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On occasion cheap sildenafil 50mg mastercard impotence existing at the time of the marriage, a cross-claim may be included in the statement of defence to raise the allegation or argument that a co-defendant in the legal action is responsible in whole or in part for the claim being asserted by the plaintif; therefore cheap 75mg sildenafil overnight delivery erectile dysfunction doctor uk, the defendant is entitled to contribution or indemnity from the co-defendant respecting any damages that might be awarded. Similarly, a third-party claim, or claim in warranty in Québec, may be initiated on behalf of the defendant against a person 5. Countersuits Upon receipt of a statement of claim, some physicians immediately seek to commence an action in defamation or to initiate a countersuit against the plaintif or the plaintif’s lawyer or both. However, allegations set out in a statement of claim are privileged and therefore cannot form the basis of an action in defamation against the plaintif or the lawyer. To succeed in a medical-legal countersuit, the physician must prove the following: ▪ The patient and the patient’s lawyer had no basis whatsoever to commence or continue the initial medical-legal action against the physician and that the action was brought without any foundation or investigation whatsoever. The loss of professional reputation, litigation expenses, the loss of income, and clearly unwarranted other expenses while defending oneself do not qualify as damages in this regard. These hurdles have prevented the countersuit from being an efective response to the frivolous legal action. Adopting a vigorous defence is a much more efective and expeditious manner of dealing with clearly unwarranted legal claims, which are often quickly abandoned or concluded by means of a dismissal order. Litigation proceedings Many legal actions seem to stall once pleadings have been exchanged; indeed, many are simply abandoned at this stage. For those actions that proceed, the defence counsel carefully investigates the claim by obtaining copies of all relevant hospital and medical records, discussing the fle thoroughly with the defendant physicians, and obtaining preliminary expert opinion. Preliminary applications may be made to the court from time to time for directions or a determination on a point of law. These usually proceed in the absence or even without the knowledge of the physician. One of the most important stages in the litigation process, and the next step in the legal proceedings, is conducting examinations for discovery. This pre-trial examination allows legal counsel to question each other’s client under oath before a court reporter who prepares a transcript of the questions and answers. In some jurisdictions, legal counsel may conduct an examination for discovery of individuals not included in the legal action, such as another treating physician or an expert witness. In most jurisdictions, however, such examinations for discovery or interviews of other treating physicians may only take place, if at all, pursuant to a court order. The individual being examined is usually subjected to detailed questioning as to any knowledge, information, and belief concerning the facts and issues in dispute in the legal action. The physician is expected to diligently prepare by reviewing very carefully all the medical records pertaining to the patient. As well, the The Canadian Medical Protective Association 5 physician must co-operate fully and be available to meet with legal counsel. It is extremely difcult to back away at any subsequent trial from an answer given during examinations for discovery. In Ontario, for example, there are mandatory mediation requirements even before discoveries may be complete. In a somewhat similar vein, it is common in some jurisdictions to use pre-trial conferences with a judge, usually one other than the judge who will preside at trial. Both mediation and pre-trial conferences attempt to reach agreement on issues in dispute to facilitate resolution or at least shorten any trial. The culmination of these legal proceedings, which can span 4 to 6 years, is the trial of the action. In Québec, parties have 6 months to have the case ready for trial, although on complicated matters this deadline is often extended. As noted earlier, in most provinces and territories trials are traditionally heard by a judge alone, without a jury. There is, however, a trend on the part of lawyers acting for patients to seek a jury trial. It is, of course, necessary for the defendant physician to be in court for most, if not all, of this to be, protecting time, which produces considerable hardship. The trial judge almost always takes the case under the professional advisement at the conclusion of the trial and the reasons for judgment are usually not delivered integrity of its for some months. There may be an additional delay while the appellate court deliberates before rendering judgment. If a party is not satisfed with a judgment of a Court of Appeal, they may seek leave (permission) to appeal the case to the Supreme Court of Canada. In the event the case is considered sufciently important that leave is granted, there will be additional delays before the appeal can be heard and fnal judgment is rendered. For this reason, a vigorous defence is always mounted for a member who has not been careless or negligent and for whom a successful defence is possible. It is a frm principle that no settlement will be reached on the basis of economic expediency. When the claim is clearly indefensible, a settlement is negotiated as early as possible. For the most part, however, settlements are not efected until after examinations for discovery to allow the evidence and credibility of the parties to be assessed, and expert opinion to be obtained as to whether or not the work of the defendant doctor is defensible. To put this in perspective, over the past 10 years ending 2014, approximately 56% of all actions commenced against physicians are dismissed or abandoned short of trial and approximately 34% of all cases are settled. Thus, the patient had 1 or 2 years from the date of last treatment to commence the action. In the early 1970s, much was written about how this special interest legislation favoured the medical profession and prejudiced the patient, particularly when the patient was unaware of the potential negligence on the part of the physician within that time period. Today, it is universal for the limitation provisions respecting actions against physicians to incorporate a discovery principle, in which the time for commencing an action against a physician does not start until the patient knew or ought to have known the facts upon which the action is based. The discovery principle can extend the limitation period signifcantly, particularly when the court is prepared to interpret the aspect of constructive knowledge to require that the patient has received appropriate expert opinion. All jurisdictions require that the running of the limitation period must be postponed when the plaintif is under a disability, either by being under the age of majority or mentally incompetent. The result can, of course, extend the limitation period to upwards of 20 years, and longer for patients sufering from a mental disability. A number of provinces and territories have placed a cap on the length of time a patient may have to initiate an action against a physician. The outside time limit in Prince Edward Island, for example, is 6 years from the day the patient had a cause of action against the physician. It may be argued that this is true for any type of litigation, but when actions involve medical matters, the problems are particularly difcult. Most important, because of rapid changes in medical science, it becomes very difcult for courts to fairly assess a physician’s work respecting the applicable standard of care if that work was done a decade or more earlier. The Canadian Medical Protective Association 7 The table below is a summary, by province and territory, of the limitation periods for commencing actions against physicians (current to January 2016). More than one cause of action can arise out of the same situation and may be advanced under one or more of the following headings. Assault and battery The Supreme Court of Canada has restricted such a claim to those non-emergency situations where the physician has carried out surgery or treatment on the plaintif without consent, or has gone well beyond, or departed from, the procedure for which consent was given. These claims are, for the most part, now restricted to errors where the wrong operation is performed on a patient or an operation is performed on the wrong patient.

E f ect of a gluten-free diet on ended for monitoring in cases with lack of clinical gastrointestinal symptoms in celiac disease discount sildenafil 50 mg visa erectile dysfunction psychological. C l a s s i f cation and management of refractory detected during initial laboratory investigation sildenafil 50mg visa erectile dysfunction drugs market. Detection of celiac disease recommendation, moderate level of evidence) in primary care: a multicenter case-fnding study in North America. Diagnostic testing for celiac (42) Early steps in the evaluation should include measure- disease among patients with abdominal symptoms: a systematic review. A gluten-free diet efectively diabetic patients, their frst-degree relatives, and healthy control subjects. A m e r i c a n g a s t r o e n t e r o l o g i c a l a s s o c i a - and tissue transglutaminase antibody compared as screening tests for tion technical review on the evaluation of dyspepsia. Celiac disease in patients with an afected member, type 1 Am J Gastroenterol 2010 ; 105 : 2520 – 4. Prevalence of celiac disease in at-risk J Pediatr Gastroenterol Nutr 2013 ; 56 : 251 – 6. D i a g n o s t i c a p p r o a c h t o a p a t i e n t w i t h s u s p e c t e d tives of sib pairs with celiac disease in U. Clinical approach to the patient with abnormal liver test the diagnostic accuracy of 9 IgG anti-tissue transglutaminase, 1 IgG anti- results. IgG antibodies against deamidated glia- Am J Gastroenterol 2011 ; 106 : 1689 – 96. Meta-analysis: coeliac disease and antibody measured with EliA Celikey indicates selective IgA defciency. Do we need to measure total serum IgA to liver disease: gluten-free diet may reverse hepatic failure. Celiac disease autoanti- common variable immunodefciency: the delineated frontiers with celiac bodies in severe autoimmune liver disease and the efect of liver transplan- disease. The prevalence of celiac disease in aver- clinical, serological, and histological characteristics and the efect of a age-risk and at-risk Western European populations: a systematic review. High prevalence of celiac disease deamidated gliadin antibodies in the diagnosis of celiac disease. Clin in patients with type 1 diabetes detected by antibodies to endomysium Gastroenterol Hepatol 2008 ; 6 : 426 – 32 ; quiz 370. Combination testing for anti- gluten-free diet on glycemic control and weight gain in subjects with type 1 bodies in the diagnosis of coeliac disease: comparison of multiplex immu- diabetes and celiac disease. A p o p u l a t i o n - b a s e d J Pediatr Gastroenterol Nutr 2008 ; 47 : 428 – 35. High prevalence of microv- gliadin-derived peptides plus conjugates for both IgA and IgG antibodies. Development of autoimmunity gliadin peptides for celiac disease diagnosis and follow-up in children. W h a t a r e t h e s e n s i t i v i t y a n d s p e c i f city of serologic tests for celiac 39. Comparative analysis of organ- serologic tests for celiac disease: a systematic review. Gastroenterology specifc autoantibodies and celiac disease-associated antibodies in type 1 2005 ; 128 : S38 – 46. P a t c h y v i l l o u s a t r o p h y o f t h e antibody tests for coeliac disease in children: summary of an evidence duodenum in childhood celiac disease. A prospective study of duodenal bulb intestinal symptoms in subjects without celiac disease: a double-blind biopsy in newly diagnosed and established adult celiac disease. Predictors of clinical response to duodenal bulb biopsies in the diagnosis of celiac disease. Gastrointest gluten-free diet in patients diagnosed with diarrhea-predominant irritable Endosc 2010 ; 72 : 758 – 65. J Pediatr Gastroenterol Nutr coeliac disease: clinical characteristics and intestinal autoantibody deposits. Mucosal recovery and mortality nosing adult celiac disease: is there an optimal biopsy site? Gastrointest in adults with celiac disease afer treatment with a gluten-free diet. Lymphocytic duodenosis and A commentary on the current practices of members of the European the spectrum of celiac disease. Gluten, major histocompatibility complex, and the small 2000 – 2009: The Mayo Clinic Experience. Comparison of the interobserv- celiac disease: a randomized, controlled clinical study. Gastroenterology er reproducibility with diferent histologic criteria used in celiac disease. Evidence for a primary association of Clin Gastroenterol Hepatol 2013 ( e-pub ahead of print ). The primary association of celiac disease to a J Pediatr Gastroenterol Nutr 2013 ; 56 : 251 – 6. Variability of histopathological retrospective evaluation of single-centre experience. Am J Med Genet IgA antibodies against gliadin and human tissue transglutaminase in 2001 ; 98 : 70 – 4. The Oslo defnitions for coeliac transglutaminase antibodies testing for celiac disease in children with disease and related terms. Clin Gastroenterol Hepatol 2008 ; 6 : 186 – 93 ; cal and symptomatic responses to gluten challenge in adults with coeliac quiz 125. Small- bowel mucosal changes pected celiac disease patients with positive celiac serology. Dig Dis Sci and antibody responses afer low- and moderate-dose gluten challenge 2011 ; 56 : 499 – 505. Cancer incidence in a population- Gastrointest Endosc Clin N Am 2012 ; 22 : 735 – 46. Intestinal malabsorption of D-xylose: intakes in adult celiac disease patients consuming a strict gluten-free diet. Immunologic and absorptive celiac disease and the efects of a gluten-free diet: a prospective case- tests in celiac disease: can they replace intestinal biopsies? J Pediatr Gastroenterol Nutr disease: insight into mechanisms and relevance to pathogenesis. C e l l o b i o s e / m a n n i t o l s u g a r t e s t — a s e n s i t i v e American adult population with celiac disease. Am J Gastroenterol tubeless test for coeliac disease: results on 1010 unselected patients.

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Pacula and others sildenafil 50 mg without prescription impotence grounds for annulment philippines, “Assessing the effects of medical mari- 182 Uruguay cheap sildenafil 25mg online erectile dysfunction effects on women, Junta Nacional de Drogas, “Regulación controlada del juana laws on marijuana use: the devil is in the details”, Journal of mercado de marihuana: una alternativa al control penal y a la crimi- Policy Analysis and Management, vol. Individuals are allowed to access only United States, including selected areas, one mode of supply, which they must declare upon regis- and Uruguay, 2000-2014 tering with the cannabis registry. In October 2015, only two private firms were issued 10 10 licences to cultivate cannabis, and to date no cannabis has been sold in pharmacies. Officials estimate that cannabis from the first harvest will not be ready for sale until mid- 5 5 2016. By February 2016, about 4,300 people had regis- tered to grow cannabis at home, and 21 cannabis clubs had been licensed. Recent surveys reveal that 40 per cent 0 0 of the cannabis users in the country are hesitant to register with the system to obtain cannabis,183 while the rest have indicated that they intend to register and obtain the drug through pharmacies. Some may play out in the longer term, especially as the regulations evolve and the Source: United States, Department of Health and Human Services, markets mature. Currently, the best data on the among young adults in the United States, outcomes of cannabis legalization come from Colorado including selected areas, 2000-2014 and Washington, the states that adopted cannabis legislation early. That cannot be said of the other 35 jurisdictions in the United States (Alaska, Oregon and 30 Washington, D. However, in the jurisdictions that 0 legalized recreational cannabis, where the prevalence of past-month cannabis use has historically been higher, past- month prevalence increased more rapidly than past-month Alaska (persons aged 18-25) prevalence at the national level during this period. Cruz, “Marijuana consumption patterns among frequent consumers in Montevi- Oregon (persons aged 18-25) deo”, paper presented at the ninth Conference of the International Washington (persons aged 18-25) Society for the Study of Drug Policy, Ghent, Belgium, 19-22 May 2015. Available at http:// Source: United States, Department of Health and Human Services, esiglesia. Further- young adults (persons aged 18-25), which is more pro- more, monthly medical cannabis sales have not exhibited nounced in Colorado, where the prevalence of past-month a downward trend in the two years since legalization. In Uruguay, the prevalence of can- ical cannabis identification cards, the impact of legalization nabis use is much lower, but household surveys suggest on the medical cannabis market may take much longer to that there was an increasing trend even before the legal- become apparent in jurisdictions with both medical and ization of cannabis use. In Colorado, and currently in Oregon, cannabis stores have been allowed to operate simultaneously as recre- Medical cannabis markets after legalization in ational and medical cannabis stores, but in the long run the United States it is unclear whether those systems will be separate or inter- twined or whether one system will fold into the other, as It is unclear whether the legalization of cannabis for rec- in the State of Washington. The original purpose of med- Products and potency ical cannabis laws was to provide access to cannabis for those with a qualifying medical need. Since the legalization Cannabis potency in the United States has been increasing of recreational cannabis use, individuals can now obtain over the past three decades, particularly in jurisdictions that have allowed medical dispensaries. However, the recreational cannabis markets in most jurisdictions are currently higher priced recreational cannabis herb sold in the states of Washington (after taxes) and often have fewer retail outlets than the and Colorado is nearly 17 per cent, with some samples existing medical cannabis market. Data on cannabis potency are ifying patients, the introduction of regulated recreational scarce in Uruguay, as authorities in that country only recently began to analyse seized cannabis,188 but the Gov- cannabis markets may not present an additional incentive to forego the benefits of their medical status. Accord- After the legalization of the non-medical use of cannabis, ing to the authorities, this limit has been set with a view the number of patients in Colorado’s mandatory medical to reducing health risks caused by cannabis use. In 2014, such products accounted for an estimated 35,000,00035,000,00035,000,000 114,000 114,000 35,000,000 114,000 35 per cent of retail sales of recreational cannabis in Col- 30,000,00030,000,00030,000,000 114,000 30,000,000 112,000 112,000112,000 orado. Pacula and Paul Heaton, “The effects of medical marijuana laws on potency”, International Journal of Drug Policy, vol. Source: Colorado Department of Public Health and Environment and Colorado Department of Revenue. Saloga, “The effect of legalized retail marijuana on the dosage: an assessment of physical and pharmacokinetic relationships demand for medical marijuana in Colorado”, paper prepared for the in marijuana production and consumption in Colorado” (Boulder, ninth Conference of the International Society for the Study of Drug Colorado, Marijuana Policy Group, University of Colorado Boul- Policy, Ghent, Belgium, 19-22 May 2015. Legalization of the use of recreational cannabis may have also increased the number of accidents or injuries Public safety associated with cannabis use or intoxication. In 2014, The increased availability of cannabis for recreational use is likely to increase the number of users driving while 190 Mark A. Kleiman, “Legal commercial cannabis sales in Colorado and Washington: what can we learn? Mello, “Half-baked: the retail lateral control with and without alcohol”, Drug and Alcohol Depend- promotion of marijuana edibles”, New England Journal of Medicine, ence, vol. However, this may have oped a unique tax scheme for legal cannabis (see table on resulted from increased law enforcement scrutiny. The recrea- tional cannabis markets in Colorado and Washington have Cannabis markets grown considerably since such schemes were put in place. In Colorado, recreational cannabis market profits reached Despite the legalization of recreational cannabis use, the nearly $600 million in 2015, compared with $313 million illicit cannabis market has not been entirely displaced in in 2014. The state collected $56 million in recreational the states of Colorado and Washington. In Washington, cannabis tax revenues in 2014 and over $114 million in the medical, recreational and illicit cannabis markets each 2015. While these figures are large, they represent only a accounts for approximately one third of the state’s canna- very small portion of the state’s total revenues, which bis sales,200 while in Colorado the illicit cannabis market totalled nearly $11 billion in the fiscal year 2014. Smith, Washington State Liquor and Cannabis Board, “Data on supply, higher taxation and regulatory burden. Addi- In Oregon, data on initial sales or tax revenues are not yet tional revenues are distributed primarily to the Marijuana available, although the Oregon Liquor Control Commis- Enforcement Division and to public health programmes sion has indicated that recreational cannabis sales tax rev- such as substance abuse intervention and prevention pro- enue after regulatory costs will be distributed as follows: grammes and educational campaigns. Just the Oregon Health Authority for alcohol and drug use eight months into the fiscal year 2016, sales have already prevention. Wash- ington collected $65 million in tax receipts in the fiscal In Uruguay, taxation on cannabis sale has been deferred, year 2015 (accounting for 0. While Colo- revenues) and over $100 million during the first eight rado and Washington illustrate that tax revenues from months of the fiscal year 2016. One important con- lion to the Washington State Liquor and Cannabis Board sideration for legalization is whether the costs of enforcing to regulate the industry; $500,000 to the Washington State prohibition exceed the budgetary costs of regulation. In a Healthy Youth Survey; $200,000 to fund cost-benefit anal- recent study, it was estimated that for 2014 the State of yses of the effects of cannabis legalization on the economy, Vermont spent approximately $1 million enforcing crimi- public health and public safety; and $20,000 to the Uni- nal laws against cannabis compared with an estimate of versity of Washington Alcohol and Drug Abuse Initiative “low to middle single-digit millions” of dollars to establish to publish medically and scientifically accurate informa- and maintain a regulatory system. Caulkins and others, Considering Marijuana Legaliza- Analysis Division, “Tax statistics 2015”, December 2015. Available tion: Insights for Vermont and other Jurisdictions (Santa Monica, Cali- at www. It should be pointed out, however, that this trend reflects the number of 120 offences recorded in the criminal justice system, and that 100 prior to legalization cannabis-related offences may not necessarily have led to prosecution or sentencing. Data on 80 other cannabis-related police interactions, such as citations 60 or verbal warnings for public consumption, are not readily 40 available. Uruguay does not disaggregate its criminal jus- tice figures by drug-related offences, although overall 20 annual drug-related detentions have remained more or less 0 stable in the past decade. Licitly and illicitly produced cannabis in jurisdictions that Colorado: court cases involving the possession, have legalized recreational cannabis use can be used to consumption, distribution or cultivation of cannabis Washington, D. However, in December 2014, the states of Washington: misdemeanours and offences involving Nebraska and Oklahoma requested that the United States the possession of cannabis Supreme Court reverse Colorado’s decision to legalize can- United States: percentage of drug arrests for the nabis, complaining that the new law in Colorado had gen- possession of cannabis erated an increase in cannabis trafficking in neighbouring jurisdictions. Early statements from police officials in Uruguay indicate that cannabis trafficking has remained unchanged and that organized criminal groups may have benefited in the initial period before establishment of the retail phar- macy system. After three years of relative stability, that, in principle, can be manufactured anywhere. Central AmericaCentral America Central America North America Note: The data presented in the figure do not include seizures of pre- North America scription stimulants and substances placed under international control Source: Responses to the annual report questionnaire.

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A specific list of supplies and medications should be made for each vessel and each cruise buy line sildenafil erectile dysfunction effexor xr, depending upon individual criteria such as: Skills of medical provider Size of crew (also age order sildenafil with a mastercard erectile dysfunction pump on nhs, gender) Health of crew (and known medical conditions) Length of voyage Distance from land Availability of shore side consultation (radio, phone, electronic, etc. G-2 Isopropyl Alcohol Pads Kerlix Roller Gauze Non-adherent 2” X 3” Pad Petrolatum Gauze 3" X 18" Povidone-Iodine Impregnated Pad Sterile Eye Pad, 2 X 2” Surgical Sponge, 4” X 4” Water-Jel Burn Dressing Wire Fabric 5 ¼” X 36” Splints/Walking Aids: Adjustable Wood Crutch, 48-59” with Sponge-Rubber Cushion Aluminum Finger Splint, ¾ X 18” Cane/Crutch Tip Field Leg Splint, Support and Foot Rest Knee Immobilizer, Medium and Large Sizes Leg Splint, Thoms, Hare or Sagar Pneumatic Arm Splint with Zipper Closure Pneumatic Leg Splint with Zipper Closure Stiff Neck Cervical Collar (Size: No Neck, Short, Regular, Tall, Pediatric, Baby No Neck) Stirrup Ankle Splint Universal Sam Splint Walking Cane with Curved Handle, 36” Whole Leg Pneumatic Plastic Splint Wrap-Around Splint for Leg/Arm/Back/Neck Adhesive Tape: Adhesive Surgical Tape, 1”X 5 yds, 1/2” X 10 yds Rayon Adhesive Surgical Tape, 1” X 10 yds Skin Closure Adhesive Tape, 1/4" X 4” Ear Plugs: Ear Plug Sizing Gauge Ear Plug, Universal Fit Foam Plastic Ear Plug Case Plastic Ear Plugs (Various Sizes) Rubber Ear Plugs, Triple Flanged (Various Sizes) Silicone Rubber Ear Plug (Various Sizes) Miscellaneous: Deet Insect Repellent for Cloth & Skin, 20Z Heat Pack, Medium & Body App. G-7 Obstetrics Kit, Small Portable Plastic Sheet Stethoscope Suction Catheters (14g, 18g) Surgical Skin Marker, Pen-Type Surgical Sponge, 4” X 4” Surgical Towel Pack Universal Sam Splint Ziplock Bags (Small, Medium, Large) Oxygen/Resuscitation Equipment Oxygen cylinders must never come in contact with organic lubricant (oil, grease, etc. Cylinders should be stored in a permanently mounted rack in an upright position at all times unless in use within a portable container. All oxygen delivery and resuscitation equipment should be inspected weekly, inspection should be documented with the kit and in the medical department log. A three part tagging system (full, in use, empty), should be utilized to indicate status of tank. To clear dust particles, crack the tank valve slightly prior to applying a regulator to a new bottle. Prior to placing non-rebreather masks on the patient, care should be taken to fully inflate the oxygen reservoir bag. A minimum of one stokes litter should be maintained with flotation devices permanently affixed. Each end of the litter shall have a minimum of 20 feet (or longer based on ship’s configuration), of 21 thread manila line permanently secured with a minimum of 4 – 5 tucks on each splice. The line will allow the stretcher to be handled from the main deck of the ship and above. A minimum of three patient securing straps shall be permanently affixed to the stretcher and stopped with twine. Each ship will be required to have on board a full allowance of Medevac Rescue Litters. G-8 Hoisting Sling and Trail Line Assembly must be purchased for hoisting operations. Item: Inventory List Adhesive Bandage, ¾”X 3” (Band Aids) Adson Tissue Forceps, 4 ½” Artificial Respiration & Mouth To Mouth Resuscitation Instruction Card Aspirin Tablets, 325mg Tabs Compress and Bandage, 4” X 4” Compressed Gauze Bandage, 2”X 6”, 4”X 6” Compressed Gauze Sponge Surgical, 2”X 2” Compressed Muslin Bandage (Cravat), 37” X 52” Eye Dressing First Aid Kit First Aid Field Dressing, 4"X 7" First Aid Instruction Sheet General Surgical Scissors, Straight 5 ½” Lipstick, Antichap Meclizine, 25 mg, Tabs Medical Chest Petrolatum Gauze 3" X 18" Povidine Iodine Solution, 10%, ½ Fl Oz Sulisobenzone Lotion U/V Screen 10% 75gm Wire Fabric 5 ¼” X 36” First Aid Kit, Carry Bag These kits should be placed throughout the vessel for emergency use. The kits should be inventoried quarterly and inspected monthly or immediately after use. Item: Inventory List Absorbent Gauze, 18" X 36" Adhesive Bandage, ¾”X 3” (Band Aids) Adhesive Surgical Tape, 1”X 5 Yards Compressed Gauze Bandage, 2" X 6", 3" X 6" Compressed Muslin Bandage (Cravat), 37” X 52” Compress and Skull Cap, Head Dressing Elastic Cotton Bandage with Rubber Wrap Threads, 3” X 4 ½ yds First Aid Field Dressing, 4” X 7”, 7 ½” X 8”, 11 ¾” Square App. These areas should be designated in writing and posted in the ships operational plan and sickbay operating plan. Health care personnel must ensure the water is secure and not being used for other purposes. Portable medical lockers contain enough medical supplies and equipment to support a large number of casualties remote from sickbay. Decontamination lockers should be maintained at or near each saltwater decontamination station as designated in the ships design. This inventory should include as a minimum, nomenclature, quantity, quality control data, and documented date of inspections. Decontamination Locker Requirements: One or two per vessel as required by ships configuration. An inventory list with expiration dates should be affixed to the outside and the locker should be sealed in such a manner to ensure that tampering has not occurred. Poison Control Center phone numbers should be posted on the outside of the antidote locker. Items annotated with a “C” are Drug Enforcement Administration designated Controlled Substances and must be stored in a safe within a secure area. G-17 Sulisobenzone Lotion U/V Screen 10% 75gm Surgical Lubricant, 4oz Transdermal Scopalomine 1. Nevertheless, the nature of sea duty is such that dental emergencies will arise periodically. While rarely serious, these emergencies can be extremely painful and can serve to debilitate any sailor. A working knowledge of the drug locker, especially antibiotic and analgesic medications, is essential in the management of dental emergencies at sea. Item: Color Chlorine - Bromine & Ph Determination Comparator Set, Dpd Method Colilert Bacteriological Water Thest Starter Kit (Cat. Worthington Oconomowoc, Wi 53066 (414) 567-4047 *(Second Unit To Be Used As Backup While Primary Unit Is Being Calibrated Or Repaired) Thermometer, Pocket Max-Registering (Part #07293) Adams-Burch, Inc. H- i Tuberculosis H-42 Typhoid Fever (Enteric Fever) H-43 Typhus Fever H-44 Undulent Fever (Brucellosis, Malta Fever or Mediterranean Fever) H-46 Whooping Cough (Pertussis) H-47 Yaws H-48 Yellow Fever H-49 App. Since the epidemiology and treatment recommendations change over time, as new antibiotics are developed and resistance to older ones evolves, more current information is available at the Centers for Disease Control and Prevention website at: http://www. Obtain immediate medical consultation when treating patients suspected of having any serious infectious disease. These may be as simple as wearing a long sleeved-shirt or applying insect repellant to prevent a tick-born or mosquito transmitted disease. Lifestyle, including sexual practices, is also linked to infectious disease transmission. Over 30 microorganisms can be sexually transmitted with many having similar symptoms. Despite this complexity, initial management (with subsequent referral) can be accomplished in many settings with a minimum of resources. The following clinical syndromes associated with sexually transmitted diseases will be discussed in this section: Urethral discharge (urethritis) App. The end of this section addresses general management issues including counseling, partner notification, referral, sexual practices, symptomatic individuals and prevention. Urethral Discharge (Urethritis) Urethritis is characterized by a discharge from the urethra and burning with urination. It is usually caused by one of two bacteria: Neisseria gonorrhoeae (which causes gonorrhea) and Chlamydia trachomatis (which causes chlamydia), both of which infect and irritate the urethra. The usual incubation period for gonorrhea is 3-5 days and the discharge is yellow or green. The incubation period for chlamydia is longer, 1-5 weeks (usually 10-16 days), and the discharge is less profuse, less purulent (often white or watery) and less painful. If a microscope is available, examination of a Gram-stain of the discharge may disclose gram-negative diplococci inside of white blood cells, diagnostic of gonorrhea and the patient should be treated for both gonorrhea and chlamydia. If the Gram stain of the exudate does not disclose white cells with gram-negative intracellular diplococci, the patient should be treated for chlamydia. If no microscope is available, it is difficult to distinguish gonococcal urethritis from chlamydial urethritis with surety and the patient should be treated for both. These women do not have a urethral discharge, but have pain with urination due to the urethral inflammation. Various antibiotic regimens have been developed to treat gonorrhea and chlamydia, separately and/or together. H-2 The epididymis, which stores sperm and is located on the posterior side of the testicle, may become infected by C.