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Defibrillation is a nonsynchronized delivery of shock at any phase of cardiac cycle cheap serophene online mastercard women's health center reno. Therapeutic hypothermia reduces the risk of this type of severe neurologic injury discount serophene 25mg with mastercard women's health center towson md. Initiate it if a patient is not following commands or showing purposeful movements buy generic serophene online menopause queasy. The goal of the protocol is to reach core temperature 32– 34 F (90–93 F) within 6 hours and maintain for 12–24 hours. Absolute contraindications for induced hypothermia are active bleeding and do- not-resuscitate order. It is most commonly caused by ischemia, myocardial infarction, and anatomic cardiac disease. The electrical impulses must travel throughout the myocardium, from myocyte to myocyte, without the benefit of the more rapidly conducting normal pathways such as the bundle branches or His-Purkinje fibers. Conscious patients should be sedated with midazolam, fentanyl, or morphine before cardioversion. In stable patients with pulse, procainamide is the preferred drug, If there is no response, try amiodarone or sotalol, followed by electrical cardioversion. Patients undergoing cardioversion should be sedated first with midazolam, fentanyl, or morphine. Essentially, the heart may still be beating, but there is no blood in the heart, and therefore there is no cardiac output. Other causes in which there may not be actual muscular contraction are hypoxia, hypothermia, potassium disorders, acidosis, and drug overdoses with tricyclics, digoxin, beta-blockers, or calcium-channel blockers. Bicarbonate is useful if a known acidosis has caused the arrest; it can also be used in a prolonged resuscitation if severe lactic acidosis develops and causes the refractory state of arrest. Clinical Recall Which of the following disorders is not an indication for cardioversion? He has had 5 cups of coffee, 4 beers, 3 stimulant tablets, 2 cheeseburgers, and 1 Viagra. Drug toxicity (such as digoxin), pericarditis, pulmonary embolism, surgery, chest wall trauma, or ischemia can also cause atrial dysrhythmias. Symptoms vary on the basis of the duration of the disorder, the ventricular rate, and the underlying health of the heart. With a normal heart, only 10–20% of cardiac output is directly derived from the contribution of atrial systole. Rate-related symptoms are unlikely in those with heart rate <150 per minute in atrial dysrhythmia. If the patient is hemodynamically stable, then the first step is to control the ventricular rate. The modified Valsalva maneuver is more effective than the standard technique: do Valsalva followed by supine repositioning and immediate passive leg raise. Do not use verapamil in patients with severe left ventricular dysfunction and low ejection fraction. Be cautious using beta-blockers in patients with a history of reactive airway disease. After the rate has been lowered <110/min, conversion of the rhythm to normal sinus does not need to be routinely done.

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He comes in with facial lacerations generic 50 mg serophene visa women's health issues at 50, upper extremity fractures generic serophene 25mg overnight delivery womens health first buffalo grove il, and blunt trauma to his chest and abdomen buy generic serophene women's health clinic lismore. In the confusion of dealing with multiple traumas, it is possible to miss less- obvious injuries. In this scenario, as the knees strike the dashboard, the femoral heads may drive backward into the pelvis, or out of the acetabulum. The ultimate hidden injury (because of the devastating complications if missed) is the fracture of the cervical spine. On physical examination, when asked to hang her hand limply in front of her, numbness and tingling are reproduced over the distribution of the median nerve (the radial side 3 1/2 fingers). The same happens when her median nerve is pressed over the carpal tunnel, or when it is percussed. The American Academy of Orthopedic Surgery recommends that wrist x-rays (including carpal tunnel view) be done, primarily to rule out other things. If surgery is needed, electromyography and nerve conduction velocity should precede it. A 58-year-old woman describes that she awakens at night with her right middle finger acutely flexed, and she is unable to extend it. She can do it only by pulling on it with her other hand, at which time she feels a painful “snap. A young mother complains of pain along the radial side of the wrist and the first dorsal compartment. She relates that the pain is often caused by the position of wrist flexion and simultaneous thumb extension that she assumes to carry the head of her baby. On physical examination the pain is reproduced by asking her to hold her thumb inside her closed fist, and then forcing the wrist into ulnar deviation. A 72-year-old man of Norwegian ancestry has a contracted hand that can no longer be extended and be placed flat on a table. A 33-year-old carpenter accidentally drives a small nail into the pulp of his index finger, but he pays no attention to the injury at the time. This kind of abscess is called a felon, and like all abscesses it has to be drained. There is an urgency to it, however, because the pulp is a closed space and the process is equivalent to a compartment syndrome. Physical examination shows collateral laxity at the thumb metacarpophalangeal joint. She tries to grab one of the offenders by his jacket, but he pulls away, hurting the woman’s hand in the process. Now, when she makes a fist, the distal phalanx of her ring finger does not flex with the others. Two classic tendon injuries, with appropriate names: jersey finger (to the flexor), and mallet finger (to the extensor). While working at a bookbinding shop, a young man suffers a traumatic amputation of his index finger. The answer is to clean it with sterile saline, wrap it in saline- moistened gauze, place it in a plastic bag, and place the bag on a bed of ice. The digit should not be placed in antiseptic solutions or alcohol, put in dry ice, or allowed to freeze. He was told previously that he had muscle spasms, and was given analgesics and muscle relaxants. He comes in now because of the sudden onset of very severe back pain that came on when he tried to lift a heavy object.