency during acute illness…

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

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

…are dynamic conditions. Treatment must be guided by the clinical response and by repeated laboratory measurements, not by the values on admission alone. Diagnosis Current…