Tucson Community Profile Assignment Example | Topics and Well Written Essays - 1000 words

Tucson Community Profile - Assignment ExampleInvestigation, development, on with production within A & D forms the key economic facets for Tucson. Also, Tucson community is bited amongst the best v within the country in this sector. Also, Tucson economy comprises of aerospace-related companies, manufacturing ultra-modern fields, production, distribution, along with warehousing and business aviation repairs. Davis-Monahan Military Base as well is a noteworthy cistron of Tucson society and the primary driver of growth of Tucson since 1950. It generates over one billion US dollars in the financial system per annum (Luckingham, 2015). Furthermore, Raytheon Missile facilities are the leading nongovernmental organization industries within Tucson, having in excess of 10,800 workers. Likewise, historically, Tucson has been a junction for traders within Southwest area as well as the main center for shipping as well as logistics till presently. Additionally, Tucsons closeness towards Mexic o State, its position at crossroads of Pacific Railway Major Line, 2-11 as well as 2-20, along with Tucson Global Airdrome offer ease plus swiftness for delivery of products. Numerous companies, comprising of Target as well as HomeGoods, have decided to position center of distribution in Tucson (Luckingham, 2015). Fascinating Attractions Tucson provides a fascinating array of sceneries in addition to attractions. Local attractions comprise of the National Parks of Saguaro (both east as well as a Western side), the planets celebrated Desert of Arizona-Sonora Museum and Sabina Gorge.

Explain what it means to be educated. Make sure you use at least one Essay

Explain what it means to be better. Make sure you use at least one and only(a) reading as the base of your argument - Essay ExampleIn reality, to be enlightened means to stupefy acquaintance, potential to think, ability to learn, and the capacity to chance upon use of language. The mental capability of such an individual enables one to have awareness of any vagueness, realize when familiarity is missing, open minded, readiness, capability to doubt, questions things, logical curiosity, and beaming to learn. Education has the potential to enhance knowledge, skill, and attitude which empowers individuals to deal with problems. In this way, an educated psyche is one who has the power to deal with life problems employ the experiences that come from education. For instance, in Coming to an Awareness of Language by Malcolm X, it is clear that Malcolm was uneducated because he could not read or write. However, he transformed himself and began to larn himself vocabulary from the di ctionary and from this he began gaining knowledge. This knowledge opened his language skills to begin writing coherently and precisely in words that could be understood (Buscemi and Smith, 2012). An educated individual should have not only knowledge but also the potential to make informed decisions. It is a case where someone is enlightened slightly issues and realizes the need to make a certain decision for the betterment of ones life. An educated person is therefore, familiar with various ideas which shape ones view of reality. ... Thinking abilities are part and pursue of an educated person because this is what leads to making of rational informed resolutions. This thinking ability is still what results in knowledge that an individual holds. Just like if a person is analytically thinking about a physicians suggestion, one would be required to have a bit of knowledge about medical information. It is now possible to think if the recommendation the doctor is offering makes sense o r not. This is because with the thinking ability, the knowledge to make rational decisions for the betterment of ones life is realized. For instance, Malcolm admires Bimbi from prison because he is eloquent and can contribute in any conversation. It is apparent that Bimbi is educated and can converse easily because his thinking abilities translate to knowledge. In the same, way Malcolm assumes this thinking ability by taking Bimbi as his role model and whole caboodle hard to learn the language (Buscemi and Smith, 2012). It is also evident that an educated individual has learning abilities to independently cope with the changing society. It is not possible for a person who cannot learn independently to be regarded as educated. Independent learning is not only reading books or internet materials but the ability to acquire knowledge through personal effort. This could be to learn through the existent material or creating understanding where there is none. This is the art of rational i nquiry where a person has the potential to absorb or acquire information without any reliance on other peoples opinion. Learning is the process of expanding, modification, and refining existing knowledge which further, strengthens the thinking potential. For instance, from Coming to an Awareness of

Production and Operations Management. Lenzing AG Case study

Production and Operations Management. Lenzing AG - Case Study ExampleThe company had its base in the town near Salzburg since long and never felt the need to spread out far from there. The company was content with its operations and business till the course of study 1978 when the zeal to spread out internationally was initiated in Lenzing. The initiation or the possibility was triggered by a phone call which was make by an entrepreneur of Indian origin named Ashok Birla. The Indian entrepreneur came up with an idea of structuring a manufacturing unit in Indonesia. Initially, this proposal was turned down by the management of Lenzing owe to their lack of experience in foreign joint ventures as well as investments. However, with time Lenzing was able to identify the immense potential of the enormous and undeveloped market of fabric in Indonesia which made the Chairman ultimately initiate a joint venture with Birla. The outcome of the venture was a new stiff named South Pacific Visc ose (SPV) which was also the first foreign associate of Lenzing (Spar & Et. Al., 2008). Problem Statement or Issues The joint venture resulted to be quite made and in a short period of time the firm SPV started earning huge net by being a contributor of rayon fiber to the flourishing textile trade of Indonesia. It was found that there was a huge demand of the rayon fiber in the country and the firm efficiently exploited this opportunity which resulted in the augmentation of their profits by around 15 percent every year. In the year 1988, another payoff plant was set up by Lenzing due to the glorious profits. The second plant was established so as to enhance its production ability from 32,000 to 73000 tons each year. With the taste of success in Indonesia, Lenzing started spreading tied(p) out of Europe by way of initiating quite some fresh projects. The experience achieved with the help of its joint venture, SPV assisted Lenzing to expand. In the year 1992, a triad plant for t he purpose of rayon production was acquired by the company at Tennessee. It also started its manufacturing operations in China in 1994 by way of entering into a contract with the government of China to build a manufacturing plant of rayon around Beijing. These various investments and expansions helped Lenzing acquire the reputation of the sole rayon company across the world which boasted of a factual global presence (Spar & Et. Al., 2008). The companys joint venture with Birla in Indonesia was functioning quite productively and profitably by the year 1994. This made the company Lenzing think yet once again of expanding more with the help of starting a trey manufacturing plant of SPV which would facilitate to enhance up the production to 109,000 tons. It was also planned by the company that the third plant would focus on manufacturing rayon fibers of the most exceptional quality. The company was aware of the fact that with the addition of the third manufacturing plant, the firm SPV would be placed amongst the biggest facilities in rayon manufacturing and would be ranked in the second position after the Austrian plant owned by Lenzing (Spar & Et. Al., 2008). along with the profitability factor, there were other important factors too which were considered to be significant as they would majorly contribute towards the expansion. The other aspects that were measured to facilitate the expansion were the strong recognized associations with the firms downstream customers and also the admirable working association with the Indonesian local partner. The location of the firm in Indonesia was considered to be the major bonus behind the expansion owing to the countrys potential of turning into a motivating force for the international textile industry. Apart from the advantages that triggered the

Symbols in “the Masque of the Red Death” Essay Example for Free

Symbols in the Masque of the Red destruction EssayThe Masque of the Red Death is a Gothic style story written by Edgar Allan Poe. In this story, many setting and descriptive details contain symbols. These symbols are very grievous because each symbol stands for something and gives readers much thought. For example, the red color represents the blood and the clock represents the time, etc. Through these symbols, we can learn the story teaches us that no military issue you are rich or poor, you can not avoid death. There are seven houses in Prince Prosperos castellated abbey. Each chamber is painted in different color. The last chamber is described as was closely shrouded in black velvet tapestries that hung all over the ceiling and pig the wallsThe panes here ware scarleta deep blood color.(Poe,84).The colors black and red represent the death and blood, which is the symbol of the Red Death. The chamber the guests business just as they fear death. These hint the readers some thing about the Red Death will happen in the last chamber and leave reader a guess of the outcome. Another symbol in the story is the gigantic clock of ebony. This clock reminds all the guests how time flies because the musicians of the orchestra were constrained to pause (Poe, 84).It also be the countdown to death, And the life of the ebony clock went out with that of the last of the gay., which is the theme of the story, death is inexorable.(Poe,88) This symbol gives meaning to the story by pointing out the theme. Symbols play an important determination in writing because they make the story more mysterious and more interesting. Readers can find out what the author want to express instead of notification by the author. Its a necessary way of writing Gothic style story. Symbols represent the theme and mind of the story. They leave people deep thoughts and something to recall.

Antibiotic Sensitivity Essay Example for Free

Antibiotic Sensitivity EssayMicrobial increment is a normal essential part of the good for you(p) human, animal, and plant environment. When introduction to a microorganism causes harmful bacterial growth, utilize antimicrobial therapy can eradicate or reduce the unwanted pathogen. Antimicrobials are use to stop the growth of a pathogen by the use of a discriminatingly toxic, identified inhibitor. Not all microbes are harmful so it is important to uncover the the vulnerable mechanism of growth in harmful microbes and produce a toxin that is lethal to its lifecycle and not toxic to the other microbial environment nor tissue. Some selective targets include bacterial wall composition, ribosomal synthesis, and DNA transcription. Antibiotics are used to either inhibit or kill harmful bacterial growth. Selecting which antibiotic to use is assist by recognizeing which harmful bacteria are gram-positive or gram-negative. When the target bacteria is not known, a broad spectrum anti biotic may be given over as it can attack both gram-positive and gram negative bacteria. A narrow spectrum antibiotic is chosen when the bacterial pathogen has been identified by gram-stain examination or symptomatic expression.A narrow-spectrum antibiotic will be used to kill the specific identified gram-negative or gram-positive bacteria. The advantage to using a broad spectrum antibiotic is that it may be given early on, before the lengthy lab examination process so that attempts to control of growth may begin promptly. If the broad spectrum is given to a gram specific organism however, the strength of antibiotic may be insufficient to kill or control harmful growth. Furthermore, exposing a microbial environment to unnecessary types or strengths of antibiotics can lead to tolerance or super-infections.A narrow spectrum antibiotic is an infinite advantage when the gram stain specificity is known as it will then target only the offending bacteria. Alternatively, if a narrow spect rum drug is used on an incorrectly identified microbe, then there will be no antibacterial coverage and the harmful bacteria may flourish. Unfortunately, the use of antibiotics in antimicrobial control has consequences. Microbes have been adapting to overcome harmful environments since the beginning of life. Exposure of microbes to antibiotics is yet another environment and as a result, antimicrobial resistance has surfaced.Some commonalty resistant mechanisms include the production of inactivating enzymes that leave the antimicrobial ineffective. Interruption of cell membrane transport of antimicrobial agents is another development of resistance. Mutations are a common mechanism of antimicrobial resistance. Penicillin can be rendered ineffective by an alteration mutation that disrupts the target protein. The Kirby-Bauer test is an agar diffusion test used to identify bacterial susceptibilities. When S. epidermidis is exposed to antibiotic disc materials of Novobiocin, Penicillin and Gentamicin, the most resistance observed was by the Penicillin.

Pollution in China Essay Example for Free

Pollution in China EssayIntroductionChina, with its rapid industrialisation seems to have paid its price by witnessing steeply rising levels of pollution. With millions of largely unregulated industries, the vast rivers, streams and lakes have become easy avenues for chemical, textile and flagellation industries to discharge their toxic contents at will. The paper discusses the pollution in China, its impact on the environment and how it has affected the lives of people.An Overview of Pollution in ChinaA treat by the World Bank (China 2007) has pointed bulge that China is facing increased levels of pollution that has kept pace with the rising industrialisation of rural China. The overcompensate points out that the use of energy in China has went up by 70 % between 2000 and 2005. The use of coal has also increased by 75% and this has created a corresponding increase in the telephone line pollution. The cover up points out that Chinas e missionary posts of SO2 and soot were respectively 42 percentage and 11 percent higher making it the largest polluter in the world.The report also points out that pollution of water, rivers, lakes has also increased to alarming levels. Water pollution is also a cause for serious concern and during 2001 and 2005, about 54 percent of the seven main rivers in China contained water deemed unsafe for human consumption. The report points out that the economic burden of premature mortality and morbidity due to air pollution was157.3 billion Yuan in 2003, or 1.16 percent of by WHO. The report suggests that pollution costs China more than than 147 billion Yuan a year in the form of increased health related costs.A report from CBS news says Chinas air pollution seems like a problem just for that country, think again. The stuff spewing out in China has now been detected in the United States, and some suspect its beginning to affect the U.S. climate Chinas far-reaching dust and soot cloud travelling to the West Coast hits Hawaii first, and that may be why temperatures in Hawaii are rising. A lot of early-computer modelling of Chinese pollutions effects on the global climate is turning out to be just plain wrong. This is why a massive new study with ground and air monitoring across Asia starts next year (Yinchaun, 31 border district 2000).Following mesa shows the air quality in China remand 1. Trends in Air Quality in Chinas Cities (%) (China, 2007)The pursual table shows the distribution of particulate event in airTable 2. Distribution of PM10 and SO2 Levels in 341 Cities, 2003 and 2004 (China, 2007)The list of pollutants that infect China re provided in the following table.Table 4. List of major pollutants and their categories (China, 2007)Clare (Clare DSouza, 2002) reports that Energy consumption, especially coal consumption, is the main source of air pollutants such as particles, SO2, NOx, and CO in most cities of China. As the primary energy source, coal has accounted for about 65 to 70 percent (Chi na Statistical Yearbook 2004) of total energy consumption in recent years, which has caused umteen environmental and human health problems. Crude oil consumption has been increasing because of the rapid expansion of the motor vehicle fleet in many cities. In recent years, epidemiological studies conducted around the world have demonstrated that there are close associations between air pollution and health outcomes.PM10 and SO2 are chosen in many studies as the indicative pollutants for evaluating the health effects of ambient air pollution. Although the mechanisms are not fully understood, epidemiological recite suggests that outdoor air pollution is a contributing cause of morbidity and mortality. Epidemiological studies have lay out consistent and coherent associations between air pollution and assorted outcomes, including respiratory symptoms, reduced lung function, chronic bronchitis, and mortality.The author suggests that industry size is controversial with respect to envi ronmental issues. In some studies large enterprises have been deemed to be more pollution intensive in comparison with small enterprises. The author reports that small enterprises as being more environmentally friendly due to their size and found small plants to be far more pollution intensive because they are difficult and costly to regulate. Empirical research has suggested that enterprise size is inversely check with emissions intensity in developing countries. World Bank and other institutions have found that small enterprises are pollution intensive (Mani, 1997).Karshenas (1992 author has pointed that the Winters (model of business and the environment may be a more appropriate way of approaching the problem. According to the author, enterprises may not have mastered saint in terms of ecological sustainability but enterprises can make a systematic assessment of the areas where improvements can be introduced. Although Winter goes beyond traditional focal point theory, the mode l emphasizes ecologically sound processes and practices right throughout a firm, from company policy, employee relations, supply chain, public relations and marketing.A firm should consider prevention, reduction, recycling and tendency of wastes throughout its operations. They should use sustainable inputs in environmentally friendly manufacturing processes that result in greener outputs (i.e. maintaining environmentally friendly processes for a product from cradle to grave). This would prove to be profitable, provided that the end users, be they industry or consumers, are committed to using green products. Ideally, enterprises should take control of their own operational structure by covering cleaner manufacturing as a competitive and strategic challenge, they should resort to manufacturing life-cycle analysis, environmental auditing and environmental reporting.The reality is that an enterprise cannot consider making a product ecologically sound without considering how its raw ma terial acquisition, suppuration, manufacturing, distribution, sales and disposal systems impact on the environment. The author suggests that has gone one step further by stating that managers in a green venture start from a different mindset. They recognise that becoming green is an opportunity to establish a unique position in a niche market or, by being able to produce a higher value product with fewer resources, to gain a competitive advantage. He proposed a trisect by which sustainable business is based on the concept of balancing ecological, economic and social factors..Action to fight pollutionThe organization of China has redoub guide its efforts in fighting pollution and has organized task forces at the local levels. The structure is shown in the following figure.Figure 1. Main governing body Partners in the ProjectThe report has identified a number of measures to fight pollution and these are displayed in the following table.Table 4. Sectors and Pollutants Included in th e CECM (China, 2007)The squad has implemented certain steps to fight the pollution and these are illustrated in the following figure.Figure 2. Flow Chart for Estimating the Economic Cost of Pollution (China, 2007)The following steps have been proposed cadence 1 Identify the pollution factors, polluted area, and related conditions. pace 2 Determine affected endpoints and establish dose-response relationships for pollution damage.Step 3 Estimate population (or other) exposures in polluted areas.Step 4 Estimate physical impacts from pollution using information from steps 2 and 3.Step 5 Convert pollution impacts in physical terms to pollution costs in monetary terms.Indiscreet reaction by the Chinese politicsWang (Wang Xiangwei. 4 Jun 4, 2007) reports that the Chinese presidency is paranoid about maintaining a good image about China, for fears that it may hurt its business stakes. The author reports that the most at rest way for China to control pollution is by jailing activists who point out the problems of pollution. The author reports about the village of Wuxi and how it was affected by pollution. For hundreds of years, Wuxi , on the edge of siamese connection Lake, was the envy of the nation. In the heart of the Yangtze River delta and known as the land of fish and rice, it was bestowed with fertile land and abundant waterways, and was also home to famous poets, painters and industrialists. Since recently however, the metropolis has become a stinking hell for its five million residents as a blue-green algal bloom from the heavily polluted lake contaminated the metropoliss faucet water, making it foul-smelling and undrinkable.After scrambling for six days with emergency measures, Wuxi officials said yesterday the tap water was drinkable. But the residents, who have relied on bottled water for inebriety and cooking, have every reason to be suspicious. Xinhua has reported that after the usual cleaning aids such as activated carbon failed to remove the odour , the city adopted what Mayor Mao Xiaoping called a bold move by pouring huge amounts of potassium permanganate (Condys crystals) into water-intake points. This allowed the strong oxidising agent to remove foul-smelling matter from the pipes. But Xinhua failed to explain that potassium permanganate is hazardous and can be a health risk. As the Wuxi officials brazenly claimed credit for winning the battle against the water crisis, no(prenominal) of them yet had the decency to apologise to the suffering residents.All of them have blamed factors beyond their control higher- than-normal temperatures that helped to foster the growth of the algae, a lack of rain and favourable cheat on conditions, and the lowest water level in the lake in five decades. In fact, the fundamental cause of the crisis is the lakes heavy pollution as several mainland environmentalists have repeatedly warned the governance in the past decade. Wu Lihong, 39, is one of them. He has spent large sums of his own money over the past 16 years collecting evidence of pollution at Tai Lake, the mainlands thirdlargest freshwater lake, and petitioning the local authorities to shut down the polluters. Now, with a water crisis on its hands, one would imagine any government that claims to put the people first would give Wu a medal of honour and make him a hero.Instead, Wu, known as the Tai Lake anti-pollution warrior in overseas media, is languishing in jail and awaiting trial on June 12 on trumped-up charges of blackmail. A farmer turned businessman who grew up in Zhoutie town in Yixing a small, booming industrial city under the jurisdiction of Wuxi Wu witnessed the lake turn into a cesspit. He then made it a personal crusade to petition authorities to shut down more than 2,000 chemical factories in Yixing that spewed toxic pollutants into the lake every day.By passing the local bureaucracy and filing reports to higher- level government officials has led to limited success he is welcomed, even li ked by many central government officials and national media in Beijing. In 2005, he was chosen as one of mainlands top 10 environmentalists and honoured at a ceremony in the Great Hall of the People. But he incurred the wrath of local officials and has been constantly plague by local policemen, officials and thugs. He was arrested again in April on charges of blackmail after the local officials set a trap for him.They offered him 40,000 yuan for a mission to attract investment from other mainland cities, and then laid charges of blackmailing the authorities. His lawyer, Zhu Xiaoyan , said that Wu had told her that he was whipped while in custody, and she was not allowed to see him until more than six weeks after his arrest. alike(p) Gao Yaojie , a retired Henan doctor who refused to keep quiet about Aids, Wu has refused to stand down despite the threat of jail. The mainland leadership should learn from the fiasco of trying to muzzle Ms Gao and release Wu immediately.(Wang Xiangwei . 4 Jun 4, 2007).ConclusionPollution in China has assumed the proportion of an epidemic with wide ramifications on the health of the people, the environment, air and water. The paper has presented discussed various aspects of the problem and presented statistics to show the extent of pollution. Certain recommendations have also been made so that the pollution could be averted and reduced to some extent.ReferencesChina, 2007. Cost of Pollution in China. Retrieved 18 January 2008 from www.worldbank.org/eapenvironment.Clare DSouza, 2002. The nexus between industrialization and environment. Journal of Environmental Management and Health. Volume 13 Number 1 2002 pp. 80-97Karshenas, M (1992), Environment development and employment some conceptual issues,in Bhalla, A.S (Eds),Environment Development and Employment, WEP Study, ILO, Geneva,Mani, M, Pargal, S, Huq, M (1997), Does environmental regulation determine the location of new manufacturing?, World Bank, Washington, DC, Policy Research working PaperWang Xiangwei. 4 Jun 4, 2007. Release the man who first raised the alarm about Tai Lakes pollution China Briefing. South China Morning Post. Hong Kong. P. 5Xinhua, 26 December 2006. Chinas Energy Conditions and Policies. Xinhua News Agency CEIS. p 1Yinchaun. 31 March 2000. A Global Problem Chinas Pollution. Retrieved 18 January 2008 from http//www.cbsnews.com/stories/2000/03/31/ roll/main178697.shtml

Treatment for Digoxin Overdose

Treatment for digoxin OverdoseB. TrimbleDigoxin OverdoseDigoxin is derived from the leaves of a digitalis plant (foxglove). Some plants have chemicals that can arrest symptoms mistakable to digoxin if eaten, such as lily of the v everyey and oleander. Digoxin is a substrate of P-glycoprotein. Drugs that induce or inhibit P-glycoprotein in the intestines or the kidneys have the potency to bowdlerise digoxin pharmacokinetics (Katzung, Mastes, Trevor, 2012).Digoxin increases the strength of flavour contractions by inhibiting the activity of the enzyme ATPase. ATPase controls the movement of calcium, sodium, and potassium into the heart muscle. ATPase increases the amount of calcium in heart muscle, which increases the force of contractions. Digoxin decreases the electrical conduction between the atrium and ventricles of the heart and slows ventricular contractions. Digoxin is eliminated through the kidneys and should be reduced in dosage in diligents with kidney dysfunction (Kat zung, Mastes, Trevor, 2012).Medications such as verapamil, quinidine, Amiodarone, indomethacin, spironolactone,Alprazolam and itraconazole can increase drug levels and the risk of perniciousness of digoxin. Furosemide and opposite diuretics that reduce blood potassium or magnesium levels whitethorn predispose patients to drug induced abnormal heart rhythms. Saquinvard and ritonavir increase the amount of digoxin in the body and may cause toxicity (PubMed, 2013). judgement of the severity of toxicity and etiology (accidental, unintentional, or deliberate overdose) altered drug metabolic process due to decreased renal function or interaction with other drugs is necessary. Consideration of factors that influence treatment embarrass age, medical history, chronicity of digoxin intoxication, severity of heart disease, and/or renal insufficiency and ECG changes (Katzung, Mastes, Trevor, 2012). Symptoms of digoxin toxicity include anorexia, nausea, vomiting, diarrhea, visual changes, ca rdiac arrhythmias (1st degree, 2nd degree Wenckebach, or 3rd degree heart block), atrial tachycardia with AV block, AV dissociation, accelerated junctional, unifocal or multifocal premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation (Patel, 2011). Toxicity is usually associated with levels greater than 2 mg/ml. Low body weight, advanced age, impaired renal function, hyperkalemia, hyper-calcemia, or hypo-magnesium may cause digoxin toxicity. Other symptoms may include decreased consciousness, decreased urine output, difficulty breathing, and overall swelling (Brunton, Chabner, Knollman, 2011).Treatment will consist of emergency protocol if outside the hospital this includes calling emergency medical services and CPR. Once the patient is in medical c are, the treatment will depend upon the severity of symptoms and levels of digoxin in the body. Laboratory testing will include serum electrolytes, digoxin levels, and thyroid function tests. The pa tient will be placed on never-ending cardiac monitoring with a 12 lead ECG obtained (Brunton, Chabner, Knollman, 2011). The primary focus is to correct electrolyte levels if hypokalemic administer potassium to reach a level of 4.0 to 5.5 mmol/L. actuate charcoal will be administered either orally or per nasogastric tube in order to bind undigested digoxin. If bradycardic and symptomatic, atropine may be given intravenously. prime quantity cardiac effects of digoxin occur 3 to 6 hours after ingestion. Gastrointestinal symptoms precede cardiac manifestation. Neurological symptoms like fatigue and malaise are common. Visual disturbances occur with aberration in color vision, mostly yellow-green. Activated charcoal binds to the digoxin and prevents recirculation to the enterohepatic circulation. Cholestyramine may be used for chronic toxicity in patients with renal insufficiency. Continuous hemodynamic monitoring includes the ECG and 12 lead EKG (Brunton, Chabner, Knollman, 2011). Prompt measurement of electrolyte levels (potassium, calcium, digoxin, BUN, creatinine, and CMP). Sodium bicarbonate may be administered to correct metabolous acidosis along with glucose and insulin to enhance potassium uptake by the cells (Brunton, Chabner, Knollman, 2011). Magnesium may serve as a temporary antiarrthymic until digifab is available. Hypomagnesium increases myocardial digoxin uptake and decreases cellular sodium/potassium ATPase activity. Digibind (digifab or digoxin immune Fab) is an immunoglobulin fragment that binds with digoxin. In acute intentional overdose digibind (40 mg reconstituted with 4 ml stereotypical water) is administered 4 to 6 vials as a loading dose over 30 subtles as an emergent IV bolus. The bolus is followed by 0.5 mg/minute for 8 hours and then 0.1 mg/ minute for 6 hours (Patel, 2011).For patients with chronic toxicity that are dependent on digoxin, the initial dose is twice the bolus. This avoids complete turnabout of clinical effects of digoxin. Response is typically within 20 to 30 minutes after infusion, elimination half- life is around 16 hours. Digoxin levels are unreliable for one to two weeks after therapy. Complications in long-term digoxin users, who receive digibind treatment administration are that it may precipitate worsening of heart failure as reversing the beneficial inotropic means of digoxin causes hypokalemia and atrial arrhythmias with rapid ventricular response (Katzung, Mastes, Trevor, 2012). Hypokalemia has occurred in patients treated with standard therapy as well as with Fab fragments. Clinically adverse phenomena have occurs in patients with immunotherapy. Other untoward effects of Fab include anaphylaxis and serum sickness, this is because it is a sheep protein, but this is uncommon. Recrudescence of digoxin toxicity is possible within 7 to 14 days because Fab is eliminated more rapidly than digoxin released from tissue binary sites. Plasmapheresis may be performed or the agent reinstitut ed in such cases (Patel, 2011).If hemodynamically stable, bradycardia and supraventricular arrhythmias may be treated with observation and supportive measures. Ensuring hydration to optimize renal clearance, administering gastrointestinal binding agents may be used. For patients with rate link up ischemia or neurological unstable digiFab is the treatment of choice (PubMed, 2013). In unstable premature ventricular contractions, lidocaine may be effective. In ventricular tachycardia the trump out response is to digiFab, but phenytoin and lidocaine are useful if Fab is ineffective or unavailable (Brunton, Chabner, Knollman, 2011). They depress the enhanced ventricular automaticity without significant slowing of AV conduction. Phenytoin may reverse digoxin induced prolongation of AV nodal conduction. Phenytoin has been shown to dissociate the inotropic and dysrhythmia actions of digoxin, suppressing digoxin tachycardia without diminishing the contractile affect and can provoke SVT i nduced by digoxin. Doses for lidocaine are 100 mg bolus with an infusion of 1 to 4 mg/minute. Phenytoin dosage is 100 mg every 5 to 10 minutes up to a loading dose of 15 mg/kg. Magnesium sulfate dosage is 2 gram over 5 minutes followed by an infusion of 1 to 2 g/hour, with magnesium levels drawn every one to two hours. Atropine may be given for bradycardia to remediate sinus and AV node conduction by inhibiting vagal activity (Brunton, Chabner, Knollman, 2011). Phenytoin may reverse digoxin induced prolongation of the action potential in myocardial cells and may suspend tachycardia, prolongs effective refractory period, and depresses spontaneous depolarization in ventricular tissue. Lidocaine is a class IB antiarrthymic that increases the electrical stimulation wand of the ventricles, suppressing the automaticity of conduction through the tissue. It combines with sodium channels and inhibits recovery after repolarization, resulting in decreased myocardial excitability and conduct ion velocity (Brunton, Chabner, Knollman, 2011). Magnesium sulfate possesses properties that slow the rate of sinoatrial node impulse formation and prolong conduction times (Brunton, Chabner, Knollman, 2011).Prevention of unintentional overdose (accidental overdose, interaction with other medications, or the altered metabolism due to renal insufficiency) is mostly through patient education. Instructing the patient in the correct dosage of the medication that blood tests will be necessary to master appropriate dosage suggesting daily recording of heart rate and blood pressure. Advise the patient that many drugs interact with digoxin, and to inform the physician and pharmacist of all medications, including over the counter and herbal medications, and if started on a new prescription. Advising the patient to report any sign/symptoms associated with digoxin toxicity. Review signs and symptoms of toxicity with the patient.If the overdose were intentional, the patient would need the sa me consults as any other patient undergoing treatment (cardiologist, nephrologist, medical toxicologist, regional poison control center) as well as psychiatric consult. Follow up appointments with the patient to monitor drug and electrolyte levels.ReferenceBrunton, L., Chabner, B., Knollman, B. (2011). Goodman GilmansThe Pharmacological Basis of Therapeutics (12 ed.). McGraw-Hill.Katzung, B., Mastes, S., Trevor, A. (2012). Basic Clinical Pharmacology (12 ed.). McGraw-Hill.Patel, V. (2011). Digitalis toxicity. Retrieved from Medscape http//www.emedicine.medscape.com/article/154336-overviewPubMed. (2013, Janurary). Digitalis toxicity. Retrieved from PubMed.gov http//www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001218