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Veterinary Emergency & Anaesthesia Pfizer
AVA ECVA & AVEF Thank all their sponsors for this spring edition PARIS 2007 On VETERINARY EMERGENCY & ANAESTHESIA PFIZER MERIAL FORT DODGE BAYER BOEHRINGER MEDISUR COVETO OPTOMED HALLOWELL SCIL JANSSEN SOGEVAL KRUSSE TECHNIBELT MILA TEM The Organisatiors 7th AVEF European Meeting- 10th March 2007-ROISSY 2 AVA – ECVA Spring Meeting 2007 on Veterinary Emergency & Anesthesia 7 – 10 March 2007, Paris, France AVA PARIS 2007 — Wednesday March 7th RESIDENT DAY RUMINANT ANAESTHESIA Hyatt Regency Hotel, Roissy CDG, France K OTTO, D HOLOPHERNE, G TOUZOT 8.30 REGISTRATIONS 9.00-9.45 Specific anatomo-physiology to consider for ruminant peri-anaesthetic period K OTTO 10.00-10.30 COFFEE BREAK 10.30-11.15 Post-anaesthetic and pain management in ruminants K OTTO 11.30-12.15 Physical restraint and sedation of ruminants D HOLOPHERNE 12.30-1.30 LUNCH 1.30-2.15 Anaesthesia of Lamas & Alpagas G TOUZOT 2.30-3.15 Regional & local anaesthesia for ruminants D HOLOPHERNE 3.30-4.00 COFFEE BREAK 4.00-4.45 Pharmacology and protocols for ruminant anaesthesia G TOUZOT AVA-ECVA PARIS 2007, Veterinary Emergency & Anaesthesia, 7-10th March AVA-ECVA PARIS 2007, Veterinary Emergency & Anaesthesia, 7-10th March AVA – ECVA Spring Meeting 2007 on Veterinary Emergency & Anesthesia 7 – 10 March 2007, Paris, France Specific anatomo-physiology to consider for ruminants peri-anaesthetic period Klaus A. Otto Institut für Versuchstierkunde und Zentrales Tierlaboratorium, Medizinische Hochschule Hannover, D-30623 Hannover, Germany The suborder “ruminantia” includes members of the family “bovidae” such as cattle (bos taurus), sheep (ovis spp) and goats (capra spp). Members of the family “camelidae” (camelus spp, llama spp, vicugna spp) belong to the suborder “tylopodia” and therefore are not true ruminants. -
Idarucizumab Reverses Dabigatran Anticoagulant Activity in Healthy Chinese Volunteers: a Pharmacokinetics, Pharmacodynamics, and Safety Study
Adv Ther (2020) 37:3916–3928 https://doi.org/10.1007/s12325-020-01439-2 ORIGINAL RESEARCH Idarucizumab Reverses Dabigatran Anticoagulant Activity in Healthy Chinese Volunteers: A Pharmacokinetics, Pharmacodynamics, and Safety Study Zining Wang . Xia Zhao . Pengkang He . Shuqing Chen . Jie Jiang . Akiko Harada . Steven Brooks . Yimin Cui Received: May 25, 2020 / Published online: July 20, 2020 Ó The Author(s) 2020 ABSTRACT b.i.d., oral). After a washout period, the 12 subjects again received dabigatran etexilate Introduction: Idarucizumab is a humanized (220 mg b.i.d., oral) and idarucizumab monoclonal antibody fragment that specifically (2.5 ? 2.5 g, intravenous) 2 h after the last binds to dabigatran with high affinity and administration of dabigatran etexilate. reverses its anticoagulant effect. This study Results: The geometric mean (gMean) values of investigated the pharmacokinetics (PK) and area under the plasma concentration–time pharmacodynamics (PD) of idarucizumab in curve (AUC0–?) and maximum concentration healthy Chinese subjects at steady state of (Cmax) were 44,200 nmol h/L and 30,900 nmol/ dabigatran and explored the effect of idaru- L, respectively. An amount of 35.3 lmol of cizumab on PK and PD of dabigatran. idarucizumab, corresponding to 33.8% of the Methods: Twelve subjects received dabigatran total dose, was excreted by urine over 72 h. The etexilate treatment alone (220 mg twice daily, area under the effect (AUECabove,2–12) in the presence and absence of idarucizumab was close to zero for all coagulation parameters, diluted Zining Wang and Xia Zhao contributed equally to this work. thrombin time (dTT), ecarin clotting time (ECT), activated partial thromboplastin time Digital Features To view digital features for this article (aPTT), and thrombin time (TT), which indi- go to https://doi.org/10.6084/m9.figshare.12613334. -
Reversal of Oral Anticoagulation in Patients with Acute Intracerebral Hemorrhage Joji B
Kuramatsu et al. Critical Care (2019) 23:206 https://doi.org/10.1186/s13054-019-2492-8 REVIEW Open Access Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage Joji B. Kuramatsu* , Jochen A. Sembill and Hagen B. Huttner Abstract In light of an aging population with increased cardiovascular comorbidity, the use of oral anticoagulation (OAC) is steadily expanding. A variety of pharmacological alternatives to vitamin K antagonists (VKA) have emerged over recent years (direct oral anticoagulants, DOAC, i.e., dabigatran, rivaroxaban, apixaban, and edoxaban) which show a reduced risk for the occurrence of intracerebral hemorrhage (ICH). Yet, in the event of ICH under OAC (OAC-ICH), hematoma characteristics are similarly severe and clinical outcomes likewise substantially limited in both patients with VKA- and DOAC-ICH, which is why optimal acute hemostatic treatment in all OAC-ICH needs to be guaranteed. Currently, International Guidelines for the hemostatic management of patients with OAC-ICH are updated as several relevant large-sized observational studies and recent trials have established treatment approaches for both VKA- and DOAC-ICH. While the management of VKA-ICH is mainly based on the immediate reversal of elevated levels of international normalized ratio using prothrombin complex concentrates, hemostatic management of DOAC-associated ICH is challenging requiring specific antidotes, notably idarucizumab and andexanet alfa. This review will provide an overview of the latest studies and trials on hemostatic reversal agents and timing and summarizes the effects on hemorrhage progression and clinical outcomes in patients with OAC-ICH. Keywords: Intracerebral hemorrhage, Anticoagulation reversal, Tranexamic acid, Ciraparantag, Desmopressin Introduction importantly have a greater frequency of hematoma ex- Of all stroke sub-types, intracerebral hemorrhage (ICH) pansion (HE), all of which are significant outcome pre- constitutes roughly 15% and is associated with the worst dictors determining an even poorer prognosis [11–13]. -
Current Awareness in Clinical Toxicology Editors: Damian Ballam Msc and Allister Vale MD
Current Awareness in Clinical Toxicology Editors: Damian Ballam MSc and Allister Vale MD August 2016 CONTENTS General Toxicology 6 Metals 30 Management 14 Pesticides 31 Drugs 16 Chemical Warfare 33 Chemical Incidents & 24 Plants 34 Pollution Chemicals 25 Animals 34 CURRENT AWARENESS PAPERS OF THE MONTH Toxicity evaluation of α-pyrrolidinovalerophenone (α-PVP): results from intoxication cases within the STRIDA project Beck O, Franzén L, Bäckberg M, Signell P, Helander A. Clin Toxicol 2016; 54: 568-75. Context An increasing number of new psychoactive substances (NPS) of different chemical classes have become available through marketing and sale over the Internet. This report from the Swedish STRIDA project presents the prevalence, laboratory results, and clinical features in a series of intoxications involving the stimulant NPS -pyrrolidinovalerophenone (-PVP), a potent dopamine re-uptake inhibitor, over a 4-year period. Study design Observational case series of consecutive patients with admitted or suspected intake of NPS presenting to hospitals in Sweden from 2012 to 2015. Patients and methods In the STRIDA project, blood and urine samples are collected from intoxicated patients with admitted or suspected intake of NPS or unknown drugs presenting to hospitals over the country. Analysis of NPS is performed by mass spectrometry multicomponent methods. Clinical data are collected when caregivers consult the Swedish Poisons Information Centre Current Awareness in Clinical Toxicology is produced monthly for the American Academy of Clinical Toxicology by the Birmingham Unit of the UK National Poisons Information Service, with contributions from the Cardiff, Edinburgh, and Newcastle Units. The NPIS is commissioned by Public Health England 2 (PIC), and retrieved from medical records. -
AHFS Pharmacologic-Therapeutic Classification System
AHFS Pharmacologic-Therapeutic Classification System Abacavir 48:24 - Mucolytic Agents - 382638 8:18.08.20 - HIV Nucleoside and Nucleotide Reverse Acitretin 84:92 - Skin and Mucous Membrane Agents, Abaloparatide 68:24.08 - Parathyroid Agents - 317036 Aclidinium Abatacept 12:08.08 - Antimuscarinics/Antispasmodics - 313022 92:36 - Disease-modifying Antirheumatic Drugs - Acrivastine 92:20 - Immunomodulatory Agents - 306003 4:08 - Second Generation Antihistamines - 394040 Abciximab 48:04.08 - Second Generation Antihistamines - 394040 20:12.18 - Platelet-aggregation Inhibitors - 395014 Acyclovir Abemaciclib 8:18.32 - Nucleosides and Nucleotides - 381045 10:00 - Antineoplastic Agents - 317058 84:04.06 - Antivirals - 381036 Abiraterone Adalimumab; -adaz 10:00 - Antineoplastic Agents - 311027 92:36 - Disease-modifying Antirheumatic Drugs - AbobotulinumtoxinA 56:92 - GI Drugs, Miscellaneous - 302046 92:20 - Immunomodulatory Agents - 302046 92:92 - Other Miscellaneous Therapeutic Agents - 12:20.92 - Skeletal Muscle Relaxants, Miscellaneous - Adapalene 84:92 - Skin and Mucous Membrane Agents, Acalabrutinib 10:00 - Antineoplastic Agents - 317059 Adefovir Acamprosate 8:18.32 - Nucleosides and Nucleotides - 302036 28:92 - Central Nervous System Agents, Adenosine 24:04.04.24 - Class IV Antiarrhythmics - 304010 Acarbose Adenovirus Vaccine Live Oral 68:20.02 - alpha-Glucosidase Inhibitors - 396015 80:12 - Vaccines - 315016 Acebutolol Ado-Trastuzumab 24:24 - beta-Adrenergic Blocking Agents - 387003 10:00 - Antineoplastic Agents - 313041 12:16.08.08 - Selective -
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. -
Oral Anticoagulants
4/26/2018 Disclosure • Kelsey Gander, PharmD, BCACP Direct Oral Anticoagulants: – Declares no financial relationships pertinent to this session When to Use and How to Choose – Declares off-label use of medication will not be discussed during this presentation. Kelsey Gander, PharmD, BCACP Minnesota Academy of Physician Assistants Conference May 11th, 2018 Abbreviations Objectives • DOAC= direct oral anticoagulant 1) Compare and contrast the efficacy and safety • VTE= venous thromboembolism • DVT= deep vein thrombosis of direct oral anticoagulants (DOACs) to • PE= pulmonary embolism warfarin • A-fib, AF= atrial fibrillation 2) Identify which anticoagulant would be most • ESRD= end stage renal disease appropriate for a given patient • ACC= American College of Cardiology • AHA= American Heart Association 3) Recognize when it would not be appropriate • HRS= Heart Rhythm Society to use a DOAC • BID= twice daily Appropriate Abbreviations Patient Case JJ is a 66 y/o male who was hospitalized for pulmonary • NOAC embolism and initiated on anticoagulant therapy one week – Novel Oral Anticoagulant ago. – Chief complaint: – Non-Vitamin K Oral Anticoagulant • Presents to clinic today for INR check, post-hospital discharge follow- up • TSOAC – Past medical history: • Hypertension, hyperlipidemia, osteoarthritis, erectile dysfunction, – Target Specific Oral Anticoagulant BPH, type 2 diabetes, peripheral artery disease – Home medications • DOAC • Acetaminophen 650mg po every 6 hours PRN – Direct Oral Anticoagulant • Diazepam 5mg po at bedtime PRN anxiety -
Geisinger Lewistown Hospital Published: March 25, 2019
Geisinger Lewistown Hospital Published: March 25, 2019 DESCRIPTION CHARGE Fine needle aspiration; without imaging guidance $ 607.00 Fine needle aspiration; without imaging guidance $ 286.00 Fine needle aspiration; with imaging guidance $ 2,218.00 Fine needle aspiration; with imaging guidance $ 1,691.00 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion $ 1,979.00 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each $ 1,385.00 additional lesion (List separately in addition to code for primary procedure) Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single $ 657.00 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or $ 986.00 multiple Incision and drainage of pilonidal cyst; simple $ 657.00 Incision and drainage of pilonidal cyst; complicated $ 3,726.00 Incision and removal of foreign body, subcutaneous tissues; simple $ 1,694.00 Incision and removal of foreign body, subcutaneous tissues; complicated $ 4,710.00 Incision and drainage of hematoma, seroma or fluid collection $ 3,470.00 Puncture aspiration of abscess, hematoma, bulla, or cyst $ 1,272.00 Puncture aspiration of abscess, hematoma, bulla, or cyst $ 657.00 Incision -
RCEM NPIS Antidote Guideline Appx 1
Royal College of Emergency Medicine and National Poisons Information Service Guideline on Antidote Availability for Emergency Departments (January 2017) Appendix 1. Stock levels & storage recommendations Doses and Clinical Advice on the Administration of Antidotes TOXBASE and/or the BNF should be consulted for further advice on doses and indications for antidote administration. If necessary, the National Poisons Information Service (NPIS) should be telephoned for more patient-specific advice. Contact details for NPIS are available on TOXBASE. Stock Levels The recommended minimum stocking levels (rounded up to full “pack-sizes” where necessary) are based on the amount of antidote required to initiate treatment for an adult patient in the ED and to continue treatment for the first 24 hours. Higher stock levels may be required and individual departments should determine the amount of each antidote they stock based on the epidemiology of poisoning presentations to their department. Additional drugs that are used in the poisoned patient that are widely available in ED are not listed in the table – in particular it is important to ensure that insulin, benzodiazepines (diazepam and/or lorazepam), glyceryl trinitrate or isosorbide mononitrate and magnesium are immediately available in the ED. The following drugs should be immediately available in the ED or any area where poisoned patients are initially treated These drugs should be held in a designated storage facility Recommended stock Drug Indication Presentation Special storage conditions -
Unit 4: Medication Administration Fundamental of Nursing
Unit 4: Medication Administration Fundamental of Nursing Unit 4: Medication Administration: Medication: Is a substance administered for the diagnosis, cure, treatment, relief, or prevention of disease. Six Rights of Medication Administration After paramedics have received the medication or fluid order, they should then administer the drug in question. In performing drug administration, pre-hospital care providers adhere to the six rights of medication administration: 1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time 6. Right documentation Basic principle of nurse on drugs administration 1. The nurse must know the drug's prescribed dose, method of administration, actions, expected therapeutic effect, possible interactions with other drugs, and adverse effects. 2. The nurse must know the institution's administration procedures for the client's welfare and the nurse's legal protection. 3. The nurse must Review physician's order for completeness the client's name, date of the order, name of the drug, dose, rout, time of administration, and the physician's signature. 1 Unit 4: Medication Administration Fundamental of Nursing 4. The nurse discusses the medication and its actions with the client; recheck the medication order if the client disagrees with the dose or the physician's order. 5. The nurse must check the physician's order against the client's medication administration record for accuracy. 6. The nurse gives the patient the right to know about the medication he is receiving and the right to refuse it. Routes of Administration A: Enteral Tract Routes The common enteral routes of administration used in general medical practice are as follows: 1. -
Federal Register/Vol. 71, No. 34/Tuesday, February 21, 2006
Federal Register / Vol. 71, No. 34 / Tuesday, February 21, 2006 / Notices 8859 DEPARTMENT OF HEALTH AND DEPARTMENT OF HEALTH AND of the Public Health Service Act to HUMAN SERVICES HUMAN SERVICES conduct directly or by grants or contracts, research, experiments, and Office of the National Coordinator; Office of the National Coordinator; demonstrations relating to occupational American Health Information American Health Information safety and health and to mine health. Community Chronic Care Workgroup Community Consumer Empowerment The BSC shall provide guidance to the Meeting Workgroup Meeting Director, NIOSH on research and prevention programs. Specifically, the ACTION: Announcement of meeting. ACTION: Announcement of meeting. board shall provide guidance on the institute’s research activities related to SUMMARY: SUMMARY: This notice announces the This notice announces the developing and evaluating hypotheses, third meeting of the American Health third meeting of the American Health Information Community Consumer systematically documenting findings Information Community Chronic Care and disseminating results. The board Workgroup in accordance with the Empowerment Workgroup in accordance with the Federal Advisory shall evaluate the degree to which the Federal Advisory Committee Act (Pub. activities of NIOSH: (1) Conform to L. 92–463, 5 U.S.C., App.) Committee Act (Pub. L. 92–463, 5 U.S.C., App.) appropriate scientific standards, (2) DATES: March 22, 2006 from 1 p.m. to address current, relevant needs, and (3) DATES: March 20, 2006 from 1 p.m. to 5 p.m. produce intended results. 5 p.m. ADDRESSES: Hubert H. Humphrey Matters to be Discussed: Agenda items ADDRESSES: Hubert H. Humphrey Building (200 Independence Ave., SW., include a report from the Director, Building (200 Independence Ave., SW., Washington, DC 20201), Conference NIOSH; progress report by BSC working Washington, DC 20201), Conference Room 705A. -