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Review: MG Extender กระบะยักษ์พันธุ์แกร่ง

MG Extender 2.0 Giant Cab D 6MT ราคา 619,000 บาท- MG Extender 2.0 Giant Cab GRAND D 6MT ราคา 659,000

2019 New MG Extender  DC 4WD 6AT กับ 4 เหตุผลที่คุณควรซื้อ 

และจุดเด่นด้านออปชั่นที่เรียกได้ว่าจัดเต็ม จนทำให้หลายคนหันมามองและอยากได้รถคันนี้มาใช่้งาน และนี่คือ 4

2021 Mercedes-Benz S-Class เปิดตัวในอินโดนีเซีย เล็งประกอบไตรมาส 4 แล้วไทยเมื่อไหร่ดีนะ...

เปิดตัวอย่างเป็นทางการในประเทศอินโดนีเซีย โดยเป็นการนำเข้าสำเร็จรูป ก่อนเปิดสายการผลิตอย่างเป็นทางการในไตรมาส 4

Porsche ยอมแบกต้นทุนสูงกว่าเพื่อผลิตในเยอรมนีดีกว่าประทับตรา “Made in China”

แต่ Porsche ยืนยันหนักแน่นว่าจะไม่ย้ายฐานการผลิตออกจากเยอรมนีอย่างแน่นอนแบกต้นทุนสูงกว่าเพื่อตรา Made in

2020 NEW MG HS PHEV เปิดตัวรุ่นใหม่จะชิงส่วนแบ่งตลาดจาก Honda CR-V ได้หรือไม่?

เมื่อไม่นานมานี้ MG เปิดตัวรถ Compact SUV ทางเลือกใหม่ Plug-in Hybrid ในชื่อ 2020-2021 NEW MG HS PHEV

MG เปิดบริการรถไฟฟ้าเหมาจ่ายเดือนละ 250 บาท ทำไมเมืองไทยไม่มีแบบนี้บ้าง!!!

MG Motor (เอ็มจี มอเตอร์) แห่งสหราชอาณาจักร เปิดตัวบริการรูปแบบใหม่เพื่อเอาใจลูกค้าผู้ใช้รถยนต์ไฟฟ้าในสหราชอาณาจักร

BMW i8 รถสปอร์ตที่มาพร้อมความประหยัดด้วยเทคโนโลยีไฮบริด ด้วยราคาเริ่ม 12.999 ล้านบาท

Package 5 ปี เมื่อทำสัญญาทางการเงินกับบีเอ็มดับเบิลยู ไฟแนนเชียล เซอร์วิส ประเทศไทย สำหรับ BMW Plug-in

รู้ข้อดีข้อเสีย MG V80 ก่อนเป็นเจ้าของ

นั่นรวมถึง MG V80 (เอ็มจี วี 80) รถตู้ 4 แถว 11 ที่นั่ง ให้เป็นทางเลือกสำหรับลูกค้าที่ต้องการรถ Passenger

อ่านก่อนซื้อ! MG EXTENDER มีข้อดีกับข้อเสียอย่างไร

และต้องบอกเลยว่า MG กล้าหาญชาญชัยมากที่นำรถกระบะ MG EXTENDER (เอ็มจี เอกซ์เทนเดอร์) เข้ามาขายในประเทศไทย

รีวิว 2019 MG HS พิสูจน์ตำแหน่งผู้นำตลาดรถคอมแพ็กต์เอสยูวี มีดีที่ความคุ้มค่า?

3 รุ่นย่อย ได้แก่ MG HS Turbo รุ่น C ราคา 919,000 บาท MG HS Turbo รุ่น D ราคา 1,019,000 บาทและ MG HS

ดูเพิ่มเติม

MG เล็งไทยเป็นฮับอาเซียน ผลิต MG ZS พวงมาลัยซ้าย ส่งออกอินโดนีเซีย-เวียดนาม-มาเลเซีย

MG (เอ็มจี) ประเทศไทย ขยับสายการผลิตเพิ่มการผลิต MG ZS (เอ็มจี แซดเอส) พวงมาลัยซ้าย เพื่อเริ่มการส่งออกไปยังตลาดเวียดนามภายในสิ้นปีนี้

ไขข้อสงสัยข้อดีข้อเสียก่อนซื้อ MG HS

หลังจาก MG HS รถสไตล์รถครอบครัวจากแบรนด์จีนเปิดตัวก็ได้รับความสนใจล้นหลาม และก็กลายเป็น Compact SUV ที่มียอดขายดีในกลุ่มได้อย่างรวดเร็วด้วยชื่อ

ไฟเขียว! MG เตรียมเปิดตัวรถสปอร์ตพลังไฟฟ้าปลายปีนี้ รอลุ้นราคาจำหน่าย

รถต้นแบบ MG E-Motionรถสปอร์ตพลังงานไฟฟ้ารุ่นแรกของ MG (เอ็มจี) ยุคใหม่เตรียมเปิดตัวครั้งแรกในโลกภายในช่วงปลายปีนี้

2021 Mazda CX-30 จ่อแตกไลน์ขุมพลังเบนซินเทอร์โบ 2.5 ลิตร 250 แรงม้า

จะมาพร้อมเครื่องยนต์เบนซินเทอร์โบ ออกทำตลาดในฐานะรุ่นท็อปไลน์ใหม่ในสหรัฐอเมริกา มีพละกำลังให้ใช้ถึง 250

เทียบสเปกรถกระบะ 4 ประตู ขุมพลัง 2.0 ลิตร 2019 MG Extender วัดมวย 2019 Ford Ranger

Extender Ford Ranger เครื่องยนต์ ดีเซล 4 สูบ DOHC 16 วาล์ว เทอร์โบ อินเตอร์คูลเลอร์ ดีเซล

หน้าตาคุ้น ๆ BYD SS Summer ขายแล้วในจีน ในราคาที่ซื้อ MG HS PHEV ได้ 2 คัน

เสริมด้วยล้ออะไหล่ที่ติดตั้งไว้บริเวณประตูท้ายคล้ายกับรถเอสยูวียุคก่อนเหมาะสำหรับการออกไปกางเตนท์แคมป์ปิ้ง เสริมด้วยล้ออะไหล่ที่ด้านท้ายคล้ายกับรถในสมัยก่อนเครื่องยนต์จาก BYDติดตั้งขุมพลัง Plug-in

รู้ข้อดีข้อด้อยก่อนซื้อ MG HS ตัวท็อป

MG HS (เอ็มจี เอชเอส) ถือเป็นรถอเนกประสงค์อีกรุ่นที่ได้รับความนิยมไม่แพ้ MG ZS ของค่ายเอ็มจีเลย ด้วยความโดดเด่นในด้านเทคโนโลยี

2020 MG HS PHEV กับคำถามที่พบบ่อยของระบบปลั้กอินไฮบริด อ่านก่อนคิดจะซื้อ

รถ Plug-In Hybrid ดีกว่ารถทั่วไปอย่างไรข้อดีหลัก ๆ คือ สมรรถนะที่แรงขึ้น จากการทำงานของมอเตอร์ไฟฟ้า ที่เสริมแรงให้กับเครื่องยนต์

Review: 2019 BMW i8 รถสปอร์ตแห่งโลกอนาคต

Frozen Yellow) และราคา 12.999 ล้านบาท ในรุ่น BMW i8 Roadster รถสปอร์ตรุ่นนี้ขับเคลื่อนด้วยระบบ Plug-In

เปิดค่าซ่อมจากศูนย์ 2021 MG ZS หลังจากผ่านไป 4 ปีต้องเปลี่ยนอะไรบ้าง ราคาเท่าไร

2021 MG ZS (เอ็มจี แซดเอส) เอสยูวีขวัญใจคนไทยหลาย ๆ คน ด้วยราคาที่ไม่แพงมาก เริ่มต้นที่ 689,000 บาท ออพชั่นให้มาเยอะ

2021 MG HS ราคาเริ่มต้น 9.19 แสนบาทพร้อมเครื่องยนต์เบนซินเทอร์โบขนาด 1.5 ลิตรที่ออกแบบเพื่อครอบครัว

HSเมื่อจองรถ MG HS ในงาน Motor show ระหว่างวันที่ 24 มีนาคม 2564 - 4 เมษายน 2564 จะได้รับอุปกรณ์ตกแต่งแท้จาก

2020 MG HS PHEV เทียบ MG HS 1.5X เจาะออพชั่นต่างกันทุกด้าน เพิ่มเงินแค่ 240,000 บาท

/ลิตรเกียร์ลูกใหม่ EDU II 10 จังหวะ MG HS PHEV MG HS 1.5X

MG คว้ารางวัลแบรนด์รถยนต์คุ้มค่ายอดเยี่ยม – MG ZS EV รับรางวัลรถใหม่คุ้มค่าสูงสุด

MG (เอ็มจี) ได้รับรางวัลแบรนด์รถยนต์ที่ความคุ้มค่ายอดเยี่ยม (Best Value Brand 2020) จากการประกาศผลรางวัล

เปิดตัว MG5 EV และ MG HS Plug-in ก่อนในอังกฤษ ไทยจะตามมาสิ้นปี

และใช้งานได้จริง เพื่อมาเคียงข้างกับ MG ZS EV ให้กับประเทศอังกฤษ คือรถ MG5 EV และ MG HS Plug-in ซึ่งทางเอ็มจีหวังว่าจะช่วยเพิ่มยอดขายให้ได้มากกว่าเดิม

แบงค์บอกต่อ ซินเจียยู่อี่ซินนี้ฮวดใช้ ซื้อรถแถมทองรับเทศกาลตรุษจีนกับ MG และ BMW

(เอ็มจี) และ BMW (บีเอ็มดับเบิ้ลยู) มาให้ดูกันMG ราชพฤกษ์12 - 13 ก.พ.นี้ ที่เอ็มจีราชพฤกษ์ โชคชั้นที่

2021 Mitsubishi Outlander PHEV เปิดตัวใหม่จะท้าชน MG HS PHEV ได้ไหม?

Outlander PHEV (มิตซูบิชิ เอาท์แลนเดอร์ พีเอชอีวี) รุ่นใหม่ล่าสุดเมื่อปลายปี 2020 โดยเป็นรถ SUV Plug-in

MG HS VS Mazda CX-30 คันไหนใช่โดนใจคุณ....

-30 2019 (มาสด้า ซีเอ็กซ์ 30) มาเทียบกันให้เห็นกันว่าคันไหนโดนใจคุณมากกว่ากันราคาเริ่มกันที่ราคาของ MG

เปิดตัว 2020 MG HS PHEV โวลั่นแรงเหนือคู่แข่ง-ประหยัด 65 กม.ต่อลิตร เคาะค่าตัวถล่ม Toyota Corolla Cross

(Plug-in Hybrid) พร้อมการออกแบบที่สวยงามลงตัวและการติดตั้งระบบอำนวยความสะดวกและระบบความปลอดภัยครบครัน

ชม 4 รถสมรรถนะสุดขั้วแห่งยุค พละกำลังรวมกันเฉียด 6,000 แรงม้า

เรียกว่าเป็นจตุรเทพแห่งโลกยานยนต์ก็ว่าได้ สำหรับรถสมรรถนะสูง 4 รุ่น นำโดย Bugatti Divo ที่เริ่มส่งมอบคันแรกให้ลูกค้ามหาเศรษฐีกระเป๋าหนักเรียบร้อยแล้วเซกเมนท์รถไฮเปอร์คาร์มีทางเลือกเพิ่มขึ้นทุกปี

เสียงวิจารณ์โลกโซเชียลไม่ระคาย ทำไม MG ทำยอดขายผงาดผู้นำ

ความสำเร็จของรถอเนกประสงค์ค่าย MG ทั้ง MG ZS (เอ็มจี แซดเอส) และ MG HS (เอ็มจี เอชเอส) แสดงให้เห็นว่าค่ายรถยนต์น้องใหม่สามารถโค่นแบรนด์ยักษ์อันเก่าแก่ลงได้หากเดินถูกทางยอดขายสะสมของรถอเนกประสงค์ขนาดซับคอมแพ็กต์อย่าง

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What are the most helpful vitamins and supplements for people with alzheimers?

Effects of medicinal plants on Alzheimer's disease and memory deficits Clinical Literature Review, Neural Regeneration Research. M. Akram, M.D. Phd. April 12, 2017 Summary of Findings: Withania somnifera Withania somnifera belongs to the family Solanaceae. It (500 mg/d) exhibited calming effects on stress and reversed memory loss (Auddy et al., 2008). Cholinergic activity of Withania somnifera has been reported in a previous study (Schliebs et al., 1997). Memory enhancing activity and cognition improving property of Withania somnifera increase due to its ability to increase acetylcholine level in the brain. Neurotic outgrowth activity of Withania somnifera is reported already in human neuroblastoma cells that are time- and dose-dependent. Withania somnifera enhances dendrite and axon regeneration (Tomoharu et al., 2005). A molecular modeling study indicates that withanamides A and C bind to Aβ and inhibit fibril synthesis (Jayaprakasam et al., 2010). Curcuma longa Curcuma longa belongs to the family Zingiberaceae. In Southeast Asian countries, prevalence of AD is low due to consumption of turmeric. It has anti-inflammatory activity that is also associated with reduced risk of AD (Aggarwal and Harikumar, 2009). Curcumin reduces the plaque deposition in the brain. Turmeric decreases oxidative stress and amyloid pathology (Mishra and Palanivelu, 2008). In one study, administration of low doses of Curcumin reduced Aβ level up to 40% in mice with AD as compared to control drug (Shytle et al., 2009). Curcumin at low doses caused 43% decrease in the plaque burden that these Aβ have on the brain of mice with AD (Mishra and Palanivelu, 2008). A previous study indicates that low doses of Curcumin administered for long duration are more effective in the treatment of AD as compared to higher doses of Curcumin (Yang et al. 2005). Curcumin has an ability to bind with Aβ and inhibits its self assembly (Reinke and Gestwicki, 2007). Curcumin has powerful anti-inflammatory and antioxidant effects (Fan et al., 2015); according to the researchers, these effects help in treating Alzheimer's symptoms caused by inflammation and oxidation (Frautschy and Hu, 2001). Hypercholesterolemia and hyperlipidemia increase amyloid plaques by intracellular accumulation of cholesterol esters (Tokuda et al., 2000). Scientists believe that Curcumin might have therapeutic effects on AD by inhibiting cholesterol synthesis and reducing serum peroxides (Soni and Kuttan, 1992). Convolvulus pluricaulis Convolvulus pluricaulis belongs to the family Convolvulaceae. It is used as a memory enhancing agent. A previous study has shown that aqueous and ethyl acetate extract of Convolvulus pluricaulis increases memory functions and learning abilities (Bihaqi et al., 2011). In another study, a wide range of secondary metabolites such as steroids, anthocyanins, flavonol glycosides and triterpenoids have been isolated that are responsible for memory enhancing and nootropic properties (Malik et al., 2011). Convolvulus pluricaulis has been repoted to calm the nerves by regulating the stress hormones synthesis (cortisol and adrenaline) in the body (Sethiya et al., 2009). The ethanolic extract of Convolvulus pluricaulis and its aqueous and ethyl acetate fractions significantly improved memory retention and learning abilities in rats (Nahata et al., 2008). Another study conducted by Bihaqi et al. (2011) indicated that extracts of Convolvulus pluricaulis enhance the memory in Wistar rats in a dose-dependent manner. Similarly, administration of Convolvulus pluricaulis for 1 week increased memory in aged mice (Sharma et al., 2010). Administration of Convolvulus pluricaulis increased the acetylcholinesterase activity in the hippocampal CA1 and CA3 regions associated with the memory function and learning abilities (Dubey et al., 1994). Centella asiatica Centella asiatica belongs to the family Apiaceae. It contains saponins, asiaticosides, madecassoside, madasiatic acid, brahmoside, brahminoside, sasiaticoside, sitosterol, tannins, ascorbic acid, centoic acid, centellic acid, thankuniside, brahmoside, brahminoside, siatic acid, thankuniside, glycoside, triterpine, thankunic acid, vellarin, asiaticosides, thankuniside, and isothankuniside (Siddiqui et al., 2007). Centella asiatica is used in depression, rheumatism, mental weakness, abdominal pain, and epilepsy (Gohil et al., 2010). It is diuretic, anti-spasmodic, anti-convulsive, tonic, stimulant, emmenagogue, antioxidant and spermatogenic (Heidari et al., 2007). Centella asiatica reversed the Aβ pathology and reduced oxidative stress response (Amala et al., 2012). Rao et al. (2007) reported that treatment with Centella asiatica (Linn) fresh leaf extract enhanced learning ability and memory retention power in Wistar rats. Adult rats of 2.5 months old were selected for this study. Three different doses (2, 4, and 6 mg/kg) of extracts were administered for 2, 4, and 6 weeks. Spatial learning (T-maze) and passive avoidance tests were performed after the treatment period. Results were compared with those of age matched control rats. Improvement in spatial learning was significant at the dose of 6 mL of extract. The use of Centella asiatica extract enhanced memory retention that was evident from passive avoidance test. This data showed that Centella asiatica enhances learning ability and memory retention power in adult rats. Veerendra and Gupta (2003) reported efficacy of Centella asiatica in AD. Its cognition enhancing activities and anti-oxidant effects have been reported. Aqueous extract of Centella asiatica (100, 200 and 300 mg/kg) was administered for 21 days in streptozotocin (STZ)-induced cognitive impairment and oxidative stress in rats. STZ at 3 mg/kg was intracerebroventricularly injected into male Wistar rats bilaterally on days 1 and 3. Cognitive behavior was assessed after 13, 14 and 21 days of treatment. Rats were sacrificed for assessment of oxidative stress after 21 days of treatment. Cognitive behaviors of rats treated with Centella asiatica extract improved significantly. The maximum response was observed after administration of extract at the doses of 200 and 300 mg/kg. Results from Veerendra and Gupta (2003) showed that Centella asiatica is effective in STZ-induced cognitive impairment in rats. Celastrus paniculatus Celastrus paniculatus belongs to the family Celastraceae. It prevented neuronal cell damage against hydrogen peroxide toxicity due to its antioxidant activity (Godkar et al., 2006). Administration of Celastrus paniculatus prevents neuronal cell damage caused by glutamine induced toxicity (Godkar et al., 2003). Celastrus paniculatus increases cholinergic activity that contributes its ability to improving memory performance (Bhanumathy et al., 2010). Aqueous extract of Celastrus paniculatus has antioxidant and cognition enhancing properties (Kumar and Gupta, 2002). Celastrus paniculatus extracts protected neuronal cells against hydrogen peroxide induced toxicity in part by virtue of their antioxidant and free radical scavenging activities (Katekhaye et al., 2011). Nardostachys jatamansi Nardostachys jatamansi belongs to the family Caprifoliaceae. It contains sesquiterpene valeranone that has been used for treatment of stress (Lyle et al., 2009). In a study, Nardostachys jatamansi exhibited memory retention and learning enhancing abilities in aged and young mice and reversed scopolamine and diazepam induced amnesia. Nardostachys jatamansi also reversed aging induced amnesia (Joshi and Parle, 2006). Karkada et al. (2012) reported efficacy of Nardostachys jatamansi in the prevention of stress induced memory deficit. Coriandrum sativum Coriandrum sativum belongs to the family Apiaceae. In one study, Coriandrum sativum was given for 45 days for its efficacy on cognitive function in male Wistar rats. This study was conducted in comparison with aging, scopolamine and diazepam induced amnesia. Coriandrum sativum exhibited memory enhancing effects due to its antioxidant, anti-inflammatory and cholesterol lowering activities (Vasudevan and Milind, 2009). Ficus carica Ficus carica belongs to the family Moraceae. It was investigated for its effect in retrieval, retention and acquisition of spatial recognition. Ficus carica contains quercetin that plays an important role in memory deficit and AD due to its antioxidant activity. For this study, mice with memory deficit and normal mice were used. Rectangular maze model and Y-maze were used to assess efficacy of Ficus carica on cognitive functions. Hexane extract (100 and 200 mg/kg) was administered to adult swiss Wistar albino mice. In this study, Bacopa monniera and scopolamine were used as standard drug and amnestic agent respectively. Ficus carica 200 mg/kg exhibited maximum nootropic response that is near to response exhibited by a standard drug Bacopa monniera. In conclusion, Ficus carica at lower doses exhibits mild memory enhancing effet and higher doses evoke better learning ability and alter behavior (Saxena et al., 2013). Ginkgo biloba Ginkgo biloba belongs to the family Ginkgoaceae. It contains bilobalide that has a neuroprotective activity (Chandrasekaran et al., 2001). Ginkgo biloba decreases free radical and improves memory in patients with AD (Shi et al., 2010). It contains flavonoids that are involved in memory enhancement (Bastianetto et al., 2000). Gingko biloba prevents neurodegeneration and GABA inhibitory neurotransmission induced by hippocampal corticosterone (Walesiuk and Braszko, 2009). Administration of Ginkgo biloba significantly improved memory and learning performance in albino rats (Nalini et al., 1992). Ilex paraguariensis Ilex paraguariensis belongs to the family Aquifoliaceae. It has a memory enhancing property. It contains vitamin B12, B1 and C. Ilex paraguariensis is being used as an anti-dementia agent (Bastos et al. 2007). Its memory enhancing property was investigated in different rat models (Colpo et al., 2007). Ilex paraguariensis has been shown to improve short and long term memory (Rui et al., 2008). There is evidence that Ilex paraguariensis for treatment of vascular dementia improves memory (Heck et al., 2007). Literature review indicates that Ilex paraguariensis is effective in the treatment of neurodegenerative disorders such as AD (Muzzafera, 1997). Commiphora whighitti Commiphora whighitti belongs to the family Burseraceae. It is a potent cognition enhancer for memory improvement in scopolamine induced memory deficits (Gujran et al., 2007). Another study shows that brain pathology develops in cholesterol fed rabbits similar to AD (Ghribi, 2008), which is supported by clinical trials in human, showing that statin treatment decreases the risk of AD (Raja and Hoyer, 2004). Memory enhancing and anti-dementia activity of Commiphora whighitti has been reported that is due to reduction in acetylcholinesterase contents in the hippocampus (Lannert and Hoyer, 1998). Glycyrrhiza glabra Glycyrrhiza glabra belongs to the family Fabaceae. It contains pentanol, hexanol, linalool oxide, tetramethyl pyrazine, terpinen, terpinol, geraniol, propionic acid, benzoic acid, ethyl linolenate, methyl ethyl ketone, butanediol, feuferaldehyde, furfuryl formate, trimethylpyrazine, maltol, glycyrrhizin, tannin, and glycyrrhizic acid (Rekha and Parvathi, 2012). Glycyrrhiza glabra is used in gastric ulcer, lung congestion, hoarseness and throat problems (Dastagir and Rizvi, 2016). Memory enhancing activity of Glycyrrhiza glabra was reported in scopolamine induced dementia (Ambawade et al., 1998). Dhingra et al. (2004) reported the memory enhancing activity of Glycyrrhiza glabra in mice. Three dose levels (75, 150, 300 mg/kg, p.o.) of Glycyrrhiza glabra extracts were administered to mice in 7 successive days. Glycyrrhiza glabra at 150 mg/kg was found effective in memory enhancement. Lepidium meyenii Lepidium meyenii belongs to family Brassicaceae. It is known as Maca which shows improvement in learning abilities and memory function (Julio et al., 2007). Lepidium meyenii exhibited memory enhancing activity in patients with AD. It enhances memory by increasing level of acetylcholine (Wang et al., 2006). It improves experimental memory impairment induced by ovariectomy, due in part to its acetylcholinesterase inhibitory and antioxidant effects. Results showed that Lepidium meyenii can enhance memory retention and learning abilities in ovariectomized mice and this activity might be related, at least in part, to its ability to decrease lipid peroxidation and acetylcholinesterase in ovariectomized mice (Rubio et al., 2011). Panax ginseng Panax ginseng belongs to the family Araliaceae. A previous study has shown that learning ability increases in animals by consumptions of Panax ginseng. Recent studies have shown the efficacy of Panax ginseng powder, extract and various ginsedosides on AD using in vivo and in vitro models (Heo et al., 2008; Cho, 2012; Hee et al. 2013). Patients receiving Korean white ginseng powder (4.5 g/d) or Korean red ginseng powder (9 g/d) showed significant improvement in Clinical Dementia Rating, Mini-Mental State Examination scores and the Alzheimer's Disease Assessment Scale after 12 weeks of ginseng treatment in comparison with those in the control group (Heo et al., 2008; Lee et al., 2008). Emblica officinalis Emblica officinalis belongs to the family Euphorbiaceae. It exhibited significant improvement in memory retention of young and aged rats in a dose-dependent manner. It reversed the diazepam and scopolamine induced amnesia. As a memory enhancer and reversal of memory deficits, Emblica officinalis plays an important role in the treatment of memory deficits and AD (Mani et al., 2007). A study was conducted to investigate the memory enhancing effect of piracetam when used together with Emblica officinalis and Curcuma longa against aluminium-induced cognitive dysfunction and oxidative damage in rats. Aluminium chloride at 100 mg/kg was given orally to rats for 6 weeks. Emblica officinalis (100 mg/kg, p.o.), Curcumin (100 mg/kg, p.o.) and piracetam (200 mg/kg, i.p.) were concomitantly administered to rats daily for 6 weeks. Elevated plus maze task paradigms and Morris water maze tests were used to evaluate memory on days 21 and 42 of treatment. On day 43 of treatment, rats were sacrificed to evaluate the extent of oxidative stress. Oxidative stress was significantly reduced and memory was significantly improved in rats treated with Emblica officinalis (100 mg/kg, p.o.), Curcumin (100 mg/kg, p.o.) and piracetam (200 mg/kg, i.p.) than the rats treated only with piracetam (200 mg/kg, i.p.). As antioxidant and memory enhancer agent, Emblica officinalis could be used to treat memory loss and AD (Ramachandran et al., 2013). Magnolia officinalis Magnolia officinalis belongs to the family Magnoliaceae. It improves the scopolamine induced memory deficits (Lee et al., 2009). Magnolia officinalis inhibits acetyl cholinesterase activity (Jae et al., 2009). Ethanolic extract of Magnolia officinalis containing honokiol and magnolol has been reported to possess antioxidant effects (Lo et al., 1994; Chiu et al., 1997; Kong et al., 2000). In vitro antioxidant activities of various Soxhlet and supercritical fluid extracts have been reported, with the ethyl acetate Soxhlet extract being the most active (Li and Weng, 2005). Biphenolic lignins (magnolol (29) and honokiol (28) derived from Magnolia officinalis, have the ability to enhance the choline acetyltransferase effects and inhibit the acetylcholine cleavage and have also been shown to release acetylcholine from the hippocampus (Hou et al., 2000). Both compounds exhibited in vivo antioxidant effects (Lo et al., 1994). Magnolol showed in vitro neuroprotective activity (Lee et al., 2000). The compound also exhibited anti-inflammatory effect in vivo and in vitro (Wang et al., 1992, 1995). Honokiol exhibits anti-inflammatory activity by inhibiting reactive oxygen species synthesis (Dikalov et al., 2008). As an anti-inflammatory and antioxidant agent, Magnolia officinalis plays an important role in the management of AD and memory deficits (Jie et al., 2000; Chen et al., 2001; Liou et al., 2003). Zingiber officinale Zingiber officinale belongs to the family Zingiberaccae. It is used for treatment of headache, rheumatism and stomach trouble (Malhotra and Singh, 2003). It improves memory impairment induced by scopolamine via inhibition of acetylcholinesterase activity (Hanumanthacar et al., 2006). As a booster of antioxidant and a reducer of free radical, Zingiber officinale plays an important role in the treatment of AD and memory deficits (Masuda et al., 1997). In another study, male rats (250–300 g) were divided into treatment and control groups. The treatment group was further divided into three subgroups. Plant mixed in food at a ratio of 6.25% was administered in the first group. Plant extract at 50 mg/kg and 100 mg/kg (intraperitoneal) was administered to the second and third subgroups, respectively. Shuttle box test and Y maze test were used to investigate acquisition-recalling and spatial recognition behaviors. Significant improving effects on recall, retention and acquisition were observed in male rats after intraperitoneal and oral administration of Zingiber officinale (Gharibi et al., 2013). Tinospora cordifolia Tinospora cordifolia belongs to the family Menispermaceae. Pharmacological activities include anti-fertility, antioxidant and immunomodulating activities (Reddy and Rajasekhar, 2015). Tinospora cordifolia possesses a memory improving effect in animals with memory deficits (Malve et al., 2014). The mechanism by which Tinospora cordifolia improves memory is the synthesis of acetylcholine and immunostimulation (Asuthosh et al., 2000). Administration of Tinospora cordifolia increases the cognitive function in patients with AD (Lannert and Hoyer, 1998). Punica granatum Punica granatum belongs to the family Punicaceae. It contains corilagin, granatin, punicacortein A, pedunculagin and punicafolin. Punica granatum is used in diarrhea and dysentery (Das et al., 1999). It is anthelmintic and astringent. Cambay et al. (2011) reported the efficacy of Punica granatum flower in learning and memory performance impaired by diabetes mellitus in rats. In this study, rats were divided into five groups (n = 12): control, streptozocin, streptozocin + pomegranate flowers at 300, 400 and 500 mg/kg/d. Results showed that rats in the streptozocin group showed memory impairment than those in the control group. Administration of pomegranate flower powder led to improvement in learning abilities and memory retention in diabetic rats. Pomegranate flower powder supplementation decreased oxidative stress and alleviated learning and memory impairment as compared to streptozocin induced diabetic rats. Therefore, Punica granatum flower plays an important role in the treatment of neurological deficits in patients with diabetes mellitus. Crocus sativus Crocus sativus belongs to the family Iridaceae. There is an increasing trend to prescribe the Crocus sativus in the treatment of AD and memory deficits. In clinical trials, efficacy of Crocus sativus was investigated in 54 patients aged 55 years during a 22-week study period. Patients were randomly assigned to receive donepezil 10 mg/d or capsule saffron 30 mg/d. Crocus sativus at 30 mg/d was found to be effective similar to donezepil in patients with mild to moderate AD after 22 weeks of treatment. Adverse effects occurred at similar frequencies between donezepil-treated and saffron-treated patients, with the exception of vomiting which occurred more in donezepil-treated patients (Akhondzadeh et al., 2010). Another similar study was conducted to investigate the effects of saffron extract versus memantine in decreasing cognitive deterioration of patients with moderate to severe AD. In this clinical trial, 68 patients received saffron extract (30 mg/d) or memantine (20 mg/d) for 1 year. Functional Assessment Staging and Severe Cognitive Impairment Rating Scale were used to evaluate patients every month and possible adverse effects were recorded. Crocus sativus at 30 mg/d was found to be effective similar to memantine in patients with moderate to severe AD after 1 year of treatment. There was no significant difference in frequency of adverse effects in both treatment groups (Farokhnia et al., 2014). Cissampelos pareira Cissampelos pareira belongs to the family Menispermaceae. It was investigated for its effect on memory and learning in mice. Memory and learning was tested via passive avoidance paradigm and elevated plus maze. Hydroalcoholic extract of Cissampelos pareira was given orally at 100, 200 and 400 mg/kg for 7 days. Memory and learning significantly improved after administration of Cissampelos pareira at 400 mg/kg in mice. Cissampelos pareira extract at 400 mg/kg reversed the scopolamine induced amnesia. Nootropic effect of Cissampelos pareira was observed that may be due to decreased activity of acetylcholinesterase enzyme and increased antioxidant and anti-inflammatory activities (Pramodinee et al., 2011). Mellisa officinalis Mellisa officinalis belongs to the family Lamiaceae. It is anxiolytic, anti-inflammatory and antidepressant (Taiwo et al., 2012). In a randomized clinical trial conducted by Kennedy et al. (2002), 20 young participants received a single dose of 300, 600 and 900 mg of Mellisa officinalis or a matching placebo at 7 day intervals. Mellisa officinalis at 600 mg significantly improved memory and cognitive performance. Akhondzadeh et al. (2003a) conducted a study to investigate the efficacy and safety of Mellisa officinalis (60 drops/day) in the treatment of AD. Patients were randomly divided into test and placebo groups. Mellisa officinalis extract was administered to patients between 65 and 80 years of age for 4 months. At 4 months of treatment, Mellisa officinalis extract exhibited a significant effect on cognitive function as compared to the placebo group. There were no significant side effects observed in both treatment groups except agitation in the placebo group. Moringa oleifera Moringa oleifera belongs to the family Moringaceae. Moringa oleifera leaf extract contains Vitamin C and E that are anti-oxidant and are involved in enhancing memory in AD (Pakade et al., 2013). It has nootropics activity and combat stress in AD (Mohan et al., 2005). Moringa oleifera alters monoamines that are involved in memory process (Ganguly and Guha, 2008). A study conducted in rats indicated that Moringa oleifera ameliorates the colchicines-induced AD by modifying levels of monoamines such as nor epinephrine, dopamine and serotonin (Obulesu and Rao, 2011). Salvia officinalis Salvia officinalis belongs to the family Lamiaceae. It enhances memory retention by interacting with muscarinic and cholinergic pathways that are involved in memory retention process (Eidi et al., 2006). A study was conducted to investigate the efficacy of Salvia officinalis in 42 patients (18 female and 24 male, age between 65 and 80 years) with AD living in Tehran, Iran. After 4 months of treatment, significant efficacy was observed in Salvia officinalis treated patients than in the placebo-treated patients. The findings indicate the effectiveness of Salvia officinalis in the treatment of AD and memory deficits (Akhondzadeh et al., 2003b). Myristica fragrans Myristica fragrans belongs to the family Myristicaceae. It contains camphene, b-pinene, sabinene, cymene, garaniol, d-borneol, linolool, terpineol, safrol, elemicin, myristicins, phenylpropane derivatives, lauric acid, myristic acid, pentadecanoic acid, palmitic acid, heptadecanoic acid, stearic acid, oleic acid and b-sitosterol (Maeda et al., 2008). Myristica fragrans is used in nervous disorders, digestive disorders, leukemia, bodyache, vomiting, tachycardia, dizziness and memory disturbances (Asgarpanah and Kazemivash, 2012). It is hypolipidemic, antidepressant, antioxidant and antibacterial (Narasimhan and Dhake, 2006). N-hexane extract of Myristica fragrans at three dose levels (5, 10 and 20 mg/kg p.o.) was administered orally to young and aged mice for 3 successive days. This drug was found effective at 5 mg/kg in reversing scopolamine and diazepam induced impairment in learning and memory. This study validated use of Myristica fragrans in the management of AD and memory deficits (Parle et al., 2004). Bacopa monnieri Bacopa monnieri belongs to family Scrophulariaceae. It contains sterols, saponins, alkaloids, monnierin, hersaponin acid A, herpestine and brahmine (Singh, 2012). Traditional healers use Bacopa monnieri in combination with Centella astiatica and Evolulus alsinoides to treat memory disorders and AD (Russo and Borrelli, 2005). Bacopa monnieri enhances memory in patients with AD. It is adaptogenic, neuroprotective, antimicrobial and memory enhancer (Aguiar and Borowski, 2013). Carlo et al. (2008) reported the efficacy of Bacopa monnieri on cognitive performance, anxiety, and depression in the elderly and found effective in enhancing cognitive functions in the elderly. This study justifies its use as a memory enhancer. Another study demonstrated that Bacopa monnieri inhibits cholinergic degeneration and exhibits cognition enhancing activity in a rat model of AD (Uabundit et al., 2010). Evolvulus alsinoides Evolvulus alsinoides belongs to the family Convolvulaceae. Nahata et al. (2010) reported the efficacy of Evolvulus alsinoides in learning behavior and memory enhancement activity in rodents. Ethanol extracts of Evolvulus alsinoides and its ethyl acetate and aqueous fractions were investigated for memory enhancing activities in rats. Extracts at 100 mg/kg and 200 mg/kg were administered orally. All extracts significantly enhanced learning ability and memory retention in rats. Furthermore, these extracts (0.3 mg/kg, i.p) significantly reversed scopolamine induced amnesia in rats. Nootropic activity of extracts was compared with piracetam as the standard drug. Extract showed significant memory enhancing activity in the step-down and shuttle-box avoidance paradigms. Ficus racemosa Ficus racemosa belongs to the family Moraceae. Faiyaz et al. (2011) reported the memory enhancing activity of Ficus racemosa bark in rats and found that Ficus racemosa (250 and 500 mg/kg) significantly increased acetylcholine level in the hippocampus of rats. This study suggests its potential to treat memory deficits in patients with AD. Ginkgo ginseng Ginkgo ginseng belongs to the family Ginkgoaceae. Wesnes et al. (2000) reported the memory enhancing effect of Ginkgo ginseng in 256 healthy middle-aged volunteers through a 14-week study period. A questionnaire including sleep, mood, and quality of life was filled before and during the treatment period. Assessment was done at weeks 0, 4, 8, and 14 of the treatment. Ginkgo ginseng powder was found effective in improving memory deficits.

What did doctors carry in their black bags?

The items listed below are very comprehensive, and recommended for general practitioners working in the Highlands of Scotland (UK and European guidelines). Doctor's Bag – Contents. What to have in a Doctor's Bag Introduction The doctor's bag is very important and the contents of it vary according to the individual doctor and their pattern of work. GPs working in remote parts of the Highlands of Scotland will obviously have very different requirements from those working in the inner city. Many GPs will no longer work out of hours but will still need to be able to assess and manage patients while out on home visits. Those working for out of hours organisations may have some, or all, of the necessary equipment and medications provided. Click to find out more » General issues Some GPs may prefer to wear a jacket or coat with capacious pockets rather than carry a bag. Most GPs will use a bag of some variety and the following should be considered: The bag must be lockable and not left unattended. Most medicines should be stored between 4° and 25°C. A silver-coloured bag or cool bag is more likely to keep drugs cooler than a traditional black bag. Consider keeping a maximum-minimum thermometer in the bag to record extremes of temperature. Bright lights may inactivate some drugs (eg, injectable prochlorperazine) so keep the bag closed when not in use. Lock the bag out of sight in the vehicle boot when not in use. Basic and administrative equipment Photocard ID should be carried. Many patients may recognise their regular GP but locums or new GPs may need to confirm their identity before admission and all GPs may be required to identify themselves to other emergency services. Mobile phone - smartphones may also serve a number of other functions but this may be dependent on adequate reception. Stationery and a limited number of FP10 prescriptions, Med3 (fit notes), letter-headed paper and envelopes. British National Formulary or equivalent - but electronic versions of these which can be used via a smartphone or tablet are available and can replace the need for printed reference material. Investigation forms. Local map or electronic equivalent - satnav/GPS or smartphone. Personal alarm - several versions are readily available. The police suggest that when used, an alarm be thrown about 10-20 feet to cause distraction. Diagnostic equipment Stethoscope and pocket diagnostic set. Sphygmomanometer and infrared thermometer - sphygmomanometers should have calibration date stickers. Pulse oximeter. Glucometer including appropriate strips and lancets. Alcohol wipes, gloves, lubricating jelly. Alcohol gel for hands. Additional sphygmomanometer cuffs. Reflex hammer. Multistix for urinalysis. Tongue depressors, preferably wrapped. Small torch. Peak flow meter, preferably low-reading. Specimen bottles (urine/faeces) and swabs. Other equipment Some GPs will also carry the following equipment: A selection of syringes (1 ml, 2 ml and 5 ml), needles and tourniquet will need to be included if any parenteral medication is carried. A small sharps box. Face mask. A selection of airways can form part of the car's first aid kit and can be extended to one's own preference and skills up to full 'BASICS' level. Reversible fluorescent jacket (with Velcro® 'Doctor' signs) carried in the vehicle boot can be helpful in emergencies. Handheld spotlight plugged into the cigarette lighter can highlight house numbers (where they exist). Out of hours services are likely to provide equipment such as an automated external defibrillator (AED), oxygen and nebulisers. Individual GPs will need to assess whether these items are appropriate to their practice. Administrative issues There are a number of requirements around the administration of any medications. See also separate Controlled Drugs article. A record should be kept of the origin, expiry date and batch numbers of all drugs administered. Check at least twice a year that drugs are in date and usable (more often for medications that have a short shelf life like Syntometrine® and nitrates). If oxygen is carried the car should display the appropriate 'Hazchem' sticker. Patients given more than immediate treatment should be supplied with a patient information leaflet. A separate Controlled Drug (CD) register should be kept for the CD stock held within the doctor's bag. Each doctor is responsible for the receipt and supply of CDs from their own bag. Restocking of a bag from practice stock should be witnessed by another member of the practice staff, as should the appropriate entries into the practice's CD register. Where a prescription is written by a doctor following the administration of a CD to a patient, the doctor should endorse the prescription form with the word 'administered' and then date it. Information on any medications given should be entered into the patient's record as soon as practicable. Drugs The selection of a particular drug to be carried in a doctor's bag should be based on a number of considerations including the GP's personal familiarity with the drug, storage requirements, shelf life, cost, the availability of ambulance paramedic cover, the availability of a 24-hour pharmacy and the proximity of the nearest hospital. Out of hours centres may require their clinicians to use FP10P-REC forms to record medications dispensed to patients during out of hours consultations. The list of drugs below, based on guidance from the Drugs and Therapeutics Bulletin, can be used as the basis for a selection that can be used to meet common clinical scenarios. It is not exhaustive and neither is it expected that all GPs would carry all these medications.[1 , 2 ] NB: when an antibiotic or antiviral is given, a full course should be provided (ie enough medication to treat the presenting condition[3 ] Analgesia Paracetamol - 120 mg/5 ml and 250 mg/5 ml oral suspensions, 500 mg tablets. Ibuprofen - 100 mg/5 ml oral suspension, 400 mg tablets. Codeine - 25 mg in 5 ml syrup, 30 mg tablets. Morphine - 10 mg/5 ml oral solution, 10 mg/ml injection. Diamorphine - 5 mg or 10 mg (powder for reconstitution with water for injection). Diclofenac - 25 mg/ml injection, 25 mg tablets and 100 mg suppositories. Diazepam - 5 mg tablets (for muscle spasm). Naloxone - 400 micrograms/ml injection (to reverse opioid overdose). Antimicrobials Benzylpenicillin - 600 mg vials (x 2) for reconstitution with sodium chloride or water for injection. Cefotaxime - 1 g vial reconstituted with water for injection. Chloramphenicol - 1 g vial reconstituted in water for injection. Amoxicillin - 125 mg/ml and 250 mg/5 ml oral suspension, 250 mg capsules. Erythromycin - 125 mg/5 ml and 250 mg/5 ml suspensions, 250 mg tablets. Clarithromycin - 125 mg/5 ml and 250 mg/5 ml suspensions, 250 mg tablets. Trimethoprim - 50 mg/5 ml suspension, 200 mg tablets. Cefalexin - 125 mg/5 ml and 250 mg/5 ml suspension, 250 mg capsules. Flucloxacillin - 125 mg/5 ml and 250 mg/5 ml suspensions, 250 mg tablets. Aciclovir - 800 mg tablets. Asthma[4 ] A short-acting beta agonist - salbutamol metered dose inhaler (MDI) via spacer or 1 mg/ml nebuliser solution, or terbutaline MDI or 2.5 mg/ml nebuliser solution. Prednisolone - available as soluble tablets or solution. Oxygen - delivered via a close-fitting face mask with rebreather bag or nasal prongs. Ipratropium - 250 micrograms/ml nebuliser solution. Hydrocortisone - 100 mg powder as sodium succinate for reconstitution with water for injection (also useful for anaphylactic shock, adrenal crises). Rehydration Oral rehydration salts - eg, Dioralyte® or Electrolade® sachets. Diabetic hypoglycaemia[5 ] Quick-acting carbohydrate such as GlucoGel® or Dextrogel®. Glucagon - 1 mg/ml injection. Intravenous (IV) glucose - 50 ml of 50% is available in pre-filled disposable syringes. Seizures[6 ] Rectal diazepam - 2 mg/ml and 4 mg/ml strengths in a 2.5 ml rectal application tube. Midazolam - 5 mg/ml oromucosal solution, 2 ml pre-filled syringe given buccally (unlicensed route). Lorazepam- 4 mg/ml injection. Anaphylaxis[7 ] Adrenaline (epinephrine) - 1 mg/ml ampoules (1:1,000) for intramuscular (IM) use. Chlorphenamine - 4 mg tablets, 2 mg/5 ml syrup, 10 mg/ml ampoules for injection. Sodium chloride - 0.9%, 500 ml via giving set. Hydrocortisone - 100 mg powder as sodium succinate for reconstitution with water for injection (also useful for asthma, adrenal crises). Nausea and vomiting Domperidone - 1 mg/ml suspension, 10 mg tablets, 30 mg suppositories. Prochlorperazine 5 mg tablets, 3 mg buccal tablets, 12.5 mg/ml injection. Cyclizine - 50 mg tablets, 50 mg/ml injection. Procyclidine - (to reverse oculogyric crises and other dystonic reactions) 5 mg/ml injection. Metoclopramide - 10 mg tablets, 5 mg/ml injections. Myocardial infarction and angina[8 ] Aspirin - 300 mg dispersible (or chewed) tablets. Glyceryl trinitrate spray or sublingual tablets. Thrombolytics - some GPs may administer as per protocol drawn up in conjunction with local specialists. Pre-hospital thrombolysis is indicated if the time from the initial call to arrival at hospital is likely to be over 30 minutes. The National Institute for Health and Care Excellence (NICE) recommends using an IV bolus (reteplase or tenecteplase) rather than an infusion for pre-hospital thrombolysis Atropine - 600 micrograms/ml injection for bradycardia. See also separate Acute Myocardial Infarction Management article. Acute left ventricular failure Furosemide - 10 mg/ml injection, 20-50 mg by slow IV injection. It is also useful to have 40 mg tablets available for less severe congestive cardiac failure. Postpartum haemorrhage[9 ] Syntometrine® - ergometrine maleate 500 micrograms plus oxytocin 5 units/ml injection. Psychiatric emergencies Haloperidol - 1.5 mg tablets, 5 mg/ml injection[10 ]. Lorazepam - 1 mg tablets, 4 mg/ml injections. Flumazenil - 100 micrograms/ml injection to reverse respiratory depression caused by lorazepam. Provide Feedback Further reading & references Baird A ; Emergency drugs in general practice. Aust Fam Physician. 2008 Jul;37(7):541-7. Drugs for the doctor's bag: 1 - adults ; Drug Ther Bull. 2005 Sep;43(9):65-8. Drugs for the doctor's bag: 2 - children ; Drug Ther Bull. 2005 Nov;43(11):81-4. Guidelines for the management of community acquired pneumonia in children ; British Thoracic Society (2011), Thorax Vol 66 Sup 2 British Guideline on the management of asthma ; Scottish Intercollegiate Guidelines Network (2016) Diabetes (type 1 and type 2) in children and young people: diagnosis and management ; NICE Guidelines (Aug 2015) Epilepsies: diagnosis and management ; NICE Clinical Guideline (January 2012) Emergency treatment of anaphylactic reactions - guidelines for healthcare providers ; Resuscitation Council (UK) Guidelines (2008) Tackling myocardial infarction ; Drug Ther Bull. 2000 Mar;38(3):17-22. Prevention and management of postpartum haemorrhage ; Royal College of Obstetricians and Gynaecologists (May 2009 with revisions April 2011) Violence and aggression: short-term management in mental health, health and community settings ; NICE Guideline (May 2015) Original Author: Dr Laurence Knott Current Version: Dr Roger Henderson Peer Reviewer: Prof Cathy Jackson Document ID: 1153 (v10) Last Checked: 23/09/2016

Why are there so many wrong-dose errors in hospitals?

(1) Bean Counters, (2) Pharmacists, (3) Physicians, (4) Nurses, and (5) Paramedics The Bean Counter: Seriously, one of the biggest reasons that people make medication errors is “cost saving measures.” For instance, a pre-loaded syringe containing 1 mg of Epinephrine at a concentration of 1:10,000 costs about $10 retail. A single unit-dose vial of the same medication costs about half that ($5 retail), and a multi-dose vial of 30 mg at a concentration of 1:1000 costs around $90. Yep. The pharmacy is ultimately paying for packaging (compare that to a pre-loaded automatic epi-pen that costs around $700 for 0.3 mg of 1:1000.) Human beings (including doctors, nurses, pharmacists, and paramedics) are creatures of habit and tend to screw things up when conditions change…) When you change both the packaging and the concentration, the opportunity for error doubles. The bean-counter that decides to switch from pre-loaded syringes to multi-dose vials without consulting the clinical staff needs to get his head out of his ass. The Pharmacist: Likewise, you get the occasional pharmacist that thinks compounding a medication during an ambulance ride is a good idea… We had this with Lidocaine a few years back: take the 2 gram pre-loaded syringe of Lidocaine and inject that into a 500 ml bag of Dextrose 5% in Water (D5W) after pulling out 10 ml D5W and discarding. Mix thoroughly, giving a concentration of 4 mg/ml. Administer at a therapeutic rate of 1–4 mg/min. as per the results of your “lidocaine clock” calculation… Sure! Unfortunately, the 2 gram lidocaine pre-load is sitting in the same drug box as the “normal” 100 mg pre-loaded syringes used for IV bolus (as opposed to drip) use… Grab the wrong syringe (having almost exactly the same appearance) during a code and you’ve just administered 20 times the recommended dose. I never made this error, but it was merely by the grace of God that I didn’t. Yes, it’s true that mixing, re-constituting, diluting, and preparing these drugs is simple. Yes, it’s true that almost anybody can be trained to do it properly. Do you trust a person with minimal training and experience to do it, unsupervised, in the middle of the night? You shouldn’t. The Physician: Sorry, even the God-like physicians contribute to medication errors. One of my favorites was an order for 1 drop of 1% Atropine in the left eye for treatment of amblyopia (lazy eye.) The order was written: 1 gtt Atropine per O.S. which was interpreted as “by mouth” by the nurse instead of “oculus sinestra” as intended. A minor error, admittedly, that resulted in a very dry mouth and no improvement in the patient’s vision. I had a similar problem with an order for Aminophyline years ago, where the physician wanted a loading dose of 100 mg IV followed by a maintenance drip of 250 mg over 30 minutes. The order was written for a double-bolus rather than a bolus followed by a drip… He assumed that I would instantly be on his wavelength; I questioned the order and got chewed out for arguing with the physician. The Nurse: Nurses typically have their shit together when it comes to administering medications — they even specify five particular “rights” that have to be verified before pushing any drug: (1) The Right Patient, (2) The Right Drug, (3) The Right Dose, (4) The Right Route, and (5) The Right Time. Unfortunately, there are some circumstances where even the judicious application of these “rights” doesn’t keep the patient safe. One that comes to mind is the use of Adenocard (Adenosine Tri-Phosphate) for the treatment of supraventricular tachycardia (SVT); the physician ordered 6 mg Adenosine IV “Stat.” Watching the monitor for the characteristic “break” in the rhythm when the patient’s heart actually stops and resets itself, the physician saw no change. He was about to order an additional bolus of 12 mg IV when he noticed the nurse was still pushing the first dose. Knowing that Adenocard must be administered “IV SLAM” (a very rapid infusion) the doctor ordered her to push it FASTER… The nurse responded by quoting a hospital policy that all IV meds were to be given over five minutes so that any untoward effects could be noted and the administration halted. Since the metabolic half-life of adenosine is typically less than 30 seconds, pushing it slowly over five minutes precludes the drug from ever reaching therapeutic levels. The Paramedic: This is my own particular bailiwick, and I’ve seen evidence of medication errors that make my skin crawl. Most result from a lack of training and education but some seem like intentional oversights meant to sabotage the effectiveness of pre-hospital care. When paramedics administer drugs to a patient, they are (in the United States) operating under the authority of the medical command physician who oversees their particular service and to whom they are ultimately accountable. Rather than on-line medical direction, most services operate on a system of “standing orders” and “protocols” that specify the treatment to be rendered under a particular set of circumstances. A “chest pain” call where the pain is of suspected cardiac origin might specify (for instance) 324 mg Aspirin (chewed), establishment of IV access, a blood draw for stat labs on arrival, 0.4 mg Nitroglycerin SL, an option to repeat the Nitroglycerin once or twice at five minute intervals, and 4–10 mg Morphine Sulfate IV along with optional orders for oxygen (if hypoxic), Naloxone to reverse the Morphine (if needed), and a fluid bolus if the Nitroglycerin or Morphine result in significant hypotension. A classic problem here is not considering that the patient may already have ingested a large quantity of nitroglycerin before calling EMS. Another problem is misapplication of the protocol, say for a patient with traumatic chest pain or one who is suffering from an aortic aneurysm. Trust me, aspirin and nitroglycerin are probably the last drugs I would want under those circumstances. Finally, some medics are simply medication happy and try to find justification to push something on every call — these medics tend to over-treat and administer medications under inappropriate circumstances. Right now, the most “over used” medications seem to be Naloxone (Narcan), Zofram (Ondansetron), and Albuterol Sulfate (Proventil.) Likewise, for some reason, paramedics prefer to administer Dextrose 50% as a first-line drug for Hypoglycemia and underutilize Glucagen (Glucagon.) Pharmacology is a complex subject and people make mistakes. It’s easy to get self-righteous and condemn those people making the mistakes, but first we need to recognize the potential for human error and take steps to eliminate the opportunity to make those errors.

Do doctors still carry those black bags they used when they still made house calls?

Some do. The items listed below are very comprehensive, and recommended for general practitioners working in the Highlands of Scotland (UK and European guidelines). Doctor's Bag – Contents. What to have in a Doctor's Bag Introduction The doctor's bag is very important and the contents of it vary according to the individual doctor and their pattern of work. GPs working in remote parts of the Highlands of Scotland will obviously have very different requirements from those working in the inner city. Many GPs will no longer work out of hours but will still need to be able to assess and manage patients while out on home visits. Those working for out of hours organisations may have some, or all, of the necessary equipment and medications provided. Click to find out more » General issues Some GPs may prefer to wear a jacket or coat with capacious pockets rather than carry a bag. Most GPs will use a bag of some variety and the following should be considered: The bag must be lockable and not left unattended. Most medicines should be stored between 4° and 25°C. A silver-coloured bag or cool bag is more likely to keep drugs cooler than a traditional black bag. Consider keeping a maximum-minimum thermometer in the bag to record extremes of temperature. Bright lights may inactivate some drugs (eg, injectable prochlorperazine) so keep the bag closed when not in use. Lock the bag out of sight in the vehicle boot when not in use. Basic and administrative equipment Photocard ID should be carried. Many patients may recognise their regular GP but locums or new GPs may need to confirm their identity before admission and all GPs may be required to identify themselves to other emergency services. Mobile phone - smartphones may also serve a number of other functions but this may be dependent on adequate reception. Stationery and a limited number of FP10 prescriptions, Med3 (fit notes), letter-headed paper and envelopes. British National Formulary or equivalent - but electronic versions of these which can be used via a smartphone or tablet are available and can replace the need for printed reference material. Investigation forms. Local map or electronic equivalent - satnav/GPS or smartphone. Personal alarm - several versions are readily available. The police suggest that when used, an alarm be thrown about 10-20 feet to cause distraction. Diagnostic equipment Stethoscope and pocket diagnostic set. Sphygmomanometer and infrared thermometer - sphygmomanometers should have calibration date stickers. Pulse oximeter. Glucometer including appropriate strips and lancets. Alcohol wipes, gloves, lubricating jelly. Alcohol gel for hands. Additional sphygmomanometer cuffs. Reflex hammer. Multistix for urinalysis. Tongue depressors, preferably wrapped. Small torch. Peak flow meter, preferably low-reading. Specimen bottles (urine/faeces) and swabs. Other equipment Some GPs will also carry the following equipment: A selection of syringes (1 ml, 2 ml and 5 ml), needles and tourniquet will need to be included if any parenteral medication is carried. A small sharps box. Face mask. A selection of airways can form part of the car's first aid kit and can be extended to one's own preference and skills up to full 'BASICS' level. Reversible fluorescent jacket (with Velcro® 'Doctor' signs) carried in the vehicle boot can be helpful in emergencies. Handheld spotlight plugged into the cigarette lighter can highlight house numbers (where they exist). Out of hours services are likely to provide equipment such as an automated external defibrillator (AED), oxygen and nebulisers. Individual GPs will need to assess whether these items are appropriate to their practice. Administrative issues There are a number of requirements around the administration of any medications. See also separate Controlled Drugs article. A record should be kept of the origin, expiry date and batch numbers of all drugs administered. Check at least twice a year that drugs are in date and usable (more often for medications that have a short shelf life like Syntometrine® and nitrates). If oxygen is carried the car should display the appropriate 'Hazchem' sticker. Patients given more than immediate treatment should be supplied with a patient information leaflet. A separate Controlled Drug (CD) register should be kept for the CD stock held within the doctor's bag. Each doctor is responsible for the receipt and supply of CDs from their own bag. Restocking of a bag from practice stock should be witnessed by another member of the practice staff, as should the appropriate entries into the practice's CD register. Where a prescription is written by a doctor following the administration of a CD to a patient, the doctor should endorse the prescription form with the word 'administered' and then date it. Information on any medications given should be entered into the patient's record as soon as practicable. Drugs The selection of a particular drug to be carried in a doctor's bag should be based on a number of considerations including the GP's personal familiarity with the drug, storage requirements, shelf life, cost, the availability of ambulance paramedic cover, the availability of a 24-hour pharmacy and the proximity of the nearest hospital. Out of hours centres may require their clinicians to use FP10P-REC forms to record medications dispensed to patients during out of hours consultations. The list of drugs below, based on guidance from the Drugs and Therapeutics Bulletin, can be used as the basis for a selection that can be used to meet common clinical scenarios. It is not exhaustive and neither is it expected that all GPs would carry all these medications.[1 , 2 ] NB: when an antibiotic or antiviral is given, a full course should be provided (ie enough medication to treat the presenting condition[3 ] Analgesia Paracetamol - 120 mg/5 ml and 250 mg/5 ml oral suspensions, 500 mg tablets. Ibuprofen - 100 mg/5 ml oral suspension, 400 mg tablets. Codeine - 25 mg in 5 ml syrup, 30 mg tablets. Morphine - 10 mg/5 ml oral solution, 10 mg/ml injection. Diamorphine - 5 mg or 10 mg (powder for reconstitution with water for injection). Diclofenac - 25 mg/ml injection, 25 mg tablets and 100 mg suppositories. Diazepam - 5 mg tablets (for muscle spasm). Naloxone - 400 micrograms/ml injection (to reverse opioid overdose). Antimicrobials Benzylpenicillin - 600 mg vials (x 2) for reconstitution with sodium chloride or water for injection. Cefotaxime - 1 g vial reconstituted with water for injection. Chloramphenicol - 1 g vial reconstituted in water for injection. Amoxicillin - 125 mg/ml and 250 mg/5 ml oral suspension, 250 mg capsules. Erythromycin - 125 mg/5 ml and 250 mg/5 ml suspensions, 250 mg tablets. Clarithromycin - 125 mg/5 ml and 250 mg/5 ml suspensions, 250 mg tablets. Trimethoprim - 50 mg/5 ml suspension, 200 mg tablets. Cefalexin - 125 mg/5 ml and 250 mg/5 ml suspension, 250 mg capsules. Flucloxacillin - 125 mg/5 ml and 250 mg/5 ml suspensions, 250 mg tablets. Aciclovir - 800 mg tablets. Asthma[4 ] A short-acting beta agonist - salbutamol metered dose inhaler (MDI) via spacer or 1 mg/ml nebuliser solution, or terbutaline MDI or 2.5 mg/ml nebuliser solution. Prednisolone - available as soluble tablets or solution. Oxygen - delivered via a close-fitting face mask with rebreather bag or nasal prongs. Ipratropium - 250 micrograms/ml nebuliser solution. Hydrocortisone - 100 mg powder as sodium succinate for reconstitution with water for injection (also useful for anaphylactic shock, adrenal crises). Rehydration Oral rehydration salts - eg, Dioralyte® or Electrolade® sachets. Diabetic hypoglycaemia[5 ] Quick-acting carbohydrate such as GlucoGel® or Dextrogel®. Glucagon - 1 mg/ml injection. Intravenous (IV) glucose - 50 ml of 50% is available in pre-filled disposable syringes. Seizures[6 ] Rectal diazepam - 2 mg/ml and 4 mg/ml strengths in a 2.5 ml rectal application tube. Midazolam - 5 mg/ml oromucosal solution, 2 ml pre-filled syringe given buccally (unlicensed route). Lorazepam- 4 mg/ml injection. Anaphylaxis[7 ] Adrenaline (epinephrine) - 1 mg/ml ampoules (1:1,000) for intramuscular (IM) use. Chlorphenamine - 4 mg tablets, 2 mg/5 ml syrup, 10 mg/ml ampoules for injection. Sodium chloride - 0.9%, 500 ml via giving set. Hydrocortisone - 100 mg powder as sodium succinate for reconstitution with water for injection (also useful for asthma, adrenal crises). Nausea and vomiting Domperidone - 1 mg/ml suspension, 10 mg tablets, 30 mg suppositories. Prochlorperazine 5 mg tablets, 3 mg buccal tablets, 12.5 mg/ml injection. Cyclizine - 50 mg tablets, 50 mg/ml injection. Procyclidine - (to reverse oculogyric crises and other dystonic reactions) 5 mg/ml injection. Metoclopramide - 10 mg tablets, 5 mg/ml injections. Myocardial infarction and angina[8 ] Aspirin - 300 mg dispersible (or chewed) tablets. Glyceryl trinitrate spray or sublingual tablets. Thrombolytics - some GPs may administer as per protocol drawn up in conjunction with local specialists. Pre-hospital thrombolysis is indicated if the time from the initial call to arrival at hospital is likely to be over 30 minutes. The National Institute for Health and Care Excellence (NICE) recommends using an IV bolus (reteplase or tenecteplase) rather than an infusion for pre-hospital thrombolysis Atropine - 600 micrograms/ml injection for bradycardia. See also separate Acute Myocardial Infarction Management article. Acute left ventricular failure Furosemide - 10 mg/ml injection, 20-50 mg by slow IV injection. It is also useful to have 40 mg tablets available for less severe congestive cardiac failure. Postpartum haemorrhage[9 ] Syntometrine® - ergometrine maleate 500 micrograms plus oxytocin 5 units/ml injection. Psychiatric emergencies Haloperidol - 1.5 mg tablets, 5 mg/ml injection[10 ]. Lorazepam - 1 mg tablets, 4 mg/ml injections. Flumazenil - 100 micrograms/ml injection to reverse respiratory depression caused by lorazepam. Provide Feedback Further reading & references Baird A ; Emergency drugs in general practice. Aust Fam Physician. 2008 Jul;37(7):541-7. Drugs for the doctor's bag: 1 - adults ; Drug Ther Bull. 2005 Sep;43(9):65-8. Drugs for the doctor's bag: 2 - children ; Drug Ther Bull. 2005 Nov;43(11):81-4. Guidelines for the management of community acquired pneumonia in children ; British Thoracic Society (2011), Thorax Vol 66 Sup 2 British Guideline on the management of asthma ; Scottish Intercollegiate Guidelines Network (2016) Diabetes (type 1 and type 2) in children and young people: diagnosis and management ; NICE Guidelines (Aug 2015) Epilepsies: diagnosis and management ; NICE Clinical Guideline (January 2012) Emergency treatment of anaphylactic reactions - guidelines for healthcare providers ; Resuscitation Council (UK) Guidelines (2008) Tackling myocardial infarction ; Drug Ther Bull. 2000 Mar;38(3):17-22. Prevention and management of postpartum haemorrhage ; Royal College of Obstetricians and Gynaecologists (May 2009 with revisions April 2011) Violence and aggression: short-term management in mental health, health and community settings ; NICE Guideline (May 2015) Original Author: Dr Laurence Knott Current Version: Dr Roger Henderson Peer Reviewer: Prof Cathy Jackson Document ID: 1153 (v10) Last Checked: 23/09/2016

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