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Fetal Tachycardia

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161. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock

; however, cardiac output (CO) is usually maintained or increased by two mechanisms: tachycardia and ventricular dilation. Adults who do not develop this adaptive process to maintain CO have a poor prognosis ( , ). “ Pediatric septic shock ” is typically associated with severe hypovolemia, and children frequently respond well to aggressive volume resuscitation; however, the hemodynamic response of fluid resuscitated children seems diverse compared with adults. Contrary to the adult experience, low CO (...) Doppler ultrasound to measure CO ( , ). They found that previously healthy children with community-acquired sepsis often had a low CO with a higher mortality rate, whereas CO was high and mortality rate was low in septic shock related to catheter-associated blood stream infections ( ). “Neonatal septic shock ” can be complicated by the physiologic transition from fetal to neonatal circulation. In utero, 85% of fetal circulation bypasses the lungs through the patent ductus arteriosus (PDA) and foramen

2017 Society of Critical Care Medicine

162. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

a critical role in diagnosing and treating fetal tachycardia. Transplacental or direct fetal antiarrhythmia treatment, follow-up evaluations, and delivery plans can be appropriately determined on review of the images. Of note, several commercial and US Food and Drug Administration (FDA)–approved handheld Doppler fetal heart rate monitors are readily available for use. Prospective parents can purchase them at low cost on the Internet. These devices hold promise, especially if they have Bluetooth (...) statement on the use of telemedicine in pediatric cardiology. Specific areas explored in this document include both neonatal and fetal tele-echocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine

2017 American Heart Association

163. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

to high risk for both the mother and her fetus. Many such women, however, do not have access to adult congenital heart disease tertiary centers with experienced reproductive programs. Therefore, it is important that all practitioners who will be managing these women have current information not only on preconception counseling and diagnostic evaluation to determine maternal and fetal risk but also on how to manage them once they are pregnant and when to refer them to a regional center with expertise (...) disturbances, including atrial and ventricular premature beats and reentrant supraventricular tachycardia (SVT). Similarly, ventricular arrhythmias, although rare in labor, have been reported in 5% of normal gravidas. Common changes observed on the ECG are listed in . Table 2. Normal Electrocardiographic Changes Associated With Pregnancy Left axis shift is seen, with the greatest shift in the third trimester caused by elevation of the diaphragm. Shortening of the PR, QRS, and QT intervals may accompany

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2017 American Heart Association

164. Flowchart: Induction of labour, Prostaglandin E2 (Dinoprostone) (PDF, 118kB)

, ongoing care as for latent first stage of labour · Continuous CTG when in active labour or when contractions are = 3 in 10 minutes · After insertion advise woman to: o Remain recumbent for 30 minutes o Inform staff as soon as contractions commence Yes No Yes No Recommend ARM irrespective of MBS PESSARY removal indications · Onset of regular, painful uterine contractions, occurring every 3 minutes 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 or uterine surgery · Malpresentation/high presenting part · Undiagnosed PV bleeding · Abnormal CTG

2017 Queensland Health

165. Flowchart: Ectopic pregnancy

, FBC: full blood count, GP: General Practitioner, GTD: gestational trophoblast disease, IMI: intramuscular injection, IU/L: international units per litre, IUP: intrauterine pregnancy, IVI: intravenous injection, MFM: maternal fetal medicine, POC: products of conception, PUL: pregnancy of unknown location, PV: per vaginam, QTC: Queensland Trophoblast Centre, RhD-Ig: RhD immunoglobulin, TVS: transvaginal scan, USS: ultrasound scan, >: greater than, 5000 IU/L • Ectopic > 3 cm on TVS • Fetal heart (...) motion present • Blood transfusion not an option Methotrexate • If ß-hCG = 3000 IU/L, IMI • If ß-hCG > 3000 IU/L, IVI Ongoing management • EPAS or equivalent • Serial ß-hCG as per methotrexate protocol • USS in one week then as clinically indicated o If fetal heart present, refer to MFM • Avoid conception for 4 months due to potential teratogenicity Medical Indications • Haemodynamically unstable • Signs of rupture • Any ß-hCG level • Persistent excessive bleeding • Heterotopic pregnancy

2017 Queensland Health

166. Flowchart: Induction of labour, Oxytocin

: uterine dehiscence and rupture • Rarely (< 0.1%) arrhythmias, ECG changes, anaphylaxis, tetanic contractions, transient hypotension, reflex tachycardia ARM Artificial rupture of membranes; CS Caesarean section; CTG Cardiotocography; ECG Electrocardiograph; FHR Fetal heart rate; IOL Induction of labour; IV Intravenous; VBAC Vaginal birth after caesarean section; < less than; = greater than or equal to (...) administration: • Via sideline/secondary IV access • Volumetric pump required • Record dose in milliunit/minute Induction of labour See flowchart: Method of induction Observation and care • Provide one-to-one midwifery care • Commence intrapartum record • Commence continuous CTG at the onset of first contractions • Maternal and fetal observations as per first stage of active labour • Maintain fluid balance chart Dose management • Use minimum dose required to establish and maintain active labour • Maternal

2017 Queensland Health

167. Occupational Radiation Exposure in the Electrophysiology Laboratory with a Focus on Personnel with Reproductive Potential and During Pregnancy: 2017 EHRA Consensus Document

procedure 15.2 2.7 1.6–59.6 0.24–9.6 Atrial ?brillation 16.6 3.3 6.6–59.6 UR b AT/AVNRT/AVRT 4.4 2.6 1.6–25 0.2–9 Ventricular tachycardia 12.5 UR b 3–> _45 VVI/DDD PM or ICD implant 4 4.8 1.4–17 0.29–17.4 CRT implant 22 UR b 2.2–95 Coronary angiography 7 4.4 2.0–16 0.02–38 Percutaneous coronary intervention 15 4.9 7–57 0.17–31 a The reported mean doses and mean dose ranges are mean estimates from a small number of studies including low number of procedures performed before 2008 and should be interpreted (...) with caution. Operator doses varied by two to three orders of magnitude for the same type of procedure. b Under-reported: occupational exposure is reported in an insuf?cient number of procedures to produce representative numbers for operator effective doses. AT/AVNRT/AVRT, atrial tachycardia, atrioventricular nodal re-entry tachycardia, atrioventricular re-entry tachycardia; CRT, cardiac resynchronization therapy; ICD, implant- able cardioverter-de?brillator; PM, pacemaker; UR under-reported. EHRA

2017 Heart Rhythm Society

168. Guidelines for the Use of Laparoscopy during Pregnancy

with intraperitoneal insufflation there has been concern for deleterious effects to the fetus from pneumoperitoneum. Some animal studies have confirmed fetal acidosis with associated tachycardia, hypertension and hypercapnia during CO2 pneumoperitoneum [111-113] , while other animal studies contradict these findings [114] . There are no data showing detrimental effects to human fetuses from CO2 pneumoperitoneum [88] . Intra-operative CO2 Monitoring Guideline 13: Intraoperative CO2 monitoring by capnography should (...) Stefanidis Preamble Surgical interventions during pregnancy should minimize fetal risk without compromising the safety of the mother. Favorable outcomes for the pregnant woman and fetus depend on accurate and timely diagnosis with prompt intervention. Surgeons must be aware of data regarding differences in techniques used for pregnant patients to optimize outcomes. This document provides specific recommendations and guidelines to assist physicians in the diagnostic work-up and treatment of surgical

2017 Society of American Gastrointestinal and Endoscopic Surgeons

170. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Hea

(Belhassen Tachycardia) e335 8.4. Idiopathic Polymorphic VT/VF e336 9. PVC-Induced Cardiomyopathy e337 10. VA and SCD Related to Specific Populations e338 10.1. Athletes e338 10.2. Pregnancy e338 10.3. Older Patients With Comorbidities e339 10.4. Chronic Kidney Disease e340 10.5. Valvular Heart Disease e340 10.6. Sex-Related Differences in the Risk of SCD e340 10.7. Medication-Induced Arrhythmias e341 10.8. Adult Congenital Heart Disease e342 11. Defibrillators Other than Transvenous ICDs e347 11.1 (...) , was conducted from April 2016 to September 2016. Key search words included, but were not limited, to the following: sudden cardiac death, ventricular tachycardia, ventricular fibrillation, premature ventricular contractions, implantable cardioverter-defibrillator, subcutaneous implantable cardioverter-defibrillator, wearable cardioverter-defibrillator, and catheter ablation. Additional relevant studies published through March 2017, during the guideline writing process, were also considered by the writing

2017 American Heart Association

172. Evaluation of the Neck Mass in Adults

”[Mh] OR infant[tiab] OR infants[tiab] OR infantile[tiab] OR prenatal[tiab] OR perinatal[tiab] OR fetal[tiab]) AND (“Practice Guideline”[ptyp] AND systematic[sb] AND (Randomized Controlled Trial[ptyp] OR randomized[tiab] OR randomised[tiab]); (“Head and Neck Neoplasms/epidemiology”[Mesh] OR “Head and Neck Neoplasms/etiology”[mh] OR “Head and Neck Neoplasms/diagnosis”[mh]) AND (“Papillomaviridae”- [Mesh] OR “human papillomavirus”[tiab] OR hpv[tiab] or “HPV-mediated”[tiab] OR “HPV-associated”[tiab (...) ] OR “HPV-related”[tiab]) AND (“1980/01/01”[PDAT] : “2016/12/31”[PDAT]) NOT (“child”[mh] OR child[tiab] OR childhood[tiab] OR children[tiab] OR “pediatrics”[Mh] OR pediatric[tiab] OR paediatric[tiab] OR “infant”[Mh] OR infant[tiab] OR infants[tiab] OR infantile[tiab] OR prenatal[tiab] OR perinatal[tiab] OR fetal[tiab]) AND “Practice Guideline”[ptyp] AND systematic[sb] (Randomized Controlled Trial[ptyp] OR randomized[tiab] OR randomised[tiab]) AND (Comparative Study[ptyp] OR comparative[tiab

2017 American Academy of Otolaryngology - Head and Neck Surgery

173. 2017 AHA/ACC Key Data Elements and Definitions for Ambulatory Electronic Health Records in Pediatric and Congenital Cardiology: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards

to occur. The other domains include: congenital heart defect nomenclature, adult congenital heart disease, critical care, cardiomyopathy, cardiac transplantation, pulmonary hypertension, congenital cardiac surgery, echocardiography, diagnostic and interventional catheterization, exercise stress testing and physiology, electrophysiology, cardiac magnetic resonance imaging, fetal physiology, perfusion, and cardiac anesthesia. The reason that this domain was chosen first was that there are other nascent (...) , nonavailability of natural history of unoperated patients in the present era, and insufficient patient numbers—from which to draw statistically significant conclusions. Pediatric and congenital cardiology and cardiovascular surgery comprise a wholly separate set of diagnoses and procedures compared with those of adult cardiology. Pediatric and congenital cardiac care begins at fetal cardiology through congenital as well as acquired pediatric cardiac disease, leads up to and through adult congenital cardiac

2017 American Heart Association

174. Intrapartum Management of Intraamniotic Infection

is based on clinical criteria, which include maternal intrapartum fever and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. Confirmed intraamniotic infection is based on a positive amniotic fluid test result (gram stain, glucose level, or culture results consistent with infection) or placental pathology demonstrating histologic evidence of placental infection or inflammation. In clinical practice, confirmed intraamniotic infection among women (...) Intrapartum Management of Intraamniotic Infection Intrapartum Management of Intraamniotic Infection - ACOG Menu ▼ Intrapartum Management of Intraamniotic Infection Page Navigation ▼ Number 712, August 2017 Committee on Obstetric Practice The Society for Maternal–Fetal Medicine endorses this document. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in collaboration with R. Phillips Heine, MD; American Academy

2017 American College of Obstetricians and Gynecologists

175. Atrial Fibrillation

time in therapeutic range UFH unfractionated heparin VKA vitamin K antagonist VT Ventricular tachycardia VVI Ventricular pacing, ventricular sensing, inhibited response pacemaker WOEST What is the Optimal antiplatElet and anticoagulant therapy in patients with oral anticoagulation and coronary StenTing WPW Wolff-Parkinson-White syndrome 1. Preamble Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health (...) . The prevalence of atrial flutter is less than one-tenth of the prevalence of AF. Atrial flutter often coexists with or precedes AF. In typical, isthmus-dependent flutter, P waves will often show a ‘saw tooth’ morphology, especially in the inferior leads (II, III, aVF). The ventricular rate can be variable (usual ratio of atrial to ventricular contraction 4:1 to 2:1, in rare cases 1:1) and macro-re-entrant tachycardias may be missed in stable 2:1 conduction. Vagal stimulation or intravenous adenosine can

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2016 European Society of Cardiology

177. Arrhythmias in Congenital Heart Disease: A Position Paper of EHRA, AEPC, and ESC Working Group on Grown-up Congenital Heart Disease

. Keywords Congenital heart disease ? Arrhythmia ? Sudden cardiac death ? Heart failure ? Macroreentry tachycardia ? Atrioventricular block ? Bradycardia ? Implantable cardioverter-de?brillator ? Pacemaker ? Cardiac resynchronization therapy ? Ablation ? European Heart Rhythm Association position paper Table of Content Introduction 3 Evidencereview 3 Relationships with industry and other conflicts of interest. . . . . . . . 4 Scopeoftheconsensusdocument 4 Arrhythmias in congenital heart disease: general (...) for invasive procedures: roadmapping 8 Specificarrhythmiatypes 8 Supraventricular arrhythmias in patients with congenital heartdisease 8 Accessory pathways and atrioventricular reentrant tachycardias 8 Atrioventricularnodalreentranttachycardia 8 Atrialtachycardias 8 Atrialfibrillation 10 2 A. Herna ´ndez-Madrid et al. Downloaded from https://academic.oup.com/europace/advance-article-abstract/doi/10.1093/europace/eux380/4944677 by guest on 21 March 2018Ventricular arrhythmias and sudden cardiac death

2017 Heart Rhythm Society

178. Intrapartum care for healthy women and babies

tr ansferred (% of total transferred from each ansferred from each setting) setting) F From home rom home (n=3,529) (n=3,529) F From a freestanding rom a freestanding midwifery unit (n=2,457) midwifery unit (n=2,457) F From an alongside rom an alongside midwifery unit midwifery unit (n=4,401) (n=4,401) Delay during first or second stage of labour 1,144 (32.4%) 912 (37.1%) 1,548 (35.2%) Abnormal fetal heart rate 246 (7.0%) 259 (10.5%) 477 (10.8%) Request for regional analgesia 180 (5.1%) 163 (6.6 (...) on ultrasound) Abnormal fetal heart rate/doppler studies Ultrasound diagnosis of oligo-/polyhydramnios Intrapartum care for healthy women and babies (CG190) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 13 of 89Previous gynaecological history Myomectomy Hysterotomy T T able able 8 Medical conditions indicating individual assessment when planning place of 8 Medical conditions indicating individual assessment when planning

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

180. ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above

and is a more reliable discriminant in later years. However, there is increasing evidence that some people with type 1 diabetes retain C-peptide secretion for many years so the presence of C-peptide does not exclude type 1 diabetes. 1.3 Immediate Treatment Insulin must be commenced as soon as the diagnosis is made. A patient with the following symptoms should be admitted to hospital as an emergency for treatment of diabetic ketoacidosis: ? Nausea/vomiting ? Increased respiratory rate ? Tachycardia ? Signs (...) 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 pre.gnancy. The team should: ? explain the importance of re.gular clinic visits to ensure good glycaemic control and monitoring of fetal development and wellbeing ? set glycaemic targets (taking into account individual risk of hypoglycaemia) ? provide individual dietetic advice

2016 Association of British Clinical Diabetologists

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