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ative agents (especially aminophylline) stopped Atrial fibrillation should be rapidly controlled or converted to sinus rhythm Intravenous -blockers such as metoprolol (25 5 mg/h) or short-acting esmolol (50 200 mcg/kg/ min) are the agents of choice if cardiac function is adequate Intravenous diltiazem (5 15 mg/h) may be used if -blockers are contraindicated or ineffective Digoxin (05 mg as initial dose, then 025 mg every 90 120 minutes [up to 1 125 mg] for a loading dose, followed by 025 mg daily if renal function is normal) is preferable if heart failure is present with atrial fibrillation, but the onset of action is delayed Electrical cardioversion (commencing with 100 J) may be necessary if atrial fibrillation is complicated by hypotension, heart failure, or ischemia, but the arrhythmia often recurs Amiodarone (150 mg intravenous bolus and then 15 30 mg/h intravenously, or rapid oral loading with 400 mg three times daily) may be helpful to restore or maintain sinus rhythm 3 Ventricular arrhythmias Ventricular arrhythmias are most common in the first few hours after infarction Ventricular premature beats may be premonitory for ventricular tachycardia or fibrillation but generally should not be treated in the absence of frequent nonsustained ventricular tachycardia (usually more than six consecutive beats) Lidocaine is recommended as a prophylactic measure Toxicity (tremor, anxiety, confusion, seizures) is common, especially in older patients and those with hypotension, heart failure, or liver disease Sustained ventricular tachycardia should be treated with a 1 mg/kg bolus of lidocaine if the patient is stable or by electrical cardioversion (100 200 J) if not If the arrhythmia cannot be suppressed with lidocaine, procainamide (100 mg boluses over 1 2 minutes every 5 minutes to a cumulative dose of 750 1000 mg) or intravenous amiodarone (150 mg over 10 minutes, which may be repeated as needed, followed by 360 mg over 6 hours and then 540 mg over 18 hours) should be initiated, followed by an infusion of 20 80 mg/kg/min Ventricular fibrillation is treated electrically (300 400 J) Unresponsive ventricular fibrillation should be treated with additional amiodarone and repeat cardioversion while cardiopulmonary resuscitation (CPR) is administered Accelerated idioventricular rhythm is a regular, widecomplex rhythm at a rate of 70 100/min It may occur with or without reperfusion and does not require specific therapy 4 Conduction disturbances All degrees of AV block may occur in the course of acute myocardial infarction Block at the level of the AV node is more common than infranodal block and occurs in approximately 20% of inferior myocardial infarctions First-degree block is the most common and requires no treatment Second-degree block is usually of the Mobitz type I form (Wenckebach), is often transient, and requires treatment only if associated with a heart rate slow enough to cause symptoms Complete AV block occurs in up to 5% of acute inferior infarctions, usually is preceded by Mobitz I second-degree block, and generally resolves spontaneously, though it may persist for hours to several weeks The escape rhythm originates in the distal AV node or AV junction and hence.

Note that as transaction codes call up screens, there must be a link from the screen you are trying to access to the relevant screen you wish to call You will not be able to use the transaction code [VA00] while in the SAP Customizing Implementation Guide because the screen related to [VA00] is not available from within this transaction A tip in cases like this is to enter /n before the transaction code For example, [/nVA00] will take you out of whatever transaction you are in to the VA00 screen The /n terminates the transaction you are working with, so be aware that you will lose any unsaved data in the screen you are currently on As an alternative, you can use /o in front of the transaction code (for example, [/oVA00] This opens the transaction in a new SAP session, keeping your existing screen in place

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Chalder T et al Predictors of outcome in a fatigued population in primary care following a randomized controlled trial Psychol Med 2003 Feb;33(2):283 7 [PMID: 12622306] Chronic fatigue syndrome Clinical practice guidelines 2002 Med J Aust 2002 May 6;176 Suppl:S23 56 [PMID: 12056987] Sood A et al Cancer-related fatigue: an update Curr Oncol Rep 2005 Jul;7(4):277 82 [PMID: 15946587] Viner R et al Fatigue and somatic symptoms BMJ 2005 Apr 30;330(7498):1012 5 [PMID: 15860829] Whiting P et al Interventions for the treatment and management of chronic fatigue syndrome: a systematic review JAMA 2001 Sep 19;286(11):1360 8 [PMID: 11560542]

A careful history and physical examination should aim to identify causes of acute headache that require immediate treatment These causes can be broadly classified as imminent or completed vascular events (intracranial hemorrhage, thrombosis, vasculitis, malignant hypertension, arterial dissection, or aneurysm), infections (abscess, encephalitis, meningitis), intracranial masses causing intracranial hypertension, preeclampsia, and carbon monoxide poisoning A detailed description of the onset of headache can be helpful Report of a sudden-onset headache that reaches maximal and severe intensity within seconds or a few minutes is the classic description of a thunderclap headache and should precipitate workup for subarachnoid hemorrhage, since the estimated prevalence of subarachnoid hemorrhage in the setting of a thunderclap headache is 43% A new headache in a patient of advanced age or with a history of HIV disease under most circumstances (including a normal neurologic examination) warrants neuroimaging immediately (Table 2 7) When the patient has a medical history of hypertension particularly uncontrolled hypertension a complete search for criteria satisfying a diagnosis of malignant hypertension is appropriate to determine the correct urgency level of hypertension management (see 11) Headache and hypertension associated with pregnancy may be due to preeclampsia Episodic headache associated with the triad of hypertension, heart palpitations, and sweats is suggestive of pheochromocytoma In the absence of thunderclap headache, advanced age, and HIV disease, findings on physical examination will usually determine the time course and need for further diagnostic testing Patient symptoms can also be useful for diagnosing migraine headache in the absence of the classic migraine

Age > 50 years Rapid onset and severe intensity (ie, "thunderclap" headache) Fever Trauma Vision changes HIV infection Current or past history of hypertension Neurologic findings (mental status changes, motor or sensory deficits)

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