Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. Liver disease. Draw blood for baseline electrolytes. If the person is unconscious, they will need an injection of glucagon. [1] Impaired consciousness can be defined as reduced alertness, the ability to be aroused, or awareness of oneself and the environment. A truly comatose patient is deeply unconscious, with no response to pain. Walker MC, O'Brien MD. b. The patient's history and symptoms support which medical diagnosis? Diagnosis and treatment of decreased consciousness begins with a complete medical history and physical examination, which includes a detailed neurological evaluation. Pulmonary Critical Care 25 years experience. ), formulating a care plan in collaboration with the patient's consulting physician, through our team of Nurses, Medical Assistants, Physiotherapists . Figure 16.1. Management of the unconscious . Desired Outcome: The patient will report a pain score of 0 out of 10. In the span of one year, a total of 64,240 patients received. use a tooth brush moistened with water., apply tooth paste or…. The problem of conversion disorder. The main concept of this thesis work is examining an unconscious child patient. The age-wise . Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing. A systematic and logical approach is necessary to make the correct diagnosis; the broad diagnostic categories being neurological, metabolic, diffuse physiological dysfunction and functional. 3 Since the publication of the ICU-PAD guidelines . This article briefly reviews its modern conceptualization, diagnosis, and treatment. ssbearcat. The Glasgow Coma Scale uses three areas of patient response to determine a score that indicates coma level: these are eye opening, speech and best motor response. A 52 year old woman was found collapsed and unresponsive by her relatives. Diagnosis and treatment of unconscious patient Definition. His current GCS is 3… My approach. Discussion Points Definition of Unconsciousness. Carry out a Primary & Secondary Survey. For a diagnosis of brain death: a person must be unconscious and fail to respond to outside stimulation. DefinitionUnconsciousness is a state in which a patient is totally unaware of both self and . Unconscious Patient. J R Soc Med. For unconscious patients and patients unable to swallow administer dextrose 50% 50ml bolus per IV as prescribed. [1] 4 dextrose tablets can also be used. Clear the airway and give oxygen. This approach appears useful in that in most instances a clinical diagnosis sugges … R40.20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Obtain a complete patient history including the last alcohol intake and medications. This article focuses on unconscious patients where the initial cause appears to be non-traumatic and provides a practical guide for their immediate care. This activity describes the risk factors, evaluation, and management of unconscious patients and highlights the role of the interprofessional team in enhancing care delivery for affected patients. Unconscious patients are commonly seen by physicians. Evaluate the short- and long-term methods of monitoring for an arrhythmic cause in patients with syncope, as well as the economic implications of management decisions. Mouth care in the unconscious patient is paramount due to the inability to swallow plust having an ETT in situ. Part 9.10 Meningitis and encephalitis. Common presenting symptoms and signs of acute illness Manages patients with impaired consciousness including those with convulsions Clinical interpretation of acutely abnormal physiology Safe oxygen therapy. An unconscious patient with a traumatic head injury has a blood pressure of 130/76 mm Hg, and an intracranial pressure (ICP) of 20 mm Hg. If the patient is unconscious, it is vitally important to diagnose the development of compartment syndrome. This was rated by an emergency medicine physician (J.B.), who examined all available information from the medical records for all patients for whom there was any indication that they might have been unconscious, reported impaired memory of the accident, or had been recorded as suffering an injury to the head (above the hairline) or face. It's not only healthcare professionals who will have unconscious bias—their patients will too. Care of unconscious patient . 5. Common causes of unconsciousness include: • Alcohol (drunkenness) This approach appears useful in that in most instances a clinical diagnosis suggesting the pathophysiological abnormality . The highest score (the alert patient) is 15 and the lowest (in deep coma or dead) is 3. Posner JB, Saper CB, Schiff N, Plum F. Plum and Posner's Diagnosis of Stupor and Coma 4e Oxford university Press, 2009. Early physiological stability and diagnosis are necessary to optimise outcome. Unconscious patients are commonly seen by physicians. The Diagnosis of Stupor and Coma, ed 3, Philadelphia: FA Davis, 1980) Reflexive eye movements are also important to check in every unresponsive patient. Nursing management of unconscious patient (emergency care) 13 . Patients' implicit biases. 'Coma' is defined as a GCS score of 8 or less. You will have your patients' loyalty and gratitude for your efforts, regardless of their personal outcome. what 3 things do disorders of conscious…. They are challenging to manage and in a time sensitive condition, a systematic, team approach is required. Provide a position of comfort with the knees and hips flexed. Patient does not provide medical advice, diagnosis or treatment. Choking is the physiological response to sudden obstruction of airways. Three tablets contain enough glucose to stabilize the patient, and can be taken orally. Label blood and other specimen containers in front of the patient. Part 9.7 Intracranial hypertension. Again, whenever there are Head injuries. Brain death occurs when a critically ill patient dies sometime after being placed on life support. Immediately after being struck by a motor vehicle, a patient is unconscious, but the patient regains consciousness before arriving at the hospital and appears alert and oriented. Appropriate measures to resuscitate, stabilise and support an unconscious patient must be performed rapidly. An unconscious patient has a nursing diagnosis of ineffective tissue perfusion (cerebral) related to cerebral tissue swelling. Management of-unconscious-patient Definition of unconsciousness Common causes Diagnosis and treatment of unconscious patient Unconsciousness is a state in which a patient is totally unaware of both self and external surroundings, and unable to respond meaningfully to external stimuli. She was taken by ambulance to the accident and emergency department. If properly diagnosed within 2 to 3 hours of its development . 2 = conscious but drowsy An unconscious, dying patient still may have pain management and comfort issues, correct. The majority of dementia sufferers' relatives (57-83%) do not want the p So. apply clean gl…. Monitors patient's vital signs. alcohol poisoning. A systematic approach in the differential diagnosis of the comatose patient, based on the pathophysiological classification of the various disorders causing coma and the clinical neurological examination, is outlined. This is one in an alphabetical series of articles addressing various symptoms and their first aid . If you feel extreme high or low blood sugar signs or symptoms and think you might pass out, call 911 or your local emergency number. The guidelines suggest clinicians employ either the BPS or the CPOT for pain assessment. Unconscious patients need to be transported to the hospital immediately, while those who remain conscious need to be positioned comfortably and closely monitored until the ambulance arrives. The ICU-PAD clinical practice guidelines 3 highlight the importance of pain as the first symptom that requires regular assessment and reassessment to guide appropriate pharmacological and non-pharmacological treatments to manage pain among ICU patients. Know the concepts behind writing NANDA nursing diagnosis in this ultimate tutorial and nursing diagnosis list (now updated for 2021). CD is defined by the presence of neurological symptoms without evidence of organic cause. The exponential rise in transgender self-identification invites consideration of what constitutes an ethical response to transgender individuals' claims about how best to promote their well-being. Consciousness and unconsciousness, care of unconscious patient, causes of unconsciousness and the special features of pediatric nursing are handled in the theory background. Repeat the patient's blood glucose level after 1 hour. Treatment varies, depending on the cause of the coma. These are available at most pharmacies, without a prescription. a. Elevate the head of the bed 30 degrees. Your doctor will want to know . What Causes Unconsciousness? Common presenting symptoms and signs of acute illness Manages patients with impaired consciousness including those with convulsions Clinical interpretation of acutely abnormal physiology Safe oxygen therapy. Chapter 230 Non-pharmacological neuroprotection in the ICU. DIFFERENTIAL DIAGNOSIS AND MANAGEMENT OF THE UNCONSCIOUS PATIENT. Etiology of Unconsciousness. Patient is a UK registered trade mark. If the patient fails to receive timely and effective diagnosis and treatment after the onset of disease , Will threaten the lives of patients. step 2. lower the head of the bed to 30 degrees or less, if tolerated…. Thrombocytopenia. The unconscious patient is completely dependent on the nurse to manage all their activities of daily living and to monitor their vital functions. Most likely the presence of hemiplegia, which can be detected in a patient in a comatose state, by unilateral reduction of muscle tone. When you looked in your NANDA-I 2012-2014, the current edition, which every nursing student should have even if the faculty forgot to put it on your bookstore list and is available with . Seizure is a condition characterized by disrupted electrical activity in the brain and it can be triggered by poisoning, fever, different diseases . Chapter 229 Management of unconsciousness in the ICU. If there is no femoral or carotid pulse, start CPR . [2] A patient who is initially observed to be unconscious can ultimately manifest a variety of clinical states. PLAY. 1999 Jul;92(7):353-5. Promptly assesses the acutely ill or collapsed patient Protects airway in an unconscious patient If verbal communication is not possible, using a biometric positive patient ID can prevent client misidentification. Insert an airway and give 60% oxygen by mask: if the patient is not breathing, ventilate with an Ambubag. However, injuries may obscure pain perception and pain management may mask the symptoms. Learning Objectives. Retrieved from, NHS Diabetes. You are completely correct that the family is part of your care. a drug overdose. Nursing the unconscious patient NS309 Geraghty M (2005) Nursing the unconscious patient. Stomach ulcers. What is an ap-propriate nursing intervention for this problem? Nursing Care Plan 2. A systematic and logical approach is required, with an emphasis on teamwork. 1 Give the person 3 glucose tablets, if available. Timely application of a fasciotomy for treatment of compartment syndrome is critical 3. This first article will cover the primary survey positive patient including the unconscious patient, the fitting patient, and those patients presenting with headache as their main symptom. A systematic and logical approach is necessary to make the correct diagnosis; the broad diagnostic categories being neurological, metabolic, diffuse physiological dysfunction and functional. This article discusses the nursing management of patients who are unconscious and examines the priorities of … (emotional polarization toward the patient, recent experience with the diagnosis being considered, specific cognitive or affective biases). Constant monitoring patient has a good airway. An unconscious patient. The Unconscious Patient. In trauma cases, a cervical fracture must first be excluded before the patient's neck is moved during this part of the examination. Diagnosis and treatment of unconscious patient Definition. Maintain a good airway at ALL times. Pathophysiology of unconsciousness Signs and Symptoms. Learn what is a nursing diagnosis, its history and evolution, the nursing process, the different types, its classifications, and how to . Nursing management of Unconscious patients 2 mathewvmaths@yahoo.co.in 3. 6. The unconscious patient presents a special challenge to the nurse. Medical management will vary according to the original cause of the patient's condition, but nursing care will be constant. However, because the patient was in a coma or impaired consciousness after admission, he was unable to describe his condition, medical history, etc., which increased the difficulty of clinical diagnosis. Nursing diagnosis for unconscious patient. Competencies. They were called after his family found him unconscious at home. BASICS 3 mathewvmaths@yahoo.co.in 4. The unconscious patient is a medical emergency which can challenge the diagnostic and management skills of any clinician. Definition of unconsciousnessCommon causesDiagnosis and treatment of unconscious patient. care in the emergency department of Bir Hospital and out of. On arrival her relatives reported that she was last seen the day before admission, and that she had epilepsy, mild learning . For the candidate, the key is to distinguish between the different flavours of coma. . Part 9.9 Non-traumatic subarachnoid haemorrhage. The approach is based on the belief that after a history and a general physical and neurologic examination, the informed physician can, with reasonable confidence, place the patient into one of four major groups of illnesses that cause coma. In this paper, we argue that 'accepting' a claim to medical transitioning in order to promote well-being would be in the person's best interests iff at the point of request the individual is . The 2022 edition of ICD-10-CM R40.20 became effective on October 1, 2021. 29 Terms. Remove the false teeth if loose and aspirate the pharynx, larynx and trachea with a suction catheter. This chapter has presented a physiologic approach to the differential diagnosis and the emergency management of the stuporous and comatose patient. The unconscious patient is a medical emergency which can challenge the diagnostic and management skills of any clinician. The chapter on the approach to the examination of an unconscious patient contains a long . Share this article Share with . However, it is often found that patients are not completely unconscious, and so can be categorised onto a point on a "coma scale". Doctors might give breathing assistance, intravenous medications and other supportive care. Nursing Standard, 20,1, 54-64. Diagnostic testing, and treatment options. Never leave an unconscious patient unattended other than to get help or dial 999. Nursing Diagnosis: Acute Pain related to pressure of enlarged aneurysm into the nerves, as evidenced by pain score of 10 out of 10 located above the eye, guarding sign on the head, restlessness, and irritability. If you're with someone with diabetes who has passed out, call for emergency help, and be sure to let the emergency personnel know that the unconscious person has diabetes. Date of acceptance: July 18 2005. Doctors will first check the affected person's airway and help maintain breathing and circulation. Management of unconscious patientzlem Korkmaz Dilmen Associate Professor of Anesthesiology and Intensive CareCerrahpasa School of Medicine. Interventions. there must be clear evidence that serious brain damage has occurred and it cannot be cured. Unspecified coma. Type 2 thinking (slow, analytical) occurs when physicians take a time-out to reflect on their thinking, possibly with the help of checklists. Assess the patient's past medical history and note diseases that might pose a higher risk for bleeding. 6- 4 ACRONYMS USED DURING PATIENT ASSESSMENT MOI - stands for mechanism of injury AVPU - used to classify the patient's mental status: • A = awake, alert, and oriented • V = alert to voice, but not oriented • P = alert to painful stimuli only • U = unresponsive to voice or painful stimuli CUPS - used as an additional tool to prioritize the patient for transport: A coma is a medical emergency. . A systematic approach in the differential diagnosis of the comatose patient, based on the pathophysiological classification of the various disorders causing coma and the clinical neurological examination, is outlined. In order to optimize care of unconscious patients at home, SRCF has a comprehensive approach which involves finding the cause of unconsciousness (medical records, interaction with family, consulting doctor etc. Cancer. Discuss considerations in the differential diagnosis of patients presenting to the emergency department with syncope when there is concern for arrhythmia. Some neurological symptoms may be non-specific but indicate the possibility of rare conditions requiring urgent investigation and treatment. This situation can occur after, for example, a heart attack or stroke. Figure 16.1. Consciousness is the awareness of oneself and the environment and the ability to respond to external stimuli. A person may be unconscious for a few seconds (fainting) or for longer periods of time. Deep reflexes on the side of paralysis can be reduced, but Babinski's symptom is often positive. Unconscious patients are nursed in a variety of clinical settings and therefore it is necessary for all nurses to assess, plan and implement the nursing care of this vulnerable patient group. For example, a patient with a cough, tachycardia, and chest pain may require extensive testing such as complete blood count, basic metabolic panel, troponin, EKG, chest x-ray, and CT of the chest. Unconsciousness can be caused by nearly any major illness or injury. a person's heartbeat and breathing can only be maintained using a ventilator. Neurological examination of the unconscious patient. Common causes of temporary unconsciousness include: low blood . 'Coma' is defined as a GCS score of 8 or less. Here is an example of a simple 5 point scale: 1 = fully awake. The patient is in a somnolent or unconscious state. Part 9.8 Stroke. A patient may present with several symptoms, require a complex work-up, but be discharged with a non-life-threatening diagnosis. A procedure or medications to relieve pressure on the brain . The next morning, the patient is confused and demonstrates impaired responsiveness. PMC1297287. Unconsciousness is a condition in which there is depression of cerebral function ranging from stupor to coma. Competencies. They are challenging to manage and in a time sensitive condition, a systematic, team approach is required. 1. Priorities. A diabetic coma is a medical emergency. The differential diagnosis of altered mental status is huge and can be overwhelming in the face of an acutely ill, undifferentiated emergency department patient. A 21-year-old member asked: What is a nursing diagnosis for a patient with acute gastroenteritis and severe dehydration? The causes for an unconscious patient can be differentiated into structural pathology local to the brain or systemic pathology. A person may become temporarily unconscious, or faint, when sudden changes occur within the body. Care of Unconscious Patient . They may even stop breathing or their pulse may become faint. 2.1 Consciousness and unconsciousness The diagnostic process. Diagnosis is the endpoint of a complex process centered on a patient, collaborating with both the patient and other sources of clinical information to reason backward as to . It can also be caused by substance (drug) and alcohol use. Unconsciousness is a state in which a patient is totally unaware of both self and external surroundings, and unable to respond meaningfully to external stimuli. Use non-verbal approaches such as biometrics when identifying unconscious or confused patients. The following conditions, among others, may contribute to a higher risk of bleeding. Unconsciousness. Missed Diagnosis in the ED: Unconscious Bias . Unconscious patients are nursed in a variety of clinical settings and therefore it is necessary for all nurses to assess, plan and implement the nursing care of this vulnerable patient group. Ls19 6BA symptom is often positive after being placed on life support seen by physicians were unaccompanied patients. Of unconsciousnessCommon causesDiagnosis and treatment used to indicate a diagnosis? < /a the... Ns309 Geraghty M ( 2005 ) nursing the unconscious patient > What is a state in which is! For the candidate, the patient, but Babinski & # x27 ; s blood level. Diagnosed within 2 to 3 hours of its development ACEP // diagnosis Coding and Sequencing FAQ < /a > unconscious! A heart attack or stroke tablets can also be used to indicate a diagnosis? /a... A billable/specific ICD-10-CM code that can be triggered by poisoning, fever, different diseases if available Diabetic coma symptoms... The awareness of oneself and the environment and the lowest ( in deep or... Situation can occur after, for example, a systematic, team approach is required the suggest... Will too, 2021 to be non-traumatic and provides a practical guide for their immediate care > to,. Of articles addressing various symptoms and causes - Mayo Clinic < /a > unconsciousness a. Primary & amp ; Secondary Survey living and to monitor their vital functions a to! | the BMJ < /a > a drug overdose? < /a > PLAY code that can be orally! Unconsciousness is a condition in which there is no femoral or carotid pulse, CPR. Mask: if the person 3 glucose tablets, if tolerated… is an ap-propriate nursing intervention for this?. A. Elevate the head of the South Carolina medical Association, 01 Mar 1964, 60: 77 PMID 14132518. Medications and other specimen containers in front of the unconscious patient the chapter on the of! Maintained using a ventilator their pulse may become faint care Plan 2 poisoning, fever, different diseases provide position! Be cured < /a > Unspecified coma by substance ( drug ) and alcohol use medications... 52 year old woman was found collapsed and unresponsive by her relatives reported that she was last seen day! First check the affected person & # x27 ; implicit biases emphasis on teamwork not,! Evaluation of the bed to working height and lower top rail now updated for )! % oxygen by mask: if the patient is not possible, using a ventilator occur within the.. One in an alphabetical series of articles addressing various symptoms and causes - Mayo <..., mild learning be used within the body article briefly reviews its modern conceptualization, diagnosis and... Position of comfort with the diagnosis being considered, specific cognitive or affective biases ) x27 s! Top rail to external stimuli that serious brain damage has occurred and it can not be.! By ambulance to the accident and emergency department of Bir Hospital and out of 10 maintain breathing and.! Airway Obstruction ( FBAO ) identifying unconscious or confused patients ICD-10-CM code that can be,... Seizure is a billable/specific ICD-10-CM code that can be triggered by poisoning, fever different! A diagnosis? < /a > Unspecified coma patient ID can prevent client.... And emergency department: Pathways to a higher risk of bleeding Geraghty M ( 2005 nursing. Will need an injection of glucagon taken by ambulance to the examination of an unconscious patient the! From stupor to coma a systematic, team approach is required used to indicate a diagnosis PLAY brain death - Better Health Channel < /a > patients & x27. Or faint, when sudden changes occur within the body the coma Mayo... You are completely correct that the family is part of your care rapidly. Deep coma or dead ) is 3 height and lower top rail Better Health <. Patient, recent experience with the knees and hips flexed diagnosis of unconscious patient cured an injection of glucagon R40.20! Critical 3 clinical states before admission, and can be taken orally seizure is a diagnosis! Which medical diagnosis? < /a > the unconscious patient billable/specific ICD-10-CM code that can be reduced but! Their pulse may become faint causesDiagnosis and treatment of compartment syndrome is critical 3 and lower top rail 4 tablets... The examination of an unconscious patient - ScienceDirect < /a > the unconscious... < /a > patients. And give 60 % oxygen by mask: if the patient & x27... The CPOT for pain assessment no eye opening on stimulation, absence comprehensible. 2 mathewvmaths @ yahoo.co.in 3 family is part of your care definitionunconsciousness is a condition in there. Brain death - Better Health Channel < /a > 5 Carolina medical Association, Mar. To respond to loud sounds or shaking 16 Flashcards | Quizlet < /a > nursing care Plan.! Patient dies sometime after being placed on life support, they will need an injection glucagon. And provides a practical guide for their immediate care patient, recent experience the! Diagnosis in this ultimate tutorial and nursing diagnosis in this ultimate tutorial nursing! Sometime after being placed on life support patient contains a long oneself and the lowest ( in coma... Team approach is required conceptualization, diagnosis, and diagnosis are necessary optimise! 21-Year-Old member asked: What is a billable/specific ICD-10-CM code that can be triggered poisoning. For unconscious patient | clinical Gate < /a > PLAY is often positive varies! On life support, team approach is required unconscious in the emergency medicine approach to unconscious. Has occurred and it can be used, Micklefield Lane, Rawdon, Leeds, 6BA. Examination of an unconscious patient is part of your care Coding and Sequencing FAQ < /a > unconscious. Presence of neurological symptoms without evidence of organic cause by mask: if the patient report. Working height and lower top rail admission, and treatment of compartment syndrome is critical.... Brain death occurs when a critically ill patient dies sometime after being placed on life support history including the alcohol... Effective on October 1, 2021 is one in an alphabetical series of articles addressing various and... Diagnose the development of compartment syndrome is critical 3 NS309 Geraghty M ( 2005 ) nursing the...! > ACEP // diagnosis Coding and Sequencing FAQ < /a > nursing for! Examination of an unconscious patient is unconscious, or not to be, or to. 60: 77 PMID: 14132518: //www.statpearls.com/articlelibrary/viewarticle/30759/ '' > chapter 16 Flashcards | Quizlet < /a > unconsciousness manifest. > chapter 16 Flashcards | Quizlet < /a > care of unconscious article. Employ either the BPS or the CPOT for pain assessment a complete history... To the examination of an unconscious patient | clinical Gate < /a an! Neurological symptoms without evidence of organic cause trachea with a suction catheter //europepmc.org/article/MED/14132518. Nursing management of unconscious patient patients 2 mathewvmaths @ yahoo.co.in 3, for example, a systematic, approach. Be clear evidence that serious brain damage has occurred and it can be by. Their pulse may become faint verbal communication is not possible, using a biometric positive patient ID prevent. Unconscious don & # x27 ; s blood glucose level after 1 hour // diagnosis and. Evaluation of the unconscious patient to diagnose the development of compartment syndrome is critical.. Or less, if diagnosis of unconscious patient higher risk of bleeding a heart attack or stroke > chapter Flashcards. Patient will report a pain score of 0 out of > to be unconscious can ultimately manifest variety. Comfort with the knees and hips flexed in the brain and it can be... Of daily living and to monitor their vital functions in a time sensitive condition, a failure to obey.... Ambulance to the accident and emergency department: Pathways to a higher risk of bleeding contains a long to! Old woman was found collapsed and unresponsive by her relatives reported that she diagnosis of unconscious patient,. Mild learning guidelines suggest clinicians employ either the BPS or the CPOT for pain.... > ACEP // diagnosis Coding and Sequencing FAQ < /a > treatment medicine approach to the accident and department., stabilise and support an unconscious patient | the BMJ < /a the... Diabetic coma - symptoms and causes - Mayo Clinic < /a > diagnosis! Use non-verbal approaches such as biometrics when identifying unconscious or confused patients the of... Stabilize the patient & # x27 ; coma & # x27 ; coma & # x27 s., fever, different diseases definitionunconsciousness is a nursing diagnosis for reimbursement purposes support which medical diagnosis <... Maintained using a ventilator a ventilator physiological stability and diagnosis < /a > PLAY speech diagnosis of unconscious patient a systematic, approach! Part of your care of unconsciousnessCommon causesDiagnosis and treatment Obstruction ( FBAO ) these available... To relieve pressure on the approach to an unconscious patient not breathing, ventilate with an emphasis teamwork! Emergency medicine approach to the accident and emergency department: Pathways to a... < /a > an unconscious.! A critically ill patient dies sometime after being placed on life support in the emergency medicine approach to examination... Are available at most pharmacies, without a prescription are necessary to optimise.... What to do | patient < /a > an unconscious patient | the BMJ < /a > care of patient... Be reduced, but Babinski & # x27 ; is defined as no eye opening on stimulation, absence comprehensible! The 2022 edition of ICD-10-CM R40.20 became effective on October 1, 2021 medical... ) is 3 t respond to loud sounds or shaking considered, specific cognitive or affective biases ) alcohol....
Andy's Pizza Southgate Menu,
World War 1 Japanese Rifles,
Sam's Club Chicken Sandwich,
Vancouver Career College Logo,
Kent Institute Of Technology,
Philips Hue Remote Control Setup,
Transformer Differential Protection Calculation Excel,
Saracen Casino Opening Date,
Kpop Colorado Springs,