...Continuous quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal t ube placement Cardiac arrest algorithms are simplified and redesigned to emphasize the importance of hig h-quality CPR Key changes from the 2005 ACLS Guidelines Atropine is no longer recommended for routine use in the management of PEA/asystole There is an increased emphasis on physiologic monitoring to optimize CPR quality and detec t ROSC Key changes from the 2005 ACLS Guidelines Chronotropic drug infusions are recommended as an alternative to pacing in symptomatic and unstable bradycardia Adenosine is recommended as a safe and potentially effective therapy in the initial mana gement of stable undifferentiated regular mono morphic wide-complex tachycardia Topic in ACLS 2010 Management Management of Cardiac Arrest of Symptomatic Bradycardia and Tachycardia Management of Cardiac Arrest Management of Cardiac Arrest Early CPR and rapid defibrillation can significantly increase the chance for survival to hospital discharge Management of Cardiac Arrest Medications and advanced airways associated with an increased rate of ROSC • But have not been shown to increase the rate of survival to hospital discharge Higher quality CPR and post– cardiac arrest interventions...
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...Title: Experiment 2 Determination of the valency of the magnesium Objective: -To study the quantitative relationship between the amount of reactants and products of a reaction. -A known starting mass of magnesium and the measured collection of hydrogen gas will be used to determine the reaction stoichiometry and the valency of magnesium. - To identify the unknown X value in the chemical equation between magnesium and hydrochloric acid - To determine the valency of magnesium Introduction: Stoichiometry is the study of the quantitative relationship between amounts of reactants and products of a reaction (that is, how many moles of A react with a given number of moles of B). In this section, a known starting mass of magnesium and the measured collection of hydrogen gas will be used to determine the reaction stoichiometry. Magnesium reacts with hydrochloric acid to form hydrogen gases. The aim of this experiment is to determine the value of x in the following equation: Mg + X HCI → MgCIX + H2 A known amount of magnesium is reacted with a large excess of HCl, and the volume of H2 evolved is measured. As HCl is in excess, all the magnesium will be consumed, and the yield of both MgClX and H2 is dependent on the amount of magnesium used. A comparison of the amount of hydrogen produced with the amount of magnesium consumed will enable the X value to be determined. Apparatus and Materials: Magnesium ribbon, 0.5M Hydrochloric acid, Burette (50 cm3), Pipette (25...
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...At one point in time exercises for people with MS was not always considered. As stated in the article, “exercise was not often prescribed for persons with MS because it was believed to exacerbate symptoms and fatigue” (Garrett & Coote 2009). Even though people with MS may experience difficulties when doing recreational activities. Research shows that physical activities does help multiple sclerosis, “A meta-analysis based on results from 22 publications showed a small but significant improvement of walking performance after exercise training. Both aerobic (endurance) exercise and resistance training were shown to be effective” (Béthou, Fox & Rae-Grant 2013). These results indicate that despite the limitations people with MS deal with, there are still options to help relieve some of their...
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...Early in her career, Orem gained experienced as a staff nurse in a variety of hospitalclinical settings. While serving as director of nursing service at a Detroit hospital, she recallsthat she was asked a substantive question and didn’t have an answer because she “had noconceptualization of nursing” (McLaughlin-Renpenning & Taylor, 2002, p. xii).Orem goes on to say while working at Indiana University where her goal was to upgradethe quality of nursing in general hospitals throughout the state, she noted that nurses haddifficulty articulating needs to hospital administrators in the face of demands made upon themregarding such issues as length of stay, scheduling admissions and discharges, etc.(McLaughlin-Renpenning and Taylor, 2002). As a result, Orem recognized a need to look for the uniqueness of nursing. Specifically she was looking for an answer to questions such as“What is nursing?”, ‘What is the domain and what are the boundaries of nursing as a field of practice and a field of knowledge?”, and “What condition exists when judgments are made that people need nursing?” In a 1996 newsletter to the International Orem Society she puts it thisway, “What do nurses encounter in their worlds as they design and produce nursing for others?What meaning can and should nurses attach to persons, things, events, conditions, andcircumstances they encounter?” In 1978, Orem (cited in Fawcett 2005) commented that the task required identification of the domain and boundaries of nursing as...
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...COVER ARTICLE PRACTICAL THERAPEUTICS Acute Management of Atrial Fibrillation: Part I. Rate and Rhythm Control DANA E. KING, M.D., LORI M. DICKERSON, PHARM.D., and JONATHAN L. SACK, M.D. Medical University of South Carolina, Charleston, South Carolina Atrial fibrillation is the arrhythmia most commonly encountered in family practice. Serious complications can include congestive heart failure, myocardial infarction, and thromboembolism. Initial treatment is directed at controlling the ventricular rate, most often with a calcium channel blocker, a beta blocker, or digoxin. Medical or electrical cardioversion to restore sinus rhythm is the next step in patients who remain in atrial fibrillation. Heparin should be administered to hospitalized patients undergoing medical or electrical cardioversion. Anticoagulation with warfarin should be used for three weeks before elective cardioversion and continued for four weeks after cardioversion. The recommendations provided in this two-part article are consistent with guidelines published by the American Heart Association and the Agency for Healthcare Research and Quality. (Am Fam Physician 2002;66:249-56. Copyright© 2002 American Academy of Family Physicians.) I Members of various family practice departments develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family Medicine at the Medical University of South Carolina. Guest editor of the series is ...
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...Analysis of Indirect-acting Cholinergic Stimulants: Pyridostigmine and Neostigmine Vanessa Rhule Drugs can be are related by their chemical structure, the way they work or if they are used for the same purpose (Pubmed Health, 2012). A cholinergic stimulant is a class of drugs used to increase activity at acetylcholine synapses and can be further subdivided into two categories; direct and indirect acting cholinergic stimulants. This categorization is based on their mechanisms of action and specificity for clinical use (Ciccone, 2007). Direct-acting cholinergic stimulants increase activity at the acetylcholine synapses by binding directly with the cholinergic receptor on the other hand; indirect-acting cholinergic stimulants put forth the same effect by inhibiting the acetylcholinesterase enzyme situated on the cholinergic synapse. For the purpose of this paper, an analysis of indirect acting cholinergic stimulants will be completed, with focus on Pyridosigmine and Prostigmin and their implications to physical therapy practice. Indirect-Acting Cholinergic Stimulants Indirect-acting cholinergic stimulants are also known as Cholinesterase inhibitors or Anticholinesterase agents. Cholinesterase inhibitors increase activity at cholinergic synapses by preventing the acetylcholinesterase enzyme from breaking down acetylcholine (ACh) after its release from the presynaptic terminal. Cholinesterase inhibitors inhibit acetylcholinesterase thus allowing more acetylcholine to remain...
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...Nursing care plans for Diabetes Mellitus Submitted by lifenurses on Monday, 4 January 2010 2 Comments Nursing care plans for Diabetes Mellitus, Diabetes mellitus is a disorder in which the level of blood glucose is persistently raised above the normal range. Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate. Diabetes mellitus occurs in two primary forms: type 1, characterized by absolute insufficiency, and the more prevalent type 2, characterized by insulin resistance with varying degrees of insulin secretory defects. Diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both (ADA], Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2003. Causes for Diabetes Mellitus The cause of both type 1 and type 2 diabetes remains unknown, although genetic factors may play a role. Diabetes mellitus results from insulin deficiency or resistance. Insulin transports glucose into the cell for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage. Insulin deficiency or resistance compromises the body tissues’ access to essential nutrients for fuel and storage. The resulting hyperglycemia can damage many of the...
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...Toxicology 236 (2007) 1–6 Personal communication Regulatory perspectives of Type II prodrug development and time-dependent toxicity management: Nonclinical Pharm/Tox analysis and the role of comparative toxicology Kuei-Meng Wu ∗ , James G. Farrelly Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States Received 4 April 2007; accepted 7 April 2007 Available online 21 April 2007 Abstract Many therapeutic agents are prepared in prodrug forms, which are classified into Type I, II and subtypes A, B based on their sites of conversion. Recently, an increasing number of INDs have appeared as Type II prodrugs that often contain dual tracks of toxicity profile exploration, one on the prodrug and another on the active drug. A comparative toxicology analysis is introduced here to assist reviewers to evaluate the dual toxicity profiles effectively. The analysis helps determine which toxicity is contributed by the prodrug itself, its intermediates, or the active drug itself. As prodrug INDs, or any other new molecular entity (NME) INDs progress into advanced phases of toxicology development, analysis of time-dependent component of toxicity expression, regarding the emergence of new target organs over time, becomes more significant. A strategy is developed to address Pharm/Tox issues such as what duration is required for a toxicity to emerge at the exposure level achieved or dose studied, how many animals...
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...skeletal muscles. - SNS I. Adrenergic Agents - Give Epinephrine. Signs and Symptoms: - SNS Contraindication: - Contraindicated to patients suffering from COPD (Broncholitis, Bronchoectasis, Emphysema, Asthma). II. Beta-adrenergic Blocking Agents - Also called Beta-blockers. - All ending with “lol” - Propranolol, Atenelol, Metoprolol. Effects of Beta-blockers B – roncho spasm E – licits a decrease in myocardial contraction. T – reats hypertension. A – V conduction slows down. Should be given to patients with Angina Pectoris, Myocardial Infarction, Hypertension. ANTI- HYPERTENSIVE AGENTS 1. Beta-blockers – “lol” 2. Ace Inhibitors – Angiotensin, “pril” (Captopril, Enalapril) 3. Calcium Antagonist – Nifedipine (Calcibloc) In chronic cases of arrhythmia give Lidocaine(Xylocaine) Parasympathetic Nervous System (CHOLINERGIC, VAGAL, SYMPATHOLYTIC) - Involved in fight or withdrawal response. - Release of Acetylcholine. - Decreases all bodily activities except GIT. EFFECTS OF PNS - Constriction of pupils (meiosis). - Increase salivation. - Decrease BP and Heart Rate. - Bronchoconstriction, Decrease RR. -...
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...The Future of Cardiovascular Diagnostics THE MARKET, TRENDS & FUTURE DIRECTIONS Extracted on: 20 Apr 2011 Reference Code: BI00021-008 Publication Date: 02 Mar 2010 Publisher: Datamonitor © Datamonitor This content is a licensed product, no part of this publication shall be reproduced, sold, modified or stored in a retrieval system or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Datamonitor. The information in this document has been extracted from published research by a registered user of the Datamonitor360 platform. Datamonitor shall not be responsible for any loss of original context and for any changes made to information following its extraction. All information was current at the time of extraction although the original content may have been subsequently updated. Please refer back to the website http://360.datamonitor.com/ to view the most recent content and the original source of the information. To the maximum extent permitted by applicable law we exclude all representations, warranties and conditions relating to the facts of all publications. At time of publication no guarantee of accuracy or suitability, whether express or implied, shall attach to this publication (including, without limitation, any warranties implied by law of satisfactory quality, fitness for purpose and/or the use of reasonable care and skill). Please note that the findings, conclusions and recommendations...
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...the Critically Ill Preventive Practices in the Critically Ill Chapter 3 - Infection Control in the ICU Chapter 4 - Alimentary Prophylaxis Chapter 5 - Venous Thromboembolism Section III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia and Hypercapnia Chapter 20 - Oximetry and Capnography Chapter 21 - Oxygen Inhalation Therapy Chapter 22 - Acute Respiratory Distress Syndrome Chapter 23 - Severe Airflow Obstruction Section VIII - Mechanical Ventilation Mechanical Ventilation Chapter 24 - Principles of Mechanical Ventilation Chapter 25 - Modes of Assisted Ventilation Chapter 26 - The Ventilator-Dependent Patient Chapter 27 -...
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...Long-term implications of a single home-based educational intervention in patients with heart failure ` ` Ofelia Aguado, MD, Cesar Morcillo, MD, PhD, Jordi Delas, MD, PhD, Mark Rennie, MD, Siraj Bechich, MD, ´ndez, MD, and Franscesc Rosell, MD, PhD Anna Schembari, PhD, Francesc Ferna OBJECTIVE: The objective of the study was to evaluate the effectiveness of a single home-based educational intervention for patients admitted with heart failure. METHODS: There were 106 patients: 42 in the intervention group and 64 in the control group. Patients were randomly assigned to receive an intervention by nursing staff 1 week after discharge. Primary end points were readmissions, emergency department visits, deaths, costs, and quality of life. RESULTS: During the 24-month follow-up, there were fewer mean emergency department visits in the intervention group than in the control group (.68 vs 2.00; P = .000), fewer unplanned readmissions S14 www.heartandlung.org NOVEMBER/DECEMBER 2010 HEART & LUNG Aguado et al Educational intervention in heart failure patients readmissions, emergency department visits, and deaths. The impact on healthcare costs and quality of life measures is also assessed. MATERIALS AND METHODS Design We previously5 described a randomized clinical trial performed at the Sagrat Cor University Hospital (a 400-bed urban teaching hospital). The trial included patients admitted to the internal medicine and cardiology services between July 2001 and October...
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...………………………………………………….13 3.4 Conclusions…..…………………………………………………………………………………………………………………….20 4. Turning research into novel medical devices………………………………………………………………………………….22 4.1 The Medical Device Development Process…..……………………………………………………………………..22 4.2 CIMIT: A Structure for Medical Device Innovation…..………………………………………………………….23 4.3 Stanford Biodesign: Innovation as a Discipline…..………………………………………………………………..26 4.4 Conclusions and Recommendations…..……………………………………………………………………………….28 5. Summary and Conclusions…………………………………………………………………………………………………………….30 6. Acknowledgements……………………………………………………………………………………………………………………….32 7. References…………………………………………………………………………………………………………………………………….33 Appendices A1 Selection of Key Institutes A2 Results Patent Analysis A3 Research Profiles 1. Introduction This report analyzes the R&D infrastructure in the United States in the field of new medical devices. It is part of the Innovative Medical Devices Initiative the Netherlands (IMDI.NL) thematic program that aims to focus the Netherlands’ R&D infrastructure for medical devices on health care demands and economic growth (1). The study is a collaboration...
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...MedDRA® TERM SELECTION: POINTS TO CONSIDER Release 3.13 Based on MedDRA Version 12.1 ICH-Endorsed Guide for MedDRA Users Application to Adverse Drug Reactions /Adverse Events & Medical and Social History & Indications 1 October 2009 © Copyright ICH Secretariat (c/o IFPMA) Copying is permitted, with reference to source, but material in this publication may not be used in any documentation or electronic media which is offered for sale, without the prior permission of the copyright owner. IFPMA Chemin Louis-Dunant, 15 P.O. Box 195 1211 Geneva 20 Switzerland Tel: +41 (22) 338 32 00 Fax: +41 (22) 338 32 99 2 Table of Contents 1.0 1.1 1.2 1.3 1.4 2.0 2.1 2.2 2.3 2.4 2.5 2.6 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 4.0 4.1 4.2 INTRODUCTION ...................................................................................................................... 4 OBJECTIVE OF THIS DOCUMENT ................................................................................................. 4 PURPOSES OF USING MEDDRA ................................................................................................. 5 BACKGROUND ........................................................................................................................... 5 SCOPE OF THE POINTS TO CONSIDER ......................................................................................... 6 GENERAL PRINCIPLES...
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...Ques 1. What is Neostigmine? Discuss why this drug may have been given to Mrs. Lim. Include drug action and desired effects, adverse drug reaction(s), drug interactions, appropriate dosage and rationale for use. Ans 1. Neostigmine is a drug which belongs to the family of medicines called as the anticholinesterases (neostigmine). This drug works by inhibiting the action of the enzyme acetylcholinesterase, which in turn leads to a prolonged action of the enzyme acetylcholine. Acetylcholine stimulates the muscarinic receptors present in the muscles, thus causing muscle contraction. Vecuronium, given to Mrs. Lim is a neuromuscular blocking agent. To subside its effect, she was given Neostigmine, which also improves the respiratory function (Brodie & Axelrod, 2009). Neostigmine produces an antagonistic effect to Vecuronium. After Vercuronium, a dose of 2.5mg or 5mg Neostigmine is sufficient to produce a muscle twitch of about 90%. It also leads to increased cardiovascular effect (Caldwell,J., 1995). The drug is required to cause muscle contraction opposite to the muscle relaxation, as was caused by the dose of anaesthesia. Some of the common side effects associated with the drug use are nausea, vomiting, diarrhoea, stomach cramps, involuntary urination, faintness, muscle cramps or twitching. These symptoms however, due not require any medical treatment. Some other severe problems associated with this drug are slow heart rate, shortness of breath, severe rashes, irritation...
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