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Fetal Tachycardia

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121. Primary postpartum haemorrhage

(e.g. rudimentary horn) Presentation · Intrapartum—act to rapidly deliver baby and placenta · Signs of uterine rupture may include 37 : o Maternal: tachycardia and signs of shock, sudden shortness of breath, constant abdominal pain, possible shoulder tip pain, uterine/suprapubic tenderness, change in uterine shape, pathological Bandl’s ring, incoordinate or cessation of contractions, frank haematuria, abnormal vaginal bleeding, abdominal palpation of fetal parts, absent presenting part o Fetal (...) · After vaginal birth: 500 mL or more 4 · After caesarean section (CS): 1000 mL or more 9 · Severe: 1000 mL or more 10,11 · Very severe: 2500 mL or more 10 · Queensland perinatal data collection, categorises PPH blood volume as 500–999 mL, 1000–1499 mL, 1500 mL or more Haemodynamic compromise · Due to frequent underestimation of blood loss 11 , PPH may first be detected through haemodynamic compromise 3 o Manifests as increasing tachycardia and hypotension · A healthy pregnant woman will only show

2019 Queensland Health

122. Evaluation and management of polyhydramnios

lesions; severe cardiac abnormalities, such as Ebstein anomaly or tetralogy of Fallot with absent pulmonary valve, cardiomyopathy, supraventricular tachycardia, and complete heart block; or fetal thyrotoxicosis. In addition, polyhydramnios may be caused by anomalies that cause fetal urine overproduction, such as ureteropelvic junction obstruction (termed “paradoxical” polyhydramnios). Small placental chorioangiomas are relatively common and rarely cause pregnancy complications, but large (≥5 cm (...) Evaluation and management of polyhydramnios SMFM Consult Series #46: Evaluation and management of polyhydramnios - American Journal of Obstetrics & Gynecology Email/Username: Password: Remember me Search Terms Search within Search Share this page: Access provided by Volume 219, Issue 4, Pages B2–B8 SMFM Consult Series #46: Evaluation and management of polyhydramnios Society for Maternal-Fetal Medicine (SMFM) ∗ , x Jodi S. Dashe , MD , x Eva K. Pressman , MD , x Judith U. Hibbard , MD Society

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2019 Society for Maternal-Fetal Medicine

123. Intrapartum fever

urine dip-stick is of relevance in the acute phase. o Infection parameters can be considered, but are of limited diagnostic value in the acute phase. They might be valuable when monitoring development post partum. D Suspicion on intrauterine infection in case of intrapartum fever and at least one of the folowing: • Fetal tachycardia >160 beats per minute • Foul smelling vaginal discharge/amniotic fluid • Uterine tenderness The individual signs have low predictive value. B Continuous CTG (...) of >38.0ºC 30 minutes apart or 1 rectal temperature measurement of = 39°C B Temperature should be measured during labor in the following circumstances: • Suspicion of fever • PROM • ROM = 18 hours • Dystocia • Foul-smelling vaginal discharge/amniotic fluid • FHR > 150 beats per minute or rising baseline • Maternal tachycardia =100 beats per minute • Placement of epidural analgesia (before and after placement) • Threatening preterm labor/PPROM B-C Temperature measurement during labor is recommended every

2019 Nordic Federation of Societies of Obstetrics and Gynecology

124. Neonatal seizures

and hypsarrhythmia 36 • Occur rarely but carry worst prognosis 35,36 Subtle • More common in term babies 36 but also found with preterm babies 35 • May have 10,36 : o Ocular–tonic horizontal eye deviation or sustained eye opening with ocular fixation or cycle fluttering o Oral-facial-lingual movements–chewing movements, tongue thrusting, lip smacking o Limb movements–cycling, paddling, boxing jabs o Autonomic CNS phenomena–tachycardia, bradycardia o Apnoeic spells: ? Area rare manifestation of seizures (...) change 7 • Tremulousness of all limbs or just one limb • May also have a pathological basis • Commonly seen in many of the same conditions that are associated with neonatal seizures, e.g. drug withdrawal (from maternal drug ingestion), HIE, hypocalcaemia, and hypoglycaemia • Can clinically differentiate from seizures by disappearance with physical restraint (by holding the baby) and also a lack of associated features e.g. tachycardia or apnoea 10 Excessive startles • Markedly excessive startles

2019 Queensland Health

125. Management of Infants at Risk for Group B Streptococcal Disease

be available at the time of delivery for infants born at or near term. Suspected intraamniotic infection is defined as a single maternal intrapartum temperature ≥39.0°C or maternal temperature of 38.0°C to 38.9°C in combination with 1 or more of maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. Recognizing the uncertainties surrounding the diagnosis of intraamniotic infection, the ACOG recommends that intrapartum antibiotic therapy be administered whenever intra-amniotic infection (...) fetal and neonatal deaths throughout the world, with the largest concentration of GBS perinatal deaths occurring in Africa. Late-Onset GBS Disease GBS late-onset disease (LOD) is defined as isolation of GBS from a normally sterile site from 7 to 89 days of age. Rarely, very–late-onset GBS disease may occur after 3 months of age, primarily among infants born very preterm or infants with immunodeficiency syndromes. , GBS LOD rates have not changed with widespread use of IAP. GBS LOD incidence

2019 American Academy of Pediatrics

126. Identifying Child Abuse Fatalities During Infancy

, liver, kidney, heart, muscle, adrenal gland, and/or pancreas for further analysis. In any case in which the medical examiner is unable to demonstrate an adequate reason for death, a blood sample can be retained for potential future analysis. More recently, it has been suggested that genetic mutations associated with cardiac rhythm disturbances, such as prolonged QT syndrome, catecholaminergic ventricular paroxysmal tachycardia, and others, are responsible for up to 10% of cases of sudden unexpected (...) for Medicolegal Death Investigation . Principles for Communicating with Next of Kin During Medicolegal Death Investigations . Washington, DC : National Institute of Justice ; 2012 . Available at: . Accessed January 23, 2018 Oyen N , Skjaerven R , Irgens LM . Population-based recurrence risk of sudden infant death syndrome compared with other infant and fetal deaths . Irgens LM , Skjaerven R , Peterson DR . Prospective assessment of recurrence risk in sudden infant death syndrome siblings . Irgens LM , Oyen N

2019 American Academy of Pediatrics

129. Sodium zirconium cyclosilicate (Lokelma) - Hyperkalemia

weakness or signs of cardiac arrhythmias such as palpitations, bradycardia, or tachycardia. Hyperkalaemia is detected via blood testing, often during routine screening for a medical disorder or after complications (such as cardiac arrhythmias) have developed. Of greatest concern is the effect of hyperkalaemia on the cardiac system, where impairment of cardiac conduction sometimes leads to fatal cardiac arrhythmias such as asystole or ventricular fibrillation. Because of the potential for fatal cardiac

2018 European Medicines Agency - EPARs

130. Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association

stiffness. , The Lungs Throughout the first years of life for the child with a single ventricle, the pulmonary vasculature is subjected to multiple alterations likely to affect growth and function. During fetal life, pulmonary flow is altered from normal, and pulmonary vascular development can be affected. Neonatal palliation will frequently result in further alterations (usually an increase) in pulmonary blood flow, whereas the staged cavopulmonary connections will decrease pulmonary blood flow. Flow (...) ascites, and exercise intolerance. Heart failure can be related to systolic ventricular dysfunction, with important diastolic ventricular dysfunction increasing with age, although symptomatic circulatory failure may occur independently of ventricular function. Potential contributors to heart failure include ventricular dysfunction, atrial tachycardia, valvar regurgitation, and volume-loading shunts. Cyanosis The purpose of the Fontan operation is to separate the systemic from the pulmonic venous blood

2019 American Heart Association

131. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures

/files/lipid-guidelines.pdf and www.lipid.org/recommendations) (Grade D). R17. (2013*). Candidates for bariatric procedures should avoid pregnancy pre- procedure and for 12 to 18 months post-procedure (Grade D). Women who become pregnant after bariatric procedures should be counseled and monitored for appropriate weight gain, nutritional supplementation, and fetal health (Grade C; BEL 3). All women DOI:10.4158/GL-2019-0406 © 2019 AACE. 30 of reproductive age should be counseled on contraceptive (...) , and copper (Grade D). Patients who become pregnant post-laparoscopic adjustable gastric band should have band adjustments as necessary for appropriate weight gain for fetal health (Grade B; BEL 2). R18. (2008*). Estrogen therapy should be discontinued before a bariatric procedure (1 cycle of oral contraceptives in premenopausal women; 3 weeks of hormone replacement therapy in postmenopausal women) to reduce the risks for post-procedure thromboembolic phenomena (Grade D). R19. (2008*). Women should

2019 American Association of Clinical Endocrinologists

132. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, I

(ventricular fibrillation/pulseless ventricular tachycardia), we suggest administration of epinephrine after initial defibrillation attempts are unsuccessful during CPR (weak recommendation, very low certainty of evidence). We suggest against the administration of vasopressin in place of epinephrine during CPR (weak recommendation, very low certainty of evidence). We suggest against the addition of vasopressin to epinephrine during CPR (weak recommendation, low certainty of evidence). Justification

2019 American Heart Association

133. Meckel's diverticulum

/pubmed/18216533?tool=bestpractice.com It is a true diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. Patients are often asymptomatic. However, this embryological remnant may cause bleeding, obstruction, inflammation, or perforation. It was named after Johann F. Meckel, a German anatomist who described the structure in 1809. Meckel JF. Ueber die Divertikel am Darmkanal. Arch Physiol. 1809;9:421-453. History and exam age <2 years (...) passage of bright red blood per rectum (haematochezia) intractable constipation (obstipation) male sex nausea and vomiting abdominal cramps lower abdominal pain diffuse abdominal tenderness palpable abdominal mass hypotension/tachycardia there are no known risk factors Diagnostic investigations FBC technetium-99m pertechnetate scan ('Meckel's scan') plain abdominal radiography CT scan of the abdomen and pelvis ultrasound of the abdomen contrast enema small bowel enteroclysis mesenteric angiography

2017 BMJ Best Practice

134. Pulmonary Embolism Diagnosis and Treatment

of this guideline, the recommendations for treatment of pulmonary embolism (see p. 9) can also be applied to patients with DVT. Symptoms of pulmonary embolism • Pleuritic chest pain • Shortness of breath • Dyspnea • Tachycardia • Hypoxemia Abbreviations ACCP American College of Chest Physicians PERC Pulmonary Embolism Rule-out Criteria DOACs Direct oral anticoagulants PESI Pulmonary Embolism Severity Index DVT Deep vein thrombosis SSPE Subsegmental pulmonary embolism LMWH Low molecular weight heparin UFH (...) and are associated with embryopathy during the first trimester, and with fetal and neonatal hemorrhage as well as placental abruption if used in the third trimester. • Warfarin may be associated with CNS anomalies throughout pregnancy. • DOACs may cross the placenta and are contraindicated in pregnant women. They can be used postnatally if the woman is not breastfeeding. • There is insufficient evidence to determine the optimal duration of anticoagulation after an unprovoked PE in pregnant women

2017 Kaiser Permanente Clinical Guidelines

135. CRACKCast Episode 142 – Electrical and Lightning Injuries

findings / burns (see Question 4) Cardiac Arrest Due to induced VF or asystole Arrhythmias Bradycardia, tachycardia. A fib, ectopy Respiratory arrest Tetanic paralysis of thoracic respiratory muscles Causing apnea CNS: Direct injury to brainstem respiratory centres Seizure disorder Secondary vascular injury (stroke/CVT) from blood vessel injury Vertigo Delayed and chronic manifestations include ascending paralysis, transverse myelitis, and amyotrophic lateral sclerosis. Peripheral neuropathies (...) , mottled, and pulseless, may persist up to 24 hours . The lower extremities are more commonly involved, and the typical pattern is recovery over minutes to days. 4) Describe the management of a pregnant patient (1st trimester and 2nd /3rd trimester) in the setting of electrical injury. For obstetric patients, the overall risk to the fetus is small, but a spontaneous abortion can occur. Secondary trauma may lead to placental abruption. Obstetric consultation and fetal monitoring are essential. 5) How

2018 CandiEM

136. CRACKCast E144 – High Altitude Medicine

in the gradual return of the resting heart rate to near sea-level values. Continued resting tachycardia is evidence of poor acclimatization. 1.3 Release of erythropoietin (in hours: but the response is delayed) Leading to new circulatory red blood cells in 4 or 5 days. During the next 2 months, red blood cell mass increases in proportion to the degree of hypoxemia. Delayed (days to weeks) Renal excretion of bicarbonate to adapt to the respiratory alkalotic state induced by the HVR, Maximum rate/amount by 6-8 (...) hypoxia stress. Up to 20% of patients with hemoglobin sickle cell and sickle cell–thalassemia disease may experience a vaso-occlusive crisis, even under pressurized aircraft conditions. Oxygen is therefore advised for air travelers who have sickle cell disease. Pregnancy an increased incidence of complications in maternal, fetal, and neonatal life. Lower birth weight, increased premature birth Increased risk of gestational hypertension, preeclampsia Travel above 13000 ft is not advised Children Most

2018 CandiEM

137. CRACKCast E171 – Pediatric Cardiac Disorders

are the main emergency department (ED) treatment of infants and children who present with congestive heart failure (CHF). If vagal maneuvers fail to convert stable paroxysmal supraventricular tachycardia in children, rapid adenosine administration (0.1 mg/kg for the first dose, followed by 0.2 mg/kg on repeated doses) is the treatment of choice. Verapamil should be avoided in children younger than 1 year old because of its profound hypotensive effects. Consider the use of lidocaine instead of amiodarone (...) in cases of ventricular fibrillation or ventricular tachycardia due to medications (eg, cyclic antidepressants) or toxins that prolong the QT interval. Young athletes with a positive family history of sudden unexplained death or exertion-induced symptoms (such as, chest pain, dyspnea, palpitations, and syncope) should be evaluated by a cardiologist before their resumption of vigorous activity. The increased presence of automated external defibrillators (AEDs) in public places and at sporting events can

2018 CandiEM

138. CRACKCast Episode 183 – The Immunocompromised Patient

tachypnea or tachycardia, mental status changes, metabolic acidosis, increased volume requirements, rapid changes in serum glucose or sodium concentration, or acute abdominal pain. In neutropenic cancer patients, most severe infections and almost all instances of bacteremia occur when the neutrophil count is less than 100 cells/mL. In neutropenic patients, the temperature should be measured orally or tympanically, not rectally. In neutropenic cancer patients, pneumonia and anorectal infection are more (...) the respiratory or gastrointestinal tract. Immunoglobulin E (IgE), surface of mast cells and basophils responsible for immediate-type hypersensitivity reactions important in defense against helminthic pathogens. IgG widely distributed in tissues accounts for 75% of the total immunoglobulin mass. It crosses the placenta and provides fetal immunity during the first 6 months of life Congenital or acquired deficiencies of IgG lead to infection with encapsulated organisms Complement complex interaction of 30

2018 CandiEM

139. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease

systemic venous desaturation. 33,46 The initial symptoms of a high Qp:Qs include tachypnea and tachycardia. The tachy- pnea results from increased pulmonary interstitial ede- ma and poor lung compliance associated with elevated pulmonary venous pressure. The tachycardia represents an attempt to increase cardiac output to meet systemic oxygen requirements. Signs and symptoms of shock develop once a critical reduction of SBF is present. 54 The development of a prearrest state can be herald- ed by lactic

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2018 American Heart Association

140. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association

of fetal development, the RV will account for ≈60% of total cardiac output (CO), which provides systemic perfusion via the foramen ovale and the ductus arteriosus. At birth, the LV becomes the dominant systemic ventricle while the RV adapts to provide flow through the pulmonary circulation alone, assuming that the foramen ovale and ductus arteriosus close appropriately. Figure 1. Cardiac embryogenesis. During embryogenesis, the primary heart field is formed by early cardiac progenitor cells

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2018 American Heart Association

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