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Murphy Sign

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23. 2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation (Management of) Guidelines Full Text available with Trip Pro

by a qualified physician. While the ECG in the setting of NSTE-ACS may be normal in more than 30% of patients, characteristic abnormalities include ST-segment depression, transient ST-segment elevation, and T-wave changes. , , If the standard leads are inconclusive and the patient has signs or symptoms suggestive of ongoing myocardial ischaemia, additional leads should be recorded; left circumflex artery occlusion may be detected only in V7–V9 or right ventricular MI only in V3R and V4R. In patients (...) with suggestive signs and symptoms, the finding of persistent ST-segment elevation indicates STEMI, which mandates immediate reperfusion. Comparison with previous tracings is valuable, particularly in patients with pre-existing ECG abnormalities. It is recommended to obtain additional 12-lead ECGs in case of persistent or recurrent symptoms or diagnostic uncertainty. In patients with left bundle branch block (LBBB), specific ECG criteria (Sgarbossa’s criteria) may help in the detection of candidates

2020 European Society of Cardiology

27. CCS/CTS Position Statement on Pulmonary Hypertension Full Text available with Trip Pro

: 1023-1030 , Peacock A.J. Murphy N.F. McMurray J.J. Caballero L. Stewart S. An epidemiological study of pulmonary arterial hypertension. Eur Respir J. 2007; 30 : 104-109 The morbidity and mortality remain significant and early diagnosis and treatment are essential. This document is targeted at clinicians and intended to: (1) provide a framework for screening and diagnosis of PH; and (2) highlight the current approach to PH management in Canada, including specifically PAH as well as other types of PH (...) but a nonspecific symptom of PH. Later symptoms and signs can include syncope, angina, and peripheral edema. Algorithms for the work-up of PH ( ) are extensively discussed elsewhere. Frost A. Badesch D. Gibbs J.S.R. et al. Diagnosis of pulmonary hypertension. Eur Respir J. 2019; 53 : 1801904 , Haddad R.N. Mielniczuk L.M. An evidence-based approach to screening and diagnosis of pulmonary hypertension. Can J Cardiol. 2015; 31 : 382-390 , Hoeper M.M. Bogaard H.J. Condliffe R. et al. Definitions and diagnosis

2020 Canadian Cardiovascular Society

28. Organisation of diagnosis and treatment of obstructive sleep apnoea syndrome: an international comparison

recently. 15 This approach is based on two shortcomings. First, it is assumed that when the AHI is increased, the presenting symptoms and signs are caused by OSA. This premise results in a substantial number of false positive cases, and consequently, in medical overconsumption. Second, it is assumed that AHI indicates clinical severity of OSA. None of these associations seem to be substantiated by sound scientific evidence. 15 a Of note, the study participants were relatively old, with 40% of male (...) , the US Preventive Services Task Force concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults or adults with unrecognized symptoms. 8, 9 However, screening may be appropriate in individuals whose occupation involves driving or in patients with resistant hypertension. 6 Testing the presence of OSAS should be done, after a thorough sleep history, in adult patients presenting with signs and symptoms that indicate an increased

2020 Belgian Health Care Knowledge Centre

29. Children and young people exposed prenatally to alcohol

, gender, race, religion/belief and sexual orientation. SIGN guidelines are produced using a standard methodology that has been equality impact assessed to ensure that these equality aims are addressed in every guideline. This methodology is set out in the current version of SIGN 50, our guideline manual, which can be found at The EQIA assessment of the manual can be seen at The full report in paper form and/or alternative format (...) to produce clinical guidelines. The accreditation term is valid until 31 March 2020 and is applicable to guidance produced using the processes described in SIGN 50: a guideline developer’s handbook, 2015 edition ( More information on accreditation can be viewed at Intercollegiate Guidelines Network Gyle Square, 1 South Gyle Crescent Edinburgh EH12 9EB First published January 2019 ISBN 978-1-909103-67-2 Citation

2019 SIGN

30. British guideline on the management of asthma

; or Extrapolated evidence from studies rated as 2 + Good-practice points ? Recommended best practice based on the clinical experience of the guideline development group. Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. SIGN guidelines are produced using a standard methodology that has been equality impact assessed to ensure (...) that these equality aims are addressed in every guideline. This methodology is set out in the current version of SIGN 50, our guideline manual, which can be found at The EQIA assessment of the manual can be seen at The full report in paper form and/or alternative format is available on request from the Healthcare Improvement Scotland Equality and Diversity Officer. Every care is taken to ensure that this publication is correct in every detail

2019 SIGN

31. Options for national testing and surveillance for hepatitis E virus in the EU/EEA

), Heidi Lange (Norway), Zdenka Mandáková (Czech Republic), Kassiani Mellou (Greece), Niamh Murphy (Ireland, 2018 only), Joanne O’Gorman (Ireland, replacement of Lelia Thornton from 2018), Ruska Rimhanen-Finne (Finland), Bengü Said (United Kingdom), Lena Sundqvist (Sweden), Lelia Thornton (Ireland, until 2018), Maria Elena Tosti (Italy), Rita de Sousa (Portugal), Wilfrid van Pelt (Netherlands, until 2018) and Hans Zaaijer (Netherlands). Conflict of interest declarations were provided and are available (...) developing surveillance systems. Therefore, the development and implementation of clinical recommendations and guidelines for testing should involve and inform national or local public health authorities. The ECDC expert group agreed with EASL recommendations that patients with signs of viral hepatitis and certain other groups (even without clinical symptoms) should be considered a priority for HEV testing. The ECDC expert group considered that the minimum laboratory criterion for confirming an acute

2019 European Centre for Disease Prevention and Control - Technical Guidance

32. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

What is new in the 2019 Guidelines? 8 3. Patients with angina and/or dyspnoea, and suspected coronary artery disease 10 3.1 Basic assessment, diagnosis, and risk assessment 10 3.1.1 Step 1: symptoms and signs 11 Stable vs. unstable angina 12 Distinction between symptoms caused by epicardial vs. microvascular/vasospastic disease 13 3.1.2 Step 2: comorbidities and other causes of symptoms 13 3.1.3 Step 3: basic testing 13 Biochemical tests 13 Resting electrocardiogram (...) in Figure . The diagnostic management approach includes six steps. The first step is to assess the symptoms and signs, to identify patients with possible unstable angina or other forms of ACS (step 1). In patients without unstable angina or other ACS, the next step is to evaluate the patient’s general condition and quality of life (step 2). Comorbidities that could potentially influence therapeutic decisions are assessed and other potential causes of the symptoms are considered. Step 3 includes basic

2019 European Society of Cardiology

36. Management of Poisoning

for a minimum of 6-8 hours. Major complications (such as seizures and arrhythmias) typically occur in the ? rst 6 hours after ingestion. Monitoring in symptomatic patients should continue until the ECG ? ndings have been normal for 12-24 hours. Patients may be discharged then if there are no signs of toxicity and no signi? cant ECG abnormalities (QRS 50 stings, the elderly and in those with underlying medical problems and > 1 sting per kg in children) Grade D, Level 3 D When there is severe systemic (...) (irrespective of dose). • If toxic dose is consumed (see above). • Suspected non-accidental ingestion (irrespective of dose). • Poor home support (lives alone, inability of caregivers to monitor). Grade D, Level 4 6.1.4 Clinical presentation The most common signs and symptoms are nausea, vomiting, drowsiness, blurred vision, and dizziness which usually only require symptomatic management. • Central nervous system toxicity: – Altered mental status. 172 – Seizures 173-179 (1) Seizures have been reported

2020 Ministry of Health, Singapore

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