…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…

…of ultrasound throughout the puncture, and maintaining maximal barrier precautions without shortcuts. The most common serious error is dilating a vessel that turns out to…

…pain of transcutaneous pacing. It is a bridge to a permanent pacemaker or to resolution of the underlying cause. Contraindications Hypothermia with a body temperature…

…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…

…to local practice Relative Skin infection, herpes zoster or burns over the puncture site Relative Mechanical ventilation with a high PEEP (an increased risk 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…

…towards the lateral side with your free hand. The needle is inserted directed medially and slightly caudally, parallel to the posterior surface of the patella…

…at least 2–3 cm of free fluid depth with no bowel in the path of the needle and measure the skin to peritoneum distance…

…swelling. A vein suspected of thrombosis or previously thrombophlebitic. Intraosseous access (absolute, for the bone in question): A fracture of the bone to be punctured…

…allow to air dry. 2. Anaesthetise the skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the…

…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

…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…

…oedematous picture without a demarcated fluid collection. Ultrasound also shows the depth of the cavity and its distance to vessels. Contraindications and when to involve…

…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…

…A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from 140 to 125 mmol/L…

…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…

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

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

…oedema, together with at least one of the following: airway compromise respiratory compromise circulatory compromise severe gastrointestinal symptoms, particularly after exposure to a drug, insect…

…previous care provider. 5. Confirm delirium with a structured instrument , for example the 4AT or the CAM according to local protocol. 6. Look for several…

…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…

…function and the rate of rise. Often outpatient or brief inpatient follow up depending on the clinical picture Moderate 6.0 to 6.4 mmol…

…be checked with a capillary or venous measurement [5]. Treatment The awake patient who can swallow safely Give 15 to 20 g of rapid acting…

…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…

…history of angina or MI, making the distinction from primary dilated cardiomyopathy particularly difficult. When present, the clinical picture may include: Symptoms attributable to chronic…

…pressure and may affect interpretation of the clinical picture. A 24 hour urine collection for electrolytes can be used to quantify sodium and potassium intake…