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Because of the common and particularly the illicit use of opioids, poisoning is a frequent occurrence This happens also as a result of ingestion or injection with suicidal intent, errors in the calculation of dosage, the use of a substitute or contaminated street product, or unusual sensitivity Children exhibit an increased susceptibility to opioids, so that relatively small doses may prove toxic This is true also of adults with myxedema, Addison disease, chronic liver disease, and pneumonia Acute poisoning may also occur in addicts who are unaware that available opioids vary greatly in potency and that tolerance for opioids declines quickly after the withdrawal of the drug; upon resumption of the habit, a formerly well-tolerated dose can be fatal Varying degrees of unresponsiveness, shallow respirations, slow respiratory rate (eg, two to four per minute) or periodic breathing, pinpoint pupils, bradycardia, and hypothermia are the well-recognized clinical manifestations of acute opioid poisoning In the most advanced stage, the pupils dilate, the skin and mucous membranes become cyanotic, and the circulation fails The immediate cause of death is usually respiratory depression, with consequent asphyxia Patients who suffer a cardiorespiratory arrest are sometimes left with all the known residua of anoxic encephalopathy Mild degrees of intoxication are revealed by anorexia, nausea, vomiting, constipation, and loss of sexual interest Treatment of Overdose This consists of the administration of naloxone (Narcan), or the longer acting nalmefene, both speci c antidotes to the opiates and also to the synthetic analgesics The dose of naloxone is 07 mg/70 kg body weight intravenously, repeated if necessary once or twice at 5-min intervals In cases of opioid poisoning, the improvements in circulation and respiration and reversal of miosis are usually dramatic In fact, failure of naloxone to produce such a response should cast doubt on the diagnosis of opioid intoxication If an adequate respiratory and pupillary response to naloxone is obtained, the patient should nonetheless be observed for up to 24 h and further doses of naloxone (50 percent higher than the ones previously found effective) can be given intramuscularly as often as necessary Naloxone has less direct effect on consciousness, however, and the patient may remain drowsy for many hours This is not harmful provided respiration is well maintained Although nalmefene has a plasma halflife of 11 h, compared to 60-90 min for naloxone, it has no clear advantage in emergency practice Gastric lavage is a useful measure if the drug was taken orally This procedure may be ef cacious many hours after ingestion, since one of the toxic effects of opioids is pylorospasm and ileus, which causes much of the drug to be retained in the stomach Once the patient regains consciousness, complaints such as pruritus, sneezing, tearing, piloerection, diffuse body pains, yawning, and diarrhea may appear These are the recognizable symptoms of the opioid abstinence, or withdrawal, syndrome, described later An antidote therefore must be used with great caution in an addict who has taken an overdose of opioid, because in this circumstance it may precipitate withdrawal phenomena Nausea and severe abdominal pain, due presumably to pancreatitis (from spasm of the sphincter of Oddi), are other troublesome symptoms of opiate use or withdrawal Seizures are rare. ssrs gs1 128 SSRS GS1-128 / EAN-128 Generator - OnBarcode
Generate high quality EAN - 128 barcode images in Microsoft SQL Reporting Service ( SSRS ) with a Custom Report Item (CRI). ssrs gs1 128 How to Embed Barcodes in Your SSRS Report - CodeProject
24 Jun 2014 ... How to use barcodelib generated Barcodes in SSRS (consider Barcode fonts don't work in runtime) . ms word code 39, birt qr code, free upc barcode font for word, data matrix word 2010, free ean 13 barcode font word, gs1-128 word ssrs gs1 128 Code 128 barcodes with SSRS - Epicor ERP 10 - Epicor User Help ...
Does anyone have any recommendations for adding Code 128 barcodes to Epicor ERP SSRS reports? Has anyone successfully added Code 128 barcodes, ... ssrs ean 128 SSRS Barcode Generator Tutorial | User Manual - IDAutomation.com
SSRS Barcode Generator User Manual | Tutorial ... text file from the SSRS Barcode Generator download, such as IDAutomation SSRS Native - Code 128 .txt . the initial effects These persons, after several repetitions, recognize a high, despite the subsequent recurrence of unpleasant, or dysphoric, symptoms (nausea, vomiting, and faintness as the drug effect wanes) One of our patients described the initial effect as dying and going to heaven The repeated self-administration of the drug is the most important factor in the genesis of addiction Regardless of how one characterizes the state of mind that is produced by episodic injection of the drug, the individual quickly discovers the need to increase the dose in order to obtain the original effects (tolerance) Although the initial effects may not be fully recaptured, the progressively increasing dose of the drug does relieve the discomfort that arises as the effects of each injection wear off In this way a new pharmacogenically induced need is developed, and the use of opioids becomes self-perpetuating At the same time a marked degree of tolerance is produced, so that enormous amounts of drugs, eg, 5000 mg of morphine daily, can eventually be administered without the development of toxic symptoms The pharmacologic criteria of addiction, as indicated in the chapter on alcoholism, are tolerance and physical dependence The latter refers to the symptoms and signs that become manifest when the drug is withdrawn following a period of continued use These symptoms and signs constitute a speci c clinical state, termed the abstinence or withdrawal syndrome (see later) The mechanisms that underlie the development of tolerance and physical dependence are not fully understood However, it is known that opioids activate an opioid antinociceptive system (enkephalins, dynorphins, endorphins), which are opioid receptors and are located at many different levels of the nervous system (these are described in Chap 8, on pain; see also the review of Fields) The Opioid Abstinence Syndrome The intensity of the abstinence or withdrawal syndrome depends on the dose of the drug and the duration of addiction The onset of abstinence symptoms in relation to the last exposure to the drug, however, is related to the pharmacologic half-life of the agent With morphine, the majority of individuals receiving 240 mg daily for 30 days or more will show moderately severe abstinence symptoms following withdrawal Mild signs of opiate abstinence can be precipitated by narcotic antagonists in persons who have taken as little as 15 mg of morphine or an equivalent dose of methadone or heroin three times daily for 3 days The abstinence syndrome that occurs in the morphine addict may be taken as the prototype The rst 8 to 16 h of abstinence usually pass asymptomatically At the end of this period, yawning, rhinorrhea, sweating, piloerection, and lacrimation become manifest Mild at rst, these symptoms increase in severity over a period of several hours and then remain constant for several days The patient may be able to sleep during the early abstinence period but is restless, and thereafter insomnia remains a prominent feature Dilatation of the pupils, recurring waves of goose esh, and twitchings of the muscles appear The patient complains of aching in the back, abdomen, and legs and of hot and cold ashes ; he frequently asks for blankets At about 36 h the restlessness becomes more severe, and nausea, vomiting, and diarrhea usually develop Temperature, respiratory rate, and blood pressure are slightly elevated All these symptoms reach their peak intensity 48 to 72 h after withdrawal and then gradually subside The opioid abstinence syndrome is rarely fatal (it is life-threatening only in infants) After 7 to 10 days, the clinical signs of abstinence are no longer evident, although the patient may complain of insomnia, nervousness, weakness, and muscle aches for several more weeks, and small. ssrs gs1 128 SSRS Barcode Font Generation Tutorial | IDAutomation
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