…outcome — that the confirmation of death is carried out in a formally unimpeachable way, and that the donor's organs are maintained physiologically for as…

…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…

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

…is part of the treatment itself. Indications Salicylate poisoning with symptoms or a rising serum concentration. Alkalinisation increases renal elimination several fold and at the…

…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…

…A D dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10…

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…

…A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior iliac spine is the standard…

…foot pulses are not an acceptable substitute, and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis…

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

…Choice of vein and cannula size Choose the veins of the forearm for planned treatment: they are stable, they disturb the patient least, and they…

…call coagulation service Always in parallel: mechanical control of bleeding, tranexamic acid where it is not contraindicated, and contact with the on call coagulation service…

…Do not wait for hypotension in young, pregnant or previously athletic patients. Beta blockade, a pacemaker and autonomic neuropathy can at the same time mask…

…is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly unstable…

…injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against the skin, protects against the edges of the…

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…

…suspicion of tension pneumothorax in a haemodynamically or respiratorily unstable patient. Contraindications In tension pneumothorax and in empyema there are no absolute contraindications — the procedure…

…dysfunction and epicardial coronary spasm. The absence of obstructive CAD on ICA should therefore not automatically be interpreted as evidence that the patient’s symptoms…

…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…

…A pot of 4 % formalin, and for immunofluorescence Michel's medium or saline according to local procedure. Photograph and draw in the site before the…

…useful in practice: An examination couch that can be approached from all sides and on which the patient's head can hang over the end…

…in approximately 80% of patients. Evaluation and clinical assessment Clinical factors influencing treatment selection The following characteristics favour CABG when clinically and anatomically appropriate: Diabetes…

…or selectively after initial medical treatment. The presence of ST segment changes or a positive troponin assay identifies patients in whom an invasive strategy is…

…not with force. The methods that work best exploit time, gravity and slow movement; those that fail usually do so because the patient tenses up…

…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…

…patient , since positive airway pressure further reduces the venous return. Procedure Choice of access The ultrasound, not tradition, determines the site. Scan subxiphoid, parasternally and…

…Coagulopathy and thrombolytic treatment are relative contraindications and are an argument for a superficial, compressible vessel. Allen's test is still used in many units…

…indication: LMWH at treatment dose in parallel. Procedure Initiation with a loading dose Used when a rapid effect is wanted and the patient is also…

…upper abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression. Assessment of pulmonary involvement in systemic…

…the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated. A decision to withhold further life sustaining treatment…

…whose diagnosis you have not established. Indications Lesion Freeze time per cycle Number of cycles Margin : : : : Actinic keratosis, thin 5–10 s 1 1–2…

…Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is…

…get through the day of the test can therefore be given dexamethasone. That is the practical key: the patient does not have to be left…

…Four numbered sample tubes, and a light protected tube if spectrophotometry is to be performed. Procedure 1. Position the patient correctly. The lateral position with…

…an additional mechanism of dissection and impaired distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate…

…electrodes come off, the patient has not kept a diary. The set up and the instructions decide whether the investigation will be usable. Ambulatory blood…

…likelihood of atherosclerotic obstructive CAD. CAC is therefore not merely an incidental imaging finding; it can refine the decision to test and may identify patients…

…a route of administration and a target range for the saturation . What usually goes wrong is not that the patient gets too little oxygen but…

…after anaphylaxis that required treatment; biphasic reactions occur. Everyone must go home with an adrenaline auto injector and written instructions. Patients taking beta blockers may…

…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…

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

…treatment with antianginal drugs and PCI or CABG, daily or weekly angina remains present in approximately 2%–24% of patients with CAD. The pathophysiology of…

…to conventional CPR in patients with refractory out of hospital cardiac arrest. Patients aged 18 to 70, who received bystander CPR and initially presented with…

…remains possible after DES implantation. Clinical Presentation and Symptoms The clinical spectrum of ISR is broad: Many patients remain asymptomatic. The most common symptomatic presentation…

…risk patients. The strategy may, however, increase peri procedural complications and bleeding. Clinical presentation The available source material does not provide a detailed description of…

…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…

…radiofrequency procedures, nerve stimulators, and other electronic equipment may also interfere with device function. The clinical consequences depend on the device, the patient's dependence…

…estimate of SCD risk, which facilitates informed discussions between clinicians and patients. This is particularly important when considering ICD implantation, as the procedure carries both…

…and procedural complexity. Overall incidence and major complications Complications during diagnostic coronary angiography occur in approximately 2% of patients. Serious events such as stroke and…

…the patient finding the procedure painful. Test with a needle tip before you start. Apply the tourniquet only after the block has taken effect, and…

…hours of fasting before the test is recommended. Shoes and clothing should be suitable for exercise. Motivation is of utmost importance because the patient must…

…magnetic resonance imaging has demonstrated procedural injury in patients undergoing either procedure, and postprocedural cTnI elevation correlates with evidence of injury on cardiac magnetic resonance…

…Tono Pen). Procedure Systematic examination 1. Visual acuity in each eye separately , with the patient's usual glasses and then through a pinhole. This is…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…Contraindications The laryngeal mask is a compromise and does not protect the airway completely. Relative contraindications: A high risk of aspiration: a non fasted patient…

…evidence base of any physiological index; lesion specific and largely independent of resting hemodynamics; guideline reference standard. Requires pressure wire + vasodilator (cost, time, patient discomfort…

…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…

…forwards , not backwards. Procedure Step 1 — compression Have the patient blow out the clot. The pinch is applied to the lower third of the nose…