9. Vasopressin

26. Magnesium Sulfate

29. antivenoms

30. There are more than 5 million snake bites each year in the world mostly in Africa, Middle East and Asia. The estimated evenomation burden is 150 000 deaths

31. For Middle East snake bite ; Favirept : Initial dosage is 20 mL of antivenom by slow direct intravenous injection or in diluted in 250 ml of infusion fluid (0.9% sodium chloride or 5% glucose solution) (see Sanofi Pasteur table). For Scorpion stings ; Scorpifav: Initial dosage is 10 mL of antivenom diluted in 50 mL of 0,9% sodium chloride solution

32. DURATION FOR ADMINISTRATION 5 minutes by slow intravenous injection 1 hour by infusion (less for scorpion antivenom : 50 mL dilution). Always starting infusion at slow rate : 15 drops/min or 50 mL/hour After the first antivenom administration, the patient must be monitored closely for at least 12 hours

33. A third intravenous infusion may also be considered using these same criteria: this should be administered 4 hours after the end of the second infusion or 6 hours after the end of the first infusion. As represented in this diagram

34. Dog Bite

35. Intramuscular schedules One dose of the vaccine should be administered on days 0, 3, 7, 14 and 30. All intramuscular injections must be given into the deltoid region or, in small children, into the anterolateral area of the thigh muscle. Vaccine should never be administered in the gluteal region. Post-exposure treatment, which consists of local treatment of the wound, followed by vaccine therapy (with or without rabies immunoglobulin) should be initiated immediately with contacts of categories II and III.

36. Healthcare Errors – Not a New Problem “I would give great praise to the physician whose mistakes are small for perfect accuracy is seldom to be seen” Hippocrates

37. What is Patient Safety? Patient safety is freedom from injury or illness resulting from the processes of healthcare.

38. Healthcare Errors – How Big is the Problem? W 3-38% of hospitalized patients affected by iatrogenic injury or illness. W 44,000-98,000 hospital deaths/year. W 2-35% of hospitalized patients suffer adverse drug events (average 7%). W >7,000 ADE deaths/year. W 2 million nosocomial infections/year.

39. “Grant me the courage to realize my daily mistakes so that tomorrow I shall be able to see and understand in a better light what I could not comprehend in the dim light of yesterday” Maimonides (1135-1204)

40. IV Catheters

41. Gauge Catheters (and needles) are sized by their diameter, which is called the gauge. The smaller the diameter, the larger the gauge. Therefore, a 22-gauge catheter is smaller than a 14- gauge catheter. Obviously, the greater the diameter, the more fluid can be delivered. To deliver large amounts of fluid, you should select a large vein and use a 14 or 16-gauge catheter. To administer medications, an 18 or 20-gauge catheter in a smaller vein will do. Smaller catheters reduce inflammation from medications.

42. Complications of Peripheral Intravenous Therapy Infiltration Assessment: – 0 = no symptoms – 1 = skin blanched, edema <1 “ in any direction, cool to the touch, with or without pain – 2 = skin blanched, edema 1-6” in any direction, cool to the touch, with our without pain. – 3 = skin blanched, translucent, gross edema >6 “ in any direction, cool to touch, mild-moderate pain, possible numbness – 4 = skin blanched, translucent, skin tight, gross edema >6 “ in any direction, deep pitting tissue edema, skin discolored, bruised, swollen, circulatory impairment moderate-severe pain

43. Complications of Peripheral Intravenous Therapy Phlebitis Assessment – 0 = no symptoms – 1+ = erythema at access site with or without pain – 2+ = pain at access site with erythema and/or redness – 3+ = pain at access site with erythema and/or edema, streak formation – 4+ = pain at access site with erythema and/or edema, streak formation, palpable venous cord >1’ in length, purulent discharge

44. Infiltration

45. Extravasation

47. Phlebitis

48. Cellulitis

49. About the use of I.V fluid There is a wide use of intravenous fluid and our responsibility is to understand the compatibility of these mixtures to keep the health care at minimum.

50. Do you know about 40% of all drugs administered in the hospital are given in the form of injection.

51. I.V fluids are sterile solution of simple chemical glucose, amino acid, electrolyte, and materials that easy can be carried by circulatory system and assimilated. " pyrogen free "

52. Administration of antibiotics Intermittent administration of antibiotic and other drugs can be achieved by: 1.Direct I.V injection (I.V bolus). 2.Addition of the drug to a predetermined volume of fluid in a volume-control device. 3.Use of a second container (minibottle, minibag) with already hanging I.V fluid (piggybacking).

53. 1. G.W5%(D5/W)(10%)(20%)(25%)(50%) - most frequent I.V fluid used. - used as fluid and nutrition replenisher. 1 g of glucose give 3.4 kcal L = 2 pint of D5/W give 170 kcal

54. 2.Sodium chloride N/S(0.9)(3)(5) as fluid & electrolyte replenisher.

55. 3. Glucose saline for fluid, nutrient and electrolyte replenisher. 1/5 for early age 1/3 DKa 1/2 for children & adult (I.V) 1 adult

56. 4.Ringer solution (NaCl,KCl,CaCl2): K+ 2 mmol/L Na+ 147 mmol/L Cl- 156 mmol/L Ca+ 2 2.2 mmol/L Fluid and electrolyte replenisher.

57. 5.Hartmann's solution: K+ 5 mmol/L Na+ 131 mmol/L Cl- 111 mmol/L Ca+ 2 2 mmol/L HCO3- 29 mmol/L Systemic alkalizer,fluid & electrolyte replenisher.

58. 6. Mannitol for osmotic diuresis. 7. Sodiom bicarbonate for metabolic acidosis. 8. Dextran used as plasma volume expander. 9. Sterile water for injection used as diluent.

59. PH range: (D.W 5.5) (G.W 3.5-6.5) (N.S 4.5-7) (G.S 3.5-6.5) (Ringer 5-7.5) (Hartmann's 6-7.5) (mannitol 5-7) (sod.bicar. 8)

63. Any Questions? Thanks