• Low saturated fats
• Limit sugar intake
• Limit salt intake
• Encourages 4-9 servings fruits/veg. per day
• Encourages 6-8 servings of whole grains per day, legumes, nuts
• Less than 6 oz. Fish, meats and lean poultry daily

DASH Diet

• Low-fat, low salt diet
• Encourages fruits, vegetables, whole grains, fish poultry and nuts
• Lowers BP, LDL cholesterol
• Promotes weight loss
• May lower risk of heart attack and stroke in women

Atkin’s Diet

• Low carbohydrate
• High protein and fat intake (good and bad fats)
• Promotes weight loss
• Lowers triglycerides.
• Increases HDL
• Lowers BP
• Questionable long term physical effects

South Beach Diet

• Low carbohydrate (but allows for “good” carbohydrates with low glycemic index
• Includes good fats
• Encourages fruits, vegetables, whole grains and lean protein
• Promotes weight loss
• May help decrease risk for the Metabolic Syndrome

Ornish Diet

• Vegetarian diet
• Extremely low fat, high fiber diet
• Encourages complex carbohydrates
• Incorporates exercise and stress management
• Decreases LDL
• Promotes weight loss
• May decrease angina and plaque development in blood vessels

Mediterranean Diet

• Low fat
• Small portions of high quality foods
• Encourages 7-10 servings of fruits and vegetables/day, olive oil, nuts, red wine, and fish
• Incorporates exercise and healthy lifestyle changes
• Decreases LDL, BP, and blood sugar
• Promotes weight loss
• May help prevent repeat heart attacks/angina

Low saturated fats:

These are foods such as lean meats and meat alternatives like beans or tofu. White meats are better than red meats. If possible, stay away completely from organ meats although liver is rich in iron and other important macro-nutrients. Other foods includes fish, vegetables, beans, and nuts nonfat and low-fat dairy products polyunsaturated or monounsaturated fats, like canola and olive oils, to replace saturated fats, such as land.

Eat a variety of whole grain products such as oats, whole wheat bread, and brown rice.

Eat fish twice a week. Oily fish, which contain omega-3 fatty acids, are best for your heart. These fish include tuna, salmon, mackerel, lake trout, herring, and sardines.

 Limit sugar intake.

If you must use sweeteners, use bee honey or brown sugar.

Limit salt intake to 2,300mg/day

Encourages 4-9 servings fruits/veg. per day.
Eat a wide variety of fruit and vegetable servings every day. Notice that vegetables have almost no calories and can help in weight loss. It is advisable to eat fruits and vegetables of all colors like dark green, deep orange, yellow etc. Each color variety is rich in different micronutrients.

Limit meat intake to less than 6 oz. Fish, meats and lean poultry daily

BIPOLAR LEADS:

Bipolar leads are so named because they require a positive pole and a negative pole. Just like a a battery that have positive an begative poles. The positive electrode is the one that actually “sees” the current coming. The lead that sees the current makes the wave. The direction the current is coming from determines if the wave will face upwards of downwards. Sounds like Greek in England? I apologize but I will try to make it as simple as possible.
Lets review that small paragraph:

• That bipolar leads have positive and negative poles = CHECK
• The positive lead is the one that sees the current = CHECK
• The direction the current is coming from determines the direction of wave deflection = CHECK

So which are these bipolar leads that have positive and negative poles with the positive lead seeing the current? There are 3 bipolar leads in a 12 lead EKG: -

• Lead I. Measures the current traveling between the right and left arms. The right arm is negative pole and the left arm is positive pole. So, the lead on the left arm is the one that sees the current travelling from the right arm = CHECK
• Lead II. Measures the current traveling between the right arm and the left leg. The right arm is negative pole and the left leg is positive pole. So, the lead on the left leg sees the current coming from the right arm. = CHECK
• Lead III. Measures the current traveling between the left arm and the left leg. The left arm is the negative pole and the left leg is the positive pole. Likewise, the lead on theleft leg sees the current coming from the left larm. =CHECK

You’ll notice that in the bipolar leads the right arm is always negative and the left leg is always positive. Also note that the left arm can be positive or negative depending on which lead it is a part of. If you join leads I, II, and III at the middle, you get the triaxial diagram

AUGMENTED LEADS:

· aVR. Measures the current traveling toward the right arm. This is a positive electrode. The electrode is on the right arm.
· aVL. Measures the current traveling toward the left arm. This is a positive electrode. The electrode is on the left arm.
· aVF. Measures the current traveling toward the left foot (or leg). This is a positive electrode. The electrode is on the left leg.

These are called augmented leads because they generate such small waveforms on the EKG paper that the EKG machine must augment (increase) the size of the waveforms so they’ll show up on the EKG paper. These leads are also unipolar, meaning they require only one electrode to make the leads. In order for the EKG machine to augment the leads, it uses a midway point between the other two limbs as a negative reference point
Both the bipolar and augmented leads are also called frontal leads because they look at the heart from only the front of the body.

PRECORDIAL (CHEST) LEADS

These leads are located on the chest. They are also unipolar leads, and each one is a positive electrode. The precordial leads see a wraparound view of the heart from the horizontal plane. These leads are named V1, V2, V3, V4, V5, and V6.

 FACTS ABOUT EKG

· An impulse traveling toward (or parallel to) a positive electrode writes a positive complex on the EKG paper.
· An impulse traveling away from a positive electrode writes a negative complex.
· An impulse traveling perpendicularly to the positive electrode writes an isoelectric complex (one that is as much positive as it is negative).
· If there is no impulse at all, there will be no complex¾just a flat line.

NORMAL QRS DEFLECTIONS

How should the QRS complexes in the normal EKG look? Let’s look at the frontal leads:

• Lead I Should be positive.
• Lead II Should be positive.
• Lead III Should be small but mostly positive.
• aVR Should be negative.
• aVL Should be positive.
• aVF Should be positive.

Now that this might need a day or two to digest, I will stop at this point. Next, we will re-visit this same topic with descriptive diagrams to show you how the current travel and the expected EKG wave deflection.

The length of pregnancy is calculated at 280 days from the first day of the LMP. However, there are various factors that will affect the length of pregnancy and the calculation of the EDD: -

Ever heard that the gestation period of a human being is 9 months or 40 weeks? This is a generalization because various factors can affect expected day of delivery.

* The length of the menstrual cycle: Some people have 28, 30 or 33 days cucles. Others even have 25 days cycle whle others are never consistent.
* Conception within three months of discontinuing the contraceptive pills:
* Conception while taking the contraceptive pill
* Conception when an intrauterine device is in situ
* When the last bleed is calculated as a menstrual period when it is an implantation bleed
* In vitro fertilization when the day of conception is known.

When taking details of a woman’s menstrual history, the following questions should be asked:
* At what age when menstruation started
* Regularity of menstrual bleeds
* Frequency of menstrual bleeds
* Length of menstrual bleeds, especially the last one.

Gestational age and calculation of EDD by LMP is calculated according to Naegele’s rule. That is, counting forwards by nine months and adding seven days from the first day of the LMP or by adding a year, counting backwards by three months and adding seven days.

It is important to calculate using the length of the menstrual cycle. The latter calculation is based on a 28-day cycle. For a 33-day cycle, the calculation is to add nine months, then seven days then five days.

Enjoy and share with a friend

In the second part of 12 lead EKG interpretation, we will look at simple heart arrhythmias that can be detected by 12 lead EKG or just a primary lead EKG strip. By basic I mean those rhythms that you can look at only one primary lead (usually lead 2) and tell what it is. There are other EKG abnormalities that needs you to look at more than one lead, the position of the heart (also called axis), specific segments, amplitude and voltage of the leads. But don’t let this make you run away from 12 lead EKG interpretation because it is quintessential you understand it. If reading this can make you save only 1 life, then it is all worth understanding 12 lead EKG interpretations. Needless to say, more lessons are coming about: -

1. Understanding 12 ECG/EKG lead placement
2. Understanding the circulation of the heart and which arteries when blocked caused AMI
3. Understanding which leads on EKG are positive, negative or neutral in polarity.
4. Understanding the normal axis of the heart and what deviation from normal axis mean (Have you ever seen some numbers at the top of EKG graph and you wonder what they mean? Just understanding those numbers points you to the problem area and when you look at specific waves, you are just confirming. This is a key to successful 12 lead EKG interpretation

The following are the common arrhythmias of the heart that you probably already know about. They are straight forward to diagnose and most of them has no emergent attention command

1. Sinus Bradycardia:AKA Sinus Brady is a regular heart rhythm with less than 60 beats per minute. It should be noted that sinus bradycardia has regular beats. There must be P waves before every QRS at a ratio of 1:1, meaning per every 1 P wave, there is 1 QRS complex. The distance between P wave and the beginning of QRS complex (PR interval) must be between 0.12-0.20 seconds. Each small box in EKG measures 0.04 seconds, meaning a normal PR interval has 3-5 small boxes.  Got it? Are you sure? Soon we will find out because if you see a rhythm of 45 and call it sinus bradycardia before measuring PR interval, you could be misdiagnosing with junctional rhythms.
2. Sinus tachycardia:AKA Sinus Tach is a regular rhythm with more than 100 beats is a minute but less than 150 beats. Why less than 150? If a rhythm has more than 150 beats, it is not possible to see the P-Wave as the beats succession is so rapid. This is what is called supraventricular tachycardia and recently renamed as narrow complex tachycardia. We will look into this soon. Sinus tachycardia must have a normal P-Wave before each QRS complex and PR interval must be the same. The distance from one R wave (top of QRS) to the other must be the same (R-R). If R-R wave is not regular, you might be looking at atrial fibrillation AKA A-Fib. Are you feeling like you might have misdiagnosed sinus Tachycardia already? Most likely not but keep reading
3. Sinus Arrhythmia: What? Never heard of that! Sinus arrhythmia is an irregular heart rhythm usually seen in ICU or telemetry patients on continuous monitoring. The heart rate is variable depending on inspiration or expiration. With inspiration, the heart rate increases and with expiration, the heart rate decreases. All other parameters are normal like 1:1 ratio of P-wave and QRS complex, PR interval of 0.12-0.20 and QRS complex less than 0.10 seconds.
4. Premature Atrial Complex (PAC):This is yet another rarely heart arrhythmia that is benign in nature. You never call a rhythm PAC but rather mention the underlying rhythm with PAC. Example, Sinus rhythm with PAC or Sinus Bradycardia with PAC’s. So what is it? There is an ectopic beat once in a while. The ectopic beat originates from atrial heart cells firing before they are supposed to. Except the ectopic beats, all other beats are normal with normal measurements. Patients may complain of feeling as if the heart stopped for a beat, something also reported in A-Fib
5. Atrial Flutter: The so called saw tooth wave form is one of the easiest for many of us to diagnose. The atrial beats (firing) could be as many as 230-350 times in a minute but ventricular conduction may be normal (60-100 beats). These saw tooth like waves are called U-Waves. Aha! U-Waves. QRS is normal in morphology and measurements. Of course, there are no P-Waves as they have been replaced by U-waves.
6. Atrial Fibrillation: A-fib is a silent killer FYI due to clots formation in the right atria. Nothing about A-Fib is regular. The rhythm is irregular meaning that there are variable R-R wave distances between each beat. The baseline may look like a wavy line with irregular U-Waves. It is an irregular irregularity in simpler terms. There are no P-waves but U waves. QRS is upright and normal in measurements (<0.1 second).
7. Supra Ventricular Tachycardia (SVT) also called narrow complex tachycardia (NCT).This is a super fast sinus tachy is simpler terms. The heart is so fast, between 150-250 beats a minute. Do you know how it is treated? Ever heard of adenosine?
   



8. Junctional Rhythms:There are 3 types of junctional rhythms namely Junctional escape(40-60 beats a minute, less than normal), accelerated junctional rhythm (61-99 beats, normal heart beats a minute) and junctional tachycardia (100-140 beats a minute). How do you know if it is a junctional rhythm?
   1. The heart rate is regular, meaning R-R is regular
   2. The P-wave is inverted instead of facing upright OR
   3. There is no P-Wave in front of every QRS complex
   4. The PR interval is larger than 1.20 seconds
9. Ventricular Tachycardia:V-Tach (Code blue) is a life threatening emergency rhythm that must be intervened immediately or sudden death will occur. This monster is between 100-250 beats a minute with no P-waves. There is no QRS complex, meaning that the heart is NOT perfusing itself or other organs and cardiopulmonary resuscitation (CPR) is warranted. The waves in this rhythm are through to be bizarre looking QRS complexes. If you see this rhythm (monitor alarms will scream at you even before you see it if you have your alarms set and armed), immediately call for help, assess ABC’s and start CPR. Remember, this is a NON PERFUSINGrhythm and CPR is warranted unless the patient is awake and alert. Guess what, the patient cannot be awake and alert if they are in true V-Tach. If the monitor shows V-Tach and you see them moving, it could be a false rhythm caused by insecure leads or movement. If it is a true V-Tach, they will be unresponsive and you must start CPR NOW! Do you hear me? It is also a shockable rhythm per ACLS algorithms.
10. Ventricular Fibrillation: Call Code blue and start CPR ASAP. Just like V-Tach, V-Fib is a NON-PERFUSING Rhythm. You cannot see any P-Waves, no heart rate, no QRS complex, just a wavy line.

In one of the future articles, I will talk about other rhythms that you may never see easily but can tell you that a life threatening emergency is likely. Example, Torsades de Pointes, which may be seen during long resuscitation due to low magnesium or calcium level. It can also be caused by Haldol IV-Push. (Always give haldol as I.M. and never as IV although you might say… we do this all the time and even doctors order it as I.V. Consider yourself warned!

In the next article, we will look at heart blocks, how to recognize them easily by just checking key areas and then we will go back to interpreting 12 Lead EKG. After heart blocks, we will look at how 12 Lead EKG leads are placed, what they mean, what side of the heart are they are looking at, and what lead correspond to what side of the heart. We will also look at the axes of the heart because understanding axes can accelerate your 12 lead EKG interpretation.

Discussion:

By replying here with comments, describe in as many words as you can: -

1. A life threatening emergency you have ever taken part in. Tell us what happened and what was done to save the patient. Did the patient survive? Do not mention names or locations.
2. Have you ever been in a code blue and how did it go? Did you participate? CPR? How did that go?
3. There are other rhythms that are not mentioned here. Can you identify any?

Do you know what to look for to determine if Mrs. Troponin 12-lead ECG is abnormal? Could you recognize signs that she’s having a myocardial infarction (MI)? How about heart blocks, all of them?

If you can independently interpret a 12-lead ECG, you can anticipate and prepare for the emergency care your patient may need. In this article, I’ll cover the basics of 12-lead ECG interpretation,focusing on a normal ECG. Once we are clear with the normal EKG, we will look at abnormal EKG and how to interpret.

To understand the normal EKG, you must understand the heart contractile process, the electrical pace makers, and electrical pathways all the way to the ventricles. Since my goal is EKG and not cardiac anatomy, I will only focus on what is happening at what point. Maybe we can re-visit cardiac anatomy in future.

The contraction of the heart begins at sinoatrial node (SA node) located on the right atria (also called the natural pace maker). The SA node fires between 60-100, hence the normal heart rate of a human being. All contractions must start from SA-Node for us to call a rhythm as a Normal Sinus Rhythm (NSR). On EKG, the firing of sinoatrial node is indicated by P-Wave on EKG. Got it? After the SA-Node fires, the electrical impulses travels down to atrial-ventricular node (AV-Node) located between the atria and the ventricles, hence the name— atrial-ventricular node (AV-Node). This causes the atria to contract (depolarization indicated by the P-Wave on ECG).

AV-Node has an intrinsic pace between 40-60, meaning if SA-Node failed to fire, the AV node can initiate contractions at a rate between 40-60 beats a minute. Such beats are called Junctional, because they are from AV-Junction and not from SA-Node. To recognize these beats: -

1. The heart rate is between 40-60
2. There is no P-Wave before every QRS complex OR
3. The P-Wave is inverted.

The time the impulse take to travel from SA node to AV node in EKG is indicated by P-R interval (0.12-0.2 seconds). The AV node holds the impulse briefly allowing the ventricles to fill with blood.

HINT: To understand abnormal EKG, you must remember the time each process takes. There is no way around this. You also need to know that a QRS complex must be preceded by an upright P-Wave and a PR interval lasting between 0.12-0.2 seconds and not longer. A P-wave must always face upwards in a normal EKG, not downwards. We’ll talk more about this when talking about abnormal ECG.

EKG waves explained

Back to the AtrioVentricular node where we said it delays the impulse and gives time to let the ventricles fill with blood after atrial contraction. Assuming that you know your cardiac anatomy, the impulse travels from AV-Node through bundles of His and down to Purkinje fibers. There is left and right bundles, something you also need to know to understand bundle branch blocks (BBB) coming soon.

The bundle branches are high speed conduction fibers and connects with Purkinje fibers.The moment the impulse leaves the AV node, ventricular contraction begins. Since these are high speed fibers, the ventricular contraction takes 0.06-0.1 seconds indicated by QRS complex. Got it?

HINT: If there is an issue with either right or left bundle of His, the QRS contraction takes longer than 0.1 second, indicated by a wide QRS. Any time you are looking at a 12 lead EKG and QRS is greater than 0.1, you automatically know there is a bundle branch block. We will talk more about how you tell if it is right or left from an EKG.

Normal EKG

Back to QRS complex, which we said it indicates ventricular contraction and relaxation. Before I start confusing you with why QRS has downwards and upwards deflections, before I start explaining why R wave is taller than the rest, let us finish all parts of a normal EKG. I will explain the leads position, their polarity, what side of the heart they look at and the direction the current is traveling before going to abnormal EKG. Deal?

The QRS is followed by a T wave. Between the T wave and the end of QRS (S-section) is the S-T segment. This is a very important section of an EKG because it indicates the oxygenation of the myocardium and potassium levels. Peaked T wave indicates high potassium level. When myocardial cells are injured,the ST segment often is elevated above the baseline. So ST segment elevations are a key indicator of MI. Depressed ST segment may indicate old myocardial infarction.Myocardial ischemia (temporary and reversible) often results in an ST segment below the baseline of the ECG tracing.

HINT: You must know the baseline of an EKG tracing and notice the height of each wave. You also should know what parts of EKG can show you life threatening events are imminent.— ST segment. In the next article, I will go through the leads and which leads you should look at to detect MI.

Discussion:

1. Assuming that Mrs Troponin was having MI, and as a good nurse, you remembered MONA. What is the rationale of using Morphine?
2. How well do you understand bundle branch blocks?
3. How many abnormal Rhythms do you know? List them on comments section of this article and we will discuss them later.

Acute Myocardial Infarction

Acute myocardial infarction (AMI) is a medical emergency requiring immediate hospitalization; patients suspected of having AMI should be admitted immediately to the coronary or intensive care unit for evaluation and potentially life-saving treatment. (Do you know how AMI is treated? Please tell us in comments section below)

The clinical presentation of AMI is characterized by chest pain, ECG changes, and serial elevation of cardiac biomarkers. (Do you know specific ECG/EKG changes indicate myocardial infarction? Tell us in comments section)

Serum cardiac enzymes and specific cardiac biomarkers may be elevated, indicating cardiac muscle damage, ischemia, necrosis, thereby aiding in the diagnosis of AMI.

Cardiac troponins level are considered the gold standard for diagnosing AMI. Why? Because two of the proteins that compose cardiac troponins have the greatest sensitivity and specificity for detecting myocardial damage. By sensitivity, it means even the slightest damage will show changes and with specificity, it means that the change can only be cardiac related and not any other part of the body.  troponin levels are now considered the world criteria for defining and diagnosing AMI according to American College of Cardiology, the American Heart Association, the European Society of Cardiology, and the World Heart Federation

Creatine kinase (CK) & CK isoenzymes , specifically CK-MB (CK-2), found in cardiac muscle, are specific markers for myocardial damage or necrosis and are considered to be sensitive early markers of AMI if troponin assays are not available. That means if these biomarker levels start getting elevated, early intervention and evaluation should be started while troponin levels are pending.

Myoglobin levels have high sensitivity but poor specificity for detecting AMI. However, when used in conjunction with other studies, elevated myoglobin levels may be a useful marker. Normal myoglobin values are < 90 ng/L. Myoglobin level elevation to anyone presenting with chest pains whether radiating to the arms, shoulders, elbows and lower back or NOT should be considered positive unless otherwise ruled out.

Discussion:

1. Discuss by posting a comment how you should treat AMI as soon as you suspect is
2. Not all ECG/EKG changes indicate AMI. What EKG changes would alarm you that the patient could be having AMI?
3. Do you have any mnemonics related to myocardial infarction?
4. Close your comments by suggesting the next topic you would like us to discuss

1/3(SBP-DBP)+DBP = MAP
Explanation.
Systole is the time when the ventricles are contracting and diastole is the relaxation time. In normal condition, the systole phase takes about half the time the diastole takes. In other words, diastole takes twice as longer as systole.
This explains why we cannot just add systolic blood pressure and diastolic blood pressure and divide it with 2. The time each takes is different. In-stead, if we divided the time in equal parts, we would have 3 equal parts, where the systole takes 1/3 and diastole takes 2/3 of total time.

To test if this is true, we can multiply systolic BP by 1/3 and diastolic BP by 2/3 and add the results together to come up with the mean arterial pressure.

Lets use real example using the known formula of 1/3(SBP-DBP)+DBP = MAP and control theoretical explanation and see if we will come up with the same results.
Lets say a patient BP = 120/60. Pulse pressure (SBP-DBP) would be 120-60 = 60.
Mean Arterial Formula: 1/3(SBP-DBP)+DBP = MAP
1/3 X 60 = 20
Add the result above to DBP (60)
20+60 = 80
Lets now use the theoretical way of testing if the formula above gives a true picture of how the heart works in normal conditions.
Our sample BP is 120/60

We will multiple SBP X 1/3 AND DBP X 2/3 and then add the total. We should get the same results as above
1/3×120 = 40 + 2/3×60 = 40. 40+40 = 80

Happy? Leave your comments/complements

PICC lines are also safe for patients to take home and administer medications intravenously. Home care for PICC lines can be tricky and likely to develop complications such as infection, dislodging or blockage.

PICC line is centrally placed into the big veins of the body, specifically the subclavian vein. This make PICC line a great asset that can be used for months if maintained properly.

Here are some few tips on how to care for a PICC line at home.

1. Make sure the clear occlusive dressing is intact all the time. Covering the PICC line with occlusive dressing when taking a shower is recommended.
2. Avoid heavy using of the arm that has a PICC line to avoid complications such as dislodging and kinking.
3. PICC line dressing must be changed every 72 hours under sterile technique is no Biopatch was used and every 7 days if a biopatch was used.
4. Flush each PICC line port with 10cc normal saline without mixing the syringe. This is a good way to prevent cross contamination of PICC line ports.
5. Always use alcohol prep to clean PICC line head/ports before and after use. Alcohol prep helps to prevent introducing bacteria into your body.
6. You must flush PICC line with atleast 10cc of normal saline after administering medications. This prevents mixing of incompatible medications that may precipitate and clog the PICC line.
7. Never administer any medication on PICC line without consulting your physician.
8. PICC line ports should be changed with every dressing change, Microclave male adaptors are recommended for use as PICC line access ports.

Advantages of using microclave male adaptors on PICC lines

1. Microclave male adaptors prevent PICC line leakages
2. The minimize/eliminate use of needles, thus making them safer for patient and staff use.
3. They minimize introduction of bacteria into the blood stream
4. Makes it easy to make a connection or disconnection without compromising sterility
5. They can be changed regularly with dressing changes and as needed.

How to flush a PICC line

1. Wash your hands with soap and warm water for at least 15 seconds and dry with clean towel.
2. Wear gloves for protection incase of accidental PICC line retrograde leakage.
3. Clean the tip of the microclave port with alcohol pad and wait for it to dry.
4. Using the luer, screw in a 10cc syringe filled with normal saline. Do not use less than 5cc syringe to prevent bursting out the tip of the PICC line, which can cause ischemic conditions like stroke, pulmonary embolism or heart attack.
5. Use turbulence flush technique. In turbulence PICC line/central line flush technique, you flush intermittently with the full 10 cc of normal syringe.
6. Never leave blood showing on PICC line tube.

1. If you are planning on having a baby, be healthy before you get pregnant and take folic acid to prevent birth defects of the brain and spine.
2. Tell your doctor if you have high blood pressure, diabetes or any other illness.If you think you may be pregnant, see a medical provider immediately. Early prenatal care could prevent having the baby too soon. Learn the signs of pre-term delivery – dads, family and friends need to know too.
3. If possible, breastfeed your baby. Breastfeeding during the first year may prevent the baby from getting sick and may reduce the risk of infant death. Research has shown that breast fed babies have very few cases of sudden infant death syndrome (SIDS)
4. Make the baby’s sleep environment safe. Babies should sleep on their back. Do not use soft bedding, don’t smoke around the baby and don’t let the baby get too warm. Avoid sharing the bed with an infant as this can facilitate SIDS. The true causes of SIDS are not clearly known but heat and possible suffocation/asphyxia has been blamed for infant deaths.
5. Use a car seat that is the right size for the age and weight of the baby. Make sure it is properly installed. If unsure how to secure a car seat, your local fire department can help you learn how to do it for free.
6. Never shake a baby. Crying is a baby’s way of communicating but if the crying is too much to handle, call someone to help or place the baby in a safe place and leave the room until you are calm. Shaking the baby can break bones, cause spinal cord injuries with permanent injuries and disability. Shaking a baby is illegal in USA punishable with jail time and fine and the baby taken away by child protection services.