Contraindications: There are no known contraindications according to the Commission E and the WHO. The British Herbal Compendium (BHC) contraindicates ginseng for patients with acute illnesses, hypertension, or who use excessive amounts of stimulants, particularly caffeine-containing beverages. However, adequate documentation for the contraindication of ginseng in acute illness is lacking, but may be based on traditional Chinese medicine guidelines. Similarly, it may be prudent to contraindicate Asian ginseng in persons with bleeding disorders, as ginseng and ginseng components have been associated with blood-thinning activity as evidenced by diminished coagulation in experimental animal studies, although this effect has not been well documented in humans. Based on the issue of its potential synergy with caffeine, it is sometimes contraindicated with large amounts of caffeine and presumably other central nervous system (CNS) stimulants. It is prudent to discontinue use of ginseng at least one week prior to surgery, due to ginseng's observed long-term potential blood thinning activity in laboratory animals and its potential hypoglycemic affect. Pregnancy and Lactation: There are no known restrictions for use during pregnancy or lactation, although the BHC contraindicates ginseng during pregnancy. While there are no data to document the safety of Asian ginseng in pregnancy or lactation; research has indicated that Asian ginseng is not teratogenic (it does not cause abnormal growth in the fetus). The American Botanical Council advises pregnant or lactating women to consult a healthcare practitioner before using any herbal product or conventional medication. Adverse Effects: A recently published critical review of safety data and potential interactions of ginseng, concluded that it was well tolerated by most users. The review also notes that of the 146 clinical trials using various ginseng preparations (monopreparations and combination products) conducted on over 8500 subjects, relatively few adverse events were reported in the trials. Further, it states that in 22 of 27 case reports of adverse effects, no details were provided regarding the type of ginseng or the dose used, thereby raising questions as to the clinical reliability of such reports. Drug Interactions: Individuals should use caution when consuming large amounts of caffeine along with Asian ginseng. Asian ginseng has been implicated in two cases of interactions with phenelzine, a monoamineoxidase (MAO) inhibitor, producing manic-like symptoms. The clinical significance of these reported interactions has not yet been properly evaluated. Some references suggest a possible interaction with ginseng and the blood-thinning drug warfarin (Coumadin) so patients on warfarin should consult with a healthcare professional before using Asian ginseng, although a recent review of this ginseng and warfarin reports concluded that the documentation for this interaction is not well established. Diabetic patients may need to adjust insulin dosage as ginseng may slightly reduce blood glucose levels. Safety Statement: Asian ginseng is considered generally safe and is well tolerated by most users. Disclaimer: This information was derived from information compiled by the American Botanical Council (ABC). Although great care was taken in compiling this information, due to the ever changing nature of healthcare, ABC does not accept responsibility for the consequences of the use of this information or the most up-to-date accuracy of the information. ABC does not endorse or test products, nor does it verify the content or claims made, either implicit or explicitly. Keep out of reach of children. If you are pregnant or nursing, or have abnormal blood pressure, consult your physician before taking this product. Double safety sealed with an outer neckband film and a printed inner freshness seal. Do not use if either seal is broken or missing.
FINAL PROFICIENCY EXAM RETEST SCENARIO ONE You are called to a private residence to evaluate a 65 year old male patient – “sick call”. SCENE SAFETY : GENERAL IMPRESSION: The pt is sitting upright, looking tired. LOC: CHIEF COMPLAINT: “I feel so weak, and my chest feels a little heavy.” BREATHING: CIRCULATION: Radial pulses are present. but are weak and slow