…in order to obtain a central venous catheter. 4. Take samples for blood grouping and cross matching before transfusion if this can be done without…

…Limitations Requires detailed clinical and angiographic data. Calculation can be complex without dedicated software. May not account for all patient specific factors (e.g., frailty…

…clip and have the patient seal the lips tightly around the mouthpiece without the tongue blocking it. 3. Quiet breathing for a few breaths until…

…Assessment of chronotropic function and pacemaker settings. Preoperative functional assessment before major surgery. At a low pre test probability most positive results are false positives…

…appropriately selected patients. In diabetes, carotid plaque prevalence correlates linearly with diabetes and carotid atherosclerosis tends to be more advanced than in people without diabetes…

…patients with high bleeding risk, because newer DES provide greater efficacy with acceptable safety even when shorter DAPT regimens are used. BMS now account for…

…the specific context of perioperative care in patients with pulmonary arterial hypertension (PAH), progression of right heart failure may indicate the need for inodilator therapy…

…than patients without AF; both short and long term prognosis are worse than in patients who remain in sinus rhythm. Several mechanisms may account for…

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

…Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the…

…pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis…

…consciousness and air entry repeatedly. 9. Measure PEF or FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care…

…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…

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

…A high risk of aspiration: a non fasted patient, ileus, third trimester pregnancy, marked reflux. A need for high airway pressures, for example severe ARDS…

…target — the nasal cannula stays in place for days without anyone asking why, or the patient at risk of carbon dioxide retention is given 15…

…a unit is selected electronically against the blood group Standard for planned transfusion in a patient without irregular red cell antibodies Serological crossmatch (MG test…

…the patient's usual saturation. Previous exacerbations and hospital admissions. Current inhaled treatment and adherence. Opioids, benzodiazepines and other sedating drugs. Thromboembolic risk, for example…

…among others. Acute severe balance disturbance without nystagmus: HINTS does not apply. Assess gait and truncal stability and investigate for a central cause. Acute vestibular…

…fail more often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept…

…cap. Lidocaine 10 mg/mL for local anaesthesia in the awake patient — the anaesthetic also improves the chance of success by counteracting vascular spasm. Pressure…

…10. Elevate the limb and inform the patient. Backslab or circumferential cast A dorsal backslab or another half slab for a fresh injury, acute swelling…

…or copious secretions Subclavian vein Most comfortable for the patient, the most stable dressing, lowest risk of infection and thrombosis with prolonged dwell time Highest…

…possible without prior anticoagulation. The 2024 ESC guidelines and several Swedish clinical knowledge support documents have tightened the threshold to 24 hours for patients with…

…Sampling for a suspected sexually transmitted infection — although chlamydia and gonorrhoea can be tested on urine or a self taken vaginal sample without a speculum…

…occur without acute organ damage. Conversely, a rapid rise in blood pressure from a previously low level can cause organ damage at lower values, for…

…according to local practice. Enteral nutrition and drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and…

…without assessment, when a modified release preparation is started in an opioid naive patient, or when a conversion between drugs is made without reduction for…

…with a loading dose Used when a rapid effect is wanted and the patient is also receiving LMWH, for example in newly diagnosed venous thromboembolism…

…account for approximately 5% of presentations in some populations. Despite this relatively low prevalence, missed myocardial infarction remains consequential, and historically 2–6% of patients…

…severe acute or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A recent echocardiographic examination should be…

…patient quickly into the supine position with the head extended approximately 20–30° below the horizontal, maintaining the 45° rotation. 4. Observe the eyes for…

…equipment Edrophonium 10 mg/mL, 1 mL (named patient product — order well in advance). Atropine 0.5 mg for premedication, plus further atropine drawn up…

…the soft part , and held continuously for at least 10 minutes without letting go to look. Compression can be preceded by a dose of decongestant…

…lamp — the cornea should not be instrumented without magnification. With a suspected chemical injury the priorities are reversed: irrigate first , for at least 30 minutes…

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

…measure in decontamination, and gastric lavage is today a rare procedure reserved for very serious poisonings in which the patient reaches hospital early. The benefit…

…The patient manages the pump themselves where possible. In impaired consciousness or DKA: remove the pump and change to an infusion or injections Drugs for…

…an iodine solution. Lidocaine 10 mg/mL without adrenaline for the block (adrenaline is safe in fingers and toes according to modern data, but there…

…target value that must never be exceeded, during the first 72 hours for as long as the patient remains unconscious. The evidence Trial Question Result …

…B In patients with inferior myocardial infarction, consider connecting V3R and V4R to detect concomitant right ventricular infarction. IIa B Routine blood sampling for serum…

…et al 1 ). Representative single beat morphs for a low risk patient (blue) and the corresponding high risk morph (red). Beyond the difference in R…

…awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI is diagnosed when typical ischaemic symptoms occur without persistent ST…

…benefit of beta blockers in patients with CAD without previous MI and with normal LVEF is uncertain. Similarly, evidence for routine long term beta blocker…

…Interleukin 1β inhibition Canakinumab reduced inflammatory biomarkers without affecting lipids or other major coronary risk factors. In patients with previous myocardial infarction and residual…

…a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for individuals without known clinical coronary artery disease, especially when…

…level C. The European regulatory threshold described in the source material differs from the trial based threshold: ivabradine was approved for patients with HFrEF, LVEF…

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

…must be incorporated. In symptomatic individuals without known CAD, newer clinical prediction algorithms are preferred over older approaches based solely on age, sex and typicality…

…unexplained drop in arterial pressure. Silent or unrecognized infarction occurs more often in patients without antecedent angina and in those with diabetes and hypertension. Of

…region but typically does not radiate below the umbilicus. Epigastric or subxiphoid pain may be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting…

…establish whether the presentation represents ACS and whether the patient is clinically unstable. Particular attention is required for evidence of: Ongoing or recurrent chest discomfort…

…syndromes (NSTE ACS). The division into STE ACS and NSTE ACS has profound implications for management and treatment of patients with acute coronary syndromes. Moreover…

…virtually all these patients will develop myocardial infarction, which is classified as STEMI (ST Elevation Myocardial Infarction) . NSTE ACS is the acronym for Non ST…

…than the current threshold for hypertension, and the current treatment target levels for patients with and without diabetes. The threshold for hypertension is currently 140…

…not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has…

…a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate…

…infection or gastroenteritis at home Double or triple the oral daily dose during the days of illness (the patient's sick day rules) Vomiting or…

…for the former, a COPD exacerbation with carbon dioxide retention for the latter. The treatment is also time limited by its very nature: a patient…

…Conversely, patients with chronic renal failure may have very high values without the classical ECG findings. A rapidly rising potassium is usually more dangerous than…