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If you need to use the same injection site, just make sure it is not the same spot on that site you used last time. Do not remove the gray needle cap from the prefilled syringe until you are ready to inject. Syringe label with Plunger rod Syringe barrel expiration date Gray needle cap on Medicine Always hold the prefilled syringe by the syringe barrel. Do not use the prefilled syringe if any part of the prefilled syringe appears cracked or broken. Do not use the prefilled syringe if the gray needle cap is missing or not securely attached. Do not use the prefilled syringe if the medicine is cloudy or discolored or contains particles. Step 2: Get ready 2 A Carefully pull the gray needle cap straight out and away from your body. It is normal to see a drop of Place the cap in the sharps medicine at the end of the needle. Pinch skin firmly between your thumb and fingers, creating an area about two inches wide. Step 4: Finish 4 A Place the used syringe in a sharps disposal container right away. There may be state or local laws about how you should throw away used needles and syringes. Do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. Keep the used syringe and sharps container out of the sight and reach of children. Page 1 Important Before you use the on-body infusor and prefilled cartridge for use with Repatha (evolocumab), read this important information: It is important that you do not try to give yourself the injection unless you have received training from your healthcare provider. Storing your on-body infusor and prefilled cartridge Keep the on-body infusor and prefilled cartridge in the original carton to protect from light or physical damage. Using your on-body infusor and prefilled cartridge Do not shake the on-body infusor or prefilled cartridge. Part of the on-body infusor and prefilled cartridge may be broken even if you cannot see the break. Page 2 the single-use on-body infusor for subcutaneous injection is made to only be used with the prefilled cartridge. A healthcare provider who knows how to use the on-body infusor should be able to answer your questions. Step 1: Prepare Remove the on-body infusor and prefilled cartridge carton from the refrigerator. Wait at least 45 minutes before injecting for the on-body infusor and prefilled 1A cartridge in the carton to naturally reach room temperature.
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Safeguards to secure a safe sleep environment were recommended, and the patient was instructed to avoid alcohol and sleep deprivation. Treatment with continuous positive airway pressure followed an in-laboratory titration study, resulting in a near cessation of arousal episodes. Treatment of sleep disorders producing sleep fragmentation such as obstructive sleep apnea often reduces the frequency of parasomnia episodes in both children and adults. Episodes usually tion (Supplemental Digital Content classified as distinct terminate spontaneously with the pa 6-8, links. Affected individuals recurrent dream-enacting partial recollection the following day. Sleep-related injuries to ple episodes per night with clustering children, adults with sleep terrors may the affected person or for several nights, followed by pro bolt out of bed in a violent or agitated bed partner occur in longed periods of remission. Nightly manner with some dream recollection approximately one-third episodes that cluster are rare. Most affected children had confusional Episodes typically last several minutes arousals at an earlier age. Sleepwalking and are followed by the patient calmly typically begins in the first decade of life and quietly returning to sleep. Sleepwalking has a iors that are occasionally challenging strong genetic predisposition, with first to differentiate from nocturnal seizures degree relatives of sleepwalkers having and at times overlap with disorders of at least a 10-fold increased likelihood of arousal. Sleepwalking was iors, including vocalizations and motor inherited as an autosomal dominant dis activity in relation to altered dream order with reduced penetrance in a mentation (Case 6-3)(Supplemental four-generation family with localization Digital Content 6-12, links. Sleep-related injuries genetic locus identified that contains to the affected person or bed partner 35 the adenosine deaminase gene. In occur in approximately one-third of hibition of adenosine metabolism in cases (Supplemental Digital Content creases slow-wave sleep, rendering this 6-13, links. Sleep terrors (ie, night abruptly at the end of an episode and terrors, pavor nocturnus) are character are alert and able to recount a coherent 116 During the interview, he reluctantly described having vivid dreams associated with violent movements, yelling, and swearing in sleep. He appeared embarrassed by these behaviors and expressed remorse when telling the story of how he once repeatedly punched and kicked his wife while dreaming that he was fending off an attacker. In turn, his wife stated adamantly that this behavior was highly uncharacteristic of her loving husband. His wife once found him with blood dripping from his eyelid, bruises on his face, and the bedside table on the floor; she assumed that he had struck himself in his sleep. After an episode, he would usually wake up and provide a detailed account of his dream. Home safety precautions were implemented, including the removal of potentially dangerous objects from the bedroom and placement of a cushion around the bed. Almost immediately after the patient started treatment, the frequency of his violent behaviors declined markedly. Primitive behav attacked by unfamiliar people, animals, iors (including chewing, eating, drink insects, or other beings.
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Patient education and prevention of toxicological emergencies and drug and alcohol abuse Page 208 of 385 Medicine Respiratory Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Specific illness/injuries: causes, assessment findings and management for each condition A. Patient education and prevention of complications or future respiratory emergencies. Page 215 of 385 Medicine Hematology Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Management for a patient with acute renal condition, chronic renal conditions with acute exacerbations or dialysis problems, or end stage renal disease. Transport decisions Page 227 of 385 Medicine Non-Traumatic Musculoskeletal Disorders Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. General Management for a patient with a common or major non-traumatic musculoskeletal disorder. Soft tissue infections (Fascitis, Gangrene, Paronychia, Flexor tenosynovitis of the hand) V. Patient education and prevention Page 229 of 385 Medicine Diseases of the Eyes, Ears, Nose, and Throat Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Integrates a comprehensive knowledge of the causes and pathophysiology into the management of shock, respiratory failure or arrest with an emphasis on early intervention to prevent arrest. With every breath, muscle contractions in the chest and diaphragm reduce the pressure within the lungs and chest cavity. That same low pressure created within the chest during inspiration sucks blood into the cavity and right atrium. Basic Cardiac Life Support (Refer to current American Heart Association guidelines) 1. Special arrest and peri-arrest situations Refer to the current American Heart Association guidelines A. Transport Page 242 of 385 Trauma Trauma Overview Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Transfer of patients to the most appropriate hospital Page 246 of 385 Trauma Bleeding Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Unable to maintain +90% investigate cause (tension pneumothorax) Page 251 of 385 4. Fluid choice a) Types of fluid (Refer to American College of Surgeons guidelines) i) Advantages ii) Disadvantages iii) Role of hydrostatic pressure iv) Role of colloid oncotic pressure b) Blood substitute products c) Blood administration in the field c.
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With a management commission that can be made up of local people, and with responsibility for interpretation shared with individual sites, the heritage area concept allows a variety of complementary and even conflicting points of view to find expression, as 142 Low Country Gullah Culture Special Resource Study befits a living, changing culture. This alternative thus provides Gullah/Geechee people the greatest amount of control over their story. Given the large and diverse array of sites that could be included in a heritage area, the potential exists to expose a wide spectrum of the public to Gullah/Geechee culture. Alternative D (Alternatives A and C in Com bination) this alternative would combine the benefits from the various programs designed to assist Gullah/Geechee communities with the economic benefits offered by tourism to the cultural centers and the heritage area. Alternative E (no action) Opportunities would remain available for members of the Gullah/Geechee community to preserve their culture, protect ancestral lands, and educate visitors about Gullah/Geechee culture. However, funding for these opportunities would be harder to come by and activities would be less coordinated over a large area than under the action alternatives. Im pacts on Cultural Sites and Structures Alternative A (Gullah/Geechee Coastal Heritage Centers) this alternative would direct new funding for restoration and preservation of existing structures at the proposed heritage centers. However, each heritage center would direct visitors to other important Gullah/Geechee sites, thereby raising the profile of these sites and possibly making it easier to engage in private fundraising activities for restoration and preservation. Overall, this alternative would likely result in beneficial impacts to fewer sites and structures than Alternative C, but the sites and structures affected would receive more thorough and effective treatments. Alternative B (Expanding the Gullah/Geechee Story) this alternative would be limited to existing park sites. Expanding the interpretive focus to include Gullah/Geechee culture would not be likely to result in major enhancements of cultural resources, as most such resources will already be subject to a high degree of protective effort. Alternative C (Gullah/Geechee National Heritage Area) Under this alternative, a heritage area commission would work with landowners, communities, institutions, and government offices to document and protect important cultural resources (landscapes and structures) of the heritage area. Technical assistance and grant money may be available to rehabilitate and restore historic structures meeting eligibility requirements. In all likelihood, any such grants would have to be matched by local contributions. Alternative D (Alternatives A and C in Com bination) this alternative would direct funds appropriated by Congress toward rehabilitation/restoration of specified structures at the cultural centers, as well as qualifying structures in the heritage area. Alternative E (no action) Opportunities would remain for members of Gullah/Geechee communities to raise funds for historic preservation from foundations and other private and public funding sources. However, fundraising would continue to face the obstacles that have hampered past efforts, including ignorance of Gullah/Geechee culture in society at large and limited availability of government grants and matching funds. Im pact on the Econom y and Local Com m unities Alternative A (Gullah/Geechee Coastal Heritage Centers) this alternative would attract visitors to the locations of the heritage centers and would direct some of these visitors to other significant sites in adjacent communities. Economic benefits would depend on the level of visitation generated by the centers. The fact that the three centers would be located relatively far apart would mean that economic benefits to the Gullah/Geechee community would be concentrated in fewer areas under this alternative than under the other action alternatives. However, the centers would be sited in such a way as to protect fragile sites from being overwhelmed by visitors.
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