…lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia, cold agglutinin disease, cold urticaria. Relative: Basal cell carcinoma and squamous…

…Clarke RC, Mertes PM, et al. Molecular mechanisms and pathophysiology of perioperative hypersensitivity and anaphylaxis: a narrative review. Br J Anaesth 2019; 123:e3849. Wallmuller…

…channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia…

…pattern and syndrome: from ECG criteria to management Although the early repolarization pattern has been recognized for almost 50 years, it is still one of…

…in the management of coronary artery disease, as demonstrated in the figure below (from Nabel et al, NEJM, 2014). In this post I would like…

…diagnostic strategy or management. Appropriate objectives include: Measuring exercise tolerance Determining whether symptoms are reproduced by exertion Assessing the relationship between symptoms and ECG changes…

…Femoral vein Fastest, and does not interfere with ongoing CPR or airway management, no risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the…

…wall motion abnormality and it may evidence of myocardial infarction, which would have implications for the management of this patient, regardless of the ejection fraction…

…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 …

…ulcer that has not healed within three months despite adequate treatment — malignancy (Marjolin's ulcer, basal cell carcinoma) and vasculitis do occur. Wound debridement 1…

…and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal radiograph. Contraindications An open fracture or a wound…

…if possible, otherwise give IM with a fine needle and 5 minutes of compression. Anticoagulant treatment is not in itself a bar to vaccination. Relative…

…sparingly Prepatellar and olecranon bursitis The bursa Exclude septic bursitis first Injection is considered when 4–6 weeks of adequate conservative treatment — modification of loading…

…Bladder washout and continuous irrigation in macroscopic haematuria with clots (a three way catheter). Instillation therapy and contrast studies of the urinary tract. Wound healing…

…doses below are taken from the recommendations of Strama Stockholm for the empirical antibiotic treatment of adults in hospital and in residential care homes (SÄBO…

…a slightly upturned leading edge, and lubricate the dorsal surface. 2. Position the head in the sniffing position if the neck may be moved. 3…

…would not be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze or reduced exercise capacity. Suspected asthma or COPD — diagnosis and…

…of myocardial infarction and stroke. Indications Intermittent claudication, rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of…

…can precipitate ventricular fibrillation, and cardioversion of fibrillation of unknown duration without anticoagulation can cause a stroke hours to weeks later. Everything else in the…

…At least 90% of AAAs larger than 4 cm are associated with atherosclerotic pathology. AAA prevalence increases with age and is approximately five times higher…

…precisely, FFR compares the pressure driving flow distal to a stenosis with the pressure that would be available in the absence of that stenosis. The…

…rest, which does not reveal the functional (maximum) capacity of the left ventricle, as this would require measuring the ejection fraction during submaximal exercise testing…

…coordinate system presenting the limb leads in the frontal plane. This format of displaying the ECG leads is referred to as the Cabrera format and…

…3 s) would warrant further investigation. 6. Which of the following ECG findings is generally considered a normal variant in asymptomatic athletes and typically does…

…20% increase in NSTEMI and a corresponding decrease in unstable angina in the past two decades (many of those who would previously have been classified…

…infarction. The location of the thrombus in the artery: a proximally located thrombus will cut off blood flow to more branches, and thus more myocardium…

…International System of Units is used throughout this book. This includes the base units metre (length), kilogram (mass), second (time), ampere (electric current) and Kelvin…

…of all ischemic episodes are asymptomatic (refer to The Ischemic Cascade). Acute coronary syndromes occur when atherosclerotic plaques rupture or erode, leading to atherothrombosis and…

…thick layer that much of it may receive oxygen directly from the blood within the atrial cavity. The left ventricle is considerably thicker and – except…