Monday, December 1, 2008, 08:13 PM PST [JoJo's News]
New Year's Eve will bring an upbeat reunion for Travis Barker and DJ AM - who will perform together for the first time since they survived a fiery plane crash in September. The duo are set to headline New Year's Nation's Los Angeles New Year's Eve Party at The Lot in West Hollywood, the Associated Press reports.
No Doubt will headline the second day of the Live Nation-promoted Bamboozle festival on May 3 at the Meadowlands Sports Complex in East Rutherford, N.J. Fall Out Boy will headline the opening day.
Conforme pasa el tiempo te vas dando cuenta de lo importante que es tener la suficiente fortaleza y capacidad para poder resolver esos pequeños problemas que a veces se convierten en obstaculos por vencer.
Estoy segura de que todos hemos sufrido de alguna manera decepciones las cuales en ocasiones nos han hecho desvanecer y nos han hecho pensar que nada en esta vida tiene sentido, sentimos tal dolor que lo unico que queremos es desaparecer y olvidarnos de todo lo que nos rodea y asi mismo olvidarnos de aquellas heridas que otras personas han dejado en nuestros corazones.
Sin embargo es de suma importancia darse cuenta de que la vida es el mejor regalo que nos han otorgado, sea quien sea el ser que nos ha dado vida, es lo mejor que podemos tener.....
Me he dado cuenta de que debemos buscar esas respuestas a la pregunta de ¿como ser feliz?, nadie mejor que uno mismo puede encontrar esa salida a una vida llena de felicidad, de armonia, de paz y asi mismo una vida llena de exito y buenos logros.
Por años el orgullo me ha manejado a su antojo, sin embargo llegò el momento en que las cosas cambiaron y por fin era yo quien tenia el control sobre èl.
Un sentimiento puro y a la misma vez un sentimiento dañino que al tomar posesion de mi alejaba a las personas que de alguna u otra manera eran importantes en mi vida... Personas que a pesar de sus errores entregaban todo de si para mantenerme a su lado, que lo unico que esperaban era cariño y amor de mi parte hacia ellos y las mismas que de mi solo obtuvieron malos tratos y palabras hirientes llenas de rencor y odio.
¿Perdonar?.. No se aun si conozco el concepto, sin embargo en aquel tiempo el perdon no tenia cabida, lo unico que dejaba pasar dentro de mi alma y de mi corazon era la idea de hacer daño a todas esas personas que con palabras me habian destrozado ilusion tras ilusion...
No me daba cuenta de nada , era como si algo vendara mis ojos y me cegaba y solo podia creer que yo, unicamente yo era la que sufria , como si todo lo que la gente hacia era con intension de hacerme mal, sin embargo ....
...El tiempo paso y fue como si el destino me abriera puertas a una nueva vision, como si algo hubiese iluminado dentro de mi ser para darme cuenta de que las cosas no eran como yo las creia...
Las personas siempre estuvieron a mi lado ofreciendo lo incondicional pero mi agonia entre esos pequeños reconres inncesesarios que en mi misma quise cargar fue lo que hizo de mi una persona desinteresada de lo que los demas pudieran sufrir con mis acciones...
Hoy en dia, quizas despues de haber perdido algo hermoso que yo misma pude mantener conmigo, despues de haber alejado a esos pequeños angeles que se cruzaron en mi camino y a los cuales no supe valorar como merecian, me doy cuenta de que la vida no es facil, y que aunque la soledad es la unica amiga que llega cuando todos se van, no es muy placentero pasar los dias enteros solo con su presencia, aunque no voy a negar que la soledad es la mejor compañera para reflexionar ...no dudo que gracias a esos momentos con ella ha sido que mi ser a tomado otra direccion en esta vida.
Y me siento agradecida por todo con lo que mis sentimientos se han enfrentado por que solo de esa manera he podido comprender que el tiempo es Sabio y es el mejor maestro que pueda conducirme a un mundo lleno de Metas realizadas y Exitos placenteros....
PORQUE DE TAL MANERA AMO DIOS AL MUNDO QUE DIO A SU HIJO UNIGENITO PARA QUE TODO AQUEL QUE EN EL CREA NO SE PIERDA MAS TENGA VIDA ETERNA EN CRISTO JESUS. SAN JUAN 3:16
Peep Beyonce's GQ spread for a little morning inspiration.
Here is a preview of the double cover of the upcoming issue of Essence; and the world's most influential and eloquent couple bless it. Although the pick with Hillary may be kind of shady, we will not lose faith so quickly in our man of the millennium. They look spectacular.
Some thoughts are shared concerning Yeezy's recent comments:
As you may have heard, Kanye West announced at the American Music Awards that he wants to be the next Elvis. Then West had to take it even further.
"When I said the statement, 'I want to be Elvis,' I really should have thought that out more because that statement was actually really incorrect," West told E! News' Ryan Seacrest Tuesday. "Actually, the true statement was 'I want to be better than Elvis.' "
So does West have what it takes to get anywhere near Elvis' stratosphere? We talked to some industry insiders to find out...
"Kanye is one of the biggest hip-hop stars in the world right now," says Emil Wilbekin, editor-in-chief of urban lifestyle magazine Giant. "But I do believe he has delusions of grandeur."
Wilbekin goes on to say, "I think Kanye is hugely self-absorbed, and I think that he thinks he could be bigger than Elvis. Kanye is very much concerned with how big he could be, how much music he can make and how many awards he could win."
It's that oversize ego that's propelled him to the top of his game, says Hillary Crosley, R&B/hip-hop correspondent for Billboard. "People find it so amusing that he takes it so seriously," Crosley says. "If he didn't have the ego, he wouldn't make it as far as he has."
Cory Cooper, a noted Elvis historian, says he's impressed with West's goals, but he needs a reality check.
"Even though Mr. West has a fantastic idea of what he aspires to become, he nor any other performer, past, present or future will ever accomplish Presley's unparalleled career," Cooper writes in an email. "Elvis stands alone. With all due respect to Mr. West, Elvis Presley is not called 'The King of Rock 'n' Roll' for nothing."
Nunca cierres tus ojos al Divino y maravilloso regalo de la vida; vivela, disfrutala, amala y respetala pero sobre todo conservala en la armonia sublime de la perfeccion esperitual, no tiene precio!
I wanted to highlight some of my favorite leather-crafters on Etsy to help display the breadth of work that is possible in leather and to hint at all the possibilities there are with this wonderful material.
I'm sure there are a ton of other talented leather crafters on Etsy as well. This is just a small selection of some brilliant leather crafters I happened to chance upon. Hope you enjoy!
Tis the season, but I just can't get into the spirit. All I would ever want for Christmas is awesome MegaMan games and gear, but there just isn't enough! Here's a list of some cool stuff that we can hopefully look forward to in the future...
1. The Yellow Devil Play-Doh Playset
Everyone loves Play-Doh, and everyone hates the Yellow Devil: the perfect combination! Mold the Yellow Devil into all sorts of fun shapes just like in the game, then mash it altogether so he can go back to his original form. In the end, I guess it's just a giant tub of yellow Play-Doh, but at least you get a box.
2. The Dr. Wily Decoy Bobble Head
I've never really understood the bobble head phenomenon. What I do know is that no character deserves to be immortalized more than Dr. Wily, and the weird world of bobble heads is perfect for him. Wily's ingenious sping-headed distraction has been bamboozling MegaMan for years, and would sure look great on top of your sock drawer!
3. AirMan w/ Real Working Fan
I'm sure just about everyone's seen this by now. However, I bet not a single one of you rushed out to buy...whatever it is he has. Oh well! AirMan paves the way for other handy-dandy possibilities as well, including SnoCone-Making IceMan and the CutMan Head-Scissors.
4. HeatMan Zippo Lighter
Who didn't see this one coming? I'm not even a smoker, and I gotta have it! HeatMan's design wasn't on accident, so it's a travesty that all these years have passed and he still doesn't have his own brand of lighter to smoke with. I would be worried about it luring the tikes to light-up at an early age, but none of them even know who HeatMan is. For shame!
5. TurboMan Transformer
He's a car that transforms into a robot; what more could you want?! This cross-over was destined, and everyone's wondering whether he'll end up an Autobot or a Decepticon. His slick tires allow for maximum speed, while his battle mode is just a few flips here and there away. Regardless of how you feel about MegaMan or Transformers, you just have to get this toy. Why? Because it's TURBOMAN!!
When you get together with family & friends this holiday season, a digital camera makes all the difference taking pictures! Take as many shots as you want, edit, & send them before you go to bed!
Ladies and gentlemen, I have a problem. While my bowling can always improve (and hopefully will) I am attempting to learn NOT to roll the ball over the finger holes, and having some problems with it. Would I like some help? of course I would. I use four different balls (a smokin and ragin inferno, a hammer pyscho, and for ten pins my white dot) but have been attempting not to roll them over the finger holes. I am also praticing with a wrist brace and am undercided on whether I will continue to use it or not (may still since I bowl better with it). Any hints or tips will help. Thank you.
Conscious (or moderate) sedation has become an increasingly important subject in recent years. We have seen a vast increase in the number of procedures moving from traditional OR settings to ambulatory surgery centers and office-based practices over the last decade. As this trend continues, physicians and staff who have not administered sedation previously are looking to become informed on safe and efficient use of sedation in their patients.
Based on a review of state guidelines from several states we have prepared the following:
Every patient needs a free flowing intravenous line and supplemental oxygen administered via nasal cannula or face mask.
A health care provider other than the person performing the procedure should monitor the patient at all times. This is non-negotiable. That person should record in the medical record at minimum every five (5) minutes:
Level of consciousness (0 = unconscious, 1 = sedate but responsive, 2 = alert)
Peripheral oxygenation via pulse oximeter and respiratory rate
Heart rate, Heart rhythm, Blood Pressure
Pain score (0= none, 1= tolerable, 2= not tolerated)
This level of monitoring meets JCAHO guidelines. The provider monitoring the patient should be aware of known allergies, medical history, NPO status, and whether the patient may be difficult to intubate. Large men with bull necks and small mouths can be very difficult to ventilate and intubate. Such a person, or those with morbid obesity or other significant airway issues should be evaluated by an anesthesia provider.
Important history includes personal or family history of malignant hyperthermia, cardiac arrest, congestive heart failure, recent MI, stroke or TIA, heart rhythm disturbance, smoking, diabetes, COPD, or recent change in respiratory status. Is there recent onset of URTI or flu? A listing of current medications is important. It is recommended that patients be NPO for eight (8) hours before drug administration.
There should be suction capability and resuscitation equipment immediately available. Do not start until it is available. All providers should have ACLS certification. For almost all patients, a combination of two drugs, midazolam (Versed: 1 mg/cc) and fentanyl (Sublimaze: 50 ug/cc) can accomplish the goal of safely getting the patient through the procedure. Patients should be tolerating the procedure, and responsive to a command to open their eyes at all times. This state is called conscious sedation. The risk of administering any intravenous sedative or narcotic drug is loss of consciousness, inability to maintain the airway or apnea, desaturation and hypoxemia which if unrecognized and treated can proceed all the way to cardiac arrest. It can happen.
Midazolam treats anxiety. It has a specific anxiolytic action. The onset is 60-90 seconds. The duration of action for small doses is 10-15 minutes. Dose range for relatively healthy people is 1-5 mg total over 60 minutes. It is important to wait the 90 seconds to see what the effect of the first dose is before giving a second dose. Additional effects of midazolam are antegrade amnesia, and sedation. By itself, it rarely results in apnea when given in doses of 0.5 to 1 mg at a time. If the patient becomes disoriented- stop. Wait 15 minutes before resuming. Consider trying again later with an anesthesia provider.
Fentanyl treats pain. Onset of action is 90-120 seconds. Duration is also 10-1 minutes. Initial dose is 25-50 ug. Again it is important to wait to evaluate the effect of the first dose before administering a second dose. Dose range is 50-150 ug over 60 minutes. Effects of fentanyl are analgesia and respiratory depression. There may be a sedative effect, but there is rarely loss of consciousness. The patient may experience pruritus.
Each of these drugs by themselves are fairly predictable. However in combination, especially when administered simultaneously, there may be unpredictable loss of consciousness and or apnea. So do not administer both drugs simultaneously. Wait between doses. Patience is good. For a non-invasive procedure give a milligram of midazolam after monitoring is established, and before positioning the patient. For relatively healthy and robust patients a second milligram can be given safely.
If the patient still seems to be especially anxious, continue with midazolam. Wait between doses. Look for spontaneous eye closure, but with retained responsiveness to verbal commands. The simple phrase "Open your eyes" said gently should be able to establish responsiveness. Avoid the question "Are you OK?" It requires the patient to make an abstract evaluation of the situation. They think you are in charge. Ask what they sense or feel, and whether it is painful, tolerable or any other specific question. Warn them before inserting the examining finger or beginning the procedure. They probably won't remember anything, but they are supposed to be conscious and should be able to cooperate.
If the patient obviously experiences pain, then add fentanyl. Once you start using the fentanyl do not give any more midalozam unless you can really justify it to yourself. Start with half a cc (25 ug). Wait. Resume the procedure. If not tolerated repeat the dose. Wait. If you need more than 100-150 ug of fentanyl reexamine the situation. Fentanyl as the sole drug works nicely in patients who have previous experience with medical procedures, or otherwise seem to have good coping mechanisms. The dose range can be 150-300 ug over 60 minutes in divided doses. In the event the patient's respiratory rate slow to 6 breaths per minute, they may still be able to maintain adequate oxygenation. Occasionally you may have to encourage them to breathe. At these doses apnea unresponsive to stimulation is unusual unless there has been prior administration of midazolam. Meperidine (Demerol) in doses of 25-50 mg to a maximum of 200 mg is another good agent used by itself. It increases recovery time.
Another technique involves the use of a constant infusion of propofol. Propofol is a very short acting anesthetic which has been used frequently for GI procedures. Repeated use of this drug has the potential to render the patient unconscious, and thus it has been employed primarily by specilized anesthesia providers. Emergency Department physicians and gastroenterologists with appropriate training have successfully administered propofol for procedures in those arenas. It is used as a constant infusion to avoid fluctuating levels of sedation and responsiveness associated with intermittent bolus administration. Usually a base pre-medication with 1-2 mg of midazolam given IV over 5 minutes is followed by 2-3 ccs of propofol as an IV bolus followed by an infusion of 25-75 ug/kg/min. This regimen rarely results in apnea, but upper airway obstruction is a real possibility if the patient becomes deeply sedated. A jaw thrust usually suffices to relieve the obstruction. Supplemental oxygen administration is obviously crucial, as is constant awareness of the status of the patient.
Regardless of the pharmaceutical regimen, if the patient loses consciousness, but continues to ventilate and maintain oxygenation, then nothing needs to be done other than continued evaluation. Avoid further drug administration. If heavy snoring or desaturation occurs, then a simple jaw thrust is usually adequate. Unresponsiveness with cessation of spontaneous ventilation should be treated with mask ventilation. Hopefully intubation will never be required, but the capacity to do so should always be available. This is why all providers should have ACLS Certification.
You can get a feel for how the patient will respond to the drugs by carefully watching the response to the first dose. Patients taking narcotics or benzodiazepines chronically may require doubling of the corresponding doses. The art of it all involves balancing the dose to the level of stimulation associated with the procedure, with a common sense evaluation of how the patient is responding to the situation. Remember that if higher doses have been necessary to get the patient through the procedure, he may become unconscious or apneic once the stimulation ceases.
It may take 20-50 patients to gain some confidence with the regimen. Patients should not drive themselves home. If nausea occurs it can be treated with Zofran, 4 mg, though it usually resolves spontaneously within 2-3 hours.
For additional information or comments, call Conscious Sedation Consulting 888-581-4448
Our consulting firm and Web-site make every effort to provide accurate and up-to-date information, which is in accord with accepted standards and guidelines. Under no circumstances should any advice or information we may provide be considered the practice of medicine in Missouri or any other State. Diagnosis and treatment recommendations can only be made by a licensed independent practitioner in accordance with any laws or regulations in the state or states in which they may practice. The Partners of Conscious Sedation Consulting make no warranties that any information contained on their web site or which they may offer is totally free from error. This is the case especially because clinical standards are constantly changing through research and regulation. Conscious Sedation Consulting therefore disclaims all liability for direct or consequential damages resulting from the use of material presented on the web-site, in seminars or presentations, or in written or spoken responses to questions or requests. The proper dose for any medication cannot be predicted in advance. For sedative drugs, it is influenced by 1) the type, location, and duration of the procedure being performed in which sedation is being administered. 2) the age, sex, and family history of the person receiving the drug, 3) the acute or chronic administration of any other pharmaceuticals, herbal medicines, other treatment modalities, or other substances such as tobacco, alcohol, narcotics, and any and all other legal and illicit drugs 4) any concomitant medical, or psychological diseases for which the person may or may not be receiving treatment 5) the physiological state of the person including temperature, oxygenation, and function of all organ systems, and 6) the particular circumstances of any clinical or treatment situation. The administration of sedative medications is an art as in any form of healing art.
