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http://cs.gmu.edu/~xzhou10/semester/thesis-statements-for-high-school-research-papers.html thesis statements for high school research papers Nonpharmacologic measures are used to viagra for sale in france prevent recurrence. Termination of psvt hemodynamically unstable psvt should be treated with immediate synchronized dcc, using an initial energy level of 50 to 100 j. If the initial dcc attempt is unsuccessful, the shock energy should be increased in a stepwise fashion. 11 the primary method of termination of hemodynamically stable psvt is inhibition of impulse conduction and/or prolongation of the refractory period within the av node. Because psvt is propagated via a reentrant circuit involving the av node, inhibition of conduction within the av node interrupts and terminates the reentrant circuit. Prior to initiation of drug therapy for termination of hemodynamically stable psvt, some simple nonpharmacologic methods known as vagal maneuvers may be attempted. 11,35 vagal maneuvers stimulate the activity of the parasympathetic nervous system, which inhibits av nodal conduction, facilitating termination of the arrhythmia. Vagal maneuvers alone may terminate psvt in up to 25% of cases. 11 perhaps the simplest vagal maneuver to perform is cough, which stimulates the vagus nerve. Instructing the patient to cough two or three times may successfully terminate chapter 9  |  arrhythmias  153 the psvt. Another vagal maneuver that may be attempted is carotid sinus massage. One of the carotid sinuses, located in the neck in the vicinity of the carotid arteries, may be gently massaged, stimulating vagal activity. Carotid sinus massage should not be performed in patients with a history of stroke or transient ischemic attack, or in those in whom carotid bruits may be heard on auscultation. The valsalva maneuver, during which patients bear down against a closed glottis, may also be attempted. If vagal maneuvers are unsuccessful, iv drug therapy should be initiated. 11,34,35 drugs that may be used for termination of hemodynamically stable psvt are presented in table 9–11. 11 a decision strategy for pharmacologic termination of hemodynamically stable psvt is presented in figure 9–7. 11,35 adenosine is the drug of choice for pharmacologic termination of psvt and is successful in 90% to 95% of patients. Adenosine inhibits conduction transiently and is associated with adverse effects (see table 9–7), including flushing, sinus bradycardia or av nodal block, and bronchospasm in susceptible patients. In addition, adenosine may cause chest pain that mimics the discomfort of myocardial ischemia but is not actually associated with ischemia. The half-life of adenosine is approximately 10 seconds, due to deamination in the blood. Therefore, in the vast majority of patients, adverse effects are of short duration. If adenosine therapy is unsuccessful for termination of psvt, subsequent choices of therapy depend on whether the patient has hfref. Psvt vagal maneuvers adenosine lvef ≥ 40% or no history of hfref hfref diltiazem or verapamil digoxin β-blocker amiodarone digoxin diltiazem figure 9–7.

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