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YdolstG YnsbaH ZnsbaJ ZnsbaL ZnsbaN ZnsbaQ [nsbaR [nsbaS \&nsba ' \Hnsba ( \Znsba ) \lnsba * \~fnav \nsba2 ]dolst ]nsba  ^nsba  ansba b0nsba brnsba bnsba bnsba  bnsba  bnsba bfnav cnsba c\nsbaW dolst d|nsba dnsba dnsba ensba ensba e$nsba e6nsba erfnav ensba#E f olst fnsba gBnsba gnsba  jnsba W jnsba X jnsba Y jnsba Z jnsba c kfnav kPnsba l nsba lnsba%# lolst lnsba. nnsba1 nLnsba- nnsba nnsba nnsba nnsba nnsba o fnav3 onsba3 p nsba$ polst3 pnsba qnsbaT qnsba qnsba rnsba r(nsba r:nsba rLfnavV r^nsbaV rnsba$ rolstV sdnsbaZ t6nsbam t@nsbad tRnsba nsba nsba nsba nsba nsba & fnav nsba#5 olst nsba Xnsba bnsba lnsba vnsba nsba S ,nsba T >nsba U Pnsba V bfnavd tnsba% olstd vnsban 4nsbap pnsbag nsba nsba nsba nsba nsba nsba d ,fnavw nnsba$ olstw `nsba nsbaz Lnsba  nsba Znsba lnsba ~nsba nsba nsba e fnavw nsbav nsbaw nsba% olstw nsba 0 >nsba D Pnsba bnsba lnsba ~nsba Jnsba \nsba nnsba fnav + nsba + nsba  0olst + nsba B nsba C nsba 7 nsba : nsba ; nsba < nsba = nsba > nsba ' fnav .nsba olst 8nsba nsba @nsba vnsba nsba nsba >nsba Pnsba bnsba tfnav nsba"n 2olst nsba  nsba nsba  nsba  nsba  2nsba  Dfnav Vnsba!M olst `nsba  nsba nsba  nsba  nsba  nsba  nsba  fnav (nsba# olst Znsba nsba nsba K nsba L nsba M nsba N nsba nsba Rnsba nsba nsba nsba Bnsba ~nsba fnav nsba!r olst 0nsba nsba nsba nsba  ʜnsba ʮnsba ! nsba " nsba nsba nsba \nsba ˘nsba nsba nsba Lfnav ̈nsba%o dolst nsba ξnsba nsba  nsba Fnsba Xnsba jnsba |fnav юnsba%Y "olst ҈nsba 6nsba Hnsba nsba  lnsba ٨nsba ٺnsba nsba fnav nsba$ ڔolst nsba nsba nsba  ߚnsba nsba nsba nsba nsba nsba ( Znsba ! fnav  nsba  nsba olst  0nsba  nsba  nsba  nsba  nsba  nsba  nsba  .fnav 8nsba nsba nsba# olst Nnsba (nsba nsba nsba nsba nsba .nsba O @nsba P Rnsba Q dnsba R vfnav G nsba nsba Pnsba bfnav tnsba nsbaJ ,olst nsba nsba nsba nsba Pnsba Znsba lnsba ~nsba nsba nsba nsba nsba fnav G nsba G Pnsba Zolst G nsba nsba nsba ,nsba >fnav i Pnsba i nsba olst i nsba Dnsba Vnsba hnsba zfnav , nsba , @nsba ^olst , nsba - nsba . nsba / nsba 0 nsba ? nsba B ,fnav >nsba nsba olst hnsba Rnsba dnsba vnsba nsba nsba nsba nsba nsba nsba nsba fnav >nsba ?nsbab ?olst @ nsba Ansba Ansba AJnsba A\nsba Annsba Ansba Ansba Ansba Ansba E:fnav/ E\nsba Eolst/ FNnsba5 Gnsba6 G nsba7 G2nsba8 GDnsbaC GVfnavE G`nsbaE Gnsba HolstE HnsbaH InsbaI InsbaJ InsbaK InsbaL Jnsba^ J nsba_ J2nsbaf JDfnavi JVnsba Jolsti K nsbaj Knsbak Knsbal Knsbam Knsbap L nsbaq LFnsbat L`nsba} PHP` N[@gd@g[@g [@gVW@g`vpH"` N8`vpH"` NX8`h&R +sf +f(R`8?*?*?*/ HzHz3,Nu(H/ NOR@8 D,Od8<,XD`AHP?<wAHPNOO `(R,H@ig[@g`[@gW@g` ,f`pc*vpH"` NX8`~68` ,@f`pc v`v&R +f(R`8?*?*?*/ HzHz2&Nu(H/ NOR@8 D,Od8<,XD`xp0/NO"n " I/NO!"F"JnPOg F&P8. Dsg DSg DNg DIg`(KX(=j=D`=j=n`:*>.`X???./HzHz1nNu(H0.O @Ig[@gT[@g@g[@gr[@gW@g`( D (sf$ (f Cf HH&`H6` Cf/,/,tNO&PO`/,/,tNO6PO`( D (sf: (f2 CfHH// tNOPO`lHH/tNO&XO`V Cf &'l`D/,/,t NO&PO`.( D (sf$ (f Cf HH&`H6` Cf/,/,tNO&PO`/,/,tNO6PO`( D (sf: (f2 C fHH// tNOPO`HH/tNO&XO` C f &'l`t/,/,t NO&PO`` RJ(f / NO6XO`vp0// / NO& RJ(O f0B'Hxp0A/NO'O `/,/,tNO F P POp0REJf R0( `0*R@@eRnJf R0( `0*R@nbfRnJ f R0(`0*R@nb6` F(Ppb R (sf R(H@ig [@g[@g`&LX&=j`f=j=n`6:*>.` ???./HzHz.bNu(&R+HO @ig[@gF[@glW@g` +f D/(/(tNO(PO` D/(/(tNO8PO` +@f D()h`v D/(/(t NO(PO``J+f /NO6XO`vp0/// NO& RJ(O f2B'Hxp0A/NO'O ` D/(/(tNO F P POp0REJf R0( `0*R@@eRnJf R0( `0*R@nbRnJ f R0(`0*R@nbLN^NuUnrecognized type in external library callnsbasic.cNVH8>.<.BB|BBB8gr=|.z$mEX qg ygzJEf |gBn.0..VDHD/NO-HXOfAHP?<AHPNOO /.NO!-HXOz$mEX {WDH=@>f |gz0VDH=@=|0=|2 qWDH:f ygBn2Jn2f |gBn00.0VDHDngJn>f |gp`p=@JEf yg |gp`pDnr2/NO-HXOfAHP?<AHPNOO /.NO!&Hz$mEX {XOg |gz0VDH=@ qg yg |gp`pDnr2/NO-H|XOfAlHP?<AxHPNOO /.|NO!-HXO=|4=|6$mEX qWDH:f ygBn6Jn6f |gBn40.4VDHDgPJEf yg |gp`pDr2/NO-HXOfAHP?<AHPNOO /.NO!(HXOz=DP` 0E BRE=|=|$mEX qg ygBnJnf |gBn0.VDHnP@e {g |gp`pJ@gp A-pA"n"v=DN`V0C* r` N-@r$nEHjHjHj HjHjHjHzHzNu$JOg n0XH`p=@l=| mAX-HP .{g .|gBn0.VDHCmJg n0XH`p=@j=| mAX-H {WDH=@f |gBn0.VDH=@nJnf |gp`p=@p0C*?.j0nnHs0npH nHp Ht/ HzHzNuRCOnNe$mEXp@p @ b ,@0;NT  6 6/ /. {g |gp`pD??. ?HzHzNuO` AA*AA&EEHnHnHn/// HzHz Nu-H(HO@ig[@g2[@gW@gL` n (f Av-H`Az-H` n (@f A-H`AV-H`p0-@-@ A-H^HxNO"n^" I/NO!-HPO`r E? C??/.HzHz&NuO /NOR@=@Z @,XOd=|,Zp0-@-@A-Hbp0.Z/NO"nb" I/NO!-HPOp0-@RA"n# .R/ /.0R@??. ?HzHzFNu-@Of. n(H@ig[@gj[@gW@g` n (f/.vHntNOPO`0nz/HntNOPOHn E? C??/.` NxO` n ( f/.VHnt NOPOHn E? C??/.` NxO`j/.HntNOHn E? C??/.` NxO`2~>(GH/NO"/NO!-H/. E? C??Hn` NrO`AA*AA&EEHnHnHn/// HzHz(Nu-H=nH0.HO@Cg]@g0[@gv[@gW@gP@ g]@g[@gZ[@gW@g4`=n@ n@f Az-H` n@f Av-H`A HP?<ZA HPNOO `=nB nBf AV-H` nBf A-H`A HP?<fA HPNOO ` E? C??/.HzHz#NuO /NOR@=@\ @,XOd=|,\p0-@-@A-Hfp0.\X/NO"nf" I/NO!-HX"n"XPO`A :HP?<{A HHPNOO =|8 mAX-H"PE .{Eg .|EgBn8A0.8VDHDr2"n#=|: mAX-H&PF .{Fg .|FgBn:0.:VDHDr2=|< mAX-H*PG .{Gg .|GgBn(GH/NO"/NO!-H-P/. E? C??Hn` NrO`A 2HP?<A VHPNOO `rA NHP?<A \HPNOO `V/ /.??HzHzNuO `4AA(AA&EEHnHnHn/// HzHzpNu-H(HO@ig[@g[@gW@g8` n (f2/ /.??HzHzjNu-@v/.vHntNOO`0/ /.??HzHz8Nu=@z0@/HntNOOHn D? C??/.` NxO`4 n (@f./ /.??HzHzzNu-H-P-hO `6/ /.??HzHzNu*/tNOXO/Hnt NOOHn D? C??/.` NxO`/ /.??HzHzNu-H/.HntNOHn D? C??/.` NxO"`D/ /.??HzHzNu-H/. D? C??Hn` NrOBn=F=FL`0n* r` N&&nG8$KJg& n08H n08H=@`vJ f Sp0(" ` N&Jf Sp0( " ` N&Jf Sp0( " ` N&xpcP& CA. G ifxI C (f=|`(=|` nfxN C (@f=|`=|6 CIf /4NO"x mAX* E {XOg |gx0VDHnH/4NO!-H-P>+=nXO`8*<`|6*:`Z nf n/HntNOXPO` n2P/ HntNOTPOHn???/` NxRCOJf R0( `0*R@@eRDJf R0( `0*R@@elRGJ f R0(`0*R@@eH` CNf /4NO"x mAX* E {XOg |gx0VDHnH/4NO!-H-P>+=nXO`8*<`v6*:`T nf n/Hnt NOXPO` n-P-hPHn???/` NxRCOJf R0( `0*R@@eRDJf R0( `0*R@@erRGJ f R0(`0*R@@eN`& CA( D sg Sf /4NO"x mAX* E {XOg |gx0VDHnH/4NO!-H-P>+XO`j8*<`H6*:`&/.???/ ` NrRRCOJf R0( `0*R@@eRDJf R0( `0*R@@eRGJ f R0(`0*R@@e~` vg Vfx$mEX {g |gx0VDHnH n p/HntNO0n( r` N&$nE8Hn?*?*?*/` NxORn0.nLex=nJ`,0D,*GX$S gZ*&G8/ NO"/NO+RDPO|z$mEX qWDH>f ygzJEf |g|0VDHnJ@e {g |gp`p8JGf yg |gp`pnDg$/.NO"/.NO+/.|NO"/.|NO+Ozx$mEX qg ygxJDf |gz0VDHng/.NO"/.NO+POJng/.NO"/.NO+POLN^Nuunable to make handlensbasic.cunable to make handlensbasic.cunable to make handlensbasic.cunable to make handlensbasic.cUndefined integer sizensbasic.cUndefined float sizensbasic.cUnsupported return typensbasic.cUndefined integer sizensbasic.cType mismatch on return from external librarynsbasic.cType mismatch on return from external librarynsbasic.cType mismatch on return from external librarynsbasic.cUnsupported return typensbasic.cNVHHzHzNu6HzHzNu@:HzHzNu8HxHxB???p A?0?<HzHzNuOL8N^NuNVH8HzHzZNu=@HzHzFNu@=@HzHz.Nu:~|˕(mIX yg |f,HzHzNur>HzHzNur<(mIX yg xg {g |fPJEgLv6/NO&H/NO$HxPO`.v6HzHzlNu8HzHzXNu8RDEe/ / ????.?.p A?0?<HzHzNu Og/ NOXO g/ NOXOLN^NuNV//HzHzNu@8HzHzNu6HxHxB??BgBHzHz NuO&(N^NuNVH8HzHzNu8HzHzvNu/-HnNO m (zXPOfHzHzfNu6|< r ` N*EEXJRf m (zXf?/ CBPBTBS j cHzHz"Nu j cHzHzNu`?HzHz Nu"E" E/// ?<HzHznNu:* C8EOc?0R@??*HzHz>Nu\O`g* j c HzHzNu6f j cHzHzdNu`?HzHzzNu"G" G// / ?<HzHzNu8* 60@@Oc?0R@??*HzHzNu\O`g j cxHzHzNu6gd?HzHzNu"F" F// / ?<HzHzBNu8* 60@@Oc?0R@??*HzHzNu\O JLN^NuNV/ /$nJgZHnBgB/.` NH6.Of*?A:HPHnNOHn` NO` 0@4`BR&$_N^NuFound illegal subscript = %uNV np(rI@0N^NuNVHzHzNuHzHz Nu m+P+h m+P+h/-/-BBt%NOJOg"AfHP` N`4?* C?(A.HPHn^NOHn^` N/ NO<FPOm0`0=@\v`&0C($nXEH$nTEHm6nZRCn\mԾFgvFo`B8. D g D g +S+k DfBB/-/-t*NOHO`T Df$BB/-/-t'NOHJ@WDHO`* DfBB/-/-t'NOHO` Df$BB/-/-t*NOHJ@WDHO` Dg Df6/-/-BBt%NOJOg DVDH` DWDH` D g. D g(?AHPHn^NOHn^` NO$K`J +g -ffR`6 D VDH`B 0m 9nR` .fR` D VDH`f D WDH`8. D g< D g6$K` 0m 9o D fp`p`Rf D WDH`$K`4 am zo  g Am ZnR` D fp`p`f D WDH`x6. Cg Cg Cg Cg Cfp`Rp`N6. Cg Cg Cg C g Cfp`(p`$6.g Cg Cg Cg Cfp`pLN^NuIllegal compare of string var. to numeric var. (%d) (%d)illegal compare operation code %iNV/ / n0. nn r2 (sf, ЀIdIICdIJTfG`"0G` GdGGCdG K&_(_N^NuNV/ /6.g0 m$h0Hr2Jf?.` NTO R`&$_N^NuNV m0(Rhr2"h1N^NuNV/ EHzHzNuHzHzNu@0.$_N^NuNV/HzHzNu60S@@ m"h01h&N^NuNVHzHzjNuHzHzNuN^NuNVHzHzNuHzHzNuN^NuNVHzHzNuHzHzDNuN^NuNVHmHmHmHmHmHmHzHz~Nu+H`Og(?-?-?-/-HzHzNu+HO N^NuNV/ HmHmHmHmHmHmHzHzNu+H$H`Og&?-?-?-/ HzHzxNu+HO $_N^NuNV/ HmHmHmHmHmHmHzHzNu+H$H`Og&?-?-?-/ HzHzNu+HO $_N^NuNV/ HmHmHmHm$Hm"Hm HzHzBNu+H $H`Og&?-$?-"?- / HzHzNu+HO $_N^NuNV/ Hm8Hm4Hm0Hm@Hm>Hm?-AHP` NXO`$ m (sfAHP` NXO m hdN m hcJg$ m h cJg m h cJfAZHP` NXO$m jc j c0JgA^HP` NXO$m m0(jf0( j f 0( j gABHP` NXOBn`~<.`v:`8???/-HzHz:Nu+H???/-HzHzNu+H;F;E;D m (sOf/-` NZXO`/-` NXORC$mԶj elRGj eZRn$m0.je<` j cJgAHP` NXOJf6$m m0(jf 0( j gNAjHP` NXO`4$m m0( jf 0( j gAnHP` NXO|`x6`JfN:Bg??/ HzHzNu+HBg??/-HzHzNu+H;C;EBmO`N:Bg??/ HzHzNu+H???-/-HzHzjNu+H;C;EBmO m (sf/-` NZXO`/-` NXORD$mԸj eRF mԼhe`2JgAHP` NXOJf, m"m0)hgvArHP` NXO`\Jf, m"m0) hgDAzHP` NXO`* m"m0) hgAHP` NXOv`8JfN8B?/-HzHz*Nu+HB?/-HzHzNu+H;DBmBmO`JfP8Bg??-/-HzHzNu+HB?/-HzHzNu+H;DBmBmO`P8??-?-/-HzHzNu+HB?/-HzHzdNu+H;DBmBmO m (sf/-` NZXO`/-` NXORC mԶhe`: m (sf/-` NZXO`/-` NXOLN^NuMis-matched argsMis-matched argsPassed an entire array to a subroutine not expecting it.Too many levels of subscripting.Subroutine and calling program array bounds do not match.Too many levels of subscripting.Subroutine and calling program array bounds do not match.Subroutine and calling program array bounds do not match.Too many levels of subscripting.Subroutine and calling program array bounds do not match.Subroutine and calling program array bounds do not match.Subroutine and calling program array bounds do not match.NVHzHz NuHzHzDNu m/(/( m/(/(Hnt5NOHn` NN^NuNVHHzHzNu:HzHzNu8HzHzNu6p0ЀA pfp0Ѐ pfp0Ѐ1`p0ЀABpL8N^NuNVHzHzNu m1@N^NuNVHHzHzNu:HzHzNu8HzHzNuHzHz>Nu6p0ЀAJpg m1D` m1EL8N^NuNV/ /HzHzNuHzHzNu6 m-P-h m/(/(/./.Hnt5NOHn` N~ m"H#hHxNO$H Of?<` NTO/ NO!"m#H I h1C I"i#h$mE m"R"" m"R#P#h m"R#hXO&$_N^NuNVH0HzHzNuHzHzNu6HzHzNu8 mJfAHPNOHxNOPO&mG$S m *fjg$ m!J$HE R$ m/(NOXO`/* /* m/(/(Hnt3NOHn` N~&mG$SBB/* /*t)NOJO(g /*/*/./.t)NOJOg ` /*/*/./.t'NOJOf`* m!J$HE R$ m/(NO m1DXOL N^NuInternal error--for processingNV/HzHzNu6 m1C&N^NuNVHHzHzNu:HzHz~Nu8HzHzlNuHzHz"Nu6p0ЀA pf m1D` m1EL8N^NuNVHHzHzNu:HzHzNu8HzHzNuHzHzNu6p0ЀAJpf m1D` m1EL8N^NuNVHzHzNuHzHzNuHzHzNuHzHz8NuN^NuNVHzHzZNu m1@N^NuNVHzHz:Nu m1@N^NuNVHzHzNu m1@N^NuNV//HzHzNuHzHzNur8HzHzNu6+m`+m`?/-/-/-/-HzHzRNuS@Ofp0ЀA1`p0ЀABp&(N^NuNVH8HzHzNuAHP?<&// HzHzNNu8TGXOJgRR`R/-HnNOJ@POg2RC mhm/-A(HPHmNOHmNOHxNOO/ NO"/ NOaNO POg0BNOBNOBgNOs/NO m/(NO mBO m1DHxNO$H XOf?<` NTO/ NO!+H0` m"m3h I1| HzHzNu m1@ NOu mhXOf NOs/NOrXO/-NO/-NOPOLN^NuvtocCan't find view TOC recordIllegal form name used = %sNV//HzHzNu8HzHz Nu6p0ЀAJpg p0ЀBp`p0ЀA1&(N^NuNVHHzHzNu:HzHzNu8HzHzNu6p0ЀA pgp0Ѐ pfp0ЀA1`p0ЀABpL8N^NuNVH0HzHzpNu6HxNO&H XOf?<` NTO/ NO!$H m4%h!K/ NO5 m1CPOL N^NuNV//HzHz2NuHzHzNu8HzHzNu6?/-/-/-/-HzHzjNuS@Ofp0ЀA1`p0ЀABp&(N^NuNV=|=|=|HnNON^NuNVH $nv8. `2?/ NO@\Of"?#H|A#HA#HA&^#HA#HA#HA #HA>#HA=|#HA=H#HA'#HA%#HA$\#HA"#HA #HA0#HAX#HAH#HA#HA#HA7T#HA9J#HA#HAt#HAC#HAEh#HAo$#HAH#HAn#H` A#HAtr#HAFX#H AsN#HAn,#HA#HAH#HA #H A #H$A Z#H(A &#H,A#H0A<#H4AD#H8A~#H$#HA=V#HAiZ#HA#HA#H A#H`A#HdA#HA#HA#HAf#HA`#HA#HAE#HAG#HAEp#H AEt#HvAB00RC CmHzHzPNuBmHx.NO&H XOf?<` NTO/ NO!$H$` m!J h1|P m h!m` m hB m hBh m h!m` A"m"i#HA"m#H I hBh I hBh" I hBh& IB!m`XOL 8N^NuNVHnHnNO0.N^NuNVHnHnNO0.N^NuNVtH0HzHz٢NuB.|/-/- HzHzͪNu=@tEtEBRBnzBnvv/-NOR@r2XO//-A|A/NO&/-NOR@@/-NO8 D Oo8< :8RD0D//-A|A0/NO&0EA|B0DO HzHzvNu mԱ`g:/-NOR@r2XO//-A|A0/NO&/-NOCR@6RRO`HxHntHn|NO&B?<// HzHz:Nu6XOfHzHzNu`?HzHzNuTO&$_N^NuNVH0$n&j *o"g0<`/ NOJ6|c"5|BBj 0XOL N^NuNVH0?<HzHz ,NuHzHz Nu$H/- m/(/(tNOPO?NOE%@&*POfNON?HzHzDNuTO`?</ m/(/(tNOPO?NOI&H POf\?</* m/(/(tNOPO?NOI&H POfNON?HzHzNuTO`V?<HzHzNuTO`HzHzNu|o"%K5|BBj m/(/(tNO5@POL N^NuNVH?<HzHz NuHzHzôNu m/(/(tNO6B'/g8zHn?<p0A/HzHz%Nu0n/HntNOOHn` NEXO G0LN^NuNVH8*.(n &n$m( j cJ8f j cJ4f jcXJ0fR|`Dx`8v`(;F<;D>;C@/ / /HzHzNuRCO $m(j eRDj eRFje``x`4v`$;D>;C@/ / /HzHzNuRCO $m(j eRDj e`v` ;C@/ / /HzHzhNuRCO m(he` j cJ4f jcHJ0fBx`4v`$;D<;C>/ / /HzHzNuRCO $m(j eRDje`v` ;C>/ / /HzHzNuRCO m(h e`X jc6J0f0v` ;C.<./. NO!$H&T +sXOfl+@g0vRB.Hn???./ ` NrO`8/ ???./ ` Nr/ NOR@r2&O`A( DH0@g2vHn?</ HzHz"Nu/.HntNOO`0@@g"vHn?</ HzHz"NuO `p0@ g0vHn?</ HzHz"nNu/.Hnt NOO`80@g0vHn?</ HzHz"6Nu0n/HntNOOHn???./` NxO=CHzHzjNu m(`g Hn/ /.HzHz2NuO `/. 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Qk < (  @L <(@ X6 210/.-,+*)('&`p '@x !9W  ! !.@h V F@Q@QpЍA/-p@-`V P@$ $ ,4$( @T JP "@XUp@Ѝ/-A-MP4  @ $@HT" . .< $(`<p'@xW @hV@X UЍAЍ/-A-M` P >|? Ypp@] p KPPppP% @!a@!XQ!R@X@QP=@(Q PP@P@PP PP@P@PP PP@P< VЍAЍ/absn&.KQ@- M@B  Ѝ@/-A-MpO((@`( ?0 8#8<P yP@#Qu, P *!; P!a H`T:ЍAЍ/ / / /e /Q /p@-@ @l,PU  >8C8p@/-I-MpP@OX  HT:g!\`P( 8P PP@T ! P!P:68P P@T! PP ! QPJЍIЍ/p@-$P  H`p@/p@-@P% % ,4$( PoP < @hc" p@/ /! p@-` @P p@/@-  @@/@-Mp`V PPPE@$ $<$Ѝ@/-A-M` & h@ $ H"sP@ P\p pP%@Xp@pЍAЍ/0@-MP@@Ѝ0@/@-\Mp@p`V  0P  P DP @ \Ѝ@/A-M`@P   ("(    ("(  ?P U   ! U P ! X' ! PPPU  0ppp 0IA  ("(0U P ! XPPU  0p pp 0 @Q A! ("(0xUG PD ! \X PU  1Jcppp 0@Q A! ("(1:PU  1`"PU  1TPU  0H PU  0<ЍA/-@-@@Ѝ// G(G0G()"#dpI)pGHPDhI"LTD$hGFh p Jp ppHPDh!#LTD$h GFp Sp ppq Pq qqHPDh!KLTD$hGp Sp ppq Pq qqHPDh!KLTD$hnGp Sp ppqQqHPDhI#LTD$hLGp #3psppp3qsqqq3rsrrr3sssp ]p pp q Xq qqr Xr rrsHPDh~!2#LTD$h  pG0%p ep pp q `q qq r `r rr s `s ssHPDhv!#LTD$h 0G𵅰  p Jp pp0qNq(q( q( rMr8r8 r8 sOs s s tLt HPDhP!#NVD6h -+J@ "@C)/;h! @ I @N1@K@1C CC=`,#h! @ I @ N1@K@1C CC%`G0$p\pppq\qqq%p ep pp qaqqHPDh^!#LTD$h9 0GFp Sp ppqQqHPDh\!KLTD$hG p Jp ppHPDhJ!#LTD$h GFpPpp p qQqHPDhE!#LTD$hGpXpp p qYqqqHPDhI!KLTD$hGFp \p ppq Xq qqr Xr rrHPDh&! #LTD$h GF p Jp ppHPDh-!#LTD$hcGF p Jp ppHPDh"!#LTD$hE GF p Jp ppHPDh!!KLTD$h%GF p Jp ppHPDh+!#LTD$h GF p Jp ppHPDh!KLTD$hGF p Jp ppHPDh!#LTD$hGF p Jp ppHPDh!#LTD$h GF p Jp ppHPDha!#LTD$h GFp Sp ppqQqHPDh_!KLTD$hdG p Jp ppHPDh!#LTD$hE GFp Sp ppq Pq qqHPDhb!KLTD$hG p Jp ppHPDh!KLTD$hGF p Jp ppHPDh5!#LTD$h GFHPDhI"KLTD$hGFs pHpHPDhIKLTD$hGF~p Sp ppqQqHPDhI#LTD$hGp Sp ppqQqHPDhIKLTD$hbGp Sp ppqQqHPDhI#LTD$h> Gp Sp ppqQqHPDhI#LTD$h G p Jp ppHPDhI#LTD$h GFp Sp ppqQqHPDhI#LTD$hG[𵇰   p Jp pp(q( Hq( qq8r8 Hr8 rrs Hs ss t Ht ttHPDhI#NVD6h-*I@ ! @C(/9 H@ @ C:(  H@ @ C,! H@ @ C"GF0%p ep pp  qaq qq  rcrrrHPDhI #LTD$h-0GF p Jp ppHPDhI#LTD$h GF p Jp ppHPDhI#LTD$hGF p Sp ppq Pq qqHPDhI#LTD$hGp Sp pp qQqHPDhIKLTD$hG p Jp ppHPDhI#LTD$hGFp Sp pp qQqHPDhI#LTD$h\Gp Sp pp qQqHPDhI#LTD$h8G p Jp ppHPDhIKLTD$hGFp Sp pp qQq HPDh I# LTD$h H@)HCGFkHPDhI"LTD$hGFg pHpHPDhI#LTD$hGFdp Sp ppqQqHPDhIKLTD$hGp \p ppqYqq q rZrHPDhI #LTD$h_GF p Jp ppHPDhIKLTD$h?GFS p Jp ppHPDhI#LTD$hGF50%p ep pp q `q qq rbrrrHPDhI #LTD$h0G?𵅰  p Jp pp q Hq qq(r( Hr( rr8s8 Hs8 ssHPDhI#NVD6h,! H@ @ C"-)  H@ @ C*/9 H@ @ C:Gp Sp ppqQqHPDhI#LTD$htGp Sp ppqQqHPDhI#LTD$hRG p Jp ppHPDhIKLTD$h3GFp Sp ppq Pq qq HPDh!# LTD$h H@)HCGF0%p ep pp  qaq qq  rcrrrHPDhI #LTD$h0GFp \p ppqYqq q rZrHPDhI #LTD$hGF0  p Jp pp q Hq qq HPDh I# MUD-hy,! H@ @ C"0GO p Jp pp HPDh I# LTD$hK H@)HCG p Jp ppHPDhIKLTD$hGF9 p Jp pp HPDh I# LTD$h H@)HCGp \p ppq Xq qq rZrHPDhI #LTD$hGF p Jp ppHPDhI#LTD$hGF p Jp ppHPDhO!#LTD$h GF p Jp pp HPDh I# LTD$ha H@)HCG p Jp ppHPDh!#LTD$h3GF p Jp ppHPDhI#LTD$hGFp Sp ppq Pq qqHPDhI#LTD$hGp \p pp qYq qqHPDhI#LTD$hGFp \p pp qYq qqHPDhI#LTD$hGFp \p pp qYqqqHPDhI#LTD$hqGFp \p pp qYqq q rZrHPDhI #LTD$hEGF0%p ep pp  qaq qq rcrHPDhI #LTD$h0Gp \p pp qYq qqHPDhI#LTD$hGFp \p pp qYqqqHPDhI#LTD$hGFp \p pp qYqqqHPDhI#LTD$hGFpPpp p qQqHPDhI#LTD$h|GpPpp p qQqHPDhI#LTD$hZG𵇰  -+GI @ ! @C*/;BI @ ! @C:) p@/0000000000000000000000000000000Out of memory stodbl--null addrUsing string var. where numeric expected(stostr--null addrUsing numeric var where string expectedgetdbl--null addrUsing string variable where numeric expectedgetint--null addrUsing string variable where numeric expected: Program MessageOKOut of Memory-alert:/-n.0ABORT MESSAGE=0.*Control position too high.statusselectdselectedValuecurrentminValuemaxValuepageSizenoItemsCannot find the control referenced. May be caused by using bitmap.index which does not work.String '' is not a valid date in mm/dd/yy format.ERR: Could not find resourceERR: Could not openERR: Database not found***Hour= Minute=Second= is not a valid time.Year= Month= Day= is not a valid date.' is not a valid time. pm am/' is not a valid date.Version < 5 with PNO?Database needed for grid cannot be opened.Grid column format is illegalThe database linked to a bound grid cannot be opened0numericcheckboxdatetimetextIllegal column type () usedNot enough memory to load grid dataThe database 'linked to a bound grid cannot be openedCellMatrixOut of memory.Attempt to reference column data without a current record for database=Attempt to read past end-of-file for database=Attempt to access deleted record for database=yes/noNOYEStrue/falseFALSETRUEon/offOFFONCannot locate object on formControl position too high.textitemText***cellMatrixadditemcleardeleteitemstartCaptureerasedisplaysetFocusAddDeleteColTypeBindToDatabaseindex () is invalid for list.add operation.statusselectdselectedmaxCharscurrentminValueminmaxValuemaxpageSizeValuepageSizeColColWidthRowRowsCellMatrixvalueMatrixValuerowDataRowDatatopRowTopRowfontMatrixLeftTopWidthHeightIllegal object name used = Cannot get property () on control type Cannot set property (Wrong type of variable used in call to get property for 'Wrong type of variable used in call to set property for 'Wrong number of func argsinternal error exiting a function.Can't find view recordcan't find control object #= cnt= TOT =Can't find a bitmap to draw.Can't find program's parag recordaccessing an unopened databaseoffset too bigInternal error-Can't release work record.Accessed an unknown window=Can't locate draw window=Can't find view TOC recordIllegal form name used = Internal error--for processingMis-matched argsPassed an entire array to a subroutine not expecting it.Too many levels of subscripting.Subroutine and calling program array bounds do not match.Illegal comparison between string var and numeric varIllegal comparison code Error divide by 0Found illegal subscript = D- O /D/?rwdc|D-/D/-@-MP p` @ @48 @    0/ Ѝ@Ѝ/-@-MP p` @ @48 `@   4 0/ Ѝ@Ѝ/-@-MP p` @ @48 .@   4 0/ ]Ѝ@Ѝ/-@-MP p` @ @48 @   4 0/ +Ѝ@Ѝ/-@-MP p` @ @48 @   4 0/ Ѝ@Ѝ/-@-MP p` @ @48 @   4 0/ Ѝ@Ѝ/-@-MP p` @ @48 f@   4 0/ Ѝ@Ѝ/-@-MP p` @ @48 4@    0/ cЍ@Ѝ/-@-MP p` @ @48 @   4 0/ 2Ѝ@Ѝ/-@-MP p` @ @48 @   4 0/ Ѝ@Ѝ/-@-MP p` @ @48 @   4 0/ Ѝ@Ѝ/ -@-MP p` @ @48 m@   4 0/ Ѝ@Ѝ/ -@-MP p` @ @48 ;@   4 0/ jЍ@Ѝ/ -@-MP p` @ @48 @   4 0/ 8Ѝ@Ѝ/ -@-MP p` @ @48 @   4 0/ Ѝ@Ѝ/-@-MP p` @ @48 @   4 0/ Ѝ@Ѝ/-@-MP p` @ @48 s@   4 0/ Ѝ@Ѝ/-@-$MP p` @ @<@ A@DH <@   4 0/ k$Ѝ@Ѝ/-@-$MP p` @ @<@ @DH @   4 0/ 4$Ѝ@Ѝ/-@-,M$ 0,Ѝ@Ѝ/ / /1-A-M@ p`R %  0/ЍAЍ/A-MP \@$ $ 48@p( ( 48``p   048`` 0/` ЍA/-A-Mp l`& & 48`@R % @S % @S % @ 0 /ЍAЍ/-A-MPp X@$ $ 48@`48 `' ' 48 0/ЍAЍ/-@- M      Ѝ@Ѝ/@- M0$0$ Ѝ@/-@- M !<$. 0.,  Ѝ@Ѝ/-0@-MP@!P @ T! Ѝ0@Ѝ/ /m / /ᕥ-A-`MPUxx ;sP%@`a ``@Pp' xj@P@)xP+n(8OX! MiPg+ +P  SH 0`ЍAЍ/ /ŝ-A-HM@P` sP ` P$s&7p帀(          E0A& 7!  X% XU   xp t Pt  h h@ U1 W t 0FUA 0VK*t 0FGA 0Q *0   0C0C1  P: 0 , ,`, 0 s&7'kS T UP Q 0 , ,`, 0s&7 F@R)*@F@'$$P $(0(  C0F B0(  0CF 0C($ t 0FA 0aUJ E0@0  P& P#@   0E0 A  R@P@P@Pm} ~ P3{s&77\At 0F TA 0RL@@ @E00  C &7!    @  048,`, 0HЍAЍ/{|~ /቗ / /Y /቙ / /y / /ὕ /ቖA-M@p8 0@hV !    P    @X 2P   @X 2.e,,Q, v    l @X   0=X MN~ 0.,@hD 0@hV !ߍA/tlaT! /  /ᵔ /ᑙ /Y /U /὚-A-Mἂ@P $ H % XsP @ 0`& hp @0pЍAЍ/-@-M@$ 0Y    Z x  SP p  m  H$ e  b Ѝ@Ѝ/-@-M@$ 0i  q  $ B  P :  7  $ /  , Ѝ@Ѝ/-A-MP --P) +P& ,P# +P #P nP.P0P nP #P Q  " X   Qp`@ +P+`P-PL-`H0P#@Q5876543253-P )nP &-P( @" @@ @0@ @ @ @pP,PP WPnP @ p.PM PJ 0P +@Q76#P* 2nP /-P1 @+ @% @,` @` @ ` @ @pPA 0P .P.P 0P 0#P! -nP * @..P&`$P @0` @P ` @ @pp` `*PЍAЍ/-A-hM@dP OtP { 0 0)P p`P-P .PP P@x@h@XUpP  @P  !@1 uP1 G@XUX 1l ;P1X 5@XU1 0hЍAЍ/-0@-AMP@ @@PPA@PP./Aߍ0@Ѝ/-A-BM@8 0 0 AQ$( 0(P -$!(1&+$(p 0(P!7G)P @x p7\*!P75)PG@x (7W% 7(P 0#$$  &% 06& 0(P -  P&6$h&h6#  P $&@6|(P  &6p(P   R0RP RRPeP RxRPEPRq RAY]@XRe R @#R^PWRZRPeP RSRPEPIRL RA48@XR@ R @UUR6@UR1R AEBR RSRUURR R SATARW(-X- T-X    L R@g@x-X-@X W   B  (B(q  @  u| pG@x W  AaT^.8`VX:FQR-X(FA5PF@A0P9P 9P0 @ T @D FA 'FA5PF@A0P9P 9P0 @ T @D FA 6@@X0PE@XU,,T BߍAЍ/|A$@i A>^ 9^;Hj>:0y5>ư>z> /!-A-M VVPVVPeP VVPEPV VA V V @VPVVPeP VVPEPV VA V V @ -P +P@@VV V P +PVW$VPp@VPPO .P+P+P -P .P X= ;T9P6 3T1P. +V0P'V9P#V0P pW@XU X $0$ X V@ V@HVG 0"-P +P@@$$ $ P +P$%Pp`$-P .P $0P pW@XU $@h$V$  0.! 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T &06Ѝ@/@-M@    T &06]Ѝ@/@-M@    T &06:Ѝ@/@-M@    T &06Ѝ@/@-M@    T &06Ѝ@/@-M@|    T &06Ѝ@/@-M@Y   m T &06Ѝ@/@-M@6   J T &06Ѝ@/@- M@ 0    T &06` Ѝ@/@-M@    T &06=Ѝ@/@-M@    T &06Ѝ@/@-M@    T &06Ѝ@/@- M@  0T &06 Ѝ@/ /QQ0@- M@VsP Ѝ0@/@- M@`PV$Vt T &06 ppT &06 Ѝ@/C /R /Q0@-M@P Ѝ0@/ /N-0@-M@$(F@X_   T &06TЍ0@Ѝ/0@-M@PPP:   T &06/Ѝ0@/ /=Q0@-M@P   T &06 Ѝ0@/0@- M@!PUd T &06` PT &06S Ѝ0@/G /N0@- M@!PUd T &065 PT &06( Ѝ0@/G /%Op@-M`P@1 0 0 AQT@HQd Q Q @@ U UP VQ EV @Ѝp@/l-A-@p@D`D@PPPD @ P@1Gd`@$@ @AЍ/ : K -I-MRBrD KD D Al }D yPdto, `AЍIЍ/o$@-M@4 p` P@A(B(    T &06Ѝ@/@-M@wp `P@A(B( _T &06Ѝ@/@-M@CT &06Ѝ@/@-M@  0P P P P P P PP P P P  P T &062Ѝ@/@-M@  0 Z T &06Ѝ@/0@-$M@ P  0q@@ & T &06$Ѝ0@/0@-$M@ Z{PU  0=@ ]T &06$Ѝ0@/0@-$M@ &GP!  0 @@ @@@P T &06\$Ѝ0@/0@-$M@ P  0@ @@@ P n T &06$Ѝ0@/p@- M@ `  0 PPE  0 4 T &06 Ѝp@/p@- M@ h`c  0K PP  0W eT &06 Ѝp@/A-M@ .  K4_pW TP#@h@h VPT &06*<ЍA/A-M@   XP`@x@h @xWPT &06ЍA/p@-8M@ `  0P.P PU P~   z   T &068Ѝp@/@-M@V   0:P l\`T &06Ѝ@/?@-M@'    < T &06}Ѝ@/@-M@  c   T &06[Ѝ@/0@-M@  0! ("(08#80P! 0(ET &06Ѝ0@/A- M@  0I``P<P   02``P<PpGT &06 ЍA/p@- M@]  0E ` L  04 PEVT &06 Ѝp@/@-M@  0 v*T &06kЍ@/ /u<@-M@  0JT &06?Ѝ@/@-M@  0"T &06Ѝ@/@-M@  0AT &06Ѝ@/@-M@w  0T &06Ѝ@/@-M@O  0^T &06Ѝ@/@-M@'  06T &06wЍ@/A-`MP  p<`X XW;WV;V.@ @@P @@P @@P  8   T &06`ЍA/HNW_A-`MP p<` >P.@ y@w@P l@j@P _@]@P R   h T &06`ЍA/u|A-M`P@:P P AH @H0P AH @:P P@:P P AH @H0P AH@:P P@P P AH @H0 @H@XPP P;PP;PX ,p pp , T &06ЍA/@-0M@h  0 P  U P @@ HP  \ xR!T &060Ѝ@/@-(M@  .  JT &06(Ѝ@/0@-$M@     \P@XUT &06$Ѝ0@/@-8M@    .$$P $$T &06y8Ѝ@/@-(M@    T &06T(Ѝ@/@-lM@p 0PU  PUPPU ` T`P` K aT &06lЍ@/p@-M@7c`VpXPPT &06;MЍp@/A-MP 9pW.`@E P@@aPzPAP.ZP+aP zP AaA @ @AP ZP a}AzA @ @P P@@P PP`T &06uЍA/@-0M@  0T &06V0Ѝ@/@-M@w   T &06Ѝ@/A-M@bX4;P F  c p<=  Z `VڀAWG@x6@P0@@h Y PT &065GЍA/ /Up@-M@/`Vp$PPT &06Ѝp@/@-M@1    T &06&Ѝ@/@-M@    T &06Ѝ@/A-M@    PUڀ@XUPpWe`@@ `T &065ЍA/@-M@ K  h PQUڀL@XUPspWt h` j`T &06J\Ѝ@/-@- M@ 0   H  0 P  0m   0f - 0VP 0 P  0&P d 0&  <0=  00 Ѝ@Ѝ/??@-4M@ p 0@X  E@XU-P00P.P @XU >yP 35P#@h P -P .P 9P @0F@hV  6  I T &064Ѝ@/0@-M@P!PZ    \0}"T &06cЍ0@/@ /)@-$M@   PUe@xp `   0K  @hVU  0+ 01 T &06 $Ѝ@/?$@p@-M@   `V@XV@XV@XP%@X   T &06Ѝp@/@- M@K F-* 0    0 0 FT &06 Ѝ@/@-M@Q  0 P  0v    T &06VЍ@/0@-M@P&   T &066Ѝ0@/@-M@   0 P  0+    T &06 Ѝ@/@-M@  T &06ZЍ@/-@-$M 0d  0 0$Ѝ@Ѝ/@-@- M@cTڬ 0d  0 0 Ѝ@Ѝ/@-A-M@p`@P/P @ AX @X0@ AX@/P `@P/P @ AX @X0@ AX@/P `@P19@@P@ (BX  @ (BX  @4ЍAЍ/-A-M@p`@/P19@@P@ AX@ AX_@4/P `@P/P @ AX @X0@ AX3@/P `@PP @ AX @X0AX   @ЍAЍ/A- M@ 4 P (P <"X`<t 0U P RO@ 13pWQ4P @@ T &06 ЍA/? /! /0@- MP@U@| 0T@P 0eT$ 0  Ѝ0@/?$@0@-MP\^ H$@ H$@ H$@ H$@ H$@ H$@ H$@Ѝ0@/ /5 /0@-MP H$@ H$@ H$@ H$@ H$@ H$@ H$@ Ѝ0@/0@-M@P aPzP @ @ PpUЍ0@/0@-M@P APZP @ PXUЍ0@/-Ѝ/p@-` @P p@/@-  @@/ G(G0Gp Sp ppq Pq qqHPDh!#LTD$hGHPDh!"LTD$hGFp Sp ppq Pq qqHPDh!KLTD$hG pHpHPDhI#LTD$h GF p Jp ppHPDh!#LTD$hiGFp #3psppp3qsqqq3rsrrr3sssp ]p pp q Xq qqr Xr rrsHPDh~!2#LTD$h( pG0%p ep pp q `q qq r `r rr s `s ssHPDhv!#LTD$h 0G p Jp ppHPDhJ!#LTD$h GFpPpp p qQqHPDhE!#LTD$hGpXpp p qYqqqHPDhI!KLTD$hGF0$p\pppq\qqqr\r%p ep pp q `q qq"rHPDh'! #LTD$h[ 0GFp \p ppq Xq qqr Xr rrHPDh&! #LTD$h- GF p Jp ppHPDh"!#LTD$h  GF p Jp ppHPDh!!KLTD$hGF p Jp ppHPDh+!#LTD$h GF p Jp ppHPDh!KLTD$hGF p Jp ppHPDh!#LTD$hGFp Sp ppqQqHPDhm!#LTD$hl G0%p ep pp q `q qq rbrr r scsHPDhe!#LTD$h< 0G p Jp ppHPDha!#LTD$h GF p Jp ppHPDh!#LTD$h GFp Sp ppqQqHPDhn!KLTD$hGp Sp ppq Pq qqHPDhb!KLTD$hG p Jp ppHPDh!KLTD$hGF p Jp ppHPDh5!#LTD$hu GFHPDhI"KLTD$h^GFs pHpHPDhIKLTD$hAGF~p Sp ppqQqHPDhIKLTD$hGp Sp ppqQqHPDhI#LTD$h G p Jp ppHPDhI#LTD$h GF𵇰   p Jp pp(q( Hq( qq8r8 Hr8 rrs Hs ss t Ht ttHPDhI#NVD6h-*I@ ! @C(/9 H@ @ C:(  H@ @ C,! H@ @ C"GFp Sp pp qQqHPDhIKLTD$h<G p Jp ppHPDhIKLTD$hGF0%p ep pp q `q qq rbrr r scsHPDhl!KLTD$h0G p Jp pp HPDh I# LTD$h H@)HCG p Jp ppHPDhIKLTD$hGF9 p Jp pp HPDh I# LTD$hy H@)HCGHPDhI"LTD$hT GF% p Jp pp HPDh I# LTD$h3 H@)HCG p Jp ppHPDh!#LTD$hGFpp Sp ppqQq q q rTrHPDhI #MUD-h ,#h! @ I @ N1@ K@1C CC%`pGF{p Sp ppq Pq qqHPDh!KLTD$hGp Sp ppq Pq qqHPDh!KLTD$htG pXp pp qZq HPDh I# LTD$hM H@)HCG_p \p ppq Xq qqrZrHPDhd! #LTD$h GFJRD`HPD`pGF@-11#BJP* 0 P!ʠJt6 #J5:%B @\ T 8T?@ @D d3$ : d d2$.34 :@a`~ * ! @/  @/@/ \ᠣ࠳ @b#J5:%JW tU@S W Tᠣ࠳K @OI@ #J5:%JtJ.J 1.ʌ#ʠJ& t$@/ 4@# @1QZ.ʌ.J:@a`Q\* ! @/@/  @/@/Q\ ! @/P@/@/@/ \ᠣ࠳ @/1< #*R R51:Q3`B/// D !*R R51:3//qP//P/;0JP0C21P0C21P0C21P0C21P0CRP !/!`BP/;0P0C21P0C21P0C21P0C21P0CRP !/@-!!ʠjv7 #J5:%Zu@ 1K Rs@`r@s@QL\}J| jvJ* ! @/@/  @/@/ `#J5:%Z uP P |K4 `}w`$ Q LJ `Q`F21Q`F21Q`F21Q`F21Q`FRP0 `fL#J5:%Zu 1K#J5:%Zg ue`P JP` @S @D0 J `S`F281S`F241S`F221S`F211S`FR0P26 `f&@Dk4|# 8J 04@ T 0 @D Pd$3%4  l \ L @l0 1R@/@/  @/@/ |@/@/@/ @/@/@/@/!0!!   @-11#BJP*. 0 P!ʠJt #J5:% @\' T 8T?@ @D d3$ P JR d d2$.34 PHZ* ! @/  @/@/P Q%J LJ @Q@D21Q@D21Q@D21Q@D21Q@DRP0 @dL\ l \ L @l0 1@/Q\ ! @/ Q LJ @Q@D21Q@D21Q@D21Q@D21Q@DRP0 @dL\.ʌ l \ L @l0 1@/ \ᠣ࠳ @J#J5:%J? t=@E ? Tᠣ࠳K @71@ #J5:%JtJ.J 1.ʌG#ʠJ t @@" @ @1.ʌ.J2@/Q\ ! @/@@/@/@/@/4S3/1S3/1PC`BQCaBP/4SS!3/1PC`BQCaBP/4S3/1S3/100/P/4S3/1S3/100/P/4S* /S* /00/P/4SS!3/1PC`BQCaBP/4SS!3/1PC`BQCaBP/4SS!*$"/00P/ JP/Q/4SS!3/1PC`BQCaBP/4SS!3/1PC`BQCaBP/4SS!*/00P/ JP/Q/4S3/1S3/1/4S3/1S3/1/Ơ|*|*JQP3//SR3//P/|:/R/Ơ|*|*JQP3//SR3//P/|:/R/Ơ|*|*JQP//SR//P/|:/R/Ơ|*|*JQP//SR//P/|:/R/Ơ| *|*JQP//SR/ /P/|: /R/Ơ|*|*JQP3#//SR3#//P/|:/R/Ơ|*|*JQP//SR//P/|:/R/Ơ| *|*JQP/Q/SR/ Ġœ/PĠœ/|: Ġœ/RĠœ/Ơ|*|*JQP//SR//P/|:/R/Ơ|*|*JQP#3//SR#3//P/|:/R/Ơ| *|*JQP/Q/SR/ /P/|: /R/Ơ|*|*//P/|:/R/Ơ|*|*//P/|:/R/@-@ AP`@Qa1`0a@/Q/P13/1 2#Q B#8#Q B#4Q B#2a 00C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C000C0/!0!!   p@-@!\ όIT :6LQP*L$@O# r0BC%eS"ke k%X%VBV%$MCA@\&D \ZΌ ]J r@O`@@b0. ^Jp@/p@/p@/`4VOE V `f`f5 `f `f4F 3`f `f0Ǝ `fZU`f5@ rPP0C$ TUp@/P@ TJU :PU@P@P@ TJp@/U:p@/p@/p@/ r0QPp@/p@/Pv \-  QL21QL21QL21QL21QLRPP0 PeόPL21PL21PL21PL21PLRP όVNQ U*Q%p@/VMRP3 T+ 6 S@D281S@D241S@D221S@D211S@DR0PP525 Pe%@@R@D2(1R@D2$1R@D2"1R@D2!1R@DR P5*@Vp@/p@/P Q UR !p@/ Q URp@/ p@/>p@/0000000000000000000000000000000Out of memory stodbl--null addrUsing string var. where numeric expected(stostr--null addrUsing numeric var where string expectedgetdbl--null addrUsing string variable where numeric expectedgetint--null addrUsing string variable where numeric expected: Program MessageOKOut of Memory-alert:/-n.0ABORT MESSAGE=0.*Control position too high.statusselectdselectedValuecurrentminValuemaxValuepageSizenoItemsCannot find the control referenced. May be caused by using bitmap.index which does not work.String '' is not a valid date in mm/dd/yy format.ERR: Could not find resourceERR: Could not openERR: Database not found***Hour= Minute=Second= is not a valid time.Year= Month= Day= is not a valid date.' is not a valid time. pm am/' is not a valid date.Version < 5 with PNO?D- O /D/drwdct}x}D-/D/-@-,M$ }0,Ѝ@Ѝ/x} /_ /i-A-M@ p`R %  0/ЍAЍ/-A-M@ p8P% %< $(Pb &  0/yЍAЍ/-@- M      Ѝ@Ѝ/@- M0$0$ Ѝ@/-@- M !<$. 0.,  Ѝ@Ѝ/0@-M^Q P% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPP% %<$PPM$ HM  H$ H@  H$ H@  H$ H@ M$ HM  H$ H@ M$ HMM$ HM H$ H@N$ HN H$ H@ H$ H@ H$ H@ H$ H@ H$ H@ H$ H@ H$ H@ H$ H@ H$ H@ H$ H@O$ HO H$ H@O$ HOO$ HO @$ H @  H$ H@  @$ H @  H$ H@   H$ H@ Ѝ0@/-A-`MPUxx GsP%@`a ``@Pp' x@P@)xP+n(8X! iP P  H 0`ЍAЍ/}} /U-A-HM@P` sP ` P$s&7~p帀(          E0A& 7!  X% XU | xp tpPtk h h@ U1 W t 0FUA 0VK*t 0FGA 0Q *0   0C0C1  P 0 , ,`, 0 s&7kS T UPZQ 0 , ,`, 0s&7u F@R)*@F@'$$P $$(0(  C0F B0(  0CF 0C($ t 0FA 0aUJ E0@0  P& P#@   0E0 A  V@P@P@Pm} ~ P{s&7\At 0F TA 0RL@@ @E00  C &7!    @  048,`, 0HЍAЍ/}}{|~ /Q /1L /9R /iR /Q /P /P /O /P-A-`M@ጀPTx ksP   h`x ]g(8P^0p `ЍAЍ/<~N~-A-Mἂ@P $ H % XsP @ 0`& hp @0pЍAЍ/-0@-AMP@ @@PPA@PPstAߍ0@Ѝ/~-0@-MP@@ 0Ѝ0@Ѝ/ /- Ѝ/-A-M@PxPP U0,A A  A A A A A A A A A |A plA `\A<PLA0@<A40,A ({,w,v (: X }W /``aЍAЍ/@!\;D, 7#% (l-0X1l3T7<*$ .l /R@-@@P@/@-@@P@/-0@-M@P@PUЍ0@Ѝ/p@-$P  H`p@/@-M`Pp'@sPP Q@)Q@#@!"@  n 0P  0P @HЍ@/ /J-@-@oP  @Ѝ/A-XMP r @@ @p' '< $(pa & hP V yV:=O #3 c  ! <!<P*  !<$` < 0 !<$  !  #3j XЍA/ /=G /B /UBA-`M`(  @@ @p' '< $(pP% 0%, PUo(#34 w꼁 ( P % 0%, Da DP>    Q:(U(#3D8 DP # D 0s   $ $' $ (#3 ?`ЍA/ /A-A-PMPpl`& 0&, ` @sP P @@P @@P @ P @P @ P 0sPP  0d _P $($(@   048:@P 2 P Y$($(,,, ,, P ?$($( @  053@h03 0P h0l 0PPЍAЍ/ /9 /:-A-M@      PPPc P`P4P1p+P#` (("(8#8V <(0 40X @hV@XU@xWP"` (!8#8' <(0 40X @hV@XU` (!1 <(0 40X @hVPQ PNP+P(p"P(("(8#8 <(0 40jX a@XU@xWSP(!8#8 <(0 40DX ;@XU3P"Pp(("(1 <(0 40X @xW <(0 40 X ЍAЍ/-I-$MP@T`Hp' 0', psPCP P * P 0`[ *   hP _@n`}P V !< $  B@P : P . !< $  P   !@P * P V 0`T`$ЍIЍ/ /!5-A-@M`@2P Tp $ $P $\ 0@ЍAЍ/-@- M   0 Ѝ@Ѝ/-@-M@ 0Ѝ@Ѝ/-p@-M(P@<$  ` H@Ѝp@Ѝ/B@@-Mp@`sP!P  !1`P!`!1VO X  !P V  !1Ѝ@/@-M`pPP @A 1   048 C@P @A   4 P @A    048d P @A  @  Ѝ@/-A-M@帀(     PVPSPA P>X#P pP` qQa , (0/ hV: XU: xW:tP` Qa , (0/ hV: XU:[` a , (0/ hV:LP/ P,XPpP qQ , (0/ XU: xW:)P Q , (0/ XU:XPp q , (0/ xW: , (0/ЍAЍ/A-`MP$B@@ @ @$ $ 48@ I@@@0`& & 48`D 0:pW WPG xD P m    $#3`ЍA/ /5.A-`M`$s@@ @ipP% % 48P@@@0( (< $(D 0@fT@UT0 D H@[D HP @0* $ @' 8 H+T@@' @0 $ @     $#3[`ЍA/A-`MP$@@ @`& & 48`@@@0p' '< $(pD 0 @T@56D HD Pju@ D0dP  $  @L @$   Q $#3`ЍA/A-`M`$.@@ @$> @$ $ 48@ ?PU@@@0p' ' 48pD 0oPU0E XU(P0D P "E       $#36`ЍA/ /QA-pMP4@@ Pp@$ $ 48@PP@0`& 0&, `T 0@ Q-*T rPA y  I 4$4R& ^   GP a T0P ?c$($( $($4$4,0,0,0,4$4p pЍA/? /A-XM` @@ <Pp' ' 48p$A $ HT \TT  #3 <A $ HD H@!  <0! _ q #3$ XЍA/-@-M EPЍ@Ѝ/A-pM`8@@ 4.HPp' ' 48p@H $@H@H=TPPP@(!3  40 ! &@㼁 (   (  "2[pЍA/p@-0M@@@ `P% % ,4$( PT   "2%0Ѝp@/A-8MP@@ pa& h@$ $ 48@+@X Y   k "2X"28ЍA/ /yA-M@81@@ T'p$!t(,(,P  008X @1P@xW6XM`   $09    $0!04040408$4JЍA/atad /q / /q /A-MP0@@ Lh@l{  MP`& & ,4$( VP}0$4i & lpW.  cpW[+X0$4D $ $E $ 0$4(,(,2(,(0$4o"' ' 48P ( ЍA/@ / /p@-@P% % ,4$( PoP < @hc" p@/ /p@-8M@@@ `PU   "2/"28Ѝp@/A-M`(}@@ Ds`pP@$ $ 48@HLH ,   ppW`K(#3D  0$" ZPPNp( d' 0',  5 $ $ $ (#3~ЍA/@ /@-,MP.@@ `@$ $ 48@9p   "2B,Ѝ@/p@-` @P p@/@-  @@/@-Mp`V PPP@$ $<$Ѝ@/-A-M` & h@ $ H"sP@ P\p pP%@Xp@pЍAЍ/@-\Mp@p`V  0P  P P @ \Ѝ@/ʃA-M`@P   ("(    ("(  KP U   ! U P ! X' ! PPPU  0ppp 0IA  ("(0U P ! XPPU  0p pp 0 @Q A! ("(0xUG PD ! \X PU  1Joppp 0@Q A! ("(1:PU  1l"PU  1`PU  0T PU  0HЍA/-@-@@Ѝ// G(G0G()"#dpI)pGp Sp ppq Pq qqHPDh!KLTD$hG𵏰 pQp1p1 p1 qVqq q rPrr r sPs s s tTt(t( t( uUu8u8 u8 vWvv v wPww w pAp p p qAq q q rAr r r sAs s s tAtfHPDhF!2#dNVD6h/ ( _I@ ! @C,"YI@ ! @C -,h" @! RH@ RK@$QK@ CC C*`/:h @ IH@HL @HJ@ CC C;`(h @ ?H@>L @>J@ CC C`(h @ 4H@4L @3J@ CC C`(h @ *H@)L @)J@ CC C`(h @ H@L @J@ CC C`(h @ H@L @J@ CC C`(h @ H@ L @ J@ CC C`0GpPpp p qQqHPDhB!#LTD$hF Gp Sp ppqQqHPDhV!#LTD$h$ Gp \p ppqYqq q rZrHPDh]!KLTD$hGF p #3psppp3qsqqq3rsrrr3sssp ]p pp q Xq qqr Xr rrsHPDh~!2#LTD$h pG0%p ep pp q `q qq r `r rr s `s ssHPDhv!#LTD$h 0Gp \p ppq Xq qqr Xr rrHPDhw! #LTD$hY GF0 ,%)K@- #@)C! p Kp pp q Hq qqr Hr rr HPDhU! K MUD-h!,"I @ ! @C#0G 0$p\pppq\qqq%p ep pp qaqqHPDh^!#LTD$h 0GFp Sp ppqQqHPDh\!KLTD$hG p Jp ppHPDhJ!#LTD$h GFpPpp p qQqHPDhE!#LTD$hGpXpp p qYqqqHPDhI!KLTD$h]GFp"&p[R*#pTp p p qQqq q rPr(r( r( sUs|sHPDhA!#LTD$h pGp \p ppq Xq qqr Xr rrHPDh&! #LTD$h GF p Jp ppHPDh-!#LTD$hGF p Jp ppHPDh"!#LTD$h GF p Jp ppHPDh!!KLTD$hGF p Jp ppHPDh+!#LTD$hs GF p Jp ppHPDh!KLTD$hSGF p Jp ppHPDh!#LTD$h3GF p Jp ppHPDh!#LTD$h GFp Sp ppq Pq qqHPDhb!KLTD$hG p Jp ppHPDh!KLTD$hGF p Jp ppHPDh5!#LTD$h GF p Jp ppHPDhO!#LTD$h GF0%p ep pp q `q qq r `r rr s `s ss!t`tHPDhI#LTD$hU 0GFp Sp ppq Pq qq HPDh!# LTD$h,H@)HCGFHPDhN!"LTD$h GF𵑰( I@ ! @C,"I@ ! @C .3h @ H@H@H@C CC5`/;h @ H@H@H@C CC=`(h @ H@H@H@C CC`(h @ H@H@H@C CC`(h @ H@H@H@C CC`(h @ H@H@H@C CC`(h @ H@H@H@C CC`(h @ H@H@H@C CC`pAp p p qAq q q rAr r r sAs!s! s! tDt1t1 t1 uFu9u9 u9 vGv v v wAw w w pAp p p qAq q q rAr r r sAs s s tAtOHPDhG!2#MMUD-h ( CI@ ! @C,"=I@ ! @C .4h" @! 6H@ 6K@$5K@ CC C2`/:h @ -H@,L @,J@ CC C;`(h @ #H@"L @"J@ CC C`(h @ H@L @J@ CC C`(h @ H@ L @ J@ CC C`(h @ H@L @J @ CC C`(h @ H@L @J@ CC C`(h @ H@L @J@ CC C`(GFJRD`HPD`pGF!!ʠ :s*\\24> ///6//6/| J!4>l3 l<0//////1< #*R R51:Q3`B/// D !*R R51:3//qP//P/;0JP0C21P0C21P0C21P0C21P0CRP !/!`BP/;0P0C21P0C21P0C21P0C21P0CRP !/4S3/1S3/1PC`BQCaBP/4SS!3/1PC`BQCaBP/4S3/1S3/100/P/4S3/1S3/100/P/4S* /S* /00/P/4SS!3/1PC`BQCaBP/4SS!3/1PC`BQCaBP/4SS!*$"/00P/ JP/Q/4SS!3/1PC`BQCaBP/4SS!3/1PC`BQCaBP/4SS!*/00P/ JP/Q/4S3/1S3/1/4S3/1S3/1/Ơ|*|*JQP3//SR3//P/|:/R/Ơ|*|*JQP3//SR3//P/|:/R/Ơ|*|*JQP//SR//P/|:/R/Ơ|*|*JQP//SR//P/|:/R/Ơ| *|*JQP//SR/ /P/|: /R/Ơ|*|*JQP3#//SR3#//P/|:/R/Ơ|*|*JQP//SR//P/|:/R/Ơ| *|*JQP/Q/SR/ Ġœ/PĠœ/|: Ġœ/RĠœ/Ơ|*|*JQP//SR//P/|:/R/Ơ|*|*JQP#3//SR#3//P/|:/R/Ơ| *|*JQP/Q/SR/ /P/|: /R/Ơ|*|*//P/|:/R/Ơ|*|*//P/|:/R/!ˠ4 \ ͌ # /S/0SL281SL241SL221SL211SLR0P0S//Out of memory stodbl--null addrUsing string var. where numeric expected(stostr--null addrUsing numeric var where string expectedgetdbl--null addrUsing string variable where numeric expectedgetint--null addrUsing string variable where numeric expected: Program MessageOKOut of Memory-alert:/-n.0ABORT MESSAGE=0.*Control position too high.textitemText***cellMatrixadditemcleardeleteitemstartCaptureerasedisplaysetFocusAddDeleteColTypeBindToDatabaseindex () is invalid for list.add operation.statusselectdselectedmaxCharscurrentminValueminmaxValuemaxpageSizeValuepageSizeColColWidthRowRowsCellMatrixvalueMatrixValuerowDataRowDatatopRowTopRowfontMatrixLeftTopWidthHeightIllegal object name used = Cannot get property () on control type Cannot set property (Wrong type of variable used in call to get property for 'Wrong type of variable used in call to set property for 'Wrong number of func argsinternal error exiting a function.Can't find view recordcan't find control object #= cnt= TOT =Can't find a bitmap to draw.Can't find program's parag recordaccessing an unopened databaseoffset too bigInternal error-Can't release work record.Accessed an unknown window=Can't locate draw window=Can't find view TOC recordIllegal form name used = Internal error--for processingMis-matched argsPassed an entire array to a subroutine not expecting it.Too many levels of subscripting.Subroutine and calling program array bounds do not match.Illegal comparison between string var and numeric varIllegal comparison code Error divide by 0Found illegal subscript = 1.100z}r|x|vz{ #[dedWr+ĠzpF disclaimer splash cepMaincalculatormainscoresmaintablesmainCanadianCSpineCanadianCT scanadiancommNewOrleans neworleanscommNexus.OttawaAnkle ottawaanklecommOttawaFoot ottawafootcommOttawaKnee ottawakneecommPERCpitt pittkneecommSanFran sfcommentaryNWellsaaanc&aniongapurineaniongapstempconversioncorrnacorrcacockcroftmdrdtfenaZw8conversion\maposmgap?osmolality parkland!pedsettdepthpedsettsize^pedsfluids5qtcGh2odeficit abcd2 abcd2commappy apache3Apache2VApache3apgardCentorwCurbwGCS +pedsgcs ICHScoreminimentalminimental2NIHnih2PORTPORT2TIMI timicommpedsvs Gsepsis gsepsisdefinitions adultburns synovialfluid csfanalysis Ginfantburns ichildburns ,sixhs vasopressors troponins redeye #wellsdvt Ubandemia mthrombolytics tpaexclusions mithrombolytics heparin gp2b3a/drugdosingExigrisitoxidromeantidotesinrtpadosingstrokemimicsiiiiiiiiiiiiiiiiiiiiiiiiiiiiii ssss s sss i isssrrssss i i s++si))s((s**s sss i i ssss i i s AAs ss i issss i i ssss i isss s! i" i# s$ccs%uus&sss'__s(jjs)s*ffs+nns,pps-nns.dds/ees0pps1AAs2s3i4i5 i6s7i8s9 i:s;s<s=ffs>``s?s@QQsAiB iCsDiEiFiGiHiI iJsKsLiMiNiOsPsQ sRsS sTsUsVsW sXsY sZs[ s\s]s^s_s`sasbscsdsesfigihiiij iksl sminsospsqsrssst susvswsxsyszs{s| s}s~ssssssss ssss s sssss ss ss s sss ss siiii ississs sssssssssssss sssssssiiii ississ ssss ssss sssssssss s ss s s s s ss s s s isss i iisss i iisss i iiiissss i iiss i i svvsss i iss s s i i ssss i isAAs isss i i sMMsss i i!s"CCs#s$s% i& i' s(SSs)s*s+ i, i-@@s.i/i0i1i2i3i4i5s6s7 i8 i9s:!!s;s<s=s> i? 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s @s A s Bs Cs D s Es F!!s G s HBBs Is J s Ks Ls Ms Ns O@@s Ps Qs R i S i T[[s U i Vs Ws Xs Y i Z i [s \''s ]i ^i _i `i ai bi ci di e n@ f n@ g n@ h n@ i n@ j n@ k n@ l n@ ms ns o i p i q n@ ri ss t&&s u--s v55s ws xs y i z i {s | i }s ~ s s s i i i s s s i i s ees s s i i s s s s s s s i i UUs s s i i s 44s s s i i s BBs 55s s s s s i i s s s s i i s DDs ,,s ++s s ))s 99s s ((s s **s s 00s //s s <<s i ##s KKs //s 22s --s s s 33s 99s i i s s s i i s &&s s s ''s i ??s QQs ..s UUs s s 11s 66s ,,s $$s s i i s s s i i i i i i s s s i i n@ n@ n@ i i i s i i s s i i s s i s i s s s i s s s i  i  n@  n@  n@  n@  n@ s  i  i i s i n@ n@ ccs s n@ s s !n@ "hhs #s $s %i &i 's (s )i *s +s ,i - i .s /s 0s 1i 2s 3''s 4OOs 5::s 6""s 7IIs 8YYs 9i : i ;s <s =s > i ? i @88s A i Bs Cs Ds E i F i Gi Hs Ii JOOs Ks L s Ms Ns O s Ps Qs Rs Ss T s Us Vs Ws Xs Y s Zs [s \ s ] s ^s _s `s a s b s cs ds e s fs gLLs h s i s j s k s l s ms n s os ps qs r i ss ts us v i w i xi y s zi {s |s } s ~s s s s s s s s ##s s ,,s s 11s s s s BBs s s s s s s s s s s s s s ==s s s i s s s i i @@s i i s i s qqs ((s s EEs s s \\s ((s s s s ''s DDs ++s s ^^s 88s s s $$s AAs 11s s s ++s iis s i s s s i i __s s s i i n@ n@ n@ n@ i n@ i i i s s i 44s i s ccs s >>s s JJs s CCs s s i i __s010100122223132010101145678910 NSBSystemLibNSLmaincalculatormain scoresmain tablesmainAuthor EM Ruless was created by Michael Ward MD, MBA while he was an Emergency Medicine resident at the University of CincinnatiOK Contributors,Aaron Bernard, MD-University of Cincinnati.10*Ben Bassin, MD- University of Cincinnati.)Ben Donham, MD-University of Cincinnati.+Ali Raja, MD MBA-University of Cincinnati. disclaimer DistributionThis program is meant to be freely distributed. You can either beam this to other individuals or email the program. We encourage the free distribution of this program! HandHeldDoc.com BVisit us at www.handhelddoc.com and let us know how we are doing!Help?Interested in helping with EM Rules? Feel free to send your suggestions, ideas or comments to Michael Ward at info@handhelddoc.com NavigationClick the boxes in the top right to move to another section. When you see a 'd' it indicates that commentary is available. An 'i' is for reference, 'R' is for decision rule, 'C' Calculator 'S' Scores and 'T' Tables.ProgramThis program was developed by Emergency Medicine Residents at University of Cincinnati. This goal of this program is to provide information available at the click of a button.# Our Sponsor$dWe would like to thank CEP America (www.cep.com) for their sponsorship and support of this project.%vThese materials are intended to provide assistance to the user as a reference tool. While every effort has been made &tto ensure the accuracy of the recommendations made herein, these materials are not intended to be a substitute for '`professional medical advice or treatment or the exercise of professional judgment in any given (ksituation. Rather, these materials are intended only for general informational purposes. They reflect the )best judgment of the editors And contributors as of the date of this publication and are subject to change. The content set forth in these *gmaterials should Not be construed as the sole basis For the user's own medical judgments or decisions.+oUnder no circumstances will Michael Ward, CEP, its affiliates or any of their respective directors, officers, ,qmembers, employees or agents or otherwise any editor or contributor to these materials be responsible or liable -oto any user or other entity for any direct, compensatory, indirect, incidental, consequential (including lost .eprofits or lost business opportunities), special, exemplary or punitive damages that result from or /frelate in any manner whatsoever to (1) use of these materials or reliance on the content thereof, or 0q(2)errors, inaccuracies, omissions, defects, untimeliness, security breaches or any other failure to perform by 1BMichael Ward, his affiliates or any editor or contributor hereto.2i3297240758menu;cep<CEP America is the premier democratic emergency physician group in the nation with over 900 physician partners practicing in multiple states. We =gare looking for quality Board Eligible/Certified emergency physicians to staff our growing practices, >aand we have many opportunities for physicians interested in Administrative and Medical Director ?opportunities.@RVisit our website at www.cep.com or call 800-476-1504 to obtain more information.A3021D1820E1F1817G1818H1819KCanadian C-Spine RuleL1018M11N2OCanadianCSpinePCanadian CT Head RuleQ CanadianCTRNew Orleans Head CT CriteriaS NewOrleansTNEXUS C-Spine RuleUNexusVOttawa Ankle RuleW OttawaAnkleXOttawa Foot RuleY OttawaFootZOttawa Knee Rule[ OttawaKnee\PERC Rule for PE]PERC^Pittsburgh Knee Rule_Pitt`San Francisco Syncope RuleaSanFranbWell's Criteria for PEcWellsdWell's Criteria for DVTe wellsdvtf2107g2106h2108i2109l Aa Gradientm1518naaoAbsolute Neutrophil CountpancqAnion Gap-Serumr aniongapsAnion Gap-UrineturineaniongapuCelsius <--> FahrenheitvtempconversionwCorrected Serum CalciumxcorrcayCorrected Serum Sodiumzcorrna{Cr Clearance (Cockcroft-Gault)| cockcroft}Cr Clearance (MDRD)~mdrdFractional Excretion of SodiumfenaGP IIb/IIIa Inhibitorsgp2b3aHeparin DosingheparinKilograms <--> Weight w8conversionMean Arterial PressuremapOsmolality-Calculated osmolality Osmolal GaposmgapParkland Formula parklandPediatric Maintenance Fluids pedsfluidsPediatric ET Tube Depth pedsettdepthPediatric ET Tubes & Lines pedsettsize QT CorrectedqtcTotal Body Water Deficit h2odeficittPA Dosing Calculator tpadosing2111211021122113ABCD2 Score for TIA/Stroke1841abcd2Alvarado Appendicitis Scoreappy APGAR ScoreapgarAPACHE II ScoreapacheCentor Score for PharyngitisCentorCURB-65 for CAPCurbGlasgow Coma ScoreGCSIntracerebral Hemorrhage Score ICHScoreMini Mental Status Exam minimentalNIH Stroke ScaleNIHPORT Score for PneumoniaPORTTIMI Risk Score for UA/NSTEMITIMI2114211521162117Activated Protein C (Xigris)1808xigrisAntidotes-Common antidotesBandemia-Differential bandemiaBurns Management adultburnsCardiac Arrest-6 H's & T'ssixhsCSF Fluid Analysis csfanalysisElevated INR ManagementinrPediatric Vital SignspedsvsRed Eye-CausesredeyeSepsis DefinitionssepsisStroke Mimics strokemimicsSynovial Fluid AnalysissynovialfluidThrombolyticsthrombolytics Toxidromes toxidromeTroponin Elevation troponins Vasopressors vasopressors1282Radiography is indicated. Canadian C-Spine Rule is 100% sensitive and 42.5% specific for identifying clinically important C-Spine injuries.1284Radiography is indicated. Canadian C-Spine Rule is 100% sensitive and 42.5% specific for identifying clinically important C-Spine injuries.128312851287NO radiography is indicated. Canadian C-Spine Rule is 100% sensitive and 42.5% specific for identifying clinically important C-Spine injuries.Radiography is indicated1288 ReferencewStiell, IG. The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients. JAMA. 2001; 286: 1841-8.Dangerous MechanismDangerous Mechanism includes: 1.Fall >=1 meter or 5 Stairs 2.MVC High Speed (>100km/hr, Rollover, Ejection) 3.Motorized Recreation Vehicles 4.Bicycle Collision Simple Rear End MVCSimple Rear End MVC EXCLUDES: 1. Pushed into oncoming traffic 2. Hit by bus/large truck 3. Rollover 4. Hit by High-speed vehicle.Delayed Onset of Neck PainBDelayed Onset of Neck Pain means no immediate onset of neck pain. High RiskNIf patient has any of these, pt is at high risk for neurological intervention!Basal Skull Fracture"DHemotympanum, Raccoon eyes, Battle's Signs, CSF Otorrhea/Rhinorrhea' Medium Risk(TIf patient has either of these, they are at medium risk for brain injury on Head CT-APedestrian vs. car, occupant ejected, Fall from >3ft or 5 stairs.1060/105201053110542105531056410599Canadian Head CT:"Non-Contrast Head CT is indicated;Head CT is not indicated@vStiell, IG et al. The Canadian CT Head Rule For patients With minor head injury. Lancet. 2001 May 5;357(9266):1391-6.A canadiancommBMainCD2965EF2684G28H152IIn 2001 a Canadian Group published their results for a study to help decrease the usage of head CT in patients with head trauma (1). They looked at patients that had a loss of consciousness but had GCS scores greater than 13.J Their goal was to identify all patients that had a clinically significant injury or one that required Neurosurgical intervention.K The CanadianHead CT rule is good for excluding patients that will need a Neurosurgical intervention or that have a clinically significant brain injury.L, However, given the design of the study it MDwill not pick up every patient with a traumatic finding on head CT.N They carried out a prospective cohort study and found that you were high risk for Neurosurgical intervention if you had a GCS less than 15 Otwo hours after injury, a suspected open or depressed skull fracture, any sign of basal skull fracture, more than two episodes of vomiting, or if you were 65 years old or greater.P They also concluded that you were at medium risk for brain injury on CT if the patient had amnesia before impact greater than 30 minutes, or if they had a dangerous mechanism.QeAccording to their study the presence of any one of the 7 factors would indicate ordering a head CT.R Their study has was 100% sensitive and 68% specific in predicting the need for Neurosurgical intervention, and was 98.4% sensitive and 49.6%Su specific for predicting clinically important brain injury.Using their head CT rule would reduce CT ordering by 54%.T3 Their study has been prospectively validated by U1other studies that showed similar results (2-3).VThe Canadian Head CT rule is good for excluding patients that will need a Neurosurgical intervention or that have clinically significant brain injury.Wp However, given the design of the study it will not pick up every patient with a traumatic finding on head CT.X REFERENCESYz1. Stiell IG et al. The Canadian CT Head Rule For patients With minor head injury.Lancet. 2001 May 5;357(9266):1391-6. Z2. Smits M et al. External validation of the Canadian CT Head Rule And the New Orleans Criteria For CT scanning in patients With minor head injury. JAMA. 2005 Sep 28;294(12):1519-25.[3. Stiell IG et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury.JAMA. 2005 Sep 28;294(12):1511-8.\2676c ContributordDDr. Donham is a Resident Physician at the University of Cincinnati.g1048h1047i1044j1043k1042l1041m1040rNew Orleans Head CTsneworleanscommxSmits M et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005 Sep 28;294(12):1519-25.y2968z2966{8In 2000 Haydel et al (1) published a set of indications| for head CT in patients With minor head injury. This set of indications is commonly referred to as the New Orleans Head CT rule.}b In their study they looked at patients that had minor head trauma which was defined as patients~O with head trauma with a loss of consciousness but a normal neurological exam.tThe factors that they found that were found important in predicting abnormal head CT scans were headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure._In their study they reported 100% sensitivity and a specificity of 25% for detecting patients with any traumatic abnormality on head CT. Their rule has been prospectively validated, but with slightly lower sensitivity of 98.3%(2). The New Orleans head CT rule is very good at excluding the presence of any traumatic abnormality on head CT; however it does not significantly reduce head CT usage because of its poor specificity./1. Haydel MJ et al. Indications For computedY tomography in patients with minor head injury.N Engl J Med. 2000 Jul 13;343(2):100-5. 2. Smits M et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005 Sep 28;294(12):1519-25.268914311432143514361437NEXUS C-Spine"C-Spine Radiography is Indicated.&C-Spine Radiography is NOT Indicated.Stiell, IG et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma.N Engl J Med 2003;349:2510-8.1073Ankle Xrays are Indicated10741081Ankle Xrays are not Indicated.ottawaanklecomm30733072nThe best known of the lower extremity clinical decision rules from the Ottawa Health Research Institute, the wOttawa Ankle Rules were developed in order to decrease x-ray usage for the evaluation of ankle injuries. The initial studyk determined the criteria by analyzing 32 clinical variables using a survey of 900 patients with ankle and wfoot injuries. All 70 of the malleolar fractures in this patient population were picked up using any of the clinical wsigns of pain near the malleoli, age greater than 55 years, localized bony tenderness of the posterior edge or tip of eeither malleolus, or the inability to bear weight both immediately after the injury and in the ED. tThe following year, the Rules were further refined to make them simpler while maintaining their clinical usefulness. The final {Rules of inability to bear weight and tenderness of either the posterior aspects or tips of either malleoli were found to whave a sensitivity of 100%. This sensitivity has remained almost constant (97-100%) through many validation studies, ~however the specificity of the Rules has varied considerably. In the 16 studies that have analyzed the Ankle Rules to date, &specificities have varied from 10-79%#{Despite their high sensitivity and the multiple studies that have reproduced their findings, practitioner adoption of the 4Ottawa Ankle Rules has not been as high as expectedH. In one study in Canada, x-ray utilization after education about the ,Rules actually increased in study hospitalsN. Nevertheless, given their sensitivity and the rise in healthcare costs in zgeneral, the use of the Ottawa Ankle Rules use to determine which patients do not need radiographic evaluation for their  ankle injuries is well advised. References Stiell IG et al. A Study to Develop Clinical Decision Rules for the Use of Radiography in Acute Ankle Injuries. Annals of EmergencyMedicine 1992; 21:384-390.p Stiell IG et al. Decision Rules for the Use of Radiography in Acute Ankle Injuries. JAMA 1993; 269:1127- 1132. Bachmann, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003;326:417. Cameron, C., Naylor, C. D. No impact from active dissemination of the Ottawa Ankle Rules: further evidence of the need for local implementation of practice guidelines CMAJ 1999 160: 1165-1168.3074BDr. Raja is a Resident Physician at the University of Cincinnati.150115001502Foot Xrays are IndicatedFoot Xrays are not Indicatedottawafootcomm30853086}An extension of the Ottawa Ankle Rules, the Ottawa Foot Rules were developed to decrease the use of radiographs ordered for diagnosis of midfoot fractures. The Rules were initially defined during by analyzing 32 clinical variables using a survey of 900 &patients with ankle and foot injuries^. All 32 significant midfoot fractures were found during this study using the signs of pain fin the midfoot and bony tenderness at the base of the fifth metatarsal, the navicular, or the cuboid.zIn a manner similar to their Ankle Rules, the investigators at the Ottawa Health Research Institute then further refined the Foot Rules to maintain their high sensitivity while making them easier to use. In their final iteration (pain at the base of the 5th metatarsal or the navicular or the inability to bear weight immediately after the injury and in the ED), the Rules mremained 100% sensitive and potential decreased x-ray utilization For evaluation of midfoot fractures by 30%} Their simplicity and high sensitivity make the Foot Rules as useful as the Ottawa Ankle Rules and they should both be used hon patients with foot and ankle pain in order to decrease unnecessary radiographic evaluation and cost. Stiell IG et al. A Study to Develop Clinical Decision Rules for the Use of Radiography in Acute Ankle Injuries. Annals of Emergency Medicine 1992; 21:384-390.308714741475147814811482Knee Xrays are IndicatedKnee Xrays are NOT IndicatedStiell IG, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA 1996 275: 611-615 ottawakneecomm30573055Given the number of patients presenting with complaints of knee pain, the need for a clinical decision rule is obvious. Investigators in Ottawa published their Ottawa Knee Rule H in 1995 after designing it using a convenience sample of 1,047 adults. They found that the use of five variables led to the most useful rule: (1) age 55 years or older, (2) tenderness at the head of the  fibula, (3) isolated tenderness of the patella, (4) inability to flex to 90 degrees, and (5) inability to bear weight both immediately and in the ED (four steps). Their prospective validation study , performed on a convenience sample of 1,096 patients, found that the Rule had a sensitivity of 100%, a specificity of 49%, and that its  +use would have reduced x-ray usage by 28%.vDue to the development of clinical decision rules for the evaluation of knee injuries at approximately the same time Yin both Ottawa and Pittsburgh, it was only natural to compare them. A comparative study (performed by the developers of the Pittsburgh Rules) published in 1998 and enrolling a convenience sample of 934 patients found that their Rules vhad a sensitivity of 99% and a specificity of 60% while the Ottawa Rules had both a slightly lower sensitivity (97%) rand a much lower specificity (27%). Not to be outdone, the Ottawa investigators published a comparative abstractt the following year after retrospectively reviewing their database of 3,115 patients using both Rules. They found that, in their patient population, their Ottawa Knee Rule had a slightly higher sensitivity (100% vs. 99%) and a much higher specificity (51% vs. 19%) than the Pittsburgh Rules.oWhile both Rules have extremely high sensitivities and the ability to rule out significant knee injury, their Odiffering specificities leaves room for many false positives. A meta-analysis published in 2003 determined that, due to the fact that it had been validated in a larger number of patients and had high intraobserver fagreement (kappa= 0.77), the Ottawa Rule (see Ottawa Rule in EM Rules) should be used preferentially.Stiell IG et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med.1995;26:405-13. I. G. Stiell et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA 1996 275: 611-615. Seaberg DC et al. Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries. Ann Emerg Med 1998;32:8-13.y Stiell, et al. Retrospective Evaluation of the Pittsburgh Criteria for Knee Radiography. Acad Emerg Med 1999; 6: 433-B.c J. L. Jackson et al. Evaluation of Acute Knee Pain in Primary Care. Ann Intern Med 2003; 575-588.3053(1265)&Further evaluation for PE is required*1257+1258,1259-1266.1260/1261012641PERC Rule applies and D-Dimer is not indicated. PE prevalence in this population is 1.3% in the Low risk group and 0% in the Very Low risk group.6Kline JA et al. Clinical criteria to prevent unnecessary diagnostic testing inemergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 124755.91415:1416?Result@%Radiography of the Knee is indicatedA)Radiography of the Knee is not indicatedFReference/DataGcSeaberg DC, Jackson R. Clinical decision rule for knee radiographs. Am J Emerg Med 1994;12:541-3.H pittkneecommI3061J3060KiPublished in 1995, the Pittsburgh Knee Rules were designed to optimize the use of radiologic evaluation Lyof the acutely injured knee. Using a 10-month retrospectivechart review at a single study site, the investigators used MP26 physical exam criteria and 12 elements of the history to develop the rule. N}They concluded that radiography was indicated if the mechanism was either due to blunt trauma or a fall and the patient met Oxeither age (less than 12 or greater than 50) or functional (the inability to walk four weight bearing steps in the ED) Pgcriteria. Using these few decision points, the investigators performed a prospective validation studyQR on 133 consecutive patients with knee injuries and found that the rule was 100% Rusensitive and 79% specific and that, if it had been used, the number of x-rays taken would have been reduced by 78%.Sw Due to the development of clinical decision rules for the evaluation of knee injuries at approximately the same time T} (performed by the developers of the Pittsburgh Rules) published in 1998 and enrolling a convenience sample of 934 patients Ujfound that their Rules had a sensitivity of 99% and a specificity of 60% while the Ottawa Rules had both Vga slightly lower sensitivity (97%) and a much lower specificity (27%). Not to be outdone, the Ottawa W/investigators published a comparative abstractXh the following year after retrospectively reviewing their database of 3,115 patients using both Rules. Yj They found that, in their patient population, their Ottawa Knee Rules had a slightly higher sensitivity ZV(100% vs. 99%) and a much higher specificity (51% vs. 19%) than the Pittsburgh Rules.[iWhile both Rules have extremely high sensitivities and the ability to rule out significant knee injury, \Utheir differing specificities leaves room for many false positives. A meta-analysis]| published in 2003 determined that, due to the fact that it had been validated in a larger number of patients and had high ^xintraobserver agreement (kappa = 0.77), the Ottawa Rules (see Ottawa Rules in EM Rules) should be used preferentially._^ Seaberg DC et al. Clinical decision rule for knee radiographs. Am J Emerg Med 1994;12:541-3.`3062cpitth2589k1004lXSerious Outcome at 7 days is likely, SF Syncope rule is 96% sensitive and 62% specific.m1005n1006o1008p1007qLikelihood is lowv DefinitionwSerious Outcome is 'death, MI, arrhythmia, PE, CVA, subarachnoid hemorrhage, significant hemorrhage, OR any condition causing a return ED visit AND hospitalization for a related event.'x sfcommentary}Quinn JV. Derivation of the San Francisco Syncope Rule to Predict Patients with Short Term Serious Outcome._ Annals of EM, February 2004.~29642587The San Francisco Syncope Rule should be considered a risk stratification tool to aid in physician judgment and not a traditional decision rule aimed to work in place of physician judgment. Two very important caveats should be considered when applying this rule. The first is that the rule is intended to be applied on the tail end of an emergency department workup.n Every patient requires a full history and physical examination With testing based upon information obtained.Simply ordering an electrocardiogram and hemoglobin level on every patient with syncope has the potential to miss many significant events such as subarachnoid hemorrhage, pulmonary embolism, ectopic pregnancy, and acute myocardial infarction. If no cause for syncope can be determined during the emergency department visit, the rule can then be applied to help with risk stratification. The second major caveat to the rule is that during internal derivation and validation the sensitivity was only 96% and 98% respectively.1,2 Only one external validation has been attempted to date which found an even lower sensitivity of 89%.3 In the absence of 100% sensitivity, which traditional decision rules attempt to achieve, it can only be used to assist in physician judgment by providing risk stratification and not replace judgment. The value of the rule is probably in its simple mnemonic (CHESS: CHF, HCT, ECG, SOB, SBP) that highlights risk factors which have consistently been shown to be associated with bad outcomes. Specifically, congestive heart failure and electrocardiogram changes.1-6 The clinician may want to consider age as well in their final decision.z Although not included in this rule, prior work has found older age to be a significant risk factor for bad outcomes.4-61.Quinn JV et al. Derivation of the san francisco syncope rule to predict patients With Short-term serious outcomes. Ann Emerg Med 2004;43:224-232.2.Quinn J et al. Prospective validation of the san francisco syncope rule to predict patients With serious outcomes. Ann Emerg Med 2006;47:448-454.c3.Sun BC et al. External validation of the san francisco syncope rule. Ann Emerg Med 2007;49-427.`4.Martin JP et al. Risk stratification of patients With syncope. Ann Emerg Med 1997;29:459-466.5.Colivicchi F et al. Development And prospective validation of a risk stratification system For patients With syncope in the emergency department: the OESIL risk score. Eu Heart J. 2003;24:811-819.6.Sarasin FP et al. A risk score to predict arrythmias in patients With unexplained syncope. Acad Emerg Med 2003;10:1312-1317.2583eDr. Bernard is Assistant Professor of Emergency Medicine, University of Cincinnati, Cincinnati Ohio.sanfranSigns & Sx of DVTMMinimum of leg swelling and pain upon palpation of the deep veins of the leg MalignancySOn treatment, previously on treatment in the past 6 months or palliative treatment110311041114111511161117111831.5 Well's ScoreThe Patient receives W point. Low Probability For PE (3.6%) With (-) D-Dimer: 1.5% With (+) D-Dimer: 8.6%.6^ points. Moderate Probability for PE (20.5%) With (-) D-Dimer: 7.6% with (+) D-Dimer: 36.1%.[ points. High Probability for PE (66.7%) With (-) D-Dimer: 20.0% with (+) D-Dimer: 79.6%.1677xxx165716791694713100.81681Alveolar Arterial Gradient*Aa Gradient = (713*FiO2)-(PaCO2/0.8)-PaO2 WBC CountAEnter as a number per 1000. For example, enter '24' not 24,000.Bands/Enter as an integer (i.e. 24) instead of 0.24.PMNs2041202720232025ANCANC = 10 * WBC (1000s) * (%PMNs + %Bands) Neutropenia: ANC < 1500 cells/ml Mild: 1000-1500 cells/ml Moderate: 500-999 cells/ml Severe : < 500 cells/ml1575157915771592 Anion GapAnion Gap = Na - (Cl+HCO3)17461750174817681761 Urine Anion Gap )Urine Anion Gap = UNa + UK - (UCl+UHCO3) Fahrenheit19153291908Celsius F1919 CTemperature ConversionCF = (9/5*C)+32 C= (F-32)*5/9. 38C=100.4F 39C=102.2F 40C=104F"1525#1527$.016%1523*.Corrected Sodium = Na + ((Glucose-100)*0.016)+4,17220172411739217267.45359?1938@.85A140B72C1936D1941E1923F1934KCockroft GaultLWCreatinine Clearance = [(140-age(yrs))*weight(kg) *0.85 (if female)]/[(Serum Cr * 72)]T1978U1.18V1967W.762X170Y.18Z.17[.32\-.18]-.17^1953_1964`1979a1983fMDRD Equationg[Creatinine Clearance = [(170*Age^-.18*(0.762 if female)*(1.18 if black)*BUN^-0.17*Alb^.32]h1966i1962m1653n1655o1673p1671uFractional Na ExcretionvFeNa = (Una*Pcr)/(Pna*Ucr)z Kilogram{1900|2.2}1885~Pound lbs1904 kgWeight Conversion1 Kilogram = 2.2 * Pounds162916331631MAP = SBP*(1/3) + DBP*(2/3)204920532051JOsm Gap = Measured Osmolality - Calculated Osmolality. Normal <10 mOsm.Calculated OsmolalitySerum Osmolality = 2Na + BUN/2.8 + Glucose/18 + ETOH/4.6 + Isopropanolol/6 + Methanol/3.2 + Ethylene Glycol/6.2 (Normal=275-290)16001604160216211615Ethanol16244.6Ethylene Glycol6.2Isopropanolol Methanol2.818Serum OsmolalityCalculated Serum Osmolality = 2Na + BUN/2.8 + Glucose/18 + ETOH/4.6 + Isopropanolol/6 + Methanol/3.2 + Ethylene Glycol/6.2 (Normal=275-290)Percent Body BurneddEnter the number as a whole number, not a decimal. Utilize the Rule of 9's. See 'Tables' for more.4200018631865Give 1 liters of IV Fluids over 1st 8 hours then give  liters over next 16 hours.Fluid Requirements = Surface area burned(%) x Wt (kg) x 4mL Give 1/2 of total fluid in 1st 8 hours, and 2nd half over next 16 hours.1718ETT Depth: ET Size Method+Predicted ET tube depth by size method is 1712121700ETT Depth: Age Method*Predicted ET tube depth by age method is  12 + age(yrs)/2 -OR- 3xETT Size15671549156515662.58 Fr1553Newborn ET Tube SizesIpremie 2.5 term newborn 3-3.5 6-12 mos 3.5-4. All tubes are uncuffed. Pediatric Tube Sizes zCuffed: (3 + Age/4) Uncuffed: (4 + Age/4). NG, Suction and Foley=2*ETT Size. Chest Tube=4*ETT Size (for Pneumothorax).2165215820406021682152Pediatric Fluids^Bolus Fluids = 20 ml/kg Maintenance Fluids: 0-10kg: 4cc/kg. 11-20kg: 2cc/kg. >20kg: 1cc/kg.#1846$1850%1848&.5+ Corrected QT,=Corrected QT= QT/SQRT(RR Interval). The RR Interval = 60/HR1 QT Interval23Enter QT Interval as a whole number, NOT a decimal3kg4213992120:2124;2122<.4ATotal Water DeficitB&Water Deficit = .4 * Wt * (na/140 -1)O2818P2820Q2844R2841S2837T2838U2836V ABCD2 ScoreW^ points and they are LOW risk for Stroke: 1.0% at 2 days, 1.2% at 7 days, 3.1% at 90 days.X^ point and they are LOW risk for Stroke: 1.0% at 2 days, 1.2% at 7 days, 3.1% at 90 days.Yl points and the patient is at MODERATE risk for Stroke: 4.1% at 2 days, 5.9% at 7 days, 9.8% at 90 days.Zj points and the patient is at HIGH risk for Stroke: 8.1% at 2 days, 11.7% at 7 days, 17.8% at 90 days._Johnston SC et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007 Jan 27;369(9558):283-92.` abcd2comma3043b3042cThere is much debate in the Stroke/TIA literature regarding the ability of clinicians to risk stratify patients for developing subsequent CVA dafter suffering a TIA. High-risk patients should certainly be hospitalized for observation, expedited diagnostic work-up and rapid access to therapeutic e]interventions (tPA) should a stroke occur. Low to moderate risk patients might necessitate f]hospitalization if expedited work-ups cannot be arranged within 24-48 hours with guaranteed geneurologist follow-up. The ABCD Risk Score is a unified risk score comprised of various components h`of previous risk scores described in the TIA literature and has been validated and shown to be iimost predictive of 48 hour risk of CVA following a TIA. It can be used by clinicians to identify higher j2risk patients to facilitate disposition planning.k1. Johnston SC et al. Validation And refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007; 369:283-92.lm2. Hankey GJ. The ABCD, California, And unified ABCD risk scores predicted stroke within 2, 7, And 90 days mafter TIA. EBM 2007; 12:88.n3034uHDr. Ben Bassin is a Resident Physician at the University of Cincinnati.x1772y1773z1776{1777|1778}1779~17801784Alvarado Appy Score# point. Appendicitis Less Likely. points. Possible Appendicitis. points. Probably Appendicitis.% points. Very Probably Appendicitis.sAlvarado A. A Practical Score for the Early Diagnosis of Acute Appendicitis. Annals Emerg Med 15:5;557-586, 1986.11110554971267512547131571431541041142768Aa Gradient vs PAO29Use Aa Gradient if FiO2 >50%. Use PAO2 if FiO2 is <50%.Arterial pH vs. HCO3!Only use HCO3 if no ABG is done.Apache2Knaus WA, Draper EA, Wagner DP, Zimmerman JE. (1985). APACHE II: a severity of disease classification system. Critical Care Medicine. 13,818-29.51138ApacheApache3137>= 41129739-40.9 38.5-38.936-38.434-35.932-33.930-31.9<=29.9>=1601299130-159110-12970-10950-69<=49>= 50131335-4925-3412-2410-116-9<=5>=1801301140-179110-13955-6940-54<=39>=5001303350-499200-349<200 Or PAO2 >70 PAO2 61-70 PAO2 55-60 PAO2 <55>=7.7 or >=5213057.6-7.69 Or 41-51.9 7.5-7.59 Or 32-40.9 7.33-7.49 Or 23-31.9 7.25-7.32 Or 18-21.9 7.15-7.24 Or 15-17.9 <7.15 or <151307160-179155-159150-154130-149120-129111-119<=110>=713096-6.95.5-5.93.5-5.43-3.42.5-2.9<2.5>=3.51311 2-3.4!1.5-1.9"0.6-1.4#<0.6$>=40%1321&20.39.9'15-19.9(3-14.9)1-2.9*<1+>=60,1323-50-59.9.46-49.9/30-45.9020-29.91<202>7531387465-74555-64645-547<448136291363:1397;Spontaneous: 4<1374= To Speech: 3> To Pain: 2?None: 1@ Oriented: 5A1372B Confused: 4CInappropriate Words: 3DNonspecific Sounds: 2EFollows Commands: 6F1370GLocalizes Pain: 5HWithdraws to Pain: 4IAbnormal Flexion: 3JAbnormal Extension: 2K15LH points. Hospital Mortality is 4% Non-Operative and 1% Post-Operative.MH points. Hospital Mortality is 6% Non-Operative and 3% Post-Operative.N14OI points. Hospital Mortality is 12% Non-Operative and 6% Post-Operative.P19QJ points. Hospital Mortality is 22% Non-Operative and 11% Post-Operative.R24SJ points. Hospital Mortality is 40% Non-Operative and 29% Post-Operative.T25U29VJ points. Hospital Mortality is 51% Non-Operative and 37% Post-Operative.W30X34YJ points. Hospital Mortality is 71% Non-Operative and 71% Post-Operative.Z35[J points. Hospital Mortality is 82% Non-Operative and 87% Post-Operative.lEntire Body Pink: 2m1797nPink Body; Blue Ext: 1oEntire Body Pink Or Blue: 0p >100 BPM: 2q1791r <100 BPM: 1s1149t Absent: 0uCough, Sneeze, Vigorous Cry: 2v1793wGrimace, Slight Cry: 1xNo Response: 0yActive Movement: 2z1799{Some Movement: 1|Limp, Motionless: 0}Strong, crying: 2~1802Slow, irregular: 17 APGAR is . Good. . Assist.. Resuscitate.Age@Centor score was not validated for children 2 years and younger1137113911401131113011291126-1Answera points. No further testing nor antibiotics are required. Risk of Strep infection Is 1.-2.5%` point. No further testing nor antibiotics are required. Risk of Strep infection is 1.-2.5%g points. Culture these patients and treat all positive cultures. Risk of Strep infection is 11-17%.g points. Culture these patients and treat all positive cultures. Risk of Strep infection Is 11-17%.p points. Treat all patients with antibiotics. You may culture, but is not required. Risk of strep is 51-53%.McIsaac, WJ et al. Empirical Validation of Guidelines for the Management of Pharyngitis in Children and Adults JAMA, April 7, 2004; 291: 1587 - 1595.14001401140414051406CURB-65 ResultsMortality for a score of E points is 0.7%. Since Mortality is Low, recommend home treatment.D point is 3.2%. Since Mortality is Low, recommend home treatment.Q points is 3.0%. Since Mortality is Intermediate, consider hospital treatment. points is 17.0%. Since Mortality is High, hospital treatment is necessary. Manage as severe Pneumonia and consider ICU level care. points is 41.5%. Since Mortality is High, hospital treatment is necessary. Manage as severe Pneumonia and consider ICU level care. points is 57.0%. Since Mortality is High, hospital treatment is necessary. Manage as severe Pneumonia And consider ICU level care.W S Lim, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58;377-382.Definition of ConfusionEMental Test Score <=8 or new disorientation to person, place or time26082628pedsgcs11821151GCS is 262726262611Infant coos/babbles: 52613 Irritable/continually crying: 4Infant cries to pain: 3Infant moans to pain: 2Spontaneous/Purposeful: 62615Withdraw to Touch: 5Pediatric GCS is  ICH Volume'ICH Volume calculated by ABC/2 method.2753 2754 2755 2737 2738 27392740 ICH Score" points. 30 day mortality is 0%." point. 30 day mortality is 13%.# points. 30 day mortality is 26%.# points. 30 day mortality is 72%.# points. 30 day mortality is 97%.$ points. 30 day mortality is 100%.|Hemphill, JC et al. The ICH Score: A Simple, Reliable Grading Scale for Intracerebral Hemorrhage. Stroke 2001;32;891-897. minimental20 5 out of 5119982 4 out of 53 3 out of 54 2 out of 55 1 out of 56 0 out of 57 3 out of 3820029 2 out of 3: 1 out of 3; 0 out of 3<2006= 2 out of 2>2010? 1 out of 2@ 0 out of 2ASays ProperlyB2012CSay ImproperlyD2297E Closes EyesF2303GDoes Not Close EyesHPt Writes SentenceI2305JPt Does Not Write Sent.KCopied AppropriatelyL2307MNot Copied AppropriatelyN2293O MMSE is Rnih2WLOC 1aXGeneral level of how alert the patient is. The investigator must choose a response if the pt is intubated or other communication barriers are present.]LOC 1b^'Ask patient the month and his/her age.cLOC 1cdXAsk patient open and close the eyes and then to grip and release the non-paretic hand.i Best Gazej.Test best gaze with horizontal eye movements.oVisualpVTest Visual Fields using confrontation, finger counting or visual threat, as needed.uQTest for Palsy by asking Patient to show teeth or raise eyebrows and close eyes.z Arm Testing{Extend the arm (palm down) 90 degrees (if sitting) or 45 degrees (if supine). Score Drift if the arm falls before 10 seconds.Alert2186 ArousableReq. StimulationUnarousable/Reflex Only Both Correct2188 1 Correct None Correct2217 Normal Gaze2220Partial Gaze PalsyForced DeviationNo Visual Loss2223Partial HemianopiaComplete HemianopiaBilat. HemianopiaNml sym mvmts2226Minor paralysisPartial paralysisParalysis of 1 side No drift2228DriftSome effort vs gravityNo effort vs gravity No movementAmputee/joint fusion223222392243Absent2246Present in 1 limbPresent in 2 limbsNormal2249Mild-Mod Sens. LossSevere/Total Loss No Aphasia2252Mild-Mod AphasiaSevere AphasiaMuteNo Dysarthria2255Mild-Mod DysarthriaSevere DysarthriaIntubated/UnableNo abnormality2258Sensory inattentionProfound hemi-inattention2264 Leg TestingdHold the leg at 30 degrees (always done in supine). Score drift if the leg falls before 5 seconds. Limb AtaxiarTest with eyes open. Do finger to nose and heel-shin on both sides. Score only if out of proportion to weakness.Sensory TestingUse pinprick or noxious stimuli (obtunded/aphasic pt). Test as many body parts as needed to accurately check for sensory loss. LanguageUse a picture to have the pt describe what is happening and have them name objects. Judge comprehension and language from their responses. DysarthriaIf the pt is normal, have pt repeat the following: 'MAMA', 'TIP TOP', 'FIFTY FIFTY','THANKS','HUCKLEBERRY','BASEBALL PLAYER'.Extinction/InattentionMay be obtained in prior exam.501220PORT212361225122612271228122912301232123312341235 PORT Score oThe Patient is class I and 30 Day Mortality is 0.1 to 0.4%. The patient qualifies for outpatient treatment.|Fine, MJ et al. A Prediction Rule to Identify Low-Risk Patients with Community Acquired Pneumonia. NEJM 336:243-50, 1997.1218121912411242124312441245124612472703&The Patient is class II and receives 4n points. 30 Day Mortality is 0.6 to 0.7% and should qualify for outpatient treatment. Consider observation.5906'The Patient is class III and receives 7k points. 30 Day Mortality Is 0.9 to 2.8% And should qualify for outpatient treatment after observation.81309&The Patient is class IV and receives :P points. 30 Day Mortality is 8.5 to 9.3% and inpatient treatment is required;%The Patient Is Class V And receives <P points. 30 Day Mortality Is 27 to 31.1% And inpatient treatment is requiredC1460D1447E1448F1451G1452H1453I1454VTIMI Risk ScoreWi points. 14 day mortality, new or recurrent MI or severe ischemia requiring revascularization is 4.7%.Xh point. 14 day mortality, new or recurrent MI or severe ischemia requiring revascularization Is 4.7%.Yi points. 14 day mortality, new or recurrent MI or severe ischemia requiring revascularization Is 8.3%.Zj points. 14 day mortality, new or recurrent MI or severe ischemia requiring revascularization Is 13.2%.[j points. 14 day mortality, new or recurrent MI or severe ischemia requiring revascularization Is 19.9%.\j points. 14 day mortality, new or recurrent MI or severe ischemia requiring revascularization Is 26.2%.]j points. 14 day mortality, new or recurrent MI or severe ischemia requiring revascularization Is 40.9%.bAntman, EM et al. The TIMI Risk Score for Unstable Angina/Non ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making. JAMA 2000;284: 835-842.gRisk Factors for CADh}Risk factors for CAD include family history of CAD, hypertension, hypercholesterolemia, diabetes or being a current smoker.i timicommj3356k3357lPublished by Antman JAMA in 2000, the TIMI risk score was conceived as a prognostication scheme for patients admitted with a diagnosis of Unstable Angina/Non-STEMI. mmUsing a multivariate logistic regression model applied to patients in the TIMI 11b trial, the investigators ngwere able to identify seven risk factors among their test cohort of patients that predicted increased oglikelihood of all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring urgent pgrevascularization at 14 days. The variables found to be statistically significant predictors of said qend points were as follows:r1. Age >65 yearss2. 3 Or more risk factors For CAD (Risk factors defined asfamily hx of CAD, hypercholesterolemia, DM, Or current tobacco use)t3. Significant prior coronary stenosis of >50% (a value of zero was assigned if patient had not had a previous cardiac catheterization)u4. ST-deviationv@5. Severe anginal symptoms (=2 events in the previous 24 hours)w6. Use of ASA in past 7 daysx77. Elevated serum biomarkers (CK-MB or troponin level)ytOnce these risk factors were identified, they were then prospectively validated on 3 cohorts from the TIMI-11b and zoESSENCE trials. Rates of all cause mortality, myocardial infarction, and severe recurrent ischemia requiring {9urgent revascularization within 14 days were as follows:| 0/1: 4.7%}2: 8.3%~ 3: 13.2% 4: 19.9% 5: 26.2% 6/7: 40.9% Utility of Antmans risk score in an emergency setting is limited due to the fact that its cohort is made up of only admitted patients xwho are diagnosed with unstable angina/NSTEMI. In addition, even those patients with risk scores of 0 or 1 still have Wsignificant 14 day event rates that still are high enough that they warrant admission.fAttempts have been made in EM literature to both retrospectively and prospectively validate the TIMI crisk score to a broader cohort of patients who present to the emergency department with complaint lof chest pain and require EKGs. In his retrospective study of 3,929 patients, Pollack et al. found that a TIMI risk score of 0 predicted a 2.1% rate of death, MI, or urgent revascularization at 30 days and a TIMI risk score of 6 to have a 45% (CI 20.9-69.1%) event rate. h In a prospective trial, Hollander et al found a TIMI risk score of 0 to carry a 1.7% (CI 0.42-2.95%) k death/AMI/urgent revascularization rate at 30 days and a risk score of 6 carried a 30% risk (CI 0-100%).In summary, the TIMI risk score has been proven as a useful tool in risk stratifying patients who are admitted with a diagnosis of UA/NSTEMI, but its aability to differentiate which patients in an ED setting with chest pain are at low enough risk Yfor discharge has yet to be proven. It should be used as an aide in communication with acardiology consultants as well as guide to which level of inpatient care a patient may require. 3358Antman, EM et al. The TIMI Risk Score for Unstable Angina/NonST Elevation MI: A Method for Prognostication and Therapeutic Decision Making. JAMA 2000;284: 835-842.CDr. Krupp is a Resident Physician at the University of Cincinnati.NB3012Newborn2-3kg120-16030-50603.027176 mos 6 Months7kg120-14030-40703.51 yr1 Year10kg100-14020-304.02 yr2 Years12kg744.54 yr4 Years16kg100-120785.06 yr6 Years20kg80-10016-20825.58 yr8 Years25kg866.010 yr 10 Years30kg60-100906.512 yr 12 Years40kg50-10012-20947.0>14 yr >14 Years>50kg987.5Low Limit SBPlMin. Acceptable SBP up to 1 mos old=60mmHg, 1mos-1y/0=70mmHg then up to 10 y/o= 70+2*(Age). >10y/o=90mmHg2632263326342635265026512652Defining Sepsis&The Patient does not have SIRS/Sepsis The Patient meets SIRS criteria"The Patient meets Sepsis criteria)The Patient meets Severe Sepsis criteria(The Patient meets Septic Shock criteriaNguyen, HB et al. Severe Sepsis and Septic Shock: Review of the Literature andEmergency Department Management Guidelines. Annals Emerg Med. 2006;48:28-54. Refractory Hypotension cRefractory Hypotension is defined as a SBP <90mmHg, MAP <65mmHg following 20-40 ml/kg fluid bolus Organ Dysfunction Organ dysfunction is defined as renal/liver/cardiac failure, acute lung injury, coagulation abnormalities, thrombocytopenia, CNS (AMS) or hypoperfusion with lactic acidosis. sepsisdefinitions Adult Sepsis has several definitions that are important to understand.They include: SIRS, Sepsis, Severe Sepsis and Septic Shock. SIRS SIRS, or Systemic Inflammatory ResponseSyndrome is defined as two or more of the following: (1) Temperature >38C or <36C(2)Respiratory Rate >20 or PaCO2 <32mmHg (3)White Blood Cell count >12,000 or <4,000or >10% Bands and (4)Pulse >90 beats/minute Sepsis 5Sepsisis defined as presence of infection plus SIRS. Severe Sepsis oSevere Sepsisis defined as Sepsis plus organ dysfunction in one or more system (i.e. renal/liver/heart failure  Septic Shock cSeptic Shock is defined as Severe Sepsis plus hypotension refractory to a 20-40 ml/kg fluid bolus. 2665 2853 2851 2852  infantburns childburns 5Burn Resuscitation 62875 74.5 82876 92869 :2868 ;2863 <2862 =2866 >2865 ?2860 @2861 A2872 B2871 C2878 D1000 E2954 FThe Patient's burn is GK% and does not require use of the Parkland formula for burn resuscitation. H'% of BSA. Parkland formula indicates I Liters over 24hrs and J% Liters over the first 8 hours then K Liters over the next 24 hrs. P Burns Help QClick on the body part that is burned. Click on 'A' for Anterior and 'P' for Posterior. Click 'Calc' to find out the total % burned and fluid resuscitation. VYWolfson, AB. Harwood Nuss' Clinical Practice of Emergency Medicine. LWW, 4th ed, 2005. W43 X159 [3010 \ Clear/Yellow ] Transparent ^High _<200 `<10% a~90% of serum bGood c2780 dNon-Inflammatory eYellow f 200-2,000 g<25% h Inflammatory iYellow to Green jTurbid kLow l1,000-100,000 m>50% n~70% of serum o Good to Poor pSeptic qYellow to Gray r Variable s15,000-200,000 t>75% u<50% of serum vPoor {Hals, GD et al. Evaluation of the Acutely Injured Knee in the ED: Diagnosis and Treatment. Part I. EM Reports. April 30, 2007 ~Fungal 3008 Predominance of Lymphoctes Elevated 2801 Bacterial >=1,000 per mm3 Predominance of PMNs* Mild-Marked Elev. Normal to Marked Decrease Tubercular Viral Usually Normal <100 per mm3 Predominance of Lymphoctes* Normal to Elevated Cell Differential Bacterial Meningitis has a predominance of PMNs but Lymphocytosis is present 10% of the time. However viral meningitis may have a PMN predominance early. Glucose Ratio /This refers to the CSF to Serum Glucose ratio. \Seehusen, DA et al. Cerebrospinal Fluid Analysis. American Family Physician.2003;68:1103-8. 81 42 134 156 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, December 13, 2005.  1 3282 2 3283 %University of Cincinnati Pharmacists 3256 3266 Dobutamine (2-10 mcg/kg/min) 3262 +  +++  ++ - ^Used in decompensated heart failure. Can be used in septic patients with low cardiac output. Dobutamine (>10 mcg/kg/min) ++  ++++ +++ - Dopamine (1-3 mcg/kg/min) -  +  - ++++ Useful in patients with compromised systolic function. More tachycardia than Norepinephrine. 'Renal dose' is not really effective in preserving kidney function. Dopamine (3-10 mcg/kg/min)  -  ++++  ++ ++++ Useful in patients with compromised systolic function. More tachycardia than Norepinephrine. 'Renal dose' is not really effective in preserving kidney Function. Dopamine (>10-20 mcg/kg/min)  +++  +  - #Epinephrine (0.01-0.05 mcg/kg/min)  +  ++++ ++ Last line agent for Sepsis. Epinephrine (>0.05 mcg/kg/min)  +++  +++  +  - "Milrinone (0.375-0.75 mcg/kg/min)  -  -  - APDE Inhibitor. Used in decompensated heart failure. Lowers BP. "Norepinephrine (0.02-3mcg/kg/min)  ++++  ++  - eFirst line for Sepsis, More potent than DA, more effective at reversing hypotension in septic shock. !Phenylephrine (0.5-3 mcg/kg/min)  - #Least likely to cause tachycardia. Vasopressin (0.04 Units/min)  -  - ?Adjunctive therapy for sepsis. Do not exceed 0.04 units/min. Alpha 3Alpha receptor stimulation causes vasoconstriction Dopamine 7Stimulation of Dopamine receptors causes vasodilation. Beta1 OBeta1 receptor stimulation causes an increase in cardiac output and inotropy. Beta2 7Stimulation of Beta2 receptors causes bronchodilation. AMI Open Heart Surgery Post-PCI 3315 Acute Pulmonary Embolism Aortic Dissection-Type A Cardiac Contusion-Trauma Defibrillation Heart Failure-Acute & Chronic Heart Transplant Pericarditis/Myocarditis Rhabdomyolysis Strenuous Exercise 3313 41 150 !KKorff,S et al. Differential of Elevated Troponins. Heart 2006;92:987993. $3335 %3337 &3339 '3341 (3343 )3345 *3347 +Acute Anterior Uveitis ,3325 -"Diffuse, more prominent by limbus .Minimal to none /$Constricted, poor response to light 0Present 1 Affected 2Clear to hazy 3,Cell and flair in anterior chamber, hypopon 4Acute Angle Closure Glaucoma 5#Diffuse, more prominent by limbus. 6None 7:Moderately dilated, perhaps irregular, minimally reactive 8:Present, often associated with headache, nausea, vomiting 9Hazy :!Will not help with Dx, check IOP ;Conjunctivitis <%Diffuse, more prominent by fornices. =Yes >None, just minor irritation ? Unaffected @Clear A Episcleritis BFocal CUsually present DHSV Keratitis EDiffuse F"Constricted if associated uveitis G May be hazy HCDendrites with fluoroscein, punctate lesions; can have iritis too. IHerpes Zoster Ophthalmicus J Scleritis KFocal to diffuse LMay be affected MSuperficial Keratitis NOnly if infectious etiology OAMultiple punctate lesions with fluorescein; can have iritis too. T\Presentation by Erin Grise, MD at University of Cincinnati Emergency Medicine Grant Rounds. [Cancer \(Treatment within 6 months or palliation ]3364 ^3365 _3366 `3367 a3368 b3369 c3370 d3381 r-2 sWell's DVT Score t' point. Low Probability for DVT (3%). u. points. Moderate Probability for DVT (17%). v6 points. They have high probability for a DVT (75%). {Wells PS et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. ~ Tablesmain tPA Dose for Stroke ftPA dosing: 0.9 mg/kg (max=90 mg) with 10% given over 1 min with the remainder given over 60 minutes. Inclusions for tPA 1. Age: >=18 yo 2. Clinical Diagnosis of Stroke 3. Onset <180 minutes tpaexclusions VHarwood-Nuss' Clinical Practice of Emergency Medicine Editor: Wolfson, AB. LWW 2005. MI Thrombolytic Dosing 5tPA (Alteplase): 10mg IV bolus then 90mg over 3 hrs. MI Thrombolysis C1. ST-Elevation MI or LBBB with Hx suggestive of MI in pts <75 yo 62.Cath lab is not available or delayed accessibility 3. <12 hrs since onset mithrombolytics PE Thrombolytic Dosing rTPA: 100 mg over 2 hours STREPTOKINASE: 250,000 IU over 30 min then 100,000 IU/hr x 24 hrs UROKINASE is 4,400 IU over 10 minutes then 4,400/hr x 12-24 hrs. PE Thrombolysis EFor patients with Pulmonary Embolism causing hemodynamic compromise. -1.Current use of anticoagulants and INR >1.5 ,2.Use of Heparin (<48hrs) and PTT prolonged 3.Hx of CVA in past 3 mos *4.Hx of serious head injury in past 3 mos :5.Major surgery, biopsy of organ or trauma in past 14days 6.Hx of any previous ICH )7.Hx of intracranial CA, AVM or aneurysm 8.Hx of Seizure at onset of CVA +9.Hx of GI orurinary bleed in past 21 days 10.Hx of MIin past 3 mos. 111.Hx of pregnancy or parturitionin past 30 days 012.Hx of hereditary/acquired abnormalhemostasis !13.Lumbar puncture in past 7days =14.Arterial puncture at non-compressible sitein past 30 days 3476 $1.Rapidly improving neurological Sx L2.Isolated mild neurological Sx or NIHSS <4 and normal speech/visual fields 03.Presentation suggesting SAH despite normal CT 34.Pretreatment HTN: SBP >=185mmHg or DBP >=110mmHg .5.Presumed septic embolus (stroke with fever) 6.Glucose <50 mg/dl 7.Platelets <100,000/mm 48.Clinical presentation suggestingaortic dissection :9.Head CT suggesting intracranial hemmorrhage of any type 3478 1.Suspected Aortic Dissection '2.Previous hemorrhagic CVA at any time 3.Hx of CVAin last 1 year 4.Known intracranial neoplasm (5.Active internal bleeding (not menses) 3492 @1.Uncontrolled HTN at presentation: SBP>180 mmHgor DBP>110 mmHg R2. Trauma within 2-4wks including CPR >10 minhead trauma or major surgery (<3 wk) /3.Presentation suggestingSAH despite normal CT V4.Hx of CVA or known intracerebralpathology not covered in absolute contraindications 5.Knownbleeding disorder 6.Pregnancy 27.Allergy to streptokinase (can use other agents) 78.Active peptic ulcer;recent internal bleeding <2-4wks -9.Current oral anticoagulantuse with INR 2-3 %10.Noncompressible vascularpunctures 11.Hx of chronic severe HTN 3494 71 153 118 3512 Acute Coronary Syndrome (ACS) 3505 80 1,000 Units/hr 3519 4000 4,000  Units 3517 Atrial Fibrillation 5000 5,000 Deep Vein Thrombosis (DVT) Pulmonary Embolism (PE) 3552 Abciximab (ReoPro) 3545 .25 .125 dAbciximab (ReoPro): 0.25 mg/kg IV bolus then 0.125 mcg/kg/min (up to 10 mcg/min), no renal dosing. Eptifibatide (Integrilin) .12 Eptifibatide (Integrilin): 180 mcg/kg IV bolus (up to 22.6 mg) then 2 mcg/kg/min (up to 15mg/hr) until 18-24 hrs after PCI, decrease by 50% for renal dosing. Tirofiban (Aggrastat) !.1 "iTirofiban (Aggrastat): 0.4 mcg/kg/min for 30 min then 0.1 mcg/kg/min, decrease by 50% for renal dosing. #15 $ mg/hr %3558 &22 '22.6 ( mg )3556 *10 + mcg/min ,3570 / 1.Severe Sepsis or Septic Shock 02.APACHE II >=25 13682 21.Active internal bleeding 3(2.Recent (<3 months) hemorrhagic stroke 4P3.Recent (<2 months) intracranial or intraspinal surgery, or severe head trauma 5;4. Trauma with increased risk of life-threatening bleeding 6#5.Presence of an epidural catheter 7J6.Intracranial neoplasm or mass lesion or evidence of cerebral herniation 8Z7.Known hypersensitivity to drotrecogin alfa (activated)or any component of this product 93684 @9Manufacturer website: www.xigris.com accessed on 8/6/07. G3702 H Anticholinergic (Antihist/TCAs) I3700 JP'HOT as a hare, RED as a beet, DRY as a bone, BLIND as a bat, MAD as a hatter' K1.Hyperthermia L 2.Dry Skin M3.Dilated pupils N4.Delirium, Hallucinations O5.Tachycardia P6.Urgency and retention QCholinergic (Organophosphates) RDUMBELS or SLUDGE S1.Diarrhea, Diaphoresis T 2.Urination U3.Miosis, muscle fasiculation V4.Bradycardia, bronchospasm W 5.Emesis X6. Lacrimation Y 7.Salivation ZNarcotic (Heroin/Methadone) [ 1.Miosis \2.Bradycardia ]3.Hypotension ^4.Hypoventilation _5.Coma `Sympathomimetic (Coke/Amph.) a 1.Mydriasis b2.Tachycardia c3.Hypertension d4.Hyperthermia e 5.Seizures fWithdrawal (ETOH, Opioids etc) gMexamples include: alcohol, opioids, benzos, barbiturates, antihypertensives h 1.Diarrhea i 2.Mydriasis j3.Goose flesh k4.Tachycardia l5.Lacrimation m6.Hypertension n 7.Yawning o 8.Cramps p9.Hallucination q10.Seizures (ETOH, Benzos) x3723 yAcetaminophen z3721 {NAC (N-Acetylcysteine) |Anticholinergics }Physostigmine ~Anticoagulants Vitamin K1, Protamine Benzodiazepines Supportive, Flumazenil* *Use of Flumazenil is contraindicated in many situations including tricyclic overdose or in chronic users which may precipitate seizures Botulism Botulinum antitoxin Beta Blockers $High dose insulin therapy, glucagon Calcium Channel Blockers -High dose insulin therapy, glucagon, calcium Cholinergics 2Atropine, Pralidoxime in organophosphate overdose Carbon Monoxide Oxygen, Hyperbaric therapy Cyanide CAmyl Nitrate, Sodium Nitrate, Sodium Thiosulfate, Hydroxycobalamin Digoxin Digoxin Fab Antibodies Iron Deferoxamine Isoniazid Pyridoxime Lead BAL, EDTA, DMSA Methemoglobin Methylene Blue Opioids Naloxone (Narcan) Toxic Alcohols >Ethanol drip, Ethanol, Dialysis, Fomepizole (Ethylene Glycol) Tricyclic Antidepressants Sodium Bicarbonate A1.University of Cincinnati: www.cpqe.com 2.Chest 2004; 126:204S; 3750 3754 Life Threatening Bleeding 3752 1.Hold Warfarin r2.Administer Vitamin K1 10mg IV by slow IV push (consider diluting in 50cc saline or D5W to prevent anaphylaxis) )3.Give prothrombin complex concentrate* 4.Repeat if necessary F*Recombinant Factor VIIa may be used as an alternative to prothrombin Admission !Serious Bleeding (Any Elev. INR) ]3.Give fresh frozen plasma (FFP) or prothrombin complex concentrate depending on severity* )4.Repeat Vitamin K1 if necessary Q12 hrs INR (supratherapeutic but <5) 1.Lower Warfarin dose -OR- (2.Follow INR if only minimally elevated E3.Omit 1 or 2 doses And resume at lower dose when INR is therapeutic ,Home: patient can be followed as outpatient INR 5-9; No Bleeding _1.Omit next 1-2 warfarin doses, monitor INR and resume Warfarin at lower dose when therapeutic 92.Omit 1 warfarin dose And administer 1-2.5mg Vitamin K1 Admit all high risk patients (elderly, higher INR, history of bleeding, stroke, CHF, cancer, renal insufficiency, anemia, hypertension) INR 9-20; No Bleeding %2.Administer 5-10mg oral Vitamin K1 B3.Monitor INR frequently and administer oral Vitamin K1 as needed 24.Resume Warfarin at lower dose when therapeutic Close follow-up for low-risk patients. Admission or observation for high risk patients (elderly, higher INR, history of bleeding, stroke, CHF, cancer, renal insufficiency, anemia, hypertension) INR >20; No Bleeding ,1.Omit next 1-2 warfarin doses, monitor INR j2.Administer 10mg IV Vitamin K1 slowly (consider diluting in 50cc saline or D5W to prevent anaphylaxis) 3.Supplement with prothrombin complex concentrate, fresh frozen plasma or recombinant human factor VIIa depending upon severity `Adams HP et al. Guidelines for Management of Adults with Ischemic Stroke. Stroke 2007, p. 1674. 3774 .9 3778 3780 Complicated Migraine 3795 5History of similar events, preceding aura, headache. 3796 Conversion Disorder dLack of cranial nerve findings, neurological findings in a nonvascular pattern, inconsistent exam. Hypertensive Encephalopathy ?Headache, delirium, significant hypertension, cerebral edema. Hypoglycemia KHistory of diabetes, low serum glucose, decreased level of consciousness. Seizures DHistory of seizures, witnessed seizure activity, postictal period. `Adams HP et al. Guidelines for Management of Adults With Ischemic Stroke. Stroke 2007, p. 1663.&                      !$            &8$F:;<=#1A@?>#"EDCB%;      &,'+&"!      ~  r s t w x y z | &" E              $      &D         1       $\        &       $o        I       %I      !$       # =       &E%       $      ! "  N%a`bT     %# c d e f"J 3 4 5 6&$ ')+8-126 s t u v#_ [ \ ] ^"tvxyz ? @ A B$>     #w _ ` a b" ; < = >" 7 8 9 :#uwy{~ g h i j"]apefj C D E F#]_acghj k l m n"0   / 0 1 2 ?#@BUOFJKM o p q rXD#GXIWMQRV     $ w x y z$3  { | } ~!nhxacde # $ % &"68:<@AE G H I J G!HJLNQRS ' ( ) *2          W       #E  W X Y Z c  %#.1-     3$T     V$Zmd      &#5  S T U V%npg      d$z      evw% 0 D     +  B C 7 : ; < = > '         "n     !M       #  K L M N !r    ! 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B              Y       9         + 4 . - / 0 1 2 6 [ ^ _ ` a c k o p q u v w x y z { | } ~                                 b          5678CEHIJKL^_fjklmpqt}z^  n EM Rules Disclaimer P  t  R   C   S   T  "Rj9 9: >$ Enter t  R   C   S   T Copyright 2008 HandHeldDoc v1.13 9EM Rules Medical decision rules, calculators, and tables for the Emergency Practitioner. ,Sponsored by a Grant From: 5ywww.cep.com   :RCEPAmerica t  R   C   S   T www.cep.com(e UPU ΀  ](800) 476-1504 t "8^Decision Rulesu Canadian C-Spine RuleCanadian CT Head RuleNew Orleans Head CT CriteriaNEXUS C-Spine RuleOttawa Ankle RuleOttawa Foot RuleOttawa Knee RulePERC Rule for PEPittsburgh Knee RuleSan Francisco Syncope RuleWell's Criteria for DVTWell's Criteria for PEt  R  C  S  TSelect a Decision Rule:Copyright 2008 HandHeldDoc t&<RtCalculatoruAa GradientAbsolute Neutrophil CountAnion Gap-SerumAnion Gap-UrineCelsius <--> FahrenheitCorrected Serum CalciumCorrected Serum SodiumCr Clearance (Cockcroft-Gault)Cr Clearance (MDRD)Fractional Excretion of SodiumGP IIb/IIIa InhibitorsHeparin DosingKilograms <--> WeightMean Arterial PressureOsmolal GapOsmolality-CalculatedParkland FormulaPediatric ET Tube DepthPediatric ET Tubes & LinesPediatric Maintenance FluidsQT CorrectedTotal Body Water DeficittPA Dosing Calculator:t  R;  C<  S=  TSelect an Equation:Copyright 2008 HandHeldDoc t,B`Scores1u ABCD2 Score for TIA/StrokeAlvarado Appendicitis ScoreAPACHE II ScoreAPGAR ScoreCentor Score for PharyngitisCURB-65 for CAPGlasgow Coma ScoreIntracerebral Hemorrhage ScoreMini Mental Status ExamNIH Stroke ScalePORT Score for PneumoniaTIMI Risk Score for UA/NSTEMIAt  R@  C?  S>  T2Select a Score:Copyright 2008 HandHeldDoc t0F\rTablesuActivated Protein C (Xigris)Antidotes-CommonBandemia-DifferentialBurns ManagementCardiac Arrest-6 H's & T'sCSF Fluid AnalysisElevated INR ManagementPediatric Vital SignsRed Eye-CausesSepsis DefinitionsStroke MimicsSynovial Fluid AnalysisThrombolyticsToxidromesTroponin ElevationVasopressorsEt  RD  CC  SB  TSelect a Table:Copyright 2008 HandHeldDoc 4Ld|2H^:`Canadian C Spinex" Yesx- NowV Yeswa No Yes No  Clear i  i t  R   C   S   Tb) ?\N ?wn ?)Dangerous MechanismAge >= 65 yo4Parasthesias in ExtremitiesXSitting Position in EDxAbsence of C-Spine TendernessMSimple Rear End MVCcAmbulatory at Any TimenDelayed Onset of Neck Pain1. Any High Risk Factors?3. Can Rotate Neck 45 deg L&RB2. Any Low Risk Factors? <h :bx2Lb~Canadian Head CT,4 ?$' Failure to reach GCS 15 in 2hrs3~ Suspected Open Skull Fx@_ Basal Skull Fx Signs'pB ?Mt Vomiting >=2 episodesZT Age >=65 years+Ej ? u Amnesia B4 Impact >30 min#m Dangerous Mechanism&} ?"x" Clear!?" Calc i  i t  R   C   S   T)High Risk*iMedium Risk ~^  d " <- Back Click All That Apply: s   6VlCanadian Head CT t u  wt  R x  C y  S z  T {by Ben Donham, MD |u    2Z4J`vN.O. Head CT v Drug or ETOH Ingestion0@ Heachache@\ VomitingP\ Age > 60 years old`| Short Term Memory LosspT Seizuret Trauma Above Clavicles Ew" Clear" <- Back?" Calc t  R   C   S   T ^  d i  i Click All That Apply:  "8NnN.O. Head CT Comm.   t  R   C   S   T u  by Ben Donham, MD    T0F\NEXUS C-Spine Rule# Midline C-Spine Tenderness7 Any Evidence of IntoxicationK Abnormal Level of Consciousness_{ Focal Neurological Deficitss Any Painful Distracting Injuriesv" Clear?" Calc i  i t  R   C   S   T Click All That Apply: " <- Back. .b|LbOttawa Ankle1, Posterior Edge or Tip of the2L Posterior Edge or tip of the9l Inability to bear weight immed.D?" Calc t  R   C   S   T6Does Pt Have Pain in Malleolar Zone:x& in ED;AND Pain at any of the Following: i  i 8Lateral Malleolus XMedial Malleolus " <- Back w" Clear ^  d  2H^Ottawa Ankle   y     t  R   C   S   T by Ali Raja, MD MBA  Tp(>lOttawa Foot/ Pain at base of 5th MetatarsalB Pain at the Navicular BoneU Inability to bear weight immed." <-Back?" Calc i  i t  R   C   S   T Does Pt Have Pain in the Mid Footb& in EDZone AND any of the Following: ^  d v" Clear  0F\Ottawa Foot   y     t  R   C   S   T by Ali Raja, MD MBA H0F\Ottawa Knee$ Age >=55 years old4t Pain at Fibular HeadD Isolated Tenderness at PatellaT Inability to Flex Knee to 90 Degrsd Inability to Walk 4 Weight Bearing" <- Back?" Calc i  i t  R   C   S   TpSteps Immediately & in ED ^  d x" Clear Click All That Apply:  0F\Ottawa Knee   y    t  R   C   S   T by Ali Raja, MD MBA 2T0F\rPERC Rulev Age < 50 years old,^ Pulse < 100 BPM:\ SaO2 > 94%H\ No HemoptysisVz No Unilateral Leg Swellingd No Recent Trauma/SurgeryrT No Prior DVT/PEt No Hormone Use" <- Back?" Calc i  i t  R   C   S   T Click All That Apply: !v" Clear 8Rh~ .bxPittsburgh KneeOS Age <12 or >50^ Inability to walk 4 weight bearing" <- Back?" Calc i  i t  R   C   S   Tksteps in the ED6-PLUS either of the following-Patient MUST have: Blunt Trauma or Fall as the Mechanism ^  d #x" Clear  4J`Pittsburgh Knee   y    t  R   C   S   T by Ali Raja, MD MBA 4\~0F\SF Syncope Rule!%T History of CHF!5\ Hematocrit <30%!E\ ECG Abnormalities!Ud Shortness of Breath!eT SBP <90 mmHg?" Calc" <- Back%)~N Serious Outcome ^  d i  i t  R   C   S   T "Click All That Apply: $x" Clear  4XnSF Syncope Rule    t  R   C !  S "  T by Aaron Bernard, MD    N 8V2LbxWell's Criteria for PEO$x Clinical Signs & Sx of DVTP2 Altern. Dx Less Likely Than PEZ@B HR > 100[N Immob/Surgery in Past 4 Weeks\\j Previous DVT/PE]jB Hemoptysis^x@ Malignancya}% ?`Dy ?bv" ClearT?" Calc t  R   C   S   T Check All That Apply: %" <- Back $Lt&:J^rAa GradientC BPC' BPC5 BPBd P>x$ Calc(FiO2:-YA-a Gradient:>$ Formula $ <- Backs$ Clear'PaCO2:#5PaO2:b%b&mmHgb5mmHg ct  R d  C e  S f  T 4\r 4Pl,Abs Neutrophil CountC BP> ?C/ BPk/ ?C> BPk ?CQ P>w$ Calc% PMNs:/% Bands:+SANC:>$ Formula $ <- Backs$ Clearb%b/%'>WBC:b>cells/mlbRcells/ml 3t  R 4  C 5  S 6  T& (Px&<Ph|Anion Gap'C BP)C/ BP+CY P8CA BP->r$ Calc1>$ Formula2 $ <- Back6s$ Clear st  R t  C u  S v  T7#AHCO3://Chloride:3bmeq/l0 [Anion Gap:.Sodium:;b/meq/l<bAmeq/l=bZmeq/l @h&B^r  6LUrine Anion GapA BPA& BPA5 BPAD BPAi P>|$ CalcUr. Sodium:5Ur. Chloride:-^Ur. Anion Gap:>$ Formula $ <- Back`meq/ls$ ClearDUr. HCO3:`&meq/l`5meq/l`jmeq/l`Dmeq/l&Ur. K+: [t  R \  C ]  S ^  Ts  F`6LbxTemperature{VH Select|c;CelsiusFahrenheit{|tV. BPv>A$ Calc?v)Pw.Temperature:x>$ Formulay $ <- Backzs$ Clear}Temp. Unit:~kConverted Temperature: ?t  R @  C A  S B  T 4Pl 8NfCorrected Na+C BPC/ BP>k$ Calc>$ Formula $ <- Back s$ Clear t  R   C   S   T bmmol/l bSmmol/l b/mg/dlSCorr. Na+:Sodium:/Glucose:CQ P  2Z &:TrCorrected Total Ca^ BP^. BP^> BPDY P>v$ Calc Normal Albumin:.Pt's Albumin:ZCorr. Ca:>$ Formula $ <- Backx.g/dls$ Clear>Serum Calcium:x>mg/dlxg/dl]Zmg/dl _t  R `  C a  S b  T *Rz.Jf  6LbCr Clearance0"$ MaleS"$ FemaleB2 BPB? BPBL BPaL KgqL Lb>]$ CalcDzP ?Plasma Cr:>$ Formula $ <- Backs$ Clear+2Age:.oCr Clearance:LWeight:Cockcroft-Gaultb2yrsb?mg/dlb}mls/min ;t  R <  C =  S >  T 0V~8Rn.BZpCr ClearanceY$ Male|! Female#Z African American?B- BPB: BPBG BPBT BP?d" CalcDyP :Plasma Cr:>$ Formula $ <- Backs$ Clear+-Age:|Cr Clearance:MDRD Equation:b-yrsb:mg/dl_|mls/min)GBUN:TAlbumin: 7t  R 8  C 9  S :  Tt &Nv0JbzFractional Na ExcruT BPwT' BPT6 BPTE BPyBd P{>x$ Calc|#Urine Na:}YFractional Na Excretion:~>$ Formula $ <- Backs$ Clear'Serum Na:%6Urine Cr:ESerum Cr: gt  R h  C i  S j  TZ   Hb ,BXnWeight ConversionlVH Selectmc;KilogramPoundlm]V. BPa>A$ Calcp>v)Pc+.Weight:e>$ Formulaf $ Menujs$ ClearnWeight Unit:o kConverted Weight: Ct  R D  C E  S F  T\ $Lf">Rh~Mean Art Pressure]L BP_L/ BPaAY Pc>r$ CalcdSystolic BP:fNMean Arterial Pressure:g>$ Formulah $ <- BackikmmHgjs$ Clearp`ZmmHgq /Diastolic BP:rk/mmHg kt  R l  C m  S n  T /CApproximate F`.DZpOsmolal GapC BPA6 BPCV P>k$ CalcMeasured Osmolality: WOsmolal Gap: >$ Formula $ <- Backs$ ClearbWmOsm/kg*Calculated Osmolality:`6mOsm/kgbmOsm/kg /t  R 0  C 1  S 2  T 6 ?? &Nv4J`t& Serum Osmolality@T BPBT% BPUT5 BPOTE BPF>x$ CalcJ>$ FormulaK $ MenuMs$ Clear ot  R p  C q  S r  TQs%mg/dLLsmeq/lH@%BUN:G3Sodium:RsEmg/dLSsemOsm/kgTs5mg/dLW25Glucose:XES AlcoholsY EF,EthanolEthylene GlycolIsopropanololMethanolXYZeOsmolality:DPc"