Si può desiderare di provare un trattamento naturale disfunzione erettile come un diverso per i problemi di costruzione. Al giorno d oggi ci sono diverse terapie sul mercato, ma un trattamento naturale disfunzione erettile è stato confermato qualche ora e ora di nuovo per dare risultati efficienti e permanenti. Cos è la disfunzione sessuale? L incapacità di sviluppare o sostenere una costruzione abbastanza lungo per fare l amore è chiamato disfunzione erettile, ED https://farmacia-senzaricetta.it/ o (maschio) problemi di erezione. Tutti gli uomini possono avere problemi di costruzione di volta in volta e gli scienziati considerano ED essere presenti se si verificano problemi di costruzione almeno il 25% del tempo. Alcuni fatti duri: ED Può essere dovuto a problemi emotivi. Stress, pressione, giltiness, depressione, bassa autostima e ansia prestazioni può essere la causa dei vostri problemi di costruzione. La ricerca ha confermato che il 90 per cento della disfunzione erettile è fisica in origine, non emotiva. L impotenza colpisce la maggior parte degli uomini durante la loro vita e può essere dovuto a troppo colesterolo, problemi cardiaci, diabete, ipertensione, fumo o alcol. Alcuni rimedi possono essere la ragione. Le questioni legate al movimento sono collegate. Se ti occupi dei tuoi problemi di movimento, hai piu possibilita di risolvere questo problema. Qui ci sono 5 consigli facili su come aumentare la circolazione: 1. Mangia i pasti giusti. Questo ti rendera il flusso sanguigno ovvio. Una grande parte di rimanere sani e anche mantenere il flusso sanguigno ovvio è legato al vostro piano di alimentazione quotidiana e quello che si mangia. Una buona cura per la disfunzione erettile è mangiare un piano a basso contenuto di grassi e grande alimentazione di fibre. Mangiare fibre tutti i giorni e questo viene scoperto in prodotti cerealicoli cereali integrali, frutta e verdura. Evitare il più possibile pasti pronti o pasti non sani. 2. Wonder herbal rimedi. Molti rimedi vegetali per ED eseguire bene come possono migliorare il movimento. Hanno molto meno reazioni avverse rispetto ai farmaci convenzionali e si svolgono in modo efficiente per migliorare hardons e la forza, troppo. Erbe naturali come Ginkgo Biloba sono utilizzati come una strategia per ED. Gli specialisti di erboristeria credono anche che le spezie o le erbe come noce moscata, portano al movimento intorno al corpo, tra cui il pene. 3. Vitamine naturali vitali. Gli scienziati sanitari hanno scoperto che una mancanza di supplemento è tipico tra gli uomini con ED in particolare vitamina A. Se si ha una mancanza del nutriente ossido di zinco, Questo è stato confermato per portare alla disfunzione erettile. Queste inadeguatezze derivano dal fatto che molti valori nutrizionali in quello che mangiamo piano non sono sufficienti. Aggiungere al vostro fabbisogno di nutrienti aumenterà la circolazione del sistema e migliorare questa condizione. Gli integratori alimentari sono completamente naturali, quindi non dovrete preoccuparvi dei rischi di reazioni avverse. Inoltre, queste vitamine naturali sono utili per il vostro benessere over-all. Oltre a questi vantaggi benessere, disfunzione erettile vitamine naturali e integratori costano molto meno di farmaci rimedi. 4. Esercitare. Fai una mossa e non un tablet vibrante. Camminare farà di più per migliorare e sostenere hardons di qualsiasi altra compressa chimica nel lungo periodo. Il fitness fisico manterrà bassi livelli di pressione e mantenere grandi stadi di movimento. Andando per un 20-30 minuti di movimento rapido ogni giorno, può affrontare questo problema e può sostenere la vostra libido senza l uso di qualsiasi farmaco. 5. Sottolineare. Questo è il peggior attaccante per problemi di erezione. Scopri diversi metodi per riposare. Alcuni metodi tipici per riposare includono la lettura di un libro, la meditazione, un bagno rilassante o allenamenti di respirazione. Sto solo imparando alcuni semplici allenamenti di respirazione che possono migliorare significativamente il movimento nel reparto pantaloni. Una naturale disfunzione erettile soluzioni di trattamento stanno diventando sempre più popolare con gli uomini. Questi rimedi a base di erbe sono preferiti perché non hanno reazioni avverse e sono confermati essere efficiente come il farmaco. La maggior parte degli uomini combattere parlano dei loro problemi, in particolare la disfunzione erettile come c è poca discussione sui problemi di erezione. La verita e che ED ha un impatto su piu di dieci milioni di uomini solo negli Stati Uniti. Non siete soli e l aiuto è disponibile.
Resus.org.uk
Acute care Resuscitation Council (UK) Published by the Resuscitation Council (UK) 5th Floor Tavistock H ouse North Copyright Resuscitation Council (UK) Tavistock S
No part of this publication may be reproduced
without the written permission of the Resuscitation
Tel: 020 7388 Hyperlinks to other document sections or external websites are shown in blue.Fax: 020 7383 0773 Website: www.resus.org.uk email: enquiri [email protected] Registered Charity No. 286360 November 2013 Drug tables for cardiac arrest are highlighted in the text with the symbol !
1 Introduction and scope
Healthcare organisations have an obligation to provide a high-quality resuscitation service, and to ensure that staff are trained and updated regularly to a level of proficiency appropriate to each individual’s expected role. As part of the quality standards for cardiopulmonary resuscitation practice and training this document provides lists of the minimum equipment and drugs required for cardiopulmonary resuscitation. These lists are categorised according to the clinical setting. This document is referred to by the standards documents pertaining to specific clinical settings. Links to these documents are provided below: Community care * Mental health – inpatient care * * Documents currently in development
The core standards for the provision of cardiopulmonary resuscitation across all healthcare settings are described in the document:
to quality standards for cardiopulmonary practice and training
2 General points
All clinical service providers must ensure that their staff have immediate access to appropriate resuscitation equipment and drugs to facilitate rapid resuscitation of the patient in cardiorespiratory arrest. The standard defibrillator sign should be used in order to reduce delay in locating a defibrillator in an emergency
All settings must have a means of calling for help (e.g. landline telephone [internal or external], mobile telephone with reliable signal, or alarm bell).
Standardisation of the equipment used for cardiopulmonary resuscitation (including defibrillators and emergency suction equipment), and the layout of equipment and drugs throughout an organisation is recommended.
It is recognised that planning for every eventuality is complex; therefore, organisations must undertake a risk assessment to determine what resources are required given their local circumstances. Risk factors to consider include patient group (e.g. adults, children), incidence of cardiac arrest, training of staff, and access to expert help.
a. For example, in secondary or tertiary care specific locations may need
special provisions (e.g. for failed intubation, tracheostomy care, cardiac arrest in pregnancy etc).
b. Some settings need a wide range of equipment immediately available
(e.g. resuscitation room in emergency department). Suggested options include having basic equipment (and possibly drugs) available immediately (on a resuscitation trolley), and further equipment and drugs arriving with a resuscitation team (in a ‘grab-bag’), or in some settings as part of an ambulance response.
Staff should be trained to use the available equipment according to their expected roles.
Depending on the organisation, this risk assessment must be overseen by a Resuscitation Committee or a designated resuscitation lead. Expert advice should also be sought locally from those commonly involved in resuscitation (e.g. resuscitation officers, emergency physicians, cardiac care unit staff, intensivists, anaesthetists, prehospital care physicians).
Resuscitation equipment should be single-patient-use and latex-free, whenever possible and appropriate. Where non-disposable equipment is used, a clear policy for decontamination after each use must be available and must be followed.
Personal protective equipment (e.g. gloves, aprons, eye protection) and sharps boxes must be available, based on a local risk assessment and local polices.
A reliable system of equipment checks and replacement must be in place to ensure that equipment and drugs are always available for use in a cardiac arrest. The frequency of checks should be determined locally.
It is recommended that equipment and drugs are presented in a clear and logical manner to enable easier use during an emergency.
10. The manufacturer’s instructions must be followed regarding use, storage,
servicing and expiry of equipment and drugs.
11. Further equipment and drugs may be needed to manage other types of
emergencies that are likely to be encountered in a particular setting; this may include:
• monitoring equipment (e.g. blood pressure, pulse oximetry, 3-lead
electrocardiogram [ECG], temperature, waveform capnography)
• 12-lead ECG recorder • near-patient tests (e.g. blood glucose, blood gas analysis).
12. A formal procurement process that includes trialing of equipment before
purchase is recommended. Trialing of resuscitation equipment can take place in actual care settings or in simulated clinical scenarios.
13. The precise availability of equipment and drugs should be determined locally.
The equipment lists include a suggestion on the immediacy with which equipment and drugs should be available:
Immediate – available for use within the first minutes of cardiorespiratory
arrest (i.e. at the start of resuscitation).
Accessible – available for prompt use when the need is determined by
14. These lists are not exhaustive. Local experts should be consulted to ensure
that the appropriate equipment and drugs are available when they are needed, to enable provision of high-quality attempted resuscitation.
Acute hospital care – ADULT AIRWAY AND BREATHING Suggested Comments availability
Portable suction (battery or manual) with
Yankauer sucker and soft suction catheters
equipment. NPSA Signal. Reference number 1309. February 2011
Supraglottic airway device with syringes,
i-gel®, laryngeal tube) and size will depend on local policy and staff training
Oxygen cylinder (with key where necessary)
For example, there is not consenus on the role of
Laryngoscope handles (x 2) and blades (size 3 and 4)
Spare batteries for laryngoscope and spare bulbs (if applicable)
Syringes, lubrication and ties/tapes/scissors for tracheal tube
Waveform capnograph – with appropriate
airways or tracheal tube. NAP4 – 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011.
Standards of monitoring - addendum regarding the use of capnography outside the operating theatre. Association of Anaesthetist of Great Britain and Ireland, 2011.
EBA Recommendation for the use of Capnography. European Board of Anaesthesiology, 2011
Acute hospital care – ADULT CIRCULATION Suggested Comments availability
Manual and/or automated external defibrillator
locations determined by a local risk assessment.
Available to enable shock within 3 minutes of collapse
Pacing function is recommended for cardiac units, cardiac catheter laboratories, emergency departments, intensive care units and operating theatres. It may also be appropriate for other settings, and this should be determined locally
Pads should be suitable for external pacing if needed.
Intravenous cannulae (selection of sizes) and
2% chlorhexidine/alcohol wipes, tourniquets
Central venous access – Seldinger kit, full
barrier precautions (hat, mask, sterile gloves,
gown) and skin preparation (2% chlorhexidine
To identify and treat reversible causes of cardiorespiratory arrest
Acute hospital care – ADULT OTHER ITEMS Suggested Comments availability
Further personal protective equipment may be required according to local policy
Sharps container must be immediately available wherever sharps used
Types of connectors, ports, and caps to be determined locally
Guidance on colour coding for syringe labels.
SResuscitation Council (UK) November 2009
Cardiorespiratory arrest record forms for
patient records, audit forms and DNACPR forms
Access to algorithms, emergency drug doses
Acute hospital care – ADULT CARDIAC ARREST DRUGS – FIRST LINE for intravenous use Suggested Comments availability
depends on access to further syringes. 1mg needed for each 4-5 min of CPR
Amiodarone 300mg as a prefilled syringe x 1
First dose required after 3 defibrillation attempts
Acute hospital care – ADULT CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use Suggested Comments availability
Adrenaline 1mg (= 10 ml 1:10,000) prefilled
be accessible for prolonged resuscitation attempts
If decision is made to give further doses of amiodarone
Calcium gluconate can be used as an alternative. Note: 10 ml 10% Calcium chloride = 6.8 mmol Ca2+ 10 ml 10% Calcium gluconate = 2.26 mmol Ca2+
Second-line treatment for anaphylaxis, can also be given intramuscularly
Second-line treatment for anaphylaxis, can also be given intramuscularly
For use in areas where large doses of local anaesthetic are used for regional blocks, according to Association of Anaesthetists Guidelines.
Formulation to be determined locally. Potassium chloride concentrate solutions. Patient safety alert. The National Patient Safety Agency. July 2002.
Volume and concentration according to local policy
Acute hospital care – ADULT OTHER DRUGS Suggested Comments availability
First-line treatment for anaphylaxis – 0.5 mg intramuscular injection in adults.
Can be part of an ‘anaphylaxis kit’ so that it is not mixed / confused with cardiorespiratory arrest drugs
Ipratropium bromide 500 microgram nebules
Salbutamol 5mg nebules x 2 (and nebuliser
0.9% sodium chloride or Hartmann’s solution
therapeutic hypothermia as part of post-cardiorerspiratory arrest care
NOTES: Acute Hospital Care – ADULT
Portable monitoring and other equipment for patient transfer should be readily available.
Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be available readily, according to local critical care policies.
Supporting information
Association of Anaesthetists of Great Britain and Ireland (AABBI) Safety Guideline – Interhospital Transfer. 2009.
Intensive Care Society. Guidelines for the transport of the critically ill adult (3rd Edition 2011). http:/
Acute hospital care – PAEDIATRIC AIRWAY AND BREATHING Suggested Comments availability
Pocket mask with oxygen port – paediatric
Oxygen mask with reservoir - paediatric and
Self-inflating bag with reservoir - paediatric
Clear face masks, size 00, 0, 1, 2, 3, 4, 5
Oropharyngeal airways, sizes 00, 0, 1, 2, 3, 4 Immediate
Nasopharyngeal airways, sizes 4.0, 4.5, 5.0,
of appropriate length may be used as an alternative according to local policy
Portable suction (battery or manual) with
Yankauer sucker (paediatric and adult) and soft suction catheters, sizes 5, 6, 8, 10, 12, 14
Magill forceps (adult and paediatric sizes)
Supraglottic airway device with syringes,
Tracheal tubes, uncuffed sizes 2, 2.5, 3, 3.5,
Croup tube (uncuffed, longer than standard
be substituted according to local policy (e.g. Cole’s® tubes)
Tracheal tube introducer (stylet) small and
Spare batteries for laryngoscope and spare bulbs (if applicable)
Syringes, lubrication and ties/tapes (e.g.
Elastoplast® / Hypofix® /ribbon gauze/tape) and scissors
Waveform capnograph – with appropriate
Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011.
Acute hospital care – PAEDIATRIC CIRCULATION Suggested Comments availability
local risk assessment. AEDs are not intended
for use in infants (less than 12 months old) and this should be considered at risk assessment.
Availability of pacing function according to local policy
Adhesive defibrillator pads – paediatric and
Pads should be suitable for external pacing if needed
ECG electrodes (paediatric & adult sizes)
Intravenous cannulae (sizes 14, 16, 18, 20,
22, 24G) and 2% chlorhexidine / alcohol wipes, tourniquets and dressings
Intravenous infusion sets (with and without
IV extension set with 3-way taps and bungs
Amount depends on access to further fluids
Intra-osseous access device with needles
suitable for neonates, children and adults
Central venous access – Seldinger kit, full
barrier precautions (hat, mask, sterile gloves,
To identify and treat reversible causes of cardiorespiratory arrest
Acute hospital care – PAEDIATRIC OTHER ITEMS Suggested Comments availability
Sharps container must be immediately available wherever sharps are used
Blood glucose monitor with appropriate strips
SResuscitation Council (UK) November 2009
Cardiorespiratory arrest record form for
patient records and audit forms. DNACPR forms appropriate for children.
doses, paediatric drug dose calculators (e.g. Broselow tape)
Acute hospital care – PAEDIATRIC CARDIAC ARREST DRUGS – FIRST LINE for intravenous use Suggested Comments availability
Adrenaline 1mg (= 10 ml 1:10,000) prefilled
depends on ease of access to further syringes if needed
Acute hospital care – PAEDIATRIC CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use Suggested Comments availability
ALERT: Atropine is available in various concentrations
Calcium gluconate may be used as an alternative. Note: 10 ml 10% Calcium chloride = 6.8 mmol Ca2+
10 ml 10% Calcium gluconate = 2.26 mmol Ca2+
Second-line treatment for anaphylaxis, can also give intramuscular
For treatment of status epilepticus. Agent, dose and route of administration according to local policy
Second-line treatment for anaphylaxis, can also be given intramuscularly
Potassium chloride concentrate solutions. Patient safety alert.
The National Patient Safety Agency. July 2002.
Concentration and preparation according to local policy
Acute hospital care – PAEDIATRIC OTHER EMERGENCY DRUGS Suggested Comments availability
Can be part of an ‘anaphylaxis kit’ so that it is not mixed / confused with cardiorespiratory arrest drugs
Ipratropium bromide 500 microgram nebules
NOTES - Acute Hospital Care – PAEDIATRIC
The volume and/or quantities of the listed fluids and drugs stored and their location should be determined by local policy. This should ensure that there is sufficient availability to manage a paediatric resuscitation according to Resuscitation Council (UK) resuscitation guidelines without undue delay.
Portable monitoring and other equipment for patient transfer should be readily available.
Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be readily available according to local critical care policies.
All interventions (e.g. drug therapy, practical procedures, discussions with other staff or relatives) should be documented with date and time and signed by an identifiable member of staff.
9. Summary: Differences in Students’ Classroom Experiences by Jose Blackorby and Mary Wagner Language arts is a core academic content area for elementary and middle school students, both with and without disabilities. Because of numerous reports of students having poor language arts skills and the potential of direct intervention to improve those skills, reading and language arts are the f
Diário Oficial REPÚBLICA FEDERATIVA DO Imprensa Nacional BRASÍLIA - DF . Nº 165 – DOU de 27/08/10 – p. 55 – seção 1 Ministério da Saúde SECRETARIA DE ATENÇÃO À SAÚDE CONSULTA PÚBLICA No- 33, DE 26 DE AGOSTO DE 2010 O Secretário de Atenção à Saúde, no uso de suas atribuições, Considerando a importância do papel que desempenham os Protocolos Cl