Syncope in children
•Download as PPTX, PDF•
8 likes•2,569 views
This document discusses syncope (fainting), including its definition, causes, pathophysiology, history and examination, investigations, and treatment. Syncope is defined as a sudden, transient loss of consciousness due to cerebral hypoperfusion. It can be caused by neurological, cardiovascular, orthostatic hypotension, or other factors like anemia or hypoglycemia. Evaluation involves taking a history of symptoms and potential triggers, physical exam including orthostatic vital signs, ECG, echocardiogram if needed, and lab tests like glucose and electrolytes. Treatment depends on the identified cause, and may include rehydration, non-pharmacological approaches, or referral to a cardiologist for potential arr
Report
Share
Report
Share
Recommended
Syncope in pediatrics
This document discusses syncope in pediatrics. It defines syncope and differentiates it from seizures. The most common cause of syncope in children is neurocardiogenic or vasovagal syncope. While usually benign, syncope can sometimes be a sign of cardiac issues. The document outlines potential cardiac and non-cardiac causes of pediatric syncope and lists "red flag" signs that warrant further investigation to rule out serious underlying conditions. It also discusses the evaluation, testing, and treatment approaches for syncopal episodes depending on their identified cause.
Syncope
Syncope is a transient loss of consciousness caused by a drop in blood pressure. It is common in children and usually benign, but can sometimes indicate cardiac disease. Key points include:
1) Syncope is differentiated from seizures based on features like tongue biting and incontinence.
2) Causes include neurologic issues like vasovagal syncope, cardiac problems like arrhythmias, and other non-cardiac etiologies.
3) Evaluation involves history, physical exam, ECG, and monitoring like Holter or event monitors to check for arrhythmias, with more invasive testing if initial workup is abnormal.
APPROACH TO SYNCOPE ,DIAGNOSIS AND MANAGEMENT
This document discusses the management of two patients presenting with syncope.
Case 1 is a 42-year-old female with a history of passing out at work. Her workup including physical exam, EKG, labs and tilt table test was normal. She was diagnosed with vasovagal syncope as her tilt table test induced syncope.
Case 2 is an 82-year-old male found unresponsive. His workup in the ER was negative but he was admitted where 2 hours later he developed nonsustained VTach on ECG monitoring. An EP study showed inducible VTach and he received an ICD. He was found to have diffuse coronary artery disease on cardiac cath.
Syncope in children and adolescents
syncope in children , vasovagal syncope , fainting in children , causes of syncope in children , how to manage syncope in children , cardiac syncope , differnetial diagnosis of syncope , approach to syncope
Syncope
This document provides information on evaluating and managing patients presenting with syncope (transient loss of consciousness). It describes the initial assessment including ABCs, vital signs and ECG. It outlines key questions to determine if it is true syncope, identify the cause, and assess risk of serious outcomes. Causes are categorized as high, moderate or low risk. Evaluation involves establishing the diagnosis, identifying triggers, risk factors and ruling out conditions like arrhythmias. Scoring systems like SFSR and ROSE can stratify risk. Prolonged QT interval may indicate conditions like long QT syndrome or Brugada syndrome. Management involves stabilizing and monitoring patients or transferring to higher levels of care based on risk level.
Syncope Presentation
Syncope, or transient loss of consciousness, can be caused by various cardiac and non-cardiac conditions. A thorough history, physical exam, ECG and diagnostic testing are needed to evaluate the cause. Patients found to have cardiac syncope, abnormal vital signs, ECG changes or structural heart disease have a higher risk of adverse outcomes and should be admitted. Risk stratification tools like the San Francisco Syncope Rule and Oesil Risk Score can help determine which low-risk patients can be safely discharged. High-risk features predicting serious underlying rhythm issues include age over 45, history of heart disease or abnormal ECG.
Approach to dizziness
This document outlines the approach to evaluating a patient presenting with dizziness. It discusses the overview, epidemiology, major etiologies including vertigo, disequilibrium, syncope, and nonspecific dizziness. For each etiology, the summary includes defining the condition, taking a relevant history, performing a physical exam including special maneuvers, generating a differential diagnosis, ordering appropriate investigations, management, identifying red flags, providing health education, follow up, and the role of family medicine. The approach emphasizes taking a thorough history to determine the type and characteristics of dizziness and using physical exam findings to distinguish peripheral from central causes of vertigo.
ATRIAL FIBRILLATION 2016
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Recommended
Syncope in pediatrics
This document discusses syncope in pediatrics. It defines syncope and differentiates it from seizures. The most common cause of syncope in children is neurocardiogenic or vasovagal syncope. While usually benign, syncope can sometimes be a sign of cardiac issues. The document outlines potential cardiac and non-cardiac causes of pediatric syncope and lists "red flag" signs that warrant further investigation to rule out serious underlying conditions. It also discusses the evaluation, testing, and treatment approaches for syncopal episodes depending on their identified cause.
Syncope
Syncope is a transient loss of consciousness caused by a drop in blood pressure. It is common in children and usually benign, but can sometimes indicate cardiac disease. Key points include:
1) Syncope is differentiated from seizures based on features like tongue biting and incontinence.
2) Causes include neurologic issues like vasovagal syncope, cardiac problems like arrhythmias, and other non-cardiac etiologies.
3) Evaluation involves history, physical exam, ECG, and monitoring like Holter or event monitors to check for arrhythmias, with more invasive testing if initial workup is abnormal.
APPROACH TO SYNCOPE ,DIAGNOSIS AND MANAGEMENT
This document discusses the management of two patients presenting with syncope.
Case 1 is a 42-year-old female with a history of passing out at work. Her workup including physical exam, EKG, labs and tilt table test was normal. She was diagnosed with vasovagal syncope as her tilt table test induced syncope.
Case 2 is an 82-year-old male found unresponsive. His workup in the ER was negative but he was admitted where 2 hours later he developed nonsustained VTach on ECG monitoring. An EP study showed inducible VTach and he received an ICD. He was found to have diffuse coronary artery disease on cardiac cath.
Syncope in children and adolescents
syncope in children , vasovagal syncope , fainting in children , causes of syncope in children , how to manage syncope in children , cardiac syncope , differnetial diagnosis of syncope , approach to syncope
Syncope
This document provides information on evaluating and managing patients presenting with syncope (transient loss of consciousness). It describes the initial assessment including ABCs, vital signs and ECG. It outlines key questions to determine if it is true syncope, identify the cause, and assess risk of serious outcomes. Causes are categorized as high, moderate or low risk. Evaluation involves establishing the diagnosis, identifying triggers, risk factors and ruling out conditions like arrhythmias. Scoring systems like SFSR and ROSE can stratify risk. Prolonged QT interval may indicate conditions like long QT syndrome or Brugada syndrome. Management involves stabilizing and monitoring patients or transferring to higher levels of care based on risk level.
Syncope Presentation
Syncope, or transient loss of consciousness, can be caused by various cardiac and non-cardiac conditions. A thorough history, physical exam, ECG and diagnostic testing are needed to evaluate the cause. Patients found to have cardiac syncope, abnormal vital signs, ECG changes or structural heart disease have a higher risk of adverse outcomes and should be admitted. Risk stratification tools like the San Francisco Syncope Rule and Oesil Risk Score can help determine which low-risk patients can be safely discharged. High-risk features predicting serious underlying rhythm issues include age over 45, history of heart disease or abnormal ECG.
Approach to dizziness
This document outlines the approach to evaluating a patient presenting with dizziness. It discusses the overview, epidemiology, major etiologies including vertigo, disequilibrium, syncope, and nonspecific dizziness. For each etiology, the summary includes defining the condition, taking a relevant history, performing a physical exam including special maneuvers, generating a differential diagnosis, ordering appropriate investigations, management, identifying red flags, providing health education, follow up, and the role of family medicine. The approach emphasizes taking a thorough history to determine the type and characteristics of dizziness and using physical exam findings to distinguish peripheral from central causes of vertigo.
ATRIAL FIBRILLATION 2016
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Approach to syncope
Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion. It is characterized by rapid onset, short duration, and spontaneous recovery. The most common causes are reflex-mediated syncope and orthostatic hypotension, which account for one-third of syncopal episodes. Evaluation involves detailed history taking and physical examination, including orthostatic vital signs and carotid sinus massage. Tilt table testing can be used to confirm neurogenic causes when initial evaluation is insufficient.
Approach to headache
This document provides an overview of Dr. Faisal Al Hadad's approach to evaluating and diagnosing headaches. It begins with definitions of headache and classifications of primary versus secondary headaches. It then discusses taking a thorough history, including onset, location, severity of pain, concurrent conditions, medications, and recent trauma. The physical exam focuses on identifying secondary causes, and red flags requiring further investigation are outlined. Diagnostic criteria for common primary headaches like migraines and cluster headaches are provided. Recommendations are given for imaging, lumbar puncture, and indications for neurology referral. The goal is to distinguish primary from secondary headaches and accurately diagnose the underlying condition.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Syncope
Syncope is defined as a transient loss of consciousness and postural tone caused by a fall in cerebral blood flow. The document outlines the various causes of syncope including neurally-mediated, orthostatic, cardiac, metabolic, neurological/psychiatric disorders, and unexplained causes. It emphasizes obtaining a detailed history of the syncopal episode including circumstances, symptoms, age of onset, drugs, and pregnancy to help determine the underlying cause, which guides further testing and management.
Syncope
1) Syncope accounts for 1-2% of ED visits and 6% of hospital admissions. The cause remains unknown in around 40% of cases even after investigation.
2) Common causes include vasovagal (21%), cardiac (10%), orthostatic (9%), medications (7%), and neurological (4%). Cardiac causes carry the highest risk of death.
3) Evaluation involves detailed history, physical exam including orthostatic vital signs, ECG, and testing as indicated based on risk stratification scores. High risk features suggest further cardiac workup while low risk features may not require extensive testing.
General approach and differential diagnosis of coma
This document provides guidance on evaluating and managing comatose patients. It outlines the following key steps:
1. Ensure airway, breathing and circulation are stabilized. Treat any rapidly reversible causes of coma like hypoglycemia.
2. Use the Glasgow Coma Scale to assess the level of consciousness. Common causes of coma include head injuries, strokes, infections, tumors, and metabolic derangements.
3. Perform a full neurological exam including pupil size and response, motor function, and posture. Request diagnostic tests like bloodwork and CT or MRI as indicated.
4. Manage increased intracranial pressure with osmotic diuretics if present. Treat any identifiable structural or metabolic causes. Monitor
Syncope: Etiology & Pathophysiology
Transient loss of consciousness can be caused by reduced cerebral blood flow (syncope). There are three main etiologies of syncope: cardiogenic, neurocardiogenic, and metabolic. Cardiogenic syncope is caused by structural heart issues or arrhythmias like bradycardia or tachycardia. Neurocardiogenic, or vasovagal, syncope is the most common type and caused by pain, fear, or anxiety triggering a vagal response and hypotension. Metabolic syncope is rare and caused by issues like hypoxia or hypoglycemia. Neurocardiogenic syncope may serve as a protective mechanism for the heart during times of central hypovolemia.
Epilepsy Syndromes
Epilepsy syndromes can be categorized based on age of onset from neonates to childhood. Syndromes include self-limited, developmental and epileptic encephalopathies, and genetic generalized epilepsies. Syndromes are defined by seizure type, EEG findings, development, and treatment response/prognosis. Examples provided include benign familial neonatal epilepsy, Dravet syndrome, childhood absence epilepsy, Lennox-Gastaut syndrome, and Landau-Kleffner syndrome.
Headache in children and adolescents
The document discusses headaches in children and adolescents. It describes the different types of headaches including acute, recurrent, chronic, and secondary headaches. It outlines the evaluation process for headaches including obtaining a thorough history, physical exam, and determining if imaging is needed. Lifestyle factors and various treatment options are also covered such as acute medication, preventative treatment, and lifestyle modifications.
Syncope dr yate
Syncope is defined as a brief, self-limited loss of consciousness due to reduced cerebral blood flow. It is characterized by rapid onset, short duration, and spontaneous recovery. The document discusses the various causes of syncope including neurally-mediated (vasovagal), orthostatic, cardiac, and others. It outlines the evaluation process including history, physical exam, ECG, and cardiac monitoring. Further tests like tilt table testing and electrophysiology studies may be used depending on the suspected cause to determine the etiology and appropriate treatment. The history is critical to differentiate syncope from other mimics and identify high-risk patients who require more extensive cardiac evaluation and monitoring.
Aproach to syncope
Syncope, or fainting, is caused by insufficient blood flow to the brain. It is usually brief and self-limited. Evaluation of syncope involves obtaining a detailed history, physical exam, ECG, and testing based on risk factors. Causes are categorized as benign if due to things like vasovagal response, or dangerous if due to cardiac arrhythmias. High-risk patients warrant further cardiac workup and monitoring, while low-risk patients can often be evaluated as outpatients.
Approach to palpitations
This document discusses the approach to evaluating and managing palpitations. It defines palpitations as an awareness of heartbeat and describes potential causes like arrhythmias, structural heart issues, and psychiatric factors. The evaluation involves taking a history of symptoms and triggers, examining for irregularities, and testing with ECG, Holter monitor or event recorder depending on frequency. Management depends on the identified cause, with arrhythmias potentially treated with beta blockers and reassuring patients if no serious issues are found.
Palpitations
This document discusses the evaluation and management of palpitations. It begins with definitions and introduces common causes of palpitations including arrhythmias, augmentation of heart contractility, and cardiac neurosis. The diagnostic pathway involves obtaining a thorough history, physical exam including ECG, and potential additional testing such as echocardiogram, Holter monitor, or cardiac MRI if indicated. The document provides details on the diagnostic criteria and clinical findings of various cardiac and extracardiac conditions that can cause palpitations. Management is tailored based on the underlying cause.
Syncope 1
Syncope refers to a transient loss of consciousness due to decreased cerebral blood flow. It accounts for 1% of hospital admissions. The main causes are neurally mediated syncope and cardiac syncope. Neurally mediated syncope involves a sudden change in autonomic activity leading to bradycardia and vasodilation. Orthostatic hypotension is a manifestation of sympathetic vasoconstrictor failure and involves a drop in blood pressure within 3 minutes of standing. Treatment focuses on fluid intake, avoidance of triggers, and medication in refractory cases.
Acute Decompensated Heart Failure
An overweight middle-aged man presented with acute shortness of breath, elevated blood pressure, coarse lung sounds, low oxygen saturation, and leg swelling. His initial evaluation found signs of severe congestive heart failure including pulmonary edema. Further assessment is needed to determine the underlying cause, guide treatment, and classify the type and severity of heart failure.
Approach to a bleeding child
This document discusses the approach to managing bleeding in children. It covers various causes of bleeding including platelet disorders like thrombocytopenia from conditions like ITP, coagulation disorders, and dysfunctional fibrinolysis. It provides details on evaluating the clinical history and performing examinations and lab tests to identify the underlying cause. Specific conditions discussed in more depth include ITP, hemophilia, vitamin K deficiency, and DIC. Treatment approaches are described for replacing coagulation factors, corticosteroids, IVIG, platelet transfusions, and managing thrombotic disorders.
Approach to Syncope
This document provides an overview of syncope (transient loss of consciousness). It defines syncope and discusses mechanisms and common causes. Cardiac causes include arrhythmias and structural heart issues. Common non-cardiac causes are neurocardiogenic syncope and orthostatic hypotension. The document outlines how to take a history and perform an exam for a syncope patient. It recommends ECG, monitoring, and risk stratification. The summary emphasizes differentiating cardiac from non-cardiac syncope, as cardiac causes have higher mortality and recommends not missing life-threatening conditions.
HYPERTENSION EMERGENCY & URGENCY
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
SVT in pediatrics
This document discusses supraventricular tachycardia (SVT) in pediatric patients. SVT is the most common abnormal heart rhythm seen in children and the most common arrhythmia requiring treatment. It is usually caused by re-entry mechanisms involving an accessory pathway or the atrioventricular node. Diagnosis involves obtaining an electrocardiogram during episodes to identify P wave patterns. Treatment options include vagal maneuvers, medications like adenosine, calcium channel blockers, or beta blockers, and cardioversion. Radiofrequency ablation can provide a cure for refractory or recurrent cases. Proper diagnosis of the underlying SVT mechanism guides selection of the most appropriate treatment approach.
Approach to palpitation [autosaved]
This document discusses the clinical approach to evaluating patients presenting with palpitations. It defines palpitations and describes the physiology and common causes. Cardiac causes account for 43% of cases, while psychiatric conditions cause 31%. The document outlines the diagnostic evaluation including history, physical exam, ECG and ambulatory monitoring. It provides guidance on when to refer to cardiology or admit to the hospital. The management focuses on reassurance, lifestyle changes, treating underlying conditions, anxiolytics, beta-blockers, antiarrhythmics or cardioversion depending on the severity and nature of the arrhythmia.
Approach to syncope in Emergency Department
Transient loss of consciousness is known as syncope. It is caused by a lack of oxygen to the brainstem due to a drop in cardiac output. The most common cause is a reflex response leading to vasodilatation and bradycardia. Etiologies include neurally-mediated, orthostatic, cardiac arrhythmias, structural heart disease, and neurologic causes. Evaluation involves ECG, labs, and imaging depending on suspected etiology. Treatment focuses on ACLS for unstable patients and managing the underlying cause. Patients are admitted or discharged based on risk factors and etiology.
Differential Diagnosis of Syncope
Syncope, or fainting, is a brief loss of consciousness caused by reduced blood flow to the brain. It can be triggered by standing for long periods, hot environments, exercise, or medical conditions affecting the heart or blood vessels. The major types of syncope are vasovagal, which involves a reflex drop in heart rate and blood pressure, cardiac syncope caused by abnormalities of heart rhythm or function, and orthostatic (or postural) syncope brought on by standing up. Evaluation involves medical history, physical exam, ECG, echocardiogram and tests to check for underlying heart, brain or blood vessel diseases.
More Related Content
What's hot
Approach to syncope
Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion. It is characterized by rapid onset, short duration, and spontaneous recovery. The most common causes are reflex-mediated syncope and orthostatic hypotension, which account for one-third of syncopal episodes. Evaluation involves detailed history taking and physical examination, including orthostatic vital signs and carotid sinus massage. Tilt table testing can be used to confirm neurogenic causes when initial evaluation is insufficient.
Approach to headache
This document provides an overview of Dr. Faisal Al Hadad's approach to evaluating and diagnosing headaches. It begins with definitions of headache and classifications of primary versus secondary headaches. It then discusses taking a thorough history, including onset, location, severity of pain, concurrent conditions, medications, and recent trauma. The physical exam focuses on identifying secondary causes, and red flags requiring further investigation are outlined. Diagnostic criteria for common primary headaches like migraines and cluster headaches are provided. Recommendations are given for imaging, lumbar puncture, and indications for neurology referral. The goal is to distinguish primary from secondary headaches and accurately diagnose the underlying condition.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Syncope
Syncope is defined as a transient loss of consciousness and postural tone caused by a fall in cerebral blood flow. The document outlines the various causes of syncope including neurally-mediated, orthostatic, cardiac, metabolic, neurological/psychiatric disorders, and unexplained causes. It emphasizes obtaining a detailed history of the syncopal episode including circumstances, symptoms, age of onset, drugs, and pregnancy to help determine the underlying cause, which guides further testing and management.
Syncope
1) Syncope accounts for 1-2% of ED visits and 6% of hospital admissions. The cause remains unknown in around 40% of cases even after investigation.
2) Common causes include vasovagal (21%), cardiac (10%), orthostatic (9%), medications (7%), and neurological (4%). Cardiac causes carry the highest risk of death.
3) Evaluation involves detailed history, physical exam including orthostatic vital signs, ECG, and testing as indicated based on risk stratification scores. High risk features suggest further cardiac workup while low risk features may not require extensive testing.
General approach and differential diagnosis of coma
This document provides guidance on evaluating and managing comatose patients. It outlines the following key steps:
1. Ensure airway, breathing and circulation are stabilized. Treat any rapidly reversible causes of coma like hypoglycemia.
2. Use the Glasgow Coma Scale to assess the level of consciousness. Common causes of coma include head injuries, strokes, infections, tumors, and metabolic derangements.
3. Perform a full neurological exam including pupil size and response, motor function, and posture. Request diagnostic tests like bloodwork and CT or MRI as indicated.
4. Manage increased intracranial pressure with osmotic diuretics if present. Treat any identifiable structural or metabolic causes. Monitor
Syncope: Etiology & Pathophysiology
Transient loss of consciousness can be caused by reduced cerebral blood flow (syncope). There are three main etiologies of syncope: cardiogenic, neurocardiogenic, and metabolic. Cardiogenic syncope is caused by structural heart issues or arrhythmias like bradycardia or tachycardia. Neurocardiogenic, or vasovagal, syncope is the most common type and caused by pain, fear, or anxiety triggering a vagal response and hypotension. Metabolic syncope is rare and caused by issues like hypoxia or hypoglycemia. Neurocardiogenic syncope may serve as a protective mechanism for the heart during times of central hypovolemia.
Epilepsy Syndromes
Epilepsy syndromes can be categorized based on age of onset from neonates to childhood. Syndromes include self-limited, developmental and epileptic encephalopathies, and genetic generalized epilepsies. Syndromes are defined by seizure type, EEG findings, development, and treatment response/prognosis. Examples provided include benign familial neonatal epilepsy, Dravet syndrome, childhood absence epilepsy, Lennox-Gastaut syndrome, and Landau-Kleffner syndrome.
Headache in children and adolescents
The document discusses headaches in children and adolescents. It describes the different types of headaches including acute, recurrent, chronic, and secondary headaches. It outlines the evaluation process for headaches including obtaining a thorough history, physical exam, and determining if imaging is needed. Lifestyle factors and various treatment options are also covered such as acute medication, preventative treatment, and lifestyle modifications.
Syncope dr yate
Syncope is defined as a brief, self-limited loss of consciousness due to reduced cerebral blood flow. It is characterized by rapid onset, short duration, and spontaneous recovery. The document discusses the various causes of syncope including neurally-mediated (vasovagal), orthostatic, cardiac, and others. It outlines the evaluation process including history, physical exam, ECG, and cardiac monitoring. Further tests like tilt table testing and electrophysiology studies may be used depending on the suspected cause to determine the etiology and appropriate treatment. The history is critical to differentiate syncope from other mimics and identify high-risk patients who require more extensive cardiac evaluation and monitoring.
Aproach to syncope
Syncope, or fainting, is caused by insufficient blood flow to the brain. It is usually brief and self-limited. Evaluation of syncope involves obtaining a detailed history, physical exam, ECG, and testing based on risk factors. Causes are categorized as benign if due to things like vasovagal response, or dangerous if due to cardiac arrhythmias. High-risk patients warrant further cardiac workup and monitoring, while low-risk patients can often be evaluated as outpatients.
Approach to palpitations
This document discusses the approach to evaluating and managing palpitations. It defines palpitations as an awareness of heartbeat and describes potential causes like arrhythmias, structural heart issues, and psychiatric factors. The evaluation involves taking a history of symptoms and triggers, examining for irregularities, and testing with ECG, Holter monitor or event recorder depending on frequency. Management depends on the identified cause, with arrhythmias potentially treated with beta blockers and reassuring patients if no serious issues are found.
Palpitations
This document discusses the evaluation and management of palpitations. It begins with definitions and introduces common causes of palpitations including arrhythmias, augmentation of heart contractility, and cardiac neurosis. The diagnostic pathway involves obtaining a thorough history, physical exam including ECG, and potential additional testing such as echocardiogram, Holter monitor, or cardiac MRI if indicated. The document provides details on the diagnostic criteria and clinical findings of various cardiac and extracardiac conditions that can cause palpitations. Management is tailored based on the underlying cause.
Syncope 1
Syncope refers to a transient loss of consciousness due to decreased cerebral blood flow. It accounts for 1% of hospital admissions. The main causes are neurally mediated syncope and cardiac syncope. Neurally mediated syncope involves a sudden change in autonomic activity leading to bradycardia and vasodilation. Orthostatic hypotension is a manifestation of sympathetic vasoconstrictor failure and involves a drop in blood pressure within 3 minutes of standing. Treatment focuses on fluid intake, avoidance of triggers, and medication in refractory cases.
Acute Decompensated Heart Failure
An overweight middle-aged man presented with acute shortness of breath, elevated blood pressure, coarse lung sounds, low oxygen saturation, and leg swelling. His initial evaluation found signs of severe congestive heart failure including pulmonary edema. Further assessment is needed to determine the underlying cause, guide treatment, and classify the type and severity of heart failure.
Approach to a bleeding child
This document discusses the approach to managing bleeding in children. It covers various causes of bleeding including platelet disorders like thrombocytopenia from conditions like ITP, coagulation disorders, and dysfunctional fibrinolysis. It provides details on evaluating the clinical history and performing examinations and lab tests to identify the underlying cause. Specific conditions discussed in more depth include ITP, hemophilia, vitamin K deficiency, and DIC. Treatment approaches are described for replacing coagulation factors, corticosteroids, IVIG, platelet transfusions, and managing thrombotic disorders.
Approach to Syncope
This document provides an overview of syncope (transient loss of consciousness). It defines syncope and discusses mechanisms and common causes. Cardiac causes include arrhythmias and structural heart issues. Common non-cardiac causes are neurocardiogenic syncope and orthostatic hypotension. The document outlines how to take a history and perform an exam for a syncope patient. It recommends ECG, monitoring, and risk stratification. The summary emphasizes differentiating cardiac from non-cardiac syncope, as cardiac causes have higher mortality and recommends not missing life-threatening conditions.
HYPERTENSION EMERGENCY & URGENCY
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
SVT in pediatrics
This document discusses supraventricular tachycardia (SVT) in pediatric patients. SVT is the most common abnormal heart rhythm seen in children and the most common arrhythmia requiring treatment. It is usually caused by re-entry mechanisms involving an accessory pathway or the atrioventricular node. Diagnosis involves obtaining an electrocardiogram during episodes to identify P wave patterns. Treatment options include vagal maneuvers, medications like adenosine, calcium channel blockers, or beta blockers, and cardioversion. Radiofrequency ablation can provide a cure for refractory or recurrent cases. Proper diagnosis of the underlying SVT mechanism guides selection of the most appropriate treatment approach.
Approach to palpitation [autosaved]
This document discusses the clinical approach to evaluating patients presenting with palpitations. It defines palpitations and describes the physiology and common causes. Cardiac causes account for 43% of cases, while psychiatric conditions cause 31%. The document outlines the diagnostic evaluation including history, physical exam, ECG and ambulatory monitoring. It provides guidance on when to refer to cardiology or admit to the hospital. The management focuses on reassurance, lifestyle changes, treating underlying conditions, anxiolytics, beta-blockers, antiarrhythmics or cardioversion depending on the severity and nature of the arrhythmia.
What's hot (20)
General approach and differential diagnosis of coma
General approach and differential diagnosis of coma
Similar to Syncope in children
Approach to syncope in Emergency Department
Transient loss of consciousness is known as syncope. It is caused by a lack of oxygen to the brainstem due to a drop in cardiac output. The most common cause is a reflex response leading to vasodilatation and bradycardia. Etiologies include neurally-mediated, orthostatic, cardiac arrhythmias, structural heart disease, and neurologic causes. Evaluation involves ECG, labs, and imaging depending on suspected etiology. Treatment focuses on ACLS for unstable patients and managing the underlying cause. Patients are admitted or discharged based on risk factors and etiology.
Differential Diagnosis of Syncope
Syncope, or fainting, is a brief loss of consciousness caused by reduced blood flow to the brain. It can be triggered by standing for long periods, hot environments, exercise, or medical conditions affecting the heart or blood vessels. The major types of syncope are vasovagal, which involves a reflex drop in heart rate and blood pressure, cardiac syncope caused by abnormalities of heart rhythm or function, and orthostatic (or postural) syncope brought on by standing up. Evaluation involves medical history, physical exam, ECG, echocardiogram and tests to check for underlying heart, brain or blood vessel diseases.
Heart failure update 2012
This document provides an overview of heart failure, including its definition, pathophysiology, types, causes, symptoms, diagnosis, prognosis, and treatment options. It discusses systolic and diastolic heart failure, highlighting key differences. Medical treatments that improve survival in systolic heart failure are reviewed, including ACE inhibitors, beta blockers, spironolactone/eplerenone, hydralazine/nitrates, and ARBs. The roles of diuretics, neurohormonal activation, and beta blockers are explained. Carvedilol is positioned as superior to metoprolol based on direct comparison trials.
acute heart failure.pptx
AHF is a leading cause of hospitalization in older adults and is associated with high mortality and readmission rates, with in-hospital mortality ranging from 4-10% and 1-year mortality after discharge reaching 25-30% or higher. AHF can be the first presentation of heart failure or a decompensation of known heart failure. It is classified by reduced or preserved ejection fraction and NYHA functional classification. Common causes include myocardial infarction, drugs, arrhythmias, valve dysfunction, and cardiomyopathy. Diagnosis involves clinical signs and symptoms overlapping with other conditions, along with diagnostic tests like ECG, imaging, and natriuretic peptide levels. Presentations include acute decompensated heart failure, acute pulmonary edema
Cardiology for g psaediatrics[1]
1. Syncope is often related to cardiac causes in adults. Common cardiac causes include structural heart disease, arrhythmias, and obstructive lesions.
2. Long QT syndrome is an inherited condition that can cause syncope, seizures, or sudden cardiac death, especially with exercise or emotions. It is diagnosed by an elongated QT interval on ECG.
3. Congenital heart defects can cause left-to-right shunts, obstructive lesions, or valvular issues, each with their own pathophysiology that can potentially lead to syncope.
cardio emergencies I.pptx
It includes emergency situations related to the cardiovascular aspect of humans. it focuses on the critical care aspect to manage certain emergencies. Nursing care is also included thus, fosters a better aspect of nursing individuals to manage a cardiovascular emergency.
SHOCK_2.ppt
This document discusses different types of shock, including their causes, pathophysiology, clinical features, diagnosis, and treatment. It defines shock as a life-threatening condition where inadequate perfusion leads to tissue hypoxia and organ damage. The main types of shock covered are hypovolemic, cardiogenic, obstructive, distributive (septic, anaphylactic, neurogenic), and their compensatory mechanisms. Effective treatment depends on identifying the specific cause of shock in each case.
Approach to a patient with palpitations
Palpitations refer to an uncomfortable awareness of one's own heartbeat and can occur due to cardiac arrhythmias, drug or substance use, medical conditions affecting the heart or metabolism, psychiatric issues, or structural heart abnormalities. A thorough history and physical exam aims to determine the nature, triggers, and underlying cause of the palpitations. Additional testing like ECG, Holter monitoring, echocardiogram, or electrophysiology study may help detect and diagnose any cardiac arrhythmias present.
sheikh Jeelani sadiq internal disease.pptx
This document provides an overview of left ventricular failure, hypertensive crises, their diagnosis, complications, and emergency care. It begins with definitions and types of left ventricular failure, risk factors, and symptoms. Physical exam findings and diagnostic tests for left ventricular failure are outlined. Differential diagnoses and potential complications are described. Emergency care steps for left ventricular failure are mentioned. Hypertensive crisis is defined and causes, symptoms, diagnostic tests, complications are outlined. The conclusion summarizes that left ventricular failure reduces the heart's ability to pump blood, while hypertensive crisis is very high blood pressure that requires immediate treatment to prevent organ damage.
Stroke (Ischemic and Hemorrhagic)
In this presentation, I have described stroke and its subtypes, the ischemic stroke and the hemorrhagic stroke, their diagnosis, clinical manifestations and treatments.
Management of shock in children
This document provides guidelines for the management of shock in children. It defines shock as a pathophysiological state characterized by inadequate tissue perfusion. The main types of shock are hypovolemic, distributive, cardiogenic, and obstructive. Initial evaluation of a child in shock involves assessing appearance, breathing, and circulation to identify life-threatening conditions and classify shock severity and type. Management begins with oxygen, IV access, glucose check, and fluid boluses. Further treatment depends on shock type but may include antibiotics for sepsis, vasoactive drugs for cardiogenic shock, or epinephrine for anaphylaxis. Children are monitored for response and complications, with transfer to ICU for non-responders.
2cardiac arrhytmia
Cardiac arrhythmia refers to abnormal cardiac rhythm involving changes in rate or regularity. Causes can be physiological due to autonomic nervous system changes or pathological factors like valvular heart disease, ischemic heart disease, cardiomyopathies, or drug effects. Clinical evaluation involves physical exam findings like palpitations or abnormal pulse, and diagnostic tests like ECG, EP testing, or lab tests checking electrolyte levels. Arrhythmias occur via disorders of impulse formation, conduction, or a combination. They are described by rate, origin, pattern, and duration. Treatment involves antiarrhythmic drugs that alter automaticity, conduction velocity, or refractory periods.
Syncope
This document discusses syncope, which is a brief loss of consciousness due to decreased blood flow to the brain. It can be caused by cardiac issues like aortic stenosis or arrhythmias, neurological issues like carotid sinus hypersensitivity, orthostatic changes in blood pressure, psychiatric conditions, or certain medications. The evaluation of syncope involves taking a detailed history, performing a physical exam focusing on cardiovascular and neurological systems, doing tests like an ECG, labs, and tilt table testing, and considering imaging if needed to diagnose the underlying cause. Treatment depends on the identified cause but the goal is to prevent future episodes.
syncope.ppt
This document discusses syncope, including its definition, mechanisms, causes, evaluation, and management. Key points include:
1. Syncope is defined as a transient loss of consciousness due to decreased blood flow to the brain. Common causes include neurally-mediated syncope, orthostatic hypotension, and cardiac arrhythmias or structural heart disease.
2. Evaluation of syncope involves determining if the loss of consciousness is attributable to syncope, assessing for underlying heart disease, and identifying important historical features that suggest potential causes. Initial testing may include ECG, cardiac monitoring, and tilt table testing.
3. Insertable loop recorders can help correlate transient symptoms to arrhythmias when events are
Heart failure
Heart failure (HF), often used to mean chronic heart failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the needs of the body.
Cardiomyopathy Edited for medical students.pptx
Different types of cardiomyopathies and management plans
Loss of Conciousness
This is about the symptoms of Loss of Conciousness.
The symptomology that differentiates 2 basic causes- seizures and syncope amongst other causes.
Cardiac Failure, Cardiac Shock, Cardiac Arrest, PPT
The Advanced Cardiovascular Life Support (ACLS) algorithm is a systematic, evidence-based approach designed to guide healthcare providers in the urgent treatment of: Cardiac arrest. Arrhythmias. Stroke. Other life-threatening cardiovascular emergencies.
Evaluation of syncope in adults
This document discusses the evaluation of syncope in adults. Syncope is defined as a brief, self-limited loss of consciousness due to decreased blood flow to the brain. The causes of syncope can be categorized as neurally-mediated, orthostatic, cardiac, or structural/cardiopulmonary. A thorough history, physical exam, and diagnostic testing are needed to determine the underlying cause and guide treatment. The history provides clues to distinguish syncope from other conditions and identify risk factors, while the physical exam focuses on vital signs and signs of end-organ damage or dysfunction.
Congestive Cardiac Failure presentation and diagnosis
This document provides an overview of congestive heart failure (CHF), including its definition, causes, pathophysiology, clinical manifestations, diagnostic evaluation, and management. CHF is defined as a clinical syndrome where the heart cannot pump enough blood to meet the body's needs. It is most commonly caused by conditions that overload or damage the heart such as hypertension, heart attacks, and cardiomyopathy. Clinically, it presents with symptoms of fluid backup like dyspnea, edema, and fatigue. Diagnostic tests include chest x-rays, EKGs, blood tests like BNP, and echocardiography. Treatment focuses on managing symptoms, addressing the underlying cause, and preventing complications through medications, lifestyle changes, and potentially devices
Similar to Syncope in children (20)
Cardiac Failure, Cardiac Shock, Cardiac Arrest, PPT
Cardiac Failure, Cardiac Shock, Cardiac Arrest, PPT
Congestive Cardiac Failure presentation and diagnosis
Congestive Cardiac Failure presentation and diagnosis
Recently uploaded
11.1 Role of physical biological in deterioration of grains.pdf
Storagedeteriorationisanyformoflossinquantityandqualityofbio-materials.
Themajorcausesofdeteriorationinstorage
•Physical
•Biological
•Mechanical
•Chemical
Storageonlypreservesquality.Itneverimprovesquality.
Itisadvisabletostartstoragewithqualityfoodproduct.Productwithinitialpoorqualityquicklydepreciates
Direct Seeded Rice - Climate Smart Agriculture
Direct Seeded Rice - Climate Smart AgricultureInternational Food Policy Research Institute- South Asia Office
PPT on Direct Seeded Rice presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
The cost of acquiring information by natural selection
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
Equivariant neural networks and representation theory
Or: Beyond linear.
Abstract: Equivariant neural networks are neural networks that incorporate symmetries. The nonlinear activation functions in these networks result in interesting nonlinear equivariant maps between simple representations, and motivate the key player of this talk: piecewise linear representation theory.
Disclaimer: No one is perfect, so please mind that there might be mistakes and typos.
dtubbenhauer@gmail.com
Corrected slides: dtubbenhauer.com/talks.html
THEMATIC APPERCEPTION TEST(TAT) cognitive abilities, creativity, and critic...
THEMATIC APPERCEPTION TEST(TAT) cognitive abilities, creativity, and critic...Abdul Wali Khan University Mardan,kP,Pakistan
hematic appreciation test is a psychological assessment tool used to measure an individual's appreciation and understanding of specific themes or topics. This test helps to evaluate an individual's ability to connect different ideas and concepts within a given theme, as well as their overall comprehension and interpretation skills. The results of the test can provide valuable insights into an individual's cognitive abilities, creativity, and critical thinking skillsThe binding of cosmological structures by massless topological defects
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
concentrically a number of such topological defects can establish a flat stellar or galactic rotation curve, and can also deflect
light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
mitigated, at least in part.
快速办理(UAM毕业证书)马德里自治大学毕业证学位证一模一样
学校原件一模一样【微信：741003700 】《(UAM毕业证书)马德里自治大学毕业证学位证》【微信：741003700 】学位证，留信认证（真实可查，永久存档）原件一模一样纸张工艺/offer、雅思、外壳等材料/诚信可靠,可直接看成品样本，帮您解决无法毕业带来的各种难题！外壳，原版制作，诚信可靠，可直接看成品样本。行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备。十五年致力于帮助留学生解决难题，包您满意。
本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
【主营项目】
一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
Authoring a personal GPT for your research and practice: How we created the Q...
Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
ESR spectroscopy in liquid food and beverages.pptx
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
Shallowest Oil Discovery of Turkiye.pptx
The Petroleum System of the Çukurova Field - the Shallowest Oil Discovery of Türkiye, Adana
The debris of the ‘last major merger’ is dynamically young
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
Compexometric titration/Chelatorphy titration/chelating titration
Classification
Metal ion ion indicators
Masking and demasking reagents
Estimation of Magnisium sulphate
Calcium gluconate
Complexometric Titration/ chelatometry titration/chelating titration, introduction, Types-
1.Direct Titration
2.Back Titration
3.Replacement Titration
4.Indirect Titration
Masking agent, Demasking agents
formation of complex
comparition between masking and demasking agents,
Indicators/Metal ion indicators/ Metallochromic indicators/pM indicators,
Visual Technique,PM indicators (metallochromic), Indicators of pH, Redox Indicators
Instrumental Techniques-Photometry
Potentiometry
Miscellaneous methods.
Complex titration with EDTA.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
在线办理(salfor毕业证书)索尔福德大学毕业证毕业完成信一模一样
学校原件一模一样【微信：741003700 】《(salfor毕业证书)索尔福德大学毕业证》【微信：741003700 】学位证，留信认证（真实可查，永久存档）原件一模一样纸张工艺/offer、雅思、外壳等材料/诚信可靠,可直接看成品样本，帮您解决无法毕业带来的各种难题！外壳，原版制作，诚信可靠，可直接看成品样本。行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备。十五年致力于帮助留学生解决难题，包您满意。
本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
【主营项目】
一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
Recently uploaded (20)
11.1 Role of physical biological in deterioration of grains.pdf
11.1 Role of physical biological in deterioration of grains.pdf
The cost of acquiring information by natural selection
The cost of acquiring information by natural selection
GBSN - Biochemistry (Unit 6) Chemistry of Proteins
GBSN - Biochemistry (Unit 6) Chemistry of Proteins
Equivariant neural networks and representation theory
Equivariant neural networks and representation theory
THEMATIC APPERCEPTION TEST(TAT) cognitive abilities, creativity, and critic...
THEMATIC APPERCEPTION TEST(TAT) cognitive abilities, creativity, and critic...
The binding of cosmological structures by massless topological defects
The binding of cosmological structures by massless topological defects
Authoring a personal GPT for your research and practice: How we created the Q...
Authoring a personal GPT for your research and practice: How we created the Q...
ESR spectroscopy in liquid food and beverages.pptx
ESR spectroscopy in liquid food and beverages.pptx
The debris of the ‘last major merger’ is dynamically young
The debris of the ‘last major merger’ is dynamically young
Compexometric titration/Chelatorphy titration/chelating titration
Compexometric titration/Chelatorphy titration/chelating titration
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Syncope in children
- 1. Syncope(fainting) Prepared by: Hemin Jamal Supervised by: Dr. Aso Faiq
- 2. What is syncope Sudden transient loss of consciousness with loss of postural tone(falling) which is followed by spontaneous and complete recovery. Usually it is due to cerebral hypoperfusion.
- 3. Neurologic Vasovagal syncope(pain,fear, Sight of blood) Situational(cough, defecation, micturition , swallowing….) Breath-holding spells Causes
- 4. Cardiovascular Primary electrical disorder Tachyarrthmia SVT,WPW VT Braddyarrhythmia Sick sinus syndrome Heart block Long QT syndrome
- 5. Outflow obstruction Aortic stenosis Hypertrophic obstructive cardiomyopathy Pulmonary hypertension Pulmonary stenosis Poor contractility Congestive heart failure Myocarditis Dilated cardiomyopathy
- 6. Orthostatic hypotension Hypovolemia(dehydration) Adrenal Insufficiency Other Anemia Hypoglycemia Medication ingestions Conversion disorder
- 8. Cardiogenic
- 9. Neurogenic
- 10. History Patient: collapsed , passed out ,drop out It is syncope or not? (presyncope ,seizure) Precipitating factor( standing, pain, emotion fear ) Prodrome (sweating, pallor, dizziness, visual change) Duration of unconsciousness
- 11. Was there associated chest pain, palpitations, or rapid heart rate Were there symptoms of dehydration, vomiting, and diarrhea . Past medical hx congenital heart disease, cardiac diseases Drug hx; diuretics , beta blocker, Drugs prolonging QT interval Family hx : Early cardiac death <45y Familial cardiomyopathy
- 12. Physical examination 1.Vital signs Make sure to take orthostatic vital signs: heart rate and blood pressure in supine, sitting, and standing positions.
- 13. 2. General hydration status, pallor suggesting anemia 3. Cardiac a. Systolic ejection murmurs: AS, hypertrophic obstructive cardiomyopathy b. S3 and S4 suggest heart failure 4. Neurologic: focal deficits, signs of increased intracranial pressure (ICP)/papilledema
- 14. 1.Lab investigations a. glucose and electrolytes b. hematocrit if history or physical examination suggests anemia Investigations
- 15. 2. ECG: evaluate for rate, rhythm, and conduction abnormalities. • Holter monitor • Stress ECG 3.Echocardiography: if needed, to evaluate for obstruction, structural abnormalities
- 16. • palpitations • syncope in the supine position. • absence of a prodrome. • Family history of sudden death, • Syncope with exertion • Systolic ejection murmurs arrhythmia Outflow obstruction syncope History and examination ECG echocardiographyPediatric cardiologist
- 17. • Symptoms of dehydration, vomiting, and diarrhea suggesting hypovolemia. • BP drop(>20) during standing. • Episodes occurring after coughing, urination, defecation, or swallowing? Orthostatic hypotension Situational Syncope History and examination • Rehydration • Non pharmacotherapy • Reassurance • Non pharmacotherapy • Triggered by prolonged standing, pain, or unpleasant environment • Prodrome of sweating, nausea, vomiting, dizziness, feeling cold Vasovagal attack • Reassurance • Non pharmacotherapy
- 18. Non pharmacological Avoidance of precipitating factors Awareness of prodrome Behavior modification with regard to changing position from supine to standing Avoidance of volume depletion
Editor's Notes
- Sit or lie down quickly: Have your child sit and bend over to put his head between his knees, or lie down if he feels lightheaded or dizzy. This helps to increase blood flow to his heart and brain. Change position carefully: Remind your child to change positions slowly. Teach him to take deep breaths before he sits or stands up. He may need to move his legs frequently if he sits or stands for long periods of time. TREATMENT Most patients with neurocardiogenic syncope will experience eventual resolution by adulthood; many even get better spontaneously within a few months or years. Many therapies have been employed for this condition, but it is difficult to determine which ones are truly effective because of the lack of randomized prospective studies. Nonetheless, initial salt and water supplementation is commonly recommended, particularly in those who have a low-salt diet or who have limited their fluid intake. A reasonable second step is treatment with fludrocortisone, a mineralocorticoid that promotes sodium and water retention with potassium loss. In patients who have a prominent low-bloodpressure response, the α-agonist midodrine may be useful. Both midodrine and fludrocortisone should be managed with careful monitoring of the supine blood pressure, as they may lead to supine hypertension. The most important therapeutic step is educational. Once the young patient is aware of the importance of the prodromal symptoms, they can take appropriate steps to change position and not attempt to remain standing. In many, this is all that is necessary to adequately manage their symptoms