Promethazine

By J. Cyrus. University of Akron.

To date generic 25 mg promethazine amex, the majority of the factors for drinking and strategies for reducing 166 screening- and intervention-related research alcohol use and related problems order promethazine 25 mg without a prescription. Screening and brief interventions who did not participate in the intervention to have proven successful in reducing risky alcohol 171 have reduced their alcohol consumption four use and its consequences in this population. The Department of Education recommends the implementation of screening and brief intervention programs in all college health Justice Settings 172 centers. Unfortunately, jurisdictions typically do not provide adequate screening or 174 brief intervention services even though there are several screening tools that have been 175 validated for use with juvenile offenders. Even those facilities that screen an ideal venue for offering confidential youth and use a standardized screening screening, brief interventions and treatment instrument do not necessarily provide referrals. Several ‡ standardized screening and interventions are not pilot studies have demonstrated the 181 § implemented regularly in justice settings. The majority of people ages 18 and older who Comparable data on the proportion of employers meet clinical criteria for addiction (63. In this light, it frequently 193 is viewed as infringing on workers’ privacy; Barriers to Effective workers may worry about the confidentiality of Implementation of Screening and their test results and whether they will be used to deny employment or to impose other forms of Brief Interventions 194 discrimination. The drug-testing process can 195 The failure of our health care providers, schools, be costly as well. A significant barrier to change is the 196 fact that services aimed at preventing and included in the screening. Many physicians and other health professionals A significant proportion of individuals who do not screen their patients for risky use of participate in government programs have many addictive substances, provide early interventions risk factors for substance use and addiction and or treat or refer for specialty care, or they do so can benefit from screening and brief intervention inadequately because they simply have not been † services. Education about risky use and providing effective interventions for those in the disease of addiction, their impact on a need may help to reduce their risk of further patient’s health and other medical conditions, substance use, job loss, domestic violence and and how to implement screening, interventions other crime and, ultimately, can lead to cost- and treatment is not sufficiently integrated into savings through decreased demand for medical education or residency training 198 201 government services. Among those programs that do approach, there is little research on the address substance use and addiction, many have effectiveness of screening and brief shortcomings in the curriculum such as interventions in these populations and, instead of insufficient instruction, limited number of implementing these services, some states are now imposing or considering drug testing as a * The Constitutionality of these policies is being precondition for cash assistance and other tested in the courts. Inadequate training in risky use and addiction A related barrier to screening for risky use of means that many physicians do not recognize addictive substances and providing brief these conditions in their patients, do not believe interventions is the lack of effective and that substance-related interventions are appropriate specialty treatment services 203 effective, are unaware of what do with a available for referral when addiction is 211 patient who screens positive for risky use or identified. Although having more trained addiction or are uninformed about effective addiction physician specialists is critical to resources to which they could refer patients in providing care for those with severe forms of the need of more in-depth assessment or of specialty disease, the lack of such specialty providers is 204 treatment. Neither is it a legitimate Most schools lack employees or consulting reason for general health care professionals to be personnel with the necessary training and unprepared to provide addiction treatment that resources for identifying students who engage in does not require specialty care. These services risky use of addictive substances and attaining are designed to be provided in non-specialty care appropriate intervention services for those settings, along with some forms of assessment 205 students who need them. The real barrier survey of school personnel conducted for its in this case remains the lack of knowledge about 2011 report, Adolescent Substance Use: risky use and addiction and insufficient training America’s #1 Public Health Problem, found that in addressing these issues among health three-fourths of teachers are unable to identify a professionals. Lack of time and resources in the face of Other national surveys likewise find that high competing priorities is one of the most school counselors and school psychologists prominent barriers to implementation of generally report low competence in providing screening and brief interventions among health direct substance-related intervention services to 212 213 professionals, school personnel and students and a lack of relevant opportunities to 214 government agencies. Most schools have not set up partnerships with health care Because the general model in medicine today providers trained in conducting screening or (which is reflected or driven by insurance early interventions to refer students who engage reimbursement structures) is procedure-oriented in risky use nor do they have links to appropriate and reactive more than preventive, and because treatment programs to which they refer students insurance coverage for screening and brief 208 * with addiction. Too often, state substance increases the likelihood that risky use policymakers or administrators of these will not be adequately detected or that programs fail to understand how risky use and interventions will fail to reduce risky use across addiction impede progress in achieving their the board. Only a few screening instruments have The priorities of protecting patient undergone rigorous scientific examination to confidentiality and maintaining an amicable and determine their reliability, validity, sensitivity trusting doctor-patient relationship also may and specificity--key elements determining the § 221 impede health professionals’ implementation of effectiveness of such instruments. While existing federal than using objective and standardized measures * regulations protect the privacy of patients of risky use and risk for addiction, many of the receiving addiction-related services in settings more commonly-used screening instruments that are federally assisted and that are primary determine risk by relying on respondents’ providers of these services, the regulations do subjective reports of their own reactions to their 218 not apply to other service venues. These use of addictive substances and the reactions of ambiguous rules serve as a disincentive to health those around them, or their experiences of professionals to offer screening and brief adverse social and health consequences intervention services and an incentive to keep associated with such use. For example, while substance-related services divorced from risky alcohol use commonly is defined simply as 219 mainstream medicine. These tools also do not follow consistent standards nor are they designed to be tailored to ever had a drink first thing in the morning to the unique patterns, symptoms and steady your nerves or to get rid of a hangover 222 consequences of substance use of different age (Eye-opener)? Further, most screening instruments focus on specific other drug use (excluding nicotine) asks: (1) substances independently rather than identifying Have you ever ridden in a Car driven by risky use of all addictive substances or risk for addiction as a unified disease. Sensitivity refers to ‡ For example, any use of addictive substances by an instrument’s ability to identify correctly the children, adolescents or pregnant women constitutes presence of a condition; the higher the sensitivity the risky use; risky alcohol use is defined differently for less likely the instrument is to produce false women vs. Specificity is an instrument’s ability to individuals with co-occurring health conditions poses identify correctly those without the condition; the extreme risks even at levels that may be considered higher the specificity, the less likely the instrument is relatively safe among those without such conditions. An affirmative answer to each question is worth one point and a cut-off score of two is recommended for identifying 223 risky alcohol and other drug use, even though any use of addictive substances by adolescents is 224 considered risky. The typical screening process also may fail to distinguish those individuals with a higher level of substance involvement and the associated health and social consequences (including the risk for addiction) from those with lower levels of involvement--a distinction necessary for 225 providing appropriate interventions. In accordance with standard medical practice for the treatment of other chronic diseases, best practices for the effective treatment and management of addiction must be consistent with the scientific evidence of the causes and course of the disease. Behavioral therapies are those psychosocial interventions that focus more directly on addressing the patient’s substance-related behaviors, typically through behavioral reinforcement approaches, with less of an emphasis on the psychological or social determinants of their substance use. It is grounded in a public health model for addiction involving nicotine to be ignored in that addresses system and service coordination; the course of treating addiction involving health promotion and prevention, screening and alcohol or other drugs. Accordingly, when early intervention; treatment and recovery; and treating addiction, it is critical to recognize the resiliency supports to promote social integration 4 high rates of co-occurrence of different and optimal health and productivity. Treating the disease of occurring medical, including mental health, addiction involves addressing not only the problems exist and allow for the development of 10 specific object of the addiction, but the an appropriate and specific treatment plan.

If a certain protease is used to digest the Y-formed antibody buy promethazine 25 mg low cost, three fragments result: two identical fragments termed Fab (fraction antigen binding) and one fragment representing the other end promethazine 25mg with amex, containing a large part of the constant region. In early experiments, this fraction was successfully crystallized, giving the fragment the name Fc (fraction crystallizable). As this is the "back" end of an antibody, many cells of the immune system have receptors binding 16 to it: so-called Fc-receptors, named for the heavy chain they recognize: Fcγ-R (for IgG), Fcα- R (for IgA), Fcα/µ-R (for IgA and IgM), Fcε-R (for IgE). The affinity of most of these receptors is too low to bind single, free antibodies for longer periods of time. Only after antigen-binding, resulting in larger immune complexes, cooperative binding between several Fc ends and their receptors leads to rapid internalization by phagocytosis, providing a mechanism for rapid antigen clearance. An exception to this rule are mast cells and eosinophils, which also bind free (meaning non-antigen-complexed) IgE via their high- affinity Fc-ε-receptors. After a lag phase of at least five days, which we must survive with the help of innate immunity, B-lymphocyte-derived plasma cells will produce specific antibodies. For example, these may be virus-infected cells exposing viral envelope proteins in their cell membrane. Neutralizing viruses or toxins means studding them from all directions with antibodies, so that they are no longer able to make contact with their receptors. Of course, the protein was not intended to be a virus receptor; it has some physiological function that is quite different. Some bacterial diseases, like tetanus or diphtheria, are not so much caused by the bacteria themselves, but rather by toxins they produce. These bacterial toxins also work by binding and misusing cellular proteins, directing the cells to do something that is in the interest of the bacteria. Vaccinating babies with inactivated versions of these toxins produces neutralizing anti-toxin antibodies. If a child later is infected, it will not even notice, as the disease-causing toxins cannot bind to their receptors: they are neutralized. The Fc portion of these antibodies binds complement component C1q, with further steps unfolding as described in section 1. This is possible only after the antibodies have bound their antigen --formed an immune complex—, modifying their conformation. Antibodies make the process much more efficient: more opsonizing C3b is deposited per bacterial cell, and much faster. With that, erythrocytes become the garbage truck for immune complexes, transporting them to spleen and liver, where phagocytes will take them off their backs. If this transport system is overwhelmed, soluble immune complexes will deposit at sites of filtration, e. It is always the first immunoglobulin coming up in response to an infection, gradually declining afterwards. For that, it can be used to tell apart a recent infection from an old one: an acutely infected patient will have specific IgM, but little or no IgG, while a patient infected long ago will only have IgG. The ability of IgM to activate complement is so strong that a single bound IgM-"crab" functions as a landing platform for C1q. This is different from IgG, where at least two IgG molecules have to bound at a distance allowing C1q to go in between. By its size, IgM is mainly confined to blood plasma; it is simply too big to squeeze through between endothelial cells. IgG is the only class of antibodies transported across the placenta, equipping a newborn child for 2-3 months with antibodies against pathogens "seen" by its mother. IgG reach high molar concentrations in plasma, a prerequisite for effective neutralization of viruses or toxins. IgA, of which two subclasses exist (IgA1 and IgA2), can be found as a monomer in the blood, but its main function is to protect "outer" epithelial surfaces. Its strong glycosylation localizes and concentrates sIgA in the thin mucus layer lining the epithelium. There, sIgA prevents viruses, bacteria and toxins to make contact with their respective receptors by keeping them near the surface of the mucus lining, a mechanism termed immune exclusion. Unlike the other isotypes, it is present in plasma only in small amounts as most of it is tightly bound by the high-affinity Fc-ε-receptor of mast cells, which sit in connective tissue below outer and inner surfaces, e. If a worm penetrates the epithelial barrier, it binds to and crosslinks specific IgE, resulting in mast cell degranulation. An inflammatory reaction, induced via H1 receptors, facilitates the movement of eosinophils, which are guided in their chemotaxis by H4 receptors. Eosinophil granulocytes, which also express Fc-ε- receptor, assault the parasite by secretion of highly toxic basic proteins from their large eosinophil granules. A problem arises when the immune system confuses innocuous entities such as inhaled tree or grass pollen with dangerous parasites. IgD is found together with IgM on the cell membrane of newly produced B lymphocytes, and in negligible amounts in plasma.

It is estimated that the number of cases of malaria rose from 233 million in 2000 to 244 million in 2005 but decreased to 225 million in 2009 purchase promethazine 25mg with visa. The number of deaths due to malaria is estimated to have decreased from 985 000 in 2000 to 781 000 in 2009 cheap promethazine 25 mg overnight delivery. While progress in reducing the malaria burden has been remark- able, there was evidence of an increase in malaria cases in 3 countries in 2009 (Rwanda, Sao Tome and Principe, and Zambia). The increases in malaria cases highlight the fragility of malaria control and the need to maintain control programmes even if numbers of cases have been reduced substantially. The experiences in Rwanda and Zambia also indicate that monthly monitoring of disease surveillance data, both nationally and subnationally, is essential. Since many countries in sub-Saharan Africa had inadequate data to monitor disease trends, it is apparent that greater eforts need to be made to strengthen routine surveillance systems. Major epidemiological events could be occurring in additional countries without being detected and inves- tigated. On World Malaria Day 2008, the United Nations Secretary-Gen- countries in other Regions reported having a policy of parasito- eral called for eforts to ensure universal coverage with malaria logical testing of suspected malaria cases in persons of all ages, prevention and treatment programmes by the end of 2010. By November 2010, 25 countries were still allowing the marketing of  Policies and strategies for malaria control these products (down from 37 in 2009) and 39 pharmaceutical To attain the 2010 and 2015 targets, countries must reach all companies were manufacturing them. Spending by national governments on malaria transmission by vector control in all epidemiological settings. Of 106 malaria-endemic countries and areas, 77 received external quences, particularly pregnant women and infants. External fnancing appears to be Guinea, in the Western Pacifc Region, also adopted this policy concentrated on programme activities, particularly the procure- in 2009. The widespread use of a single class of insecticide to larger amounts of external fnancing, government fnancing increases the risk that mosquitoes will develop resistance, which exceeds that of external fnancing in countries in the pre-elimi- could rapidly lead to a major public health problem, particularly nation and elimination stages. The percentage of pregnant women who received the second 2010, sufcient to cover a further 10% of the population at risk. A model-based estimate showed that 42% of African households primarily to low coverage rates in Nigeria. There is no diference ularly in the African Region (from 26% to 35%), Eastern Mediterra- in usage rates between female and male children < 5 years of age nean Region (47% to 68%) and South-East Asia Region excluding (ratio girls: boys = 0. Data which corresponds to protection for 10% of the population at risk from a limited number of countries suggest that both microscopy in 2009. In 2009, the than fve-fold, and the total number of tests carried out (micros- European Region reported no cases of P. By combining household survey data with health facility data it be given to countries which harbour most of the malaria burden can be estimated that, on average, 65% of treatment needs are outside Africa. There were 8 countries in the pre-elimination stage of malaria are more difcult to construct for patients who are treated in the control in 2009 and 10 countries are implementing elimina- private sector, but household surveys indicate febrile patients tion programmes nationwide (8 having entered the elimina- treated in the private sector are 25% less likely to receive an anti- tion phase in 2008). A further 9 countries (Armenia, Bahamas, malarial than those visiting public sector facilities, while those Egypt, Jamaica, Morocco, Oman, Russian Federation, Syrian that stay at home are 60% less likely. The use of oral artemisinin-based monotherapies threatens and are in the phase of preventing re-introduction of malaria. It is estimated that the number of cases of malaria rose from 233 cal companies were manufacturing these products. Most of the million in 2000 to 244 million in 2005 but decreased to 225 million countries that still allow the marketing of monotherapies are in 2009. The number of deaths due to malaria is estimated to have located in the African Region and most of the manufacturers are decreased from 985 000 in 2000 to 781 000 in 2009. Parasite resistance has rendered previous antimalarial medicines largest proportional decreases noted in the European Region, inefective in most parts of the world, jeopardizing malaria followed by the Region of the Americas. Since 2008, containment activities to limit the spread of artemisinin-resistant parasites have been ongoing. Global control efforts have resulted in a reduction in the estimated number of deaths from nearly 1 million in 2000 to 781 000 in 2009. A total of 11 countries and one area in the African Region showed a reduction of more than 50% in either confrmed malaria cases or malaria admissions and deaths in recent years (Algeria, Botswana, Cape Verde, Eritrea, Madagascar, Namibia, Rwanda, Sao Tome and Principe, South Africa, Swaziland, Zambia, and Zanzibar, United Republic of Tanzania). No part of this book may be reproduced and/or distributed in any form without the express, written permission of the author. Readers are advised to check the product information currently pro- vided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician who relies on experience and knowledge about the patient to deter- mine dosages and the best treatment for the patient. The contributors to this site, including AmedeoGroup and Flying Publisher, disclaim responsibility for any errors or omissions or for results obtained from the use of information contained herein. It is the first major new infectious disease of this century, unusual in its high morbidity and mortality rates, and it is taking full advantage of the opportunities provided by a world of international travel. Fortunately, one by one, the outbreaks in the initial waves of infection have been brought under control.

Success depends on the current flow are on the patient’s chest and must not be moved through the myocardium and therefore to reduce between defibrillator and patient whilst charged order promethazine 25mg free shipping. This is often referred to as with the patient or trolley promethazine 25mg low cost, directly or indirectly ‘manual defibrillation’. Increasingly, ‘hands free’ (via spilt electrolyte solution), when the defibrilla- systems consisting of two large, self-adhesive tor is discharged. Any nitrate patches The paddles or self-adhesive electrodes are should be removed from the patient’s chest placed anterolateral: one to the right of the ster- along with any high-flow oxygen to eliminate num, just below the clavicle; and the other over the risk of fire. Al- ally a shout of ‘stand back’, and a visual check of though the paddles are marked positive and nega- the area are mandatory before discharging the tive, each can be placed in either position (Fig. An alternative is to place them anteroposterior to If further shocks are required, the paddles should the heart. A •Shout ‘stand back’ and make a visual check of precordial thump can be used under the same cri- the area. In general, the outcome from asystole is Epinephrine (adrenaline) poor unless there are ‘p’ waves present that may re- This is a naturally occurring catecholamine, ad- spond to cardiac pacing. This leads to an in- Atropine crease in the peripheral vascular resistance that tends to divert blood flow to the vital organs An anticholinergic acting at muscarinic receptors, (heart, brain). It is the first drug used in cardiac ar- causing block of the vagus nerve at both the sinoa- rest of any aetiology. Furthermore, if the optimum support is to be given, the techniques must be adjusted ac- • Hypoxia • Hypovolaemia cording to the size of the child. It is usually a result of conditions that • Head tilt plus chin lift A hand is placed on the mechanically restrict cardiac filling or outflow, or forehead, and the head is gently tilted back as for biochemically disrupt cardiac contractility. The best chance of survival is rapid identification and fingers of the other hand should then be placed treatment of the underlying cause. It may be necessary to use the thumb of the Open chest cardiac compression same hand to part the lips slightly. The output generated by direct compression of the • Jaw thrust This is achieved by placing two or heart is two to three times greater than closed chest three fingers under the angle of the mandible bilat- compression and coronary and cerebral perfusion erally, and lifting the jaw upwards. The procedure is may be easier if the rescuer’s elbows are resting on performed via a left thoracotomy through the the same surface as the child is lying on. The It can also be considered in those patients in whom child’s soft palate is easily damaged, causing bleed- closed chest compression is less effective, namely ing, and foreign bodies may become impacted in severe emphysema, a rigid chest wall, severe valvu- the child’s cone-shaped airway and be even more lar heart disease or recent sternotomy. The technique of expired-air ventilation The airway is kept open using the techniques described above. If the mouth of the child alone is used, then the nose should be pinched closed using the thumb and index fingers of the Figure 4. Since children vary in size, only general guid- The technique of external cardiac ance can be given regarding the volume and pres- compression in children sure of inflation (Table 4. Children vary in size, and the technique used must If the chest does not rise then the airway is not reflect this. In children over 8 years of age, the clear: method used in adults can be applied with appro- • readjust the head tilt/chin lift position; priate modifications for their size. The infant heart is lower compared to external landmarks; the area of compression is found by imagining a line running between the nipples and Circulation compressing over the sternum one finger’s breadth Because of the difficulties in identifying the pres- below this line. Two fingers are used to compress ence of a pulse, lay persons should look for signs of the chest to a depth of approximately 1. Healthcare An alternative in infants is the hand-encircling professionals should check for a pulse; in children technique. The infant is held with both the res- the carotid artery can be palpated, but in infants cuer’s hands encircling the chest. The thumbs are the neck is generally short and fat, and it may be placed over the correct part of the sternum (see difficult to identify; alternatives are the brachial above) and compression carried out. If a pulse cannot be detected or there are no The area of compression is one finger’s breadth signs of a circulation, or if in an infant the heart above the xiphisternum. The heel of one hand is rate is less than 60 beats/min, chest compressions used to compress the sternum to a depth of ap- will be required. One ventila- Larger children tion should be delivered for every five compres- The area of compression is two fingers’ breadth sions. The heels of both hands re-establishing the correct position for compres- are used to compress the sternum to a depth of ap- sions will seriously decrease the total number of proximately 3–4cm, depending on the size of the compressions given per minute. Practice [The Association of Anaesthetists of Great Guidelines for Management of the Difficult Britain & Ireland. Medical Treatment of Anaphylactic Reactions British Guidelines on the Management of for First Medical Responders and for Asthma.

If initial ventilation strategy results in significant stacking of breaths and thus autopeep or dynamic hyperinflation - eventually this will cause decreased venous return with hypotension promethazine 25 mg visa, shock buy 25mg promethazine with mastercard, cardiac arrest etc. The aim is to limit minute ventilation and maximize expiratory time, and thus reduce the risk of air- trapping. Daily Transcranial Doppler exams may detect impending spasm before clinical symptoms (stroke) develop. Other treatments of vasospasm include angiography w/angioplasty, and/or intra-arteial milrinone or papaverine (case reports). Refractory status epilepticus- continual seizures after 1-2 meds have been tried 20% of these patients go on to have persistent neurological defects- behavior, memory, emotional Incidence of status epilepticus- Less than 1 % of all seizures Management – 1. Hypertensive emergency- increase in systolic and diastolic blood pressure leading to end-organ damage A. The clinical differentiation between these two entities is the presence or absence of end organ damage not the level of blood pressure elevation. The aim is to lessen pulsatile load and force of left ventricular contraction to slow the propagation of the dissection. Definition: Hyponatremia is generally defined as a plasma sodium level of less than 135 mEq per L (135 mmol per L). Pseudohyponatremia: This condition results from increased percentage of large molecular particles in the serum relative to sodium. These large molecules do not contribute to plasma osmolality resulting in a state in which the relative sodium concentration is decreased, but the overall osmolality remains unchanged. Glucose molecules exert an osmotic force and draw water from the intracellular compartment into the plasma, thereby causing a diluting effect. Hypervolemic hyponatremic conditions: congestive heart failure, liver cirrhosis, and renal diseases such as nephrotic syndrome. Treatment: Step 1: Based on Na levels and severity of symptoms decide whether immediate treatment is required. In patients with chronic hyponatremia, overzealous and rapid correction should be avoided because it can lead to central pontine myelinolysis. In central pontine myelinolysis, neurologic symptoms usually occur one to six days after correction and are often irreversible. In patients with hypernatremia and depletion of total body Na content (ie, who have volume depletion), the free water deficit is greater than that estimated by the formula. Dialysis (diffusion): The movement of solutes from a high concentration compartment to a low concentration compartment. An electrolyte solution (dialysate) runs countercurrent to blood across a semi-permeable (small pore) filter. Ultra-filtration (convection) – Solute is carried (in solution) across a semipermeable membrane in response to a transmembrane pressure gradient (a process known as solvent drag). The rate of ultrafiltration depends upon the porosity of the membrane and the hydrostatic pressure of the blood. Intermittent hemodialysis is the most efficient – Large amounts of fluid can be removed and electrolyte abnormalities can be rapidly corrected. Continuous Renal Replacement Therapy: The concept behind continuous renal replacement techniques is to dialyse patients in a more physiologic way, slowly, over 24 hours, just like the kidney. The ultrafiltration rate is high, and replacement electrolyte solution is required to maintain hemodynamic stability. It is hypothesized that removal of mid sized inflammatory cytokines may play a role in improving outcome in sepsis. Pathophysiology: premature activation of trypsin in pancreatic acinar cells sets of inflammatory cascade. Confirmed infected necrosis can be treated with imipenem, fluouroquinolone+flagyl, or cephalosporin + flagyl, all +/- vanco. Likely to decrease bleeding from esophageal varices but does not change mortality Pitressin (Vasopressin) • For gastric ulcers, stress ulcers and gastritis initiate at 0. Definition: A group of syndromes characterized by increased pressure within a closed anatomical space resulting in local ischemia (limb compartment syndrome) or local and systemic complications (abdominal compartment syndrome). Injury (trauma, hemorrhage, ischemia-reperfusion, venous obstruction) leads to swelling and increased pressure within a compartment. The increased pressure collapses venules, and as hydrostatic pressure increases, eventually collapses arterioles causing limb ischemia. Most common cause is fracture of tibia or distal radius/ulna, in which compartment syndrome has been described in 2-30% of fractures c. Can occur with dilated loops of bowel in absence of trauma, rarely with ascites, peritonitis, pancreatitis. Pressure=Force (fluid volume, cardiac output)/ area (vasodilation) When one part fails, others try to compensate (hopefully). Definition: use of invasive device for continuous, detailed assessment of hemodynamics in order to guide treatment decisions. Exam: generally poor at predicting volume responsiveness and estimating cvp, except maybe the abdomino-jugular reflux Which is a fair estimate of cvp/pcwp.