tag:blogger.com,1999:blog-100468462024-03-14T09:23:37.586-04:00Pedi cardiologySome images worth learning from are posted hereBalahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.comBlogger457125tag:blogger.com,1999:blog-10046846.post-82691894888259097142024-01-06T14:32:00.001-05:002024-01-06T14:32:50.312-05:00Management of psychosis with Long QT<p> </p><p align="center" class="MsoNormal" style="text-align: center;"><b><u>Use of anti-psychotic
medications in Long QT<o:p></o:p></u></b></p>
<p class="MsoNormal">General information:<o:p></o:p></p>
<p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><br />
Anti-psychotics that prolong QT<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>i.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Typical anti-psychotics<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Low-potency are associated with higher risk of
QT prolongation<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.5in; mso-add-space: auto; mso-list: l0 level5 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Especially at higher doses – e.g. 2 g of Chlorpromazine
(a phenothiazine)<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->High-potency anti-psychotics<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.5in; mso-add-space: auto; mso-list: l0 level5 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Fluphenazine (a phenothiazine)<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.5in; mso-add-space: auto; mso-list: l0 level5 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Pimozide (Dopamine blocker) – decreases BP.<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>ii.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Atypical anti-psychotics<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Ziprasidone<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Haloperidol<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Quetiapine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Risperidone<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Olanzapine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Thioridazine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Sertindole<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Iloperidone<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Anti-psychotics that do not prolong QT<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Lurasidone (beware, not well tested in female)<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Clozapine<o:p></o:p></p>
<p class="MsoListParagraphCxSpLast" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Aripiprazole (Abilify)<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><u><b>3 categories:</b></u><o:p></o:p></p>
<p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><u>1. At risk for long QT:</u></b><o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Risk factors: <o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>i.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Hypokalemia, Hypocalcemia, Hypomagnesemia<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>ii.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Renal dysfunction, diabetes, hypothyroidism,
malnutrition and obesity – may lead to electrolyte imbalance and therefore, may
cause prolongation of QT.<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Options for management:<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>i.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Check electrolytes and for presence of risk
factors<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>ii.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Telemetry<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>iii.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Baseline EKG for QTc<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>iv.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Avoid psychotic polypharmacy<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>v.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Avoid combining with other meds that prolong QTc<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>vi.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Initial meds<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Quetiapine or Olanzapine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Aripiprazole<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Risperidone<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Haloperiodol – only IM. Low or medium-dose (do
not use IV – higher risk of QT prolongation and TdP)<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>vii.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Atypical anti-psychotics – watch BP.<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>viii.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Discontinue Pimozide if used before.<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>ix.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->If baseline QTc is normal, the following may be
used:<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Fluphenazine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Low dose chlorpromazine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0in; mso-add-space: auto; mso-list: l0 level4 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Ziprasidone (avoid if there is CVD, prior AMI,
CMP, electrolyte abnormality or HT).<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto;"><o:p> </o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><u>2. Long QT < 500 ms:</u></b><o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Aripiprazone<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Olanzapine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Risperidone<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Quetiapine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l0 level3 lfo1; mso-text-indent-alt: -9.0pt; text-indent: -1.5in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>i.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->All 4 of the above cause decrease in BP. Therefore,
watch BP.<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Asenapine<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Lorazepam (2 mg) or Alprazolam (Zanax)<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Others: Ziprasidone, Valproate (check LFT),
trazodone. <o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto;"><o:p> </o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b><u>3. Long QT > 500 ms:</u></b><o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->If QTc > 500 ms during treatment – reconsider
that medication<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Rule out other risk factors – electrolyte abnormalities,
drug interactions<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->May use Aripiprazole, Valproate, Trazodone and
Benzodiazepines<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Oral Loxapine (first generation, typical anti-psychotic)
inhalable form.<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->? Perospirone (Japan)<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Discuss in interdisciplinary conferences<o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Discuss in ethics committee – risk of self harm
vs. QT prolongation/TdP.<o:p></o:p></p>
<p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Discuss non-pharmacologic treatments: Family
member stay nearby to calm patient, Music therapy.<o:p></o:p></p>
<p class="MsoNormal">Reference: <a href="https://drive.google.com/file/d/1D6X05h4a8LI-OgWCtzXIofh2ksUKvhdJ/view?usp=sharing">Ries R, Sayadipour A. Management of psychosis andagitation in medical-surgical patients who have or are at risk for prolonged QTinterval. J Psychiatr Practice 2014;20:338-344.</a><o:p></o:p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-55027270407569141532024-01-05T09:58:00.001-05:002024-01-05T09:58:03.931-05:00Andexxa - Recombinant Factor Xa - Antidote for Apixaban and Rivaroxaban<p> Andexxa (Recombinant Factor Xa) - Adnexa net alfa: Received accelerated FDA approval in (?2018)</p><p><br /></p><p>Mechanism of Action:</p><p>Andexanet Alfa - genetically modified variant of human factor Xa (alanine substituted for serine).</p><p>Acts by binding to Factor Xa inhibitors and neutralizes their anticoagulant effect.</p><p>This is useful to reverse the anticoagulant effect caused by Apixaban (Eliquis) and Rivaroxaban (Xarelto).</p><p><br /></p><p>This is the second antidote approved by FDA for Factor Xa inhibitors:</p><p>First one, approved in 2015, was Idarucizumab (Praxbind) - for reversal of direct thrombin inhibitor - Dabigatran etexilate (Pradaxa).</p><p>Above information was taken from this <a href="https://drive.google.com/file/d/1xwEwZrg_7KG7WOnl88WMTdrg7DJeB0wM/view?usp=drive_link" target="_blank">JAMA review article: JAMA 2018;320(4):399-400</a>.</p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-4346072124484723622023-12-04T07:34:00.000-05:002023-12-04T07:34:54.126-05:00Cardioform ASD Occluder - Sizing Chart<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFju9ZLwLLZEAvreC8Zy_yXTroKMSjKM1HrmTvw_Z25r2AOs9cR6bGMIP5UZzlBgx4TA-GTVceFVHGc1pUI3vrGJpoNhdzQ9hi2vZ8iANo_cYGWilEWLXs4Ypl0CYwfpr6MyrNjCTNgIXdCdO9CEcztfbfBUa685fEsQoKdC8c-heCh5HjiBAo4w/s574/Cardioform_ASD_sizing_Chart_20231204.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="376" data-original-width="574" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFju9ZLwLLZEAvreC8Zy_yXTroKMSjKM1HrmTvw_Z25r2AOs9cR6bGMIP5UZzlBgx4TA-GTVceFVHGc1pUI3vrGJpoNhdzQ9hi2vZ8iANo_cYGWilEWLXs4Ypl0CYwfpr6MyrNjCTNgIXdCdO9CEcztfbfBUa685fEsQoKdC8c-heCh5HjiBAo4w/s320/Cardioform_ASD_sizing_Chart_20231204.png" width="320" /></a></div><br /><p></p><p><br /></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-14641025634296849042023-08-22T08:35:00.003-04:002023-10-04T15:21:07.725-04:00Long QT and antiemetics<a href="https://www.clinicalcorrelations.org/2021/01/15/antiemetics-and-qt-prolongation/#:~:text=Antiemetics%20That%20Do%20Not%20Cause%20QTc%20Prolongation&text=Scopolamine%20is%20an%20antimuscarinic%20mediation,does%20not%20prolong%20the%20QTc.">Click here</a> for the original article on this.<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeQakzXqmamuz3s6s6GBZza0t1TP5n05M4vXMuB3dl4oyGG4SsC6BoY6NTyIReWyO-A1PiAOtRxbr2hFtsBI_eNA5qIWLoleGl1teo0gQsuftWPx1zfPKgTWMCf2m0kr4-kB1cJbLGdswElMO1jtOEYNkwf25b0W8hpR1d2eQx6336x-YCDdU86A/s648/Antiemetics_table_clinicalcorrelations.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="562" data-original-width="648" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeQakzXqmamuz3s6s6GBZza0t1TP5n05M4vXMuB3dl4oyGG4SsC6BoY6NTyIReWyO-A1PiAOtRxbr2hFtsBI_eNA5qIWLoleGl1teo0gQsuftWPx1zfPKgTWMCf2m0kr4-kB1cJbLGdswElMO1jtOEYNkwf25b0W8hpR1d2eQx6336x-YCDdU86A/s320/Antiemetics_table_clinicalcorrelations.jpg" width="320" /></a></div><div><br /></div><div>Reference: Offer Fass MD. Antiemetics and QT prolongation. www.Clinicalcorrelations.org. Posted Jan 15, 2021.</div><div><a href=" https://www.clinicalcorrelations.org/2021/01/15/antiemetics-and-qt-prolongation/#:~:text=Antiemetics%20That%20Do%20Not%20Cause%20QTc%20Prolongation&text=Scopolamine%20is%20an%20antimuscarinic%20mediation,does%20not%20prolong%20the%20QTc. " target="_blank"> https://www.clinicalcorrelations.org/2021/01/15/antiemetics-and-qt-prolongation/#:~:text=Antiemetics%20That%20Do%20Not%20Cause%20QTc%20Prolongation&text=Scopolamine%20is%20an%20antimuscarinic%20mediation,does%20not%20prolong%20the%20QTc. </a></div><div><br /></div>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-82718302481465278042023-08-16T03:15:00.007-04:002023-08-18T07:55:39.959-04:00Long QT - drugs list by therapeutic category<p><a href="https://docs.google.com/document/d/1yrhyPZj2lYTFrnxiRfbF6rhjs-umwD3O/edit?usp=sharing&ouid=115604702923685836338&rtpof=true&sd=true" target="_blank"> Click here</a> for a drug list - to avoid and usable, by therapeutic category in Long QT syndrome. Downloaded on Aug 16, 2023 from CredibleMed.Org</p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-10420418691574463562023-04-17T11:38:00.001-04:002023-04-17T11:38:08.143-04:00Risk Stratification in Arrhythmic Mitral Valve Prolapse (Mitral Annular Dysjunction)<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgywxugTdomTuXv4mEnOxqwCB7HnGVGYd-A8k1CcYbROMfibK8i1VYfhih3drXHv8Lk-394MvPIjMTRliaXQ5zVUXwvMU1PcCn3QL11Y--eV_K6oQq1PBsUc4Hll8Z5dIK0I018x-CWFJGpIBXr4FWNEK3mT4Yn6OHKZO736R8wOOZtWVx66Jg/s1280/Arrhythmic_MVP_Risk_stratification.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgywxugTdomTuXv4mEnOxqwCB7HnGVGYd-A8k1CcYbROMfibK8i1VYfhih3drXHv8Lk-394MvPIjMTRliaXQ5zVUXwvMU1PcCn3QL11Y--eV_K6oQq1PBsUc4Hll8Z5dIK0I018x-CWFJGpIBXr4FWNEK3mT4Yn6OHKZO736R8wOOZtWVx66Jg/s320/Arrhythmic_MVP_Risk_stratification.png" width="320" /></a></div><br /> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-52708236795979080582023-03-20T07:52:00.005-04:002023-03-20T07:52:59.195-04:00Myocarditis Management - Circulation:Heart Failure (Adult)<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi512sBOy2O1RmdjziVUKvRwtYjrnB3PYHKt3igFQ4RkgnxZFONSjXOdWx1SfDq7pu_Zhx9XBDCV9yI7HEn5DC51cawZFiUNQkSs5Oi_pGTpXuCwdS7WBiC5qSzlJsX3BbM06dgLLcSUDaE7Ofx9wbD7lubb_xiT9SOAS9NaMfoc9PhA3r2kQ/s850/Management%20plan%20for%20myocarditis_2020_Circulation.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="676" data-original-width="850" height="254" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi512sBOy2O1RmdjziVUKvRwtYjrnB3PYHKt3igFQ4RkgnxZFONSjXOdWx1SfDq7pu_Zhx9XBDCV9yI7HEn5DC51cawZFiUNQkSs5Oi_pGTpXuCwdS7WBiC5qSzlJsX3BbM06dgLLcSUDaE7Ofx9wbD7lubb_xiT9SOAS9NaMfoc9PhA3r2kQ/s320/Management%20plan%20for%20myocarditis_2020_Circulation.png" width="320" /></a></div><br /> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-21793158961301840732023-01-10T15:11:00.005-05:002023-01-10T15:11:29.042-05:00Coronary Fistula vs. VSD. Difference in Doppler trace (timing of the trace)<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLkDkfmIJm9o9JbXFxp1hnd9VYTgHS-GINm-P8guY_GBYIOowFJRTSkigJGs6oYxuNiWj1w2t-AfAMFGAjPkQH1drCysOeqFI56nwU2quXooluatTpebdhL_34swWY39Y-QICC24UOQMDvYs3hjk9O9GZ_eN4_I3j7O4u5uRL0RA7SJIpIqVM/s1280/Coronary_fistula_vs_VSD_Doppler_Trace_comparison_difference.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLkDkfmIJm9o9JbXFxp1hnd9VYTgHS-GINm-P8guY_GBYIOowFJRTSkigJGs6oYxuNiWj1w2t-AfAMFGAjPkQH1drCysOeqFI56nwU2quXooluatTpebdhL_34swWY39Y-QICC24UOQMDvYs3hjk9O9GZ_eN4_I3j7O4u5uRL0RA7SJIpIqVM/s320/Coronary_fistula_vs_VSD_Doppler_Trace_comparison_difference.PNG" width="320" /></a></div><p><br /></p>Doppler flow peak in systole in VSD, but it peaks in diastole in coronary fistula.<br /> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-90991810191454121152022-10-25T03:15:00.008-04:002023-09-22T08:35:15.646-04:00Bronchopulmonary dysplasia_Pulmonary Hypertension_European algorithm<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8yUabEQCh7uLf1Z_FBHWZoHwxd4rx2M7yilU20dsjXUn4iHqAeCF5zNPuKh6cleqlUNKfXfKUxc_0B7YswtWNvo415iXoxKjofTokMaTJCde1W1LKqkmddDzgh3SADbGwDJo9TmlUFVFajSdmSA1zOj6t3uGFGCyRn6SMQH_nityujr5cCHI/s615/bpd_ph_MANAGEMENT_ALGORITHM_EUROPEAN.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="615" data-original-width="599" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8yUabEQCh7uLf1Z_FBHWZoHwxd4rx2M7yilU20dsjXUn4iHqAeCF5zNPuKh6cleqlUNKfXfKUxc_0B7YswtWNvo415iXoxKjofTokMaTJCde1W1LKqkmddDzgh3SADbGwDJo9TmlUFVFajSdmSA1zOj6t3uGFGCyRn6SMQH_nityujr5cCHI/s320/bpd_ph_MANAGEMENT_ALGORITHM_EUROPEAN.png" width="312" /></a></div><br /> From <a href="https://pubmed.ncbi.nlm.nih.gov/32521539/">Hansmann G, et al. Pediatr Research 2021;89:446-455</a>.<p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-10452230273843905482022-10-09T06:44:00.019-04:002022-10-09T07:13:58.614-04:00Rivaroxaban (Xarelto) for Post-Fontan children<p>Source: <a href="https://www.xareltohcp.com/pediatric-indications/pediatric-post-fontan#clinical-trial" target="_blank">Manufacturer webpage</a></p><p>UNIVERSE clinical trial</p><p></p><ul style="text-align: left;"><li>n = 112 (Final n = 98, 64 Rivaroxaban, 34 Aspirin)</li><li>Randomized 2:1 (Rivaroxaban : Aspirin) </li><li>Open label Rivaroxaban vs. Usual Aspirin.</li><li>Age 2-8 yrs</li><li>Follow up for 12 months.</li></ul><p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2wn1xB3rFvp0Ehsxa6bW7Z9eUOZBNGraY3pJYXCyg-YrLxEoxy4kqyEXQ-1JKVBRLzjtzzJO2DIdLaFgHRmP-ya-gOD183x0Tm60LOty-Sa5fxi0NAfZII1ebnnzJ-BkwcKHBKH9Gwfqrqkuiub843QjHHAPUEXw7IJnHYXOH-ooRjWEH7EY/s848/Xarelto_dose_postFontan.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="456" data-original-width="848" height="172" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2wn1xB3rFvp0Ehsxa6bW7Z9eUOZBNGraY3pJYXCyg-YrLxEoxy4kqyEXQ-1JKVBRLzjtzzJO2DIdLaFgHRmP-ya-gOD183x0Tm60LOty-Sa5fxi0NAfZII1ebnnzJ-BkwcKHBKH9Gwfqrqkuiub843QjHHAPUEXw7IJnHYXOH-ooRjWEH7EY/s320/Xarelto_dose_postFontan.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQeZsdlrzZqWYIm53vPDDQ3XbqtoFotGGFdJgmbHYJzeVLumPjIhnei8DXkgJN55bXTSdZXnERNQO4AbazZ_vFnUA57QO-HAsMXF-0epU3rqnN8H0Iv8fhBxnGn_XyPlKagUtNRKRA0NJNi0rBJ6ri3sobjeAtsnoQnI8OJm4NgCqEcIX3uBo/s574/Xarelto_efficacy_webpage.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="456" data-original-width="574" height="254" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQeZsdlrzZqWYIm53vPDDQ3XbqtoFotGGFdJgmbHYJzeVLumPjIhnei8DXkgJN55bXTSdZXnERNQO4AbazZ_vFnUA57QO-HAsMXF-0epU3rqnN8H0Iv8fhBxnGn_XyPlKagUtNRKRA0NJNi0rBJ6ri3sobjeAtsnoQnI8OJm4NgCqEcIX3uBo/s320/Xarelto_efficacy_webpage.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnWjYxAYOPphlbKGx9qMBr2Bc2uEIdhrVXQ3G0Mtx2eG3S361jEnXoXQIbmLUvHuRVXoalNaR2GOFm-dkBYAU8SWlJHxymXqMicsORhdgi95J1m8KZUil0Bc6yrZw1H4i-hMkHtK18CsCRG-4Gq8oRDvm8jPW8t9CbfNeeuFZEu7sNaFSyJOo/s758/Xarelto_safety%20profile.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="456" data-original-width="758" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnWjYxAYOPphlbKGx9qMBr2Bc2uEIdhrVXQ3G0Mtx2eG3S361jEnXoXQIbmLUvHuRVXoalNaR2GOFm-dkBYAU8SWlJHxymXqMicsORhdgi95J1m8KZUil0Bc6yrZw1H4i-hMkHtK18CsCRG-4Gq8oRDvm8jPW8t9CbfNeeuFZEu7sNaFSyJOo/s320/Xarelto_safety%20profile.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></div></div><br /><br /><p><br /></p><p> </p><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-51979404162385092472022-07-22T10:15:00.006-04:002022-12-15T08:14:26.452-05:00Myocarditis risk is lower if interval between doses of Covid Vaccine increased to > 8 weeks (CDC slide)<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh02LywFBZIc8TcdcFQCw1Ods50yqHZpKrDmAjk1hBEIqdNP95kjiJC-iLi9Cyp007eeT4ZTDg6WGmYXupBlJ4ZwnHMEk9Hupm_8dOmZBo9tBIaSoK0_jvMXJWX5RIoVXtBupZeSJxANyMyxdUV01hRiwzr15tOtmON2PAatS020lrB56_WU6A/s1280/Myocarditis_Vaccine_dose_interval.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh02LywFBZIc8TcdcFQCw1Ods50yqHZpKrDmAjk1hBEIqdNP95kjiJC-iLi9Cyp007eeT4ZTDg6WGmYXupBlJ4ZwnHMEk9Hupm_8dOmZBo9tBIaSoK0_jvMXJWX5RIoVXtBupZeSJxANyMyxdUV01hRiwzr15tOtmON2PAatS020lrB56_WU6A/s320/Myocarditis_Vaccine_dose_interval.png" width="320" /></a></div><br /><p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-92189026537914886992022-05-26T22:46:00.007-04:002022-05-26T22:46:36.143-04:00Causes of Troponin elevation<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil9mYUIuKkNijXXO1-8viW69oN2o2bOSubFo2OKqdrUIQ4ZwYVRb4MXP0jS_ffocILHH96fGeMVzdaojEqALnjyRbeU0ksEtPRukPXWTOAuolFJhMVBG9VFBfb7TSgseIwGwTG1fofPhN0CfL5RZJiXwEf590z53dJ2acB1m43gUTKxrupyoM/s854/Troponin%20elevation%20causes.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="615" data-original-width="854" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil9mYUIuKkNijXXO1-8viW69oN2o2bOSubFo2OKqdrUIQ4ZwYVRb4MXP0jS_ffocILHH96fGeMVzdaojEqALnjyRbeU0ksEtPRukPXWTOAuolFJhMVBG9VFBfb7TSgseIwGwTG1fofPhN0CfL5RZJiXwEf590z53dJ2acB1m43gUTKxrupyoM/s320/Troponin%20elevation%20causes.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p></p><div class="separator" style="clear: both; text-align: left;"><b>Circulation 2011;124:2350-4.</b></div><p></p></blockquote>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-65809536783698652152022-05-16T07:39:00.003-04:002022-05-16T07:39:42.482-04:00Kobayashi Score 2006 - Kawasaki disease<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2CvmTxTr5elkX-bZRhoQ6DAoyWutbLH1_VX-OrMh9GonUu001I-SRC2ftehciI_SaWC6zXgfPBbnxujL9N49ypVf-1rkGesAC8iktfW6jnuQliDHdqm_XQVEJyeIp-OdqE3mcMyZAJFWZX_A_rPuVWJ388aaeOKq-Xbcu9ZegHDFfD1GCV_g/s1280/2006_IVIG_Unresponsiveness_Kobayashi%20Score.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2CvmTxTr5elkX-bZRhoQ6DAoyWutbLH1_VX-OrMh9GonUu001I-SRC2ftehciI_SaWC6zXgfPBbnxujL9N49ypVf-1rkGesAC8iktfW6jnuQliDHdqm_XQVEJyeIp-OdqE3mcMyZAJFWZX_A_rPuVWJ388aaeOKq-Xbcu9ZegHDFfD1GCV_g/s320/2006_IVIG_Unresponsiveness_Kobayashi%20Score.png" width="320" /></a></div><br /><p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-41396026024161703852022-03-10T15:26:00.019-05:002022-03-10T15:35:23.532-05:00Normal values_BP_2017_AAP<p> Reference: <a href="https://doi.org/10.1542/peds.2017-1904" style="background-color: white; border: 0px; color: #303235; cursor: pointer; font-family: "Open Sans", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 12px; margin: 0px; padding: 0px; vertical-align: baseline; word-break: normal;" target="_blank">https://doi.org/10.1542/peds.2017-1904</a></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;">Girls</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiY3V64iTDx4SW6C_lSOXlFImjjSU0VWZWReFJ5-2gUPqmG3SKWTwjnxWHsCITyPK-NMncD4sxY46rOdb0Tmk12Po0lIJiGmsQMD-ga-OVVJZBPMEQLxcLSeC7eaZRFkbvwwqyL0xRyH2VkM3wrFYzhoePNpADwIRu4Ob7MQ--fwZEvlxq26Fo=s1066" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1066" data-original-width="764" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEiY3V64iTDx4SW6C_lSOXlFImjjSU0VWZWReFJ5-2gUPqmG3SKWTwjnxWHsCITyPK-NMncD4sxY46rOdb0Tmk12Po0lIJiGmsQMD-ga-OVVJZBPMEQLxcLSeC7eaZRFkbvwwqyL0xRyH2VkM3wrFYzhoePNpADwIRu4Ob7MQ--fwZEvlxq26Fo=s320" width="229" /></a></div><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgaFb3X42lY1whK6xQsBquyJEYX4a4otgji3Q7wGJSDJnz-cdsA9ETjqPdO9c07xkooQLTA1OFcMEEXtj0O79rRoFyp_yXY6EcINYhrVNIT-xWGlTEkys3Ki027C418BgwjXtPBfnTTrdZ6CsfWjglFBAcM47-YOKO5ic1P8um6muIleVnGK_4=s975" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="975" data-original-width="793" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEgaFb3X42lY1whK6xQsBquyJEYX4a4otgji3Q7wGJSDJnz-cdsA9ETjqPdO9c07xkooQLTA1OFcMEEXtj0O79rRoFyp_yXY6EcINYhrVNIT-xWGlTEkys3Ki027C418BgwjXtPBfnTTrdZ6CsfWjglFBAcM47-YOKO5ic1P8um6muIleVnGK_4=s320" width="260" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="text-align: center;">Boys:</div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; margin-left: 1em; margin-right: 1em; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEg4WlZ_v79UlyIw7ewi1Otjin-_YWDTtvthDVugiKcpaYrJgdHW4zEJ7Sm7LGD_B4PrHEPXND7jqQgxoFijHtzzDhxj9Tvn2Tz5nGoSmHMI0ZFmCRZevLIYK69U5uq75LldyggdR2U63GEyvVZB2b_vm3PZdUV1MvWWY7gn8piQMe64aLzTCbM=s1062" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1062" data-original-width="754" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEg4WlZ_v79UlyIw7ewi1Otjin-_YWDTtvthDVugiKcpaYrJgdHW4zEJ7Sm7LGD_B4PrHEPXND7jqQgxoFijHtzzDhxj9Tvn2Tz5nGoSmHMI0ZFmCRZevLIYK69U5uq75LldyggdR2U63GEyvVZB2b_vm3PZdUV1MvWWY7gn8piQMe64aLzTCbM=s320" width="227" /></a></div><span style="margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEh48fzrZfP870ugqd_mTKoM8S0v2spA4DFxDmMiChnJaIs7sYmcdHsyP1AMQRIEQ4Cxd2bnijJuaLHy8b3KCc0tnvscc_DfQi9ncOUzEu5-HWLKyLkhsMYIDbS9vCQVQ_Diw-K-bMi7-W1dRInSeXDJWCd_JnbmX9tXsEi6bBVx_m1wSf0Qb-E=s1020" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1020" data-original-width="827" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEh48fzrZfP870ugqd_mTKoM8S0v2spA4DFxDmMiChnJaIs7sYmcdHsyP1AMQRIEQ4Cxd2bnijJuaLHy8b3KCc0tnvscc_DfQi9ncOUzEu5-HWLKyLkhsMYIDbS9vCQVQ_Diw-K-bMi7-W1dRInSeXDJWCd_JnbmX9tXsEi6bBVx_m1wSf0Qb-E=s320" width="259" /></a></span></div><br /><a href="https://link.springer.com/article/10.1007/s11906-017-0780-8/tables/3">https://link.springer.com/article/10.1007/s11906-017-0780-8/tables/3</a> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-19077335346035690372022-01-05T14:21:00.006-05:002022-03-01T14:00:11.785-05:00Anti-viral therapy for Covid (as of 1/5/22)<p> 1) Sotrovimab IV (GSK) - Monoclonal antibodies - reduces hospitalization by 90%, effective against Omicron variant.</p><p>2) Oral Paxlovid (Nirmatlevir/Ritonavir, Pfizer) - x 5 days - reduces hospitalization by 90%.</p><p>3) Remdesvir IV (Gilead) - x 3 days - reduces hospitalization by 90%.</p><p>4) Oral Molnupiravir (Merck) - x 5 days - reduces hospitalization by 30%.</p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-88247843227279525742021-11-28T22:21:00.003-05:002021-11-28T22:21:49.443-05:00BNP_NT-ProBNP_Elevation_Causes_Sepsis<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLLTfmeeVSxIBqQWmSq1D7MntcVjuchaI0jgTw-Njg97ZNW_B2NFtLBkwu1vUWAD-Sse_g5_MJe877KgSCPHm42PSxMWeMZogr9ueqZp2Zvtl7ZmQscvjrMGPK4aS584Zpw3CQ1g/s1280/BNP_ProBNP_elevation_causes_sepsis_2019.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLLTfmeeVSxIBqQWmSq1D7MntcVjuchaI0jgTw-Njg97ZNW_B2NFtLBkwu1vUWAD-Sse_g5_MJe877KgSCPHm42PSxMWeMZogr9ueqZp2Zvtl7ZmQscvjrMGPK4aS584Zpw3CQ1g/s320/BNP_ProBNP_elevation_causes_sepsis_2019.png" width="320" /></a></div><br /> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-59033208043850577442021-11-21T13:59:00.003-05:002021-11-21T13:59:54.246-05:00Pfizer vaccine efficacy<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQB7a8oyCgP30ELHS0KYkHMjSguQdMn9OuX-1SHSXFJAlpv8HOWmyI7nZAhyphenhyphenZHQSzSKgMegbJWXd9q6fAJhWA7CC-Cf_BmZ-1VoRSSWrPIHjUh0OqOmch1e15GMHQ1XGdaNniNUA/s1280/20211109_NEJM_Pfizer_6to11yrs_result.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQB7a8oyCgP30ELHS0KYkHMjSguQdMn9OuX-1SHSXFJAlpv8HOWmyI7nZAhyphenhyphenZHQSzSKgMegbJWXd9q6fAJhWA7CC-Cf_BmZ-1VoRSSWrPIHjUh0OqOmch1e15GMHQ1XGdaNniNUA/s320/20211109_NEJM_Pfizer_6to11yrs_result.png" width="320" /></a></div><br /> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-63672022613303917472021-11-01T17:43:00.007-04:002021-11-01T17:45:23.008-04:00EKG changes normal & abnormal for athletes<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKgtH6RDGmiaCMJNtpVBrWmb_Y-rfKfI4Xge2P23tidSxhYFw8SVIiisc0r1D-bYKgJFNYSQYCfuj7mHWJQmFhruw2oftfiQu8v46rkEsdDoIH9vxKjkfNcQ6y4OWq0HCZFkxYxQ/s960/EKG_changes_normal_for_athletes.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKgtH6RDGmiaCMJNtpVBrWmb_Y-rfKfI4Xge2P23tidSxhYFw8SVIiisc0r1D-bYKgJFNYSQYCfuj7mHWJQmFhruw2oftfiQu8v46rkEsdDoIH9vxKjkfNcQ6y4OWq0HCZFkxYxQ/s320/EKG_changes_normal_for_athletes.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1FJIgVIeEaQCeeHzQ3v98Olej4ABt9DvqUeOluDX93gLZrgE-hPVFYKfsMqvqCWx7bO9BOJ9doGeiOYd7zi9zvyJOR3lkjdg5BdHP2WlL0r2mbUrVgh8yzlBkqNJWeJ-stF7-sA/s960/EKG_changes_abnormal_for_athletes.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1FJIgVIeEaQCeeHzQ3v98Olej4ABt9DvqUeOluDX93gLZrgE-hPVFYKfsMqvqCWx7bO9BOJ9doGeiOYd7zi9zvyJOR3lkjdg5BdHP2WlL0r2mbUrVgh8yzlBkqNJWeJ-stF7-sA/s320/EKG_changes_abnormal_for_athletes.png" width="320" /></a></div><br /><p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-84484694523994045592021-09-21T09:44:00.011-04:002021-12-09T12:59:34.838-05:00Athletic Participation for Children with Systemic Hypertension - 2010 AAP Policy Statement<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie-EDktzvOmyJkZrSc_UiSvJF-Bi5IhhvGKsxlPOgfpRK9anItm6KtXUoD6zFRj8I0pbsEHRu-q2GHdqYmjvYd2AsO2HtAwQtczJMwUkK2a8KUtTU5Ohj656mEV7JxeflwpWPebA/s1280/Slide2.PNG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie-EDktzvOmyJkZrSc_UiSvJF-Bi5IhhvGKsxlPOgfpRK9anItm6KtXUoD6zFRj8I0pbsEHRu-q2GHdqYmjvYd2AsO2HtAwQtczJMwUkK2a8KUtTU5Ohj656mEV7JxeflwpWPebA/s320/Slide2.PNG" width="320" /></a></div><p></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">Basis of classification:</span></div><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">These are based on peak static and dynamic components achieved during competition. Higher values may be reached during training.</span></div><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">Dynamic component - estimated % of Max O2 and cardiac output.</span></div><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">Static component - estimated Maximal voluntary contraction (MVC) reached/results in high BP.</span></div><p></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">*Danger of bodily collision</span></div><p></p></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large; text-align: left;">† Increased risk if syncope occurs</span></div><p></p></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p class="MsoNormal"><span style="line-height: 107%;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnGutynxHXnwTqeo3cvbPxDMRauu-pUkPMWD-O9OZsv5OF377OcQkeuwBKH2j7o1HTfyjhznYhEXTdPSIhda1inJmvxFK2DeLk0yYDnhGSanZGuQxITtuQbV0SYNYCv9WCJ-Gq6A/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="30" data-original-width="60" height="20" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnGutynxHXnwTqeo3cvbPxDMRauu-pUkPMWD-O9OZsv5OF377OcQkeuwBKH2j7o1HTfyjhznYhEXTdPSIhda1inJmvxFK2DeLk0yYDnhGSanZGuQxITtuQbV0SYNYCv9WCJ-Gq6A/w39-h20/image.png" width="39" /></a>Participation not recommended by AAP</span></div><p></p></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p class="MsoNormal"><span style="line-height: 107%;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">+ AAP classifies cricket in I-B</span></div><p></p></blockquote></blockquote></blockquote><p class="MsoNormal"><span style="line-height: 107%;"><br /><br /></span></p><div class="separator" style="clear: both; text-align: center;"></div><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div> <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKdg7iiyzbecZ8pfdIV6kUOGvuhIMU6x0yq42PgypnEHLDpdrBll6MYOoQRg6yyulcQBE6INojU0VKBLs4ReU1kRFj2Cn1_MygwiN4FR9j7zExEnhcrQpeIl1ghEf1TexG3SIgwQ/s1280/Slide3.PNG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKdg7iiyzbecZ8pfdIV6kUOGvuhIMU6x0yq42PgypnEHLDpdrBll6MYOoQRg6yyulcQBE6INojU0VKBLs4ReU1kRFj2Cn1_MygwiN4FR9j7zExEnhcrQpeIl1ghEf1TexG3SIgwQ/s320/Slide3.PNG" width="320" /></a></div><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://pediatrics.aappublications.org/content/pediatrics/125/6/1287.full.pdf " style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="116" data-original-width="959" height="39" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhP1se8WcjHFDRAFz04GL4S4V6m5YbgGI5k0VL2NKAv-N6smkmJNusERqwrgtsALm0UXrwUw6zQBV24PbhC30oTFZC75_1yogBQIYZfHnD__AgqQN1VCRgGzQFY-AOpRAtwkYv2g/s320/Slide1+%25282%2529.jpg" width="320" /></a></div><br /><p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-42152467096847185082021-05-11T08:30:00.007-04:002021-05-11T08:39:20.635-04:00Botulism treatment<p> California Dept. of Public Health</p><p>BabyBIG (Botulism Immunoglobulin)</p><p>Contact telephone: 510-231 7600</p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-19689957914179654602021-05-05T07:50:00.004-04:002021-05-05T07:50:49.908-04:00Troponin T high-sensitivity Generation 5 - Levels in healthy newborn<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1cVZDV7iJyLCeaxKzIm_wiRo5NnjF4b85F5I5cyqRsOeD0PfbOj8A7QbjK1FRmhGP64zMEwTod78wthTYy8hrp5Ll7ohe3JDvMc4R12HOkMISurb6ieY_Xw2ExAtGZpWzIViZpQ/s1280/20201209_Troponin_T_hs_generation_5_healthy_newborn_sweden.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1cVZDV7iJyLCeaxKzIm_wiRo5NnjF4b85F5I5cyqRsOeD0PfbOj8A7QbjK1FRmhGP64zMEwTod78wthTYy8hrp5Ll7ohe3JDvMc4R12HOkMISurb6ieY_Xw2ExAtGZpWzIViZpQ/s320/20201209_Troponin_T_hs_generation_5_healthy_newborn_sweden.jpg" width="320" /></a></div><br /><b> Pediatric Cardiology 2019;40:1645-1654.</b><p></p><p><br /></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-16577039422325435432021-05-05T07:43:00.003-04:002021-05-05T07:43:53.478-04:00Troponin T hs generation 5 - Interpretation in the context of the test<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBGZ3UwxOrHhrBUOjRnVPhdEgtcCE_V437xCRXR7omn_pNLzayM5WIwUmTLUpP46tmOAP80ERafEeRY_J5RXTiiNLcWO2dxzPD4KhTTTywXj7o1m8lOe8zeF2ETF0jwGUAZuAkFA/s1280/Troponin_Interpretation_context.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBGZ3UwxOrHhrBUOjRnVPhdEgtcCE_V437xCRXR7omn_pNLzayM5WIwUmTLUpP46tmOAP80ERafEeRY_J5RXTiiNLcWO2dxzPD4KhTTTywXj7o1m8lOe8zeF2ETF0jwGUAZuAkFA/s320/Troponin_Interpretation_context.jpg" width="320" /></a></div><br /><p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-4322478642549026902021-04-19T09:58:00.006-04:002021-04-25T03:14:50.262-04:00PDA Morphologic Types - Updated 2016<p></p><div class="separator" style="clear: both; text-align: center;">Click on the image to enlarge</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWRqv8LquJWqGJcTGk5ApVFV6cXizXPaXx3Z-TBmC5G5DMct3jXiycuuYt9lEHxeL-VnHNAB7jMDtbxnB8jPOpr0gKCgW0S4e8JgmTKTU7mECCdgfuDKqyl4qfbtOaJwhV-a5D3Q/s1278/20210419_PDA_morphologic_types.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="1278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWRqv8LquJWqGJcTGk5ApVFV6cXizXPaXx3Z-TBmC5G5DMct3jXiycuuYt9lEHxeL-VnHNAB7jMDtbxnB8jPOpr0gKCgW0S4e8JgmTKTU7mECCdgfuDKqyl4qfbtOaJwhV-a5D3Q/s320/20210419_PDA_morphologic_types.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-45695829232026687512021-04-19T09:51:00.000-04:002021-04-19T09:51:00.303-04:00Ampatzer Duct Occluder (ADO aka. "ADO-I") - Device Specifications<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWfK9UN1vtRkxvqyMzbYRgdzrkjY2gNhDjjOa2YSwRyyzTn6PoxXZ6KiicUKm98_nGmPqMYFtSuPd7ogL8RFpU0htMggdjjnkNGmYjZjTzogjQYj5yfx-sm7m_1ATVQkl7Cl_wRA/s1280/ADO_Amplatzer_Duct_Occluder_Device_Specifications.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWfK9UN1vtRkxvqyMzbYRgdzrkjY2gNhDjjOa2YSwRyyzTn6PoxXZ6KiicUKm98_nGmPqMYFtSuPd7ogL8RFpU0htMggdjjnkNGmYjZjTzogjQYj5yfx-sm7m_1ATVQkl7Cl_wRA/s320/ADO_Amplatzer_Duct_Occluder_Device_Specifications.PNG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnb8jGF9B2uDOVrn6ZREC7UnjgWQMukZD3IhTkAIE5aiuvMbvrX1KYC8uXzNGIDjD5sX6HRpkYtx6z7M7CFYrgonm_cszF2F2OQCn3BhVvhd-dVgvmN1No_6YpV0eu6ixbOB_ZOg/s1280/ADO_Amplatzer_Duct_Occluder_Procedure_Steps.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnb8jGF9B2uDOVrn6ZREC7UnjgWQMukZD3IhTkAIE5aiuvMbvrX1KYC8uXzNGIDjD5sX6HRpkYtx6z7M7CFYrgonm_cszF2F2OQCn3BhVvhd-dVgvmN1No_6YpV0eu6ixbOB_ZOg/s320/ADO_Amplatzer_Duct_Occluder_Procedure_Steps.PNG" width="320" /></a></div><br /> <p></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0tag:blogger.com,1999:blog-10046846.post-3766580300135892462021-04-07T14:50:00.006-04:002022-02-04T13:18:24.877-05:00High sensitivity Troponin T level in normal infants<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi6VGdwGJz7bVWW4SRBgfXJc0LjenFPAI4dRkOYF94aM5MaQ_FjaylJJddFOEMc_KYtaZiwAODVpXwPo5ouXOW8WCaIUnsx_MEoKY3ydY7gwD2ltymKdj2-R6t94zesk3LV5o-znigCNcjKagTD5yD4DbVXtXN1Hr1MGqmd76_abwMvIqkaL_E=s1280" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/a/AVvXsEi6VGdwGJz7bVWW4SRBgfXJc0LjenFPAI4dRkOYF94aM5MaQ_FjaylJJddFOEMc_KYtaZiwAODVpXwPo5ouXOW8WCaIUnsx_MEoKY3ydY7gwD2ltymKdj2-R6t94zesk3LV5o-znigCNcjKagTD5yD4DbVXtXN1Hr1MGqmd76_abwMvIqkaL_E=s320" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEj8lj0TipuYZYm88knu3Y8-Xj8GDtcv079tDtZjB4jRcsnB5e49clZC1f7RTX0soqd07TyKBYsxO3OJRgsZno__kmpJZ13ZdRaNjwxxgxpnDF3V7Cw7NyskUZeqZ49_SU2kzOm4BqNZ-L__mwIcF-81W3XcgHbmuo-YrPQSxeIlLnmQSKls_RU=s1280" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1280" height="180" src="https://blogger.googleusercontent.com/img/a/AVvXsEj8lj0TipuYZYm88knu3Y8-Xj8GDtcv079tDtZjB4jRcsnB5e49clZC1f7RTX0soqd07TyKBYsxO3OJRgsZno__kmpJZ13ZdRaNjwxxgxpnDF3V7Cw7NyskUZeqZ49_SU2kzOm4BqNZ-L__mwIcF-81W3XcgHbmuo-YrPQSxeIlLnmQSKls_RU=s320" width="320" /></a></div><p></p><p><a href="https"//doi.org/10.33549/physiolres.934453" rel="nofollow" target="_blank">Jehlicka, P. et al. Physiologic Research 2021;27:27-32.</a></p>Balahttp://www.blogger.com/profile/15733753013309416857noreply@blogger.com0