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tŚĂƚ ƐƵƉƉůŝĞƐ ĂŶĚ ĞƋƵŝƉŵĞŶƚ ƐŚŽƵůĚ ďĞ ĂǀĂŝůĂďůĞ͍
ŽŽ•—’’Ž‹‡• ƒ† ‡“—‹’‡– ‡ ‡••ƒ”› ˆ‘” ƒ ‘’Ž‡–‡ ”‡•—• ‹–ƒ–‹‘ —•–
„‡ ”‡ƒ†‹Ž›ƒ˜ƒ‹Žƒ„Ž‡ ƒ† ˆ— –‹‘ƒŽˆ‘” ‡˜‡”›„‹”–ŠǤ Š‡ƒŠ‹‰ŠǦ”‹•
‡™„‘” ‹•‡š’‡ –‡†ǡ ƒŽ‹ ƒ’’”‘’”‹ƒ–‡ •—’’Ž‹‡•ƒ† ‡“—‹’‡–•Š‘—Ž†„‡
”‡ƒ†› ˆ‘” ‹‡†‹ƒ–‡ —•‡Ǥ – ‹• ‘– •—ˆˆ‹ ‹‡––‘ •‹’Ž›Ž‘‘ƒ–™Šƒ– ‹•‘
–Š‡ ”ƒ†‹ƒ–™ƒ”‡”Ǥ – ‹• — Š ‘”‡ ‡ˆˆ‡ –‹˜‡–‘ ‡•–ƒ„Ž‹•Š ƒ ‘”‰ƒ‹œ‡†
”‘—–‹‡—•‹‰ƒ•–ƒ†ƒ”†‹œ‡† Š‡ Ž‹•–„‡ˆ‘”‡‡˜‡”›„‹”–ŠǤ –Š‹• ™ƒ›ǡ
›‘—™‹ŽŽ ‘ˆ‹”™Šƒ– ‹•”‡ƒ†›ˆ‘” ‹‡†‹ƒ–‡ —•‡ ƒ† ‹†‡–‹ˆ›™Š‹ Š
’‹‡ ‡•‘ˆ‡“—‹’‡– ƒ”‡‹••‹‰Ǥ
Š‡ ƒ’’‡†‹ ‡• ‘ˆ–Š‹• Ž‡••‘ ‹ Ž—†‡ʹŽ‹•–•Ǥ
Ȉ Š‡ ‡‘ƒ–ƒŽ‡•—• ‹–ƒ–‹‘ ”‘‰”ƒ ̺ȋ ̺Ȍ—‹ “—‹’‡–
Š‡ Ž‹•– ‹•ƒ–‘‘Ž –Šƒ–›‘— ƒ —•‡ †—”‹‰›‘—”„”‹‡ˆ‹‰–‘ Š‡ –Š‡
‘•– ‡••‡–‹ƒŽ•—’’Ž‹‡• ƒ† ‡“—‹’‡–Ǥ – ˆ‘ŽŽ‘™• –Š‡ •–‡’• ‘ˆ–Š‡
Ž‰‘”‹–ŠǤ ‘•‹†‡” ‡‡’‹‰ –Š‹• Š‡ Ž‹•– ‡ƒ” –Š‡ ”ƒ†‹ƒ–
™ƒ”‡”•‘ ‹– ‹• ƒ ‡••‹„Ž‡ „‡ˆ‘”‡‡˜‡”›„‹”–ŠǤ
Ȉ Š‡ ‡‘ƒ–ƒŽ‡•—• ‹–ƒ–‹‘ —’’Ž‹‡• ƒ† “—‹’‡–‹•–‹•ƒ
‘’”‡Š‡•‹˜‡ ‹˜‡ͳͳ–‘”›‘ˆ–Š‡ •—’’Ž‹‡• ƒ† ‡“—‹’‡––Šƒ– •Š‘—Ž†
„‡ ƒ˜ƒ‹Žƒ„Ž‡™‹–Š‹–Š‡ ”‡•—• ‹–ƒ–‹‘ ƒ”‡ƒǤ
tŚĂƚ ĂƌĞ ƚŚĞ ĐŚĂƌĂĐƚĞƌŝƐƚŝĐƐ ŽĨĂŶ ĞĨĨĞĐƚŝǀĞ ƚĞĂŵ ůĞĂĚĞƌ͍
˜‡”›”‡•—• ‹–ƒ–‹‘ –‡ƒ ‡‡†• –‘ Šƒ˜‡ ƒ–‡ƒ Ž‡ƒ†‡”Ǥ ›–‡ƒ
‡„‡” ™Š‘ Šƒ• ƒ•–‡”› ‘ˆ–Š‡ Ž‰‘”‹–Šƒ† ‡ˆˆ‡ –‹˜‡
Ž‡ƒ†‡”•Š‹’ •‹ŽŽ• ƒ „‡–Š‡ –‡ƒ Ž‡ƒ†‡”Ǥ Š‡ Ž‡ƒ†‡” δŽ‘‡•‘– Šƒ˜‡ –‘
„‡ –Š‡ ‘•– •‡‹‘”‡„‡” ‘ˆ–Š‡ –‡ƒ ‘”–Š‡ ‹†‹˜‹†—ƒŽ ™‹–Š –Š‡
‘•– ƒ†˜ƒ ‡††‡‰”‡‡Ǥ Šƒ– ’‡”•‘ ƒ› Šƒ˜‡ –‡ Š‹ ƒŽ •‹ŽŽ• –Šƒ–™‹ŽŽ
„‡ ”‡“—‹”‡††—”‹‰–Š‡ ”‡•—• ‹–ƒ–‹‘ ƒ† ƒ›‘–„‡ ƒ„Ž‡ –‘ ƒ‹–ƒ‹
–Š‡‹”ˆ—ŽŽ ƒ––‡–‹‘ ‘ –Š‡ „ƒ„›̵• ‘†‹–‹‘Ǥ ˆ›‘—ƒ”‡ –Š‡ ’‡”•‘ ™‹–Š
•‘Ž‡ ”‡•’‘•‹„‹Ž‹–›ˆ‘” ƒƒ‰‡‡– ‘ˆ–Š‡ „ƒ„›ƒ–„‹”–Š ƒ† –Š‡ „ƒ„›
—‡š’‡ –‡†Ž›”‡“—‹”‡• ”‡•—• ‹–ƒ–‹‘ǡ›‘—„‡ ‘‡–Š‡ –‡ƒ Ž‡ƒ†‡”ƒ†
†‹”‡ – ›‘—”ƒ••‹•–ƒ–• –‘ Š‡Ž’ ›‘— —–‹Ž –Š‡ ˆ—ŽŽ ”‡•—• ‹–ƒ–‹‘ –‡ƒ
ƒ””ͳ˜‡•Ǥ
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‰‹˜‹‰ Ž‡ƒ” †‹”‡ –‹‘•–‘ •’‡ ‹ˆ‹ ‹†‹˜‹†—ƒŽ•ǡ •Šƒ”‹‰ ‹ˆ‘”ƒ–‹‘ǡ
†‡Ž‡‰ƒ–‹‰”‡•’‘•‹„‹Ž‹–‹‡•–‘ ‡•—”‡ ‘‘”†‹ƒ–‡† ƒ”‡ǡ ƒ†
ƒ‹–ƒ‹‹‰ƒ’”‘ˆ‡••‹‘ƒŽ‡˜‹”‘‡–Ǥ
Ȉ •‹ŽŽ‡† Ž‡ƒ†‡”‡ˆˆ‡ –‹˜‡Ž›—•‡• ”‡•‘—” ‡•„› ƒŽŽ‘™‹‰ƒŽŽ –‡ƒ
‡„‡”• –‘ ‘–”‹„—–‡ –Š‡‹” —‹“—‡–ƒŽ‡–• –‘–Š‡ ”‡•—• ‹–ƒ–‹‘
’”‘ ‡••Ǥ
Ȉ – ‹• ‹’‘”–ƒ– ˆ‘” –Š‡ –‡ƒ Ž‡ƒ†‡”–‘ ”‡ƒ‹ ƒ™ƒ”‡‘ˆ–Š‡ ‡–‹”‡
Ž‹‹ ƒŽ •‹–—ƒ–‹‘ǡ ƒ‹–ƒ‹ƒ˜‹‡™ ‘ˆ–Š‡ ̶„‹‰ ’‹ –—”‡Ǣ̵ ƒ† ‘–
„‡ ‘‡ †‹•–”ƒ –‡†„›ƒ•‹‰Ž‡ƒ –‹˜‹–›Ǥ Š‹• ‹• ƒŽŽ‡† situ tion
reness.
Ȉ ˆ–Š‡ Ž‡ƒ†‡”‹• ‹˜‘Ž˜‡†‹ ƒ’”‘ ‡†—”‡ –Šƒ– †‹˜‡”–• –Š‡‹” ƒ––‡–‹‘ǡ
–Š‡ Ž‡ƒ†‡”ƒ› ‡‡†–‘ ƒ’’‘‹– ƒ‘–Š‡” “—ƒŽ‹ˆ‹‡†’‡”•‘–‘ ƒ••—‡
–Š‡ Ž‡ƒ†‡”•Š‹’”‘Ž‡Ǥ ˆ–Š‡ ’‡”•‘‹ –Š‡ Ž‡ƒ†‡”•Š‹’ ”‘Ž‡ Šƒ‰‡•
†—”‹‰–Š‡ ”‡•—• ‹–ƒ–‹‘ǡ ƒ Ž‡ƒ” ˜‡”„ƒŽ •–ƒ–‡‡– •Š‘—Ž†„‡ƒ†‡ •‘
–Šƒ– ƒŽŽ –‡ƒ ‡„‡”• ‘™™Š‘ ‹•Ž‡ƒ†‹‰–Š‡ –‡ƒǤ
tŚĂƚŝƐ ĐůŽƐĞĚͲůŽŽƉĐŽŵŵƵŶŝĐĂƚŝŽŶ͍
Ž–Š‘—‰Š–Š‡ –‡ƒ Šƒ• ƒŽ‡ƒ†‡”ǡ ‡ƒ Š –‡ƒ ‡„‡”•Šƒ”‡•
”‡•’‘•‹„‹Ž‹–›ˆ‘” ‘‰‘‹‰ƒ••‡••‡– ƒ† ‡•—”‹‰–Šƒ– ‹–‡”˜‡–‹‘•
ƒ”‡’‡”ˆ‘”‡† ‹ –Š‡ ‘””‡ – •‡“—‡ ‡ ™‹–Š–Š‡ ‘””‡ ––‡ Š‹“—‡Ǥ
— ‡••ˆ—Ž ‘‘”†‹ƒ–‹‘”‡“—‹”‡• –‡ƒ ‡„‡”• –‘ •Šƒ”‡ ‹ˆ‘”ƒ–‹‘
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–‡ Š‹“—‡ –Šƒ– ‡•—”‡• ‹•–”— –‹‘• ƒ”‡Š‡ƒ”†ƒ† —†‡”•–‘‘†Ǥ
Š‡›‘— ‰‹˜‡ ƒ‹•–”— –‹‘ǡ
Ȉ ‹”‡ – –Š‡ ”‡“—‡•– –‘ ƒ•’‡ ‹ˆ‹ ‹†‹˜‹†—ƒŽǤ
Ȉ ƒŽŽ›‘—” –‡ƒ ‡„‡”„› ƒ‡Ǥ
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Ȉ ˆ–‡”‰‹˜‹‰ƒ ‹•–”— –‹‘ǡ ƒ•–Š‡ ”‡ ‡‹˜‡” –‘ ”‡’‘”–„ƒ  ƒ••‘‘
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tŚĂƚĚŽLJŽƵĚŽĂĨƚĞƌϯϬƐĞĐŽŶĚƐŽĨ ƉŽƐŝƚŝǀĞͲƉƌĞƐƐƵƌĞ
ǀĞŶƚŝůĂƚŝŽŶƚŚĂƚǀĞŶƚŝůĂƚĞƐƚŚĞ ůƵŶŐƐ͍
ˆ–‡”͵Ͳ•‡ ‘†•‘ˆ–Šƒ–˜‡–‹Žƒ–‡• –Š‡ Ž—‰•ǡ ƒ• ‹†‹ ƒ–‡†„› ƒ
‹ ”‡ƒ•‹‰Š‡ƒ”– ”ƒ–‡ ‘” Š‡•– ‘˜‡‡–ǡ›‘— ™‹ŽŽ Š‡ –Š‡ „ƒ„›̵•
Š‡ƒ”– ”ƒ–‡ ”‡•’‘•‡ ƒ‰ƒ‹Ǥ
1
.
••‹•–‡†˜‡–‹Žƒ–‹‘Šƒ• „‡‡ •— ‡••ˆ—ŽǤ
Ǧ ‘–‹—‡˜‡–‹Žƒ–‹‰ƒ– ƒ”ƒ–‡ ‘ˆͶͲ –‘ ͸Ͳ„”‡ƒ–Š• ’‡” ‹—–‡Ǥ
Ǧ ‘‹–‘”–Š‡ „ƒ„›̵• Š‡•– ‘˜‡‡–ǡŠ‡ƒ”– ”ƒ–‡ǡ ƒ† ”‡•’‹”ƒ–‘”›
‡ˆˆ‘”–Ǥ
Ǧ †Œ—•––Š‡ 1 ƒ• ‡‡†‡†„ƒ•‡†‘ ’—Ž•‡‘š‹‡–”›Ǥ
Ǧ Š‡–Š‡ Š‡ƒ”– ”ƒ–‡ ‹• ‘•‹•–‡–Ž›‰”‡ƒ–‡” –Šƒ ͳͲͲ„’ǡ
‰”ƒ†—ƒŽŽ›”‡†— ‡ –Š‡ ”ƒ–‡ ‘ˆǡ‘„•‡”˜‡ ˆ‘”‡ˆˆ‡ –‹˜‡•’‘–ƒ‡‘—•
”‡•’‹”ƒ–‹‘•ǡ ƒ† ‰‡–Ž›•–‹—Žƒ–‡–Š‡„ƒ„›–‘ „”‡ƒ–Š‡Ǥ
Ǧ ‘•‹–‹˜‡Ǧ’”‡••—”‡˜‡–‹Žƒ–‹‘ƒ›„‡†‹• ‘–‹—‡†™Š‡ –Š‡ „ƒ„›
Šƒ• ƒŠ‡ƒ”– ”ƒ–‡ ‘–‹—‘—•Ž›‰”‡ƒ–‡”–Šƒ ͳͲͲ„’ ƒ† •—•–ƒ‹‡†
•’‘–ƒ‡‘—• „”‡ƒ–Š‹‰Ǥ
1
.
ˆ–Š‡ Š‡ƒ”– ”ƒ–‡ ‹• ‹’”‘˜‹‰ǡ ‘–‹—‡ –‘ ƒ†‹‹•–‡”ƒ•Ž‘‰
ƒ•–Š‡ „ƒ„›‹• •Š‘™‹‰•–‡ƒ†›‹’”‘˜‡‡–Ǥ ‘‹–‘”–Š‡ ‘š›‰‡
•ƒ–—”ƒ–‹‘ ƒ†ƒ†Œ—•––Š‡ 1 –‘ ‡‡– –Š‡ –ƒ”‰‡– •ƒ–—”ƒ–‹‘ ”ƒ‰‡
‹†‹ ƒ–‡†‹ –Š‡ –ƒ„Ž‡Ǥ
ˆ–Š‡ Š‡ƒ”– ”ƒ–‡
‹’”‘˜‹‰ǡ ‘•‹†‡” ‡ƒ Š‘ˆ–Š‡ ˆ‘ŽŽ‘™‹‰ǣ
Ǧ —‹ Ž›”‡ƒ••‡•• ›‘—”˜‡–‹Žƒ–‹‘–‡ Š‹“—‡Ǥ • –Š‡ Š‡•– ‘˜‹‰ǫ
”‡ ›‘— ˜‡–‹Žƒ–‹‰ƒ– ƒ”ƒ–‡ ‘ˆͶͲ –‘ ͸Ͳ„”‡ƒ–Š•Ȁ‹—–‡ǫ ‘
›‘— Š‡ƒ”„”‡ƒ–Š •‘—†•ǫ ˆ‡ ‡••ƒ”›ǡ ’‡”ˆ‘” –Š‡˜‡–‹Žƒ–‹‘
‘””‡ –‹˜‡ •–‡’•Ǥ
Ǧ †Œ—•––Š‡ 1 –‘ ‡‡––Š‡ –ƒ”‰‡– •ƒ–—”ƒ–‹‘Ǥ
Ǧ
ˆ‘–ƒŽ”‡ƒ†›†‘‡ǡ ‘•‹†‡”’Žƒ ‹‰ ƒ”†‹ƒ ‘‹–‘”Ž‡ƒ†• ˆ‘”
‘–‹—‘—•‘‹–‘”‹‰Ǥ
Ǧ
ˆ‘–ƒŽ”‡ƒ†›†‘‡ǡ ‘•‹†‡”‹•‡”–‹‰ƒŽƒ”›‰‡ƒŽƒ•‘”
‡†‘–”ƒ Š‡ƒŽ –—„‡Ǥ
Ǧ
ˆƒ˜ƒ‹Žƒ„Ž‡ǡ ƒŽŽ ˆ‘”ƒ††‹–‹‘ƒŽ‡š’‡”–‹•‡–‘ Š‡Ž’ ’”‘„Ž‡ •‘Ž˜‡–Š‹•
•‹–—ƒ–‹‘Ǥ
.
Š‹•— ‘‘ •‹–—ƒ–‹‘‘ —”•™Š‡ –Š‡ Š‡ƒ”– ƒ‘– ”‡•’‘†
–‘ ˜‡–‹Žƒ–‹‘ƒŽ‘‡ƒ† ”‡“—‹”‡• ƒ††‹–‹‘ƒŽ•—’’‘”––‘ „”‹‰
‘š›‰‡ƒ–‡†„Ž‘‘†–‘ –Š‡ ‘”‘ƒ”›ƒ”–‡”‹‡•Ǥ
ϴϱ
‘•‹†‡”‡ƒ Š ‘ˆ–Š‡ ˆ‘ŽŽ‘™‹‰ǣ
Ǧ —‹ Ž›”‡ƒ••‡•• ›‘—” ˜‡–‹Žƒ–‹‘ –‡ Š‹“—‡Ǥ •–Š‡ Š‡•– ‘˜‹‰ǫ
”‡›‘—˜‡–‹Žƒ–‹‰ƒ–ƒ”ƒ–‡‘ˆͶͲ–‘ ͸Ͳ„”‡ƒ–Š•Ȁ‹—–‡ǫ ‘›‘—
Š‡ƒ” „”‡ƒ–Š •‘—†•ǫ ˆ‡ ‡••ƒ”›ǡ ’‡”ˆ‘” ˜‡–‹Žƒ–‹‘ ‘””‡ –‹˜‡
•–‡’•Ǥ
Ǧ ˆ–Š‡ ’—Ž•‡ ‘š‹‡–‡” Šƒ• ƒ”‡Ž‹ƒ„Ž‡•‹‰ƒŽǡ ƒ†Œ—•––Š‡ ͳͲ–‘ ‡‡–
–Š‡ –ƒ”‰‡– •ƒ–—”ƒ–‹‘Ǥ
Ǧ ˆ‘– ƒŽ”‡ƒ†› †‘‡ǡ ’Žƒ ‡ ƒ”†‹ƒ ‘‹–‘”Ž‡ƒ†• ƒ† „‡‰‹
‘–‹—‘—• ‘‹–‘”‹‰Ǥ
Ǧ ˆ‘– ƒŽ”‡ƒ†› †‘‡ǡ ‹•‡”– ƒŽƒ”›‰‡ƒŽ ƒ• ‘” ‡†‘–”ƒ Š‡ƒŽ –—„‡Ǥ
Ǧ
ˆƒ˜ƒ‹Žƒ„Ž‡ǡ ƒŽŽ ˆ‘” ƒ††‹–‹‘ƒŽ ‡š’‡”–‹•‡ –‘ Š‡Ž’ ’”‘„Ž‡ •‘Ž˜‡ –Š‹•
•‹–—ƒ–‹‘Ǥ
Ǧ
ˆ–Š‡ „ƒ„›̵• Š‡ƒ”–”ƒ–‡ ”‡ƒ‹• Ž‡••–Šƒ ͸Ͳ„’ ƒˆ–‡” ƒ–Ž‡ƒ•–
͵Ͳ•‡ ‘†• ‘ˆ–Šƒ– ‘˜‡• –Š‡ Š‡•–ǡ ’”‡ˆ‡”ƒ„Ž›–Š”‘—‰Š ƒ
ƒŽ–‡”ƒ–‹˜‡ƒ‹”™ƒ›ǡ ‹ ”‡ƒ•‡ –Š‡ ͳͲ–‘ ͳͲͲΨƒ†„‡‰‹ Š‡•–
‘’”‡••‹‘• ƒ•†‡• ”‹„‡† ‹‡••‘ ͸Ǥ
tŚŝůĞ ƉĞƌĨŽƌŵŝŶŐ ƚŚĞǀĞŶƚŝůĂƚŝŽŶ ĐŽƌƌĞĐƚŝǀĞƐƚĞƉƐ͕ ĐĂŶĂ
ĐĂƌďŽŶ ĚŝŽdžŝĚĞ ĚĞƚĞĐƚŽƌ ŚĞůƉ ĂƐƐĞƐƐ ƚŚĞ ĞĨĨĞĐƚŝǀĞŶĞƐƐ ŽĨ
ǀĞŶƚŝůĂƚŝŽŶ͍
•‹‰ƒ ƒ”„‘ †‹‘š‹†‡ ȋ Ͳ †‡–‡ –‘” †—”‹‰–Š‡˜‡–‹Žƒ–‹‘
‘””‡ –‹˜‡ •–‡’• ƒ ’”‘˜‹†‡ ƒ˜‹•—ƒŽ —‡ –Šƒ– Š‡Ž’• ›‘— ƒ† ›‘—” –‡ƒ
‹†‡–‹ˆ›™Š‡ ›‘— Šƒ˜‡ ƒ Š‹‡˜‡†˜‡–‹Žƒ–‹‘–Šƒ– ‹ˆŽƒ–‡•ƒ† ƒ‡”ƒ–‡•
–Š‡ Ž—‰•Ǥ Žƒ ‡ ƒͲ †‡–‡ –‘” „‡–™‡‡ –Š‡ †‡˜‹ ‡ ƒ† ƒ•Ǥ ˆ
–Š‡ Ž—‰• ƒ”‡„‡‹‰ ‡ˆˆ‡ –‹˜‡Ž›˜‡–‹Žƒ–‡†ƒ†‰ƒ• ‡š Šƒ‰‡ ‹• ‘ —””‹‰ǡ
Ͳ •Š‘—Ž† „‡‡šŠƒŽ‡†–Š”‘—‰Š–Š‡ ƒ•Ǥ
&ŝŐƵƌĞ ϰ͘ϮϮ͘ ĂƌďŽŶ ĚŝŽdžŝĚĞ
ĚĞƚĞĐƚŽƌ ƵƐĞĚ ǁŝƚŚ ĨĂĐĞ ŵĂƐŬ ĚƵƌŝŶŐ
ǀĞŶƚŝůĂƚŝŽŶ ĐŽƌƌĞĐƚŝǀĞ ƐƚĞƉƐ͘ zĞůůŽǁ
ĐŽůŽƌ ŽŶ ƚŚĞ ĚĞǀŝĐĞ ĂƐ ƐŚŽǁŶ
ƐƵŐŐĞƐƚƐ ǀĞŶƚŝůĂƚŝŽŶ ŽĨ ƚŚĞ ůƵŶŐƐ͘
ϴϲ
Ȉ ˆ›‘— ƒ”‡‡ˆˆ‡ –‹˜‡Ž›˜‡–‹Žƒ–‹‰–Š‡ Ž—‰•ǡ›‘— •Š‘—Ž† •‡‡–Š‡
†‡–‡ –‘”–—” ›‡ŽŽ‘™†—”‹‰‡ƒ Š ‡šŠƒŽƒ–‹‘ ȋ ‹‰—”‡ͶǤʹʹȌǤ
Ȉ ˆ–Š‡ Ͳ †‡–‡ –‘”‹• ’—”’Ž‡ ƒ†–—”•›‡ŽŽ‘™ƒˆ–‡” ƒ ‘””‡ –‹˜‡ •–‡’ǡ
–Š‡ •–‡’ ™ƒ•‡ˆˆ‡ –‹˜‡ƒ†–Š‡ „ƒ„›̵• Š‡ƒ”– ”ƒ–‡™‹ŽŽŽ‹‡Ž›‹’”‘˜‡
“—‹ Ž›Ǥ
Ǧ ˆ–Š‡ Ͳ †‡–‡ –‘”δŽ‘‡•‘––—” ›‡ŽŽ‘™ǡ›‘—” ˆƒ ‡Ǧƒ•
˜‡–‹Žƒ–‹‘ ƒ––‡’–• ƒ› ‘–„‡˜‡–‹Žƒ–‹‰–Š‡ Ž—‰•Ǥ
Ǧ ˆ–Š‡ †‡–‡ –‘” ”‡ƒ‹•’—”’Ž‡ƒˆ–‡” –Š‡ ˆ‹”•– ͷ ‘””‡ –‹˜‡ •–‡’•
ƒ†–Š‡ Š‡ƒ”– ”ƒ–‡Šƒ• ‘– ‹’”‘˜‡†ǡ ‹– ƒ›„‡ƒ‘–Š‡” ‹†‹ ƒ–‹‘
–Šƒ–›‘— Šƒ˜‡ ‘–ƒ Š‹‡˜‡†‡ˆˆ‡ –‹˜‡˜‡–‹Žƒ–‹‘ ƒ†ƒ ƒŽ–‡”ƒ–‹˜‡
ƒ‹”™ƒ›‹• ‡‡†‡†Ǥ
Ȉ &DXWLRQ ˆ–Š‡ „ƒ„›̵• Š‡ƒ”– ”ƒ–‡ ‹•˜‡”›Ž‘™ ‘”‘–’—’‹‰„Ž‘‘†ǡ
–Š‡ †‡–‡ –‘”ƒ›‘– Šƒ‰‡ ‘Ž‘”„‡ ƒ—•‡ Ͳ ‹•‘–„‡‹‰ ƒ””‹‡†
–‘ –Š‡ Ž—‰•‡˜‡ –Š‘—‰Š›‘— ƒ”‡˜‡–‹Žƒ–‹‰–Š‡ Ž—‰•Ǥ
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A aryn ea mas is a sma mas attac ed to an
air ay t e i re
e mas is inserted into
t e a y s mo t and ad anced into t e t roat nti
it ma es a sea o er t e entrance to t e a y s trac ea
t e ottis
i re
e aryn ea mas ma es
a etter sea t an a face mas and may im ro e t e
effecti eness of enti ation n i e endotrac ea
int ation no instr ments are re ired to insert
a aryn ea mas and yo do not need to is a i e
t e a y s oca cords d rin insertion f t e a y
cannot e s ccessf y enti ated it a face mas and
int ation is nfeasi e or ns ccessf a aryn ea
mas may ro ide a s ccessf resc e air ay
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e era ariations are a ai a e inc din de ices
it an inf ata e mas a soft e mas t at oes
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ort for a astric draina e t e
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face mas enti ation or int ation are ns ccessf
ƚŚĞ ŐůŽƚƚŝƐ
o e er its se in reterm ne orns is imited eca se
e en t e sma est aryn ea mas may e too ar e for ery reterm
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re ent y As ed
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e ices ary y man fact rer and yo s o d refer
to t e man fact rer s instr ctions for t e s ecific de ice sed at yo r
instit tion
f not a ready done attac cardiac monitor eads for acc rate
assessment of t e a y s eart rate
f
sin c ean tec ni e remo e t e de ice from t e steri e ac a e
and rotecti e container o may ace a t in ayer of ater ased
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t t is may not e
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ricate t e de ice i re
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‘Ž†–Š‡ †‡˜‹ ‡ ƒŽ‘‰–Š‡ ƒ‹”™ƒ›–—„‡ ™‹–Š–Š‡ Ž‘•‡†„‘––‘‘ˆ
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ˆƒ ‹‰–‘™ƒ”† –Š‡ „ƒ„›̵• Š‹ ȋ ‹‰—”‡ͶǤʹ͸ȌǤ
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‡‰‹ ƒ† •‡ —”‡ –Š‡ †‡˜‹ ‡ ‹ ’Žƒ ‡ ȋ ‹‰—”‡ͶǤʹͻȌǤ
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˜‡–‹Žƒ–‹‘–Šƒ–‹ˆŽƒ–‡• –Š‡ Ž—‰•ǡ›‘— •Š‘—Ž††‡–‡ –‡šŠƒŽ‡† Ͳ ™‹–Š‹ ͺ–‘ ͳͲ’‘•‹–‹˜‡Ǧ’”‡••—”‡„”‡ƒ–Š•Ǥ ‘— •Š‘—Ž†•‡‡ Š‡•– ™ƒŽŽ
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tŚĞŶ ƐŚŽƵůĚLJŽƵƌĞŵŽǀĞƚŚĞ ůĂƌLJŶŐĞĂů ŵĂƐŬ͍
e air ay can e remo ed en t e a y esta is es effecti e
s ontaneo s res irations and t e de ice is no on er needed or en
an endotrac ea t e can e inserted s ccessf y a ies can reat e
s ontaneo s y t ro
t e de ice and cryin and r ntin so nds
may e a di e
en yo decide to remo e t e aryn ea mas s ction secretions
from t e mo t and t roat efore yo remo e t e de ice
f t e de ice as an inf ata e rim def ate t e rim efore remo a
tŚĂƚĚŽLJŽƵĚŽŝĨƚŚĞďĂďLJŝƐďƌĞĂƚŚŝŶŐƐƉŽŶƚĂŶĞŽƵƐůLJĂŶĚŚĂƐ
ĂŚĞĂƌƚƌĂƚĞŽĨĂƚ ůĞĂƐƚ ϭϬϬďƉŵ͕ďƵƚŚĂƐůĂďŽƌĞĚďƌĞĂƚŚŝŶŐŽƌ
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f t e a y is reat in s ontaneo s y and as a eart rate of at east
m t as a ored or r ntin res irations or o o y en
sat ration PAP may e considered PAP is
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ŶƚŝĐşƉĂƚĞ ĂŶĚ ƉůĂŶ͘
ŶƐƵƌĞ ƚŚĂƚ LJŽƵ ŚŽǀĞ ĞŶŽƵŐŚ ƉĞƌƐŽŶŶĞů ƉƌĞƐĞŶƚ Ăƚ ƚŚĞ ƚŝŵĞ ŽĨ ďŝƌƚŚ ďĂƐĞĚ ŽŶ ƚŚĞ ƌŝƐŬ
ĨĂĐƚŽƌƐ LJŽƵ ŝĚĞŶƚŝĨŝĞĚ͘
ƵƌŝŶŐ LJŽƵƌ ƉƌĞͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ƚĞĂŵ ďƌŝĞĨŝŶŐ͕ ĚĞƚĞƌŵŝŶĞ ǁŚŽ ƉĞƌĨŽƌŵƐ WWs͕ ĂƵƐĐƵůƚĂƚĞƐ
ƚŚĞ ŚĞĂƌƚ ƌŽƚĞ͕ ĂƐƐĞƐƐĞƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ͕ ƉůĂĐĞƐ ƚŚĞ ƉƵůƐĞ ŽdžŝŵĞƚĞƌ ĂŶĚ ĐĂƌĚŝĂĐ
ŵŽŶŝƚŽƌ͕ ĂŶĚ ĚŽĐƵŵĞŶƚƐ ĞǀĞŶƚƐ ĂƐ ƚŚĞLJ ŽĐĐƵƌ͘
ĞůĞŐĂƚĞ ǁŽƌŬůŽĂĚ ŽƉƚŝŵĂůůLJ͘ ůĨ WWs ŝƐ ƌĞƋƵŝƌĞĚ͕ Ăƚ ůĞĂƐƚ Ϯ Žƌ ϯ ƋƵĂůŝĨŝĞĚ ƉƌŽǀŝĚĞƌƐ ĂƌĞ ŶĞĞĚĞĚ ƚŽ ƉĞƌĨŽƌŵ Ăůů ŽĨƚŚĞ
Ăůů ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ
ƚĂƐŬƐ ƋƵŝĐŬůLJ͘
ůĨ LJŽƵ ŚŽǀĞ ĚŝĨĨŝĐƵůƚLJ ŵĂŝŶƚĂŝŶŝŶŐ Ă ŐŽŽĚ ƐĞĂů͕ ƚŚĞ ϮͲŚĂŶĚ ŚŽůĚ ŵĂLJďĞ ƌĞƋƵŝƌĞĚ͕
ǁŚĞŶ ŶĞĞĚĞĚ͘
ǁŚŝĐŚ ƌĞƋƵŝƌĞƐ Ă ƐĞĐŽŶĚ ƉĞƌƐŽŶ ƚŽ ĂĚŵŝŶŝƐƚĞƌ ƚŚĞ ĂƐƐŝƐƚĞĚ ďƌĞĂƚŚ ĂŶĚ Ă ƚŚŝƌĚ
ƉĞƌƐŽŶ ƚŽ ĞǀĂůƵĂƚĞ ƚŚĞ ƌĞƐƉŽŶƐĞ͘
zŽƵ ŵĂLJ ŶĞĞĚ ƚŽ ĐĂůů ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ ŝĨ ŝŶƚƵďĂƚŝŽŶ ŝƐ ƌĞƋƵŝƌĞĚ͘
ŽŵŵƵŶŝĐĂƚĞ ĞĨĨĞĐƚŝǀĞůLJ͘
dŚĞ ŝŶĚŝǀŝĚƵĂůƐ ƉƌŽǀŝĚŝŶŐ WWs ĂŶĚ ĂƐƐĞƐƐŝŶŐ ƚŚĞ ĞĨĨĞĐƚŝǀĞŶĞƐƐ ŽĨ ǀĞŶƚŝůĂƚŝŽŶ ŵƵƐƚ
ƐŚĂƌĞ ŝŶĨŽƌŵĂƚŝŽŶ ĂŶĚ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ĞĂĐŚ ŽƚŚĞƌ͘
ůĨ ƚŚĞ ǀĞŶƚŝůĂƚŝŽŶ ĐŽƌƌĞĐƚŝǀĞ ƐƚĞƉƐ ĂƌĞ ƌĞƋƵŝƌĞĚ͕ ĨƌĞƋƵĞŶƚ ŝŶĨŽƌŵĂƚŝŽŶ ƐŚĂƌŝŶŐ ĂĨƚĞƌ ĞĂĐŚ
ƐƚĞƉ ŝƐ ĐƌƵĐŝĂů͘
ůƚ ŝƐ ŝŵƉŽƌƚĂŶƚƚŽ ĂŶŶŽƵŶĐĞ ǁŚĞŶ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ ŚĂƐ ďĞĞŶ ĂĐŚŝĞǀĞĚ ;ΗŚĞƐƚŝƐ ŵŽǀŝŶŐ
12: ƐŽ ƚŚĂƚ ƚŚĞ ƚĞĂŵ ŬŶŽǁƐƚŚĂƚ ƚŚĞ ŚĞĂƌƚ ƌŽƚĞ ƐŚŽƵůĚ ďĞ ĂƐƐĞƐƐĞĚ ŝŶ ϯϬ ƐĞĐŽŶĚƐ͘
<ŶŽǁLJŽƵƌ ĞŶǀŝƌŽŶŵĞŶƚ͘
hƐĞ ĂǀĂŝůĂďůĞ ƌĞƐŽƵƌĐĞƐ͘
<ŶŽǁ ŚŽǁ ƚŽ ŽƉĞƌĂƚĞ ĂŶĚƚƌŽƵďůĞƐŚŽŽƚ LJŽƵƌ WWs ĚĞǀŝĐĞ͘
<ŶŽǁ ŚŽǁ ƚŽ ŽďƚĂŝŶ Ă ůĂƌLJŶŐĞĂů ŵĂƐŬ ĂŶĚ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ͘
YƵĂůŝƚLJůŵƉƌŽǀĞŵĞŶƚKƉƉŽƌƚƵŶŝƚŝĞƐ
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‘”ƒ‡™„‘”Ž‡•• –Šƒ ͵ͷ™‡‡•̵ ‰‡•–ƒ–‹‘ǫ
†Ǥ Šƒ– ‹•–Š‡ ”‡ ‘‡†‡† ‹‹–‹ƒŽ˜‡–‹Žƒ–‹‘’”‡••—”‡ ƒ† ”ƒ–‡
ˆ‘” ƒ–‡” ‡™„‘”ǫ
‡Ǥ Šƒ–‹• –Š‡ ‘•–‹’‘”–ƒ–‹†‹ ƒ–‘”‘ˆ•— ‡••ˆ—Ž˜‡–‹Žƒ–‹‘ǫ
ˆǤ Šƒ–ƒ”‡ –Š‡ Ǥ˜‡–‹Žƒ–‹‘ ‘””‡ –‹˜‡•–‡’•ǫ
‰Ǥ Šƒ–ƒ”‡ –Š‡ ‹†‹ ƒ–‹‘• ˆ‘” ǫȋ‘’–‹‘ƒŽȌ
ŠǤ Šƒ–‹• –Š‡ ’—”’‘•‡ ‘ˆƒ ‘”‘‰ƒ•–”‹ –—„‡ǫ
‹Ǥ Šƒ–ƒ”‡ –Š‡ ‹†‹ ƒ–‹‘• ˆ‘” ƒŽƒ”›‰‡ƒŽƒ•ǫ Šƒ–ƒ”‡ –Š‡
Ž‹‹–ƒ–‹‘• ‘ˆƒŽƒ”›‰‡ƒŽƒ•ǫ
ŒǤ –™Šƒ–’‘‹– •Š‘—Ž†›‘— ’”‘ ‡‡†–‘ Š‡•– ‘’”‡••‹‘•ǫ
™‹–Š›‘—”‹•–”— –‘”Ǥ
ͺ
ƒǤ ƒˆ‡–› Š‡ ƒ•‡ŽˆǦ‹ˆŽƒ–‹‰„ƒ‰’”‹‘”–‘ —•‡Ǥ ȋ•—”‡ –Šƒ––Š‡
’”‡••—”‡Ǧ”‡Ž‡ƒ•‡˜ƒŽ˜‡ ‹• ‘–‘ Ž—†‡†ǤȌ
„Ǥ ƒˆ‡–› Š‡ ƒǦ’‹‡ ‡”‡•—• ‹–ƒ–‘”’”‹‘” –‘ —•‡Ǥ ȋ•—”‡ –Šƒ–
’”‡••—”‡• ƒ”‡ ‘””‡ –Ž›•‡– ’”‹‘”–‘ ‹‹–‹ƒ–‹‰‘ –Š‡
‡™„‘”ǤȌ
Ǥ ‘•‹–‹‘ –Š‡ ‡™„‘”̵• Š‡ƒ† ƒ† ‡ ‹ •‹ˆˆ‹‰’‘•‹–‹‘Ǥ
†Ǥ ‘•‹–‹‘ –Š‡ ‘””‡ –Ǧ•‹œ‡† ƒ• ‘ –Š‡ ‡™„‘”̵• ˆƒ ‡Ǥ
‡Ǥ ‡”ˆ‘” –Š‡˜‡–‹Žƒ–‹‘ ‘””‡ –‹˜‡ •–‡’• ȋǤ ȌǤ
ˆǤ ‡Ž‹˜‡”ƒ– –Š‡ ‘””‡ – ”ƒ–‡ǡ ’”‡••—”‡ǡ ƒ†‘š›‰‡
‘ ‡–”ƒ–‹‘ ’‡” ’—Ž•‡ ‘š‹‡–”›Ǥ
‰Ǥ •‡ –Š‡ ʹǦŠƒ†Š‘Ž†™‹–ŠŒƒ™–Š”—•–Ǥ
ŠǤ ‹• ‘–‹—‡ „›†‡ ”‡ƒ•‹‰”ƒ–‡ ƒ†’”‡••—”‡ ƒ•–Š‡ „ƒ„›
„‡‰‹• –‘ „”‡ƒ–Š‡Ǥ
‹Ǥ
•‡”–ƒ† ”‡‘˜‡ ƒŽƒ”›‰‡ƒŽƒ•ȋ‹ˆ–Š‹• •‹ŽŽ‹• ™‹–Š‹›‘—”
• ‘’‡ ‘ˆ”‡•’‘•‹„‹Ž‹–›ȌǤ
ŒǤ ‡ƒ•—”‡ƒ† ‹•‡”–ƒ‘”‘‰ƒ•–”‹ –—„‡ –‘ †‡ ‘’”‡•• –Š‡
•–‘ƒ ŠǤ
Ǥ †‹‹•–‡” ™‹–Š ƒǦ’‹‡ ‡”‡•—• ‹–ƒ–‘”ƒ†Ȁ‘”ƒ
ˆŽ‘™Ǧ‹ˆŽƒ–‹‰„ƒ‰ —•‹‰ ‘””‡ ––‡ Š‹“—‡ ȋ‹ˆ–Š‹• •‹ŽŽ ‹• ™‹–Š‹
›‘—”• ‘’‡ ‘ˆ”‡•’‘•‹„‹Ž‹–›ȌǤ
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ƒ’’Ž‹ ƒ„Ž‡–‘ ›‘—””‘Ž‡ ™‹–Š›‘—”
‹•–”— –‘”—–‹Ž ›‘— ‡‡†Ž‹––Ž‡ ‘” ‘ ƒ••‹•–ƒ ‡‘” ‘ƒ Š‹‰Ǥ
„›Ž‡ƒ†‹‰’”ƒ –‹ ‡
• ‡ƒ”‹‘ȋ•Ȍ ƒ†’‡”ˆ‘”‹‰–Š‡ •‹ŽŽ• ”‡Ž‡˜ƒ– –‘ ›‘—””‘Ž‡ ƒ†
”‡•’‘•‹„‹Ž‹–‹‡•Ǥ ˆƒ–‡ Š‹ ƒŽ•‹ŽŽ‹ Ž—†‡† ‹ ƒ• ‡ƒ”‹‘ ‹• ‘–
™‹–Š‹›‘—” • ‘’‡‘ˆ”‡•’‘•‹„‹Ž‹–›ǡ †‡Ž‡‰ƒ–‡–Š‡ •‹ŽŽ –‘ ƒ“—ƒŽ‹ˆ‹‡†
–‡ƒ‡„‡” ƒ† ’‡”ˆ‘”–Š‡ ”‘Ž‡ ‘ˆƒ••‹•–ƒ– ‹ˆƒ’’”‘’”‹ƒ–‡Ǥ
Ͳ Š‡›‘— ƒŽ‡ƒ† –Š‡ • ‡ƒ”‹‘ȋ•Ȍ ƒ†’‡”ˆ‘” –Š‡ •‹ŽŽ• ™‹–ŠŽ‹––Ž‡
‘” ‘ ‹•–”— –‘” ‘ƒ Š‹‰ǡ †˜ƒ ‡†Ž‡ƒ”‡”• ƒ›’”‘ ‡‡†
–‘ –Š‡ ‡š–Ž‡••‘̵• ’”ƒ –‹ ‡ • ‡ƒ”‹‘Ǥ Š‡••‡–‹ƒŽ•Ž‡ƒ”‡”•
ƒ›’”‘ ‡‡† –‘ –Š‡ ‹—Žƒ–‹‘ƒ† ‡„”‹‡ˆ‹‰ ‘’‘‡–‘ˆ–Š‡
”‘˜‹†‡”‘—”•‡Ǥ
‘–‡ǣ ˆ–Š‡ ‹•–‹–—–‹‘̵•’‘Ž‹ ›‹• –Šƒ– ƒǦ’‹‡ ‡”‡•—• ‹–ƒ–‘”‘”ƒŽŽ›‹•
—•‡† ‹ –Š‡ †‡Ž‹˜‡”›”‘‘ǡ–Š‡ Ž‡ƒ”‡”•Š‘—Ž††‡‘•–”ƒ–‡’”‘ˆ‹ ‹‡ ›
™‹–Š –Šƒ–†‡˜‹ ‡Ǥ ‘™‡˜‡”ǡ –Š‡ Ž‡ƒ”‡”ƒŽ•‘ •Š‘—Ž††‡‘•–”ƒ–‡ ƒ„‹Ž‹–›
–‘ —•‡ ƒ•‡ŽˆǦ‹ˆŽƒ–‹‰„ƒ‰ƒ†ƒ•Ǥ
WƌĂĐƚŝĐĞ^ĐĞŶĂƌŝŽƐ
Š”‡‡ • ‡ƒ”‹‘ ‘’–‹‘• ƒ”‡ ‘ˆˆ‡”‡†Ǥ Š‡ —„‡”‘ˆ’‡‘’Ž‡ƒ––‡†‹‰
–Š‡ „‹”–Š • ‡ƒ”‹‘• ƒ†–Š‡‹”“—ƒŽ‹ˆ‹ ƒ–‹‘• ƒ”‡ †‡–‡”‹‡†„› –Š‡
‹•–”— –‘”ƒ†„ƒ•‡†‘ Š‘•’‹–ƒŽ’‘Ž‹ ›Ǥ
‡”‡™„‘”™‹–Š ”‹•ˆƒ –‘”• ”‡“—‹”‡• Ǥ ȋƒ†
‘”‘‰ƒ•–”‹ –—„‡ ‹•‡”–‹‘ƒ”‡ ‘’–‹‘ƒŽ‹ –Š‹• • ‡ƒ”‹‘ǤȌ
ˆǤȌ ‡”‡™„‘”™‹–Š‘—–‘™ ”‹•ˆƒ –‘”• —‡š’‡ –‡†Ž›”‡“—‹”‡•
Ǥ
‡”‡™„‘”‹• †‹ˆˆ‹ —Ž––‘ ˜‡–‹Žƒ–‡™‹–Š ƒˆƒ ‡ƒ•ƒ†
”‡“—‹”‡• ƒŽƒ”›‰‡ƒŽƒ•Ǥ
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ůĚĞŶƚŝĨŝĞƐ ƚĞĂŵ ůĞĂĚĞƌ͘
ƐƐĞƐƐĞƐ ƌŝƐŬ ĨĂĐƚŽƌƐ͕ ĚĞůĞŐĂƚĞƐ ƚĂƐŬƐ͕ ŝĚĞŶƚŝĨŝĞƐ ǁŚŽ ǁŝůů ĚŽĐƵŵĞŶƚ ĞǀĞŶƚƐ ĂƐ ƚŚĞLJ ŽĐĐƵƌ͕ ĚĞƚĞƌŵŝŶĞƐ ƐƵƉƉůŝĞƐ ĂŶĚ
ĞƋƵŝƉŵĞŶƚ ŶĞĞĚĞĚ͕ ŝĚĞŶƚŝĨŝĞƐ ŚŽǁ ƚŽ ĐĂůů ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ͘
WĞƌĨŽƌŵ ĞƋƵŝƉŵĞŶƚĐŚĞĐŬ͘
ΗdŚĞ ďĂďLJ ŚĂƐ ďĞĞŶ ďŽƌŶ͘Η
ZĂƉŝĚ ĞǀĂůƵĂƚŝŽŶ͘
ƐŬƐ ϯ ƌĂƉŝĚ ĞǀĂůƵĂƚŝŽŶ ƋƵĞƐƚŝŽŶƐ͗
ͻdĞƌŵ͍
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ΗEŽ͘Η
ͻ ƌĞĂƚŚŝŶŐ Žƌ ĐƌLJŝŶŐ͍
ΗEŽ͕ ŶŽƚ ďƌĞĂƚŚŝŶŐ Žƌ ĐƌLJŝŶŐ͘Η
ůŶŝƚŝĂů ƐƚĞƉƐ Ăƚ ƌĂĚŝĂŶƚǁĂƌŵĞƌ͘
ZĞĐĞŝǀĞƐ ďĂďLJ ĂƚƌĂĚŝĂŶƚǁĂƌŵĞƌ͕ ĚƌŝĞƐ ĂŶĚ ƌĞŵŽǀĞƐ ůŝŶĞŶ͕ ƐƚŝŵƵůĂƚĞƐ ďƌŝĞĨůLJ ďLJ ƌƵďďŝŶŐ ƚŚĞ ďĂďLJΖƐ ďĂĐŬ͕
ƉŽƐŝƚŝŽŶƐ ĂŝƌǁĂLJ͕ ƐƵĐƚŝŽŶƐ ŵŽƵƚŚ ĂŶĚ ŶŽƐĞ
ƐƐĞƐƐ ďƌĞĂƚŚŝŶŐ͘ ůĨ ďƌĞĂƚŚŝŶŐ͕ ĐŚĞĐŬ ŚĞĂƌƚƌŽƚĞ͘
/Ɛ ƚŚĞ ďĂďLJ ďƌĞĂƚŚŝŶŐ͍
ΗEŽ͘Η
;,ĞĂƌƚ ƌŽƚĞсϲϬďƉŵ͕ ŝĨ ĂƐƐĞƐƐĞĚͿ
ůŶĚŝĐĂƚĞƐ ŶĞĞĚ ĨŽƌ WWs
ĞŐŝŶ WWs ǁŝƚŚŝŶ ϲϬƐĞĐŽŶĚƐ ŽĨ ďŝƌƚŚ͘
ƉƉůŝĞƐ ŵĂƐŬ ĐŽƌƌĞĐƚůLJ
^ƚĂƌƚƐ WWs ŝŶ Ϯϭ йŽdžLJŐĞŶ ;ƌŽŽŵ ĂŝƌͿ ĂƚϮϬ ƚŽ Ϯϱ Đŵ ,ϮϬ ;WW ŽĨ ϱ Đŵ ,ϮϬ ŝĨ ƵƐŝŶŐ dͲƉŝĞĐĞ ƌĞƐƵƐĐŝƚĂƚŽƌ͕
ĨůŽǁͲŝŶĨůĂƚŝŶŐ ďĂŐ͕ Žƌ ƐĞůĨͲŝŶĨůĂƚŝŶŐ ďĂŐ ǁŝƚŚ WW ǀĂůǀĞͿ͖ ƌŽƚĞ ϰϬ ƚŽ ϲϬ ďƌĞĂƚŚƐͬŵŝŶ
ZĞƋƵĞƐƚƐ ĂƐƐŝƐƚĂŶƚƚŽ ƉůĂĐĞ ƉƵůƐĞ ŽdžŝŵĞƚĞƌ ƐĞŶƐŽƌ ŽŶ ďĂďLJΖƐ ƌŝŐŚƚ ŚĂŶĚ Žƌ ǁƌŝƐƚ
ΗWƵůƐĞŽdžŝŵĞƚĞƌ ŚĂƐ ŶŽƐŝŐŶĂů͘Η
ZĞƋƵĞƐƚƐ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ ;ŽƉƚŝŽŶĂůͿ
tŝƚŚŝŶ ϭϱ ƐĞĐŽŶĚƐ ŽĨ ďĞŐŝŶŶŝŶŐ WWs͕ ƌĞƋƵĞƐƚƐ ŚĞĂƌƚ ƌŽƚĞ ĐŚĞĐŬ ƚŽ ĂƐƐĞƐƐ ŝĨ ŚĞĂƌƚ ƌŽƚĞ ŝƐ ŝŶĐƌĞĂƐŝŶŐ
,ĞĂƌƚ ƌĂƚĞсϰϬ ďƉŵ͕ ŶŽƚ ŝŶĐƌĞĂƐŝŶŐ
ƐƐĞƐƐĞƐĐŚĞƐƚŵŽǀĞŵĞŶƚ
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sĞŶƚŝůĂƚŝŽŶ ĐŽƌƌĞĐƚŝǀĞƐƚĞƉƐ ;DZ͘ ^KWͿ͘
/ŶƐƚƌƵĐƚŽƌ ĚĞƚĞƌŵŝŶĞƐ ŚŽǁ ŵĂŶLJ DZ͘ ^KW ƐƚĞƉƐ ĂƌĞ ŶĞĞĚĞĚ ďĞĨŽƌĞ WWs ĐĂŶ ƌĞƐƵůƚ ŝŶ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ͘
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'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗEŽĐŚĞƐƚŵŽǀĞŵĞŶƚ͘Η ,ĞĂƌƚƌŽƚĞсϰϬďƉŵ ΗWƵůƐĞŽdžŝŵĞƚĞƌ ŚĂƐ ŶŽƐŝŐŶĂů͘Η
ͻ ůŶĐƌĞĂƐĞƐ WƌĞƐƐƵƌĞ ďLJϱ ƚŽ ůKĐŵ ,ϮϬ ŝŶĐƌĞŵĞŶƚƐ ƚŽ ŵĂdžŝŵƵŵ ϰϬ Đŵ ,ϮϬ ĨŽƌ ƚĞƌŵ ďĂďLJ
'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗŚĞƐƚŵŽǀĞƐǁŝƚŚ WWs͘Η ;EŽƚĞ͗ ůĨ ŝŶƐƚƌƵĐƚŽƌ ƐƚĂƚĞƐ ƚŚĂƚ ƚŚĞ ĐŚĞƐƚ ŝƐ ŶŽƚ ŵŽǀŝŶŐ ǁŝƚŚ WWs ĂĨƚĞƌ ƚŚŝƐ DZ͘ ^KW ƐƚĞƉ͕
ƚŚĞ ůĞĂƌŶĞƌƐ ƐŚŽƵůĚ ŝŶƐĞƌƚĂ ůĂƌLJŶŐĞĂů ŵĂƐŬ͘ ^ĞĞKƉƚŝŽŶ ϯ͘Ϳ
dŚĞ ůĞĂƌŶĞƌΖƐ ĂƐƐŝƐƚĂŶƚ ĂŶŶŽƵŶĐĞƐ͕ ΗdŚĞ ĐŚĞƐƚ ŝƐ ŵŽǀŝŶŐ EKt͘ ŽŶƚŝŶƵĞ WWs ĨŽƌ ϯϬ ƐĞĐŽŶĚƐ͘Η
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ŽĨ WWs͘Ϳ
ƐƐĞƐƐĞƐ ŚĞĂƌƚ ƌŽƚĞ ĂĨƚĞƌ ϯϬ ƐĞĐŽŶĚƐ ŽĨ WWs ƚŚĂƚ ŵŽǀĞƐ ƚŚĞ ĐŚĞƐƚ
,ĞĂƌƚ ƌŽƚĞсϭϮϬďƉŵ ϱWϬϮ с ϲϰй ΗKĐĐĂƐŝŽŶĂů ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚ͘Η
ŽŶƚŝŶƵĞƐ WWs͕ ĂĚũƵƐƚƐ ŽdžLJŐĞŶ ĐŽŶĐĞŶƚƌĂƚŝŽŶ ƉĞƌ ƉƵůƐĞ ŽdžŝŵĞƚƌLJ͕ ŵŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚ
,ĞĂƌƚ ƌŽƚĞсϭϰϬďƉŵ ^WϬϮ с ϳϰй
ΗdŚĞďĂďLJŚĂƐŝŶĐƌĞĂƐŝŶŐ ƐƉŽŶƚĂŶĞŽƵƐ ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚĂŶĚ ŝŵƉƌŽǀŝŶŐ ŵƵƐĐůĞƚŽŶĞ͘Η
'ƌĂĚƵĂůůLJĚŝƐĐŽŶƚŝŶƵĞƐ WWs
,ĞĂƌƚ ƌŽƚĞсϭϰϬďƉŵ ^WϬϮ с ϳϮй
ΗdŚĞďĂďLJŚĂƐƐƚƌŽŶŐ ĂŶĚ ĐŽŶƚŝŶƵŽƵƐ ƌĞƐƉŝƌĂƚŽƌLJĞĨĨŽƌƚ͘Η
&ƌĞĞͲĨůŽǁ ŽdžLJŐĞŶ͘
ŝƐĐŽŶƚŝŶƵĞƐ WWs͘
ƐƐĞƐƐĞƐ ŶĞĞĚ ĨŽƌ ĨƌĞĞͲĨůŽǁ ŽdžLJŐĞŶ ƚŽ ŵĂŝŶƚĂŝŶ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ ǁŝƚŚŝŶ ƚĂƌŐĞƚ ƌĂŶŐĞ͘
,ĞĂƌƚ ƌŽƚĞсϭϰϬďƉŵ ϱWϬϮ с ϳϬй ΗdŚĞ ďĂďLJŚĂƐŐŽŽĚ ƐƉŽŶƚĂŶĞŽƵƐ ƌĞƐƉŝƌĂƚŽƌLJĞĨĨŽƌƚ͘Η
ůŶŝƚŝĂƚĞƐ ĨƌĞĞͲĨůŽǁ ŽdžLJŐĞŶ ĐŽƌƌĞĐƚůLJ͘
ƐƐĞƐƐĞƐ ŚĞĂƌƚ ƌŽƚĞ͕ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ͕ ƌĞƐƉŝƌĂƚŽƌLJ ƐƚĂƚƵƐ͘
,ĞĂƌƚ ƌŽƚĞсϭϰϬďƉŵ ϱWϬϮсϵϬй ΗdŚĞ ďĂďLJŚĂƐŐŽŽĚ ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚ͘Η
ŶĚ ƐĐĞŶĂƌŝŽ͘
tĞĂŶƐ ĂŶĚ ĚŝƐĐŽŶƚŝŶƵĞƐ ĨƌĞĞͲĨůŽǁ ŽdžLJŐĞŶ ĂŶĚ ŵĂŝŶƚĂŝŶƐ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ ǁŝƚŚŝŶ ƚĂƌŐĞƚ͘
DŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌŽƚĞ͕ ďƌĞĂƚŚŝŶŐ͕ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ͕ ƚĞŵƉĞƌĂƚƵƌĞ͘
WůĂŶƐ ƉŽƐƚͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ĐĂƌĞ͘
ŽŵŵƵŶŝĐĂƚĞƐ ǁŝƚŚ ƉĞƌŝŶĂƚĂů ƚĞĂŵ ĂŶĚ ƉĂƌĞŶƚƐ͘
ĞďƌŝĞĨƐ ƚŚĞ ƌĞƐƵƐĐŝƚĂƚŝŽŶ͘
KƉƚŝŽŶĂů͗WWĂŶĚ ŽƌŽŐĂƐƚƌŝĐ ƚƵďĞ͘
ΗĨƚĞƌ ĚŝƐĐŽŶƚŝŶƵŝŶŐ WWsĂŶĚ ĨƌĞĞͲĨůŽǁŽdžLJŐĞŶ͕ ƚŚĞ ŶĞǁďŽƌŶ ŚĂƐůĂďŽƌĞĚ ďƌĞĂƚŚŝŶŐ ĂŶĚ ŐƌƵŶƚŝŶŐ ƌĞƐƉŝƌĂƚŝŽŶƐ͘Η
,ĞĂƌƚ ƌŽƚĞсϭϰϬďƉŵ ^WϬϮ с ϴϬй
ĚŵŝŶŝƐƚĞƌWWĂŶĚ ŝŶƐĞƌƚŽƌŽŐĂƐƚƌŝĐ ƚƵďĞ͘
ƉƉůŝĞƐ WW Ăƚϱ Đŵ , ƉƌĞƐƐƵƌĞ͘
ĚũƵƐƚƐ ŽdžLJŐĞŶ ĐŽŶĐĞŶƚƌĂƚŝŽŶ ƉĞƌ ƉƵůƐĞ ŽdžŝŵĞƚƌLJ͘
,ĞĂƌƚ ƌŽƚĞсϭϰϬ ďƉŵ
^WϬϮ с ϴϱй
ŽŶƚŝŶƵĞƐ WW͕ ĂĚũƵƐƚƐ ŽdžLJŐĞŶ ĐŽŶĐĞŶƚƌĂƚŝŽŶ ƉĞƌ ƉƵůƐĞ ŽdžŝŵĞƚƌLJ
,ĞĂƌƚ ƌŽƚĞсϭϰϬďƉŵ ^WϬϮ с ϵϬй
ΗdŚĞďĂďLJŝƐͺ ŵŝŶƵƚĞƐŽůĚ͘ ƌĞĂƚŚŝŶŐ ĞĨĨŽƌƚ ŚĂƐŝŵƉƌŽǀĞĚ͘Η
DĞĂƐƵƌĞƐ ŝŶƐĞƌƚŝŽŶ ĚĞƉƚŚ ĨŽƌ ŽƌŽŐĂƐƚƌŝĐ ƚƵďĞ ǁŚŝůĞ WW ŝƐ ŝŶ ƉƌŽŐƌĞƐƐ
ͻ WůĂĐĞƐ ƚŚĞ ĚŝƐƚĂů ĞŶĚ ŽĨ ƚŚĞ ŽƌŽŐĂƐƚƌŝĐ ƚƵďĞ ĂƚƚŚĞ ďƌŝĚŐĞ ŽĨ ƚŚĞ ŶŽƐĞ ĂŶĚ ŵĞĂƐƵƌĞƐ ƚŽ ƚŚĞ ĞĂƌůŽďĞ ĂŶĚ ĨƌŽŵ ƚŚĞ
ĞĂƌůŽďĞ ƚŽ Ă ƉŽŝŶƚ ŚĂůĨǁĂLJ ďĞƚǁĞĞŶ ƚŚĞ džŝƉŚŽŝĚ ƉƌŽĐĞƐƐ ĂŶĚ ƚŚĞ ƵŵďŝůŝĐƵƐ͘ EŽƚĞƐ ƚŚĞ ĐĞŶƚŝŵĞƚĞƌ ŵĂƌŬ ŽŶ ƚŚĞ
ƚƵďĞ͘ ůŶƐĞƌƚƐ ƚŚĞ ƚƵďĞ ƚŚƌŽƵŐŚ ƚŚĞ ŵŽƵƚŚ͘ ZĞƐƵŵĞƐ WW͘
ͻ ƚƚĂĐŚĞƐ Ă ƐLJƌŝŶŐĞ ĂŶĚ ƌĞŵŽǀĞƐ ƚŚĞ ŐĂƐƚƌŝĐ ĐŽŶƚĞŶƚƐ͘ ZĞŵŽǀĞƐ ƚŚĞ ƐLJƌŝŶŐĞ ĨƌŽŵ ƚŚĞ ƚƵďĞ ĂŶĚ ůĞĂǀĞƐ ƚŚĞ ĞŶĚ
ŽƉĞŶ ĂƐ ĂŶ ĂŝƌǀĞŶƚ͘
ͻ dĂƉĞƐ ƚŚĞ ƚƵďĞ ƚŽ ƚŚĞ ďĂďLJΖƐ ĐŚĞĞŬ͘
ŶĚ ƐĐĞŶĂƌŝŽ͘
DŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌŽƚĞ͕ ďƌĞĂƚŚŝŶŐ͕ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ͕ ƚĞŵƉĞƌĂƚƵƌĞ͘
WůĂŶƐ ƉŽƐƚͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ĐĂƌĞ͘
ŽŵŵƵŶŝĐĂƚĞƐ ǁŝƚŚ ƉĞƌŝŶĂƚĂů ƚĞĂŵ ĂŶĚ ƉĂƌĞŶƚƐ͘
ĞďƌŝĞĨƐ ƚŚĞ ƌĞƐƵƐĐŝƚĂƚŝŽŶ͘
11
KƉƚŝŽŶ dĞƌŵ ŶĞǁďŽƌŶǁŝƚŚŽƵƚŬŶŽǁŶ ƌŝƐŬĨĂĐƚŽƌƐ ƵŶĞdžƉĞĐƚĞĚůLJ ƌĞƋƵŝƌĞƐ 339;dŚŝƐ ƐĐĞŶĂƌŝŽ ŝƐ ĚĞƐŝŐŶĞĚ ĨŽƌ
ĂƚƚĞŶĚĂŶĐĞďLJϭƉĞƌƐŽŶ ĂƐƐŝŐŶĞĚ ƚŽ ŵĂŶĂŐĞ ŶĞǁďŽƌŶĐĂƌĞĂƚďŝƌƚŚ͘Ϳ
&ULWLFDO 3HUIRUPDQFH 6WHSV
ƐƐĞƐƐ ƉĞƌŝŶĂƚĂů ƌŝƐŬ͘
ƐƐĞƐƐĞƐ ƉĞƌŝŶĂƚĂů ƌŝƐŬ ;ůĞĂƌŶĞƌ ĂƐŬƐ ϰ ƉƌĞͲďŝƌƚŚ ƋƵĞƐƚŝŽŶƐ ĂŶĚ ŝŶƐƚƌƵĐƚŽƌ ΀ΗK ƉƌŽǀŝĚĞƌΗ΁ ƌĞƐƉŽŶĚƐͿ
'ĞƐƚĂƚŝŽŶĂů ĂŐĞ͍
ΗϯϵǁĞĞŬƐΖŐĞƐƚĂƚŝŽŶ͘Η
ůĞĂƌ ĨůƵŝĚ͍
ΗŵŶŝŽƚŝĐ ĨůƵŝĚ ŝƐ ĐůĞĂƌ͘Η
ĚĚŝƚŝŽŶĂů ƌŝƐŬ ĨĂĐƚŽƌƐ͍
ΗdŚĞƌĞ ĂƌĞ ŶŽ ĂĚĚŝƚŝŽŶĂů ƌŝƐŬĨĂĐƚŽƌƐ͘Η
WůĂŶ ĨŽƌ ƵŵďŝůŝĐĂů ĐŽƌĚ ŵĂŶĂŐĞŵĞŶƚ͍ Η/ ǁŝůůĚĞůĂLJĐŽƌĚ ĐůĂŵƉŝŶŐ͘ ůĨƚŚĞ ďĂďLJŝƐ ŶŽƚĐƌLJŝŶŐ͕ ϭΖϭϭƚĂŬĞĂ ŵŽŵĞŶƚƚŽ
ƐƚŝŵƵůĂƚĞ ƚŚĞ ďĂďLJ͘ ůĨƚŚĞƌĞΖƐŶŽƌĞƐƉŽŶƐĞ͕ ϭΖϭϭĐůĂŵƉĂŶĚ ĐƵƚƚŚĞ ĐŽƌĚ͘Η
dŚŝƐ ďŝƌƚŚ ǁŝůů ďĞ ĂƚƚĞŶĚĞĚ ďLJ ϭƋƵĂůŝĨŝĞĚ ŝŶĚŝǀŝĚƵĂů͘
<ŶŽǁƐ ƚŚĞ ĂŶƐǁĞƌƐ ƚŽ ƚŚĞ ϰ ƉƌĞͲďŝƌƚŚ ƋƵĞƐƚŝŽŶƐ͕ ĚĞƚĞƌŵŝŶĞƐ ƐƵƉƉůŝĞƐ ĂŶĚ ĞƋƵŝƉŵĞŶƚ ŶĞĞĚĞĚ͕ ŬŶŽǁƐ ŚŽǁ ƚŽ ĐĂůů ĨŽƌ ŚĞůƉ͘
WĞƌĨŽƌŵ ĞƋƵŝƉŵĞŶƚĐŚĞĐŬ͘
ΗdŚĞďĂďLJŚĂƐďĞĞŶ ďŽƌŶ͘Η
ZĂƉŝĚĞǀĂůƵĂƚŝŽŶ͘
ƐŬƐ ϯ ƌĂƉŝĚ ĞǀĂůƵĂƚŝŽŶ ƋƵĞƐƚŝŽŶƐ͗
ͻdĞƌŵ͍
ΗzĞƐ͕ ĂƐ ĞdžƉĞĐƚĞĚ͘Η
ͻDƵƐĐůĞ ƚŽŶĞ͍
ΗEŽ͘Η
ͻ ƌĞĂƚŚŝŶŐ Žƌ ĐƌLJŝŶŐ͍
ΗEŽ͕ ŶŽƚďƌĞĂƚŚŝŶŐ Žƌ ĐƌLJŝŶŐ͘Η
ůŶŝƚŝĂů ƐƚĞƉƐ Ăƚ ƌĂĚŝĂŶƚǁĂƌŵĞƌ͘
ZĞĐĞŝǀĞƐ ďĂďLJ Ăƚ ƌĂĚŝĂŶƚǁĂƌŵĞƌ͕ ĚƌŝĞƐ ĂŶĚ ƌĞŵŽǀĞƐ ůŝŶĞŶ͕ ƐƚŝŵƵůĂƚĞƐ ďƌŝĞĨůLJ ďLJ ƌƵďďŝŶŐ ƚŚĞ ďĂďLJΖƐ ďĂĐŬ͕
ƉŽƐŝƚŝŽŶƐ ĂŝƌǁĂLJ͕ ƐƵĐƚŝŽŶƐ ŵŽƵƚŚ ĂŶĚ ŶŽƐĞ
ƐƐĞƐƐ ďƌĞĂƚŚŝŶŐ͘ ůĨ ďƌĞĂƚŚŝŶŐ͕ ĂƐƐĞƐƐ ŚĞĂƌƚ ƌĂƚĞ͘
/Ɛ ƚŚĞ ďĂďLJ ďƌĞĂƚŚŝŶŐ͍
ΗEŽ͘Η
;,ĞĂƌƚƌĂƚĞсϳϬďƉŵ͕ ŝĨĂƐƐĞƐƐĞĚͿ
ůŶĚŝĐĂƚĞƐ ŶĞĞĚ ĨŽƌ WWs
hƐĞƐ ƐƚĂŶĚĂƌĚŝnjĞĚ ƉƌŽĐĞƐƐ ƚŽ ĐĂůů ĨŽƌ ƌĞƐƵƐĐŝƚĂƚŝŽŶ ƚĞĂŵ
ĞŐŝŶ WWs ďLJϲϬƐĞĐŽŶĚƐĂĨƚĞƌďŝƌƚŚ͘
WŽƐŝƚŝŽŶƐ ŚĞĂĚ ŝŶ ƐŶŝĨĨŝŶŐ ƉŽƐŝƚŝŽŶ
ƉƉůŝĞƐ ŵĂƐŬ ĐŽƌƌĞĐƚůLJ
^ƚĂƌƚƐ WWs ŝŶ Ϯϭй ŽdžLJŐĞŶ ;ƌŽŽŵ ĂŝƌͿ Ăƚ ϮϬƚŽ Ϯϱ Đŵ ,Ϯ ;WW ŽĨ ϱ Đŵ , ϮŝĨ ƵƐŝŶŐ dͲƉŝĞĐĞ ƌĞƐƵƐĐŝƚĂƚŽƌ͕
ĨůŽǁͲŝŶĨůĂƚŝŶŐ ďĂŐ͕ Žƌ ƐĞůĨͲŝŶĨůĂƚŝŶŐ ďĂŐ ǁŝƚŚ WW ǀĂůǀĞͿ͖ ƌŽƚĞ ϰϬƚŽ ϲϬ ďƌĞĂƚŚƐͬŵŝŶ
ZĞƋƵĞƐƚƐ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ ƵŶƚŝů ƌĞƐƵƐĐŝƚĂƚŝŽŶ ƚĞĂŵ ĂƌƌŝǀĞƐ
ZĞƋƵĞƐƚƐ ƉƵůƐĞ ŽdžŝŵĞƚĞƌ ƐĞŶƐŽƌ ƉůĂĐĞŵĞŶƚ ŽŶ ďĂďLJΖƐ ƌŝŐŚƚ ŚĂŶĚ Žƌ ǁƌŝƐƚ
ZĞƋƵĞƐƚƐ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ ;ŽƉƚŝŽŶĂůͿ
tŝƚŚŝŶ ϭϱ ƐĞĐŽŶĚƐ ŽĨ ďĞŐŝŶŶŝŶŐ WWs͕ ƌĞƋƵĞƐƚƐ ŚĞĂƌƚ ƌŽƚĞ ĐŚĞĐŬ ƚŽ ĂƐƐĞƐƐ ŝĨ ŚĞĂƌƚ ƌŽƚĞ ŝƐ ŝŶĐƌĞĂƐŝŶŐ
,ĞĂƌƚ ƌĂƚĞсϳ ϬďƉŵ ĂŶĚ ŶŽƚŝŶĐƌĞĂƐŝŶŐ ^WϬϮсϲϲй
dŚĞ ůĞĂƌŶĞƌ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗEŽĐŚĞƐƚŵŽǀĞŵĞŶƚ͘Η
ϭϭϭ
&ULWLFDO 3HUIRUPDQFH 6WHSV FRQW sĞŶƚŝůĂƚŝŽŶ ĐŽƌƌĞĐƚŝǀĞ ƐƚĞƉƐ ;DZ͘ ^KWͿ͘
/ŶƐƚƌƵĐƚŽƌ ĚĞƚĞƌŵŝŶĞƐ ŚŽǁ ŵĂŶLJ DZ͘ ^KW ƐƚĞƉƐ ƚŽ ƵƐĞ ďĞĨŽƌĞ WWs ĐĂŶ ƌĞƐƵůƚ ŝŶ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ͻ DĂƐŬĂĚũƵƐƚŵĞŶƚ
ͻ ZĞƉŽƐŝƚŝŽŶƐ ƚŚĞ ŚĞĂĚ ĂŶĚ ŶĞĐŬ
'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗEŽĐŚĞƐƚŵŽǀĞŵĞŶƚ͘Η
ͻ ^ƵĐƚŝŽŶƐ ƚŚĞ ŵŽƵƚŚ ĂŶĚ ŶŽƐĞ
ͻ KƉĞŶƐ ƚŚĞ ŵŽƵƚŚ
'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗEŽĐŚĞƐƚŵŽǀĞŵĞŶƚ͘Η ,ĞĂƌƚƌŽƚĞсϳϬďƉŵ
^WϬϮ с ϲϲй
ĨŽƌ ƚĞƌŵ ŶĞǁďŽƌŶ
ͻ ůŶĐƌĞĂƐĞƐ WƌĞƐƐƵƌĞ ďLJ ϱ ƚŽ Ž Đŵ
ŝŶĐƌĞŵĞŶƚƐ ƚŽ ŵĂdžŝŵƵŵ ϰϬ Đŵ
'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗŚĞƐƚŵŽǀĞƐǁŝƚŚ WWs͘Η ;EŽƚĞ͗ ůĨ ŝŶƐƚƌƵĐƚŽƌ ƐƚĂƚĞƐ ƚŚĂƚ ƚŚĞ ĐŚĞƐƚ ŝƐ ŶŽƚ ŵŽǀŝŶŐ ĂĨƚĞƌ ƚŚŝƐ DZ͘ ^KWƐƚĞƉ͕ ƚŚĞ ůĞĂƌŶĞƌƐ
ƐŚŽƵůĚ ŝŶƐĞƌƚĂ ůĂƌLJŶŐĞĂů ŵĂƐŬ͘ ^ĞĞKƉƚŝŽŶ ϯ͘Ϳ
dŚĞ ůĞĂƌŶĞƌΖƐ ĂƐƐŝƐƚĂŶƚ ĂŶŶŽƵŶĐĞƐ͕ ΗdŚĞ ĐŚĞƐƚ ŝƐ ŵŽǀŝŶŐ EKt͘ ŽŶƚŝŶƵĞ WWs ĨŽƌ ϯϬ ƐĞĐŽŶĚƐ͘Η
ĞůŝǀĞƌWWs ƚŚĂƚ ŵŽǀĞƐ ƚŚĞ ĐŚĞƐƚ͘
ĞůŝǀĞƌƐ WWs dž ϯϬ ƐĞĐŽŶĚƐ͘
;>ĞĂƌŶĞƌ ŵĂLJŐƌĂĚƵĂůůLJĚŝƐĐŽŶƚŝŶƵĞ WWs ŝĨ ďĂďLJ ŚĂƐ Ă ŚĞĂƌƚ ƌŽƚĞ ŐƌĞĂƚĞƌƚŚĂŶ ϭϬϬ ďƉŵ ĂŶĚ ĐƌşĞƐ ďĞĨŽƌĞ ϯϬ
ƐĞĐŽŶĚƐ ŽĨWWs͘Ϳ
ƐƐĞƐƐĞƐ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ĂƐƐĞƐƐĞƐ ŶĞĞĚ ĨŽƌ ĨƌĞĞͲĨůŽǁ ƐƵƉƉůĞŵĞŶƚĂů ŽdžLJŐĞŶ
,ĞĂƌƚ ƌŽƚĞсϭϮϬďƉŵ
^WϬϮ с ϳϮй ΗdŚĞ ďĂďLJ ŚĂƐ ŝŶĐƌĞĂƐŝŶŐ ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚ͘Η
'ƌĂĚƵĂůůLJĚŝƐĐŽŶƚŝŶƵĞƐ WWs͕ ŵŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚ
,ĞĂƌƚ ƌŽƚĞсϭϰϬďƉŵ ϱWϬϮсϳϱй ĂŶĚ ŝŶĐƌĞĂƐŝŶŐ ΗdŚĞ ďĂďLJ ŝƐ ďƌĞĂƚŚŝŶŐ ƌĞŐƵůĂƌůLJ͕ ŵƵƐĐůĞ ƚŽŶĞ ŝƐ ŝŵƉƌŽǀŝŶŐ͘Η
ŶĚ ƐĐĞŶĂƌŝŽ͘
ŝƐĐŽŶƚŝŶƵĞƐ WWs͘
DŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌĂƚĞ͕ ďƌĞĂƚŚŝŶŐ͕ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ͕ ƚĞŵƉĞƌĂƚƵƌĞ͘
ŽŵŵƵŶŝĐĂƚĞƐ ǁŝƚŚ ƌĞƐƵƐĐŝƚĂƚŝŽŶ ƚĞĂŵ ŵĞŵďĞƌƐ ĂƐƚŚĞLJ ĂƌƌŝǀĞ͘
hƉĚĂƚĞƐ ƉĂƌĞŶƚƐ ĂŶĚ ŝŶĨŽƌŵƐ ƚŚĞŵ ŽĨ ŶĞdžƚ ƐƚĞƉƐ͘
ĞďƌŝĞĨƐ ƚŚĞ ƌĞƐƵƐĐŝƚĂƚŝŽŶ͘
KƉƚŝŽŶ ϯ͗ dĞƌŵ ŶĞǁďŽƌŶ ŝƐ ĚŝĨĨŝĐƵůƚƚŽ ǀĞŶƚŝůĂƚĞ ǁŝƚŚ Ă ĨĂĐĞ ŵĂƐŬĂŶĚ ƌĞƋƵŝƌĞƐ Ă ůĂƌLJŶŐĞĂů ŵĂƐŬ͘
&ULWLFDO 3HUIRUPDQFH 6WHSV
ƐƐĞƐƐ ƉĞƌŝŶĂƚĂů ƌŝƐŬ͘
ƐƐĞƐƐĞƐ ƉĞƌŝŶĂƚĂů ƌŝƐŬ ;ůĞĂƌŶĞƌ ĂƐŬƐ ϰ ƉƌĞͲďŝƌƚŚ ƋƵĞƐƚŝŽŶƐ ĂŶĚ ŝŶƐƚƌƵĐƚŽƌ ΀ΗK ƉƌŽǀŝĚĞƌΗ΁ ƌĞƐƉŽŶĚƐͿ
'ĞƐƚĂƚŝŽŶĂů ĂŐĞ͍
ΗϰϬǁĞĞŬƐΖ ŐĞƐƚĂƚŝŽŶ͘Η
ůĞĂƌĨůƵŝĚ͍
ΗŵŶŝŽƚŝĐ ĨůƵŝĚ ŝƐ ĐůĞĂƌ͘Η
ĚĚŝƚŝŽŶĂů ƌŝƐŬ ĨĂĐƚŽƌƐ͍
ΗĨĞǁĨĞƚĂů ŚĞĂƌƚĚĞĐĞůĞƌĂƚŝŽŶƐ ŝŶ ƚŚĞ ůĂƐƚϮϬŵŝŶƵƚĞƐ͘Η
hŵďŝůŝĐĂů ĐŽƌĚ ŵĂŶĂŐĞŵĞŶƚ ƉůĂŶ͍ ,ǁŝůůĚĞůĂLJĐŽƌĚ ĐůĂŵƉŝŶŐ͘ ůĨ ƚŚĞ ďĂďLJ ŝƐ ŶŽƚ ĐƌLJŝŶŐ͕ ƚĂŬĞĂ ŵŽŵĞŶƚ ƚŽ
ƐƚŝŵƵůĂƚĞ ƚŚĞ ďĂďLJ͘ ůĨ ƚŚĞƌĞΖƐ ŶŽƌĞƐƉŽŶƐĞ͕ ĐůĂŵƉ ĂŶĚ ĐƵƚƚŚĞ ĐŽƌĚ͘Η
ƐƐĞŵďůĞƚĞĂŵ͘
ƐƐĞŵďůĞƐ ƚĞĂŵ ďĂƐĞĚ ŽŶ ƉĞƌŝŶĂƚĂů ƌŝƐŬ ĨĂĐƚŽƌƐ͘
tŚĞŶ ƚŚĞ ůŝŬĞůŝŚŽŽĚ ŽĨ ƌĞƐƵƐĐŝƚĂƚŝŽŶ ŝƐ ůŽǁ͕ ϭ ƋƵĂůŝĨŝĞĚ ŝŶĚŝǀŝĚƵĂů ƐŚŽƵůĚ ĂƚƚĞŶĚ ƚŚĞ ďŝƌƚŚ͘
ůĨ ƌŝƐŬ ĨĂĐƚŽƌƐ ĂƌĞ ƉƌĞƐĞŶƚ͕ ĂƚůĞĂƐƚ Ϯ ƋƵĂůŝĨŝĞĚ ƉĞŽƉůĞ ƐŚŽƵůĚ ďĞ ƉƌĞƐĞŶƚ ƐŽůĞůLJ ƚŽ ŵĂŶĂŐĞ ƚŚĞ ďĂďLJ͘
dŚĞ ŶƵŵďĞƌ ŽĨƚĞĂŵ ŵĞŵďĞƌƐ ĂŶĚ ƋƵĂůŝĨŝĐĂƚŝŽŶƐ ǀĂƌLJ ĚĞƉĞŶĚŝŶŐ ŽŶ ƌŝƐŬ͘
ůĨ ƚŚĞ ďŝƌƚŚ ǁŝůů ďĞ ĂƚƚĞŶĚĞĚ ďLJ ϭƉĞƌƐŽŶ͕
<ŶŽǁƐ ƚŚĞ ĂŶƐǁĞƌƐ ƚŽ ƚŚĞ ϰ ƉƌĞͲďŝƌƚŚ ƋƵĞƐƚŝŽŶƐ͕ ĚĞƚĞƌŵŝŶĞƐ ƐƵƉƉůŝĞƐ ĂŶĚ ĞƋƵŝƉŵĞŶƚ ŶĞĞĚĞĚ͕ ŬŶŽǁƐ ŚŽǁ ƚŽ ĐĂůů
ĨŽƌ ŚĞůƉ
11
&ULWLFDO 3HUIRUPDQFH 6WHSV FRQW ůĨƚŚĞ ďŝƌƚŚ ǁŝůů EHĂƚƚĞŶĚĞĚ ďLJĂ ƚĞĂŵ͕ ƉĞƌĨŽƌŵ Ă ƉƌĞͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ďƌŝĞĨŝŶŐ͘
ůĚĞŶƚŝĨŝĞƐ ƚĞĂŵ ůĞĂĚĞƌ͘
ƐƐĞƐƐĞƐ ƌŝƐŬ ĨĂĐƚŽƌƐ͕ ĚĞůĞŐĂƚĞƐ ƚĂƐŬƐ͕ ŝĚĞŶƚŝĨŝĞƐ ǁŚŽ ǁŝůů ĚŽĐƵŵĞŶƚ ĞǀĞŶƚƐ͕ ĚĞƚĞƌŵŝŶĞƐ ƐƵƉƉůŝĞƐ ĂŶĚ ĞƋƵŝƉŵĞŶƚ
ŶĞĞĚĞĚ͕ ŬŶŽǁƐ ŚŽǁ ƚŽ ĐĂůů ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ͘
ZĂƉŝĚ ĞǀĂůƵĂƚŝŽŶ͘
ƐŬƐ ϯ ƌĂƉŝĚ ĞǀĂůƵĂƚŝŽŶ ƋƵĞƐƚŝŽŶƐ͗
ͻdĞƌŵ͍
ΗzĞƐ͕ ĂƉƉĞĂƌƐƚĞƌŵĂƐĞdžƉĞĐƚĞĚ͘Η
ͻDƵƐĐůĞ ƚŽŶĞ͍
ΗEŽ͘Η
ͻ ƌĞĂƚŚŝŶŐ Žƌ ĐƌLJŝŶŐ͍
ΗEŽ͕ ŶŽƚ ďƌĞĂƚŚŝŶŐ Žƌ ĐƌLJŝŶŐ͘Η
ůŶŝƚŝĂů ƐƚĞƉƐ Ăƚ ƌĂĚŝĂŶƚǁĂƌŵĞƌ͘
ZĞĐĞŝǀĞƐ ďĂďLJ ĂƚƌĂĚŝĂŶƚ ǁĂƌŵĞƌ͕ ĚƌŝĞƐ ĂŶĚ ƌĞŵŽǀĞƐ ůŝŶĞŶ͕ ƐƚŝŵƵůĂƚĞƐ ďƌŝĞĨůLJ ďLJ ƌƵďďŝŶŐ ƚŚĞ ďĂďLJΖƐ ďĂĐŬ͕
ƉŽƐŝƚŝŽŶƐ ĂŝƌǁĂLJ͕ ƐƵĐƚŝŽŶƐ ŵŽƵƚŚ ĂŶĚ ŶŽƐĞ
ƐƐĞƐƐ ďƌĞĂƚŚŝŶŐ͘ ůĨ ďƌĞĂƚŚŝŶŐ͕ ŽƐƐĞƐƐ ŚĞŽƌƚƌĂƚĞ͘
/Ɛ ƚŚĞ ďĂďLJ ďƌĞĂƚŚŝŶŐ͍
ΗEŽ͘Η
;,ĞŽƌƚƌŽƚĞсϳϬďƉŵ͕ ŝĨ ŽƐƐĞƐƐĞĚͿ
ůŶĚŝĐĂƚĞƐ ŶĞĞĚ ĨŽƌ WWs͘
ZĞƋƵĞƐƚƐ ŝŵŵĞĚŝĂƚĞ ŚĞůƉ ĨƌŽŵ ϭ ƉĞƌƐŽŶ ĂŶĚ ƵƐĞƐ ƐƚĂŶĚĂƌĚŝnjĞĚ ŵĞƚŚŽĚ ƚŽ ĐĂůů ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ͘
ĞŐŝŶ WWsǁŝƚŚŝŶ ϲϬƐĞĐŽŶĚƐŽĨ ďŝƌƚŚ͘
WŽƐŝƚŝŽŶƐ ŚĞĂĚ ŝŶ ƐŶŝĨĨŝŶŐ ƉŽƐŝƚŝŽŶ
ƉƉůŝĞƐ ŵĂƐŬ ĐŽƌƌĞĐƚůLJ
^ƚĂƌƚƐ WWs ŝŶ Ϯϭй ŽdžLJŐĞŶ ;ƌŽŽŵ ĂŝƌͿ ĂƚϮϬ ƚŽ Ϯϱ Đŵ , ;WW ŽĨ ϱ Đŵ , ŝĨ ƵƐŝŶŐ dͲƉŝĞĐĞ ƌĞƐƵƐĐŝƚĂƚŽƌ͕
ĨůŽǁͲŝŶĨůĂƚŝŶŐ ďĂŐ͕ Žƌ ƐĞůĨͲŝŶĨůĂƚŝŶŐ ďĂŐǁŝƚŚ WW ǀĂůǀĞͿ͖ ƌŽƚĞ ϰϬ ƚŽ ϲϬ ďƌĞĂƚŚƐͬŵŝŶ
ZĞƋƵĞƐƚƐ ƉƵůƐĞ ŽdžŝŵĞƚĞƌ ƐĞŶƐŽƌ ƉůĂĐĞŵĞŶƚ ŽŶ ďĂďLJΖƐ ƌŝŐŚƚ ŚĂŶĚ Žƌ ǁƌŝƐƚ
ZĞƋƵĞƐƚƐ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ ;ŽƉƚŝŽŶĂů ĂƚƚŚŝƐ ƚŝŵĞͿ
tŝƚŚŝŶ ϭϱ ƐĞĐŽŶĚƐ ŽĨ ďĞŐŝŶŶŝŶŐ WWs͕ ƌĞƋƵĞƐƚƐ ŚĞĂƌƚ ƌŽƚĞ ĐŚĞĐŬƚŽ ĂƐƐĞƐƐ ŝĨ ŚĞĂƌƚ ƌŽƚĞ ŝƐ ŝŶĐƌĞĂƐŝŶŐ
,ĞŽƌƚ ƌŽƚĞсϳϬ ďƉŵ ŽŶĚ ŶŽƚ ŝŶĐƌĞĂƐŝŶŐ
^WϬϮ с ϲϳй
ƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗEŽĐŚĞƐƚŵŽǀĞŵĞŶƚ͘Η
WĞƌĨŽƌŵǀĞŶƚŝůĂƚŝŽŶ ĐŽƌƌĞĐƚŝǀĞ ƐƚĞƉƐ ;DZ͘ ^KWͿ͘
/ŶƐƚƌƵĐƚŽƌ ĚĞƚĞƌŵŝŶĞƐ ŚŽǁ ŵĂŶLJ DZ͘ ^KW ƐƚĞƉƐ ƚŽ ƵƐĞ ďĞĨŽƌĞ WWs ĐĂŶ ƌĞƐƵůƚ ŝŶ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ͘
ͻ DĂƐŬĂĚũƵƐƚŵĞŶƚ
ͻ ZĞƉŽƐŝƚŝŽŶ ƚŚĞ ŚĞĂĚ ĂŶĚ ŶĞĐŬ
'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗEŽĐŚĞƐƚŵŽǀĞŵĞŶƚ͘Η ,ĞĂƌƚƌĂƚĞсϳϬďƉŵ ĂŶĚ ŶŽƚ ŝŶĐƌĞŽƐŝŶŐ ^WϬϮ с ϲϳй
ͻ ^ƵĐƚŝŽŶƐ ƚŚĞ ŵŽƵƚŚ ĂŶĚ ŶŽƐĞ
ͻ KƉĞŶƐ ƚŚĞ ŵŽƵƚŚ
'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗEŽĐŚĞƐƚŵŽǀĞŵĞŶƚ͘Η ,ĞĂƌƚƌĂƚĞсϳϬďƉŵ ĂŶĚ ŶŽƚ ŝŶĐƌĞŽƐŝŶŐ
^WϬϮ с ϲϱй
ͻ ůŶĐƌĞĂƐĞƐ WƌĞƐƐƵƌĞ ďLJϱ ƚŽ ŽĐŵ , Ͳ ŝŶĐƌĞŵĞŶƚƐ ƚŽ ŵĂdžŝŵƵŵ ϰϬ Đŵ , Ͳ ĨŽƌ ƚĞƌŵ ďĂďLJ
'ŝǀĞƐ ϱ ďƌĞĂƚŚƐ ĂŶĚ ĂƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ΗŚĞƐƚŵŽǀĞƐǁŝƚŚ WWs͘Η ;EŽƚĞ͗ ůĨ ŝŶƐƚƌƵĐƚŽƌ ƐƚĂƚĞƐ ƚŚĂƚ ƚŚĞ ĐŚĞƐƚ ŝƐ ŶŽƚ ŵŽǀŝŶŐ ĂĨƚĞƌ ƚŚŝƐ DZ͘ ^KW ƐƚĞƉ͕ ůĞĂƌŶĞƌƐ
ǁŝůů ƉƌŽĐĞĞĚ ǁŝƚŚ ůĂƌLJŶŐĞĂů ŵĂƐŬ ŝŶƐĞƌƚŝŽŶ ŶŽǁ͘Ϳ
>ĞĂƌŶĞƌΖƐ ĂƐƐŝƐƚĂŶƚ ĂŶŶŽƵŶĐĞƐ͕ ΗdŚĞ ĐŚĞƐƚ ŝƐ ŵŽǀŝŶŐ EKt͘ ŽŶƚŝŶƵĞ WWs ĨŽƌ ϯϬ ƐĞĐŽŶĚƐ͘Η
&ULWLFDO 3HUIRUPDQFH 6WHSV FRQW ĞůŝǀĞƌ WWs ƚŚĂƚ ŵŽǀĞƐ ƚŚĞ ĐŚĞƐƚ͘
ĞůŝǀĞƌƐ WWs ƚŚĂƚ ŵŽǀĞƐ ƚŚĞ ĐŚĞƐƚ dž ƐĞĐŽŶĚƐ
ZĞƋƵĞƐƚƐ ŚĞĂƌƚ ƌŽƚĞ ĂƐƐĞƐƐŵĞŶƚ
,ĞĂƌƚ ƌŽƚĞсϲϬďƉŵ ĂŶĚ ŶŽƚ ŝŶĐƌĞĂƐŝŶŐ ΗWƵůƐĞŽdžŝŵĞƚĞƌ ŚĂƐ ŶŽ ƐŝŐŶĂů͘Η
>ĂƌLJŶŐĞĂů ŵĂƐŬ ƉƌĞƉĂƌĂƚŝŽŶ͘
ĂůůƐ ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ ŝĨ ŶĞĞĚĞĚ͘
WůĂĐĞƐ ĐŚĞƐƚ ůĞĂĚƐ ĂŶĚ ĂƚƚĂĐŚĞƐ Ă ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ͕ ŝĨ ŶŽƚ ĂůƌĞĂĚLJĚŽŶĞ͘
KďƚĂŝŶƐ Ă ƐŝnjĞ ϭ ůĂƌLJŶŐĞĂů ŵĂƐŬ ;ĂŶĚ Ă ϱͲŵů ƐLJƌŝŶŐĞ ŝĨ ŵĂƐŬ ƌĞƋƵŝƌĞƐ ŝŶĨůĂƚŝŽŶͿ͕ ĂŶĚ Ă ϱ& Žƌ ϲ& ŽƌŽŐĂƐƚƌŝĐ ƚƵďĞ
ŝĨ ƚŚĞ ůĂƌLJŶŐĞĂů ŵĂƐŬ ŚĂƐ ĂŶ ŝŶƐĞƌƚŝŽŶ ƉŽƌƚ
ZĞƐƵƐĐŝƚĂƚŝŽŶ ƚĞĂŵ ĐŽŶƚŝŶƵĞƐ DZ͘ ^KW ƐƚĞƉƐ ǁŝƚŚ ĨĂĐĞ ŵĂƐŬ ǁŚŝůĞ ŽƉĞƌĂƚŽƌ ŝƐ ƉƌĞƉĂƌŝŶŐ ůĂƌLJŶŐĞĂů ŵĂƐŬ
ůĨ ƚŚĞ ůĂƌLJŶŐĞĂů ŵĂƐŬ ƌĞƋƵŝƌĞƐ ŝŶĨůĂƚŝŽŶ͕
YƵŝĐŬůLJ ŝŶĨůĂƚĞƐ ƚŚĞ ƌŝŵ ǁŝƚŚ ŶŽ ŵŽƌĞ ƚŚĂŶ ϰ ŵů ŽĨ ĂŝƌƚŽ ƚĞƐƚ ĨŽƌ ůĞĂŬƐ͘
tŝƚŚĚƌĂǁƐ Ăŝƌ͘
>ƵďƌŝĐĂƚĞƐ ďĂĐŬ ĂŶĚ ƐŝĚĞƐ ŽĨ ƚŚĞ ŵĂƐŬ ǁŝƚŚ ǁĂƚĞƌͲƐŽůƵďůĞ ůƵďƌŝĐĂŶƚ͕ ŬĞĞƉŝŶŐ ůƵďƌŝĐĂŶƚ ĂǁĂLJĨƌŽŵ ƚŚĞ ŝŶƐŝĚĞ ŽĨ ƚŚĞ
ŵĂƐŬ ;ŽƉƚŝŽŶĂů ƐƚĞƉ ĨŽƌ ŵĂŶŝŬŝŶ ƵƐĞͿ
>ĂƌLJŶŐĞĂů ŵĂƐŬ ŝŶƐĞƌƚŝŽŶ͘
^ƚĂŶĚƐ Ăƚ ƚŚĞ ďĂďLJΖƐ ŚĞĂĚ͘ WůĂĐĞƐ ďĂďLJΖƐ ŚĞĂĚ ŝŶ ƐŶŝĨĨŝŶŐ ƉŽƐŝƚŝŽŶ͘
,ŽůĚƐ ƚŚĞ ĚĞǀŝĐĞ ĂůŽŶŐ ƚŚĞ ĂŝƌǁĂLJ ƚƵďĞ ǁŝƚŚ ƚŚĞ ĐůŽƐĞĚ ďŽƚƚŽŵ ŽĨ ƚŚĞ ŵĂƐŬ ĨĂĐŝŶŐ ƚŚĞ ďĂďLJΖƐ ƉĂůŽƚĞ ĂŶĚ ƚŚĞ
ŽƉĞŶ ďŽǁů ŽĨ ƚŚĞ ŵĂƐŬ ĨĂĐŝŶŐ ƚŽǁĂƌĚ ƚŚĞ ďĂďLJΖƐ ĐŚŝŶ
KƉĞŶƐ ƚŚĞ ŶĞǁďŽƌŶΖƐ ŵŽƵƚŚ ďLJ ŐĞŶƚůLJ ƉƌĞƐƐŝŶŐ ĚŽǁŶǁĂƌĚ ŽŶ ƚŚĞ ďĂďLJΖƐ ĐŚŝŶ͘
ůŶƐĞƌƚƐ ƚŚĞ ůĞĂĚŝŶŐ ƚŝƉ ŽĨ ƚŚĞ ŵĂƐŬ ŝŶƚŽ ƚŚĞ ďĂďLJΖƐ ŵŽƵƚŚ͕ ŽŶ ƚŽƉ ŽĨ ƚŚĞ ƚŽŶŐƵĞ͕ ǁŝƚŚ ƚŚĞ ďŽƚƚŽŵ ŽĨ ƚŚĞ ŵĂƐŬ
ƉƌĞƐƐĞĚ ĂŐĂŝŶƐƚ ƚŚĞ ďĂďLJΖƐ ƉĂůŽƚĞ͘
'ůŝĚĞƐ ƚŚĞ ĚĞǀŝĐĞ ĚŽǁŶǁĂƌĚ ĂŶĚ ďĂĐŬǁĂƌĚ͕ ĨŽůůŽǁŝŶŐ ƚŚĞ ĐŽŶƚŽƵƌ ŽĨ ƚŚĞ ƉĂůŽƚĞ͕ ǁŝƚŚ Ă ĐŽŶƚŝŶƵŽƵƐ ďƵƚ ŐĞŶƚůĞ
ƉƵƐŚ ƵŶƚŝů ĚĞĨŝŶŝƚŝǀĞ ƌĞƐŝƐƚĂŶĐĞ ŝƐ ŵĞƚ
ůĨ ƚŚĞ ůĂƌLJŶŐĞĂů ŵĂƐŬ ƌĞƋƵŝƌĞƐ ŝŶĨůĂƚŝŽŶ͕
^ƵƉƉŽƌƚƐ ƚŚĞ ĚĞǀŝĐĞ ŝŶ ƉůĂĐĞ͕ ĂůůŽǁŝŶŐ ŝƚ ƚŽ ƌŝƐĞ ĂŶĚ ƐĞĂƚ ǁŚŝůĞ ŝŶĨůĂƚŝŶŐ ƚŚĞ ƌŝŵ ďLJ ŝŶũĞĐƚŝŶŐ Ϯ ƚŽ ϰ ŵů ŽĨ ĂŝƌǀŝĂ
ƚŚĞ ŝŶĨůĂƚŝŽŶ ǀĂůǀĞ͘ dŚĞ ƉŝůŽƚ ďĂůůŽŽŶ ŵŝƌƌŽƌƐ ŝŶĨůĂƚŝŽŶ ŽĨ ƚŚĞ ƌŝŵ͘ ZĞŵŽǀĞƐ ƐLJƌŝŶŐĞ͘
,ŽůĚƐ ƚŚĞ ůĂƌLJŶŐĞĂů ŵĂƐŬ ŝŶ ƉůĂĐĞ ĂŶĚ ĂƚƚĂĐŚĞƐ Ă Ϭ ʹ ĚĞƚĞĐƚŽƌ ĂŶĚ ƚŚĞ WWs ĚĞǀŝĐĞ
WŽƐŝƚŝǀĞͲƉƌĞƐƐƵƌĞǀĞŶƚŝůĂƚŝŽŶ ǁŝƚŚ ůĂƌLJŶŐĞĂů ŵĂƐŬ
dŚĞ ƉĞƌƐŽŶ ŚŽůĚŝŶŐ ƚŚĞ ůĂƌLJŶŐĞĂů ŵĂƐŬ ŚŽůĚƐ ƚŚĞ WWs ĚĞǀŝĐĞ ĂŶĚ ďĞŐŝŶƐ WWs͘
>ĞĂƌŶĞƌ ĂŶĚͬŽƌ ƚŚĞ ĂƐƐŝƐƚĂŶƚ ĐŽŶĨŝƌŵƐ ŝŶƐĞƌƚŝŽŶ ďLJ ĂƐƐĞƐƐŝŶŐ ĂŶĚ ĂŶŶŽƵŶĐĞƐ ƚŚĞ ƉƌĞƐĞŶĐĞ ŽĨ
ͻ ^LJŵŵĞƚƌŝĐĂů ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ͻ ŝůĂƚĞƌĂů ďƌĞĂƚŚ ƐŽƵŶĚƐ
ͻ ŽůŽƌ ĐŚĂŶŐĞ ŽŶ Ϭ ʹ ĚĞƚĞĐƚŽƌ ǁŝƚŚŝŶ ϴ ƚŽ ϭKƉŽƐŝƚŝǀĞͲƉƌĞƐƐƵƌĞ ďƌĞĂƚŚƐ
KƉĞƌĂƚŽƌ ĐŽŶƚŝŶƵĞƐ WWs Ăƚ ĂƉƉƌŽƉƌŝĂƚĞ ƌŽƚĞ ĂŶĚ ƉƌĞƐƐƵƌĞ ĨŽƌ ƐĞĐŽŶĚƐ͕ ŵŽŶŝƚŽƌŝŶŐ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ^WϬ ʹ
^ĞĐƵƌĞƐ ůĂƌLJŶŐĞĂů ŵĂƐŬ ǁŝƚŚ ǁĂƚĞƌƉƌŽŽĨ ƚĂƉĞ
ůĨ ƚŚĞ ůĂƌLJŶŐĞĂů ŵĂƐŬ ŚĂƐ Ă ŐĂƐƚƌŝĐ ƉŽƌƚ ĂŶĚ ǁŝůů ďĞ ŝŶ ƉůĂĐĞ ĨŽƌ ŵŽƌĞ ƚŚĂŶ ƐĞǀĞƌĂ͊ ŵŝŶƵƚĞƐ͕ ŵĞĂƐƵƌĞƐ ĨŽƌ
ŽƌŽŐĂƐƚƌŝĐ ƚƵďĞ ŝŶƐĞƌƚŝŽŶ ;ĚĞƐĐƌŝďĞĚ ĂďŽǀĞͿ͕ ŝŶƐĞƌƚƐ ŽƌŽŐĂƐƚƌŝĐ ƚƵďĞ ĚŽǁŶ ƉŽƌƚ͕ ĂŶĚ ĚĞĐŽŵƉƌĞƐƐĞƐ ƐƚŽŵĂĐŚ
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–‘ ƒ Š‹‡˜‡ ‡ˆˆ‡ –‹˜‡˜‡–‹Žƒ–‹‘ƒ†‹–—„ƒ–‹‘ ‹• —•— ‡••ˆ—Ž ‘”
‘–ˆ‡ƒ•‹„Ž‡Ǥ
ĂƐĞ͗ ZĞƐƵƐĐŝƚĂƚŝŽŶ ǁŝƚŚ ƉŽƐŝƚŝǀĞͲƉƌĞƐƐƵƌĞ ǀĞŶƚŝůĂƚŝŽŶ ƵƐŝŶŐ
ĂŶ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ
‘—”–‡ƒ ‹• ƒŽŽ‡† –‘ ƒ––‡† –Š‡ „‹”–Š ˆ‘”ƒ™‘ƒƒ– ͵͹™‡‡•̵
‰‡•–ƒ–‹‘™Š‘•‡Žƒ„‘”‹• ‘’Ž‹ ƒ–‡† „› ƒ–‡”ƒŽˆ‡˜‡” ƒ†
ˆ‡–ƒŽ –ƒ Š› ƒ”†‹ƒǤ Š‡ƒ‹‘–‹ ˆŽ—‹†‹• Ž‡ƒ”Ǥ ‘— ‘’Ž‡–‡ ƒ
’”‡Ǧ”‡•—• ‹–ƒ–‹‘„”‹‡ˆ‹‰ƒ†’”‡’ƒ”‡ ›‘—”•—’’Ž‹‡• ƒ†‡“—‹’‡–Ǥ
ˆ–‡”–Š‡ ˜ƒ‰‹ƒŽ„‹”–Šǡ –Š‡ ‘„•–‡–”‹ ‹ƒ†”‹‡• ƒ†•–‹—Žƒ–‡•–Š‡
„ƒ„›ǡ „—– –Š‡ „ƒ„›”‡ƒ‹• Ž‹’ƒ†ƒ’‡‹ Ǥ Š‡—„‹Ž‹ ƒŽ ‘”†
‹• Žƒ’‡† ƒ† —– ƒ†–Š‡ „ƒ„›‹• ‘˜‡† –‘ –Š‡ ”ƒ†‹ƒ–™ƒ”‡”Ǥ
‘— ’‘•‹–‹‘ƒ† •— –‹‘–Š‡ ‘—–Š ƒ†‘•‡™Š‹Ž‡’”‘˜‹†‹‰„”‹‡ˆ
ƒ††‹–‹‘ƒŽ•–‹—Žƒ–‹‘ǡ„—– –Š‡ „ƒ„› ‹• •–‹ŽŽ ‘–„”‡ƒ–Š‹‰Ǥ ‘— •–ƒ”–
’‘•‹–‹˜‡Ǧ’”‡••—”‡˜‡–‹Žƒ–‹‘ ȋȌ ™Š‹Ž‡ƒ‘–Š‡”–‡ƒ ‡„‡”
’Žƒ ‡• ƒ’—Ž•‡ ‘š‹‡–‡”•‡•‘”‘ –Š‡ „ƒ„›̵• ”‹‰Š– Šƒ†ƒ†ƒ‘–Š‡”
†‘ —‡–•–Š‡ ‡˜‡–• ƒ•–Š‡›‘ —”Ǥ Š‡„ƒ„›̵• Š‡ƒ”– ”ƒ–‡ ‹• ͷͲ„‡ƒ–•
’‡”‹—–‡ ȋ„’Ȍ ƒ†‘–‹ ”‡ƒ•‹‰Ǥ ‘—‘„•‡”˜‡ –Šƒ––Š‡ Š‡•– ‹•
‘–‘˜‹‰™‹–Š „”‡ƒ–Š• ƒ†„‡‰‹ –Š‡˜‡–‹Žƒ–‹‘ ‘””‡ –‹˜‡
•–‡’•Ǥ ˆ–‡”–Š‡ ˆ‹”•–ͷ ‘””‡ –‹˜‡•–‡’•ǡ –Š‡ Š‡•– ‹• •–‹ŽŽ ‘–‘˜‹‰
ƒ† –Š‡ Š‡ƒ”– ”ƒ–‡ Šƒ•‘–‹’”‘˜‡†Ǥ ƒ”„‘ †‹‘š‹†‡ ȋ Ͳ †‡–‡ –‘”
’Žƒ ‡†„‡–™‡‡ –Š‡ †‡˜‹ ‡ ƒ†ƒ•”‡ƒ‹•’—”’Ž‡™‹–Šƒ••‹•–‡†
„”‡ƒ–Š•Ǥ ‘— †‡ ‹†‡–‘ ‹•‡”–ƒ ‡†‘–”ƒ Š‡ƒŽ–—„‡–‘ ‹’”‘˜‡–Š‡
‡ˆˆ‡ –‹˜‡‡•• ‘ˆǤ
‡ƒ†• ƒ”‡ ’Žƒ ‡† ‘ –Š‡ Š‡•– ƒ†ƒ––ƒ Š‡†–‘ ƒ ƒ”†‹ƒ ‘‹–‘”Ǥ 
ƒ••‹•–ƒ–Š‘Ž†• ƒ͵ǤͷǦ ‡†‘–”ƒ Š‡ƒŽ –—„‡ǡ ’”‘˜‹†‡• ”‹ ‘‹†’”‡••—”‡ǡ
ƒ†‘‹–‘”• –Š‡ ’”‘ ‡†—”‡–‹‡™Š‹Ž‡ƒ“—ƒŽ‹ˆ‹‡†’”‘˜‹†‡”—•‡• ƒ
•‹œ‡ ͳŽƒ”›‰‘• ‘’‡–‘ ‹•‡”––Š‡ ‡†‘–”ƒ Š‡ƒŽ–—„‡Ǥ Ͳ †‡–‡ –‘”
‹•’Žƒ ‡†‘ –Š‡ –—„‡ǡ ‹• ”‡•—‡†ǡ ƒ† –Š‡ †‡–‡ –‘”–—”•›‡ŽŽ‘™ǡ
‹†‹ ƒ–‹‰–Šƒ– –Š‡ –—„‡ ‹• ‹ –Š‡ –”ƒ Š‡ƒƒ†–Š‡ Ž—‰•ƒ”‡ „‡‹‰
˜‡–‹Žƒ–‡†Ǥ Š‡„ƒ„›̵• Š‡•– ‹• ‘˜‹‰ ƒ† –Š‡ Š‡ƒ”– ”ƒ–‡ ”ƒ’‹†Ž›
increases ased on t e nasa tra s en t
meas rement
t e endotrac ea t e is e d it t e cm mar in ad acent to t e
i
reat so nds are e a in ot a i ae t e t e is sec red and
PP contin es o ad st t e o y en concentration ased on
se
o imetry
e a y sti as oor tone and irre ar res iratory effort
o
ic y date t e arents and transfer t e a y to t e n rsery
for a c est ray and ost res scitation care
ort y after ard yo r
res scitation team cond cts a de riefin to disc ss re aration
team or and comm nication
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An endotrac ea t e i re
is a t in t e t at is inserted
t e ottis et een t e oca cords and ad anced into t e
t ro
trac ea A t o
di ita int ation sin on y t e o erator s fin er
as een descri ed endotrac ea int ation ty ica y re ires t e se
of a i ted instr ment aryn osco e i re
to is a i e t e
aryn and ide t e insertion of t e t e et een t e oca cords
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nsertion of an endotrac ea t e int ation is stron y
recommended if t e a y s eart rate remains ess t an
m and
is not increasin after PP
it a face mas or aryn ea mas
nsertion of an endotrac ea t e is stron y recommended efore
startin c est com ressions f int ation is not s ccessf or
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tŚĂƚ ƐƵƉƉůŝĞƐ ĂŶĚ ĞƋƵŝƉŵĞŶƚƐŚŽƵůĚ ďĞĂǀĂŝůĂďůĞ ĨŽƌ
ŝŶƚƵďĂƚŝŽŶ͍
–—„ƒ–‹‘ •—’’Ž‹‡•ƒ† ‡“—‹’‡–•Š‘—Ž†„‡‡’––‘‰‡–Š‡”ƒ† ”‡ƒ†‹Ž›
ƒ ‡••‹„Ž‡Ǥ – ‹• ‹’‘”–ƒ––‘ ƒ–‹ ‹’ƒ–‡–Š‡ ‡‡†ˆ‘”‹–—„ƒ–‹‘ƒ†
’”‡’ƒ”‡ –Š‡ •—’’Ž‹‡• ƒ†‡“—‹’‡–„‡ˆ‘”‡ ƒŠ‹‰ŠǦ”‹•†‡Ž‹˜‡”›Ǥ
ƒ Š †‡Ž‹˜‡”›”‘‘ǡ —”•‡”›ǡ ƒ† ‡‡”‰‡ ›†‡’ƒ”–‡– •Š‘—Ž†Šƒ˜‡
ƒ– Ž‡ƒ•– ͳ ‘’Ž‡–‡ •‡– ‘ˆ–Š‡ ˆ‘ŽŽ‘™‹‰‹–‡• ȋ ‹‰—”‡ ͷǤͷȌǣ
ƒ”›‰‘• ‘’‡Šƒ†Ž‡Ȉ
Ȉ ˆ–Š‡ Šƒ†Ž‡ —•‡• ”‡’Žƒ ‡ƒ„Ž‡„ƒ––‡”‹‡• ƒ† „—Ž„•ǡ ƒ ‡š–”ƒ •‡–
•Š‘—Ž†„‡ƒ˜ƒ‹Žƒ„Ž‡Ǥ
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ƒ”›‰‘• ‘’‡„Žƒ†‡• ȋ•–”ƒ‹‰Š–‹ŽŽ‡”Ȍȗ
Ȉ ‘Ǥ ͳȋ–‡” ‡™„‘”Ȍ
Ȉ ‘Ǥȋ’”‡–‡” ‡™„‘”Ȍ
Ȉ ‘ǤͲͲ o tion l for e tre el
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Ȍ †‘–”ƒ Š‡ƒŽ –—„‡• ™‹–Š ‹•‹†‡ †‹ƒ‡–‡”• ‘ˆʹǤͷǡ ͵ǤͲǡ ƒ†͵Ǥͷ 
Ȉ ‹œ‡ʹǤͲ ǡ•‹œ‡ ͶǤͲ ǡƒ†–—„‡• ™‹–Š ‹ˆŽƒ–ƒ„Ž‡ —ˆˆ• ƒ”‡
ƒ˜ƒ‹Žƒ„Ž‡ ƒ†ƒ›„‡ ‘•‹†‡”‡†ˆ‘” •’‡ ‹ˆ‹ ‹†‹ ƒ–‹‘• „—– ƒ”‡
‘–”‘—–‹‡Ž›—•‡† †—”‹‰‡‘ƒ–ƒŽ”‡•—• ‹–ƒ–‹‘Ǥ
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Ͳ ʹ †‡–‡ –‘”
— –‹‘ •‡–—’ ™‹–Š •— –‹‘ ƒ–Š‡–‡”•ǣ •‹œ‡ Ž ‘” Žƒ”‰‡” ȋˆ‘”
•— –‹‘‹‰–Š‡ ’Šƒ”›šȌǡ •‹œ‡ ͺ ǡ ƒ†‡‹–Š‡”•‹œ‡ ͷ ‘” ͸ ȋˆ‘”
•— –‹‘‹‰‡†‘–”ƒ Š‡ƒŽ–—„‡• ‘ˆ˜ƒ”‹‘—• •‹œ‡• –Šƒ–„‡ ‘‡
‘„•–”— –‡†™‹–Š•‡ ”‡–‹‘• †—”‹‰”‡•—• ‹–ƒ–‹‘Ȍ
2 ƒ–‡”’”‘‘ˆƒ†Š‡•‹˜‡–ƒ’‡ ȋͳȀʹ‘” ͵ȀͶ‹ ŠȌǡ‘” ‘–Š‡”–—„‡Ǧ•‡ —”‹‰
†‡˜‹ ‡
‡ƒ•—”‹‰–ƒ’‡ ƒ†Ȁ‘” ‡†‘–”ƒ Š‡ƒŽ–—„‡‹•‡”–‹‘†‡’–Š –ƒ„Ž‡
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A ideo aryn osco e it an inte rated camera t at dis ays a ma nified
ie of t e air ay str ct res on a ideo screen is an o tion
Ȍ ”ƒ Š‡ƒŽƒ•’‹”ƒ–‘”
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ƒ†–—„‹‰ˆ‘”„Ž‡†‡†ƒ‹”ƒ†‘š›‰‡
ǡ —Ž•‡‘š‹‡–‡”ǡ •‡•‘”ǡ ƒ† ‘˜‡”
Ͷ ƒ”›‰‡ƒŽ ƒ• ȋ•‹œ‡ ͳȌƒ• ƒ”‡• —‡ ƒ‹”™ƒ›
Ȉ ͷǦ•›”‹‰‡ ‹ˆ—•‹‰ƒŽƒ”›‰‡ƒŽƒ•™‹–Šƒ ‹ˆŽƒ–ƒ„Ž‡ ”‹
–—„ƒ–‹‘ •Š‘—Ž†„‡ ’‡”ˆ‘”‡†ƒ• ƒ Ž‡ƒ’”‘ ‡†—”‡Ǥ ŽŽ•—’’Ž‹‡•
•Š‘—Ž†„‡ ’”‘–‡ –‡†ˆ”‘ ‘–ƒ‹ƒ–‹‘„›„‡‹‰ ‘’‡‡†ǡ ƒ••‡„Ž‡†ǡ
ƒ†’Žƒ ‡†„ƒ ‹–Š‡‹”’ƒ ƒ‰‹‰ —–‹ŽŒ—•–„‡ˆ‘”‡ —•‡Ǥ Š‡
Žƒ”›‰‘• ‘’‡„Žƒ†‡•ƒ†Šƒ†Ž‡•Š‘—Ž†„‡ Ž‡ƒ‡†ǡ ˆ‘ŽŽ‘™‹‰›‘—”
Š‘•’‹–ƒŽ̵• ’”‘ ‡†—”‡•ǡƒˆ–‡”‡ƒ Š —•‡Ǥ
Š‡ ‹–—„ƒ–‹‘„‡ ‘‡• ‡ ‡••ƒ”›ǡ ƒ ƒ”†‹ƒ ‘‹–‘” ‹•
”‡ ‘‡†‡†ˆ‘”–Š‡ ‘•–ƒ —”ƒ–‡ ƒ••‡••‡– ‘ˆ–Š‡ „ƒ„›̵• Š‡ƒ”–
”ƒ–‡Ǥ —”‹‰”‡•—• ‹–ƒ–‹‘ǡ ƒ—• —Ž–ƒ–‹‘ ƒ „‡ †‹ˆˆ‹ —Ž–ƒ†’—Ž•‡
‘š‹‡–”›ƒ›‘– ”‡Ž‹ƒ„Ž›†‡–‡ ––Š‡ „ƒ„›̵• ’—Ž•‡Ǥ ƒ”†‹ƒ ‘‹–‘”
‹• ƒ˜ƒŽ—ƒ„Ž‡–‘‘Žƒ– –Š‹•’‘‹– ‹ ”‡•—• ‹–ƒ–‹‘„‡ ƒ—•‡ƒ ‹ ”‡ƒ•‹‰
Š‡ƒ”– ”ƒ–‡ ‹• ƒ ”‹–‹ ƒȔ‹†‹ ƒ–‘”ˆ‘”’”‘’‡”‡†‘–”ƒ Š‡ƒŽ–—„‡ ‹•‡”–‹‘
ƒ† „‡ ƒ—•‡›‘—”†‡ ‹•‹‘ –‘ ’”‘ ‡‡†™‹–Š Š‡•– ‘’”‡••‹‘• ƒˆ–‡”
‹–—„ƒ–‹‘ †‡’‡†• ‘ ƒ —”ƒ–‡ ƒ••‡••‡–‘ˆ–Š‡ Š‡ƒ”– ”ƒ–‡Ǥ
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ĨƌŽŵ ƉĂĐŬĂŐŝŶŐ ĨŽƌ ĚĞŵŽŶƐƚƌĂƚŝŽŶ ƉƵƌƉŽƐĞƐ͘Ϳ
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&ŝŐƵƌĞ ϱ͘ϲ͘ EĞŽŶĂƚĂů ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ǁŝƚŚ Ă ƵŶŝĨŽƌŵ ĚŝĂŵĞƚĞƌ ;Ϳ͘ dŚŝƐ ƚƵďĞ ŚĂƐ Ă ǀŽĐĂů ĐŽƌĚ ŐƵŝĚĞ ƚŚĂƚ ŝƐ ƵƐĞĚ
ƚŽ ĂƉƉƌŽdžŝŵĂƚĞ ƚŚĞ ŝŶƐĞƌƚŝŽŶ ĚĞƉƚŚ ;Ϳ͘ dŚĞ ƚƵďĞ ŝƐ ŝŶƐĞƌƚĞĚ ƐŽ ƚŚĂƚ ƚŚĞ ǀŽĐĂů ĐŽƌĚƐ ĂƌĞ ƉŽƐŝƚŝŽŶĞĚ ŝŶ ƚŚĞ ƐƉĂĐĞ ďĞƚǁĞĞŶ
ƚŚĞ ĚŽƵďůĞ ůŝŶĞ ĂŶĚ ƐŝŶŐůĞ ůŝŶĞ ;ŝŶĚŝĐĂƚĞĚ ďLJ ƚŚĞ ĂƌƌŽǁƐͿ͘ dŚĞ ǀŽĐĂů ĐŽƌĚ ŐƵŝĚĞ ŝƐ ŽŶůLJ ĂŶ ĂƉƉƌŽdžŝŵĂƚŝŽŶ ĂŶĚ ŵĂLJ ŶŽƚ
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ƚŚƌŽƵŐŚ ĂŶ ĞŶĚŽƚƌĂĐŚĞĂůƚƵďĞ͍
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tŚĂƚƉƌŽďůĞŵƐƐŚŽƵůĚ LJŽƵ ĐŽŶƐŝĚĞƌŝĨĂ ďĂďLJΖƐĐŽŶĚŝƚŝŽŶ
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ƐĞĐƌĞƚŝŽŶƐ ƚŚĂƚ ŽďƐƚƌƵĐƚ ǀĞŶƚŝůĂƚŝŽŶ
ƵƐŝŶŐ ĂŶ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ĂŶĚ
ƚƌĂĐŚĞĂů ĂƐƉŝƌĂƚŽƌ
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ŚĂŵĞŝĚĞƐ >͕ ^ĐŚĞdžŶĂLJĚĞƌ ^D͕ Ğƚ Ăů͘
WĂƌƚ ϭϰ͗ WĞĚŝĂƚƌŝĐ ĂĚǀĂŶĐĞĚ ůŝĨĞ ƐƵƉƉŽƌƚ͗
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ĞůĞŐĂƚĞ ǁŽƌŬůŽĂĚ
ŽƉƚŝŵĂůůLJ͘
ĞƚĞƌŵŝŶĞ ǁŚŝĐŚ ƚĞĂŵ ŵĞŵďĞƌ;Ɛ΃ ǁŝůů ƉĞƌĨŽƌŵ ŝŵƉŽƌƚĂŶƚ ƚĂƐŬƐ ƐƵĐŚ ĂƐ ŝŶƐĞƌƚŝŶŐ ƚŚĞ ĞŶĚŽƚƌĂĐŚĞĂů
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ƚŚĞ ŽƉĞƌĂƚŽƌƐ ƚŽ ĂŶLJ ŝŵƉŽƌƚĂŶƚ ĐŚĂŶŐĞƐ ;ĞŐ͕ ŚĞĂƌƚ ƌŽƚĞ͕ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶͿ͘
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ŵĂŬĞ ƌĞƉĞĂƚĞĚ ŝŶƚƵďĂƚŝŽŶ ĂƚƚĞŵƉƚƐ͘ hƐĞ LJŽƵƌ ŽƚŚĞƌ ƌĞƐŽƵƌĐĞƐ͕ ƐƵĐŚ ĂƐ ĂŶŽƚŚĞƌ ŝŶĚŝǀŝĚƵĂů
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ƌĞƐƉŝƌĂƚŽƌLJ ƚŚĞƌĂƉŝƐƚΖƐ ƐŬŝůůƐ ĚƵƌŝŶŐ ŝŶƚƵďĂƚŝŽŶ ŵĂLJ ĂůůŽǁ ĂŶŽƚŚĞƌ ƉƌŽǀŝĚĞƌ ƚŽ ĨŽĐƵƐ ĂƚƚĞŶƚŝŽŶ
ŽŶ ƉƌĞƉĂƌŝŶŐ ĞƋƵŝƉŵĞŶƚ ĨŽƌ ǀĂƐĐƵůĂƌ ĂĐĐĞƐƐ ĂŶĚ ŵĞĚŝĐĂƚŝŽŶƐ͘
YƵĂůŝƚLJ ůŵƉƌŽǀĞŵĞŶƚ KƉƉŽƌƚƵŶŝƚŝĞƐ
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YƵĂůŝƚLJŝŵƉƌŽǀĞŵĞŶƚƋƵĞƐƚŝŽŶƐ
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ΗEŽĐŚĞƐƚ ŵŽǀĞŵĞŶƚ͘Η
WĞƌĨŽƌŵǀĞŶƚŝůĂƚŝŽŶ ĐŽƌƌĞĐƚŝǀĞ ƐƚĞƉƐ ;DZ͘ ^KWͿ͘
WĞƌĨŽƌŵƐ D ĂŶĚ Z͕ ^ ĂŶĚ K͕ ĂŶĚ WƐƚĞƉƐ͖ ĂƐƐĞƐƐĞƐ ĨŽƌ ŝŶĐƌĞĂƐŝŶŐ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ ĂĨƚĞƌ WWs
ĨŽůůŽǁŝŶŐ ĞĂĐŚ ƐƚĞƉ
,ĞĂƌƚƌŽƚĞ ϰϬ ďƉŵ ĂŶĚ ŶŽƚ ŝŶĐƌĞĂƐŝŶŐ͘
ΗEŽĐŚĞƐƚ ŵŽǀĞŵĞŶƚ͘Η
ΗWƵůƐĞ ŽdžŝŵĞƚĞƌ ŚĂƐŶŽ ƐŝŐŶĂů͘Η
WůĂĐĞ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ ůĞĂĚƐ ĂŶĚ ĐŽŶŶĞĐƚ ƚŽ ŵŽŶŝƚŽƌ ŝŶ ĂŶƚŝĐŝƉĂƚŝŽŶ ŽĨ ŝŶƚƵďĂƚŝŽŶ ;ŝĨ ŶŽƚ ĂůƌĞĂĚLJĚŽŶĞͿ͘
&ULWLFDO 3HUIRUPDQFH 6WHSV FRQW WƌĞƉĂƌĂƚŝŽŶ ĨŽƌ ŝŶƚƵďĂƚŝŽŶ͘ ;DŽƐƚŽĨ ƚŚĞƐĞ ƚĂƐŬƐ ĂƌĞ ŝŶĐůƵĚĞĚ ŝŶ ƚŚĞ ƉƌĞͲďŝƌƚŚ ĞƋƵŝƉŵĞŶƚĐŚĞĐŬ͘Ϳ
KƉĞƌĂƚŽƌ ;ůŶƚƵďĂƚŽƌͿ
KƉĞƌĂƚŽƌ ƐƐƐŝƐƚĂŶƚ
WƌĞƉĂƌĞƐ ĨŽƌ ŝŶƚƵďĂƚŝŽŶ
ͻ ZĞƋƵĞƐƚƐ ĐŽƌƌĞĐƚͲƐŝnjĞĚ ƚƵďĞ
ͻ ZĞƋƵĞƐƚƐ ĐŽƌƌĞĐƚͲƐŝnjĞĚ ůĂƌLJŶŐŽƐĐŽƉĞ ďůĂĚĞ
ͻ ŽŵŵƵŶŝĐĂƚĞƐ ƉƌĞĨĞƌĞŶĐĞ ĨŽƌ ƐƚLJůĞƚ ƵƐĂŐĞ
ͻ ŶƐƵƌĞƐ ƐƵĐƚŝŽŶ ƐĞƚ Ăƚ ϴϬ ƚŽ ϭϬϬ ŵŵ ,Ő
ͻ ^ĞůĞĐƚƐ ĐŽƌƌĞĐƚͲƐŝnjĞĚ ƚƵďĞ
ͻ ŚŽŽƐĞƐ ĐŽƌƌĞĐƚ ůĂƌLJŶŐŽƐĐŽƉĞ ďůĂĚĞ ;ƐŝnjĞ ϭ ΀ƚĞƌŵ΁͕
ƐŝnjĞ K ΀ƉƌĞƚĞƌŵ΁Ϳ
ͻ ŚĞĐŬƐ ůĂƌLJŶŐŽƐĐŽƉĞ ůŝŐŚƚ
ͻ ůŶƐĞƌƚƐ ƐƚLJůĞƚ ĐŽƌƌĞĐƚůLJ ;ƐƚLJůĞƚ ŽƉƚŝŽŶĂůͿ
ͻ KďƚĂŝŶƐ Ϭ Ϯ ĚĞƚĞĐƚŽƌ
ͻ WƌĞƉĂƌĞƐ ƚĂƉĞ Žƌ ƚƵďĞͲƐĞĐƵƌŝŶŐ ĚĞǀŝĐĞ
ůŶƚƵďĂƚŝŶŐ ƚŚĞ ŶĞǁďŽƌŶ͘
KƉĞƌĂƚŽƌ
KƉĞƌĂƚŽƌΖƐ ƐƐŝƐƚĂŶƚ
ͻ ,ŽůĚƐ ůĂƌLJŶŐŽƐĐŽƉĞ ĐŽƌƌĞĐƚůLJ ŝŶ ůĞĨƚ ŚĂŶĚ
ͻ KƉĞŶƐ ďĂďLJΖƐ ŵŽƵƚŚ ǁŝƚŚ ĨŝŶŐĞƌ ĂŶĚ ŝŶƐĞƌƚƐ ďůĂĚĞ ƚŽ
ďĂƐĞ ŽĨ ƚĞŶŐƵĞ
ͻ >ŝĨƚƐ ďůĂĚĞĐŽƌƌĞĐƚůLJ ;ŶŽ ƌŽĐŬŝŶŐ ŵŽƚŝŽŶͿ
ͻ ZĞƋƵĞƐƚƐ ĐƌŝĐŽŝĚ ƉƌĞƐƐƵƌĞ ŝĨ ŶĞĞĚĞĚ
ͻ ůĚĞŶƚŝĨŝĞƐ ůĂŶĚŵĂƌŬƐ͕ ƚĂŬĞƐ ĐŽƌƌĞĐƚŝǀĞ ĂĐƚŝŽŶ ƚŽ
ǀŝƐƵĂůŝnjĞ ŐůŽƚƚŝƐ ŝĨ ŶĞĞĚĞĚ
ͻ ůŶƐĞƌƚƐ ƚƵďĞ ĨƌŽŵ ƌŝŐŚƚ ƐŝĚĞ͕ ŶŽƚ ĚŽǁŶ ĐĞŶƚĞƌ ŽĨ
ůĂƌLJŶŐŽƐĐŽƉĞ ďůĂĚĞ
ͻ ůŝŐŶƐ ǀŽĐĂů ĐŽƌĚ ŐƵŝĚĞ ǁŝƚŚ ǀŽĐĂů ĐŽƌĚƐ
ͻ ZĞŵŽǀĞƐ ůĂƌLJŶŐŽƐĐŽƉĞ ƚŚĞŶ ƌĞŵŽǀĞƐ ƐƚLJůĞƚ ǁŚŝůĞ
ĨŝƌŵůLJ ŚŽůĚŝŶŐ ƚƵďĞ ĂŐĂŝŶƐƚ ďĂďLJΖƐ ƉĂůŽƚĞ
ͻ ,ŽůĚƐ ƚƵďĞ ĂŐĂŝŶƐƚ ďĂďLJΖƐ ƉĂůŽƚĞ
ͻ WŽƐŝƚŝŽŶƐ ŶĞǁďŽƌŶΖƐ ŚĞĂĚ ŝŶ ƐŶŝĨĨŝŶŐ ƉŽƐŝƚŝŽŶ͕ ďŽĚLJ
ƐƚƌĂŝŐŚƚ͕ ƚĂďůĞ Ăƚ ĐŽƌƌĞĐƚ ŚĞŝŐŚƚ ĨŽƌ ŽƉĞƌĂƚŽƌ
ͻ ƉƉůŝĞƐ ĐƌŝĐŽŝĚ ƉƌĞƐƐƵƌĞ ŝĨ ƌĞƋƵĞƐƚĞĚ
ͻ ,ĂŶĚƐ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ƚŽ ŽƉĞƌĂƚŽƌ
ͻ DŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ĂŶŶŽƵŶĐĞƐ ŝĨ ĂƚƚĞŵƉƚ ůĂƐƚƐ
ůŽŶŐĞƌ ƚŚĂŶ ϯϬ ƐĞĐŽŶĚƐ
ͻ ZĞŵŽǀĞƐ ƐƚLJůĞƚ ;ŝĨ ƵƐĞĚͿ
ͻ ŽŶŶĞĐƚƐ Ϭ Ϯ ĚĞƚĞĐƚŽƌ ĂŶĚ WWs ĚĞǀŝĐĞ ƚŽ
ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ
ͻ ,ĂŶĚƐ WWs ĚĞǀŝĐĞ ƚŽ ŽƉĞƌĂƚŽƌ
WŽƐŝƚŝǀĞͲƉƌĞƐƐƵƌĞ ǀĞŶƚŝůĂƚŝŽŶ ĂŶĚ ĐŽŶĨŝƌŵŝŶŐ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ŝŶƐĞƌƚŝŽŶ͘
ͻ ĚŵŝŶŝƐƚĞƌƐ WWs
ͻ KďƐĞƌǀĞƐ ĨŽƌ ƐLJŵŵĞƚƌŝĐĂů ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ
ͻ ƵƐĐƵůƚĂƚĞƐ ĨŽƌ ŝŶĐƌĞĂƐŝŶŐ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ĂƐƐĞƐƐĞƐ
Ϭ Ϯ ĚĞƚĞĐƚŽƌ ĐŽůŽƌ ĐŚĂŶŐĞ
ͻ >ŝƐƚĞŶƐ ĨŽƌ ďŝůĂƚĞƌĂů ďƌĞĂƚŚ ƐŽƵŶĚƐ͕ ŶŽƚĞƐ ƐLJŵŵĞƚƌŝĐĂů
ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ ǁŝƚŚ WWs͕ ĂŶĚ ƌĞƉŽƌƚƐ ĨŝŶĚŝŶŐƐ
,ĞĂƌƚ ƌŽƚĞ ϰϬďƉŵ ĂŶĚ ŶŽƚ ŝŶĐƌĞĂƐŝŶŐ
ΗŚĞƐƚ ŝƐ ŶŽƚ ŵŽǀŝŶŐ ǁŝƚŚ WWs͘ EŽ ĂƵĚŝďůĞ ďƌĞĂƚŚ ƐŽƵŶĚƐ͘
ΗŽůŽƌ ŝƐ ŶŽƚĐŚĂŶŐŝŶŐ ŽŶ ƚŚĞ Ϭ ĚĞƚĞĐƚŽƌ͘Η
Η/Ŷ ƚŚŝƐ ƐĐĞŶĂƌŝŽ͕ ƚŚĞĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ŚĂƐ ďĞĞŶ ĐŽƌƌĞĐƚůLJ ŝŶƐĞƌƚĞĚ͕ ďƵƚ ƚŚĞƌĞ ŝƐ ŶŽ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ ǁŝƚŚ WWs͘
tŚĂƚ ŝƐ LJŽƵƌ ŶĞdžƚ ƐƚĞƉ͍Η
^ƵƐƉĞĐƚ ĂŝƌǁĂLJŽďƐƚƌƵĐƚŝŽŶ ĂŶĚ ƵƐĞ ƚƌĂĐŚĞĂů ĂƐƉŝƌĂƚŽƌ͘
ͻ ŽŶŶĞĐƚƐ Ă ƚƌĂĐŚĞĂů ĂƐƉŝƌĂƚŽƌ ƚŽ Ă ƐƵĐƚŝŽŶ ƐŽƵƌĐĞ ;ϴϬͲϭϬϬ ŵŵ ,Ő ƐƵĐƚŝŽŶͿ ĂŶĚ ĚŝƌĞĐƚůLJ ƚŽ ƚŚĞ ĞŶĚŽƚƌĂĐŚĞĂů
ƚƵďĞ ĐŽŶŶĞĐƚŽƌ Žƌ ŽĐĐůƵĚĞƐ ŝŶƚĞŐƌĂƚĞĚ ƐƵĐƚŝŽŶ ƉŽƌƚ
ͻ KĐĐůƵĚĞƐ ƚŚĞ ƚƌĂĐŚĞĂů ĂƐƉŝƌĂƚŽƌ ǁŝƚŚ Ă ĨŝŶŐĞƌ Žƌ ŽĐĐůƵĚĞƐ ƚŚĞ ƐƵĐƚŝŽŶͲĐŽŶƚƌŽů ƉŽƌƚ ŽŶ ƚŚĞ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ĂŶĚ
ŐƌĂĚƵĂůůLJǁŝƚŚĚƌĂǁƐ ƚŚĞ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ŽǀĞƌ ϯ ƚŽ ϱ ƐĞĐŽŶĚƐ ǁŚŝůĞ ĐŽŶƚŝŶƵŝŶŐ ƚŽ ƐƵĐƚŝŽŶ ƐĞĐƌĞƚŝŽŶƐ ŝŶ ƚŚĞ
ƚƌĂĐŚĞĂ
&ULWLFDO 3HUIRUPDQFH 6WHSV FRQW ĨƚĞƌ ƚƌĂĐŚĞĂů ƐƵĐƚŝŽŶ͕ ƌĞͲŝŶƚƵďĂƚĞ ďĂďLJǁŝƚŚ Ă ĐůĞĂŶ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ͘
;>ĞĂƌŶĞƌ ŵĂLJ ĂůƐŽ ƌĞƐƵŵĞ ĨĂĐĞͲŵĂƐŬ WWs Žƌ ŝŶƐĞƌƚĂ ůĂƌLJŶŐĞĂů ŵĂƐŬ͘Ϳ
$IWHU UHLQWXEDWLRQ LIHQGRWUDFKHDOWXEH LV QRWVXFFHVVIXOO\ LQVHUWHG
ΗŽůŽƌ ŝƐ ŶŽƚĐŚĂŶŐŝŶŐ ŽŶ ƚŚĞϬ Ϯ ĚĞƚĞĐƚŽƌ͘Η
,ĞĂƌƚ ƌŽƚĞс ďƉŵ ĂŶĚ ŶŽƚ ŝŶĐƌĞĂƐŝŶŐ
ͻ ZĞŵŽǀĞƐ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ
ͻ ZĞƐƵŵĞƐ WWs ďLJ ĨĂĐĞ ŵĂƐŬ
ͻ ZĞƉĞĂƚƐ ŝŶƚƵďĂƚŝŽŶ ĂƚƚĞŵƉƚ Žƌ ŝŶĚŝĐĂƚĞƐ ŶĞĞĚ ĨŽƌ ůĂƌLJŶŐĞĂů ŵĂƐŬ
$IWHU UHLQWXEDWLRQ LIHQGRWUDFKHDOWXEH LV VXFFHVVIXOO\ LQVHUWHG
ΗŽůŽƌ ŝƐ ĐŚĂŶŐŝŶŐ ŽŶ ƚŚĞ Ϭ Ϯ ĚĞƚĞĐƚŽƌ͘Η
,ĞĂƌƚ ƌĂƚĞ с ďƉŵ ĂŶĚ ŝŶĐƌĞĂƐŝŶŐ
WƵůƐĞ ŽdžŝŵĞƚĞƌ ĚŝƐƉůĂLJƐ ƐŝŐŶĂů ĂƐ ŚĞĂƌƚ ƌŽƚĞ ŝŶĐƌĞĂƐĞƐ ƚŽŵŽƌĞ ƚŚĂŶ ďƉŵ
ͻ KƉĞƌĂƚŽƌ ĐŽŶƚŝŶƵĞƐ WWs dž ϯϬƐĞĐŽŶĚƐ
ͻ ƐƐŝƐƚĂŶƚ ĐŚĞĐŬƐ ƚŝƉͲƚŽͲůŝƉ ĚĞƉƚŚ ƵƐŝŶŐ ŐĞƐƚĂƚŝŽŶĂů ĂŐĞͬǁĞŝŐŚƚƚĂďůĞ Žƌ Ed> ŵĞĂƐƵƌĞŵĞŶƚ
Ͳ ůĨ ƵƐŝŶŐ Ed>͕ ŵĞĂƐƵƌĞƐ ĚŝƐƚĂŶĐĞ ĨƌŽŵ ƚŚĞ ŶĂƐĂů ƐĞƉƚƵŵ ƚŽ ƚŚĞ ĞĂƌ ƚƌĂŐƵƐ ;ŝŶƐĞƌƚŝŽŶ ĚĞƉƚŚ ΀Đŵ΁сEd>н ů Đŵ΃
ͻƐƐŝƐƚĂŶƚ ƐĞĐƵƌĞƐ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ
sŝƚĂů ƐŝŐŶƐ͘
ŚĞĐŬƐ ŚĞĂƌƚ ƌŽƚĞ ĂĨƚĞƌ ĐŽŵƉůĞƚŝŶŐ ϯϬƐĞĐŽŶĚƐ ŽĨ WWs
,ĞĂƌƚ ƌĂƚĞс ďƉŵ ĂŶĚ ŝŶĐƌĞĂƐŝŶŐ
ΗƉŶĞŝĐ͘Η
ϱWŽϮ с ĂŶĚ ŝŶĐƌĞĂƐŝŶŐ
ŽŶƚŝŶƵĞƐ WWs ĂŶĚ ĂĚũƵƐƚƐ ŽdžLJŐĞŶ ĐŽŶĐĞŶƚƌĂƚŝŽŶ ƉĞƌ ƉƵůƐĞ ŽdžŝŵĞƚƌLJ
ŚĞĐŬƐ ŚĞĂƌƚ ƌŽƚĞ ĂĨƚĞƌ ϯϬ ŵŽƌĞ ƐĞĐŽŶĚƐ ŽĨ WWs
,ĞĂƌƚ ƌĂƚĞ ŝƐ х ďƉŵ ĂŶĚ ŝŶĐƌĞĂƐŝŶŐ
ΗƉŶĞŝĐ͘Η
^WϬϮ с ĂŶĚ ŝŶĐƌĞĂƐŝŶŐ
ŶĚ ƐĐĞŶĂƌŝŽ͘
^ƵƉƉŽƌƚƐ ďĂďLJ ǁŝƚŚ WWs ĂŶĚ ƐƵƉƉůĞŵĞŶƚĂů ŽdžLJŐĞŶ ƉĞƌ dĂƌŐĞƚ KdžLJŐĞŶ ^ĂƚƵƌĂƚŝŽŶ dĂďůĞ͘
DŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌŽƚĞ͕ ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚ͕ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ͕ ĂĐƚŝǀŝƚLJ͕ ƚĞŵƉĞƌĂƚƵƌĞ͘
WƌĞƉĂƌĞƐ ƚŽ ŵŽǀĞ ďĂďLJ ƚŽ ƉŽƐƚͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ĐĂƌĞ ƐĞƚƚŝŶŐ͘
ŽŵŵƵŶŝĐĂƚĞƐ ǁŝƚŚ ƉĞƌŝŶĂƚĂů ƚĞĂŵ͘
hƉĚĂƚĞƐ ƉĂƌĞŶƚƐ ĂŶĚ ŝŶĨŽƌŵƐ ƚŚĞŵ ŽĨ ŶĞdžƚ ƐƚĞƉƐ͘
ĞďƌŝĞĨƐ ƚŚĞ ƌĞƐƵƐĐŝƚĂƚŝŽŶ͘
^ĂŵƉůĞ ĞďƌŝĞĨŝŶŐ YƵĞƐƚŝŽŶƐ
Šƒ–™‡–™‡ŽŽ †—”‹‰–Š‹• ”‡•—• ‹–ƒ–‹‘ǫ
ˆȌ Šƒ–‹• –Š‡ ‘•–‹’‘”–ƒ– ‹••—‡ –‘ †‹• —•• †—”‹‰–Š‹• †‡„”‹‡ˆ‹‰ǫ
ͺ –™Šƒ–’‘‹–δŽ‹†›‘— †‡ ‹†‡–‘ —•‡ ƒ ƒ”†‹ƒ ‘‹–‘”–‘ ƒ••‡••
–Š‡ Š‡ƒ”– ”ƒ–‡ǫ ‘™δŽ‹†–Šƒ–Š‡Ž’›‘—ǫ Š‡‹• ƒ ƒ”†‹ƒ ‘‹–‘”
”‡ ‘‡†‡††—”‹‰‡‘ƒ–ƒŽ ”‡•—• ‹–ƒ–‹‘ǫ
Šƒ–™‹ŽŽ›‘— †‘ †‹ˆˆ‡”‡–Ž›™Š‡ˆƒ ‡† ™‹–Š ‹–—„ƒ–‹‘ ‹ ƒˆ—–—”‡
• ‡ƒ”‹‘ǫ
Ͳ
ȋ’–‹‘ ʹȌˆ–‡”‹•‡”–‹‰ƒ ƒŽ–‡”ƒ–‹˜‡ ƒ‹”™ƒ›ǡ –Š‡”‡ ™ƒ• •–‹ŽŽ ‘
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Ăůů ĨŽƌ ĂĚĚŝƚŝŽŶĂů ůĨ ĐŚĞƐƚ ĐŽŵƉƌĞƐƐŝŽŶƐ ĂƌĞ ƌĞƋƵŝƌĞĚ͕ LJŽƵ ŵĂLJ ŶĞĞĚ ϰ Žƌ ŵŽƌĞ ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ͘ WĞƌĨŽƌŵŝŶŐ
ŚĞůƉ ǁŚĞŶ
Ăůŝ ŽĨ ƚŚĞ ƚĂƐŬƐ ƋƵŝĐŬůLJ͕ ŝŶĐůƵĚŝŶŐ WWs͕ ĂƵƐĐƵůƚĂƚŝŽŶ͕ ƉůĂĐŝŶŐ Ă ƉƵůƐĞ ŽdžŝŵĞƚĞƌ͕ ŝŶƚƵďĂƚŝŶŐ ƚŚĞ
ŶĞĞĚĞĚ͘
ĂŝƌǁĂLJ͕ ĂĚŵŝŶŝƐƚĞƌŝŶŐ ĐŽŵƉƌĞƐƐŝŽŶƐ͕ ŵŽŶŝƚŽƌŝŶŐ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ĐŽŵƉƌĞƐƐŝŽŶƐ ĂŶĚ ǀĞŶƚŝůĂƚŝŽŶƐ͕
ĞůĞŐĂƚĞ ǁŽƌŬůŽĂĚ
ŵŽŶŝƚŽƌŝŶŐ ƚŚĞ ďĂďLJΖƐ ƌĞƐƉŽŶƐĞ͕ ƉƌĞƉĂƌŝŶŐ ĞŵĞƌŐĞŶĐLJ ǀĂƐĐƵůĂƌ ĂĐĐĞƐƐ͕ ĚŽĐƵŵĞŶƚŝŶŐ ĞǀĞŶƚƐ ĂƐ
ŽƉƚŝŵĂůůLJ͘
ƚŚĞLJ ŽĐĐƵƌ͕ ĂŶĚ ƐƵƉƉŽƌƚŝŶŐ ƚŚĞ ďĂďLJΖƐ ĨĂŵŝůLJ͕ ƌĞƋƵŝƌĞƐ ŵƵůƚŝƉůĞ ƚĞĂŵ ŵĞŵďĞƌƐ͘
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ůůŽĐĂƚĞ ĂƚƚĞŶƚŝŽŶ
ǁŝƐĞůLJ͘
dŚĞ ƚĞĂŵ ůĞĂĚĞƌ ŶĞĞĚƐ ƚŽ ŵĂŝŶƚĂŝŶ ƐŝƚƵĂƚŝŽŶ ĂǁĂƌĞŶĞƐƐ͕ ƉĂLJŝŶŐ ĂƚƚĞŶƚŝŽŶ ƚŽ ƚŚĞ ĞŶƚŝƌĞ ƐŝƚƵĂƚŝŽŶ͕
ĂŶĚ ŶŽƚ ďĞĐŽŵŝŶŐ ĚŝƐƚƌĂĐƚĞĚ ďLJ ĂŶLJƐŝŶŐůĞ ĂĐƚŝǀŝƚLJ Žƌ ƉƌŽĐĞĚƵƌĞ͘ dŚŝƐ ŵĞĂŶƐ ƚŚĂƚ ůĞĂĚĞƌƐŚŝƉ
ŵĂLJ ŶĞĞĚ ƚŽ ƐŚŝĨƚ ƚŽ ĂŶŽƚŚĞƌ ƉĞƌƐŽŶ ŝĨ ƚŚĞ ƚĞĂŵ ůĞĂĚĞƌ ŝƐ ƉĞƌĨŽƌŵŝŶŐ Ă ƉƌŽĐĞĚƵƌĞ ƚŚĂƚ
ŽĐĐƵƉŝĞƐ ƚŚĞŝƌ ĂƚƚĞŶƚŝŽŶ͘
ůƚ ŝƐ ŝŵƉŽƌƚĂŶƚ ĨŽƌ ƐŽŵĞŽŶĞ ƚŽ ŵŽŶŝƚŽƌ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ǀĞŶƚŝůĂƚŝŽŶ ĂŶĚ ĐŽŵƉƌĞƐƐŝŽŶƐ ǁŚŝůĞ ĂůƐŽ
ŵŽŶŝƚŽƌŝŶŐ ƚŚĞ ďĂďLJΖƐ ŚĞĂƌƚ ƌŽƚĞ͘
hƐĞ ĂǀĂŝůĂďůĞ
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ƌĞƐƉŝƌĂƚŽƌLJ ƚŚĞƌĂƉŝƐƚ ĐĂŶ ĂĚŵŝŶŝƐƚĞƌ WWs͕ ĞŶĂďůŝŶŐ Ă ŶƵƌƐĞ Žƌ ƉŚLJƐŝĐŝĂŶ ƚŽ ƉƌĞƉĂƌĞ ĨŽƌ
ĞŵĞƌŐĞŶĐLJ ǀĂƐĐƵůĂƌ ĂĐĐĞƐƐ ĂŶĚ ŵĞĚŝĐĂƚŝŽŶ ĂĚŵŝŶŝƐƚƌĂƚŝŽŶ͘
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ĞĨĨĞĐƚŝǀĞůLJ͘
DĂŝŶƚĂŝŶ
ƉƌŽĨĞƐƐŝŽŶĂů
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ƵƌŝŶŐ ĐŽŵƉƌĞƐƐŝŽŶƐ͕ ƚŚĞ ĐŽŵƉƌĞƐƐŽƌ ĂŶĚ ǀĞŶƚŝůĂƚŽƌ ŶĞĞĚ ƚŽ ĐŽŽƌĚŝŶĂƚĞ ƚŚĞŝƌ ĂĐƚŝǀŝƚLJ ĂŶĚ
ŵĂŝŶƚĂŝŶ ĐŽƌƌĞĐƚ ƚĞĐŚŶŝƋƵĞ͘ dŚĞLJ ĐĂŶŶŽƚ ƉĞƌĨŽƌŵ ŽƚŚĞƌ ƌŽůĞƐ Žƌ ŚŽǀĞ ĐŽŶǀĞƌƐĂƚŝŽŶƐ ǁŚŝůĞ
ĐŽŵƉƌĞƐƐϭŽŶƐ ĂƌĞ ϭŶƉƌŽŐƌĞƐƐ͘
ůĨ Ă ĐŽƌƌĞĐƚŝŽŶ ŝƐ ƌĞƋƵŝƌĞĚ͕ ŵĂŬĞ Ă ĐůĞĂƌ͕ ĐĂůŵ͕ ĂŶĚ ĚŝƌĞĐƚĞĚ ƐƚĂƚĞŵĞŶƚ͘
^ƉĞĂŬĐůĞĂƌůLJ͕ ĚŝƌĞĐƚůLJ͕ ĂŶĚ ůŽƵĚůLJ ĞŶŽƵŐŚ ĨŽƌ ƚĞĂŵ ŵĞŵďĞƌƐ ƚŽ ŚĞĂƌ LJŽƵ͕ ďƵƚ ĂǀŽŝĚ ĞdžƚƌĂŶĞŽƵƐ
ĐŽŶǀĞƌƐĂƚŝŽŶ Žƌ ƵŶŶĞĐĞƐƐĂƌŝůLJ ůŽƵĚ ĐŽŵŵƵŶŝĐĂƚŝŽŶ ƚŚĂƚ ŵĂLJ ďĞ ĚŝƐƚƌĂĐƚŝŶŐ͘
^ŚĂƌĞ ŝŶĨŽƌŵĂƚŝŽŶ ǁŝƚŚ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ĚŽĐƵŵĞŶƚŝŶŐ ĞǀĞŶƚƐ ƐŽ ƚŚĞLJ ĐĂŶ ďĞ ĂĐĐƵƌĂƚĞůLJ ŶŽƚĞĚ͘
YƵĂůŝƚLJ ůŵƉƌŽǀĞŵĞŶƚKƉƉŽƌƚƵŶŝƚŝĞƐ
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WƌŽĐĞƐƐĂŶĚ ŽƵƚĐŽŵĞ ŵĞĂƐƵƌĞƐ
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WůĂĐĞƐ ƚŚƵŵďƐ ŽŶ ƐƚĞƌŶƵŵ ;ůŽǁĞƌ ƚŚŝƌĚ͕ ďĞůŽǁ ŝŵĂŐŝŶĂƌLJ ůŝŶĞ ĐŽŶŶĞĐƚŝŶŐ ŶŝƉƉůĞƐͿ͖ ĨŝŶŐĞƌƐ ƵŶĚĞƌ ďĂĐŬ͕ ƐƵƉƉŽƌƚŝŶŐ
ƐƉŝŶĞ ;ĨŝŶŐĞƌƐ ĚŽ ŶŽƚ ŶĞĞĚ ƚŽ ƚŽƵĐŚͿ
ŽŵƉƌĞƐƐĞƐ ƐƚĞƌŶƵŵ ŽŶĞͲƚŚŝƌĚ ŽĨƚŚĞ ĂŶƚĞƌŝŽƌͲƉŽƐƚĞƌŝŽƌ ĚŝĂŵĞƚĞƌ ŽĨĐŚĞƐƚ͕ ƐƚƌĂŝŐŚƚ ƵƉ ĂŶĚ ĚŽǁŶ
ͻ ŽŵƉƌĞƐƐŽƌ ĐŽƵŶƚƐ ĐĂĚĞŶĐĞ ΗKŶĞͲĂŶĚͲƚǁŽͲĂŶĚͲƚŚƌĞĞͲĂŶĚͲďƌĞĂƚŚĞͲĂŶĚΗ
ͻ WŽƐŝƚŝǀĞͲƉƌĞƐƐƵƌĞ ǀĞŶƚŝůĂƚŝŽŶ ĂĚŵŝŶŝƐƚĞƌĞĚ ĚƵƌŝŶŐ ĐŽŵƉƌĞƐƐŝŽŶ ƉĂƵƐĞ ;ΗďƌĞĂƚŚĞͲĂŶĚΗͿ
ͻ KŶĞ ĐLJĐůĞ ŽĨ ϯ ĐŽŵƉƌĞƐƐŝŽŶƐ ĂŶĚ ϭ ďƌĞĂƚŚ ĞǀĞƌLJ Ϯ ƐĞĐŽŶĚƐ
ŚĞĐŬ ŚĞĂƌƚ ƌŽƚĞ ĂĨƚĞƌ ů ŵŝŶƵƚĞ͘
WĂƵƐĞƐ ĐŽŵƉƌĞƐƐŝŽŶƐ͕ ĐŽŶƚŝŶƵĞƐ WWs͕ ĂŶĚ ĐŚĞĐŬƐ ŚĞĂƌƚ ƌŽƚĞ ĂĨƚĞƌ ϲϬ ƐĞĐŽŶĚƐ ŽĨ ĐŽŵƉƌĞƐƐŝŽŶƐ ĂŶĚ ǀĞŶƚŝůĂƚŝŽŶƐ
,ĞĂƌƚƌŽƚĞс ϳϬďƉŵ ĂŶĚ ƌŝƐŝŶŐ
ΗWƵůƐĞ ŽdžŝŵĞƚĞƌ ŚĂƐ ŽƐŝŐŶĂů͘ EŽ ƐƉŽŶƚĂŶĞŽƵƐ ƌĞƐƉŝƌĂƚŝŽŶƐ͘Η
ŝƐĐŽŶƚŝŶƵĞ ĐŽŵƉƌĞƐƐŝŽŶƐͲŽŶƚŝŶƵĞ WWs͘
ͻ ŝƐĐŽŶƚŝŶƵĞƐĐŚĞƐƚ ĐŽŵƉƌĞƐƐŝŽŶƐ
ͻ ŽŶƚŝŶƵĞƐ WWs ǁŝƚŚ ŚŝŐŚĞƌ ǀĞŶƚŝůĂƚŝŽŶ ƌŽƚĞ ;ϰϬͲϲϬ ďƌĞĂƚŚƐͬŵŝŶͿ
ͻ ĚũƵƐƚƐ ŽdžLJŐĞŶ ĐŽŶĐĞŶƚƌĂƚŝŽŶ ƉĞƌƚĂƌŐĞƚ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ
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ŚĞĐŬ ǀŝƚĂů ƐŝŐŶƐ͘
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ŶĚ ƐĐĞŶĂƌŝŽ͘
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DŽŶŝƚŽƌƐ ŚĞĂƌƚ ƌŽƚĞ͕ ƌĞƐƉŝƌĂƚŽƌLJ ĞĨĨŽƌƚ͕ ŽdžLJŐĞŶ ƐĂƚƵƌĂƚŝŽŶ͕ ĂĐƚŝǀŝƚLJ͕ ƚĞŵƉĞƌĂƚƵƌĞ͘
WƌĞƉĂƌĞƐ ƚŽ ŵŽǀĞ ďĂďLJ ƚŽ ƉŽƐƚͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ĐĂƌĞ ƐĞƚƚŝŶŐ͘
ŽŵŵƵŶŝĐĂƚĞƐ ǁŝƚŚ ƉĞƌŝŶĂƚĂů ƚĞĂŵ͘
hƉĚĂƚĞƐ ƉĂƌĞŶƚƐ ĂŶĚ ŝŶĨŽƌŵƐ ƚŚĞŵ ŽĨ ŶĞdžƚ ƐƚĞƉƐ͘
ĞďƌŝĞĨƐ ƚŚĞ ƌĞƐƵƐĐŝƚĂƚŝŽŶ͘
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medication orders
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e me di ca ro ider i and erson administerin medications
ay or first a ree on an estimated ei t
/L] ay or est mate t e a y s ei t is t ree i o rams
lor
ei t is t ree i o rams
e medica ro ider t en i es t e medication name
concentration ose and ro te
e order is re eated ac
erson administerin t e medication
yt e
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concentration ero oint ero t o mi i rams er i o ram
ra id y t ro
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mi i iters of sa ine f s
a e e ine rine one n i i ram in ten mi i iters s o
o
m i in ero oint ero t o mi i rams er i o ram
ic is e a to ero oint t o mi i iters er i o ram
e a y ei s t ree i o rams so i i e ero oint si
mi i iters s o syrin e m i in it ra id y t ro
t e
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en
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nce com eted
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i e ine rine as een i en and t e f s is com eted
tŚĂƚ ƐŚŽƵůĚLJŽƵ ĞdžƉĞĐƚ ƚŽ ŚĂƉƉĞŶĂĨƚĞƌŐŝǀŝŶŐĞƉŝŶĞƉŚƌŝŶĞ͍
Assess t e a y s eart rate min te after e ine rine administration
As yo contin e PP
it o y e and c est com ressions t e
eart rate s o d increase to m or i er it in a ro imate y
min te of intra eno s or intraosseo s e ine rine administration
f t e eart rate is ess t an m after t e first ose of intra eno s
or intraosseo s e ine rine contin e coordinated enti ation
and com ressions o can re eat t e e ine rine ose e ery to
min tes f yo started it t e s ested initia ose of m
or o er yo s o d consider increasin s se ent doses o not
e ceed t e ma im m recommended ose f t ere is not a satisfactory
res onse after intra eno s or intraosseo s e ine rine consider ot er
ro ems s c as y o o emia and tension ne mot ora
e res onse may ta e on er or may not occ r if yo i e
endotrac ea e ine rine f t e first ose is i en y t e endotrac ea
ro te and t ere is not a satisfactory res onse a re eat ose s o d e
i en as soon as an m i ica eno s cat eter or intraosseo s need e is
inserted o not de ay f t e eart rate is ess t an m yo do not
need to ait for min tes after an endotrac ea ose to i e t e first
intra eno s or intraosseo s ose nce an m i ica eno s cat eter or
intraosseo s need e as een inserted a i s se ent doses s o d e
i en y t e intra eno s or intraosseo s ro te
n addition c ec to e certain t at
A cardiac monitor is ein sed for t e most acc rate assessment of
eart rate
e n s are ein ade ate y enti ated as indicated y c est
mo ement nsertion of an endotrac ea t e or a aryn ea
mas s o d e stron y considered if not a ready done f PP is
ro ided t ro
an endotrac ea t e or a aryn ea mas t ere
s o d e e a reat so nds
e endotrac ea t e is not dis aced ent or o str cted y
secretions
est com ressions are ein i en at t e correct de t one t ird
of t e anterior osterior AP diameter of t e c est and correct rate
min
nterr tions in c est com ressions are minimi ed eca se eac
interr tion decreases coronary artery erf sion
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ŵĞƌŐĞŶĐLJ ŝŶƐĞƌƚŝŽŶ ŽĨ ĂŶ ƵŵďŝůŝĐĂů ǀĞŶŽƵƐ ĐĂƚŚĞƚĞƌ Žƌ ŝŶƚƌĂŽƐƐĞŽƵƐ ŶĞĞĚůĞ ĂŶĚ
ďůŽŽĚ ĂĚŵŝŶŝƐƚƌĂƚŝŽŶ ĂƌĞ ŝŶĨƌĞƋƵĞŶƚůLJ ƵƐĞĚ ƐŬŝůůƐ͕ ĂŶĚ ƚĞĂŵƐ ŵƵƐƚ ƉƌĂĐƚŝĐĞ ƚŚĞŵ
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ĚƵƌŝŶŐ ĂŶ ĞŵĞƌŐĞŶĐLJ͘
ůĨ Ă ďĂďLJ ƌĞƋƵŝƌĞƐ ĐŚĞƐƚ ĐŽŵƉƌĞƐƐŝŽŶƐ͕ ŝƚ ŝƐ ůŝŬĞůLJ ƚŚĂƚ ĞƉŝŶĞƉŚƌŝŶĞ ĂůƐŽ ǁŝůů ďĞ
ƌĞƋƵŝƌĞĚ͘ KŶĐĞ ĐŽŵƉƌĞƐƐŝŽŶƐ ĂƌĞ ƐƚĂƌƚĞĚ͕ Ă ƚĞĂŵ ŵĞŵďĞƌ ƐŚŽƵůĚ ƉƌĞƉĂƌĞ
ĞƉŝŶĞƉŚƌŝŶĞ ĂŶĚ ĂŶ ƵŵďŝůŝĐĂů ǀĞŶŽƵƐ ĐĂƚŚĞƚĞƌ ŽƌĂŶ ŝŶƚƌĂŽƐƐĞŽƵƐ ŶĞĞĚůĞ ƐŽ ƚŚĂƚ
ŝŶƚƌĂǀĂƐĐƵůĂƌ ĞƉŝŶĞƉŚƌŝŶĞ ĐĂŶ ďĞ ĂĚŵŝŶŝƐƚĞƌĞĚ ǁŝƚŚŽƵƚ ĚĞůĂLJ͘
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zŽƵƌ ƚĞĂŵ ŶĞĞĚƐ ƚŽ ŬŶŽǁ ǁŚĞƌĞ ƚŚĞ ĞŵĞƌŐĞŶĐLJ ǀĂƐĐƵůĂƌ ĂĐĐĞƐƐ ĞƋƵŝƉŵĞŶƚ ŝƐ
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dŚĞ ŶƵŵďĞƌ ŽĨ ƚĞĂŵ ŵĞŵďĞƌƐ ĂŶĚ ƋƵĂůŝĨŝĐĂƚŝŽŶƐ ǀĂƌLJĚĞƉĞŶĚŝŶŐ ŽŶ ƌŝƐŬ͘
WĞƌĨŽƌŵ Ă ƉƌĞͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ďƌŝĞĨŝŶŐ͘
ůĚĞŶƚŝĨŝĞƐ ƚĞĂŵ ůĞĂĚĞƌ͘
ƐƐĞƐƐĞƐ ƌŝƐŬ ĨĂĐƚŽƌƐ͕ ĚĞůĞŐĂƚĞƐ ƚĂƐŬƐ͕ ŝĚĞŶƚŝĨŝĞƐ ǁŚŽ ǁŝůů ĚŽĐƵŵĞŶƚ ĞǀĞŶƚƐ ĂƐ ƚŚĞLJ ŽĐĐƵƌ͕ ĚĞƚĞƌŵŝŶĞƐ ƐƵƉƉůŝĞƐ ĂŶĚ
ĞƋƵŝƉŵĞŶƚ ŶĞĞĚĞĚ͕ ŝĚĞŶƚŝĨŝĞƐ ŚŽǁ ƚŽ ĐĂůů ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ͘
WĞƌĨŽƌŵ ĞƋƵŝƉŵĞŶƚĐŚĞĐŬ͘
ΗdŚĞ ďĂďLJŚĂƐ ďĞĞŶ ďŽƌŶ͘Η
ZĂƉŝĚ ĞǀĂůƵĂƚŝŽŶ͘
ͻ dĞƌŵ͍
ͻ dŽŶĞ͍
ͻ ƌĞĂƚŚŝŶŐ Žƌ ĐƌLJŝŶŐ͍
ΗƉƉĞĂƌƐƚĞƌŵ͘Η
ΗEŽƚŽŶĞ͘Η
ΗEŽ ďƌĞĂƚŚŝŶŐ͘Η
ůŶŝƚŝĂů ƐƚĞƉƐ͘
ZĞĐĞŝǀĞƐ ďĂďLJ Ăƚ ƌĂĚŝĂŶƚǁĂƌŵĞƌ͕ ĚƌŝĞƐ͕ ƐƚŝŵƵůĂƚĞƐ͕ ƉŽƐŝƚŝŽŶƐ ĂŝƌǁĂLJ͕ ƐƵĐƚŝŽŶƐ ŵŽƵƚŚ ĂŶĚ ŶŽƐĞ
ƐƐĞƐƐ ďƌĞĂƚŚŝŶŐ͘ ůĨ ďƌĞĂƚŚŝŶŐ͕ ĂƐƐĞƐƐ ŚĞĂƌƚ ƌŽƚĞ͘
ŚĞĐŬƐ ďƌĞĂƚŚŝŶŐ
ΗdŚĞ ďĂďLJŝƐ ĂƉŶĞŝĐ͘Η
;,ĞĂƌƚ ƌŽƚĞ ϱϬ ďƉŵ͕ ŝĨĂƐƐĞƐƐĞĚͿ
ĞŐŝŶ WWsǁŝƚŚŝŶ ϲϬ ƐĞĐŽŶĚƐ ŽĨďŝƌƚŚ͘
ĞŐŝŶƐ WWs ŝŶ Ϯϭй ŽdžLJŐĞŶ ;ƌŽŽŵ ĂŝƌͿ͘ tŝƚŚŝŶ ϭϱ ƐĞĐŽŶĚƐ ŽĨ ďĞŐŝŶŶŝŶŐ WWs͕ ůĞĂƌŶĞƌ ĂƐŬƐ ƚŚĞ ĂƐƐŝƐƚĂŶƚ ƚŽ ĂƐƐĞƐƐ
ƚŚĞ ŚĞĂƌƚ ƌŽƚĞ ĂŶĚ ƐƚĂƚĞ ŝĨ ŚĞĂƌƚ ƌŽƚĞ ŝƐ ƌŝƐŝŶŐ͘
,ĞĂƌƚ ƌŽƚĞ ϰϬ ďƉŵ͕ ŶŽƚ ŝŶĐƌĞĂƐŝŶŐ
ƐƐĞƐƐ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ͘
ͻ ůĨ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ ŽďƐĞƌǀĞĚ͕ ĐŽŶƚŝŶƵĞƐ WWs dž ϭϱ ƐĞĐŽŶĚƐ ;ĨŽƌ ƚŽƚĂů ŽĨ ϯϬ ƐĞĐŽŶĚƐͿ
ͻ ůĨ ŶŽ ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ ŽďƐĞƌǀĞĚ͕ ƉƌŽĐĞĞĚƐ ƚŚƌŽƵŐŚ ĐŽƌƌĞĐƚŝǀĞ ƐƚĞƉƐ ;DZ͘ ^KWͿ ƵŶƚŝů ĐŚĞƐƚ ŵŽǀĞŵĞŶƚ͖ ƚŚĞŶ
ĂĚŵŝŶŝƐƚĞƌƐ WWs dž ϯϬƐĞĐŽŶĚƐ
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ŚĞĐŬƐ ŚĞĂƌƚ ƌĂƚĞ
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ůŶĚŝĐĂƚĞƐ ŶĞĞĚ ĨŽƌ ĂůƚĞƌŶĂƚŝǀĞ ĂŝƌǁĂLJ
WůĂĐĞƐ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ ůĞĂĚƐ ĂŶĚ ĐŽŶŶĞĐƚ ƚŽ ŵŽŶŝƚŽƌ ŝŶ ĂŶƚŝĐŝƉĂƚŝŽŶ ŽĨ ĂůƚĞƌŶĂƚŝǀĞ ĂŝƌǁĂLJ ;ŝĨ ŶŽƚ ĂůƌĞĂĚLJĚŽŶĞͿ͘
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ͻ ůŶƚƵďĂƚĞƐ ;ƐŝnjĞ ϭ ďůĂĚĞ ĂŶĚ ƐŝnjĞ ϯ͘ϱ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞͿ Žƌ ŝŶƐĞƌƚƐ ůĂƌLJŶŐĞĂů ŵĂƐŬ ;ƐŝnjĞ ϭͿ
ͻ ŚĞĐŬƐ ĨŽƌ Ϭ Ϯ ĚĞƚĞĐƚŽƌ ĐŽůŽƌ ĐŚĂŶŐĞ͕ ƌŝƐŝŶŐ ŚĞĂƌƚ ƌŽƚĞ͖ ĂůƐŽ ĐŚĞĐŬƐ ĨŽƌ ďŝůĂƚĞƌĂů ďƌĞĂƚŚ ƐŽƵŶĚƐ ĂŶĚ ĐŚĞƐƚ
ŵŽǀĞŵĞŶƚ ǁŝƚŚ WWs
ͻ &Žƌ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ͗ ĐŚĞĐŬƐ ƚŝƉͲƚŽͲůŝƉ ŝŶƐĞƌƚŝŽŶ ĚĞƉƚŚ ƵƐŝŶŐ ŶĂƐĂůͲƚƌĂŐƵƐ ůĞŶŐƚŚ ;Ed>Ϳ Žƌ ŝŶƐĞƌƚŝŽŶ ĚĞƉƚŚ ĐŚĂƌƚ
ͻ ƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ƐĞĐƵƌĞ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ Žƌ ůĂƌLJŶŐĞĂů ŵĂƐŬ
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ͻ ZĞŵŽǀĞƐ ĚĞǀŝĐĞ
ͻ ZĞƐƵŵĞƐ WWs ďLJ ĨĂĐĞ ŵĂƐŬ
ͻ ZĞƉĞĂƚƐ ŝŶƐĞƌƚŝŽŶ ĂƚƚĞŵƉƚ
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ͻ KƉĞƌĂƚŽƌ ĐŽŶƚŝŶƵĞƐ WWs dž ϯϬ ƐĞĐŽŶĚƐ
ͻ ƐƐŝƐƚĂŶƚ ĐŚĞĐŬƐ ƚŝƉͲƚŽͲůŝƉ ĚĞƉƚŚ ƵƐŝŶŐ ŐĞƐƚĂƚŝŽŶĂů ĂŐĞͬǁĞŝŐŚƚƚĂďůĞ Žƌ Ed> ŵĞĂƐƵƌĞŵĞŶƚ
Ͳ ůĨ ƵƐŝŶŐ Ed>͕ ŵĞĂƐƵƌĞƐ ĚŝƐƚĂŶĐĞ ĨƌŽŵ ƚŚĞ ŶĂƐĂů ƐĞƉƚƵŵ ƚŽ ƚŚĞ ĞĂƌ ƚƌĂŐƵƐ ;ŝŶƐĞƌƚŝŽŶ ĚĞƉƚŚ ΀Đŵ΁сEd> н ϭĐŵͿ
ͻ ƐƐŝƐƚĂŶƚ ƐĞĐƵƌĞƐ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ
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ŚĞĐŬƐ ŚĞĂƌƚ ƌĂƚĞ ďLJ ŽďƐĞƌǀŝŶŐ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ ;ŵĂLJ ĂůƐŽ ĂƵƐĐƵůƚĂƚĞ ŚĞĂƌƚ ƌŽƚĞͿ ĂĨƚĞƌ ϯϬ ƐĞĐŽŶĚƐ ŽĨ WWs ƚŚĂƚ
ŵŽǀĞƐ ƚŚĞ ĐŚĞƐƚ ǁŝƚŚ ĂŶ ĂůƚĞƌŶĂƚŝǀĞ ĂŝƌǁĂLJ
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ͻ ĂůůƐ ĨŽƌ ĂĚĚŝƚŝŽŶĂů ŚĞůƉ
ͻ ƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ŝŶĐƌĞĂƐĞ ŽdžLJŐĞŶ ƚŽ ϭϬ Ϭй
ͻ ƐŬƐ ĂƐƐŝƐƚĂŶƚ ƚŽ ƉůĂĐĞ ƐĞƌǀŽͲĐŽŶƚƌŽůůĞĚ ƚĞŵƉĞƌĂƚƵƌĞ ƐĞŶƐŽƌ ŽŶ ďĂďLJ͕ ŝĨ ŶŽƚ ĂůƌĞĂĚLJĚŽŶĞ͕ ĂŶĚ ĂĚũƵƐƚ ƚŽ
ŵĂŝŶƚĂŝŶ ďĂďLJΖƐ ƚĞŵƉĞƌĂƚƵƌĞ ϯϲ͘ϱ Ǒ ƚŽ ϯϳ͘ϱ Ǒ ͻ ĚŵŝŶŝƐƚĞƌƐ ĐŽŵƉƌĞƐƐŝŽŶƐ ĨƌŽŵ ŚĞĂĚ ŽĨ ďĞĚ ǁŝƚŚ ĐŽŽƌĚŝŶĂƚĞĚ ǀĞŶƚŝůĂƚŝŽŶ ;ƚŚƵŵďƐ ŽŶ ůŽǁĞƌ ŽŶĞͲƚŚŝƌĚ ŽĨ ƐƚĞƌŶƵŵ͕
ĐŽŵƉƌĞƐƐŝŽŶƐ ŽŶĞͲƚŚŝƌĚ ŽĨ ƚŚĞ ĂŶƚĞƌŝŽƌͲƉŽƐƚĞƌŝŽƌ ΀W΁ ĚŝĂŵĞƚĞƌ ŽĨ ƚŚĞ ĐŚĞƐƚ͕ ϯ ĐŽŵƉƌĞƐƐŝŽŶƐ͗ϭǀĞŶƚŝůĂƚŝŽŶ ĞǀĞƌLJ Ϯ
ƐĞĐŽŶĚƐͿ
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WĂƵƐĞƐ ĐŽŵƉƌĞƐƐŝŽŶƐ͕ ĐŽŶƚŝŶƵĞƐ WWs͕ ĂŶĚ ĐŚĞĐŬƐ ŚĞĂƌƚ ƌŽƚĞ ĂĨƚĞƌ ϲϬ ƐĞĐŽŶĚƐ ŽĨ ĐŽŵƉƌĞƐƐŝŽŶƐ ĂŶĚ ǀĞŶƚŝůĂƚŝŽŶƐ͘
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ůŶĚŝĐĂƚĞƐ ŶĞĞĚ ĨŽƌ ĞŵĞƌŐĞŶĐLJ ǀĂƐĐƵůĂƌ ĂĐĐĞƐƐ͘
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ZĞƋƵĞƐƚƐ ĞƉŝŶĞƉŚƌŝŶĞ ǀŝŽ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ
ŽŶĐĞŶƚƌĂƚŝŽŶ͗ Ϭ͘ϭ ŵŐͬŵůс ů ŵŐͬϭϬ ŵů
^ƵŐŐĞƐƚĞĚ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ĚĞƐĞ͗ Ϭ͘ϭ ŵŐͬŬŐ ;ů ŵůͬŬŐͿ
ͻ ZĞƋƵĞƐƚƐ ĞƐƚŝŵĂƚĞĚ ǁĞŝŐŚƚ͗ 7KH EDE\ VHVWLPDWHGZHLJKWLV NJ
ͻ KƌĚĞƌƐ ĞƉŝŶĞƉŚƌŝŶĞ ĨŽƌ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ĨŽƌ Ă ďĂďLJ ǁĞŝŐŚŝŶŐ ϯ ŬŐ͗
Ϭ͘ϯ ŵŐ ĞƉŝŶĞƉŚƌŝŶĞ ǀŝŽ ƚŚĞ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ ;ĞƋƵĂů ƚŽ ϯ ŵů ŝŶ ƐLJƌŝŶŐĞͿ
ͻ hƐĞƐ ĐůŽƐĞĚͲůŽŽƉ ĐŽŵŵƵŶŝĐĂƚŝŽŶ ǁŝƚŚ ĐŽŶĨŝƌŵĂƚŝŽŶ ŽĨ ŵĞĚŝĐĂƚŝŽŶ͕ ĚĞƐĞ͕ ĂŶĚ ƌŽƵƚĞ
ͻ ƐƐŝƐƚĂŶƚ ĐŚĞĐŬƐ ŵĞĚŝĐĂƚŝŽŶ ůĂďĞů͕ ŽƉĞŶƐ ŵĞĚŝĐĂƚŝŽŶ͕ ĂƚƚĂĐŚĞƐ ƐƚŽƉĐŽĐŬ Žƌ ƐLJƌŝŶŐĞ ĐŽŶŶĞĐƚŽƌ ĂŶĚ ϱͲŵů ƐLJƌŝŶŐĞ
ͻ ƐƐŝƐƚĂŶƚ ƉƌĞƉĂƌĞƐ ĐŽƌƌĞĐƚ ǀŽůƵŵĞ͕ ůĂďĞůƐ ƐLJƌŝŶŐĞ ǁŝƚŚ ŵĞĚŝĐĂƚŝŽŶ ŶĂŵĞ ĂŶĚ ŝŶƚĞŶĚĞĚ ƌŽƵƚĞ
ĚŵŝŶŝƐƚĞƌƐ ĞŶĚŽƚƌĂĐŚĞĂů ĞƉŝŶĞƉŚƌŝŶĞ ;ĐĂŶ ďĞ ƉĞƌĨŽƌŵĞĚ ďLJ ĂƐƐŝƐƚĂŶƚ Žƌ ŽƉĞƌĂƚŽƌͿ
ͻ 'ŝǀĞƐ ƚŚĞ ĞƉŝŶĞƉŚƌŝŶĞ ĚŝƌĞĐƚůLJ ŝŶƚŽ ƚŚĞ ĞŶĚŽƚƌĂĐŚĞĂů ƚƵďĞ͕ ĚŽĞƐ ŶŽƚ ůĞĂǀĞ ŝƚ ĚĞƉŽƐŝƚĞĚ ŝŶ ƚŚĞ ƚƵďĞ ĐŽŶŶĞĐƚŽƌ͘
ͻ &ŽůůŽǁƐ ƚŚĞ ĚƌƵŐ ǁŝƚŚ ƐĞǀĞƌĂů ƉŽƐŝƚŝǀĞͲƉƌĞƐƐƵƌĞ ďƌĞĂƚŚƐ ƚŽ ĚŝƐƚƌŝďƵƚĞ ƚŚĞ ĚƌƵŐ ŝŶƚŽ ƚŚĞ ůƵŶŐƐ͘
ͻ ŶŶŽƵŶĐĞƐ (7HSLQHSKULQHJLYHQ
ZĞƋƵĞƐƚƐ ŚĞĂƌƚ ƌŽƚĞ ĐŚĞĐŬ ĂĨƚĞƌ ϲϬ ƐĞĐŽŶĚƐ͘ WĂƵƐĞƐ ĐŽŵƉƌĞƐƐŝŽŶƐ ďƌŝĞĨůLJ ĂŶĚ ŽďƐĞƌǀĞƐ ĐĂƌĚŝĂĐ ŵŽŶŝƚŽƌ͖ ŵĂLJ ĂůƐŽ
ĂƵƐĐƵůƚĂƚĞ ŚĞĂƌƚ ƌŽƚĞ͘
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ŽŶƚŝŶƵĞƐ WWs ĂŶĚ ĐŽŵƉƌĞƐƐŝŽŶƐ͘
3UHSDUHHPHUJHQF\XPELOLFDO YHQRXV FDWKHWHU PD\EH SHUIRUPHG E\DVVLVWDQWRURSHUDWRU ͻ KďƚĂŝŶƐ ƐLJƌŝŶŐĞ ǁŝƚŚ ŶŽƌŵĂů ƐĂůŝŶĞ ĨůƵƐŚ
ͻ ƚƚĂĐŚĞƐ ϯͲǁĂLJ ƐƚŽƉĐŽĐŬ ƚŽ ƵŵďŝůŝĐĂů ǀĞŶŽƵƐ ĐĂƚŚĞƚĞƌ
ͻ &ůƵƐŚĞƐ ĐĂƚŚĞƚĞƌ ĂŶĚ ƐƚŽƉĐŽĐŬ ǁŝƚŚ ŶŽƌŵĂů ƐĂůŝŶĞ
ͻ ůŽƐĞƐ ƐƚŽƉĐŽĐŬ ƚŽ ĐĂƚŚĞƚĞƌ
OQVHUWHPHUJHQF\ XPELOLFDO YHQRXV FDWKHWHU
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ͻ ŽŶƚŝŶƵĞƐ WWs ĂŶĚ ĐŽŵƉƌĞƐƐŝŽŶƐ
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ǁŚŽ ƚŽ ĐŽŶƚĂĐƚ ŝĨ ƚŚŝƐ ƚŚĞƌĂƉLJ ŵĂLJ ďĞ ŝŶĚŝĐĂƚĞĚ͘
WƌĂĐƚŝĐĞ ŚŽǁ ƚŽ ŝŶŝƚŝĂƚĞ ƚŚĞƌĂƉĞƵƚŝĐ ŚLJƉŽƚŚĞƌŵŝĂ Žƌ ƚŚĞ ƉƌŽĐĞƐƐ ĨŽƌ ƉƌŽŵƉƚůLJ ƚƌĂŶƐĨĞƌƌŝŶŐ ƚŚĞ ďĂďLJ
ƚŽ Ă ƌĞĨĞƌƌĂů ĐĞŶƚĞƌ ǁŝƚŚ ƚŚĞ ƌĞƋƵŝƌĞĚ ĞdžƉĞƌƚŝƐĞ͘
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<ŶŽǁ ǁŚĂƚ ĞƋƵŝƉŵĞŶƚ ŝƐ ĂǀĂŝůĂďůĞ ŝŶ LJŽƵƌ ŝŶƐƚŝƚƵƚŝŽŶ ƚŽ ŽďƚĂŝŶ Ă ďůŽŽĚ ŐĂƐ͕ ĞůĞĐƚƌŽůLJƚĞƐ͕ ĂŶĚ
ƐĞƌƵŵ ŐůƵĐŽƐĞ ůĞǀĞů͘
<ŶŽǁ ŚŽǁ ƚŽ ƵƐĞ ƚŚĞ ƚĞŵƉĞƌĂƚƵƌĞ ƐĞŶƐŽƌ ŽŶ LJŽƵƌ ƌĂĚŝĂŶƚ ǁĂƌŵĞƌ͘
ĞůĞŐĂƚĞ
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ŽƉƚŝŵĂůůLJ͘
DĂŶLJ ƉƌŽĐĞĚƵƌĞƐ ŶĞĞĚ ƚŽ ďĞ ƉĞƌĨŽƌŵĞĚ ĚƵƌŝŶŐ ƚŚĞ ĨŝƌƐƚ ŚŽƵƌ ĂĨƚĞƌ Ă ƐƵĐĐĞƐƐĨƵů ƌĞƐƵƐĐŝƚĂƚŝŽŶ͘ WůĂŶ
ǁŚŽ ǁŝůů ƉĞƌĨŽƌŵ ĞĂĐŚ ƚĂƐŬ ƚŽ ĂǀŽŝĚ ƵŶŶĞĐĞƐƐĂƌLJ ĚĞůĂLJƐ͘
ŽŵŵƵŶŝĐĂƚĞ
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ƌŝŶŐ ƚŚĞ ĐĂƌĞ ƚĞĂŵ ƚŽŐĞƚŚĞƌ ĨŽƌ Ă ƉŽƐƚͲƌĞƐƵƐĐŝƚĂƚŝŽŶ ĚĞďƌŝĞĨŝŶŐ ƚŽ ƌĞŝŶĨŽƌĐĞ ŐŽŽĚ ƚĞĂŵǁŽƌŬ
ŚĂďŝƚƐ ĂŶĚ ŝĚĞŶƚŝĨLJ ĂƌĞĂƐ ĨŽƌ ŝŵƉƌŽǀĞŵĞŶƚ͘ ůĚĞŶƚŝĨLJŝŶŐ ƐŵĂůů ĐŚĂŶŐĞƐ ŵĂLJ ƌĞƐƵůƚ ŝŶ ƐŝŐŶŝĨŝĐĂŶƚ
ŝŵƉƌŽǀĞŵĞŶƚƐ ŝŶ LJŽƵƌ ƚĞĂŵΖƐ ƉĞƌĨŽƌŵĂŶĐĞ ĂŶĚ ƉĂƚŝĞŶƚ ƐĂĨĞƚLJ͘
YƵĂůŝƚLJůŵƉƌŽǀĞŵĞŶƚKƉƉŽƌƚƵŶŝƚŝĞƐ
As yo rse f t e fo o in
estions and e in a disc ssion it yo r
team if yo find a difference et een t e
P recommendations and
at is c rrent y done in yo r o n os ita settin
onsider sin t e
s ested rocess and o tcome meas res to ide yo r data co ection
identify areas for im ro ement and monitor if yo r im ro ement
efforts are or in
YƵĂůŝƚLJŝŵƉƌŽǀĞŵĞŶƚƋƵĞƐƚŝŽŶƐ
f a a y as recei ed o y en PP or PAP d rin t e initia
sta i i ation
o i e res onsi e for ost res scitation care
and contin ed assessments
f
at reso rces are a ai a e to care for a a y
ad anced neonata care
o re
ires
at c a en es oes yo r team face en trans ortin a ne orn
from t e de i ery ocation to an en ironment ere contin o s
cardiores iratory monitorin is a ai a e and ita si ns can e
meas red fre ent y
a e neonata care ro iders een trained to identify a ies t at
may e candidates for t era e tic y ot ermia
o yo no
o to contact if yo
t era e tic y ot ermia
e ie e a a y is a candidate for
o yo a e a rocess to s
ort t e mot er s reastfeedin
en t e ne orn re ires on oin monitorin
an
WƌŽĐĞƐƐĂŶĚ ŽƵƚĐŽŵĞ ŵĞĂƐƵƌĞƐ
o often is a res scitation record com eted t at doc ments a i
inter entions erformed d rin res scitation and sta i i ation
f
o often oes t e res scitation team com ete a
ost res scitation de riefin
o often are a ies
y
o ycemic after res scitation
o often are a ies transferred from t e de i ery ocation to an
ad anced care n rsery nit
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