%PDF-1.7
%
1 0 obj
<>>>
endobj
2 0 obj
<>stream
2019-10-25T14:43:56-04:00
2019-10-25T14:44:01-04:00
2019-10-25T14:44:01-04:00
Adobe InDesign CC 13.1 (Windows)
uuid:d5a7a6a3-fdf1-4d3a-897e-145216ef7451
xmp.did:4A42F9656056E111960DCE8E95F0DF9D
xmp.id:63b60bd8-459e-1f40-ad0c-3eea09f3819b
proof:pdf
xmp.iid:08f89d54-b44b-d941-becf-9d36ea9c8b81
xmp.did:977e577c-030c-ee45-ba7b-e70f7c8b1c76
xmp.did:4A42F9656056E111960DCE8E95F0DF9D
default
converted
from application/x-indesign to application/pdf
Adobe InDesign CC 13.1 (Windows)
/
2019-10-25T14:43:56-04:00
application/pdf
Adobe PDF Library 15.0
False
endstream
endobj
12 0 obj
<>
endobj
3 0 obj
<>
endobj
5 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
6 0 obj
<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
7 0 obj
<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
8 0 obj
<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
9 0 obj
<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
10 0 obj
<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
11 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
14 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
45 0 obj
<>stream
BT
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
7 0 0 7 18 24.6817 Tm
(168)Tj
/Span<>> BDC
( )Tj
EMC
5.143 0 Td
(Internal Medicine Alert)Tj
ET
175.7 671.5 381.8 71 re
f
BT
0 0 0 0 k
/GS1 gs
/T1_0 1 Tf
42 0 0 42 188.2 698.5 Tm
[(EC)21 (G R)-4 (eview)]TJ
12 0 0 12 452.5535 684.1 Tm
[(B)-4 (y Ken Gr)5.1 (auer)53 (, MD)]TJ
ET
0 0 0 1 K
4 M
/GS0 gs
175.7 671.5 381.8 71 re
S
0 0 0 0.1 k
/GS1 gs
36 671 139.2 72 re
f
/PlacedGraphic /MC0 BDC
EMC
q
36 671 139.2 72 re
W n
0 0 0 0.502 k
q 1 0 0 1 109.9577 688.2064 cm
0 0 m
-0.224 0 -0.456 0.016 -0.835 0.016 c
-1.261 0.016 -1.531 0 -1.632 0 c
-1.678 0.031 l
-1.678 0.217 -1.648 0.518 -1.648 1.694 c
-1.648 5.221 l
-1.648 6.397 -1.678 6.698 -1.678 6.884 c
-1.632 6.915 l
-1.531 6.915 -1.261 6.899 -0.835 6.899 c
-0.456 6.899 -0.224 6.915 0 6.915 c
0 6.683 l
-0.371 6.683 l
-0.533 6.683 -0.688 6.675 -0.828 6.66 c
-0.99 6.644 -1.013 6.489 -1.013 6.35 c
-1.013 0.565 l
-1.013 0.426 -0.99 0.271 -0.828 0.255 c
-0.688 0.24 -0.533 0.232 -0.371 0.232 c
0 0.232 l
0 0 l
f
Q
q 1 0 0 1 116.1684 689.0995 cm
0 0 m
-0.348 0.016 -0.696 0.031 -1.067 0.031 c
-1.446 0.031 -1.833 0.016 -2.228 0 c
-2.228 0.232 l
-2.142 0.232 l
-1.965 0.232 -1.663 0.263 -1.663 0.456 c
-1.663 0.557 -1.732 0.766 -1.818 1.013 c
-2.119 1.91 l
-3.875 1.91 l
-4.122 1.106 l
-4.199 0.843 -4.292 0.642 -4.292 0.503 c
-4.292 0.271 -3.968 0.232 -3.712 0.232 c
-3.627 0.232 l
-3.627 0 l
-3.936 0.016 -4.254 0.031 -4.563 0.031 c
-4.842 0.031 -5.12 0.016 -5.398 0 c
-5.398 0.232 l
-5.352 0.232 l
-5.05 0.232 -4.795 0.41 -4.679 0.735 c
-3.442 4.285 l
-3.341 4.571 -3.202 4.958 -3.155 5.244 c
-2.908 5.329 -2.599 5.483 -2.452 5.576 c
-2.428 5.584 -2.413 5.592 -2.39 5.592 c
-2.366 5.592 -2.351 5.592 -2.336 5.569 c
-2.312 5.507 -2.289 5.437 -2.266 5.375 c
-0.843 1.33 l
-0.75 1.06 -0.657 0.773 -0.557 0.541 c
-0.464 0.325 -0.302 0.232 -0.046 0.232 c
0 0.232 l
0 0 l
-3.009 4.532 m
-3.728 2.344 l
-2.282 2.344 l
-2.993 4.532 l
-3.009 4.532 l
f
Q
q 1 0 0 1 121.2887 689.0995 cm
0 0 m
-0.681 0 -1.362 0.031 -2.042 0.031 c
-2.723 0.031 -3.404 0 -4.084 0 c
-4.084 0.232 l
-3.976 0.232 l
-3.697 0.232 -3.396 0.271 -3.396 0.75 c
-3.396 4.726 l
-3.396 5.128 -3.697 5.166 -3.976 5.166 c
-4.084 5.166 l
-4.084 5.399 l
-3.674 5.399 -3.272 5.368 -2.862 5.368 c
-2.468 5.368 -2.081 5.399 -1.687 5.399 c
-1.687 5.166 l
-1.88 5.166 l
-2.173 5.166 -2.406 5.159 -2.406 4.749 c
-2.406 0.758 l
-2.406 0.449 -2.189 0.356 -1.942 0.325 c
-1.804 0.315 -1.659 0.309 -1.511 0.309 c
-1.32 0.309 -1.121 0.318 -0.921 0.34 c
-0.596 0.379 -0.318 0.565 -0.178 0.758 c
-0.055 0.928 0.015 1.145 0.062 1.315 c
0.286 1.315 l
0.201 0.874 0.092 0.441 0 0 c
f
Q
q 1 0 0 1 126.4325 689.0995 cm
0 0 m
-0.495 0 -1.385 0.031 -2.08 0.031 c
-2.776 0.031 -3.697 0 -4.138 0 c
-4.138 0.232 l
-4.029 0.232 l
-3.751 0.232 -3.457 0.271 -3.457 0.673 c
-3.457 4.726 l
-3.457 5.128 -3.751 5.166 -4.029 5.166 c
-4.138 5.166 l
-4.138 5.399 l
-3.666 5.399 -2.862 5.368 -2.212 5.368 c
-1.562 5.368 -0.758 5.399 -0.232 5.399 c
-0.247 5.066 -0.24 4.556 -0.216 4.215 c
-0.449 4.153 l
-0.487 4.656 -0.58 5.058 -1.392 5.058 c
-2.467 5.058 l
-2.467 3.032 l
-1.547 3.032 l
-1.083 3.032 -0.982 3.295 -0.936 3.712 c
-0.704 3.712 l
-0.719 3.411 -0.727 3.109 -0.727 2.808 c
-0.727 2.514 -0.719 2.22 -0.704 1.926 c
-0.936 1.879 l
-0.982 2.344 -1.005 2.645 -1.539 2.645 c
-2.467 2.645 l
-2.467 0.843 l
-2.467 0.34 -2.019 0.34 -1.523 0.34 c
-0.595 0.34 -0.186 0.402 0.047 1.284 c
0.263 1.23 l
0.162 0.82 0.07 0.41 0 0 c
f
Q
q 1 0 0 1 132.9145 689.0995 cm
0 0 m
-0.255 0 -0.503 0.031 -0.758 0.031 c
-0.998 0.031 -1.245 0 -1.485 0 c
-2.081 0.781 -2.591 1.616 -3.094 2.506 c
-3.604 2.506 l
-3.604 0.851 l
-3.604 0.255 -3.326 0.232 -2.97 0.232 c
-2.831 0.232 l
-2.831 0 l
-3.272 0 -3.72 0.031 -4.161 0.031 c
-4.533 0.031 -4.896 0 -5.283 0 c
-5.283 0.232 l
-5.144 0.232 l
-4.857 0.232 -4.594 0.363 -4.594 0.65 c
-4.594 4.579 l
-4.594 5.143 -4.904 5.166 -5.144 5.166 c
-5.283 5.166 l
-5.283 5.399 l
-5.035 5.399 -4.555 5.368 -4.084 5.368 c
-3.62 5.368 -3.248 5.399 -2.838 5.399 c
-1.864 5.399 -0.998 5.136 -0.998 4.037 c
-0.998 3.341 -1.462 2.916 -2.073 2.676 c
-0.75 0.696 l
-0.534 0.371 -0.379 0.279 0 0.232 c
0 0 l
-3.164 5.12 m
-3.395 5.12 -3.496 5.097 -3.604 5.089 c
-3.604 2.784 l
-3.226 2.784 l
-2.452 2.784 -2.034 3.078 -2.034 3.991 c
-2.034 4.68 -2.475 5.12 -3.164 5.12 c
f
Q
q 1 0 0 1 136.9609 689.0995 cm
0 0 m
-0.302 0 -0.843 0.031 -1.261 0.031 c
-1.725 0.031 -2.267 0 -2.568 0 c
-2.568 0.232 l
-2.421 0.232 l
-1.995 0.232 -1.779 0.271 -1.779 0.882 c
-1.779 5.012 l
-3.048 5.012 l
-3.628 5.012 -3.651 4.873 -3.767 4.308 c
-3.999 4.308 l
-3.968 4.525 -3.929 4.741 -3.906 4.966 c
-3.875 5.182 -3.86 5.399 -3.86 5.623 c
-3.674 5.623 l
-3.616 5.405 -3.443 5.398 -3.249 5.398 c
-3.236 5.398 -3.223 5.399 -3.21 5.399 c
0.781 5.399 l
0.99 5.399 1.184 5.406 1.199 5.638 c
1.384 5.607 l
1.353 5.399 1.323 5.19 1.299 4.981 c
1.284 4.772 1.284 4.563 1.284 4.354 c
1.052 4.269 l
1.036 4.556 0.997 5.012 0.48 5.012 c
-0.789 5.012 l
-0.789 0.897 l
-0.789 0.302 -0.518 0.232 -0.147 0.232 c
0 0.232 l
0 0 l
f
Q
q 1 0 0 1 141.1675 688.2064 cm
0 0 m
-0.101 0 -0.371 0.016 -0.797 0.016 c
-1.175 0.016 -1.408 0 -1.632 0 c
-1.632 0.232 l
-1.261 0.232 l
-1.098 0.232 -0.944 0.24 -0.804 0.255 c
-0.642 0.271 -0.619 0.426 -0.619 0.565 c
-0.619 6.35 l
-0.619 6.489 -0.642 6.644 -0.804 6.66 c
-0.944 6.675 -1.098 6.683 -1.261 6.683 c
-1.632 6.683 l
-1.632 6.915 l
-1.408 6.915 -1.175 6.899 -0.797 6.899 c
-0.371 6.899 -0.101 6.915 0 6.915 c
0.046 6.884 l
0.046 6.698 0.016 6.397 0.016 5.221 c
0.016 1.694 l
0.016 0.518 0.046 0.217 0.046 0.031 c
0 0 l
f
Q
0 0 0 1 k
83.572 725.794 0.914 -10.564 re
f
q 1 0 0 1 87.0997 715.2291 cm
0 0 m
0 6.977 l
0.77 6.977 l
0.77 5.86 l
1.107 6.278 1.476 6.589 1.877 6.793 c
2.277 6.996 2.713 7.098 3.187 7.098 c
3.977 7.098 4.586 6.852 5.014 6.358 c
5.442 5.865 5.656 5.163 5.656 4.251 c
5.656 0 l
4.886 0 l
4.886 3.881 l
4.886 4.722 4.739 5.35 4.444 5.766 c
4.15 6.181 3.705 6.388 3.111 6.388 c
2.628 6.388 2.191 6.265 1.801 6.018 c
1.411 5.772 1.067 5.404 0.77 4.916 c
0.77 0 l
h
f
Q
q 1 0 0 1 96.0798 716.9433 cm
0 0 m
0 -0.468 0.064 -0.778 0.193 -0.929 c
0.321 -1.08 0.551 -1.155 0.884 -1.155 c
1.055 -1.155 1.233 -1.126 1.42 -1.069 c
1.606 -1.011 1.815 -0.921 2.047 -0.801 c
2.047 -1.563 l
1.83 -1.659 1.617 -1.731 1.408 -1.778 c
1.199 -1.826 0.989 -1.85 0.778 -1.85 c
0.199 -1.85 -0.209 -1.712 -0.446 -1.435 c
-0.682 -1.158 -0.8 -0.675 -0.8 0.015 c
-0.8 4.614 l
-2.288 4.614 l
-2.288 5.263 l
-0.77 5.263 l
-0.77 6.857 l
-0.181 7.536 l
0 7.536 l
0 5.263 l
1.873 5.263 l
1.873 4.614 l
0 4.614 l
h
f
Q
q 1 0 0 1 99.9702 719.6391 cm
0 0 m
4.433 0 l
4.352 0.614 4.113 1.107 3.715 1.48 c
3.318 1.853 2.837 2.039 2.273 2.039 c
1.694 2.039 1.193 1.85 0.77 1.473 c
0.347 1.095 0.091 0.604 0 0 c
5.211 -3.64 m
4.758 -3.952 4.314 -4.184 3.882 -4.334 c
3.448 -4.486 3.003 -4.561 2.545 -4.561 c
1.503 -4.561 0.666 -4.219 0.034 -3.534 c
-0.598 -2.849 -0.914 -1.941 -0.914 -0.808 c
-0.914 0.249 -0.615 1.099 -0.019 1.741 c
0.578 2.383 1.362 2.703 2.333 2.703 c
3.235 2.703 3.962 2.399 4.516 1.79 c
5.07 1.18 5.346 0.372 5.346 -0.634 c
5.346 -0.665 l
-0.098 -0.665 l
-0.098 -0.748 l
-0.098 -1.659 0.146 -2.396 0.635 -2.96 c
1.123 -3.524 1.755 -3.806 2.53 -3.806 c
2.993 -3.806 3.438 -3.724 3.866 -3.56 c
4.294 -3.397 4.742 -3.139 5.211 -2.786 c
h
f
Q
q 1 0 0 1 107.327 715.2291 cm
0 0 m
0 6.977 l
0.778 6.977 l
0.778 5.256 l
1.211 5.92 1.606 6.393 1.963 6.675 c
2.321 6.957 2.693 7.098 3.081 7.098 c
3.292 7.098 3.497 7.055 3.696 6.97 c
3.895 6.884 4.103 6.751 4.319 6.57 c
3.897 5.83 l
3.685 6.001 3.493 6.127 3.319 6.207 c
3.145 6.288 2.978 6.328 2.817 6.328 c
2.504 6.328 2.187 6.177 1.865 5.875 c
1.543 5.573 1.18 5.085 0.778 4.41 c
0.778 0 l
h
f
Q
q 1 0 0 1 112.7278 715.2291 cm
0 0 m
0 6.977 l
0.77 6.977 l
0.77 5.86 l
1.107 6.278 1.476 6.589 1.877 6.793 c
2.277 6.996 2.713 7.098 3.187 7.098 c
3.977 7.098 4.586 6.852 5.014 6.358 c
5.442 5.865 5.656 5.163 5.656 4.251 c
5.656 0 l
4.886 0 l
4.886 3.881 l
4.886 4.722 4.739 5.35 4.444 5.766 c
4.149 6.181 3.705 6.388 3.111 6.388 c
2.628 6.388 2.191 6.265 1.801 6.018 c
1.411 5.772 1.067 5.404 0.77 4.916 c
0.77 0 l
h
f
Q
q 1 0 0 1 124.1546 716.6335 cm
0 0 m
0 2.182 l
-1.007 2.167 -1.802 1.986 -2.386 1.639 c
-2.97 1.291 -3.262 0.833 -3.262 0.264 c
-3.262 -0.093 -3.141 -0.375 -2.9 -0.581 c
-2.658 -0.788 -2.326 -0.891 -1.903 -0.891 c
-1.616 -0.891 -1.319 -0.819 -1.012 -0.676 c
-0.705 -0.532 -0.368 -0.307 0 0 c
0.015 -0.725 m
-0.373 -1.022 -0.734 -1.235 -1.068 -1.363 c
-1.403 -1.491 -1.755 -1.555 -2.122 -1.555 c
-2.696 -1.555 -3.162 -1.389 -3.519 -1.057 c
-3.876 -0.725 -4.055 -0.294 -4.055 0.234 c
-4.055 1.004 -3.707 1.611 -3.009 2.054 c
-2.312 2.497 -1.309 2.746 0 2.802 c
0 3.542 l
0 4.065 -0.124 4.447 -0.374 4.686 c
-0.623 4.925 -1.019 5.044 -1.563 5.044 c
-1.9 5.044 -2.24 4.977 -2.583 4.841 c
-2.925 4.705 -3.297 4.488 -3.7 4.191 c
-3.7 4.954 l
-3.308 5.216 -2.931 5.409 -2.571 5.535 c
-2.211 5.661 -1.855 5.724 -1.503 5.724 c
-0.702 5.724 -0.123 5.539 0.234 5.169 c
0.592 4.799 0.77 4.196 0.77 3.36 c
0.77 -0.294 l
0.77 -0.445 0.79 -0.557 0.831 -0.63 c
0.871 -0.704 0.934 -0.74 1.02 -0.74 c
1.14 -0.74 1.349 -0.609 1.646 -0.347 c
1.717 -0.282 1.77 -0.234 1.805 -0.204 c
1.812 -0.906 l
1.586 -1.117 1.377 -1.276 1.186 -1.382 c
0.994 -1.488 0.826 -1.54 0.68 -1.54 c
0.458 -1.54 0.296 -1.476 0.193 -1.348 c
0.089 -1.219 0.03 -1.012 0.015 -0.725 c
f
Q
127.418 725.794 0.793 -10.564 re
f
q 1 0 0 1 70.7862 698.6232 cm
0 0 m
0 13.581 l
1.136 13.581 l
6.203 7.32 l
11.251 13.581 l
12.407 13.581 l
12.407 0 l
11.29 0 l
11.29 11.989 l
6.203 5.669 l
1.087 11.989 l
1.087 0 l
h
f
Q
q 1 0 0 1 87.1554 704.2923 cm
0 0 m
5.698 0 l
5.595 0.79 5.287 1.424 4.776 1.903 c
4.265 2.382 3.647 2.621 2.922 2.621 c
2.178 2.621 1.534 2.379 0.99 1.893 c
0.447 1.408 0.116 0.777 0 0 c
6.698 -4.679 m
6.116 -5.08 5.546 -5.378 4.99 -5.572 c
4.433 -5.766 3.86 -5.863 3.272 -5.863 c
1.932 -5.863 0.856 -5.423 0.044 -4.543 c
-0.769 -3.663 -1.175 -2.495 -1.175 -1.039 c
-1.175 0.32 -0.791 1.413 -0.024 2.238 c
0.743 3.063 1.751 3.475 3 3.475 c
4.158 3.475 5.093 3.084 5.805 2.301 c
6.517 1.518 6.873 0.479 6.873 -0.815 c
6.873 -0.854 l
-0.126 -0.854 l
-0.126 -0.961 l
-0.126 -2.132 0.188 -3.081 0.815 -3.805 c
1.443 -4.53 2.255 -4.893 3.252 -4.893 c
3.847 -4.893 4.42 -4.787 4.97 -4.577 c
5.52 -4.367 6.097 -4.035 6.698 -3.582 c
h
f
Q
q 1 0 0 1 102.7772 700.3705 cm
0 0 m
0 5.514 l
-0.33 5.857 -0.689 6.111 -1.078 6.276 c
-1.466 6.441 -1.909 6.523 -2.407 6.523 c
-3.404 6.523 -4.216 6.177 -4.844 5.485 c
-5.472 4.792 -5.786 3.886 -5.786 2.767 c
-5.786 1.647 -5.472 0.741 -4.844 0.048 c
-4.216 -0.644 -3.404 -0.99 -2.407 -0.99 c
-1.896 -0.99 -1.448 -0.911 -1.063 -0.752 c
-0.678 -0.594 -0.324 -0.343 0 0 c
0 -1.087 m
-0.362 -1.366 -0.751 -1.571 -1.165 -1.704 c
-1.579 -1.836 -2.032 -1.903 -2.524 -1.903 c
-3.831 -1.903 -4.891 -1.474 -5.703 -0.617 c
-6.516 0.241 -6.922 1.362 -6.922 2.747 c
-6.922 4.132 -6.516 5.253 -5.703 6.111 c
-4.891 6.968 -3.831 7.397 -2.524 7.397 c
-2.032 7.397 -1.579 7.331 -1.165 7.198 c
-0.751 7.065 -0.362 6.86 0 6.582 c
0 11.834 l
0.971 11.834 l
0.971 -1.747 l
0 -1.747 l
h
f
Q
106.818 707.593 1.019 -8.97 re
106.818 698.623 m
106.818 712.204 1.019 -1.65 re
f
q 1 0 0 1 117.2362 698.9823 cm
0 0 m
-0.369 -0.181 -0.74 -0.315 -1.112 -0.403 c
-1.484 -0.49 -1.867 -0.534 -2.262 -0.534 c
-3.641 -0.534 -4.773 -0.097 -5.66 0.777 c
-6.547 1.65 -6.99 2.77 -6.99 4.136 c
-6.99 5.462 -6.534 6.572 -5.621 7.465 c
-4.708 8.358 -3.563 8.805 -2.185 8.805 c
-1.848 8.805 -1.513 8.772 -1.18 8.708 c
-0.846 8.643 -0.511 8.543 -0.175 8.407 c
-0.175 7.29 l
-0.518 7.491 -0.864 7.638 -1.214 7.732 c
-1.563 7.826 -1.932 7.873 -2.32 7.873 c
-3.317 7.873 -4.163 7.509 -4.859 6.781 c
-5.555 6.053 -5.902 5.164 -5.902 4.116 c
-5.902 3.061 -5.556 2.175 -4.864 1.456 c
-4.171 0.738 -3.323 0.379 -2.32 0.379 c
-1.945 0.379 -1.565 0.44 -1.18 0.563 c
-0.795 0.686 -0.401 0.87 0 1.116 c
h
f
Q
119.364 707.593 1.02 -8.97 re
119.364 698.623 m
119.364 712.204 1.02 -1.65 re
f
q 1 0 0 1 123.3267 698.6232 cm
0 0 m
0 8.97 l
0.99 8.97 l
0.99 7.533 l
1.424 8.07 1.898 8.47 2.412 8.732 c
2.927 8.994 3.488 9.125 4.097 9.125 c
5.113 9.125 5.896 8.808 6.446 8.174 c
6.996 7.54 7.271 6.637 7.271 5.465 c
7.271 0 l
6.281 0 l
6.281 4.99 l
6.281 6.07 6.091 6.878 5.713 7.412 c
5.334 7.946 4.763 8.213 4 8.213 c
3.378 8.213 2.817 8.054 2.315 7.737 c
1.814 7.42 1.372 6.947 0.99 6.32 c
0.99 0 l
h
f
Q
q 1 0 0 1 134.1237 704.2923 cm
0 0 m
5.698 0 l
5.595 0.79 5.287 1.424 4.776 1.903 c
4.265 2.382 3.647 2.621 2.922 2.621 c
2.178 2.621 1.534 2.379 0.99 1.893 c
0.446 1.408 0.116 0.777 0 0 c
6.698 -4.679 m
6.116 -5.08 5.546 -5.378 4.99 -5.572 c
4.433 -5.766 3.86 -5.863 3.271 -5.863 c
1.932 -5.863 0.856 -5.423 0.044 -4.543 c
-0.769 -3.663 -1.175 -2.495 -1.175 -1.039 c
-1.175 0.32 -0.791 1.413 -0.024 2.238 c
0.743 3.063 1.75 3.475 3 3.475 c
4.158 3.475 5.093 3.084 5.805 2.301 c
6.517 1.518 6.873 0.479 6.873 -0.815 c
6.873 -0.854 l
-0.126 -0.854 l
-0.126 -0.961 l
-0.126 -2.132 0.188 -3.081 0.815 -3.805 c
1.443 -4.53 2.255 -4.893 3.252 -4.893 c
3.847 -4.893 4.42 -4.787 4.97 -4.577 c
5.52 -4.367 6.096 -4.035 6.698 -3.582 c
h
f
Q
Q
BT
0 0 0 1 k
/GS0 gs
/T1_1 1 Tf
9 0 0 9 137.2246 645.532 Tm
(Professor Emeritus in Family Medicine, College of Medicine, University o\
f Florida)Tj
0 0 0 0.7 k
/GS1 gs
/T1_2 1 Tf
1.775 -2.056 Td
[(Dr)74 (. Grauer reports no \037nancial relationships relevant to this \037eld o\
f study)92 (.)]TJ
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
26 0 0 26 36 587.5261 Tm
(Is This Acute?)Tj
/T1_3 1 Tf
10 0 0 10 36 566.5261 Tm
(There is a stack of ECGs in need of interpretation. The tracing in the \037\
gure below is among those tracings. No clinical )Tj
0 -1.2 Td
(information is available. How would one interpret this ECG? Are the chan\
ges acute?)Tj
0 -23.957 Td
(The rhythm is sinus at about 85 beats per minute. All )Tj
0 -1.2 Td
(intervals and the axis are normal. There is no chamber )Tj
0 -1.2 Td
(enlargement. The most remarkable \037ndings relate to )Tj
0 -1.2 Td
(assessment of Q-R-S-T changes. )Tj
0 -2.4 Td
(Considering the tiny size of the QRS complex in lead III, )Tj
0 -1.2 Td
(the Q wave in this lead is large. There also appears to be )Tj
0 -1.2 Td
[(a small q wave in lead aVF)129.1 (, although the tiny size of the )]TJ
0 -1.2 Td
(QRS complex in this lead makes it dif\037cult to be certain of )Tj
0 -1.2 Td
(this. )Tj
0 -2.4 Td
(Regarding R wave progression, transition is delayed )Tj
0 -1.2 Td
(slightly \(i.e., the R wave does not become greater than the )Tj
0 -1.2 Td
(depth of the S wave until lead V5\).)Tj
0 -2.4 Td
(Each inferior lead manifests ST segment elevation. )Tj
0 -1.2 Td
(Compared to the size of the QRS complex in leads )Tj
0 -1.2 Td
[(II, III, and aVF)129.1 (, the relative amount of ST elevation is )]TJ
0 -1.2 Td
(considerable. This is followed by beginning T wave )Tj
0 -1.2 Td
(inversion in each inferior lead. Reciprocal changes to the )Tj
0 -1.2 Td
(inferior ST elevation are seen in the form of ST depression )Tj
ET
0.86 0.57 0 0.16 K
0.5 w 10 M
/GS1 gs
q 1 0 0 1 379.3091 73.9601 cm
0 0 m
91.679 0 l
S
Q
BT
/GS0 gs
10 0 0 10 303.75 314.96 Tm
(in lead aVL. The rest of the ECG looks nonspeci\037c. ST )Tj
0 -1.2 Td
(segments are coved but not elevated in the lateral chest )Tj
0 -1.2 Td
(leads. There is no ST depression in the anterior leads.)Tj
0 -2.4 Td
(ECG \037ndings in the limb leads are diagnostic of inferior )Tj
0 -1.2 Td
(infarction. The fact that ST segments in each inferior lead )Tj
0 -1.2 Td
[(are signi\037cantly elevated, with mirror)55.1 (-image reciprocal )]TJ
0 -1.2 Td
(ST depression in lead aVL, suggests that infarction is )Tj
0 -1.2 Td
(most probably recent, if not still ongoing. At this point, )Tj
0 -1.2 Td
[(someone needs to learn the patient\222)74.2 (s history)92 (. W)86 (as this )]TJ
0 -1.2 Td
[(patient admitted to the hospital? W)86.1 (as potential acuity of )]TJ
0 -1.2 Td
[(these ECG \037ndings recognized? W)86.2 (as appropriate treatment )]TJ
0 -1.2 Td
(initiated?)Tj
0 -2.4 Td
(Further research reveals the patient had been admitted. )Tj
0 -1.2 Td
(The possibility of an infarction that still was acutely )Tj
0 -1.2 Td
(evolving was not appreciated. The patient died before )Tj
0 -1.2 Td
(referral was made.)Tj
0 -2.4 Td
(For more information about and further discussion in this )Tj
0 -1.2 Td
(case, please visit: )Tj
0.86 0.57 0 0.16 k
/GS1 gs
(http://bit.ly/35SYzKT)Tj
0 0 0 1 k
/GS0 gs
16.724 0 Td
(.)Tj
ET
q
36 374.035 522 130.285 re
W n
q
/GS1 gs
522.0000234 0 0 130.2843034 36 374.035704 cm
/Im0 Do
Q
Q
endstream
endobj
46 0 obj
<>
endobj
49 0 obj
<>/Filter/FlateDecode/Height 453/Intent/RelativeColorimetric/Length 1584059/Metadata 50 0 R/Name/X/SMask 51 0 R/Subtype/Image/Type/XObject/Width 1815>>stream
HiKci8=]eA(n E!bPD_D\p
JE#'FcIgK!fi,g8>T
K ;K
=C ?@Hw?RńEj(2 aZ|&RE(+^HiD"b' BiX,' )MNSEUUMt]O~&Wh"Ur1Alh$ P. x`](zxxÑH$>==bD"!I,ˊz2#M6MDˋH}~~b"Fyyyqqq~~~vv /tvvv~~~qqqyyonn@0Bp8?'EQ4Mu=F^UUeY$I>>>`Q.&|>1pwwwggg{{{+m `+m{{{gggwww@
%IeYUU]דi"&GQQ(:Eskkk+++Nsvv״ 6;;t:WVVnޞ9==|@
Ex<.˲'R_Q 2DL$ ~_tlmm\%hfffbbp
f s8333Nsiirmmm`0D,˪&R_EMEI$"F$|#۽*'''HlZ===]]]m ]]]===Vo```xxxlllrrt##H"PEӴdZx뺪$===݉$dz(jGFFm6b[[[kkkkjjf )l6744477Y,?22299x|>ӓ$I꺞LKCɲ~Z"N0Leee LʪO>555Yց1??y||b,˚%RO\u]UUI"H z;;;KKKvb477fBJJJFcaaaAAA~~~ |BX\\\RRRZZj2*++fsssbKKK;;;^7D"ITUu=Lޟi,˱XrMOOvww766VUUr1H5999?g 쌜_TTTRRb2].},eYӴd2zg4UU%IF^v͍l겲2ј'EK>~ 6?O Og~J3eee---6mtttnnv{h4*Iɴ{u]QD"=嚚555&I/E>{=+ cou
E~Ǐ
h4L555v}jjry