Home » Episode 5

Episode 5

The one where Jane has more insulin than is healthy…..

The next day, Jane rushes Jane back to the hospital – she is now running a very high fever,

 

 

 

 

 

 

 

 

 

is feeling faint and the surgical wound is oozing yellow discharge. The registrar on duty, Dr Smith,

 

 

 

 

 

 

 

 

quickly assesses Jane, recognizes the presence of infection and diagnoses sepsis.

 

He immediately begins to administer IV antibiotics, and Jane stays overnight in the hospital.

 

 

 

 

 

 

 

As a type I diabetic, Jane is very good with staying on top of her insulin regime; however, the requirements for insulin are increased during sepsis. The insulin doses are not adjusted to allow for the increased requirements, but as the day progresses Jane starts to become drowsy and confused and the nurse on the ward calls the registrar to return.

 

Jane is in diabetic ketoacidosis, a medical emergency which is seriously problematic if not treated promptly. The usual treatment is a combination of rehydrating fluids, replenishment of lost electrolytes, and insulin.

 

The fluids and electrolytes are written up on the fluid balance chart and administered by the nurses. Meanwhile the registrar goes to draw up 10 units of insulin for direct injection. Immediately after he delivers the injection, the registrar is stricken with panic as he realizes that he drew 10 mls of insulin, rather than 10 units – each ml contains 100 units of insulin, so Jane has effectively been given 100 times the intended dose. This is a medical emergency as action needs to be taken immediately.

 

 

 

 

 

 

The registrar quickly vocalizes the error to the nurses, and the team prepares an emergency administration of IV dextrose (a sugar solution) to counteract the insulin overdose.

 

Jane recovers despite the infection and the insulin overdose and is kept in the hospital for several more days until the bacterial infection is cleared. She is then discharged home and make a good recovery.

 

Question for Student Comment:

Please identify areas within this episode where an improvement approach could be undertaken to improve Patient Safety ?

775 thoughts on “Episode 5”

  1. Anonymous says:

    Мойки и смесители на сайте http://www.zorg.msk.ru/ можно приобретать действительно выгодно. Удовлетворять все потребности по использованию сантехники может каждый покупатель. В каталоге можно также находить разные аксессуары, фильтры для воды. Продаваемая продукция считается оригинальной и обязательно реализуется при условии наличия всех нужных сертификатов. В магазине есть товары как от зарубежных, так и отечественных производителях. Подбирать решения можно, вне зависимости от имеющегося бюджета.

  2. Anonymous says:

    Теплый пол на сайте https://azbukaklimata.ru/teplyj-pol можно купить. Такие системы хорошо подходят для того, чтобы сохранять тепло в комнатах и производственных помещениях. Подобные системы используются часто в качестве вспомогательного и основного источника тепла. Хорошая температурная регуляция теплых полов позволяет использовать их практически повсеместно. Кроме этого, есть у нас и нужные для монтажа систем отопления элементы – приводы для коллекторов, распределительные коробки и термостаты.

  3. Anonymous says:

    GO!!!
    This term was said away the essential cosmonaut on Soil – Yuri Gagarin. (Yuri Gagarin)
    He was the key astronaut on Earth. He was Russian! …
    Any longer Russia is tasteful a definite realm, gas pipelines, a vaccine against COVID-19, an army.
    Is this very reminiscent of the communist Soviet Union?
    How do you think?
    Now we keep total control in our country. I am interested in the opinion of foreigners.

    А я ищу работу в Белгороде:(

    … Альбонумизматико – трудоустройство

    grevorgАЛИdVhower

  4. Anonymous says:

    Компания “Мульти шар” предлагает большой выбор воздушных шаров, которые актуальны на любом празднике. На сайте https://sharikisgeliem.ru/ можно заказать шарики с гелием на День Рождения, 14 февраля, 8 марта, выпускной, девичник, выписку из роддома. В ассортименте представлены фольгированные шары, шарики в коробке, композиции из шаров, цифры и буквы, собранные из шариков. Вместе с шарами можно подобрать открытку, свечу или хлопушку. На сайте можно посмотреть примеры работ и подобрать подходящую композицию с доставкой в Москве и Московской области.

  5. Anonymous says:

    На интернет – сайте организации http://impulse-a72.ru/ можно отыскать предложения по обследованию зданий и сооружений. Труды российских ученых запатентованы, а каждый клиент можно ознакомиться с имеющимися сертификатами. В работе используются технологии российских, а также зарубежных трендов и марок. После усиления фундамента и восстановительных работ, будет проводить определение качества ремонта по разным параметрам.

  6. Anonymous says:

    С топ – рейтингом лучших казино, которые в 2021 году в России были популярны, на сайте https://blog-slotcasino.com можно ознакомиться. Список азартных заведений всегда обновляется, поскольку спрос на удовольствие и прибыль всегда растет. Выбирать сайты, уже успевшие зарекомендовать себя только с лучшей стороны, можно достаточно просто. Разнообразие бонусной программы и особенности интерфейсов указаны на сайте правильно. Выводить деньги и выигрывать в казино можно очень легко.

  7. Anonymous says:

    GO!!!
    This phrase was said by the first cosmonaut on Earth – Yuri Gagarin. (Yuri Gagarin)
    He was the first astronaut on Earth. He was Russian! …
    Now Russia is becoming a strong country, gas pipelines, a vaccine against COVID-19, an army.
    Is this very reminiscent of the communist Soviet Union?
    How do you think?
    Now we have total control in our country. I am interested in the opinion of foreigners.

    … Альбонумизматико – альбомы для монет

    ПОЕХАЛИ!! a

  8. Anonymous says:

    how to get cialis is there a generic cialis available? what are the side effects of cialis

  9. Anonymous says:

    На сайте производственного объединения https://m-strop.by/ представлено много образцов подъёмного оборудования, которые можно купить в Беларуси. Продукция своего производства создана по ориентации на применение универсальных технологий. Со стороны специалистов компании всегда предпринимались необходимые усилия, чтобы подъемное оборудование создавалось идеально. Осуществляться может доставка товаров в другие страны СНГ. Ответственное отношение и профессионализм обязательно будут обеспечены.

  10. Anonymous says:

    Дети с помощью видео https://www.youtube.com/watch?v=GiAlL0yveG4 могут понять, как именно стоит жить в синем и розовом. Делать покупки, одеваться и готовить, есть и не только можно детям в любое время. Раскрашивать сладости и наслаждаться приготовлением вкусных и красочных блюд может каждый ребенок. Голубые и розовые спагетти приготовить сможет практически каждый – итальянская кухня и банановый коктейль, разноцветный коктейль и другие вкусности порадуют каждого просматривающего человека.

  11. Anonymous says:

    Акционные предложения и скидки на сайте https://o-potolki.ru/ могут использовать все, кому нужны качественные потолки. Благодаря предоставлению уникальных условий сотрудничества со стороны поставщиков, как простые матовые, так и многоуровневые потолки в разных городах можно устанавливать. Многообразные и простые товары, которые реализуются по доступным ценам и имеют хороший внешний вид, обновляеются в каталоге часто. Потолки отличаются практичностью, многообразием и действительно быстрым монтажом.

  12. Anonymous says:

    Для печатающих в небольших количествах и желающих поработать с компанией цифровой печати, ознакомление с предложениями сайта https://mandarin-print.ru будет действительно полезно. Если у человека есть свой бизнес, то продвижение с помощью использования услуг компании будет наилучшим вариантом для развития. Сотрудничать с типографией можно, не покидая территорию своего дома. Брошюры, листовки, флаеры и продукцию другого типа заказывать как в Симферополе можно, так и в других городах.

  13. Anonymous says:

    На канале по ссылке https://zen.yandex.ru/id/6088d5493285e40e061539a3 можно ознакомиться с рецептами супов, тортов, закусок и не только. Большое внимание уделяется советам и секретам приготовления блюд, рецепты которых просто невозможно найти на других сайтах. Благодаря подписке на канал, каждый человек может узнать гораздо больше о мире кулинарии, вторых блюдах и не только. Тонкости разной кухни и рецептов можно узнать, подписавшись на канал на данном сервисе.

  14. Anonymous says:

    does daily cialis lower blood pressure can women take cialis cost of cialis in canada

  15. Anonymous says:

    Основы психологии, аспекты и тонкости на сайте https://psy-top.ru/ подаются действительно тактично, информативно, точно и понятно. Процесс обмена информацией, который ведет к обоюдному пониманию, показывается здесь очень интересно. Общение и взаимодействие между людьми после осознания и применения изменения информации непременно улучшаются. Рационализацией своей жизни, координацией задач и не только можно заниматься удобно, в домашних условиях и без напряжения.

  16. Anonymous says:

    Информацию о том, как работает строительная компания “Рост”, можно на сайте https://rost-sk.com/ изучить. Данная компания работает с разными учреждениями и заказчиками. Организация в Ростове для многих других организаций является очень ответственным партнером. Все результаты полученные обеспечиваются за счет ответственной работы персонала. Качество работы всегда является высоким, поскольку удовлетворение потребностей требовательных заказчиков является очень важным для каждого из сотрудников компании.

  17. Anonymous says:

    На сайте https://egrn.appany.ru можно заказать выписку из ЕГРН, что позволит получить информацию о любом объекте недвижимости в России. Проверка данных об объекте стоит 190 рублей, полную проверку можно осуществить за 1900 рублей, с примерами можно ознакомиться на сайте. Заказывая здесь выписку, вы экономите время и можете получить всю информацию об интересующей вас квартире, частном доме или земельном участке. Заполняйте заявку, чтобы получить вечный промокод со скидкой.

  18. Anonymous says:

    С помощью сайта сервиса https://printime.online/simferopol воспользоваться можно хорошими полиграфическими услугами. За счет использования технологий по полиграфии и рекламным услугам, итоговый результат будет идеальным, а экономить можно будет и время, и деньги. Возможность объединения крымских полиграфий, совершенствование сервиса и уникальный продукт – это не все преимущества, которые есть у сервиса. Больше узнать можно на указанном выше сайте.

  19. Anonymous says:

    Политические новости на сайте https://pressapro.ru/ прочитать можно. Экономические и общественные, политические и автомобильные новости на сайте постоянно обновляются. Большое внимание уделяется на сайте адекватной оценке происходящих перемен в обществе, а также анализу сложившейся ситуации в социуме. Прочитать на сайте в любое время можно о карантинных ограничениях, праздниках и не только. Авторы публикаций всегда стараются адекватно подать информацию, чтобы читателю было интересно.

  20. Anonymous says:

    Детское игровое шоу, магические и сказочные рассказы, мультфильмы и не только на канале https://www.youtube.com/c/EmiOceanUSA/ можно просматривать. Погони и забавные истории, поиски сокровищ и квесты понравятся каждому человеку, который зашел на сайт. Сказочные и загадочные животные, супергерои и пираты могут радовать детей в любое время суток. Именно поэтому, стоит подписаться на этот канал, а также поставить лайки понравившимся видео. На тайм-коды также стоит обратить внимание.

  21. Anonymous says:

    При помощи форума https://forum.pro-zakupki.su можно узнать много новой информации, читая сообщения. Множество данных о закупках, контрактной системе и участии в них можно прочесть на ресурсе в любое время. Аспекты осуществления сделок раскрыты тут поистине полноценно. За счет этого, опыт могут как новички, так и опытные специалисты получить. Модераторы тут хорошо выполняют свою работу, а пользователи часто пишут о том, о чем просто не знают новые люди. Кроме этого, общаться можно и с опытными специалистами.

  22. Anonymous says:

    Коллегия адвокатов “Фемида” предоставляет юридическую помощь в гражданских, уголовных, административных делах. Специалисты консультируют, помогают оформить важные документы, анализируют каждую индивидуальную ситуацию и выстраивают грамотную защиту. На странице https://www.femida-law.com/ можно оставить заявку и получить необходимую информацию об услугах.Специалисты работают в Ногинске, контактные данные указаны на сайте.

  23. Anonymous says:

    Какой бы домашний халат (махровый, шелковый или вафельный) вы бы не выбрали, он всегда позволит комфортно провести время, а приобрести его можно по ссылке https://ev-k.ru/shop/khalaty/ — в магазине с большим ассортиментом. В перечне товаров есть и халаты одного цвета, и разноцветные — любой пользователь сможет удовлетворить свой запрос. Здесь есть как халаты для мужчин, так и для женщин — домашняя одежда пошита для всех желающих, кто любит принимать горячий душ, а потом релаксировать. Чтобы быстро найти желаемую позицию, можно воспользоваться навигационной панелью, расположенной справа от списка.

  24. Anonymous says:

    Смоленские срубы для бани и дома на сайте https://xn--90atcilcdr.xn--p1ai/ можно купить – строительство крепких домов под ключ из дерева, которые сберегают тепло, всегда происходит ответственно. Со стороны мастеров компании прилагаются усилия, чтобы деревянные строения по избранным проектам возводились действительно качественно. Подбор нужных материалов всегда осуществляется верно со стороны специалистов компании. Оценить многогранность предложений компании можно на сайте, а заказ сруба для дома доступен при заказе по телефону.

  25. Anonymous says:

    На сайте https://bogema.io/ вы найдете большой выбор обучающих онлайн-курсов в различных сферах. Подписавшись на премиум-рассылку, вы по выгодной цене получаете доступ ко всем образовательным курсам по графическому дизайну, оптимизации сайтов, иностранным языкам, программированию, психологии и многое другое. На сайте представлена обширная база курсов, которая постоянно обновляется. Предлагается безопасный и полезный контент, после оплаты премиума вы получаете доступ ко всем материалам.

  26. Anonymous says:

    cialis generic name how to buy cialis buy cialis online cheap

  27. Anonymous says:

    На портале https://postroidomsam.ru предлагается масса полезной информации на тему ремонта и строительства.Здесь вы узнаете, как самостоятельно утеплить пол, обустроить стены, подвести коммуникации, установить входные и межкомнатные двери. В помощь предлагаются детально расписанные рекомендации, советы от профессиональных строителей, что позволит быстро и качественно сделать ремонт своими силами. Воспользуйтесь рекомендациями, чтобы сэкономить на услугах специалистов.

  28. Anonymous says:

    В интернет-магазине https://vitamax.shop/ можно приобрести оригинальную продукцию компании Витамакс.В каталоге представлены витаминные и минеральные добавки, средства для снижения веса, гепатопротекторы, препараты для улучшения работы жкт и нормализации обмена веществ, добавки для улучшения иммунитета и женского здоровья. Покупателям предлагаются качественные товары для здоровья по выгодной стоимости. Здесь можно приобрести биодобавки со скидкой и доставкой по всей России.

  29. Anonymous says:

    На веб-ресурсе https://profistrah.ru/ можно найти удобный калькулятор страхования, который поможет быстро рассчитать стоимость страховки в разных компаниях. Кроме калькуляторов, на странице можно ознакомиться с полезными тематическими статьями о страховании на все возможные случаи. После прочтения Вы сможете намного быстрее сориентироваться при выборе страховых услуг, будете знать соответствующие нюансы. Если у вас остались вопросы, их можно задать в специальной форме обратной связи или позвонив по номеру телефона, указанному на странице.

  30. Anonymous says:

    Новостройки в Санкт-Петербурге и Москве на сайте https://spb.adresanovostroek.ru/ можно просматривать. Благодаря использованию данного сервиса, доступными становятся более 50 000 предложений с ценами от надежного застройщика. Подбор квартиры в новостройках осуществляется по параметрам, которые излагает заказчик. Квартиры доступны как с отделкой, так и без нее. Использовать можно достаточно просто акции, скидки, горячие специализированные предложения.

  31. Anonymous says:

    Информационный ресурс https://auto-parad.ru/ создан для публикации сообщений на автомобильные темы, здесь представлено большое количество познавательного контента. На сайте можно ознакомиться с обзорами, полезными статьями, а также текстами о том, что делать во время дорожно-транспортного происшествия — для этого есть раздел «Авто-юрист». Также на сайте можно прочитать обзоры экспертов и личные мнения тех, кто опробовал некоторые автомобили или модификации на машину. Чтобы на сайте можно было быстро сориентироваться, созданы тематические разделы — так каждый сможет быстро найти интересующий его контент.

  32. Anonymous says:

    Компания предлагает услуги изготовления овалов для памятников. На сайте https://foto-ovali.ru/ представлены различные дизайны фотоовалов, которые отличаются по цвету фона, характеру окантовки и виду надписи.Здесь можно заказать фотоовалы, таблички, арки из акрила, металлокерамики, стекла, закаленного стекла. Для оформления заказа предлагается подробная форма, где нужно указать тип изделия, материал, цвет, выбрать окантовку и вариант надписи. Актуальный прайс с ценами и контактные данные также представлены на сайте. Изделия доставляются почтой по всей России.

  33. Anonymous says:

    Одна из стратегий трейдинга — это работа по сигналам, и узнать о ней можно по ссылке https://signal.pro-traiding.ru/ — по ссылке можно получитьинформацию о том, как работают сигналы и почему они эффективны. Трейдер будет получать от системы уведомления о совершаемых сделках и должен решать, будет ли он в ней участвовать. Сигналами может пользоваться и новичок, и опытный пользователь, который хочет сэкономить время. Это отличный способ оптимизации заработка, который повышает шансы на хорошую прибыль без больших затрат времени на изучение других стратегий.

  34. Anonymous says:

    На сайте https://zvonil.online/ можно узнать, откуда вам звонили с незнакомого номера. Введите номер телефона в специальную форму, после чего вы узнаете его номер регистрации и можете почитать отзывы, которые оставляют пользователи, столкнувшиеся с мошенниками. Так вы будете знать, кто вам звонил и стоит ли перезванивать. На сайте представлена обширная база номеров мошенников, которые под разными предлогами требуют деньги. Так вы сможете защитить себя и сохранить финансы.

  35. Anonymous says:

    В интернет-магазине http://master5.ru предлагается большой выбор техники, которая используется для обустройства дома и участка.В ассортименте представлены бетономешалки, лестницы, насосные станции, трубы, электроинструменты, а также запчасти и комплектующие, которые понадобятся в работе. Товары разделены в каталоге по категориям, что облегчает поиск и выбор. Обратите внимание на выгодные предложения со скидками. Доставка осуществляется в Москве и Подмосковье, а также в другие регионы России.

  36. Anonymous says:

    Сайт http://bizgaz.ru/ предлагает познакомиться с новостями, характер которых является деловым. Этот портал работает с 2012 года, а сегодня издание выпускает новости исключительно в цифровом формате. На постоянной основе на площадке публикуются социальные, политические, а также деловые и иные новости разных регионов. Широко освещаются события республик Адыгея, Крым и города Севастополь, а также Ростовской и Волгоградской областей, Краснодарского и Ставропольского краев.

  37. Anonymous says:

    Узнать об одной из действенных стратегий трайдинга можно по ссылке https://indicators.pro-traiding.ru/ и начать ею пользоваться. Trend Indicator поможет пользователям определять, в каком состоянии на данный момент рынок, на какой он позиции, чтобы выбрать наиболее выгодный момент для входа. Если использовать представленный индикатор, это позволит серьезно повысить шанс на получение хорошего заработка. Узнать больше информации о стратегии можно, если прочитать опубликованную на сайте по ссылке информацию. Там же опубликованы линки, которые могут быть полезны новичкам.

  38. Anonymous says:

    Fantastic beat ! I would like to apprentice while you amend your website, how can i subscribe for a blog web site?
    The account helped me a acceptable deal. I had been a
    little bit acquainted of this your broadcast provided bright clear concept

    Visit my website; buy lamivudin

  39. Anonymous says:

    Хорошую работу для женщин отыскать на сайте https://rdv-agency.com/ можно. Деньги нужны часто уже сейчас, однако без опыта и образования, а также полезных связей их заработать непросто. Во многих городах обеспечить желания и потребности можно с помощью обращения к данному проекту. Быть успешнее можно действительно быстро. Красиво одеваться, отдыхать на море, иметь самостоятельность и независимость уже смогли многие девушки из России и Украины. Решить финансовые проблемы – просто!

  40. Anonymous says:

    На сайте http://lex-center.ru/ можно заказать юридическую консультацию и услуги адвоката. Специалисты компании «Лекс Центр» ведут гражданские дела, предоставляют грамотную защиту бизнеса, сопровождают сделки. Юристы помогут составить и подать документы, проконсультируют, предоставляют корпоративное обслуживание юридических лиц. На сайте можно узнать стоимость, заказать консультацию, узнать нюансы сотрудничества. Адвокатская консультация работает в Санкт-Петербурге, контактные данные для связи указаны на сайте.

  41. Anonymous says:

    Онлайн-журнал Columbist рассказывает о современной жизни Берлина, его жителях, модных трендах, еде, культуре и других аспектах этого многонационального города. На сайте https://thecolumbist.com/ публикуются интересные заметки, новости, освещаются важные культурные события и необыкновенные истории, связанные с городом.Журнал создан для туристов и экспатов, которые хотят больше узнать о городе из первых уст. Журнал составляют журналисты, жизнь которых связана с Берлином, поэтому в подлинности и актуальности информации не приходится сомневаться.

  42. Anonymous says:

    Трейдинг — это популярный способ заработка, и узнать о нем можно на сайте https://pro-traiding.ru/ — изучив тематический портал, можно получить развернутые сведения по данному вопросу. На странице опубликованы полезные статьи, а также видео, которые можно смотреть и слушать на досуге, чтобы узнавать много нового. Новички могут воспользоваться опубликованными рабочими стратегиями, чтобы быстрее влиться в трейдинг. Для тех, кто мало знает о разных биржах, есть раздел с обзорами, чтобы было проще выбрать подходящую рабочую площадку.

  43. Anonymous says:

    Красивые номера на сайте https://royalnumbers.com.ua/ с разными началами и поистине подходящими цифровыми комбинациями можно купить просто. Операторы Украины могут выпускать часто хорошие номера, и потому мы подбираем варианты хорошие. Покупатель может подобрать наилучшие телефонные номера – при этом, можно применять номера на свое усмотрение. Покупать телефонные номера можно также и для своих знакомых, близких и друзей. Связаться для покупки можно по указанным контактным данным.

  44. Anonymous says:

    Ремонтные работы по восстановлению кровли в Москве проводятся компанией по ссылке https://dvk-stroi.ru/ — это официальная страница команды специалистов-кровельщиков. Компания готова оказаться услуги по ремонту и монтажным работам крыши. На сайте можно ознакомиться с условиями предоставления услуг, а также с прайс-листом, чтобы можно было сразу прицениться. Компания работает не только в Москве, но и в Московской области, поэтому на странице по ссылке можно узнать, в каких населенных пунктах и районах можно заказать услуги профессиональных кровельщиков.

  45. Anonymous says:

    За установкой и ремонтом ворот и рольставней в Москве и области обращайтесь в компанию RemRol. Сотрудники компании специализируются на установке разных видов ворот – автоматических, секционных, распашных, откатных, а также ремонтируют рольставни, используя качественные запчасти. По ссылке https://remrol.ru/ можно узнать об услугах и заказать установку дверей или рольставней.Работы проводятся специалистами с большим опытом, на используемые запчасти предоставляется гарантия.

  46. Anonymous says:

    Интернет-магазин https://m2sputnikspb.ru/ предлагает уникальное решение для путешественников и всех, кто хочет свободно общаться с иностранцами без знания языка. На сайте можно заказать беспроводные наушники-переводчики, которые позволят без проблем понять собеседника. Система быстро переводит разговор и передает информацию через наушник. Наушники также можно использовать для прослушивания музыки. Они автоматически подключаются к смартфону и работают без подзарядки 6 часов.

  47. Anonymous says:

    Самые маленькие камеры можно купить на сайте https://minicamera.ru/ — в каталоге представлен широкий ассортимент видеогаджетов, наушников и других аксессуаров. Площадка предлагает даже маленькие телефоны, видеоглазки и просто камеры для системы видеонаблюдения, работающей от сигнала Wi-Fi. Камеры могут устанавливаться для разных целей, например, для слежения за порядком перед домом, для контроля работы домработницы или няни. На сайте можно не только ознакомиться с каталогом, но и узнать о доставке, оплате и гарантии на товары, а также о скидках на некоторые позиции.

  48. Anonymous says:

    HC Retinol Serum: Bir A vitamini formu olan Retinol, ince çizgilerin ve yaşlanma belirtilerinin görünümünü azalttığı klinik olarak
    kanıtlanmış güçlü bir aktiftir.

    Retinol aynı zamanda leke oluşumuna ve ciltteki ton eşitsizliklerine karşı mücadele eder.

    Canlı, taze ve daha genç bir cilt görünümü kazandırmaya yardımcı olur.

    HC Retinol Serum’un, en ileri düzeyde konsantre edilmiş saf Hyaluronik Asit,
    Pentavitin (Saccharide Isomerate), Anadenanthera Colubrina
    Bark Extract ve Bisabolol ile güçlendirilmiş
    aktif içeriği, güçlü nemlendirici ve canlandırıcı özelliği sayesinde cildi sıkılaştırmaya yardımcı olur.

    HC Retinol Serum akneli ve yağlı ciltlerde, lekelerde ve ciltte oluşan A
    Vitamini eksikliğinde kullanılır.

    Bu tür ciltlerde daha iyi bir etki alınabilmesi için HC Çay Ağacı (Tea
    Tree) Temizleme Jeli ile birlikte kullanılması
    tavsiye edilir.

    Retinol Serum

  49. Anonymous says:

    Бонсай недорого можно на сайте https://bonsay.ru купить. Инструкции по уходу, а также подарочные наборы, статуэтки и клубная карта предоставляются при покупке каждому клиенту. Доставка бонсая осуществляется по Московской области и Петербургу за 2 часа. По Москве доставка производится всего лишь за час. Если товар доставляется по России, то для этого потребуется 2 дня. Консультации также всегда предоставляются. Московский адрес для желающих приехать указан на сайте.

  50. Anonymous says:

    sell casino script goldsvet 6.5 https://www.win-game.net/

  51. Anonymous says:

    На сайте https://ars-games.ru предлагаются бесплатные уроки по информатике в онлайн-формате.Здесь вы найдете полезную информацию для освоения возможностей компьютера, которая составлена с учетом школьной программы. На сайте вы найдете решенные домашние задания, что облегчит работу ученикам и поможет разобраться в теме. Здесь представлены решебники по информатике для учащихся разных классов. Информация на сайте постоянно обновляется в соответствии с актуальными изменениями.

  52. Anonymous says:

    Электронный сервис https://xn--e1afboiidhj0d.xn--p1acf/ принадлежит команде, занимающейся строительством печей, каминов и барбекю в Москве. У команды большой опыт работы, поэтому все ее члены работают с учетом профессиональных стандартов и делают качественные конструкции. И печь, и камин может не только согреть, но и дополнить интерьер, а с помощью барбекю лето станет еще более интересным. На страничке по ссылке можно узнать все услуги, а также посмотреть готовые проекты. В портфолио указывается, сколько длилась стройка, чтобы было проще оценить возможные затраты по времени.

  53. Anonymous says:

    На сайте https://casino-avtomati-onlain.com/top-kazino/joy-casino-onlain.html доступно популярнейшее онлайн-казино ДжойКазино. Здесь представлен большой выбор игорных развлечений – слоты, настольные игры, автоматы с прогрессивным джекпотом, ставки на спорт и многое другое. Играть в онлайн-казино можно на гривны. За первый депозит игрок получает бонусы и бесплатные вращения. Для пополнения счета и вывода средств предлагается несколько удобных способов.

  54. Anonymous says:

    sell casino script sports bet https://www.win-game.net/

  55. Anonymous says:

    What’s Taking place i am new to this, I stumbled upon this I’ve discovered It
    positively useful and it has aided me out loads.
    I am hoping to contribute & assist different customers like its aided me.
    Great job.

    Have a look at my web blog … asmr in

  56. Anonymous says:

    What’s up friends, its enormous post on the topic of cultureand
    fully explained, keep it up all the time.

    Also visit my web blog … takipçi satışı yapan site

  57. Anonymous says:

    На сайте http://www.xn—57-fddotkqrbwclei3a.xn--p1ai/ заказать можно услугу уничтожения насекомых туманом. В Орле эта услуга предоставляется без запаха. Уничтожение насекомых всегда происходит быстро. Кроме этого, также оказывается услуга удаления плесени. Для заказа услуги, можно обратиться по телефонным номерам, которые указаны на сайте. Обработки проходят всегда по предварительной записи. График работы компании указан на сайте.

  58. Anonymous says:

    На сайте https://supro.pro можно купить специальные присадки, которые помогут механизмам автомобиля прослужить дольше. Компания предлагает широкий выбор соответствующих товаров для легкового и коммерческого транспорта. Кроме того, команда осуществляет ремонтные работы, например, регулировку клапанов, замену ГРМ, сцепления, ремонт системы охлаждения и так далее. Больше информации обо всех услугах можно узнать на сайте или позвонив по указанному контактному телефону.

  59. Anonymous says:

    На сайте https://magiya-gadaniya.ru/ предлагаются бесплатные онлайн-гадания на все случаи жизни.Если вы ищете работу, хотите проверить отношения и понять, что вас ожидает в финансовой сфере, выбирайте гадания из интересующей вас категории. Простые онлайн-гадания предоставят подробные ответы на волнующие вас вопросы. Выбирайте в меню интересующее вас гадание, чтобы получить ответы на свои вопросы быстро и абсолютно бесплатно. Вы можете гадать столько раз, сколько будет нужно.

  60. Anonymous says:

    Именно на сайте https://magdeti.ru/ отыскать можно расширенный товарный ассортимент. Заказ на сайте очень просто оформляется. Перед совершением заказа, желательно ознакомиться с фактами, изложенными на сайте. Игрушки всегда ввозятся на территорию России официально. Кроме того, на них также оформлены сертификаты. Для возможного возврата или обмена, покупателю дается около месяца времени. Интернет – магазин работает официально. По стоимости доставки при приобретении может сориентировать наш менеджер.

  61. Anonymous says:

    Благодаря ссылке https://www.litprichal.ru/pozdravleniya/ не придется самостоятельно придумывать поздравления. Самые красивые фразы и пожелания уже составили опытные писатели и поэты, так что их можно позаимствовать на сайте. Здесь есть множество поздравлений на самые разные праздники: дни рождения, годовщины, именные поздравления, если хотите особенно персонифицировать подарок. Если подготовлен особенный подарок, который также нужно подчеркнуть, на сайте есть поздравления к определенным предметам, например, бутылке шампанского.

  62. Anonymous says:

    Instagram takipçi konusu oldukça büyümüştü kişiler tarafından itibar görmekte.
    Instagram kullanıcılarının yakından ilgilendiği bu hizmetler sayesinde,
    kullanıcılar Instagram kapsamında ki tüm desteğe sahip olmaktadır

    Günümüzde en çok kullanılan toplumsal medya vasıtalarından Instagramı, takipçi kazanarak geliştirmek, normal olarak mümkündür.
    fakat internet ortamında binlerce takipçi site mevcut
    olduğu benzer biçimde her sitenin de doğal takipçi üretmediğini unutmamak gerekiyor.
    normal olarak web ortamında ki her site, naturel takipçi kazandırmayacaktır.

    Takipçi Satın AL

  63. Anonymous says:

    Instagram Takipçi Satın Alma Hizmeti

    Kişiler instagram da öncelikle takipçi satın almak isterler çünkü Fazla takipçi adedi
    olan hesaplar, daha çok ilgi çeker daha çok kişinin onu takip etme isteğini uyandırır
    Bu sebepten firma, Size dilediğiniz kadar takipçi paketleri sunuyor.

    1000 takipçi den 100.000 takipçiye kadar gönül rahatlığı güvenli ödeme ile ,
    instagram takipçi satın al hizmetini hemen alabilirsiniz.

  64. Anonymous says:

    Нашел для себя интересный портал.
    https://profhim4istka.ru
    Скорее нужно глянут!

  65. Anonymous says:

    Заработок в интернете возможен и без вложения денежных средств, нужно только найти источник полезной информации, чтобы выбрать правильное направление. На сайте https://zarabotok-v-internete-bez-vlozheniy.ru/ представлено множество вариантов онлайн-заработка без инвестирования и финансового риска.Информация понадобится тем, кто хочет начать зарабатывать в интернете и ищет для себя перспективные возможности. Заработок на просмотрах, рекламе, выгодные партнерские программы – эти и многие другие темы подробно рассматриваются на портале.

  66. Anonymous says:

    Продвигать социальные сети можно по ссылке https://soclmed.ru/ — здесь можно заказать подписчиков, лайки, комментарии и другую активность в аккаунте. Компания охватывает все популярные социальные сети и даже поможет раскрутить аккаунт в TikTok. На главной странице можно увидеть список социальных сетей, с которыми работает компания, а также спектр предоставляемых услуг. Там же опубликованы ответы на самые популярные вопросы, чтобы можно было сразу понять, как сотрудничать со специалистами и раскручивать свой аккаунт.

  67. Anonymous says:

    En iyi leke kremini düşünecek olursak eğer ve bu araştırma işinie girdiyseniz sizlere
    tavsiye leke kremi olarak hc nin leke kremini öneriyoruz.
    Cilt lekelerinize artık son verebilirsiniz.
    Tamamen sağlıklı olup doğal ürünlerden oluşmaktadır.

  68. Anonymous says:

    Посмотреть обзоры игр и свежие кинематографические новости прочитать на сайте https://kinogames-info.ru/ в любое удобное время можно. Подборки игр и игрофильмы постоянно обновляются на сайте. Новое и интересное из ТОП-списков всегда можно посмотреть. На сайте можно найти хорошие новости даже во время, которое для кинематографа является сложным. Трейлеры кассовых фильмов разных годов всегда можно посмотреть, чтобы составить верное мнение о фильмах до их просмотра.

  69. Anonymous says:

    Веб-ресурс https://www.polokron.ru — это магазин домашнего текстиля в Москве, который можно купить оптом. В каталоге можно найти подушки, пледы, полотенца, постельное белье и многое другое. Товары можно приобрести как себе, так и знакомым, чтобы сделать приятный сюрприз, или же оснастить свой отель. Фирма работает с клиниками, заведениями общественного питания, общежитиями и другими организациями, где нужен большой объем продукции из текстиля. О том, как сделать заказ, можно узнать на сайте в соответствующих разделах или уточнить у менеджера.

  70. Anonymous says:

    На странице https://satu.msk.ru можно ознакомиться с ассортиментом защищающего от грязи покрытия. Такие коврики кладут на входе в здание, в тамбуре, а также в вестибюле. О специальную поверхность вытирают ноги, заходя с улицы, а рельеф коврика очищает обувь от грязи. На сайте можно ознакомиться со всеми вариантами покрытия, а также со сферами их использования. Кроме того, по ссылке есть контактный номер телефонов, позвонив на которые можно получить консультацию или сразу оформить заказ на покупку и доставку.

  71. Anonymous says:

    Электростанции дизельные на сайте https://neoenergo.ru/ реализуются. Крупная российская инжиниринговая компания имеет достаточно ресурсов, чтобы удовлетворить потребности каждого человека. Производственные, строительные и проектные мощности позволяют поставлять и реализовать станции оперативно. Обслуживание и пакетирование осуществляются всегда ответственно. Для покупки электростанции дизельной, можно просто связаться с нами по телефону.

  72. Anonymous says:

    По ссылке https://www.youtube.com/c/Pianinkin вы попадаете на ютуб-канал Пианинкин, где можно слушать и угадывать известные хиты, которые исполнены на электропианино. На канале представлены видео, где предлагается угадать песню по картинкам, мелодии, а также в чат-рулетке. Новые видео выходят регулярно, они не оставят равнодушными любителей музыки и помогут весело и интересно провести время. Лучшие ролики с музыкальными ремиксами собраны в отдельную подборку для ценителей.

  73. Anonymous says:

    Стандартный ремонт на сайте https://kvartiragotova.ru/ всегда осуществляется при условии применения качественных отделочных материалов. Экономить средства заказчика специалисты умеют действительно хорошо. Электрика меняется быстро, а разработка проектов и монтаж всегда осуществляются комплексно. Отделка помещений осуществляется всегда быстро, а сантехника устанавливается ответственно. Ремонты бизнес – класса под ключ заказать можно в любое время.

  74. Anonymous says:

    Минимальный депозит от 20000$ на сайте https://finikomylove.ru/ может дать действительно ощутимый результат. Как ввод, так и вывод депозита может осуществляться в биткоинах и USDT. Чтобы оформить профиль правильно, до начала инвестирования нужно будет отправить данные на верификацию, используя при этом инструкцию. После пополнения баланса в личном кабинете, нужно будет купить индекс CTI в личном кабинете. Ежедневно можно получить прибыль с депозита в размере 1,0-1,1 %. Ежедневно можно выводить проценты.

  75. Anonymous says:

    Игральные карты — огромный мир, и это понимают на веб-ресурсе https://cardsdealer.ru/ в магазине игральных карт. Для продажи предлагаются коллекционные колоды, для иллюзионистов и покера, а также готовые наборы. Продукция распределена по разделам — клиенты быстро найдут тот товар, который они искали. На сайте постоянно предоставляются скидки, а также добавлена возможность купить колоду в магазине ebay. Больше информации о том, как пользоваться услугами компании и заказывать колоды, можно узнать непосредственно на сайте.

  76. Anonymous says:

    hello!,I really like your writing very so much! proportion we keep up a correspondence extra about your post on AOL?

    I need a specialist on this area to resolve my problem.
    Maybe asmr that‘s you!
    Looking ahead to look you.

  77. Anonymous says:

    Если вам интересна тема интернет-маркетинга, переходите по ссылке на сайт https://pavelrix.ru/ — это авторский блог, который расскажет всю необходимую информацию по теме. Платформа предоставляет возможность читать статьи по теме, смотреть полезные видео и ознакомиться с проверенными сайтами. Из статей можно узнать, как создавать описания товаров, как зарабатывать на Яндекс.Дзен, не допускать ошибок в ведении своего интернет-магазине и многое другое. Поэтому если нужно научиться интернет маркетингу, то сайт станет отличным помощником.

  78. Anonymous says:

    Продать или купить участок на сайте http://www.zem23.ru/ можно очень просто. Благодаря профессиональной помощи, можно сэкономить время. Участок подготавливается к продаже всегда ответственно. Демонстрация, подбор и оформление правильно всегда происходят. Землю оценить можно человек, сайт которого работает всегда круглосуточно, может бесплатно. Контакты, район и адрес города указываются на сайте. Информация по площади домов всегда предоставляется верно.

  79. Anonymous says:

    Онлайн-телевидение http://inttv.ru предлагает большое разнообразие каналов, где можно смотреть любимые кинофильмы, телепередачи, спортивные события, музыкальные клипы. На сайте представлены категории каналов, где можно подобрать все, что вам будет интересно. Смотреть новости, кино, мультфильмы, футбольные матчи, познавательные передачи удобнее всего через приложение. Выбирайте интересующую вас категорию для ознакомления со всеми предложениями. Онлайн-телевидение доступно на компьютере, планшете и смартфоне, для этого достаточно подключиться к интернету.

  80. Anonymous says:

    Жители Владимира могут воспользоваться сервисом на сайте https://skold.ru/ для заказа распечатки фотоснимков и получения прочих полиграфических продуктов. На основной странице размещен перечень доступных услуг, а также полезный контент. Тут указаны данные о том, какого размера фотографии можно напечатать, а также какая полиграфия доступна. Можно отправить на печать наклейки, флаеры, личные карточки, плакаты и многое другое. Там же описана инструкция о том, как сделать заказ, чтобы клиенты быстро ориентировались в услугах компании.

  81. Anonymous says:

    Шоппинг – данное прекрасный метод никак не только лишь отдохнуть, однако также существенно поменять собственный облик. Но в некоторых случаях шоппинг никак не дает ровным счетом ничего, помимо расстройства также лишних предметов, какие еще долгое время станут пылиться в войске.

    Промокоды для Cupshe WW – Промокоды, акции, черная пятница 2021 года

  82. Anonymous says:

    Keluaran HK result hongkong pools tercepat dan akurat.

  83. Anonymous says:

    Промокоды в большом многообразии на сайте https://promocody-ot-shpiona.ru можно отыскать. Информация об акциях, магазинах и предложениях на сайте всегда обновляется. В блоге регулярно обновляются тексты – там действительно много полезной информации. В гипермаркетах и интернет – магазинах часто можно найти реально выгодные расценки, а купоны иногда использовать можно действительно долгосрочно. Базовые футболки и другие товары часто продаются по доступным ценам – таких цен нельзя найти в других местах.

  84. Anonymous says:

    В списке на веб-сайте https://safari24.by/ можно найти много непродовольственных товаров, которые продаются в Минске. Есть раздел автомобильных и велосипедных запчастей, посуды, инструментов, комплектующих для компьютерной техники и многого другого. К преимуществам платформы относится не только широкий ассортимент, но и разные способы оплаты, удобная доставка и другие плюсы сотрудничества. Больше информации можно получить в тематических разделах сайта или позвонив по контактному номеру телефона.

  85. Anonymous says:

    sildenafil walmart sildenafil 20 mg viagra cvs

  86. Anonymous says:

    Телевизионные каналы на сайте http://inttv.ru в достаточном количестве представлены. По категориям и странам, а также иным параметрам каналы подбирать можно очень просто. Чтобы смотреть ТВ-каналы, нужно установить приложение. Детское телевидение, познавательные передачи и развлекательный контент доступны всегда. Новости узнавать, слушать музыку и кино смотреть можно в любых странах и населенных пунктах.

  87. Anonymous says:

    You can publish Jane’s story also on instagram and buy instagram followers to more students read it and discuss.

  88. Anonymous says:

    Great post! We will be linking to this particularly great
    post on our website. Keep up the great writing.

    My blog post – asmr (bit.ly)

  89. Anonymous says:

    roman sildenafil viagra 100mg viagra triangle chicago

  90. Anonymous says:

    Сайт по ссылке https://portlive.ru расскажет о новостях Ростовской области и самого города Ростов-на-Дону. Здесь представлены познавательные статьи, информационные заметки, публикации о бизнесе, политике и спортивных мероприятиях. Тексты о приготовлении кулинарных шедевров, о литературных произведениях, способах повышения продаж и многие другие не только полезны, но и интересны. Достаточно пройти простую регистрацию, чтобы абсолютно бесплатно получить доступ к дополнительным возможностям. А чтобы найти подходящий вашим интересам контент, нужно всего лишь ввести несколько ключевых слов по интересующей теме.

  91. Anonymous says:

    Сайт https://forexareal.ru посвящен теме торговли на форекс-рынке и поможет лучше разобраться в соответствующей системе. На главной странице можно получить основную информацию о торговой площадке, а также узнать, как сделать первые шаги в данном деле. Помимо небольшой инструкции о том, как начать торговать, на информационном портале опубликованы стратегии, новости, статьи и другая полезная информация. Еще рекомендуем посмотреть перечень брокеров и мошенников, чтобы понимать, кому можно доверять, а кому нет.

  92. Anonymous says:

    Купить оптом обувь детскую при помощи сайта http://integral.tomsk.ru можно очень просто. Долговечная продукция является очень надежной. На российском рынке компания работает длительно, а детская обувь продается по приемлемым ценам. Крупные производители брендовой обуви более 10 лет сотрудничают с компанией, а купить продукцию можно всего лишь в один клик. Предложения пополняются постоянно – ассортимент регулярно обновляется.

  93. Anonymous says:

    С помощью сайта https://mebelroom-krd.ru/ можно заказать мебель по собственному вкусу. Корпусная мебель для гостиной, спальни, прихожей и не только всегда есть в наличии. Мебель для отелей, гостиниц, домов отдыха и развлекательных заведений представлена в ассортименте в достаточном количестве. По индивидуальным и стандартным размерам производиться может мебель быстро под заказ. Кроме этого, купить матрасы можно как для взрослых, так и для детей.

  94. Anonymous says:

    viagra 100mg price sildenafil davis pdf home remedy viagra

  95. Anonymous says:

    Веб-ресурс http://fullinvest.ru/ расскажет, что такое бинарные опционы и как ими пользоваться для торговли. На сайте опубликованы полезные статьи, а также стратегии трейдеров, новости из мира бинарных опционов и другая нужная информация. Для удобства все тексты поделены на тематические разделы, чтобы в них было легче ориентироваться. Публикуются обзоры о мошенниках, чтобы вы знали об их методах и не попались на уловки. Сайт полностью полезен для понимания сферы бинарных опционов и рекомендуется всем новичкам.

  96. Anonymous says:

    На сайте https://www.liga-detstva.ru/ можно купить белорусскую детскую обувь оптовыми партиями. Чтобы сориентироваться по цене, нужно просматривать каталог. Наличие товара можно всегда уточнить на сайте. Кроме этого, каждый человек может также запросить актуальный прайс. На детскую обувь можно также получить скидку в розничном магазине. При приобретении качественной обуви, можно рассчитывать на информационную поддержку.

  97. Anonymous says:

    Именно на сайте https://perspektiva24vdk.ru/ можно отыскать предложения от различных застройщиков и по различным ценам. Получить персональную подборку квартир под собственные нужды может каждый человек. Чтобы выбирать, необходимо ответить лишь на 7 вопросов на сайте. На сайте подобрано действительно много предложений от застройщиков Владивостока – сотни объектов недвижимости представлены для просмотра и изучения. Недвижимость подбирать можно по различным административным городским районам.

  98. Anonymous says:

    У вас бывает такое, что, услышав крутой трек в фильме, вы не можете его нигде найти? Веб-ресурс https://kinomuzic.ucoz.ru/news/1-0-26 создан для того, чтобы все могли слушать треки из любимых фильмов, сериалов и других картин. Чтобы ваш поиск был комфортным, есть разделение песен по тематике, также можно воспользоваться строкой поиска. Музыку можно слушать сразу на сайте с помощью удобного плеера или скачать разными способами на свое устройство. Если вам нравится определённая песня, и вы хотите найти нечто похожее, вам будут показаны похожие варианты.

  99. Anonymous says:

    С помощью сайта https://kreslo-kupi.ru/ купить можно компьютерное кресло и парту. При этом, цены на все будут демократичными. Сформировать заказ и провести оплату можно любым удобным способом. Определить удобное время доставки можно самостоятельно, ведь компания всегда старается стать лучшим партнером и помощником для клиентов. Заказ мебели возможен по телефону, электронной почте. Кресла и стулья подбирать просто можно для баров, салонов и не только. Список городов, в которые могут доставляться товары, указан на сайте.

  100. Anonymous says:

    priligy for sale uk dapoxetine pharmacy

  101. Anonymous says:

    На сайте http://gamearmy.ru/monitoring представлен мониторинг популярных игровых серверов. Серверы разделены по странам, жанрам игр, популярности, дате добавления. Здесь всегда можно найти последние новинки для любителей стрелялок. Удобная навигация позволяет быстро найти нужную игру для мониторинга. На сайте регулярно пополняется перечень серверов для разных стран. Для каждой игры подготовлено краткое описание, что поможет сделать выбор. Следите за последними серверами или добавляйте сервер самостоятельно.

  102. Anonymous says:

    Чтобы оставаться красивой и желанной, можно посетить https://womensblog.pp.ua сайт от женщин для женщин. Здесь вы найдете для себя интереснейшие материалы. Статьи о семье, взаимоотношениях с мужчинами, детьми, советы при беременности, лайфхаки в области красоты и многое другое есть на сайте. Кроме этого, есть и другие полезные советы, которые помогут улучшить жизнь. Новости выходят постоянно, скучать вам не придется. Можно найти даже откровенные ответы на такие же вопросы — на портале нет места стеснению, ведь нужно предоставить читательницам реальную картину мира.

  103. Anonymous says:

    Сайт https://aromafiolent.ru предоставляет возможность приобрести натуральную косметику из Крыма, чтобы любой человек оставался красивым и молодым. В перечне предложений можно найти средства для волос, парфюмы, соль, выпаренную из морской воды, товары для поддержания здорового состояния организма, а также травяные сборы-чаи. Магазин предлагает продукцию от лучших крымских брендов, которые успели зарекомендовать себя как производители натуральных товаров. Также на сайте часто проводятся акции — пользователи могут купить любимые косметические средства по существенно сниженной стоимости.

  104. Anonymous says:

    Для всех уставших от поисков портала для покупки и продажи товаров создан сайт https://karedo.ru/ для быстрых и выгодных сделок. Любой пользователь сайта может абсолютно бесплатно открыть свой интернет-магазин и начать зарабатывать. Также площадка подойдет тем, кто хочет быстро реализовать тот или иной товар: хоть куртку, хоть диван. Для пользователей, которые хотят получить расширенный функционал сайта, есть ряд платных услуг. Кроме того, на сайте есть полезные статьи, с помощью которых отдельные категории товаров станут понятнее.

  105. Anonymous says:

    Компании, осуществляющие строительство различных объектов, отдельные специалисты-строители и клиенты могут перейти по ссылке https://stroyzakaz.net/ и опубликовать здесь свое сообщение. Использование сервиса совершенно бесплатно, чтобы каждый мог найти исполнителя или клиента. Это удобная и простая в использовании строительная биржа, на которой легко оставить свое предложение. Кроме доски объявлений и списка строителей и компаний, можно найти статьи и новости по соответствующей теме. Полезный контент не только даст ранее неизвестную информацию, но и поможет развлечься, пока клиенты пишут отклик на сообщение.

  106. Anonymous says:

    Благодаря сайту https://investzoloto.ru/kurs_zoloto/ можно быстро проверить курс золота в российских банках на сегодняшний день, а также узнать прогнозы изменения цены. Здесь есть перечень банков, также их курс купли и продажи золота. Ниже представлен график динамики изменения курса за последний 3 месяца, чтобы можно было составить прогноз, исходя из него. Еще на ресурсе есть дополнительные сведения о монетах и о других изделиях из этого драгоценного металла. Очень удобная опция — в графе аналитики уже можно ознакомиться с готовыми прогнозами.

  107. Anonymous says:

    Выход сексуальной энергии находится на сайте https://sexcall.online/ — тут собраны номера телефонов, позвоним по которым можно найти виртуальную подругу для интимных разговоров. Девушки, работающие на сайте, готовы на все, чтобы в процессе общения доставить максимальное удовольствие клиентам. Каждая барышня имеет свой номер телефона, позвонив по которому можно испытать невероятные ощущения от виртуального соития. Обратившись к удобному меню, можно определить свой регион России, чтобы точно дозвониться тем, с кем можно хорошо провести время.

  108. Anonymous says:

    Нашел полезный сайт спортивный направленности.
    https://1-xbet-zerkalo.ru
    Скорее нужно взглянуть!

  109. Anonymous says:

    С помощью материалов по ссылке https://soundsmix.com можно не думать о том, заблокируют ли ваше видео из-за нарушения авторских прав на аудиодорожку. На платформе представлено множество треков, которые не защищены авторским правом и распространяются по свободной лицензии. Блокировка контента не случится. Так, и профессионал, и любитель смогут создать контент любого типа с музыкальным сопровождением, которое не повлечет за собой никаких проблем. В каталоге сайта представлена музыка разных жанров, поэтому подобрать подходящую не составит труда. Чтобы скачать музыку, нужно зарегистрироваться, и можно пользоваться всем функционалом.

  110. Anonymous says:

    Лучшая база для тех людей, которые работают с брокерами — это бездепозитный бонус, и веб-сайт https://xn--90aaidbbkcjkn6acifbi1arek1ay5n.xn--p1ai/ поможет узнать, где его можно получить. Не все брокеры могут позволить себе так поощрять трейдеров, но некоторые все-таки радуют пользователей. Бонус может быть разного размера, но лучше выбирать по рейтингу брокера — в списке будет указана информация о сайтах, чтобы каждому было проще выбрать подходящий вариант. Еще на нашем сайте есть вся необходимая информация для новичков в работе с брокерами.

  111. Anonymous says:

    От том, как можно зарабатывать больше, можно узнать из статей, которые размещены по ссылке https://xn——cddcgbdkcccbzjcbcebg0a6diedb2em2a6a2m5a.xn--p1ai/ — информации очень много. За несколько лет на сайте собрано более сотни публикаций, в которых рассказывается о маркетинге, инфобизнесе, запуске собственного ютуб-канала и многом другом. После ознакомления ест возможность написать комментарий, что обычно делают те, кто посещает сайт образовательного центра. Новые статьи загружаются на данную страницу постоянно — веб-ресурс всегда располагает актуальной информацией.

  112. Anonymous says:

    Купить на сайте https://edenwood.ru/ можно массу прекрасных изделий из дерева. В каталоге можно найти мебель из массива дерева или небольшие деревянные аксессуары. Товары можно приобрести в качестве подарка, а также для того, чтобы украсить свой интерьер. Все позиции отличаются уникальность и практичностью – приобрести можно именно то, что обязательно пригодится, а не просто будет пылиться на полке. При этом стиль продукции понравится каждому. Творческая мастерская рада предложить широкий ассортимент изделий на любой бюджет.

  113. Anonymous says:

    Часто где в интернете можно наткнуться на рекламу графическими баннерами, и веб-площадка https://bannerswall.ru делает все возможно, чтобы такие услуги стали доступнее. Здесь можно быстро найти рекламодателя или вебмастера для рекламы, чтобы сработаться и начать зарабатывать деньги. Главное — соблюдать правила сервиса, с которыми можно ознакомиться в соответствующем разделе. Сервис доступен для каждого, поскольку и авторизация, и использование ресурса бесплатные. Быстрая ссылка стоит всего 2 рубля, о данной опции информация расположена на баннере справа.

  114. Anonymous says:

    Букмекерская контора Mostbet как по мне очень достоянная простая регистрация, частые бонусы при первой регистрации бонус к депозиту очень солидный, отзывчивая техподдержка и быстрые выплаты меня лично устраивает данный бк на все 100%
    Мостбет официальный сайт

  115. Anonymous says:

    С отзывами о тренинг-центре Евгения Гришечкина можно ознакомиться на сайте https://xn—–dlcccbkccvgcbjt5bit5a1c8fua2fb.xn--p1ai/ — тут находятся отклики тех, кто уже занимался на курсах. На веб-страницу постоянно добавляются новые сообщения. С 2019 года на сайте собрано несколько десятков подробных рецензий о деятельности тренинг-центра. Авторы сообщений рассказывают о своем опыте учебы, а также раскрывают суммы, которые они смогли заработать, получив ценные советы от именитого тренера. Представители разных профессий смогли выйти на новый уровень, благодаря образовательному центру.

  116. Anonymous says:

    Чтобы на мероприятии было все специальное оборудование, можно зайти на страницу https://t-audio.com/ — тут есть все, что нужно.. Уже больше двух десятилетий компания занимается сдачей в аренду светового и звукового оборудования, а также приборов для спецэффектов и конструкций для сцен. На веб-странице можно ознакомиться с кейсами, представленными в портфолио. Кроме того, сайт предлагает к ознакомлению политику компании в отношении формирования цен на предоставляемые услуги. Больше информации можно получить через различные способы обратной связи.

  117. Anonymous says:

    Сегодня очень важно быстро обменить электронные деньги, и сервис https://obmenneg.com/ отлично с этим справляется. Это сервис, в котором можно проводить операции по обмену и обычных денег, и криптовалюты, осуществлять переводы между картами банков, онлайн-кошельков и тому подобное. Здесь не требуется авторизация, а еще нет ограничений на наименьшую сумму перевода. Уже на второй ступени создания заявки пользователь может увидеть сумму, которую он получит в результате перевода. Подробности узнаете, перейдя по ссылке, либо при использовании нашего обменника.

  118. Anonymous says:

    Ich habe im Internet etwas Interessantes gefunden. Gut fur Sportler.
    Sport Deutschland
    Es ist sehenswert. Haben Sie einen schonen Tag, jeder!

  119. Anonymous says:

    Gefunden etwas Unerwartetes. Es wird fur Sportler interessant sein.
    Gesundheit
    Achten Sie darauf, einen Blick darauf zu werfen. Viel Gluck an alle!

  120. Anonymous says:

    Ich bin auf etwas Interessantes gesto?en. Nutzliches medizinisches Material.
    Gesundheit
    Ein Blick lohnt sich. Haben Sie einen schonen Tag, jeder!

  121. Anonymous says:

    Книги, являющиеся фантастикой можно почитать на сайте https://skachat-fb2.net/ — тут представлены произведения, которые можно читать на любом современном устройстве. Электронные книги доступны всем желающим. Чтобы загрузить то или иное произведение, достаточно кликнуть по понравившейся обложке. Линки со страницы с каталогом произведений ведут к развернутому их описанию, тут же можно выбрать расширение файла для скачивания. Никакой лишней информации в каталоге — любой пользователь видит названия представленных на сайте романов и может быстро выбрать, что почитать.

  122. Anonymous says:

    В каких продуктах питания магния больше всего? Официальный сайт препарата Магнелис В6. Препарат Магнелис В6 — когда нужен магний.

    https://infobuh.com.ua/sitemap-3.xml

  123. Anonymous says:

    На странице https://grishechkin.ru/ расположен официальный сайт бизнес-тренера Евгения Гришечкина. Интернет-предприниматель готов помочь каждому, кому исполнилось 25 лет, чтобы выйти на новый уровень заработка. Специалист уже не первый год проводит тренинги и может подтвердить свои результаты цифрами и прочими фактами. Благодарные клиенты даже оставили свои отзывы на странице предпринимателя, и они рекомендуют пользоваться тренингами Евгения. Любой человек может получить практические навыки, которые кардинально изменят его жизнь.

  124. Anonymous says:

    Tremendous issues here. I am very happy to look your post.
    Thank you so much and asmr I’m having a
    look ahead to touch you. Will you please drop me a mail?

  125. Anonymous says:

    Никак Не все без исключения согласованны в форма наушников, во каковых слышен внешний вид общество, если ходишь согласно улице, трудишься во кабинете либо летишь во аэроплане. Также инженеры Sony
    наушники

  126. Anonymous says:

    Прочная, высококачественная, дешевая также престижная меблировка согласно персональному заказу в Владимире Владимирской сфере, но кроме того также во Столице Столичной сфере непосредственно со производства МФВ по оптовым ценам также во розницу. Во нашем мебельном сеть интернет-торговом центре присутствие изготовлении Вам сможете приобрести меблировка, что Для Вас приглянется либо выбрать меблировка согласно собственному дизайну, привкусу также объему со осторожной доставкой также опрятной также высококлассной сборкой.
    мебель на заказ по индивидуальным размерам

  127. Anonymous says:

    It’s gamefly an
    remarkable post in support of all the web users; they will obtain advantage from it I am sure.

  128. Anonymous says:

    Robofixer.ru – низкие цены на ремонт роботов-пылесосов

  129. Anonymous says:

    Робофиксер – низкие цены на ремонт роботов-пылесосов

  130. Anonymous says:

    what is chloroquine used for https://chloroquineorigin.com/ chlorowuine

  131. Anonymous says:

    what is the brand name for the generic drug for viagra in canada https://canadaviagrastore.com/ anyone order viagra from canada

  132. Anonymous says:

    erectile photos https://canadaerectiledysfunctionpills.com/ erectile dysfunction exercises

  133. Anonymous says:

    canadian pills pharmacy https://canadapillstorex.com/ best canadian mail order pharmacies for diet pills

  134. Anonymous says:

    Ищешь сайт, где можно скачать рингтоны для своего телефона? По ссылке https://ringtonbaza.com/ есть все необходимое. Любой пользователь может не только загрузить ту композицию, которая понравилась, но и, нажав на сердечко, добавить трек в список избранного. Пройдите простую авторизацию, и вам станут доступны расширенные функции библиотеки рингтонов. Вы можете найти тут, как мелодии-хиты, так и композиции, которые стали популярными за последнее время. Все они сгруппированы по категориям: русские, зарубежные и т. д. Теперь каждый может прокачать свой смартфон, установив рингтон своей мечты!

  135. Anonymous says:

    По ссылке https://xn—-dtbbchbcsbfle4bf8a0ipa.xn--p1ai/ можно найти больше информации о бизнес-тренере Евгении Гришечкине. Интернет-предприниматель работает уже не первый год и помог сотням людей выйти на новый уровень заработка. Страница по ссылке расскажет о том, как блогер получает доход и какие достижения успел получить. Тренер рассказывает о своей миссии — прокачать эффективность любого обратившегося к нему человека. Всего несколько тренингов смогут прокачать нужные бизнесмену навыки и кардинально изменить жизнь.

  136. Anonymous says:

    cialis pillendienst instructions for cialis disfuncion erectil cialis 5 mg

  137. Anonymous says:

    cialis pzn levitra dosage cialis lexomil

  138. Anonymous says:

    cialis c5 pill generic cialis tadalafil cialis 5mg vaikutus

  139. Anonymous says:

    Скачать фильмы с торрента бесплатно, быстро и в хорошем качестве без регистрации на нашем сайте.
    https://small-biznes.com

  140. Anonymous says:

    I’m truly enjoying the design and layout of your site.
    It’s a very easy on the eyes which makes it much more pleasant for me to come here and
    visit more often. Did you hire out a designer to create your theme?
    Superb work!

    my website: that asmr

  141. Anonymous says:

    Heya just wanted to give you a brief heads up and let you know a few
    of the images aren’t loading properly. I’m not sure why but I
    think its a linking issue. I’ve tried it in two
    different internet browsers and both show the
    same outcome.

    Also visit my blog :: asmr there

  142. Anonymous says:

    sildenafil price in usa https://eunicesildenafilcitrate.com/ sildenafil 200mg online

  143. Anonymous says:

    Hey! This post could not be written any better! Reading through this post reminds
    me of my previous room mate! He always kept talking about this.
    I will forward this page to him. Pretty sure he will have a good read.

    Many thanks for sharing!

    my web page; asmr what

  144. Anonymous says:

    buying canadian cialis https://canadacialisstore.com/ is it safe to order cialis from canadian pharmacy

  145. Anonymous says:

    Для тех, кто любит кинематограф, но не любит посещать общественные места и предпочитает проводить свой досуг дома, существует прекрасная альтернатива походу в шумный кинозал

    https://forumzavoda.net/sitemap-1.xml

  146. Anonymous says:

    Asking questions are in fact good thing if you are not understanding something completely, but this piece of
    writing presents fastidious understanding yet.

    Here is my page :: gamefly for

  147. Anonymous says:

    Для тех, кто любит кинематограф, но не любит посещать общественные места и предпочитает проводить свой досуг дома, существует прекрасная альтернатива походу в шумный кинозал

    https://adrenalin-tour.com/sitemap-3.xml

  148. Anonymous says:

    Thank you for some other wonderful article. The place
    else could anyone get that type of information in such a perfect method of writing?
    I’ve a presentation subsequent week, and I am on the look for such information.

    Feel free to visit my web page nice

  149. Anonymous says:

    Свой веб-сайт сможет помочь Для Вас стремительно понять во законах вид развлечения также извлекать благодарные композиции ранее со 1-ый вращений барабанов. По Какой Причине непосредственно Azino777? Но неужели имеют все шансы являться колебания? В Случае Если вам хорошо понимаете во игровых автоматах, в то время Вам четко представляете свойства наилучших интернет клубов: порядочность, безопасность, большой степень дисперсии также обширный перечень игр. Все Без Исключения данное имеется около нас!
    Игры 777

  150. Anonymous says:

    Произвести поисковое продвижение сайта, поднять ИКС сайта, улучшить позиции сайта, привлечь целевой поисковый трафик – все это теперь легко, как никогда. Для этого Вам достаточно воспользоваться размещением ссылок с ИКС от 10 и получить долгожданный результат на сайте: http://proflinks.ru/

  151. Anonymous says:

    Спасибо за помощь в этом вопросе.

    схемы для заработка

  152. Anonymous says:

    Just wanna remark on few general things, The website style and design is perfect, the content is real fantastic : D.
    온라인카지노

  153. Anonymous says:

    It’s exhausting to seek out educated individuals on this subject, however you sound like you understand what you’re talking about! Thanks
    메리트카지노

  154. Anonymous says:

    Very interesting information!Perfect just what I was searching for! “I live in company with a body, a silent companion, exacting and eternal.” by Eugene Delacroix.
    스포츠토토사이트

  155. Anonymous says:

    “Everything is very open with a precise explanation of the challenges. It was definitely informative. Your website is useful. Thanks for sharing!”
    דירות דיסקרטיות בעפולה

  156. Anonymous says:

    tadalafil pills https://elitadalafill.com/ tadalafil 30 mg

  157. Anonymous says:

    “After I initially commented I appear to have clicked on the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I recieve 4 emails with the same comment. There has to be an easy method you are able to remove me from that service? Thanks a lot!”
    דירות דיסקרטיות בעפולה

  158. Anonymous says:

    “I’m excited to find this website. I want to to thank you for ones time just for this fantastic read!! I definitely liked every bit of it and I have you saved as a favorite to see new information in your site.”
    דירות דיסקרטיות

  159. Anonymous says:

    “An interesting discussion is worth comment. I do believe that you ought to publish more on this topic, it may not be a taboo subject but generally people don’t talk about these subjects. To the next! Kind regards!!”
    דירות דיסקרטיות ברחובות

  160. Anonymous says:

    Букмекерская контора — это игорное заведение, занимающееся приемом ставок. Букмекер оценивает вероятность того или иного исхода события
    https://adst.com.ua/sitemap-4.xml

  161. Anonymous says:

    профессия профессионального спорщика, занимающегося … Произошло это в Великобритании, которая и сейчас удерживает первое место в мире как по числу
    https://adst.com.ua

  162. Anonymous says:

    профессия профессионального спорщика, занимающегося … Произошло это в Великобритании, которая и сейчас удерживает первое место в мире как по числу
    https://adst.com.ua/sitemap-0.xml

  163. Anonymous says:

    warnings for vardenafil https://vegavardenafil.com/ vardenafil tablets 20 mg best price

  164. Anonymous says:

    Смотрите лучшие видео из категории порно со зрелыми на ПорноДома.me
    https://puzzleservice.net

  165. Anonymous says:

    открыто одну суть, мамаши в сексе без всякого стеснения способны воплотить из мечты в реальность самые грязные сексуальные фантазии парней.
    https://puzzleservice.net/sitemap-0.xml

  166. Anonymous says:

    GO!!!
    This phrase was said by the first cosmonaut on Earth – Yuri Gagarin. (Yuri Gagarin)
    He was the first astronaut on Earth. He was Russian! …
    Now Russia is becoming a strong country, gas pipelines, a vaccine against COVID-19, an army.
    Is this very reminiscent of the communist Soviet Union?
    How do you think?
    Now we have total control in our country. I am interested in the opinion of foreigners.

    … rolo Gelenter norvatic

    ПОЕХАЛИ!!

  167. Anonymous says:

    Как так?
    ссылка
    Взгляните

  168. Anonymous says:

    Как так?
    read
    Вы поняли?

  169. Anonymous says:

    Stumbled upon something entertaining on the Internet.
    click here
    I think you will like it too!

  170. Anonymous says:

    “After I initially commented I seem to have clicked on the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I recieve four emails with the exact same comment. There has to be a way you are able to remove me from that service? Appreciate it!”
    חברת ניקיון

  171. Anonymous says:

    cheap generic cialis cialis from canada when will cialis become generic

  172. Anonymous says:

    cialis viagra how long for cialis to peak can you buy cialis over the counter

  173. Anonymous says:

    Hi there just wanted to give you a quick heads up. The text in your
    content seem to be running off the screen in Ie. I’m not sure
    if this is a formatting issue or something to do with browser compatibility but
    I figured I’d post to let you know. The design and style look great though!
    Hope you get the issue fixed soon. Thanks

    Here is my homepage: avengers fathor shirt

  174. Anonymous says:

    alprostadil generic prices https://alprostadildrugs.com/ alprostadil intraurethral (muse) therapy

  175. Anonymous says:

    lisinopril and cialis cialis vs viagra reddit does cialis make you bigger

  176. Anonymous says:

    cialis coupons tadalafil 20 mg tablet cialis dosage 20mg

  177. Anonymous says:

    buy cialis cialis without a doctor prescription usa what happens if you take 2 cialis

  178. Anonymous says:

    canadian pharmacy ezzz cialis cialis strength cialis vs. viagra recreational use

  179. Anonymous says:

    cialis canadian pharmacy https://canadacialisstore.com/ buy generic cialis without prescription canadian pharmacy

  180. Anonymous says:

    how to write a good short essay college admissions essay how to write the title of a website in an essay

  181. Anonymous says:

    how to write an introductory paragraph for an essay boston college supplement essay how to write a essay to get into college

  182. Anonymous says:

    Нашел весьма интересный сайт с загадками для детей https://zagadki-dlya-detej.ru/ Тем у кого есть дети – смотреть обязательно!

  183. Anonymous says:

    This design is steller! You most certainly know how to keep a reader amused.
    Between your wit and your videos, I was almost moved to start
    my own blog (well, almost…HaHa!) Wonderful job. I really enjoyed what you had to say, and more than that, how you presented it.
    Too cool! asmr (tinyurl.com) 0mniartist

  184. Anonymous says:

    how to write a 3 page essay college essay scholarship how to write a 1 page essay

  185. Anonymous says:

    who to write an essay writing a essay about yourself how to write a story essay

  186. Anonymous says:

    how to write an awesome essay legitimate essay writing service how to write poem title in essay

  187. Anonymous says:

    how to write a perfect essay essay writing help write an essay in spanish

  188. Anonymous says:

    thromax https://zithromaxes.com/ zithromax and uti

  189. Anonymous says:

    Каждый день Вы получаете ссылку на актульное зеркало 1хбет на сегодня. 1xbet отзывы 2021

  190. Anonymous says:

    law essay help research writing which of the following is not a motive for your essay that your sources might help you establish?

  191. Anonymous says:

    high school application essay help help research paper sociology essay help

  192. Anonymous says:

    help on essay writing introduction for research paper essay about how money will help my career

  193. Anonymous says:

    cheap viagra generic viagra viagra alternative

  194. Anonymous says:

    viagra government funded viagra over the counter walmart marley drug sildenafil

  195. Anonymous says:

    women viagra pills like viagra buy viagra online

  196. Anonymous says:

    tadalafil dosage https://elitadalafill.com/ tadalafil generic

  197. Anonymous says:

    What’s up, always i used to check web site posts here
    in the early hours in the dawn, since i like to
    gain knowledge of more and more. 0mniartist asmr

  198. Anonymous says:

    buy sildenafil uk https://eunicesildenafilcitrate.com/ sildenafil 100mg purchase

  199. Anonymous says:

    vardenafil vs viagra https://vegavardenafil.com/ buy generic vardenafil over the counter with no pres. online

  200. Anonymous says:

    Meds information for patients. What side effects can this medication cause?
    we can buy a sedative in canada without a prescription? in Canada
    All trends of drugs. Get information here.

  201. Anonymous says:

    Pills information. What side effects can this medication cause?
    where buy generic lyrica for sale in US
    Best what you want to know about meds. Read here.

  202. Anonymous says:

    kamagra and kratom kamagra order online ezzz pharmacy the kamagra store reviews

  203. Anonymous says:

    trimix vs alprostadil https://alprostadildrugs.com/ where can i buy alprostadil suppositories

  204. Anonymous says:

    This was unexpected. All details on
    hemp oil for pain

  205. Anonymous says:

    how to write am in an essay write a personal essay for college how to write a visual arts essay

  206. Anonymous says:

    “Greetings! Very useful advice within this article! It is the little changes that produce the largest changes. Thanks a lot for sharing!”
    דירות דיסקרטיות בחיפה

  207. Anonymous says:

    Информация от экспертов и врачей о ковиде, на авторитетном портале Coronavirus-Control со ссылками на официальные и государственные источники Роспотребнадзор – https://coronavirus-control.ru/karantin/ Эта информация для меня была полезна, сохранил в закладки.

  208. Anonymous says:

    Кондиционеры, генераторы, стартеры для авто:
    https://kgs.kiev.ua/

  209. Anonymous says:

    Кондиционеры, генераторы, стартеры для авто: https://kgs.kiev.ua/

  210. Anonymous says:

    “Everything is very open with a really clear clarification of the issues. It was truly informative. Your website is extremely helpful. Many thanks for sharing!”
    https://israelnightclub.com/%d7%a0%d7%a2%d7%a8%d7%95%d7%aa-%d7%9c%d7%99%d7%95%d7%95%d7%99-%d7%91%d7%97%d7%99%d7%a4%d7%94/

  211. Anonymous says:

    “Everything is very open with a precise clarification of the issues. It was truly informative. Your site is extremely helpful. Thank you for sharing!”
    https://israelnightclub.com/apartments/%d7%93%d7%99%d7%a8%d7%95%d7%aa-%d7%93%d7%99%d7%a1%d7%a7%d7%a8%d7%98%d7%99%d7%95%d7%aa-%d7%91%d7%99%d7%a8%d7%95%d7%a9%d7%9c%d7%99%d7%9d/

  212. Anonymous says:

    I am really loving the theme/design of your web site.

    Do you ever run into any browser compatibility issues?
    A couple of my hobby art blog readers have complained about my website not operating correctly
    in Explorer but looks great in Firefox. Do you have any advice to help fix this issue?

  213. Anonymous says:

    Hi there, this weekend is nice in support of me, since this moment
    i am reading this fantastic informative post here at my hobby blog home.

  214. Anonymous says:

    Hey! Do you use Twitter? I’d like to follow you if that would
    be ok. I’m absolutely enjoying your hobby craft blog and look forward to new updates.

  215. Anonymous says:

    Drugs information for patients. Generic Name.
    where buy generic lyrica without insurance in the USA
    All information about medicines. Get information now.

  216. Anonymous says:

    Drugs prescribing information. What side effects?
    get generic lyrica no prescription in the USA
    Best information about drugs. Read here.

  217. Anonymous says:

    I found something new. All about on
    fab cbd oil

  218. Anonymous says:

    how to write a classical argument essay write my essay for cheap write about holiday essay

  219. Anonymous says:

    https://kino-serialy.net/filmy-2021-goda/
    Все новинки кино 2021 года с возможностью посмотреть онлайн. Портал собрал огромное множество увлекательных картин разных стран мира. Почти все кино и сериалы в хорошем HD качестве и без регистрации.

  220. Anonymous says:

    Качественные автозапчасти на сайте https://1line.parts/
    Огромный выбор расходников и запчастей!

  221. Anonymous says:

    Guzel Rus ve Ukraynali kizlarin fotograflari – ukraynali kizlar

  222. Anonymous says:

    Hi! I’m at work browsing your blog from my new apple iphone!
    Just wanted to say I love reading your blog and look forward to all your posts!
    Keep up the fantastic work!

    my homepage: sehh213124131

  223. Anonymous says:

    I constantly spent my half an hour to read this website’s articles or reviews
    daily along with a mug of coffee.

    Also visit my web blog HTown Junk Car Buyer

  224. Anonymous says:

    I’m really loving the theme/design of your website. Do you ever run into any browser compatibility problems?
    A small number of my blog readers have complained
    about my website not working correctly in Explorer but looks great in Safari.
    Do you have any suggestions to help fix this problem?

    Here is my web blog :: Steam Gift Card Generator

  225. Anonymous says:

    Great info. Lucky me I ran across your site by accident (stumbleupon).
    I’ve book-marked it for later!

    Feel free to visit my blog; Paypal Money Adder

  226. Anonymous says:

    Hi to every one, it’s in fact a good for me to go to see this web page,
    it contains valuable Information.

    Also visit my site; Imvu Credit Generator

  227. Anonymous says:

    Hmm it seems like your website ate my first comment (it was extremely long) so I guess I’ll just sum it up what I
    submitted and say, I’m thoroughly enjoying your blog.
    I too am an aspiring blog blogger but I’m still new to the whole thing.
    Do you have any points for beginner blog writers?
    I’d genuinely appreciate it.

    my site :: Apex Legends Coins Generator

  228. Anonymous says:

    Have you ever thought about adding a little bit more than just your articles?
    I mean, what you say is fundamental and everything.
    Nevertheless imagine if you added some great photos or video clips to
    give your posts more, “pop”! Your content is excellent but with pics and videos, this
    blog could undeniably be one of the greatest in its niche.
    Great blog!

    Feel free to visit my web page; Xbox Gift Card Generator

  229. Anonymous says:

    My family all the time say that I am wasting my time here at
    net, except I know I am getting knowledge daily by reading such good articles
    or reviews.

    Feel free to visit my homepage :: Cash App Money Generator

  230. Anonymous says:

    Medicines information. What side effects? where to buy generic lexapro without prescription All about medicines. Read now.

  231. Anonymous says:

    Medicine information for patients. What side effects? how to get viagra online in the USA. Everything what you want to know about medicines. Read here.

  232. Anonymous says:

    Drug information sheet. Long-Term Effects.
    generic risperdal https://risperdal4u.top in US
    All what you want to know about medicines. Get information now.

  233. Anonymous says:

    Medicament information sheet. Long-Term Effects.
    keflex without dr prescription in USA
    Some about medicines. Read information here.

  234. Anonymous says:

    Medicines information. Long-Term Effects.
    lipitor order
    All about medicament. Read now.

  235. Anonymous says:

    Drugs information. Long-Term Effects.
    where can i buy promethazine online
    Everything information about pills. Read now.

  236. Anonymous says:

    Medicine information. Long-Term Effects. buy cheap lexapro pill Some about medicament. Get here.

  237. Anonymous says:

    Medication prescribing information. Generic Name.
    crestor without rx https://crestor4u.top in USA
    Best about medicine. Get now.

  238. Anonymous says:

    Medication information sheet. What side effects can this medication cause?
    cialis generic in USA
    All what you want to know about medication. Get information here.

  239. Anonymous says:

    Drugs information for patients. What side effects can this medication cause?
    can i buy cymbalta
    All what you want to know about medication. Read information here.

  240. Anonymous says:

    Medicines prescribing information. What side effects?
    generic motrin sale
    Best about medicine. Get now.

  241. Anonymous says:

    This was unexpected.See on the URL

  242. Anonymous says:

    Medicine information sheet. Brand names.
    effexor buy https://effexor4u.top in USA
    Actual trends of medicine. Read information here.

  243. Anonymous says:

    Drugs information. Short-Term Effects.
    get lyrica
    All information about pills. Read here.

  244. Anonymous says:

    Medication information sheet. Generic Name. can i buy cheap lisinopril without dr prescription All news about drug. Get now.

  245. Anonymous says:

    Medicine prescribing information. What side effects can this medication cause? cost of generic viagra prices in the USA. All trends of meds. Get now.

  246. Anonymous says:

    Medicine prescribing information. Drug Class.
    risperdal cheap https://risperdal4u.top in the USA
    Everything information about drug. Read now.

  247. Anonymous says:

    Drugs information for patients. Generic Name.
    where to buy synthroid in the USA
    Everything about drug. Read here.

  248. Anonymous says:

    Medicines information for patients. Cautions.
    lyrica online
    Best what you want to know about meds. Get now.

  249. Anonymous says:

    новости туризма операторов

    http://knigaturizma.ru/description.asp?company=3004622

  250. Anonymous says:

    Последние данные о короне, по информации официальных государственных источников Минздрава РФ – https://coronavirus-control.ru/coronavirus-senegal/
    Это важно!

  251. Anonymous says:

    Еще совсем недавно основным заказчиком корпоративного обучения персонала были международные компании, в которых процесс развития персонала традиционно воспринимался как неотъемлемая составляющая маркетинговой стратегии. Сейчас важность проведения бизнес тренингов и семинаров окончательно осознали и собственники отечественных компаний, которые заинтересованы в развитии бизнеса и продвижении своих товаров и услуг.
    Найти хорошую обучающую компанию или тренинговый центр непросто, особенно при существующем разнообразии выбора тренинговых программ и курсов. Поэтому надо рекомендовать обучение там, где за качество тренинговых программ и работу преподавателя можно ручаться.
    Я рекомендую:
    https://kurspresent.ru/kursyi-i-treningi-dlya-korporativnogo-obucheniya-personala

  252. Anonymous says:

    Medication information for patients. Cautions.
    how to buy baclofen
    Everything what you want to know about medicament. Get information now.

  253. Anonymous says:

    Drug information sheet. What side effects can this medication cause?
    buy generic promethazine without a prescription
    Everything information about medicines. Get information here.

  254. Anonymous says:

    Дорогие ценители прекрасного! Вы находитесь на официальном сайте компании Кубачи-Центр, напрямую представляющей кубачинское столовое серебро в Москве. Все самые интересные новинки златокузнецов незамедлительно занимают центральное место в нашем каталоге. Над каждым изделием, которое станет украшением вашей жизни, кубачинские мастера работали несколько месяцев. Они по миллиметру наносили на кувшины, стаканы, сахарницы или вазы орнаменты, рисунки, созданные поколениями. Филигранная работа ценна еще тем, что в ней остается тепло рук и щедрость души мастера. Покупая кубачинское серебро в Москве у прямого дилера, вы гарантированно приобретаете эксклюзивные изделия настоящих потомственных златокузнецов из села Кубачи.

    Кубачинское серебро

  255. Anonymous says:

    Drugs information leaflet. Cautions. can i buy trazodone prices Everything trends of medicines. Read here.

  256. Anonymous says:

    Pills information. What side effects? can you get generic viagra for sale in USA. Best about meds. Get here.

  257. Anonymous says:

    Medicines prescribing information. Long-Term Effects.
    price macrobid https://macrobid4u.top in USA
    Best trends of medicament. Read now.

  258. Anonymous says:

    Drugs information sheet. Drug Class.
    fluoxetine get https://fluoxetine4u.top in Canada
    Everything what you want to know about drug. Read information here.

  259. Anonymous says:

    Drugs information leaflet. Cautions.
    prednisone online
    All information about medication. Read here.

  260. Anonymous says:

    Medicine information. Long-Term Effects.
    cost zyrtec
    All news about medication. Get information here.

  261. Anonymous says:

    Perhaps you have considered writing an ebook or guest authoring on other blogs?
    We have a blog centered on the very same subjects you discuss and would
    really like to possess you share some stories/information. I know my
    subscribers would enjoy work. If you will be even remotely interested, go ahead and send me
    an email.

    Here is my homepage … HeathUSubich

  262. Anonymous says:

    Medicines information for patients. What side effects? cost lisinopril no prescription Everything information about medicines. Read now.

  263. Anonymous says:

    Medicine information. Cautions. order generic prednisone no prescription in US. Everything trends of drugs. Read information here.

  264. Anonymous says:

    Drug information leaflet. Generic Name.
    online voltaren https://voltaren4u.top in Canada
    Best what you want to know about drugs. Get now.

  265. Anonymous says:

    Pills information sheet. What side effects can this medication cause?
    cost keflex https://keflex4u.top in the USA
    Best trends of drug. Get information now.

  266. Anonymous says:

    Medicament information leaflet. Long-Term Effects.
    buy baclofen
    Everything information about medicament. Read information here.

  267. Anonymous says:

    Pills information for patients. What side effects can this medication cause?
    where to buy claritin online
    Some trends of meds. Read information now.

  268. Anonymous says:

    новости туризма операторов

    http://knigaturizma.ru/description.asp?company=3004545

  269. Anonymous says:

    hi!,I like your writing so so much! proportion we be in contact extra about your article on AOL?
    I require an expert in this space to unravel my problem.
    May be that is you! Having a look forward to peer you.

    Also visit my website: Pubg Mobile Uc Hilesi

  270. Anonymous says:

    Drugs information for patients. Brand names. buy lasix Actual what you want to know about drug. Get information here.

  271. Anonymous says:

    Drug information sheet. Short-Term Effects. where can i buy viagra without a prescription in US. Some what you want to know about meds. Get here.

  272. Anonymous says:

    Medication information. What side effects can this medication cause?
    how to buy januvia https://januvia4u.top in the USA
    Everything about medicament. Get information here.

  273. Anonymous says:

    Medicament information. Long-Term Effects.
    zantac buy https://zantac4u.top in US
    Some trends of medicament. Read now.

  274. Anonymous says:

    Drug prescribing information. What side effects?
    can i order baclofen
    Actual what you want to know about meds. Read information here.

  275. Anonymous says:

    Meds prescribing information. Drug Class.
    order cheap prednisone
    Some about pills. Read here.

  276. Anonymous says:

    сайт для путешественников

    http://knigaturizma.ru/description.asp?company=3000715

  277. Anonymous says:

    новости поездок

    http://knigaturizma.ru/?company=3001965

  278. Anonymous says:

    Medicines information sheet. Short-Term Effects.
    cost buspar in the USA
    All about medication. Get information here.

  279. Anonymous says:

    Hey would you mind sharing which blog platform you’re using?
    I’m looking to start my own blog soon but I’m having a difficult time making a decision between BlogEngine/Wordpress/B2evolution and Drupal.
    The reason I ask is because your layout seems different then most blogs and I’m looking for something completely unique.
    P.S My apologies for getting off-topic but I had to ask!

    Feel free to surf to my site :: Pubg Free Uc Generator

  280. Anonymous says:

    Hey there, You have done an excellent job.
    I will certainly digg it and personally suggest to my friends.

    I am sure they’ll be benefited from this web site.

    my web site; Dragon City Hack

  281. Anonymous says:

    I am truly delighted to glance at this website posts which contains
    lots of helpful facts, thanks for providing these
    kinds of information.

    my web site Cash App Generator

  282. Anonymous says:

    Hurrah, that’s what I was exploring for, what a material!
    present here at this web site, thanks admin of this website.

    Have a look at my web blog – Walmart Gift Card Generator

  283. Anonymous says:

    Hello There. I found your blog using msn. This is an extremely well written article.
    I will be sure to bookmark it and return to read more of your
    useful information. Thanks for the post. I’ll definitely return.

    Visit my website … Top Eleven Hack

  284. Anonymous says:

    Hi there! I simply want to offer you a big thumbs up for
    your excellent information you have right here on this post.
    I am returning to your website for more soon.

    Have a look at my web site :: Pokemon Masters Hack

  285. Anonymous says:

    Appreciation to my father who shared with me about this web
    site, this blog is truly awesome.

    Have a look at my web blog Roblox Gift Card Generator

  286. Anonymous says:

    I am really enjoying the theme/design of your website.

    Do you ever run into any internet browser compatibility problems?
    A couple of my blog readers have complained about
    my website not operating correctly in Explorer but looks great in Firefox.
    Do you have any tips to help fix this issue?

    my site – Netflix Gift Codes

  287. Anonymous says:

    It’s very easy to find out any matter on web as
    compared to books, as I found this post at
    this web page.

    Also visit my blog … Mafia City Hack

  288. Anonymous says:

    It’s going to be end of mine day, except before end I am reading this impressive paragraph
    to improve my knowledge.

    Check out my site: Google Play Gift Card Code

  289. Anonymous says:

    What’s up Dear, are you truly visiting this web page on a regular basis, if so
    then you will without doubt get good knowledge.

    Stop by my website :: Coin Master Free Spins

  290. Anonymous says:

    Everything is very open with a precise description of the issues.
    It was really informative. Your website is extremely helpful.
    Thanks for sharing!

    my homepage – Star Wars Hack

  291. Anonymous says:

    It’s an amazing paragraph designed for all the online viewers; they will take benefit from it I am
    sure.

    Review my page Star Stable Hack

  292. Anonymous says:

    Every weekend i used to pay a visit this site, as i wish
    for enjoyment, since this this web site conations actually nice funny
    data too.

    my web page: itunes Gift Card Generator

  293. Anonymous says:

    Everything is very open with a precise description of the issues.
    It was truly informative. Your site is extremely helpful.
    Thank you for sharing!

    Visit my web site: Valorant Hack

  294. Anonymous says:

    Do you mind if I quote a few of your articles as long as
    I provide credit and sources back to your blog?

    My blog site is in the exact same area of interest
    as yours and my users would genuinely benefit from some of the information you provide here.
    Please let me know if this alright with you.
    Thank you!

    Have a look at my web page: Steam Gift Card Generator

  295. Anonymous says:

    Ahaa, its pleasant conversation regarding this article at this place at this web site, I have read all that, so now me also commenting at this place.

    Look into my web blog – Soccer Stars Hack

  296. Anonymous says:

    Useful info. Lucky me I found your site by chance, and I am stunned
    why this accident did not happened earlier!
    I bookmarked it.

    Also visit my web site … Soccer Manager 2021 Hack

  297. Anonymous says:

    all the time i used to read smaller posts that also clear their motive,
    and that is also happening with this post which I am reading at this time.

    My webpage: Red Ball 4 Hack

  298. Anonymous says:

    Quality articles is the important to interest the people to
    go to see the site, that’s what this web page is providing.

    Also visit my homepage; PUBG Mobile Lite Hack

  299. Anonymous says:

    I constantly spent my half an hour to read this weblog’s articles every day along with a mug of coffee.

    Review my page; Lords Mobile Hack

  300. Anonymous says:

    Hey there! I know this is kinda off topic but I was wondering if you
    knew where I could find a captcha plugin for my comment form?
    I’m using the same blog platform as yours and I’m having problems finding one?

    Thanks a lot!

    my web site – Bus Simulator Hack

  301. Anonymous says:

    Its such as you learn my mind! You appear to know a lot about this, like you wrote the ebook in it or something.
    I feel that you can do with a few percent to drive the message home a little bit, but other than that, that is
    excellent blog. A great read. I will definitely be back.

    my web-site; Dragon Ball Legends Hack

  302. Anonymous says:

    I am regular visitor, how are you everybody? This piece of writing posted at this
    web page is truly pleasant.

    My web site: Archero Hack

  303. Anonymous says:

    Magnificent site. A lot of useful info here. I’m sending it to
    several friends ans also sharing in delicious. And naturally, thanks for your sweat!

    Also visit my web site – apex legends hack

  304. Anonymous says:

    It’s very trouble-free to find out any topic on net as
    compared to textbooks, as I found this article at this web page.

    Feel free to surf to my page … 8 Ball Pool Coins

  305. Anonymous says:

    Appreciation to my father who shared with me concerning this website,
    this blog is in fact amazing.

    Have a look at my webpage; Plants vs Zombies 2 Hack

  306. Anonymous says:

    Hi there, I check your blogs daily. Your writing style is awesome,
    keep it up!

    Have a look at my webpage; PES Money Generator

  307. Anonymous says:

    If you are going for finest contents like me, just visit this web page everyday since
    it presents quality contents, thanks

    My web blog; paypal money adder

  308. Anonymous says:

    I couldn’t refrain from commenting. Exceptionally well written!

    Also visit my web site: OnlyFans Hack

  309. Anonymous says:

    Hello there! Do you know if they make any plugins to safeguard against hackers?

    I’m kinda paranoid about losing everything I’ve worked hard on.
    Any recommendations?

    Have a look at my website; Linduu Hack

  310. Anonymous says:

    I’ve read a few just right stuff here. Certainly price
    bookmarking for revisiting. I wonder how a lot attempt you place to make one of these great informative web site.

    Here is my blog post … LivU App Hack

  311. Anonymous says:

    Hello fantastic website! Does running a blog like this require a
    massive amount work? I’ve very little expertise in programming however I had been hoping to start my
    own blog soon. Anyways, should you have any ideas or techniques for new blog owners please share.

    I know this is off subject nevertheless I just had to ask.
    Thanks a lot!

    Feel free to surf to my web blog – link

  312. Anonymous says:

    This is a topic that’s near to my heart… Thank you! Where are your contact details though?

    Feel free to surf to my blog post link (Julienne)

  313. Anonymous says:

    Great post. I was checking continuously this blog and I am impressed!
    Very useful information specially the final part 🙂 I
    care for such information much. I was seeking this particular information to get a long time.
    Many thanks and best of luck.

    my web page :: KortneyDFure

  314. Anonymous says:

    Very nice post. I simply stumbled upon your weblog and wanted to say that I have really enjoyed surfing around your blog posts.
    After all I’ll be subscribing to your feed and I am hoping you write once more soon!

    my page; psn code generator

  315. Anonymous says:

    Great article.

    Also visit my page roblox robux generator

  316. Anonymous says:

    It’s truly very complex in this active life to
    listen news on Television, therefore I only use world wide web for that purpose, and get the
    latest information.

    my web page :: tiktok followers generator

  317. Anonymous says:

    My relatives always say that I am killing my time here at net, but I know I am getting familiarity daily
    by reading thes fastidious articles or reviews.

    my web-site; bingo blitz free credits

  318. Anonymous says:

    This is my first time go to see at here and i am in fact impressed to read all at alone place.

    Take a look at my web page call of duty cp hack

  319. Anonymous says:

    What i do not understood is in reality how you’re not
    actually a lot more well-appreciated than you might be now.
    You are so intelligent. You recognize thus considerably in terms of this matter,
    made me individually believe it from numerous various angles.
    Its like women and men don’t seem to be interested until it’s something to accomplish with Woman gaga!

    Your individual stuffs nice. At all times care for it up!

    Feel free to surf to my webpage – xbox codes generator

  320. Anonymous says:

    I’m gone to say to my little brother, that he should also pay a visit this webpage on regular basis to get updated from most recent news update.

    Here is my web blog :: netflix premium accounts

  321. Anonymous says:

    Good day! This post could not be written any better! Reading this post reminds me of my good old room mate!

    He always kept chatting about this. I will forward this post to him.
    Pretty sure he will have a good read. Thanks for sharing!

    Also visit my webpage: amazon gift card generator

  322. Anonymous says:

    You could certainly see your expertise within the article
    you write. The world hopes for even more passionate writers such as
    you who aren’t afraid to say how they believe.
    Always follow your heart.

    my site … PES 2021 Hack

  323. Anonymous says:

    I needed to thank you for this great read!!
    I definitely loved every bit of it. I have got you
    book marked to look at new things you post…

    Feel free to surf to my web page fortnite free skins

  324. Anonymous says:

    Having read this I thought it was really informative.
    I appreciate you spending some time and energy to put this informative article together.
    I once again find myself spending way too much time both reading and commenting.
    But so what, it was still worth it!

    Stop by my blog: minecraft account generator

  325. Anonymous says:

    Appreciating the hard work you put into your website and in depth information you offer.
    It’s great to come across a blog every once in a while that isn’t the same outdated rehashed
    material. Excellent read! I’ve bookmarked your site and
    I’m including your RSS feeds to my Google account.

    Also visit my web blog … imvu hack credits

  326. Anonymous says:

    Very nice post. I just stumbled upon your weblog and wished to say that I’ve
    truly enjoyed browsing your blog posts. After all I’ll
    be subscribing to your rss feed and I hope
    you write again soon!

    My blog; xbox gift card generator

  327. Anonymous says:

    Hello, i think that i saw you visited my web site so
    i came to “return the favor”.I’m trying to find things to improve my site!I suppose its ok to use some of your ideas!!

    My blog: link (Claudio)

  328. Anonymous says:

    I every time emailed this web site post page to all my associates, as if like to
    read it next my links will too.

    My homepage link (Elane)

  329. Anonymous says:

    Remarkable! Its in fact awesome article, I have got much clear idea concerning from this paragraph.

    Look into my blog: link

  330. Anonymous says:

    Heya! I just wanted to ask if you ever have any trouble with hackers?
    My last blog (wordpress) was hacked and I ended up losing months of hard work due to no data backup.
    Do you have any solutions to protect against hackers?

    My web page: link (Louise)

  331. Anonymous says:

    You can definitely see your skills within the article you write.
    The sector hopes for even more passionate writers such as you who
    aren’t afraid to say how they believe. Always follow your heart.

    my web-site … Braw Stars Generator

  332. Anonymous says:

    I simply couldn’t leave your web site prior to suggesting that I really loved the standard information an individual supply on your guests?
    Is going to be back frequently in order to investigate cross-check new posts

    Feel free to surf to my web page; xbox code generator

  333. Anonymous says:

    Hmm is anyone else having problems with the pictures on this blog
    loading? I’m trying to determine if its a problem on my end or if it’s the blog.
    Any suggestions would be greatly appreciated.

    Visit my homepage – Pubg mobile uc hack

  334. Anonymous says:

    I used to be able to find good information from your content.

    my web blog :: pixel gun 3d hack

  335. Anonymous says:

    hey there and thank you for your information – I’ve definitely picked up anything
    new from right here. I did however expertise several
    technical issues using this website, as I experienced to reload the
    site a lot of times previous to I could get
    it to load properly. I had been wondering if your web hosting is OK?

    Not that I’m complaining, but slow loading instances times
    will sometimes affect your placement in google and could damage your quality score if ads
    and marketing with Adwords. Well I am adding this RSS to my e-mail and could look out for much more of your respective intriguing content.
    Ensure that you update this again soon.

    Here is my web site Homescapes Hack

  336. Anonymous says:

    Hey there! I know this is kinda off topic but I was wondering if you knew
    where I could find a captcha plugin for my
    comment form? I’m using the same blog platform as yours and I’m having difficulty finding one?
    Thanks a lot!

    Take a look at my web site; Netflix Premium Generator

  337. Anonymous says:

    I’ve been browsing online more than 3 hours today, yet I never found any interesting article like yours.
    It’s pretty worth enough for me. In my view, if all web owners and bloggers made good content as you
    did, the internet will be a lot more useful
    than ever before.

    Have a look at my web blog Coin Master Spins

  338. Anonymous says:

    Hi there, just became aware of your blog through Google,
    and found that it’s truly informative. I’m going to watch
    out for brussels. I’ll appreciate if you continue this in future.
    Lots of people will be benefited from your writing.
    Cheers!

    My blog: gems generator

  339. Anonymous says:

    Stunning story there. What happened after?

    Good luck!

    My website; Coin Maste Hack

  340. Anonymous says:

    There is definately a great deal to know about this topic. I love all call of duty mobile hack the points you’ve made.

  341. Anonymous says:

    I blog frequently and I seriously appreciate your information.
    The article has really peaked my interest. I will take a
    note of your site and keep checking for new information about
    once per week. I subscribed to your RSS feed
    too.

    Also visit my web blog … Fortnite Skins Generator

  342. Anonymous says:

    Hello, its nice piece of writing concerning media
    print, we all be aware of media is a great source of data.

    Have a look at my homepage … bingo blitz credits generator

  343. Anonymous says:

    Hello there! This post couldn’t be written much better! Going
    through this post reminds me of my previous roommate! He always
    kept talking about this. I will send this article
    to him. Fairly certain he’s going to have a very good read.
    Thanks for sharing!

    my web-site Robux Generator

  344. Anonymous says:

    Spot on with this write-up, I absolutely believe this site needs
    a great deal more attention. I’ll probably be returning to see more,
    thanks for the info!

    Review my page – free robux

  345. Anonymous says:

    Admiring the time and energy you put into your blog and in depth information you provide.

    It’s awesome to come across a blog every once in a while
    that isn’t the same unwanted rehashed material. Excellent read!
    I’ve bookmarked your site and I’m including your RSS feeds to my Google Fortnite Account Generator.

  346. Anonymous says:

    I like what you guys tend to be up too. This sort of clever work and
    coverage! Keep up the amazing works guys I’ve added you guys to our blogroll.

    Look at my website … Tiktok Followers Generator

  347. Anonymous says:

    Hey very nice blog!

    Also visit my site … link (Lakeisha)

  348. Anonymous says:

    I have read so many posts about the blogger lovers except this article is in fact a fastidious post, keep it up.

    My page – Tiktok Fans Generator

  349. Anonymous says:

    Thank you for sharing your info. I really appreciate your efforts and I will be waiting for your further write ups thank you once again.

    Also visit my web blog: Clash of Clans Hack

  350. Anonymous says:

    When someone writes an post he/she retains the plan Clash of Clans Generator a user in his/her mind
    that how a user can understand it. Thus that’s why
    this piece of writing is outstdanding. Thanks!

  351. Anonymous says:

    Thanks for sharing your thoughts. I really appreciate your efforts and
    I am waiting for your next write ups thank you once again.

    Feel free to surf to my page … Snapchat Hack

  352. Anonymous says:

    Really no matter if someone doesn’t understand after that its up to
    other visitors that they will assist, so here it
    takes place.

    Check out my blog post – pubg mobile uc generator

  353. Anonymous says:

    This piece of writing is in fact a pleasant one it helps new internet viewers, who are wishing
    for blogging.

    Feel free to visit my page :: pokemon go hack

  354. Anonymous says:

    Excellent blog you have here.. It’s difficult to find good quality writing
    like yours these days. I truly appreciate people like you!

    Take care!!

    My webpage: v bucks generator

  355. Anonymous says:

    Good information. Lucky me I ran across your site by accident (stumbleupon).
    I have saved it for later!

    my web blog :: xbox gift card generator

  356. Anonymous says:

    Keep this going please, great job!

    Feel free to visit my web blog – roblox hack

  357. Anonymous says:

    My partner and I stumbled over here by a different web address and thought I might
    as well check things out. I like what I see so now i’m following you.
    Look forward to exploring your web page yet again.

    Check out my web blog: link (Zane)

  358. Anonymous says:

    After I initially left a comment I appear to have clicked the -Notify me
    when new comments are added- checkbox and from now on whenever a comment is added I
    receive 4 emails with the same comment. Perhaps there is a means you can remove me from that service?
    Cheers!

    My page :: robux generator

  359. Anonymous says:

    Definitely believe that which you said. Your favorite justification seemed
    to be on the web the easiest thing to be aware of.
    I say to you, I definitely get annoyed while people consider worries that they just don’t know about.
    You managed to hit the nail upon the top as
    well as defined out the whole thing without having side effect ,
    people could take a signal. Will likely be back to get more.
    Thanks

    Check out my web-site; GTA 5 Money Generator

  360. Anonymous says:

    Hello, I enjoy reading all of your article. I like to write
    a little comment to support you.

    Also visit my web page; link (Etsuko)

  361. Anonymous says:

    It’s an amazing paragraph in support of all the web people; they will obtain benefit from it I am sure.

    Review my web site – psn code generator

  362. Anonymous says:

    I like the helpful info you supply for your articles.
    I will bookmark your weblog and check again right here frequently.
    I’m fairly sure I’ll learn lots of new stuff right right
    here! Good luck for the following!

    Take a look at my page :: Free Pokemon Go Spoofer

  363. Anonymous says:

    It’s actually a great and useful piece of info.
    I am happy that you simply shared this useful info with us.
    Please stay us up to date like this. Thank you for sharing.

    Also visit my web blog – free instagram followers

  364. Anonymous says:

    Hi, I think your website might be having browser compatibility issues.

    When I look at your blog in Firefox, it looks fine
    but when opening in Internet Explorer, it has some
    overlapping. I just wanted to give you a quick heads up!
    Other then that, wonderful blog!

    Feel free to visit my web page :: link (Natisha)

  365. Anonymous says:

    GTA 5 money give be very leisurely to add to your friend’s chronicle without existence spotted by the admins.

    my site – wings io

  366. Anonymous says:

    If you are going for most excellent contents like myself, simply visit this web site everyday as it presents feature
    contents, thanks

    Feel free to surf to my web site … link (Vonnie)

  367. Anonymous says:

    Appreciation to my father who shared with me on the topic
    of this blog, this website is in fact awesome.

    Also visit my website link – Cornelius

  368. Anonymous says:

    Good blog you have here.. It’s hard to find excellent writing like yours nowadays. I truly appreciate people like you! Take care!!|
    atmospheric water generator for sale http://lupin3.jp/other/link/rank.cgi?mode=link&id=219&url=https://www.pexels.com/@atmospheric-water-generator-3538524

  369. Anonymous says:

    Thanks for one’s marvelous posting! I quite enjoyed reading it, you will be a great author.I will be sure to bookmark your blog and definitely will come back down the road. I want to encourage yourself to continue your great job, have a nice weekend!|
    thefeed http://biyougeka.esthetic-esthe.com/rank.cgi?mode=link&id=848&url=https://cbdoil9.cheezburger.com/

  370. Anonymous says:

    I do agree with all of the ideas you’ve presented for your post. They’re very convincing and can definitely work. Still, the posts are very short for newbies. May you please prolong them a little from subsequent time? Thanks for the post.|
    feed http://www.railcommu.com/rank.cgi?mode=link&id=60&url=https://followus.com/CBDOil9

  371. Anonymous says:

    An interesting discussion is worth comment. I do believe that you ought to write more on this topic, it may not be a taboo matter but usually people don’t speak about such issues. To the next! Kind regards!!|
    feed http://locost-e.com/yomi/rank.cgi?mode=link&id=78&url=https://pr.business/the-feed-boulder-colorado

  372. Anonymous says:

    Excellent article. I am dealing with many of these issues as well..|
    the feed http://cslcc.org/logs/footer.php?aid=791374&link=https://nuun1.livejournal.com%2Fprofile/

  373. Anonymous says:

    I blog often and I really appreciate your content. This article has really peaked my interest. I will bookmark your site and keep checking for new details about once per week. I opted in for your Feed as well.|
    thefeed http://freelancewritersden.com/dap/a/?a=4851&p=http://clifbar5.brandyourself.com/

  374. Anonymous says:

    It’s an remarkable post for all the online visitors; they will get benefit from it I am sure.|
    berkey https://bit.ly/3nYQwo7

  375. Anonymous says:

    Do you have a spam problem on this site; I
    also am a blogger, and I was wanting to know your situation; many of us have developed some nice
    procedures and we are looking to exchange methods with others, be
    sure to shoot me an email if interested.

    Also visit my web site we just did hats

  376. Anonymous says:

    Please identify areas within this episode where an improvement approach could be undertaken to improve Patient Safety?
    – Implement regulations and training so that doctors take the time to check the patient’s chart and adjust medications accordingly.
    – Retraining of doctors to administer insulin to septic patients in the appropriate higher doses
    – Ensuring all doctors are able to calculate and administer insulin safely
    – Keeping the Higher dosages of insulin separately from the lower dosages and having them labeled in both units and ml so as to avoid any possible mistake in dosing
    – Implementing a protocol were doctors check the dosage just prior to injecting the patient.

  377. Anonymous says:

    Jane is a Type I diabetic. This should be known by the people who treat her and care for her. Close observation and propper menagement could and should have prevented Jane getting into a state of diabetic ketoacidosis altogether. Secondly, it is very important that medication is administered using the right doses. To make sure that that happens, it is important to keep all handwritten notes clear and readable. Additionally, drugs have to be labled in a standardized way, so that doctors can easily find and prepare the right amount of medication. By using patents’ savety messures, stansardized procedures and intuitive models you can make sure that a mistake like the one that happend to Jane’s doctor won’t happen again.

  378. Anonymous says:

    Please identify areas within this episode where an improvement approach could be undertaken to improve Patient Safety ?
    – A hospital wide change to using either mls or units for insulin to reduce confusion, and more training to be given to make double checking doses
    – For insulin levels to be reassessed whenever a diabetic is diagnosed with sepsis as a protocol
    – For PMH to be regarded when diagnosing patients

  379. Anonymous says:

    The registrar should have taken a thorough medical history and been aware of the dose change during sepsis. To ensure of safe drug administration it is good practice for the doctor to check with another member of the staff the dose of the medication if unsure.

  380. Anonymous says:

    The registrar should have been aware of Jane’s T1D as part of her medical history to ensure her medical care was safe for her. By acknowledging her condition and adjusting for the necessary insulin dosage from the onset. This would have prevented the ketoacidosis as blood sugars would have been properly controlled. After realising Jane’s condition and the urgency of the insulin injection, the registrar should have ensured that the dose she received was correct as there was a time pressure now in place. The dosage should have been double checked due to the high stakes of this situation. There should be a standard unit of administration used throughout the hospital to avoid errors like this, especially as some doctors who are administering the insulin will work in different wards.

  381. Anonymous says:

    1. Please identify areas within this episode where an improvement approach could be undertaken to improve Patient Safety ?
    The dosage of medication to be administered to the patients should be checked by another member of staff if possible, or at the very least by the same member of staff, to reduce the number of errors that could put a patient at risk. Alternatively, the staff should undergo more training to reduce the chances of another mistake occuring.
    The registrar wasn’t as thorough as he should have been, as a quick history taking or check with Jane’s medical records would have shown that she is diabetic, and that the sepsis would have affected how much insulin she requires. The computer system could be updated to show warnings when other diseases affect seemingly unrelated medication, as well as training to explain the importance of being thorough when it comes to patient safety.

  382. Anonymous says:

    An improvement approach could be used in many areas in this example. Firstly, I feel it is important to highlight that although errors were made, the doctor in question did not do so deliberately and arguably these errors could be as a result of systemic failures, not individuals. It worries me to see so many comments such as “the doctor should”. Blame culture is a thing of the past but instead a positive environment of improving patient safety has been shown as better for patients, along with employees.
    Areas for systemic improvement could regard the sepsis protocols. The sepsis six movement has been successful in raising awareness of sepsis as a time-critical medical emergency and guidelines are in place to standardise the treatment steps. Perhaps adding insulin adjustments for diabetics could be added to guidelines to prevent further episodes of diabetic ketoacidosis due to insufficient evidence. However, the nurses in this situation did brilliantly to notice the signs and symptoms of DKA in Jane and correctly informed the doctor rapidly.
    Improvement options for administration of insulin are of high importance on inpatient wards currently. Options for double checking administration of insulin include prescriptions having to be written by a doctor and once drawn up, by a doctor/nurse, must be countersigned as checked by a second doctor/nurse. This failsafe helps healthcare staff work together to prevent human errors. This failsafe is very quick, so can be carried out in a time-critical situation where human error is more likely to occur. I would imagine this doctor has or will become very comfortable with prescribing insulin but a countersignature measure in every circumstance can prevent any prescribing or administration error. Additionally, separate insulin prescription charts contain easily accessed guidelines for insulin dosages. Perhaps these could be adapted for prescribing insulin in septic patients.

  383. Anonymous says:

    Dr Smith should have been aware of the increased insulin requirements during sepsis. If the insulin dose was corrected after the sepsis diagnosis Jane’s condition would not have deteriorated causing Dr Smith to have to act quickly and panic, causing the insulin overdose. The ward could also be organised in such a way that the syringes are difficult to mix up in an emergency situation. Perhaps being stored in different areas or obviously labelled or colour coded. Even in the high pressure situation if Dr Smith had of taken a moment to double check either with himself or the other members of the team the overdose would have been avoided.

  384. Anonymous says:

    When Jane was diagnosed with Sepsis, her past records should have been read up and her change in insulin dosage should have been top priority.
    The registrar should have taken their time to calculate the dosage- they were in no rush to not be reading the chart which the nurses use.

  385. Anonymous says:

    Before administering the antibiotics, Jane’s medical history should have been checked. Dr Smith would have been aware Jane had type I diabetes. This could have then been noted and staff should have been made aware. This would have ensured Jane received extra insulin and would have also prevented diabetic ketoacidosis. A root cause analysis could be performed to see why the registrar made the mistake. It may have been because he was tired or perhaps he didn’t fully understand the conversion and as a result more training is needed on converting between ml and units of insulin. However, if he was unsure he should have checked with a colleague prior to delivering the injection.

  386. Anonymous says:

    Dr Smith should have checked Jane’s medical history before administering the IV antibiotics to ensure that it was safe to do so. This would have confirmed that Jane was diabetic, and all medical staff should be made aware of this to allow the appropriate changes to be made to her insulin when she is suffering with sepsis. More training should also be provided on converting between units and ml of insulin, and if the registrar was unsure of these conversions he should feel able to double check with another staff member to minimize the amount of errors which are made (however, he quickly realizes his mistake and informs other staff members to ensure that it can be fixed as quickly as possible.

  387. Anonymous says:

    Firstly, the registrar should have knowledge about Jane’s condition and medical history, to ensure that she is receiving proper, personalized care. This would have allowed the registrar to prepare for ketoacidosis, and provide Jane with extra insulin, to begin with, which was his second area for improvement. The registrar should have provided Jane with the insulin to begin with to prevent any other issues to arise. When he did realise his mistake, the registrar should have carefully administered the insulin to ensure that it is the correct amount. To prevent administering the wrong amount, the dosage should be double-checked. Moreover, there should be a standard unit that is used for administration and the hospital should provide intensive training to ensure staff knew how to properly calculate and administer the insulin.

  388. Anonymous says:

    Potential improvements include the administration of insulin to patients. Healthcare professionals should be able to administer the correct dosage even under strict time constraints as if not this leads to serious consequences, highlighted with Jane. Perhaps there should be more training sessions with regards to the administration of drugs and their dosage. A system should be in place whereby the dosage and type of drug is double checked before given to the patient, to minimise any error. In addition, patient notes should be thoroughly checked before a plan of action is put in place.

  389. Anonymous says:

    The potential areas for improvement include sufficient training on insulin doses and how to convert between mls and units. If they are unsure with these calculations they should consult with another member of staff. The doctor could also have checked the notes before administering the insulin. If the doctor had done this, they would have realised the need to change the insulin dosage, preventing the Diabetic Ketoacidosis. Protocols should be put in place to avoid this in the future such as warning signs on the wards or compulsory courses.

  390. Anonymous says:

    The registrar, before administering antibiotics, should have been aware of Jane’s type 1 diabetes by consulting her medical records. In addition, it is vital that the correct dosage is used when administering insulin. If the registrar was unsure about issues regarding administration units, he could have asked another colleague or reviewed guidelines regarding appropriate dosages.

  391. Anonymous says:

    Firstly, Jane’s status as a type I diabetic should have being identified prior to commencing antibiotics. Secondly, the correct dose of insulin was not delivered: doctors should be aware of the guidelines and regularly check them as well as double checking the dose before it is administered.

  392. Anonymous says:

    The registrar not administering the correct dose of insulin to account for the increased requirements during sepsis needs to be improved. Also the registrar not administering the correct dose of insulin was a mistake that needs to be improved. This mistake caused Jane to overdose. A more thorough approach is needed to prevent the same mistake occurring again. The notes of patients need to be thoroughly read before any treatment is given. Treatment guidelines like NICE should be checked regularly to ensure that all treatment procedures are up to date.

  393. Anonymous says:

    The registrar should have been aware of Jane’s Type 1 diabetes prior to administering antibiotics and should have consulted her medical notes. Second area for improvement would be to ensure the correct units of insulin are administered. Perhaps, the registrar could ask a member of the team before administering the correct dose.

  394. Anonymous says:

    The registrar should have looked through her notes to see whether she has any other medications that may be altered upon receiving any treatment. This is because the doses of some medications would change when there is an infection or disease. Besides, the registrar should double-check the amount of insulin required by Jane before administering it to her as overdosage may be fatal. ain this context, all medical professionals are required to undergo training in calculating and converting the volume of medication using different units. In addition, the label for the medication should be accurate and clear so that medical professionals would not misinterpret it and prescribe wrongly to patients, hence causing patient harm.

  395. Anonymous says:

    The first area for improvement regards the registrar not administering the correct dose of insulin to account for the increased requirements during sepsis. Meaning as a result Jane becomes drowsy and confused. The second area involves the registrar not administering the correct dose of insulin, the registrar had given the patient an overdose due to not correctly interpreting the correct dose. In both situations patient safety could be improved my more thorough approach. Detailed examination of the patient notes would have shown that Jane is a type 1 diabetic meaning the correct insulin dose could be given. Finally, before giving the insulin, the syringe should be checked for volume and unit dosage.

  396. Anonymous says:

    Areas of improvement are evidently necessary as constant mistakes require more care and treatment to be provided to Jane.
    To improve patient safety a number of things could be done such as; drug calculation training for all the medical staff, speaking to Jane when she is administered to determine any other illnesses she may already have and having another colleague check that the correct dosage of medication is being administered. The work of the nurses In the emergency response must be praised and so the emergency procedures being carried out efficiently when required is something which must continue to be so professionally carried out. If the doctor had taken more time to examine Jane at the start of the day and establish she was a diabetic a lot of complications could have been avoided.

  397. Anonymous says:

    Patient notes should be thoroughly checked and before administering anything to a patient, the exact dosage should be made sure of considering the serious consequences of the wrong dosage being given. More training should be provided on units and mls, and all medical staff should be confident with these skills. Drug calculations and regulations should always be checked.

  398. Anonymous says:

    There are many areas throughout this episode where an improvement approach could have been taken. Dr Smith initially should have checked Jane’s notes more thoroughly to see she was a type 1 diabetic, then he would have known to alter the intake of insulin during sepsis. Any large calculation of insulin should have been double checked by Dr Smith or by one of the nurses on duty before entering it into a critically ill patient. Dr’s could be more updated on the protocols for diabetics and the dosage of insulin units of measurement. Better communication between the medical records and staff would have prevented this whole episode from occurring.

  399. Anonymous says:

    There are many examples throughout this episode of times when patient safety was put at risk. In the initial diagnosis, a more thorough check into Jane’s medical notes would show her as a type 1 diabetic and would have resulted in a correct insulin prescription. In the case of the registrar administering the wrong dose of insulin, safety could be improved by having another member of staff check the syringe before it is used.

  400. Anonymous says:

    Patient safety could be improved by learning from this incident
    Firstly, the doctor should have checked janes medical history and notes that she was diabetic and therefore her insulin needs would have to be adjusted to account for the infection. Secondly, there was a miscalculation in how much insulin should be administered. This incident indicates that more training is needed for staff to correctly deal with diabetic patients, including how to calculate their insulin requirements. Syringes should also be more clearly labelled with the number of units they contain as well as the volume

  401. Anonymous says:

    There are numerous areas within this episode where an improvement approach could be undertaken. Firstly, a more informed diagnosis could have been made when diagnosing Jane with sepsis, by reading her past medical history briefly within her notes to realise that Jane has Type 1 Diabetes. As a result, Dr Smith would have recognised the importance for Jane to receive the correct dosage of insulin. Also, the insulin administered by Dr Smith could have been checked by another team member of staff to ensure the correct dosage is given in this emergency situation, where errors are likely to occur under pressure. To decrease the likelihood of this happening in the future, Dr Smith could attend training to ensure he understands effectively how to calculate the number of insulin units per ml to be given to the patient and how to administer this safely.

  402. Anonymous says:

    Areas of improvement should include: when Jane was incorrectly given 100x the dosage of the insulin she needed, this could have easily been avoided if there was a training on how to convert units. This could have also been avoided if it was checked by another health care worker before it was administered, as they would have likely noticed it was too large of a dose. It should have also been made clear when Jane came in with the infection that she was diabetic, as the doctor should have been aware if she was, that he would have had to alter her insulin intake. Therefore it should be asked if the patient has any other medical conditions during all consultation ( as they may effect there current illness/treatment)

  403. Anonymous says:

    Areas of improvement should include: when Jane was incorrectly given 100x the dosage of the insulin she needed, this could have easily been avoided if there was a training on how to convert units. This could have also been avoided if it was checked by another health care worker before it was administered, as they would have likely noticed it was too large of a dose. It should have also been made clear when Jane came in with the infection that she was diabetic, as the doctor should have been aware if she was, that he would have had to alter her insulin intake.

  404. Anonymous says:

    Systems improvement could take place, in which future risk could be reduced by improving the drug labeling system, as this seems an easily made mistake.

  405. Anonymous says:

    Areas for improvement could include updated training for doctors on how diabetics needs change during medical problems like sepsis, and updated training on how to convert successfully between mls and units. Additionally the reminder that each ml contains 100 units of insulin could be displayed on a sign in the packages of the drugs to have staff pause and check they are correct. The doctor could have also avoided the situation by making sure to fully check medical notes or speaking to Jane herself about her own medical needs, as she could have had the ch ace to remind them of her diabetes. Lastly, a checklist of things to do and check during sepsis May be helpful in making sure the doctor fully considered the patient’s needs during infection to prevent adverse events from occurring.

  406. Anonymous says:

    Firstly, the initial inspection should have been more in depth so that they were able to recognise the fact that Jane’s insulin requirements would be increased due to the sepsis. This error should have also been caught before consequences occurred by increased observation since she had a pre-existing condition. Additionally, the doctor in charge should have had better training in drug administration in order to prevent the overdose, as should the nurses so that they can catch any mistakes.

  407. Anonymous says:

    The first area for improvement would be to check Jane’s medical records before beginning any treatment. If this was done then the medical team would have seen that Jane is a diabetic and therefore her dose of insulin required when she has sepsis is different to her usual dose. This could have been dealt with by communicating with the medical team what you are going to do beforehand to allow anyone to speak up if they have an issue or simply checking Jane’s medical history before administering any drugs. The other major issue which occurred was the failure to administer the correct dose of insulin to Jane due to an error in the dosage calculations. This is a very serious issue in terms of Jane’s safety and needed to be acted upon quickly. This error could be avoided by offering compulsory training programmes to doctors for their dosage calculation skills to be updated and improved. This also could have been avoided by communicating with other medical staff and ensuring that they agree with your decision.

  408. Anonymous says:

    Training for staff in knowing how to administer safe doses of insulin and be aware of when a patient’s needs for insulin may differ than what would be normally expected could prevent incidents like this. Looking into a patient’s medical records for any previous conditions or medications they may need to take is essential to avoid mistakes like letting Jane go without insulin. Better communication between patients and medical professionals could also prevent this – if Jane’s doctor had asked Jane personally about her past medical history, if possible, he would have known about her diabetes.

  409. Anonymous says:

    There are many potential areas for improvement for patient safety. These include:
    1. Training on pharmacological drug calculations, particular those involving insulin dosage calculations for Type I diabetic patients for all doctors and healthcare staff
    2. Training classes regarding the conversion of specific measurement units – for example, the conversion between mL and Units of Insulin for Type 1 diabetic patients
    3. Improve the communication within the hospital between healthcare staff and patients. If the doctors had of involved the patient in the management of the condition, asking if she is aware how many units of insulin she normally takes, this could have potentially avoided the awful complications that ensued in episode 5 and would dramatically have improved patient safety.
    4. Always double check any drug calculation to ensure you have the right dosage of the right medication in the correct quantity.

  410. Anonymous says:

    Jane was assessed too quickly and the fact that she was a Type 1 diabetic was overlooked for her treatment of sepsis. The registrar should have taken more time not only to assess Jane but also read through her notes before deciding on treatment. The registrar had to act immediately to administer insulin however he injected the wrong dose of insulin. In future if a drug is being administered quickly it should be double checked by another health professional especially drugs that are normally given in very small doses. Training for dosages, conversions and the checking of the correct dosage should be implemented to ensure this does not happen again. This case should be brought up as a near miss case to identify that this is a possible problem.

  411. Anonymous says:

    Firstly, Jane’s initial examination should be more careful and include recognizing her chronic condition (type I diabetes) which may affect or be affected by the condition she was currently suffering from (sepsis). Moreover, administering the incorrect dose of insulin was a very serious mistake and could lead to fatal consequences. All of the medication should be administered carefully and double checked before they are given to patients. The ability to correctly calculate and administer medications should be improved in order to prevent mistakes and their potential serious effects on patients’ health.

  412. Anonymous says:

    The registrars initial assessment of Jane was not thorough enough. While he correctly recognised and diagnosed her sepsis, he did not look into her pass medical history which was extremely necessary in this particular case. This then led to Jane developing diabetic ketoacidosis and the registrar making mistake with the insulin dose delivered to Jane.
    In addition, there maybe should be specific training when it comes to dosage, measurements and conversions. This training should be regularly carried out so hospital staff do not forget.

  413. Anonymous says:

    The areas of improvement would be to inform Jane of the need for increased insulin, giving her the option to manage the new dose or to get a member of the medical team to administer the higher dose.
    Another area of improvement would be to provide more training about converting units and for all the medical staff to ensure that they are confident in this skill. Checking the dosage with another member of medical staff could also be a solution.

  414. Anonymous says:

    The registrar seems to be examining Jane in a very rushed manner, when she first come into the hospital and perhaps if he was more thorough, he would’ve found out that Jane has diabetes and would’ve ensured her insulin dosage was increased. Upon discovering she had sepsis, he should’ve investigated if she has diabetes. The registrar also made the lethal mistake of giving the wrong dosage of insulin to Jane, most likely as he wasn’t concentrating properly. It’s clear that there’s a communication breakdown between the registrar and Jane.

  415. Anonymous says:

    Communication between the patient and the medical staff should be improved in this case, this would give an opportunity for the medical team to learn Jane had type 1 diabetes. Knowing about her condition would allow better treatment for her which could have prevented the ketoacidosis. The registrar should have also taken extra time and care to check the correct dose of insulin or any drug is being given taking particular care with units. For this issue placing signs in the room where the drugs are kept reminding staff of units could help to prevent this happening in the future.

  416. Anonymous says:

    Throughout this episode of Jane’s story there are multiple occasions where patient safety has been put in danger. Firstly, Jane’s insulin dose not being adjusted for the sepsis she had in her wound. This is very dangerous for Jane and one way in which this could have been avoided and patient safety improved would be to a warning on the forms filled out for the treatment of sepsis to see if the patient is diabetic. This could act as a reminder to the personnel administering the treatment that they have to adjust insulin dosage given to the patient as a result of the sepsis. Another area where patient safety was endangered was when Jane was given an overdose of insulin. This could have been avoided by having specific syringes for administering insulin that have scale bars measured in units of insulin rather than millilitres. Once again there is a lack of communication with the patient which can be the most valuable asset for treating a condition. Jane is described as “very good at staying on top of her insulin regime”. Therefore, it would follow that a conversation with Jane about her health would remind doctor Smith of her type 1 diabetes. This would make him less likely to forget about the adjustments that need to be made for the sepsis.

  417. Anonymous says:

    Upon diagnosis of sepsis, Jane’s notes should have been checked, the sepsis noted and her diabetes recognized, allowing her insulin requirements to be changed quickly to prevent diabetic ketoacidosis. Multiple members of staff should have been informed about her as sepsis is a life-threatening condition, with increased risk due to her diabetes, and if multiple members of staff were aware of the case to monitor Jane more closely, the diabetic ketoacidosis may have been avoided. Measurements of insulin should be carefully checked before administration, and syringes stored and labelled separately to minimize the risk of administering the incorrect dose. There should be increased communication between staff members and the incident should be recorded to allow the staff members to reflect on the situation and prevent the near-miss from happening again.

  418. Anonymous says:

    Jane has returned to hospital with a worsening infection. She is suffering from a high fever, faintness and an oozing wound. In situations such as sepsis, time is critical. Dr Smith’s quick assessment technique is effective in recognising these signs meaning a prompt diagnosis can be made for immediate treatment. Similarly to episode 1, the ‘quick assessment’ is not thorough enough, and key patient background details are overlooked. In this case, Jane’s type 1 diabetes was not recognised by Dr Smith and he would therefore not consider this condition when providing treatment. Had he been aware of this fact, Jane would not be put at risk-yet again-and the diabetic ketoacidosis could have been avoided. Ultimately more harm was caused, but fast actions were necessary.
    Dr Smith should have followed up with a more detailed review of Jane’s medical history once the IV antibiotics were administered. The initial process of introductions and gaining consent seemed to be skimmed over during the consultation due to the urgent nature of Jane’s complaint. This lack of communication would mean there was no opportunity for Jane to discuss her previous conditions. Even after IV treatment, there was a continued breakdown of patient-doctor communication. Patient’s are an invaluable source of knowledge, particularly Jane who has a good understanding of her diabetes and how to manage it. She would likely be aware of what could aggravate it which she could relay to Dr Smith. This follows a recurring issue throughout the story-lack of communication on all levels being detrimental to the patient’s safety and wellbeing.
    Giving the incorrect dosage is a human error, perhaps resulting from tiredness, rushing under pressure or lack of understanding of conversions. In the interest of patient safety, to prevent this occurring in the future doctors should be more educated in conversions and dosage measurements-perhaps refresher courses could be run. Equipment could be labelled or organised in a clearer way. Dr Smith should have been careful in double checking the amount and the units of the Insulin medication. Also, more open communication with the rest of the healthcare team may have prevented this overdose. If other nursing staff were informed of the dosage required, they could have intervened and corrected Dr Smith.
    Dr Smith quickly noticed his error and announced it good and timely. He instantly admitted to his mistake meaning the issue could be resolved. However, announcing it so abruptly could possibly cause alarm or confusion among the team.

    I think it is important for doctors and other healthcare workers alike to identify when issues like this occur and reflect on the root of the error. If mistakes are repeatedly caused by something more than just human error, it is necessary to flag this up with a manager so the system can be looked at objectively and a newer, more effective approach can be put into effect.

  419. Anonymous says:

    To improve, a more thorough assessment of Jane’s records should have been carried out when she was first admitted to hospital so that the whole multidisciplinary team could have been made aware of her diabetes. Moreover, the insulin that the doctor administered could have been double checked by another member of staff to ensure it was correct. Renewed training of doctors would also benefit to prevent drugs being administered in incorrect doses. As reflection is crucial in medicine, after the incident a ‘near miss’ report should be recorded and all members of the team should be informed. This will allow them to learn from the mistake and ensure this does not happen again. However, there should not be a blame culture – all members of the team should use the mistake to improve their performance rather than blaming one individual.

  420. Anonymous says:

    Firstly in order to improve patient safety, more time should be spent in assessing patients since vital information can be missed. In this case Dr Smith quickly assessed Jane and failed to get her history of type 1 diabetes. This is vital information about the patient and appropriate care should be taken. When prescribing medication Dr Smith should’ve checked her file to ensure that the drug was safe and in the best interest of that specific patient. After this incident, the whole team involved in Jane’s case should assess this incident in order to prevent its reoccurrence.

  421. Anonymous says:

    In the beginning, more careful examination of the patient along with the patient’s notes by Dr Smith may have resulted in a different patient outcome and the avoidance of a diabetic ketoacidosis for Jane.
    Likewise, more careful measuring and consideration of units when administering drugs would improve the safety of the patient and reduce the risk of getting the dosage wrong.
    Notably, communication with the patient could be improved as there was no apparent introduction or consent given. Also, the way in which Dr Smith quickly vocalized the error of the incorrect dosage of insulin to the nurses poses a risk of miscommunication and misunderstanding with both the nursing staff and the patient.

  422. Anonymous says:

    Dr Smith ‘quickly’ diagnosed Jane with sepsis and if more time had been taken he could have realised that she had type 1 diabetes. This would have resulted in increased amounts of insulin being given to the patient and avoiding ketoacidosis. Moreover, further training and updating of knowledge with regards to converting mls to units could be carried out. Better communication could also have helped the situation. Communication with Jane about the medicine Dr Smith was about to administer could have brought to light the high dosage level as Jane is an expert in her condition and may have realised it was too high a dosage. Moreover, communication with the medical team could have led to another member realising the issue and averting the problem.

  423. Anonymous says:

    It would have been better if the staff had gone through the patient history and realised that Jane was a type 1 diabetic so that they could administer an increased dose of insulin . It could be said that if this procedure was done correctly and on time , Jane would have not fallen ill and drowsy . Another area to work on is in double checking doses before administering it to the patient . It would be good if hospitals have a procedure where another staff checks medications before administration to the patient , to avoid errors such as the one that happened to Jane .

  424. Anonymous says:

    Although Dr smith correctly identified that Jane had sepsis, he “quickly assesses” her and therefore has the potential to miss other factors including the fact that she is a type 1 diabetic, and therefore when it comes to her treatment as a result there is a greater chance that mistakes will be made, of which they are, as the insulin requirements are not amended. Potentially spending a little bit more time to talk with the patient or check her notes again which would highlight that she is a diabetic, would reduce the likelihood for mistakes to occur.
    The human error made by the registrar shows a lapse in concentration which is potentially a result of having worked a long shift or being under staffed potentially so has more pressure forcing him to carry out the task more quickly. In order to improve patient safety the registrar should have taken the time to double check the volume given and that he has calculated the conversion correctly.
    As the registrar made his mistake known to others rather quickly there was a greater potential for it to rectified, the mistake should then be acknowledged by managers which could potentially implement a better system or change current systems to ensure that this was a learning experience and it would not take place again.

  425. Anonymous says:

    Firstly the staff should consult with each other before administering doses of drugs, and this would likely have prevented the doctor giving Jane an overdose of insulin. This would have prevented the subsequent panic and emergency response to combat the overdose, as this put Jane’s welfare and life at risk. If Jane hadn’t recovered from this overdose or if there was more of the insulin administered, there would have been more sinister repercussions for the medical team. Another improvement could be further training for the staff on unit conversion and in more accurate measurements. After this incident, a formal reflection should be undertaken to identify the personal failings of the medical staff in dealing with Jane, and this would help to prevent similar cases of this happening in the future. This would inevitably improve patient safety.

  426. Anonymous says:

    My Views on Jane’s Story Episode 5
    Obviously after the events in Episode 4 we knew that jane would be back with the infection. Dr Smith does a great job of quickly assessing and diagnosing Jane and immediately gets to work on treating her, this is exactly what should have been done in Episode 4 by Dr Patel and Dr Lynch to prevent the infection turning into sepsis.
    Once again no one is talking to the patient – patients know a lot about their own bodies and their own health, they’re a resource that should be used whenever possible. Jane is very good at treating her diabetes and could have alerted Dr Smith or the nurse on duty to her typical regime and this mistake could have been avoided. Also reading Jane’s chart or investigated her past medical history would have alerted the doctor to Jane’s diabetes and stopped her from falling into diabetic ketoacidosis.
    Despite being in an emergency it is still important to double check everything especially dosages. Dr Smith could have double checked the dosage or even had a nurse double check to ensure a second opinion. It is great that Dr Smith immediately realises his mistake and alerts everyone ASAP so the proper action can be taken, and Jane is saved.
    Jane has had a terrible time from a simple fractured ankle and has had such a bad experience overall but most importantly she has finally left the hospital with a complete recovery and no permanent damage.

    Please identify areas within this episode where an improvement approach could be undertaken to improve Patient Safety?
    Even though the registrar quick action with diagnosing Jane was good at getting her treatment started quickly it also meant he missed out on vital information (her diabetes). Quick assessment is essential in certain circumstances such as sepsis but once the patient was stabilised Dr Smith should have done a more in-depth assessment to ensure he didn’t miss anything. Just because the initial emergency is resolved there may be underlying conditions of importance to consider as well – and to ensure a situation like Jane’s doesn’t occur doctors should endeavour to be as thorough as possible.
    A course on drug distribution or dosage calculations should be given to Dr Smith to refresh his training on the subject. Also, as I mentioned above having a second person double check things like dosage of a drug adds an extra barrier of protection against mistakes such as this.
    Even though the issue was immediately brought to light and resolved this should not be the end of it, there needs to be a meeting on what went wrong (without pointing fingers) and what can be done to prevent this happening in the future for all staff. Having a protocol in place where dosages are double checked may also help.

  427. Anonymous says:

    Areas for improvement include:
    Regular training updates relating to administration of medication
    Double check with staff about administering the correct amount of insulin
    Accessible documents which include conversions for staff to double check in situations like this.
    A MDT meeting could be held to inform the team of the near miss situation which could prevent situations like this occurring in the future.

  428. Anonymous says:

    • Dr Smith should have been able to identify Jane had diabetes in the first place, which would have avoided Jane going into diabetic ketoacidosis.
    • The registrar should have double checked the dosage required dosage needed and the dosage they withdrew from the vial before administering, instead of after.
    • The hospital could bring in a new way of labelling the bottles of insulin in order to minimise the likelihood of this happening.

  429. Anonymous says:

    Areas of improvement:
    Double check before giving medication the amount that is given,
    Doctors and nursing staff should be proficient in the conversion of units to mls, this could be better displayed around the hospital and act as a reminder to staff. A numeracy course could help this potentially help to retrain staff. Furthermore, a near miss form should be filled so that learning can take place and so that the hospital can check to see if any changes need to take place concerning hospital trust policy better communication between the staff could also help to prevent medical emergencies.

  430. Anonymous says:

    Dr Smith assessed Jane quickly, and correctly identified sepsis, but failed to discover that she suffers from type I diabetes. If he discovered this, he would have been able to administer the correct dose of insulin immediately, alongside the IV antibiotics, preventing diabetic ketoacidosis from occurring. Additionally, Dr Smith should have taken more time to draw the insulin, checking the amount of insulin in the syringe and then hopefully realising that it was an excessive amount of insulin. Whilst Dr Smith fortunately vocalised his error as soon as possible allowing for immediate treatment with IV dextrose, it obviously would have been preferable if the error hadn’t been made in the first place, which would have prevented Jane from undergoing acute hypoglycaemia. Following the incident, Jane should receive an honest explanation and apology, and an incident report should be filed to prevent such an occurrence from being repeated in the future.

  431. Anonymous says:

    As Jane arrives at the hospital she is diagnosed correctly and swiftly however no one in charge of her care realises that she has Type 1 diabetes so her insulin dosage is affected by sepsis. This endangers Jane’s life as it could result in a very high glucose level in her blood which puts her safely at risk. If someone had checked Janes notes this mistake wouldn’t have occurred. Furthermore another error occurs where the wrong dose of insulin was given by the registrar, this is another subject where the patients safety is at risk even if Jane’s health wasn’t affected in the end and no other issues occurred it still must be remedied as things could have turned out a lot worse. To improve this they could make sure all medical staff is alert enough to treat patients so that they don’t make mistakes like this in the future and make sure members of the team in charge of Jane’s care check that the treatment she is being given is correct.

  432. Anonymous says:

    Dr Smith responded quickly to Jane’s symptoms and the sepsis was diagnosed in a timely manner. However, there were some serious flaws in terms of patient safety which could be greatly improved upon in the future. Renewed training in dosages of insulin would be valuable for all doctors, especially in cases of sepsis, where the needs of the patient change dramatically. Also, the importance of double checking with other staff about administering the correct amounts of insulin would improve patient safety by eliminating the risk of one person making a mistake. The near miss incident could also be analysed and evaluated at greater detail in a future MDT meeting in order to prevent this from happening again.

  433. Anonymous says:

    Improvement could be achieved in multiple areas of this incident. Firstly, being unaware of a key element of Jane’s medical heath – type 1 diabetes – is a critical mistake which could ultimately lead to a rapid decline in Jane’s health. When handing over Jane’s care to Dr Smith, a run through of her medical history would have brought up her condition of diabetes and Dr Smith likely would have been aware that Jane would have needed higher doses of insulin. This may have also been prevented had there been a second overview of Jane’s care by another health professional. Having two people check over Jane’s treatment plan and her medical history may have prevented this occurrence of DKA. However a fast recognition of the mistake and quick action taken by the medical team prevented a potentially fatal outcome. The fact that the consequences of this situation could have been fatal, highlight how important it is to check a dose before it is given, and to make sure you understand and prepare yourself with a patient’s history. Particularly when a health condition, an allergy or other key elements of a patient’s medical history may be missed.

  434. Anonymous says:

    Dr.Smith quickly assesses Jane, missing that she is type 1 diabetic which must be factored into the treatment of her sepsis. She begins to deteriorate, entering diabetic ketoacidosis. At first a more thorough examination is necessary, even when time is of the essence a full assessment is important; perhaps a medical bracelet could have been prescribed, but her type 1 diabetes should be placed clearly in the notes which must be read fully. While Dr.Smith does recognise the need for insulin later on, neither he nor anyone else checks his working and he administers 100x the dose necessary, which would obviously be a medical emergency. Luckily, he immediately realises his mistake and the team works to resolve it, however proper checks on any calculations can prevent situations like this from occurring. If possible then a chart containing the most common calculations for insulin should be present beside the medication for double checking. The case should be anonymised and used in medical training to ensure that mistakes, especially those which could be life-threatening don’t happen again.

  435. Anonymous says:

    When Jane initially returns to hospital she is correctly diagnosed with sepsis by Dr Smith following her post-op infection. The multidisciplinary team immediately recognise that this is a serious concern and administer treatment however nobody recognises that as Jane is diabetic, her insulin dosage needs to be increased. This then caused Jane to go into diabetic ketoacidosis which put her life in serious danger. This could have been avoided if Janes notes had been inspected more thoroughly and if the entire team was more informed on the protocol surrounding sepsis in diabetic patients. When the mistake was realised Dr Smith accidentally administered 100 times more than the required dose of insulin in an attempt to correct the insulin levels. This could have been avoided if Dr Smith was more informed on measurements and understood the difference between a unit of insulin and a millilitre. This also could have been avoided if Dr Smith had asked a colleague to chaperone him and confirm he had measured out the correct dose. This probably did not occur as Dr Smith would have been in a panic trying to rectify the situation, and although this could have been a potentially fatal error it good that it was realised in time and could be rectified and hopefully learnt from.

  436. Anonymous says:

    Dr Smith correctly recognises Jane has sepsis and correctly acknowledges he needs to assess her and act quickly to prevent things getting any worse. However, in doing so he overlooks Jane’s medical history and doesn’t see that she is a diabetic, and does not provide her with the adequate medication. In future, even in emergency situations there should still be some time set aside to read over patient notes as this incident could have been prevented. The wrong dose of insulin was also delivered to Jane, resulting in a medial emergency. Although Jane was OK in the end, things could have been much worse. In future, there should be more checks made before any administration of drugs and also there could be drug calculation sessions which healthcare staff should attend every so often to practice such scenarios. The incident should also be noted as an educational resource from which staff can learn from in the future.

  437. Anonymous says:

    Please identify areas within this episode where an improvement approach could be undertaken to improve Patient Safety?
    Mandatory training could be provided to remind the clinical staff about the requirement to increase insulin administration during sepsis, this method of raising awareness among staff may reduce the risk of the same scenario happening with other diabetic patients. The error made by the registrar to administer 100 times the correct dose of insulin could have potentially been avoided by having another staff member check the drug calculation prior to administration, this would have reduced the risk of human error by an individual member of staff compromising patient safety. As well as double checking of the calculation by another appropriately trained member of staff, the hospital could implement a better system, for example, better labelling of the insulin bottles with their concentrations to try to minimise the risk of administering an incorrect dose. A record should be kept of both instances and be used as a learning tool to improve patient safety in the future.

  438. Anonymous says:

    Dr Smith did not take into account Jane’s diabetes when administering IV antibiotics and therefore, her insulin was not adjusted appropriately. This could have been avoided if Dr Smith had done a more thorough examination of Jane when she arrived, making sure to be familiar with her past and present medical history. Another mistake that Dr Smith made was administering the incorrect dose of insulin into Jane. This is a serious mistake that puts patient safety at risk. To prevent this mistake from reoccurring, another colleague should double check that the dosage is correct and therefore the likelihood of the incorrect dose being administered is reduced. Furthermore, a note should be taken of this mistake for future teaching practice to highlight the importance of correct drug calculations.

  439. Anonymous says:

    Dr Smith’s quick initial assessment of Jane led to him missing that Jane was a type 1 diabetic, this may have been avoided by taking a more thorough history and asking Jane if she was currently on any medications and the note taking method could maybe be adjusted to highlight important information so this mistake does not occur in the future. The risk of administering the wrong dosage of drug could be reduced in the future by allowing the staff to undertake further training on drug calculations. It may also be beneficial in future to have a system in place where all dosages should be checked by a colleague to reduce the chances of an error being made.

  440. Anonymous says:

    All doctors working with Jane should be aware that she is a diabetic so a safe approach can be taken with her treatment and the correct medication can be given quickly and safely. This would have allowed Jane to get the proper level of insulin required when originally diagnosed with sepsis, preventing complications.
    More training could also be provided for doctors in calculating dosages and converting between different units to ensure the patient is given a safe and effective amount of medication.
    This incident should also be noted for future reference and teaching so something like this will not happen again.

  441. Anonymous says:

    Improvements could have been made in relation to Dr. Smith’s approach to Jane and her treatment. Dr. Smith should’ve made the connection between sepsis and insulin levels and been aware early on of what needs to be done. Furthermore, correct drug calculations are vital for maintaining patient safety. Dr. Smith should’ve been more attentive to his actions and checked his calculations again. If this mistake had gone unnoticed, there would’ve been detrimental consequences for Jane and her safety. In relation to improvements in this situation, drug calculations should be checked and confirmed, patient notes should be analysed and drug calculation training should be provided to all medical staff and reviewed. This incident should also be noted for educational purposes in order to avoid it occurring in the future, thus, reducing the likelihood of errors and improving patient safety overall.

  442. Anonymous says:

    The first area for improvement that would improve patient safety is having Jane’s insulin requirements adjusted in relation to her sepsis. Perhaps Dr Smith was unaware of her type 1 diabetes through not fully reading her medical notes. If this was the case, it needs to be investigated as to why he missed something as crucial as Jane having type 1 diabetes. Was he distracted? Is there a poor note taking system in place where important information can be lost among less important information? Once this has been identified, appropriate action can take place. The next area for improvement is Dr Smith’s mistake in delivering 100 times the amount of insulin Jane needs. This could be improved simply through double checking the amount to be delivered with another member of the team before it is administered. It could also be addressed through emphasising to doctors and nurses the dangers of administering wrong dosages. Ultimately, Dr Smith should reflect on why he made the dosage error and consider how he could prevent it in the future.

  443. Anonymous says:

    Jane’s infection is developing and having noticed it, Jane has returned to the hospital presenting with a very high fever, feeling faint and with yellow discharge oozing from the surgical wound. Dr Smith assesses Jane quickly, recognising the infection and detecting sepsis. Although he did pick up on these vital signs, it is possible in his haste, the registrar didn’t fully consider Jane’s medical history of type I diabetes by thoroughly checking her notes and factor her insulin dosage into account while treating her current problems. When the registrar calculates Jane’s dosage of fluids for treatment, not only is he alone, but this dosage is not checked by anyone (including Dr Smith himself) before being administered to Jane. An improvement approach would be ensuring whenever possible, fluid dosages are checked by another medical professional before being given to the patient. However, I understand not every situation allows for a check by a colleague, and regardless, all doctors and nurses should have adequate training in dosage calculations, training and knowledge which should be maintained and reviewed regularly. It is very important that whoever may be administering drugs or calculating dosages is very diligent in their practice to avoid preventable yet potentially fatal errors such as this. Furthermore, when errors such as this do happen, even in the event they are caught before affecting the patient, they should be reviewed by the medical team to allow for reflection and evaluation.

  444. Anonymous says:

    Unsurprisingly Jane has to be rushed back to hospital, after being discharged from hospital with an infection brewing. First problem is how the registrar “quickly assesses” Jane, whilst he made a correct diagnoses and acts to distribute correct treatment for it, he didn’t take a thorough enough PMH or check her notes and realise she is a diabetic.
    This could be avoided by paying particular attention to PMH and current drugs the patient is taking. If her insulin levels were modified accordingly from first admittance, diabetic Ketoacidosis would have been avoided.

    The registrar did realise immediately he had made a mistake and acted immediately to try correct it. This mistake in dosage measurements could be improved by increased compulsory dosage measurement and drug distribution training. From an early point, such as in university, tutorials on dosages and maths calculations and IPL training with pharmacists can maybe prevent these types of mistakes by having an increased awareness of the detrimental mistakes that can be made in these areas. Whilst the mistake was made, it was immediately corrected and Jane didn’t suffer because of the immediate correction – however this shouldn’t be swept under the carpet, instead the staff should hold an audit with other doctors to discuss the mistake and how they can prevent the same mistake occurring in the hospital again.

    Increased team work across different positions in healthcare would have benefitted jane in this situation. For example if the doctor had double checked the dosage with a nurse, another doctor or more senior member of staff, the mistake would likely have been corrected.

  445. Anonymous says:

    Unsurprisingly Jane has to be rushed back to hospital, after being discharged from hospital with an infection brewing. First problem is how the registrar “quickly assesses” Jane, whilst he made a correct diagnoses and acts to distribute correct treatment for it, he didn’t take a thorough enough PMH or check her notes and realise she is a diabetic.
    This could be avoided by paying particular attention to PMH and current drugs the patient is taking. If her insulin levels were modified accordingly from first admittance, diabetic Ketoacidosis would have been avoided.

    The registrar did realise immediately he had made a mistake and acted immediately to try correct it. This mistake in dosage measurements could be improved by increased compulsory dosage measurement and drug distribution training. From an early point, such as in university, tutorials on dosages and maths calculations and IPL training with pharmacists can maybe prevent these types of mistakes by having an increased awareness of the detrimental mistakes that can be made in these areas. Whilst the mistake was made, it was immediately corrected and Jane didn’t suffer because of the immediate correction – however this shouldn’t be swept under the carpet, instead the staff should hold an audit with other doctors to discuss the mistake and how they can prevent the same mistake occurring in the hospital again.

    Increased team work across different positions in healthcare would have benefitted jane in this situation. For example if the doctor had double checked the dosage with a nurse, another doctor or more senior member of staff, the mistake would likely have been corrected.

  446. Anonymous says:

    Firstly, if the healthcare team are aware that a patient is diabetic then extra caution should be taken to ensure their disease and respective treatment do not impact on their insulin levels. I feel that there should be a document outlining how to adjust insulin provision to diabetic patients, depending on the specific disease from which they are suffering. Secondly, doctors should be extremely precise when administering drugs, double checking their intended dose themselves, and with a colleague, to ensure it is correct. It may be an idea to have pre-prepared injections of insulin which are clearly labelled with the number of units contained inside.

  447. Anonymous says:

    The staff need informed and refreshed on the increased requirements for insulin administration during infections such as sepsis. The registrar and medical colleagues involved in Jane’s care should also ensure to read Jane’s notes so that they are aware to increase her insulin levels at this time.
    Additionally, care and time should be taken when calculating dosage levels for insulin, in terms of converting and understanding between mls and units. Administrating incorrect insulin doses can be catastrophic and life-threatening, especially to diabetic patients. This case where the registrar has delivered 10 times the amount to Jane, has caused a medical emergency and requires medical equipment, staff and time, which has wasted valuable NHS resources. Before medication is given to a patient, it should be double checked by another colleague in order to reduce errors.
    Rectifying these mistakes can help and aid in improving patient safety for everyone involved, including saving finite resources.

  448. Anonymous says:

    Dr Smith quickly assessed Jane initially. He should have taken more time to take a past medical history so he would find out Jane is a diabetic. He then could have adjusted her insulin levels; this would have prevented Jane going into diabetic ketoacidosis. Dr Smith should have taken more care when injecting Jane with the insulin as it was such a huge overdose. Perhaps more training is required on converting units to ml, or an electronic unit converter could be used. Additionally, the team need to review this mistake, they need to identify how it happened and put measures in place to ensure it doesn’t happen again. Perhaps warning signs in the room where the insulin is kept would remind doctors to be extra careful when administering. Dosages should be drawn up and then the member of staff should double check in the notes/with another member of staff that they have the right amount of chemical.

  449. Anonymous says:

    Areas of improvement include:
    – Training on drug calculations should be provided to all doctors and medical staff
    – The dose of drugs should be double checked by a colleague before being administered to the patient, in order to minimize errors
    – Doctors should check the medical files of the patients as well as discussing with the patient if it is possible, before administering any type of drug as Dr Smith should have done in this instance
    – Doctors must be really careful and concentrated while administering drugs to the patients and also before and after they proceed to a diagnosis they have to take everything into consideration and make the appropriate adjustments based on the patient – as Dr Smith should have done based on the fact that Jane was diabetic and insulin requirements are increased during sepsis.

  450. Anonymous says:

    Improvements that would improve patient safety in this episode include checking patient notes before administering drugs, as the Doctor would’ve realised that Jane’s insulin dose needs to be increased when she has sepsis. In addition, more care needs to be taken before administering important drugs and the calculations should always be checked and if necessary clarified by another doctor or nurse. Regular training in drug calculations and regulations should be provided to all doctors and nurses to ensure they are familiar and up to date with calculating doses.

  451. Anonymous says:

    More training needs to be provided on converting between mls and units. Errors in this area lead to serious medical emergencies, in this case, the registrar instantly releases his mistake but if he had not had this would have had a drastic consequence for Jane. The doctor also should have made the connection earlier between Jane being a diabetic and the requirements for insulin changing and extra precautions should have been taken as a result. This ‘near miss’ incident should also be the subject of the next team meeting and discussions/protocols should take place to ensure this never happens again and review the mistake made.

  452. Anonymous says:

    Areas for improvement include training on insulin doses and how to convert between mls and units. Retrain everyone on the ward so they are aware how to administer insulin effectively. If the doctor had spoken to Jane about what they were administering and how much Jane may have noticed that the insulin dose they are giving was too large. If unsure about how to convert between mls and units double check with another member of staff.

Leave a Reply to Anonymous Cancel reply

Your email address will not be published.