…instability. Evaluation and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These…

…infarction and it is associated with poorer survival. Patients with unstable angina pectoris with low risk (according to TIMI score or similar) may undergo stress…

…cases, enhanced elimination. For many poisonings, well delivered supportive treatment matters more than the antidote [1,2]. Telephone your national or regional poison control centre …

…Haemodynamics Right ventricular strain (echo or CT) Troponin Management : : : : : High Unstable Yes Often raised Reperfusion, intensive care Intermediate–high Stable Yes Raised Admission with monitoring…

…patients with risk factors. Check what applies in your own region. The time limit is not a guarantee. Where the stroke risk is high or…

…inflammation may be faint or absent. Take cultures immediately, but never let sampling, imaging, the blood count or contact with the patient's own clinic…

…at least a few centimetres away from them Full bladder Have the patient void, or catheterise, before puncture Pregnancy, previous extensive abdominal surgery Ultrasound guidance…

…deal in a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that…

…PEF or FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an…

…treatment. 5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document…

…line if the patient is unstable or frequent blood gases are needed 3 Blood grouping and cross matching. Order red cells early with ongoing major…

…in ongoing bleeding with coagulopathy, or as part of balanced transfusion in massive haemorrhage. Transfusion thresholds in the stable, non bleeding patient Patient category Transfusion…

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

…delirium with a structured instrument , for example the 4AT or the CAM according to local protocol. 6. Look for several concurrent causes. In older patients…

…kill patients during airway management , and both are predictable. Indications Inability to protect the airway: reduced level of consciousness, loss of pharyngeal reflexes, vomiting with…

…risk stratification and prognosis For patients with low or moderate pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be preferred when…

…the explanation for the presentation. Clinical presentation and symptoms Patients typically present with symptoms suggestive of ACS and troponin elevation. The clinical and electrocardiographic manifestations…

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…Lying down, turning over in bed or looking up triggers a new attack. A patient with vestibular neuritis or stroke, by contrast, is already continuously…

…when fitting the device. Use the arm with the higher pressure, or the non dominant arm if the values are equal. Check against a manual…

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

…tongue depressor, a vomit bowl. Local anaesthesia and vasoconstriction: lidocaine 4 % with oxymetazoline 0.5 % (or xylometazoline) on cotton pledgets. Cautery: silver nitrate sticks; electrocautery…

…Imaging (coronary CT angiography, myocardial perfusion scintigraphy, stress echocardiography) has greater diagnostic accuracy. Contraindications Absolute: Acute coronary syndrome within 48 hours, or ongoing unstable angina…

…substance, where the patient arrives within about 1 hour (a liquid preparation) or 2 hours (tablets). With very large quantities of an extremely toxic preparation…

…examination must be preceded by information about each step, take place with the patient's ongoing consent, and be able to be stopped at any…

…the muscle insertion. 3. Stretch the skin with the thumb and index finger, or compress the muscle in a slim patient. 4. Insert the needle…

…that saves the patient — the puncture must never delay it. Indications Suspected meningitis or encephalitis. Suspected subarachnoid haemorrhage with a normal or non diagnostic CT…

…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…

…why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off into a respiratory acidosis…

…movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than more slowly. The…

…with the patient fasting or having had a light breakfast according to local practice. Let the patient rest lying down or sitting for at least…

…In parallel with the drug treatment Resuscitation, investigation and drug treatment must proceed simultaneously. Do not wait for laboratory results, CT or EEG before the…

…33 °C has not been shown to improve survival or the neurological outcome compared with keeping the patient normothermic — but fever after cardiac arrest is…

…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…

…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…

…are also recommended in patients within one year of MI and in those with LVEF ≤50% in the cited North American guideline discussion. By contrast…

…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…

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

…3 For patients with a BMI below 35 kg/m², direct assessments such as waist circumference, waist to hip ratio, or dual X ray absorptiometry…

…In patients with a high probability, testing may add little diagnostic value and invasive coronary angiography may be more appropriate when symptoms, risk or anatomical…

…or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic…

…underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension, with particular vigilance when the clinical history includes hypokalaemia. Endocrine…

…ischaemic symptoms or equivalent presentations together with persistent ST segment elevation, or an equivalent electrocardiographic pattern, suggesting acute coronary occlusion. Most patients with this working…

…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…

…serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not…

…In older, malnourished, amputee or muscle wasted patients, an apparently normal creatinine may therefore correspond to markedly impaired renal function [3]. Urine output can change…

…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…

…toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel, a…

…With a raised anion gap, is there a further metabolic disturbance? Calculate the delta gap or delta ratio 6 Does the result fit the patient…

…Procedure 1. Place the patient in the lateral position with the knees drawn up , or prone with a pillow under the pelvis. The lateral position…

…and obtain consent if the patient is awake, and scan the vessel with ultrasound before you drape — a thrombosed or non compressible vein changes the…

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

…Preparation and equipment A device capable of both CPAP and bilevel ventilation, or alternatively flow generated CPAP with a PEEP valve. Masks in several sizes…

…Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according…

…Children, pregnant women and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and…

…to diplopia on upward gaze, or the number of seconds the patient can hold the head lifted off the couch. Filming before and during the…

…then reserved for patients with a CHA₂DS₂ VA score of 0–1. Check what applies in your own region. Duration above the threshold or unknown:…

…or a hand held device (iCare, Tono Pen). Procedure Systematic examination 1. Visual acuity in each eye separately , with the patient's usual glasses and…

…the reaction. The battery must come out immediately, with a hook, forceps or suction, and if that is not possible on the spot, ENT must…

…ECG changes or serious neuromuscular symptoms mean a high risk even if the plasma potassium is below 6.5 mmol/L. Conversely, patients with chronic…