![]() Sixteen of the 68 ketamine infusion with PCA bolus patients (24%), 77 of the 203 hydromorphone and ketamine patients (38%), and 28 of the 44 morphine and ketamine patients (64%) experienced an ADE. Of these patients, 121 experienced at least one ADE (38%). Results: A total of 315 patients met the inclusion criteria and were included in the final analysis. Patient charts were reviewed for ADEs including psychological and neurological side effects, nausea, and new-onset tachycardia. Perioperative information including patient characteristics and preoperative morphine equivalent daily dose (MEDD) were collected. Methods: The medical records of patients who underwent spine surgery between March 2016 and March 2020 who were postoperatively treated with a ketamine infusion and as-needed PCA boluses and parenteral opioids or treated with a combined opioid and ketamine PCA were reviewed. The objectives of this study were to compare the incidence and type of ADEs in postoperative spine surgery patients on ketamine infusions with as-needed PCA boluses to patients on combined opioid and ketamine PCAs. However, the incidence of ADEs with ketamine infusions with patient-controlled analgesia (PCA) boluses compared with combined opioid and ketamine PCAs is not well described. ![]() There are several known adverse drug effects (ADEs) associated with ketamine. Objective: There has been increasing use of ketamine at subanesthetic doses as an adjunct to opioids in perioperative pain management. Tiffany M Pouldar, 1 Dermot P Maher, 2 Alexander W Betz, 1 Jeffrey J Wiegers, 1 Jeremy A Friedman, 1 Sameer S Zaidi, 1 Ali Rejali, 3 Hai P Tran, 3 Roya Yumul, 1, 4 Charles Louy 1ġDepartment of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA 2Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins Hospital, Baltimore, MD, 21205, USA 3Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA 4Department of Anesthesiology, David Geffen School of Medicine-UCLA, Los Angeles, CA, 90095, USAĬorrespondence: Charles Louy, Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd #8211, Los Angeles, CA, 90048, USA, Tel +1 31, Email
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Highly susceptible people can experience symptoms from 2500 m (7000 ft) onwards, in rare cases even below that. (Older people will ascend more slowly, and nothing protects you better from altitude sickness than ascending slowly.) Older people seem to be less susceptible. ![]() (Competitiveness and the desire to show off plays a part in this. Men appear to be more susceptible than women, especially young and fit men. There are many stories that indicate they may be even more susceptible! ![]() People who are extremely fit and exercise a lot get it just an easily as couch potatoes. Susceptibility to altitude sickness is random. There is no way to predict how your body will react if exposed to high altitude without proper acclimatization. As I said above, these conditions are extremely rare, provided you act sensibly when on the mountain.Īnybody can get altitude sickness. Also keep an eye on your climbing partners, since people suffering from these severe conditions may not be able to correctly assess their own condition.Īnybody experiencing symptoms that could indicate HAPE or HACE needs to descend IMMEDIATELY or they will die.īut please don’t panic now. Make sure that you always remain in contact with your guides and let them know exactly how you are feeling. However, if you do experience symptoms, your guides should also keep monitoring you, because AMS can progress to one of the more severe forms of altitude sickness. In fact, your guides may tell you during the briefing not to worry, that it is totally normal to be throwing up repeatedly during that last final push top the summit. The symptoms of acute mountain sickness as described above are self limiting and not dangerous. HACE becomes apparent as a lack of coordination, inability to walk in a straight line, confusion and irrational behaviors (to the point of not acknowledging the symptoms). The most obvious symptoms for HAPE are extreme breathlessness, even at rest rattling breath, coughing with pink froth and blue lips or finger nails. Everybody can expect to experience at least some of these symptoms in a mild form. The symptoms of AMS are headaches, loss of appetite, nausea, vomiting, sleeplessness, fatigue, dizziness. ![]() What are the symptoms of altitude sickness? None of those symptoms are altitude sickness. You may experience periodic breathing at night (where you stop breathing for up to 15 seconds, and then breathe very fast to make up for it, scary but harmless), They are considered normal and shouldn’t worry you: There is also a range of other symptoms you are likely to experience during a Kilimanjaro climb due to the altitude. If you want to know more details, there is a link to an excellent tutorial at the bottom of this page. What exactly causes the individual symptoms of altitude sickness is still not fully understood. HACE (High Altitude Cerebral Edema) is fluid build up in the brain.īoth HAPE and HACE are potentially fatal but are thankfully extremely rare during a well planned Kilimanjaro climb. HAPE (High Altitude Pulmonary Edema) is a fluid build up in the lungs. There are three main forms of altitude sickness:ĪMS (Acute Mountain Sickness) is very common when climbing Kilimanjaro. If you ascend faster, and everybody climbing Kilimanjaro will, then you may develop altitude sickness. The body can adjust to the reduced air pressure at higher altitude, but only at a rate of about 300 m (1000 ft) altitude gain per day. Very High Altitude: 3500 – 5500 m (11500 – 18000 ft)Įxtreme Altitude: above 5500 m (18000 ft)Īltitude sickness is a range of symptoms that can occur when someone ascends to a high altitude too rapidly, without sufficient acclimatization. If you are planning to climb Mount Kilimanjaro you will sooner or later hear about altitude sickness.For those unfamiliar with the ins and outs of altitude illness, here are answers to the most common questions regarding mountain sickness. ![]() If you’re sending to an iOS device, first go through the on boarding process, then make sure you don’t have any documents open at the time or you won’t see the alert asking if you want to accept the file transferring from the other device.Ī: Tap Forms 5 for Mac is $49.99 USD. Then use the ‘Send Document’ function to transmit the document to the other device. To do that, you only need to create your document on one device (either from scratch or via migrating your old Tap Forms database). The main thing to know about getting sync working is that you need to have a copy of the same document already loaded onto each device in Tap Forms 5. 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Featuring the steady patter groove of David Gibson McLean's drum performance, Tournament Arc presents a thoroughly-chill atmosphere, helping to relax you for the light drizzle present in Shellwood Forest's second act. ![]() Our second offering is Tournament Arc's Latin Jazz reinterpretation of the Sherwood Forest theme. Shellwood Forest (Act 2), Tournament Arc - Make Way For Me Her hopeful demeanor in the face of darkness is represented here by the violin.Ģ. To me, this theme best represents our courageous protagonist, Aine. Our journey begins with the menu theme, presented here in its original arrangement. Welcome to Renaine! 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![]() If you’re going to be mixing music videos, make sure you have a video card with dedicated graphics memory.A professional sound card such as the Electrix Ebox 44, or the Forusrite Scarlett 2i4 provide 2 stereo outputs, with RCA connections, offer easy two-channel output connection to external DJ mixer and very low latency output. This means you have no way to cue in your headphones (pre-fade listening) and in the case of Windows machines, you’re software latency will be much higher due to having to use the native windows Direct Sound (or WDM/WASAPI) driver. Furthermore, they only have one stereo output in almost all cases. Computers come with ‘decent’ built-in sound cards, but they weren’t intended for live use and plugging into amplified systems. Use either a professional grade DJ-ready sound card, or DJ controller with one built in.USB 3.0 is ‘better’ but I still suggest the alternatives as Windows can and will often change your HD drive letters, breaking your shortcuts to your files, when using USB. Try to use firewire / thunderbolt or ESATA. Preferably (if you have the option) external HD’s should NOT be USB due to buss throttling when using USB DJ controllers and/or USB sound cards. Most DJ’s take out a second computer/laptop for backup to all gigs, and with an external HD it’s easy to plug-in and play with the backup machine. This ensures you’ll always have plenty of “breathing room” on your local boot drive, but it also means in case of catastrophic machine failure, you’ve got your files ready to go. ![]() Use an external HD for your media files.We suggest at least 4GB of RAM on both Windows 7 and Windows 8. The more RAM the merrier. Your OS needs around 1GB of RAM for normal operations, and in the case of Windows 7 or Windows 8, you need a minimum of 2GB for the OS itself.Under 20% of drive space you will notice system slow-down. Try to spare at least 20% of drive space to ensure “breathing room” for the OS. Never let your boot drive (C drive/Internal drive) get too full.Ideally however, you should not have ANY antivirus software on your machine, since some (including the popular Norton) will still run even when you disable them (so they are never completely disabled) Virus Software, especialy overly intrusive products such as Norton will do random background scans that can eat into valueable resources. If you must surf the web with the computer, and therefore use Antivirus software, make sure you disable it completely while you gig. Remove any un-necessary applications, even antivirus software.This holds true for your DJ machine, especially considering most laptops come with various adware and pre-loaded extra’s you simply won’t need.Īudio mixing, and even more so video mixing, with robust and feature intense DJ software really tax your machines resources – so you really want to squeeze as much dedicated power from the machine as possible. The suspension, gearing, and timing all need to be tweaked before a car is ready to be pushed to their limits.” ![]() Even high-performance sports cars come tuned for the road, not the racetrack. “You can’t walk into a car dealership and buy a car that’s ready to enter a race. Numark used an analogy on their website that I feel sums this up well: While it’s true you want to dedicate the machine you’re going to use to DJ with as much as possible to DJ software such as PCDJ, rarely are computers truly ‘ gig-ready‘. Many assume that an off-the-shelf machine is ready to fly, since they haven’t installed any other software etc. ![]() One question that’s asked often, and no surprise here, is how to ensure their MAC or Windows based computer is optimized for DJ software use. When I’m not busy socializing with our PCDJ community via our forums, social sites and blog posts I like to take a few minutes each week to answer our sales and customer service lines, mainly to gauge our audience on what their frequently asked questions are regarding PCDJ and DJing with a computer in general. |