…are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis, often with antibiotic prophylaxis. Deep puncture wounds …

…line set with a triple lumen catheter, usually 7 Fr. Catheter length: the right internal jugular vein requires the shortest catheter, while left sided and…

…underlying cause. Contraindications Hypothermia with a body temperature below about 30 °C — the hypothermic myocardium is irritable and pacing can precipitate ventricular fibrillation. Prioritise rewarming…

…that saves the patient — the puncture must never delay it. Indications Suspected meningitis or encephalitis. Suspected subarachnoid haemorrhage with a normal or non diagnostic CT…

…Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk of pneumothorax; ultrasound guidance…

…around the puncture site , and wait a few minutes. 4. Make a small skin incision with the scalpel. 5. Aspiration: advance the needle with the…

…Examine the joint, locate the effusion and mark the puncture site with a pen or an indentation from a fingernail before cleaning the skin. 2…

…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…

…1. Apply the tourniquet 10–15 cm proximal to the intended puncture site, let the arm hang, ask the patient to pump with the hand…

…Anaesthetise the skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the wrist crease at an angle…

…liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and to the left

…blood cultures from separate peripheral punctures. Also culture from a central line if one is present 4 Take a full blood count with a differential…

…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…

…moment of sampling, but does not by itself identify the cause. The result must always be weighed together with the clinical picture, medication, fluid balance…

…Pilonidal abscess, hidradenitis abscess and paronychia with a collection of pus. Persistent painful induration after a few days of antibiotics — suggests that an abscess has…

…can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked tolerance. The most important measures in severe or complicated withdrawal…

…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…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…left shows many sample volumes within a Doppler sector. The picture on the right shows color Doppler located across the mitral valve and the left…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is associated with more severe and more protracted reactions, biphasic courses and fatal outcome…

…and the incidence is particularly high after hip fracture, major surgery and intensive care [1,2]. The condition is associated with falls, aspiration, pressure sores…

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

…and record an ECG. 2. Confirm the potassium with a repeat sample, but do not delay treatment when there are ECG changes, circulatory compromise or…

Endokrinologi & metabolism Akutsjukvård Lathundar Emergency overview Measure the plasma glucose immediately in everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour…

…in: Diabetes with neuropathy or peripheral arterial disease — a risk of osteomyelitis and poor healing. Check the ankle brachial index and the foot status before…

…or extensive MI with necrosis and scar formation Diffuse myocardial fibrosis Reversible ischemic dysfunction Chronic hypoperfusion with hibernating myocardium Post ischemic stunning Adverse left ventricular …

…the aorta and renovascular disease are important non endocrine causes, particularly in patients with resistant hypertension. Dietary sodium and potassium abnormalities and commonly used over…