PK Y\_rels/PK Y\ docProps/PK Y\ppt/PK Y\ ppt/_rels/PK Y\ ppt/charts/PK Y\ppt/charts/_rels/PK Y\ppt/embeddings/PK Y\ ppt/media/PK Y\ppt/slideLayouts/PK Y\ppt/slideLayouts/_rels/PK Y\ppt/slideMasters/PK Y\ppt/slideMasters/_rels/PK Y\ ppt/slides/PK Y\ppt/slides/_rels/PK Y\ ppt/theme/PK Y\ppt/notesMasters/PK Y\ppt/notesMasters/_rels/PK Y\ppt/notesSlides/PK Y\ppt/notesSlides/_rels/PK Y\"˩[Content_Types].xml PK Y\]] _rels/.rels PK Y\docProps/app.xml 0 0 Microsoft Office PowerPoint On-screen Show (16:9) 0 12 12 0 0 false Fonts Used 2 Theme 1 Slide Titles 12 Arial Calibri Office Theme Slide 1Slide 2Slide 3Slide 4Slide 5Slide 6Slide 7Slide 8Slide 9Slide 10Slide 11Slide 12 PptxGenJS false false false 16.0000 PK Y\LFdocProps/core.xml PptxGenJS Presentation PptxGenJS Presentation PptxGenJS PptxGenJS 1 2026-07-20T17:10:50Z 2026-07-20T17:10:50Z PK Y\* * ppt/_rels/presentation.xml.rels PK Y\Oݨ ppt/theme/theme1.xmlPK Y\ ppt/presentation.xml PK Y\Xppt/presProps.xml PK Y\ppt/tableStyles.xml PK Y\D >00ppt/viewProps.xml PK Y\H7t!ppt/slideLayouts/slideLayout1.xml PK Y\ђ77,ppt/slideLayouts/_rels/slideLayout1.xml.rels PK Y\OH$s$sppt/slides/slide1.xml 1. DIABETIC KETOACIDOSIS (DKA)MANSOURA ENDOCRINOLOGY ICU — QUICK CARDGlucose ≥200 mg/dL (or Hx diabetes)Blood ketones ≥3.0 mmol/LpH <7.3 or HCO3 <181. FLUIDS0.9% NaCl 15–20 mL/kg/hr first hour.Then 0.45% NaCl if corrected Na normal/high; keep 0.9% if low.Replace 50% of deficit in 8–12 h.2. CHECK K+K+ <3.3: HOLD insulin — replace K+ first.K+ 3.3–5.3: add 20–30 mEq KCl/L fluid.K+ >5.3: no KCl, recheck 2h.3. INSULINRegular insulin 0.1 units/kg/hr IV infusion.NO bolus dose.Do not start until K+ result is back.4. ADJUSTGlucose <250: add 5–10% dextrose, reduce insulin to 0.05 units/kg/hr.Check blood ketones + K+ q4h.5. RESOLUTIONGlucose <200 AND HCO3 ≥18 AND pH >7.3.Overlap IV/SC insulin 1–2h before stopping infusion.CALL ENDOCRINE ON-CALL: every DKA admission for co-management — always reachable.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYpH <7.0 or HCO3 <10 mEq/L at any point during treatmentGlucose not falling ≥50–70 mg/dL/hr after 1st hour of correct insulin infusionK+ <3.3 or >6.0 mEq/L on any checkNew headache, confusion, or falling consciousness (cerebral edema warning)Hemodynamic instability not responding to fluidsFirst presentation of diabetes, pregnancy, or unclear precipitantPK Y\3 ppt/slides/_rels/slide1.xml.rels PK Y\.ppt/notesSlides/notesSlide1.xml 1PK Y\:A*ppt/notesSlides/_rels/notesSlide1.xml.rels PK Y\v5kkppt/slides/slide2.xml 2. HYPEROSMOLAR HYPERGLYCEMIC STATEMANSOURA ENDOCRINOLOGY ICU — QUICK CARDGlucose ≥540–600 mg/dLOsmolality ≥320 mOsm/kgNo significant ketones/acidosis1. FLUIDS ALONE0.9% NaCl 15–20 mL/kg/hr first hour.Do NOT start insulin yet.Replace ~50% of deficit in first 12h.2. REASSESSInsulin starts ONLY once osmolality stops falling with fluids alone — UNLESS significant ketonemia also present.3. INSULINFixed-rate 0.05 units/kg/hr IV — LOWER than DKA rate.Starting insulin too early risks rapid osmotic shift + cerebral edema.4. ADJUSTGlucose <250: start 5–10% dextrose.Check Na, K+, osmolality regularly.5. RESOLUTIONOsmolality <300, urine output ≥0.5 mL/kg/hr, cognition at baseline, glucose <270 mg/dL.CALL ENDOCRINE ON-CALL: every HHS admission — mortality higher than DKA, always reachable.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYOsmolality correcting too fast or too slow vs. agreed target rateSodium trajectory not matching expected patternAny neurological deterioration beyond presenting baselineNew chest pain, focal weakness, or other stroke/MI signsK+ <3.3 or >6.0 mEq/L on any checkInsulin started before osmolality-plateau criteria met (check sequencing)PK Y\2- ppt/slides/_rels/slide2.xml.rels PK Y\ppt/notesSlides/notesSlide2.xml 2PK Y\xշ*ppt/notesSlides/_rels/notesSlide2.xml.rels PK Y\2eeppt/slides/slide3.xml 3. SEVERE HYPOGLYCEMIAMANSOURA ENDOCRINOLOGY ICU — QUICK CARDLevel 3: cognitive impairmentrequiring external assistance(no fixed glucose cutoff)CONSCIOUS15–20g fast-acting oral carb (3–4 glucose tabs or 150–200mL juice).Recheck at 15 min, repeat if <70 mg/dL.UNCONSCIOUS + IV ACCESSIV dextrose 25g (50mL of 50% dextrose, or equivalent 25%).Recheck at 15 min.UNCONSCIOUS, NO IVGlucagon 1mg IM/SC while obtaining IV access.SULFONYLUREA CASECan be prolonged/recurrent — minimum 24h observation, not treat-and-discharge.REFRACTORY SU CASEOctreotide 50mcg SC q6h suppresses insulin secretion (available on formulary).CALL ENDOCRINE ON-CALL: any severe (Level 3) episode, and any sulfonylurea-related episode.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYGlucose not rising after standard oral or IV dextrose treatmentRecurrent hypoglycemia within a few hours, especially post-sulfonylureaSeizure at any point during the episodePersistent altered consciousness after glucose confirmed normalizedAny accompanying hemodynamic instabilityPK Y\W/ ppt/slides/_rels/slide3.xml.rels PK Y\K |Őppt/notesSlides/notesSlide3.xml 3PK Y\9 Y*ppt/notesSlides/_rels/notesSlide3.xml.rels PK Y\1o1oppt/slides/slide4.xml 4. THYROID STORMMANSOURA ENDOCRINOLOGY ICU — QUICK CARDBurch-Wartofsky Score≥45 = highly suggestive25–44 = impending storm1. BETA-BLOCKIV propranolol 0.5–1 mg over 10 min, then 1–2 mg IV q15min PRN.Or oral/NG 60–80 mg q4h if stable.2. THIONAMIDEPTU load 500–1000 mg PO/NG, then 250 mg q4h.Or carbimazole 60–80 mg/day.Give BEFORE iodine.3. IODINESSKI 5 drops (~250 mg) q6h.GIVE ≥ 1 HOUR AFTER thionamide — never before.4. STEROIDHydrocortisone 100 mg IV q8h.Blocks T4→T3 conversion + covers possible adrenal insufficiency.5. SUPPORTCool actively — paracetamol, NOT aspirin.Treat precipitant. No improvement 24–48h: consider plasmapheresis.CALL ENDOCRINE ON-CALL: immediately on suspicion — do not wait for a completed score.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYBWPS ≥45, or strong suspicion even before score is finalizedNew-onset atrial fibrillation or any new arrhythmiaTemperature still rising despite active cooling + therapy startedNew agitation, psychosis, delirium, or falling consciousnessHigh-output heart failure, shock, or need for vasopressor supportSuspected concurrent adrenal crisis or DKAPK Y\` ppt/slides/_rels/slide4.xml.rels PK Y\vsppt/notesSlides/notesSlide4.xml 4PK Y\J *ppt/notesSlides/_rels/notesSlide4.xml.rels PK Y\_5]BkBkppt/slides/slide5.xml 5. MYXEDEMA COMAMANSOURA ENDOCRINOLOGY ICU — QUICK CARDHypothermia + altered mental status+ bradycardia in severedecompensated hypothyroidism1. STEROID FIRSTHydrocortisone 100mg IV bolus then 100mg IV q8h.MUST come before or WITH thyroid hormone — NEVER after.2. THYROID HORMONEIV levothyroxine 200–400mcg load, then 1.6mcg/kg/day.If IV unavailable: oral/NG same load (inferior fallback).3. REWARMPASSIVE rewarming only (blankets).Active rewarming risks vasodilation + cardiovascular collapse.4. SUPPORTCorrect hypoglycemia immediately.Ventilate if GCS ≤8.Correct hyponatremia cautiously (see Sec.10).5. TREAT TRIGGEREmpiric antibiotics reasonable — infection may be masked by hypothermia.CALL ENDOCRINE ON-CALL: immediately on suspicion — highest mortality condition in this protocol.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYANY suspected case at all — call immediately, do not wait for certaintyPersistent hypothermia despite passive rewarmingHypotension unresponsive to fluids, even after hydrocortisone givenWorsening consciousness at any pointNew arrhythmia, particularly bradyarrhythmiasPK Y\5 ppt/slides/_rels/slide5.xml.rels PK Y\W8ppt/notesSlides/notesSlide5.xml 5PK Y\Qe*ppt/notesSlides/_rels/notesSlide5.xml.rels PK Y\:iippt/slides/slide6.xml 6. ADRENAL CRISISMANSOURA ENDOCRINOLOGY ICU — QUICK CARDShock + vomiting + abdo painin known/suspected AIRandom cortisol <3mcg/dL supports1. HYDROCORTISONE100 mg IV/IM bolus IMMEDIATELY.Then 200mg/24h infusion (or 50mg IV/IM q6h).NEVER delay for cortisol result.2. FLUIDS1000 mL 0.9% saline in first hour.Then 4–6 L over 24h — caution in renal/elderly.3. OVERNIGHT/WEEKENDStat cortisol/ACTH NOT available out of hours at Mansoura.Treat empirically — send sample when possible.4. FIND TRIGGERLook for infection, missed steroid doses, surgery, or other stressor precipitant.5. STABILIZEOnce improved: taper to maintenance dose, add fludrocortisone if primary AI.CALL ENDOCRINE ON-CALL: immediately on suspicion — never contingent on cortisol results.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYAny suspected adrenal crisis — call immediately, never wait for cortisolPersistent hypotension despite fluids and hydrocortisone already givenRefractory hypoglycemia not correcting with standard treatmentHyperkalemia with ECG changes (peaked T waves, widened QRS)Unexplained shock in a new patient with no prior AI diagnosisPK Y\ج+ ppt/slides/_rels/slide6.xml.rels PK Y\zppt/notesSlides/notesSlide6.xml 6PK Y\=|*ppt/notesSlides/_rels/notesSlide6.xml.rels PK Y\^eeppt/slides/slide7.xml 7. HYPERCALCEMIC CRISISMANSOURA ENDOCRINOLOGY ICU — QUICK CARDCorrected Ca >14 mg/dL (3.5 mmol/L)Altered mental status, AKI,short QT / arrhythmia1. IV SALINE0.9% NaCl 200–300 mL/hr, titrate to urine output.Caution in cardiac/renal impairment.2. CALCITONINRapid but short-lived (tachyphylaxis by 48–72h) — a bridge only.3. BISPHOSPHONATEIV zoledronic acid or denosumab — mainstay for sustained control.AVAILABILITY NOT CONFIRMED at Mansoura.4. LOOP DIURETICFurosemide ONLY after adequate rehydration — not a primary calcium-lowering step.5. IF REFRACTORYHemodialysis with low-calcium dialysate if AKI present or agents unavailable.CALL ENDOCRINE ON-CALL: every hypercalcemic crisis — involve nephrology early too.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYCardiac arrhythmia or short QT on ECG at any pointDeclining consciousness — any drop in GCS from presentation baselineCalcium not falling despite hydration and calcitonin, no antiresorptive plan in placeWorsening AKI despite adequate hydrationSuspected parathyroid crisis needing urgent surgical referralPK Y\F ppt/slides/_rels/slide7.xml.rels PK Y\)lppt/notesSlides/notesSlide7.xml 7PK Y\|g*ppt/notesSlides/_rels/notesSlide7.xml.rels PK Y\eCggppt/slides/slide8.xml 8. SEVERE HYPOCALCEMIA / TETANYMANSOURA ENDOCRINOLOGY ICU — QUICK CARDAdjusted Ca <7.5 mg/dL (1.9 mmol/L)Carpopedal spasm, laryngospasm,Chvostek's / Trousseau's signs1. IV CALCIUMCalcium gluconate 10%: 1–2g (10–20mL) IV over 10 min, diluted in D5W.Repeat q10–60min until symptoms resolve.ECG monitoring mandatory.2. INFUSIONContinuous 0.5–2 mg/kg/hr elemental calcium after the bolus.Recheck calcium q4–6h.3. CHECK MAGNESIUMCorrect Mg alongside calcium — low Mg blocks response to calcium replacement.4. POST-THYROIDECTOMYCommon, usually transient. Routine 24h calcium check post-op.5. MONITORWatch airway closely — laryngospasm is the immediate life threat.CALL ENDOCRINE ON-CALL: every severe symptomatic case.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYAirway compromise or stridor — laryngospasm is an airway emergencyNew seizure at any pointQT prolongation or arrhythmia on cardiac monitoringCalcium not responding to the first bolus — check magnesium before repeatingPost-thyroidectomy patient with worsening symptomsPK Y\6 ppt/slides/_rels/slide8.xml.rels PK Y\iސppt/notesSlides/notesSlide8.xml 8PK Y\pO*ppt/notesSlides/_rels/notesSlide8.xml.rels PK Y\aappt/slides/slide9.xml 9. PHEOCHROMOCYTOMA CRISISMANSOURA ENDOCRINOLOGY ICU — QUICK CARDParoxysmal severe HTN+ tachycardia + headache+ diaphoresis1. NEVER BETA-BLOCK FIRSTBeta-blocker before alpha-blockade risks unopposed vasoconstriction → pulmonary edema / worse crisis.2. ALPHA-BLOCKADEPhentolamine 1–5mg IV bolus q5–10min, OR IV nitroprusside, OR IV urapidil.AVAILABILITY NOT CONFIRMED at Mansoura.3. THEN FLUIDSVolume resuscitation AFTER alpha-blockade starts — not before.4. MONITORContinuous BP + cardiac monitoring. Watch for post-crisis hypotension.5. PLAN SURGERYInvolve anesthesiology/surgery once pharmacologically stabilized.CALL ENDOCRINE ON-CALL: immediately on suspicion.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYSBP >200 mmHg or any hypertensive-emergency sign (chest pain, focal deficit, pulmonary edema)New arrhythmia at any pointA beta-blocker given before alpha-blockade confirmed adequate — flag immediately, near-miss or realSuspected tumor rupture/hemorrhage: severe abdominal pain + hemodynamic instabilityPK Y\>$ ppt/slides/_rels/slide9.xml.rels PK Y\qppt/notesSlides/notesSlide9.xml 9PK Y\1*ppt/notesSlides/_rels/notesSlide9.xml.rels PK Y\aappt/slides/slide10.xml 10. SIADH / SEVERE HYPONATREMIAMANSOURA ENDOCRINOLOGY ICU — QUICK CARDNa <125 + severe symptoms:vomiting, cardioresp distress,seizure, coma (GCS ≤8)1. HYPERTONIC SALINE150mL bolus of 3% NaCl IV over 20 min.Repeat up to 2 more times if severe symptoms persist.2. RECHECK NaAfter each bolus. Aim +5 mmol/L or symptom resolution, whichever first.3. WATCH THE LIMITMax +10 mmol/L in first 24h, +8 mmol/L per 24h after — overcorrection risks ODS.4. IF OVERSHOOTINGRe-lower with DDAVP + D5W (free water) rescue.5. ONCE STABLESwitch to fluid restriction (500mL–1L/day) ± second-line agent.CALL ENDOCRINE ON-CALL: immediately for severe symptomatic cases.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYSeizure or GCS ≤8 at presentation or during treatmentSodium correcting faster than 10 mmol/L in 24h — stop hypertonic saline, consider DDAVP+D5WSodium not rising despite three hypertonic saline bolusesNew neurological deficit appearing days into treatment (possible ODS)PK Y\Ѳ!ppt/slides/_rels/slide10.xml.rels PK Y\O ppt/notesSlides/notesSlide10.xml 10PK Y\T+ppt/notesSlides/_rels/notesSlide10.xml.rels PK Y\jeeppt/slides/slide11.xml 11. DIABETES INSIPIDUS (CENTRAL)MANSOURA ENDOCRINOLOGY ICU — QUICK CARDPolyuria >3L/dayDilute urine (Osm <300)despite rising serum Na1. FREE WATER FIRSTOral water matched to urine output if alert.If NPO: IV D5W matched to losses + deficit.2. CORRECT SLOWLYCorrect hypernatremia no faster than ~0.5 mmol/L/hr — same overcorrection risk as hyponatremia, reversed.3. DDAVPIV/SC 1–2mcg if available (onset ~1h).Intranasal/oral less reliable if altered consciousness.4. POST-OP WATCHTriphasic response: DI → antidiuretic phase (risk of hyponatremia) → possible permanent DI.Reassess DDAVP dose DAILY.5. DEFER TESTINGWater deprivation/copeptin testing is NOT an acute-phase tool — defer until stable.CALL ENDOCRINE ON-CALL: any new acute DI presentation, and through the postop triphasic window.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYSustained urine output >300–500 mL/hr with no correction plan in placeRising sodium despite replacement effortsAny postop neurosurgical patient with new polyuria — check urine osmolalitySudden drop in urine output after starting DDAVP postop — possible antidiuretic phasePK Y\;!ppt/slides/_rels/slide11.xml.rels PK Y\s6ӑ ppt/notesSlides/notesSlide11.xml 11PK Y\O+ppt/notesSlides/_rels/notesSlide11.xml.rels PK Y\קcTfTfppt/slides/slide12.xml 12. PANHYPOPITUITARISM CRISISMANSOURA ENDOCRINOLOGY ICU — QUICK CARDCombined 2° adrenal insufficiency+ 2° hypothyroidism± apoplexy / Sheehan's1. STEROID FIRSTHydrocortisone 100mg IV bolus, then 50mg IV q6h.ABSOLUTE RULE: before or WITH levothyroxine, NEVER after.2. THEN THYROXINEStart only once hydrocortisone on board.Dose by weight, target free T4 — do NOT use TSH (unreliable centrally).3. APOPLEXY CHECKSudden headache + visual change? Urgent MRI + ophthalmology + neurosurgery.4. CHECK FOR DIMay coexist post-apoplexy/surgery — check urine output/osmolality (see Sec.11).5. CHECK NaHyponatremia common — often improves once hydrocortisone corrects the ACTH-deficiency water retention.CALL ENDOCRINE ON-CALL: immediately on suspicion, given the sequencing rule and mortality risk.RED FLAGS — JUNIOR STAFF: CALL SENIOR ON-CALL IMMEDIATELYSudden severe headache with visual change — suspected apoplexy, urgent imaging + ophtho + neurosurgeryAny hypotension or shock — treat empirically as adrenal crisis, do not wait for resultsHypoglycemia at any pointHyponatremia not improving after hydrocortisoneDeclining consciousness or new visual field deficit — surgical urgencyPK Y\c!ppt/slides/_rels/slide12.xml.rels PK Y\*)@ ppt/notesSlides/notesSlide12.xml 12PK Y\Fb+ppt/notesSlides/_rels/notesSlide12.xml.rels PK Y\K !ppt/slideMasters/slideMaster1.xml PK Y\N),ppt/slideMasters/_rels/slideMaster1.xml.rels PK Y\6TT!ppt/notesMasters/notesMaster1.xml 7/23/19Click to edit Master text stylesSecond levelThird levelFourth levelFifth level‹#›PK Y\s **,ppt/notesMasters/_rels/notesMaster1.xml.rels PK Y\_rels/PK Y\ $docProps/PK Y\Kppt/PK Y\ mppt/_rels/PK Y\ ppt/charts/PK Y\ppt/charts/_rels/PK Y\ppt/embeddings/PK Y\ ppt/media/PK Y\Bppt/slideLayouts/PK Y\qppt/slideLayouts/_rels/PK Y\ppt/slideMasters/PK Y\ppt/slideMasters/_rels/PK Y\  ppt/slides/PK Y\3ppt/slides/_rels/PK Y\ bppt/theme/PK Y\ppt/notesMasters/PK Y\ppt/notesMasters/_rels/PK Y\ppt/notesSlides/PK Y\ppt/notesSlides/_rels/PK Y\"˩P[Content_Types].xmlPK Y\]] V_rels/.relsPK Y\!docProps/app.xmlPK Y\LF(docProps/core.xmlPK Y\* * +ppt/_rels/presentation.xml.relsPK Y\Oݨ 6ppt/theme/theme1.xmlPK Y\ Wppt/presentation.xmlPK Y\Xheppt/presProps.xmlPK Y\fppt/tableStyles.xmlPK Y\D >00gppt/viewProps.xmlPK Y\H7t!jppt/slideLayouts/slideLayout1.xmlPK Y\ђ77,mppt/slideLayouts/_rels/slideLayout1.xml.relsPK Y\OH$s$skoppt/slides/slide1.xmlPK Y\3 ppt/slides/_rels/slide1.xml.relsPK Y\.ppt/notesSlides/notesSlide1.xmlPK Y\:A*ppt/notesSlides/_rels/notesSlide1.xml.relsPK Y\v5kkppt/slides/slide2.xmlPK Y\2- Yppt/slides/_rels/slide2.xml.relsPK Y\[ppt/notesSlides/notesSlide2.xmlPK Y\xշ*bppt/notesSlides/_rels/notesSlide2.xml.relsPK Y\2eedppt/slides/slide3.xmlPK Y\W/ ppt/slides/_rels/slide3.xml.relsPK Y\K |Őppt/notesSlides/notesSlide3.xmlPK Y\9 Y*ppt/notesSlides/_rels/notesSlide3.xml.relsPK Y\1o1oppt/slides/slide4.xmlPK Y\` Eppt/slides/_rels/slide4.xml.relsPK Y\vsGppt/notesSlides/notesSlide4.xmlPK Y\J *Mppt/notesSlides/_rels/notesSlide4.xml.relsPK Y\_5]BkBkOppt/slides/slide5.xmlPK Y\5 hppt/slides/_rels/slide5.xml.relsPK Y\W8tppt/notesSlides/notesSlide5.xmlPK Y\Qe*Appt/notesSlides/_rels/notesSlide5.xml.relsPK Y\:iiTppt/slides/slide6.xmlPK Y\ج+ !0ppt/slides/_rels/slide6.xml.relsPK Y\z-2ppt/notesSlides/notesSlide6.xmlPK Y\=|*8ppt/notesSlides/_rels/notesSlide6.xml.relsPK Y\^ee ;ppt/slides/slide7.xmlPK Y\F ,ppt/slides/_rels/slide7.xml.relsPK Y\)l8ppt/notesSlides/notesSlide7.xmlPK Y\|g*ppt/notesSlides/_rels/notesSlide7.xml.relsPK Y\eCggppt/slides/slide8.xmlPK Y\6 ppt/slides/_rels/slide8.xml.relsPK Y\iސppt/notesSlides/notesSlide8.xmlPK Y\pO*ppt/notesSlides/_rels/notesSlide8.xml.relsPK Y\aappt/slides/slide9.xmlPK Y\>$ ppt/slides/_rels/slide9.xml.relsPK Y\qppt/notesSlides/notesSlide9.xmlPK Y\1*ppt/notesSlides/_rels/notesSlide9.xml.relsPK Y\aa͋ppt/slides/slide10.xmlPK Y\Ѳ!ppt/slides/_rels/slide10.xml.relsPK Y\O ppt/notesSlides/notesSlide10.xmlPK Y\T+ppt/notesSlides/_rels/notesSlide10.xml.relsPK Y\jeeppt/slides/slide11.xmlPK Y\;!^ppt/slides/_rels/slide11.xml.relsPK Y\s6ӑ `ppt/notesSlides/notesSlide11.xmlPK Y\O+gppt/notesSlides/_rels/notesSlide11.xml.relsPK Y\קcTfTfippt/slides/slide12.xmlPK Y\c!!ppt/slides/_rels/slide12.xml.relsPK Y\*)@ /ppt/notesSlides/notesSlide12.xmlPK Y\Fb+ppt/notesSlides/_rels/notesSlide12.xml.relsPK Y\K !ppt/slideMasters/slideMaster1.xmlPK Y\N),ppt/slideMasters/_rels/slideMaster1.xml.relsPK Y\6TT!ppt/notesMasters/notesMaster1.xmlPK Y\s **,ppt/notesMasters/_rels/notesMaster1.xml.relsPKSS