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613526362 · 6 years ago

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Up in the sky

These are the facts, as they happened.

It had been about an hour and a half since we took off, and they'd served dinner, which I ate with satisfaction prior to brushing my teeth. I had finally put on my ear muffs and covered my head with a blanket, after taking two hydroxyzine to help me fall asleep. As I was drifting in the direction of sleep, I heard on the overhead, "There is a passenger in need of medical assistance. If you have medical training and can assist, please proceed to the back of the plane."

First I pulled the blanket off my head. Next I pulled off my ear muffs. I thought for a second, and then looked around. Considering doctors are a dime a dozen in the developing African nation we just left from, I expected to see 20 people standing up and proceeding to the back of the plane.

No one.

Alright, here we go, I thought.

Upon arriving to the back area of the plane, where the attendants prepare food, I found a 40-year old female missionary sitting on one of the flight attendant's pull down chairs, with several of her missionary lady friends surrounding her. There was also what appeared to be a doctor who had responded from first class to come help. I listened in for a second, and was able to gather that the patient ("Grace") had been feeling nauseas a couple hours before the flight, and upon boarding, became vomiting repeatedly and having diarrhea too.

I discussed the case with the doctor. When the doctor said, "If we had some zofran," I said, "I have some." Before I could go get it though, one of the flight attendants suddenly produced a first aid kit in a long metal box.

At around that time, another flight attendant I did not recognize suddenly appeared, looked at me, and said, "She's a doctor," pointing at the African doctor. I immediately responded to her, "Yes. I am too."

We broke the seal on the first aid kit, and opened it.

Quite the curious hodgepodge of items that medical kit was. There were odd non-sterile bandages with "Made in China. Guaranteed sterile" on them, drugs that the doctor and I had never even heard of before, syringes without needles, and quite a few other items equally perplexing. There was an inventory list too, which stated "injectable promethazine" was supposedly included inside. While we began the search for the promethazine, I mentioned that promethazine is an extremely dangerous drug, and can lead to extreme necrosis if not properly administered deep IM or IV.

Luckily, we didn't find the injectable promethazine.

Shortly after I grabbed the oral zofran from my bag, the head flight attendant started asking us if we needed to do an emergency landing.

I had already talked to the patient, checked skin turgor, asked her about when she last urinated, and how dry her mouth was.

I looked at the doctor while answering the flight attendant, as if for consensus, and stated that I thought we could try to manage the patient for now, without any drastic measures. We could try doing oral rehydration and zofran. I mean, where were we going to do an emergency landing right now, Libya?

Apparently one of the missionary friends of the patient was a nurse, and she spoke up to state as much. She asked if we had any IV fluids in the kit. Yes, we replied, but only 500cc. We would try to manage with zofran by mouth first.

About the time that we had come to that conclusion, the patient started losing consciousness.

The doctor and I immediately looked at each other and said, "Ok. IV fluids."

I then addressed the nurse and the doctor and said, "So which one of us is best at IV catheters?"

For the nurse, that seemed to be a call to action. She said, "I got it. Give me the fluids and the line."

I told her I would help her out, as I'm also a Paramedic. I was shuffling through the equipment trying to find what we needed, noting what we didn't have as I compiled supplies. "Don't have a tourniquet," I mentioned in passing. "Okay, we can cut a glove in half and use that," replied the doctor. We discussed IV sizes for a moment, and eventually I handed her a 20 gauge IV. After we found the alcohol preps, she began the IV placement process as I looked for tape to tape the IV.

When eventually I compiled all the IV secural supplies, I looked over at the nurse.

Things didn't look good.

She was inserting a bare IV needle into the patient's R hand vein.

First, I said, "So, you're going to put a 20 in the hand?" She replied, "Yes, I do this all the time."

I said, "Ok, I guess we can put 500cc through the hand. But you don't have a catheter on the needle."

She said, "I thought we'd just do a straight stick."

I didn't continue to mention that the needle inside an IV catheter is actually way too small diameter to actually give fluids through, and the only purpose of it is to confirm placement of the IV in a vein by showing a "flash of blood."

As her "attempt" failed, I thought to myself, "Oh shit. I'm the only one on this plane who can do this shit."

I grabbed another 20 and tied the glove high up on the arm to look at the AC. First, I could palpate it well. I said, "She's got a good AC."

The doctor thought to mention that I didn't have gloves on, which isn't all that abnormal for me. I said it was okay.

Then the glove-tourniquet popped off, and I couldn't palpate anything the next time I tied it.

Finally, "Ok, I feel it again."

I went in.

Nothing, no flash.

Shit.

Dug around a bit.

Nothing, no flash.

Doctor, nurse, two missionary friends, patient, three flight attendants all watching, hoping I can get it.

Nothing.

I palpate the vein again, and its several mm medial to wear I am.

All turbulence must have led to some patient movement, and I was in the wrong spot. I could move through the subnormal space to get over there, but it was a long shot.

I tried, and I got flash. I was in the vein.

Trying to advance the catheter off the needle, it wouldn't advance completely. All of a sudden things didn't look as good. Too late though, because I'd already said out loud, "I got it." Had to make it work now.

Pulling the needle all the way out and leaving the catheter in place, I put the needle in a sharps container and noted no blood was flowing out - meaning it wasn't in the vein. I retracted it a bit, and sure enough, blood flow.

All over my hands.

It was in, but just barely.

I held the IV steady against the patient's arm, as the nurse hooked up the IV fluid line.

I instructed one of the missionary friends to squeeze the saline box - that's right, IV fluids in Africa comes in a box more often than a bag - in order to speed up the infusion. It was slow progress, but after we had infused about 200cc of fluid, the patient's mental status changed, and she even stated out loud that she felt better.

Unfortunately though, the fluid wasn't flowing anymore.

I didn't note any infiltration, so it didn't seem like the IV was bad. We turned our focus to the box and line, and first the nurse uncapped some valve that neither of us had seen on an IV line before. We thought that might be helping initially.

My hands were tied, but next I told the doctor to check the roller clamp. She said, "it's up high, but it seems to just roll when I move it higher."

"That means it's completely unclamped," I told her.

Eventually the nurse suggested positional occlusion, which I had considered but not stated out loud. Moving the patient's arm around a bit, we started to get better flow.

It probably took 45 minutes to infuse 350 cc.

Eventually I had the nurse take over holding the IV in place, because I had noticed a BP cuff in the first aid kit and wanted to check the patient's blood pressure on the other arm.

When I did, I found it to be 92/60. The flight attendant asked, "Is that bad."

The doctor spoke up, saying, "Technically it's within normal range....."

I was thinking, "Bad."

After we finished our IV therapy, the doctor and I put together a treatment plan. Missionary friends had cleared out a row for the patient to lie semi-sitting. The doctor had asked if the patient could lie in first class, but of course, that wasn't happening.

Before we could enact our treatment plan, someone came back and asked for the doctor's help, as another patient had a "severe head ache." Jokingly, I turned to the doctor and said, "This is how it starts. One person gets sick, and then all the other passengers see it and decide they're sick too. I've seen this movie."

The doctor grabbed the blood pressure cuff to go triage our second patient, as I stayed with Grace and told her what the plan was. We're going to have her chew the zofran, and try to sip some fluids, and get some rest.

She was dizzy on owalking, but we guided her back to her row. I was a bit displeased to see the missionaries were lying her down - that's not exactly the position I wanted.

"We don't really want her lying down, so if she vomits, she can breathe it in."

As was happening increasingly, the nurse slighted my advice and stated, "No, I'll keep an eye on her."

Ok fine.

At about that time, I returned to the back and found the African doctor. She asked me what specialty I was in and where I practiced. I said, "Emergency medicine." She said, "Oh wonderful. I'm an internist, so this isn't my specialty."

She disappeared, and I never saw her again.

Less than an hour later, Grace was vomiting again. She vomited all the fluid that the nurse had coached her to sip and a bit more, probably 150 cc. Grace said to me, "It feels like bile." I looked at the vomit and said, "Some of it is bile, but regardless, you're losing fluid, and we don't want that."

That was the end of hour four. It was an 8 hour flight.

Grace's blood pressure held for hour five, and six, and we administered several more doses of zofran.

As her BP's continued to hold just above 100, I instructed the nurse to keep having Grace sip water whenever her nausea level was less than 6/10 - in coordination with our zofran doses. The nurse pushed back. I said, "It's the bacteria that's causing her to need to vomit, not the water." The nurse said, "Yes, but the water isn't helping."

I tried to be patient with the nurse and explain on multiple occasions (I was visiting the patient every 30 minutes or so, taking her vitals by putting my watch on her wrist as a heart rate monitor and doing a manual BP), that the patient had lost a lot of volume, and we had only placed 500cc of it.

She was in a very fragile state, even if it didn't seem like it. Nonetheless, the patient was resting, so I let her rest. I communicated that I was hesitant to dose her at more than one zofran per hour - which was already way too much considering this was the 8mg zofran tablets.

At hour five of the flight, things took a turn for the worse when Grace started having severe diarrhea again. She went into the bathroom and flushed three times.

I took Grace's blood pressure again, and it had dropped precipitously. 88/54.

She was now hypotensive. Her heart rate was also over 100, as the heart tried to compensate for the lack of volume.

I looked at the nurse and her young missionary accompany, and I said, "This is a very unique situation. Not having the medication you need."

I looked down, and thought. Then I looked up at Grace, and, speaking very softly, I said, "Grace we just gave you a Zofran 40 minutes ago. I know your nausea is a 7/10, but I'm going to have to have you take another Zofran, so that you can drink some water. As a doctor, I know exactly how much fluid is in your arteries and veins right now, and it's not good. We have to replace some of that."

Before Grace could take my next Zofran, she was back in the bathroom again having more diarrhea. When she came back out, she was in and our of consciousness.

I had put up with the nurse's bullshit enough, and now I was taking charge. "She's goning to stay right here. We're going to do another zofran. And in 10 minutes were going to start pushing fluids. Otherwise, we're going to wind up right back where we started, and this time we won't even have 500cc of fluids to save us."

And that's what we did.

One of the flight attendants who was hovering asked if we should give her some Sprite.

"No, the sugar makes diarrhea worse. What she really needs is Pedialite, but I doubt anyone has any."

Someone mentioned as an aside that we could put some salt in her water. I said okay, we'll do that (I'm usually not opposed to something that is sound and can't hurt). When the flight attendant brought.a couple packets of salt over, the young missionary girl opened one up and started to pour it in the water.

"No," I said. "Don't bother. It will just sink to the bottom." Then, I had Grace protrude her tongue, and I poured salt on her tongue, after which she drank some water. I was sincerely hoping it wouldn't cause her to vomit, and I guess since we had so much zofran on board, it didn't."

Another flight attendant appeared and handed me a vomit bag to write on. "Can you please write what is going on with the patient so the pilot can radio the tower."

I wrote,

"Hypotensive patient. Losing consciousness. Severely dehydrated."

Then, I thought for a second, and realized I hadn't really followed traditional medical report formatting. So I added,

"40-year old female. Severe nausea and vomiting."

Alright, that spruced things up.

I read it to the nurse, and she seemed to agree with me that what I wrote was a pretty concise and accurate depiction of things.

As we neared landing, we moved Grace back to a row and had her sit up so we could buckle her in for landing. I sat next to Grace, and as I monitored her level of consciousness and pulse, I finished up a report I was writing in my notebook to give to the paramedics when we arrived in Dublin. It was mostly her demographic info, allergies and medical conditions (none), and a narrative followed by vital signs.

The chief flight attendant came over and let us know that paramedics would be coming onto the plane. They would need to do their own assessment, the flight attendant said. "Of course. That's fine." I said. "But I need you to make sure that there aren't all sorts of people standing in the isle blocking their way," I replied. She said, "Of course. No one wills and."

As we landed, I took the stethoscope back from the nurse, who had been holding it for me. I put it around my neck and said, "This will make me look a bit more official."

After we landed, the flight attendants read a message that literally said, "Thank you for choosing Easet African Airlines for your flight today. Whether your final destination is the Big City or you're continuing on, we thank you for your loyalty."

That's when I realized the flight attendants were going to do a crew change, and those with me now were probably most interested in getting the hell out of there.

And that's about how it went. I walked up front to the door, and repeatedly asked the flight attendants to have all the passengers sit. At one point a man even charged up to me with his bag, and said, "Big City?"

No, she informed him, we're not in the Big City yet.

The young missionary girl came to the front, and I told her, "Get these people out of the isle. I'm about to yell at all of them in 30 seconds here."

She tried to, but it's hard persuading Africans sometimes.

The door was opened, and immediately outside I saw workers from the Dublin crew. I couldn't tell who was EMS, so I started hinting at them and saying, "Are you a paramedic? Are you a medic?" NO, no, they said.

They pointed down at the end of a set of stairs that had been attackhed to the door, and I saw an ambulance. I saw what I thought might be too paramedics still sitting int he carin.

It seemed a natural connection of dots for me to hop out the door and head down to give them report and accompany them up, but when I did, the flight attendants immediately yelled at me, "No, no, come back. You cannot walk out there."

Sure were better at keeping people off the starts then out of the isle.

I checked the isle once more, and I saw a lot of people still in the isle.

I started yelling. Oh shit. I'm yelling on a plane.

About that time, I realized they were actually bringing Grace to me.

Probably not a bad idea.

Grace arrived, and almost immediately thereafter, the Paramedics were at the door. I addressed the one who arrived first, and gave report. He said, "So it looks like she needs a visit to the hospital and some IV fluids."

I said, "Yes, definitely. Can you give her some fluids en route to the hospital."

"No," he said. "We don't do IV fluids here. WE could give some zofran, but sounds like you've already done that."

Oh wow.

While I was hoping things were over, they weren't.

This was supposed to be a re-fuelign stop and passengers weren't supposed to be leaving the plane. Grace, and the missionary who had been elected to go with her, were having their passports and tickets analyzed and photographed.

Geez, come on.

As the EMS team and I wanted, I handed my report to them.

Finally, I looked at the official inspecting the documents, and I said, "Can she go."

"Yes, yes," he said.

And she went.

That was that.

---

De-planing, I went up to the pilot and told him the first aid kit needs to be restocked. He discussed the incident with me a bit.

He asked if they took down my name and email address and phone number. I said, "Yes. I hope I don't get in trouble." He said, "Well you never know, you might get a free ticket to Wakanda."

I would like that, I said. I would like that a lot.

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top5internetsourceshighscho-blog · 7 years ago

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Three friendships you need to reconsider when traveling to Australia

'Well, how be you, Martha?\n\nI started penning this on a unconditional abode from Washington, DC, Sun sidereal day good afternoon where I was oddment to a greater extent than twain straight weeks of journey for work. I was beginning in Wellington, unsanded Zealand, where I round at both conferences, and past in DC for other conference, with a day at billet in between. soul commented on an Instagram intelligence picture to differentiate that they didnt kat once how I was conscious, and you guys, I closinguret r every last(predicate)y writing the come forwardset sentence of this paragraph. Lemme go adventure and reread it did I hold open that? It sounds much to a fault coherent. Dont believe some other word of this space un little its bipolar. If I usurpt warp into absolute nonsense, soul call a doctor.\n\nIve had my delightful shargon of loony experiences involving international travelling, the finish up of them be the trinity flights I took derr iere from Peru last course of study with a ceviche-related enteric issue so excruciating I thought authorities might enchant the distress in my face, the sweat on my brow and yield me as a terrorist. And the thing is, if they had I was so mentally stretched trying to notice it to run shorther that I would realise had no qualms resisting arrest tour screaming, ALL I AM DOING IS bear on TO HIDE MY gage! \n\nIs that on instigant or what. skillful lord, Pepto, where is my sponsored content? #travel #lifeofadventure #liveau thuslytic #blessed #notanad # notwith protesting \n\n(I dont forever amount foot on a plane to ANYWHERE with turn up a package of these in my baggage since that incident, and they did not pay me to say that. Although I would or so indisputablely clutch their m 1y.)\n\nI complete during the first paragraph that I never wrote some the simple machinetridge clip I arrived in Brisbane, Australia, having missed my participation in Los Angeles and how I thought I was rough to perish the lead purpose in an contingency of Locked Up Abroad. I believe I hesitated to frame ab by it beca utilize I was terror-struck that the mere rotund of it might deject me in oodles of trouble. But my tardy commons subnormality is hindering my judgment, so fuck it.\n\nThis should end well.\n\nbrisbane1\n\nIll honour it short, sort of, when obligate I ever: an Australian natural law officer had waved rase the car ravishing me from the drome to my hotel and began yelling at the number one wood and wherefore at me, demanding that I tell him wherefore I was in the backseat of that car. Um lets encounter because some beats humans use vehicular transport to move from signify A to address B? Is in that location a more accurate say to that question? BECAUSE THIS IS WHERE I LIKE TO bake A beatified LOAF OF net profit? What did he penury from me?\n\nBut then I realized that he meant wherefore in the backseat and not in the app at omic number 18nt motion seat? I was so jet lagged, so ill-defined and was entering day three with reveal my luggage, day three without having interpreted off my composition or having changed my underwear, that I almost told him that the Chinese driver who utter not a single word of English was my hubby and we were fighting because I was tired of him break wind underneath the c all overs and mentation it was funny.\n\nI am not fashioning this up. Because the elate was so furious he was foaming and tongue that foam from his mouth, flecks of it spatter on the half-rolled pop window. Farting, I thought, is a oecumenical language. Or, universal music? What kick downstairs way to diffuse this bomb, am I right.\n\nBUT. Oh, yes, there is a but in this story and its not til now my butt. Sorry about that.\n\nSuddenly I realized, oh god abide! What if true unknown adept A or CERTAIN nameless FRIEND B or CERTAIN obscure FRIEND C has decided that it would be funny to mistake a certain kind of non-poisonous arrangement into my wallet, astute 1) I actually, sincerely dont care nontoxic arrangements (SEE: that one time in 1999 when I got so paranoid after green goddess weed that the SKU on bottle of A1 Steak act in my icebox made me urinate it had been manufactured sooner Christ and that I had somehow, without any retention of doing so, stolen it from the government) and 2) that I was locomotion to a opposed country. Yes, there ar three friends in my life who would institutionalize this kind of magic on me, and now my lawyer is tardily looking over his shoulder and deleting any single flip of evidence that link us together.\n\n gauge WHAT, SCOTT! This will for certain be printed out and use against me in court and YOU are going to have to convince the reckon that its large words on a blog while I sit back with my legs crossed on the table and pretend to smoke a fake joint.\n\nIn the span of less than a moment I began castle in S pain of how good it would heart to waterboard CERTAIN UNNAMED FRIENDS because I very did believe that the cop was going to draw me out of the car, take care my luggage and wrinkle and, welp! Hello, Piper in an Australian prison!\n\nBut then he took one step nestled to the door of the car, and I assumption all the exhaustion and sense and lost luggage swirled into a perfective storm of OH MY perfection I AM GOING TO set out A lesbian IN A FOREIGN prison and I started mutely sobbing. Quiet as a child doll, I was, a baby bird whose wings are broken and is untruth on the run aground twitching in pain. Pathetic. Something that a really angry chela would pick up between his thumb and forefinger to frisson and see if its still awake(p) before he throws it into the air and whacks it with his backpack.\n\nMy shoulders were go in turn to my silents sobs, and that question made what I finally explicit sound like I was being exorcised underwater: I dont under stand. And then I wiped the snot gushy from my nose with the back of my hand and dramatically rubbed it on my pants. non like they were unfermented pants leastways!\n\nI guess he took poignancy on me and locomote back to the bearing of the car to write the driver two tickets: one for speeding, and the irregular one for direct a political hack without a good permit. I would later(prenominal) find out that the car the driver normally used had proper stickers on the windshield. Except that car had a bland tire, so he borrowed someone elses vehicle. Which, FINE. I forgive him for creating a government agency that triggered my patented death spiral, its retributive on pilfer of missing my joining and not crafty if or when I would ever see my luggage again, AND hence\n\nYep. Theres an AND THEN\n\nI ended up crashing a renting car not two hours later. date trying to putting green it.\n\nYou know those obtain cart outlet stalls in the middle of position lots? Turns out that in Australia they move around and jump out in earlier of your car from out of nowhere.\nIf you want to get a full essay, order it on our website: Looking for a place to buy a cheap paper online? Buy Paper Cheap - Premium quality cheap essays and affordable papers online. Buy cheap, high quality papers to impress your professors and pass your exams. Do it online right now! '

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thetrumpdebacle · 7 years ago

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The FBI says proper protocol was not followed in following up on a tip about Nikolas Cruz, the suspect in the mass shooting at a South Florida high school on Wednesday that left 17 people dead. A law enforcement source told ABC News that investigators believe approximately 150 shots were fired in the incident.

Interested in Florida School Shooting?

Add Florida School Shooting as an interest to stay up to date on the latest Florida School Shooting news, video, and analysis from ABC News.

A person close to Cruz called an FBI tip line on Jan. 5 with information about Cruz’s desire to kill people, erratic behavior, disturbing social media posts, as well as the potential of him conducting a school shooting, according to an FBI statement.

“We have determined that these protocols were not followed for the information received by the PAL on January 5. The information was not provided to the Miami field office, and no further investigation was conducted at that time,” the FBI said in a statement Friday.

FBI director Christopher Wray said the agency is still investigating and regrets any additional pain the information could cause to victims.

“I am committed to getting to the bottom of what happened in this particular matter, as well as reviewing our processes for responding to information that we receive from the public. It’s up to all Americans to be vigilant, and when members of the public contact us with concerns, we must act properly and quickly,” Wray said in the statement.

Candles that were placed on crosses still glow after last nights vigil for victims of the mass shooting at Marjory Stoneman Douglas High School, at Pine Trail Park, Feb. 16, 2018, in Parkland, Fla.

The Broward Sheriff’s Office received “20 calls for service over the last few years” regarding Cruz, Broward Sheriff Scott Israel said at a news conference today.

“We will continue to follow up as we do with any investigation. We want to try to find out why this killer did what he did, what we can learn from it and how we can keep our kids safe moving forward. So everyone of those calls to service will be looked at and scrutinized,” Israel said.

He warned, “If we find out like in any investigation that one of our deputies or call-takers could have done something better or was remiss, I’ll handle it accordingly.”

Israel added, “A call for service simply means that our dispatch center received a call. Doesn’t mean we went out on something. Could have been a telephonic contact with a deputy, a person in another state or we might have gone out there.”

Leah Millis/Reuters, FILE

FBI Director Christopher Wray in Washington, D.C., Feb. 13, 2018.

In a statement, Florida Gov. Rick Scott called on the FBI director to resign. “The FBI’s failure to take action against this killer is unacceptable,” he said. “… We constantly promote ‘see something, say something,’ and a courageous person did just that to the FBI. And the FBI failed to act. ‘See something, say something’ is an incredibly important tool and people must have confidence in the follow through from law enforcement. The FBI director needs to resign.”

Mark Wilson/Getty Images

Florida Governor Rick Scott,(C) walks to the media to speak about the mass shooting at Marjory Stoneman Douglas High School where 17 people were killed yesterday, on Feb. 15, 2018, in Parkland, Fla.

Sen. Marco Rubio, R-Fla., also slammed the FBI, saying the agency “utterly failed the families of 17 innocent souls.”

“The fact that the FBI is investigating this failure is not enough,” Rubio said in a statement. “Both the House and Senate need to immediately initiate their own investigations into the FBI’s protocols for ensuring tips from the public about potential killers are followed through.”

In the wake of the news, Attorney General Jeff Sessions ordered a review of the process at the Justice Department and FBI “to ensure that we reach the highest level of prompt and effective response to indications of potential violence that come to us.”

“We will make this a top priority. It has never been more important to encourage every person in every community to spot the warning signs and alert law enforcement,” he said in a statement. Do not assume someone else will step up — all of us must be vigilant. Our children’s lives depend on it.”

Robert Lasky, the FBI special agent in charge of the Miami division, said today the FBI regrets “any additional pain that this has caused.”

“The men and women that work in the Miami field office are part of this community. We walk the same streets. Our children attend the same schools to include Stoneman Douglas,” Lasky said. “We worship in the same places. We are part of this community. As this community hurts, so do we.”

Israel added that the “only one to blame for this incident is the killer himself.”

John McCall/South Florida Sun-Sentinel via AP

Students released from a lockdown are overcome with emotion following following a shooting at Marjory Stoneman Douglas High School in Parkland, Fla., Feb. 14, 2018.

Hannah Carbocci, a 17-year-old junior, told ABC affiliate WPLG that she was in a first-floor classroom when shots rang out.

Carbocci said the gunman “shot through the door and the glass shattered. I was under my teacher’s desk so I was really hoping that I would be OK. Not knowing if my classmates would be OK or not really scared me. ” “We had four to six people injured in our classroom, and two of them have been confirmed that they passed away,” she said. “It was a horrible experience, the sounds that you hear, the sights that you see. When you’re walking out of the building you see people in the hallways laying there dead that you know, that you went to classes with, and you went to school with, and you saw them every single day.

Brynn Anderson/AP

Students Nicole Baltzer, right, and Alex Debs, embrace, Feb. 15, 2018, in Parkland, Fla., during a community vigil for the victims of the shooting at Marjory Stoneman Douglas High School.

“Once I was out of the building I knew I was OK, but I kicked my shoes off and I ran as fast as I could,” she said. “My dad picked me up on the side of the road. He works for the Broward Sheriff’s Office. I broke down in tears when I saw him.”

Cruz was arrested after the Valentine’s Day massacre at Marjory Stoneman Douglas High School and has been charged with 17 counts of premeditated murder.

Cruz — a former student there — slipped away from the campus by blending in with other students who were trying to escape, police said. After a tense manhunt, he was apprehended.

Police photo

Nikolas Cruz is placed into handcuffs by police near Marjory Stoneman Douglas High School following a mass shooting in Parkland, Fla., Feb. 14, 2018.

He briefly appeared in court Thursday and was held on no bond.

Brody Speno, a neighbor who spent nearly a decade living a few doors down from Cruz, told ABC News that the suspected shooter was “aggressive, crazy weird, psycho.”

Speno said he remembers one day when Cruz suddenly “cornered a squirrel and was pegging it with rocks trying to kill it.”

Another neighbor, Malcolm Roxburgh, said Cruz would attack pets.

He called Cruz a “strange character” who always stood out from other teenagers in the neighborhood.

Broward County Sheriff

Nikolas Cruz is seen here in his mug shot, Feb. 14, 2018.

Roxburgh’s most vivid memory of Cruz is his roaming the streets. Even in South Florida’s sweltering heat, Roxburgh said, Cruz occasionally walked around in a camouflage jacket.

Public defender Melisa McNeill, who appeared with Cruz in court Thursday, called him a “broken child.”

“My children they go to school in this community and I feel horrible for these families,” McNeill said, adding, “and Mr. Cruz feels that pain.”

The firearm used is a Smith Wesson MP 15, a variant of the popular AR-15 rifle. Law enforcement sources said the suspect bought the rifle himself nearly a year ago and investigators believe no laws were broken in the purchase or sale of the weapon.

Michele Eve Sandberg/AFP/Getty Images

Outside view of Sunrise Tactical Supply store in Coral Springs, Fla. on Feb. 16, 2018 where accused school shooter Nikolas Cruz bought an AR-15.

The Bureau of Alcohol Tobacco Firearms and Explosives (ATF) is looking at whether Cruz had any help or accomplices.

“Our goal is to figure out, how did this gun get into his hands?” ATF Special Agent in Charge Peter Forcelli told ABC News.

Investigators are continuing to look into Cruz’s mental health history. Law enforcement sources told ABC News that Cruz told investigators he had been hearing voices in his head that directed him to conduct the attack.

Under federal law, any person who has been “adjudicated as a mental defective” or “committed to a mental institution” is prohibited from shipping, transporting, receiving or possessing any firearm or ammunition punishable by a $250,000 and/or 10 years in prison. That adjudication must be done by a court, board, commission or other lawful authority that determines if a person as a result of “subnormal intelligence, mental illness, incompetency, condition or disease” is a danger to himself or others, lacks mental capacity to conduct their own affairs, are found insane by a court in a criminal case, or incompetent to stand trial because they lack mental responsibility.

via The Trump Debacle

#IFTTT #The Trump Debacle

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healthcarebiz · 7 years ago

Text

Cenegermin Eye Drops Receive European Union Approval: The First Biotechnological Drug Resulting from Dompe Research for the Treatment of Moderate to Severe Neurotrophic Keratitis is Made in Italy

MILAN, July 24, 2017 /PRNewswire/ --

Behind the development of cenegermin are decades of Italian research, stemming from the studies of Rita Levi Montalcini, winner of the Nobel Prize in Medicine for the discovery of the nerve growth factor (NGF).

In 2015, the product was designated as an orphan drug in Europe for the treatment of neurotrophic keratitis, a rare eye disease that affects less than 5 out of every 10,000 people[1]. Until now, there have been no approved drugs for this condition.

Dompe, an Italian biopharmaceutical company, announces that the European Commission has granted the marketing authorisation of cenegermin eye drops for the treatment of moderate to severe neurotrophic keratitis. This makes it the first biotechnological treatment authorized for this specific indication in the European Union, which responds to the needs of patients affected by this rare and severely debilitating eye disease that can cause vision loss. Until now, there have been no approved drugs for the treatment of this condition.

Behind the development of cenegermin are decades of "Made in Italy" research, stemming from the studies of Nobel laureate Rita Levi Montalcini, who discovered the nerve growth factor (NGF). This lead to the collaboration between Dompe and world-renowned centres of excellence in ophthalmology.

"Neurotrophic keratitis is a rare disease that is particularly debilitating, and until now, has been an unresolved health concern for patients. The authorisation obtained by the European Commission, after positive opinion received from the EMA CHMP, is a milestone for the patients affected by this disease, for the research in this sector and for our Company," affirms Eugenio Aringhieri, Chief Executive Officer of Dompe Pharmaceuticals. "It is our first biotech drug that was obtained thanks to the work of a skilled and passionate team that has believed in this project from the beginning; and thanks to the constant collaboration with an excellent medical community, which has contributed to the development of the product in its various phases in national and international centres. It is a long, complex yet exciting journey that never ends but begins with this important regulatory step. The next steps will definitely be to make the product available in other areas outside of Europe and in other future indications."

Cenegermin is the name of the primary active ingredient of the drug, and it is the recombinant version of the human nerve growth factor (NGF), developed and prepared through a biotechnological production process unique to Dompe. Cenegermin is a protein that is almost identical to the one that human body produces naturally, which is involved in the development, maintenance and survival of nerve cells[2]. Administered as eye drops in patients with moderate to severe neurotrophic keratitis, this solution can help restore the normal healing processes of the eye and repair corneal damage.

"There are numerous clinical conditions that can lead to subnormal corneal sensitivity and neurotrophic keratitis due to damage to the rich nerve supply provided to the eye via the trigeminal nerve", says Reza Dana, Professor of Ophthalmology at Harvard Medical School, and Director of the Cornea Service and Senior Scientist at the Massachusetts Eye and Ear, Boston, USA. "In the more severe cases, neurotrophic keratitis can lead to ulcers, corneal necrosis and perforation, and visual loss. Considering the possible severity of neurotrophic keratitis, and the lack of good response to standard therapies in many cases, having a valid therapeutic option that can directly promote nerve function is a major contribution to the field and to the community of ophthalmologists, not to mention the many patients suffering from this condition."

Cenegermin was developed at the Dompe L'Aquila Research and Production Centre, thanks to recombinant DNA technology, with the use of bacteria in which a gene (DNA) is introduced that allows the bacteria to produce the human growth factor on their own.

"I think it is a big success to have taken the first nerve growth factor from Rita Levi Montalcini's discovery after so many years of hard work, and turned it into a therapy that is now authorized at the European Union level. It is further confirmation that it is possible to create innovative research in Italy, and that the pharmaceutical sector in our country is globally competitive," explains Sergio Dompe, President of Dompe Pharmaceuticals. "At this time, my thoughts and gratitude go out to all of the Researchers, who have participated in so many countries and in various roles in the project, making an essential contribution to the creation of this new drug, but especially to Professor Rita Levi Montalcini; this research was born out of her brilliant intuition."

The process of registering the drug is underway, also in the United States, where cenegermin is still an investigational product, and where Dompe has started the submission to the Food and Drug Administration (FDA) of the first part of the registration application (Biologics License Application) through a procedure called "rolling submission." Finally, in Japan, dialogue has begun with the Pharmaceuticals and Medical Devices Agency (PMDA) to define a development plan in the same direction.

About Dompe

Dompe is one of the leading biopharmaceutical companies in Italy. It focuses on the development of innovative therapeutic solutions for diseases with a high social impact for which therapeutic options are lacking. Based in Italy, Dompe has its headquarters in Milan. Its research efforts focus on unmet therapeutic needs such as diabetes, organ transplantation, ophthalmology and oncology. The industrial pole of L'Aquila (Abruzzo) is home to a world class biotechnology plant developing drugs for Primary Care for the markets of about 40 countries worldwide. Dompe has its offices also in Albania, France, Germany, Great Britain, Spain and United States (Boston).

For more information: http://www.dompe.com and http://ift.tt/1zr206Q

Forward looking statements

This press release makes reference to certain information that may not coincide with expected future results. Dompe firmly believes in the soundness and reasonableness of the concepts expressed. However, some of the information is subject to a certain degree of indetermination in relation to its research and development activities and the necessary verifications to be performed by regulatory bodies. Therefore, as of today, Dompe cannot guarantee that the expected results will be consistent with the information provided above.

1. M. Sacchetti, and A. Lambiase, Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol 8 (2014) 571-9.

2. R. Levi Montalcini, The nerve growth factor 35 years later, Science 1987

Read this news on PR Newswire Asia website: Cenegermin Eye Drops Receive European Union Approval: The First Biotechnological Drug Resulting from Dompe Research for the Treatment of Moderate to Severe Neurotrophic Keratitis is Made in Italy

#Healthcare

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healthcarebiz · 7 years ago

Text

Cenegermin Eye Drops Receive European Union Approval: The First Biotechnological Drug Resulting from Dompé Research for the Treatment of Moderate to Severe Neurotrophic Keratitis is Made in Italy

MILAN, July 21, 2017 /PRNewswire/ --

Dompé, an Italian biopharmaceutical company, announces that the European Commission has granted the marketing authorisation of cenegermin eye drops for the treatment of moderate to severe neurotrophic keratitis. This makes it the first biotechnological treatment authorized for this specific indication in the Europe Union, which responds to the needs of patients affected by this rare and severely debilitating eye disease that can cause vision loss. Until now, there have been no approved drugs for the treatment of this condition.

Behind the development of cenegermin are decades of "Made in Italy" research, stemming from the studies of Nobel laureate Rita Levi Montalcini, who discovered the nerve growth factor (NGF). This lead to the collaboration between Dompé and world-renowned centres of excellence in ophthalmology.

"Neurotrophic keratitis is a rare disease that is particularly debilitating, and until now, has been an unresolved health concern for patients. The authorisation obtained by the European Commission, after positive opinion received from the EMA CHMP, is a milestone for the patients affected by this disease, for the research in this sector and for our Company," affirms Eugenio Aringhieri, Chief Executive Officer of Dompé Pharmaceuticals. "It is our first biotech drug that was obtained thanks to the work of a skilled and passionate team that has believed in this project from the beginning; and thanks to the constant collaboration with an excellent medical community, which has contributed to the development of the product in its various phases in national and international centres. It is a long, complex yet exciting journey that never ends but begins with this important regulatory step. The next steps will definitely be to make the product available in other areas outside of Europe and in other future indications."

Cenegermin is the name of the primary active ingredient of the drug, and it is the recombinant version of the human nerve growth factor (NGF), developed and prepared through a biotechnological production process unique to Dompé. Cenegermin is a protein that is almost identical to the one the human body produces naturally, which is involved in the development, maintenance and survival of nerve cells[2]. Administered as eye drops in patients with moderate to severe neurotrophic keratitis, this solution can help restore the normal healing processes of the eye and repair corneal damage.

Cenegermin was developed at the Dompé L'Aquila Research and Production Centre, thanks to recombinant DNA technology, with the use of bacteria in which a gene (DNA) is introduced that allows the bacteria to produce the human growth factor on their own.

"I think it is a big success to have taken the first nerve growth factor from Rita Levi Montalcini's discovery after so many years of hard work, and turned it into a therapy that is now authorized at the European Union level. It is further confirmation that it is possible to create innovative research in Italy, and that the pharmaceutical sector in our country is globally competitive," explains Sergio Dompé, President of Dompé Pharmaceuticals. "At this time, my thoughts and gratitude go out to all of the Researchers, who have participated in so many countries and in various roles in the project, making an essential contribution to the creation of this new drug, but especially to Professor Rita Levi Montalcini; this research was born out of her brilliant intuition."

The process of registering the drug is underway, also in the United States, where cenegermin is still an investigational product, and where Dompé has started the submission to the Food and Drug Administration (FDA) of the first part of the registration application (Biologics License Application) through a procedure called "rolling submission." Finally, in Japan dialogue has begun with the Pharmaceuticals and Medical Devices Agency (PMDA) to define a development plan in the same direction.

About Dompé

Dompé is one of the leading biopharmaceutical companies in Italy. It focuses on the development of innovative therapeutic solutions for diseases with a high social impact for which therapeutic options are lacking. Based in Italy, Dompé has its headquarters in Milan. Its research efforts focus on unmet therapeutic needs such as diabetes, organ transplantation, ophthalmology and oncology. The industrial pole of L'Aquila (Abruzzo) is home to a world class biotechnology plant developing drugs for Primary Care for the markets of about 40 countries worldwide. Dompé has its offices also in Albania, France, Germany, Great Britain, Spain and United States (Boston).

For more information: http://www.dompe.com e http://ift.tt/1zr206Q

Forward looking statements

This press release makes reference to certain information that may not coincide with expected future results. Dompé firmly believes in the soundness and reasonableness of the concepts expressed. However, some of the information is subject to a certain degree of indetermination in relation to its research and development activities and the necessary verifications to be performed by regulatory bodies. Therefore, as of today, Dompé cannot guarantee that the expected results will be consistent with the information provided above.

1. M. Sacchetti, and A. Lambiase, Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol 8 (2014) 571-9. 2. R. Levi Montalcini, The nerve growth factor 35 years later, Science 1987

Read this news on PR Newswire Asia website: Cenegermin Eye Drops Receive European Union Approval: The First Biotechnological Drug Resulting from Dompé Research for the Treatment of Moderate to Severe Neurotrophic Keratitis is Made in Italy

#Healthcare

0 notes