…yourself what a maximal blow looks like. The patient sits upright with both feet on the floor and must not lean forward during expiration. 2…

…deep vein thrombosis with post thrombotic syndrome. Differential diagnosis Feature Venous ulcer Arterial ulcer Diabetic foot ulcer : : : : Site Gaiter area, above the medial malleolus Toes…

…thrombus may form at a site that was previously only mildly or moderately stenosed. Plaque rupture Plaques prone to rupture characteristically contain a large lipid…

…as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb…

…which causes the shoulder injury known as SIRVA. Both are avoided with the right landmark and the right needle length. Indications Route Typical drugs Absorption :…

…abandoning the procedure. Choice of site The posterior superior iliac spine is the standard site for both aspiration and biopsy in adults. Here the posterior…

…obesity or a stiff chest wall. Glottic or subglottic obstruction — the mask sits above the obstruction and solves nothing. A mouth opening below about 2…

…the threshold, but the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before…

Procedurer What determines the outcome of a central venous catheter insertion is decided before the needle goes in: the choice of site, the use of…

Procedurer Almost all the complications of pleural aspiration arise from two errors: the needle is placed in the wrong site, and too much is drained…

…again within a day, and the abscess sits somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial…

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…and thrombosis interact to produce focal arterial lesions. Although epicardial coronary arteries are a major site of disease, atherosclerosis is systemic and may affect multiple…

…injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to the aortic root, engaging the…

…high quality medical education simply. Life in the Fast Lane Australian site with one of the most impressive ECG libraries available. A must for anyone…

…of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus plugging. Expiratory…

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

…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…

…See the separate guide to joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff syndrome The subacromial space The best documented…

…less dramatic despite a sudden deterioration in function. The severity of tissue injury depends on the site, duration and completeness of occlusion and on the…

…a decrease in Vmax. Consequently, shifts in the pacemaker site within the sinus node and sinus exit block may occur. In humans, adenosine initially slows…

…coronary intervention (PCI). Complications are uncommon, but their clinical spectrum ranges from transient arrhythmias and minor access site bleeding to myocardial infarction, stroke, coronary perforation…

…sodium pump. Digoxin binds reversibly to a specific high affinity site on the extracytoplasmic face of the alpha subunit of the Na+ K+ ATPase. This…

…the ribs increase, providing larger windows for the ultrasound beam. The operator can sit on either side of the patient, depending on preferences. The operator…

…Procedure The Dix–Hallpike test 1. The patient sits upright on the couch, far enough forward that the head will extend beyond the end of…

…bleeding. Raise the chair so that the patient's nose is at your eye level. The patient sits upright and tilts the head forwards , not…

…A small or uncooperative child Movement causes injury Preparation and equipment Otoscopy: an otoscope with a charged battery and clean disposable specula in several sizes…

…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

…External rotation (the Hennepin technique). The patient lies supine or sits. The upper arm is held adducted against the trunk and the elbow is flexed…

…procedure. Photograph and draw in the site before the local anaesthetic is given — the anaesthetic can make a subtle lesion hard to find again, and…

…pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein…

…limit is not the clock but the degree of contamination, the depth and site of the wound, and how well the wound can be cleaned …

…Whether electrosurgery or diathermy will be used. Whether monopolar or bipolar electrocautery is planned. The operative site in relation to the pulse generator and the

…At pathological examination, Dressler syndrome is generally characterized by localized fibrinous pericarditis containing polymorphonuclear leukocytes. Important distinction from subacute cardiac rupture A post AMI pericardial…

…Infarction (STEMI) [1] . Historically viewed as a simple plumbing problem characterized by the gradual accumulation of inert cholesterol debris, modern vascular biology has redefined atherosclerosis…