…prophylaxis. Deep puncture wounds , where the base cannot be inspected or irrigated clean. Wounds with retained foreign material or devitalised tissue that cannot be removed…

…in: the choice of site, the use of ultrasound throughout the puncture, and maintaining maximal barrier precautions without shortcuts. The most common serious error is…

…where the pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site…

…tubes go to the right place. In suspected bacterial meningitis it is the time to antibiotics that saves the patient — the puncture must never delay…

…Otherwise: Type Contraindication : : Absolute No safe pocket of fluid to puncture (no ultrasound verified fluid) Relative Uncorrected coagulopathy or thrombocytopenia Relative Ongoing anticoagulant treatment — plan…

…that clots before the smears are made is unusable, no matter how well the puncture went. Indications Unexplained cytopenia in one or more cell lines…

…disease. Contraindications Infection of the skin or soft tissues over the puncture site — use another approach or refrain. Bacteraemia without suspicion of joint infection (relative…

…abdominal wall collaterals (caput medusae) Puncture at least a few centimetres away from them Full bladder Have the patient void, or catheterise, before puncture Pregnancy…

…analysers — check locally. Contraindications Peripheral venous cannula: Infection, burns or trauma at the puncture site. An arm with an arteriovenous fistula, previous axillary clearance or…

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

…exclude Diastolic collapse of the right atrium and right ventricle The cardinal echocardiographic finding A dilated inferior vena cava without respiratory variation Strongly suggests a…

…septic shock, or a need for high dependency or intensive care 3 Take at least two sets of blood cultures from separate peripheral punctures. Also…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

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

…heterogeneous area whose contents move under pressure; cellulitis instead gives a diffuse oedematous picture without a demarcated fluid collection. Ultrasound also shows the depth of…

…and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake Common clinical picture : : 4 to 12 hours Tremor, sweating…

…and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or does not fit the clinical picture. 4. Where possible…

…looking for right ventricular strain. If CT pulmonary angiography can be performed immediately, do it. Otherwise the echocardiographic findings plus the clinical picture are sufficient…

…within a Doppler sector. The picture on the right shows color Doppler located across the mitral valve and the left atrium. The main advantage of…

…non inferior to alteplase with respect to an excellent functional outcome, without an increased risk of symptomatic intracerebral haemorrhage or death [3]. Acute overview 1…

…Isolated urticaria, localised angio oedema or itching without compromise of the airway, breathing or circulation is usually an allergic reaction but not in itself anaphylaxis…

…and level of consciousness immediately. 2. Check oxygen saturation and capillary glucose. 3. Exclude immediately treatable threats without delay: hypoxia, hypoglycaemia, circulatory failure, sepsis, stroke…

…high osmolality Blood ketones are preferable to urine ketones. The principal ketone body in DKA is beta hydroxybutyrate, whereas ordinary urine dipsticks mainly measure acetoacetate…

…5. At the same time, start treatment that eliminates potassium from the body. 6. Check the plasma potassium after about 1 hour and follow the…

…for example after relatives have given carbohydrate or glucagon. In a person without diabetes, a hypoglycaemic disorder is defined primarily by Whipple's triad : 1…

…it as an open fracture. The anatomy of the nail apparatus The terminology is hard to follow without a picture, and several of the steps…

…When present, the clinical picture may include: Symptoms attributable to chronic LV systolic dysfunction and HF Angina, although its absence does not exclude ischemic cardiomyopathy…

…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…