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Valsalva Maneuver

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141. 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

142. 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

143. 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

145. AIUM Practice Parameter for the Performance of a Transcranial Doppler Ultrasound Examination for Adults and Children

. For ? ?detection ? ?of ? ?right-to-left ? ?shunts, ? ?TCD ? ?monitoring ? ?is ? ?performed ? ?during ? ?the ? ?intravenous injection ? ?of ? ?agitated ? ?saline ? ?or ? ?a ? ?contrast ? ?medium ? ?and ? ?patient ? ?performance ? ?of ? ?a ? ?Valsalva maneuver ? ?to ? ?enhance ? ?flow ? ?across ? ?the ? ?shunt. ? ?The ? ?degree ? ?of ? ?shunting ? ?is ? ?quantitatively ? ?assessed by ? ?the ? ?number ? ?of ? ?detected ? ?HITS. ? 56 VI. Documentation Adequate ? ?documentation ? ?is ? ?essential ? ?for ? ?high

2017 American Institute of Ultrasound in Medicine

146. AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum

should be noted. For detection of hernias, Valsalva maneuvers and upright positioning may be helpful. A Doppler examination may be useful to define the relationship of blood vessels to a detected mass. © 2017 American Institute of Ultrasound in Medicine 14750 Sweitzer Ln, Suite 100 Laurel, MD 20707-5906 USA www.aium.org 8 8. Kidneys A complete examination of the kidneys need not be performed with every abdominal examination that may be targeted to other specific abdominal sites. When a complete

2017 American Institute of Ultrasound in Medicine

148. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association Full Text available with Trip Pro

, cautious incremental dosing is advised, especially in gravidas whose maternal cardiac output is sensitive to falls in preload. The pelvic descent of the fetus in the second stage of labor elicits pressure and an urge to bear down against a closed glottis in a gravida without effective epidural anesthesia. When performed in the absence of contractions or between contractions, the Valsalva maneuver typically elicits a moderate transient fall in cardiac output resulting from decreased venous return (...) . Minimizing maternal expulsive effort by passive delivery and facilitating the second stage by assisted delivery (forceps or vacuum extraction) to avoid the Valsalva maneuver and thereby minimize hemodynamic perturbations should be considered in those with critical obstructive lesions (eg, aortic stenosis [AS]), fragile aortas (bicuspid aortic valve with aortopathy, coarctation), and pulmonary hypertension. Postpartum Further challenges to maternal cardiac reserve occur at delivery, that result from

2017 American Heart Association

149. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

not distinguish the specific type of incontinence. After performing a history and physical examination, including a pelvic examination with a comfortably full bladder, the diagnosis of SUI may be fairly straightforward in the index patient. The sine-qua-non for a definitive diagnosis is a positive stress test, or witnessing of involuntary urine loss from the urethral meatus coincident with increased abdominal pressure, such as occurs with coughing and Valsalva maneuver. If leakage is not witnessed (...) evaluation lead to better outcomes than office evaluation alone. 16 However, the conclusions of this study were weakened by the low enrollment of only 72 patients, 12 of whom were excluded from the urodynamics arm because of “unfavorable parameters” for surgery, including detrusor overactivity, and valsalva leak point pressure (VLPP) less than 60 cm H 2 O. Close Guideline Statement 6 Physicians may perform urodynamic testing in non-index patients. (Expert Opinion) × Discussion In certain patients

2017 American Urological Association

150. Cervical and ocular vestibular evoked myogenic potential testing

internal body sounds) due to increased sensitivity to sound conducted through bone. Clinical examination may reveal eye movements induced by Valsalva maneuvers, by pressure in the external auditory canal, or by sounds. , Patients may have an air–bone gap, especially at the lower frequencies. For those with disabling symptoms, case series suggest a benefit with surgical plugging or resurfacing of the bony opening. A 2000 American Academy of Neurology (AAN) guideline provides guidance on vestibular

2017 American Academy of Neurology

151. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

in the index patient. The sine-qua-non for a definitive diagnosis is a positive stress test, or witnessing of involuntary urine loss from the urethral meatus coincident with increased abdominal pressure, such as occurs with coughing and Valsalva maneuver. If leakage is not witnessed in the supine position, the test may be repeated in the standing position to facilitate the diagnosis. Once the increase in abdominal pressure has subsided, flow through the urethra should subside as well. Rarely, one may (...) by clinical reduction in complaints measured by the Urinary Distress Inventory and the Patient Global Impression of Improvement (PGI-I). Another RCT did show that urodynamics in addition to office evaluation lead to better outcomes than office evaluation alone. 16 However, the conclusions of this study were weakened by the low enrollment of only 72 patients, 12 of whom were excluded from the urodynamics arm because of “unfavorable parameters” for surgery, including detrusor overactivity, and valsalva leak

2017 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

152. SCAI/HFSA Clinical Expert Consensus Document on the Use of Invasive Hemodynamics for the Diagnosis and Management of Cardiovascular Disease Full Text available with Trip Pro

be an alternative provocative maneuver. However, direct comparative studies have revealed that in patients with heart failure, increases in cardiac filling pressures are nearly Twofold higher with exercise compared with saline loading alone, indicating that exercise is the more sensitive (and clinically relevant) provocative maneuver. Figure 8 Exercise‐induced changes in LV filling pressures in patients with heart failure and normal EF. Patients with normal EF and exertional dyspnea displayed normal ventricular (...) of the aortic pulse pressure on provocation (e.g., post‐ectopic beat, Valsalva strain, amyl nitrate inhalation, or isoproterenol administration). Significant LVOT obstruction is defined as >30 mm Hg, with >50 mm Hg commonly required to proceed with surgical therapies for relief of obstruction - . Shock and Ventricular Assist Devices In the setting of decompensated heart failure or cardiogenic shock, LV contractility (i.e., Ees) and SV are reduced, whereas LV end‐diastolic volume (LVEDV) and Ea are increased

2017 Society for Cardiovascular Angiography and Interventions

153. Benign Paroxysmal Positional Vertigo (BPPV) Full Text available with Trip Pro

the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV (...) and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side

2017 American Academy of Otolaryngology - Head and Neck Surgery

154. Approaches to Limit Intervention During Labor and Birth

comfort and promote optimal fetal positioning can be supported as long as adopted positions allow appropriate maternal and fetal monitoring and treatments and are not contraindicated by maternal medical or obstetric complications. Second Stage of Labor: Pushing Technique Obstetrician–gynecologists and other obstetric care providers in the United States often encourage women in labor to push with a prolonged, closed glottis effort (ie, Valsalva maneuver) during each contraction. However, when (...) data regarding superiority of spontaneous versus Valsalva pushing, each woman should be encouraged to use her preferred and most effective technique. 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 has not been shown to significantly improve the likelihood of vaginal birth and risks of delayed pushing, including infection, hemorrhage

2017 American College of Obstetricians and Gynecologists

155. Headache ? Child

with syringohydromyelia) or headache worsened by the Valsalva ACR Appropriateness Criteria ® 8 Headache — Child maneuver are typical findings. Most literature agrees that occipital headache in children is rare and calls for diagnostic caution; however, isolated occipital and cervical pain are not characteristic symptoms of any headache group in the pediatric age group, and their presence or absence does not correspond to changes on conventional brain MRI [37]. Children with sickle cell anemia are a special subgroup

2017 American College of Radiology

156. Detection of Second Primary Malignancies of the Esophagus and Hypophraynx in Oral Squamous Cell Carcinoma Patients Full Text available with Trip Pro

carcinoma without any established symptoms of esophageal or hypopharyngeal squamous cell carcinoma underwent modified EGD based on the Valsalva maneuver and U-turn method, image-enhanced endoscopy, and chromoendoscopy using Lugol's iodine for diagnosis. All suspected lesions were biopsied to determine the clinical stages and duplication rates. Odds ratios for the occurrence of duplicate lesions according to the oral lesion subsite were determined.In total, 37 esophageal and 16 hypopharyngeal lesions

2018 Laryngoscope investigative otolaryngology

158. Sonographic sling position and cure rate 10-years after TVT- O procedure. Full Text available with Trip Pro

were 67% (45/67) and 77% (52/67), respectively. In these 67 women the mean distances from the bladder neck to the proximal edge of the tape (BNTD) during Valsalva maneuver were significantly higher in cured women compared to the not-cured women (11.2 vs. 9.4mm). The distance between tape and urethra (TUD) was significantly lower in cured vs. not cured patients (2.6 vs. 4.1mm). All women with a TUD of >5mm (n = 5) were incontinent. Tape position was not associated with overactive bladder (...) Sonographic sling position and cure rate 10-years after TVT- O procedure. To examine the position of the TVT-O sling 10 years postoperatively and its association with outcome.A total of 124 patients who received a TVT-O sling at two centers in 2004 and 2007 were invited for follow-up. The position of the sling on perineal ultrasound was described relative to the bladder neck and the lower margin of the pubic symphysis at rest and on Valsalva. Objective cure was defined as a negative cough

2019 PLoS ONE

159. Association of small fiber neuropathy and post treatment Lyme disease syndrome. Full Text available with Trip Pro

nerve fiber density (SGNFD) and functional autonomic testing (deep breathing, Valsalva maneuver and tilt test) were performed to assess SFN, severity of dysautonomia and cerebral blood flow abnormalities. Heart rate, end tidal CO2, blood pressure, and cerebral blood flow velocity (CBFv) from middle cerebral artery using transcranial Doppler were monitored.10 participants, 5/5 women/men, age 51.3 ± 14.7 years, BMI 27.6 ± 7.3 were analyzed. All participants were positive for Lyme infection by CDC

2019 PLoS ONE

160. Parameters of 2-Dimensional Perineal Ultrasonography Before and After Male Sling Procedure for Urinary Incontinence After Radical Prostatectomy. (Abstract)

the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest.Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck

2020 Urology

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