Please find below the recommended doses of adrenaline for Adult Life Support (ALS) in different scenarios:

– Anaphylaxis: 0.5mg or 0.5ml of 1:1,000 adrenaline should be administered intramuscularly.
– Cardiac arrest: For intravenous administration, 1mg or 10ml of 1:10,000 adrenaline or 1ml of 1:1000 adrenaline is recommended.

Understanding Adrenaline and Its Indications

Adrenaline is a type of sympathomimetic amine that has both alpha and beta adrenergic stimulating properties. It is commonly used in emergency situations such as anaphylaxis and cardiac arrest. For anaphylaxis, the recommended adult life support adrenaline dose is 0.5ml 1:1,000 IM, while for cardiac arrest, it is 10ml 1:10,000 IV or 1ml of 1:1000 IV.

Adrenaline is responsible for the fight or flight response and is released by the adrenal glands. It acts on α 1 and 2, β 1 and 2 receptors, and causes vasoconstriction in the skin and kidneys, resulting in a narrow pulse pressure. It also increases cardiac output and total peripheral resistance, while causing vasodilation in skeletal muscle vessels.

When adrenaline acts on α adrenergic receptors, it inhibits insulin secretion by the pancreas and stimulates glycogenolysis in the liver and muscle. On the other hand, when it acts on β adrenergic receptors, it stimulates glucagon secretion in the pancreas, stimulates ACTH, and stimulates lipolysis by adipose tissue.

In case of accidental injection, the management involves local infiltration of phentolamine. Understanding the indications and actions of adrenaline is crucial in emergency situations, and proper administration can help save lives.

Causes of Pneumonia

Pneumonia is a respiratory infection that can be caused by various infectious agents. Community acquired pneumonia (CAP) is the most common type of pneumonia and is caused by different microorganisms. The most common cause of CAP is Streptococcus pneumoniae, which accounts for around 80% of cases. Other infectious agents that can cause CAP include Haemophilus influenzae, Staphylococcus aureus, atypical pneumonias caused by Mycoplasma pneumoniae, and viruses.

Klebsiella pneumoniae is another microorganism that can cause pneumonia, but it is typically found in alcoholics. Streptococcus pneumoniae, also known as pneumococcus, is the most common cause of community-acquired pneumonia. It is characterized by a rapid onset, high fever, pleuritic chest pain, and herpes labialis (cold sores).

In summary, pneumonia can be caused by various infectious agents, with Streptococcus pneumoniae being the most common cause of community-acquired pneumonia. It is important to identify the causative agent to provide appropriate treatment and prevent complications.

It is typical for itching to continue for a period of 4-6 weeks after elimination.

Scabies: Causes, Symptoms, and Treatment

Scabies is a skin condition caused by the Sarcoptes scabiei mite, which is spread through prolonged skin contact. It is most commonly seen in children and young adults. The mite burrows into the skin and lays its eggs in the stratum corneum, leading to intense itching. This itching is caused by a delayed-type IV hypersensitivity reaction to the mites/eggs, which occurs about 30 days after the initial infection. Symptoms of scabies include widespread itching, linear burrows on the fingers, interdigital webs, and flexor aspects of the wrist. In infants, the face and scalp may also be affected. Scratching can lead to secondary features such as excoriation and infection.

The first-line treatment for scabies is permethrin 5%, while malathion 0.5% is second-line. Patients should be advised to avoid close physical contact with others until treatment is complete. All household and close physical contacts should be treated at the same time, even if asymptomatic. Clothing, bedding, and towels should be laundered, ironed, or tumble-dried on the first day of treatment to kill off mites. The insecticide should be applied to all areas, including the face and scalp, contrary to the manufacturer’s recommendation. Patients should apply the insecticide cream or liquid to cool, dry skin, paying close attention to areas between fingers and toes, under nails, armpit area, and creases of the skin such as at the wrist and elbow. The insecticide should be left on the skin for 8-12 hours for permethrin or 24 hours for malathion before washing off. Treatment should be repeated 7 days later.

Crusted scabies, also known as Norwegian scabies, is seen in patients with suppressed immunity, especially HIV. The crusted skin will be teeming with hundreds of thousands of organisms. Isolation is essential, and ivermectin is the treatment of choice.

Bacterial vaginosis during pregnancy can lead to various pregnancy-related issues, such as preterm labor. In the past, it was advised to avoid taking oral metronidazole during the first trimester. However, current guidelines suggest that it is safe to use throughout the entire pregnancy. For more information, please refer to the Clinical Knowledge Summary provided.

Bacterial vaginosis (BV) is a condition where there is an overgrowth of anaerobic organisms, particularly Gardnerella vaginalis, in the vagina. This leads to a decrease in the amount of lactobacilli, which produce lactic acid, resulting in an increase in vaginal pH. BV is not a sexually transmitted infection, but it is commonly seen in sexually active women. Symptoms include a fishy-smelling vaginal discharge, although some women may not experience any symptoms at all. Diagnosis is made using Amsel’s criteria, which includes the presence of thin, white discharge, clue cells on microscopy, a vaginal pH greater than 4.5, and a positive whiff test. Treatment involves oral metronidazole for 5-7 days, with a cure rate of 70-80%. However, relapse rates are high, with over 50% of women experiencing a recurrence within 3 months. Topical metronidazole or clindamycin may be used as alternatives.

Bacterial vaginosis during pregnancy can increase the risk of preterm labor, low birth weight, chorioamnionitis, and late miscarriage. It was previously recommended to avoid oral metronidazole in the first trimester and use topical clindamycin instead. However, recent guidelines suggest that oral metronidazole can be used throughout pregnancy. The British National Formulary (BNF) still advises against using high-dose metronidazole regimes. Clue cells, which are vaginal epithelial cells covered with bacteria, can be seen on microscopy in women with BV.

New-onset Achilles tendon disorders, including tendinitis and tendon rupture, are likely caused by ciprofloxacin, a medication with important side effects to consider.

Achilles tendon disorders are a common cause of pain in the back of the heel. These disorders can include tendinopathy, partial tears, and complete ruptures of the Achilles tendon. Certain factors, such as the use of quinolone antibiotics and high cholesterol levels, can increase the risk of developing these disorders. Symptoms of Achilles tendinopathy typically include gradual onset of pain that worsens with activity, as well as morning stiffness. Treatment for this condition usually involves pain relief, reducing activities that exacerbate the pain, and performing calf muscle eccentric exercises.

In contrast, an Achilles tendon rupture is a more serious condition that requires immediate medical attention. This type of injury is often caused by sudden, forceful movements during sports or running. Symptoms of an Achilles tendon rupture include an audible popping sound, sudden and severe pain in the calf or ankle, and an inability to walk or continue the activity. To help diagnose an Achilles tendon rupture, doctors may use Simmond’s triad, which involves examining the foot for abnormal angles and feeling for a gap in the tendon. Ultrasound is typically the first imaging test used to confirm a diagnosis of Achilles tendon rupture. If a rupture is suspected, it is important to seek medical attention from an orthopaedic specialist as soon as possible.

This individual is experiencing shingles, which is caused by the herpes zoster virus and is characterized by a unique distribution along a specific dermatome.

Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The rash is well demarcated by the affected dermatome and may be accompanied by fever and lethargy. Treatment includes analgesia, antivirals, and potentially oral corticosteroids. Complications include post-herpetic neuralgia, ocular and ear complications. Antivirals should be used within 72 hours to reduce the risk of post-herpetic neuralgia.

For a patient with poorly controlled hypertension who is already taking an ACE inhibitor, the addition of a calcium channel blocker or a thiazide-like diuretic is recommended. In individuals under the age of 55 and of Caucasian ethnicity, the first-line treatment for hypertension is an ACE inhibitor such as ramipril. If the blood pressure remains elevated despite maximum dose of ramipril, a second medication should be added. A calcium channel blocker or thiazide-like diuretic is the preferred choice for second-line therapy in this scenario.

NICE Guidelines for Managing Hypertension

Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of a calcium channel blocker or thiazide-like diuretic in addition to an ACE inhibitor or angiotensin receptor blocker.

The guidelines also provide a flow chart for the diagnosis and management of hypertension. Lifestyle advice, such as reducing salt intake, caffeine intake, and alcohol consumption, as well as exercising more and losing weight, should not be forgotten and is frequently tested in exams. Treatment options depend on the patient’s age, ethnicity, and other factors, and may involve a combination of drugs.

NICE recommends treating stage 1 hypertension in patients under 80 years old if they have target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For patients with stage 2 hypertension, drug treatment should be offered regardless of age. The guidelines also provide step-by-step treatment options, including adding a third or fourth drug if necessary.

New drugs, such as direct renin inhibitors like Aliskiren, may have a role in patients who are intolerant of more established antihypertensive drugs. However, trials have only investigated the fall in blood pressure and no mortality data is available yet. Patients who fail to respond to step 4 measures should be referred to a specialist. The guidelines also provide blood pressure targets for different age groups.

A loop ileostomy is the appropriate procedure for defunctioning the colon to protect an anastomosis. This involves taking a loop of ileum, making a horizontal incision, and bringing it up to the skin. It is commonly used after rectal cancer surgery and can be reversed at a later time.

An end colostomy is performed when an anastomosis is not possible or desirable, and the colon needs to be diverted or resected. The distal part of the colon is brought up to the skin in this procedure.

An end ileostomy is typically done after the complete removal of the colon or when an ileocolic anastomosis is not planned. While it can be used to defunction the colon, it is more challenging to reverse.

A gastrostomy is used for gastric decompression or feeding.

A loop jejunostomy is used as a high-output stoma and may be performed after an emergency laparotomy with planned early closure.

Abdominal stomas are created during various abdominal procedures to bring the lumen or contents of organs onto the skin. Typically, this involves the bowel, but other organs may also be diverted if necessary. The type and method of construction of the stoma will depend on the contents of the bowel. Small bowel stomas should be spouted to prevent irritant contents from coming into contact with the skin, while colonic stomas do not require spouting. Proper siting of the stoma is crucial to reduce the risk of leakage and subsequent maceration of the surrounding skin. The type and location of the stoma will vary depending on the purpose, such as defunctioning the colon or providing feeding access. Overall, abdominal stomas are a necessary medical intervention that requires careful consideration and planning.

Incomplete immunisation may be a concern for patients belonging to travelling communities with regards to acute epiglottitis caused by Haemophilus influenzae type B.

Acute epiglottitis is a rare but serious infection caused by Haemophilus influenzae type B. It is important to recognize and treat it promptly as it can lead to airway obstruction. Although it was once considered a disease of childhood, it is now more common in adults in the UK due to the immunization program. The incidence of epiglottitis has decreased since the introduction of the Hib vaccine. Symptoms include a rapid onset, high temperature, stridor, drooling of saliva, and a tripod position where the patient leans forward and extends their neck to breathe easier. Diagnosis is made by direct visualization, but x-rays may be done to rule out a foreign body.

Immediate senior involvement is necessary, including those who can provide emergency airway support such as anaesthetics or ENT. Endotracheal intubation may be necessary to protect the airway. It is important not to examine the throat if epiglottitis is suspected due to the risk of acute airway obstruction. The diagnosis is made by direct visualization, but only senior staff who are able to intubate if necessary should perform this. Treatment includes oxygen and intravenous antibiotics.

Differential Diagnosis for a Raised Nodular Lesion: Common Skin Conditions in HIV-1 Patients

Kaposi’s sarcoma is a prevalent tumour in HIV-1-positive individuals and a leading cause of death in these patients. It is an AIDS-defining illness in 15% of patients and commonly occurs with a CD4 count of fewer than 200 cells/mm3. Other common tumours in HIV-1 include non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, and those caused by human papillomavirus. Basal cell carcinoma, the most common non-melanoma skin cancer, typically presents with a single, shiny, pearlised nodule and may ulcerate, but does not match the description in this scenario. Cryoglobulinaemia, a condition associated with hepatitis C infection, causes a vasculitic rash and does not match this scenario’s description. Fixed drug eruption describes the development of one or more annular or oval erythematous plaques resulting from systemic exposure to a drug and does not tend to cause raised nodular lesions. Melanoma is typically black/darkly pigmented and usually a single lesion, therefore it does not match the description in this scenario.