Pulse deficit

A 24-year-old woman briefly lost consciousness and had nausea and vomiting several minutes after smoking marijuana. She had hyporeflexia, atrial fibrillation (maximum 140/minute with a pulse deficit), and a blood pressure of 130/80 mmHg. Echocardiography was unremarkable. Within 12 hours, after metoprolol, propafenone, and intravenous hydration with electrolytes, sinus rhythm was restored. 

Arterial pulses are an accurate measure of the ventricular rate in healthy persons with good ventricular function. In patients with a rapid ventricular rate—because of supraventricular tachyarrhythmias such as atrial flutter or fibrillation or rapid ventricular rates (e.g., ventricular tachycardia or premature ventricular beats)—extremity pulses (e.g., radial pulse) may be considerably slower than the true ventricular rate. A more accurate ventricular rate is determined by listening to the ventricles with the stethoscope (usually at the apex) or counting from an ECG. In patients with atrial fibrillation and a fast ventricular rate, a pulse deficit (measure of the difference in true ventricular rate and peripheral pulse rate) may exist. This may be as much as 10 to 20 beats per minute. Thus the location of the pulse (radial or apical) should be recorded. The pulse deficit will be reduced as the ventricular rate is controlled with drug therapy or normal sinus rhythm is restored. 

Brunton s findings were quickly applied to the therapy of patients with heart disease. Drummond (102) used a tincture of Erythrophleum in two cases of congestive heart failure due to rheumatic mitral stenosis or insufficiency. He noted a desirable decrease in pulse rate, a disappearance of pulse deficit, an increase in blood pressure, and diuresis. Overdosage did cause a temporary cessation of urine flow. Drummond believed that Erythrophleum would be useful in therapy to slow the pulse rate, make the heart rhythm more regular, and increase the force of cardiac systole but but implied that digitalis acted with greater certainty and regularity. 

Fever pattern may range in severity and perserverance may cause a pulse-temperature deficit. 

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

Fluid replacement ORT 50 mL/kg over 2-4 hours ORT 100 mL/kg over 2-A hours Lactated Ringers 40 mL/kg in 15-30 minutes, then 20-40 mL/kg if skin turgor, alertness, and pulse have not returned to normal or Lactated Ringers or normal saline 20 mL/kg, repeat if necessary, and then replace water and electrolyte deficits over 1-2 days, followed by ORT 100 mL/kg over 4 hours... 

Depending on the temperature, there may be a carbon deficit in the mass balance upon individual pulses, i.e. CO consumption may be higher than C02 formation. A certain amount of carbon may be stored in the catalyst and released upon the following CO pulses or upon the first pulses of 02. In this case, some C02 appears in phase 2. A detailed investigation of C and O mass balance during OSC measurements has been made by Holmgren et al. [24],... 

ADHD, attention-deficit hyperactivity disorder BP, blood pressure CLO, clomipramine FLX, fluoxetine IMP, imipramine N, total number of subjects in study ( ), number of preschool-age subjects in study P, pulse rate PDD-NOS, pervasive developmental disorder, not otherwise specified SE, side effect VNF, venlafaxine. DSM-III-R or DSM-IV criteria used not specified by authors. 

Fig. 2.24 Portion of a time-of-flight spectrum in pulsed-laser stimulated field evaporation of a Rh tip in 2 x 10 8 Torr of 4He. Besides the formation of 4HeRh2+, the Rh2+ line now shows a low energy peak of 51 eV additional energy deficit (shaded). Rh2+ ions in this secondary peak are produced by field dissociation of 4HeRh2+ in the field dissociation zone which is about 150 A in width and is centered at —220 A above the tip surface.

Fig. 3.19 Mass separated energy distributions of pulsed-laser field desorbed 4He+ and ions obtained with the Penn State pulsed-laser ToF atom-probe when the flight path length was 778 cm. Their onset flight times are separated by 34 ns, exactly that calculated from the system constants and their critical ion energy deficits at 5.5 kV.

In a preliminary pulsed-laser atom-probe measurement,158 the critical ion energy deficits of Rh and W atoms, field evaporated from kink sites, are measured at a rate of 1010 layers per second at a temperature around 100 K. Using the system constants, i.e. the flight path constant and the... 

In field ionization, hydrogen molecules near the tip region are attracted to the tip surface. They either hop around the tip surface or are field adsorbed on it. As the hopping motion and the field adsorption are dynamical phenomena, some of the ionic species detected may also come from field adsorbed states, not necessarily just from the gas phase. On the other hand, in pulsed-laser stimulated field desorption, where gas pressure is very low, of only 1 X 10-8 Torr, gas molecules are thermally desorbed by laser pulses from their field adsorbed and chemisorbed states. When they pass across the field ionization zone some of them are field ionized. The critical ion energy deficit in pulsed-laser stimulated field desorption of a gas is therefore found to be identical to that found in field ionization. In both pulsed-laser stimulated field desorption and field ionization of hydrogen, the majority of ions detected are H3 and H+. 

The equilibrium state is characterized by a complete lack of coherence (random phase), a slight excess of population in the a state (M2 + 5), and a deficit in the p state (N/2 - 5). Anything that perturbs this equilibrium (e.g., an RF pulse) will be followed immediately by a process of relaxation back to the equilibrium state that can take as long as seconds to reestablish. Relaxation is extremely important in NMR because it not only determines how long we have to wait to repeat the data acquisition for signal averaging, but it also determines how quickly the FID decays and how narrow our NMR fines will be in the spectrum. Relaxation is also the basis of the nuclear Overhauser effect (NOE), which can be used to measure distances between nuclei one of the most important pieces of molecular information we can obtain from NMR. 

Wilkinson LS, Killcross AS, Humby T, Hall FS, Geyer MA, Robbins TW (1994) Social isolation produces developmentally-specific deficits in pre-pulse inhibition of the acoustic startle response but does not disrupt latent inhibition. Neuropsychopharmacology 70 61-72. 

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