Table of Contents
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Study Protocol and Statistical Analysis Plan
The University of Texas Southwestern Medical Center at Dallas Institutional Review Board PROJECT SUMMARY Study Title: Ultrasound-guided fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial Principal Investigator: Irina Gasanova, MD Sponsor/Funding Source: Department of Anesthesiology and Pain Management, UT Southwestern Medical School IRB Number: STU 122015-022 NCT Number: NCT02658240 Date of Document: 01 April 2016 Page 1 of 7 Purpose: In this randomized, controlled, observer-blinded study we plan to evaluate ultrasound-guided fascia iliaca compartment block with ropivacaine and periarticular infiltration with ropivacaine for postoperative pain management after total hip arthroplasty (THA). Background: Despite substantial advances in our understanding of the pathophysiology of pain and availability of newer analgesic techniques, postoperative pain is not always effectively treated (1). Optimal pain management technique balances pain relief with concerns about safety and adverse effects associated with analgesic techniques. Currently, postoperative pain is commonly treated with systemic opioids, which are associated with numerous adverse effects including nausea and vomiting, dizziness, drowsiness, pruritus, urinary retention, and respiratory depression (2). Use of regional and local anesthesia has been shown to reduce opioid requirements and opioid-related side effects. Therefore, their use has been emphasized (3, 4, 5, 6). Fascia Iliaca compartment block (FICB) is a field block that blocks the nerves from the lumbar plexus supplying the thigh (i.e., lateral femoral cutaneous femoral and obturator nerves). The obturator nerve is sometimes involved in the FICB but probably plays little role in postoperative pain relief for most surgeries of the hip and proximal femur. -
Intravenous Therapy Procedure Manual
INTRAVENOUS THERAPY PROCEDURE MANUAL - 1 - LETTER OF ACCEPTANCE __________________________________________ hereby approves (Facility) the attached Reference Manual as of _____________________. (Date) The Intravenous Therapy Procedure Manual will be reviewed at least annually or more often when deemed appropriate. Revisions will be reviewed as they occur. Current copies of the Intravenous Therapy Procedure Manual shall be maintained at each appropriate nursing station. I have reviewed this manual and agree to its approval. __________________________ (Administrator) __________________________ (Director of Nursing) __________________________ (Medical Director) - 2 - TABLE OF CONTENTS TABLE OF CONTENTS INTRODUCTION A. Purpose 1 B. Local Standard of Practice 1 RESPONSIBILITIES A. Responsibilities: M Chest Pharmacy 1 B. Responsibilities: Administrator 1 C. Responsibilities: Director of Nursing Services (DON/DNS) 1 D. Skills Validation 2 AMENDMENTS GUIDELINES A. Resident Candidacy for IV Therapy 1 B. Excluded IV Medications and Therapies 1 C. Processing the IV Order 1 D. IV Solutions/Medications: Storage 2 E. IV Solutions/Medications: Handling 3 F. IV Solutions and Supplies: Destroying and Returning 4 G. IV Tubing 5 H. Peripheral IV Catheters and Needles 6 I. Central Venous Devices 7 J. Documentation and Monitoring 8 K. IV Medication Administration Times 9 L. Emergency IV Supplies 10 I TABLE OF CONTENTS PROTOCOLS A. IV Antibiotic 1 1. Purpose 2. Guidelines 3. Nursing Responsibilities B. IV Push 2 1. Purpose 2. Guidelines C. Anaphylaxis Allergic Reaction 4 1. Purpose 2. Guidelines 3. Nursing Responsibilities and Interventions 4. Signs and Symptoms of Anaphylaxis 5. Drugs Used to Treat Anaphylaxis 6. Physician Protocol PRACTICE GUIDELINES A. Purpose 1 B. Personnel 1 C. Competencies 1 D. -
Absorbine Veterinary Liniment for Horses
Doc# 03.287 Ver. 11 SAFETY DATA SHEET ABSORBINE® VETERINARY LINIMENT SECTION 1 - PRODUCT AND COMPANY IDENTIFICATION 1.1 Trade Name (as labeled): Absorbine® Veterinary Liniment Synonyms: N/A CAS No: Mixture 1.2 Product Use: Soothes sore muscles and stiff joints 1.3 Company Name: W.F. Young Company Address: 302 Benton Dr Company Address Cont: East Longmeadow, MA 01028 Business Phone: ( 413) 526-9999 Website: www.wfyoung.com 1.4 Emergency Telephone Number: (413) 526-9999 Date of Current Revision: January 17, 2017 Date of Last Revision: August 7, 2015 SECTION 2 - HAZARD IDENTIFICATION EMERGENCY OVERVIEW: This product is a green thin liquid with an acetone odor. Health Hazards: May cause skin, eye, and respiratory system irritation. Flammabilit Hazards: This product is a flammable liquid with a flash point over 20°F (-6. 7°C). Reactivit Hazards: None. Environmental Hazards: The environmental effectsof this product have not been investigated, however release may cause long term adverse environmental effects. US DOT Symbols: EU and GHS Symbols: Signal Word: Danger! 2.1 CLASSIFICATION OF SUBSTANCE OR MIXTURE IN ACCORDANCE WITH 29 CFR 1200 (OSHA HCSl AND THE EUROPEAN UNION DIRECTIVES: This product does meet the definition of a hazardous substance or preparation as defined by 29 CFR 1910. 1200 or the European Union Council Directives 67 /548/EEC, 1999/45/EC, 1272/2008/EC and subsequent Directives. EU HAZARD CLASSIFICATIONOF INGREDIENTS PER DIRECTIVE 1272/2008/EC: IndexNumber: EC# 201-939-0 This substance is not classified in the AnnexVI of Directive 67/548/EEC EC# 200-662-2 This substance is classified in the AnnexVI of Directive 67/548/EEC Index# 606-001-00-8 Substances not listed either individually or in group entries must be self classified. -
Priority for Everyone, and Even More So for Those with Chronic Illnesses
Mouth Care: Patient/Caregiver Training Hospice of Cincinnati Mouth Care is a high priority for everyone, and even more so for those with chronic illnesses. Proper mouth care has many benefits including: 1. Increasing appetite 2. Maintaining comfort 3. Clearer speech 4. Easier swallowing 5. Preventing sores and infection. General tips: Mouth care should be performed a minimum of twice daily and more frequently for dry mouth, if breathing through the mouth, or if you are not eating. Mouth care should always be performed after using an inhaler/nebulizer to prevent thrush. Thrush is slightly raised white patches or a rash typically seen on the tongue or inner cheeks. There may be pain with swallowing. Contact your hospice nurse immediately if you suspect thrush. Dentures may no longer fit well. You may consider using them only when eating or when visiting with friends and family. Questions or concerns? Call a hospice nurse at 513-891-7700. Training: Mouth Care. ©2017 Hospice of Cincinnati Hospice of Cincinnati Relieving dry mouth: 1. Increase frequency of mouth care. 2. Encourage sucking on candy, ice chips, popsicles or taking small sips of water to increase saliva. 3. Use of a mouthwash can increase dryness. Talk to your nurse about a proper mouth moisturizer/artificial saliva product. For those with difficulty swallowing: • Raise the head of the bed and support the head with pillows, turn head to one side. • Cover the upper body with a towel to keep the area clean and dry. • Remove dentures prior to mouth care and brush separately. • Use a toothette, which is a sponge-tipped oral swab, to clean the mouth and teeth using a small amount of toothpaste. -
Inhalation Solution, USP for Oral Inhalation Use What Is Tobramycin
PATIENT INFORMATION TOBRAMYCIN (TOE-BRA-MYE-SIN) Inhalation Solution, USP for oral inhalation use What is Tobramycin Inhalation Solution? Tobramycin inhalation solution is a prescription medicine that is used to treat people with cystic fibrosis who have a bacterial infection called Pseudomonas aeruginosa. Tobramycin inhalation solution contains an antibacterial medicine called tobramycin (an aminoglycoside). It is not known if tobramycin inhalation solution is safe and effective: in children under 6 years of age in people who have an FEV1 less than 25% or greater than 75% predicted in people who are colonized with a bacterium called Burkholderia cepacia Do not take tobramycin inhalation solution if you are allergic to tobramycin, any of the ingredients in tobramycin inhalation solution, or to any other aminoglycoside antibacterial. See the end of this Patient Information for a complete list of ingredients in tobramycin inhalation solution. Before you take tobramycin inhalation solution, tell your healthcare provider about all of your medical conditions, including if you: have or have had hearing problems (including noises in your ears such as ringing or hissing) have dizziness have or have had kidney problems have or have had problems with muscle weakness such as myasthenia gravis or Parkinson’s disease have or have had breathing problems such as wheezing, coughing, or chest tightness are pregnant or plan to become pregnant. Tobramycin inhalation solution is in a class of drugs that can harm your unborn baby. are breastfeeding or plan to breastfeed. It is not known if tobramycin passes into your breast milk. are receiving aminoglycoside therapy by injection or through a vein (intravenous) while taking tobramycin inhalation solution. -
Hydrogen Peroxide, and This Is the Same Substance That Can Be Purchased in a 32-Ounce Plastic Bottle at Walmart, for 88 Cents, Or at Walgreens for Under a $1.00
An At-Home Treatment That Can Cure Any Virus, Including Coronavirus Originally Conceptualized, circa 1990, by Charles Farr, MD Subsequently Researched and Prescribed by Frank Shallenberger, MD Current Protocol Created by Thomas Levy, MD, JD Although COVID-19, aka coronavirus, is deadly in some select cases, and it can spread rapidly, there is a simple, very inexpensive, and highly effective treatment that can treat and rapidly resolve coronavirus and virtually any other respiratory virus. While different individuals can be expected to have variable degrees of positive response, this intervention can be anticipated to eliminate eventual fatal disease outcomes in all but the most advanced cases. As I hope you will eventually experience, the treatment works for all acute viral infections, and especially well for flu viruses of any variety. In fact, although we are constantly conditioned to not believe in anything “too good to be true,” you will never have to worry about getting a cold or the flu again because you can cure it on your own. The key ingredient in this treatment is common household 3% hydrogen peroxide, and this is the same substance that can be purchased in a 32-ounce plastic bottle at Walmart, for 88 cents, or at Walgreens for under a $1.00. Perhaps you have never heard of hydrogen peroxide therapy, but since the treatment was first championed by Dr. Charles Farr in about 1990, thousands of doctors have used this therapy for decades to conquer infections in many thousands of patients throughout the world. How and Why Hydrogen Peroxide Works Because hydrogen peroxide consists of a water molecule (H2O) with an extra oxygen atom (H2O2), it is this extra oxygen atom that makes it so deadly for viruses. -
An Overview On: Sublingual Route for Systemic Drug Delivery
International Journal of Research in Pharmaceutical and Biomedical Sciences ISSN: 2229-3701 __________________________________________Review Article An Overview on: Sublingual Route for Systemic Drug Delivery K. Patel Nibha1 and SS. Pancholi2* 1Department of Pharmaceutics, BITS Institute of Pharmacy, Gujarat Technological university, Varnama, Vadodara, Gujarat, India 2BITS Institute of Pharmacy, Gujarat Technological University, Varnama, Vadodara, Gujarat, India. __________________________________________________________________________________ ABSTRACT Oral mucosal drug delivery is an alternative and promising method of systemic drug delivery which offers several advantages. Sublingual literally meaning is ''under the tongue'', administrating substance via mouth in such a way that the substance is rapidly absorbed via blood vessels under tongue. Sublingual route offers advantages such as bypasses hepatic first pass metabolic process which gives better bioavailability, rapid onset of action, patient compliance , self-medicated. Dysphagia (difficulty in swallowing) is common among in all ages of people and more in pediatric, geriatric, psychiatric patients. In terms of permeability, sublingual area of oral cavity is more permeable than buccal area which is in turn is more permeable than palatal area. Different techniques are used to formulate the sublingual dosage forms. Sublingual drug administration is applied in field of cardiovascular drugs, steroids, enzymes and some barbiturates. This review highlights advantages, disadvantages, different sublingual formulation such as tablets and films, evaluation. Key Words: Sublingual delivery, techniques, improved bioavailability, evaluation. INTRODUCTION and direct access to systemic circulation, the oral Drugs have been applied to the mucosa for topical mucosal route is suitable for drugs, which are application for many years. However, recently susceptible to acid hydrolysis in the stomach or there has been interest in exploiting the oral cavity which are extensively metabolized in the liver. -
Inhalation Anesthesia Machine / Vaporizer / Waste Gas Maintenance
Office of Research Office of Responsible Research Practices Institutional Animal Care and Use Committee INHALATION ANESTHESIA MACHINE / VAPORIZER / WASTE GAS MAINTENANCE Overview/Purpose To reduce risk of anesthetic gas exposure to animals and personnel, proper maintenance of anesthesia equipment, appropriate waste scavenging systems, and safe administration techniques must be employed. Preventative maintenance is key in reaching this goal. ULAR machines are maintained by ULAR while maintenance of lab owned machines is required by the research team. Personnel must be properly trained to provide safe anesthesia to animals and in the proper use and maintenance of anesthetic machines. Training is available through ULAR http://ular.osu.edu/training/animal-handling-and-technique-training/. Definition 1. Anesthesia Machine. - The entire piece of equipment that is used to deliver precise amounts of inhaled anesthetic gas and/or a carrier gas (usually air, O2 or CO2, alone or in a mix). It consists of multiple parts (precision vaporizer, carrier gas regulators, flow meters, delivery/breathing circuits and scavenge systems and possibly a rebreathing reservoir (bag). a. Rebreathing systems – for animals weighing over ~5kg b. Non-rebreathing systems – for rodents and animals weighing under ~5kg. 2. Breathing Circuit: The tubing that delivers the fresh gas/anesthetic gas mixture from the machine to the patient. a. Rebreathing circuits direct the expired gases through a soda lime canister for absorption of carbon dioxide, which are then “rebreathed” by the patient. b. Non-rebreathing circuits are designed to deliver oxygen and anesthetic gases with less resistance to breathing in small patients and have a higher fresh gas flow to remove carbon dioxide. -
Vaccine Administration Joellen Wolicki, BSN, RN and Elaine Miller, RN, BSN, MPH
Vaccine Administration JoEllen Wolicki, BSN, RN and Elaine Miller, RN, BSN, MPH This chapter summarizes best practices related to vaccine administration, a key factor in ensuring vaccination is as safe NOTES and effective as possible. Administration involves a series of actions: assessing patient vaccination status and determining needed vaccines, screening for contraindications and precautions, educating patients, preparing and administering vaccines properly, and documenting the vaccines administered. Professional standards for medication administration, manufacturer instructions, and organizational policies and procedures should always be followed when applicable. 6 Staff Training and Education Policies should be in place to validate health care professionals’ knowledge of, and skills in, vaccine administration. All health care professionals should receive comprehensive, competency- based training before administering vaccines. Training, including an observation component, should be integrated into health care professionals’ education programs including orientation for new staff and annual continuing education requirements for all staff. In addition, health care professionals should receive educational updates as needed, such as when vaccine administration recommendations are updated or when new vaccines are added to the facility’s inventory. Training should also be offered to temporary staff who may be filling in on days when the facility is short-staffed or helping during peak periods of vaccine administration such as influenza season. Once initial training has been completed, accountability checks should be in place to ensure staff follow all vaccine administration policies and procedures. Before Administering Vaccine Health care professionals should be knowledgeable about appropriate techniques to prepare and care for patients when administering vaccines. Assess for Needed Vaccines The patient’s immunization status should be reviewed at every health care visit. -
Chapter 1 Controlling Drug Delivery
chapter 1 Controlling drug delivery Overview In this chapter we will: & differentiate drug delivery systems according to their physical state & differentiate drug delivery systems according to their route of administration & differentiate drug delivery systems according to their type of drug release & discuss drug transport across epithelial barriers. Introduction KeyPoints & Continued developments in Pharmacotherapy can be defined as the treatment chemistry, molecular biology and prevention of illness and disease by means of and genomics support the drugs of chemical or biological origin. It ranks discovery and developments among the most important methods of medical of new drugs and new drug treatment, together with surgery, physical targets. & treatment, radiation and psychotherapy. There The drug delivery system are many success stories concerning the use of employed can control the pharmacological action of a drugs and vaccines in the treatment, prevention drug, influencing its and in some cases even eradication of diseases pharmacokinetic and (e.g. smallpox, which is currently the only subsequent therapeutic human infectious disease completely profile. eradicated). Although it is almost impossible to estimate the exact extent of the impact of pharmacotherapy on human health, there can be no doubt that pharmacotherapy, together with improved sanitation, better diet and better housing, has improved people’s health, life expectancy and quality of life. Tip Unprecedented developments in genomics Combinatorial chemistry is a way to and molecular biology today offer a plethora of build a variety of structurally related new drug targets. The use of modern chemical drug compounds rapidly and synthetic methods (such as combinatorial systematically. These are assembled chemistry) enables the syntheses of a large from a range of molecular entities number of new drug candidates in shorter times which are put together in different ‘ ’ than ever before. -
Pharmacology – Inhalant Anesthetics
Pharmacology- Inhalant Anesthetics Lyon Lee DVM PhD DACVA Introduction • Maintenance of general anesthesia is primarily carried out using inhalation anesthetics, although intravenous anesthetics may be used for short procedures. • Inhalation anesthetics provide quicker changes of anesthetic depth than injectable anesthetics, and reversal of central nervous depression is more readily achieved, explaining for its popularity in prolonged anesthesia (less risk of overdosing, less accumulation and quicker recovery) (see table 1) Table 1. Comparison of inhalant and injectable anesthetics Inhalant Technique Injectable Technique Expensive Equipment Cheap (needles, syringes) Patent Airway and high O2 Not necessarily Better control of anesthetic depth Once given, suffer the consequences Ease of elimination (ventilation) Only through metabolism & Excretion Pollution No • Commonly administered inhalant anesthetics include volatile liquids such as isoflurane, halothane, sevoflurane and desflurane, and inorganic gas, nitrous oxide (N2O). Except N2O, these volatile anesthetics are chemically ‘halogenated hydrocarbons’ and all are closely related. • Physical characteristics of volatile anesthetics govern their clinical effects and practicality associated with their use. Table 2. Physical characteristics of some volatile anesthetic agents. (MAC is for man) Name partition coefficient. boiling point MAC % blood /gas oil/gas (deg=C) Nitrous oxide 0.47 1.4 -89 105 Cyclopropane 0.55 11.5 -34 9.2 Halothane 2.4 220 50.2 0.75 Methoxyflurane 11.0 950 104.7 0.2 Enflurane 1.9 98 56.5 1.68 Isoflurane 1.4 97 48.5 1.15 Sevoflurane 0.6 53 58.5 2.5 Desflurane 0.42 18.7 25 5.72 Diethyl ether 12 65 34.6 1.92 Chloroform 8 400 61.2 0.77 Trichloroethylene 9 714 86.7 0.23 • The volatile anesthetics are administered as vapors after their evaporization in devices known as vaporizers. -
Nebulizers and Inhalation Drugs
JURISDICTIONS B & C DOCUMENTATION CHECKLIST NEBULIZERS AND INHALATION DRUGS Small Volume Nebulizers (A7003, A7004, A7005) & Related Compressor (E0570) REQUIRED DOCUMENTATION Standard Written Order (original, faxed, or copied) that contains: Beneficiary’s name or Medicare Beneficiary Identifier (MBI) Order date General description of the item The description can be either a general description (e.g., wheelchair or hospital bed), a HCPCS code, a HCPCS code narrative, or a brand name/model number For equipment - In addition to the description of the base item, the SWO may include all concurrently ordered options, accessories or additional features that are separately billed or require an upgraded code (List each separately). For supplies – In addition to the description of the base item, the DMEPOS order/ prescription may include all concurrently ordered supplies that are separately billed (List each separately) Quantity to be dispensed, if applicable Treating Practitioner Name or NPI Treating Practitioner’s signature Any changes or corrections have been initialed/signed and dated by the ordering practitioner Treating practioner’s signature on the written order meets CMS Signature Requirements https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/downloads/MM6698.pdf For drugs used as a supply for a DME item, the written order may include: The type of solution to be dispensed is described by either: The name of the drug and the concentration of the drug in the dispensed solution (Example: Cromolyn 20