The FAWKS Company

AAARRRGGGHHH!! Nick Bockmann Pharm.D. Presenting at #SCAhealth #NWELT last week in Portland Long Live ASCs! ?

More specialization Leveling reimbursement Technology Staffing - better work life balance is attractive Better accessibility Increased Demand Exciting times for ASCs ahead! Long Live ASCs!??

90 minute slide deck on CSOS last week Just re-listened to the recording today CSOS Process Flow Key Points 1. Current CSOS Users ? No action required unless: ? DEA license expires within 45 days (Registrant must log in after renewing DEA license). ? Approvals or revocations of certificates are needed (must be done through the new portal). 2. New User Registration Step 1: Registrant creates an account in login.gov: ? Verify email. ? Upload license (front and back). ? Provide SSN. ? Save personal key for recovery. Step 2: Registrant logs in to the CSOS portal and submits registration. Step 3: After registrant approval: ? Coordinators can create accounts. ? Coordinators’ account creation triggers an email to the registrant for approval. 3. Portal Actions ? Renewals: ? DEA license renewal must be completed first. ? Certificate renewal follows via the CSOS portal. ? Approvals/Revocations: ? Registrants approve/revoke coordinators. ? Coordinators can approve/revoke POA. 4. Certificates & Status Tracking ? Status Updates in portal: ? Submitted → In Process → Certificate Generation → Cert Ready for Download → Certificate Downloaded. ? Certificates are generated within 3-5 days and mailed. Resources ? Questions: [email protected] ? FAQs: https://lnkd.in/gBJqXGYy ? CSOS E-commerce Site: CSOS E-commerce site: https://deaecom.gov/csos2

CSOS application slow? Read below ????

Mastering emergency medication protocols can save lives! ?? 1. Epinephrine Drug Class: Alpha/Beta Adrenergic Agonist ??Uses: - Ventricular fibrillation (VF) / Pulseless Ventricular Tachycardia (VT) - Symptomatic bradycardia - Anaphylaxis - Asystole / Pulseless Electrical Activity (PEA) ??Pathophysiology: Stimulates alpha and beta-adrenergic receptors to relax heart and lung smooth muscles and dilate blood vessels, increasing heart rate and blood pressure. ??Dosing: - VF/PEA/Asystole: 1 mg IV/IO every 3–5 minutes - Symptomatic Bradycardia: Infusion at 2–10 mcg/min, titrating to response 2. Atropine Drug Class: Anticholinergic ??Uses: - Bradycardia - Pre-surgical reduction of saliva and respiratory secretions ??Pathophysiology: Blocks acetylcholine at parasympathetic sites in smooth muscle, increasing heart rate. ??Dosing: 1 mg IV/IO every 3–5 minutes (maximum: 3 mg) 3. Amiodarone Drug Class: Antiarrhythmic ??Uses: - Ventricular fibrillation (VF) / Pulseless Ventricular Tachycardia (VT) - Recurrent, hemodynamically unstable VT ??Pathophysiology: Blocks potassium channels, reducing abnormal electrical activity in the heart. This slows conduction and restores normal rhythm. ??Dosing: - First dose: 300 mg IV/IO push - Second dose: 150 mg IV/IO push 4. Adenosine Drug Class: Antiarrhythmic ??Uses: - Supraventricular Tachycardia (SVT) not resolved by vagal maneuvers ??Pathophysiology: Temporarily blocks AV node conduction, interrupting reentrant circuits causing SVT. ??Dosing: - First dose: 6 mg IV/IO rapid push over 1–3 seconds, followed by 20 mL saline flush - Second dose: 12 mg IV/IO rapid push 5. Calcium Chloride Drug Class: Electrolyte ??Uses: - Cardiac arrest - Hyperkalemia - Hypocalcemia ??Pathophysiology: Enhances contraction of muscles and cardiac function by increasing calcium availability. ??Dosing: - In cardiac arrest: 20 mg/kg IV/IO bolus - Non-arrest: Infuse over 30–60 minutes 6. Sodium Bicarbonate Drug Class: Alkalinizing Agent ??Uses: - Tricyclic antidepressant overdose - Metabolic acidosis in cardiac arrest - Hyperkalemia-related cardiac arrest ??Pathophysiology: Neutralizes excess acid in the blood, correcting acidosis and improving heart function. ??Dosing: 1 mEq/kg IV push in a dose of 50 mL D5W 7. Magnesium Sulfate Drug Class: Antiarrhythmic and Electrolyte ?Uses: - Torsades de pointes (a type of polymorphic VT) - Arrhythmias due to hypomagnesemia ?Pathophysiology: Slows down calcium influx into the SA node, stabilizing the heart's rhythm. 8. Lidocaine Drug Class: Antiarrhythmic ?Uses: - Ventricular fibrillation (VF) - Pulseless Ventricular Tachycardia (VT) - Local anesthesia ?Pathophysiology: Blocks sodium influx into cardiac cells, stabilizing their electrical activity and reducing excitability. ?Dosing: 1–1.5 mg/kg IV push, repeated every 5–10 minutes as needed #EmergencyMedicine #Pharmacology #HealthcareProfessionals #CardiacCare #ClinicalPharmacology #MedicalEducation #LifeSavingDrugs #Pharmacy #CriticalCare

??Health Dept. Alert?? Came up this morning. Health inspectors on site The package insert may not explicitly indicate your eye drops are appropriate for use multiple times…. THATS OK! IF your package insert does indicate presence of a preservative THEN you are in the clear for multiple patients and multiple times Use this URL for package insert (https://lnkd.in/ePYpmPd)

Simplified and formalized from a couple of posts ago. We have been getting ALOT of these questions lately. Reach out if you have any questions!

“I don’t need paper records of receipt because we use CSOS!” ?? ?? ?? To paraphrase our most recent email with the DEA about C2 recordkeeping (21 CFR 1311.60) ??: Correct—paper records are not necessarily REQUIRED. But… if you keep them on your individual CSOS account, you’ll need to personally retrieve those records in case of a DEA audit. (And trust me, you don’t want to be scrambling to do that in front of an agent—that’s the real nightmare ??). ?? Best Practice ?? ?? Maintain your packing slip/invoice from your C2 order in paper form, with the date it was signed into inventory and by whom. (Yes, it’s extra work—but think of it as your “audit-proof” workout plan ??). ?? Attach the e222 form from your wholesaler to the packing slip/invoice. This form can be printed after receipt of the order from your wholesaler account. (No, you don’t have to tattoo it on your forehead. Just keep it with the order. ??) ?? Keep it separate from other records of receipt. No, don’t throw it in with your stash of non-controlled substances or CIII-CV medication records. They’re like the weird cousin at a family reunion—keep them in their own space. ??? Now, you can avoid paper clutter AND avoid the DEA’s eagle-eyed gaze. ?? #C2Recordkeeping #CSOS

Transferring from one DEA registration to another? Steal attached PDF for reference. This is SUPER valuable!