Abstract:
A dosage dispenser according to the invention is intended to provide a solution for measuring and dilution of liquid medications and issuing marked and ready for use. The dosage dispenser device carries out actions required for the preparation of a required dose of medication, including identifying ampoules, breaking them, filling a syringe, diluting the medication in a solution, marking the syringe, disposing of waste and documenting the process, all at the patient bedside. The dosage dispenser is aimed at reducing the number of errors in the dosage, which is a problem, menacing medical services throughout the world. The problem is made acute by considerable pressure on the medical teams while carrying out many and complex procedures under pressure in a situation of uncertainty and with variable data.

Description:
[0001]    The present invention claims the benefit of earlier U.S. Provisional Patent Application Ser. No. 61/006,825, filed Feb. 1, 2008. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to a dosage dispenser apparatus configured to be located at patient bedside, optionally integrated with monitoring systems for measuring and optionally diluting liquid medications and dispensing marked and ready for use syringes filled with the medication. 
       BACKGROUND OF THE INVENTION 
       [0003]    Many serious errors occur during drug delivery, and specifically, during a high stress situation as in a resuscitation situation. Stress and the need for preparing the drug dose in a hurry increases the potential for errors. Many errors in intravenous (I.V.) drug administration are fatal. 
         [0004]    It is one object of the present invention to reduce the number of medication dosage errors, reduce potential for human error, especially in critical situations like resuscitation and trauma care. 
       Closest Known Related Technology: 
       [0005]    There are systems that provide a solution for dosing and dilute I.V. medication. These systems are of large scale designs and are located at the main hospital pharmacy, they are not portable and not adopted to be used at bedside location, and they are incapable of using patient life signs or using medication that are packed in ampoules (a standard package). 
         [0006]    For example, U.S. Application 2005/224137 entitled “Device for Reconstituting a Drug Vial and Transferring the Contents to a Syringe in an Automated Matter” by Tribble, et al, discloses an automated medication preparation system in the form of an automated syringe preparation that includes reconstitution of the medication and delivery of the reconstituted medication to a syringe. The system includes an automated fluid delivery device that is movable in at least one direction and is adapted to perform at least one of the following operations: (1) receiving and discharging diluents from a diluents supply in a prescribed amount to reconstitute the medication in a drug vial; and (2) aspirating and later discharging reconstituted medication from the drug vial into the syringe. The system also includes a transfer device that includes a first section for piercing the septum of the drug vial and a second section for sealing, yet releasably, mating with the fluid delivery device. The transfer device is constructed so that it remains within the drug vial for multiple uses without the need to pierce the septum more than one time and therefore, the disadvantages associated with the prior art are overcome. The transfer device has a first channel extending through the first and second sections for carrying diluents or reconstituted medication and a second channel that is in fluid communication with a vent that is formed as part of the transfer device to permit air to flow into the drug vial. 
         [0007]    For example U.S. Application No. 2006/0178578 entitled “Vision System To Calculate A Fluid Volume In A Container” by Tribble, et al, discloses a system for calculating a volume of fluid that is disposed within a container. The system includes (1) an imaging device that captures and stores an image of at least the volume of fluid in the container; (2) a background disposed behind the container so that at least the volume of fluid in the container is disposed in front of the background; and (3) a processor that performs at least one operation on the stored image to calculate the volume of the fluid within the container. 
         [0008]    U.S. Pat. No. 6,070,761 entitled “Vial Loading Method And Apparatus For Intelligent Admixture And Delivery Of Intravenous Drugs” by Bloom, et. al., discloses a vial-loading mechanism for a system that prepares and delivers one or more IV drugs to a patient. The vial-loading mechanism is used to load a vial onto a cassette spike and includes a vertical support member located adjacent to the spike. A holding assembly holds at least one vial. The holding assembly is mounted to the support member so as to be positioned between an upper position for loading a vial and a lower position for piercing the vial with a spike. The holding assembly has an arcuate-shaped holding member for holding the vial. A catch is provided with an engagement unit for securing the holding assembly in the lower position. This arrangement provides an easy way to add, retain, and remove vials from the system and protects the clinicians that do this from contacting the spikes and hurting themselves. 
         [0009]    U.S. Pat. No. 7,163,035 to Khan, et al, entitled “Automated Use Of A Vision System To Detect Foreign Matter In Reconstituted Drugs Before Transfer To A Syringe” describes an automated medication preparation system including automated syringe preparation that involves reconstitution of the medication. The system includes: an automated device for delivering a prescribed unit dose of medication to the syringe by delivering the medication through the uncapped barrel. One exemplary automated device for delivering a prescribed unit dose of medication to the syringe is in the form of an automated device having a fluid delivery device that is movable in at least one direction. The fluid delivery device is adapted to perform the following operations: (1) receiving and discharging diluents from a diluents supply in a prescribed amount to reconstitute the medication in a drug vial; and (2) aspirating and later discharging reconstituted medication from the drug vial into the syringe. The system further includes a sensor for detecting any foreign matter (e.g., undissolved drug, pieces of septum, etc.) present in the reconstituted unit dose of drug prior to transfer of the reconstituted drug (unit dose) to the syringe. 
       SUMMARY OF THE INVENTION 
       [0010]    The present invention relates to a dosage dispenser apparatus configured to be located at patient bedside for measuring and optionally diluting liquid medications and dispensing marked and ready for use syringes filled with the medication. 
         [0011]    A dosage dispenser according invention is intended to provide a solution for measuring and dilution of liquid medications and issuing syringes marked and ready for use. The dosage dispenser device carries out actions required for the preparation of a required dose of medication, including identifying medication that is preferably in its standard container; ampoules or vials, breaking them or open the cover, filling a syringe, if needed—diluting the medication in a solution, marking the syringe, disposing of waste and documenting the process, all at the patient bedside with the speed required for critical care. The dosage dispenser is aimed at reducing the number of errors in the dosage, which is a problem, menacing medical services throughout the world. The problem is made acute by considerable pressure on the medical teams while carrying out many and complex procedures under pressure in a situation of uncertainty and with variable data. 
         [0012]    Dosage dispenser device according to embodiments of the present invention is designed for medical staff in various medical facilities such as: all wards &amp; outpatient clinics as a resuscitation cart, and in any wards which use other injectable medications such as: Oncology, Intensive Care, Trauma and Resuscitation, Anesthesia and Cardiology. 
         [0013]    Dosage dispenser device according to embodiments of the present invention prepares injectable medications and at the same time make available large database on the medications, procedures, drug interactions. 
         [0014]    The system can provide a set of doses needed for a procedure such as a resuscitation set of syringes, optionally prepared for a patient with known weight. 
         [0015]    Dosage dispenser device according to embodiments of the present invention is portable, it may be maneuvered and stationed at the patient bedside being able to use patient life signs in order to suit the optimal dose to the patient condition. 
       Main Aspects of the Present Invention Are: 
       [0016]    Dosage dispenser device according to embodiments of the present invention may work with resuscitation kit designed as magazines that include plurality of kinds and amount of medication and syringes a plurality of sizes that may be needed for one resuscitation procedure. 
         [0017]    In other uses such as Oncology, Anesthesia and Cardiology, the Kit may include different medication and syringes correspondingly. 
         [0018]    According to an exemplary embodiment of the current invention, there is no need to know how many medication bottles or ampoules were left before starting a procedure, all required medications have been stored packed marked and sealed as a set for the said procedure with the ability to track and to manage the kit by software. 
         [0019]    There is no need to load single bottle or ampoule into the system, just to load magazines (medication, saline and syringes). 
         [0020]    Dosage dispenser device according to embodiments of the present invention is mobile and may be used near the patient bed. It provide a solution for measuring dosages and dilution of liquid medications, including issuing syringes which are marked and ready for use not in the hospital pharmacy but near the patient bed in real time, it can use hospital database and life sings enabling the system to recommend and dispense the optimal dose according to the patient condition. 
         [0021]    Dosage dispenser device according to embodiments of the present invention is configured to handles different types of medication packaging; breaks medication ampoules and open medication bottles. The same dosage dispenser device according to embodiments of the present invention can handle ampoules and bottles. Ampoules need to be broken and then pumped from the top while bottles come with caps that need to be removed and then the medication needs to be pumped from the bottom, when the bottle is up side down using the same apparatus. 
         [0022]    Dosage dispenser device according to embodiments of the present invention is configured to handles different types of syringes to get high accuracy. 
         [0023]    Dosage dispenser device according to embodiments of the present invention pumps saline and medication directly to the syringe with no need of pipe cleansing between actions. 
         [0024]    The saline and medication that was pumped into the syringe is checked and approved for example by using image processing or weighing and database compare. 
         [0025]    Some advantages of the current invention may be that the dosage dispenser device according to embodiments of the present invention is configured for working under time pressure such as critical care and resuscitation locations. 
         [0026]    The dosage dispenser device according to embodiments of the present invention prepares injectable medications and at the same time handles a large database including information regarding the medications, procedures and drug interactions. 
         [0027]    The dosage dispenser device according to embodiments of the present invention uses magazines that are simple to use: loading medications and syringes into the system is simple as loading a video cassette; there is no need to know how much bottles or ampoules are left before starting a procedure, no need to load single bottle or ampoule into the system. 
         [0028]    All required medications have been stored packed marked and sealed as a set for the said procedure with the ability to track and to manage the kit by software. 
         [0029]    The dosage dispenser device according to embodiments of the present invention provides accurate and fast dosing I.V. medication at the patient bedside in real time. 
         [0030]    The dosage dispenser device according to embodiments of the present invention may integrate the patient real time life signs data in order to determine in real time optimal dose for the patient. 
         [0031]    The dosage dispenser device according to embodiments of the present invention may use standard medication ampoules and bottles and standard syringes. 
         [0032]    The dosage dispenser device according to embodiments of the present invention uses no pipes between the medication packages to syringe. Thus there is no need to clean pipes. 
         [0033]    In the dosage dispenser device according to embodiments of the present invention the syringe is labeled and ready to use. 
         [0034]    The dosage dispenser device according to embodiments of the present invention uses image processing to validate the accurate amount of saline and medication solution in the syringes and the existence of air bubble. 
         [0035]    According to an exemplary embodiment of the invention, an automated dosage dispensing device is provided comprising: a pumping station configured to pump medication into a syringe from both medication bottle and medication ampoule. 
         [0036]    In some embodiments, the pumping station is configured to pump medication into a syringe from a medication bottle while said syringe is positioned below said medication bottle. 
         [0037]    In some embodiments, the pumping station is configured to pump medication into a syringe from a medication ampoule while said syringe is positioned above said medication ampoule. 
         [0038]    In some embodiments, the device further comprising: a medication magazine holding plurality of medication bottles and medication ampoules; and a medication gripper configured to remove at least one of medication bottle or medication ampoule from said medication magazine and load said at least one of medication bottle and medication ampoule into said pumping station. 
         [0039]    In some embodiments, the medication gripper is configured brake the neck of said medication ampoule. 
         [0040]    In some embodiments, the pumping station is configured to remove the cap of said medication bottle. 
         [0041]    In some embodiments, the device further comprising: a syringe magazine holding plurality of syringes; and a syringe gripper configured to remove at least one syringe from said syringe magazine and load said at least syringe into said pumping station. 
         [0042]    In some embodiments, each syringe in said syringe magazine is fitted with a hypodermic needle. 
         [0043]    In some embodiments, each of said hypodermic needle is covered with a needle cover. 
         [0044]    In some embodiments, the syringe gripper, along with spring apparatus, is configured to: remove said needle cover from said needle prior to loading said needle into said pumping station; and to recap said needle with said needle cover after medication pumping is completed. 
         [0045]    In some embodiments, the pumping station is configured to rotate about a horizontal axis to position said syringe below said medication bottle. 
         [0046]    In some embodiments, the syringe magazine is configured to hold at least two different sizes of syringes. 
         [0047]    In some embodiments, the syringes in the syringe magazine are arranged in a two dimensional array; said syringe magazine is configured to move in a first direction; and said syringe gripper is configured to move in a second direction substantially perpendicular to said first direction for accessing said syringes arranged in said two dimensional array. 
         [0048]    In some embodiments, the medication pumping is performed directly through said hypodermic needle. 
         [0049]    In some embodiments, the device further comprising a saline magazine configured to hold a saline bag. 
         [0050]    In some embodiments, the saline bag is standard intravenous saline infusion bag. 
         [0051]    In some embodiments, the saline bag is standard plurality of medication bottles and medication ampoules are standard medication bottles and standard medication ampoules. 
         [0052]    In some embodiments, the medication magazine is selected from a group of medication magazine types, wherein each type of said medication magazine types is loaded with medication needed for treating a different medical condition. 
         [0053]    In some embodiments, each of said medication magazine is fitted with an RFID device. 
         [0054]    In some embodiments, the medication magazine is replaced after each medical procedure. Alternatively, same magazine may be used for a plurality of procedures. 
         [0055]    In some embodiments, the device is configured to be placed at patient bedside. 
         [0056]    In some embodiments, the device further comprising at least one patient life-sign monitor. 
         [0057]    In some embodiments, the patient life-sign monitor is selected from the group comprising: ECG monitor, EEG monitor; blood oxygen monitor; patient temperature monitor; and blood pressure monitor. 
         [0058]    In some embodiments, the device is further comprising a computer analyzing signals from said at least one patient life-sign monitor and recommending medication based on said signal analysis. 
         [0059]    In some embodiments, the device is further comprising a computer recommending medication based on patient information and user input regarding patient medical condition. 
         [0060]    In some embodiments, the recommending medication based on said signal analysis is further based on patient information. 
         [0061]    In some embodiments, the patient information is selected from a group comprising: patient weight; patient age; patient gender; patient known allergies; and other medications used by said patient. 
         [0062]    In some embodiments, the syringe magazine is configured to hold said syringes in a predetermined orientation. 
         [0063]    In some embodiments, the device is further comprising a medication camera verifying at least one of: medication type; medication lot number; medication expiration date; and amount of medication in the medication container. 
         [0064]    In some embodiments, the device is further comprising a syringe camera verifying at least one of: amount of medication pumped into said syringe; absence of air bubbles in said syringe. The vision system may be capable to capture and process plurality of syringe sizes, for example at least 4 sizes of syringes. 
         [0065]    In some embodiments, the medication volume measured by the camera is calibrated. 
         [0066]    In some embodiments, the device is configured to be mobile and be moved to patient bedside. 
         [0067]    In some embodiments, the device further comprises wheels to ease moving said device to patient bedside. 
         [0068]    In some embodiments, the time from ordering medication to dispensing a syringe with the required medication is less than 60 seconds. 
         [0069]    In some embodiments, the time from ordering medication to dispensing a syringe with the required medication is less than 30 seconds. 
         [0070]    In some embodiments, the time from ordering medication to dispensing a syringe with the required medication is less than 20 seconds. 
         [0071]    According to another embodiment, of the current invention, a method of dispensing syringe with medication is provided comprising the steps of: loading a pumping station with any one of: medication bottle or medication ampoule; loading a syringe fitted with hypodermic needle into said pumping station; pumping medication from said one of medication bottle or medication ampoule into said syringe through said hypodermic needle; and dispensing said syringe. 
         [0072]    In some embodiments, the said pumping medication into a syringe from a medication bottle is performed while said syringe is positioned below said medication bottle. 
         [0073]    In some embodiments, the pumping medication into a syringe from a medication ampoule is performed while said syringe is positioned above said medication ampoule. 
         [0074]    Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable methods and materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0075]    The invention is herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of the preferred embodiments of the present invention only, and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the invention. In this regard, no attempt is made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the invention may be embodied in practice. 
         In the Drawings: 
         [0076]      FIG. 1   a  schematically depicts a dose dispenser seen without its covers according to an exemplary embodiment of the current invention. 
           [0077]      FIG. 1   b  schematically depicts a dose dispenser seen with its covers according to an exemplary embodiment of the current invention. 
           [0078]      FIG. 2   a  schematically depicts medication magazine  1  which can be inserted into the system  100  according to the exemplary embodiment of the current invention. 
           [0079]      FIG. 2   b  schematically depicts the saline magazine  2  which can be inserted into the system  100  according to the exemplary embodiment of the current invention. 
           [0080]      FIG. 2   c  schematically depicts the syringe magazine  3  which can be inserted into the system  100  according to the exemplary embodiment of the current invention. 
           [0081]      FIG. 3   a  schematically depicts a standard medication bottle as used in the system acceding to the current invention. 
           [0082]      FIG. 3   b  schematically medication depicts a medication gripper  20  holding a medication bottle  35  acceding to the current invention. 
           [0083]      FIG. 3   c  schematically depicts a camera  4  for medication check and control acceding to an exemplary embodiment of the current invention. 
           [0084]      FIG. 4  schematically depicts the pumping carousel  5  according to an exemplary embodiment of the invention. 
           [0085]      FIGS. 5   a  and  5   b  schematically depict syringe gripper  141  removing a syringe  300  from syringe magazine  3  according to an exemplary embodiment of the invention. 
           [0086]      FIGS. 6   a  schematically depicts syringe gripper  141  holding syringe  300  and pumping through needle  302  medication from ampoule  95  held in medication holder  14  located on carousel  5  according to an exemplary embodiment of the invention. 
           [0087]      FIG. 6   b  schematically depicts a lower plunger gripper  40  according to an exemplary embodiment of the current invention. 
           [0088]      FIG. 7  schematically depicts the syringe gripper  141  near cameras  4  and  6  after the needle  302  was covered again by needle cover  301  using needle cover remover  219  according to an exemplary embodiment of the invention. 
           [0089]      FIG. 8  schematically depicts syringe label printing and sticking unit  7  ready to affix label  23  on syringe  300  according to an exemplary embodiment of the invention. 
           [0090]      FIG. 9  schematically depicts disposal of opened ampoule  95  and bottle cap  37  from carousel  5  into waste disposal container  10  according to an exemplary embodiment of the invention. 
           [0091]      FIG. 10  schematically depicts syringe dispensing apparatus  9  having syringe entrance cone  25 , a syringe director lip  26  and syringe tray  99  according to an exemplary embodiment of the current invention. 
           [0092]      FIG. 11  schematically depicts a method of syringe volume measurement and calibration using vision subunit according to an exemplary embodiment of the current invention. 
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0093]    The present invention relates to a dosage dispenser apparatus configured to be located at patient bedside for measuring and optionally diluting liquid medications and dispensing syringes filled, marked and ready for use. 
         [0094]    Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments or of being practiced or carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein is for the purpose of description and should not be regarded as limiting. 
         [0095]    In discussion of the various figures described herein below, like numbers refer to like parts. 
         [0096]    The drawings may not be to scale. For clarity, non-essential elements were omitted from some of the drawings. 
         [0097]      FIG. 1   a  schematically depicts a dose dispenser seen without its covers according to an exemplary embodiment of the current invention. 
         [0098]    Dose dispenser  100  comprises a main frame  151  supporting its components including: Medication Magazine  1 ; Saline magazine  2 ; Syringes magazine  3 ; Camera for medication check and control  4 ; Pumping carousel  5 ; Syringe Camera  6  for syringe volume check; Syringe label printing and sticking unit  7 ; Needle cover handling unit  219 ; Syringe dispensing apparatus  9  having Syringe submission tray  99 ; Sharps waste disposal container  10 ; medication gripper  20 ; Syringe gripper  141 ; Touch Screen  31 ; Card Reader  32 ; waste disposal container  44  ; Keyboard with pointing device  102 ; computer  33 ; and an optional backup battery such as Uninterrupted Power Supply (UPS, not seen in this figure). 
         [0099]    Some components marked in this figure are detailed later. 
         [0100]      FIG. 1   b  schematically depicts a dose dispenser seen with its covers according to an exemplary embodiment of the current invention. 
         [0101]    Dose dispenser  100  seen in  FIG. 1   b  showing: a main frame  151 ; side covers  104 ; top cover  105  which may be used as work space; optional handles  103  which may be used for transporting the dispenser by rolling it on its wheels  106  at least two of which are preferably equipped with stoppers  107 . 
         [0102]    Also seen in  FIG. 1   b  are: Touch Screen  31 ; Card Reader  32 ; Syringe submission tray  99 ; waste disposal container  44 ; Keyboard with pointing device  102  (seen here in retracted position); gloves box  43 ; and drawers  41  and  333 , for storing of other devices and machines that are in use throughout resuscitation, for example apparatus such as defibrillator, Ambo bagging, airways, Ambo resuscitator, knives, etc. In some embodiments, drawers  41  and  333  hold a sensor or sensors such as ECK; EEG; thermometers; oximeter for acquiring data concerning the patient health. In some embodiments, computer  33  analyze the patient condition, optionally issue an alert when condition changed or become critical and optionally suggest medication to be administered and optionally prepare the suggested medication. Optionally, additionally or alternatively, drawers may store replacement magazines, for example medication magazines for use with different patient, for different procedure or if on or few of the supplies in a magazine used by the dispenser is finished or at low level. 
         [0103]    Preferably, dosage dispenser  100 , according to embodiments of the present invention, is placed in locations where emergency medical care is provided, for example in hospital emergency room, intensive care units, ambulances, etc. 
         [0104]    The dosage dispenser dispense a “ready for injection” syringe, already filled with the correct amount of medication, on demand received trough at least one of its input devices touch screen  31 , keyboard and pointing device  102 . 
         [0105]    The necessary medications are stored within dosage dispenser  100  in medication magazine  1 . Proper amount of medication or combination of a plurality of medications is loaded into a syringe of proper size, already fitted with hypodermic needle, selected from a collection of syringes stored in syringes magazine  3 . Optionally, the medication is diluted in proper amount of saline drawn from a saline bag housed in saline magazine  2 . 
         [0106]    The syringe is labeled with a proper label specifically printed by the syringe label printing and sticking unit  7 . The syringe is than dispensed through syringe dispensing apparatus  9  onto syringe submission tray  99 . 
         [0107]    Dosage dispenser  100 , according to embodiments of the present invention, is configured to work with resuscitation kit designed as magazines that includes all kind and amount of medication that are needed for one resuscitation procedure. 
         [0108]    There is no need to know how much bottles/ampoule lefts before starting a procedure, no need to load single bottle/Ampoule into the system, just load magazines, (medication, saline and syringes) 
         [0109]    Dosage dispenser device according to embodiments of the present invention is mobile. It can be moved using optional handles  103  and wheels  106  and can be used near the patient bed. Preferably, wheels are locked using optional locks  107  before use. Optional UPS backup power supply optionally maintains computer operation and optionally other processes while the dose dispenser is disconnected from power while it is moved. However, mechanical motion may optionally be halted while the system is being moved to prevent accidental dropping of medication or syringes due to vibrations. 
         [0110]    The device provides a solution for measuring dosages and dilution of liquid medications, including issuing syringes which are marked and ready for use not in the hospital pharmacy but near the patient bed in real time and can use life sings enabling the system to recommend and dispense the optimal dose according to the patient condition. 
         [0111]    Dosage dispenser device according to embodiments of the present invention is a computer based system that works under mechanical and electronics control. The system may replaces the resuscitation cart that is in use today in many departments in hospitals, to be used in situations such as resuscitation, pulmonary edema, tachycardia bradycardia, fibrillation, etc. 
         [0112]    Dosage dispenser device according to embodiments of the present invention automates the preparation of liquid medication: Determines dosage, dilutes and draws syringe. Preferably, the device is easy to use as it includes all information needed in one place, colored and detailed. Dosage dispenser device according to embodiments of the present invention is preferably fully controlled throughout all the medication dispensing process and displays status and warning signals on screen  31  and optional LEDs warnings preferably installed near display  31  (LEDs are not seen in this figure). 
         [0113]    To activate the system, the operator (typically a doctor or medical personnel) sweeps his/her employee card on the card reader  32  to get approval for using the system. Alternatively, password may be entered using keyboard  102  or the virtual keyboard on the touch screen  31 . Optionally, the system may be used for accessing data base information. In this case, access may be granted to people not authorized to activate medication dispensing activity. Optionally the computer recognize the authorization level of the user, for example by using a password, a code on the card or a combination and grant the user the ability to perform specific tasks appropriate to that specific user. For example, a technician may be authorized to re-program the computer or to change data sets; a doctor may be authorized to view patient&#39;s records and issue medication; and a nurse may be ale to only view records. 
         [0114]    To start dispensing medication the operator preferably input a request. The request may be in the form of specifically requesting type and amount of medication. Alternatively or additionally, the operator may input the nature of the patent condition or the procedure to be done on the patient and optionally some details of the patient and the computer within the dispenser uses database to select medication or medication mix and optionally calculate the recommended amount. Patient details may be obtained from patients&#39; records, for example at hospital data base. 
         [0115]    The operator optionally inputs the patient weight category and risk category. Weight categories can be categorized, for example in the following groups: 1-60 Kg, 61-90 Kg, 91-150 Kg, 151-250 Kg, 250 Kg and up. Additionally, weight adjustment for the 1-60 Kg group can be for example in groups like: 3 Kg, 4 Kg, 5 Kg, 6-7 Kg, 8-9 Kg, 10-11 Kg, 12-14 Kg, 15-18 Kg, 19-22 Kg, 24-28 Kg, 30-36 Kg, 37-60 Kg. Alternatively, exact or estimates weight (in Kg or lb may be entered. Preferably, this information is retained and used for the same patient throughout the treatment. 
         [0116]    Risk Categories may include Kidney Disease, Liver Disease, Age over 80 years old; known allergies; etc. 
         [0117]    The operator optionally selects the procedure and a default dosage for every drug is shown on the display screen regarding the selections done. Optionally, the operator may override default dosage displayed. If the amount of the requested medication is above the amount that is allowed to give to the patient, a warning is displayed informing the user the amount that can be issued to this patient exceeds (more than that will harm the patient). Optionally if the procedure goes for a long time and the amount that was asked for the patient is grater than the amount stored in the medication magazine a warning is displayed informing the user the amount that can be issued is finished and the amount that need to be obtained from another source. With the optional user s approving the suggested selection, medication preparation starts. 
         [0118]    Supplies for the system are stored in three dedicated magazines: medication magazine  1 ; saline magazine  2 ; and syringe magazine  3 . 
         [0119]      FIG. 2   a  schematically depicts medication magazine  1  which can be inserted into the system  100  according to the exemplary embodiment of the current invention. 
         [0120]    Medication magazine  1  comprises a tray  341  with receptacles, preferably configured to hold several types of medication containers, such as bottles and ampoules of different sizes. For clarity, only few of which are labeled ( 342   a ,  342   b  and  342   c ). It should be noted that different types of medication magazine  1  may be used, having different size of receptacles for medication containers and containing different types and amounts of medications depending on the medical applications. 
         [0121]    Each receptacle preferably configured to snugly fit the medication container that assigned to it. Preferably, each receptacle holds only one type of medication; however, few receptacles may hold the same medication as same type of medication may be administered more than once during a medical procedure. 
         [0122]    Preferably, the quantity for each drug in medication containers inserted in the receptacles in the magazines may be same as the quantity used today in typical resuscitation (or other) kits in the hospitals. Preferably standard medication containers are used. Preferably, standard medication ampoules, vile or bottles are used. The use of standard medication container leads to flexibility and reduce cost of the medication and the ability to switch from one medication provider to another. The location, type, concentration and amount of medication in each medication receptacle in medication tray  341  is stored in the computer&#39;s data base so that the correct medication container may be retrieved and correct amount drawn. 
         [0123]    Preferably, medication vials are stored at its designated place upside down. This orientation eases gripping the medication containers by the gripper (seen in the following figures). 
         [0124]      FIG. 2   b  schematically depicts the saline magazine  2  which can be inserted into the system  100  according to the exemplary embodiment of the current invention. 
         [0125]    Saline magazine  2  comprises a saline drawer  310  holding a bag of Saline  311 . Saline is drawn from the bag by piercing silicon pipe  315  that comes with the bag. Saline is used for diluting the medication when needed. Handles  314  eases placing and removing saline magazine  2 . 
         [0126]    An amount of saline or medication pumped is controlled by the length of motion of plunger pincher  18  on gripper  141 . The motion is controlled by computer  33  using a servo motors or a step motor. 
         [0127]      FIG. 2   c  schematically depicts the syringe magazine  3  which can be inserted into the system  100  according to the exemplary embodiment of the current invention. 
         [0128]    Syringe Magazine  3  comprises a syringe tray  370  with a plurality of syringe receptacles for syringes of different volumes  300   a ,  300   b ,  300   c  and  300   d  (for example: 1 cc, 2.5 cc, 5 cc, 10 cc and 50 cc). Four types of syringes are seen in this figure; however number and types of syringes may vary. The syringes are placed in the magazine  3 . Preferably, syringes are all placed in tray  370  in same orientations so that all scale marks directed to the same side. This may ease later disclosed image processing without the interfering of the scale mark. It is also easy to put a label to mark the syringe without covering the scale mark, so that the doctor can still see and read the dosage amount that in the syringe. 
         [0129]    According to an embodiment of the invention, medication magazine need to be replaced after each procedure. In some embodiments, once a procedure ends, the system needs re-activation by changing at least the medication magazine and preferably all of medication, saline and syringe magazines. 
         [0130]    Reactivation may be performed by an RFID tag affixed to the magazines or a barcode on the magazines or an authorization code that is entered using the keyboard or a magnetic card that placed in the package of a replacement magazine and is read by the card reader. 
         [0131]      FIG. 3   a  schematically depicts a standard medication bottle as used in the system acceding to the current invention. 
         [0132]    The system preferably uses standard bottles and ampoules. Bottles  35  come with caps  37  that need to be taken off before the silicon head  36  can be stabbed with the syringe&#39;s hypodermic needle and medication may be drawn. 
         [0133]      FIG. 3   b  schematically medication depicts a medication gripper  20  holding a medication bottle  35  acceding to the current invention. 
         [0134]    Each ampoule or vial of medication is stored in away which enable the gripper  20  to pull the required medication out of medication magazine  1 . 
         [0135]    Medication gripper  20  is equipped with movable jaws  211  and can move up and down (z axis) on vertical rail  212 . Grabbing is actuated by closing the jaws  211  using motor  101   a.    
         [0136]    Motion along Z axis on rail  212  is actuated by motor  101   b.  Additionally, as can be seen in  FIG. 1   a , medication gripper  20  can move horizontally left and right (X axis) on horizontal rails  207  using motor  101   b.  To access all the receptacles in medication magazine  1 , the medication magazine  1  is placed on a horizontal rail  119  (seen in  FIG. 1   a ) which enables controlled motorized motion in the front to back (y axis). 
         [0137]      FIG. 3   c  schematically depicts a camera  4  for medication check and control acceding to an exemplary embodiment of the current invention. 
         [0138]    In  FIG. 3   c , medication gripper  20  is seen holding a medication container such as medication bottle  35  in front of camera for medication check and control  4 . Camera for medication check and control  4  is situated on camera rotation stage  218 . Motor  101   d  rotates the camera rotation stage  218  using belt  216 . By rotating camera  4 , medication container may be inspected from several angles. Using image processing software such as Optical Character Recognition (OCR), the computer may optionally read the medication label and verify that the correct medication container was used. Optionally, barcode may be printed or affixed to the medication container and used for medication recognition. If a barcode is used, a barcode reader may replace camera  4 . Optionally, an image or several images of medication container may be kept as a record. 
         [0139]      FIG. 4  schematically depicts the pumping carousel  5  according to an exemplary embodiment of the invention. 
         [0140]    Pumping caroused  5  comprises a pumping turning plate  13  which can rotate using a motor  503  (seen in  FIG. 6 ). 
         [0141]    One function of pumping carousel  5  is to remove the cap  37  covering the silicon head  36  of medication bottle  35 . To remove the cap, caroused  5  is rotated so bottle cover remover  11  is on the top. Bottle cover remover unit  11  engages the cap  37  while bottle  35  is held by medication gripper  20 , and the bottle is pulled up by a vertical upward movement of the gripper  20  thus braking and removing the cap. The caps come off exposing the silicon head  36 . The cap  37  then falls down through pipe  16  to the internal sharps waste disposal container  10  (as seen in  FIG. 9 ). After cap removal, the bottle  35  is transferred and held by the medication Bottle/Ampoule holder  14  installed on pumping turning plate  13  of pumping carousel  5 . 
         [0142]      FIGS. 5   a  and  5   b  schematically depict syringe gripper  141  removing a syringe  300  from syringe magazine  3  according to an exemplary embodiment of the invention. 
         [0143]    Syringe gripper  141  comprises two pincers: syringe body pincher  19  for holding the syringe  300 ; and plunger pincher  18  for holding the plunger  611  during pumping liquid. Syringe gripper  141  is positioned above the required syringe  300 , pincers  18  and  19  are open and gripper  141  is lowered to position. Pincers  18  and  19  are closed and hold the syringe body  300  and the syringes plunger  611 . The two grippers open and close together. Motor  602  moves the inside plunger pincer  18  separately to pull the plunger upward for liquid pumping. 
         [0144]    Syringe gripper  141  moves up and down (z axis) on vertical rail  630  by motor  602 . Syringe gripper  141  moves horizontally from right to left (x axis) on horizontal rails  207  (seen in  FIG. 1   a ) by motor  603  (seen on  FIG. 1   a ) (omitted for clarity from  FIG. 5   b ). To access all the syringes in syringe magazine  3 , the syringe magazine  3  is placed on a horizontal rail  118  (seen in  FIG. 1   a ) which enables controlled motorized motion in the front to back (y axis). Syringe  300  is fitted with a hypodermic needle, seen in  FIG. 5   b  covered with needle cover  301 . 
         [0145]      FIG. 6   a  schematically depicts syringe gripper  141  holding syringe  300  and pumping through needle  302  medication from ampoule  95  held in medication holder  14  located on carousel  5  according to an exemplary embodiment of the invention. 
         [0146]    Before medication can be pumped out, the syringe is lowered by syringe gripper  141  to the needle cover remover  219  (seen in  FIG. 3   b ). The needle cover  301  is removed using a spring that holds the needle cover  301  without bending or breaking needle  302 . While the needle cover  301  is held in cover remover  219 , the syringe moves up and the needle  302  is revealed. 
         [0147]    If needed, the saline, a dilution solution, is first to be pumped into the syringe so that it is not contaminated with medications. The same bag is used throughout all the resuscitation (or other) procedure, and may be used more than once. The syringe is lowered by syringe gripper  141  to the saline magazine  2  so that needle  302  pierces the bag&#39;s pumping location  315  (Seen in  FIG. 2   b ). Syringe body pincher  19  holds the syringe  300 ; and plunger pincher  18  pulls plunger  611  upwards for pumping saline. 
         [0148]    Optionally, once the saline has been drown into the syringe, syringe gripper  141  places the syringe  300  in front of syringe camera  6 . Syringe camera  6  acquires image or plurality of images of the syringe and the computer  33  determines by image whether the right amount of saline has been drawn into the syringe to ensure correct amount of dilution. 
         [0149]    Both medication and syringe are now moved to a pumping carousel  5 . Medication is moved by medication gripper  20  and syringe by syringe gripper  141 . 
         [0150]    The pumping carousel is designated to draw medication from a bottle when is to be held upside down and from ampoules to be held facing up. 
         [0151]    On the carousel there are two holders: medication holder  14 ; and syringe holder  15 . Medication holder  14  holds the medication (ampoule  95  or bottle  35 ). Syringe holder  15  is adopted to hold the syringe  300 . 
         [0152]    When the needed medication is in an ampoule, the ampoules neck needs to be broken to allow access to the medication. Ampoule  95  is removed by medication gripper  20  and is placed in medication Bottle/Ampoule holder  14 . The medication gripper  20 , still holding the ampoule head is moved and the head of ampoule  95  breaks. Medication gripper  20  than release the broken head of ampoule  95  into the disposal container  10 . 
         [0153]    For pumping medication from an ampoule  95 , medication gripper  20  inserts the ampoule  95  into medication holder  14 . It is than moved to brakes open the ampoule. Syringe gripper  141  moves syringe  300  such that needle  302  is deep in the liquid medication in the ampoule. Syringe body pincher  19  holds the syringe  300 ; and plunger pincher  18  pulls plunger  611  upwards for pumping medication out of the ampoule  95 . 
         [0154]    For pumping medication from a bottle  35 , medication gripper  20  inserts the bottle  35  into medication holder  14 . Carousel  5  is than rotated by 180 degrees so that the bottle  35  is positioned with exposed silicon head  36  facing up. 
         [0155]    Syringe gripper  141  moves syringe  300  such that needle  302  pierces silicon head  36  and is deep in the liquid medication in the bottle. 
         [0156]    The syringe  300  is held with the syringe holder  15  on the Carousel, the syringe gripper  141  is then open the pinchers  18  and  19 . The Carousel  5  is than rotate for pumping the bottle in an upside down position. 
         [0157]      FIG. 6   b  schematically depicts a lower plunger gripper  40 , according to an exemplary embodiment of the current invention. 
         [0158]    Lower plunger gripper  40  comprises plunger pincher  403  which can be closed by motor  401   a  and hold the syringe plunger. 
         [0159]    Plunger pincher  403  can than be moved down on vertical rail  402  by motor  401   b  and pull plunger  611  downwards for pumping medication out of the bottle. 
         [0160]    After pumping is completed, plunger pincher  403  is than opened, releasing the plunger, and carousel  5  rotates back so that the syringe is on top and can be grabbed by syringe gripper  141 . Optionally, used medication bottle is released and fall into waste disposal container  10  by opening medication holder  14 . Alternatively, medication bottle  35  not empty, and the medication in it may be needed again, bottle  35  may be returned by medication gripper  20  into its receptacle in medication magazine  1 . 
         [0161]    Optionally, once the medication has been drown into the syringe, syringe gripper  141  places the syringe  300  in front of syringe camera  6 . Syringe camera  6  acquires image or plurality of images of the syringe and the computer  33  determines by image processing whether the right amount of medication (or mixture of saline and medication) has been drawn into the syringe to ensure correct amount of dilution. Additionally and optionally, images acquired by syringe camera  6  are used for verification that no bubbles are trapped in the syringe. Additionally and optionally, images acquired by syringe camera  6  are used for verification that needle  302  is not bent or missing. 
         [0162]      FIG. 7  schematically depicts the syringe gripper  141  near cameras  4  and  6  after the needle  302  was covered again by needle cover  301  using needle cover remover  219  according to an exemplary embodiment of the invention. 
         [0163]    When the syringe has passed all the preparation and has been inspected and approved, the needle cover is assembled back. The syringe is lowered by syringe gripper  141  to the needle cover remover  219  (seen in  FIG. 3   b ). The syringe gripper  141  is then moves on the x axis to release the needle cover  301  from the spring that holds it and needle  302  is covered. 
         [0164]      FIG. 8  schematically depicts syringe label printing and sticking unit  7  ready to affix label  23  on syringe  300  according to an exemplary embodiment of the invention. 
         [0165]    After filling the syringe and re-installing the needle cover, the syringe is now labeled with a label preferably noting information such as: type and amount of medication (and optional dilution); date and/or time of medication preparation; Expiration date of the medication (if applicable); name of patient; name of the doctor ordering the medication; billing information; procedure done to the patient; notes and warnings related to the medication or the patient; typed text or barcode or both, etc. 
         [0166]    Syringe label printing and sticking unit  7  prepares a label  23  having adhesive on one side and places it pulled out aligned with a roller  24 , when the syringe moved by syringe gripper  141  against the roller which applies the label on the syringe  300 . 
         [0167]      FIG. 9  schematically depicts disposal of opened ampoule  95  and bottle cap  37  from carousel  5  into waste disposal container  10  according to an exemplary embodiment of the invention. 
         [0168]    Waste disposal container  10  is preferably used for all the leftover medication containers used during the operation of dispenser  100 . 
         [0169]    For example, after medication gripper  20  brakes off the neck of ampoule  95 , it releases the broken neck into waste disposal container  10 . 
         [0170]    Additionally and optionally, after the cap  37  is removed from bottle  35  by bottle cover remover  11 , cap  37  goes through pipe  16  into waste disposal container  10 . 
         [0171]    Additionally and optionally, after medication is pumped from ampoule  95 , medication holder  15  may release the ampoule, as depicted in  FIG. 9 , dropping ampoule  95  into waste disposal container  10 . 
         [0172]    After medication is pumped from medication bottle  35 , carousel  5  rotates so that medication bottle  35  is in the upper side. Medication gripper  20  is positioned and holds the bottle, medication holder  14  releases the bottle which is removed from the carousel  5 . Additionally and optionally, medication bottle  35  may be returned by medication gripper  20  to its original receptacle in medication magazine  1 , or preferably it may be dropped by medication gripper  20  into waste disposal container  10 . 
         [0173]      FIG. 10  schematically depicts syringe dispensing apparatus  9  having syringe entrance cone  25 , a syringe director lip  26  and syringe tray  99 . 
         [0174]    The syringe loaded with the medication, approved and labelled, is released by syringe gripper  141  through syringe entrance cone  25 , into syringe dispensing apparatus  9  that is designed to receive the syringe at the cone  25  so that the syringe is directed by director lip  26  to lay horizontal on syringe tray  99  in a way that enables the syringe to be placed on a slope beside other syringes that had been already issued. 
         [0175]    Computer  33  optionally collects and stores information during the operation of dose dispenser  100 . For example all medical information that was collected through the medical procedure (e.g. resuscitation; pulmonary edema; tachycardia; or bradycardia process) for example by external medical sensors such as ECK; EEG; thermometer; blood pressure monitor; pulse oximeter; or entered by the user, may be saved in the computer database; preferably with associated time stamp, and may be available to the user, for example, using CD; Disk On Key; or other communication links such as LAN or preferably wireless communication. The information may include: Patient details; Doctor details; Medications details (Including Name, dosage, dilution, manufacture, Lot number); Other Procedure details. 
         [0176]      FIG. 11  schematically depicts a method of syringe volume measurement and calibration using vision subunit according to an exemplary embodiment of the current invention. 
         [0177]    According to the depicted exemplary embodiment, the camera is preferably positioned in 90 degree to the syringe so that the long side of the camera&#39;s image rectangle is matching the length of the syringe and not the syringe width. 
         [0178]    First, a calibration procedure is done, preferably at manufacturing, and optionally during service. Preferably calibration is done for each system. 
         [0179]    The calibration process results in creation (or updating during service) a calibration table used for correcting calculated measured liquid volume in a syringe to actual volume in the syringe due to optical distortions and other variations such as actual camera-syringe distance; etc. 
         [0180]    The calibration process comprises of the following steps: 
         [0181]    A. System Calibration 
         [0182]    Fill a known syringe with known volume of liquid (Type of syringe and volume of liquid are preferably verified by the operator). 
         [0183]    Acquire image 
         [0184]    Noise filtering 
         [0185]    Histogram stretching and edge enhancement 
         [0186]    Identify syringe&#39;s edges 
         [0187]    Locate edge of black rubber 
         [0188]    Locate air/fluid interface 
         [0189]    Calculate (measured) fluid volume using syringe width and fluid level (wherein fluid level is the distance between the upper edge of the plunger&#39;s black rubber stopper and the air/liquid interface) 
         [0190]    Calculate calibration factor based on calculated (measured) vs. actual (known) volume 
         [0191]    Repeat (steps 1-9) for several typical volumes 
         [0192]    Repeat (steps 1-10) for all syringe types 
         [0193]    Create calibration table 
         [0194]    During regular use, the system verifies that the syringe of the desired type was indeed filed with the desired volume of liquid medication. The verification preferably comprises the following steps: 
         [0195]    B. Syringe Verification 
         [0196]    Fill a desired syringe with desired volume of liquid. 
         [0197]    Acquire image 
         [0198]    Noise filtering 
         [0199]    Histogram stretching and edge enhancement 
         [0200]    Identify syringe&#39;s edges 
         [0201]    Determine syringe size and type (if the type of syringe is not the desired type, syringe may be rejected and process terminates with error message to the user) 
         [0202]    Locate edge of black rubber 
         [0203]    Locate air/fluid interface 
         [0204]    Calculate (measured) fluid volume using syringe width and fluid level (wherein fluid level is the distance between the upper edge of the plunger&#39;s black rubber stopper and the air/liquid interface) 
         [0205]    Use calibration table to calculate actual (calibrated) volume (based on measured volume, syringe type and calibration table. In some cases, interpolation between two calibration values may be used) 
         [0206]    Compare syringe type and actual volume with desired type and volume 
         [0207]    Accept/Reject syringe (if the determined syringe type is not the desired type or if the actual volume is outside tolerance range from the desired volume - syringe may be rejected and process terminates with error message to the user) 
         [0208]    It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable sub combination. 
         [0209]    Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims. All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention.