…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…

Procedurer What determines a lumbar puncture is rarely the needle itself. It is the decision whether to perform it now or after imaging, how the…

…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…

…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…

…it passes through muscle without major vessels or nerves, and the landmark — the posterior corner of the acromion — is easy to palpate even in a…

…lateral to the rectus sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a…

…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

…a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests from the suspected focus, but avoid…

…only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with outflow tract obstruction Caution…

…simple disorder, or two opposing primary disorders It is therefore not enough to ask which of the pCO₂ and the HCO₃ deviates most. What matters…

…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…

…epilepticus should raise strong suspicion of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start…

…potassium and the total body water. In hypotonic hyponatraemia the amount of water is too great in relation to the amount of dissolved cations [3…

…cent. An sPESI of 0 indicates low risk. Anticoagulation A DOAC is the first choice in pulmonary embolism without malignancy and without antiphospholipid syndrome. The…

…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…

…if this can be done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex…

…The absence of urticaria must therefore not be used to exclude the diagnosis [1]. Isolated urticaria, localised angio oedema or itching without compromise of the…

…1. Assess vital signs and level of consciousness immediately. 2. Check oxygen saturation and capillary glucose. 3. Exclude immediately treatable threats without delay: hypoxia, hypoglycaemia…

…L pH < 7.00 or bicarbonate < 10 mmol/L Stupor or coma may occur Mixed picture of DKA and HHS Overlap is common…

…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…

…venous measurement [5]. Treatment The awake patient who can swallow safely Give 15 to 20 g of rapid acting carbohydrate orally . Suitable options are: glucose

…The anatomy of the nail apparatus The terminology is hard to follow without a picture, and several of the steps below refer to structures that…

…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…