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Fetal Tachycardia

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1201. The use of tocolytic therapy in a pregnant trauma patient

[tocolytic therapy] improve [outcome for mother and foetus]? Clinical Scenario A pregnant woman of 32 weeks gestation is admitted to the ED after a fall. She has blunt abdominal trauma and is having what seem to be uterine contractions. You wonder whether you start tocolytic therapy to try to prevent or delay a premature delivery and so prevent some of the possible complications for both mother and baby. Search Strategy Medline 1950 to November week 1 2008 using Ovid Interface EMBASE 1980-2008 Week 1 (...) in the groups with respect to gestational age, length of hospital stay, abdominal pain, abdominal tenderness, pattern of uterine contractions. Magnesium sulphate used as tocolytic to avoid the tachycardia associated with betamimetics. Peripartum complications 46.2% in preterm group v 12.5% in term group (P Wang PH et al 1999 Taiwan Patient 31 yrs old 21 weeks pregnant Case report Patient was administered tocolytic agent after repair of a cornual rupture. Premature labour did not commence until 33 weeks

2009 BestBETS

1202. EANM guidelines for ventilation / perfusion scintigraphy - Part 1

]. The majorityof patients with PE present with recognized patterns of symptoms that may include unexplained breathlessness, chest pain (central or pleuritic), cough, haemoptysis, syncope, palpitations, tachypnoea, tachycardia (heart rate >100 bpm), cyanosis, fever, hypotension (systolic blood pressure 1µminthelowerrespiratorytract. Particlesofdiameter>5µmimpactintheupperairways.Even small particles may impact with turbulent flow at stenoses. This leads to hot spots, indicative of obstructive airway disease (...) , Gelfand MJ. Dosimetry of pediatric nuclear medicine procedures. Q J Nucl Med 1998;42:93–112. 74. Camps JA, Zuur C, Blokland JA, Broerse JJ, Pauwels EK. A breathing lung phantom for 81mKr lung ventilation studies its use in dosimetry and quality control. Eur J Nucl Med 1988;14:529–32. doi:10.1007/BF00286770. 75. HurwitzLM,YoshizumiT,ReimanRE,GoodmanPC,PaulsonEK, Frush DP, et al. Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 2006;186:871–6. doi:10.2214/AJR

2009 European Association of Nuclear Medicine

1203. Approach to the Patient With a Suspected Inherited Disorder of Metabolism

-Opitz syndrome) during fetal development. Autonomic symptoms can result from hypoglycemia caused by increased glucose consumption or decreased glucose production (eg, vomiting, diaphoresis, pallor, and tachycardia in GSD or ) or from metabolic acidosis (eg, vomiting and Kussmaul respirations in organic acidemias). Some conditions cause both (ie, in propionic acidemia, accumulation of acyl-CoAs causes metabolic acidosis and inhibits gluconeogenesis, thus causing hypoglycemia). Nonphysiologic jaundice

2013 Merck Manual (19th Edition)

1204. Neonatal Sepsis

infants. Early and late onset Certain viral infections (eg, , , , ) may manifest as early-onset or late-onset sepsis. Pathophysiology Early onset Certain maternal perinatal and obstetric factors increase risk, particularly of early-onset neonatal sepsis, such as the following: (PROM) occurring ≥ 18 h before birth Maternal (most commonly manifesting as maternal fever shortly before or during delivery with maternal leukocytosis, tachycardia, uterine tenderness, and/or foul-smelling amniotic fluid (...) ) Colonization with GBS Hematogenous and transplacental dissemination of maternal infection occurs in the transmission of certain viral (eg, , ), protozoal (eg, ), and treponemal (eg, ) pathogens. A few bacterial pathogens (eg, , ) may reach the fetus transplacentally, but most are acquired by the ascending route in utero or as the fetus passes through the colonized birth canal. Though the intensity of maternal colonization is directly related to risk of invasive disease in the neonate, many mothers with low

2013 Merck Manual (19th Edition)

1205. Perinatal Anemia

and stimulate production of IgG antibody directed against fetal RBCs. The most common severe scenario is that an Rh (D antigen)-negative mother becomes sensitized to the D antigen during a previous pregnancy with an Rh-positive fetus; a 2nd Rh-positive pregnancy may then prompt an IgG response that may result in fetal and neonatal hemolysis (see ). Less often, fetal-maternal transfusion early in a pregnancy can stimulate an IgG response that affects that pregnancy. Intrauterine hemolysis may be severe (...) Anemia may develop because of prenatal, perinatal (at delivery), or . In neonates, absolute blood volume is low (eg, preterm, 90 to 105 mL/kg; term, 78 to 86 mL/kg); therefore, acute loss of as little as 15 to 20 mL of blood may result in anemia. An infant with chronic blood loss can compensate physiologically and is typically more clinically stable than an infant with acute blood loss. Prenatal hemorrhage may be caused by Fetal-to-maternal hemorrhage Twin-to-twin transfusion Cord malformations

2013 Merck Manual (19th Edition)

1206. Neonatal Hypoglycemia

/dl=""> < 30 mg/dL ( < 1.7 mmol/L) in preterm neonates in the first 48 h. Risk factors include prematurity, being small for gestational age, maternal diabetes, and perinatal asphyxia. The most common causes are deficient glycogen stores, delayed feeding, and hyperinsulinemia. Signs include tachycardia, cyanosis, seizures, and apnea. Diagnosis is suspected empirically and is confirmed by glucose testing. Prognosis depends on the underlying condition. Treatment is enteral feeding or IV dextrose (...) stores in these infants, and hypoglycemia may develop at any time in the first few hours or days, especially if there is a prolonged interval between feedings or if nutritional intake is poor. A sustained input of exogenous glucose is therefore important to prevent hypoglycemia. Hyperinsulinism most often occurs in and is inversely related to the degree of maternal diabetic control. When a mother has diabetes, her fetus is exposed to increased levels of glucose because of the elevated maternal blood

2013 Merck Manual (19th Edition)

1207. Neonatal Hyperbilirubinemia

of Jaundice Cause General examination Fever, tachycardia, respiratory distress First 24 h Accumulates > 5 mg/dL/day ( > 86 mcmol/L/day) , TORCH infection, Lethargy, hypotonia May appear in the first 24–48 h Can be prolonged ( > 2 wk) , metabolic disorder Macrosomia 24–48 h Can accumulate > 5 mg/dL ( > 86 mcmol/L) Petechiae First 24 h Accumulates > 5 mg/dL ( > 86 mcmol/L) Hemolytic states (eg, , RBC enzyme deficiencies, hereditary spherocytosis, , ) Plethora First 24 h Accumulates > 5 mg/dL ( > 86 mcmol/L (...) , or other access as available, to remove partially hemolyzed and antibody-coated RBCs as well as circulating immunoglobulins. The blood is replaced with uncoated donor RBCs that do not have the RBC membrane antigen that binds the circulating antibodies. That is, type O blood is used if the neonate is sensitized to AB antigens and Rh-negative blood is used if the neonate is sensitized to Rh antigen. Because adult donor RBCs have more ABO antigen sites than fetal cells, type-specific transfusion

2013 Merck Manual (19th Edition)

1208. Hyperthyroidism

Overview of Physiologic pH and Buffers SOCIAL MEDIA Add to Any Platform Loading , MD, MS, David Geffen School of Medicine at UCLA Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms are many and include tachycardia, fatigue, weight loss, nervousness, and tremor. Diagnosis is clinical and with thyroid function tests. Treatment depends on cause (...) loss, insomnia, weakness, and frequent bowel movements (occasionally diarrhea). Hypomenorrhea may be present. Signs may include warm, moist skin; tremor; tachycardia; widened pulse pressure; and atrial fibrillation. Graves Disease (Enlarged Thyroid Gland) © Springer Science+Business Media Elderly patients, particularly those with toxic nodular goiter, may present atypically (apathetic or masked hyperthyroidism) with symptoms more akin to or . Most do not have exophthalmos or tremor. Atrial

2013 Merck Manual (19th Edition)

1209. Amniotic Fluid Embolism

). The resulting maternal hypoxia and hypotension have profound adverse effects on the fetus. Because maternal exposure to fetal antigens is likely fairly common during labor and delivery, it is not clear why only a few women develop amniotic fluid embolism. It is thought that different fetal antigens in varying amounts probably interact with unknown maternal susceptibility factors. Risk factors Many factors are associated with increased risk, but evidence is inconsistent. As with exposure to fetal antigens (...) . Other patients suddenly develop dyspnea and have tachycardia, tachypnea, and hypotension. , with significant cyanosis, hypoxia and pulmonary crackles, often quickly follows. Coagulopathy manifests as bleeding from the uterus and/or sites of incisions and venipuncture. Uterine hypoperfusion causes uterine atony and fetal distress. Diagnosis Clinical evaluation Exclusion of other causes Diagnosis of amniotic fluid embolism is suspected when the classic triad develops during labor or immediately after

2013 Merck Manual (19th Edition)

1210. Nausea and Vomiting During Early Pregnancy

the 1st trimester Normal vital signs and physical examination Diagnosis of exclusion Frequent, persistent nausea and vomiting with inability to maintain adequate oral intake of fluids, food, or both Usually, signs of dehydration (eg, tachycardia, dry mouth, thirst), weight loss Urine ketones, serum electrolytes, magnesium, BUN, creatinine If the condition persists, possibly liver function tests, pelvic ultrasonography Larger-than-expected uterine size, absent fetal heart sounds and movement Sometimes (...) Absent fetal heart sounds Grapelike tissue from the cervix Neurologic Confusion, photophobia, focal weakness, nystagmus HEENT = head, eyes, ears, nose, and throat. Red flags The following findings are of particular concern: Abdominal pain Signs of dehydration (eg, orthostatic hypotension, tachycardia) Fever Bloody or bilious emesis No fetal motion or heart sounds Abnormal neurologic examination Persistent or worsening symptoms Interpretation of findings Distinguishing pregnancy-related vomiting from

2013 Merck Manual (19th Edition)

1211. Vaginal Bleeding During Early Pregnancy

. should include risk factors for ectopic pregnancy and spontaneous abortion. Physical examination Physical examination includes review of vital signs for fever and signs of hypovolemia (tachycardia, hypotension). Evaluation focuses on abdominal and pelvic examinations. The abdomen is palpated for tenderness, peritoneal signs (rebound, rigidity, guarding), and uterine size. Fetal heart sounds should be checked with a Doppler ultrasound probe. Pelvic examination includes inspection of external genitals (...) should not be probed because the vascular placenta may tear, especially if it covers the internal os (placenta previa). Bimanual examination should check for cervical motion tenderness, adnexal masses or tenderness, and uterine size. Red flags The following findings are of particular concern: Hemodynamic instability (hypotension, tachycardia, or both) Orthostatic changes in pulse or BP Syncope or near-syncope Peritoneal signs (rebound, rigidity, guarding) Fever, chills, and mucopurulent vaginal

2013 Merck Manual (19th Edition)

1212. Pelvic Pain During Early Pregnancy

and signs of hypovolemia (hypotension, tachycardia). Evaluation focuses on abdominal and pelvic examinations. The abdomen is palpated for tenderness, peritoneal signs (rebound, rigidity, guarding), and uterine size and is percussed for tympany. Fetal heart sounds are checked using a Doppler probe. Pelvic examination includes inspection of the cervix for discharge, dilation, and bleeding. Discharge, if present, should be sampled and sent for culture. Any blood or clots in the vaginal vault are gently (...) Pain During Early Pregnancy Cause Suggestive Findings Diagnostic Approach Obstetric disorders Abdominal or pelvic pain, which is often sudden, localized, and constant (not crampy), with or without vaginal bleeding Closed cervical os No fetal heart sounds Possibly hemodynamic instability if ectopic pregnancy has ruptured Quantitative beta-hCG measurement CBC Blood type and Rh typing Pelvic ultrasonography (threatened, inevitable, incomplete, complete, missed) Crampy, diffuse abdominal pain, often

2013 Merck Manual (19th Edition)

1213. Physiology of Pregnancy

delivery, the uterus contracts, and CO drops rapidly to about 15 to 25% above normal, then gradually decreases (mostly over the next 3 to 4 wk) until it reaches the prepregnancy level at about 6 wk postpartum. The increase in CO during pregnancy is due mainly to demands of the uteroplacental circulation; volume of the uteroplacental circulation increases markedly, and circulation within the intervillous space acts partly as an arteriovenous shunt. As the placenta and fetus develop, blood flow (...) to the uterus must increase to about 1 L/min (20% of normal CO) at term. Increased needs of the skin (to regulate temperature) and kidneys (to excrete fetal wastes) account for some of the increased CO. To increase CO, heart rate increases from the normal 70 to as high as 90 beats/min, and stroke volume increases. During the 2nd trimester, BP usually drops (and pulse pressure widens), even though CO and renin and angiotensin levels increase, because uteroplacental circulation expands (the placental

2013 Merck Manual (19th Edition)

1214. Macrolides

prolongation, ventricular tachycardia, ventricular fibrillation, torsades de pointes) may occur when clarithromycin or erythromycin is given with these drugs. This effect is most likely due to inhibition of metabolism of these drugs by erythromycin and clarithromycin . Clinical Calculator: Use During Pregnancy and Breastfeeding Animal reproduction studies with erythromycin or azithromycin have not shown risk to the fetus. A higher rate of cardiovascular anomalies has been observed after exposure

2013 Merck Manual (19th Edition)

1215. Tetanus

sympathetic nervous system, including periods of hypertension, tachycardia, and myocardial irritability. Causes of death Respiratory failure is the most common cause of death. Laryngeal spasm and rigidity and spasms of the abdominal wall, diaphragm, and chest wall muscles cause asphyxiation. Hypoxemia can also induce cardiac arrest, and pharyngeal spasm leads to aspiration of oral secretions with subsequent pneumonia, contributing to a hypoxemic death. Pulmonary embolism is also possible. However (...) to 1.5 mg/kg IV, followed by infusion of 0.5 to 1.0 mg/kg q 4 to 6 h for ≤ 25 days) relieves muscle spasticity. Dantrolene given orally can be used in place of infusion therapy for up to 60 days. Hepatotoxicity and expense limit its use. Management of autonomic dysfunction Morphine may be given q 4 to 6 h to control autonomic dysfunction, especially cardiovascular; total daily dose is 20 to 180 mg. Beta-blockade is used to control episodes of hypertension and tachycardia, but use of long-acting drugs

2013 Merck Manual (19th Edition)

1216. Volatile Solvents

Which of the following illicit drugs is most likely to cause intractable seizures, tachycardia, hypertension, and hyperthermia when a drug packet with the drug used in body packing ruptures? Anabolic steroids Cocaine Heroin Marijuana NEWS & VIDEOS Home Health Clinicians Frequently Lack Access to Hospital Records FRIDAY, March 8, 2019 (HealthDay News) -- Communication between hospitals and home health care (HHC) is suboptimal, according to a study published online Feb. 21 in the Journal of Post-Acute (...) the skin around the mouth and nose (huffer's eczema). Complications of chronic use may result from the effect of the solvent or from other toxic ingredients (eg, lead in gasoline). Carbon tetrachloride may cause a syndrome of hepatic and renal failure. Toluene may cause degeneration of CNS white matter, and . Injuries to brain, peripheral nerves, liver, kidneys, and bone marrow may result from heavy exposure or hypersensitivity. Inhalant abuse during pregnancy can cause premature birth and fetal

2013 Merck Manual (19th Edition)

1217. Cocaine

of the following illicit drugs is most likely to cause intractable seizures, tachycardia, hypertension, and hyperthermia when a drug packet with the drug used in body packing ruptures? Anabolic steroids Cocaine Heroin Marijuana NEWS & VIDEOS Home Health Clinicians Frequently Lack Access to Hospital Records FRIDAY, March 8, 2019 (HealthDay News) -- Communication between hospitals and home health care (HHC) is suboptimal, according to a study published online Feb. 21 in the Journal of Post-Acute... SOCIAL MEDIA (...) for the sympathomimetic effects: tachycardia, hypertension, mydriasis, diaphoresis, and hyperthermia. Cocaine also blocks sodium channels, accounting for its action as a local anesthetic. Cocaine causes vasoconstriction and thus can affect almost any organ. MI, cerebral ischemia and hemorrhage, aortic dissection, intestinal ischemia, and renal ischemia are possible sequelae. Onset of cocaine’s effects depends on mode of use: IV injection and smoking: Immediate onset, peak effect after about 3 to 5 min, and duration

2013 Merck Manual (19th Edition)

1218. Anxiolytics and Sedatives

and Body Stuffing Which of the following illicit drugs is most likely to cause intractable seizures, tachycardia, hypertension, and hyperthermia when a drug packet with the drug used in body packing ruptures? Anabolic steroids Cocaine Heroin Marijuana NEWS & VIDEOS Becoming Active in Middle Age Still Offers Health Benefits FRIDAY, March 8, 2019 (HealthDay News) -- Becoming physically active in middle age may provide comparable health benefits to long-term participation in leisure-time physical activity (...) benzodiazepines. (Barbiturates and are strikingly similar in the dependence, withdrawal symptoms, and chronic intoxication they cause.) Pregnancy Prolonged use of barbiturates during pregnancy can cause . Perinatal use of benzodiazepines also may cause neonatal withdrawal syndrome or toxicity (eg, apnea, hypothermia, hypotonia). Phenobarbital increases the risk of congenital malformation in fetus . Pathophysiology reference Comparative safety of anti-epileptic drugs during pregnancy: A systematic review

2013 Merck Manual (19th Edition)

1219. Tobacco

of the following illicit drugs is most likely to cause intractable seizures, tachycardia, hypertension, and hyperthermia when a drug packet with the drug used in body packing ruptures? Anabolic steroids Cocaine Heroin Marijuana NEWS & VIDEOS History of Cycling Weight May Up Risk for Heart Disease in Women FRIDAY, March 8, 2019 (HealthDay News) -- A history of weight cycling (HWC), or yo-yo dieting, is associated with poorer cardiovascular health in women, according to a study presented at the... SOCIAL MEDIA (...) effects of smoking combustible cigarettes. For people who use e-cigarettes and continue to smoke, a common practice of dual users , the health benefits of e-cigarette use are unproven. The effects of maternal e-cigarette use on fetal development are unknown. as are the effects of e-cigarette use on the developing adolescent brain. E-cigarette use among high school students now exceeds combustible tobacco use (11.3% use e-cigarettes vs 8.0% who smoke combustible cigarettes), according to the (CDC

2013 Merck Manual (19th Edition)

1220. Ultrasonography

Which of the following illicit drugs is most likely to cause intractable seizures, tachycardia, hypertension, and hyperthermia when a drug packet with the drug used in body packing ruptures? Anabolic steroids Cocaine Heroin Marijuana NEWS & VIDEOS History of Cycling Weight May Up Risk for Heart Disease in Women FRIDAY, March 8, 2019 (HealthDay News) -- A history of weight cycling (HWC), or yo-yo dieting, is associated with poorer cardiovascular health in women, according to a study presented (...) structural abnormalities in the kidneys, ureters, or bladder (see ) Female reproductive organs: For example, to detect tumors and inflammation in the ovaries, fallopian tubes, or uterus (see ) Pregnancy: For example, to evaluate the growth and development of the fetus and to detect abnormalities of the placenta (eg, placenta previa—see ). Musculoskeletal: To evaluate muscles, tendons, and nerves. Obstetric Ultrasound IAN HOOTON/SCIENCE PHOTO LIBRARY Ultrasonography can also be used to guide biopsy

2013 Merck Manual (19th Edition)

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