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Fetal Tachycardia

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141. CRACKCast E165 – Sedative Hypnotics

overdoses, particularly not in regular benzodiazepine users, in whom flumazenil can precipitate seizures. Because flumazenil’s duration of action (about 1 hour) is much shorter than that of all commonly available benzodiazepines, if flumazenil is used patients should be monitored closely for recurrent respiratory depression or re-sedation. Chloral hydrate toxicity may result in sedation and cardiotoxicity, principally in the form of supraventricular tachycardias, which are best treated with a beta (...) and duration of action Only long-acting preparations have anticonvulsant effects in doses that do not cause sedation. Short- and intermediate-acting preparations are almost completely metabolized to inactive metabolites in the liver, whereas 25% of a phenobarbital (long-acting) dose is excreted unchanged through the kidney. Barbiturates cross the placenta with fetal levels approaching those of the mother. They are also excreted in low concentration in breast milk. Use during pregnancy is associated

2018 CandiEM

142. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

account for SCAD presentation in 3% to 11% of reported series. , , , , These reports must be interpreted with care because individuals whose SCAD is not identified or is misdiagnosed, who do not survive to initial evaluation, or in whom coronary imaging or postmortem evaluation is not performed are not included in these studies. Figure 4. Frequency of presenting symptoms of acute spontaneous coronary artery dissection. VF indicates ventricular fibrillation; VT, ventricular tachycardia. Adapted from

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2018 American Heart Association

143. Induced Pluripotent Stem Cells for Cardiovascular Disease Modeling and Precision Medicine: A Scientific Statement From the American Heart Association

syndrome type 2 KCNH2 Long-QT syndrome type 3 SCN5A Timothy syndrome CACNA1C Catecholaminergic polymorphic ventricular tachycardia type 1 RYR2 Catecholaminergic polymorphic ventricular tachycardia type 2 CASQ2 Brugada syndrome SCN5A Calcific aortic valve NOTCH1 Williams-Beuren syndrome ELN Familial pulmonary hypertension BMPR2 Familial hypercholesterolemia LDLR , PCSK9 Familial hypobetalipoproteinemia PCSK9 Tangier disease ABCA1 Dyslipidemia SORT1 Maturity-onset diabetes of the young type 2 GCK Insulin (...) rhythm disorder that has proven amenable to modeling with iPSC-CMs is catecholaminergic polymorphic ventricular tachycardia (CPVT). In CPVT, ventricular arrhythmias are triggered by exercise or emotional stresses in the absence of structural heart disease. Although these arrhythmias are often self-resolving, SCD does occur in many CPVT patients. The most common cause of CPVT is autosomal dominant mutations in RYR2 (ryanodine receptor 2), with the next most common being autosomal recessive mutations

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2018 American Heart Association

144. Adults With Congenital Heart Disease

, tachycardia, tetralogy of Fallot, transplantation, tricuspid atresia, Turner syndrome, and ventricular septal defect. Additional relevant studies published through January 2018, during the guideline writing process, were also considered by the writing committee, and added to the evidence tables when appropriate. The final evidence tables, included in the Online Data Supplement, summarize the evidence used by the writing committee to formulate recommendations. References selected and published (...) data and growing ACHD expertise to develop recommendations. Congenital heart disease (CHD) encompasses a range of structural cardiac abnormalities present before birth attributable to abnormal fetal cardiac development but does not include inherited disorders that may have cardiac manifestations such as Marfan syndrome or hypertrophic cardiomyopathy. Also not included are anatomic variants such as patent foramen ovale. Valvular heart disease (VHD) may be congenital, so management overlaps

2018 American College of Cardiology

145. Blood and Clots Series: Diagnosing pulmonary embolism in pregnancy

pulmonary embolism in pregnancy? The problem with diagnosing pulmonary embolism in pregnancy is that dyspnea and tachycardia are very common during normal pregnancy, particularly in the third trimester. It’s true that the risk of VTE is higher during pregnancy by 5 to 10 times (with the highest risk in the postpartum period). However, given the low baseline risk of VTE in young women overall (1 in 10,000), the absolute risk of VTE in pregnancy is still not very high. For example, in Canadian (...) the incidence of PE is 5.4 cases per 10,000 pregnancies 1 . Unfortunately, our usual clinical prediction rules (such as the Wells Score for PE) are not applicable to pregnant females because the studies that derived these scores excluded them. The specificity of the Wells criteria is questionable in pregnancy as tachycardia and leg edema are common in normal pregnancy. The ability to assess an “alternative diagnosis” is also difficult in pregnancy 2 .For these reasons, most obstetrical guidelines suggest

2018 CandiEM

146. Evaluation and Management of Right-Sided Heart Failure

and LVs. Between the fifth and eighth weeks, ridges within the truncus arteriosus grow into the aorticopulmonary septum, which fuses with the endocardial cushions and muscular interventricular septum to form the membranous septum. At the end of the eighth week, distinct pulmonary and systemic circulations exist. For the remainder 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

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2018 International Society for Heart and Lung Transplantation

147. CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy

and for the puerperium. [1] Describe the treatment of asthma exacerbation during pregnancy. What are the potential side effects of systemic glucocorticoids? Very common problem in pregnancy; associated with maternal and fetal morbidity. Controlling asthma during pregnancy leads to less intrauterine growth retardation and fewer adverse perinatal outcomes. It has been well documented that asthma may worsen, improve, or remain the same during pregnancy. Remember that a compensated respiratory alkalosis is normal (...) in pregnancy: 7.40/32/-/19. Don’t let that pseudonormal ABG fool you. Also, remember that we must keep the SP02 > 95%! Anyone with a PEF < 50% predicted is having a severe asthma exacerbation Tidal volume and minute ventilation increase by 45% over the course of pregnancy resulting in an average Pco2 of 32 mm Hg. The kidneys compensate and maintain an average bicarbonate level of 19 mEq/mL, which results in a compensated respiratory alkalosis with a serum pH between 7.40 and 7.45. An initial fetal

2018 CandiEM

148. CRACKCast E177 – Acute Complications of Pregnancy

. Chorioamnionitis is diagnosed by the findings of fever, maternal and fetal tachycardia, and uterine tenderness in a patient past 16 weeks of pregnancy. Patients are usually treated with IV ampicillin and gentamicin. Thyroid Disease Postpartum thyroiditis is characterized by transient hyperthyroidism and/or hypothyroidism in the postpartum period. Confirmation of hypothyroidism is based on an elevated serum TSH level, relying on trimester-specific TSH reference ranges. Hyperthyroidism may be associated (...) , maternal and fetal tachycardia, and uterine tenderness in a patient past 16 weeks of pregnancy. Vaginal and cervical culture specimens for group B streptococci, E. coli, chlamydia, and gonorrhea should also be obtained. Urgent obstetric consultation should be obtained, and hospitalization for IV administration of antibiotics is required. Patients are usually treated with IV ampicillin and gentamicin. RF: Women with preterm labour Multiple digital exams Cervical insufficiency Nulliparity Genital tract

2018 CandiEM

149. CRACKCast E180 – Labor & Delivery

) Describe the descriptors of fetal HR and how changes have clinical implications Baseline HR This is the average fetal heart rate during a 10-minute period (in the absence of a uterine contraction) and is the most important aspect of fetal heart rate monitoring. Fetal bradycardia is defined as a baseline rate of less than 110 beats/min; fetal tachycardia is defined as a baseline rate of more than 160 beats/min.2 Variability This can be instantaneous (beat to beat) or long term (intervals ≥ 1 minute (...) (not tachycardia alone) Lethal fetal anomaly Chorioamnionitis Preeclampsia or eclampsia Sepsis DIC Relative Chronic hypertension Cardiopulmonary disease Stable placenta previa Cervical dilation >5cm Placental abruption 8) List 2 tests to confirm PROM. What is the management of PROM? PROM is defined as rupture of the amniotic and chorionic membranes before the onset of labor ( doesn’t refer to fetal prematurity). History Spontaneous gush of watery fluid, followed by a mild persistent seepage. Physical = Direct

2018 CandiEM

150. Neonatal stabilisation for retrieval

service capability · Seek advice: o Contact RSQ o Phone 1300 799 127 Maternal risk · Severe hypertensive disorder · Antepartum haemorrhage · Other care requirements beyond service’s CSCF Fetal risk · Threatened preterm birth · Fetal anomalies · FGR · Multiple pregnancy · Other care requirements beyond service’s CSCF Yes Yes No No CSCF: Clinical services capability framework; FGR: Fetal growth restriction; QCG: Queensland Clinical Guidelines; RSQ: Retrieval Services Queensland Queensland Clinical (...) is not possible contact the Retrieval Service Queensland (RSQ) for advice regarding management prior to the baby’s birth. Early activation of the retrieval team prior to the baby’s birth can be made when indicated. Table 1. Indications for transfer Aspect Comment Antenatal 7,8 · Known congenital anomaly · Multiple birth · Suspected cardiac anomaly · Fetal growth restriction · Preterm labour (as relevant to CSCF) · Placenta praevia · Pre-eclampsia · Prolonged rupture of membranes Neonatal 8,9 · Birth weight: o

2018 Clinical Practice Guidelines Portal

151. Induction of labour

regardless of cervical change · Ruptured membranes · Fetal distress · Uterine hyperstimulation or hypertonic uterine contractions · Maternal systemic adverse effects (e.g. nausea, vomiting, hypotension, tachycardia) · Insufficient cervical ripening after 24 hours Indications · Unfavourable cervix (MBS = 6) · Following balloon catheter if no/ minimal effect on cervical ripening and ARM not technically possible Contraindications · Known hypersensitivity · Ruptured membranes · Multiparity = 5 · Previous CS (...) , contact: Intellectual Property Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email ip_officer@health.qld.gov.au, phone (07) 3234 1479. Queensland Clinical Guideline: Induction of labour Refer to online version, destroy printed copies after use Page 3 of 30 Flow Chart: Method of induction of labour Flowchart: F17.22-1-V5-R22 Indication · Maternal and/or fetal benefit Contraindications · As for vaginal birth Communication with woman · Indication · Maternal &/or fetal benefit & risk

2018 Queensland Health

152. Management of Neonates Born at ?34 6/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

diagnosis and management. A confirmed diagnosis of IAI is made by a positive result on an amniotic fluid Gram-stain, culture, or placental histopathology. Suspected IAI is diagnosed by maternal intrapartum fever (either a single documented maternal intrapartum temperature of ≥39.0°C or a temperature of 38.0–38.9°C that persists for >30 minutes) and 1 or more of the following: (1) maternal leukocytosis, (2) purulent cervical drainage, and (3) fetal tachycardia. The ACOG recommends that intrapartum (...) is complex. EOS primarily begins in utero and was originally described as the “amniotic infection syndrome.” , Among term infants, EOS pathogenesis most commonly develops during labor and involves ascending colonization and infection of the uterine compartment with maternal gastrointestinal and genitourinary flora, with subsequent colonization and invasive infection of the fetus and/or fetal aspiration of infected amniotic fluid. This intrapartum sequence may be responsible for EOS that develops after

2018 American Academy of Pediatrics

154. Fever during labor

should be considered. D o All microbiotic tests may be valuable postpartum, but only 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. 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 (...) (A) Intrapartum fever/ fever during labor is defined as: 2 rectal temperature measurements 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

2018 Nordic Federation of Societies of Obstetrics and Gynecology

155. Heart Failure

in patients following resuscitated cardiac arrest, sustained ventricular tachycardia in the presence of haemodynamic compromise and ventricular tachycardia associated with syncope and an LVEF of less than 40% to decrease mortality. Strong FOR High An ICD should be considered as a primary prevention indication in patients at least 1 month following myocardial infarction associated with an LVEF of less than or equal to 30% to decrease mortality. Strong FOR High An ICD should be considered as a primary (...) [22] Thibodeau, J.T., Turer, A.T., Gualano, S.K., Ayers, C.R., Velez-Martinez, M., Mishkin, J.D. et al. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart Fail . 2014 ; 2 : 24–31 | | | ] [22] . Other important symptoms of heart failure are fatigue and palpitations. Typical signs of heart failure can be divided into those related to cardiac dysfunction and strain (tachycardia, third heart sound, murmurs and displaced apex beat), reduced end-organ perfusion

2018 Cardiac Society of Australia and New Zealand

158. WHO recommendations on maternal health

Abbreviations iv Introduction 1 Promote, prevent and protect maternal and perinatal health 3 1. Antenatal care 3 Nutritional supplements 3 Maternal and fetal assessment 4 Preventive measures 6 Interventions for common physiological symptoms 7 Health systems interventions 8 2. Prevention of pre-eclampsia and eclampsia 9 3. Interventions to improve preterm birth outcomes 10 4. Prevention of maternal peripartum infections 12 5. Labour and child birth 13 Induction of labour 13 Delay in the first stage of labour (...) ¦ ¦ For pregnant women with high daily caffeine intake (more than300 mg per day) lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and low-birth-weight neonates. (Context-specific recommendation). Source Maternal and fetal assessment Anaemia ¦ ¦ Full blood count testing is the recommended method for diagnosing anaemia in pregnancy. In settings where full blood count testing is not available, on-site haemoglobin testing with a haemoglobinometer is recommended

2017 World Health Organisation Guidelines

159. ABCD position statement on standards of care for management of adults with type 1 diabetes

ketoacidosis: ? Nausea/vomiting ? Increased respiratory rate ? Tachycardia ? Signs of dehydration ? Impaired conscious level In the absence of these symptoms, insulin may be commenced in the community or in secondary care, by a team specialised in the management of type 1 diabetes, depending on local policy. Serum or urine should be checked for ketones and if these are present the patient should be monitored closely until the ketones have resolved (hospital referral should be considered). Multiple daily (...) ophthalmologist, nephrologist, cardiologist) ? Advise folic acid 5mg daily preconception until the end of the first trimester 7.3.2 Antenatal care Antenatal care must be provided by a combined team including diabetes physician, specialist nurse and dietitian, obstetrician and midwife, all of whom should have specialist experience in the management of diabetic pregnancy. The team should: ? Explain the importance of regular clinic visits to ensure good glycaemic control and monitoring of fetal development

2017 Association of British Clinical Diabetologists

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