…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 …

…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…

…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…

…the left lower quadrant. Confirm at least 2–3 cm of free fluid depth with no bowel in the path of the needle and measure…

…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…

…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

…neutropenic fever is limited, but delayed antibiotics are associated with a worse outcome in sepsis and in several studies of neutropenic patients. In septic shock…

…Relative: Condition Comment : : Left main stenosis Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without…

…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…

…tender, erythematous and indurated swelling in the skin or subcutis. Pilonidal abscess, hidradenitis abscess and paronychia with a collection of pus. Persistent painful induration after…

…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…

…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…

…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…

…The condition is associated with falls, aspiration, pressure sores, loss of function, longer length of stay, institutional care, readmission, cognitive decline and increased mortality [3…

…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…

…spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : : Acute paronychia with fluctuance or visible pus Incision and drainage Acute…

…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…