…made to withdraw life sustaining treatment, in whom total brain infarction is not expected to occur within a reasonable time, and in whom death is…

…if possible, otherwise give IM with a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative…

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…

…assessment of function and prognosis, arrhythmia evaluation, known coronary artery disease and evaluation of treatment effect, the medication is continued — abrupt withdrawal carries a risk…

…The treatment looks simple — bicarbonate and a look at the urine dipstick — but it fails routinely for one single reason: without normal potassium the urine…

…follow cardiac surgery, coronary angiography or other invasive procedures, and affected patients may be relatively painless compared with those with spontaneous dissection. Clinical manifestations may…

…local procedure. Low molecular weight heparin, not a DOAC Active cancer A DOAC or low molecular weight heparin. Consider the bleeding risk with gastrointestinal and…

Procedurer An abscess is emptied, not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous…

Procedurer Aspirate and biopsy answer different questions and do not replace one another: the aspirate shows cellular morphology and provides material for flow cytometry and…

…5. Biopsy any ulcer that has not healed within three months despite adequate treatment — malignancy (Marjolin's ulcer, basal cell carcinoma) and vasculitis do occur…

…superior wall of the ear canal , past the plug — not straight at it. The water should get behind the wax and push it out. 6…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

…Three questions come up again and again on call: which dose, how long to interrupt treatment before a procedure, and how to reverse in bleeding…

…not on a single threshold value. The combination of physiology, rate of bleeding, the pattern of injury or disease, the response to initial treatment and…

…in units with airway expertise. Procedure 1. Dry the skin and shave where necessary. Do not clip the hair — small cuts cause burning pain. 2…

…Procedure 1. Place the joint at the angle the treatment requires before the cast is applied, and hold that position until the cast has set…

Procedurer CPAP and NIV are two different treatments with different physiology, and the commonest source of error is confusing them. CPAP delivers a constant pressure…

…place in the modern treatment of poisoning. Charcoal also does not bind every poison. With the following substances charcoal is ineffective and management is instead…

…with at least 15 mm depth of fluid throughout the respiratory cycle and where the lung does not come up against the probe on inspiration…

…to outweigh procedural risks. This balance forms part of shared clinical decision making. Pathophysiological and Diagnostic Considerations Angiographic severity and physiological severity do not always…

…Out of office measurement is consequently central to diagnosis and long term management. Clinical presentation and symptoms The source material does not describe the typical…

…Procedure Punch biopsy 1. Mark the biopsy site. In an inflammatory dermatosis: the active edge , not the burnt out centre. 2. Clean the skin and…

Procedurer Benign paroxysmal positional vertigo is the commonest cause of vertigo in primary care and one of the few diagnoses that can be cured on…

…stents do not prevent the development of new proximal atherosclerosis. The choice between procedures therefore depends on the balance between: Anatomical completeness and complexity of…

…comorbidities, procedural complexity, age, frailty, and anticipated adherence to antithrombotic therapy. Anatomical and functional completeness are not synonymous. Anatomically incomplete revascularization may nevertheless be functionally…

Procedurer A dislocation is reduced with muscle relaxation, not with force. The methods that work best exploit time, gravity and slow movement; those that fail…

…and it is needed more often than it is used — not only in claudication, but before every compression treatment of a leg ulcer and as…

…thrombocytopenia and ongoing anticoagulant treatment. In tamponade with shock the coagulation is corrected in parallel with the procedure, not before it. Preparation and equipment Ultrasound…

…for dialysis. Previous vascular surgery in the area. Coagulopathy and thrombolytic treatment are relative contraindications and are an argument for a superficial, compressible vessel. Allen…

…life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment is safe is not the starting dose but…

Procedurer Spirometry is the only investigation that distinguishes obstructive from restrictive impairment of lung function, and COPD cannot be diagnosed without it . The quality of…

…in which the bradycardia and reduced contractility of hypothermia are not tolerated. A decision to withhold further life sustaining treatment. Preparation and equipment Continuous core…

…to protect the surrounding skin. Eye protection and gloves for the operator. Explain before treatment that it stings intensely during thawing, that a blister (sometimes…

…shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period before a urological procedure…

…test is not the first line investigation in a suspected acute crisis. There, cortisol and ACTH are taken immediately, treatment is given, and the test…

…pressure with bradycardia. A known or suspected intracranial space occupying lesion with mass effect and midline shift. Ongoing anticoagulant treatment or marked coagulopathy. A platelet…

…Evaluation and Procedural Recognition Recognition is primarily angiographic and clinical. No reflow should be suspected when distal coronary perfusion remains reduced despite successful treatment of…

…medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept a diary. The set up and the…

…the result meaningfully increases the likelihood of disease and can justify further investigation or treatment. Testing is therefore not an automatic response to chest pain…

…first line treatment during an attack and aborts most attacks within 15–20 minutes. An undrained pneumothorax. A high oxygen concentration washes nitrogen out of…

…not a treatment review. For a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain…

…has been out of stock for a long period — check local availability. Betamethasone (Betapred 4 mg/mL) is water soluble and short acting, not a…

…surgery — and cardiac arrest. Contraindications There are no absolute contraindications in the emergency situation. Consider alternatives when: Intubation is not consistent with the treatment plan…

…appropriate investigation has identified the relevant endotype and its treatment options have been addressed. ANOCA/INOCA should not be labelled refractory before further diagnostic evaluation…

…efficacy of compressions and defibrillation diminishes considerably. Extracorporeal Life Support (ECLS) emerges as the sole therapeutic alternative for such situations. Presently, this treatment is confined…

…both ISR and stent thrombosis. Optical coherence tomography (OCT) is currently the most suitable imaging modality for detecting neoatherosclerosis, although its resolution does not consistently…

…however, increase peri procedural complications and bleeding. Clinical presentation The available source material does not provide a detailed description of the presenting symptoms of NSTEMI…

…small vessels, multivessel disease, bifurcation lesions, treatment of acute myocardial infarction Procedural and mechanical Stent underexpansion, incomplete wall apposition, residual inflow or outflow disease, edge…

…most frequent source of EMI, although radiofrequency procedures, nerve stimulators, and other electronic equipment may also interfere with device function. The clinical consequences depend on…

…discussions between clinicians and patients. This is particularly important when considering ICD implantation, as the procedure carries both benefits (life saving therapy) and risks (e…

…in fewer than 3%, and stroke in 0.1–0.4%. Risk is substantially higher in older patients, emergency or urgent procedures, chronic kidney disease…

…taken effect, and note the time. It must not stay on for longer than 20–30 minutes. Procedure Paronychia — incision and drainage 1. A digital…

…safe procedure, the risk of complications calls for careful consideration of contraindications. Contraindications may be absolute or relative. Briefly, exercise stress testing must not be…

…acute procedural injury. Even then, it may not be possible to determine precisely how much of the postprocedural increase results from the index MI and…

Procedurer The single most important step in any eye injury is to measure and document the visual acuity before anything else is done. The second…

…are no absolute contraindications, but refrain or adapt in: The patient does not consent — the examination must then not be carried out. Vaginismus or marked…

…assessment indicates that difficulties are likely. Contraindications The laryngeal mask is a compromise and does not protect the airway completely. Relative contraindications: A high risk…

…and the key trials supporting each. A more detailed mechanistic discussion of each index follows in Section 2, and a guideline oriented comparison (procedural requirements…

…Procedure Batteries and magnets A button battery in the nose or the ear canal is an emergency, not a finding that can wait until the…

…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…