…because of the cosmesis, often with antibiotic prophylaxis. Deep puncture wounds , where the base cannot be inspected or irrigated clean. Wounds with retained foreign material…

…risk of pneumothorax, the vessel cannot be compressed after arterial puncture, technically more difficult with ultrasound Femoral vein Fastest, and does not interfere with ongoing…

…or to resolution of the underlying cause. Contraindications Hypothermia with a body temperature below about 30 °C — the hypothermic myocardium is irritable and pacing can…

…the scan contributes. Only clinical signs of herniation halt the puncture, and antibiotics and a corticosteroid are then given immediately after blood cultures. For questions…

…punctured. Identify the diaphragm, the liver or spleen, the lung and the fluid level. 2. Choose a point with at least 15 mm depth of…

…the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of…

…50 mL syringe for a knee with a large effusion, 5–10 mL for smaller joints. Local anaesthesia of the skin and subcutis where needed…

…choose a new site if in doubt Cellulitis over the insertion site Change the puncture site Preparation and equipment Ultrasound with a curved array probe…

…In shock with collapsed vessels, the antecubital fossa or the external jugular vein are the vessels that can most often still be punctured — and ultrasound…

…and note the direction. Disinfect and allow to air dry. 2. Anaesthetise the skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture…

…how wide the rim of fluid looks. With ultrasound guidance, the point at which the fluid lies most superficially is chosen and the needle is…

…and patients treated with CAR T cells or other advanced immunotherapies may require separate local protocols. Definition Criterion Practical definition : : Fever A single temperature of…

…the overall picture : exercise capacity, symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient who stops at a low workload with a…

…with the clinical picture, medication, fluid balance, renal function, electrolytes and supplemental oxygen [1]. Distinguish between: Acidaemia and alkalaemia , which describe the current pH of…

…diffuse oedematous picture without a demarcated fluid collection. Ultrasound also shows the depth of the cavity and its distance to vessels. Contraindications and when to…

…or cessation of prolonged and heavy alcohol intake. The condition can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked…

…does not fit the clinical picture. 4. Where possible, take the plasma osmolality, urine osmolality and urine sodium before treatment. 5. With severe symptoms: give…

…cent. An sPESI of 0 indicates low risk. Anticoagulation A DOAC is the first choice in pulmonary embolism without malignancy and without antiphospholipid syndrome. The…

…The picture on the right shows color Doppler located across the mitral valve and the left atrium. The main advantage of color Doppler is that…

…version 4 of 27 February 2024. The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence…

…fluid and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise despite two adequate intramuscular doses of adrenaline and…

…fracture, major surgery and intensive care [1,2]. The condition is associated with falls, aspiration, pressure sores, loss of function, longer length of stay, institutional…

…picture of DKA and HHS Overlap is common. Treat as mixed DKA and HHS if the patient has marked hyperosmolality together with significant ketosis and…

…3. Give intravenous calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high…

…everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour, collapse or an acute neurological deficit. Hypoglycaemia can cause hemiparesis, aphasia and…

…The anatomy of the nail apparatus The terminology is hard to follow without a picture, and several of the steps below refer to structures that…

…unfavorable when ischemic cardiomyopathy is associated with recurrent MI, ventricular arrhythmias, or a large burden of hibernating myocardium. Evaluation and physical examination The assessment should…

…blood pressure and may affect interpretation of the clinical picture. A 24 hour urine collection for electrolytes can be used to quantify sodium and potassium…