text:
|Publication number
|Publication type
|Publication date
|Mar 18, 1975
|Filing date
|Apr 3, 1974
|Priority date
|Apr 3, 1974
|Publication number
|Walter L Bessinger, Robert M Conklin, Elmer A Koenig, Jack A Russell
|Original Assignee
|Sherwood Medical Ind Inc
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (2), Referenced by (118), Classifications (21), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
United States Patent [1 1 Koenig et al.
[4 1 Mar. 18, 1975 PELLETIZED MEDICAMENT DISPENSING SYSTEM [75] Inventors: Elmer A. Koenig, Kirkwood, Mo.;
Robert M. Conklin, Chappaqua, N.Y.; Walter L. Bessinger, Grand Haven, Mich.; Jack A. Russell,
Libertyville, Ill.
[73] Assignee: Sherwood Medical Industries Inc.,
St. Louis, Mo.
[22] Filed: Apr. 3, 1974 [21] Appl. No.: 457,676
[52] US. Cl 53/59 R, 53/78, 53/168, 53/268, 221/2, 221/113, 221/120, 221/203 [51] Int. Cl B65b 57/20 [58] Field of Search 53/59 R, 78, 168, 268; 22l/ll3,1l9,l20,129, 130,132, 203, 2
[56] References Cited UNITED STATES PATENTS 2,176,823 10/1939 Richardson 22l/ll3 X 3,018,595 1/1962 Harris et al. 53/78 Primary Examiner-Travis S. McGehee Attorney, Agent, or Firm-Stanley N. Garber; William R. OMeara [57 ABSTRACT A pelletized medicament dispensing system having a plurality of medicament pellet containing bowls mounted on a rotatable member in a helical array. A control system rotates the array to bring a selected bowl to a packaging station. At the packaging station, a varying magnetic field vibrates the selected bowl effecting movement of a selected number of pellets, one at a time, through a bowl outlet and into a packaging cup. Patient and medicament data is printed on a label that also serves as a package cover for the cup. The package of pellets is then dispensed from the system for use. An electronic control system for automatically dispensing the desired kind and number of pellets, and for printingthe desired patient information on the label is also provided. The pellet-containing bowls are elliptical and are provided with a pair of storage bins which are selectively opened to replenish the bowls.
14 Claims, 16 Drawing Figures Pf-JENTEDHAR 1 81975 sum 1 or 7 PATENTEB MAR 1 81875 Sri'LU 3 (if 7 A A Y FIG.6
PATENTH] MAR] 81975 SHEET u or I FIG? PATENTED 1 8 I975 SEE a, a i 5 v i \ww m a l I I l Mara/e I PARK 8 WI TC/l PM'ENIEW 3,871,156 sum 5 o I PELLETIZED MEDICAMENT DISPENSING SYSTEM BACKGROUND OF THE INVENTION While vending machines are available that will dispense on command packages containing a predetermined amount of ingredients per package, these machines do not have the capability of varying the number of elements or amount of material in each package. Also, they do not have the capability of forming a package and providing a label thereon.
In the dispensing of pelletized medicaments, such as pills, tablets, capsules, suppositories, lozenges, and the like, in a hospital, the pharmacist fills a prescription by packaging a predetermined number of pellets in a container and places a typed label thereon indicating the patient, room number, type of drug, and dosage. Because of the large variety of medicament pellets and the variations in the number of pellets for each prescription, prepackaged medicament pellets have not been generally dispensed by a dispensing machine.
SUMMARY OF THE INVENTION Accordingly, it is an object of the present invention to provide a pelletized medicament dispensing system capable of dispensing packages containing any ofa variety ofmedicament pellets in any desired quantity. Another object is to provide medicament pellet containers for use in a medicament dispensing system of the above type wherein the container is capable of holding a relatively large number of pellets while requiring a relatively small space so as to reduce the overall size of the apparatus, and wherein pellets can be dispensed one at a time. Still another object is to provide storage means associated with medicament pellet containers of the above type wherein a relatively large number of pellets can be actuated selectively to reduce the number of times the dispensing machine must be entered for replenishing pellets.
In accordance with one form of the invention, a pellet dispensing system is provided which includes an array of medicament pellet containing bowls each capable of being vibrated by a magnetic field to discharge pellets therefrom and including a variable magnetic field device. The magnetic field device and array are relatively movable to bring a selected one of the bowls and the device into cooperative position so vibration caused by the magnetic field of the device effects movement of a selected number of pellets out of the bowl and into a packaging member.
These and other objects and advantages of the present invention will become apparent from the following detailed description and accompanying drawings. The novel features which are believed to be characteristic of this invention are set forth with particularity in the appended claims.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a top plan view of a pelletized medicament dispensing system, with an upper portion removed for clarity, in accordance with a preferred embodiment of the present invention.
FIG. 2 is an elevational view partly in section of the turret mechanism of the dispensing system of FIG. 1;
FIG. 3 is an enlarged fragmentary plan view illustrating one of the pellet storage units of the system of FIG.
FIG. 4 is a cross-sectional view taken along the line 4-4 of FIG. 3;
FIG. Sis a right-hand end view of the pellet container of FIG. 3;
FIG. 6 is a cross-sectional view taken along the line 6-6 of FIG. 3;
FIG. 7 is a top plan view of the bowl of the container unit of FIG. 3 removed from other portions of the storage unit;
FIG. 8 is a cross-sectional view taken along the line 88 of FIG. 7;
FIG. 9 is a perspective view of one of the storage boxes of the pellet container unit of FIG. 3;
FIG. 10 is a fragmentary vertical cross-sectional view of the drive mechanism of the turret of the dispensing system of FIG. 1;
FIG. 11 is a cross-sectional view taken along the line l11l of FIG. 10 with portions broken away for clarity;
FIG. 12 is an elevational view illustrating a motor drive system for the turret of FIG. 1;
FIG. 13 illustrates an elevational view of the motor drive system of the packaging station of the dispensing system of FIG. 1;
FIG. 14 illustrates a sectional view taken along the line 14-14 of FIG. 1 illustrating the feeding of pellets and auxiliary storage operating mechanism;
FIG. 15 is a block diagram illustrating an automatic control system of the dispensing system of FIG. 1; and
FIG. 16 is a perspective view of a completed sealed prescription package of medicament pellets with a cover label thereon dispensed from the dispensing systern of FIG. 1.
DESCRIPTION OF THE PREFERRED EMBODIMENT Referring now to the drawings and particularly to FIGS. 1-3, a pelletized medicament dispensing system 10 is shown including a rotatable medicament storage turret 12 having a carriage 14in the form ofa helix carrying a plurality of coded pellet storage units 16 disposed in a helical array. The system 10 is automatically controlled to dispense packages of a selected kind and number ofmedicament pellets by an electronic control system 15 shown in FIG. 15 which will be described in detail hereinafter.
Rotation of the turret is controlled so as to bring a selected one of the storage units 16 to a pellet feeding and packaging station indicated generally at 18. Each storage unit may store a different kind of medicament pellet. At the packaging station 18, a preselected number of pellets of a preselected kind are packaged with a label and dispensed from the system.
The dispensing system 10 is shown enclosed in a cabinet 20 having a front lower door 22 with a horizontal upper cover 23 hinged to the cabinet to provide access to the turret drive mechanism illustrated in FIGS. 10 and 12, and the packaging station driving unit illustrated in FIG. 13.
The turret assembly 12, as also seen in FIGS. 10-12, includes a vertical stationary tubular member 24 fixed at its lower end to a supporting member 26 by bolts 27 with the supporting member provided with pads bearing on a base or floor 28 of the system. A rotatable tubular drive member 30 concentric with tubular member 24 is fixed to a rotatable drive wheel or drive pulley 32 supported by bearings 31 on the supporting plate 26. A drive belt 34 on pulley 32 rotates the pulley and is driven by a stepping motor 36, as seen in FIG. 12, through a ratio changing pulley arrangement 38. A rotatable tubular member 30 is provided with three axially extending rectangular keys (one shown) 40 which are received in keyways 42 (FIG. provided in lower and upper circular coupling members 44 and 46 that are connected to a vertically extending tubular support member 48. The web 14 carrying the pellet storage unit 16 is fixed, such as by bolts, to the exterior of support member 48. Thus, the tubular member 48 carrying the units 16 is rotatable with the tubular member 30 due to the connection between the coupling members 44 and 46 of member 48 and the keys 40 fixed to the member 30.
Turret 12 carrying the helical array of units 16 is movable up and down as it rotates by means ofa rotaryto-vertical movement translating device, indicated generally at 50 and as best seen in FIG. 10. Device 50 includes a vertically extending threaded shaft 52 mounted for rotation in a bearing 53 in the drive wheel 32 and having a small gear 54 at the lower end engaged with internal threads of a ring gear 56 fixed to the supporting member 26. As the drive member 32 rotates, bearing 53 and shaft 52 rotate with it. The gear 54 causes rotation of shaft 52 as the gear 54 rotates about the stationary ring gear 56. The supporting tubular member 48 is moved up and down during rotation by means of an internally threaded coupling nut on bushing 58 threadedly received on the threaded shaft 52 and fixed by nuts 59 to the member 48. Thus, when the drive pulley 32 rotates, the gear 54 and shaft 52 rotate to cause the coupling nut 58 to move vertically up or down on the shaft 52 due to its threaded connection therewith, to thereby effect rotation as well as vertical movement of the member 48. In this way, the array of storage units 16 can be moved to position any one of them at the packaging station 18.
Turret 12 is provided with a counter-balance in the form of a weight 49 slidable in tubular member 24 and connected by a cable 51 over a wheel at the top to tubular member 48 carrying units 16. Weight 49 rises as the turret 12 lowers and lowers as the turret rises to obtain a substantially constant load on stepping motor 36.
Referring now especially to FIGS. 39, each of the storage units 16 includes an upper metal supporting frame 60 removably secured to the web 14 by means of a rotatable lever 62 (FIGS. 3 and 4) having a lower eccentric abutment member 63 engageable with a rear band 64 on the frame 60 to clamp the frame to the web. The pair of pins are shown in phantom in FIG. 3 entering holes in the rear of the frame 60 to insure that the unit 16 is rigidly connected to the web.
Frame 60 is elongated and extends radially outwardly from the web to support a pellet-carrying bowl 66 of generally elliptical configuration. Preferably, the bowl is formed of a suitable plastic, such as polypropylene. Bowl 66 is suspended in spaced relation from the frame 60 by three inclined spring members 68a, 68b and 680, which may also be formed of a suitable plastic such as polypropylene. Each of springs 68a, 68b and 68c is connected at the top by a screw 71 to the frame 60 and at the bottom of the bowl 66 by any suitable means, such as a plastic rivet or weld 72. Each of the legs extends downwardly from the frame 60 and is inclined in the same circumferential direction so that any vertical force applied to the bowl relative to the frame will cause a generally circumferential or circular movement of the bowl relative to the frame.
A plate 74 of magnetic material such as iron or steel is secured by a pair of screws 75 to the bottom of the bowl, it being centered over the center of gravity of the bowl. The plate 74 is adapted to be positioned in a variable magnetic field during the feeding or dispensing of pellets at the packaging station. A single magnetic field producing device is indicated generally at 76 in FIGS. 4 and 5, and is positioned in fixed relation at the packaging station where the pellets are to be fed into a cup. It includes an iron core 77 and a coil 78. Since the array of bowls moves in a helical path, the magnetic plate 74 of the bowl and the pole faces of magnetic member 76 are parallel to each other but inclined to the vertical so that the bowls pass the magnetic member 76 without interference, and such that when a bowl stops at the dispensing station above the magnetic member 76, the gap is of constant dimension. At the feeding station, a magnetic field is created by alternating current flow in coil 78 which acts on plate 74 to create forces causing rotary vibratory effects on the bowl 66 due to the springs 68a-68c. Thus, the bowl tends to rotate back and forth at a rate dependent on the frequency of current flowing in coil 78 which may be, for example, 60 cycle current. This vibration effect, of course, causes pellets in the bowl to vibrate and move in a direction toward the outlet of the bowl.
It has generally been considered a necessity that the bowl and other portions, such as the springs, be generally symmetrical or circular in order to obtain vibration feeding of particles out of a bowl. Use of generally circular bowls with spring members equally angularly related and having their neutral axes equally distant from the center of gravity were considered general requirements for proper operation. The use of oblong or generally elliptical bowls, such as bowl 66, instead ofcircular bowls in a system having an array, such as the helical array of bowls of turret 12, however, greatly reduces the overall size, as well as the size of parts and the inertia involved in moving a turret such as turret 12. Use of plastic bowls 66 further decreases the total weight of the turret.
As seen in FIG. 7, the bowl 66 has a bottom wall 80 with a high point or hump 81 adjacent the front portion of the bowl. A ramp, indicated at 82, has an entrance at 83 near the hump 81. Ramp 82 continuously rises and extends in a generally elliptical curve to an outlet indicated at 84 connected with a discharge chute 85 of transparent material such as plastic. The ramp is generally inclined or banked downwardly towards the outer wall 86 of the bowl for substantially the entire length of the ramp. The ramp 82 has an inner wall which is generally elliptical, as indicated at 87, and which extends above the floor of the ramp to prevent pellets from falling back into the central area 80 during feeding operations. The incline of ramp 82 is more clearly seen in FIGS. 4, 6 and 8.
It will be apparent from FIG. 7 that the three springs 68a-68c are not symmetrically angularly disposed about the bowl or its center of gravity, indicated by a point 87. Springs 68a and 68b are disposed near the outer end ofthe bowl while spring 680 is near the inner end. With this construction, the pills stored in the central portion 80 will vibrate and move into the ramp entrance 83 and then move along the ramp 82 to the exit or outlet 84. The hump 81 aides in moving the pellets outwardly and tends to prevent them from circulating in the center portion 80.
In order to insure that only one pellet at a time moves out of the bowl for counting purposes, a scraper member 88 is shown connected by screws to the frame 60 (FIGS. 6 and 7) and extends angularly across the ramp 82 and touches the side wall of the bowl near the outlet of the ramp. Member 88 is flexible so that it does not interfere or prevent bowl vibration. It is preferably of thin plastic material. Scraper 88 is in the path of the moving pellets and allows only one pellet to pass under it by scraping off any pellets that happen to ride on the top of another pellet. Between the scraper 88 and the ramp outlet 84 is a pill return chute 89 which has the effect of narrowing the ramp adjacent the outlet so that should more than one pill pass scraper 88, all of them will fall into the chute 89 and back into the bowl. Also, a vertically extending wall 90 is provided at the outlet 84 to prevent pellets in the center portion 80 from being vibrated directly to the outlet 84. The wall 90 is spaced from the bowl 66 so as not to interfere with the bowl vibration.
A feed gate 92, as seen in FIG. 5, normally closes the outlet 84 of the bowl to prevent loss of pellets. When a bowl reaches the feeding station to dispense pellets, an actuating arm 93 connected to an actuating motor 94 controlled by the electronic system, for example, is operated to engage the feed gate 92 and move it upwardly out of the path of movement of the pellets at the outlet 84 to permit the pellets to feed out of the bowl.
As seen in FIGS. 3 and 4, the frame 60 has a pair of generally rectangular openings 96 and 97 which communicate with the interior of the storage bowl 66. Each of the openings 96 and 97 is adapted to receive an auxiliary storage bin or box 98, as seen in FIG. 9. In FIG. 3, the openings 96 and 97 are shown receiving auxiliary storage boxes 98a and 9812, respectively. Each of the storage boxes is adapted to carry an auxiliary supply of pellets to be selectively dispensed into the bowl when the bowl is empty. As seen in FIG. 9, the auxiliary storage box 98 has a generally rectangular storage portion 108 and a lid 110 pivotally connected to one side of the storage portion 108. The storage portion 108 has a peripheral flange 112 which extends outwardly from the box and is adapted to engage a peripheral flange 114 around each of the openings 96 and 97 of the frame. The boxes as seen in FIG. 3 are held in their openings by a resilient spring clip 109 at each end of the openings 96 and 97. The lid 110, when closed, frictionally engages the interior of the peripheral flange 112 of the storage portion ofthe box 98 to hold the pellets therein with the pellets resting on the interior surface of the lid, such as seen in FIG. 4. The auxiliary storage box 98 is shown as a single-piece member formed of a suitable plastic such as polypropylene with the lid 110 integrally hinged to the storage portion 108.
Each of the auxiliary boxes 98 has a substantially straight side indicated at 116 and a slightly curved or multi-sided opposed side 118 to which thelid is hinged. A pair of cut-outs or grooves 120 and 122 are provided in the opposed ends 123 and 124 of the storage portion 108 which extend through the flange 112 adjacent the straight side 116. The lid 110 is provided with a pair of opening tabs 126 and 128 which, when the lid 110 is closed, enter the slots or grooves 120 and 122 in the periphery of the storage portion 108.
For proper operation of the vibrating bowl, the bowl should not be overfilled with pellets. Thus, by utilizing two auxiliary storage bins or boxes 98 which can be selectively opened after the bowls are empty, the device can operate to dispense a relatively large number of pellets without refilling the dispensing device. When a particular bowl 66 has been emptied, only one of the auxiliary boxes 98 is opened and the pellets therein drop into the bowl, thus replenishing the pellets for future feeding. After the replenished bowl is again empty, the second auxiliary storage box is emptied into the bowl. For this purpose, a lid actuating or operating member 140, as seen more clearly in FIGS. 3, 5 and 14, is mounted for controlled rotation on the front or radially outer wall of the frame 60. Operating member includes a pair of actuating wheels 142 and 144 fixed together by a hub 146 which is mounted for rotation on a shaft 148 that is fixed to a pair of extensions 150 and 152 on the frame 60.
Actuating wheel 142 has a pair of radially outwardly extending lugs or projecting abutments 154 and 156 disposed 180 apart, and wheel 144 has a pair of similar lugs or abutments 158 and 160 disposed from each other. The two wheels are related in fixed relation such that the four lugs are spaced 90 apart. The two wheels are located on'the frame 60 such that during any given 90 rotation, one of the four lugs of actuating member 140 will engage one of the tabs 126 or 128 on one of the lids 110 of one of the auxiliary storage boxes 98 to thereby move the lid downwardly to dump the stored pellets into the main center portion 80 of the bowl 66. For example, when both of the auxiliary boxes 98a and 98b are closed and filled with pellets, and the wheels are in the position indicated in FIGS. 3, 5 and 14, the lug 154 and wheel 142 will move downwardly and engage lid tab 126 to snap open the auxiliary storage box 98a to dump all of the pellets from that box into the bowl 66.
Movement of wheel 142 is effected by a dump actuating mechanism indicated generally at 164 in FIG. 14. Mechanism 164 includes a link 166 pivotally connected eccentrically or off-center on a rotatable crank or disc 167. Link is biased by a spring 168 toward the actuating member 140. It has a roller 169, shown in phantom, located near the center of the link which is engageable with a cam surface 170. At the lower opposite end of link 166 is an actuating pin 172, seen also in phantom in FIG. 3, which is long enough to engage both wheels 142 and 144. Pin 172, for one complete rotation of the disc 168, traverses a path indicated by the dash line with arrows at 173. It will be seen that the actuating pin 172 will hit one of the lugs on one of the wheels 142 or 144 on actuating member 140 to effect a 90 rotation of that wheel to thereby move the opposed lug of that wheel so that it engages one of the tabs 126 or 128 on the lid 110 of one of the storage boxes 98a or 98b to thereby dump the stored pellets into the bowl. During movement of the actuating pin 172 through the path 173, the roller 169 will, of course, leave the cam surface 170, but the cam surface will serve to guide the link 166 during return movement and to hold it in a parked position clear of the storage unit 16. In this manner, upon command from the control system 15, the mechanism 164 will cause only one storage package 98 to dump its contents at a time. That is, the two storage boxes cannot be operated simultaneously and overfill the bowl.
An elongated rotatable cup-carrying member 180, as seen in FIGS. 1, 13 and 14, is provided with openings at each end for holding cups 181 that are adapted to receive pellets from a selected storage unit 16. The member 180 is operated by a motor 182, as seen in FIG. 13, through a four-position geneva gear assembly 183. In the pellet feeding position 187 of the member 180, such as shown in FIG. 1, a cup 181 is disposed beneath the pellet chute 85 of the selected storage unit 16. After the feed gate 92 is opened, as seen in FIG. 5, and the magnetic field producing device 76 is energized, the bowl will vibrate and pellets will move out of the bowl 66 and into the cup as indicated in FIG. 14. A light source 190 and a photodetector 192 actuate electronics in the control system to count the number of pills being dispensed and to stop the energization of the magnetic device 12 and close the feed gate 92 after a desired number of pellets have been dispensed into the cup. After the selected number of pellets have been placed in cup 181, the cup-carrying member 180 is rotated 90 by the geneva gear to position it at a printing, labeling and covering station 194. As best seen in FIG. 13, the printing mechanism may be of conventional design ,which includes a supply roll 201 of strip material such as paper strip 202 which may have a heat sensitive layer of adhesive on one side. The paper is advanced by paper advance rollers 204 between a rotatable printer roller 206 and a hammer mechanism 208. An ink roller 210 is shown engaging the periphery of print roller 206 to apply ink to the characters on its periphery. The roller 206 may be provided with a plurality of axially spaced circumferential lines of type. The hammer mechanism 208 may include a plurality of electromagnetically operated hammers corresponding to the desired number oflines of type and which are actuated to hit the paper at the time a desired character is facing it. An encoder disc (not shown) for example, provides signals to the control system to control the hammers for obtaining a label printed in accordance with the selected or desired input information supplied to the control system. The printed strip 202 is cut by a cutter 220 into a labeled lid of suitable size sufficient to cover the cup located at the label station. The label may contain the patients name, room number, dosage, and kind of medicament. After the strip 202 has been cut by cutter 220, a label pull element 224 is actuated to pull the label over the open top of cup 181 to close it. A heating element 230 is then actuated to move down onto the label and activate the adhesive on the label to seal it to the periphery of the cup. The member 180 is rotated another 90 to bring the cup to a dispensing station 232.
As seen in FIG. 13, an operating label pull mechanism 234 for operating element 230, and a cup-drop mechanism for dropping a cup into member 180 at a cup drop station 260 are shown controlled by cams driven by motor 182 through suitable gearing 238. Also, a park switch 265-is activated to signal the control system 15 to insure that a cup is in place before feeding operations take place.
At the dispensing station 232, the completed sealed cup or prescription package may be blown out by a blower (not shown) or by other suitable discharge means to a position for retrieval and use. FIG. 16 shows a completed prescription package with a labeled lid.
By using the cup-carrying member as described, the packaging station performs its operations in a relatively 8 short period of time since the printing operation and label may be applied while a cup is being moved into an empty cup-receiving opening in one position of member also, a given cup may be filled while a completed package of pellets is discharged from the device.
It will be apparent that control of the operation of the turret and other functions may be done manually, semiautomatically by suitable control means or fully automatically by control electronics such as shown in FIG. 15. For example, an information input device 300 may be a suitable source of binary coded information, for example, a card reader punched in the ASCII Code or other device such as a magnetic tape input or CRT terminal. The interface electronics 302 connected to receive the coded information, in the illustrated example, supplies input date in the proper form to a random access memory 304 and provides a sync pulse to a writein address counter 306 to effect addressing of the random access memory through an address switching network 308 during the write-in cycle. In this case, a read only memory 310 is used to address the random access memory 304. A read-out address counter is provided for the read only memory and is connected to the writein address counter to transfer control between the write-in counter and read-out counter as the circuit transfers from the write-in cycle to the read-out cycle. The output of the random access memory supplies data control information to the control logic indicated at 314. The control logic 314 controls, for example, the magnetic field producing member 76 for feeding pills from the bowl 66 into a cup, the control dump mechanism 164 and the pill counter 192 as seen in FIG. 14, as well as supplying signals for controlling the packaging motor through a package control 320. Also, logic 314 is used to control signals through a motor pulse circuit 325 to control the motor 36 which operates the turret or helical storage array 12. For stopping the turret 12 to selectively position a desired storage unit 16 at the packaging station, an encoder disc 330 having a plurality of code holes in serial radial array which correspond respectively to each of the units 16, is used to stop the turret at the packaging station. For example, the control logic in response to a given input signal to the control system, keeps the turret 12 turning by means of motor 36 until a signal from a photocell hole detector senses that the requested coded storage unit 16 has reached or is about to reach the packaging station. The encoded disc 330 is coupled through a suitable mechanical ratio changer 339 to the motor. There is also provided another disc 345 coupled to the stepping motor that has a slot at the periphery thereof. A photosensitive detector 352 is provided to detect the passing of the slot and is connected to the logic to insure that the unit is always stopped at precisely the packaging station location or in an exact parking position for proper feeding of pellets. The discs 330 and 345 are shown also in FIG. 12 coupled to the motor 36.
It is to be understood that the foregoing description and accompanying drawings have been given only by way of illustration and example, and that alterations and changes of the present disclosure, which will be readily apparent to one skilled in the art, are contemplated as within the scope of the present invention.
What is claimed is:
1. A dispensing system for dispensing a predetermined number of designated medicament pellets comprising a plurality of movable medicament pellet storage units each adapted to contain different types of medicament pellets, means for moving said storage units to position a selected one of said units containing said designated pellets at a packaging station, each of said units including a bowl having an outlet for discharging pellets therefrom, means for positioning an open container adjacent said outlet for receiving pellets from the bowl, means located at the packaging station for effecting discharge of the pellets through the outlet and into the container, means for counting the discharged pellets, means for terminating the discharge of pellets when said predetermined number is discharged, and means for closing the container.
2. The system of claim 1 including an elongated rotatable member at the packaging station having a recess adjacent each end for receiving an open container, means for moving one end thereof to a position adjacent the outlet of a bowl of a storage unit positioned at the packaging station, means for rotating said member to position said one end at a printing station, means for printing a label and covering a container at said printing station, means for moving said one end to a discharge station, means for discharging the closed container from said member, and means for moving said one end to a container dispensing station to move an empty container into said recess of said member at said one end.
3. A dispensing system for dispensing medicament pellets comprising a turret having an array of medicament pellet storage units connected thereto containing different kinds of medicament pellets, means for rotating said turret to position a selected one of said units at a packaging station, each of said units including a bowl having an outlet for discharging pellets therefrom and magnetic means thereon for effecting vibration of the bowl in response to a varying magnetic field applied thereto to move stored pellets from the bowl through the outlet, means for positioning an open container adjacent said outlet for receiving pellets from the bowl, magnetic field producing means located at the packaging station for applying a varying magnetic field to the bowl magnetic means of the unit while positioned at the packaging station, and means for closing the container.
4. The system of claim 3 wherein said storage units are positioned on said turret in a helical array to pass said packaging station in a serial manner.
5. The system of claim 4 including means for moving said turret to move each of said units through a helical path.
6. The system of claim 4 further including motion translation means for effecting vertical movement of said turret simultaneously with rotary movement thereof so that each of said units traverse a helical path.
7. The system of claim 5 wherein said means for closing said container includes means for printing a label and covering the open container with the label.
8. A dispensing system for dispensing a predetermined number of medicament pellets into a container comprising information source means for receiving information designating the type and number of medicament pellets to be dispensed, turret means carrying a plurality of coded storage units each including a bowl having an outlet and magnetic means for vibrating the bowl in response to an applied magnetic field to move stored pellets through the outlet, each of said storage units containing a different type of medicament pellets, control means for moving said storage means to position a selected storage unit at a dispensing station in response to designated information applied to the information source, magnetic field producing means mounted in fixed relation at the dispensing station and closely spaced from the bowl magnetic means of the selected storage unit positioned at the dispensing station, means for providing an open container at the dispensing station adjacent the bowl outlet, said magnetic field producing means being operable to effect vibration of the bowl and movement of pills out of the bowl and into the container, and counting means for controlling the number of the pellets moved into the container in accordance with the designated information applied to the information source.
9. The system of claim 8 further including means for closing the container.
10. The system of claim 8 wherein said storage means is a continuous helical array of storage units which are mounted to said turret means and movable in a helical path.
11. The system of claim 10 wherein said control system includes drive means for rotatably driving the helical turret in opposite vertical directions, code means for detecting when a predetermined storage unit containing a prescribed medicament pellet is at the dispensing station, and stopping means responsive to said code means for stopping the drive means when the predetermined storage unit has been transferred to the dispensing means.
12. The system of claim 10 further including a first vertically extending rotatable member, rotatable drive means for rotating said first member, a second vertically extending cylindrical member concentric with said first member and having said storage units connected thereto, coupling means connecting said second member to said first member for simultaneous rotation but permitting vertical movement of said second member relative to said first member, and motion translating means for converting rotary movement of said drive means into vertical movement of said second member.
13. The system of claim 12 wherein said motion translating means comprises a vertically extending threaded shaft rotatable with said second member about the vertical axis of said second member, a stationary ring gear, a gear on said shaft engaged with said ring gear to rotate said shaft about its own vertical axis during rotation of said second member, and a threaded coupling element fixed to said second member and movable axially in response to rotation of said shaft about its own axis.
14. The system of claim 12 wherein said coupling means includes vertically slidable interconnected key and keyway means connected between said first and second members.
=l l l UNITED STATES PATENT OFFICE CERTIFICATE OF CORRECTION PATENT NO. 37 156 DATED March l8, 1975 rrivrgmomg Elmer A. Koenig et al It is certified that error appears in the above-identified patent and that said Letters Patent are hereby corrected as shown below:
In the Drawing, Sheet l Figure l numeral "l at each end of the section line through the center of carriage 14 should be --2--. Sheet 2, Figure 2, the section lines 2-2 and 9-9 should be deleted. Sheet 3, Figure 3, the numeral "1 should be -l40--. Sheet 4 Figure 5, reference numerals --93-- and --94-- should be respectively appl ied'to the movable arm engageable with gate 92 and the circular motor connected to the arm; Figure 7 the numeral 87 at the center of bowl 66 should be --9l--. Sheet 6, Figure 14, the reference numerals --l66-- and --l 67- should be applied respectively to the movable link which carries pin l72 and the disc connected to the upper end of the link. Sheet 7, Figure l5, the reference numeral --320-- should be applied to the "Pkg Motor Control box; the word "Read" in box 306 should be --write-- and the lower reference numeral "306" and its lead l ine should be deleted; the bottom word "Logic" in box 314 should be deleted. Column l line 64, after "system" insert --taken along 1 ine 2-2--. Column 4, line 62, "87" should read -9l-- Column 8, line l7 "date" should be --data--. Column l0, lines 6 and 23, "storage" should read --turret--; the word "sys-tem" at the end of line 27 and beginning of line 28 should read -means--; line 29, after "turret" insert --means--; and in line 35 "means" should read --station--.
Signed and Scaled this [SEAL] y-lhird 0f March 1976 A ttes t.-
C.(I;1A SON C. MARSHALL DANN s mg fjlcer Commissioner ofParenls and Trademarks
|Cited Patent
|Filing date
|Publication date
|Aug 19, 1936
|Oct 17, 1939
|Fischman Company
|Vending machine
|Mar 25, 1959
|Jan 30, 1962
|Hoffmann La Roche
|Package filling apparatus
|Citing Patent
|Filing date
|Publication date
|Feb 2, 1984
|Oct 15, 1985
|Buttarazzi Patrick J
|Apparatus for dispensing medication
|Feb 1, 1984
|Feb 25, 1986
|Rafael Benaroya
|Timed dispensing device for tablets, capsules, and the like
|Sep 12, 1983
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|Kermit E. Lewis
|Automatic pill dispenser and method of administering medical pills
|Mar 29, 1989
|May 12, 1992
|Delphi Technology, Inc.
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|Dispensing Technologies, Inc.
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|Kemp; Vivian
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|Yuyama Mfg. Co., Ltd.
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|Profile Systems, Llc
|Medication dispensing and timing system utilizing time reference message
|Aug 31, 1995
|Jan 20, 1998
|Kabushiki Kaisha Yuyama Seisakusho
|Tablet packing machine
|Aug 23, 1996
|May 19, 1998
|Sanyo Electric Co., Ltd.
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|Feb 20, 1997
|Jun 9, 1998
|Quandt; W. Gerald
|System for individual dosage medication distribution
|Dec 22, 1995
|Jun 16, 1998
|Sanyo Electric Co., Ltd.
|Medication filling apparatus
|Aug 14, 1995
|Dec 15, 1998
|Profile Systems, Llc
|Medication dispensing and timing system
|Dec 10, 1997
|Sep 7, 1999
|Kabushiki Kaisha Yuyama Seisakusho
|Drug filling machine
|May 30, 1997
|Nov 30, 1999
|Sullivan; Scott L.
|Pill printing and identification
|Jun 30, 1997
|Sep 5, 2000
|The Coca-Cola Company
|Variety pack vendor and method of using
|Jun 14, 1999
|Sep 12, 2000
|Kabushiki Kaisha Yuyama Seisakusho
|Method of inspecting drugs contained in a vial
|Nov 28, 1997
|Nov 7, 2000
|Diebold, Incorporated
|Apparatus and method for loading medical items in a dispenser module
|May 27, 1998
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|Nextrx Corporation
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|Kabushiki Kaisha Yuyama Seisakusho
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|Screen cloth insertion apparatus and method
|Jun 16, 2004
|May 23, 2006
|Scriptpro Llc
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|Sep 11, 2003
|Jun 13, 2006
|Sullivan Scott L
|Pill printing and identification
|Mar 2, 2004
|Sep 5, 2006
|Scriptpro Llc
|Apparatus for dispensing vials
|Jul 22, 2004
|Oct 17, 2006
|Scriptpro Llc
|Fork based transport storage system for pharmaceutical unit of use dispenser
|Nov 23, 2004
|Feb 13, 2007
|Scriptpro Llc
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|Jun 16, 2004
|Jun 12, 2007
|Scriptpro Llc
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|Method for filling vials in an automated prescription filling apparatus
|Apr 23, 2007
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|Jvm Co., Ltd.
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|Jvm Co., Ltd.
|Apparatus and method for preventing irregular packaging for automatic medicine packing machine
|Sep 26, 2007
|Jul 13, 2010
|Mckesson Automation Systems Inc.
|Vacuum pill dispensing cassette and counting machine
|Sep 30, 2005
|Jul 27, 2010
|Fonterra Co-Operative Group Limited
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|Vacuum pill dispensing cassette and counting machine
|Mar 13, 2003
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|Inspection device for loose objects, such as tablets
|Apr 26, 2007
|Nov 9, 2010
|Mckesson Automation Systems Inc.
|Method of transporting vials and cassettes in an automated prescription filling apparatus
|Feb 2, 2007
|Jan 18, 2011
|EaglePicher Technologies
|System and method for manufacturing a thermal battery
|Feb 2, 2007
|Jan 25, 2011
|EaglePicher Technologies
|Automated tracking and storage system for use with an automated thermal battery manufacturing system
|May 29, 2007
|Feb 22, 2011
|Jvm Co., Ltd
|Method and apparatus for inspecting manual dispensing tray of automatic medicine packaging machine
|Jun 27, 2008
|Mar 22, 2011
|Qem, Inc.
|Method and apparatus for automatically filling prescriptions using interchangeable platens
|Dec 10, 2010
|Apr 19, 2011
|Eaglepicher Technologies, Llc
|System and method for manufacturing a thermal battery
|Jun 27, 2008
|May 31, 2011
|Qem, Inc.
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|Jun 27, 2008
|Jun 14, 2011
|Qem, Inc.
|Pill dispenser with interchangeable platen having electronically readable identification
|Dec 15, 2010
|Aug 23, 2011
|Eaglepicher Technologies, Llc
|Automated tracking and storage system for use with an automated thermal battery manufacturing system
|Feb 2, 2007
|Nov 8, 2011
|Eaglepicher Technologies, Llc
|System and method for manufacturing a thermal battery
|May 20, 2005
|Mar 27, 2012
|KNAPP Logistics Automation, Inc.
|Systems and methods of automated tablet dispensing, prescription filling, and packaging
|Jan 26, 2007
|Aug 7, 2012
|Jvm Co., Ltd.
|Method and apparatus for backing up power failure for automatic medicine packing machine
|Mar 2, 2009
|Mar 5, 2013
|Tension International, Inc.
|Automated precision small object counting and dispensing system and method
|Aug 21, 2009
|Aug 20, 2013
|Tension International, Inc.
|Container dispersion wheel
|Feb 17, 2012
|Dec 10, 2013
|Knapp Logistics & Automation, Inc.
|Systems and methods of automated dispensing, prescription filling, and packaging
|Aug 21, 2009
|Jun 10, 2014
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|May 2, 2011
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|Jan 14, 2013
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|Rotating storage case
|Jul 23, 2015
|Jul 4, 2017
|Express Scripts, Inc.
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|Jul 15, 2002
|Jan 16, 2003
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|Method and apparatus for dispensing a customized pharamaceutical mixture
|Apr 25, 2003
|Feb 19, 2004
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|Prescription filling apparatus implementing a pick and place method
|Jun 18, 2003
|Mar 25, 2004
|Scriptpro Llc
|Active control center for use with an automatic dispensing system for prescriptions and the like
|Jul 8, 2003
|Jul 15, 2004
|Hans-Jurgen Schreiner
|Insulation for piezoceramic multilayer actors
|Jun 16, 2004
|Dec 23, 2004
|Coughlin Michael E.
|RFID tag and method of user verification
|Jun 16, 2004
|Dec 23, 2004
|Coughlin Michael E.
|RFID tag and method of user verification
|Jul 22, 2004
|Feb 17, 2005
|Scriptpro Llc
|Fork based transport storage system for pharmaceutical unit of use dispenser
|Oct 20, 2004
|May 12, 2005
|Coughlin Michael E.
|Method and system for delivering prescriptions to remote locations for patient retrieval
|Feb 25, 2005
|Aug 11, 2005
|Coughlin Michael E.
|RFID tag and method of user verification
|Oct 8, 2004
|Jan 5, 2006
|Coughlin Michael E
|Keystroke input device for use with an RFID tag and user verification system
|Aug 3, 2005
|Jan 26, 2006
|Guerra Lawrence E
|Fork based transport storage system for pharmaceutical unit of use dispenser
|May 20, 2005
|Feb 2, 2006
|Claus Henkel
|Systems and methods of automated tablet dispensing, prescription filling, and packaging
|Sep 30, 2005
|Apr 20, 2006
|Boland Michael J
|Customised nutritional food and beverage dispensing system
|Nov 23, 2004
|Aug 17, 2006
|Guerra Lawrence E
|Robotic arm for use with pharmaceutical unit of use transport and storage system
|Mar 13, 2003
|Sep 28, 2006
|Dijkstra Vereenigde Bedrijven B.V.
|Inspection device for loose objects, such as tablets
|Aug 22, 2006
|Mar 22, 2007
|Kim Jun H
|Automatic medicine packing system
|Dec 23, 2005
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|Q. E. M., Inc.
|Cassette for dispensing pills
|Feb 2, 2007
|Aug 9, 2007
|Eaglepicher Technologies, Llc
|System and method for manufacturing a thermal battery
|Feb 2, 2007
|Aug 9, 2007
|Eaglepicher Technologies, Llc
|System and method for manufacturing a thermal battery
|Feb 2, 2007
|Aug 9, 2007
|Eaglepicher Technologies, Llc
|Automated tracking and storage system for use with an automated thermal battery manufacturing system
|Apr 26, 2007
|Aug 16, 2007
|Mckesson Automation Systems Inc.
|Automated apparatus and method for filling vials
|Apr 26, 2007
|Sep 6, 2007
|Mckesson Automation Systems Inc.
|Method for filling vials in an automated prescription filling apparatus
|Apr 26, 2007
|Sep 6, 2007
|Mckesson Automation Systems Inc.
|Method of transporting vials and cassettes in an automated prescription filling apparatus
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|Dec 6, 2007
|Jun Ho Kim
|Method and device for identifying a tablet cassette in an automatic tablet packing machine
|Nov 16, 2006
|Dec 27, 2007
|Jun Ho Kim
|Apparatus for identifying support tray data and method thereof
|Sep 26, 2007
|Jan 24, 2008
|Mckesson Automation Systems Inc.
|Vacuum pill dispensing cassette and counting machine
|Nov 17, 2006
|Mar 20, 2008
|Jun Ho Kim
|Integrated control system and method for automatic medicine packaging apparatuses
|Dec 6, 2006
|Mar 27, 2008
|Jun Ho Kim
|Medicine storage cabinet
|Nov 8, 2006
|May 1, 2008
|Jun Ho Kim
|Cassette device for automatic medicine packaging apparatus
|Jan 17, 2007
|May 8, 2008
|Jun Ho Kim
|Apparatus and method for preventing irregular packaging for automatic medicine packing machine
|Jan 26, 2007
|May 15, 2008
|Jun Ho Kim
|Method and apparatus for backing up power failure for automatic medicine packing machine
|Apr 23, 2007
|Jun 26, 2008
|Jun Ho Kim
|Division-packaging method and apparatus for automatic medicine packaging machine
|May 29, 2007
|Jun 26, 2008
|Jun Ho Kim
|Method and apparatus for inspecting manual dispensing tray of automatic medicine packaging machine
|Mar 2, 2009
|Sep 3, 2009
|Robert Terzini
|Automated precision small object counting and dispensing system and method
|Jun 27, 2008
|Dec 31, 2009
|Qem, Inc.
|Pill dispenser with interchangeable platen having electronically readable identification
|Jun 27, 2008
|Dec 31, 2009
|Qem, Inc.
|Pill dispenser with canisters having electronically readable identification
|Jun 27, 2008
|Dec 31, 2009
|Qem, Inc.
|Method and apparatus for automatically filling prescriptions using interchangeable platens
|Nov 24, 2009
|Jul 8, 2010
|Jvm Co., Ltd.
|Medicine pouch arranging device
|Dec 10, 2010
|Mar 31, 2011
|Eaglepicher Technologies, Llc
|System and method for manufacturing a thermal battery
|Dec 15, 2010
|Apr 14, 2011
|Eaglepicher Technologies, Llc
|Automated Tracking And Storage System For Use With An Automated Thermal Battery Manufacturing System
|Aug 21, 2009
|Jun 23, 2011
|Robert Terzini
|Container dispersion and filling system
|Aug 11, 2009
|Jun 23, 2011
|Robert Terzini
|Automated precision small object counting and dispensing system and method
|Aug 23, 2009
|Jun 23, 2011
|Robert Terzini
|Automated pharmacy drug handling and prescription verification system and method
|Aug 21, 2009
|Jun 23, 2011
|Robert Terzini
|Container dispersion wheel
|May 2, 2011
|Aug 25, 2011
|Qem, Inc.
|Pill dispenser with interchangeable platen having electronically readable/writable identification
|Nov 24, 2011
|Sep 19, 2013
|Ho Yeon Kim
|Tablet cassette of medicine packing apparatus, and method of operating the same
|Dec 28, 1995
|Oct 24, 2001
|Solid preparation filling device
|Jun 22, 2010
|Oct 20, 2010
|Automatically-rotating explosive machine
|Jun 22, 2010
|Nov 9, 2011
|Automatically-rotating explosive machine
|Dec 2, 1994
|Jun 7, 1995
|Owen Healthcare, Inc.
|Apparatus for dispensing medication
|Dec 2, 1994
|Feb 28, 1996
|Owen Healthcare Inc
|Apparatus for dispensing medication.
|Mar 13, 2003
|Aug 26, 2004
|Dijkstra Vereenigde Bedrijven B.V.
|Inspection device for loose objects, such as tablets
|U.S. Classification
|53/501, 53/168, 221/2, 53/268, 221/203, 221/113, 221/120
|International Classification
|Cooperative Classification
|European Classification
|Apr 18, 1983
Owner name: SHERWOOD MEDICAL COMPANY
Free format text: MERGER;ASSIGNOR:SHERWOOD MEDICAL INDUSTRIES INC. (INTO);REEL/FRAME:004123/0634
Effective date: 19820412


text:
Current Newswire:
Awesomium Windowless Web Browser Framework Ported to LinuxMay 31, 2011, 12:05 (2 Talkback[s])
[ Thanks to Dart for this link. ]
"Awesomium windowless web framework and engine has been ported to Linux. Awesomium can be used for web page capture, site scrapping, in-app advertising, in-app browsing, web automation, rendering custom in-game web browser and creating HTML UIs for 3D games.
0 Talkback[s] (click to add your comment)

subset: commoncrawl


text:
WOLVES are in control at half time but a depleted Castleford Tigers side are making it tough for them.
Cas, with eight of next weekend's likely Challenge Cup Final side sat on the sidelines, took a leaf out of Leeds Rhinos' books from last week by attempting to make the Wolves defence crack under pressure.
But Wolves' resistance has been stubborn, and have looked threatening with every attack.
Tony Smith, bringing Chris Bridge and Gareth O'Brien back into the playmaking department as half backs, scored through Ryan Atkins, O'Brien and Bridge before James Clare pulled four points back for Cas.
Disappointingly, Bridge limped out of the game at the 30th minute mark.
Just like against Leeds last week, Wolves found themselves vigorously defending their own line for the opening five minutes.
Then on their second set with the ball O'Brien's kick ahead bounced backwards into the path of Atkins and after dribbling ahead he pounced for the opening try in the seventh minute. Bridge converted for 6-0.
Again Cas played the pressure game, pummelling the Warrington line for three successive sets without joy against a hard-working Wolves rearguard.
And just like early on, as soon as Wolves got their hands on their ball again they scored.
Michael Monaghan threw a dummy and darted clear on a 40-metre run before putting the supporting O'Brien on a clear dart to the line. Bridge's extras made it 12-0 after 19 minutes.
Bridge showed the strength of a forward and pace of a back as he exploded over from first receiver and then add the goal kick to move Wolves 18-0 ahead in the 26th minute.
Four minutes later Bridge hobbled off, with Michael Monaghan switching to stand off and Micky Higham being introduced off the bench at hooker.
Cas grabbed four points back in the 33rd minute, James Clare spectacularly diving over by the corner flag albeit off a pass that was two metres forward from half back Jamie Ellis.
The visitors would have hauled back another six points had it not been for a wonderful cover tackle from Rhys Evans on Frankie Mariano after the second rower had broken clear and skirted Matty Russell with ease.
But Evans chased back, covered the ball and held the bigger man up over the line in a remarkable show of defensive skill and strength.
Wolves: Matty Russell; Joel Monaghan, Stefan Ratchford, Ryan Atkins, Rhys Evans; Chris Bridge, Gareth O'Brien; Chris Hill, Michael Monaghan, Ben Harrison, Ben Westwood, Trent Waterhouse, Simon Grix. Subs: Anthony England, Paul Wood, James Laithwaite, Micky Higham.
Tigers: Ben Reynolds; Jordan Tansey, Michael Channing, Ashley Gibson, James Clare; Jamie Ellis, Liam Finn; Andy Lynch, Adam Milner, Scott Wheeldon, Frankie Mariano, Weller Hauraki, Lee Jewitt. Subs: Nathan Massey, Oliver Holmes, Brad Day, Will Maher.
Referee: James Child


text:
Comment written in December of 2006:
"Sadly, I am bringing this one up today because a member did smoke. The person made a post basically saying that even though the member knew it was against the rules and would be pulled, the post could help others. After all, a person who smokes can pass along the "valuable" insight of how bad he or she feels for having taken a cigarette.
|From: Joel
|Sent: 2/8/2004 11:28 AM
Hello David:
We have no problem with our members learning from each other's past relapses. We are just making it impossible for them to learn from the future relapse of any member. You are right that other programs recognize that relapses happen to people with drug addictions. We know people relapse too. We just don't see it as a natural or more importantly, an inevitable event. Our post Is relapse a natural part of the addiction process?addresses this concept. Here is our comment from that string that points out that we are coming from a different slant on this issue.
Most other boards, and in fact most professional programs and nicotine addiction experts see relapsing as a normal part of the addiction process. In a way we are out on a limb here at Freedom. We don't accept relapse as a normal process of addiction. We see a relapse as a natural process of not understanding and/or accepting ones own addiction. For if the true implication of a relapse is understood, any sane and recovering addict would choose not to relapse.
Every recovering nicotine addict here has the tools in place not to relapse, which is why he or she is a recovering addict now and not an active user. He or she understands full well, up to this point in time that he or she could not control quantity of cigarettes or duration of the relapse. If nicotine is readministered, the relapse will take on a life of its own, and has the full potential of taking your life in the process.
If you keep that understanding and keep in practice our one simple principle, a relapse is
not going to be a natural occurrence and in fact, a relapse is going to be an impossibility. For as long as you follow one simple principal,
you will never be able to go back to smoking. The principle, is just remembering if you want to keep control of your addiction never take
another puff! "
Also from the string Good news, our members don't relapse anymore
From: Joel Sent: 3/4/2003 5:00 PM
Wow you mean a smoker might lie when they relapse. Never thought of that one. Now that you mention it, I should have realized this. You see, sometimes when I do corporate clinics one person will have really blown a quit big time, but tell others from the group that they just smoke occasionally and seem to have it under control.
In fact sometimes the successful ex-smokers around the person figures that if the person smoking is saying that he or she can control his or her cigarettes, maybe the successful ex-smoker can do it too. So the successful ex-smoker takes a drag. He or she basically has blown his or her quit now.
But sometimes that person when caught smoking will lie about it to another from the group, saying something like, "Sure I smoke every now an then now, but I have it under control." Then the person they are telling their lie to blows his or her quit. Pretty soon they are all outside freezing together in the smoking section by the loading dock lying to each other how they will be quitting smoking one day.
I guess that is a little harder to do at Freedom, to relapse, say that you just had a slip and are now fine. Because we seem to have this insane rule that says if you say you slipped you are out for good and can never post about it. How in the world can you influence others to blow their quits with that kind of lie? Guess you will just have to find another site that takes relapsing as a matter of fact and no big deal. Luckily you will still be able to read information here and Freedom and WhyQuit if you are ever able to muster the strength to attempt a quit again. You just won't be able to influence anyone else.
There is no lying to your body though. The only way to stay smoke free is to honestly believe in your commitment and keep in force your promise to never take another puff!


text:
Rosehip by Robin Melanson
Welcome! You are browsing as a guestWould you like to see 9 projects made from this pattern and much more? create a free account What am I missing?
© Jane Heller
© Jane Heller
This pattern is available from patternfish.com for $4.50.
This lightweight and feminine scarf is knit side-to-side on a long circular needle, beginning with a botanically inspired lace pattern and finishing with a neckline-hugging series of alternating Stockinette and Reverse Stockinette Stitch welts. Bands of eyelets set in Garter Stitch separate the motifs and line the neck edge. It is worked in Fingering Weight Gems Merino, perfectly cozy and light for wearing either indoors or outside in brisk autumn weather.
For more information, see: http://www.patternfish.com/patterns/12949


text:
Looks like 3 Bedroom Ranch Home is no longer available on Rent.com which means this information is likely out of date.
Three bedroom ranch home in SW Atlanta, Cascade Heights Area.
3 bedroom brick ranch home located in South West Atlanta. Two full baths; newly added bath in Master Bedroom. Hardwood floors throughout; upgraded kitchen with new wall oven. Carport with screened in patio. Driveway in front and back of the house. Partial fenced in back yard. Beautiful neighborhood near Marta Bus Liine and Hamilton Homes Marta train station.
Elementary, middle and high schools nearby.
One year lease. Will consider lease with option to buy.
No Pets
1 unit
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text:
Here's information about Kent's Run to benefit The Leukemia & Lymphoma Society on Saturday, May 26 in Boone Grove.
Visit their website for information about registration. The event has raised more than $100,000 for their cause in just four years. This year, our friend, Pastor Jim Norris, who has supported the event as part of Boone Grove Christian Church in the past is working through his own cancer issues that fall under the umbrella of The Leukemia & Lymphoma Society.
We hope anyone interested and available to run or support the event will head out to Boone Grove Saturday morning.


text:
Five years on: strengthening protection of children in post-tsunami Banda Aceh
BANDA ACEH, 24 December 2009 - In the wide, open spaces and playing fields of the Darusada Children's Centre, a sense of peace provides a stark contrast to the violence and trauma all of the young residents have endured.
"Many children were separated from their parents, had lost their parents," says Angela Kearney, UNICEF's Country Representative in Indonesia. "One of the things first was to make sure that we brought families together, communities together."


text:
Planting Grass Seed
To some the sheer number of choices to be made when seeding their lawn seems overwhelming. Pike Nurseries is here to take the guesswork out of seeding your lawn.
1. Prepare the area. The best seedbed allows for maximum contact between the seed and the soil. To establish a seedbed, rototill the area to be seeded to a depth of three to six inches. Where clay is in abundance, add one bag of Pike's Planting Mix or Top Soil per six sq. ft. Rake or drag the surface smooth. If the area has not been limed in the past year, add 40 lbs. of lime per 1000 sq. ft. Apply Pike Starter Ferilizer, a premium, slow-release fertilizer, at the rate recommended by the manufacturer. (A soil test is always recommended to insure the proper fertilization rate and pH analysis for your lawn.)
2. Moisten after the seed is scattered according to the chart below.
3. Thorough watering, which wets the seed and the underlying soil, is necessary for proper rooting. If the soil is allowed to dry out at all during the germination period (about 10 to 14 days), the seed will not germinate. Daily water is necessary until a good root system is developed.
Warm Season
Bermuda 2 lbs. /1000 sq. ft. Mix five lbs. of sand with each pound of Bermuda seed to aid in proper spread rate.
Centipede 4 oz./1000 sq. ft. Mix twelve lbs. of sand with each ¼ pound of Centipede seed to aid in proper spread rate.
Cool Season
Annual Rye 10 lbs./1000 sq. ft. Good for overseeding warm season grasses
Fescue* 8-10 lbs./1000 sq. ft. 5 lbs./1000 sq. ft. when overseeding
* In Atlanta, use Atlanta Blend Fescue Seed. This grass seed is designed to meet the needs of Atlanta area lawns. Atlanta Blend Fescue Seed is a blend of turf type fescues including Plantation, Virtue, Duster and Creeping Red. This mixture is the best possible combination for sun and shade. It has a fast-growing, vigorous root system.
See more articles about: Monthly Lawn & Garden Tips, Seeds, Plant Guides, Lawn Care


text:
LA producer Vincent Coleman returns this week with a brand new single called 'Beast,' a super deep, sex-inducing groove that will get you right in the loins and leave your ears craving for more.
I also recommend checking out the Vincent Coleman track that won me over a few months ago. This one is called 'Sweat' and it is another sex-driven jam that is well worth of your time.
Be sure to follow Vincent Coleman on the below socials.
Facebook.com/vincentcolemanis | Soundcloud.com/vasvinny | Twitter.com/VinnieTheBooh


text:
Report NEP-ECM-2006-07-02This is the archive for NEP-ECM, a report on new working papers in the area of Econometrics. Sune Karlsson issued this report. It is usually issued weekly.
Subscribe to this report: email, RSS or Twitter.
Other reports in NEP-ECM
The following items were announced in this report:
- Juan Carlos Escanciano & Carlos Velasco, 2006. "Testing the Martingale Difference Hypothesis Using Integrated Regression Functions," Faculty Working Papers 06/06, School of Economics and Business Administration, University of Navarra.
- Javier Hualde & Carlos Velasco, 2006. "Distribution-free Tests of Fractional Cointegration," Faculty Working Papers 08/06, School of Economics and Business Administration, University of Navarra.
- Alberto Abadie & Guido W. Imbens, 2006. "On the Failure of the Bootstrap for Matching Estimators," NBER Technical Working Papers 0325, National Bureau of Economic Research, Inc.
- Item repec:dgr:kubcen:200650 is not listed on IDEAS anymore
- Javier Hualde & Peter Robinson, 2006. "Semiparametric Estimation of Fractional Cointegration," Faculty Working Papers 07/06, School of Economics and Business Administration, University of Navarra.
- Eva Boj del Val & M. Mercedes Claramunt Bielsa & Jose Fortiana Gregori, 2006. "Bootstrapping pairs in Distance-Based Regression," Working Papers in Economics 154, Universitat de Barcelona. Espai de Recerca en Economia.
- James H. Stock & Mark W. Watson, 2006. "Heteroskedasticity-Robust Standard Errors for Fixed Effects Panel Data Regression," NBER Technical Working Papers 0323, National Bureau of Economic Research, Inc.
- Heiss, Florian, 2006. "Nonlinear State-Space Models for Microeconometric Panel Data," Discussion Papers in Economics 1157, University of Munich, Department of Economics.
- Manuel Gomez & Daniel Ventosa-Santaularia, 2007. "Inflation and breaks: the validity of the Dickey-Fuller test," Department of Economics and Finance Working Papers EM200601, Universidad de Guanajuato, Department of Economics and Finance.
- Item repec:dgr:uvatin:20060047 is not listed on IDEAS anymore
- Richard K. Crump & V. Joseph Hotz & Guido W. Imbens & Oscar A. Mitnik, 2006. "Nonparametric Tests for Treatment Effect Heterogeneity," NBER Technical Working Papers 0324, National Bureau of Economic Research, Inc.
- Stephen Gordon & Michel Truchon, 2006. "Social Choice, Optimal Inference and Figure Skating," Cahiers de recherche 0624, CIRPEE.
- Michel Truchon & Stephen Gordon, 2006. "Statistical Comparison of Aggregation Rules for Votes," Cahiers de recherche 0625, CIRPEE.
- Michel Truchon, 2006. "Borda and the Maximum Likelihood Approach to Vote Aggregation," Cahiers de recherche 0623, CIRPEE.
- Roger Lord & Remmert Koekkoek & Dick van Dijk, 2006. "A Comparison of Biased Simulation Schemes for Stochastic Volatility Models," Tinbergen Institute Discussion Papers 06-046/4, Tinbergen Institute, revised 07 Jun 2007.
- Roberto Patuelli & Daniel A. Griffith & Michael Tiefelsdorf & Peter Nijkamp, 2006. "The Use of Spatial Filtering Techniques: The Spatial and Space-time Structure of German Unemployment Data," Tinbergen Institute Discussion Papers 06-049/3, Tinbergen Institute.
- Hernandez, Monica & Pudney, Stephen, 2006. "Measurement error in models of welfare participation," ISER Working Paper Series 2006-29, Institute for Social and Economic Research.
- Item repec:dgr:uvatin:20060044 is not listed on IDEAS anymore


text:
Understanding Behavior Change, Action Planning, and Coping Planning: A Review of the Literature
| [Part1] | [Part2] | [Part3] |
The process of behavior change is complex, and involves a variety of factors. These factors include things such as environment, which can drastically affect the behavior change process. For example, going to a busy crowded gym to try a get in shape may eventually discourage you from going as the machines and such are constantly full. Motivation is another important factor when considering behavior change. Having a music instructor whose teaching ability is quite inadequate for example, will decrease motivation in a student to listen to what that teacher has to say. There are various interventions that can be used to assist one in changing behavior. Action and coping planning are two helpful strategies to consider when changing behavior. Action planning being taking charge and putting action into change rather than contemplating it. Coping planning is anticipating how to overcome obstacles during the change process. That is just one of the large varieties of behavioral interventions used in various situations.
Processes of Behavior Change
The changing of a specific behavior whether it is something health related, such as going to the gym on a regular basis, or even improving practicing habits playing an instrument, is a long process. The difference between simply thinking about changing a behavior and acting to change it are farther away than one would think. Varieties of factors are involved in the change process; one of the largest factors is environment. Sniehotta(2009) mentions that despite individual's being able to make intentional behavior changes, they are largely determined by the constraints and consequences their environment produces. To counteract this, there have been various developments in the area of behavior planning, including new models to go by which can be used to assist an individual in their quest for behavior change.
One of these models that are relatively well known is the transtheoretical model (Armitage, 2009). This model can help "predict, explain, and ultimately change health behavior (Armitage, 2009)" through variety components. These consist of fourteen points that are split up in to three sub-categories. They are: stages of change, dependent variables, and independent variables. While all three are significant, stages of change has been looked at far more than the other stages to the point where it's not worth mentioning them. Stages of change consist of precontemplation, contemplation, preparation, action and maintenance (Prochaska, et al, 1994). Each stage follows after the other, going from thinking about change, preparing to change, taking action, and then maintaining that change. Various studies have used this model to prove its worth, most notably in changing poor health behaviors. In one study by Herzog and Blagg (2007), they used the model to assist smokers in changing their habits, and found positive results along with the smokers having an increase in motivation to quit throughout the program.
Urte et. Al. (2008) mention two main focuses of behavior change. These are action planning and coping planning. After an individual has the intention to change, they go through the volitional stage, which is the short stage between the intentions becoming changed into action. Once this transition is made one can progress into the action and coping planning stages. In action planning the "when, where, and how (Urte et al. 2008 pg481)" is determined, somewhat similar to the transtheoretical models stages of change. This involves setting rigid goals, such as "I will study for four hours tonight" with no escapes from the plan. This format of goal setting will lead one to change their behavior easier with no leniency in their routines. However, it has been shown that while action planning may be quite effective with changing simple behaviors, changing complex lifelong behaviors may prove difficult or unsuccessful in certain cases.
Coping planning is used for overcoming unplanned and expected obstacles in the behavior change process. An example of this may be that the weather outside is unsuitable for running so I may go run in a gym instead. This type of planning keeps potential planning mishaps from happening, and promotes the maintenance of that behavior. Once action planning is started, after a period of a few months coping tends to take over as the main plan and keeps one on track to their goal or maintaining it.
| [Part1] | [Part2] | [Part3] |


text:
The Atlanta Braves had their 14-game winning streak snapped in near mind-numbing fashion Saturday night, losing 1-0 to the Miami Marlins at Turner Field off a wild pitch.
Both offenses were pretty much shut down with Alex Wood and Nathan Eovaldi dealing for their respective teams, but it was the Marlins who finally broke through in unorthodox fashion in the ninth inning.
Atlanta and Miami both stranded runners in the first inning, but after an hour-long rain delay, neither team put a runner as far as second base until Adeiny Hechavarria tripled off Jordan Walden to start the ninth. He scored the lone run of the game when Evan Gattis couldn't corral Walden's wild pitch.
Eovaldi was mostly responsible for the Braves not scoring for their first loss of August. He held the Braves to one hit, a single by Freddie Freeman in the first inning, over his seven innings of work.
The Braves wouldn't muster another hit until Andrelton Simmons singled with one out in the eighth inning, but he would be stranded as Brian McCann struck out and Jason Heyward grounded out.
Paul Janish struck out to end the game with the tying run on base. Of course, he wouldn't have been in the position in the first place had Chris Johnson not gotten himself tossed for arguing with umpire Jim Joyce after striking out in the first inning. Janish did do a spectacular job in the field though, making a couple of diving stops.
Wood was just as, if not more, impressive than Eovaldi. He threw six shutout innings striking out seven and giving up two hits and a walk.
The Braves having their win streak snapped left them one short of the Atlanta record of 15 consecutive wins in 2000.
- Be sure to "like" Braves 101 on Facebook and follow Braves 101 on Twitter.
Gearing up for the fantasy season? Try weekly fantasy football games this year at DraftDay.com. DraftDay has awarded over $15 million to fantasy fans like you, so don't miss out on the newest way to play fantasy football! Create your free account and use promo code GIFT for an instant cash bonus.Tags: Adeiny Hechavarria, Alex Wood, Atlanta, Atlanta Braves, Baseball, Chris Johnson, Evan Gattis, Freddie Freeman, Jason Heyward, Jim Joyce, Jordan Walden, Miami Marlins, MLB, Nathan Eovaldi, Paul Janish


text:
'); var yuipath = 'clientscript/yui'; var yuicombopath = ''; var remoteyui = false; } else // Load Rest of YUI remotely (where possible) { var yuipath = 'http://yui.yahooapis.com/2.9.0/build'; var yuicombopath = 'http://yui.yahooapis.com/combo'; var remoteyui = true; if (!yuicombopath) { document.write('
Complete meltdown in the last minute. Inexcusable.
Are we still expecting anything from Danny?
i fear pg 3 after bad ballhandling coming up.
Everyone ran away from PG.. gotta be ******* me
"Freedom is nothing else but a chance to be better." - Albert Camus
"Appreciation is a wonderful thing. It makes what is excellent in others belong to us as well." - Voltaire
"Everyone's values are defined by what they will tolerate when it is done to others." - William Greider
I swear to ****ing hell they are trying to give this game to phillly
"We've got to be very clear about this. We don't want our players hanging around with murderers," said Larry Bird, Pacers president.
FU referees kiss my Efin A**
wow what a **** ending
Paul George can be a really dumb basketball player sometimes. Too often, to be honest.
One of the more frustrating losses of the season...
Well, at least we know what we need to work on now.
Way go Philly... you sure earned it
Hopefully we can get a steal on the inbound.
Well, that was the worst possible thing that could have happened.
A very frustrating loss. We gave the game away with bad shots and **** poor execution down the stretch.
Ok this is rigged, that's the proof. I mean, come on, questionable 5 seconds call on the play of the game?!
These refs. Holy ****.
Where did they get these refs from?
You can tell someting is up with this guy. That call was slow as hell. **** this ref man its noticeable. Even the announcers questioning every call @ this point
I Bleed Blue
Anyone who can defend NBA officiating is a fool.
"We've got to be very clear about this. We don't want our players hanging around with murderers," said Larry Bird, Pacers president.
Win the jump ball, take the time out, tie it and go to 2OT.


text:
Hey there, time traveller!
This article was published 2/6/2011 (2272 days ago), so information in it may no longer be current.
DELTA BEACH — Sandy Brooks' cottage looks as though a tornado picked it up and ripped it in half.
Tuesday's wind and waves crashed through her cottage with such force that most of her furniture was washed hundreds of feet into the marsh and her living room was torn off and shoved about 30 feet away.
Oddly enough, her cups and dishes remained neatly stacked in the kitchen cupboards. Those, plus a rocking chair, a futon and some things from the shed, are most of what she could salvage Thursday.
"It's beyond describing," said Brooks, as she surveyed the gaping hole where her living room once was.
Hers is one of about 38 cottages at Delta Beach that were all but totalled Tuesday night when gale-force winds caused huge waves and prompted a mandatory evacuation and damaged almost all of the 200-odd cottages at Delta Beach. The storm caused similar damage in several other cottage communities on the shore of Lake Manitoba.
At Delta Beach, days of hauling in rocks for breakwalls as well as sandbags and supersandbags for dikes proved futile. Waves higher than people's eavestroughs crashed over decks, smashed living room windows and sent debris and mini-sand dunes into people's cottages.
A boat tour revealed home after home with no north wall, piles of trees and sand where decks used to be and even many homes teetering over gaping holes where cement blocks or foundations used to be.
"The next storm will just take everything," said Doug Connery, a vegetable farmer near the Hoop and Holler cut who also has a family cottage at Delta Beach. "If that happens, there's a 60 to 70 per cent chance there will be no Delta Beach."
Cottagers such as Connery, whose father was a cabinet minister in the Filmon government, wondered why the province didn't lower lake levels over the winter when it knew a flood loomed. And they wonder why the province can't boost flows through the Fairford dam, the outlet of Lake Manitoba, or begin work post-haste on an outlet channel between Lake Manitoba and Lake Winnipeg.
The province's top flood-fighter, Steve Topping, said Thursday the Fairford dam has been working at capacity since last November — the estimated flow Thursday was 17,380 cubic feet per second.
The amount of water discharged now through the control structure is more than twice as much as the Fairford River handled before the structure was first used in 1961.
Topping said concerns about flooding three First Nations downstream on Lake St. Martin restricts the increased use of the dam. And, if too much water is released from Lake Manitoba, frazil ice can develop on the Dauphin River — it drains Lake St. Martin into Lake Winnipeg — which contributes to ice jams and further flooding.
"There are limitations both in terms of ice restriction and safety issues that we have to deal with," he said.
Topping also said the province had no option to use the Portage Diversion beyond its maximum during the height of the flood.
"It's unfortunate, but there was nowhere to put the water," he said.


text:
Yeah, RIP.
pmcg asked:
Are we doomed to have a useless Abyssal Seahorse at the top of our mounts list forever? (say, until and beyond 6.04)
See above.
matthew2 asked:
So, my PC is still fried so I don't know the answer to this yet.
Added up, all of my alts have > 100K honorable Kills. No one is at 100K individually yet.
Do I get the "Of the Horde" title (after logging onto all my toons) ?
Here's hoping I do. Here's expecting I wont!
You do! Honorable kills are one of the few achievement criteria that are tallied across all characters. Congratulations on your title.
lookinginsetx1977 asked:
wondering, is there now a cap on mana that everyone seems to think, since I have heard from some people who before the patch they have 150k+ mana and now they have around 100k? I am thinking it was just that their int changed cause of the loss of the wand and a melee weapon and everything,
Yes, there is a hard mana cap per level now. At level 85 you have 100k mana. There's a meta gem that's apparently causing people to have mana over the cap, but it's probably not intentional.
JoeSmith asked:
How many level 85 daily quests are there? Is it possible to skip leveling from 85 to 86 simply by turning in 7,120.84 daily quests on release day?
Well, you could turn in 25 of them, since that's the maximum number of quests you can have in your log. It might save you a few quests in Pandaria, but the amount of xp a Pandaria quest gives you far outclasses what a level 85 daily does. Just quest.


text:
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text:
WashPost Style Section Actually Does Decent Profile of Libertarian Comedian Remy
As regular readers of NewsBusters are well aware, the Washington Post's Style section has a habit of frequently ginning up puffy human-interest stories about all kinds of liberal politicians and celebrities. It's rare that they do a positive profile of a conservative or libertarian.
So it's worth pointing out when they do just that. In a 26-paragraph profile, Post staff writer Megan McDonough highlighted Arlington, Va., resident Remy Munasifi, a libertarian conservative YouTube sensation, whose most recent parody video "Blurred Junk" takes a swipe at Democratic New York City mayoral candidate Anthony Weiner (that video embedded below). Here's a taste of McDonough's article. For the full thing, go here.
He's opened for D.C.-born rapper Wale and comedian Brian Posehn, formerly of "The Sarah Silverman Program." And now Ron Paul.
Those are among Remy Munasifi's eclectic credits. The 33-year-old comedian has ridden his Internet fame from the mean streets of Arlington — where he rapped in 2009 about his suburban neighborhood's propensity for brown flip-flops and Starbucks outlets — to serving as a warm-up act for the Republican congressman from Texas at a "pro-liberty" student conference last week.
Munasifi, who still lives in Arlington County and makes a living producing comedic videos, has turned his satirical eye beyond suburban yuppies and toward politics — specifically the libertarian variety.
Since 2010, Munasifi has teamed with ReasonTV, linked to the libertarian think tank Reason Foundation, to create short rap parody videos.
He has lampooned the "Occupy Wall Street" movement, the debt ceiling, Jay Z and Beyoncé's Cuban vacation, and, most recently, Anthony Weiner's sexting scandal. One of his catchier spoofs, "Tap It: The NSA Slow Jam," satirizes the National Security Agency's electronic-
surveillance program.
Yeah we're saving your searches, that's just a reality
"Yes we can" ain't just a slogan, it's our view on legality
Slow-jamming the NSA story is one way that Munasifi connects with a younger audience: people who, he says, are more inclined toward libertarian views to begin with.


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RELATIVE contraindications
preferable to avoid administering the drug but may be used judiciously/carefully
ABSOLUTE contraindications
=do not administer drug under ANY circumstances...a LIFE-THREATENING risk!
ex) allergies to sulfites or esters, cocaine use, uncontrolled medical conditions
Conditions needing modifications of the agent
-liver disease (limit amide dose)
-alcoholism (limit amide dose)
-heart disease
-kidney disease (limit amide dose)
-esters vs amides
-short vs long acting
-vasoconstrictor or not?
-concentration (kid vs old vs healthy)
-normal healthy
-routine care, stress reduction
-mild-moderate systemic disease (HBP)
-routine care, stress reduction, limit length of appt
-severe systemic disease, NOT incapacitating
-strict limiting of complex procedures, control stress, modifications needed
-incapacitating disease, constant threat to life
-emergency/palliative care only
-moribund client, not expected to live
-emergency life support
-clinically DEAD
-maintained for organ harvesting
CV disease: congestive heart failure
-ASA III or IV
-decreased liver function
-limit AMIDE/dose of anesthetic
CV disease: heart attack
-ASA II or IV
-limit vasoconstrictors (.o4 mg per visit)***
-2 cartridges of 1:100,000 epi or 4 cartridges of 1:200,000 = .04 mg
CV disease: angina pectoris
-ASA III if stable
-reduce stress
-may use vasoconstrictors but LIMIT
-follow .04 dose
CV disease: valve defects, murmur, prosthetic valves, pacemakers
-evaluate for antibiotics
-use stress reduction
-can use vasoconstrictors
CV disease: bleeding disorders
-avoid highly vascular areas for injections
CV disease: hypertension
-limit vasoconstrictor dose
-stress reduction
-monitor vitals
CV disease: stroke (CVA)
-use minimum effective dose of the agents
-monitor vitals
LIVER disease/dysfuction
-limit dose of anesthetic to avoid toxicity
-may need to consider an ester
-increased risk of infection
-liver disease, AIDS, jaundice, alcoholism
Kidney disease
-ASA III or IV
-limit dose of AMIDE (not vasoconstrictor)
-potential for toxicity
Thyroid disease
HYPER: more sensitive to amides & esp. vasoconstrictors. Limit dose & avoid vasoconstrictors if uncontrolled
HYPO: no worries if controlled with med, no modifications necessary
-vasoconstrictor may interfere with the action of insulin & glucose uptake
-hyperglycemia is possible
-limit use of vasoconstrictor
**esp insulin dependants
Drug addiction
-do not use epinephrine within 24 hours!!
-may choose not to do treatment
-cocaine: NO VASOconstrictor/epi, but CAN give AMIDE
-no contraindications
-use stress reduction
-overdose to anesthetics may trigger seizures
Sulfite allergy
-avoid use of vasoconstrictors (sodium bisulfites)
-SULFA is OKAY
-relative contraindication to elective care
-avoid care in first trimester
-use lidocaine with epi or prolicaine= category B
RARE: malignant hyperthermia
-transmitted GENETICALLY
-rise in Ca levels in muscle
-triggered by specific agents like general or local anesthesia
-signs: tachycardia, fever muscle rigidity, cyanosis
-consult physician, use amides in normal dose
RARE: atypical plasma cholinesterase
-underproduction of the enzyme by the liver
-cant hydrolyze ester
-increased risk of apnea with succinylcholine (intubation in surgery, muscle relaxant)
RARE: methemoglobinemia
-oxygen carrying capacity of blood is reduced
-hereditary, congenital or acquired
-usually seen with intravenous injections
-errors in metab of prilocaine in LG dose
-triggers: ink, shoe polish, benzocaine, sulfonamides, nitrates, crayons
-4 hrs after use: lethargic, resp disease, cyanosis, gray skin
-treatment= methylene blue intravenous
Medication Considerations
-some inactivate the drug, others potentiate their action
-vasoconstrictors more often in the tissue
-use reference & physician consult
MEDS: antidepressants/antipsychotics
-tricyclic antidepressants=a RELATIVE contraindication
-LIMIT EPINEPHRINE, avoid others
-accentuate the vasoconstrictor
-elevated systolic blood pressue
MEDS: monoamine oxidase inhibitors
ex: nardil
-unable to inactivate the vasoconstrictor
-RELATIVE contraindication
-minimize the dose of EPI
MEDS: phenothiazines
ex: thorazine
-antipsychotic, also for nausea
-inhibits the vasoconstrictor
-could become hypotensive
-limit EPI
MEDS: beta-blockers (antihypertensive, antiarrythmias) SELECTIVE type
ex: Lopressor
-impairs metabolism of lidocaine
-decreases hepatic flow
-unlikely to cause toxicity in single dose
-affects how much AMIDE to use because LIVER dysfunction...MINIMIZE AMIDE
MEDS: beta-blockers NONSELECTIVE type
ex: inderal
-HYPERTENSIVE response to EPI
-limit dose of EPI, MINIMIZE EPI
-monitor blood pressue
MEDS: antidiabetics
ex: insulin, orinase
-epinephrine conteracts meds, glucose uptake
-LIMIT use of EPINEPHRINE
MEDS: cholinesterase inhibitors
-avoid ESTERS..more slowly metabolized
-topicals should be OK
-for myasthenia gravis, glaucoma
MEDS: sulfonamides
ex: bactrim, septra
-do not use ESTERS
-inhibits bacterial action..makes antibiotic less effective
MEDS: cimetidine
ex: tagamet
-used for GI problems
-potential for toxic response to AMIDES
-limit the AMIDE
Extra Recommendations
-most are only RELATIVE contras
-use the MINIMUM effective dose of the amide and vasoconstrictor
-seek consults and references
-NOT very many ABSOLUTE contras (ester allergy, cocaine use etc)
Toxicity/Overdose: definition
= clinical signs and symptoms resulting from over administration of local anesthesia
SYSTEMIC toxicity:
-most likely from intravascular injection
-incidnce is low & preventable
-blood levels of anesthetic are elevated
-CNS & CVS excitation to depression
Toxicity: client factors altering a normal rxn
-age (young & old)
-disease, hepatic and renal function
-genetics, enzyme production
-attitude, environment
Toxicity: drug factors
-great conc of dose = more mg
-route of administration
-rapid deposition = increase toxicity
-vascularity of area
-use of vasoconstrictors (epi makes it safer)
-determind by age, weight & physical status
-2-3 mg/lb recommended
-consider MRD & vasoconstrictor
-use the LEAST of the 2 (can have 4 anesthesia but only 2 epi = only use 2!)
CNS Response
-very sensitive to anesthetics
-blood levels > 4.5 ug/ml for overdose
-agitation to respiratory distress
Cardiovascular Response
-less sensitive to anesthetics
-5-10 ug/ml for miner alterations
-over 10 ug/ml for serious complications
-increased heart rate to cardiac arrest
Toxicity: MILD symptoms
-conscious, talkative, agitated, increased vital signs
-slow onset is 5 mins or more
-slower onset is more than 15 mins, lasts longer, increases in intensity could indicate abnormal biotransformation, renal dysfunction
Toxicity: MILD management
-reassure client, get assistance
-give oxygen
-monitor vital signs
-anticonvulsant IV may be needed
-allow to recover, evaluate for transport
Toxicity: SEVERE symptoms
-rapid onset: within ONE minute, unconscious, may have convulsions
-slow onset: large dose, rapid absorption may have renal or hepatic dysfunction
Toxicity: SEVERE management
-elevate feet, slightly supine
-protect from harm
-get emergency help
-use basic life support
-anticonvulsant if longer than 5 mins
-water for post seizure depression
-allow to recover, escort home
Vasoconstrictor Reactions
-too much vasoconstrictor
-intravascular injection
-idiosyncratic response: unusual individually particular response to the patient
Vaso Rxns: clinical manifestations
-fear, anxiety, tense, restless, tremors, perspirationm, weak, dizzy, palor
-heart palpitations
-respiratory difficulty
-high BP and heart rate
Vaso Rxns: management
-stop procedure
-position semi-erect to supine
-reassure client
-monitor vitals
-oxygen UNLESS hyperventilating
Systemic: allergic rxns
=hypersensitivity acquired through exposure to an allergan
-re-exposure heightens response
-uncommon with AMIDES
-likely due to preservative/antioxidant (sodium bisulfite in epi solutions)
-more common with ESTERS, watch topicals
Systemic: allergic rxn characteristics
-localized or generalized rxn
-mild to major
-immediate or delayed
-most common resp=DERMATOLOGICAL
Systemic: allergic rxn dermatological response
-usually not life-threatening
-hives, itching, swelling
-face, hands, feet, lips, tongue, pharynx, larynx, genitalia
DELAYED dermatological management
-delayed, localized
-60 mins or more
-administer oral antihistamine
-50 mg diphenhydramine (2 tablets at 25 mg each)
-medical consultation
IMMEDIATE dermatological management
-less than 60 mins
-.3 ml of 1:1000 epi (epipen) or 1:2000 for kids
-antihistamine IM (50 mg)
-med consult before discharge
-observe for one HOUR
-escort home if epi pen/parenteral drugs were used
-oral antihistamine follow up
Systemic: allergic respiratory response
-lower airway distress, wheezing, cyanosis
-laryngeal edema, swelling, obstructs airway
Systemic: respiratory management
-semi erect position, supine for laryngeal edema
-give oxygen
-use epi or bronchodilator
-observe/monitor for one HOUR
-use epi 1:1000 IM if reoccurs
-oral antihistamine after recovery
-discharge or hospitalize
Systemic: anaphylaxis
-hypersensitive body response
-happens QUICKLY!!
-progresses in 5-30 mins
-can be life threatening
Systemic: anaphylaxis signs
-smooth muscle contractions, bronchospasms, GI, genitourinary
-respiratory distress
-CV collapse, pallor, palpitations
-hypotension, unconcious, cardiac arrest
-death due to laryngeal edema
Systemic: anaphylaxis management
-activate the EMS
-place in supine position
-give EPI
-monitor until help arrives
-follow up with physician
-oral anti-histamines
Systemic: fainting
=most COMMON SYSTEMIC reaction
-contributors: emotional distress, hunger, exhaustion, heat, position, hypervent, coughing, severe cardiac conditions, drugs
-management: supine, feet up, oxygen, inhalant
Local: paresthesia
=persistent anesthesia..resolves within 8 weeks & is rarely permanent
cause: trauma to nerve sheath, hemorrhage around nerve
problem: self injury due to loss of feeling, loss of taste with Li nerve involved
manage: tell pt its temporary, record incident & re examine every 2 months, consult after 1 YEAR
Local: trismus
=motor disturbance of trigeminal nerve, spasm of mastication muscles, opening is hard
-minor but can be chronic
-cause: injection to muscles or blood vessels, hand in hand with hematoma, hemorrhage irritates, low grade infection
-prevent: good technique,limit penetrations & redirecting
Local: trismus management
-apply heat every 20 mins
-muscle relaxants
-anti inflammatory drugs
-movement therapy
Local: hematoma
=the effusion of blood into extravascular spaces
-bruising noted intra and extraorally
-increases in sizze until extravascular pressure equals intravasc or until clots
cause: nicking blood vessel, most common with high vascularity: PSA, IA and mental
Local: hematoma management
-immediately apply pressure at the site of bleeding for 2 mins
-apply cold packs
Local: facial nerve paralysis
=anesthesia of 7th cranial nerve
-impairment of muscles of mastication
-TEMPORARY symptoms
cause: needle was directed too far posteriorly into PAROTID gland (poor IA or akinosi)
Local: facial nerve paralysis problems
-temporarily loss of motor function
-unable to close the eye
-mostly a cosmetic problem
-lasts a few hours
Local: facial paralysis management
-tell client its transient
-remove contact lenses
-manually close the eye
-review your technique!!
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