Management of Neurologic Trauma Chapter
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Questions and Answers

Which type of head injury is characterized by damage due to an external force impacting the head?

  • Intracranial injury
  • Secondary injury
  • Primary injury (correct)
  • Repetitive trauma

What condition can occur immediately after a traumatic brain injury due to the physical damage?

  • Immediate coma (correct)
  • Increased intracranial pressure
  • Acute cerebral hypoxia
  • Secondary brain death

Which factor can contribute to secondary brain injury following an initial traumatic event?

  • Skull fracture
  • Scalp laceration
  • Hematoma evacuation
  • Cerebral edema (correct)

Which type of skull fracture is most likely to penetrate the brain tissue?

<p>Depressed fracture (A)</p> Signup and view all the answers

What is indicated by a halo sign in a patient with a skull fracture?

<p>Cerebrospinal fluid leaking (D)</p> Signup and view all the answers

Which of the following is NOT a common cause of brain injury?

<p>Sports injuries (A)</p> Signup and view all the answers

What does the term 'Battle sign' represent in the context of skull fractures?

<p>Ecchymosis behind the ear (C)</p> Signup and view all the answers

What is a likely consequence of increased intracranial pressure following traumatic brain injury?

<p>Cerebral herniation (A)</p> Signup and view all the answers

What is the characteristic feature of diffuse axonal injury?

<p>Immediate coma with no lucid interval (A)</p> Signup and view all the answers

Which diagnostic method is least likely to assess brain function in cases of traumatic brain injury?

<p>Skull x-rays (C)</p> Signup and view all the answers

Which symptom is NOT typically monitored for changes in a patient with traumatic brain injury?

<p>Decreased appetite (A)</p> Signup and view all the answers

Which management strategy is critical in preserving brain homeostasis in a patient with a traumatic head injury?

<p>Managing cerebral perfusion (D)</p> Signup and view all the answers

In addition to the Glasgow Coma Scale, which assessment is crucial for initial evaluation of a patient with traumatic brain injury?

<p>Health history regarding the injury (C)</p> Signup and view all the answers

Which nursing diagnosis should prioritize the prevention of further injury in a patient with traumatic brain injury?

<p>Injury Prevention (D)</p> Signup and view all the answers

What condition is indicated by the absence of brainstem reflexes in a patient?

<p>Brain death (D)</p> Signup and view all the answers

What is a potential complication that requires close monitoring in patients with traumatic brain injury?

<p>Decreased Cerebral Perfusion (C)</p> Signup and view all the answers

Which of the following is NOT a supportive measure for a patient with traumatic head injury?

<p>Immediate surgical intervention (A)</p> Signup and view all the answers

What is the main consequence of repeated concussive incidents?

<p>Chronic traumatic encephalopathy (D)</p> Signup and view all the answers

Which goal is essential for the nursing process in caring for a patient with traumatic brain injury?

<p>Maintaining skin integrity (B)</p> Signup and view all the answers

Which strategy should be implemented to promote adequate fluid balance in a patient with traumatic brain injury?

<p>Monitor blood and urine electrolytes (B)</p> Signup and view all the answers

What is a critical nursing intervention to prevent complications related to hypothermia in patients with traumatic brain injury?

<p>Maintain an appropriate environmental temperature (A)</p> Signup and view all the answers

Which nursing action is important to address the disturbed thought patterns in a patient with traumatic brain injury?

<p>Reduce environmental stimuli (C)</p> Signup and view all the answers

Which assessment is vital to ensure effective nutrition and fluid management in a patient with traumatic brain injury?

<p>Monitoring daily weights and I&amp;O (C)</p> Signup and view all the answers

Which of the following interventions is most crucial for preventing aspiration in a patient with a traumatic brain injury?

<p>Positioning with head of bed elevated 30 degrees (D)</p> Signup and view all the answers

Which factor is NOT associated with predicting a poor outcome in traumatic brain injury?

<p>Unconsciousness at the scene (C)</p> Signup and view all the answers

What distinguishes a contusion from a concussion in traumatic brain injury?

<p>Contusion involves structural damage while concussion does not. (B)</p> Signup and view all the answers

In cases of epidural hematoma, what is typically observed after the initial loss of consciousness?

<p>A brief lucid interval followed by decreased level of consciousness. (C)</p> Signup and view all the answers

Which of the following best describes intracerebral hemorrhage?

<p>Bleeding into the brain's parenchyma due to localized trauma. (C)</p> Signup and view all the answers

What is a common consequence of a subdural hematoma as it enlarges?

<p>Increased intracranial pressure and potential coma (C)</p> Signup and view all the answers

Which symptom is NOT typically associated with an altered level of consciousness in traumatic brain injury?

<p>Persistent headache (A)</p> Signup and view all the answers

What is the primary treatment goal for managing a contusion after a traumatic brain injury?

<p>Preventing increased intracranial pressure (A)</p> Signup and view all the answers

Which of the following conditions is most directly associated with poor neurological responses?

<p>Intracerebral hemorrhage due to systemic hypertension (B)</p> Signup and view all the answers

Which nursing measure is indicated to reduce the potential for seizures and increased intracranial pressure in a client with a craniotomy for a brain tumor?

<p>Maintaining the client on strict bed rest with the head of the bed slightly elevated. (A)</p> Signup and view all the answers

Which activity indicates that a client recovering from a head injury understands measures to prevent elevations in intracranial pressure?

<p>Exhaling during repositioning. (C)</p> Signup and view all the answers

What finding would alert the nurse that cerebrospinal fluid is present in a client with clear fluid leaking from the nose following a basilar skull fracture?

<p>Fluid separates into concentric rings and tests positive for glucose. (D)</p> Signup and view all the answers

Which sign should alert the nurse to a basilar skull fracture in a client exhibiting altered levels of consciousness?

<p>Battle’s sign (B)</p> Signup and view all the answers

What would be an appropriate nursing intervention for a client with suspected increased intracranial pressure after a head injury?

<p>Administer antipyretics on a PRN basis. (A)</p> Signup and view all the answers

What diagnostic test will be done to confirm neurologic determination of death in a client with severe brain injury?

<p>Electroencephalogram (EEG) (A)</p> Signup and view all the answers

Which of the following symptoms is NOT characteristic of elevated intracranial pressure?

<p>Sudden loss of appetite (A)</p> Signup and view all the answers

What complication should the nurse monitor for in a client who experienced a basilar skull fracture?

<p>Cerebrospinal fluid leak (D)</p> Signup and view all the answers

What is the primary benefit of using cooling blankets or cool baths for a patient with elevated intracranial pressure (ICP)?

<p>Support cognitive function (C)</p> Signup and view all the answers

In supporting a family of a patient with neurologic trauma, which of the following actions is most crucial for effective coping?

<p>Providing and reinforcing clear information (C)</p> Signup and view all the answers

Which nursing intervention is most appropriate when caring for a client with increased ICP?

<p>Elevate the head of the bed to 30 degrees (A)</p> Signup and view all the answers

A client displays a decreased level of consciousness and a headache within 48 hours post-trauma. What condition should the nurse suspect?

<p>Acute subdural hematoma (B)</p> Signup and view all the answers

Upon admission, which assessment takes priority for a client with a severe head injury?

<p>Assessing the patency of the airway (B)</p> Signup and view all the answers

Which symptom is most indicative of increased intracranial pressure?

<p>Bradycardia and hypertension (C)</p> Signup and view all the answers

What is the most effective way to set patient goals during family support sessions for those with neurologic trauma?

<p>Set realistic and well-defined short-term goals (A)</p> Signup and view all the answers

Which client assessment should be prioritized in a unit with multiple patients with neurologic conditions?

<p>Client with meningitis reporting a severe headache (A)</p> Signup and view all the answers

Flashcards

Primary Brain Injury

Initial damage from traumatic event, like contusions or lacerations.

Secondary Brain Injury

Damage arising AFTER the initial injury, often from swelling or bleeding.

Intracranial Pressure (ICP)

Pressure inside the skull - increases with swelling or bleeding.

Brain Herniation

Brain tissue shifts due to high ICP-- damaging brain areas.

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Battle Sign

Bruising behind the ear, sign of skull base fracture.

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Halo Sign

Ring of fluid surrounding a blood stain, likely CSF leak.

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Closed Skull Fracture

Fracture of the skull without a break in the skin.

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Open Skull Fracture

Fracture of the skull with a break in the skin.

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Altered Level of Consciousness

A change in the person's awareness and responsiveness.

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Pupillary Abnormalities

Changes in the size or responsiveness of the pupils (the black circles in the eye).

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Intracranial Hematoma (general)

Collection of blood within the skull, putting pressure on the brain.

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Epidural Hematoma

Bleeding between the dura and skull, often from the middle meningeal artery.

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Subdural Hematoma

Bleeding between the dura and the brain, usually venous.

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Intracerebral Hemorrhage

Bleeding inside the brain tissue.

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Concussion

Temporary loss of brain function with no lasting structural damage from a blunt force blow.

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Poor TBI outcome factors

Factors that increase the likelihood of a bad outcome from a traumatic brain injury, examples include: Intracranial Hematoma, increasing age, abnormal motor/eye responses, hypotension.

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Diffuse Axonal Injury

Widespread damage to nerve fibers in the brain, often caused by severe head trauma. It's characterized by immediate coma, no lucid interval, and a poor prognosis.

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What are the three cardinal signs of brain death?

The three cardinal signs of brain death on clinical examination are: Coma, Absence of brainstem reflexes, and Apnea.

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Glasgow Coma Scale (GCS)

A standardized tool used to assess a patient's level of consciousness after a head injury. It evaluates eye opening, verbal response, and motor response.

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What is the goal of management for a patient with a traumatic head injury?

Preserve brain homeostasis and prevent secondary damage. This involves treating cerebral edema, maintaining cerebral perfusion, managing fluid and electrolyte balance, and providing supportive care.

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What is the importance of maintaining cerebral perfusion in a patient with a traumatic head injury?

Maintaining cerebral perfusion ensures adequate blood flow to the brain, delivering oxygen and nutrients essential for brain function. It prevents further brain damage and dysfunction.

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What sign might indicate a skull base fracture?

Battle sign, which is a bruising behind the ear, is a potential indicator of a skull base fracture.

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What is the significance of a halo sign?

A halo sign, a ring of fluid surrounding a blood stain, is a strong indication of a cerebrospinal fluid (CSF) leak. It suggests a possible skull fracture.

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Frequent Neurologic Assessment

Regularly checking the patient's brain function for signs of deterioration after a head injury.

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Multisystem Assessment

Evaluating the patient's whole body for other injuries or complications that might relate to a brain injury.

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Ineffective Cerebral Tissue Perfusion

The brain isn't getting enough blood flow, which can lead to damage.

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Monitoring I&O and Daily Weights

Tracking how much fluid the patient takes in and puts out, and their weight, to ensure proper hydration.

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Preventing Secondary Injury

Taking steps to avoid further damage to the brain after the initial trauma.

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Maintaining Body Temperature

Keeping the patient's temperature stable, as fluctuations can worsen brain function.

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Cognitive Function Improvement

Helping the patient regain thinking, memory, and reasoning skills.

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Effective Family Coping

Providing support and education to families dealing with the challenges of a brain injury.

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ICP Monitoring: What Does 12 mm Hg Mean?

A pressure of 12 mm Hg in ICP monitoring indicates a normal balance between brain tissue, blood, and cerebrospinal fluid (CSF).

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Positioning for Increased ICP

Elevate the head of the bed to 30 degrees to improve venous drainage and decrease ICP.

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Acute Subdural Hematoma: The Telltale Signs

A sudden decrease in consciousness, a headache within 48 hours of the injury, and focal symptoms of brain damage, even without a known head injury.

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Top Priority for Head Injury: Emergency Room

The most crucial assessment in the emergency room for a severe head injury is ensuring a patent airway.

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Neurological Status Assessment: Key Tool

The Glasgow Coma Scale (GCS) is a standardized tool for assessing a client's neurological status by evaluating their eye opening, verbal response, and motor response.

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Increased ICP: What Should the Nurse Watch For?

A suddenly agitated client with meningitis reporting a severe headache (rated 10 on a 0-10 scale) requires immediate attention because it suggests increased intracranial pressure.

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Supporting Family: Key Interventions

Support for families of individuals with brain injuries includes providing information, promoting coping strategies, setting realistic goals, and referring to counseling or support groups.

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Supporting Cognitive Function: What is Important?

Maintaining cognitive function for patients with brain trauma includes using cooling blankets or cool baths to regulate temperature and prevent shivering, which can increase metabolic demand.

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Post-craniotomy Emesis

Vomiting after brain surgery (craniotomy) is concerning for increased intracranial pressure (ICP).

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ICP Reduction: Fever

Controlling fever is critical to prevent increased intracranial pressure (ICP) after a brain injury.

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ICP Reduction: Positioning

Keeping the head of the bed slightly elevated helps reduce intracranial pressure (ICP) after a head injury.

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ICP Prevention: Activity

Activities that increase intra-abdominal pressure, such as coughing or straining, can increase intracranial pressure (ICP).

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CSF Leak: Halo Sign

The presence of a halo sign around a blood stain (clear fluid surrounding blood) indicates a cerebrospinal fluid (CSF) leak.

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Basilar Skull Fracture: Battle sign

Battle sign - bruising behind the ear - is a potential indicator of a basilar skull fracture.

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ICP Management: Intubation

Intubation and mechanical ventilation can help manage increased intracranial pressure (ICP) in a client with a head injury.

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Brain Death Diagnosis

Brain death in a severely brain-injured patient is diagnosed using neurological testing, including an EEG (electroencephalogram).

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Study Notes

Management of Patients With Neurologic Trauma

  • This chapter discusses managing patients with neurologic trauma, specifically head injuries.
  • The most common causes of brain injury are falls, motor vehicle accidents, and assault.
  • Prevention measures are detailed; however, specific details aren't provided.

Head Injury

  • A broad classification, covering injury to the scalp, skull, or brain.
  • Falls, motor vehicle accidents, and assaults are common causes.

Other Definitions

  • Coma: An altered state of consciousness.
  • Vegetative state: A persistent unconscious state.
  • Brain death: Irreversible cessation of brain function.

Pathophysiology of Brain Damage

  • Primary injury: Damage from the initial impact, including contusions, lacerations, and skull fractures.
  • Secondary injury: Damage happening after the initial insult, caused by intracranial hemorrhage, cerebral edema, intracranial hypertension, hyperemia, seizures, and vasospasm.
  • Death can occur immediately after injury, within 2 hours after, or approximately 3 weeks after injury; depending on the nature and severity.

Pathophysiology of Traumatic Brain Injury

  • Brain swelling and bleeding increase intracranial volume.
  • Rigid cranium prevents expansion, increasing intracranial pressure.
  • Pressure on brain blood vessels slows blood flow, causing cerebral hypoxia and ischemia.
  • Intracranial pressure continues to rise; the brain can herniate.
  • Cerebral blood flow ceases.

Clinical Manifestations

  • Symptoms depend on injury severity and location.
  • Scalp wounds: Tend to bleed heavily; also portals for infection.
  • Skull fractures: Can be linear, comminuted, depressed, open, or closed. Usually have localized, persistent pain.
  • Fractures of the base of the skull: Bleeding from nose, pharynx, ears. Battle sign: ecchymosis behind the ear; CSF leak—halo sign—ring of fluid around the blood stain from drainage.
  • Basilar skull fracture diagram: Shows the basilar skull fracture and potential for CSF leakage.

Manifestations of Traumatic Brain Injury

  • Altered level of consciousness.
  • Pupillary abnormalities.
  • Sudden neurologic deficits (e.g., changes in sense, movement, and reflexes)
  • Changes in vital signs (e.g., blood pressure, pulse, temperature).
  • Headaches.
  • Seizures.

Factors that Predict a Poor Outcome

  • Intracranial hematoma.
  • Increasing patient age.
  • Impaired/absent motor responses.
  • Impaired/absent eye responses.
  • Early sustained hypotension, hypoxemia.
  • ICP levels higher than 20 mm Hg.

Types of Traumatic Brain Injury

  • Contusion: Brain is bruised and damaged, typically in specific areas.
  • Epidural hematoma: Bleeding between the dura and inner surface of the skull (often from the middle meningeal artery).
  • Subdural hematoma: Blood collection between the dura and brain (often venous).
  • Intracerebral hemorrhage: Bleeding into the brain parenchyma; commonly from blunt force trauma.
  • Concussion: Temporary loss of neurologic function with no apparent structural damage. Damage is from blunt force trauma.
  • Diffuse axonal injury: Widespread axon damage, often associated with prolonged coma, no lucid interval, and poor prognosis.

Diagnostic Evaluation

  • Physical and neurologic examination.
  • Skull and spinal x-rays.
  • CT scan.
  • MRI.
  • PET scan.

Management of the Patient With a Traumatic Head Injury

  • Assume cervical spine injury unless ruled out.
  • Preserve brain homeostasis and prevent secondary damage.
    • Treat cerebral edema.
    • Maintain cerebral perfusion.
    • Monitor and manage ICP.
    • Maintain oxygenation.
    • Manage fluid and electrolyte balances.

Supportive Measures

  • Respiratory support (intubation and mechanical ventilation).
  • Seizure precautions and prevention.
  • NG tube to manage reduced gastric motility and prevent aspiration.
  • Fluid and electrolyte maintenance.
  • Pain and anxiety management
  • Nutrition

Brain Death

  • Three cardinal signs: coma, absence of brainstem reflexes, and apnea.
  • Additional tests: cerebral blood flow studies, EEG, transcranial Doppler.

Nursing Process---Assessment of the Patient With Traumatic Brain Injury

  • Health history (focus on immediate injury details, cause, direction of impact).
  • Baseline assessment (Glasgow Coma Scale to assess LOC).
  • Frequent and ongoing neurologic assessments.
  • Multisystem assessment (see pertinent table).

Nursing Process---Diagnosis of the Patient With Traumatic Brain Injury

  • Airway clearance
  • Ineffective cerebral tissue perfusion
  • Deficient fluid volume
  • Nutrition
  • Injury prevention
  • Body temperature imbalance
  • Prevention of pressure injuries

Nursing Process---Diagnosis of the Patient With Traumatic Brain Injury

  • Disturbed thought patterns
  • Disturbed sleep pattern
  • Interrupted family process
  • Deficient knowledge

Collaborative Problems and Potential Complications

  • Decreased cerebral perfusion
  • Cerebral edema and herniation
  • Impaired oxygenation and ventilation
  • Impaired fluid, electrolyte, and nutritional balance
  • Risk of posttraumatic seizures

Nursing Process---Planning the Care of the Patient With Traumatic Brain Injury

  • Maintain patent airway; adequate CPP (cerebral perfusion pressure), fluid and electrolyte balance, and sufficient nutrition.
  • Prevent secondary injury.
  • Maintain normal body temperature and skin integrity.
  • Improve cognitive function.
  • Prevent sleep deprivation.
  • Support effective family coping, and increase family knowledge about rehabilitation process, while preventingcomplications.

Interventions

  • Ongoing assessment and monitoring (airway, vital signs).
  • Airway management (positioning to facilitate drainage, suctioning with caution).
  • Prevention of aspiration, respiratory insufficiency.
  • Monitoring ABG's, ventilation, and mechanical ventilation.
  • Monitoring for pulmonary complications and potential ARDS.
  • Monitoring I&O and daily weights.
  • Monitor blood and urine electrolytes, osmolality, and blood glucose.
  • Implement measures to promote adequate nutrition and prevent injury.
    • Assess oxygenation
    • Assess bladder and urinary output
    • Assess for constriction caused by dressings & casts -Pad side rails; use mittens to prevent self-injury
  • Strategies to prevent injury (Reduce environmental stimuli, Use adequate lighting to reduce visual hallucinations, Implement measures to minimize disruption of sleep-wake cycles, Provide skin care, Implement measures to prevent infection).
  • Maintain appropriate body temperature (coverings, acetaminophen, cooling blankets/baths).
  • Support cognitive function, support family and reinforce and promote effective coping mechanisms, set realistic goals, refer to counseling, and refer to support groups.
  • Patient and family education (see applicable chart).

Review Questions

  • Some review questions are provided related to patient responses to treatment, diagnoses, and indications to assess.

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Week 10 - Management of Patients With Neurologic Trauma (2) PDF

Description

This chapter focuses on the management of patients with neurologic trauma, particularly head injuries. It explores causes such as falls and motor vehicle accidents, as well as definitions of key terms like coma and brain death. Additionally, it discusses the pathophysiology of brain damage, highlighting both primary and secondary injuries.

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