Microsoft powerpoint - hair of the dog for 2002 backup

• Copies of slides and modified CIWA (Clinical Institute Withdrawal Assessment) scale available at: • 1 in 13 Americans abuses alcohol• Alcohol is the 2nd leading cause of death • Economic losses from alcoholism exceed • Be Vewy, Vewy Careful• Trust No One• Assume Nothing• Follow all 5 vital signs serially• Treat withdrawal adequately• R/O infection and metabolic imbalance• Always consider CNS etiology correctional facilities is a problem of triaging a huge volume of patients to yield a low number of critical (but dangerous) cases • Critical to have a predefined process• Critical to have individualized therapy • Very aggressive medical treatment tied to • Reliable, reproducible, validated, and • Primarily intended for alcohol, but it • Serial scoring drives individualized • Temperature• Pulse• Respirations• Blood pressure• Nausea / vomiting• Tremor• Sweating • Hallucinations• Mental status• Agitation• Thought disturbances• Convulsions / seizures• Headache – Seen when cellular tolerance to ETOH – Often treated with another drink– 1-5% will progress to full DT’s • Detoxify patient over 3-5 days• Use benzodiazepines• Nutritionally fortify• MVI (for niacin)• Thiamine• Reassess regularly for progression to • Most alcoholics are dehydrated• Fluid of choice = D5NS at 200/hr with: – MVI (1-2 amps)– Folate (1-5 mg)– KCL (40 mEq)– MgSO4 (5 grams)– Thiamine (100 mg IV) • Alcoholics have NO glycogen stores• FEED THEM!!!• Alcoholics tend to become • Significant reduction of delirium (p=.04)• All equally efficacious; longer half-lives preferred for smoother withdrawal, less abuse potential • Titrate medications to symptoms• Generally give 5 days with taper• Do not undermedicate• Drug of choice is whatever you are • Bolus initially• Redose q 30 minutes until lightly sedated• Average loading dose = 600 mg • Do not use routinely• No role if no prior seizures• No role if alcoholic seizures have already • Conflicting data in drinker with previous phenytoin are drinkers with idiopathic epilepsy or previous history of CNS – Not recommended as monotherapy, can be • Neuroleptics (haldol, phenothiazines) – Increase incidence of seizures compared to – Less effective than benzodiazepines– Can be used to calm agitated patients in – 10% of patients with prior seizures will – Without treatment: 5-30%– With treatment: 1-6% • Seen in 25% of “professional” drinkers• Visual 5x more common than auditory• Treatment – More aggressive benzodiazepine use– Hydration– Possible IM Haldol • Usually 1-6 seizures• Usually tonic-clonic, rarely status• Majority occur within 48 hours• If patient medicated with benzodiazepine • 308 patients, 294 controls• 60% of seizures were random events• Frequency of seizures increased with – 3x normal if ½ pint per day– 8x normal if 1 pint / day– 20x normal if 1 quart / day • 2375 Patients• 1915 Mortality = 52%• 1935 Mortalty = 14% • No nurses • Dehydration • Physical restraints • Neuroleptics • Be vigilant for pneumonia, GI bleeds, sepsis, • Focal seizures• Febrile • Status epilepticus • Any of the above warrant workup in the • 5 Basic Causes of Altered Mental Status – Vital Sign abnormalities– Toxic/Metabolic causes– Structural Abnormalities– Infectious Etiologies– Psychiatric Illness • Pulse—Holiday heart• Resp—hypoventilation from CNS • Na (high or low)• K (high or low)• Glucose (high or low)• BUN/Cr (dehydration)• ABG’s (hypoxia, pneumonia)• ETOH level—if below 200, look for Calculated osmolarity = (2*Na) + (Glu/18 ) + OG = true osmolarity – calculated = 10-20 • Calculate in osmolar forces contributed • Each 3.2 mg% = 1 mosm• Profound acidosis, blindness, retinal • Do not induce vomiting• Charcoal is not effective• Patients must be transferred to ER • Each 6.2 mg% = 1 mosm• No odor• Profound acidosis• Early symptoms = euphoria, seizures• Cardiac symptoms = ST-T wave changes• Renal symptoms = crystalluria, failure• Transfer to ER • Each 6.0mg% contributes 1 mosm• Twice as drunk, twice as sick, twice as • Ketosis without acidosis• No anion gap• Symptoms mostly GI • CNS trauma• Alcoholics have occult injuries• Send out for CT, LP, EEG if necessary • CBC (sepsis, anemia)• U/A (ketones, oxalate crystals)• CXR (TB, Pneumonia, Lung abscess)• LP (meningitis) • Diagnosis of exclusion• 80% of seriously mentally ill have a co- – Ataxia– Ocular findings (nystagus, lateral rectus palsy)– Encephalopathy – Coma– Miosis– Hypothermia– Hypotension– Bradycardia • Due to thiamine deficiency• 20% mortality rate• Patients with AIDS, hyperalimentation, malnutrition, diabetes are at very high risk • Rhabdomyolysis• Myopathy• Hypothermia • Alcoholics are dangerous• Assume nothing• Educate your nurses and yourself• Develop a serial screening tool and • Treat aggressively• Don’t be afraid to refer them to ER (Clinical Institute Withdrawal Assessment) scale available at:


Modelling of the interactions of some inhibitors with the pghs-1 by biodock - a stochastic approach to the automated docking of ligands to biomacromolecules

Modelling of the Interactions of some Inhibitors with the PGHS-1 by Biodock - A Stochastic Approach to the Automated Docking of Ligands to Biomacromolecules by Alessandro Pedretti , Anna Maria Villa* , Luigi Villa , Giulio Vistoli Istituto di Chimica Farmaceutica , Università di Milano, viale Abruzzi, 42, I-20131 Milano__________________________________________________________________

Microsoft word - malaria-prophylaxis-new proposal.rtf

MALARIA PREVENTION AND PROPHYLAXIS By Frans J Cronjé, MBChB(Pret), BSc(Hons) Aerosp Med Albie De Frey, MBChB(Pret) Hermie C Britz, MBChB(Pret), BSc(Hons) Aerosp Med DAN receives many inquiries from members regarding malaria. Indeed, malaria has become an increasing problem due to drug resistance. As divers venture deeper into the African tropics they incur increasing

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