…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…

…risk of major bleeding in patients with atrial fibrillation (AF) who are taking anticoagulants. It was developed in 2010, using data from the EuroHeart survey…

…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…

…ventricular rate may decrease as dyspnoea improves and sympathetic activation subsides, making it difficult to determine whether AF initiated the deterioration or resulted from it…

…survival. Patients with unstable angina pectoris with low risk (according to TIMI score or similar) may undergo stress testing when their clinical condition is stabilized…

…course deviates from what was expected. The poison control centre is the authoritative local source for the current indication, dosing, sampling and duration of treatment…

…dose are according to the local protocol. Alternatives when there is a contraindication: catheter directed treatment or surgical embolectomy where available. A vasopressor (noradrenaline) and…

…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…

…the patient has sepsis, septic shock, or a need for high dependency or intensive care 3 Take at least two sets of blood cultures from…

…Scars, hernia or visible abdominal wall collaterals (caput medusae) Puncture at least a few centimetres away from them Full bladder Have the patient void, or…

Procedurer Transcutaneous pacing takes seconds to start and can keep a patient alive until a transvenous lead is in place — but only if it is…

…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…

…the patient have severe neurological symptoms that may be due to the hyponatraemia? 2. Is the hyponatraemia acute or chronic? Severe symptoms require immediate treatment…

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

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…

…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…

…What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was preoxygenated…

ECG Exercise stress test Definition and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually…

…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…

…dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early:…

…and then selecting a targeted examination. The patient's description of the quality of the dizziness — rotatory vertigo, unsteadiness or faintness — discriminates poorly between dangerous…

…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…

Procedurer Almost all nosebleeds arise from Kiesselbach's plexus on the anterior septum and stop with correctly performed compression. The reason compression nevertheless so often…

…heart disease. Risk assessment after myocardial infarction or before revascularisation. Evaluation of treatment effect in stable angina. Exercise induced arrhythmia or exercise induced syncope. Assessment…

…or gastric surgery Gastric lavage Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning…

…in the screening interval the patient happens to be — a recently taken normal smear is no reason to refrain from investigating postmenopausal bleeding or a…

…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…

…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…

…patent one. Ask the patient about a previous nasal fracture or unilateral nasal obstruction. 2. Measure the depth of insertion by laying the tube from…

…35–60 % Never below 5 L/min — the patient then rebreathes carbon dioxide from the mask Mask with a reservoir 10–15 L/min 60…

…gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than…

…result can be interpreted. What decides that is whether the patient is taking a steroid that cross reacts in the cortisol assay, whether the samples…

…5 minutes, or repeated generalised tonic clonic seizures without the patient regaining consciousness between them. Five minutes is the practical threshold for treatment, known as…

…Severe sepsis and septic shock. Already marked hypothermia from another cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of…

…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…

…CCB therapy. Nicorandil and trimetazidine are additional options in selected patients. Treatment choices should be integrated with management of precipitating factors such as anaemia, uncontrolled…

…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…

…may also reduce treatment inertia, in which patients remain on an inadequate single drug regimen for prolonged periods. The evidence supports improved blood pressure control…

…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…

…Coronary artery calcium (CAC) provides additional information. A quantitative CAC score from dedicated testing, or a qualitative assessment of CAC on a non gated chest…

…PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise from pulmonary vascular disease, left sided cardiac disease…

…particularly in patients with resistant hypertension. Dietary sodium and potassium abnormalities and commonly used over the counter medicines may also contribute to apparent treatment resistance…

…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…

…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…

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

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

…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…

…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…

…Suspected bone marrow metastasis. Assessment of treatment response and measurement of residual disease (MRD). Fever of unknown origin or suspected granulomatous disease with marrow involvement…

…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…

…in known adrenal insufficiency A patient with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long term corticosteroid treatment cannot increase their own…

…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…

…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…

Endokrinologi & metabolism Akutsjukvård Lathundar About this quick reference Treatment protocols differ between regions. Always follow the local protocol for exact infusion rates, electrolyte concentrations and…