…in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia…

…with potential tracheal deviation to the opposite side Distended jugular veins Management Decompression using a venous cannula Can be executed in a pre hospital setting…

…passed through the valve. The order of management in acute bradycardia Atropine is given in doses of 0.5–1 mg intravenously, repeated every three…

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

…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…

…define the structure or composition of coronary atherosclerotic plaque, identify plaques at high risk of rupture, or determine whether ischaemia would occur at workloads greater…

…there would be poorly tolerated. A patient who cannot lie flat or cannot cooperate — consider sedation, a different position or a different vessel. Choice of…

…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…

…capillary refill and pulse, and active movement of every tendon crossing the wound. A tendon injury can be painless and gives normal passive movement — test…

…4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only…

…Clinical suspicion of a scaphoid fracture despite a normal radiograph. Contraindications An open fracture or a wound that needs to be inspected — use a windowed…

…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…

…of adequate conservative treatment — modification of loading, eccentric exercise, an NSAID, an orthosis — has not given a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound…

…Instillation therapy and contrast studies of the urinary tract. Wound healing with a sacral pressure sore or extensive perineal wounds where urinary leakage prevents healing…

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

…larynx. The difficult airway rarely kills because the tube would not pass, but because the team keeps trying to intubate instead of changing the plan…

…time, coach actively, and do not accept a trace you would not be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze…

…of objectively demonstrating peripheral arterial disease, and it is needed more often than it is used — not only in claudication, but before every compression treatment…

…Why Avoids the vulnerable phase of the T wave There is no R wave to synchronise to; sync mode would block the shock entirely The…

…5 mm over 6 months. Such growth may justify consideration of repair at a smaller diameter than would otherwise be used. Women have growth rates…

…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…

…to ECG interpretation Standard display of ECG leads in the 12 lead ECG Numerous conditions that can be diagnosed using the 12 lead ECG require…

…the onset of physical activity. Profound sinus bradycardia (<30 beats/min or sinus pauses ≥3 s) would warrant further investigation. 6. Which of the following…

…decrease in unstable angina in the past two decades (many of those who would previously have been classified as unstable angina are now classified as…

…repeatedly to the circumflex artery before a 60 minute occlusion of the left anterior descending coronary artery (LAD) would reduce the infarct size by 60%…

…denoted by the letter λ (lambda) . Note that The International System of Units is used throughout this book. This includes the base units metre (length…

…The myocardium is capable of upregulating or downregulating metabolism (i.e contractility) according to oxygen supplies. Consequently, reduced oxygen supply would not result in ischemia…

…dx), which originates from the right coronary artery (RCA). The RCA also supplies the inferior left ventricular wall in over 90% of all individuals. Hence…