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This is a disproportionation reaction. The balanced equation in alkaline medium is:
$S_{8} + 12OH^{-} \rightarrow 4S^{2-} + 2S_{2}O_{3}^{2-} + 6H_{2}O$
Therefore, the value of the coefficient 'a' is $12$.
[cite: 13]CRRT circuit clotting is the most common complication of CRRT in ICU, especially in patients with:
- Hypercoagulable states
- Inadequate anticoagulation
- Low blood flow rates
- High hematocrit
- High filter/transmembrane pressure alarms
- Reduced or absent effluent output
- Dark color of blood in circuit
- Frequent circuit 'down' time
- Regional citrate anticoagulation (RCA): First-line anticoagulation in CRRT (KDIGO 2012)
- Systemic heparin infusion (if no bleeding risk)
- Maintain blood flow rate \(\geq 150-200 \text{ mL/min}\)
- Predilution mode (dilutes blood before filter)
K$_2$HgI$_4$ is 40% ionized in aqueous solution. What is the van't Hoff factor ($i$)?
K$_2$HgI$_4$ dissociates as: $\text{K}_2\text{HgI}_4 \to 2\text{K}^+ + \text{HgI}_4^{2-}$ (3 particles total if fully ionized)
Degree of ionization $\alpha = 0.40$, total particles per formula unit if fully ionized = 3.
$i = 1 + (n-1)\alpha = 1 + (3-1)(0.40) = 1 + 0.80 = \mathbf{1.80}$
The stability of carbocations follows the order: $3^{\circ} > 2^{\circ} > 1^{\circ} > \text{methyl}$.
- $(CH_{3})_{3}C^{+}$ is a tertiary ($3^{\circ}$) carbocation. It is the most stable due to the maximum inductive effect (+I) and hyperconjugation from the nine $\alpha$-hydrogens[cite: 3, 49].
Acute Epiglottitis β a life-threatening supraglottic infection (typically Haemophilus influenzae type b in unvaccinated children).
Classic presentation:
- Sudden high fever, toxic appearance
- Drooling (inability to swallow secretions)
- Muffled 'hot potato' voice
- Tripod/sniffing position: leaning forward, neck extended, supporting on hands β maximizes airway opening
- Stridor (late, ominous sign)
- Anxiety, refuses to lie down
CRITICAL NURSING RULE:
NEVER examine the throat with tongue depressor, attempt IV access, take blood, agitate the child, or lay the child supine β ANY stimulation can cause complete airway obstruction.
Priority actions:
- Keep child calm, upright (let child maintain own position)
- Administer humidified Oβ gently
- Notify physician and anesthesiologist IMMEDIATELY
- Prepare for emergency intubation or tracheostomy (bedside)
- IV access and antibiotics ONLY after airway is secured
Treatment: Ceftriaxone \(100\,\text{mg/kg/day}\) IV after airway secured.
Differentiate from croup: croup has barking cough, subglottic involvement, not toxic, managed with steroids + nebulized epinephrine.
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