…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…

…technique but the handling of the specimen — an aspirate that clots before the smears are made is unusable, no matter how well the puncture went…

…skin. 2. Clean and let it dry. Do not palpate the puncture site again with an unsterile hand. 3. Insert the needle in one movement…

…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…

…the hand secured with tape. Greater extension makes the artery harder to palpate. Procedure Catheter over needle (direct technique) 1. Palpate the course of the…

…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…

…abscess sits somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face or perianally…

…often visual, auditory or tactile hallucinations with a relatively clear level of consciousness and preserved orientation 12 to 48 hours Withdrawal seizures, usually generalised tonic…

…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…

…need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right ventricular strain. If CT pulmonary angiography…

…interpretation of the Doppler signals. Figure 1. The image on the left shows many sample volumes within a Doppler sector. The picture on the right…

…acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window…

…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…

…Start non pharmacological treatment immediately , in parallel with the investigation. 8. Document the diagnosis and communicate it at every handover. Recognise it Core criteria Core…

…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…

…The grading must not be used mechanically. A patient with a plasma potassium of 6.2 mmol/L, new bradycardia and acute kidney injury may…

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…

…permitted when assessing dietary electrolyte intake, because it can increase blood pressure and may affect interpretation of the clinical picture. A 24 hour urine collection…