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The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges Related National Performance Measures and the Standards of the Accreditation Council for National applications that have clinical efficiency measures Continuing Medical Education that the people who of atrial fibrillation and atrial flutter cheap nimotop 30 mg otc back spasms 20 weeks pregnant, primarily related to present educational actions disclose significant ambulatory care buy nimotop 30 mg line spasms 1983 download, embody the next order nimotop 30 mg fast delivery muscle spasms youtube. The measure includes Average proportion of time that No staff member reported a battle of interest effective 30 mg nimotop spasms falling asleep. Drafts of this guideline were reviewed in clinical conferences Percent of all sufferers 18 years outdated with a prognosis and by distribution for comment within departments and of coronary heart failure and paroxysmal or chronic atrial divisions of the University of Michigan Health System to fibrillation who were prescribed warfarin remedy. Ischemic stroke � Anticoagulation for A- General Medicine, Infectious Disease, Neurosurgery, fib/flutter. Medication recommendations were anticoagulation remedy at hospital discharge reviewed by the Pharmacy and Therapeutics Committee. The ultimate version was endorsed by the Clinical Practice Regional (Michigan) applications that have clinical Committee of the University of Michigan Faculty Group efficiency measures of Atrial fibrillation or flutter Practice and the Executive Committee for Clinical Affairs of are the next. Validation of Advances Cardiovascular Life Support: 2010 American clinical classification schemes for predicting stroke: outcomes Heart Association tips for cardiopulmonary from the National Registry of Atrial Fibrillation. Atrial Fibrillation: Management threat stratification in an actual-world aged anticoagulated Strategies within the Emergency Department. Focused update on the management of sufferers with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Differences between views of physicians and sufferers on 21 Anticoagulation Pradaxa [bundle insert]. Antithrombotic Perioperative management of antithrombotic remedy: remedy for atrial fibrillation: American College of Chest American College of Chest Physicians Evidence-Based Physicians Evidence-Based Clinical Practice Guidelines (ninth Clinical Practice Guidelines (ninth edition). Guidelines for Surgeons follow guideline on the prophylaxis and management of sufferers with atrial fibrillation: A report of management of atrial fibrillation associated with common the American College of Cardiology Foundation/American thoracic surgical procedure: Executive summary. Rivaroxaban versus warfarin in nonvalvular atrial Cardiovasc Surg 129:997�1005, 2005. Key treatment issues embody deciding when to revive normal sinus rhythm, when to regulate fee solely, and how to prevent thromboembolism. The present recommendation for strict fee control is a resting coronary heart fee of lower than 80 beats per minute. However, one research has proven that extra lenient fee control of lower than a hundred and ten beats per minute whereas at rest was not inferior to strict fee control in stopping cardiac dying, coronary heart failure, stroke, and life- threatening arrhythmias. Anticoagulation remedy is required with fee control and rhythm control to stop stroke. Warfarin is superior to aspirin and clopidogrel in stopping stroke regardless of its slim therapeutic range and elevated threat of bleeding. Surgical choices for atrial fbrillation embody disruption of irregular conduction pathways within the atria, and obliteration of the left atrial appendage. Catheter ablation is an option for restoring normal sinus rhythm in sufferers with paroxysmal atrial fbrillation and normal left atrial measurement. If it persists, atrial the substitute of the normal constant fbrillation can cause atrial transforming, P waves (which symbolize synchronous atrial which is characterized by patchy fbrosis; activation) with oscillatory or fbrillatory irregular and excessive deposition of colla- waves of various sizes, amplitudes, and gen; fatty infltration of the sinoatrial node; timing (Figure 1). The typically speedy, between ninety and one hundred seventy beats per longer the heart remains in atrial fbrillation, minute. After a important point is reached, par- morbidity and mortality because it impairs oxysmal atrial fbrillation self-perpetuates cardiac perform and will increase the danger of and turns into persistent. The price of Defnitions caring for sufferers with atrial fbrillation Different kinds of atrial fbrillation have dif- is about fve times greater than caring for ferent prognoses, morbidity charges, mortal- sufferers with out it. For the non-public, noncommercial January 1, 2011use of one particular person user of the Web website. For instance, valvular atrial fbrillation, which is triggered cardiac and thoracic surgical procedure. It is often self-limited, by structural modifications within the mitral valve or congeni- however should be treated aggressively if it persists because tal coronary heart illness, carries the best threat of stroke. Secondary atrial fbrillation is caused by an underlying the prognosis is excellent in sufferers with lone atrial situation and is reversible if the situation is treated. Paroxysmal atrial fbrillation refers to epi- the commonest underlying conditions are listed in sodes of intermittent atrial fbrillation that terminate Table 2. Clinical Presentation Rapid ventricular response Decreased diastolic flling Blood stasis and atrial clot formation Atrial fbrillation has a large spectrum of clinical displays. Others may present with Decreased cardiac output Shorter diastolic fll time stroke, overt coronary heart failure, or cardiovascu- Reduced coronary circulation lar collapse. Patients mostly report and attainable ischemia Thromboembolism palpitations, dyspnea, fatigue, lighthead- Tachycardia-mediated cardiomyopathy edness, and chest pain. Initial Evaluation of Atrial Fibrillation Type of atrial Test Purpose fbrillation Characteristics Chest radiography Identify attainable pulmonary illness Chronic/ Continuous atrial fbrillation that (e. Secondary Causes of Atrial Fibrillation measurement Cardiac Cardiothoracic surgical procedure examination, and diagnostic testing ought to concentrate on Congenital coronary heart illness potential causes, triggers, and comorbid conditions. Stan- Heart failure dard exams used to evaluate cardiac perform and identify Infltrative illness (e. Echocar- Pericarditis diography offers information about coronary heart measurement, cham- Valvular illness ber sizes, valvular anatomy and performance, wall motion Wolff-Parkinson-White syndrome abnormalities, systolic and diastolic perform, and peri- Noncardiac cardial illness. Select sufferers may have extra Drug abuse exams, corresponding to stress testing and electrophysiology studies. Data present that sufferers assigned to rhythm control have extra hospitalizations from opposed cardiovascular events, extra Evaluation serious opposed effects from medicines, and the same the frst objective is to determine the sufferers cardiac sta- fee of thromboembolic events compared with sufferers bility and provide emergency stabilization if wanted. Rhythm control remains an ing ischemia, severe coronary heart failure, or cerebrovascular option when fee control is unsuccessful or when symp- events, emergency electrical cardioversion is warranted. Antico- agulation remedy, earlier than and after cardioversion, is beneficial with both technique to stop thrombo- embolism. Medications commonly used for cardioversion embody ibutilide (Corvert), fecainide (Tambocor), dofetilide (Tikosyn), sotalol (Betapace), propafenone (Rythmol), Figure 3. Dronedarone (Multaq), which is a noniodinated spinoff of amioda- randomized controlled trial confirmed that lenient fee rone, has been proven to cut back atrial fbrillation with- control, defned as a ventricular fee of lower than a hundred and ten out the lengthy-term serious opposed effects of amiodarone, beats per minute at rest, was not inferior to strict fee however there are considerations about safety in sufferers with control in stopping cardiac dying, coronary heart failure, stroke, severe coronary heart failure.

Risk elements corresponding to alcohol use and sleep deprivation have to be assessed order nimotop canada spasms feel like baby kicking, in addition to any historical past of head damage generic nimotop 30 mg amex spasms movie 1983, childhood seizures purchase nimotop without prescription back spasms 5 weeks pregnant, or family historical past of seizures purchase nimotop now muscle relaxant 2265. About 20 small adhesive electrodes are positioned on the scalp, and the brains activity is recorded under normal circumstances. Then the particular person is uncovered to one thing, corresponding to bright or fashing lights, to attempt to cause a seizure. During a seizure, electrical activity in the mind will increase, producing a jagged wave pattern. Administration of emergency medication ought to be accomplished consistent with school policy. About 71% of patients in scientific trials remained seizure free for 12 hours after Diastat administration. To be eligible for the surgical procedure the particular person must have seizures coming from one area of the mind that may be eliminated with out causing injury to the persons capability to operate. If a defect in the mind (corresponding to a scar) can be identifed as the cause of the seizures and is confned to a small area, surgically eradicating that area can get rid of seizures in up to 80% of individuals, or no less than reduce the severity and frequency of seizures. Electrical stimulation of the vagus nerve can reduce the number of a sure kind of seizures by a couple of half in some people. The vagus nerve is thought to have indirect connections to areas of the mind often concerned in causing seizures. A system that appears like a heart pacemaker is implanted under the left collarbone and is linked to the vagus nerve in the neck with a wire that runs under the pores and skin. The operation to implant the system is completed on an outpatient foundation and takes about 1 to 2 hours. Otherwise the system is programmed to ship intermittent stimulation to the nagus nerve. Side results of this system embrace hoarseness, cough, and deepening of the voice when the nerve is stimulated. It has a hit price of seventy five%, stopping seizures in 50% of people and additional reducing seizures in 25% of cases. It is a serious form of therapy that, like other therapies for epilepsy, has some side effects that have to be monitored. More research is being accomplished to study in regards to the underlying reasons for the diets optimistic effect. Usually with this sort of food regimen the student may have a dietitian assist the dad and mom plan meals that may go to high school with the child. Teachers ought to inform dad and mom in advance when treats are planned so that folks can send an acceptable treat substitute with their baby. It is essential to know that even half a cookie or a chunk of cupcake can result in seizures, a hospital go to, and the lack of seizure control. The treating physician of the student on this food regimen will supply a letter to the school nurse who would notify other acceptable staff. Good safety practices embrace: � Always put on a seatbelt in the automobile and observe � Do not abuse any licit or illicit substances the speed limit � Do not have interaction in bodily behavior that has the � Always put on acceptable protecting gear while potential to result in head damage skating, playing sports, or driving bikes � Immunize kids towards infectious illnesses 17 Critical Info for All school personnel 18 studying & Academic Issues general, the intellectual capability of people with epilepsy and that of people in the basic population are comparable. These college students may not be readily identifed as having a studying incapacity because their spelling and math expertise may be appropriately developed. Their problems tend to lie in the areas of attention, focus, memory, and organizational expertise. Current data tells us that about 25-30% of people with epilepsy have poor control of their seizures. Gaining control may be more diffcult for many who experience many kinds of seizures and for many who have diffculty communicating what effect their seizures have on them. Just as each individual has a singular character, epilepsy impacts each individual in another way. The reasons that college students with epilepsy could have problems with studying embrace: � Learning not occurring through the time of a seizure � Learning can be affected by the fatigue and confusion that happens after a scholar has a seizure and can final for minutes or hours � Fatigue and memory problems can be attributable to seizure medications � Learning can be disrupted by discharges in the mind that occur between seizures. This is a written plan that outlines a college students wants and objectives for the school 12 months. Please check with your school policies/procedures regarding how this process is initiated. These elements can be a cause of educational diffculties and likewise can be a consequence of educational problems. Research has shown that emotional and behavioral diffculties are higher in college students with epilepsy. A college students probabilities of having an emotional/behavioral concern in addition to their epilepsy depends on numerous elements, including how often the student has seizures, how a lot medication he/she is taking and the age of the individual when the seizures began. Approximately 50% of people with epilepsy also wrestle with symptoms of depression. Even more regarding is that in a latest examine researchers found that 39% of patients with epilepsy had never been evaluated for depression although they often co-occur. Individuals with epilepsy often experience symptoms of depression that look completely different (or atypical) from these symptoms that other people could report. Common indicators of anxiety for college students with epilepsy Symptoms of anxiety for people with epilepsy may be brought on or elevated by the unpredictability of seizures and restrictions that there may be on the persons normal activities because of the seizures. Data from one examine (Torta and Keller) estimated that as many as 66% of patients with epilepsy report anxiety between seizures. The handbook that classifes and describes all psychological issues (which incorporates anxiety) distinguishes between 11 various kinds of anxiety issues. Symptoms of inattention in kids: � Doesnt take note of details or makes careless mistakes � Has trouble staying focused; is definitely distracted � Appears not to pay attention when spoken to � Has diffculty remembering issues and following instructions � Has trouble staying organized, planning ahead, and fnishing projects � Frequently loses or misplaces homework, books, toys, or other objects Symptoms of hyperactivity in kids: � Constantly fdgets and squirms � Often leaves his or her seat in situations where sitting quietly is expected � Moves round continuously, often running or climbing inappropriately � Talks excessively, has diffculty playing quietly � Is all the time on the go, as if pushed by a motor 22 Symptoms of impulsivity in kids: � Blurts out solutions with out ready to be known as on or hearing the whole query � Has diffculty ready for his or her turn � Often interrupts others � Intrudes on other peoples conversations or video games � Inability to maintain highly effective feelings in check resulting in indignant outbursts or temper tantrums If you discover that a scholar is displaying these behaviors, you will need to refer them for additional analysis as dictated by your colleges policies/procedures.

Qualitative analysis means that for a lot of girls purchase nimotop 30mg overnight delivery muscle relaxant usa, tinguish; when requested to explain sexual desire purchase nimotop 30 mg line muscle relaxant tl 177, many women use 52 H order nimotop online now muscle relaxant gaba. Thurston / Maturitas 87 (2016) 49�60 language that describes genital sexual arousal [19�21] 30mg nimotop overnight delivery spasms while pregnant. Finally, the Among the studies that used a multidimensional evaluation of Bassonmodelacknowledgesthatbothphysicalaswellasemotional sexual perform, there were differences regarding which features of satisfaction are important outcomes of participating in sexual activ- sexual perform had been most affected by menopause. This bodily and emotional satisfaction and may result in higher wave of the Massachusetts Womens Health Study, sexual desire, emotional intimacy, which in flip can result in larger receptivity but not satisfaction, frequency, arousal, orgasm, or ache, had been neg- and in search of out of sexual stimuli, therefore the circular mannequin. The Melbourne There has been debate regarding which mannequin greatest reects Womens Midlife Health project discovered that every one domains of sexual the experiences of women. In a study of 133 girls [22], most perform, including responsivity, frequency, libido, and ache, wors- of whom had been in their 40s and 50s, 30% endorsed the Masters- ened with advancing menopause status [27]. The Penn Ovarian Johnson mannequin, 27% endorsed the Masters-Johnson-Kaplan mannequin, Aging Study discovered the sharpest decline in the lubrication area and 29% endorsed the Basson mannequin. Notably, 3 out of 4 of these studies famous declines in sexual desire A subsequent study of 404 girls with a mean age of 35 during the menopause transition. Many studies observe a positive correlation between over- the Basson mannequin to combine the responsive desire and sexual all bodily health and sexual perform [26,30,31,34]. Availability arousalphases,womenwithsexualdysfunctionweremorelikelyto of a companion can also be signicantly related to raised sexual perform endorse the Basson mannequin than the Masters/Johnson/Kaplan mannequin [26�28,30,31,34]. Finally, indicators of upper socioeconomic in the Masters-Johnson-Kaplan mannequin [24]. One problem is Johnson-Kaplan mannequin is useful for conceptualizing the bodily the measurement of sexual perform. These studies used differ- features of female sexual perform and dysfunction, whereas the ent instruments to evaluate female sexual perform, and few used Basson mannequin is useful for understanding the interaction between validated instruments. Another problem is distinguishing intercourse- emotional, interpersonal, and bodily features of sexual response. However, a analysis of sexual dysfunction requires features of sexual perform, as an outcome measure. None of these lon- ought to embody an evaluation of the psychosocial features of sexual gitudinal studies assessed sexually-related distress. Finally, female perform reected in the Basson mannequin, such as emotional intimacy, sexual perform is a fancy biopsychosocial phenomenon, and in studies of female sexual dysfunction, significantly since girls a complete understanding of womens sexual perform requires with sexual dysfunction look like more more likely to endorse this evaluation of biologic, sociocultural, psychological, and interper- mannequin. A multidimensional evaluation of phys- In summary, many of the bigger longitudinal studies using ical, interpersonal, and emotional features of sexual perform will multidimensional assessments of sexual perform do suggest that enhance the current state of the science on womens sexual func- advancing menopause status has a unfavorable effect on sexual tion. However, psychosocial variables additionally play an extremely important function in midlife womens sexual perform. Loss of a component- ner, adjustments in the quality of the connection with ones companion, and worsening temper signs are usually associated with 4. The biopsychoso- been, How and why does sexual perform change as girls cialapproachrecognizesthatbiologic,psychological,interpersonal, progress through midlife and the menopause transition Several and sociocultural factors can all have an effect on female sexual perform, and large longitudinal studies have attempted to answer this ques- these factors work together with each other in a dynamic system over tion (Table 2). Biologic factors might embody hormonal adjustments that have an effect on adjustments in sexual perform and satisfaction over time than cross- libido or medical/anatomical issues that have an effect on genital intercourse- sectional studies. Psychological factors contains temper signs, like girls over time allow comparison of a womans sexual perform despair or anxiousness, or unfavorable behaviors such as important self- to herself, present more practical control of between-subject con- monitoring during sexual activity. Some examples of interpersonal foundsandcohorteffects,andallowcharacterizationoftrajectories factors embody basic satisfaction in the womans relationship in sexual perform over time. Vaginal some sociocultural factors to contemplate embody the womans atti- dryness appears to play a key function in altering sexual perform dur- tudes about menopause and getting older, in addition to religious, cultural, ing the menopause transition [29,30]. Researchers and health- longitudinal studies that solely assessed sexual perform using one care suppliers for girls ought to contemplate all these factors when or two questions discovered that sexual activity and reports of desire addressing female sexual perform. Thurston / Maturitas 87 (2016) 49�60 fifty three Table 2 Longitudinal studies of sexual perform during midlife. Reference Study particulars Sexual perform measure Key ndings George and Weiler [105] N=278 women and men Only used 2 inquiries to � Mean sexual activity remained comparatively stable over the 6 years of Age 46�seventy one at baseline consider sexual perform the study, particularly amongst girls 4 interviews 2 years aside Hallstrom et al. Thurston / Maturitas 87 (2016) 49�60 Table 2 (Continued) Reference Study particulars Sexual perform measure Key ndings Woods et al. One outcome that may be more important to girls than the while some features of bodily sexual perform might decline during bodily features of sexual perform is overall satisfaction with intercourse. This discrepancy Sexual satisfaction has been less nicely-studied than sexual func- betweenfunctionandsatisfactionmaybeexplainedbythefactthat tion. Treatments for female sexual dysfunction cial as opposed to bodily; availability of a companion (particularly a new companion), higher scores of the importance of intercourse, fewer temper In order to assist girls keep a satisfying intercourse life as they signs, and more positive attitudes about getting older had been asso- move through midlife and beyond, therapy of sexual dysfunction ciated with better emotional and bodily sexual satisfaction. However, interpersonal, psychological, and psychosocialvariables,includingrelationshipsatisfaction,commu- sociocultural factors must be addressed as nicely. Some girls nication with ones companion, and importance of intercourse had been associated might initially report no sexual concerns when rst questioned, but with overall sexual satisfaction [36]. These ndings suggest that if a girl is allowed time and a supportive listening environ- H. Thurston / Maturitas 87 (2016) 49�60 55 Table 3 place, and if positive, acceptable referrals and resources ought to be Medical and psychiatric circumstances that are associated with female sexual provided. Cardiovascular illness [119] Treatment options for specic sexual dysfunctions are summarized Major depressive disorder and generalized anxiousness disorder [a hundred and twenty,121] in Table 4. Providers ought to recognize that ladies often have more History of emotional, bodily, or sexual abuse [122,123] Diabetes mellitus [124,a hundred twenty five] than one sexual complaint; therapy ought to be individualized to Neurologic illness (stroke, multiple sclerosis, spinal twine harm) [126�128] target the first drawback, but ought to be supplemented by deal with- Hypertension [129�131] mentofotherproblemsasneeded. Generallifestylecounselingthat Substance use issues [132�134] maybeusefulforalltypesoffemalesexualdysfunctionincluderec- Genitourinary syndrome of menopause [114,116,one hundred thirty five] ommending setting apart time for connecting with ones companion, Breast, ovarian, uterine, and cervical cancer [136�a hundred and forty] History of gynecologic surgical procedure [141,142] growing the womans publicity to sexual stimuli such as erotic Chronic renal failure [143�one hundred forty five] literature or lms, encouraging upkeep of a healthy weight Urinary incontinence [146,147] and guaranteeing adequate bodily activity and sleep, enhancing expertise Medications that are associated with female sexual dysfunction forcopingwithstress,andrecommendingbookswomencanusefor Antidepressants (selective serotonin reuptake inhibitors, serotonin self education. Some main titles embody Becoming Orgasmic [65], norepinephrine reuptake inhibitors, tricyclic antidepressants) [148�one hundred fifty five] GettingtheSexYouWant[sixty six],NakedatOurAge[sixty seven],andComeasYou Opiates [134] Are [sixty eight].

Improved resuscitation end result in emergency medical systems with elevated utilization of sodium bicarbonate throughout cardiopulmonary resuscitation order nimotop online pills spasms hands fingers. Effect of epinephrine and lidocaine remedy on end result after cardiac arrest due to ventricular fibrillation nimotop 30mg visa muscle spasms yahoo answers. Factors predicting survival for six months after cardiopulmonary resuscitation: multivariate evaluation of a potential research best purchase for nimotop muscle relaxant elemis muscle soak. Early predictors of mortality for hospitalized sufferers struggling cardiopulmonary arrest buy nimotop with mastercard muscle relaxant orange pill. Buffer solutions could compromise cardiac resuscitation by lowering coronary perfusion presssure. Evidence for a detrimental effect of bicarbonate remedy in hypoxic lactic acidosis. Low-dose Carbicarb improves cerebral end result after asphyxial cardiac arrest in rats. The effectiveness of calcium chloride in refractory electromechanical dissociation. Efficacy and security of thrombolytic remedy after initially unsuccessful cardiopulmonary resuscitation: a potential scientific trial. Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic remedy in cardiac arrest due to large pulmonary embolism. Recombinant tissue plasminogen activator throughout cardiopulmonary resuscitation in 108 sufferers with out-of-hospital cardiac arrest. Empiric tenecteplase is related to elevated return of spontaneous circulation and quick time period survival in cardiac arrest sufferers unresponsive to standard interventions. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. Breil M, Krep H, Sinn D, Hagendorff A, Dahmen A, Eichelkraut W, Hoeft A, Fischer M. Mild hypothermia throughout advanced life help: a preliminary research in out-of-hospital cardiac arrest. Dextrose containing intravenous fluid impairs end result and increases dying after eight minutes of cardiac arrest and resuscitation in canine. Effects of hypertonic saline on myocardial blood circulate in a porcine mannequin of prolonged cardiac arrest. Effects of hypertonic versus isotonic infusion remedy on regional cerebral blood circulate after experimental cardiac arrest cardiopulmonary resuscitation in pigs. Intravenous glucose after out-of-hospital cardiopulmonary arrest: a group-based randomized trial. Methylene blue added to a hypertonic-hyperoncotic solution increases quick-time period survival in experimental cardiac arrest. Critical time window for intra-arrest cooling with chilly saline flush in a canine mannequin of cardiopulmonary resuscitation. Potential opposed results of quantity loading on perfusion of significant organs throughout closed-chest resuscitation. Intra-cardiopulmonary resuscitation hypothermia with and with out quantity loading in an ischemic mannequin of cardiac arrest. Out-of-hospital transcutaneous pacing by emergency medical technicians in sufferers with asystolic cardiac arrest. Immediate transthoracic pacing for cardiac asystole in an emergency division setting. Utility of pre-cordial thump for therapy of out of hospital cardiac arrest: a potential research. Simple mechanical strategies for cardioversion: defence of the precordial thump and cough version. Serial chest thumps for the therapy of ventricular tachycardia in sufferers with coronary artery illness. Comparison of transesophageal atrial pacing with anticholinergic medication for the therapy of intraoperative bradycardia. The efficacy of atropine in the therapy of hemodynamically unstable bradycardia and atrioventricular block: prehospital and emergency division issues. Effects of atropine in sufferers with bradyarrhythmia complicating myocardial infarction: usefulness of an optimum dose for overdrive. Atropine typically results in complete atrioventricular block or sinus arrest after cardiac transplantation: an unpredictable and dose-independent phenomenon. Transthoracic cardioversion of atrial fibrillation: comparability of rectilinear biphasic versus damped sine wave monophasic shocks. Biphasic versus monophasic shock waveform for conversion of atrial fibrillation: the outcomes of a world randomized, double-blind multicenter trial. Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation. Reisinger J, Gstrein C, Winter T, Zeindlhofer E, Hollinger K, Mori M, Schiller A, Winter A, Geiger H, Siostrzonek P. Optimization of preliminary power for cardioversion of atrial tachyarrhythmias with biphasic shocks. Energy, present, and success in defibrillation and cardioversion: scientific research utilizing an automated impedance-based methodology of power adjustment.

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