…patient who develops total brain infarction An intensive care patient in whom life sustaining treatment is withdrawn and total brain infarction is not expected to…

…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…

…lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient…

…in rhabdomyolysis, and salicylate concentration in poisoning. Procedure 1. Contact your national or regional poison control centre in poisoning before treatment is started. They give…

…to anatomy correlation. Pain may be absent, particularly in iatrogenic aortic injury. Iatrogenic lesions commonly follow cardiac surgery, coronary angiography or other invasive procedures, and…

…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…

…6–10, plus spreader slides — laid out and labelled before the puncture begins . Specimen tubes: EDTA and heparin tubes according to local instructions, plus a…

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

…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…

…gravity is not enough. Lidocaine 10 mg/mL to anaesthetise the marrow cavity in a conscious patient. Fixation material for the intraosseous needle. Procedure Peripheral…

…its own thresholds in the patient on anticoagulants; see the acute stroke quick reference. Stopping the drug and forgetting to restart it after the procedure…

…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…

Procedurer Transcutaneous pacing takes seconds to start and can keep a patient alive until a transvenous lead is in place — but only if it is…

…and remove rings and jewellery distal to the injury before the swelling develops. Procedure 1. Place the joint at the angle the treatment requires before…

…the mask goes on, not after the sore has developed. Humidification, suction and the facility to give nebulised drugs within the circuit. Monitoring: continuous pulse…

…toxic dose of a substance that binds to charcoal, when it can be given early and the patient has an intact or a protected airway…

…but never below the ninth rib . Procedure Ultrasound localisation 1. Scan in the position in which the patient is to be punctured. Identify the diaphragm…

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

…lead to misclassification. Blood pressure should be measured with a validated and calibrated device using a consistent method for the individual patient. The recommended procedure…

…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…

…patient to keep the eyes open and look straight ahead — without open eyes there is no diagnosis. Procedure The Dix–Hallpike test 1. The patient…

…burden and treatment goals Diabetes, left ventricular function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and…

…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…

…shoulder dislocation, with an effect equivalent to sedation and fewer adverse effects Digital nerve block The standard in finger dislocation Procedural sedation Propofol, ketamine or…

…plastic film or a dressing to protect an ulcer, and where needed a photoplethysmograph and a toe cuff. Preparation: The patient must have rested lying…

…the procedure is the wrong treatment : Aortic dissection with haemopericardium — drainage can increase the bleeding and worsen the prognosis. The patient must go to cardiothoracic…

Procedurer An arterial line is easy to insert and easy to trust too much. Two errors make the reading useless without anyone noticing: the transducer…

…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…

…fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression…

…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…

…protection and gloves for the operator. Explain before treatment that it stings intensely during thawing, that a blister (sometimes a blood blister) is to be…

…are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin and soft tissue…

…given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1. Schedule…

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

…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…

…and in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set up and instructions Choose the cuff according to arm circumference…

…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…

…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…

…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…

…tendon and the patellar tendon — do not inject into or beside them. Anticoagulant treatment is not a contraindication to these superficial injections. Preparation and equipment…

…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…

…of an extracorporeal pump and oxygenator. ECMO (Extracorporeal Membrane Oxygenation) , a type of ECLS, operates by drawing venous blood from the patient to an oxygenator …

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

…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…

…hyporesponsiveness or resistance to aspirin or clopidogrel Anatomic Long lesions, small vessels, multivessel disease, bifurcation lesions, treatment of acute myocardial infarction Procedural and mechanical Stent…

…from the device and with monopolar electrocautery below the umbilicus. Nevertheless, perioperative planning should be individualized according to the patient, device, procedure, and anticipated electrical…

…validated risk prediction model developed I relatively large patient cohorts. It incorporates key clinical and echocardiographic parameters to calculate an individual's risk of SCD…

…contraindications to coronary angiography in the general sense; the decision depends on balancing the expected diagnostic or therapeutic benefit against the patient’s specific procedural…

…reaching out to the sides beneath the nail folds. It is these that must be destroyed during matrix ablation — miss the horn and the nail…

…personnel must be well trained in resuscitation. Subject preparations The procedure must be explained carefully to the patient, who must also be informed that his…

…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…

…the patient to look down. Grasp the eyelashes, press gently downwards on the upper border of the tarsal plate with a cotton bud, and at…

…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…

…and a person designated to keep time and read out the number of attempts. Laryngeal mask sizes Size Patient weight Maximum cuff volume (air filled…

…reserve (FFR), have been validated against outcomes and shown to outperform visual angiographic guidance in selecting lesions for percutaneous coronary intervention (PCI). Non hyperemic pressure…

…in the other nostril, in the ears and in the mouth. Nose 1. Ask the patient to blow the nose gently. Clear mucus with suction…

…upright and tilts the head forwards , not backwards. Procedure Step 1 — compression Have the patient blow out the clot. The pinch is applied to the…