Driver Injection
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You can use DISM to install or remove driver packages in an offline Windows or Windows PE image. You can either add or remove the driver packages directly by using the command prompt, or apply an unattended answer file to a mounted .wim, .ffu, .vhd, or .vhdx file.
When you use DISM to install a driver package to an offline image, the driver package is added to the driver store. When the image boots, Plug and Play (PnP) runs and associates the driver packages in the store to the corresponding devices on the computer.
To add driver packages to an offline image, you must use a technician computer running Windows 10 or later, Windows Server 2016 or later, or Windows PE for Windows 10 or later. Driver signature verification may fail when you add a driver to an offline image from a technician computer running any other operating system.
If you're adding driver packages to a Windows PE image, you can add them to the Windows PE image in the output folder you specified when you ran copype, for example: C:\\WinPE_amd64\\media\\sources\\boot.wim. This ensures that driver packages will be included in Windows PE each time you build Windows PE media from that folder.
Using /Recurse can be handy, but it's easy to bloat your image with it. Some driver packages include multiple .inf driver packages, which often share payload files from the same folder. During installation, each .inf driver package is expanded into a separate folder. Each individual folder has a copy of the payload files.
Check to see if the driver package was added. Driver packages added to the Windows image are named Oem*.inf. This guarantees unique naming for newly added driver packages. For example, the files MyDriver1.inf and MyDriver2.inf are renamed Oem0.inf and Oem1.inf.
All driver packages in the directory and subdirectories that are referenced in the answer file are added to the image. You should manage the answer file and these directories carefully to address concerns about increasing the size of the image with unnecessary driver packages.
If you need driver packages for Windows PE to see the local hard disk drive or a network, you must use the windowsPE configuration pass of an answer file to add driver packages to the Windows PE driver store. For more information, see Add Device Driver packages to Windows During Windows Setup.
When you include multiple DriverPaths by adding multiple PathAndCredentials list items, you must increment the value of Key for each path. For example, you can add two separate driver paths where the value of Key for the first path is equal to 1 and the value of Key for the second path is equal to 2.
Check to see if the driver package was added. Driver packages added to the Windows image are named Oem.inf. This guarantees unique naming for newly added driver packages. For example, the files MyDriver1.inf and MyDriver2.inf are renamed Oem0.inf and Oem1.inf.
The second information within the brackets shows the hardware architecture of the device driver. You cannot select a device driver if the hardware architecture does not match the operating systems architecture.
Driver Injector also allows to explore the content of an INF file. This feature will also display all missing files which are needed to install the driver properly. Missing files can happen on a Windows Embedded system in case not all components are installed but the driver depends on them. Missing files are being highlighted automatically by the tool.
Syringe drivers are often required to provide medicines for symptom management in patients who are terminally ill.They allow continuous subcutaneous administration of medicines to enable effective symptom control when medicines givenby other routes are inappropriate or no longer effective. With guidance and support from the local hospice or districtnursing services, General Practitioners can arrange a syringe driver infusion for a patient in their home or in a residentialcare facility, prescribe and monitor the appropriate mix of medicines and manage breakthrough symptoms.
A syringe driver is a small, portable, battery operated device that administers medicines subcutaneously over a selectedtime period, usually 24 hours. Medicines are drawn up into a syringe that is then attached to the driver, which is setto move the plunger of the syringe forward at an accurately controlled rate. Syringe drivers can be used either short-termor long-term, for patients who are ambulatory and those who are confined to bed. Syringe drivers can be placed into acarry bag or pouch when a patient is mobile or be tucked under a pillow if the patient is bed-bound.
The lockable, battery operated, Niki T34 syringe driver is the current device available in New Zealand for the continuoussubcutaneous administration of medicines in a community setting. The Graseby syringe driver has been gradually phasedout of use as it was not tamper-proof. Concerns were also raised by the Health and Disability Commissioner after a numberof cases occurred due to errors with syringe driver use.1 As a result, a recommendation was made that therebe consistency in the type of syringe driver used throughout New Zealand. Initially the preferred replacement optionwas the AD Ambulatory Syringe Driver, however, the company involved was unable to supply and support these drivers anda further decision was made so that by 30 June, 2011, the Niki T34 syringe driver was used exclusively.2
Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control ofsymptoms during palliative care. A syringe driver is useful when the oral route of administration is not possible andrepeated subcutaneous doses are inappropriate, ineffective or impractical. Although medicines can also be administeredby other routes, such as rectal or sublingual, a further advantage of a continuous subcutaneous infusion is that any peaksand troughs of intermittent delivery methods are avoided (Table 1)
Initiating use of a syringe driver in a patient during palliative care may represent a significant and unwelcome milestonefor the patient and their family/whānau, because syringe drivers are often required when a patient is close to death.The goals of administering medicines via a syringe driver therefore need to be discussed with the patient and family andany concerns addressed. A syringe driver simply provides an alternative route for the administration of medicines. Forexample, a patient with severe nausea and vomiting that temporarily prevents the use of oral medicines may need a syringedriver to gain control of symptoms. It may be possible to revert back to the use of oral medicines once control of thenausea and vomiting is achieved.4
Practical aspects of how the syringe driver functions also need to be discussed with the patient and their family/whānau.In many cases, it will be the family who become aware of any issues with the device itself or that the medicines are notcontrolling the patient's symptoms.
Hospice or district nursing services can provide equipment and certified staff who can work with General Practitioners,patients and their families/whānau. Many patients will also be under the care of a palliative care physician. Itis essential that there is good communication between the people who are providing care and support for the patient andtheir family (this also includes community pharmacy). Many residential aged care facilities have syringe drivers on siteand staff trained in their use.
In a palliative care setting, subcutaneous administration of medicines given via a syringe driver is useful for managingsymptoms such as pain, nausea, anxiety and restlessness. Injectable forms of medicines to control symptoms can be givenalone, or mixed together in a syringe depending on their physical and chemical compatibility and the diluents used (seebelow).
In palliative care, medicines may be prescribed for unapproved indications, be administered by an unapproved route orgiven in doses not seen in routine day-to-day practice.5 Most medicines can be used in a subcutaneous infusion,however, chlorpromazine, prochlorperazine and diazepam are contraindicated as they can cause skin reactions at the injectionsite.
Infusions for administration via continuous subcutaneous infusion using a syringe driver should be prescribed to runover 24 hours, although medicines mixed together may be pharmaceutically compatible and stable for longer than this.
The choice of diluent for the infusion solution varies according to local guidelines as there is evidence for and againstthe two most commonly used diluents - sterile water (water for injection) and normal saline (NaCl 0.9%).3 Ingeneral, sterile water is used.
Once mixed, syringes should be observed for any signs of precipitation or discolouration. Provided that doses are withinnormal ranges, Table 2 shows which injectable medicines are expected to be compatible in a 24-hour syringe driver solution.
The first syringe of a new prescription will lose some of the solution when the line is primed, therefore the infusionwill not run for a full 24 hours. An initial subcutaneous injection may also be required as a loading dose to manage thepatient's symptoms for the initial two to four hours of syringe driver use until the medicines in the infusion reach effectiveblood plasma levels. When an infusion is due to be changed, a delay of an hour or two should not cause problems if thepatient's symptoms are well controlled. This can be a concern for patients and families if the clinicians or nurses visitis delayed.
Hospices and residential aged care facilities are likely to have standardised prescribing and administration chartsfor syringe driver prescriptions. Similar documentation is recommended for patients who are receiving care at home.
The individual medicines to go in the syringe can be prescribed on a standard prescription for a community pharmacy.Indicate the prescription is for a syringe driver. State the dose and diluents, and remember a triplicate controlled drugprescription for any opioids. Some community pharmacies provide a service for compounding medicine solutions in dailysubcutaneous syringes. 59ce067264