![]() Non-pharmacologic interventions for extravasationįor most medications, the treatment of extravasation is nonpharmacologic in nature however, the efficacy of any specific approach has not been demonstrated in controlled studies. 3-6 Preventive measures include appropriate dilution of medication, infusion of medication via the appropriate rate of administration, ensuring patency of the vascular access device, careful monitoring of infusions during administration, use of clear tape or dressings to allow for visual inspection of the infusion site, and immobilization of the extremity with the IV cannula. The best approach to extravasation injury is prevention. Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patient’s veins. Cytotoxic agents can be further subdivided into DNA-binding and non–DNA-binding agents. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur drugs that act as vasoconstrictors can also cause tissue ischemia. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. 1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015.Ī variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate). For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%. 1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.
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![]() To install Bun, run this install script in your terminal. The answer is different for every part of Bun, but one general theme: Zig 's low-level control over memory and lack of hidden control flow makes it much simpler to write fast software. An enormous amount of time spent profiling, benchmarking and optimizing things. Most of Bun is written from scratch including the JSX/TypeScript transpiler, npm client, bundler, SQLite client, HTTP client, WebSocket client and more. Bun is written in Zig, a low-level programming language with manual memory management. ![]() ![]() Supports a growing list of Node.js core modules like node:fs and node:path, along with globals like Buffer and process.īun uses the JavaScriptCore engine, which tends to start and perform a little faster than more traditional choices like V8.Provides a low-overhead foreign function interface bun:ffi for calling native code from JavaScript.Implements most of Node-API so many native Node.js modules just work.Ships with a fast SQLite3 client built-in bun:sqlite.env files automatically-no more require("dotenv").config(). Uses the fastest system calls available with Bun.write to write, copy, pipe, send, and clone files.Exposes Bun.Transpiler-Bun's JSX & TypeScript transpiler-as an API.Supports "paths", "jsxImportSource" and more from tsconfig.json files.Transpiles every file, so TypeScript and JSX just work.Both ESM and CommonJS are supported internally Bun uses ESM. 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Multi-million-downloaded game finally receives a much-awaited sequel Nikki and her friends Clarence, Wendy and Max are ready for the new adventure as they arrive in Tinseltown where Uncle Ross needs help with his troubled supermarket chain, and Mr. Play the improved map and try new weapons in the continuation of the game gun mayhem there is also a well done campaign an. Join millions of players who are already fans of Nikki! Download the application you need (for example: Supermarket Mania® Journey) and save to your phoneģ.Running a grocery chain can be a lot of fun! Dive into this highly addictive time management game Supermarket Mania® Journey – and prepare to stay on your toes every single second. Supermarket Mania Journey for Windows 10. Accept softwares installed from external sources (Settings -> Apps -> Unknown sources selected area)Ģ. To download and install applications or games from our website to your smartphone follow these steps:ġ. 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Supermarket Mania 2 for Android Description Similar Download Description of Supermarket Mania 2 Nikki and her friends Clarence, Wend and Max are ready to a new adventure They go to Hollywood, where their uncle Ross needs help in management of a network of supermarkets. ![]() ![]() Download Supermarket Mania® Journey for PC/Laptop/Windows 7,8,10 Full description of Supermarket Mania® Journey. ![]() ![]() From the quiet stillness of the snowy Phendrana Drifts to the magma geysers of Magmoor Caverns, this alien planet introduces beautifully harsh landscapes and labyrinths. Use new dual-stick controls, intuitive motion aiming, revert to classic controls, or opt for a hybrid option – whichever you prefer.ĮXPLORE THE ALIEN ENVIRONMENTS AND EERIE ISOLATION OF TALLON IV Journey through diverse biomes as you uncover the Space Pirates’ sinister experiments and gather information about the toxic substance that left the planet in ruin. 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![]() “I liked the animations that came along with each ‘slide,’ but I thought it was strange that ‘2021’ was all that was in the background. “I am super proud of being in the top 0.05% of listeners for Ariana Grande, so I posted it on social media,” freshman Dylan Greenstein said.ĭespite the praise for Spotify Wrapped, several MSD students struggled to access Wrapped and there are still features users would like to see. The cards let users show off their accomplishments and listening habits throughout 2021. TikTok Wrapped cards were also introduced this year, meaning users can share their Wrapped cards on Snapchat, Twitter, Instagram, Facebook and TikTok. “I don’t know how I feel about the aura, I got wistful and kindness and I don’t know if that accurately describes my music,” Anaya said. In contrast, blue is for wistful or emotional people who listen to music to put their feelings out loud. Yellow is for people who like their music to help with focus, motivation and self-improvement. Pink is for the hopeless romantics and oranges are rebellious and bold users who listen to high-energy songs. Purple is for passionate music listeners who tune in to get amped up, while green is for calm, analytical and introspective Spotify users that gravitate towards complex music. “Your Audio Aura” gives users moods based on their music and pairs it with colors. ![]() In addition, a separate series of slides is created that shows their musical taste match score, the top shared album you both listened to and an artist you and your friend both listened to a significant amount this year. If you have people “friended” on Spotify, a joint playlist is created. “2021 Wrapped Blend” lets users see how their music taste matches up with their friends’ and build a “Wrapped Blend” playlists that combines friends’ tastes. Spotify will give you three-generated statements about your listening habits, such as “The top song you listened to was ‘drivers license’ by Olivia Rodrigo,” and users are able to select which statement is the lie. “Playing Cards” is a “two truths and a lie” quiz game that allows the user to guess their listening habits. Some included “The opening credits,” “The song playing as you proclaim your love in the rain,” “The song playing as you face-off against your rival dance crew” and “the song playing as a single tear drops into your reflection in the pond.” “Your Audio Aura” tells users what aura their music gives off, including “wistful,” “hopeless romantic,” “yearning,” “chill” and “kindness.” “2021: The Movie” shows which songs would be playing in different scenes in the movie. “2021: The Movie” turns your top songs into the soundtrack of your movie, while “Your Audio Aura” shows what aura your music gives off. “I really liked, I think they should keep them in because who doesn’t like to think they are the main character in their movie,” Anaya said. There are several new features in Spotify Wrapped 2021, including “2021: The Movie,” “ Your Audio Aura,” “Playing Cards” and “2021 Wrapped Blend.” Spotify Wrapped does not have an official release date each year, always sometime in “early December.” In 20, it was released on Dec. “I really liked seeing my old infatuations with certain artists, albums and songs.” ![]() “It was really interesting to see my music taste throughout the year,” Marjory Stoneman Douglas High School freshman Melanie Anaya said. Spotify Premium is not required to access Spotify Wrapped, but someone needs to have listened to at least 30 tracks on Spotify over the year. When accessed, Spotify Wrapped shows users a series of slides while their favorite songs from the year play in the background. Users can access their Spotify Wrapped from the 2021 Wrapped hub exclusively in the Spotify mobile app. Spotify Wrapped uses your listening data from January 1, the beginning of the year, to October 31 of the same year. Spotify users can see a compilation of data for their music routines, displaying everything from top artists, songs, genres, podcasts, music aura and minutes spent listening on Spotify. Spotify Wrapped was launched in 2017 by the platform to show users their listening habits for the year. 1, Spotify, a popular music streaming service, released their 2021 Spotify Wrapped feature for its users. The point is the Zodiac Killer's true identity was never discovered, and he may well still be at large. ![]() Allen's DNA does not match DNA recovered from one of the Zodiac Killer's stamps (Graysmith replies that the evidence was not stored with a view toward later DNA technology), and handwriting analysis indicates huge differences between the killer's letters and any known writings of Allen's. The theory of Graysmith's book - endorsed to a limited extent by Fincher's film - is that the killer was Arthur Leigh Allen (who died in 1992), whom Graysmith links to the killings via a raft of circumstantial evidence.īut Allen's culpability is contradicted by the fragmentary forensic evidence available. ![]() There are several books about the Zodiac Killer, one of which, by Robert Graysmith, was adapted into a 2007 film directed by David Fincher. The perpetrator of these crimes was never identified, and the combination of the mystery with the publicity-seeking and cinematic flourishes - like signing his letters with a distinctive symbol and communicating in code - have made the killings a subject of national fascination for decades. The Zodiac Killer corresponded with authorities and the public via letters and postcards sent to media organizations, occasionally cryptographically encoded, in which he claimed a total of 37 victims. He murdered at least five people (and left two surviving victims) and is regarded as a leading suspect in four more murders. The name, however, is used to denote an unknown serial killer who operated in northern California in the late 1960s and early ’70s. If I knew, I would be informing the proper authorities and not writing about it here. So why does this keep coming up? 1) Who is the Zodiac Killer? ![]() Still, the fact remains that his reputation is really bad and that Republicans are only rallying to his side because they recognize that losing a Senate seat in Texas would be a disaster. Not so long ago, the former House Speaker John Boehner even called him a “miserable son of a bitch.” Now he's showing he can laugh about his bad reputation. Happy Halloween /jIgTaIMzep- Ted Cruz October 31, 2018ĭisplaying that he has a sense of humor about himself is part of a larger Cruz project over the past year to, under pressure from a surprisingly well-funded Beto O'Rourke campaign, render himself not so toxically disliked by his colleagues. Ted Cruz (R-TX) made a little Halloween joke, tweeting a coded message patterned after the Zodiac, a notorious serial killer from the San Francisco Bay Area. |
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