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121. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society

4.2.5. Cardiac Sarcoidosis: Recommendations e36 4.3. Inheritable Arrhythmic Conditions: Recommendations e37 4.3.1. Brugada Syndrome: Recommendations e37 4.3.2. Short-QT Syndrome: Recommendation e37 4.3.3. Long-QT Syndrome: Recommendations e37 4.3.4. Catecholaminergic Polymorphic Ventricular Tachycardia: Recommendations e37 4.3.5. Early Repolarization Pattern: Recommendations e37 5. Reflex Conditions: Recommendations e37 5.1. Vasovagal Syncope: Recommendations e37 5.2. Pacemakers in Vasovagal Syncope (...) : Recommendation e38 5.3. Carotid Sinus Syndrome: Recommendations e38 5.4. Other Reflex Conditions e38 6. Orthostatic Hypotension: Recommendations e38 6.1. Neurogenic Orthostatic Hypotension: Recommendations e38 6.2. Dehydration and Drugs: Recommendations e39 7. Orthostatic Intolerance e39 8. Pseudosyncope: Recommendations e40 9. Uncommon Conditions Associated with Syncope e40 10. Age, Lifestyle, and Special Populations: Recommendations e40 10.1. Pediatric Syncope: Recommendations e40 10.2. Adult Congenital

2017 American Heart Association

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

should be made to improve coronary perfusion pressure and reverse the tachycardia by giving volume if the end-diastolic volume is low, or an inotrope if contractility is low. Because CO = HR × SV, therapies directed to increasing SV will often reflexively reduce HR and improve CO. This will be evident in improvement of the shock index (HR/systolic blood pressure [SBP]) ( ), as well as CO. Children have limited HR reserve compared with adults because they are already starting with high basal HRs

2017 Society of Critical Care Medicine

124. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope

. Inheritable Arrhythmic Conditions: Recommendations e81 4.3.1. Brugada Syndrome: Recommendations e81 4.3.2. Short-QT Syndrome: Recommendation e82 4.3.3. Long-QT Syndrome: Recommendations e82 4.3.4. Catecholaminergic Polymorphic Ventricular Tachycardia: Recommendations e83 4.3.5. Early Repolarization Pattern: Recommendations e84 5. Reflex Conditions: Recommendations e84 5.1. Vasovagal Syncope: Recommendations e84 5.2. Pacemakers in Vasovagal Syncope: Recommendation e85 5.3. Carotid Sinus Syndrome (...) : Recommendations e86 5.4. Other Reflex Conditions e86 6. Orthostatic Hypotension: Recommendations e86 6.1. Neurogenic Orthostatic Hypotension: Recommendations e86 6.2. Dehydration and Drugs: Recommendations e88 7. Orthostatic Intolerance e88 8. Pseudosyncope: Recommendations e88 9. Uncommon Conditions Associated with Syncope e89 10. Age, Lifestyle, and Special Populations: Recommendations e89 10.1. Pediatric Syncope: Recommendations e89 10.2. Adult Congenital Heart Disease: Recommendations e91 10.3. Geriatric

2017 American Heart Association

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

undergo significant physiological alterations during pregnancy. The following sections highlight the physiological changes that have particular relevance to the management of gravidas with CHD. Antepartum Blood Volume Maternal blood volume begins to increase with the early hormonal changes of conception. Overall, pregnancy increases maternal blood volume by ≈40% for a singleton and 67% for twins, with peak values at ≈32 weeks of gestation , ( ). Both plasma volume and red cell mass contribute (...) to the hypervolemia, with respective increases of ≈45% to 55% and 20% to 30%. Estrogen has a key role in plasma volume expansion and promotes sodium and water retention by upregulating the production of angiotensinogen, renin, and aldosterone. The disproportionate expansion of plasma volume relative to red cell mass contributes to the physiological anemia of pregnancy, with mean±SD hemoglobin concentrations of 10.9±0.6 and 12.4±1.0 g/dL for the second and third trimesters, respectively. Figure 1. Pregnancy

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2017 American Heart Association

126. Imaging Program Guidelines: Pediatric Imaging

or recurrent headache, when at least one of the following is present: ? Change in quality (pattern or intensity) of a previously stable headache ? Headache persisting for a period of up to 6 months duration and not responsive to medical treatment, and no prior imaging has been done to evaluate the headache ? Headache associated with at least one of the following: ? Abnormal reflexes ? Altered mental status ? Cranial nerve deficit ? Gait/motor dysfunction ? Nystagmus ? Seizure ? Sensory deficit ? Sign (...) , and no prior imaging has been done to evaluate the headache ? Headache associated with at least one of the following: ? Abnormal reflexes ? Altered mental status ? Cranial nerve deficit ? Gait/motor dysfunction ? Nystagmus ? Seizure ? Sensory deficit ? Sign of increased intracranial pressure (increased head circumference, vomiting, papilledema, symptoms that worsen with valsalva) Note: Imaging is not generally indicated for typical presentations of migraine. MRI of the Head/Brain – Pediatrics | Copyright ©

2017 AIM Specialty Health

130. Vision in Children Ages 6 Months to 5 Years: Screening

in primary care settings ( ). Visual acuity tests screen for visual deficits associated with amblyopia and refractive error. Ocular alignment tests screen for strabismus. Steroacuity tests assess depth perception. , For children younger than 3 years, screening may include the fixation and follow test (for visual acuity), the red reflex test (for media opacity), and the corneal light reflex test (for strabismus). , Instrument-based vision screening (ie, with autorefractors and photoscreeners) may be used (...) in very young children, including infants. Autorefractors are computerized instruments that detect refractive errors; photoscreeners detect amblyopia risk factors (ocular alignment and media opacity) and refractive errors. , Vision screening in children older than 3 years may include the red reflex test, the cover-uncover test (for strabismus), the corneal light reflex test, visual acuity tests (eg, Snellen, Lea Symbols [Lea-Test], and HOTV [Precision Vision] charts), autorefractors and photoscreeners

2017 U.S. Preventive Services Task Force

131. Diagnosis and Treatment of Low Back Pain

. Recommendations # Recommendation Strength* Category† A. Diagnostic Approach 1. For patients with low back pain, we recommend that clinicians conduct a history and physical examination, that should include identifying and evaluating neurologic deficits (e.g., radiculopathy, neurogenic claudication), red flag symptoms associated with serious underlying pathology (e.g., malignancy, fracture, infection), and psychosocial factors. Strong for Reviewed, Amended 2. For patients with low back pain, we suggest (...) are serious or progressive or when red flag symptoms are present. Strong for Reviewed, Amended 5. For patients with low back pain greater than one month who have not improved or responded to initial treatments, there is inconclusive evidence to recommend for or against any diagnostic imaging. Not applicable Reviewed, New-added B. Education and Self-care 6. For patients with chronic low back pain, we recommend providing evidence- based information with regard to their expected course, advising patients

2017 VA/DoD Clinical Practice Guidelines

133. Suspected cancer: recognition and referral

on the lip or in the oral cavity or or a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia. [new 2015] [new 2015] 1.8.4 Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) for oral cancer in people when assessed by a dentist as having either: a lump on the lip or in the oral cavity consistent with oral cancer or or Suspected cancer: recognition and referral (NG12) © NICE 2019. All rights reserved. Subject (...) to Notice of rights ( conditions#notice-of-rights). Page 24 of 79a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia. [new 2015] [new 2015] Th Thyroid cancer yroid cancer 1.8.5 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump. [new [new 2015] 2015] 1.9 Brain and central nervous system cancers Adults Adults 1.9.1 Consider an urgent

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

134. Spasticity in adults: management using botulinum toxin - 2nd edition

referral. Implementation Tools for application A documentation proforma is included along with some practical examples of outcome measures. Plans for review Review is planned in 5 years.2 Spasticity – what is it and why does it matter? 2.1 Definition and pathophysiology The term ‘spasticity’ was originally defined by Lance in 1980 (Lance 1980) as a velocity-dependent increase in muscle tone resulting from hyper-excitability of the tonic stretch reflex in people with upper motor neurone (UMN) syndrome

2018 British Society of Rehabilitation Medicine

135. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

for use throughout the UK. Systematic review methodology for the 2018 guidelines See Appendix 2 for the detailed methodology used in the 2012 guideline and 2018 revision. A previous systematic review considered the treatment of complex regional pain syndrome in adults, and included papers published from July 2000 to February 2012. 3 This 2013 Cossins et al review built on a previous review (Forouzanfar et al 2002, 4 which considered the treatment and prevention of reflex sympathetic dystrophy and CRPS (...) trauma, atherosclerosis in older people or thrombangiitis obliterans (Burger’s disease)) ? Raynaud’s disease ? lymphatic or venous obstruction ? Gardner–Diamond syndrome (see the list of differential diagnoses in the Rheumatology, neurology, neurosurgery and SEM section) ? brachial neuritis or plexitis (Parsonage–Turner syndrome or neuralgic amyotrophy) ? erythromelalgia (may include all limbs) ? self-harm Table 2 Earlier names for CRPS Algodystrophy Causalgia Algoneurodystrophy Reflex sympathetic

2018 British Society of Rehabilitation Medicine

136. CCS and CPCA Position Statement on the Approach to Syncope in the Pediatric Patient

, 2016 Accepted: September 28, 2016 ; Received: September 13, 2016 ; | ---- Figure 1 Clinical pathway for pediatric syncope patients. ECG, electrocardiogram; VVS, vasovagal syncope. ---- | ---- Figure 2 History and physical examination. ECG, electrocardiogram; LOC, loss of consciousness; LQTS, long QT syndrome. ---- | ---- Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green (...) of the history. Syncope occurring midexertion suggests a cardiac etiology. A family history, which includes sudden death in the young or from unknown causes or causes that might be suspected to be other than natural can be a red flag. The electrocardiogram is the most frequently ordered test, but the yield is low and the test is not cost-effective when applied broadly to a population of patients with syncope. We recommend an electrocardiogram when the history is not suggestive of vasovagal syncope

2016 Canadian Cardiovascular Society

137. Don?t Tie Me Down! Do Neckties Spread Infection?

provide no objective clinical utility in patient care or in protection of the physician. Unlike the stethoscope, penlight, or reflex hammer, they are useless for eliciting clinical findings in a patient. They are solely an accessory, with no practical use. In fact, a tie provides a convenient garrote around the neck of physician for the particularly disturbed patient. There is a paucity of data in the United States regarding patient preferences as to whether or not physicians should wear a tie (...) Knuckleballers, Active Bowtie Wearers, Major League Baseball NYU-Bellevue House Staff Dickey, Toronto Blue Jays Rabi Upadhyay, PGY-2 Stephen Wright, Boston Red Sox Matt McNeill, PGY-3 Whenever one retires (Tim Wakefield) or graduates from the program (David Levine), another one comes along to take his place. And so the fragile tradition lives on. The bowtie-wearer’s attitude has always been: “I know I’m dressed like Winston Churchill. Deal with it.” That can now be amended to: “I know I’m dressed like Pee

2016 Clinical Correlations

138. Preterm labour and birth

to hypermagnesaemia • Common (> 1%): nausea and vomiting, flushing • Infrequent (0.1–1%): headache, dizziness Baseline observations • Vital signs: BP, pulse, respiratory rate • Oxygen saturation (SpO 2 ) • Patellar reflex • Abdominal palpation • Monitor contractions for 10 minutes • FHR/CTG Monitoring during loading dose • BP, pulse, and RR every 5 minutes (for minimum 20 minutes) until stable • SpO 2 continuously • Contractions for 10 mins every 30 mins • Continuous CTG if greater than or equal to 24 weeks (...) gestation o Interpret CTG relevant to gestational age if less than 28 weeks o Document reason if CTG not able to be performed • Auscultate FHR every15–30 minutes if less than 24 weeks gestation • Observe for side effects • Check deep tendon reflexes (patellar or, if epidural insitu, biceps) after completion of loading dose o Notify obstetrician if absent and do not commence maintenance dose Monitoring during maintenance dose • BP, pulse, respiratory rate, SpO 2 every 30 minutes • Temperature every 2

2016 Queensland Health

139. Perinatal substance use: maternal

cry, excessive sucking and agitation 26,29 , poor clarity of infant cues during feeding, delayed information processing, general cognitive delay 14 , lower arousal, poor quality of movement, poor self- regulation, non-optimal reflexes 15 • Intraventricular haemorrhage 14 Lactation • Cocaine and metabolites have been detected in baby’s urine for up to 60 hours following breastfeed • Discourage use when breastfeeding: o After individual dose, discontinue breastfeeding for twenty four hours o (...) and withdrawal • Outpatient support including follow up and ongoing support 2 • High levels may result in: o Miscarriage o Stillbirth o Preterm birth 5,53 Lactation • Alcohol enters breast milk and persists for several hours • Adversely affects lactation, infant behaviour (feeding and arousal) and psychomotor development of the breastfed baby 48,56 • More than two standard drinks per day linked to: o Decreased lactation-reduced milk ejection reflex, milk production and milk consumption by baby o Earlier

2016 Queensland Health

140. Hypertensive disorders of pregnancy

stable then every 30 minutes • Respiratory rate and patellar reflexes hourly • Temperature 2nd hourly • Continuous CTG monitoring if > 24 weeks (interpret with caution if : greater than, 10 years • Nulliparity • Pre-existing medical conditions o APLS o Pre-existing diabetes o Renal disease o Chronic hypertension o Chronic autoimmune disease • Age > 40 years • BMI > 35 kg/m 2 • Multiple pregnancy • Elevated BP at booking • Gestational trophoblastic disease • Fetal triploidy Maternal investigations (...) creatinine greater than or equal to 90 micromol/L or • Oliguria Haematological • Thrombocytopenia (platelets less than 100 x 10 9 /L) • Haemolysis: schistocytes or red cell fragments on blood film, raised bilirubin, raised lactate dehydrogenase (LDH), decreased haptoglobin • Disseminated intravascular coagulation (DIC) Liver • Raised transaminases • Severe epigastric or right upper quadrant pain Neurological • Severe headache • Persistent visual disturbances (photopsia, scotomata, cortical blindness

2016 Queensland Health

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