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By: H. Peratur, M.A., Ph.D.

Clinical Director, Indiana University School of Medicine

Please do not go forward with this harmful waiver that would politicize the Federal Medicaid program anxiety symptoms head pressure purchase genuine atarax. She needs assistance for the very most basic needs including feeding anxiety symptoms muscle twitches purchase atarax 25 mg with visa, breathing anxiety symptoms going crazy cheapest generic atarax uk, and bathing. I know from personal experience both as a former state lawyer and as an advocate for TennCare/Medicaid program enrollees, that the State of Tennessee and its officials cannot be trusted to do what is right to protect the vulnerable population TennCare is designed to serve, while maintaining program integrity. If anything, Tennessee needs greater federal oversight rather than less oversight and more of what the State euphemistically calls "flexibility. The financially and medically disadvantaged citizens of Tennessee need and deserve the protections in the Medicaid statutes and regulations. I urge you to maintain these protections by rejecting the Tennessee block grant proposal. This state needs to expand Medicaid to provide insurance for over 600,000 uninsured Tennesseans. Years of not expanding Medicaid has been a disgrace to and disregard for fellow Tennesseans who deserve more from their state. Those blocking this expansion should be ashamed and those trying to plug the dike with a bandaid will live to regret this poorly devised plan. A Concerned Citizen 23 Jonathan Reeve From: Sent: To: Subject: Crystal Colter <crystal. Block grants are rife with opportunities for misuse, as the grantees may or may not ever actually deliver medical services they could be startups that fail, and the $ is gone. We have seen this happen in other arenas child welfare, for example, where facilities closed without serving a single child. The only way to guarantee medical services is to cover individuals and let them choose a provider and obtain medical care. Sent from my iPhone 25 Jonathan Reeve From: Sent: To: Subject: David Twiggs <dtwiggs2@icloud. Nor will it adequately cover the costs of Tennessee hospitals and/or nursing homes. As an autistic adult, it is most likely that what is being proposed would virtually eliminate needed services, and it would have a devastating effect, on my health and wellbeing. The proposal does nothing to address the real healthcare crises in our state such as rural hospital closures and the Medicaid coverage gap. The program ensures these individuals have access to coverage for health and financial security, and supports the health care infrastructure we all depend on. This block grant proposal would cause immense harm and jeopardize coverage for these vulnerable Tennesseans. This proposal goes against the objectives of Medicaid because it gives Tennessee new authority to cut services. The state should not be allowed to make changes to the Medicaid program without federal oversight or eliminate federal standards which are in place for the protection of patients. I work with clients who need high levels of care, and the provisions in the proposal about reducing the amount of services someone can receive is highly concerning. Under this proposal, people who need the most services are the ones who will bear the brunt of any reductions. As someone who works with the elderly on a daily basis, assisting them in applying for Tennessee Medicaid, I cannot emphasize enough how badly Tennessee Medicaid is needed to cover our most vulnerable citizens. This would allow more people access to medical treatment and medications, saving cost for more extensive treatment in the future. Charlie and Pat Cooper Sent from my iPhone 33 Jonathan Reeve From: Sent: To: Subject: Fran Rajotte <franrajotte47@gmail. It would take an unconscious person to approve this especially in light of the fact that no other state is doing it. Fran Myers Sent from my iPhone 34 Jonathan Reeve From: Sent: To: Subject: carol Fox <c. Her care, tube feeding, therapists and orthotics are costly, but are making a tremendous improvement in her life. Why not provide affordable healthcare for those in need instead of a limited annual grant

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Zinc arsenate Powder once used in the United States as insecticide on potatoes and tomatoes anxiety symptoms relief buy atarax 25mg overnight delivery. Treatment of Arsenic Compound Toxicosis the following discussion applies principally to anxiety symptoms fatigue generic atarax 25 mg mastercard poisonings by arsenicals in solid or dissolved form social anxiety symptoms yahoo discount atarax 10mg otc. Treatment of poisoning by arsine gas requires special measures described in the Arsine Gas subsection beginning on p. Wash arsenical pesticide from skin and hair with copious amounts of soap and water. If a high-concentration solution is in contact with the eyes, wash eyes with a profuse amount of water and examine the corneas carefully. Organic (Pentavalent) Cacodylic acid (sodium cacodylate) Non-selective herbicide, defoliant, silvicide. Because poisoning by ingested arsenic often results in profuse diarrhea, it is generally not appropriate to administer a cathartic. Although it is not clear how well arsenic is absorbed by charcoal, charcoal and whole bowel irrigation were used in recent case reports. Administer intravenous fluids to restore adequate hydration, support urine flow and correct electrolyte imbalances. As above, use isotonic fluids (normal saline or lactated ringers) to treat hypovolemia and hypotension associated with shock. Use chelation for severe poisoning, including symptomatic poisoning or someone with a recent significant exposure. The following dosage schedules have proven to be effective in accelerating arsenic excretion. D-penicillamine has been suggested; however, its effectiveness for arsenic exposure has been questioned in experimental models, though it has been used with some success in earlier human case reports. Hemodialysis may be indicated early in the course of poisoning to enhance arsenic elimination and maintain extracellular fluid composition if severe acute renal failure occurs. Monitor urinary arsenic excretion while any chelating agent is being administered. However, some poisonings by arsine have occurred in pesticide manufacturing plants and metal-refining operations when arsenicals came into contact with mineral acids or strong reducing agents. Arsine exposure occurs through inhalation with very little exposure required to cause a serious hemolytic reaction. Signs and symptoms are the result of sometimes profound hemolysis leading to hemolytic anemia and include fatigue, headache, malaise, weakness, dizziness, dyspnea, nausea, abdominal pain and vomiting. Basophilic stippling of red cells, red cell fragments, and ghosts are seen in the peripheral blood smear. Plasma will appear very dark, almost black, resulting from elevated level of unconjugated bilirubin. Elevated concentrations of arsenic are found in the urine, but these are not nearly as high as are found in poisonings by solid arsenicals. Usually 1-2 days after hemoglobinuria appears, jaundice and bronzing of the skin may be evident. Administer intravenous fluids to keep the urine as dilute as possible and to support excretion of arsenic and products of hemolysis. The amount of arsine that must be absorbed to cause poisoning is small, and therefore high levels of urinary arsenic excretion may not always occur, even in the face of significant poisoning. Consider plasma exchange, which has also been used to treat acute arsine poisoning. A retrospective review study in China reported successful treatment of 12 patients. Arsenic species in drinking water, hair, fingernails, and urine of patients with blackfoot disease. Arsenic in blood and urine of forest workers as indices of exposure to cacodylic acid.


  • Chest x-ray, if the health care provider suspects pneumonia
  • Age
  • Valproic acid (Depakene)
  • Blood clot that travels to the lungs
  • Blood in the stool
  • Menopause
  • Gaining more than 2 pounds a week
  • Severe pain or burning in the nose, eyes, ears, lips, or tongue
  • History of dependent behaviors including smoking, alcoholism, and excessive use of tranquilizers

Why was it necessary for Governor Bill Lee to anxiety symptoms high blood pressure order discount atarax practically be "coerced" to anxiety 4th hereford cattle discount atarax master card allow Memphians to anxiety while driving purchase genuine atarax on-line offer input which, he knew, would like not support this harmful effort It can only be that this is a political move which does not reflect the feelings or needs of the majority of people especially those who would suffer as a result of this action. If you allow Tennessee to take this money in grant form, what is to prevent the money from being diverted to other sources What prevents it the money from being used to favor one part of the state as opposed to another It seems that to release this money in block grant form will allow some unscrupulous leaders to play "loose and free" with taxpayer money which ought to have the assurance of serving those who need it the most. Mental Health treatment providers are so underfunded and numbers of those needing mental health treatment are growing daily. This is a huge issue that must be addressed as we work to keep people from hurting themselves or others due to their serious mental illnesses and their struggle with despair and limited hope for recovery. It is intended only for the use of the individual(s) named above, and the privileges are not waived by virtue of this information having been sent by Email. If you have received this Email in error, please notify the sender immediately and destroy this Email. I am worried that this proposal would allow the state to eliminate or restrict services that are important to people with mental illness, including my own daughter. I respectfully urge you to reconsider this proposal and focus on solutions that help Tennesseans with mental illness, not hurt them. It provides comprehensive health care coverage for people like us that are in need of this program. TennCare has helped me, my daughter Jireh and my husband Paul by helping us with the prescriptions and our mental and physical health. This is crucial for our recovery as if we cannot afford our medications we will not be able to live a healthy life, symptoms will come back and we will relapse. Sincerely, Marta Hernandez-Fontenot Disclaimer: the information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any 6 dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by a "reply to sender only" message and destroy all electronic or paper copies of the communication, including any attachments. My son has just graduated with all honors from High school and got a full scholarship at Belmont University. Would you, the legislators, or the governor, wish to have this type of health coverage Marvin Kronenberg 13 Jonathan Reeve From: Sent: To: Subject: Sharon Jones <sharonjones25@comcast. There are a couple of days yearly people are allowed to apply and it is very hard to get on. What this State is also good at: Not increasing or even opening any enrollment periods for eligible TennCare/Medicaid for our children, the disabled, or for seniors with only social security or those with no social security at all. It causes more emergency room visits and causes for treatable conditions to balloon into much more expensive need for care. The fact that your hearing was led off by someone representing the State saying it will not affect these folks. I suffered over a year with a prolapsed uterus that got worse and worse and worse. Thank God for minute clinics (which are also disappearing just like rural hospitals). This State has more closed rural hospitals than any other state per capita in the country and the talk is that an additional savings proposed is to do away with air ambulance services. So what do these people do if the magic hour is not going to be a possibility for them to reach emergency care

Patients must have one of the following documents or a valid alternative (such as identification bracelet indicating wishes) immediately available anxiety symptoms during exercise order atarax 10mg with visa. The interventions covered by this order and the details around when to anxiety symptoms in kindergarten buy atarax 10mg visa implement them can vary widely c anxiety symptoms 247 proven 10mg atarax. The directives frequently do not apply to emergent or potentially transient medical conditions d. One of the documents above is valid when it meets all of the following criteria: a. If there is question about the validity of the form/instrument, the best course of action is to proceed with the resuscitation until additional information can be obtained to clarify the best course of action 4. If a patient has a valid version of one of the above documents, it will be referred to as a "valid exclusion to resuscitation" for the purposes of this protocol Patient Management Assessment 1. Directives should be followed as closely as possible and direct medical oversight contacted as needed 2. If there is a personal physician present at the scene who has an ongoing relationship with the patient, that physician may decide if resuscitation is to be initiated 2. If the physician or nurse decides resuscitation is to be initiated, usual direct medical oversight procedures will be followed 4. When there is no response to prehospital cardiac arrest treatment, it is acceptable and often preferable to cease futile resuscitation efforts in the field. In patients with cardiac arrest, prehospital resuscitation is initiated with the goal of returning spontaneous circulation before permanent neurologic damage occurs. Lastly, return of spontaneous circulation is dependent on a focused, timely resuscitation. Families need to be informed of what is being done, and transporting all cardiac arrest patients to the hospital is not supported by evidence and inconveniences the family by requiring a trip to the hospital where they must begin grieving in an unfamiliar setting. Most families understand the futility of the situation and are accepting of ceasing resuscitation efforts in the field Patient Presentation Patient in cardiac arrest. Any cardiac arrest patient that has received resuscitation in the field but has not responded to treatment 2. Advanced life support resuscitation is administered appropriate to the presenting and persistent cardiac rhythm. Termination before this timeframe should be done in consultation with direct medical oversight d. There is no return of spontaneous pulse and no evidence of neurological function (nonreactive pupils, no response to pain, no spontaneous movement). Resuscitation may be terminated with direct medical oversight if these signs of life are absent ii. Consider direct medical oversight before termination of resuscitative efforts 128 Assessment 1. Cardiac activity (including electrocardiography, cardiac auscultation and/or ultrasonography) 5. Consider support for family members such as other family, friends, clergy, faith leaders, or chaplains 4. For patients that are less than 18 yo, consultation with direct medical oversight is recommended Patient Safety Considerations All patients who are found in ventricular fibrillation or whose rhythm changes to ventricular fibrillation should in general have full resuscitation continued on scene. This does not imply, however, that all resuscitations should continue this long. Transport to an emergency department will take greater than 30 minutes (this does not apply in the case of hypothermia) c. Logistical factors should be considered, such as collapse in a public place, family wishes, and safety of the crew and public 4. It is dangerous to crew, pedestrians, and other motorists to attempt to resuscitate a patient during ambulance transport 5.

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