…treated successfully in many instances. Cardiac tamponade : Tamponade in trauma patients is due to blood accumulation in the pericardial sack. This impairs atrial and ventricular…

…Wait 10 minutes — insufficient waiting time is the commonest reason for the patient finding the procedure painful. Test with a needle tip before you start…

…and under representation of patients with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably exclude clinically…

…in association with an inferior left ventricular infarction. At least minor right ventricular necrosis is found in approximately one third of patients with inferior infarction…

…Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased…

…preferred for coronary angiography and PCI because it is associated with fewer vascular and bleeding complications than femoral access. In patients with acute coronary syndrome…

…Contraindicated in patients with severe hepatic impairment (Child Pugh Class C). Pediatric population Safety and efficacy in children under 18 years have not been established…

…This has resulted in an increased prevalence of congenital heart disease in the general population, such that most clinicians will regularly encounter patients with CHD…

…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…

…A substantial proportion present with NSTEMI, although STEMI occurs in approximately one third. Patients with MINOCA related STEMI generally do not have a prodrome before…

…the patient must not have experienced chest pain during the last 12 hours before exercise. Patients with unstable angina pectoris with high risk should not…

…sex, and race to provide an eGFR value normalized to a standard body surface area of 1.73 m². Advantages of MDRD eGFR Clinical utility…

…underlying mechanisms are not uniform across the HFmrEF population. Some patients have a pathophysiological profile closer to HFrEF, whereas others have features overlapping with HFpEF…

…elevation myocardial infarction may indicate an increased long term risk of stroke. In patients with acute decompensated heart failure, AF with rapid ventricular response is…

…When did the patient first note the symptoms and how have the symptoms developed over time? In stable ischemic heart disease, symptoms are typically not…

…interrogation and reprogramming are warranted in higher risk circumstances, particularly for pacing dependent patients, patients with CRT, and ICD recipients undergoing procedures likely to generate…

…contemporary definitions distinguish HFpEF from "Heart Failure with improved EF" (HFimpEF). HFimpEF refers to patients with a historical baseline LVEF ≤40% that has subsequently improved…

…Association (NYHA) classification. The source material specifically frames many pharmacological recommendations for patients with symptomatic NYHA class II–IV HFrEF. Advanced or refractory heart failure…

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…

…as not to reduce a fracture dislocation or to miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with known…

…molecular weight heparin with dose adjustment, or warfarin Subsegmental pulmonary embolism without deep vein thrombosis An individual assessment; in selected cases the patient can be…

…Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as…

…take place with the patient's ongoing consent, and be able to be stopped at any moment. A trauma informed approach also improves the technical…

…one: with an indication, a route of administration and a target range for the saturation . What usually goes wrong is not that the patient gets…

…hours, not 48. The 2024 ESC guidelines and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors…

…COPD exacerbation with carbon dioxide retention for the latter. The treatment is also time limited by its very nature: a patient who has not responded…

…Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG all come…

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

…infranodal block with wide QRS complexes; do not delay pacing in order to try yet another dose. Chronotropic support is given as an infusion of…

…eye level. The patient sits upright and tilts the head forwards , not backwards. Procedure Step 1 — compression Have the patient blow out the clot. The…

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

…elevations in ischemia are dynamic. A patient may initially present with ST segment elevations that do not fulfill the ECG criteria, only to develop magnificent…

…the severity by the most serious finding. A patient does not have to meet every criterion in a column. Clinical deterioration or a poor response…

…symptoms or an unexpected sensor value, the glucose should therefore be checked with a capillary or venous measurement [5]. Treatment The awake patient who can…

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

…Reperfusion therapy Management Recommendation Level of evidence Reperfusion is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent ST segment…

…of shock. Patients with moderate to severe chronic kidney disease have a higher burden of comorbidity and an increased risk of in hospital complications, including…

…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…

…Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind…

…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 tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…

…several family members. Imaging studies did not reveal structural cardiac abnormalities, nor coronary artery disease. Another male patient, with similar ST segment changes, experienced syncopal…

…In patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m2, an appropriately up titrated loop diuretic is necessary before resistant…

…not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an…

…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…

…symptoms. 4. Blood pressure every second minute and on symptoms. 5. Ask actively about chest pain, breathlessness and leg fatigue; have the patient rate exertion

…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…

…Patients with mPAP greater than 20 mmHg, PAWP ≤15 mmHg, and PVR ≤2 Wood units may have increased pulmonary blood flow rather than pulmonary vascular…

…transducer against the skin. Patients with extensive subcutaneous fat require harder pressure. Orientation index marker All ultrasound transducers have an index marker, which is used…

…not an acceptable routine target. The shorter the ischaemic time, the more myocardium can be salvaged. Call the PCI service in parallel with drug treatment…

…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…

…therefore the beginning of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new…

…increased work of breathing with impending exhaustion. Threatened airway obstruction: inhalation injury, anaphylaxis, deep neck infection, an expanding haematoma, facial trauma. An anticipated course requiring…

…recording and unmask the atrial activity. The investigation is diagnostic, not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock…

…5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis…

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

…urethral trauma. The balloon is filled with sterile water according to the volume printed on the catheter , usually 10 mL in adults. Do not use…

…HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy…

…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…

…the "healthy" range can still harbor significant metabolic risk. 3 For patients with a BMI below 35 kg/m², direct assessments such as waist circumference…