My Most Instructive Complication of the Year. Douglas E. Drachman, MD, FSCAI Massachusetts General Hospital Boston, MA
|
|
- Daniel Reynolds
- 5 years ago
- Views:
Transcription
1 My Most Instructive Complication of the Year Douglas E. Drachman, MD, FSCAI Massachusetts General Hospital Boston, MA
2 Disclosure Information Douglas E. Drachman, MD, FSCAI Abbott Vascular, Inc: Advisory Board Corindus Vascular Robotics: Advisory Board St. Jude Medical: Consultant Atrium Medical Corporation: Research Grant Support Lutonix/BARD: Research Grant Support Off label use of products will be discussed in this presentation as indicated. Many stents used in the peripherial arterial circulation are indicated for biliary or tracheal application. Drachman 2015
3 HPI 71yo woman with HTN, HLP, PVD, CVD, RAS presents with exertional CP ETT-MIBI: 3 21 SB, CP+, mhr 136, pbp 142/80mmHg 1mm STd II, III, avf, v4-v6 Medium sized severe ischemia mid and basal inferolateral and basal anterolateral walls Medications: aspirin 81 mg tab oral daily metoprolol extended release 25 mg 24 hr XR tab 1 oral simvastatin 40 mg tab oral qpm clonidine 0.1 mg 1 oral bid hydrochlorothiazide 25 mg tab 1 oral daily
4 Cath at OSH Separate LAD ostium 90% mid LAD
5 Cath at OSH Separate LCx ostium 80% mid OM1
6 Cath at OSH RCA 90% mid
7 OSH Evaluation Recommended CABG She declined, sought 2 nd opinion at MGH MGH cardiologist suggested targeted PCI of RCA
8 Cath at MGH: Note LCX ostium
9 Ad hoc re-discussion with Primary Cardiologist: Reconsider CABG? She declined CABG LCX vs. RCA as culprit Fix the RCA, let s see how she does Foreshadowing: Role/responsibility of interventional team Relationship with referring MD Pre-procedural discussion with patient
10 RCA PCI: Plan: Right transradial access 6F AL 0.75 guide RunThrough PTA/stent
11 RCA PCI: Execution: Wire seized in angulated lesion Could not advance 1.5mm balloon Could not advance a buddy wire FineCross would not pass Bear Trap lesion Suboptimal guide support
12 RCA PCI: Execution (plan B): Guideliner 1.2mm PTCA Freed wire (advanced to PDA)
13 RCA PCI: Execution (Plan B): Guideliner 1.2mm PTCA Freed wire (advanced to PDA) Routine PTCA 2.5 x 32mm DES 2.75mm NC post-dil ROTA REGRET
14 One month later She has persistent symptoms Could you try to fix the LCX? Foreshadowing: Revisit the CABG discussion Continue with targeted approach (1-2 more lesions ) Risk/benefit of complex LCX lesion Rota Regret from RCA experience Plan: LCX Rota, PTCA, stent (protect LAD ostium)
15 LCX PCI: Plan: Left transradial access 6F CLS 3.0 guide RunThrough in LAD
16 LCX PCI: Plan: Left transradial access 6F CLS 3.0 guide RunThrough in LAD Air mail second RunThrough to LCX Walk guide over
17 LCX PCI: Execution: Advance Fielder FC to distal LCX Exhange for RotaFloppy wire 1.25mm burr
18 LCX PCI: Execution: Advance Fielder FC to distal LCX Exhange for RotaFloppy wire 1.25mm burr
19 LCX PCI: Execution: Burr stalled on 2nd run after prox turn Manually retracted Guide floated free Rota wire=severed Re-wire LAD
20 LCX PCI: Execution: Burr stalled on 2nd run after prox turn Manually retracted Guide floated free Rota wire=severed Re-wire LAD Air mail wire to LCX
21 LCX PCI: Execution: Fielder FC to distal LCX Balloon tamponade LCX perforation Persists after 10 min
22 Status update Persistent perforation after 10 min PTCA Patient: minimal symptoms, some ST depression Hemodynamics relatively stable STAT echo (no effusion seen) Echo cord draped over patient s left wrist (access) We ordered 1g Ancef IV RN gave Angiomax by mistake, noted after ½ bag ACT= 523 sec
23 LCX PCI: Execution: More brisk extravasation after Angiomax
24 Next steps? Retrieve fractured Rota wire? Snare: would lose PTCA balloon tamponade, or would require a second ping-pong guide Multiple wires, braiding: would lose PTCA balloon tamponade and potentially guide access Ambiguous location of proximal end of Rota wire Leave the wire in place?
25 LCX PCI: Execution: Second Fielder FC to distal LCX Intermittent release of tamponade PTCA FineCross exchange of Fielder FC for Wiggle Wire PTCA/DES of mid LCX
26 LCX PCI: Execution: Quickly advance, position Graftmaster 2.8 x 16mm to cover perforation
27 LCX PCI: Execution: After Graftmaster post-dilated 3.0mm to seal the perf DES to LCX ostium Avoid crossing LAD ostium
28 Final result after mm NC
29 Epilogue Uneventful recovery Repeat echo: no effusion Remains angina free (2 months later)
30 Additional points: Discussion of adverse events with patient Device malfunction Perforation, potential harm Retained wire (unknown long term impact) Medication dosing error Incident report for hospital QA Reporting to FDA for device evaluation (save wire, Rota burr)
31 Additional points: Appropriate follow-up? Re-look? Expectant? Lifelong DAPT to protect the wire? Can anything be done for the LCX if wire-related issues? What if she has recurrent angina from LAD? Rota? Any better solutions for management? Reversal of heparin (if no Angiomax) Retrieval of wire Other
Synopsis. Takeda Pharmaceutical Company Limited Name of the finished product UNISIA Combination Tablets LD, UNISIA Combination Tablets
Synopsis Name of the sponsor Takeda Pharmaceutical Company Limited Name of the finished product UNISIA Combination Tablets LD, UNISIA Combination Tablets Name of active ingredient Title of the study Study
More informationSSTI s :A Guideline for Effective Treatment of Skin and Soft Tissue Infections
SSTI s :A Guideline for Effective Treatment of Skin and Soft Tissue Infections Dr. Javan S. Bass, FACFAS Metro Foot & Ankle Centers, PC Georgia Podiatric Association Board of Directors Disclosures Bako
More informationSuitability of Antibiotic Treatment for CAP (CAPTIME) The duration of antibiotic treatment in community acquired pneumonia (CAP)
STUDY PROTOCOL Suitability of Antibiotic Treatment for CAP (CAPTIME) Purpose The duration of antibiotic treatment in community acquired pneumonia (CAP) lasts about 9 10 days, and is determined empirically.
More informationThe only device incorporating infrarenal anchors for active fixation with proven migration prevention through 5 years of follow-up.
The Endograft Active Fixation The only device incorporating infrarenal anchors for active fixation with proven migration prevention through 5 years of follow-up.* Flexibility The deployment catheter is
More informationTelephone Max dose amoxicillin pediatrics P.O. Box 189 Navan, ON, K4B 1J4 Canada. Sitemap
Telephone 613-835-9490 Max dose amoxicillin pediatrics P.O. Box 189 Navan, ON, K4B 1J4 Canada Sitemap 25 mg/kg/ dose ( Max : 500 mg/ dose ) PO twice daily for 10 days is recommended by the Infectious Diseases
More informationNurse Prescribing: Key Principles and Developments. Elissa Ladd, PhD, FNP-BC MGH Institute of Health Professions Boston, Massachusetts USA
Nurse Prescribing: Key Principles and Developments Elissa Ladd, PhD, FNP-BC MGH Institute of Health Professions Boston, Massachusetts USA No disclosures to report Objectives: 1) To provide an overview
More informationSolving the Antibiotic Crisis:
Solving the Antibiotic Crisis: A Top Down Strategic Re-Think Brad Spellberg, MD FIDSA FACP Associate Professor of Medicine Geffen School of Medicine at UCLA Division of General Internal Medicine Los Angeles
More informationNHS Dumfries And Galloway. Surgical Prophylaxis Guidelines
NHS Dumfries And Galloway Surgical Prophylaxis Guidelines The aim of surgical prophylaxis is to reduce rates of surgical site and health-care associated infections and so reduce surgical morbidity and
More informationUpdate on Fluoroquinolones. Charles Krasner, M.D. June 16, 2016 Antibiotic Stewardship Program -ECHO
Update on Fluoroquinolones Charles Krasner, M.D. June 16, 2016 Antibiotic Stewardship Program -ECHO Potential fluoroquinolone side-effects Increased risk, greater than with most other antibiotics, for
More informationINSTRUCTIONS FOR USE FOR:
INSTRUCTIONS FOR USE FOR: NON-REMOVABLE THE GORE VIABIL SHORT WIRE BILIARY ENDOPROSTHESIS IS INTENDED FOR PALLIATION OF MALIGNANT STRICTURES IN THE BILIARY TREE English The GORE VIABIL Short Wire Biliary
More informationCommunity-acquired pneumonia: Time to place a CAP on length of treatment?
LOGIN TO LEARN: An Engaging and Interactive Journal Club for Pharmacists and Students Community-acquired pneumonia: Time to place a CAP on length of treatment? Jennifer Ball, PharmD Learning Objectives
More informationThe products impacted are listed below: PRODUCT SKU CODE DESCRIPTION BEST BY DATE
To: From: Date: 7.24.15 Nature s Variety Retail Partners Reed Howlett, CEO and Stephanie Arnold, Senior Vice President of Sales Re: Voluntary Recall of Instinct Raw Chicken 4lb. and 7lb. Bites and Patties
More informationM5 MEQs 2016 Session 3: SOB 18/11/16
M5 MEQs 2016 Session 3: SOB 18/11/16 http://tinyurl.com/hn7qzt3 Question 1 Ms Tan is a 52 year old female with no past medical history. She comes to the emergency department presenting with a fever for
More informationOutpatient Antimicrobial Stewardship. Jeffrey S Gerber, MD, PhD Division of Infectious Diseases The Children s Hospital of Philadelphia
Outpatient Antimicrobial Stewardship Jeffrey S Gerber, MD, PhD Division of Infectious Diseases The Children s Hospital of Philadelphia Overview The case for outpatient antimicrobial stewardship Interventions
More informationManagement of CRBSI Leilani Paitoonpong MD MSc Chusana Suankratay MD PhD Division of Infectious Diseases Chulalongkorn University
Management of CRBSI Leilani Paitoonpong MD MSc Chusana Suankratay MD PhD Division of Infectious Diseases Chulalongkorn University A 60-year-old man was admitted for CABG surgery due to triple-vessel disease.
More informationClostridium difficile infection: The Present and the Future
Clostridium difficile infection: The Present and the Future Carlos E. Figueroa Castro, MD Assistant Professor, Division of Infectious Diseases Medical College of Wisconsin November 2014 I have made this
More informationAntibiotic Updates: Part II
Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More informationCipro for klebsiella uti
Cipro for klebsiella uti Search Can UTI be an effective treatment for Klebsiella Pneumoniae? It is safe or dangerous to use UTI while suffering from Klebsiella Pneumoniae? 87 discussions on Treato. instock
More informationGiving IV Medication by Balloon System (EIS)
Giving IV Medication by Balloon System (EIS) Medication: Click here to enter text. What do I do when I get the medication from HomeMed? Always check the prescription and label for final instructions. o
More informationPatient and Family Education How to Add Antibiotics and other Medicines to the Dialysate What do I do before I start? Gather these supplies and place them on a clean surface: Antibiotic vials and sterile
More informationPneumonia Antibiotic Guidance for Adults PAGL Inclusion Approved at January 2017 PGC
Pneumonia Antibiotic Guidance for Adults PAGL Inclusion Approved at January 2017 PGC APPROVED BY: Policy and Guidelines Committee TRUST REFERENCE: B9/2009 AWP Ref: AWP61 Date (approved): July 2008 REVIEW
More informationParaesophageal Hernia. Matthew Hartwig, MD
Paraesophageal Hernia Matthew Hartwig, MD Disclosure Slide Consultant for Mallincrodkt and Quark Pharmaceuticals Case Presentation: Patient PH 82 y/o woman with HTN, PVD, BrCa 10 year history of dysphagia,
More informationOutlines. Introduction Prevalence Resistance Clinical presentation Diagnosis Management Prevention Case presentation Achievements
Amal Meas Al-Anizi, PharmD Candidate KSU, Infectious Disease Rotation 2014 Outlines Introduction Prevalence Resistance Clinical presentation Diagnosis Management Prevention Case presentation Achievements
More informationHost, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus
Host, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus Montana ACP Meeting 2018 September 8, 2018 Staci Lee, MD, MEHP Billings
More informationThe products impacted are listed below: PRODUCT SKU CODE DESCRIPTION BEST BY DATE
To: From: Date: 7.24.15 Nature s Variety Retail Partners Reed Howlett, CEO and Stephanie Arnold, Senior Vice President of Sales Re: Voluntary Recall of Instinct Raw Chicken 4lb. and 7lb. Bites and Patties
More informationBlood Collection Healthcare
Blood Collection Healthcare Collection Site Preparation 1. The collection site must have all the supplies needed to complete a specimen collection (e.g. collection kits, ink pens, Custody and Control Forms
More information11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1
Disclosures Selecting Antimicrobials for Common Infections in Children FMR-Contemporary Pediatrics 11/2016 Sean McTigue, MD Assistant Professor of Pediatrics, Pediatric Infectious Diseases Medical Director
More informationDexmedetomidine. Dr.G.K.Kumar,M.D.,D.A., Assistant Professor, Madras medical college,chennai. History
Dexmedetomidine Dr.G.K.Kumar,M.D.,D.A., Assistant Professor, Madras medical college,chennai Dexmedetomidine is the most recently released IV anesthetic. It is a highly selective α 2 -adrenergic agonist
More informationCase 2 Synergy satellite event: Good morning pharmacists! Case studies on antimicrobial resistance
Case 2 Synergy satellite event: Good morning pharmacists! Case studies on antimicrobial resistance 22nd Congress of the EAHP "Hospital pharmacists catalysts for change", 22-24 March 2017, Cannes Disclosure
More informationTop Gun Phlebotomy. Pseudohyperkalemia 9/10/2018. HOT TOPIC / Phlebotomy Top Gun, Pseudohyperkalemia HOT TOPIC / 2018
Top Gun Phlebotomy Pseudohyperkalemia HOT TOPIC / 2018 Presenter: Brad Karon, M.D., Ph.D. Professor Laboratory Medicine and Pathology Department of Laboratory Medicine and Pathology, Mayo Clinic 1 Disclosure
More informationINSTRUCTIONS FOR USE FOR: English
INSTRUCTIONS FOR USE FOR: en English INSTRUCTIONS FOR USE FOR GORE VIABAHN Endoprosthesis Carefully read all instructions prior to use. Observe all warnings and precautions noted throughout these instructions.
More informationDeveloped by Kathy Wonderly RN, MSEd,CPHQ Developed: October 2009 Most recently updated: December 2014
Developed by Kathy Wonderly RN, MSEd,CPHQ Developed: October 2009 Most recently updated: December 2014 The Center for Medicare and Medicaid (CMS) is moving away from collecting data on the process of care
More informationSINGLE ANNUAL IMPLANT
Manage pet ferret adrenal cortical disease with a SINGLE ANNUAL IMPLANT NOT APPROVED BY FDA Legally marketed as an FDA Indexed Product under MIF 900-013. FOR USE IN FERRETS ONLY. Extra-label use is prohibited.
More informationPrepared: August Review: July Common Infections. A Medicines Optimisation Antibiotic Prescribing Guide.
Prepared: August 2013 Review: July 2014 Common Infections. A Medicines Optimisation Antibiotic Prescribing Guide. Contents Page: Page No Why do we want to review antibiotics? 2 What do NICE say? 3 Acute
More informationGuidelines for Treatment of Urinary Tract Infections
Guidelines for Treatment of Urinary Tract Infections Overview This document details the Michigan Hospital Medicine Safety (HMS) Consortium preferred antibiotic choices for treatment of uncomplicated and
More informationCalifornia Senate Bill 27 Livestock: Use of Antimicrobial Drugs (An Interesting Journey)
California Senate Bill 27 Livestock: Use of Antimicrobial Drugs (An Interesting Journey) Annette Jones, DVM State Veterinarian and Director Animal Health and Food Safety Services California Department
More informationJess Weidman, DVM, DACVIM- Cardiology CVCA Cardiac Care for Pets Dogwood Veterinary Emergency and Specialty
Jess Weidman, DVM, DACVIM- Cardiology CVCA Cardiac Care for Pets Dogwood Veterinary Emergency and Specialty Diagnostics Cardiac auscultation Chest Radiographs BNP Genetic testing Case Scenarios Pre-anesthesia
More informationPOTENTIAL HARMS OF ANTIBIOTIC USE. A Ben Appenheimer MD Infectious Diseases University of Iowa Hospitals and Clinics
POTENTIAL HARMS OF ANTIBIOTIC USE A Ben Appenheimer MD Infectious Diseases University of Iowa Hospitals and Clinics alpheus-appenheimer@uiowa.edu CONFLICTS OF INTEREST No disclosures GOALS AND OBJECTIVES
More informationAntibiotics in the trenches: An ER Doc s Perspective
Antibiotics in the trenches: An ER Doc s Perspective Peter Currie, MD Medical Director for Quality Emergency Physicians Professional Association (EPPA) Agenda Emergency Medicine Specific Disease Processes
More informationCLINICAL PROTOCOL FOR COMMUNITY ACQUIRED PNEUMONIA. SCOPE: Western Australia. CORB score equal or above 1. All criteria must be met:
CLINICAL PROTOCOL F COMMUNITY ACQUIRED PNEUMONIA SCOPE: Western Australia All criteria must be met: Inclusion Criteria Exclusion Criteria CB score equal or above 1. Mild/moderate pneumonia confirmed by
More informationNo Sacrifice of Pushability or Torquability = More Control
No Sacrifice of Pushability or Torquability = More Control Design enables the operator to utilize hydrophilic performance and preserve the desired pushability and torquability attributes Tapered tip enhances
More informationClinical Practice Standard
Clinical Practice Standard 1-20-6-1-010 TITLE: INTRAVENOUS TO ORAL CONVERSION FOR ANTIMICROBIALS A printed copy of this document may not reflect the current, electronic version on OurNH. APPLICABILITY:
More informationHOW TO INTERPRET CULTURE RESULTS. Karen Brust, MD November 29, 2012
HOW TO INTERPRET CULTURE RESULTS Karen Brust, MD November 29, 2012 DISCLOSURES NONE CULTURE RESULTS Based on susceptibility patterns CLSI: international, interdisciplinary, Nonprofit,
More informationMEDICATION ADMINSITRATION: ANTIBIOTIC LOCK THERAPY GUIDELINE
MEDICATION ADMINSITRATION: ANTIBIOTIC LOCK THERAPY GUIDELINE I. PURPOSE Central venous catheters are an integral part in medical management for patients requiring long-term total parenteral nutrition,
More informationSkin and Soft Tissue Infections Emerging Therapies and 5 things to know
2011 MFMER slide-1 Skin and Soft Tissue Infections Emerging Therapies and 5 things to know Aaron Tande, MD Assistant Professor of Medicine October 27, 2017 Division of INFECTIOUS DISEASES 2011 MFMER slide-2
More informationRegional and Local Anesthesia of the Wrist and Hand Aided by a Forearm Sterile Elastic Exsanguination Tourniquet - A Review
H E M A C L E A R P R E S S A u g u s t 2 0 1 2 P a g e 1 Regional and Local Anesthesia of the Wrist and Hand Aided by a Forearm Sterile Elastic Exsanguination Tourniquet - A Review Noam Gavriely, MD,
More informationHEALTH SERVICES POLICY & PROCEDURE MANUAL
PAGE 1 of 3 PURPOSE To assure that DOP inmates with Soft Tissue Infections are receiving high quality Primary Care for their infections and that the risk of infecting other inmates or staff is minimized.
More informationDevelopment of Drugs for Skin Infections
EFPIA - Skin Infection comments 1 Development of Drugs for Skin Infections John H Rex, MD EFPIA - Skin Infection comments 2 Skin Infections Significant recent debate: Acceptable forms: A focus on fever
More informationFREQUENTLY ASKED QUESTIONS Pet Owners
How does the Assisi Loop work? By emitting bursts of microcurrent electricity, the Assisi Loop creates a field which evenly penetrates both soft and hard body tissue around the target area. This electromagnetic
More informationEvent Biosecurity Worksheet
Event Biosecurity Worksheet I. General Description and Identification of Key Personnel and Contacts Event Particulars: Name of Event: Dates of Event: Will a veterinarian inspect the event venue prior to
More informationVCH PHC SURGICAL PROPHYLAXIS RECOMMENDATIONS
VCH PHC SURGICAL PROPHYLAXIS RECOMMENDATIONS CARDIAC Staphylococcus aureus, S. epidermidis, except for For patients with known MRSA colonization, recommend decolonization with Antimicrobial Photodynamic
More informationSAFETY PHARMACOLOGY: CARDIOVASCULAR TELEMETRY. Aileen Milne PhD, Manager, Safety Pharmacology
SAFETY PHARMACOLOGY: CARDIOVASCULAR TELEMETRY Aileen Milne PhD, Manager, Safety Pharmacology SAFETY PHARMACOLOGY SERVICES OVERVIEW Full Range of S7A and S7B studies herg assay Respiratory function plethysmography(rat/mouse)
More informationProcalcitonin to Predict Septic Shock & Guide Antibiotic Therapy
Procalcitonin to Predict Septic Shock & Guide Antibiotic Therapy William T. McGee, M.D. MHA, FCCM, FCCP Critical Care Medicine Associate Professor of Medicine and Surgery University of Massachusetts 759
More informationStanding Orders for the Treatment of Outpatient Peritonitis
Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.
More informationGuidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults)
Guidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults) Community Acquired Community Acquired 1) Is it pneumonia? ie new symptoms and signs of a lower respiratory
More informationVolume 1; Number 7 November 2007
Volume 1; Number 7 November 2007 CONTENTS Page 1 Page 3 Guidance on the Use of Antibacterial Drugs in Lincolnshire Primary Care: Winter 2007/8 NICE Clinical Guideline 54: Urinary Tract Infection in Children
More informationComposite Sterile Aneroid Sphygmomanometer And Rubber Bandage Tourniquet: Indications, Techniques and Results
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 5 Number 2 Composite Sterile Aneroid Sphygmomanometer And Rubber Bandage Tourniquet: Indications, Techniques and Results A Ogbemudia Citation
More informationAustralian College of Veterinary Scientists. Fellowship Examination. Small Animal Surgery Paper 1
Australian College of Veterinary Scientists Fellowship Examination June 2011 Small Animal Surgery Paper 1 Perusal time: Twenty (20) minutes Time allowed: Three (3) hours after perusal Answer your choice
More informationPharmacokinetics. Absorption of doxycycline is not significantly affected by milk or food, but coadministration of antacids or mineral supplements
Pharmacokinetics. Absorption of doxycycline is not significantly affected by milk or food, but coadministration of antacids or mineral supplements should be avoided. PDR Drug Summaries are concise point-of-care
More informationObjectives. Review basic categories of intra-abdominal infection and their respective treatments. Community acquired intra-abdominal infection
Objectives Review basic categories of intra-abdominal infection and their respective treatments Community acquired intra-abdominal infection Mild/Moderate Severe Acute biliary tract infections Nosocomial
More informationappropriate healthcare professionals employed at my pharmacy. I understand that I am
Patient Group Direction: For the supply of Silver Sulfadiazine 1% Cream by Community Pharmacists in Somerset to patients for the topical treatment of minor localised impetigo under the Somerset Minor Ailments
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS Issued March 2017 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Recicort 1.77 mg/ml + 17.7 mg/ml ear drops, solution for dogs and cats Recicort vet 1.77 mg/ml + 17.7 mg/ml
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationOptimize Durations of Antimicrobial Therapy
Optimize Durations of Antimicrobial Therapy Evidence & Application Jill Cowper, Pharm.D. Division Infectious Diseases Pharmacist Parallon Supply Chain Solutions Richmond, VA P: 607 221 5101 jill.butterfield@parallon.com
More informationGuidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults)
Guidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults) Community Acquired Pneumonia Community Acquired Pneumonia 1) Is it pneumonia? ie new symptoms and signs of
More informationAppendix: Outcomes when Using Adjunct Dexmedetomidine with Propofol Sedation in
SUPPLEMENTAL CONTENT Appendix: Outcomes when Using Adjunct Dexmedetomidine with Propofol Sedation in Mechanically Ventilated Surgical Intensive Care Patients Table of Contents Methods Summary of Definitions
More informationRegulating the scientific use of animals taken from the wild Implementation of Directive 2010/63/EU
Regulating the scientific use of animals taken from the wild Implementation of Directive 2010/63/EU Dr Kim Willoughby, Mr Peter Gray, Dr Kate Garrod. Presented by: Dr Kim Willoughby Date: 26 October 2017
More informationAntimicrobial Selection and Therapy for Equine Musculoskeletal Trauma
Antimicrobial Selection and Therapy for Equine Musculoskeletal Trauma Lucio Petrizzi DVM DECVS Università degli Studi di Teramo Surgical site infections (SSI) Microbial contamination unavoidable Infection
More informationConsider the patient, the drug and the device how do you choose?
Consider the patient, the drug and the device how do you choose? Tim Hills Lead Pharmacist Antimicrobials and Infection Control Nottingham University Hospitals NHS Trust OPAT Recommendations Drug Therapy
More informationTHIS PATIENT GROUP DIRECTION HAS BEEN APPROVED on behalf of NHS Fife by:
Patient Group Direction for Named Community Pharmacists to Supply CHLORAMPHENICOL EYE DROPS 0.5% To patients aged 1 year and older Under the Minor Ailments Service. Number 114 Issued October 2016 Issue
More informationAntibiotic Updates: Part I
Antibiotic Updates: Part I Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More informationAntimicrobial Stewardship in Continuing Care. Urinary Tract Infections Clinical Checklist
Antimicrobial Stewardship in Continuing Care Urinary Tract Infections Clinical Checklist December 2014 What is Antimicrobial Stewardship? Using the: right antimicrobial agent for a given diagnosis at the
More informationClinical Policy: Linezolid (Zyvox) Reference Number: CP.PMN.27 Effective Date: Last Review Date: Line of Business: Oregon Health Plan
Clinical Policy: (Zyvox) Reference Number: CP.PMN.27 Effective Date: 07.01.18 Last Review Date: 05.18 Line of Business: Oregon Health Plan Revision Log See Important Reminder at the end of this policy
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE VETERINARY MEDICINAL PRODUCT NOSEDORM 5 mg/ml Solution for injection for dogs and cats [DE, ES, FR, PT] 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each
More informationTO ENSURE ADEQUATE ABSORPTION, ALWAYS ADMINISTER PROGRAM FLAVOR TABS IN CONJUNCTION WITH A NORMAL MEAL.
NOVARTIS ANIMAL HEALTH US, INC. USA Product Label http://www.vetdepot.com 3200 NORTHLINE AVE. SUITE 300, GREENSBORO, NC, 27408 Customer Service: 800 332 2761 Professional Services: 800 637 0281 Fax: 336
More informationOverview. Clinical signs. Will you treat? Owner willing to treat? Surgical vs. Medical. Medical options
Part II (cushing s disease is hard to diagnose) Cushing s Disease Is Easy To Treat Why test? When to test? How to test? Will you treat? How to treat? Overview Thomas Schermerhorn, VMD, DACVIM(SAIM) Kansas
More informationNeonatal Antibiotic Prophylaxis and Surgical Site Infection Adam C. Alder, MD MSCS Ryan Walk, MD UTSW and Children s Health Dallas, TX
Neonatal Antibiotic Prophylaxis and Surgical Site Infection Adam C. Alder, MD MSCS Ryan Walk, MD UTSW and Children s Health Dallas, TX Nothing to disclose Disclosures Objectives Review the current challenges
More informationSquad Review MCEMS. Spring/Summer 2014
Squad Review MCEMS Spring/Summer 2014 - Hemorrhage Control - Sepsis Overview Bill Hall MD Medical Director, Mesa County EMS. ems.mesacounty.us Colorado West Emergency Physicians, St. Mary s Hospital and
More informationLegend. Reusable. Rotatable. Disposable. Thickness in released position. Internal diameter in released position. Cup opening.
Legend Reusable Rotatable Disposable Thickness in released position Internal diameter in released position Cup opening Cup length Disposable biopsy forceps p.2 Disposable removing forceps p.4 Reusable
More informationHighly variable pharmacokinetics of dexmedetomidine during intensive care: a case report
JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Highly variable pharmacokinetics of dexmedetomidine during intensive care: a case report Timo Iirola 1*, Ruut Laitio 1, Erkki Kentala 1, Riku Aantaa
More informationInvasive Group A Streptococcus (GAS)
Invasive Group A Streptococcus (GAS) Cause caused by a bacterium commonly found on the skin and in the throat transmitted by direct, indirect or droplet contact with secretions from the nose, and throat
More informationAcute Pyelonephritis POAC Guideline
Acute Pyelonephritis POAC Guideline Refer full regional pathway http://aucklandregion.healthpathways.org.nz/33444 EXCLUSION CRITERIA: COMPLICATED PYELONEPHRITIS Discuss with relevant specialist for advice
More informationDisclosures! Update on Keratoprosthesis! Penetrating Keratoplasty! Keratoprostheses! 12/3/11
Disclosures Update on Keratoprosthesis I have no financial interests in any of the techniques or products discussed. Bennie H. Jeng, M.D. Associate Professor of Ophthalmology Department of Ophthalmology
More informationBe it enacted by the People of the State of Illinois,
SB Enrolled LRB0 0 MGM b AN ACT concerning regulation. Be it enacted by the People of the State of Illinois, represented in the General Assembly: Section. The Animal Welfare Act is amended by changing
More informationPLEASE POST. EMS Providers are to ensure that all EMS personnel receive this information.
SLO County Emergency Medical Services Agency Bulletin 2013-07 PLEASE POST New BLS Policy # 583 BLS Tourniquet Use New ALS Policy # 623 Prehospital Tourniquet Use August 28, 2013 To All SLO County EMS Providers:
More informationFACT FUN! *Loggerheads are the most common species of sea turtle in the ocean off of South Carolina.
FACT FUN! *Loggerheads are the most common species of sea turtle in the ocean off of South Carolina. *Loggerheads are named for their large head and have powerful jaws that allow them to eat heavy shelled
More informationAntimicrobial Stewardship Strategy:
Antimicrobial Stewardship Strategy: Prospective audit with intervention and feedback Formal assessment of antimicrobial therapy by trained individuals, who make recommendations to the prescribing service
More informationTHE ONLY FLEA AND TICK PROTECTION THAT LASTS UP TO 12 WEEKS * WITH A SINGLE CHEW
THE ONLY FLEA AND TICK PROTECTION THAT LASTS UP TO 12 WEEKS * WITH A SINGLE CHEW 1 DOSE. 12 EXTRAORDINARY WEEKS OF FLEA AND TICK PROTECTION. AN EXTRAORDINARY WAY TO PROTECT YOUR DOG 1 DOSE 4 WEEKS 8 WEEKS
More informationProcedure # IBT IACUC Approval: December 11, 2017
IACUC Procedure: Anesthetics and Analgesics Procedure # IBT-222.04 IACUC Approval: December 11, 2017 Purpose: The purpose is to define the anesthetics and analgesics that may be used in mice and rats.
More informationPlease include the dog breed and whether the dog was recovered for each case.
Freedom of Information Request Reference No: I note you seek access to the following information: How many dogs were reported stolen in 2013? Please include the dog breed and whether the dog was recovered
More informationNUMBER: R&C-ARF-10.0
1. PURPOSE PAGE 1 OF 6 This policy describes the procedures for keeping and maintaining animal medical records. This procedure is approved by the Creighton University Institutional Animal Care and Use
More informationPRESCRIPTION PATTERN OF ANTI HYPERTENSIVE DRUGS IN SHRI SATHYA SAI MEDICAL COLLEGE & RESEARCH INSTITUTE
Original Article PRESCRIPTION PATTERN OF ANTI HYPERTENSIVE DRUGS IN SHRI SATHYA SAI MEDICAL COLLEGE & RESEARCH INSTITUTE Annamalai Maduram 1, Harikrishna 2 INTRODUCTION High blood pressure, termed "hypertension,"
More informationDear Doctor: Our sincerest thanks, Stephen A. Connell, DVM Director, Technical, Academic and Consumer Services Elanco Companion Animal Health
Dear Doctor: As a trained professional, you understand the loss of a pet is incredibly difficult. Every pet owner responds differently as they grieve. We believe the recent negative media coverage of Trifexis
More informationIntroduction. Introduction EVIDENCE-BASED CPR: HOW THE RECOVER GUIDELINE CHANGED US. VETgirl on the run! VETgirl elite! 6/11/17
EVIDENCE-BASED CPR: HOW THE RECOVER GUIDELINE CHANGED US Introduction Garret Pachtinger, VMD, DACVECC COO, VETgirl Kenichiro Yagi MS, RVT, VTS (ECC, SAIM) Introduction Justine A. Lee, DVM, DACVECC, DABT
More informationStanding Orders for the Treatment of Outpatient Peritonitis
Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.
More informationDr. Omar S. Tabbouche, M.Sc, D.Sc, Pharm.D Head of Pharmacy Department New Mazloum Hospital Tripoli, Lebanon
Efficacy & Safety of Ketoprofen 25mg vs. Paracetamol 1g intravenous preparations in the management of fever in adults: A pilot, double-blind, parallel-group, randomized controlled trial Dr. Omar S. Tabbouche,
More informationBLUE, 2 YEAR OLD MI GERM
FELINE ADMIN SHEET NOSECTOMY NOSECTOMY BLUE, 2 YEAR OLD MI GERM LEFT SIDED DRAINING TRACT OOCURED AFTER PLAYING OUTSDIE IN THE WOODS IN VA BEACH AFTER FOUR DIFFERENT AB GREW MRSP SENSITIVE TO CHLORAMPHENICOL
More information2/5/2016. Military Tourniquet PFN:SOMTRL0B. Terminal Learning Objective. Reason. Hours: 0.5
Military Tourniquet PFN:SOMTRL0B Hours: 0.5 Slide 1 Terminal Learning Objective Action: Communicate knowledge about the military tourniquet Condition: Given a lecture in a classroom environment Standard:
More informationWelcome! 10/26/2015 1
Welcome! Audio for this event is available via ReadyTalk Internet Streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. Limited dial-in lines
More informationFREEDOM OF INFORMATION SUMMARY
Date of Approval Letter: FREEDOM OF INFORMATION SUMMARY NEW ANIMAL DRUG APPLICATION NADA 141-148 Combination of DECCOX AND RUMENSIN in Cattle Feed (decoquinate and monensin) For the prevention of coccidiosis
More information