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Fetal Tachycardia

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161. Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

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

163. ASCIA Guidelines - Acute management of anaphylaxis

of infants weighing 7.5kg or more poses less risk, particularly when used without medical training, than use of an adrenaline ampoule and syringe. Infants with anaphylaxis may retain pallor despite 2-3 doses of adrenaline, and this can resolve without further doses. More than 2-3 doses of adrenaline in infants may cause hypertension and tachycardia. Pregnant women experiencing anaphylaxis need to be treated without delay and there are no absolute contraindications to adrenaline use in anaphylaxis (...) . If clinical judgement deems that there is a risk of maternal death or foetal compromise due to inadequately treated anaphylaxis, then in pregnant women weighing > 50kg, consider giving 500 mcg IM adrenaline. Note: • If multiple doses are required for severe reactions (e.g. 2-3 doses administered at 5 minutes intervals), consider adrenaline infusion if skills and equipment are available. • For emergency treatment of anaphylaxis, ampoules of adrenaline 1:1000 should be used for both IM doses and infusion

2019 Australasian Society of Clinical Immunology and Allergy

164. Elevated Blood Lead Levels in Children and Pregnant Women: Screening

circumference, and decreased birth weight. Studies also suggest that mildly elevated maternal blood lead levels during pregnancy may be associated with increased risk for spontaneous abortion, gestational hypertension, and adverse effects on fetal growth. Although very high blood lead levels during pregnancy are harmful, the adverse effects of elevated antepartum blood lead levels on the fetus, at least for the range of exposure typically found in the United States, have not been established. Scope (...) , and financial costs associated with return visits and repeated tests. Children with significantly elevated blood lead levels might receive chelation therapy, which is associated with a wide range of harms, including injection site pain or abscess, headache, paresthesia, tremors, rash, neutropenia, elevation of serum liver transaminase, hypertension, tachycardia, fever, nausea, vomiting, or other gastrointestinal upset. Current Practice There are no data on the proportion of clinicians who screen

2019 U.S. Preventive Services Task Force

165. Diagnosis & Assessment of Hypertension - Endocrine Hypertension

hypertension, labile hypertension, hypertensive crises triggered by beta-blockers or monoaminoxidase inhibitors, surgery, anesthesia, or symptoms such as severe headache, palpitations, sweating (a common triad of symptoms), pallor, tremulousness, syncope, weight loss, abdominal pain, paroxysmal hypertension with micturition, require investigation for pheochromocytoma/PPGL . Other suggestive signs include orthostatic hypotension, tachycardia, palpable flank mass, polycythemia, hypercalcemia, shock, port (...) if possible. Oral beta-blockers, usually necessary, should only be started after a few days of adequate alpha blockade to control tachycardia and prevent arrhythmias during surgery. Alpha-blockade with prazosin, doxazosin or phenoxybenzamine has been studied following diagnosis and as part of preparation during the preoperative period . While prasozin was associated with blood pressure reduction and diminished symptoms, it did not prevent blood pressure rises during surgery, and intravenous phentolamine

2018 Hypertension Canada

166. 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

167. 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 (...) prophylaxis** should be initiated regardless of whether the patient has a fever: - History of delivery with invasive GBS infection - GBS bacteriuria in the current pregnancy - PROM = 18 hours - Gestational age 38,0 °C after initiation of GBS-prophylaxis, see c) in the red box Flowchart 1 Intrapartum Fever Unknown GBS status * Indications of intrauterine infection: • Foetal tachycardia >160 beats/min • Foul smelling or purulent amniotic fluid • Uterine tenderness or irritation INTRAPARTUM FEVER Temp

2018 Nordic Federation of Societies of Obstetrics and Gynecology

168. Heart Failure Full Text available with Trip Pro

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

169. Vein of Galen malformation

www.cats.nhs.uk 1. Background VGAM is a rare congenital midline arteriovenous vascular malformation causing shunting of arterial blood into the median prosencephalic vein of Markowski 1, 2 . All neonates should be referred to the specialist service in Great Ormond Street Hospital NICU/PICU as clinical priority. 2. Presentation • Antenatal diagnosis on foetal ultrasound. • Postnatal diagnosis most commonly high output heart failure 3 (tachycardia, tachypnoea, cyanosis, pulmonary hypertension, hypoxaemia, multi (...) . • Ventilate and oxygenate – target PEEP of 4-6cmH2O, SaO2 >95%. • Optimise BP and avoid tachycardia with cautious 5ml/kg crystalloid boluses – monitor for increasing hepatomegaly. • Consider inotropic support – low dose adrenaline first choice. Children’s Acute Transport Service provides paediatric intensive care retrieval for Great Ormond Street, The Royal Brompton and St Mary’s NHS Trusts. Funded and accountable to the North Thames Paediatric Intensive Care Commissioning Group through Great Ormond

2018 Children's Acute Transport Service

172. 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

173. 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

2018 International Society for Heart and Lung Transplantation

174. 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

175. Trimbow (beclometasone / formoterol / glycopyrronium bromide) - chronic obstructive pulmonary disease (COPD)

tachycardia, ventricular premature contractions and 1st to 2nd degree atrio-ventricular block were observed for the mid and high doses. According to a safety margin calculation, based either on an allometric dose conversion (see Table 6) or on systemic exposure to the active components of CHF 5993 (see Table 7), the low CHF 5993 dose would correspond to about 3 to 5 times respectively 1.2 to 3 times the proposed human daily dose of CHF 5993, when considering the margins for FF and GB only (acute CV (...) studies were conducted on the CHF 5993 combination. However, in a 104-week rat inhalation carcinogenicity study and an oral 26-week carcinogenicity in transgenic Tg.rasH2 mice performed by the Applicant, GB showed no carcinogenic potential and published data concerning long term studies conducted with BDP and FF in rats do also not indicate a clinically relevant carcinogenic potential. Reproductive toxicity Only one species was used to investigate the effect of CHF 5993 administration on embryo/foetal

2017 European Medicines Agency - EPARs

177. 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

178. CRACKCast Episode 142 – Electrical and Lightning Injuries

, 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 (...) 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

2018 CandiEM

179. Anamorelin (Adlumiz) - Anorexia, Cachexia, Non-Small-Cell Lung Carcinoma

in micronuclei in bone marrow erythroblasts clinical signs: 1 dead in 200 mg/kg dose group, clinical adverse effect signs: hunched posture, subdued behavior Carcinogenicity No studies were submitted. Reproduction Toxicity The reproductive and developmental toxicity of anamorelin HCl was evaluated in a fertility and early embryonic development study in rats and embryo-fetal development studies in rats and rabbits. Table 5. Summary of fertility/ early-embryo-fetal development toxicity study in rats Study type (...) / Study ID / GLP Species; Number group Route & dose(mg/k g/day) Dosing period Major findings NOAEL (mg/kg/day) Study No.: 8002-107 Fertility and embryo-fetal development study GLP Sprague Dawley Rat (Crl:CD(SD)) 22/sex/group 0, 15, 30, 60 oral Males: 28 days prior to mating until necropsy Females: 14 days prior to mating and up to day 7 of gestation Control: 1 death 15 mg/kg/d: 1 death = 30 mg/kg: 2 deaths, ?body weight gain, ? body weight, ? food consumption NOAEL reproductive parameters: 60 NOAEL

2017 European Medicines Agency - EPARs

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