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PATIENT CARE ISSUES 1 INFECTION CONTROL NOSOCOMIAL INFECTION ACQUIRED IN THE HEALTH CARE INSTITUTION NOSOCOMIAL INFECTION MOST FREQUENT SITES 1. URINARY TRACT 2. WOUNDS 3. RESPIRATORY TRACT MICROORGANISMS 1. 2. 3. 4. BACTERIA FUNGI PROTOZOA VIRUSES HIV AIDS • AIDS CAUSED BY HIV • SPREAD BY SEXUAL CONTACT OR BY CONTACT WITH BLOOD OR BODY FLUIDS OF A PERSON WHO HAS BEEN INFECTED WITH HIV PROCESS OF INFECTION 1. 2. 3. 4. LATENT PERIOD INCUBATION PERIOD ACTUAL DISEASE CONVALESCENCE ELEMENTS NEEDED TO TRANSMIT INFECTION 1. 2. 3. 4. ENVIRONMENT A PORTAL OF EXIT MEANS OF TRANSMISSION A PORTAL OF ENTRY INTO NEW HOST MEANS OF TRANSMISSION INFECTION • INDIRECT-FOMITES ( OBJECT) • DROPLET • VEHICLES (FOOD, WATER, DRUGS, BLOOD) • AIRBORNE • VECTORS (INSECT , ANIMALS) UNIVERSAL BLOOD AND BODY PRECAUTIONS INFECTION CONTROL TECHNIQUES • MEDICAL ASEPSIS-AS FAR AS POSSIBLE MICROORGANISMS REMOVED • SURGICAL ASEPSIS-COMPLET REMOVAL MOST COMMON WAY OF SPREADING MICROBES HANDS ISOLATION TECHNIQUE • DRAINAGE SECRETION- NO MASK • ENTERIC PRECAUTION- NO MASK • ACID-FAST BACILLUS ISOLATION (TB)- MASK!! • RESPIRATORY- MASK • CONTACT-EVERYTHING • STRICT- EVERYTHING SAFETY IN CT BODY MECHANICS • PULL, DO NOT PUSH THE WEIGHT. BODY MECHANICS PATIENT TRANSFER PULL SHEET SLIDING BOARD WHEELCHAIR WITH SPINAL CORD INJURY SAFETY IN THE DEPT. FIRE RACE VITAL SIGNS TEMPERATURE • 99.6 ° F R • 98.6 ° F O • 97.6 ° F Ax PULSE PULSE DETECTION SITES • • • • • • • APICAL RADIAL CAROTID FEMORAL POPLITEAL TEMPORAL DORSALIS PEDIS AVERAGE PULSE RATE IN ADULT MAN OR WOMAN • 60-90 BEATS/MIN AVERAGE PULSE RATE IN INFANT • 120 BEATS/MIN AVERAGE PULSE RATE IN CHILD 4-10 YEARS • 90-100 BEATS/MIN PULSE ASSESSMENT • TACHYCARDIA • BRADYCARDIA RESPIRATION RESPIRATION RATES • 10-20 B/MIN – ADULT • 30-60 B/MIN – INFANT • < 10 B/MIN FOR ADULT CYANOSIS CYANOSIS BLOOD PRESSURE Blood pressure is the pressure exerted by the blood at right angles to the walls of the blood vessels. Unless indicated otherwise, blood pressure refers to systemic arterial blood pressure, i.e., the pressure in the large arteries delivering blood to body parts other than the lungs, such as the brachial artery (in the arm). The systolic pressure is defined as the peak pressure in the arteries during the cardiac cycle; the diastolic pressure is the lowest pressure (at the resting phase of the cardiac cycle). The mean arterial pressure and pulse pressure are other important quantities. Typical values for a resting, healthy adult human are approximately 120 mmHg systolic and 80 mmHg diastolic (written as 120/80 mmHg), with large individual variations. BLADDER OF THE STETHOSCOPE PLACED OVER BRACHIAL ARTERY OXYGEN DELIVERY OXYGEN DELIVERY SYSTEMS • • • • • NASAL CANULA NASAL CATHETER FACE MASK REBREATHER OXYGEN TENT NASAL CANNULA 21-60% OXYGEN 1-6 L/MIN- ADULTS ¼ -1/2 L/MIN - CHILDREN FACE MASK NO LESS THAN 5 L/MIN REBREATHER MASK 60-90% OXYGEN OXYGEN TENT EMERGENCIES IN CT SHOCK: PHYSIOLOGIC REACTION TO : ILNESS, TRAUMA OR SEVERE EMOTIONAL DISTURBANCE SHOCK SYMPTOMS: • • • • HYPOTENSION WEAK PULSE RAPID PULSE RAPID BREATHING SHOCK • • • • • HYPOVOLEMIC SEPTIC CARDIOGENIC NEUROGENIC ANAPHYLACTIC HYPOVOLEMIC SHOCK Hypovolemic shock is caused by a decreased amount of blood or fluids in the body. This decrease results from injuries that produce internal and external bleeding, fluid loss due to bums, and dehydration due to severe vomiting and diarrhea NEUROGENIC SHOCK Neurogenic shock is caused by an abnormal enlargement of the (vasodilation) blood vessels and pooling of the blood to a degree that adequate blood flow cannot be maintained. Simple fainting (syncope) is a variation, it is the result of a temporary pooling of the blood as a person stands. As the person falls, blood rushes back to the head, and the problem is solved. ANAPHYLACTIC SHOCK Anaphylactic (allergic) shock occurs when an individual is exposed to a substance to which his or her body is sensitive. The individual may experience a burning sensation, loss of voice, itching (pruritus), hives, severe swelling, and difficulty breathing. The causative agents are injection of medicines, venom's by stinging insects and animals, inhalation of dust and pollens, and ingestion of certain foods and medications. Individuals with known sensitivities carry medication in commercially prepared kits Septic shock is a serious, abnormal condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. Vital organs, such as the brain, heart, kidneys, and liver may not function properly or may fail. Decreased urine output from kidney failure may be one symptom Cardiogenic shock Cardiogenic shock results from the inability of the heart to pump blood through the body. It is the most serious consequence ofmyocardial infarction, but can also result from other cardiac emergencies, such as cardiac tamponade Neurogenic shock is shock caused by the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure. CONTRAST VS REACTION IONIC OR NON-IONIC IODINE WATER SULUABLE CONTRAST AND GLUCOPHAGE WITHELD 48 PRIOR AND AFTER THE PROCEDURE The Contraindications and Precautions sections in the FDA-approved package insert of the BristolMyers Squibb oral hypoglycemic drug Glucophage® (metformin) contain warnings about its use concomitant to the use of iodinated contrast agents. The reason for these warnings is not the presence of a direct drug-to-drug interaction; no such interaction occurs. Rather, the problem is that: 1) intravascular administration of iodinated contrast may cause acute renal failure in a small percentage of individuals, particularly those patients with preexisting, or a predisposition to, renal compromise (e.g., diabetics[!]), and 2) in patients with renal failure, Glucophage, which is excreted by the kidneys, may build up to dangerous levels, causing the potentially fatal condition of lactic acidosis. RT RESPONSE SUMMON EMERGENCY ASSISTANCE AND PLACE THE EMERGENCY CART NEARBY!!! OTHER CT EMERGENCIES! HYPOGLYCEMIA Hypoglycemia is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. The term hypoglycemia literally means "low blood sugar". Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function (neuroglycopenia). Derangements of function can range from vaguely "feeling bad" to coma and (rarely) death. Hypoglycemia can arise from many causes, and can occur at any age HYPOGLYCEMIA SYMPTOMS You feel shaky, nervous, tired, sweaty, cold, hungry, confused, irritable or impatient. It's always important to test to be sure that you actually are having low blood sugar. RT ACTION PATIENT CONCIOUS PATIENT UNCONCIOUS ADMINISTER SUGAR IMMEDIATELY ADMINISTER SUGAR (CORN SYRUP OR JELLY) UNDER HIS/HER TONGUE KETOACIDOSIS Diabetic ketoacidosis, or DKA, is a condition in which the body has a severe deficiency of insulin. Insulin is a hormone that helps regulate the level of glucose in the blood. Glucose is the main form of sugar in the body. DKA is a serious complication of diabetes. SUMMON EMERGENCY ASSISTANCE AND PLACE THE EMERGENCY CART NEARBY!!! PULMONARY EMBOLUS •Lodging of a blood clot in the lumen (open cavity) of a pulmonary artery, causing a severe dysfunction in respiratory function. Pulmonary emboli often originate in the deep leg veins and travel to the lungs through blood circulation. Symptoms include sudden shortness of breath, chest pain (worse with breathing), and rapid heart and respiratory rates SYMPTOMS: TACHYCARDIA DYSPNEA TACHYPNEA HEMOPTYSIS SYNCOPE SUMMON EMERGENCY ASSISTANCE AND PLACE THE EMERGENCY CART NEARBY!!! RESPIRATORY FAILURE OR CARDIAC ARREST 1. AIRWAY-KEEP OPEN 2. BREATHING – MOUTH-TO-MOUTH, MOUTH TO MASK 3. CIRCULATION – EXTERNAL CARDIAC COMPRESSION ADULT OR CHILD Place the heel of your hand on the victim's chest just above the V of the ribs. Put your other hand on top of your first hand with fingers interlocked. Keep your arms straight and your elbows locked. Push down with both hands in a pumping motion. If the victim is an adult, do this 15 times while counting one-thousand-one, onethousand-two, one-thousand-three, etc. Give two breaths and then 30 more chest compressions. Repeat. If the victim is a child, use the same procedure, but give just five compressions followed by just one breath, instead of the 15 adult compressions and two breaths. CHILD 1-8 YEARS INFANT FAINTING What is fainting? Most people suffer at least one fainting attack during the course of their lifetime. While fainting attacks can sometimes be linked to conditions of the heart, blood pressure, circulation and breathing they most commonly occur in people who are otherwise perfectly healthy RT ACTION SEIZURE Symptoms vary widely, depending on the part of the brain affected by the electrical misfiring. If a very small part of the brain is affected, you might sense only an odd smell or taste. In other cases you could have hallucinations, convulsions, or lose consciousness RT ACTION PREVENT PATIENT FROM INJURING HIMSELF/HERSELF RESTRAIN GENTLY PREPARE TO ASSIST IN OXYGEN ADMINISTRATION PATIENT CARE & LEGAL ASPECTS OF MEDICAL IMAGING INCIDENT REPORT (UNUSUAL OCCURRENCE REPORT) MASLOW’S HIERARCHY OF NEEDS 1. 2. 3. 4. 5. PHYSIOLOGIC NEEDS SAFETY & SECURITY LOVE & BELONGINGNESS SELF-ESTEEM SELF-ACTUALIZATION PATIENTS WHO COME TO RADIOLOGY DEPT.ARE TRYING TO SATISFY THEIR BASIC NEED - SAFETY COMMUNICATION • CONSTANTLY CHANGING PROCESS OF SPOKEN AND UNSPOKEN MESSAGES THAT GO FROM SENDER TO RECEIVER. • • • • • • • THERAPEUTIC COMMUNICATION REDUCING DISTANCE LISTENING THERAPEUTIC SILENCE RESPONDING TO UNDERLYING MESSAGE RESTATING MAIN IDEA REFLECTING MAIN IDEA SEEKING AND PROVIDIND CLARIFICATION • MAKING OBSERVATION • EXPLORING THE GRIEVING PROCESS 1. 2. 3. 4. 5. DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE 1) DENIAL In the denial stage we refuse to believe what has happened. We try in our mind to tell ourselves that life is as it was before our loss. We can even make believe to an extent by re enacting rituals that we used to go through with our loved one. Making an extra cup of tea for our loved one who is no longer there, rushing back to tell someone that you have met an old friend. Flashing back to times and conversations in the past as though they we here with us now. They can all be part of this stage. 2) ANGER We get angry. The anger can manifest itself in many ways. We can blame others for our loss. We can become easily agitated having emotional outbursts. We can even become angry with ourselves. Care must be taken here not to turn this anger inwards. Release of this anger is a far better way to cope with grief in my experience 3) BARGAINING Bargaining can be with ourselves or if you are religious with your god. Often we will offer something to try to take away the reality of what has happened. We may try to make a deal, to have our loved one back as they were before the tragic event occurred. It is only human to want thing as they were before 4) DEPRESSION Depression is a very likely outcome for all people that grieve for a loss. This is what I would consider the most difficult stage of the five to deal with. There can be a the feeling listlessness and tiredness. You may be bursting helplessly into tears. Feeling like there is no purpose to life any more. Feeling guilty, like everything is your own fault. You may find you feel like you are being punished. Pleasure and joy can be difficult to achieve even from things and activities which you have always gained delight. There can even be thoughts of suicide. There are many different ways in which this stage of grief can manifest itself. If you at any time in this stage feel like doing yourself any harm please do seek professional counseling. Self preservation is a must. ACCEPTANCE The final stage of grief. It is when you realize that life has to go on. You can here accept your loss. You should now be able to regain your energy and goals for the future. It may take some time to get here but you will LEGAL ISSUES IN MEDICAL IMAGING NEGLIGENCE •In law, negligence is a type of tort or delict that can be either criminal or civil in nature. ORDINARY NEGLIGENCE •Failure to exercise the care toward others which would reasonably be expected of a person in the circumstances, or taking action which a reasonable person would not. GROSS NEGLIGENCE •Intentional failure to perform a duty, reckless disregard of the consequences as affecting the life or property of another ASSAULT •Threat to inflict injury with an apparent ability to do so. Also, any intentional display of force that would give the victim reason to fear or expect immediate bodily harm BATTERY •In many common law jurisdictions, the crime of battery involves an injury or other contact upon the person of another in a manner likely to cause bodily harm FALSE IMPRISONMENT •confinement without legal authority DEFAMATION OF CHARACTER •In English and American law, and systems based on them, libel and slander are two forms of defamation (or defamation of character), which is the tort or delict of making a false statement of fact that injures someone's reputation. LIBEL •Written defamation that causes injury to another person SLANDER •words falsely spoken that damage the reputation of another FRAUD •An intentional perversion of truth; deceitful practice or device resorted to with intent to deprive another of property or other right INVASION OF PRIVACY •Violation of person’s right to be left alone and free from unwarranted publicity and intrusions LEGAL DOCTRINES RES IPSA LOQUITUR •a rule of evidence whereby the negligence of an alleged wrongdoer can be inferred from the fact that the accident happened STARE DECISIS •Once a decision has been made on a certain set of facts, that precedent will be applied to all subsequent cases which have the same facts RESPONDEAT SUPERIOR •A legal term referring to the fact that, under specific circumstances, an employer (or principal) is legally liable for the actions of his or her employees while in the course of their employment CONSENT – WHEN ? To obtain consent, the patient must be clinically and legally competent. In most states, the legal age of consent for medical treatment is 18 years. Parents or legal guardians normally are required to consent for the medical treatment of minors, although a few exceptions exist as follows: •The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to provide an adequate medical screening examination to anyone (including minors) who presents to the ED, even if appropriate consent cannot be obtained. If no immediately life-threatening condition is identified, institute procedures to obtain consent for treatment. •In many states, marriage or pregnancy often confers an emancipated status to minors, who then can consent to procedures and treatments. •In the interest of a greater societal good, various conditions exist (depending upon the state) for which minors can consent to treatment. These conditions include treatment for (1) sexually transmitted diseases, (2) alcohol or drug abuse, (3) domestic or sexual abuse, and (4) mental health issues. •Minor parents of children also can consent to treatment for their children and themselves. •Additionally, mature minors (ie, close to age of maturity) can consent, at times, to less invasive or less risky procedures if the physician feels the patient understands the concepts of consent. CONSENT Informed Implied INFORMED CONSENT Informed consent is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care IMPLIED CONSENT The explanation of implied consent says that consent assessed when the surrounding circumstances lead a reasonable person to believe that consent has been granted even though word of agreement were not direct, express or explicit. A consent to surgical or medical treatment or procedures, suggested, recommended, prescribed or directed by a duly licensed physician, will be implied where an emergency exists if there has been no protest or refusal of consent by a person authorized and empowered to consent or, if so, there has been a subsequent change in the condition of the person affected that is material and morbid, and there is no one immediately available who is authorized, empowered, willing and capacitated to consent. For the purposes hereof, an emergency is defined as a situation wherein, in competent medical judgment, the proposed surgical or medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain a consent would reasonably jeopardize the life, health or limb of the person affected, or would reasonably result in disfigurement or impairment of faculties. GOOD SAMARITAN LAW Doctrine: a legal principle that prevents a rescuer who has voluntarily helped a victim in distress from being successfully sued for 'wrongdoing.' Its purpose is to keep people from being so reluctant to help a stranger in need for fear of legal repercussions if they made some mistake in treatment PHARMACOLOGY PHARMACOLOGY • THE STUDY OF DRUG ACTIONS ON AND INTERACTIONS WITH LIVING ORGANISMS. PHARMACOKINETICS • THE INTERACTIONS OF DRUGS WITH BODY TISSUES SYSTEMIC ADMINISTRATION OF DRUG • • • • ABSORPTION DISTRIBUTION BIOTRANSFORMATION EXCRETION ABSORPTION • IN ORDER FOR THE DRUG TO PRODUCE DESIRED EFFECTS ON THE BODY, IT MUST REACH THE INTENDED SITE OF ACTION!!!! DRUG ABSORBED AND CIRCULATIONG IN THE BLOODSTREAM IS CALLED BIOAVAILABLE DISTRIBUTION • FOLLOWING ABSORPTION DRUGS ARE DISTRIBUTED VIA CIRCULATORY SYSTEM. BIOTRANSFORMATION • MOST DRUGS ARE METABOLIZED IN THE LIVER AND EITHER REDUCED OR CHANGED INTO A WATERSOLUABLE SUBSTANCE SO THEY CAN BE EXCRETED BY KIDNEYS EXCRETION • MOST DRUGS ARE EXCRETED BY KIDNEYS. OTHER EXCRETION ROUTES: PERSPIRATION, TEARS, FECES, BREAST MILK, SALIVA FACTORS THAT INFLUENCE DRUG ADMINISTRATION • • • • AGE GENDER HORMONAL DIFFERENCES EMOTIONAL OR PSYCHOLOGICAL STATE • TIME OF DAY • THE CHANNEL OR ROUTE OF ADMINISTRATION DRUG ADMINISTRATION ROUTES • • • • • • • • ORAL TOPICAL PARENTERAL SUBLINGUAL INTRATHECAL RECTAL TRANSDERMAL INHALATION ORAL DRUG ADMINISTRATION TOPICAL DRUGS Advantages • Base (cream, ointment, gel, spray) makes application easy and controllable. • Onset of symptom relief is usually faster than oral preparations. • Symptoms are relieved at a steady rate and relief may last longer. • A smaller amount of medicine may be needed when applied in a topical form. • Formulations diffuse through the skin and enter the bloodstream, initially bypassing the digestive system (called 'first pass'). Many systemic (whole body) side effects, such as irritated stomach lining, may be lessened or eliminated PARENTERAL DRUG ADMINISTRATION • SUBCUTANEOUS • INTRAMUSCULAR • INTRAVENOUS SUBCUTANEOUS For the subcutaneous route, a needle is inserted into fatty tissue just beneath the skin. The drug is injected, then moves into small blood vessels (capillaries) and is carried away by the bloodstream or reaches the bloodstream through the lymphatic vessels. INTRAMUSCULAR The intramuscular route is preferred to the subcutaneous route when larger volumes of a drug product are needed. Because the muscles lie below the skin and fatty tissues, a longer needle is used. Drugs are usually injected into muscle in the upper arm, thigh, or buttock. How quickly the drug is absorbed into the bloodstream depends, in part, on the blood supply to the muscle: The sparser the blood supply, the longer the drug takes to be absorbed. The blood supply is increased during physical activity INTRAVENOUS Intravenous injecting is a highly efficient way of introducing drugs into the body. However, when drugs are injected, the filtering and delaying mechanisms that protect us when things are absorbed via the gastrointestinal tract, lungs or skin are bypassed. The potential for infection and overdose are much increased SUBLINGUAL Sublingual Route A few drugs are placed under the tongue (taken sublingually) so that they can be absorbed directly into the small blood vessels that lie beneath the tongue. The sublingual route is especially good for ANGINA—which is used to relieve angina (chest pain due to an inadequate blood supply to the heart muscle)—because absorption is rapid and the drug immediately enters the bloodstream without first passing through the intestinal wall and liver. However, most drugs cannot be taken this way because they may be absorbed incompletely or erratically INTRATHECAL For the intrathecal route, a needle is inserted between two vertebrae in the lower spine and into the space around the spinal cord. The drug is then injected into the spinal canal. A small amount of local anesthetic is often used to numb the injection site. This route is used when a drug is needed to produce rapid or local effects on the brain, spinal cord, or the layers of tissue covering them (meninges)—for example, to treat infections of these structures. Anesthetics are sometimes given this way. RECTAL Rectal Route Many drugs that are administered orally can also be administered rectally as a suppository. In this form, a drug is mixed with a waxy substance that dissolves or liquefies after it is inserted into the rectum. Because the rectum's wall is thin and its blood supply rich, the drug is readily absorbed. A suppository is prescribed for people who cannot take a drug orally because they have nausea, cannot swallow, or have restrictions on eating, as is required after many surgical operations. Drugs that are irritating in suppository form may have to be given by injection TRANSDERMAL Drugs can be administered transdermally by a patch applied to the skin. The drug penetrates the skin and is absorbed into the bloodstream. INHALATION Drugs can be administered using inhalers, which deliver the drugs directly to the airways ADVERSE EFFECTS OF DRUGS • AN UNINTENDED EFFECT THAT IS EXPECTED TO OCCUR IS CALLED: • SIDE EFFECT • ANY EFFECT THAT IS NOT BENIGN IS CALLED AN ADVERSE REACTION DRUGS INCOMPATIBILITY • WHEN MIXED SOME DRUGS CAN BECOME EITHER TOXIC OR INACTIVE!!!!! RT HAS AN OBLIGATION: • TO KNOW THE LOCATION OF THE EMERGENCY CART. • TO SUMMON EMERGENCY HELP IN TIMELY MANNER • TO MAINTAIN COMPLETENESS OF THE EQUIPMENT ON THE EMERGENCY CART EMERGENCY CART DRUG NAMES • • • • TRADE NAME CHEMICAL NAME GENERIC NAME OFFICIAL NAME TRADE NAME • NAME ASSIGNED BY THE MANUFACTURER CHEMICAL NAME • EXACT CHEMICAL FORMULA GENERIC NAME • GIVEN BEFORE THE OFFICIAL APPROVAL FOR USE OFFICIAL NAME • GENERIC AND OFFICIAL NAMES ARE USUALLY THE SAME • USED IN THE OFFICIAL PUBLICATIONS DRUG CLASSIFICATIONS • • • • • • • ANT-INFECTIVE ACTING ON THE NERVOUS SYSTEM ANALGESICS ANTIPYRETICS TO TREAT CARDIO-VASCULAR DISEASE TO TREAT GI TO TREAT ALLERGIC RESPONSES ANTI-INFECTIVE • ANTIBIOTICS- (PENICILLIN, ERYTHROMYCIN) ACTING ON THE NERVOUS SYSTEM • CHLORAL HYDRATE – SEDATIVEORAL, RECTAL • MORPHINE SULFATE – CONTROL OF SEVERE PAIN- ORAL, PARENTERAL • LIDOCAINE – ANESTHETIC- PAIN BLOCKER – TOPICAL, PARENTERAL ANALGESICS, ANTIPYRETICS, ANTI-INFLAMMATORY • ASPIRIN • ACETOMINOPHEN • IBUPROFEN ORAL TO TREAT CARDIOVASCULAR DISEASE • LASIX- ( DIURETIC ACTION)- IV, ORAL • HEPARIN - IV AND COUMARIN(ANTICOAGULANTS) ORAL • NITROGLYCERIN – (VASODILATOR) ANGINA PECTORIS – SUBLINGUAL, TOPICAL TO TREAT GI • SODIUM BICARBONATE pH ORAL • CASTOR OIL- CATHARTIC- ORAL • MILK OF MAGNESIA- CATHARTICORAL TREATMENT OF ALLERGIC RESPONSES • EPINEPHRINE (ADRENALIN)BRONCHODILATORVASOCONSTRICTOR-PARENTERAL , INHALATION • BENADRYL – ORAL , PARENTERAL