…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…

…after arterial puncture, technically more difficult with ultrasound Femoral vein Fastest, and does not interfere with ongoing CPR or airway management, no risk of pneumothorax…

…puncture site, known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must not be passed through the valve. The order of…

…bacterial CNS infections states that CT must not be performed before lumbar puncture in suspected bacterial meningitis — not even with a reduced level of consciousness…

…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…

…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…

…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…

…malignancy, tuberculous peritonitis or pancreatic ascites. Therapeutic paracentesis: Tense ascites with abdominal discomfort, early satiety or respiratory compromise. Diuretic refractory or diuretic intolerant ascites, as…

…the puncture site. An arm with an arteriovenous fistula, previous axillary clearance or lymphoedema. A limb with paresis or marked swelling. A vein suspected of…

…skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the wrist crease at an angle of 30…

…The indication rests on the clinical picture together with echocardiographic signs of tamponade — not on how wide the rim of fluid looks. With ultrasound guidance…

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

…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…

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

…suspicion of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…care Intermediate–high Stable Yes Raised Admission with monitoring. Be prepared for rescue thrombolysis Intermediate–low Stable One of the two positive Admission Low Stable…

…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…

…pathology CT perfusion Used with an unclear time of onset, a late time window, or when thrombectomy can start at the earliest after 6 hours…

…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…

…Subtype Typical picture Clinical significance : : : Hyperactive Agitation, motor restlessness, picking, calling out, irritability, hallucinations More easily detected, but accounts for a minority of cases Hypoactive…

…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…

…continuous ECG monitoring and early assessment of the need for dialysis ECG changes or serious neuromuscular symptoms mean a high risk even if the plasma…

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…

…with a subungual haematoma — manage it as an open fracture. The anatomy of the nail apparatus The terminology is hard to follow without a picture…

…produce post ischemic stunning. In the absence of infarction, contractile recovery can occur rapidly after reperfusion, with recovery generally occurring within one week. By contrast…

…despite correction of the initiating disorder. Earlier diagnosis is associated with a greater likelihood of cure. When to investigate General indications Patients with suggestive signs…