Cardiopulmonary resuscitation started with chest compression and bag mask ventilation. Inj adrenaline given. After 15 minutes spontaneous circulation restored. HR 120/min, BP 80/40. Baby shifted to PICU.
Expert Writing Help is a nursing writing service that assists students write Paediatric nursing care plan and other diagnosis plans. This upload offers nursing students with a Paediatric nursing care plan example to teach them on the best template for writing nursing care plans.
Apnea (AP-nee-ah) is a pause in breathing that lasts 20 seconds or longer for full-term infants. If a pause in breathing lasts less than 20 seconds and makes your baby's heart beat more slowly (bradycardia) or if he turns pale or bluish (cyanotic), it can also be called apnea.
Expert Writing Help is a nursing writing service that assists students write Paediatric nursing care plan and other diagnosis plans. This upload offers nursing students with a Paediatric nursing care plan example to teach them on the best template for writing nursing care plans.
Apnea (AP-nee-ah) is a pause in breathing that lasts 20 seconds or longer for full-term infants. If a pause in breathing lasts less than 20 seconds and makes your baby's heart beat more slowly (bradycardia) or if he turns pale or bluish (cyanotic), it can also be called apnea.
Case presentation on mengoencephalitis |Inflammation of the brain NEHA MALIK
Inflammation of the brain and surrounding tissues, usually caused by infection.
Meningoencephalitis is a condition that's usually caused by a virus, bacterium, parasite or other microorganism. Examples include West Nile virus, mumps or tuberculosis.
Symptoms vary, depending on the cause. They may include fever, confusion, vomiting, seizures or, if left untreated, death.
Treatment may include antibiotics, antivirals or supportive care, depending on the origin of the disease.
Case presentation on mengoencephalitis |Inflammation of the brain NEHA MALIK
Inflammation of the brain and surrounding tissues, usually caused by infection.
Meningoencephalitis is a condition that's usually caused by a virus, bacterium, parasite or other microorganism. Examples include West Nile virus, mumps or tuberculosis.
Symptoms vary, depending on the cause. They may include fever, confusion, vomiting, seizures or, if left untreated, death.
Treatment may include antibiotics, antivirals or supportive care, depending on the origin of the disease.
A Case of Primigravida with 36 weeks of pregnancy with IUD with obstructed la...Faisal Abdullah
This case was presented on weekly seminar of Department of Gynaecology and Obstetrics ( Unit 1) of Faridpur Medical College Hospital, in October 2019, by Intern Doctor Dr. Faisal Abdullah.
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...Md Rabiul Alam
Surgical and Anaesthetic management of a patient with diseased heart is always challenging. Specially it sweats more when the issue is PREGNANCY. It demands skillful and sophisticated handling of the patient. Moreover, when the finding is incidental, a single break of concentration can be fatal.
Seminar on critical Congenital heart disease Dr Habibur Rahim | Dr Faria YasminDr. Habibur Rahim
Seminar on critical Congenital heart disease Dr Habibur Rahim | Dr Faria Yasmin
Duct-dependent systemic circulations
Critical aortic stenosis
Coarctation of the aorta
Interruption of aortic arch
Hypoplastic left heart syndrome
Duct-dependent pulmonary circulations
Pulmonary atresia Critical pulmonary stenosis
Tricuspid atresia
Tetralogy of Fallot
Ebstein’s anomaly
Parallel non-mixing circulation
Transposition of great arteries
Other
Total anomalous pulmonary venous connection (TAPVC)
Double outlet right ventricle
Single ventricle
Truncus arteriosus
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Particulars of the patient
• Name : B/O Tania
• Age : 10 Days
• Sex : Male
• Address : West Dewbhog,
N Gonj
• Date of admission : 04/02/19
• Date of examination : 04/02/19
• Informant : Father
4. History of present illness
Mother Tania, 31 years old, para: 4-1(IUD), having blood
group B(+) ve, fathers blood group B(+)ve, was on irregular
antenatal check up (total 3 visits) and was duly immunized
against tetanus. At 20 weeks of gestation, she was first
diagnosed as 20 weeks of alive pregnancy which was
unplanned. About 12 weeks before diagnosis of
pregnancy, she was diagnosed as coronary artery disease
(Double vessel disease) and hypertension. CABG was done
under GA on 30.05.2018 and treated with clopidogrel,
5. History of present illness cont.
aspirin, atorvastatin, frusemide, spironolactone,
metoprolol, riboflavin, ferrous sulphate, folic acid. She was
known case of DM for last 5 years and was being treated
irregularly with insulin, linagliptin, glicazide and continued
upto 20 weeks of pregnancy, her HbA1C was 7.4% . After
diagnosis of pregnancy she continued aspirin, bisoprolol,
insulin. She had no H/O of APH, PROM, Hypothyroidism,
fever with rash.
6. History of present illness cont.
At 38+4 weeks of gestation, she admitted at private
hospital, LUCS was done due to less fetal movement,
previous C/S & cardiac surgery. A male baby weighing
2300gm was delivered on 25/01/19. Baby was found
meconium stained & didn’t cry immediately after birth.
After laryngeal suction, bag mask ventilation was given,
then baby cried. APGAR score was 4/10 & 8/10 @ 1min &
5mins respectively.
7. History of present illness cont.
Soon after birth baby developed respiratory distress in the
form of tachypnea, chest retraction. Baby was shifted to
NICU of private hospital for delayed crying followed by
respiratory distress and multiple congenital anomalies. At
PNA day 10, baby referred to BSMMU for further evaluation
and management.
8. Antenatal History
At 20 weeks of gestation, she was diagnosed 20 weeks
of alive pregnancy. During this pregnancy mother
didn’t receive any ANC upto 20 weeks of gestation,
then was on regular ANC & was duly immunized
against tetanus.
At 8 weeks of pregnancy she was diagnosed as
coronary artery disease, CABG was done
She was diagnosed case of DM for last 5 years
She also diagnose case as hypertention.
9. Natal History
A male baby delivered by LUCS weighing
2300gm on 25/01/19, cried after giving bag
mask ventilation for 1 min, APGAR score
4/10, 8/10 at 1st and 5th min
10. Postnatal History
Soon after birth baby developed respiratory
distress in the form of tachypnea, chest indrawing
14. Family History
He is the 3rd issue of non-consanguineous
parents. Other sibs are good in health
15. Socio-economic History
He belongs to a middle socio-economic
background, father is a businessman, mother
is a homemaker and their monthly income is
around 35000 tk
17. •Appearance: Alert
•Anicteric
•Pink on 2L/min O2
•SPO2: 93% in 2L/min O2
•Reflex-Activities: good
•CRT: 2 sec
•Pulse volume : good
•CBG: 4.5 mmol/L
•Temperature: 36.8C
18. R/R : 54/min
H/R : 290 beats/min
Fontanelle : Open, not bulged
Back and spine : Normal
Genitalia- Normal male pattern.
Anus: Patent
Congenital anomaly: Anotia (right),
Bilateral club foot
23. Cardiovascular System Examination
• Inspection:
• Visible apex beat -Absent
• Palpation
• Apex beat: left 4th intercostal space
• Left parasternal heave, thrill, palpable P2-Absent
• Auscultation:
• Heart Rate : 290 b/min
• Heart Sound: first and second heart sounds are
audible in all four areas of precordium.
• Murmur: Systolic, grade 3/6, left 2nd ICS with no
radiation
24. GIT System Examination
• Abdomen : Soft, not distended
• Liver – 4 cm from right costal Margin
along the mid-clavicular line, margin
sharp, smooth surface
• Bowel sound –present
• Umbilicus: Healthy
25. Respiratory System Examination
• RR-54 br/ min
• Chest is normal in size and shape
• No grunting, chest indrawing
• Bilateral equal good air entry
• Breath sound vesicular, no added
sound.
26. Nervous system
• Conscious, alert
• Posture normal
• Primitive reflexes were Good
• Tone normal
• Deep tendon reflexes normal.
27. Nervous system
Facial nerve examination:
Loss of wrinkle in right side
Eyelids on right side could
easily be opened
Loss of nasolabial fold on
right side
Mouth deviated to left side
during crying
Suggestive of right sided lower
motor type facial nerve palsy
29. Salient feature
S/O Tania, outborn, 3rd issue of non-consanguineous parents, got
admitted in NICU at his 10 days of age due to delayed cry after
birth followed by respiratory distress, multiple congenital
anomalies. Mother Tania, 31 years old lady, Para: 4-1(IUD), having
blood group B(+)ve, was on irregular ANC upto 20 weeks when
she was diagnosed with 20weeks alive pregnancy. About 12
weeks before diagnosis of pregnancy, CABG was done under GA
due to coronary artery disease with hypertention. She was known
case of DM for last 5 years. She had no H/O of APH, PROM,
Hypothyroidism, fever with rash.
30. Salient feature
Regarding drug history of mother during this pregnancy, for
heart disease clopidogrel, aspirin, atorvastatin, frusemide,
spironolactone, metoprolol; for DM insulin, linagliptin,
glicazide. After diagnosis of pregnancy she continued aspirin,
bisoprolol, insulin. At 38+4 weeks of gestation, LUCS was
done due to less fetal movement, previous C/S & cardiac
surgery. A male baby weighing 2300gm was delivered.
31. Salient feature cont.
Baby was found meconium stained & didn’t cry
immediately after birth. After laryngeal suction and bag
mask ventilation baby cried. APGAR score was 4/10 &
8/10 @ 1 min & 5 mins respectively. Baby was admitted in
a private NICU for delayed crying followed by respiratory
distress and multiple congenital anomalies. There baby
was treated with O2 inhalation, injectable antibiotics,
frusemide. At PNA day 10, baby was referred to BSMMU
for further evaluation and management.
32. Salient feature cont.
On examination, baby was alert, anicteric, pink on 2L/M O2,
reflex activities were good, well perfused, euglycemic,
normothermic, SPO2 – 93% on 2L/min O2, RR- 54/m, HR –
290/min. Congenital anomaly- Anotia, Bilateral club foot.
Anthropometrically the baby was appropriate for gestational age.
CVS examination murmur present, Systolic, grade 3/6 left 2nd ICS
with no radiation. Nervous system examination revealed right
sided lower motor type facial nerve palsy. On abdominal
examination, liver is 4 cm. Other Systemic examination reveals
nothing significant.
40. Cont…
Vagal stimulation by
Ice cold compression on face
Persisting Tachycardia (HR-270-280)
Plan: Cardiology consultation
Inj Adenosine
41. Follow Up: 05.02.19 at 9AM
Subjective Objective Assessment Plan & Measures Taken
Tachycardia
persisting
Pink in 2L/min O2
Reflex activity- good
CRT -2 sec
R/R – 54 br/min
H/R- 280b/min
BP- 83/46(62)
SPO2- 98% in 2L/min O2
Lung- B/L equal air entry
Heart- S1+S2+ M
Abdomen- soft, not distended,
liver 2cm
Umbilicus- Healthy
CBG- 6 mmol/L
Temp- 98°F
Urine- 2.7 ml/kg/hr
Meconium- passed
Stable
S-72-82
D-46-54
M-55-63
• Cardiology consultation
• Inj Adenosine
• Echocardiography
Give Inj Adenosine
HR -150-156/M
42. Echocardiography
Transposition of great artery (d-TGA), PA arising from LV,
Aorta arising from RV. Large inlet VSD (Size-6.8mm) with
bidirectional shunt. Large ostium secundum ASD (size-
7.5mm) with L-R shunt. Large PDA with bidirectional shunt.
Both dynamic and fixed obstruction of LVOT. Dilated
coronary sinus. Myxomatous change to septal leaflet ant
leaflet of tricuspid valve
43. Follow up on 06.02.2019
At 3.30AM
HR- 288/M
-Ensure Digoxin maintainance dose
At 9pm
HR- 250-260 b/m
MX- Inj Adenosine
HR-120-130b/min
44. Club foot Mx(Orthopedic consultation)
Type: Flexible variety of Congenital Talepes Equino-
varus (Bilateral)
Plan:
Manipulation
Follow up & Serial plaster after 1 month
45. Follow Up: 07.02.19 at 10AM
Subjective Objective Assessment Plan & Measures Taken
Unusual weight
gain (80gm)
Pink in air
SPO2- 90% in air
Reflex activity- good
Fontanelle- Open, normal
CRT -2 sec
R/R – 58 br/min
H/R- 120-130 b/min
BP- 92/53(63)
Lung- B/L equal air entry
Heart- S1+S2+ M
Abdomen- soft, not
distended, liver 2cm
Umbilicus- Healthy
CBG- 6 mmol/L
Temp- 98°F
Urine- 2.5 ml/kg/hr
Stool- 4 times
Static
S-72-82
D-46-54
M-55-63
-Decreased fluid
-Increased feed
-Inj MgSO2 (Mg -0.6)
• At 6PM, 10PM SVT
develop > Spontaneous
resolved
46. Follow Up: 09.02.19 at 10AM
Subjective Objective Assessment Plan & Measures Taken
Repeated
episode of SVT
Pink in air
Reflex activity- good
Fontanelle- Open, normal
CRT -2 sec
R/R – 42 br/min
H/R- 120 b/min
BP- 92/53(63)
SPO2- 84% in air
Lung- B/L equal air entry
Heart- S1+S2+ M
Abdomen- soft, not distended,
liver 2cm
Umbilicus- Healthy
CBG- 6 mmol/L
Temp- 98°F
Urine- 2.5 ml/kg/hr
Stool- 4 times
Static
S-72-82
D-46-54
M-55-63
• Cardiac Consultation
• Tab Amiodarone
(5mg/kg/day) started
from 5PM
• At 8.30PM & 10.30PM
Baby developed SVT
(spontaneously
resolved)
48. Management :
Positioning, suction, stimulation and bag mask
ventilation , CPR started
2 shot of Inj Adrenaline was given (10unit/kg)
Baby having gasping respiration, heart rate 90b/min
Mechanical ventilation with SIMV mode in following
method - Rate-40, Pressure – 14/5, FiO2- 60%
- Dopamin, Dobutamine were added
49. After that
Pink in air
Reflex activity-Improving than previous
CRT - 2 sec
R/R – 45/m
H/R- 132/m
Pulse volume – good
Lungs – bilateral good air entry
Heart – S1+S2+M
Pupil – reacting to light
Plan : Chest X-ray
ABG
ABG: pH-7.37
PCO2- 34
PO2- 45
HCO3- 19.4
BE- -5
50.
51. Follow Up: 10.02.19 at 10AM
Subjective Objective Assessment Plan & Measures Taken
One episode of
SVT at 4.30AM
(Mx by Tab.
Amiodarone)
Pink in MV
F-40, P-14/5,Fio2-.60%
SPO2- 93%
Reflex activity- Moderate
Fontanelle- Open, normal
CRT -2 sec
R/R – 42 br/min
H/R- 140 b/min
BP- 97/63(75)
Lung- B/L equal air entry
Heart- S1+S2+ M
Abdomen- Distended, liver
3cm
Girth-29cm
CBG- 9 mmol/L
Temp- 98°F
Urine- 3.2 ml/kg/hr
Stool- 3 times
Static
S-72-82
D-46-54
M-55-63
• Decreased setup
FiO2 50%
PIP 12
• Weaning off Dopamin
• Decreased 10% to 7.5%
dextrose
• Send septic workup,
S. Electrolyte (Refused)
At 9PM wean from MV to
5L/M o2
52. Follow Up: 11.02.19 at 10AM
Subjective Objective Assessment Plan & Measures Taken
One episode of
SVT at 10.30PM
(Mx by Inj
Adenosine)
Pink in 3L O2
SPO2- 93%
Reflex activity- Moderate
Fontanelle- Open, normal
CRT -2 sec
Temp- 37°c
R/R – 52 br/min
H/R- 240 b/min
BP- 88/58(67)
Lung- B/L equal air entry
Heart- S1+S2+ M
Abdomen- Distended, liver 3cm
Girth-29cm
CBG-6.3
Urine- 3.2 ml/kg/hr
Stool- 3 times
Static
S-72-82
D-46-54
M-55-63
• Referred to NHF
53. Final diagnosis
Term (38+4 wks), low birth weight (2300gm), AGA,
IDM, Perinatal asphyxia (HIE-1), Congenital heart
disease (d-TGA, Large VSD, Large ASD, Large PDA),
Supraventricular tachycardia, multiple congenital
anomalies (right sided anotia, right sided lower
motor type facial palsy, bilateral club foot)
54.
55. Our patient
S/O Tania
A baby with multiple congenital malformations
(unilateral anotia, facial nerve palsy, bilateral
club foot and congenital heart disease)
Presented with tachycardia
Heart failure
Sepsis
Excluded
58. SVT
• An abnormal arrhythmia arising above or
within bundle of His.
• It includes essentially all forms of paroxysmal
or incessant tachycardia except ventricular
tachycardia.
• It is the most common abnormal tachycardia
in infancy and childhood.
59. TYPES
SITE RHYTHM
Sinus node Sinus tachycardia Always secondary; usually
non-cardiac cause e.g. sepsis,
fever, pain, hypovolaemia,
respiratory failure, anaemia,
fluid overload, ionotropes
Atrium Atrial flutter
Atrial fibrillation
Atrial tachycardia
Rare
Very rare
Uncommon
AV junction AV re-entry tachycardia
AV nodal re-entry
tachycardia
Commonest form in newborn
rare
Below AV node His bundle tachycardia
(junctional ectopic
tachycardia)
Associated with abnormal
hearts/cardiomyopathy;
Usually postoperative
60. RISK FACTORS
Bimodal age distribution
• One peak at infancy
• Another peak is in between 8-12
years (Calabro ` MP, Cerrito M, Luzza F,
Oreto G (2008) Supraventricular tachycardia
in infants: Epidemiology and clinical
management. Curr Pharm Des 14(8):723–
728 )
No significant gender differences
were present at younger ages
( Anand RG, Rosenthal GL, Van Hare GF,
Snyder CS (2009) Is the mechanism of
supraventricular tachycardia in pediatrics
influenced by age, gender or ethnicity?
Congenit Heart Dis 4(6):464–468)
Our patient:
presented in
neonatal period
Male baby
62. Post natal:
Asymptomatic
Tachycardia (HR: 180-300/min)
• Abrupt onset and cessation
• May occur during rest
• May be precipitated by acute infection
• Attacks may persist from seconds to hours
Heart failure
If tachycardia goes unrecognized for a long time
Shock
Our patient:
Tachycardia
with
Sudden onset &
spontaneous
remission;
Some episodes
occurred during
sleep; persisted
for minutes to
hours
63. Causes of SVT
• Any form of structural heart disease
• Myocardial tumors
• Myocarditis
• Electrolyte disturbances
• Indwelling right arterial lines
In our patient:
Congenital heart
defect
(murmur+)
64. ASSOCIATED CARDIAC
DEFECTS/SYNDROME
According to Tripathy A, Black GB (2014) Factors associated with
the occurrence and treatment of supraventricular tachycardia in a
pediatric congenital heart diseaes cohort. Pediatr cardiol 35:368-
373
• 6–7 % of children with CHD have SVT
• ASD secundum (14.3 %)
• VSD (6 %)
• Pulmonary stenosis (5.4 %)
• PDA (5.3 %)
• Pulmonary hypertension (2.4 %)
65. Continued….
• Two or more concomitant CHDs were present in
8.6 % of SVT patients.
• A smaller percentage (7.2 %) of patients were
diagnosed with severe/complex (cyanotic) CHDs,
i.e., tetralogy of Fallot, transposition of the great
arteries, double-outlet right ventricle (DORV),
common ventricle, truncus arteriosus,
atrioventricular canal/endocardial cushion defect
(AV/ ECD), Ebstein’s anomaly, hypoplastic left
heart syndrome (HLHS), or total anomalous
pulmonary venous return
66. Our patient had associated CHD
• TGA
• A Large inlet VSD (6.8 mm)
• A Large ostium secundum ASD (7.5 mm)
• A Large PDA
• Posterior deviation of conal septum producing
dynamic Left Ventricular Outflow Tract
Obstruction
67. This patient also had some other
congenital anomalies
• Unilateral anotia
• Facial nerve palsy
• Bilateral club foot
There was no
reported case of
SVT found to be
associated with
these congenital
malformations
72. PRINCIPLES OF MANAGEMENT
Conversion of rhythm:
Vagal maneuvers: Ice pack to the face until
conversion or max. 10 seconds
Adenosine, if vagal maneuver fails
Control of rate:
Propranolol (if there are no signs of heart failure)
Digoxin
Amiodarone
73. Management of emergency/complication:
Digoxin (if there are signs of heart failure or
propranolol has failed) after ensuring not
hypokalaemic and no WPW syndrome
Electrical cardioversion by synchronous DC
cardioversion: if the baby is in shock
74. Maintenance therapy:
Once sinus rhythm is restored, maintenance
therapy with whatever agent restored, is
usually given for 3- 6 months
Surgical correction
Artificial pacing
Radiofrequency catheter ablation
75. Our patient was treated with
Vagal maneuver:
• Ice pack to the face
Inj. Adenosine
Inj. Digoxin
Tab. Amiodarone
76. How Adenosine was given
Dose: 0.1 mg/kg/dose
Prerequisite for giving Inj.
Adenosine:
• A large fresh cannula as close to
heart as possible
• 3-way channel
Procedure: rapid IV bolus
followed by saline flush with
continuous ECG recording
79. PROGNOSIS
• Usually excellent, in absence of structural cardiac
disease or cardiomyopathy
• WPW syndrome has small risk of sudden cardiac
death
• One fifth will recur after treatment
• When SVT starts in first months of life, it resolves
in 80% cases within the first year; If SVT starts
later in life, spontaneous remission may occur in
only 15-20% cases
(Vignati G, Annoni G (2008) Characterization of supraventricular tachycardia in
infants: Clinical and instrumental diagnosis. Curr Pharm Des 14(8):729–735)
Our patient:
Prognosis is
guarded