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Fetal Tachycardia

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181. CRACKCast E049 – General Principles to Orthopedic Injuries

● Signs: Resp. distress, hypoxemia, ARDS Confusion, mental status change suddenly Thrombocytopenia Petechial rash Fever, tachycardia, jaundice Fat seen in the urine in 50% of cases in 3 days post injury Common after Tib/fib fractures (young adults) or hip fractures in the elderly 1-2 days post acute injury or IM nailing Up to 2% in long bone # Up to 10% in multi# pts Treatment Supportive care 20% mortality rate No therapy shown to benefit Fracture blisters Tense bullae from HIGH energy injuries Due (...) , lactic acidosis. 7) List 5 bones predisposed to AVN Femoral head Talus Scaphoid Lunate Capitate Lippism: FeTal ScaPLuna? OR all the crescent moon-shaped bones in the hand and… 8) Describe diagnostic criteria for CRPS Complex regional pain syndrome – type 1 “Pain syndrome that develops after a noxious event and extends beyond a single peripheral nerve and is disproportionate to the inciting event” Affects the DISTAL end of an extremity Changes in blood flow to the extremity Abnormal pseudo-motor

2016 CandiEM

182. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

ventricular tachycardia, renal and hepatic dysfunction, elevated levels of brain natriuretic peptide (BNP), persistently elevated cardiac troponin levels, peak oxygen consumption 64 years, and myocytolysis on endomyocardial biopsy (EMB). In the United States, the cause of death appears to be pump failure in approximately two thirds and sudden cardiac death in approximately one third of all deaths of patients with DCM. 28–30 In existing clinical studies, pa- tients with idiopathic DCM had a lower total (...) , alcohol use, to- bacco, age, and number of pregnancies. pathogenesis The pathogenesis of PPCM remains unknown; however, it is suspected that there are both inflammatory and genetic components. The timing of the most common presentation in the early postpartum period suggests an autoimmune component, most likely related to the cessation of the need for fetal tolerance and the reset- ting of maternal cellular immunity. 167 Viral causes and nutritional deficiency could play a significant role, par

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2016 American Heart Association

184. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient

nervous system and at presynaptic muscarinic receptors in the peripheral sympathetic nervous system, with the former resulting in vagolytic action and the latter increasing norepinephrine release, both of which cause tachycardia. Rocuronium, more so than vecuronium, has affinity for muscarinic receptors at other sites within the parasympathetic nervous system. The remaining nondepolarizing agents have even weaker affinities for the muscarinic receptor ( ). The most significant manifestation (...) of these effects is tachycardia; bronchoconstriction is not reported with any frequency, probably because of the equal antagonism between pulmonary M 2 receptors and M 3 receptors ( ). | Histamine Release. Originally seen with curare, histamine release is predominantly observed with the use of atracurium ( , ). Pancuronium causes the release of minimal amounts of histamine ( ) and cisatracurium releases virtually none ( ). Isolated reports of vecuronium-induced histamine release have not been confirmed, even

2016 Society of Critical Care Medicine

185. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

ECG. Some cardiac conditions that may present as a BRUE include channelopathies (long QT syndrome, short QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia), ventricular pre-excitation (Wolff-Parkinson-White syndrome), and cardiomyopathy/myocarditis (hypertrophic cardiomyopathy, dilated cardiomyopathy). Resting ECGs are ineffective in identifying patients with catecholaminergic polymorphic ventricular tachycardia. Family history is important in identifying

2016 American Academy of Pediatrics

186. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients

not come at the cost of decreased chest compressions that are necessary to maintain end-organ perfusion and must not take longer than 10 seconds, with a protocolized approach preferable ( ). | Ventricular Tachycardia/Fibrillation Arrest (Recommended for All Levels of Training). We recommend that BCU should be performed in patients with ventricular tachycardia/fibrillation arrest following return of spontaneous circulation (ROSC) to look for segmental wall motion abnormalities as a surrogate for CAD (...) tachycardia/fibrillation arrest. The use of BCU can help identify these conditions. In cases where wall motion abnormality is documented, CAD would be suspected as the primary cause of the arrest and early revascularization would be suggested. | Use of TEE During Cardiopulmonary Resuscitation (Suggested for Expert Levels of Training). We suggest that TEE may be helpful when performed during cardiopulmonary resuscitation, especially during intraoperative cardiac arrest (in cardiac surgery patients). Grade

2016 Society of Critical Care Medicine

187. Preterm labour and birth

intrapartum antibiotic prophylaxis for prevention of Early onset Group B streptococcal disease irrespective of GBS status or membrane status • Refer to Queensland Clinical Guideline Early onset Group B Streptococcus disease 63 Signs of chorioamnionitis (Intact or ruptured membranes)* • Signs of chorioamnionitis include: o Maternal fever greater than 38°C (present in 95–100% of cases) 64 o Maternal tachycardia greater than 100 beats per minute (bpm) (present in 50–80% of cases) 64 o Fetal tachycardia (...) observation or investigation indicated or • Other maternal or fetal concerns Admit • Analgesia if required • Clinical surveillance • Fetal monitoring/continuous CTG • TVCL if available • Consult as required • Plan care Yes No Discharge • Provide information re: signs and symptoms and returning for care • Arrange follow-up as indicated CTG: Cardiotocograph, fFN: Fetal fibronectin, FHR: Fetal heart rate, g: grams, GBS: Group B Streptococcus, IV: Intravenous, kg: kilogram, MC&S: microscopy, culture

2016 Queensland Health

188. Clinical Guideline: Early onset Group B streptococcal disease

Adequacy of IAP • Due to the rapidity of some labours, especially in multiparous women, it can be difficult to confidently estimate the time-to-birth interval • Four hours prior to birth is commonly recommended as the interval required for adequate prophylaxis 3,4,24 but there is evidence that adequate fetal concentrations may be reached earlier (within 1–2 hours) 15,44-46 • In order to maximise the window for administration of IAP, this guideline recommends aiming for administration at least 4 hours (...) ) refer to section 4.1 Obstetric procedures if GBS positive • Provided women with GBS risk factors are treated with IAP, there is insufficient evidence to recommend either avoidance of, or alterations of technique, in obstetric procedures (e.g. membrane sweeping, amniotomy, fetal scalp blood sampling or fetal scalp electrode) on the basis of positive GBS status 24,37 Chorioamnionitis • Do not inhibit labour, but consider hastening birth under broad spectrum intravenous antibiotic cover o Collect low

2016 Queensland Health

189. Perinatal substance use: maternal

(agitation, confusion), neuromuscular hyperactivity (tremor, myoclonus, rigidity, hyperreflexia), and autonomic hyperactivity (fever, sweating, tachycardia, tachypnoea) Fetal • First trimester exposure increases risk of spontaneous abortion 45 • First trimester exposure to Paroxetine may be linked to cardiac malformations but evidence is inconclusive 46 Neonatal • There is evidence of adverse signs in babies born to mothers prescribed SSRIs during pregnancy 44 o Usually present within hours of birth o (...) Pregnancy, fetal and neonatal exposure 8 1.3.2 Lactation and childhood 9 1.4 Psychostimulants exposure 10 1.4.1 Amphetamines/Methamphetamines 10 1.4.2 Nicotine 11 1.4.3 SSRI/SNRI 12 1.4.4 Cocaine 13 1.4.5 Ecstasy 13 1.5 Depressant exposure 14 1.5.1 Alcohol–maternal 14 1.5.2 Alcohol–fetal/neonatal 15 1.5.3 Benzodiazepines 15 1.5.4 Cannabis 16 1.6 Hallucinogens exposure 16 2 Antenatal screening 17 2.1 Psychosocial 17 2.2 Blood borne viruses 18 2.3 Substance use 19 2.4 Alcohol and tobacco 20 3 Management

2016 Queensland Health

190. Hypertensive disorders of pregnancy

stable then every 30 minutes • Respiratory rate and patellar reflexes hourly • Temperature 2nd hourly • Continuous CTG monitoring if > 24 weeks (interpret with caution if : greater than, 10 years • Nulliparity • Pre-existing medical conditions o APLS o Pre-existing diabetes o Renal disease o Chronic hypertension o Chronic autoimmune disease • Age > 40 years • BMI > 35 kg/m 2 • Multiple pregnancy • Elevated BP at booking • Gestational trophoblastic disease • Fetal triploidy Maternal investigations (...) • Urine dipstick for proteinuria • Spot urine protein to creatinine ratio if: o = 2+ or recurrent 1+ on dipstick • Full blood count • Urea, creatinine electrolytes and urate • LFT including LDH Fetal assessment • CTG • USS for fetal growth & wellbeing Initiate antihypertensives Commence if: • sBP = 160 or dBP = 100 mmHg Consider if: • sBP = 140 or dBP = 90 mmHg • Choice of antihypertensive drug as per local preferences/protocols Oral antihypertensive (initial dose – adjust as clinically indicated

2016 Queensland Health

191. Suspected Pulmonary Embolism

with right heart catheterization 4 This procedure is rarely indicated. It is used for clarification or catheter-directed intervention. ???? CTA chest with IV contrast with CT venography lower extremities 3 ??? MRA chest without and with IV contrast 3 This procedure may be used as a problem solver or if intervention is planned. There is concern for fetal exposure to contrast. O MRA chest without IV contrast 3 O CT chest without IV contrast 2 ??? CT chest without and with IV contrast 2 ??? US (...) , shortness of breath, and tachycardia are nonspecific and may mimic other pulmonary or cardiac conditions. Unsuspected PE continues to be a frequent autopsy finding. It has been further estimated that over 80% of PE cases are associated with deep vein thrombosis (DVT). It is, therefore, easy to see why PE, for purposes of diagnosis and treatment, is often considered a complication or a consequence of DVT [2]. A concern with this approach is that some cases of PE are due to embolization from other sites

2016 American College of Radiology

192. Cardiovascular Consequences of Childhood Secondhand Tobacco Smoke Exposure: Prevailing Evidence, Burden, and Racial and Socioeconomic Disparities: A Scientific Statement From the American Heart Association

, acrolein and other organic chemicals persist in SHS over time, are highly reactive, and are known to produce oxidative stress, inflammation, and endothelial dysfunction and to promote blood clotting. Moreover, other substances can adhere to the smoking-elaborated particulate matter and enhance their toxicities. With respect to children, investigators have demonstrated that SHS exposure markers are elevated in a graded fashion in concert with higher SHS exposure. Cotinine levels are detectable in fetal (...) and oxidized LDL-C are also higher in those who are SHS exposed. The presence of such reactive oxygen species and inflammatory markers is known to reduce the production and activity of endothelial nitric oxide synthase. Following up on animal work implicating mitochondrial damage as a potential pathogenetic mechanism in SHS exposure, a recent review by Yang et al of fetal, childhood, and adult exposure to SHS and mitochondrial damage and dysfunction concluded a potentially important role of mitochondrial

2016 American Heart Association

193. Chronic Heart Failure in Congenital Heart Disease

or hepatorenal syndrome. Thus, these agents should be used cautiously, if at all, with an understanding of the patient unique physiology and serial evaluation for potential adverse effects. Impact of Arrhythmia on HF and Its Medical Management Arrhythmias are commonly encountered in CHD, in particular with increasing age. Arrhythmias are closely linked to ventricular function and HF. The full spectrum of arrhythmias can be anticipated, including bradyarrhythmias, atrial and ventricular tachycardias (VTs (...) ), and sudden cardiac death (SCD). Atrial arrhythmias, most often intra-atrial re-entrant tachycardia, are commonly encountered and are associated with an increased risk of stroke, HF, and death. Antiarrhythmic drug therapy for the patient with CHD should be selected cautiously because underlying bradyarrhythmias and ventricular dysfunction predispose these patients to proarrhythmic and negative inotropic consequences of drug therapy. Anticoagulation may also be needed as prophylaxis against thromboembolism

2016 American Heart Association

194. Enhancing Literacy in Cardiovascular Genetics: A Scientific Statement From the American Heart Association

arrhythmias, which include long-QT syndrome (LQTS), Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and short-QT syndrome. In the young, LQTS is an important cause of SCD caused by ventricular arrhythmias, generally attributed to torsade de pointes. It is inherited in an autosomal dominant manner, and numerous genes have been identified. Although LQTS most often occurs in an isolated manner, it can occur in the setting of well-described syndromes including the autosomal recessive (...) Jervell and Lange-Nielsen syndrome (with associated congenital deafness), Andersen-Tawil syndrome (with periodic paralysis, dysmorphic facies, and malformations), and Timothy syndrome (with cardiac and other birth defects and autism). Brugada syndrome is a cause of familial idiopathic polymorphic ventricular tachycardia or fibrillation and SCD for which numerous genes, most leading to reduced cardiac sodium current, have been identified. It is characterized by the electrocardiographic findings of ST

2016 American Heart Association

195. Polyhydramnios in singleton pregnancies

Obstet Gynecol 1990 May;162(5):1344-1345. 54. Kouame N, N'goan-Domoua AM, Nikiema Z, Konan AN, N'guessan KE, Setcheou A, et al. Polyhydramnios: a warning sign in the prenatal ultrasound diagnosis of foetal malformation? Diagn Interv Imaging 2013 Apr;94(4):433-437. 55. Bagolan P, Bilancioni E, Spina V, Nahom A, Trucchi A, Gambuzza G, et al. Fetal tachycardia and chylous ascites. Br J Obstet Gynaecol 1999 Apr;106(4):376-378. 56. Bunduki V, Ruano R, da Silva MM, Miguelez J, Miyadahira S, Maksoud JG, et (...) , but it is also a fetal and neonatal risk factor. Polyhydramnios is among other things associated with malformations, aneuploidy, immunization, diabetes, infections, placenta anomalies and multiple pregnancies. Idiopathic cases, which count for 43 to 67% of all cases, are by themselves a risk factor for obstetrical and neonatal complications. The diagnosis is a combination of clinical examination and an ultrasonic verification and graduation of the amnion volume. Various diagnostic approaches can be taken

2016 Nordic Federation of Societies of Obstetrics and Gynecology

196. Amniotic fluid embolism: diagnosis and management

Amniotic fluid embolism: diagnosis and management Amniotic ?uidembolism:diagnosisand management Society for Maternal-Fetal Medicine (SMFM) with the assistance of Luis D. Pacheco, MD; George Saade, MD; Gary D. V. Hankins, MD; Steven L. Clark, MD The practice of medicine continues to evolve, and individual circumstances will vary. This publication re?ects information availableatthetimeofitssubmissionforpublicationandisneitherdesignednorintendedtoestablishanexclusivestandard of perinatal care (...) . This publication is not expected to re?ect the opinions of all members of the Society for Maternal-Fetal Medicine. OBJECTIVE: We sought to provide evidence-based guidelines regarding the diagnosis and manage- ment ofamniotic ?uid embolism. STUDY DESIGN: A systematic literature review was performed using MEDLINE, PubMed, EMBASE, andtheCochraneLibrary.ThesearchwasrestrictedtoEnglish-languagearticlespublishedfrom1966 through March2015.Prioritywasgiventoarticles reporting originalresearch,inparticularrandomized

2016 Society for Maternal-Fetal Medicine

197. Acne clinical guideline

of the iPLEDGE program on isotretinoin fetal exposure in an integrated health care system. J Am Acad Dermatol . 2011 ; 65 : 1117–1125 | | | | | , x 144 Collins, M.K., Moreau, J.F., Opel, D. et al. Compliance with pregnancy prevention measures during isotretinoin therapy. J Am Acad Dermatol . 2014 ; 70 : 55–59 | | | | | Miscellaneous therapies and physical modalities Chemical peels B II, III x 145 Grover, C. and Reddu, B.S. The therapeutic value of glycolic acid peels in dermatology. Indian J Dermatol

2016 American Academy of Dermatology

198. Guidelines for the use of local anesthesia in office-based dermatologic surgery

for procedures of urgent medical necessity, and those that are not urgent should be postponed until after delivery or delayed until the second trimester when possible (to ensure that fetal organogenesis is complete). There are no data available on the safety of agents other than lidocaine, and their use during pregnancy and lactation is not recommended. Use in children Topical anesthetics are considered safe for use in children when dosed properly. The risk of toxicity, although rare, is increased

2016 American Academy of Dermatology

199. Gastroenteritis

Cold extremities Eyes not sunken Sunken eyes* — Moist mucous membranes (except after a drink) Dry mucous membranes (except for mouth breathing) — Normal heart rate Tachycardia* Tachycardia Normal breathing pattern Tachypnoea* Tachypnoea Normal peripheral pulses Normal peripheral pulses Weak peripheral pulses Normal capillary refill time Normal capillary refill time Prolonged capillary refill time Normal skin turgor Reduced skin turgor* — Normal blood pressure Normal blood pressure Hypotension

2019 NICE Clinical Knowledge Summaries

200. Hyperthyroidism

. Symptoms of hyperthyroidism include: Breathlessness, dysphagia, neck pressure — may be caused by a toxic multinodular goitre. Palpitations, anxiety, exercise intolerance, fatigue, muscle weakness. Heat intolerance, increased sweating. Increased appetite with weight loss, diarrhoea. Note: older people may present with atypical or few symptoms. Signs of thyrotoxicosis include: Agitation, fine tremor, warm moist skin, palmar erythema. Sinus tachycardia, atrial fibrillation, heart failure, dependent oedema (...) [ ]. Thyroid storm (thyrotoxic crisis), which is rare and potentially life-threatening, and may occur after trauma, childbirth, surgery, infection, or stroke, for example (in people with untreated or suboptimally treated hyperthyroidism) [ ]. Clinical features include tachycardia, fever, atrial fibrillation, heart failure, fever, diarrhoea, vomiting, dehydration, jaundice, agitation, delirium, and coma [ ; ]. Atrial fibrillation — the risk of developing atrial fibrillation increases with decreasing levels

2019 NICE Clinical Knowledge Summaries

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