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To all UW readers - let us help ourself .. - amith
#31
UW ARRYTHMIAS APPROACH

Anytime if the patient is hemodynamically unstable [ means BP is low or patient not responding to the verbal commands treatment of choice is electrical cardioversion.

2. If the patient is hemodynamically stable, then you have to think whether it is an acute process? or a chronic process?.

a. If it is an acute [ < 48 hrs] process
i. initial approach is usually rate control.
ii. Electrical or pharmacologic cardioversion may be necessary
1. if rate control cannot be achieved and
2. the patient is experiencing ongoing ischemia or
3. hemodynamic instability.
iii. 4-6 wks warfarin anticoagulation

b. If it is a chronic [ > 48 hrs] process
i. initial approach is usually rate control
ii. 4-6 wks warfarin anticoagulation
iii. Electrical or pharmacologic cardioversion


TREATMENT
Rate control by
1. I.V beta blockers like I.V metoprolol & I.V esmolol
2. I.V calcium channel blockers like I.V verapamil or I.V diltiazem
3. I.V digoxin
4. Quinidine---for SVT ( supraventricular tachycardias )

Cardioversion
1. electrical
2. chemical like I.V ibutilide

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#32
VERAPAMIL given asap after onset of ACUTE attack
(other options: propanolol,methysergide, indomathacin , lithium,

Lithium for prophylaxis of CHRONIC FORM OF CLUSTER HEADACHE
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#33
Electromyography and conduction studies
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#34
TICK BORNE
ASCENDING P'lysis....... FAST ASCENT in hrs to days
Normal CSF
NORMAL sensation
NO fever





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#35

ASCENDING P'lysis....... SLOW ASCENT in days to weeks
annormal csf
abnormal sensation
h/o FEVER +






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#36
DESCENDING PARALYSIS !!
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#37
1. Weight reduction
2. Acetazolamide
3. Surgery: shunting or optic nerve fenestration
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#38
50-7- yrs of age
reapidly progressive dementia
myoclonus

CSF normal
HIGH voltage EEG complexes

NO SPECIFIC TT
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#39
age of onset: 25-30
slower disease progression
sensory abnormality common

EEG abnormal but no high voltage complexes
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#40
SHY DRAGGER:
older PD type pt
orthostatic hypotension
impotence
incontinence

RILEY - DAY SYNDROME
autosomal ds in askenzai jew CHILDREN
SEVERE orthostaic hypotension
gross dysfunction of the sutonomic nervous system
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