PONV Risk Factors in Adults1 - "SAMBA Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: An Executive Summary for Perianesthesia Nurses." 0000026693 00000 n 0000009505 00000 n 0000041217 00000 n 0000016288 00000 n American Society of Enhanced Recovery and Society of Ambulatory Anesthesia. 0000010069 00000 n Incidence and predictors of postdischarge nausea and vomiting in a 7-day population. 0000016041 00000 n 0000003371 00000 n 0000013894 00000 n POSTOPERATIVE NAUSEA AND VOMITING (PONV) remains one of the most common, and most distressing postoperative complications. The foregoing list of medications/drug names is based on clinical guidelines and other evidence. 0000012961 00000 n Table 1. Since the 2002 ASA guidelines were released, another >250 comparative trials on anti-emetic agents have been published; these data were considered in the 2007 revised set of evidence-based recommendations for treating PONV and PDNV, created with the support of SAMBA, by a multidisciplinary international panel of experts. Ponv Samba Guidelines And Risk Factors Doc. 0000004278 00000 n Establishment of Expert Guidelines To produce the SAMBA guidelines for the management of PONV, an unrestricted educational grant was provided by Baxter (transdermal scopolamine), GSK (ondansetron), Merck (aprepitant), MGI Pharma (palonosetron) and Roche, Inc. (granisetron). 0000005366 00000 n 186 76 0000005048 00000 n The article reports on the new guidelines for Postoperative Nausea and Vomiting (PONV) issued by Society for Ambulatory Anesthesia (SAMBA) entitled "Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting" in December 2007. 0000003599 00000 n 0000016434 00000 n Anesth Analg 118(1): 85-113. 0000041280 00000 n by SAMBA toreview current evidence, review, and revise the 2007 SAMBA guideline. This pandemic is evolving and recommendations and restrictions change frequently. 0000008658 00000 n 0000004730 00000 n knowledge of the guidelines and low adherence to them are a well-known problem.6,7 The first consensus guidelines for the management of PONV were published in 2003,8 with updates in 2007 and 2014.5,8,9 In accordance with the latest version of these guidelines, we introduced our departmental algorithm for PONV prophylaxis in 2014. x�b```c``����� r�A�D�2�,m� ����,+��ĥ��J+0 �ӷ���Y�3sC�D) ����.�r��yyi�&���z�f��5��r��8=Y+��r�Y�l"V��"c�N�0���rv�*��1�ZN:��u��MK�@�� ����(�bRR� +`Lit�(G����y"H{�� ���Ǡ�����h�* ������ ��h��@���a��]�- JH] Q����w��A���`J�:��t�Ǡȩ��A�!��� �^0���8�idg*aL�a��s�'�OZ�;�Q��A�a�V�>�=�4��_ w`S��+.0,`?�Թ��i!��@����C(�X �[8?n҆����V��%��bw n �� � 0000005603 00000 n In our study, we used 0.2 mg /kg Gan, T. J., et al. 186 0 obj <> endobj Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. It is associated with the use of anaesthetic gases and opioid pain-killers and is particularly common following gynaecological, abdominal, breast, eye and ear operations, especially those lasting an hour or more. 0000006543 00000 n 0000002665 00000 n and treat PONV. The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. 0000000016 00000 n Dr. Kovac also serves as an editorial reviewer for several medical journals. "Consensus guidelines for the management of postoperative nausea and vomiting." 0000003943 00000 n He has been a member of the committee on PONV Consensus Guidelines for the Society of Ambulatory Anesthesia (SAMBA). Factors Influencing Early Postoperative Recovery After Laparoscopic Cholecystectomy. of History and Philosophy of Medicine. An Introduction to the ASPAN Evidence-Based Clinical Practice Guideline for the Prevention and/or Management of PONV/PDNV. Version [version] Download: 49: Stock [quota] Total Files: 1: File Size: 27.50 KB: Create Date 0000005286 00000 n Establishment of Expert Guidelines To produce the SAMBA guidelines for the manage-ment of PONV, an unrestricted educational grant was provided by Baxter (transdermal scopolamine), GSK (ondansetron), Merck (aprepitant), MGI Pharma (pal-onosetron) and Roche, Inc. (granisetron). 0000005996 00000 n SAMBA PONV Consensus Statement PONV-PDNV Guidelines (PDF) -- SAMBA PONV Consensus Statement Summary 0000012024 00000 n Despite advances in pharmacological and nonpharmacological prophylactic and rescue interventions, postoperative vomiting (POV) occurs in approximately 30% of surgical patients, while the incidence of nausea is around 50%. 261 0 obj <>stream 0000005207 00000 n These findings support the current recommendation of the SAMBA guidelines for PONV, which favors the 4-mg to 5-mg dose regimen of systemic dexamethasone. 0000001816 00000 n 0000004490 00000 n Acupuncture in the Management of Intraoperative Nausea and Vomiting. b. PONV is a key concern for many patients undergoing an anaesthetic and, should it occur, can lead to significant discomfort and dissatisfaction c. PONV is a major contributor to increased direct and indirect costs for both the hospital and patient 4. 0000006654 00000 n The incidence of PONV in high risk … 0000003828 00000 n 0000041343 00000 n The specified drugs were selected based on the strength of evidence for their clinical effectiveness. 0000006231 00000 n Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting. 0000006391 00000 n provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). 0000002361 00000 n PONV-PDNV Guidelines (PDF)-- Multi-disciplinary, multi-modal evidence-based practice guideline into practice to direct the prevention and/or management of PONV/ PDNV. <<1B44920E7948B6478FF268EB4DE7612C>]>> The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. 0000005917 00000 n It is reassuring and encouraging to note that the current SAMBA guidelines explicitly state the goal for antiemetic multimodal prevention to become an integral part of anesthesia[35,51]. PONV is a common complication of surgery, occurring in approximately 30% of surgical patients and up to 80% of high-risk patients. Nurses' experiences in the relief of postoperative nausea and vomiting. At the end of the day, anesthesia care providers should view PONV prevention as self-evident as preventing and treating pain. Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care. 0000009100 00000 n Although relatively short-lived in nature, patients identify PONVas one of the most…, Postoperative Nausea and Vomiting in Paediatric Anaesthesia, Factors Affecting Postoperative Nausea and Vomiting in Surgical Patients, Early Rehydration in Surgical Patients With Prolonged Fasting Decreases Postoperative Nausea and Vomiting, Development and Evaluation of an Evidence-based Nursing Protocol for Postoperative Nausea and Vomiting, COMPARISON OF ONDANSETRON, GRANISETRON AND DEXAMETHASONE FOR PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING IN THYROIDECTOMY PATIENTS IN OUR RURAL TERTIARY CARE CENTRE. A discussion of ethics in PONV research has been initiated by the meta-analysis of PONV studies. POSTOPERATIVE NAUSEA AND VOMITING (PONV) remains one of the most common, and most distressing postoperative complications. 0000006151 00000 n ... and Society for Ambulatory Anesthesiology (SAMBA) grading system for recommendations . 0000018270 00000 n The present guidelines are the most recent data on PONV and an update on 2 previous sets of guidelines published in 2003 and 2007 by the same group. Acupressure the PC6 point for alleviating postoperative nausea and vomiting, Perioperative PONV Management, a Survey from Swedish Nurse Anesthetists' Perspectives. SAMBA issues new guidelines for PONV. These findings support the current recommendation of the SAMBA guidelines (21) for PONV, which favours the 4-mg to 5-mg dose regimen of systemic dexamethasone. 0000004385 00000 n %PDF-1.7 %���� 0000004058 00000 n startxref Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate orders Guidelines for Ambulatory Anesthesia and Surgery Guidelines for Delineation of Clinical Privileges in Anesthesiology 0000003035 00000 n 0000005682 00000 n 0000007098 00000 n 0000017413 00000 n 0000004888 00000 n 0000033439 00000 n Tabrizi S, Malhotra V, Turnbull ZA, Goode V. PURPOSE: Postoperative nausea and vomiting (PONV) is one of the most common complications after anesthesia. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses, Turkish journal of anaesthesiology and reanimation, Journal of acupuncture and meridian studies, View 4 excerpts, references methods and background, By clicking accept or continuing to use the site, you agree to the terms outlined in our, Postoperative anesthesia care unit (PACU). You are currently offline. In addition, the current guidelines focus on the evidence for newer drugs (such as second generation 5-HT 3 antagonists, NK1 antagonists and dopamine antagonists), discussion regarding the use of general multimodal PONV prophylaxis, and PONV management as part of enhanced recovery pathways. 0000005524 00000 n 0000015744 00000 n Faculty Opinions recommendation of Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. 0000006073 00000 n BARHEMSYS Is a Selective D 2 and D 3 Receptor Antagonist 1. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. In addition, the current guidelines focus on the evidence for newer drugs (eg, second-generation 5-hydroxytryptamine 3 [5-HT3] receptor antagonists, neurokinin 1 (NK1) receptor antagonists, and dopamine antagonists), discussion regarding the use of general multimodal PONV prophylaxis, and PONV management as part of enhanced recovery pathways. 0000005128 00000 n What other guidelines are available on this topic? 0000004570 00000 n 0000003486 00000 n (2014). 0000016232 00000 n PONV is common complaint second only to ... Bergese S, et al. Since the previous Guideline in 2009, SIGN have implemented the Grades of Recommendation, Assessment, Development The incidence of PONV in high risk patients may run as high as 80%. 0000004809 00000 n The group included individuals who had been involved in the development of the previous ASPAN and SAMBA guidelines, as well as representatives from healthcare organizations with an interest in the prevention and/or management of PONV/PDNV. Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. 0000005446 00000 n %%EOF The latest Consensus Guidelines for the Management of PONV (CGM-PONV) recommend an assessment of a patient’s baseline risk for PONV using a validated risk score based on … 1, 2 The 2 guidelines published in 2006 and 2008 focused primarily on perianesthesia nurses and gynecologists and did not have up-to-date information on the management of PONV. P��ԝ\bK!�0 �p Despite advances in pharmacological and nonpharmacological prophylactic and rescue interventions, postoperative vomiting (POV) occurs in approximately 30% of surgical patients, while the incidence of nausea is around 50%. 0000003143 00000 n We have evaluated the current information about COVID-19 at the time this statement was issued. While multiple advances have been made in the last several years in minimizing adverse outcomes after anaesthesia, patients continue to rank nausea/vomiting as their most undesirable surgical outcome.1,2 While the incidence of postoperative nausea and vomiting (PONV) varies considerably in both the inpatient and outpatient setting,3–6 studies indicate that the incidence of nausea ranges from 22% to 38%7 and the incidence of vomiting ranges from 12% to 26%.7 Multiple risk factors have been identifie… SAMBA's ASC Group Membership is designed to provide surgical centers a cost-effective way to keep all medical staff and allied health providers that work in an ASC, Endoscopy Center or office-based setting up-to-date on the latest industry knowledge. SAMBA-Executive-Summary-PONV-Management.pdf - Free download as PDF File (.pdf), Text File (.txt) or read online for free. Pediatrics and post-discharge addressed. 0000002629 00000 n 0000041165 00000 n xref 0000014764 00000 n The guidelines have been prepared using SIGN Methodology1 drawing together available evidence and recommending best practice based on the available evidence and on the clinical experience of the guidelines development group. 0000011062 00000 n 0000040402 00000 n Management of Common Postoperative Complications. 0000003714 00000 n 0000006869 00000 n 0000006620 00000 n Postdischarge nausea and vomiting: management strategies and outcomes over 7 days. IDENTIFICATION OF THE PATIENT AT RISK OF PONV 0000004650 00000 n 0000002587 00000 n 0 To help guide antiemetic selection and PONV therapy for clinical practitioners, the Society of Ambulatory Anesthesia (SAMBA) PONV consensus guidelines have been introduced and updated. Some features of the site may not work correctly. ASPAN'S evidence-based clinical practice guideline for the prevention and/or management of PONV/PDNV. To produce the SAMBA guidelines for the management of PONV, an unrestricted educational grant was provided by Baxter (transdermal scopolamine), GSK (ondansetron), Merck (aprepitant), MGI Pharma (palonosetron) and Roche, Inc. (granisetron). 0000006311 00000 n Perioperative Nausea and Vomiting: Much Ado About Nothing? In response to inquiries, SAMBA is providing guidance which we hope our members will find helpful. 0000007589 00000 n endstream endobj 187 0 obj <> endobj 188 0 obj <> endobj 189 0 obj <> endobj 190 0 obj <> endobj 191 0 obj <> endobj 192 0 obj <. 0000004170 00000 n 0000008272 00000 n Several guidelines on the management of PONV have been published.1–7 However, they are either in non-English language,4,5,7 targeted for a speci!c surgical population,6 or have not been updated in recent years.1–3 A recent update by the American Society of Anesthesiologists task force on 0000006471 00000 n He is secretary for the Anesthesia History Association and is an Affiliate Professor in the Dept. 0000004968 00000 n SAMBA continues to monitor the COVID-19 pandemic. Increased emphasis on patients at risk for postoperative nausea and vomiting (PONV), enhanced information on anesthesia for pediatric patients, and focus on post-discharge PONV are three significant changes in the Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and … 0000003256 00000 n 0000009991 00000 n 0000005839 00000 n trailer 0000005760 00000 n The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Pdf File (.txt ) or read online for Free committee on PONV Consensus guidelines for the of... At decreasing the Incidence samba ponv guidelines PONV, optimizing PACU times, and the. Of Intraoperative nausea and vomiting. PONV Consensus guidelines for the prevention Management. And treating samba ponv guidelines 0000011062 00000 n postdischarge nausea and vomiting. on guidelines! Of Intraoperative nausea and vomiting. D 3 Receptor Antagonist 1 day, Anesthesia providers. A 7-day population n 0000002665 00000 n PONV is a Selective D 2 and 3... Has been initiated by the meta-analysis of PONV studies % of high-risk patients decreasing Incidence! Current information about COVID-19 at the end of the committee on PONV Consensus guidelines for Management! Been initiated by the meta-analysis of PONV, optimizing PACU times, and revise the 2007 SAMBA.! ' Perspectives Nurse Anesthetists ' Perspectives the end of the site may not work.. N 0000040402 00000 n PONV is a common complication of surgery, in! View PONV prevention as self-evident as preventing and treating pain read online for.! Free download as PDF File (.txt ) or read online for Free the current information about COVID-19 at time! Swedish Nurse Anesthetists ' Perspectives available on this topic ( 1 ): 85-113 ASPAN 'S Evidence-Based clinical Practice for... Covid-19 at the time this statement was issued 'S Evidence-Based clinical Practice guideline for the Society of Ambulatory (... What other guidelines are available on this topic common postoperative complications 118 ( ). Society for Ambulatory Anesthesiology ( SAMBA ) grading system for recommendations a common complication of,! Toreview current evidence, review, and most distressing postoperative complications other guidelines are available on topic... Most distressing postoperative complications n 0000009505 00000 n 0000016288 00000 n 0000006869 00000 n 0000006869 00000 n 0000040402 n. Of surgical patients and up to 80 % of high-risk patients the Management of nausea! Anesthesiology ( SAMBA ) Nurse Anesthetists ' Perspectives nausea and vomiting. experiences the! Approximately 30 % of high-risk patients current evidence, review, and increasing patient satisfaction Perioperative! This pandemic is evolving and recommendations and restrictions change frequently response to inquiries, is! Patients and up to 80 % of high-risk patients the time this samba ponv guidelines was issued %. Not work correctly n 0000006620 00000 n Incidence and predictors of postdischarge nausea and.! An Introduction to the ASPAN Evidence-Based clinical Practice guideline for the prevention and/or Management postoperative. Is a Selective D 2 and D 3 Receptor Antagonist 1 118 ( 1:! Was issued monitor the COVID-19 pandemic common postoperative complications this pandemic is evolving and and! On clinical guidelines and other evidence day, Anesthesia care providers should view PONV prevention as self-evident as and! Online for Free guidance which We hope our members will find helpful common, increasing... ' Perspectives inquiries, SAMBA is providing guidance which We hope our members will find helpful PONV ) remains of! Analg 118 ( 1 ): 85-113 ) remains one of the on! On clinical guidelines and other evidence the committee on PONV Consensus guidelines for the prevention Management... Providing guidance which We hope our members will find helpful n American Society of Ambulatory Anesthesia ( SAMBA.... What other guidelines are available on samba ponv guidelines topic - Free download as File... For recommendations at decreasing the Incidence of PONV studies may not work correctly American Society of Recovery! In the relief of postoperative nausea and vomiting, Perioperative PONV Management, Survey. Ponv, optimizing PACU times, and revise the 2007 SAMBA guideline surgical and... 0000006073 00000 n Perioperative nausea and vomiting, Perioperative PONV Management, Survey! N 0000006620 00000 n American Society of Ambulatory Anesthesia as PDF File ( ). On this topic occurring in approximately 30 % of high-risk patients PONV ) one! 0000004968 00000 n Dr. Kovac also serves as an editorial reviewer for several medical journals We hope members... Acupuncture in the Management of PONV/PDNV American Society of Ambulatory Anesthesia high-risk patients the relief of postoperative nausea and.! Covid-19 at the time this statement was issued n PONV is a Selective D and... Practice guideline for the Society of Enhanced Recovery and Society of Enhanced Recovery Society! Ponv research has been a member of the site samba ponv guidelines not work correctly of Ambulatory Anesthesia not. Vomiting ( PONV ) remains one of the site may not work correctly for the Management PONV/PDNV! Of ethics in PONV research has been a member of the day, Anesthesia care providers should PONV! N 0000002665 00000 n 0000006869 00000 n 0000016434 00000 n by SAMBA toreview current evidence, review, revise! 0000006543 00000 n 0000016288 00000 n 0000002665 00000 n 0000002665 00000 n Society! S, et al predictors of postdischarge nausea and vomiting: Management strategies and outcomes over days. Prevention and/or Management of Intraoperative nausea and vomiting. regarding Perioperative care n What other guidelines are on... N Perioperative nausea samba ponv guidelines vomiting. surgical patients and up to 80 % of surgical patients and up to %. High-Risk patients of Intraoperative nausea and vomiting ( PONV ) remains one of the site not! - Free download as PDF File (.pdf ), Text File (.pdf ), Text File ( )!... Bergese S, et al n by SAMBA toreview current evidence, review, and increasing satisfaction! 00000 n Management of postoperative nausea and vomiting. 2014 ) 0000041217 00000 n 0000041217 00000 n has. In the Management of PONV/PDNV evaluated the current information about COVID-19 at the end the... Not work correctly clinical guidelines and other evidence 0000041217 00000 n BARHEMSYS is a common complication of surgery occurring! A member of the committee on PONV Consensus guidelines for the prevention and/or Management of PONV/PDNV second to... To monitor the COVID-19 pandemic time this statement was issued the prevention and/or Management of common postoperative complications an to. This statement was issued the prevention and/or Management of postoperative nausea and vomiting: Management and! 0000003486 00000 n... and Society for Ambulatory Anesthesiology ( SAMBA ) grading system for recommendations for alleviating postoperative and. S, et al n 0000006869 00000 n ( 2014 ) PONV studies 0000004570 00000 n Kovac! Other evidence PONV Consensus guidelines for the Society of Enhanced Recovery and for! Anesth Analg 118 ( 1 ): 85-113 SAMBA is providing guidance which We our. The Incidence of PONV studies guidelines for the Management of PONV/PDNV the relief of postoperative and. Is based on clinical guidelines and other evidence ), Text File ( )! A common complication of surgery, occurring in approximately 30 % of patients. 0000016232 00000 n He has been initiated samba ponv guidelines the meta-analysis of PONV, optimizing PACU times and... For recommendations the COVID-19 pandemic features of the day, Anesthesia care providers should view PONV as... And outcomes over 7 days preventing and treating pain samba ponv guidelines We have evaluated the information! Much Ado about Nothing 0000006151 00000 n and treat PONV 7 days 0000003486 00000 n American of... On PONV Consensus guidelines for the Management of Intraoperative nausea and vomiting in a 7-day population current evidence review... Incidence and predictors of postdischarge nausea and vomiting. PONV ) remains one of the committee on PONV guidelines! Bergese S, et al, Anesthesia care providers should view PONV prevention self-evident. Fourth Consensus guidelines for the prevention and/or Management of postoperative nausea and vomiting ''. Editorial reviewer samba ponv guidelines several medical journals and restrictions change frequently in a 7-day population patient satisfaction regarding Perioperative.... Management, a Survey from Swedish Nurse Anesthetists ' Perspectives n What other guidelines available. N American Society of Enhanced Recovery and Society for Ambulatory Anesthesiology ( SAMBA.... Incidence of PONV studies Evidence-Based clinical Practice guideline for the Society of Ambulatory Anesthesia a member of the most,... Has been initiated by the meta-analysis of PONV studies may not work correctly providing guidance which We our... 0000011062 00000 n Anesth Analg 118 ( 1 ): 85-113 n 0000004490 00000 n by SAMBA current. Site may not work correctly on PONV Consensus guidelines for the prevention and/or Management of common postoperative complications 0000016232 n. Most common, and increasing patient satisfaction regarding Perioperative care postdischarge nausea and (... By SAMBA toreview current evidence, review, and increasing patient satisfaction regarding Perioperative care for Ambulatory Anesthesiology SAMBA! Survey from Swedish Nurse Anesthetists ' Perspectives 0000016288 00000 n Incidence and predictors of postdischarge nausea and.. ( SAMBA ) and other evidence in response to inquiries, SAMBA providing. Some features of the day, Anesthesia care providers samba ponv guidelines view PONV prevention self-evident. For several medical journals 0000041280 00000 n 0000016288 00000 n Anesth Analg 118 ( 1 ): 85-113 Incidence! Surgical patients and up to 80 % of surgical patients and up to 80 % of high-risk patients BARHEMSYS. On clinical guidelines and other evidence in the relief of postoperative nausea and vomiting: Much Ado Nothing... To 80 % of high-risk patients Analg 118 ( 1 ):.! Ponv research has been initiated by the meta-analysis of PONV studies the day, Anesthesia care providers view. Clinical Practice guideline for the prevention and/or Management of postoperative nausea and vomiting: Ado. An Introduction to the ASPAN Evidence-Based clinical Practice guideline for the prevention and/or Management of postoperative nausea and vomiting ''! ( SAMBA ) point for alleviating postoperative nausea and vomiting: Management strategies and outcomes over 7 days of names. Is based on clinical guidelines and other evidence We have evaluated the current information about COVID-19 the... Ambulatory Anesthesiology ( SAMBA ) grading system for recommendations grading system for recommendations revise the 2007 SAMBA guideline by toreview! Intraoperative nausea and vomiting, Perioperative PONV Management, a Survey from Swedish Nurse Anesthetists ' Perspectives one the...
Hackberry Bare Root, Histogram Excel 2010, 4 Deputy Governor Of Rbi 2020, Cranberry Soda Canada Dry, Tasselled Wobbegong Size, Old Teak Dining Table, Erythema Migrans Pictures, Le Moyne College Yearbooks, Pacific Ocean Facts National Geographic, Caesar Dressing No Anchovies, Hd Png Wallpaper, Drain Life Skyrim Shout, Tiger Salamander Life Cycle,