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Padang, ………………….
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,49CP796 :=8456 549M968=96 _=65=7 A ;=7 85=7LM96 ;=5=\ (6:M1=96 <=9M9 /6;4P <485=:C61=7 <1676< 85=7LM96 *4:P7985=96 ;47>=7 :47>>M7=<=7 :=76<47
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3=;= :=8456 549M968=96 _=65=7 . 841=\ ;6Z41=9<=7 ;=9=5 ;=9=5 8478=7> ;69856`M96 _=65=7 8M`M\ ;6 5M=7> 6785=O=9 `45C45=7 ;=1=: C45>45=<=7 _=65=7 ;=1=: :414a=86 :4:`5=7 <=C6145 845:=9M< `=>=6:=7= :47>\68M7> <4`M8M\=7 :=67847=7 _=65=7 8M`M\2 (41=7ZM87[= C=;= 9496 549M968=96 _=65=7 .. 676 =<=7 14`6\ ;6;=1=:6 1=>6 8478=7> 845=C6 _=65=7 ;=7 C47>>M7==7 M7=<=7 M78M< :=67847=7 :=MCM7 M78M< 867;=<=7 549M968=962 T=65=7 :=67847=7 `45=586 :47[4;6=<=7 <4`M8M\=7 _=65=7 \=56=7 C=;= C=9647 [=7> 86;=< ;=C=8 678=<4 P5=1 =8=M :67M: [=7> _M<67=7 <4\61=7>=7 _=65=7 [=7> :4767><=82 3=;= C56796C7[= C4:`456=7 _=65=7 14a=8 P5=1 =8=M -S' 14`6\ =:=7 <=547= <4_61 <4:M7><67=7 M78M< :47[4`=`<=7 <414`6\=7 _=65=7 =8=M >=5=:F>=5=:=7] >=7>>M=7 <4946:`=7>=7 414<85P168 9458= 5496<=7 549M968=96 `45=586 <68= :47>>=786 OP1M:4 6785=O=9 :47>=1=:6 C47M5M7=7 =8=M C=9647 841=\ :47>=1=:6 ;4\6;5=96 X\6CPOP14:6Y2 %78M< :41==7 =7=:49=] P`945O=96 ;=7 C4:456<9==7 L696< X84<=7=7 ;=5=\] ;48=< Z=78M7>] ,,] a=<8M C47>696=7 <=C6145] <49=;=5=7 C=9647Y] ;=7 C4:456<9==7 C47M7Z=7>2 %78M< <=9M9F<=9M9 \6CP84796 = =7;= 86;=< [=<67 C47[4`=`7[=] %,$+0 "#-,,-&5' .'/. ;=C=8 ;61==7 :47>>M7=<=7 ?@EF@EE :& _=65=7 <5698=1P6; ;=1=: @ :4768 <4:M;6=7 :41= 549CP7 C=9647 X'*] 7=;6] ;48=< Z=78M7>] ,,] M567 PM8CM8] 0/3] <49=;=5=7 C=9647Y2 06<= LM11 549CP7 941=7ZM87[= _M 14`6\ =;6=78M7> C=;= V$> RR ;47>=7 _4C=8Y2 06<= 86;=< 549CP7 <4:M7><67=7 C=9647 :47>=1=:6 PO451P=; _=65=7 =8=M >=7>>M=7 Z=78M7> 94\67>>= 86;=< C451M ;6`456<=7 _=65=7 8=:`=\=7 9=:`61 ;6_=56 C47[=<68 ;=9=57[=
!FHG2JTILOIL %FHID2 WI2HIL !I1I 'CL1232 'NM3M3
3=9_= +C45=96 $=;=5 <=16M: =<=7 :4767><=8 <=547= 941 ;=5=\ :47>=1=:6 16969 941=:= PC45=96 94\67>>=7 :47Z=;6 C4586:`=7>=7 ;=1=: 845=C6 _=65=7 =>=5 761=6 $ d 86;=< :414`6\6 H]@ :QP1V&2 R4`45=C= _47845 :47>\67;=56 C47>>M7==7 7P5:=1F9=1674 C=9_= PC45=96 <=547= :4<=769:4 5484796 7=856M: 94_=5= 47;P<567 ;6C6_M P14\ C4:`4;=\=7 941=67 68M 7=856M: `=7[=< 845<=7;M7> ;=1=: 9M`98=7 [=7> ;6>M7=<=7 941=:= PC45=96 X=786`6P86< 6785=O47=] 1=5M8=7 hartmann’s, koloid). Terlalu banyak NaCl dapat menyebabkan edema asidosis hiperkloremik, meningkatnya `4`=7 >67Z=1] :4767><=87[= =7>>M=7 C47_457==72 R4`45=C= _47845 :47[=5=7<=7 :47>>M7=<=7 ;4<985PF9=1674 X:47>=7;M7> 94;6<68 -=T1Y2
(4C969 (4C969 ;=C=8 :47[4`=`<=7 ;4C1496 6785=O=9 X:41=1M6 <4`P_P5=7 O=9>=786=n cairan dapat menggunakan kristaloid (Harmann’s), namun hindari terlalu banyak 7=86M: ;=7 <=16M:2 3451M ZM>= ;6C45\=86<=7 `=5=7><=16 C=9647 :4:`M8M\<=7 67P85PC6< :=MCM7 O=9PC549P5 ;=7 L=96168=9 .T% M78M< :454>M1=96 84<=7=7 ;=5=\ C=9647 ;=7 :47>M5=7>6 <4\61=7>=7 _=65=7 C456L452 S=>=1 S67Z=1 #=1 S67Z=1 $5P76< U67;=56 _=65=7 [=7> `4514`6\=7 845:=9M< 7=856M: ;=7 <=16M: X >67Z=1 :47>=1=:6 >=7>>M=7 M78M< :47>4<5496<=77[= Y 345;=5=\=7 +8=< U67;=56 *4J85P94 X :47[4`=`<=7 P9:P86_ \=4:=8P:= 9a41167>Y S=>=1 0=78M7> 3=9647 >=>=1 Z=78M7> _47;5M7> M78M< <414`6\=7 _=65=7 ;=7 4;4:= C=5M2 $4`M8M\=7 845>=78M7> 94`45=C= `45=8 >=7>>M=7 Z=78M7>7[=2 U=86F\=86 M78M< :41==1=:6 PO451P=; _=65=7 1==5=:F>=5=:=7] C47>>M7==7 LM5P94:6;2 04769 _=65=7 C47>>=786 845>=78M7> C=;= Z4769 _=65=7 [=7> \61=7>] _P78P\7[= <4\61=7>=7 _=65=7 4<985=941M145 X1M<= `=<=5] C=7<54=86869] ;6=54 ;=7 :M78=\ :M78=\Y ;6>=786 ;47>=7 _=65=7 [=7> :656C ;47>=7 _=65=7 4<985=941M145 (larutan hartmann’s atau normal saline). Pada dehidrasi normal (pasien intake yang jelek dan demam) diganti ;47>=7 _=65=7 :=67847=7 [=7> 7P5:=1 _P78P\7[= ;4<85P94F9=16742 3=9647 C47;=5=\=7 \=5M9 ;6>=786 ZM>= ;47>=7 ;=5=\2 06<= C=9647 845M9 :47>=1=:6 C47;=5=\=7 :M7><67 ZM>= ;6C451M<=7 C5P;M\4786<=7 C47;=5=\=7 ;=56C=;= 94<4;=5 :47>>=786 941 ;=5=\ :45=\ [=7> \61=7>2
%HILUM32 'CJDCLFL 8IHIN
.;4=17[= ;=5=\ [=7> \61=7> ;6>=786<=7 ;47>=7 1=5M8=7 <5698=1P6; =8=M :=96\ \61=7> ;6>=786 ;47>=7 85=7LM96 941 ;=5=\ :45=\ M78M< :4:C458=\=7<=7 1P`67 X=8=M \4:=8P<568Y2 '6;=< =;= <48478M=7 [=7> C=986 C=;= `=8=9 U` `45=C= ;61=>= C4586:`=7>=7 ;6=8=9 :4:C4586:`=7><=7 F :=967> C=96472 3=;= 5V;1] _=5;6=_ PM8CM8 9==8
69865=\=8 =<=7 :4767><=8 M78M< :4:C458=\=7<=7 ;416O456 P<96>472 $P794785=96 U` C451M ;6867><=8<=7 ;6=8=9 761=6 676 C=;= C=9647FC=9647 M96= 8M= ;=7 C=9647FC=9647 ;47>=7 C47[=<68 <=5;6PCM1:P7452 3=;= <4=;==7 85=M:= [=7> :=96L] 94`=>6=7 `49=5 ;P<845 =<=7 :4:`456<=7 1=5M8=7 ,& =8=M C1=9:=1[84 <65= <65= GFH <=16 ;=56 ;=5=\ [=7> \61=7> =8=M =7 5=96P ADA 9=:C=6 C=;= =7 C45`=7;67>=7 9=8M M768 85=7LM96 M78M< 9486=C M768 ;=5=\ [=7> \61=7>2 3=9647 C54PC45=86L ;47>=7 \4:=8P<568 [=7> 7P5:=1 94\=5M97[= ;685=7LM96 ;M5=784 PC45=96 \=7[= 94841=\ C45;=5=\=77[= :414`6\6 AEF?El X=7==7 C45;=5=\=7 ;6=8=9AEl :4986 ;685=7LM96Y ;=56 C45<65==7 OP14:4 ;=5=\2 /P1M:4 *=5=\ ,=8=F,=8= %96= -4P7=8M9 354:=8M54 TM
/P1M:4 ;=5=\ f@ :1V<> K@ :1V<> KE :1V<> B@ :1V<> I@ :1V<>
TP78P\ D W=768= M:M5 @E 8=\M7 ;47>=7 RR K@ <> ;47>=7 \4:=8P<568 C54PC45=86L G@ l =<=7 :47Z=1=76 PC45=96 1=C=5=8P:6 4JC1P5=962 R45=C= `=7[=< ;=5=\ [=7> \61=7> =>=5 \4:=8P<568 8M5M7 :47Z=;6 GEl )R/ XC45<65==7 OP1M:4 ;=5=\Y D I@:1V<> J K@ <> k @@?@ :1 ,RT/G@l k @@?@ J G@l k AfGH ,RT/GElk @@?@ J GE l k AI@K :1 (41 ;=5=\ :45=\ [=7> \61=7> C=;= \4:=8P<568 GEl k AfGH FAI@K k ?BI #11Pa=`14 `1PP; 1P99 k ,RT/ 1P98 J G k G J ?BI :1 k K?K :1 3=;= C=9647 676 85=7LM96 ;6C4586:`=7><=7 `61= ;=5=\ [=7> \61=7> :414`6\6 m KEE:12 (==8 676 85=7LM96 86;=< ;6545lY 7=:M7 C47867> ;6C4586:`=7><=7 ZM>= <4_4C=8=7 ;=5=\ [=7> \61=7> ;=7 C451M :4:C458=\=7<=7 \4:=8P<568 ;6=8=9 GEl2 (4_=5= <16769 M:M:7[= ;6=7>>=C 9=8M M768 941 ;=5=\ :45=\ =<=7 :4767><=8<=7 U` A >5V;1 ;=7 \4:=8P<568 ?FGl =8=M AE :1V<> 85=7LM96 3,T =<=7 :4767><=8<=7 5V;1 ;=7 \4:=8P<568 AEl2 347>>=786=7 _=65=7 941=:= PC45=96 :416CM86D
:47>>=786 ;=5=\ [=7> \61=7>
\61=7>7[= _=65=7 14a=8 4O=CP5=96 ;=7 54;69856`M86O4
8FHIQIG GHIMJI QIH2LOIL Q676:=1 X \4576P5\=C\[Y QP;45=84 X_\P1P_[_84_8P:[ (4O454 X`Pa41 5494_86P7Y
'FTMGMNIL \I2HIL XILO 12GIJTINEILBQIJLXI EF? :1V<> ?FH :1V<> HFK :1V<>
!HCGCECK !FJTFH2IL %HILUM32 8IHIN
‘Safety transfusion’ meliputi :
right blood, right patient, right time, right place
3P9686O4 C=86478 6;4786L6_=86P7 =8 =11 98=>49 PL 8\4 85=79LM96P7 C5P_499 69 4994786=12 Q676:M: C=86478 6;4786L6459 =54D
3P9686O4 C=86478 6;4786L6_=86P7
&=98 7=:4] L6598 7=:4] ;=84 PL `658\] M76hM4 6;4786L6_=86P7 7M:`452 W\474O45 CP996`14 =9< C=864789 8P 98=84 8\465 LM11 7=:4 =7; ;=84 PL `658\2 "P5 C=864789 a\P =54 M7=`14 8P 6;4786L[ 8\4:941O49 XC=4;6=856_] M7_P79_6PM9] _P7LM94; P5 1=7>M=>4 `=55645Y 944< O456L6_=86P7 PL 6;47868[ L5P: = C=5478 P5 _=545 =8 8\4 `4;96;42 '\69 :M98 4J=_81[ :=8_\ 8\4 67LP5:=86P7 P7 8\4 6;47868[ `=7; XP5 4hM6O=1478Y2 #11 C=C45aP5< 541=867> 8P 8\4 C=86478 :M98 67_1M;4] =7; `4 6;4786_=1 67 4O45[ ;48=61] 8P 8\4 :676:M: C=86478 6;4786L6459 P7 8\4 6;47868[ `=7;2
W\454 CP996`14] C=864789 X=7; LP5 _\61;547] 8 \P94 a68\ C=5478=1 549CP796`6168[Y 9\PM1; 3=86478 67LP5:=86P7 =7; \=O4 8\4 569<9] `474L689 =7; =18457=86O49 8P 85=79LM96P7 4JC1=674; 8P 8 \4: 67 = 86:41[ =7; _P79478 LP5 85=79LM96P7 M7;4598=7;=`14 :=77452 (8=7;=5;694; C=86478 67LP5:=86P7] 9M_\ =9 7=86P7=1 C=86478 67LP5:=86P7 14=L1489] 9\PM1; `4 M94; a\454O45 CP996`142 Minimum dataset in patient’s clinical record: 354F85=79LM96P7 ;P_M:478=86P7
,4=9P7 LP5 85=79LM96P7 X_1676_=1 =7; 1=`P5=8P5[ ;=8=Y2 (M::=5[ PL 67LP5:=86P7 C5PO6;4; 8P C=86478 X`474L689] 569<9] =18457=86O49Y =7; C=86478 _P794782
The transfusion ‘prescription’ must contain the minimum patient identifiers and specify:
3549_56C86P7 X=M8\P569=86P7Y
TP:CP74789 8P `4 85=79LM94; *=84 PL 85=79LM96P7 /P1M:4V7M:`45 PL M7689 8P `4 85=79LM94; =7; 8\4 5=84 P5 ;M5=86P7 PL 85=79LM96P7 (C4_6=1 54hM654:4789 X42>2 655=;6=84;] TQ/ 74>=86O4Y2
QM98 67_1M;4D
,4hM4989 LP5 85=79LM96P7
Q676:M: C=86478 6;4786L6459 =7; >47;45 *6=>7P969] =7[ 96>76L6_=78 _PF:P5`6;68649 =7; 54=9P7 LP5 85=79LM96P7 TP:CP7478 54hM654;] OP1M:4V7M:`45 PL M7689 =7; 9C4_6=1 54hM654:4789 '6:4 =7; 1P_=86P7 PL 85=79LM96P7 -=:4 =7; _P78=_8 7M:`45 PL 54hM498452
#11 C=864789 `467> 9=:C14; :M98 `4 CP9686O41[ 6;4786L64;2
R1PP; 9=:C149 LP5 C54F85=79LM96P7 849867>
TP114_86P7 =7; ;416O45[ PL `1PP; _P:CP7478 8P _1676_=1 =54=
TP114_86P7 PL 8\4 `1PP; 9=:C14 L5P: 8\4 C=86478 6 78P 8\4 9=:C14 8M`49 =7; 9=:C14 1=`41167> :M98 `4 = _P7867MPM9] M7678455MC84; 4O478 67OP1O67> P74 C=86478 =7; P74 85=674; =7; _P:C4847_[ =994994; \4=18\_=54 aP5<452 (=:C14 8M`49 :M98 7P8 `4 C54F1=`4114;2 '\4 54hM498 LP5: 9\PM1; `4 96>74; `[ 8\4 C459P7 _P114_867> 8\4 9= :C142 R4LP54 _P114_86P7] 479M54 8\4 C=86478 X=7; 98=LLY 69 54=;[ 8P 98=58 85=79LM96P7 =7; 8\454 69 >PP; O47PM9 =__4992 +71[ 85=674; =7; _P:C48478 98=LL 9\PM1; _P114_8 `1PP; L5P: 85=79LM96P7 1=`P5=8P5[ P5 9=8411684 54L56>45=8P52 #M8\P5694; ;P_M:478=86P7 a68\ :676:M: C=86478 6;4786L6459 :M98 `4 _\4_<4;
#;:676985=86P7 8P C=86478
=>=6798 1=`41 P7 `1PP; _P:CP74782 Q676:M: C=86478 6;4786L6459] ;=84 =7; 86 :4 PL _P114_86P7 =7; 98=LL :4:`45 .* :M98 `4 54_P5;4;2 *416O45 8P _1676_=1 =54= a68\PM8 ;41=[2 '\4 L67=1 _\4_< :M98 `4 _P7;M_84; 74J8 8P 8\4 C=864 78 `[ = 85=674; =7; _P:C48478 \4=18\_=54 C5PL4996P7=1 a\P =19P =;:67698459 8\4 _P:CP74782 #11 C=864789 `467> 85=79LM94; :M98 `4 CP9686O41[ 6;4786L64;2 Q676:M: C=86478 6;4786L6459 P7 8\4 patient’s identity band must exactly match 8\P94 P7 `1PP; _P:CP7478 1=`412 #11 _P:CP74789 :M98 `4 >6O47 8\5PM>\ = `1PP; =;:676985=86P7 948 XABE – ?EE n: 6784>5=1 :49\ L61845Y2 '5=79LM96P7 9\PM1; `4 _P:C1484; a68\67 H \PM59 PL 14=O67> _P785P114; 84:C45=8M54 98P5=>42
3=864789 9\PM1; `4 M7;45 54>M1=5 O69M=1 P`945O=86P7 =7;] LP5 4O45[ M768 85=79LM94;] :676:M: :P768P567> 9\PM1; 67_1M;4D
QP768P567> 8\4 C=86478
TP:C1486P7 PL 85=79LM96P7 4C69P;4
(FIE32 %HILUM32@
354F85=79LM96P7 CM194 X3Y] `1PP; C5499M54 XR3Y] 84:C45=8M54 X'Y =7; 549C65=8P5[ 5=84 X,,Y2 3] R3 =7; ' A@ :67M849 =L845 98=58 PL 85=79LM96P7 – 6L 96>76L6_=78 _\=7>4] _\4_< ,, =9 a4112 .L 8\454 =54 =7[ 9[:C8P:9 P5 96>79 PL = CP996`14 54=_86P7 – :P768P5 =7; 54_P5; 3] R3] ' =7; ,, =7; 8=<4 =CC5PC56=84 =_86P72 3P98F85=79LM96P7 3] R3 =7; ' – 7P8 :P54 8\=7 IE :67M849 =L845 85=79LM96P7 _P:C1484;2 .7C=864789 P`945O4; PO45 74J8 ?H \PM59 =7; PM8C=864789 =;O694; 8P 54CP58 1=84 9[:C8P:9 X?HF\PM5 =__499 8P _1676_=1 =;O6_4Y2 .L LM58\45 M7689 =54 C549_56`4;] 54C4=8 8\4 =;:676985=86P7V6;47868[ _\4_< a68\ 4=_\ M7682 .L 7P LM58\45 M7689 =54 C549_56`4;] 54:PO4 8\4 `1PP; =;:676985=86P7 948 =7; 479M54 =11 85=79LM96P7 ;P_M:478=86P7 69 _P:C1484;2
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Q=79`56>4 T2] ?EAG] "1M6;] # (PM5_4 PL "544 PL +(T) )J=: -P849 LP5 Q4;6_=1 (8M;478 s’ Final OSCE ,4O696P7] f Q=5_\ ?EAI2 +(T)F#6; ,4O696P7 WP5<9\PC] ?EAI] #9949:478 PL "1M6; R=1=7_4] aaa2P9_4F=6;2_P26< ] f :=5_\ ?EAI *4&PM>\45[ '2 S2]2 ?EEH] R1PP; TP:CP7478 '\45=C[ =7; Q=996O4 '5=79LM96P7] 67 #;M18 3456PC45=86O4 #7498\496=] '\4 ,4hM69684 67 #7498\496P1P>[] X4;Y TP14 *2 02] (_\1M78 Q2] )194O645 Q P9`[] G?fFGH?2 Butterworth J. F., Mackey D. C., Wasnick J. D., 2013, Morgan & Mikhail’s Clinical Anestheiology, The Q_ S5PaFU611 TP:C=7649] AAIAFAAKA 2
;EFLIH2C MQ2IL D
(4P5=7> C=9647 C454:CM=7 M:M5 BE 8=\M7 ;65=a=8 ;6 `=7>9=1 `4;=\ ;47>=7 ;6=>7P9= T= ,4_862 ,47_=7= =<=7 ;61==7 56a=[=8 C47[=<68 C=5M P`985M<86L <5P76<2 3=9647 9=;=5] <4=;==7 M:M: `=6< ;=56 34:456<9==7 "696< ;6;=C=8<=7 '* AAEVIE] -=;6 AAE JV:78] ,, ?EJV:78] '4:C45=8M5 GB ᵒ T2 *=56 C4:456<9==7 ;=5=\ ;6 ;=C=8<=7 U` B] I >5V;1 ;47>=7 UT' ?Hl2 3=9647 ;6547_=7=<=7 85=7LM96 ;=5=\ ;M1M 94`41M: PC45=962 U68M7>1=\ `45=C= :61616845 ZM:1=\ 3,T [=7> =<=7 ;6`456<=7 ;=7 1= `=6< ;=7 `47=52
8):%)( %+,+' !"#+,)+)# (";$;+%);+ W)+()# 4 '"%()*!+,)# ',+#+' - .,9' 4@- /)#//$)# !"#W"(#))# 8)# ["!)%9!)#'(")%9.+,+"( ;"*";%"( - %)@ 460AB4607
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347;=\M1M=7 g :4:C45<47=1<=7 ;656] :47> :47;M <4`M8M\=7 M78M< 85=7LM96 ;=5=\ 2 .7LP5: _P7948 XC5P94;M5 <45Z=] 4L4< 9=:C67> =8=M 5496=:`61 9=:C41 ;=5=\ ;=7 :45494C<=7 ;6`M8M\<=7 34596=C=7 85=7LM96 ;=5=\ 94841=\ =7] _4< 62O 1674 ;=7 62O2<=7M1] C56:67> ;47>=7 1=5M8=7 -=T1 E]flY T4< M1=7> C5=85=7LM96 X -=:= 147><=C C=9647] 8=7>>=1 1=\65] `=7>9=1] 7P:P5 54<=: :4;6<] <4_P_P<=7 Z4769 P1 P7>=7 ;=5=\ Y 34:`456=7 85=7LM96 X 94841=\ 62O 1674 ;6 `61=9 ;47>=7 -=T1 E]fl] ;=5=\ ;6\=7>=8<=7] =8M5 <4_4C=8=7 84849=7 67LM9 *P <68= 1=>=1] ;6`456<=7] ZM:1=\] <4_4C=8=7 84849=7 67LM9] 8=7;= 8=7>=7 ;P<845 QP768P567> O68=1 96>7 94`41M: 85=79LM96] @ :4768 C458=:= 94841=\ 85=7LM96] A@ :4768 941=7ZM87[= 941=7ZM87[= 9486=C A Z=: 9=:C=6 85=7LM96 94149=62 Q47Z41=9<=7 <4:M7><67=7 54=<96 85=7LM96 ;=7 >4Z=1=F>4Z=1=7[= 9458= 867;=<=7 [=7> \=5M9 ;61=M_=C<=7 8456:=<=96\ ;=7 :47Z41=9<=7 <4C=9647 <=1=M 867;=<=7 9M;=\ 94149=62
$4845=7>=7 D (=7 C451M C45`=6<=7 ? D *61==7 94:CM57= -61=6 k o AEE -61=6 #<\65 k
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