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Randolph County Emergency Medical Services System Appendix A Calcium Chloride ACTION Electrolyte modifier; essential for the transmission of nerve impulses in cardiac muscle contraction. INDICATIONS 1. Symptomatic hyperkalemia 2. Hypocalcemia, especially from acute causes such as Hydrofluoric acid or flourine gas exposure 3. Calcium channel blocker overdose or toxicity; including: verapamil Calan, Isoptin ; , diltiazem Cardizem ; , nifedipine Procardia, Aadalat ; , nicardipine Cardene, Vasonase ; , nimodipine Nimotop ; , amlodipine, felodipine, flunarizine, bepridil, isradipine, nisoldapine, nitrendapine 4. Respiratory depression following administration of magnesium sulfate CONTRAINDICATIONS 1. Not to be used during resuscitation unless hyperkalemia, hypocalcemia, or calcium channel blocker toxicity has been suspected. PRECAUTIONS 1. Rapid administration of calcium in a beating heart may produce slowing of the cardiac rate. 2. Patients taking digitalis may have increased ventricular irritability and calcium may produce digitalis toxicity. 3. In the presence of sodium bicarbonate, it will precipitate calcium salts or carbonates. 4. Do not give to any patient without physician order. ADVERSE REACTIONS SIDE EFFECTS 1. Syncope 2. Arrhythmias, bradycardia, and cardiac arrest 3. Tissue necrosis at injection site ADMINISTRATION 1. Obtain physician order for all indications. 2. Dosage in adults: 8-16 mg kg of 10% solution 1.0 ml 100 mg ; . One amp 10ml ; gm IV.
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Etc. For this, the Authority requires cooperation of all concerned. I happy to note that now there is a perceptible change in the attitude of the lawyers and Judicial Officers towards the legal aid and Lok Adalats movement. The Judicial Officer are also working hard and holding Lok Adalats on weekends and holidays. The importance of this newsletter can be realised inasmuch as it is the only medium through which the activities of the authority at different levels can be viewed and the information disseminated. It will also help us to realise as to what more remains to be done to achieve the goal. Therefore I invite the suggestions from all the readers of the newsletter to improve the working of the authority and to strengthen the legal aid movement and albuterol.
This is done by measuring the symphysis-fundus height and by doing a complete abdominal examination. Labour must be suppressed if the estimated fetal weight is less than 2000 g or the estimated gestational age less than 34 weeks. The symphysis-fundus height measurement will be less than 33 cm. 5-25 1. HOW SHOULD YOU GIVE NIFEDIPINE FOR THE SUPPRESSION OF PRETERM LABOUR? Three nifedipine Aealat ; 10 mg capsules total 30 mg ; should be taken by mouth. If there are no further contractions and no continuing cervical dilatation and effacement, 20 mg should be given 8 hourly. If there are still contractions with cervical dilatation and effacement 3 hours after the initial dose, a second dose of 20 mg should be given, followed by 8 hourly doses.
The role of capsaicin-sensitive afferent nerves in the modulation of uterine contractile activity Anna Klukovits, Rbert Gspr, Pter Sntha * , Gbor Jancs * , George Falkay Department of Pharmacodynamics and Biopharmacy, and * Department of Physiology, University of Szeged, Szeged, Hungary The possible participation of capsaicin-sensitive sensory nerves in the modulation of neurogenic contractions was studied in non-pregnant and term pregnant rat uteri. Neurogenic contractions were elicited by electric field stimulation 40 V, 1-70 Hz, 0.6 ms ; in intact uteri and in uteri which were previously exposed to capsaicin in vitro. In capsaicin pretreated preparations obtained both from non-pregnant and term pregnant rats, a dose-dependent increase in the amplitude of uterine contractions was detected. Prior systemic treatment of the rats with capsaicin 130 mg kg, s.c. ; abolished the effect of in vitro capsaicin administration on the amplitude of neurally evoked contractions. These findings suggest that the effect of capsaicin on uterine contractility is of neural origin and may not be related to a direct action on the smooth muscle. Experiments using a specific antagonist of calcitonin gene-related peptide revealed that depletion of this peptide, normally contained in capsaicin-sensitive sensory nerves, may be responsible, at least in part, for the increased responsiveness of uterine smooth muscle to low frequency electric field stimulation. The findings support the notion that capsaicin-sensitive afferent nerves, by the release of sensory neuropeptides, significantly contribute to the modulation of uterine contractility. It is suggested that uterine sensory nerve activation may be part of a trigger mechanism leading to preterm contractions evoked by, e.g. inflammatory processes and alesse.
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SOFT PALATE IS A MAJOR SOURCE OF PHARYNGEAL EVOKED POTENTIALS DEMATTEIS M, 1 Donzel-Raynaud C, 2 Redolfi S, 2 Straus C, 2 Levy P, 1 Similowski T2 1 ; Laboratoires du sommeil et HP2, Hopital Universitaire et Faculte de Medecine, Grenoble, France, 2 ; Laboratoire de physiopathologie respiratoire, Groupe Hospitalier Pitie-Salpetriere, Paris, France Introduction : Pharyngeal sensitivity participates to the control of pharyngeal patency and has been shown to be impaired in apneic patients. However, measurement of pharyngeal sensitivity is currently based on patient's subjective response. Moreover, the contribution of the different pharyngeal regions in the neurogenic regulation of upper airway is unclear. To address these issues, we developed a novel procedure allowing to record cortical evoked potentials from various pharyngeal regions. Methods : Nine healthy adult volunteers were equipped for EEG recordings and for pharyngeal stimulation. Using a device previously developed for measuring pharyngeal sensation by the psychophysical method of limits, and combined to an air source delivering small air puff stimuli, different oropharyngeal regions were tested. Pharmacological modulation of the cortical response was assessed by topical anesthesia. Results : Air-pulse stimuli were well-tolerated in all participants but one. The sensory stimulation elicited consistent and reproducible electrophysiological patterns, with a good signal-to-noise ratio, as well as intra- and intersession repeatability, enabling an objective and quantitative assessment of pharyngeal sensitivity. The complete evoked response was a Wshaped waveform complex, with succession of negative and positive peaks, morphologically resembling the sensory potentials elicited by electrical or mechanical stimuli of hand, leg and face. Among the different tested regions, soft palate stimulation elicited the largest and the most complete response, that was decreased or abolished by topical xylocaine application. Conclusion : We have developed a simple procedure to record pharyngeal evoked potentials using air-puff stimuli. Among the different pharyngeal regions tested, and based on electrophysiological responses, soft palate appeared as the main source of sensory information from pharynx. Easy to adapt to standard evoked potential machine, this new technique may and allegra.
1 Correspondence: MPL, Institute of Pharmacological Sciences, via Balzaretti, 9 Milan-20133 Italy. E-mail: adriana. maggi unimi.it.
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WBAMC Pam 40-4 1 ; Results for tests ordered with ROUTINE priorities are NOT automatically printed at the ordering location. 2 ; The electronic patient file is considered the official file. HCP should review patient results in CHCS. There are no laboratory cumulative reports printed. l. Misrouted Laboratory Results. 1 ; . HCP who receive laboratory results that they have not ordered should not discard toss the results until contact is made to the DPALS computer systems analyst. 2 ; . HCP who receive critical laboratory results that they have not ordered should bring the issue to the ordering provider. The provider will pass the information to the DPALS computer systems analyst on the next normal duty day. 3 ; HCP who receive routine non-critical laboratory results that they have not ordered should bring the issue to the attention of the DPALS computer systems analyst. 4 ; The DPALS computer systems analyst will take appropriate steps to determine the correct ordering HCP department service from which the order originated. The analyst will then contact the HCP originally receiving the results and request that he she forward the results to the correct HCP. If that HCP cannot forward the results for whatever reason, the analyst will forward a hard copy of the results to the HCP who originated the orders or to his her department service chief. The HCP originally receiving the results may then discard toss the results. 17. ANATOMIC PATHOLOGY SERVICE. The Anatomic Pathology Service encompasses the sections of Cytology, Surgical, and Autopsy Pathology. The service is in the Department of Pathology on the 3rd floor of WBAMC and is open routinely 0730-1630 Monday through Friday. A staff pathologist is on call for problems arising during non-duty hours. Pathology on call roster is distributed monthly to all clinical services. The McAfee US Army Health Clinic laboratory will only receive and transport specimens for these sections. If specimens are received by 1100 hrs, they will be transported the same day. If specimens are received after 1100, they will be transported on the following business day. See the WBAMC handbook for specimen criteria. 18. CLINICAL PATHOLOGY SERVICE. McAfee US Army Health Clinic Laboratory offers clinical pathology services to White Sands Missile Range, WBAMC, and 218.
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After the doctor has made sure that the child has been treated medically, the doctor or a representative from the study team will contact the parent to let them know that his her child has been enrolled in this study.
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Success of early postoperative feeding after elective open colectomy. In the future, however, further study with different motility agents, as well as the use of nonopiate analgesics, may be done to determine if they have any notable effect on the results of early postoperative feeding. To the best of our knowledge, this study represents the largest series of patients undergoing early postoperative feeding after open colon resection. We believe our data hospital discharge following colon resection are not limited to laparoscopic techniques alone. The ideal method to compare laparoscopic vs open techniques, however, is a randomized, controlled trial that carefully incorporates identical means of postoperative feeding. Although the Phase 3 Prospective Randomized Trial Comparing LaparoscopicAssisted Colectomy vs Open Colectomy, currently underway and accruing subjects, aims primarily at comparing survival between the 2 operative approaches, quality of life and cost-effectiveness are also important study objectives.15 It is important to stress that in any randomized trial examining length of hospital stay and or costs of medical treatment following laparoscopic vs open procedures, patients must be given an identical feeding protocol to make accurate and appropriate comparisons between the 2 techniques. In patients undergoing elective open colon resection, early postoperative feeding is safe, with no evidence of increased morbidity. Early postoperative feeding is also highly effective in reducing hospital stay. For unknown reasons, men and patients undergoing total abdominal colectomy or total proctocolectomy are predisposed to feeding intolerance. Failure to tolerate early postoperative feeding does not result in increased complications or increase the overall length of hospitalization. We believe that early postoperative feeding can be safely and effectively performed in the vast majority of patients undergoing elective open colon resection. Presented at the 70th Annual Session of the Pacific Coast Surgical Association, San Jose del Cabo, Baja California Sur, February 14, 1999. We thank Stacey L. Stern, MS, for expert assistance with the statistical analysis. Reprints: Theodore X. O'Connell, MD, Department of Surgery, 4747 Sunset Blvd, Los Angeles, CA 90027 e-mail: theodore.x.o'connell kp.
Funding: No external funding. Competing interests: SO'B has been reimbursed for lectures and conferences by Hoechst Marion Roussel, Shire Pharmaceuticals, SmithKline Beecham, Eli Lilly, Searle, Sanofi Winthrop, Zeneca, Galen Laboratories, Solvay Pharmaceuticals, and Novo Nordisk. He has also received funds for research staff from Searle, SmithKline Beecham, Eli Lilly, and Sanofi Winthrop. He is married to a member of the research department of Zeneca Pharmaceuticals.
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