Sandbox vidit3: Difference between revisions
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{{Family tree | | | | | | | | A17 | | A18 | | A19 | | | | | | |A17= | {{Family tree | | | | | | | | A17 | | A18 | | A19 | | | | | | |A17= | ||
<div class="mw-customtoggle-box17" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box17" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|❑ Immediate in-hospital monitoring (in bed or telemetry) to look for abnormalities suggestive of arrhythmic syncope ([[ESC#Classes of Recommendations|Class I; Level of Evidence: B]]).}} | ||
</div> | </div> | ||
|A18= | |A18= | ||
<div class="mw-customtoggle-box18" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box18" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|Recurrent syncopes}} | ||
</div> | </div> | ||
|A19= | |A19= | ||
<div class="mw-customtoggle-box19" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box19" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|Single syncope}} | ||
</div>}} | </div>}} | ||
{{Family tree | | | | | | | | | | | | |!| | | |!| | | | | | | | }} | {{Family tree | | | | | | | | | | | | |!| | | |!| | | | | | | | }} | ||
{{Family tree | | | | | | | | | | | | A20 | | A21 |-|-|-|.| | |A20= | {{Family tree | | | | | | | | | | | | A20 | | A21 |-|-|-|.| | |A20= | ||
<div class="mw-customtoggle-box20" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box20" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|If suspicion of structural hear disease: <br> Order an echocardiography (Class I; Level of Evidence: B)}} | ||
</div> | </div> | ||
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<div class="mw-customtoggle-box21" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box21" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|Was it in high risk setting? <br> Potential risk of physical injury <br> Occupational implications }} | ||
</div>}} | </div>}} | ||
{{Family tree | | | | | | | | | |,|-|-|^|.| | |!| | | | |!| | | }} | {{Family tree | | | | | | | | | |,|-|-|^|.| | |!| | | | |!| | | }} | ||
{{Family tree | | | | | | | | | A22 | | A23 | | A24 | | A25 | |A22= | {{Family tree | | | | | | | | | A22 | | A23 | | A24 | | A25 | |A22= | ||
<div class="mw-customtoggle-box22" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box22" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|Structural heart disease present <br> Treat accordingly}} | ||
</div> | </div> | ||
|A23= | |A23= | ||
<div class="mw-customtoggle-box23" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box23" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|No structural heart disease}} | ||
</div> | </div> | ||
|A24= | |A24= | ||
<div class="mw-customtoggle-box24" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box24" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|Yes}} | ||
</div> | </div> | ||
|A25= | |A25= | ||
<div class="mw-customtoggle-box25" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box25" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|No: No further evaluation}} | ||
</div> }} | </div> }} | ||
{{Family tree | | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }} | {{Family tree | | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }} | ||
{{Family tree | | | | | | | | | | | | | | | A26 | | | | | | | |A26= | {{Family tree | | | | | | | | | | | | | | | A26 | | | | | | | |A26= | ||
<div class="mw-customtoggle-box26" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box26" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|Tilt testing}} | ||
</div>}} | </div>}} | ||
{{Family tree/end}} | {{Family tree/end}} |
Revision as of 20:24, 25 March 2014
New
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|
Characterize the symptoms |
Drug | Adult dosage |
---|---|
Inhaled Short Acting β Agonists (SABA) | |
Albuterol/Bitolterol/Pirbuterol a) Nebulizer solution b) MDI | ♦ 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed or 10-15 mg/hour continuously. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed. |
Levalbuterol a) Nebulizer solution b) MDI | ♦ 1.25-2.5 mg every 20 mins for 3 doses, then 1.25-5 mg every 1-4 hours as needed. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed. |
Anticholinergics | |
Ipratropium bromide a) Nebulizer solution b) MDI | ♦ 0.5 mg every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for upto 3 hours. |
Ipratropium with albuterol a) Nebulizer solution (each 3 ml containing 0.5 mg ipratropium and 2.5 mg albuterol) b) MDI (each puff contains 18 mcg ipratropium and 90 mcg albuterol) | ♦ 3 ml every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for 3 hours |
Systemic corticosteroids | |
Prednisone/Prednisolone/Methylprednisolone | ♦ 40-80 mg/day in 1 or 2 divided doses until peak expiratory flowrate (PEF) reaches 70% of personal best. |
Clinical course | Unstable |
---|---|
Physical examination | Signs of heart failure |
Functional class | IV |
6MWD | Less than 400 m |
Echocardiogram | RV Enlargement |
Hemodynamics | RAP high CI low |
BNP | Elevated/Increasing |
Treatment | Intravenous prostacyclin and/or combination treatment |
Frequency of evaluation | Q 1 to Q 3 months |
FC assessment | Every clinic visit |
6MWT | Every clinic visit |
Echocardiogram2 | Q 6 to Q 12 months/center dependent |
BNP | center dependent |
RHC | Q 6 to Q 12 months or clinical deterioration |