…soft globe — because a perforated eye must never be instrumented, have its pressure measured, or be palpated. Indications A sensation of something in the eye…

…that did not need syringing. The second commonest is that the syringing is performed on a tympanic membrane that was already perforated. Indications Otoscopy: earache…

…cannot be kept still without sedation. Suspected tympanic membrane perforation. Irrigation is contraindicated in: suspected perforated tympanic membrane, organic material that swells, batteries and magnets…

…the iliac crest is inaccessible, but biopsy must never be taken from the sternum — the needle may perforate into the mediastinum. The anterior superior iliac…

Procedurer Pericardiocentesis is performed on the basis of the haemodynamics, not the volume of fluid. A litre that has accumulated slowly can be asymptomatic, while…

Procedurer Two recordings that are performed in primary care but interpreted as specialist investigations. Both fail more often for practical than for medical reasons: the…

CPR This chapter discusses interventions and evaluations performed during advanced cardiovascular life support (ACLS). While basic life support (BLS) can be delivered by virtually anyone…

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…

…in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or other symptoms…

…wrong patient — a mislabelled tube, or an identity check performed at the nurses' station instead of at the bedside. The check against the patient's…

…with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right ventricular strain. If CT pulmonary angiography can be performed immediately, do it. Otherwise the echocardiographic…

…The quality of the test determines its entire value: a poorly performed manoeuvre gives a falsely low FVC and thus a falsely normal FEV₁/FVC…

…a non invasive method for detecting and quantifying calcified coronary atherosclerotic plaque. It is performed using a non contrast, electrocardiographically gated computed tomography (CT) scan…

…injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to the aortic root, engaging the…

…of death in Western countries, and ultrasound studies are now performed in the majority of patients with stroke or TIA. The purpose of performing an…

…Image acquisition and evaluation Stress Imaging : Initially performed using exercise or pharmacologic agents to elevate myocardial oxygen demand (or simulate increased demand using vasodilatory agents…

…and blood flow has been restored. This assessment is performed daily in the catheterization laboratory in patients undergoing acute PCI. The PCI operator may use…

…definitively established as the cause of cardiac arrest, cardiopulmonary resuscitation (CPR) should be performed per standard guidelines. Cardiac arrests due to trauma are characterized by…

…no mechanical valve, CHA₂DS₂ VA 0–1 Cardioversion (electrical or pharmacological) can be performed directly. An anticoagulant is then given according to CHA₂DS₂ VA 24…

…rarely, asystole, and the test must therefore never be performed without atropine, ECG monitoring and access to airway support. Indications Clinically suspected myasthenia gravis in…

…be discussed later. Lavage must never be performed routinely in poisoning — it rarely alters the course and adds a risk of aspiration. Repeated doses of…

…always weighs more heavily). A joint prosthesis: the aspiration must be performed by an orthopaedic surgeon under strictly sterile conditions. For corticosteroid injection there is…

…which needle is chosen, and that the tubes go to the right place. In suspected bacterial meningitis it is the time to antibiotics that saves…

…steroid that cross reacts in the cortisol assay, whether the samples were taken at the right times, and whether you know which decision threshold your…

…The higher the estimated risk, the earlier should angiography be performed. TIMI risk score for NSTEMI and unstable angina [calc_timi_nstemi] TIMI SCORE 30…

…The clinical presentation, whether ACS or chronic coronary syndrome (CCS). Whether and how PCI was performed. The need for non cardiac surgery. The presence of…

…a lesion proximal to the first septal perforator of the left anterior descending artery was associated with lower five year survival than a more distal…

…provides tomographic information about relative regional perfusion. Imaging is generally performed at rest and during exercise or pharmacological stress, allowing comparison between myocardial blood flow…

…on degenerated saphenous vein grafts (SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction. In SVG PCI, slow flow or no reflow rates may…

…likelihood of clinically significant EMI is generally low, particularly with bipolar electrocautery performed away from the device and with monopolar electrocautery below the umbilicus. Nevertheless…

…of moderate and vigorous intensity activity. Muscle strengthening exercise should additionally be performed on at least 2 days each week. Activities need not be undertaken…

…perfusion when ultrasound contrast agents are used The technique is particularly useful because it is rapid, can be performed at the bedside, avoids ionizing radiation…

…using a needle due to reduced risk of injury. Thoracostomy should be performed promptly following needle decompression. Thoracostomy with drainage typically serves as a stabilizing…

…Yet, autopsies are often not performed due to the high costs. The difficulties in determining the cause of out of hospital cardiac arrest are reflected…

…with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial ischemia…

…exceptions. Prior to the Doppler era, hemodynamic assessments were performed by means of right heart catheterization (with Swan Ganz catheter [ pulmonary artery catheter ]). However, hemodynamic…

…relative. Briefly, exercise stress testing must not be performed in the presence of absolute contraindications. Relative contraindications call for an individualized assessment of the risks…

…for acute severe heart failure. A recent echocardiographic examination should be available or performed urgently to evaluate ventricular and valvular function. Levosimendan drug is generally…

…may be valuable if the diagnosis is uncertain. Echocardiography is generally performed in order to evaluate ventricular function, since it may affect the choice of…

…included in the standard protocol. The majority of examinations included in the standard protocol are performed using two dimensional (2D) imaging. Some measurements are still…

…disease (e.g mitral stenosis) requires intervention. Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower…

…oral or intravenous analgesia, or procedural sedation in advance. Inadequate analgesia is the commonest reason for an incompletely performed drainage. Procedure 1. Locate the centre…

…time targets and choice of reperfusion Primary PCI is the method of choice if PCI can be performed within 120 minutes of the STEMI diagnosis…

…experienced with the head impulse test; performed on the wrong patient or by an inexperienced examiner it is unreliable. A single central feature is enough…

…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…

…thresholds. Clinical Presentation and Symptoms Most AAAs are asymptomatic and are identified either during routine abdominal examination or incidentally on imaging performed for another indication…

…secretions or a cobblestoned appearance of the mucosa. Laryngoscopy may be performed to assess for glottic inflammation, which can be a manifestation of recurrent reflux…

…troponin findings. The default treatment after ACS, whether or not PCI is performed, is 12 months of DAPT unless there is a contraindication, an indication…

…backscatter of the light signal. Imaging is therefore typically performed during contrast injection or another method of temporary blood displacement. OCT is particularly useful for…

…PCI compared with medical therapy. Clinical presentation and symptoms A CTO may be asymptomatic and identified during angiography performed for another indication. When clinically significant…

…the back. In clinical practice, this is often performed by simply placing the electrodes to lead V4, V5 and V6 on the back. One might…

…surges [4]. Surgical Interventions : Stellate ganglion block (SGB) or cardiac surgical sympathetic denervation can be performed to mechanically reduce sympathetic output [4]. Evaluation of Treatment…

…episodes and serious harm. This evaluation should include a detailed history, thorough questioning of eyewitnesses, and a complete physical and neurologic examination. Blood pressure and…

…and prolonged ICU admissions. Pending the correct level of care, the following actions can be performed. CPR Initiate CPR in adherence to standard guidelines. However…

…the atria and the ventricles (particularly the former). Even small pressure elevations on the right side can compromise venous return to the right ventricle. Therefore…

…major defects may go unnoticed until adulthood. Echocardiography in CHD Echocardiography is performed in all patients with suspected CHD. Echocardiography provides detailed morphological and functional…

…pre test probability, which is the probability that the patient actually has endocarditis (this the probability should be estimated before echocardiography is performed). Among patients…

…Survival in cardiac arrest Survival in OHCA Yan et al performed a meta analysis and systematic review of 141 studies on the survival in treated…

…exercise tolerance test . Because the vast majority of all exercise stress tests in the United States are performed using a treadmill, the term treadmill test…

…in the body. The investigator specifies where the measurement should be performed by moving the sample volume (SV) along the Doppler line. The sample volume…