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Am J Health Syst Pharm, 67 (2010), pp. valuation visuelle de la compatibilit physique de la naloxone avec dautres mdicaments intraveineux usuels. hb```l\ cg`a" D@M70I?@C Z|`d>!-Uu>]ppX=+c(rJT'c9V{L7M{{]ua;DVo"6e\W:qcf/f3%dayw-LrO{.p*zvTSf1xpSIC a. Unlike pseudohyperkalemia, pseudohypokalemia is uncommon. Compatibility depends upon many factors including temperature, pH, IV fluid, concentration, order of mixing and brand of drug. J Cardiovasc Electrophysiol. 307-309, Copyright 2018. Our members represent more than 60 professional nursing specialties. Unable to load your collection due to an error, Unable to load your delegates due to an error. Potassium chloride is sold as a generic drug, but the following brand names are also available: Klor-Con M, K-Tab, Khlor Con, and Micro K. Keep in mind that these are more expensive than generic potassium chlorides because they are brand drugs. Stability of meropenem in saline and dextrose solutions and compatibility with potassium chloride. Calvo-Calvo, . Carrillo-lvarez, M. Sanjurjo-Sez. Failure to check and replete magnesium levels. Slow-release microencapsulated (wax-matrix) KCl formulations are suboptimal if an immediate effect is desired. Over the last few years the pharmacokinetic advantages of a prolonged perfusion route of administration of these 3 antibiotics have been confirmed.1619. Med Intensiva. Cardiac arrest due to hypokalemia (e.g. and transmitted securely. National Library of Medicine Hunt-Fugate AK, Hennessey CK, Kazarian CM. Advanced diagnostic testing: Begin by checking urine potassium, creatinine, sodium, and chloride. Also, to assess the quality of the information published and generate a compatibility chart with reliable and updated information to improve safety in the administration of drugs to critically ill patients. Perfusions at drug concentrations that exceed the usual ones are often used in the critically ill patient. Visual compatibility of amiodarone hydrochloride injection with various intravenous drugs. It has been completed with the new information available on drugs in our setting and data on the most widely used concentrations of drugs. Index Medicus / MEDLINE / EMBASE / Excerpta Medica / SCOPUS / MEDES / Science Citation Index Expanded, Journal of Citation Reports, The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. Epub 2011 Aug 4. Articles published from 1990 to 2017 in English, Spanish and French were included. Of these, 366 are compatible (77.1%), 80 are incompatible (16.8%), and 29 are compatible in specific conditions (6.1%) as shown in Table 2. Save my name, email, and website in this browser for the next time I comment. Gens Castells Lao: study design and idea, data mining, analysis and interpretation of data; paper draft or critical review of the intellectual material; and final approval of this version. of taking a magnesium supplement As Fig. Failure to treat the magnesium deficiency will make it difficult or impossible to fix the hypokalemia (hypomagnesemia causes renal potassium-wasting, so the patient will keep on spilling potassium until their magnesium level is repleted). Tests were run in triplicate only in 26% of the cases. Just out of curiosity, what order did the MD write for them in? For example: In a patient with normal renal function and K = 3 mM (estimated deficiency of ~100-200 mEq), a dose of 40 mEq KCl could be given q8hr with daily measurement of electrolytes. In my time there we have still never used IV potassium and opt for PO k-dur instead. Our patients hate those because they're enormous pills. Physical compatibility studies are the most common of all because they are easy to conduct. Summary of physical and chemical compatibilities. Vomiting or large-volume gastric suction. Compatibility 2002 Jan-Feb;6(1):62-5. Use serum magnesium values to guide continued dosage. Bethesda, MD 20894, Web Policies consider target potassium level (more) For deficiency that is not severe in older children, some manufacturers have recommended 1 g (2 mL of 50% solution) once or twice daily by IM injection. MeSH Create well-written care plans that meets your patient's health goals. Compatibility of drugs administered as Physical Compatibility: Physically compatible. Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. On the other hand, for the safe coadministration of 2 drugs in the same diluent, the mix needs to be chemically stable. Use Alternative Drug. Dilution: Potassium chloride concentrate is compatible with the majority of commonly used intravenous infusion fluids. For example, diabetic ketoacidosis causes potassium to shift out of the cells. S. Tollec, K. Touzin, E. Pelletier, J.M. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. 373 0 obj <>stream Furthermore, serum hyperkalemia may cause poor retention of potassium (as it will tend to encourage potassium excretion in the urine). The problem is that magnesium blocks potassium secretion back OUT of the cell, and with low intracellular mag levels, potassium is allowed to freely exit the cell. 321 0 obj <>/Filter/FlateDecode/ID[<375F2B8E29F4DA448F0196983DC39AD5>]/Index[273 101]/Info 272 0 R/Length 178/Prev 592955/Root 274 0 R/Size 374/Type/XRef/W[1 3 1]>>stream Hypokalemia - EMCrit Project RELATED: What Does Potassium Chloride React With? Compatibility Its goal is to contribute to the safe administration of drugs to patients who can face the consequences of greater severity due to their frailty. The presence of any factors which may cause shifting of potassium in or out of the cells. I wondered that too, but it's pretty common practice to run things in one at a time on stable patients because if they have an adverse reaction, you can be pretty certain which medication they're reacting to. Magnesium Sulfate Down-titrate the rate rapidly as the EKG improves and the patient stabilizes. Danner. Overall, we found information on 82 new drug combinations from 27 different references including combinations of 3 beta-lactam antibiotics (ceftazidime, meropenem, and piperacillin-tazobactam) widely used at the ICU setting. Magnesium And Potassium Other methods were used in 16 studies (59%) to see subvisible particles. Fernndez-Llamazares, M.M. CiteScore measures average citations received per document published. Can Potassium And Magnesium Be Given Iv Together? Intravenous Ongoing fall in potassium likely (e.g., DKA or refeeding syndrome). A clear and con-cise compatibility chart can be a useful tool in helping to deliver safe, high-quality IV therapy to patients. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. An ED nurse can't have an understanding of fluid and electrolyte balance? What Are The Benefits Of Exercising Daily. The years of publication of the studies went from the1990s until December 2017 and the languages included were English, Spanish, and French. The IV was shut off. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. Visual compatibility of clonidine with selected drugs. If the renal function is adequate and stable (e.g., GFR is >30 ml/min and the patient is not oliguric), then it's unlikely that oral potassium will cause hyperkalemia. The infusions were stable for 24 hours at 22 deg C. The results from both diluents showed an average of +/-5% fluctuations in concentration. Of these, 366 are compatible (77.1%), 80 are incompatible (16.8%), and 29 are compatible in specific conditions (6.1%) as shown in Table 2. The research was published in the journal Neurotypical and was released online on December 4, 2013. Compatibility So, potassium uptake is not affected, and secretion is increased. Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. Physical and Chemical Stability of Morphine Sulfate 5mg/mL and 50mg/mL Packaged in Plastic Syringes. 651-658. However, chronically low levels can increase the risk of high blood pressure, heart disease, type 2 diabetes and osteoporosis. SRJ is a prestige metric based on the idea that not all citations are the same. Visual compatibility of diltiazem injection with various diluents and medications during simulated Y-site injection. The resulting salt can then be reconstituted by recrystallization. Select a second drug the same way (limited to 2 drugs) 3. The relationship between potassium level and total-body potassium deficit is. endstream endobj 2941 0 obj <>/Metadata 31 0 R/PageLayout/OneColumn/Pages 2938 0 R/StructTreeRoot 35 0 R/Type/Catalog>> endobj 2942 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 2943 0 obj <>stream official website and that any information you provide is encrypted government site. (i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. COMPATIBILITY Thank you you for your response to that ? Compatibility A chart was created with all the possible combinations of the drugs of interest. 9/gY'=@5y!h6{[T e- vVfbd' I&*_5u(_*h10x8C5C%4z1vE{_e"l|Yh/ c%`=DDz}Qu3lB1o]wK-a!3 {'']9x`B#_;)">I>Mb? Click Get Compatibility once both drugs are selected PEPIDs IV Compatibility tool is included in any every clinical decision support suite Only about 2% of the total Mg2+ in the body is in the plasma. #1) Familial form with onset <20 years old. Therefore, the final table shows the compatibility data of 475 out of 945 possible combinations of 2 drugs (50.3%). Want to Download the Episode?Right Click Here and Choose Save-As. Avoid or Use Alternate Drug. Use serum magnesium values to guide continued dosage. The magnesium was piggybacked onto the other saline IV with the potassium. Complicated early prosthetic aortic valve infective endocarditis, Description of the methodology used (includes number and frequency of observations and study conditions), Description of diluents of all study drugs, Description of the material of the study recipients. Antimicrob Agents Chemother, 45 (2001), pp. When handing off my patient the RN told me that the mag should go first because it is what the k will stick to. Am J Health Syst Pharm, 72 (2015), pp. Time is required for potassium to enter the cells. Magnesium plays many crucial roles in the body, such as supporting muscle and nerve function and energy production. WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. Has 10 years experience. This is especially interesting in urgent situations when any delays caused by the healthcare providers can have consequences in the patient. Patients being resuscitated from DKA will generally tend to drop their potassium levels over time. Potassium chloride is inexpensively available and is rarely used in the laboratory. Am J Health Syst Pharm, 54 (1997), pp. None of the samples appeared to form visible precipitation or to change in color or clarity. WebC = Compatible; may be mixed via Y-site. Repletion of magnesium is often necessary to successfully replete the potassium. Web1. Use serum magnesium values to guide continued dosage. Also, the information provided is in regard to 2 drug combinations, and incompatibilities may be present with>2 drug combinations at a time, which is highly not advisable. Your email address will not be published. 273 0 obj <> endobj B. Ribas Nicolau, E. Prez Juan, S.M. /`p La tabla final aporta datos de compatibilidad fisicoqumica de 475 de las 945 combinaciones posibles (50,3%), de las cuales 366 (77,1%) son compatibles y 80 (16,8%) son incompatibles. HWr8}W|MT9'emv2}r-EZvnP%"@NdtpY{wpvtz\4/?>*FGM1@FISbr7rB]sYLwu4&ijm /&)]yZY 40HsWc32ffg0aF+my=.V"[&&p~vk'T cX0;?~3!Lc56@q]uS~ >9"TyrUm@<08XD)j]oX(X4] vo7#%1TFFBiJ$z(Eo` l@Ih Well, while I'm not sure I agree with the other RN's verbiage, she is correct that hypomagnesemia can make hypokalemia refractory to treatment, so hanging the mag first would be the correct action, as far as I know. Specializes in Med nurse in med-surg., float, HH, and PDN. Study drugs and concentrations used as reference for the bibliographic search. J.T. Low magnesium levels usually don't cause symptoms. Storage: Room temperature of 22 C. We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net uptake to improve potassium levels, it's sort of like cells are scooping up potassium with a bowl, except those with low magnesium are scooping them up with a colander. Can you piggyback critical meds like IV Potassium Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available For patients with hypokalemia plus hypomagnesemia, a reasonable strategy is often to treat the hypomagnesemia fairly. 2940 0 obj <> endobj UCI de hospitales espaoles e internacionales. Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: EKG changes due to hypokalemia (e.g. Pharm Technol Hosp Pharm, 2 (2017), pp. VT, VF, or asystole), Recurrent malignant arrhythmias with a pulse, Severe hypokalemia plus {DKA or overdose of beta-blocker/calcium channel blocker}, http://traffic.libsyn.com/ibccpodcast/IBCC_EP_67_-_Hypokalemia.mp3. Es usted profesional sanitario apto para prescribir o dispensar medicamentos? Web17. Compatibility of drugs administered as Y-site infusion in intensive care units: A http://dx.doi.org/10.1016/j.medin.2012.11.002, http://dx.doi.org/10.1016/j.medin.2016.01.011, http://dx.doi.org/10.1016/j.enfi.2010.09.004, http://dx.doi.org/10.1016/j.enfcli.2010.06.002, http://dx.doi.org/10.1128/aac.45.9.2643-2647.2001, http://dx.doi.org/10.1177/106002809603000303, http://dx.doi.org/10.1093/ajhp/54.19.2192, http://dx.doi.org/10.1097/00000539-200006000-00037, http://dx.doi.org/10.1016/0952-8180(96)00043-8, Impact of vaccination on admissions to an intensive care unit for COVID-19 in a third-level hospital, Delirium in COVID-19. Some experts recommend 2550 mg/kg (up to 2 g) every 46 hours for 34 doses; repeat as needed. The IV was shut off. It can be made by treating potassium hydroxide (or other potassium bases) with hydrochloric acid: KOH + HCl + H2O. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. Int J Pharm Compd. RELATED: What Does Potassium Chloride React With? Infusions remained stable at 22 degrees C. For 24 hours. Chemical Stability: Chemically stable. Stability and compatibility study of cefepime in comparison with ceftazidime for potential administration by continuous infusion under conditions pertinent to ambulatory treatment of cystic fibrosis patients and to administration in intensive care units. Structured summary of the results of the reference search. San Francisco General or Highland Hospital. The IV was shut off. FOIA Reference: Check tubing below Y-site carefully for discoloration, cloudiness or precipitation = (Blank) DO NOT MIX; conflicting or no compatibility information available May consider checking a full electrolyte panel (including Calcium, Magnesium, and Phosphate): Electrolyte abnormalities often occur in pairs and triplets (electrolytic disarray). An elevated aldosterone/renin ratio suggests hyperaldosteronism (>750 pmol/L per ng/ml/h, or 27 ng/dL per ng/mL/h). N. Baririan, H. Chanteux, E. Viaene, H. Servais, P.M. Tulkens. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Stability of Milrinone Lactate 200 micrograms/mL in 5% Dextrose Injection and 0.9% Sodium Chloride Injection. WebMany people may need magnesium supplements. (2) Markedly elevated cell counts (leukocytes take up potassium while the blood is awaiting analysis). For instance, Flamein et al.14 studied this problem in neonatal ICUs; Knudsen et al.15 shed light on the compatibility of analgesics and sedatives. Compatibility of parenteral furosemide with seventeen secondary drugs used in standard concentrations. Commonly used for severe hypokalemia or DKA. UAiM 0g `%u?J[ +sC e#)7p:iQZ>`} d/ J;#A- 0 IJp C%tu0t}vN0{3):UVww A;{ ?M=]\:Zk-=%]%Q`l Fox. It is consistent with the gray boxes specified as I/C as shown in Fig. As far as the magnesium goes we don't piggyback it most of the time. Intravenous L. Knudsen, S. Eisend, N. Haake, T. Kunze. Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion. The terms used were physical compatibility, drug stability, y-site, y-injection, intravenous drug, plus the names and synonyms of the drugs of interest. Over the last few years, several experts have published guidelines for the design of drug stability studies.811 We can only hope that this will improve the overall quality of this type of studies in the future. To gather all published information about the stability of drugs commonly used in Intensive Care Units (ICU); evaluate the methodology of published data; and generate a compatibility table. Iv Figure 2. Mmmm, sort ofintracellular Mg2+ modulates the transport of K+ *OUT* of cells by blocking secretion of K+, so if there is a deficiency of intracellular Mg2+, then more K+ is secreted by the distal renal tubule. Compatibilidad fsica de la amiodarona en perfusin continua. However, this does not necessarily mean there are no interactions. Magnesium And Potassium Forest. For patients with hypokalemia and hypomagnesemia, rapid correction of hypomagnesemia is safe and may quickly decrease the risk of arrhythmia. Compatibility The new findings revealed 29 compatible combinations, 27 incompatible combinations, and 26 compatible combinations in specific conditions. If the etiology of hypokalemia remains elusive, the following approach may be helpful: This be calculated based on spot urine potassium and creatinine levels (using a calculator found. Regarding the trials conducted to assess the stability of the samples, all studies assessed transparency while 93% of studies reported a change in color through visual inspection. The magnesium level is the most important contributing factor, for several reasons: (a) Hypomagnesemia is common (most patients with hypokalemia have hypomagnesemia as well).(. P.R. For example, even though the pH is a critical factor in the stability of drugs in solution, it was only verified in 12 of the 27 papers. Mthe difference between oral and IV magnesium Summary of the quality criteria of the papers published. Save me from this ICU'ish intracellular speak :-). WebCompatible: metronidazole, ranitidine, vancomycin Intermittent Infusion 30-60 minutes Dilute with 50-100ml NS, G. Preferred concentration 2.5mg/ml in NS. IV or IM. Magnesium modulates the transport of potassium into cells. 2012 Jan;23 (1):54-9. doi: 10.1111/j.1540-8167.2011.02146.x. However, 93% of the papers described the conditions and methodology of the study with enough detail to guarantee its reproducibility. IV or IM. Amors-Cerd, B. Ribas-Nicolau. eplerenone and potassium. Has 10 years experience. However, information on drug compatibility is scarce and, on many occasions, difficult to interpret due to the different concentrations used, the lack of information on the assessment techniques used or the suspicious technical quality of the sources. Magnesium can be repleted rapidly (faster than potassium). Combinations of physical and chemically compatible drugs with concentrations below the reference mark. Clinical context where potassium is likely to fall further (e.g. Sodium-wasting nephropathy (e.g. Am J Health Syst Pharm, 52 (1995), pp. the difference between oral and IV magnesium sharing sensitive information, make sure youre on a federal Linear regression showed that the following factors were significantly associated with a greater change in magnesium level: About UsWelcome to TheFitnessManual, your number one source for all things related to Fitness. provided compatibility information on 393 out of 945 possible combinations.5,7 After completing the systematic review, new stability data for 82 drug combinations were added. Recently I had a patient that needed both iv k and iv mag. Due to their clinical approach and lack of methodology to determine physical and chemical stability, case studies were discarded. A fractional excretion of potassium >9.3% suggests renal potassium wasting (with sensitivity of 81% and specificity of 86%). For patients with oliguria or renal insufficiency, closer monitoring is required to avoid overshoot hyperkalemia. Thus, if this allegedly compatible mix is performed in physiological serum, a loss of concentration of amiodarone can occur with the corresponding risk of lack of therapeutic response. Less than 5% change in measured potassium and magnesium concentrations occurred in 24 hours. Magnes chloride and potassium metal reactions are generally described as a single displacement reaction. Required fields are marked *. A target potassium of >3 mM may be reasonable in most patients with severe renal failure (in the absence of digoxin or myocardial ischemia). (2) Severe hypokalemia in need of emergent treatment (see risk stratification above). Recopilar la informacin publicada sobre estabilidad de los frmacos usados en el paciente crtico, evaluar la calidad de los datos publicados y generar una tabla de compatibilidad con informacin actualizada. All works go through a rigorous selection process. $MMT=window.$MMT||{};$MMT.cmd=$MMT.cmd||[];$MMT.cmd.push(function(){$MMT.display.slots.push(["e023039a-a41d-404b-ba77-d0a561240f4b"]);}). Specializes in MPH Student Fall/14, Emergency, Research. Compatibility Times elapsed while taking the samples in the stability analysis: a 5-time sample time period is recommended including a sample time of 0. H. Pr, V. Chass, J.-M. Forest, P. Hildgen. This means prior confirmation is needed that no significant change has occurred in the concentration of either one of the drugs present in the mix.6. The results on this section are summarized in Table 3. The goal of this review is to gather the information published on the physical and chemical compatibility of the most commonly used drugs at an ICU when infused through the same line via a Y-site. Galante LJ, Stewart JT, Warren FW, Johnson SM, Duncan R. Stability of fluconazole in injectable solutions. Web17. Stability of cyclosporine with magnesium sulfate in 5% dextrose injection. MIv mag or k+ which do I hang first Compatibility of propofol, fentanyl, and vecuronium mixtures designed for potential use in anesthesia and patient transport. Choosing a specialty can be a daunting task and we made it easier. WebThe compatibility and stability of 80 mmol/L potassium chloride and 16 mmol/L magnesium sulfate in 0.9% sodium chloride injection and in 5% dextrose injection solutions at 22 deg C have been studied by means of a Beckman Clinical Chemistry Analyzer Synchron CX5 Delta. Web17. Iv Isert, D. Lee, D. Naidoo, M.L. Se proporciona una actualizacin de las compatibilidades entre los frmacos habitualmente empleados en las UCI, con la intencin de contribuir a la administracin segura de medicamentos en pacientes crticos. P. Merino, M.C. Compatibility of drugs administered as Y-site infusion in intensive care units: A systematic review, Compatibilidad de los frmacos administrados en Y en las unidades de cuidados intensivos: revisin sistemtica. Criteria for judging the quality of a publication on physicochemical stability of ready to use injectable drugs. allnurses is a Nursing Career & Support site for Nurses and Students. Table 1. Studies conducted to assess the stability of the mix: (a) transparency: for visible particles, observation with a matt black panel, automatic particle count or turbidimetry; for subvisible particles, use of optic microscopy, spectrophotometry or turbidimetry; (b) change in color: visual inspection or spectrophotometry; (c) gas formation: visual inspection; (d) pH; and (e) chemical stability: measurement of the variation of the concentration of the 2 drugs. Are you a health professional able to prescribe or dispense drugs? No visible haze or particulate formation, color change, or gas evolution. Careful consideration of the above etiologies combined with the clinical context will usually provide an explanation for the hypokalemia. ]g0i9FAA,at 0 2960 0 obj <>/Filter/FlateDecode/ID[<9C0431B6ABCE6D4C97FFF3C0974F0366>]/Index[2940 41]/Info 2939 0 R/Length 104/Prev 123650/Root 2941 0 R/Size 2981/Type/XRef/W[1 3 1]>>stream Am J Heal Syst Pharm, 58 (2001), pp. %]-tm@$`m~!Z$Z5vxU^9^W8`=DmU LSJzXAnPEkXV`*7dAv4Q4 2,B9M~_ ,0-]v =AYYXwf/WI F0Z[z%:}KbU8 (1) Delayed sample analysis (cells absorb potassium while the blood tube is sitting around). An official website of the United States government. S.E. Beta-agonists (albuterol, terbutaline, epinephrine including endogenous epinephrine surges from stress). %PDF-1.6 % Dolors Soy Muner: study design and idea; paper draft or critical review of the intellectual material; and final approval of this version. Magnesium depletion is very common in patients with hypokalemia. C. Bardin, A. Astier, A. Vulto, G. Sewell, J. Vigneron, R. Trittler. None of the papers studied met all of the quality criteria established in this review. Incompatible: amphoteracin, cephalosporins, erythromycin, penicillins, phenytoin, potassium chloride, heparin, thiopentone, tetracyclines, vitamins B and C, nitrofuranoin, warfarin pH: 4.5 L. Trissel, D. Gilbert, J. Martinez, M. Kim. 1287-1292. K of 3 mEq/L may correlate with a potassium deficit of 100-200 mEq. Maddox, K. Viswanathan, J.L. In renal failure, the primary concern is generally development of hyperkalemia (rather than hypokalemia). hb``b``g```1c@@,&a|sR9TzxYeK Updated: Feb 27, 2020 Iv Is Potassium Phosphate Compatible With Potassium Chloride? This site represents our opinions only. Errors in the administration of drugs in ICUs are due to several factors: the use of high-risk drugs (vasoactive drugs, inotropes, sedatives, etc.)