Additional "real world" data comes from the ORBIT-AF and Dresden registries. ORBIT-AF ( O utcomes R egistry for B etter I nformed T reatment of A trial F ibrillation) is a community-based registry of outpatients with atrial fibrillation receiving any oral anticoagulant; in this study, 2200 of 7372 individuals (30 percent) had interruption of anticoagulation for a procedure [ 59 ]. Bridging was used in 24 percent of these interruptions, especially in patients with a history of stroke or a mechanical heart valve and/or receiving warfarin ; bleeding events were more common in individuals who received bridging compared with those who did not receive bridging ( versus percent). A composite endpoint that included major bleeding, myocardial infarction, stroke, systemic embolism, hospitalization, or death within 30 days was also higher in those who received bridging (13 versus percent). In the Dresden NOAC registry, over 800 patients who were receiving dabigatran , rivaroxaban , or apixaban for any indication and underwent an invasive procedure had similar rates of major cardiovascular events if they received bridging, no bridging, or no anticoagulant discontinuation [ 60 ]. Bridging was not an independent risk factor for major bleeding; however, individuals undergoing major procedures were more likely to receive bridging and to have major bleeding.
During treatment of VF/pulseless VT healthcare providers must ensure that coordination between CPR and shock delivery is efficient. When VF is present for more than a few minutes, the myocardium is depleted of oxygen and metabolic substrates. A brief period of chest compressions can deliver oxygen and energy substrates and “unload” the volume-overloaded right ventricle, increasing the likelihood that a perfusing rhythm will return after shock delivery At this time the benefit of delaying defibrillation to perform CPR before defibrillation is unclear (Class IIb, LOE B).
Is it possible for PF muscles to ever fix themselves in relation to us fixing poor habits? For a while after my son was born, whenever I would stand for long periods of time, it felt like all the blood was rushing down to my perineum, and I would have this painful burning sensation in my lower back. I hadn’t found this gem of a site at that point, and was probably doing 100+ kegels daily, trying to be diligent and stay tuned. *hah* After finding this site, squatting, walking 4+ miles daily, and giving up on kegels, (My apologies to the queen!) I no longer experience that pain. I always thought it was just time more fully healing my body, but could these changes have been my body self correcting as I learn better habits?