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Valsalva Maneuver

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121. AIUM/IUGA Practice Parameter for the Performance of Urogynecological Ultrasound Examinations

images to evaluate bladder neck descent, urethral rotation, and the retrovesical angle 4 : Produce a split-screen image with the pel- vis at rest in the image on the left and during the maximal Valsalva maneuver in the image on the right. The image should include the bladder neck and the inferoposterior margin ofthesymphysispubis(Figure3). b. Observe in real time to evaluate descent of the bladder, uterus, and rectal ampulla/ pouch of Douglas: As the patient performs a maximal Val- salva maneuver (...) If a true rectocele is present, assess the max- imal rectocele depth. 10 Aseparateframe obtained during the submaximal Valsalva maneuver may be required. Inthesameplane,itispossibletoassess suburethral slings and other mesh implants, which appear as hyperechoic structures in the anterior or posterior vaginal wall. 11,12 Hypoe- choic or cysticstructures,suchasGartnercysts or urethral diverticula, can also be observed in Figure 2. B-mode single-screen image at rest for determination of residual urine

2019 American Institute of Ultrasound in Medicine

122. Neuro-urology

maneuver: a urodynamic study of 207 patients. J Urol, 1983. 130: 720. 146. Reinberg, Y., et al. Renal rupture after the Crede maneuver. J Pediatr, 1994. 124: 279. 147. Wyndaele, J.J., et al. Neurologic urinary incontinence. Neurourol Urodyn, 2010. 29: 159. 148. Menon, E.B., et al. Bladder training in patients with spinal cord injury. Urology, 1992. 40: 425. 149. Furusawa, K., et al. Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques

2019 European Association of Urology

123. Approaches to Limit Intervention During Labor and Birth

and are not contraindicated by maternal medical or obstetric complications. SecondStageofLabor: PushingTechnique Obstetrician–gynecologists and other obstetric care providers in the UnitedStates often encourage women in labor to push with a prolonged, closed glottis effort (ie, Valsalva maneuver) during each contraction. However, when not coached to breathe in a specific way, women push with an open glottis (48). A Cochrane review of eight RCTs that compared spontaneous to Valsalva pushing in the second stage of labor (...) or obstetric complications. c When not coached to breathe in a specific way, women push with an open glottis. In consideration of the limited data regarding superiority of sponta- neous versus Valsalva pushing, each woman should be encouraged to use her preferred and most effec- tive technique. c Collectively, and particularly in light of recent high- quality study findings, data support pushing at the start of the second stage of labor for nulliparous women receiving neuraxial analgesia. Delayed pushing

2019 American College of Obstetricians and Gynecologists

124. Neuro-urology

prospective mortality study in the spinal cord injured patient: comparison with the long-term living paraplegic. J Urol, 1977. 117: 486. 143. Rodrigues, P., et al. Involuntary detrusor contraction is a frequent finding in patients with recurrent urinary tract infections. Urol Int, 2014. 93: 67. 144. Bauer, S.B. Neurogenic bladder: etiology and assessment. Pediatr Nephrol, 2008. 23: 541. 145. Barbalias, G.A., et al. Critical evaluation of the Crede maneuver: a urodynamic study of 207 patients. J Urol, 1983 (...) . 130: 720. 146. Reinberg, Y., et al. Renal rupture after the Crede maneuver. J Pediatr, 1994. 124: 279. 147. Wyndaele, J.J., et al. Neurologic urinary incontinence. Neurourol Urodyn, 2010. 29: 159. 148. Menon, E.B., et al. Bladder training in patients with spinal cord injury. Urology, 1992. 40: 425. 149. Furusawa, K., et al. Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury. Spinal Cord, 2011. 49: 49

2018 European Association of Urology

125. Adult Urodynamics

Clinicians should perform repeat stress testing with the urethral catheter removed in patients suspected of having SUI who do not demonstrate this finding with the catheter in place during urodynamic testing. ( Recommendation ; Evidence Strength: Grade C ) × Discussion Patients who do not demonstrate SUI during Valsalva maneuvers or cough during urodynamics but who nevertheless complain of SUI symptoms or in whom SUI is suspected based on their history or in whom the presence of documented SUI would (...) inclusion of all possibly relevant studies. Multiple reports on the same patient group were carefully examined to ensure inclusion of only non-redundant information. Urodynamic Tests, Conditions and Outcomes Reviewed During this Process . This systematic review evaluated the following urodynamic tests: post-void residual, uroflowmetry, cystometry, pressure-flow studies, videourodynamics, EMG, urethral function tests (e.g., Valsalva leak point pressure (VLPP), urethral pressure profile) or any

2018 American Urological Association

127. Evaluation and Management of Right-Sided Heart Failure

drawn from the end-systolic to end-diastolic PV relationship (to end-diastolic volume [EDV] at P=0). The relationship of these 2 parameters (Ees:Ea) provides a ratio defining RV-PA coupling, which reflects contractility in the context of afterload. Determinations of Ees and Ea require instantaneous measurements of RV pressure and volume to generate sequential PV loops obtained by a decrease of venous return via stepwise inflation of an inferior vena cava balloon or a Valsalva maneuver. Reprinted

2018 International Society for Heart and Lung Transplantation

128. Adults With Congenital Heart Disease

of this, it is generally believed that prophylactic root replacement strategies based on sinus of Valsalva diameters can be less aggressive after a Ross procedure than in a native BAV patient, but practice patterns vary. Most patients with a Ross repair had underlying congenitally abnormal aortic valves (BAV or unicuspid aortic valve) and, therefore, are at risk of the ascending aortic dilation typical of those abnormalities. Thus, in addition to the dilation at the sinuses of Valsalva associated with the Ross repair

2018 American College of Cardiology

130. CRACKCast E143 – Diving Injuries and Dysbarism

compression limits **most common complaint of scuba divers** – 10-30% experience this Most divers attempt to stent the Eustachian Tube open, but if it collapses – symptoms of tinnitus, vertigo develop Damage to the cochleovestibular apparatus. If the diver is unable to equalize the pressure in the middle ear during descent – the pressure is transmitted to the perilymph of the cochlea If it suddenly equilibrates with a valsalva can lead to inner ear hemorrhage or labyrinthine window tear. Due (...) , positional vertigo, ataxia, vomiting. PERSISTENT symptoms: +ve rhomberg, persistent hearing loss Nystagmus, emesis, TM injury, nausea Usually self limited. Descent Descent “Difficulty equilibrating or tried performing a vigorous valsalva” At depth OR During ascent Ascent – or soon after surfacing *diver approached decompression limits; onset on ascent or soon after; other neurological symptoms” ***IEBT may be nearly impossible to distinguish from DCS Type II – and should not delay decompression

2018 CandiEM

131. CRACKCast E175 – Neurologic Disorders

history! REMEMBER: Red Flags History of head trauma Symptoms of increased ICP – Valsalva/cough/strain Awakening from sleep Chronic progressive h/a Headache on awakening Occipital h/a No family headache of migraines [11] With regards to presentation and management, how are migraines different in children? ANSWER: Pediatric migraine headaches are more commonly bilateral Atypical or migraine variants are more common in children: Hemiplegic migraine Ophthalmoplegic migraine Basilar migraine “Alice (...) positional vertigo is rare in children,but can occur spontaneously as well as after trauma. The earliest age at which it has been reported is 11 years. It is believed to be due to otoliths that have moved out of their normal positions in the utricle and is corrected by canalith repositioning maneuvers (e.g., Epley maneuver). Ménière’s disease, a syndrome with a combination of vertigo, fluctuating hearing loss, and tinnitus, is responsible for 1.5% to 4% of cases of pediatric vertigo. Vestibular

2018 CandiEM

132. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

colitis, polyarteritis nodosa, sarcoidosis, Churg-Strauss syndrome, Wegener granulomatosis, rheumatoid arthritis, Kawasaki disease, celiac disease Migraine headache NR Coronary artery spasm NR Precipitating factors >50% Patients recall a precipitating factor Intense exercise (isometric or aerobic) Intense Valsalva Retching, vomiting, bowel movement, coughing, lifting heavy objects Intense emotional stress Labor and delivery Recreational drugs (cocaine, methamphetamines) Exogenous hormones/hormone

2018 American Heart Association

133. CRACKCast E171 – Pediatric Cardiac Disorders

are the main emergency department (ED) treatment of infants and children who present with congestive heart failure (CHF). If vagal maneuvers fail to convert stable paroxysmal supraventricular tachycardia in children, rapid adenosine administration (0.1 mg/kg for the first dose, followed by 0.2 mg/kg on repeated doses) is the treatment of choice. Verapamil should be avoided in children younger than 1 year old because of its profound hypotensive effects. Consider the use of lidocaine instead of amiodarone (...) ) ● HR < 180 (children) ● Variable beat-to-beat ● HR changes with activity Mgmt ● See next question! Treat the underlying cause Trial of analgesia, fluids and antiemetics [10] Describe the management of SVT in the infant/child. Unstable (poor perfusion, AMS, long cap refill, pallor, cyanosis, hypotension) CARDIOVERSION! 5 – 1 J/kg; if no success then increase to 2 J/kg Stable Vagal attempts Vagal maneuvers (eg, a bag containing a slurry of crushed ice and water to the face, digital rectal exam

2018 CandiEM

134. Postmenopausal Subacute or Chronic Pelvic Pain

in the setting of pelvic congestion. When pelvic venous disorders are suspected clinically, color and spectral Doppler evaluation may be used to document engorged periuterine and periovarian veins ( =8 mm), low-velocity flow, altered flow with Valsalva maneuver, retrograde (caudal) flow of the ovarian veins, and direct connection between engorged pelvic veins and myometrial arcuate veins [9-11]. Increased pelvic vascularity may also be present in the setting of uterine or tubo-ovarian neoplasia

2018 American College of Radiology

135. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease Full Text available with Trip Pro

further sympathetic activation in a harm- ful feedback loop. 46,54,55 Manipulation of PVR. If the shunt is inadequately restrictive, maneuvers to increase PVR by manipulat- ing ventilation and gas exchange might not be well tolerated and could contribute to further deterioration and even cardiac arrest. In the period before single- ventricle palliation, cautious use of a hypoxic inspired gas mixture or inspired carbon dioxide with controlled hypoventilation can reduce Qp:Qs 56–59 ; however, a hypoxic (...) ) admin- istration of vasoactive agents to maximize shunt per- fusion pressure (eg, phenylephrine, norepinephrine, epinephrine); (3) anticoagulation with heparin (50–100 U/kg bolus) to prevent clot propagation 22,24 ; (4) shunt intervention by catheterization or surgery; and (5) sta- bilization with ECLS. In patients with shunt obstruc- tion, maneuvers to decrease PVR (eg, oxygen, inhaled nitric oxide [iNO]) will provide little benefit and could delay the diagnosis of the actual problem. Reduction

2018 American Heart Association

136. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

to generate sequential PV loops obtained by a decrease of venous return via stepwise inflation of an inferior vena cava balloon or a Valsalva maneuver. Reprinted from Guazzi and Naeije with permission from Elsevier. Copyright © 2017, Elsevier. Unlike the predominantly diastolic coronary flow of the LV, normal RV coronary perfusion occurs during both systole and diastole. The pressure-overloaded RV is at increased risk for developing ischemia as a result of decreased perfusion pressure in the setting

2018 American Heart Association

138. Otovent nasal balloon for otitis media with effusion

).mp. or (glue adj ear).tw. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, an, ui] 4. exp middle ear/ 5. (SOM or OME).tw. 6. ((secretory or serous) adj otitis).tw. 7. (middle and ear*).mp. or (eustachian and tube*).tw. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, an, ui] 8. middle ear ventilation/ 9. aeration/ 10. valsalva maneuver/ 11. (autoinflat* or ((auot or ear* or ME or air) and (inflat* or aerat*))).tw. 12. ((nose or nasal) and balloon).tw. 13. valsalva.tw. 14. (insufflat (...) until it is the size of a grapefruit by blowing through their nose into the nose piece. The procedure, known as the Valsalva manoeuvre, is then repeated with the other nostril. The forced expiration against the closed airway leads to auto-inflation of the middle ear, increasing the pressure in the nasopharynx. This helps to open the Eustachian tube to equalise the air pressure and allow the fluid in the middle ear to drain naturally down the back of the throat. The user may feel increased pressure

2016 National Institute for Health and Clinical Excellence - Advice

139. CRACKCast E103 – Headache Disorders

, pregnancy, immunocompromised state including HIV) Neurologic symptoms or abnormal signs (eg, confusion, impaired alertness or consciousness, papilledema, focal neurologic symptoms or signs, meningismus, or seizures) Onset is new (particularly for age >40 years) or sudden (eg, “thunderclap”) Other associated conditions or features (eg, head trauma, illicit drug use, or toxic exposure; headache awakens from sleep, is worse with Valsalva maneuvers, or is precipitated by cough, exertion, or sexual activity (...) strategy for SAH Coles notes version: Think about the dx Get a non-contrast CT head Do an LP in CT negative patients if SAH is still suspected. If > 100 RBCs in tube 4 get a CT angiogram to hunt for any aneurysms. Now for more detail…. Clinical features: Thunderclap h/a, kaboom, WHOML – 80% of people Exertional onset h/a – 20% Valsalva Sex Non-strenuous physical activity *peaking intensity in seconds to minutes* – pearl Associated symptoms: N/V Syncope Neck stiffness Photophobia Seizures Physical exam

2017 CandiEM

140. Transcatheter Aortic Valve Replacement in the Management of Adults With Aortic Stenosis

window. , Major/minor annulus dimension , Major/minor average , Annular area , Circumference/perimeter Aortic root measurements , Gated contrast-enhanced CT thorax with multiphasic acquisition. Typically reconstructed in diastole 60%–80%. , Coronary ostia heights , Midsinus of Valsalva (sinus to commissure, sinus to sinus) , Sinotubular junction , Ascending aorta (40 cm above valve plane, widest dimension, at level of PA) , Aortic root and ascending aorta calci?cation , For additional measurement (...) eccentric calcium may predispose for paravalvular regurgitation and annular rupture during valve deployment. Annular sizing Aortic annulus , De?ned as double oblique plane at insertion point of all 3 coronary cusps , Major/minor diameter , Perimeter , Area , Periprocedural TEE and/or balloon sizing can con?rm dimensions during case. Aorticrootmeasurements Sinus of Valsalva , Height from annulus to superior aspect of each coronary cusp , Diameter of each coronary cusp to the opposite commissure

2017 American College of Cardiology

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