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Valsalva Maneuver

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142. 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

143. 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 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

145. 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

146. 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

147. 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

148. 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

149. 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

150. 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

151. 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

152. 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

153. 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

155. 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

156. 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

157. CRACKCast E010 – Pediatric Resuscitation

) adenosine 0.1 mg/kg rapid IV push, max 6mg, second dose 0.2 mg/kg rapid IV push, max 12mg 4b) amiodarone 5mg/kg IV/IO over 20-50 minutes OR procainamide 15mg/kg IV/IO over 30-60 minutes 5) narrow complex – probable SVT 5a) consider vagal maneuvers – ice bath, carotid sinus massage, or any Valsalva (REVERT trial?) 5b) adenosine as above or synchronized DCCV if no vascular access 6) If probable sinus tachycardia: search for and treat the cause NOT the HR 3) Describe the PALS septic shock algorithm Rosen’s

2016 CandiEM

158. The Brain?s Effect on the Heart After a Stroke

them to age-matched controls on a variety of autonomic function tests (including Ewing’s battery autonomic function, heart rate variability in response to Valsalva, deep-breathing, and the sit-to-stand maneuver). The study revealed autonomic dysfunction in 82% of patients with large-artery and 63% of patients with small-artery strokes, as compared to only 21% of controls. Patients with large artery infarcts demonstrated decreased function of all parasympathetic tests performed (p<0.05

2016 Clinical Correlations

159. Evaluation and Management of Constipation

prolapse, and fissures. Digital rectal examination can reveal the presence of anal hypertonia, poor incremental squeeze, paradoxical puborectalis contraction, rectocele, anorectal masses, stricture, or fecal impaction that can be associated with constipation. in particular, a Valsalva maneuver should be done to diagnose a rectocele, prolapse, pelvic floor TABLE 1. The GRADE system: grading recommendations No. Description Benefit vs risk and burdens Methodologic quality of supporting evidence (...) motility and the defecation process. t he Rome iii criteria for functional constipation include at least 2 of the fol- lowing symptoms during =25% of defecations: straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction or blockage, relying on manual maneuvers to promote defecation, and having less than 3 unassisted bowel movements per week. 7,8 t hese cri- teria include constipation related to the 3 common sub- types: colonic inertia or slow transit

2016 American Society of Colon and Rectal Surgeons

160. A Pivotal Randomized Clinical Trial Evaluating the Safety and Effectiveness of a Novel Hydrogel Dural Sealant as an Adjunct to Dural Repair. (Abstract)

, randomized clinical trial designed as a noninferiority, single-blinded study, 124 patients received Adherus Dural Sealant (test sealant) and 126 received DuraSeal (control). The primary composite endpoint was the proportion of patients who were free of any intraoperative CSF leakage during Valsalva maneuver after dural repair, CSF leak/pseudomeningocele, and unplanned retreatment of the surgical site. Each component was then analyzed individually as a secondary endpoint. Patients were followed for 4 mo

2017 Operative neurosurgery (Hagerstown, Md.) Controlled trial quality: uncertain

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