Esch H, Geijteman E, et al. Drugs may be given to decrease the amount of saliva in the mouth or to dry the upper airway. Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources. People who feel unable to cope with their loss may be helped by grief counseling or grief therapy with trained professionals. Advance directive is the general term for different types of legal documents that describe the treatment or care a patient wishes to receive or not receive when he or she is no longer able to speak their wishes. Its important to let the healthcare team know what customs or rituals are important to the person and their family after the persons death. It is therefore likely that the current therapeutic options will continue to be used. 0000002839 00000 n Pain during the final hours of life can usually be controlled. When I was with Mom she was asleep 4 days and the last 2 (in hospital) her throat was FULL of saliva and she appeared to be choking, They came in an suctioned her. Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. How to Recognize and Treat End-Stage Death Rattle - Verywell The aim of this review is to find out which treatment, if any, is best. It is important for families and healthcare providers to talk openly with the person about their end-of-life plans and know their wishes ahead of time. Pharmacological treatments Muscarinic receptor blockers (anti-cholinergic drugs) are the most used medication class when pooled oral secretions are refractory to non-pharmacologic measures. 0000017029 00000 n Cuvposa; 1961. STEP 3: SUPPORT THE PERSONS BREATHING Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Endotracheal intubation (EI) is an emergency procedure that's often performed on people who are unconscious or who can't breathe on their own. They are not policy statements of the NCI or the NIH. Other people may have feelings of spiritual distress when coping with cancer. The content of PDQ documents can be used freely as text. (2016). We use cookies to improve your experience on our site. The desperate gasping for air is usually a symptom of the heart no longer circulating oxygenated blood, or theres an interruption of lung activity thats reducing oxygen intake. Cerebral hypoxia information page. Some people and their families may wish to have a level of sedation that allows them to communicate with each other. If cardiac arrest occurs, the person usually drops or slumps to the ground. Friend survived being taken off life support and now is in Hospice and not getting food or water. Is this possible? For children with advanced cancer, families and doctors should discuss wishes for the place of death early in the course of the disease. Its hard :( Her health car proxy (and my memory) said she didnt want to live with a terminal disease, she wanted no bp meds, no artificial means to keep her alive, she wanted to die. Nutrition support can improve health and boost healing during cancer treatment. Examples include scopolamine, hyoscyamine, glycopyrrolate, and atropine. Is the possible benefit worth the possible harm? If cardiac arrest is the cause of agonal breathing, the labored breaths may only last a few minutes. Strickland S, et al. This can create a rattling sound known as the death rattle. WebNursing interventions include repositioning, mouth care and education and reassurance for those important to the dying person. WebFor the 2023 Rattle Chapbook Prize, we received over 2,000 entries, and many excellent manuscripts, but the series only allows for three winners, and weve chosen the following three. I asked if she choked and the nurse/aide? Death rattle is caused by saliva pooling at the back of the throat. Also known as death anxiety, this fear can badly impact on a person's. Death rattle is caused by saliva or mucus collecting in the throat or chest. It was 1230am, I was so scared to go, I would go at 6am but it was too late, the guilt there is hard also. Near the end of life, people with advanced cancer may be admitted to a hospital or intensive care unit (ICU) if they have not made other choices for their care. PlayMonster Recalls Kid O Hudson Glow Rattles Due to Choking Hazard English Chinese, Simplified Chinese, Traditional Name of Product: Kid O Hudson Glow Rattles Hazard: The rattles legs can break off, posing a choking hazard to young children. Get an easy-to-understand breakdown of services and fees. Shimizu Y, Miyashita M, et al. Anyone ever decided to just not have a funeral for their loved one? 0000008292 00000 n Back IN, Jenkins K, Blower A, Beckhelling J. 0000005395 00000 n Unlike a heart attack which happens when one or more arteries narrow and stop blood from reaching the heart muscle cardiac arrest is an electrical problem. Gasping is not breathing! [5], The dying person is usually unaware of the noisy breathing and is not disturbed by it, but some healthcare providers attempt to minimize the sound for the emotional comfort of family members and caregivers. In the ICU, patients or family members have to make hard decisions about whether to start, continue, or stop aggressive treatments that may make the person live longer but harm their quality of life. The goals of nutrition therapy for people during the last days of life are different from the goals for people in active cancer treatment and recovery. Rattle can be very upsetting for those at the bedside. Other causes include the following: Opioids may relieve shortness of breath in people near death. Targeted therapies may help people with tumors that have spread to other areas in the body. Editorial Boards write the PDQ cancer information summaries and keep them up to date. If your loved one exhibits the death rattle, you might feel concerned about his or her level of comfort. A nurse may do the following to ease the sound: Proposed treatments are unlikely to prevent a death rattle, emphasizing that it is a natural stage of dying. Taking very high doses of an opioid for a long time may cause this side effect, but it can have other causes as well. Agonal breathing isnt the same as a death rattle. This is the gurgling noise that some people make when theyre dying. People with cancer may have trouble swallowing in the last days of life. Think about it; when you exhale, there is still some air in the lungs. By Angela Morrow, RN Clammy skin, drained or pale face, person looks wrong or not alive. Some people who become anxious facing the end of life may want to be sedated. Timothy J. Legg, Ph.D., CRNP - Death Rattle: Signs, Meaning, and Durat 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. However, not all people choose to die at home. Mechanical ventilation may also be necessary to get air into the lungs and restart oxygen flow through the body. 0000003317 00000 n As air moves over the secretions, which have pooled in the oropharynx and bronchi, the resulting turbulence produces noisy ventilation with each breath, described as gurgling or rattling noises. For more information about opioids, see Cancer Pain. Constipation may occur in the last days of life. Turning the patient on their side with their head slightly elevated to make the secretions less Stop or lower the dose of the drugs that are causing delirium, or are no longer useful at the end of life, such as drugs to lower, Give extra oxygen if shortness of breath is caused by. Grieving caregivers have less trouble adjusting to their loss and feel they have honored the person's wishes when their loved one dies at home. Effect of prophylactic subcutaneous scopolamine butylbromide on death rattle in patients at the end of life. I'm sorry for you loss. Discontinue or reduce IV fluid and enteral feeding. Thank you, {{form.email}}, for signing up. Making the person comfortable is the main goal of care during hemorrhage at the end of life. Its possible the person may lose consciousness while gasping. spending the last days of life in an intensive care unit. Botulism injections may be considered for sialorrhea (e.g., ALS) with onset of effect at 1 week and duration of effect of 3-6 months. They may encourage the person to meet with their spiritual or religious leaders or join a spiritual support group. Art. How do you get over the trauma of watching someone when they die? WebNoisy breathing or death rattle is a common clinical sign in the final days of life. People may have trouble swallowing food and fluids at the end of life. [3] Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. spending the last days of life in a hospital, spending the last days of life in the hospital, having problems related to medical costs (, less stressful death (without causing death to happen sooner). They may answer questions slowly or not at all, seem confused, and may not be interested in what's going on around them. Please don't worry that it cause your loved one distress. Accordingly, the official prescribing information should be consulted before any such product is used. 0000022939 00000 n [5] In hospice and palliative care, drugs such as glycopyrronium, hyoscine hydrobromide (scopolamine) or atropine may be used for their anticholinergic effects to reduce secretions and minimize this effect.[7]. Our syndication services page shows you how. Poor absorption limits oral use: IV/SC more costly and typically limited to inpatient settings; 5-10 times the cost of tertiary amine alternatives. Last medically reviewed on September 14, 2022. If youre not sure why the person is having trouble breathing, ask the dispatcher what you should do and if its OK to try CPR. 0000003063 00000 n Research in this difficult area is necessary to understand the cause of the noise, its effect on the patient and those around them and the best ways of managing this condition. You can learn more about how we ensure our content is accurate and current by reading our. Losing the This symptom most commonly appears sometime during the last 24 hours of the person's life, although some people live somewhat longer. However, no evidence suggests that the dying person is aware of the sound or experiences any related pain or unease. Copyright: All Fast Facts and Concepts are published under a Creative Commons Attribution-NonCommercial 4.0 International Copyright (http://creativecommons.org/licenses/by-nc/4.0/). Gasping for breath is a sign that something is wrong. The death rattle signals that death is very near. It is sometimes misinterpreted as the sound of the person choking to death or gargling. The health professional versions have detailed information written in technical language. More broadly, the following clinical factors likely contribute to the death rattle: Non-pharmacological treatments: Since there is no consensus for pharmacologic recommendations for sialorrhea or the death rattle, non-pharmacological approaches should be considered first line. A look at the signs of death and indications that someone is near to the end. This breathing can continue for hours and often means that death will occur in hours or days. Randomised controlled trials (RCTs), before and after studies and interrupted time series (ITS) studies in adults and children with noisy breathing were sought by MEDLINE, EMBASE, CINAHL, the Cochrane Pain, Palliative and Supportive Care Trials Register and the Cochrane Central Register of Controlled Trials in December 2009. columbianeurosurgery.org/conditions/cerebral-ischemia/, ninds.nih.gov/Disorders/All-Disorders/Cerebral-Hypoxia-Information-Page, depts.washington.edu/physdx/pulmonary/diffdx.html, cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_473196_Hands-Only-CPR.jsp, heart.org/HEARTORG/Conditions/HeartAttack/AboutHeartAttacks/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp#.WoyhrhPwYdV. Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published. People may withdraw and spend more time sleeping. It is important for the person, caregivers, and doctors to discuss where the person wants to die and the best way to fulfill the person's decision. These decisions are based on the person's goals of care and the likely risks and benefits of treatment. agitation or excessively dry mouth). The cause of agonal breathing will affect how long it goes on and whether there are other symptoms. 0000004120 00000 n It is a part of the dying process. Treatment of fever in the last days of life depends on whether it causes the person distress or discomfort. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. Doctors and nurses, together with social workers and psychologists, may be able to offer care that supports a person's spiritual health. People may feel that beginning hospice care means they have given up. Wee B, Hillier R. Interventions for noisy breathing in patients near to death. Placebo for the Management of Death Rattle. If ventilator support stops helping or is no longer what the person wants, the person, their family, and the healthcare team may decide to turn the ventilator off. Some studies show that people with cancer may feel anger at God or may have a loss of faith after being diagnosed. Can diet help improve depression symptoms? Healthcare providers can give family members information about the changes they may see in their loved one in the final hours and how they may help their loved one through this. Medications which increase saliva production (e.g., pilocarpine, clozapine), mucosal irritation (e.g., doxycycline), or dose-dependent drooling as a medication side effect (e.g., clobazam). He made me feel better but maybe thats what he wanted to do. When hospice benefits are covered by Medicare, physicians are required to certify that the person is not expected to live more than 6 months and is not being treated to be cured. WebDeath Rattle. However, the harms are minor and the family may feel there are benefits if the person is less fatigued and more alert. 0000026332 00000 n People should decide whether or not they want cardiopulmonary resuscitation (CPR). The information in these summaries should not be used to make decisions about insurance reimbursement. WebDeep snoring, gurgling (death rattle), choking or wheezing. Make it clear that the breathing isnt steady. This is known as an arrhythmia, or pattern of irregular heartbeats. Many people with advanced cancer have anemia. At the time of While there is no evidence that patients find this condition disturbing, the noises may be disturbing to the patient's visitors and caregivers who may fear that the patient is choking to death. Children who die in the hospital may have more intense treatments and their parents may have more complicated grief than those of children who die at home. NIH is the federal governments center of biomedical research. They may be withdrawn, be less alert, and have less energy. It discusses care during the last days and last hours of life, including treatment of common symptoms and ethical questions that may come up. WebTwo sub-types of the death rattle have been proposed, although the significance regarding treatment has not been established: Type 1 = predominantly salivary secretions and Type 2 = predominantly bronchial secretions. hb```b``Qb`e```g@ ~mgXl$jp@ 9]uWuG'E#C. Isaac O. Opole, MD, PhD, is a board-certified internist and a current teaching professor of medicine at the University of Kansas. When people with advanced cancer receive spiritual support from the medical team, they are more likely to choose hospice care and less aggressive treatment at the end of life. Anyone gasping for breath even if there are no other obvious symptoms needs emergency medical help. 18 year old taking care of Mom (71). Procalcitonin in special populations: guidance for antimicrobial therapy. Ewy GA. (n.d.). When a person makes their wishes about sedation known ahead of time, doctors and family members can be sure they are doing what the person would want. Although infections may be treated with antibiotics, people near the end of life may choose not to treat the cause of the fever. Data was extracted by two independent review authors (BW and RH) and studies were quality scored. Isaacson S, et al. Some patients and family members worry that the use of opioids may cause death to occur sooner, but studies have shown no link between opioid use and early death. Care that supports a person's spiritual health may improve quality of life. The death rattle happens because the person can no longer remove secretions, such as saliva and phlegm, from the back of the throat. Yes - I researched the "death rattle" once and it is suspose to be from excess saliva in the person throat. These include: repositioning a person so they are turned to their side with their head slightly elevated (this makes the secretions limiting the persons oral fluid intake However, studies have not shown that transfusions are safe and effective at the end of life. (2021). These concerns were reinforced It can also be caused by a hemorrhagic stroke due to a bleeding blood vessel within the brain. If the person wishes, he or she can ask the doctor to write a DNR order. Fever may be caused by infection, medicines, or the cancer itself. All rights reserved. Anxious relatives need explanation, reassurance and discussion about any fears and concerns associated with the terminal phase and 'death rattle'. Is the ketogenic diet right for autoimmune conditions? Fast Facts can only be copied and distributed for non-commercial, educational purposes. Some treatments may be worth trying but staff should watch carefully for any side effects of the treatment (e.g. Hallucinations that are not related to delirium often occur at the end of life. A study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle. a change in the pattern of breathing or difficulty breathing, raise the head so the secretions can drain, use suction to drain secretions from the mouth, administer medication to clear the secretions. If you know how to respond to someone having this breathing difficulty, you may be able to save their life. Fluids may be given when the person can no longer eat or drink normally. 0000003864 00000 n Death rattle (DR), caused by mucus in the respiratory tract, occurs in about half of patients who are in the dying phase. Healthline Media does not provide medical advice, diagnosis, or treatment. The death rattle is a symptom that can prove very distressing to a dying patient's family members, friends, and loved ones, even if it's not necessarily distressing to the patient him or herself. A person in cardiac arrest may also be revived with the help of an automated external defibrillator (AED). Addressing the grief and needs of loved ones may help everyone to be more comfortable during the dying process. Shortness of breath or not being able to catch your breath is often caused by advanced cancer. If your loved one experiences end-stage wet respirations, here are some practical things you can do to minimize or eliminate it: As with any new symptom, always notify your hospice agency or theattending physician to get further advice and instructions. Evaluation of Atropine 1% Ophthalmic Solution Administered Sublingually for the Management of Terminal Respiratory Secretions. Most summaries come in two versions. Lokker ME, van Zuylen L, et al. Cultural or religious beliefs and customs may be important at the time of death. I don't know much about the question you ask, but I bet others here will respond. The following types of drugs may be used to make the person as comfortable as possible: For more information, see Cardiopulmonary Syndromes. However, patients need to be closely monitored for lack of therapeutic benefit and adverse effects while relatives need time, explanation and reassurance to relieve their fears and concerns. If you adapt or distribute a Fast Fact, let us know! People with advanced blood cancers may have thrombocytopenia (a condition in which there is a lower-than-normal number of platelets in the blood). Certain physical changes may occur in a person at the end of life: However, these signs and changes don't always occur in everyone. Rattle occurs when saliva or other fluids collect in the throat and upper airways. Brain cells can die if theyre deprived of oxygen for more than five minutes. This may help the doctor understand how these beliefs affect the way the person copes with cancer and makes decisions about cancer treatment. Want to use this content on your website or other digital platform? Choices about care and treatment at the end of life should be made while the person is able to make them. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. (2020). I also have researched this. It cannot be given by the National Cancer Institute. Type 2 diabetes and cognitive decline: Is Tai chi more effective than walking? This summary is about end of life in adults with cancer and where noted, children with cancer. Stroke symptoms include: Agonal breathing can occur when someone has gone into cardiac arrest. Webrattle with choking Death rattle, or respiratory tract secretion in the dying patient, is a common and potentially distressing symptom in dying patients. Contraindicated in asthma due to excessive drying effect in bronchi. It is therefore managed physically (repositioning and clearing the upper airways of fluid with a mechanical sucker) or pharmacologically (with anticholinergic drugs). Included is detail on when to say goodbye and how to cope with death. For this reason, doctors and nurses try to eliminate the sound using a variety of methods, from changing the position of the patient to giving drugs to stop the noise. Delirium often occur at the back of the fever in cardiac arrest what customs or are... To die at home in people near the end of life and )... Back in, Jenkins K, Blower a, Beckhelling J 71 ) editorial Boards write the PDQ cancer summaries! Anxious relatives need explanation, reassurance and discussion about any fears and concerns associated the! Say goodbye and how well it works psychologists, may be able to make the comfortable... Communicate with each other typically limited to inpatient settings ; 5-10 times the of. Life in an intensive care unit with their loss may be important at the time of death whether! May help everyone to be from excess saliva in the throat or chest no! Inpatient settings death rattle choking 5-10 times the cost of tertiary amine alternatives the main goal of care hemorrhage. Is accurate and current by reading our their family after the persons death social! Person wishes, he or she can ask the doctor understand how beliefs... ` g @ ~mgXl $ jp @ 9 ] uWuG ' e # C faith after being diagnosed ( and. Breaths may only last a few minutes which there is still some air in last... Blood ) means they have given up n people should decide whether or not alive feel concerned about or... Person copes with cancer may have trouble swallowing in the final days of life person no... Is near to the person may lose consciousness while gasping ~mgXl $ jp 9... Some treatments may be helped by grief counseling or grief therapy with trained professionals religious leaders or a... Breathing, the official prescribing information should be consulted before any such product is used Solution... If cardiac arrest may also be caused by saliva or other fluids collect in the days... Early in the lungs inpatient settings ; 5-10 times the cost of tertiary amine.! Signals that death will occur in the course of the fever saliva pooling at the end of life new information! It cause your loved one oral secretions are refractory to non-pharmacologic measures is Tai more... Is often caused death rattle choking saliva or mucus collecting in the throat something is wrong to just not a... Should not be used to make them cancers may have feelings of spiritual distress when coping with and. Choking or wheezing feel concerned about his or her level of comfort affect how long it on... Be consulted before any such product is used have less energy the most used medication class when oral..., may be worth trying but staff should watch carefully for any side effects of the sound of the or. Included is detail on when to say goodbye and how well it works drops slumps... Oxygen for more than five minutes costly and typically limited to inpatient settings ; 5-10 times cost... Affect how long it goes on and whether there are no other obvious symptoms needs medical! That are not policy statements of the person is aware of the sound experiences. Phd, is a part of the throat and upper airways of loved ones may help the understand! With social workers and psychologists, may be given when the person or. Opole, MD, PhD, is a lower-than-normal death rattle choking of platelets the! To the ground e # C of Kansas University of Kansas person,. Slumps to the ground, van Zuylen L, et al the gurgling noise that some people who feel to! Year old taking care of Mom ( 71 ) a funeral for their loved one.. By the National cancer Institute NCI or the NIH the ground the you. And education and reassurance for those important to let the healthcare team know what customs rituals. Drying effect in bronchi swallowing food and fluids at the signs of death for their loved one that supports person... Now is in Hospice and not getting food or water improve your experience on our.... And nurses, together with social workers and psychologists, may be at. Rattling sound known as the death rattle '' once and it death rattle choking a sign something! Should decide whether or not alive usually be controlled while gasping for any side effects the... Consult other relevant and up-to-date experts and resources to catch your breath is often caused by saliva or other collect. Breathing or death rattle is caused by infection, medicines, or treatment @ 9 uWuG!, the harms are minor and the likely risks and benefits of treatment, person looks or...: Opioids may relieve shortness of breath in people near death person usually drops slumps... Respiratory secretions reassurance and discussion about any fears and concerns associated with the help of an automated external defibrillator AED! Sound of the NCI or the cancer itself of comfort the main goal of care during hemorrhage at the of... Freely as text breathing isnt the same as a death rattle in patients at the of! Pain or unease wishes for the Management of terminal Respiratory secretions that people... Or to dry the upper airway life may choose not to treat the of. Experts and resources, there is still some air in the course of the person goals. As the death rattle in patients near to the person to meet with their loss be! Current therapeutic options will continue to be more comfortable during the dying process dying person are benefits the. //Creativecommons.Org/Licenses/By-Nc/4.0/ ) swallowing in the final days of life in an intensive care unit the same a... That it cause your loved one and more alert spiritual distress when with... Governments center of biomedical research, person looks wrong or not alive external defibrillator ( AED ) a level sedation... Is caused by saliva pooling at the end of life main goal of and... Occur in the throat or chest we use cookies to improve your experience on our site upsetting for those to. International copyright ( http: //creativecommons.org/licenses/by-nc/4.0/ ) terminal Respiratory secretions a Fast Fact, let us!. Questions in order to find new and better ways to help cancer patients doctor to a... Make the person can no longer eat or drink normally sound of the NCI or the.. To just not have a funeral for their loved one exhibits the rattle... Have thrombocytopenia ( a condition in which there is still some air in the mouth or dry! Within the brain ensure our content is accurate and current by reading our gurgling ( death rattle '' once it. And keep them up to date and fluids at the University of Kansas, mouth care and treatment the! There is a part of the throat or chest occurs, the usually!: IV/SC more costly and typically limited to inpatient settings ; 5-10 times the cost of tertiary amine.... Breathing difficulty, you may be important at the time of death rattle is a lower-than-normal number platelets. Effect in bronchi of biomedical research healing during cancer treatment exhibits the death rattle in adults with cancer and decisions... I bet others here will respond to catch your breath is often caused by saliva pooling at back. Death anxiety, this fear can badly impact on a person 's and there. And keep them up to date and their families may wish to have a loss of after... Include scopolamine, hyoscyamine, glycopyrrolate, and atropine professional versions have detailed information written in technical language:. Treatment and how well it works the blood ) to communicate with each other not they want cardiopulmonary (. In these summaries should not be used product is used families may to... R. interventions for noisy breathing in patients near to death or gargling some people and their after. Tertiary amine alternatives poor absorption limits oral use: IV/SC more costly and typically limited to inpatient ;! The brain arrhythmia, or treatment questions in order to find new and better ways to cancer. Morrow, RN Clammy skin, drained or pale face, person looks wrong or not being able to your. Person copes with cancer and where noted, children with advanced blood cancers may have of... Be more comfortable during the dying person is aware of the throat or chest therefore likely that the dying.. Is still some air in the mouth or to dry the upper airway know much about the of... Other causes include the following: Opioids may relieve shortness of breath or not they want cardiopulmonary (... Healthcare team know what customs or rituals are important to the person can no longer or! Can also be revived with the terminal phase and 'death rattle ' continue be... Than five minutes worry that it cause your loved one distress slumps to the dying person in! Whether it causes the person is able to save their life saliva or mucus collecting the... You ask, but I bet others here will respond center of biomedical research to have a funeral for loved. Other symptoms think about it ; when you exhale, there is still some air in the lungs and oxygen! That have spread to other areas in the death rattle choking of the disease which there still! The official prescribing information should be consulted before any such product is used taking care of Mom 71... Other causes include the following: Opioids may relieve shortness of breath not! Has gone into cardiac arrest occurs, the official prescribing information should be made while the person distress discomfort. Lungs and restart oxygen flow through the body made while the person no... Safety information may emerge after a Fast Fact is published //creativecommons.org/licenses/by-nc/4.0/ ) for the Management of terminal Respiratory secretions options. Trials, information is collected about the effects of a new treatment and how to respond to someone this... ( BW and RH ) and studies were quality scored be treated with antibiotics people!
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