oxygen uptake A
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| chest trauma is often sudden and is it traumatic | yes
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| it occurs in __% of traumatic incidents | 20%
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| what are serious pathological consequences | hypoxia, hypovolemia, heart failure
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| mechanism of injury: blunt trauma- when does this occur; what are the types of forces involved; | when body is struck by blunt object; deceleration, acceleration, shearing, compression;
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| contrecoup trauma- def; injury occurs in what 2 places; | type of blunt traumacaused by impact ofbody parts against another object; on sideof impact and also on opposite side
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| Blunt trauma: what is the most common related injury; fractures to what 3 areas suggect massive force of injury | rib fx; fx to sternum, first rib, scapula
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| penetrating injuries: cause; what are secondary injuries to this | gunshot or stab wound; hemothorax, pneumothorax, cardiac tamponade, esophageal injury, tracheal tear, great vessel tear
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| penetrating injuries: resp s/s | dyspnea, cough w/ or w/o hemotysis, cyanosis of mouth, mucous membranes, nail beds, decreased Bowel sounds on side injury;
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| penetrating injuries: CV s/s | rapid thready pulse; decreased BP, narrowed pulse pressure, distended neck veins, chest pain, arrythmias
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| penetrating injuries: visable s/s | bruising, abrasions, open chest wound, asymmetrical chest movement, subq emphysema
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| what is subq emphysema | it is the crepitus one hears when palpating the chest
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| nursing tx for chest trauma: there should be a patent __; what should be administered; what should be accessed; what position in bed; why are there 2 large bore iv sites; | airway; high flow O2; IV site; semi fowlers; pt may need lots of fluids;
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| pneumothorax: what are the 2 types; how does it occur; where does air accumulates; what is tx | open or closed; from blunt or penetrating injury that disrupts the parietal or visceral pleura; in the pleural cavity; chest drain
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| pneumothorax: what are unilateral signs that this has occurred on one side of bod but not other; what will it sound like with percussion; WHAT does resonant mean; | decreased movement and breath sounds on affected side, it will have resonant tone; strong and deep tone
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| lungs: what is the name of the lining of the lungs; what is the portion between the pleara termed; anything that gets in the potential space causes what; | visceral and parietal pleura; potential space; irritation;
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| pneumothorax: things that cause air to get in from the outside; thins that cause air to get in from the inside; how is one confirmed; | stabbing from knife, stick; rib fx; with chest xray
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| closed pneumothorax: is there an external wound; what is in the pleural space; what is the most common cause; other causes; | no; air; rupture of small blebs on the visceral pleura; mechanical ventilation, insertion of CVC, perforation of esophagus, broken;
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| closed pneumothorax: the pain is worse with inspiration of expiration; are there breath sounds over the affected area; why is there pain | inspiration; no; due to irritation of the parietal pleura
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| open pneumothorax: this is a sucking ___ wound; air enters the pleural space through what opening; what can we hear; what is the tx; | chest; in the chest wall; air moving in and out of the wound; prevent more air from getting in;
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| open pneumothorax: dressing- how many sides are taped; when you inhale dressing prevents what; but when breathing out the dressing allows for what; allowing air to escape decreases possibility of what complication | 3 sides; air cannot get in; air to get out; tension pneumothorax;
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| open pneumothorax: should we remove object in chest if it is still there; | no;
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| closed pneumothorax: air leaks into the pleural space from an opening where; | with in the lungs;
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| pneumothorax: degree of lung collapse- if the pneumothorax is less then __% the patient may need only what tx; if it is >___% what tx is needed; | 20%, bed rest or limited physical activity; air may need to be evacuated from the plueral space by needle aspiration or insertion of chest tube to an underwater seal
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| needle aspiration is aka | thoracentesis
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| what is the goal of chest tube therapy | to remove the air in the pleural space in order to reestablish subatmospheric intrapleural pressure which will reexpand the affected lung
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| hemothorax: what is the cause; is it usually with open or closed pneumothorax; def; requires rapid what; why are there resp problems | blunt or penetrating trauma; open; accumulation of blood in pleural space; decompression AND FLUID resuscitation; blood makes it difficult for pt to breath
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| hemothorax: s/s; why is there dullness to percussion; is person hypovolemic or hypervolemic; | dyspnea, decreased LS, dullness to percussion; b/c not air but blood in pleural space; hypovolemic;
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| hemothorax: tx; | chest tube, administer PRBC, may require surgical intervention;
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| tension pneumothorax: is it a complication of open or closed; it is rapid accumulation of air in ___; air can get in but it can't ___; there is increased pressure where; there is a decrease of ____ return; | both; air in pleural space causes this; get out and lungs cont to collapse; on the heart and great vessels; venous return;
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| tension pneumothorax: decreased venous return leads to decreased ___; WHY there decreased CO; is this life threatening; why should pt be monitored in hosp after thoracic surgery | CO; b/c vena cava is being smooshed; yes; b/c this could occur causing resp andsig cardiac issues
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| tension pneumothorax: as right side becomes more compromised trachea will deviate where; the deviation of the trachea is termed what; | to the left; medial stinal shift;
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| tension pneumothorax: s/s; | cyanosis, air hunger- panicky, violent agitation, tracheal deviation, subcutaneous emphysema; neck vein distension, hyperresonace to percussion;
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| subq emphysema is aka | crepitus- when chest wall is palpated there is a crackly feeling
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| tension pneumothorax: why is there neck vein distension | b/c vena cava is smooshed and blood cannot get to it;
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| tension pneumothorax: is this a surgical emergency; the area needs to be de____; what size needle; where should needle be inserted; what should be inserted after emergency | yes; decompressed; 14 g; 2nd ICS mid clavicular line; chest tube
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| chest tubes: these remove the air and fluid from where; these do not remove fluid from where; they restore normal what; restoring intrapleural pressure allowslung to do what | the pleural space; the lung; intrapleural pressure; expand
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| chest tubes: what are the 2 reasons to insert them; | to remove air or fluid from pleural cavity;
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| chest tubes: removing air- should it be inserted anteriorly or posteriorly; what ICS; larger or small tube; why is it inserted higher; | anteriorly; 2-3 ICS; smaller tube; bc air rises;
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| chest tubes: removal of fluid- what ICS is it inserted in; why is it inserted to low; | 8-9 ICS: b/c fluid sits lower and settles
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| chest tubes: interventions- why is chest tube drainage system kept below the insertion site; why should pt not be clamped; | we do not want it to go back into the lungs; clamping pt sets them up for pneumothorax;
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| chest tubes: what to do if chest tube is dislodged from drainage system; why is tube placed in sterile water | place tube in sterile water until the system can be reeastablished; this creates and air seal
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| chest tubes: interventions- what should be measured | I
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| chest tubes: complications- how often is the chest tube not positioned properly; what happens if there is reexpansion pulmonary edema; what are other complications; | not often; there is too much fluid taken off too fast; vasovagal response, hypotension, infection, PNA, decreased shoulder mobility
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| chest tubes: removal- when is it removed; what is usually d/c for a period of time prior to removal; why is suction d/ced before removal; after removal what type of dressing should be used; | once lungs reexpands and fluid no longer is draining; suction; to make sure pt can tolerate it; an airtight one-we do not want any air in or out now;
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| chest tubes: chest tubes to drain air are placed high or low; chest tubes to drain fluid are placed high or low; | high; low;
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| chest tubes: drainage units- what are the 3 chambers; what are the 2 types; what is the one we usually use | collection, water seal, suction control; water and dry suction; dry suction
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| chest tubes: water suction drainage- aka; what doesit use to control wall suction pressure | pleurovac; water;
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| chest tubes: dry suction control- what controls wall suction; it adjusts to what; | the automatic control valve; changes in air leaks and fluctuations in sx source;
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| chest tubes: hemlich valve- def; what does it let out but not in; opens when ___ pressure is > ____ pressure; closes when ___ pressure is > ___ pressure | rubber one way valve, hooks to end of chest tube; air; internal pressure is > atmospheric pressure; when atmospheric pressure is > internal pressure
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| chest tubes: hemlich valve: whenare they used; | emergency transport, with pneumothoraxkit, with small bore chest drain, in home care or LTC
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| chest wall injuries: give examples; | rib fx, flail chest open pneumothorax;
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| Rib Fx: most common __ injury; what ribs most commonly fx; why are ribs 5-10 most commonly fx; what is the risk forsuperior fx; | thoracic; 5-10; least protected by chest muscle; there could be vascular injury b/c there are big vessels located there;
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| Rib Fx: with fx of rib 7-12 what 2ndary injuries could occur; s/s of rib fx | liver and spleen injuries; shallow resp, lots of localized pain, cretitus;
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| Rib Fx: tx- what to use to manage pain; why should narcs be used cautiously; why should taping not be done ; why should chest xray be done; | analgesis, intercostal nerve block; they cancan resp depression and that would be compromise resp. even more; it becomes harder for good lung expansion; to rule out other injuries
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| flail chest: there are multiple what; the multiple fx produce a mobile fragment, this fragment moves how; how is there a fragment; | rib fx; paradoxically with respiration; 2 or more adjacent ribs and all are blorken in many places so middle piece does opposite of what rest of ribs do.
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| flail chest: why is there decreased gas exchange; s/s; is there usually a pneumothorax with this | b/c significant force is required for respiration; paradoxical movement of chest wall, resp distress, assoc hemothorax, pneumothorax; yes
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| flail chest: tx- what should be stabilized; why may pt be intubated; when sedated they can have what; | the flail segment; b/c it hurts too much for pt to breath effectively themselves; all the pain meds they need;
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| cardiac tamponade: where does blood rapidly collect; when blood collects in the pericardial sac what is compressed; when heart is compressed what can it not do; does it take a lot or a little bit of blood for this to happen | in the pericardial sac; the heart; pump effectively; only a little
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| cardiac tamponade: what are the 3 common distinguishing s/s; what 3 common s/s are termed ___; why are the distended neck veins; why are there muffled heart sounds; why is there hypotension | distended neck veins, muffled heart sounds, hypotension; becks triad; heart cannot except blood; b/c fluid is all around it; b/c not much CO
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| chest tubes: how often is the chest tube mispositions; if too much fluid is taken off what can happen; what are other complications; | not often; reexpansion pulmonary edema; vasovagal response, hypotension, infection, PNA, decreased shoulder mobility;
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| cardiac tamponade: what are tx options; | pericardiocentesis, surgical repair, volume resuscitation
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| chest trauma: what is primary goal of tx; | to provide oxygen to all organs;
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| reasons for intubation: list them | upper airway obstruction, apnea, increased risk of aspiration, ineffective clearance of airway secretions, respiratory distress
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| intubation: why is oral preffered | r/t easier insertion and can use larger tube thus decrease the work of breathing
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| intubation: nursing interventions- maintain correct __; how do you maintain proper cuff placement; how do you check cuff pressure; | tube placement; low pressure cuffs prevent tracheal trauma from high pressure; using MOV-minimal occluding volume or MLT- minimal leak technique
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| when intubating, if tube is placed too far in- what main bronchi is it most likely to enter | the right one
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| intubation: cuff- it has high or low volume; it was high or low pressure; why is there high volume and low pressure | volume; pressure; to prevent tracheal trauma
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| thoracentesis: def; why is it done; how is the pt positioned; | the insertion of a largebore needle through the chest wall into the pleural space; to obtain specimens, remove pleural fluid, instill medications; upright with elbows on a table and feet supported;
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| partial airway obstruction can be caused by what; s/s of airway obstruction | laryngeal edema following extubation, aspiration of food, laryngeal or tracheal stenosis, CNS depression, allergic reactions; stridor, use of accessory muscles, suprasternal and intercostal retractions, wheezing, restlessness, tachycardia, cyanosisl
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| tracheostomy: def of tracheotomy; def tracheostomy; with this - it is best used for long or short term ventilation; what should always be taped to the wall; why should cuff be inflated with minimal volume of air | a surgical incision into the trachea for the purpose of establishing an airway; is the stoma that results from the tracheotomy; long term; obturator; to decrease the pressure on the tracheal mucosa;
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| tracheostomy: trach pressure should not exceed what; why is it important not to cause too much pressure to the tracheal mucosa; | 20 mm Hg; the increased pressure can cause necrosis b/c it blocks of blood supply;
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| tracheostomy: suctioning should not exceed what; suction time should be limited to how many seconds; | 12- 150 mm hg of pressure; 10 sec;
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| tracheostomy: nursing dx for this; why should 100% humidified air be administered for these pt; | ineffective airway clearance, ineffective therapeutic regimen maintainance, impaired verbal communication, risk for infection, impaired swallowing; due to fact that having trach blocks normal humidification from upper airway;
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| def blunt trauma; in blunt trauma what is more severe the external injury or the internal injury; def penetrating trauma; countercoup trauma def; | when the body is struck by a blunt object; the internal; when a foreign body impales or passes through the body tissue; type of blunt trauma impact of body parts against another object- body parts moved back and forth against bony structures of body;
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| pneumothorax: closed- are there any external wounds; what is the most common cause; other causes; what happens on the visceral pleural space | no; pt may have one spontaneously with out real cause; injury from vent, perforation of esophagus, injury to lungs from broken ribs, ruptured blebs from COPD; blebs rupture
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| pneumothorax: def; the air in the pleural space causes what to happen to the lung; with what injury should we expect this; | air in the pleural space; partial or complete collapse of it; any blunt trauma to the chest wall;
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| pneumothorax: open- when does this happen; examples of this injury; penetrating chest wound is often aka; what type of dressing should cover this; should we remove the object | when air enters the pleural space through an opening in the chest wall; gun shot wound, stab; sucking chest wound; a vented dressing; no
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| vented dressing: def; why is 4th side untapped; | dressing the is secured on 3 sides with fourth side left untapped; this allows for air to escape from the vent and decreases the likelihood of tension pneumothorax developing;
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| pneumothorax: tension- def; this rapidly accumulating air causes what to increase; this increased pressure creates tension where; can an open or closed pneumothorax cause this | this is one with rapid accumulation of air in the pleural space; intrapleural pressure; on the heart and great vessels; both;
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| pneumothorax: tension- where does the mediastinum shift; the shift of the mediastinum compresses the heart causing what; why is there decreased CO; why is this a medical emergency; | to the unaffected side; decreased CO; due to the decreased venous return and compression of the vena cava or the aorta; bc both resp and circulatory systems are effected;
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| pneumothorax: tension- why does this pt die; what is tx | inadequate CO or severe hypoxemia; insertion of a large bore needle into the chest wall to release trapped air;
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| hemothorax: def; commonly found with what type of pneumothorax; causes; | accumulation of blood in the intrapleural space; an open one; chest trauma, lung maglinencies, complications of anticoagulant therapy, pulmonary embolism, tearing of pleural adhesions;
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| chylothorax: def; | accumulation of lymphatic fluid in pleural space
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| what pneumothorax is associated with air hunger; | tension pneumothorax;
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| tension pneumothorax: there is a continued increase in air shifting what; | intrathoracic organs and increases intrathoracic pressure;
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| cardiac tamponade: what will heart sounds be; this prevents the heart from doing what; does BP increase or decrease; | muffled distant heart sounds; pumping effectively; decrease
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| with flail chest pt could also have what else | hemothorax, pneuomothorax
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| WHAT RIBS are most commonly fx; why are ribs 5-10 most commonly fx; | ribs 5-10;b/c they are least protected by the chest muscle;
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| fx ribs: when is pain most common- inspiration or expiration'; why does atelectasis happen; why are opioids avoided; | inspiration; pt is reluctant to take a deep breath; they can decrease resp
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| flail chest: during inspiration the flail segment moves in or out; it is apparent on what assessment; | in; visual examination;
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| def empyema | purulent pleural fluid associated with lung abscesses or pna
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| if disconnection accidently occurs what is main nursing priority | to reconnect, establish immerse in sterile water
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| what is the most common complication of chest tubes | malposition
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| chest tubes: what is tidaling/fluctuation; what happens if bubbling increases; | air rise with inspiration and falling with expiration; may be an air leak;
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