…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…

…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…

…finger joints). A 20–50 mL syringe for a knee with a large effusion, 5–10 mL for smaller joints. Local anaesthesia of the skin…

…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…

…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…

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

…triangle of the face or perianally. Indications Fluctuant, tender, erythematous and indurated swelling in the skin or subcutis. Pilonidal abscess, hidradenitis abscess and paronychia with…

…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…

…Haemodynamics Right ventricular strain (echo or CT) Troponin Management : : : : : High Unstable Yes Often raised Reperfusion, intensive care Intermediate–high Stable Yes Raised Admission with monitoring…

…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…

…remove the allergen. 2. Give adrenaline 1 mg/ml intramuscularly into the middle third of the anterolateral thigh. Dose 0.01 mg/kg, corresponding to…

…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…

…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…

…5 mL syringe. A tourniquet: a Penrose drain with artery forceps, or the cut off finger of a sterile glove rolled down. A nail splitter…

…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…