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23.68 22.505 C 23.678 22.591 23.682 22.676 23.69 22.761 C 23.699 22.814 23.702 22.867 23.7 22.921 L 23.7 23.017 C 23.712 23.145 23.712 23.262 23.712 23.379 C 23.712 23.539 23.712 23.71 23.701 23.882 C 23.701 24.019 23.69 24.157 23.68 24.297 C 23.68 24.35 23.67 24.393 23.67 24.446 C 23.637 24.777 23.605 25.107 23.542 25.438 L 23.542 25.481 C 23.512 25.656 23.476 25.83 23.434 26.002 C 23.393 26.174 23.348 26.345 23.297 26.514 C 23.242 26.686 23.188 26.857 23.125 27.026 C 23.061 27.198 22.997 27.369 22.922 27.529 C 22.818 27.759 22.701 27.984 22.571 28.201 C 22.507 28.318 22.432 28.425 22.368 28.521 C 22.101 28.902 21.786 29.246 21.43 29.545 C 20.419 30.352 19.17 30.802 17.877 30.825 C 17.696 30.835 17.503 30.846 17.312 30.846 C 16.971 30.846 16.63 30.836 16.32 30.825 C 16.203 30.825 16.085 30.814 15.979 30.814 C 15.399 30.779 14.821 30.704 14.251 30.59 C 14.112 30.558 13.984 30.537 13.856 30.505 C 13.595 30.436 13.339 30.35 13.088 30.249 C 12.924 30.18 12.763 30.101 12.608 30.014 C 12.523 29.971 12.437 29.918 12.352 29.865 C 12.267 29.811 12.181 29.747 12.096 29.683 C 12.009 29.626 11.927 29.561 11.851 29.491 L 11.648 29.289 L 11.456 29.075 C 11.387 28.994 11.323 28.909 11.264 28.819 C 11.197 28.741 11.14 28.655 11.093 28.563 C 11.054 28.512 11.019 28.459 10.987 28.403 C 10.976 28.382 10.965 28.35 10.955 28.329 C 10.947 28.313 10.936 28.298 10.923 28.286 C 10.911 28.25 10.897 28.214 10.881 28.179 C 10.855 28.142 10.833 28.103 10.816 28.061 C 10.806 28.03 10.795 28.009 10.784 27.977 C 10.602 27.564 10.46 27.136 10.358 26.697 C 10.316 26.535 10.28 26.371 10.251 26.206 C 10.216 26.055 10.188 25.901 10.166 25.747 C 10.114 25.468 10.075 25.187 10.048 24.905 C 10.048 24.862 10.038 24.819 10.038 24.777 C 10.015 24.603 9.997 24.429 9.985 24.255 C 9.974 24.073 9.952 23.891 9.942 23.699 C 9.943 23.653 9.94 23.607 9.932 23.562 C 9.942 23.551 9.942 23.551 9.942 23.54 C 9.943 23.518 9.94 23.496 9.932 23.476 C 9.933 23.405 9.93 23.333 9.921 23.262 L 9.921 23.252 C 9.9 22.975 9.886 22.697 9.878 22.419 C 9.878 22.301 9.878 22.173 9.868 22.057 C 9.857 21.769 9.857 21.46 9.857 21.151 C 9.846 20.83 9.846 20.511 9.846 20.18 C 9.846 19.817 9.856 19.466 9.878 19.102 C 9.91 18.751 9.932 18.398 9.974 18.047 C 10.006 17.758 10.038 17.471 10.08 17.193 C 10.162 16.629 10.277 16.071 10.422 15.519 C 10.497 15.242 10.572 14.975 10.656 14.697 C 10.731 14.431 10.828 14.175 10.923 13.908 C 11.009 13.673 11.093 13.439 11.189 13.204 C 11.212 13.161 11.221 13.119 11.243 13.076 C 11.329 12.865 11.424 12.658 11.532 12.457 C 11.555 12.398 11.584 12.341 11.616 12.287 C 11.702 12.095 11.797 11.924 11.894 11.742 C 11.908 11.709 11.925 11.676 11.947 11.647 C 12.926 9.878 14.276 8.343 15.905 7.145 C 15.677 6.312 15.373 5.502 14.998 4.723 C 14.381 3.498 14.873 2.005 16.096 1.385 C 16.107 1.376 16.129 1.376 16.14 1.364 C 16.767 1.099 17.476 1.103 18.101 1.376 C 18.726 1.648 19.211 2.164 19.445 2.804 C 19.716 3.531 19.937 4.276 20.107 5.033 C 20.586 4.884 21.067 4.756 21.579 4.64 L 21.579 3.113 C 21.582 1.958 22.504 1.014 23.66 0.985 C 24.816 0.956 25.784 1.853 25.845 3.007 C 25.905 1.853 26.874 0.956 28.03 0.985 C 29.185 1.014 30.108 1.958 30.111 3.113 L 30.111 4.692 C 36.19 6.377 35.444 11.647 35.444 11.647 Z M 9.889 23.3 C 9.897 23.37 9.901 23.441 9.899 23.513 L 9.878 23.3 L 9.846 22.457 C 9.857 22.745 9.868 23.023 9.889 23.289 Z M 9.932 18.084 C 9.963 17.796 9.996 17.508 10.049 17.231 C 10.006 17.507 9.974 17.796 9.942 18.084 C 9.899 18.436 9.878 18.788 9.846 19.14 C 9.868 18.788 9.889 18.436 9.932 18.084 Z M 10.326 26.735 C 10.428 27.173 10.571 27.601 10.753 28.015 C 10.562 27.606 10.419 27.177 10.326 26.735 Z M 9.889 23.42 L 9.889 23.431 C 9.889 23.431 9.878 23.421 9.878 23.431 L 9.846 22.588 C 9.857 22.876 9.868 23.154 9.889 23.42 Z M 9.942 18.215 C 9.899 18.567 9.878 18.919 9.846 19.271 C 9.868 18.919 9.889 18.567 9.932 18.215 L 9.942 18.215 Z M 35.404 11.652 C 35.191 11.652 34.988 11.652 34.796 11.662 C 34.593 11.662 34.402 11.662 34.209 11.672 L 33.633 11.705 C 33.527 11.705 33.419 11.715 33.313 11.726 L 33.281 11.726 C 33.174 10.116 32.364 6.99 27.937 5.764 L 27.937 4.185 C 27.937 3.118 27.149 2.215 26.092 2.073 C 26.46 1.398 27.169 0.98 27.937 0.985 C 29.114 0.988 30.067 1.941 30.071 3.118 L 30.071 4.697 C 36.151 6.382 35.403 11.652 35.403 11.652 Z M 1.197 37.856 C 1.726 40.853 3.266 43.576 5.229 45.867 L 5.229 57.674 C 5.24 58.762 5.576 59.822 6.193 60.718 C 6.869 61.686 7.841 62.407 8.963 62.772 C 9.991 63.079 11.087 63.073 12.112 62.753 C 11.015 62.359 10.064 61.686 9.393 60.718 C 8.775 59.822 8.439 58.762 8.428 57.674 L 8.428 45.866 C 6.979 44.174 5.839 42.321 5.048 40.245 C 4.45 38.677 4.162 36.946 4.162 35.274 C 4.162 30.414 7.403 27.338 11.072 24.615 C 9.868 24.836 8.389 25.412 7.155 25.186 C 6.106 25.999 5.106 26.874 4.162 27.807 C 1.313 30.658 0.555 34.005 1.198 37.856 Z M 63.945 48.752 C 63.927 48.524 63.911 48.295 63.884 48.063 C 63.869 47.923 63.846 47.78 63.827 47.639 C 63.799 47.425 63.772 47.212 63.737 46.996 C 63.712 46.846 63.681 46.693 63.654 46.542 C 63.616 46.333 63.58 46.124 63.536 45.914 C 63.502 45.756 63.464 45.595 63.427 45.436 C 63.382 45.231 63.334 45.026 63.284 44.821 C 63.242 44.656 63.195 44.492 63.151 44.326 C 63.097 44.123 63.042 43.921 62.983 43.718 C 62.764 42.97 62.518 42.229 62.247 41.498 C 61.832 40.374 61.361 39.273 60.849 38.19 C 60.425 37.299 59.972 36.422 59.49 35.561 C 58.256 33.361 56.846 31.253 55.237 29.309 C 55.134 29.185 55.032 29.059 54.928 28.938 C 54.8 28.786 54.67 28.642 54.541 28.495 C 54.438 28.379 54.335 28.259 54.232 28.145 C 54.099 28 53.967 27.862 53.835 27.722 C 53.735 27.617 53.635 27.507 53.534 27.404 C 53.396 27.262 53.257 27.128 53.119 26.992 C 53.024 26.9 52.93 26.803 52.836 26.715 C 52.678 26.563 52.519 26.423 52.361 26.281 C 52.288 26.215 52.215 26.145 52.142 26.082 C 51.918 25.886 51.69 25.697 51.457 25.512 C 51.375 25.447 51.295 25.391 51.213 25.33 C 51.068 25.219 50.922 25.107 50.777 25.004 C 50.677 24.933 50.577 24.871 50.477 24.805 C 50.354 24.722 50.231 24.637 50.11 24.562 C 50.005 24.498 49.903 24.444 49.801 24.385 C 49.684 24.319 49.568 24.249 49.454 24.19 C 49.351 24.136 49.25 24.092 49.149 24.044 C 49.057 24.001 48.965 23.952 48.874 23.914 C 49.76 23.757 50.577 23.644 51.208 23.573 C 52.867 23.419 54.404 21.983 54.407 20.267 C 54.321 18.536 52.937 17.152 51.207 17.067 C 48.794 17.15 46.404 17.564 44.103 18.296 C 43.555 17.644 42.987 17.009 42.4 16.392 C 42.668 16.201 42.942 16.019 43.222 15.848 C 44.399 15.138 44.353 13.087 43.809 12.033 C 43.321 10.629 42.025 9.665 40.54 9.6 C 39.092 9.664 37.657 9.902 36.265 10.309 C 35.904 7.333 33.812 4.855 30.94 3.999 L 30.94 3.2 C 30.94 1.938 30.198 0.794 29.046 0.279 C 27.894 -0.236 26.547 -0.025 25.607 0.818 C 24.725 0.026 23.478 -0.212 22.366 0.197 C 21.254 0.606 20.46 1.597 20.302 2.771 C 20.269 2.68 20.235 2.59 20.2 2.499 C 19.835 1.564 19.103 0.82 18.175 0.438 C 17.283 0.072 16.278 0.097 15.406 0.507 C 14.583 0.893 13.951 1.593 13.65 2.45 C 13.324 3.372 13.377 4.385 13.797 5.267 C 14.04 5.777 14.252 6.301 14.432 6.837 C 13.121 7.918 12.003 9.213 11.123 10.667 L 8.239 10.667 C 7.405 10.66 6.598 10.953 5.962 11.492 C 4.918 12.333 4.3 13.593 4.274 14.934 C 4.3 16.28 4.923 17.545 5.975 18.386 L 2.175 19.79 C 0.558 20.384 -0.336 22.117 0.118 23.78 C 0.573 25.442 2.224 26.48 3.919 26.168 L 4.484 26.064 C 4.158 26.365 3.832 26.667 3.519 26.98 C 1.002 29.498 -0.119 32.207 0.018 35.769 C 0.057 36.783 0.2 37.795 0.437 38.782 C 0.628 39.581 0.88 40.367 1.191 41.129 C 1.945 42.965 3.002 44.655 4.273 46.175 L 4.273 57.6 C 4.273 61.134 7.138 64 10.673 64 C 14.208 64 17.073 61.134 17.073 57.6 L 17.073 56.231 C 23.164 59.841 30.529 62.933 37.339 62.933 C 39.273 62.933 41.795 62.797 43.65 63.341 C 44.613 63.427 45.576 63.516 46.54 63.6 C 47.005 63.64 47.489 63.675 47.964 63.711 C 48.345 63.741 48.717 63.773 49.102 63.8 C 49.602 63.833 50.113 63.856 50.619 63.882 C 50.993 63.902 51.36 63.929 51.735 63.943 C 52.621 63.979 53.513 64 54.407 64 C 62.864 64 64.006 56.989 64.006 50.133 C 64.006 49.797 63.997 49.455 63.975 49.109 C 63.968 48.991 63.954 48.871 63.945 48.752 Z M 45.412 24.385 C 44.802 24.802 44.131 25.12 43.423 25.329 C 42.833 25.502 42.222 25.593 41.607 25.6 C 41.384 25.598 41.162 25.58 40.942 25.546 C 40.868 25.536 40.789 25.516 40.713 25.502 C 40.541 25.471 40.37 25.435 40.201 25.391 C 39.815 25.287 39.436 25.161 39.065 25.013 C 38.977 24.978 38.881 24.936 38.79 24.898 C 38.557 23.724 38.428 22.531 38.406 21.334 C 38.595 19.833 39.648 18.698 40.727 17.726 C 41.417 18.452 42.082 19.2 42.72 19.971 C 42.852 20.131 42.964 20.276 43.087 20.429 C 43.523 20.976 43.944 21.535 44.342 22.11 C 44.433 22.241 44.528 22.376 44.608 22.499 C 44.979 23.056 45.329 23.631 45.632 24.228 C 45.563 24.279 45.497 24.329 45.413 24.385 Z M 51.207 19.2 C 51.728 19.272 52.371 19.809 52.26 20.395 C 52.1 20.987 51.581 21.411 50.969 21.452 C 49.604 21.604 48.248 21.831 46.907 22.132 C 46.482 21.435 46.024 20.758 45.535 20.104 C 47.38 19.564 49.286 19.261 51.207 19.2 Z M 41.838 12.85 C 42.031 13.245 42.074 13.697 41.956 14.122 C 40.682 14.922 39.507 15.871 38.456 16.949 C 38.24 17.176 38.033 17.408 37.836 17.65 C 37.402 18.171 37.036 18.745 36.747 19.358 C 36.707 19.444 36.674 19.531 36.638 19.619 C 36.586 19.75 36.532 19.881 36.491 20.011 C 36.456 20.12 36.434 20.232 36.406 20.343 C 36.38 20.452 36.348 20.56 36.33 20.666 C 36.221 21.315 36.281 21.985 36.329 22.636 C 36.382 23.342 36.469 24.047 36.592 24.744 C 36.749 25.65 36.951 26.555 37.203 27.439 C 36.561 27.894 34.679 28.8 29.873 28.8 C 29.327 28.799 28.782 28.769 28.239 28.711 C 28.163 28.704 28.085 28.699 28.01 28.69 C 27.461 28.624 26.917 28.519 26.383 28.377 C 25.974 28.269 25.573 28.131 25.184 27.965 C 25.126 27.94 25.072 27.912 25.016 27.886 C 24.649 27.72 24.298 27.521 23.968 27.29 C 24.254 26.419 24.235 25.481 24.491 24.626 C 24.517 24.24 24.541 23.854 24.541 23.467 C 24.541 23.057 24.511 22.646 24.488 22.237 C 24.367 20.206 24.203 17.427 26.058 15.458 C 27.719 13.696 30.796 12.8 35.207 12.8 C 35.321 12.8 35.435 12.782 35.545 12.745 C 37.162 12.204 38.839 11.864 40.539 11.734 C 41.153 11.822 41.659 12.257 41.839 12.851 Z M 16.295 8.093 C 17.385 7.293 16.138 5.218 15.722 4.35 C 15.545 3.981 15.522 3.557 15.658 3.171 C 15.774 2.835 16.025 2.564 16.35 2.42 C 16.675 2.277 17.044 2.275 17.371 2.415 C 17.757 2.575 18.061 2.885 18.213 3.275 C 18.461 3.935 18.661 4.612 18.811 5.302 C 18.873 5.609 19.064 5.875 19.335 6.032 C 19.606 6.19 19.932 6.223 20.229 6.125 C 20.662 5.988 21.112 5.873 21.573 5.769 C 22.06 5.661 22.407 5.228 22.407 4.729 L 22.407 3.202 C 22.407 2.613 22.884 2.136 23.473 2.136 C 24.062 2.136 24.54 2.613 24.54 3.202 C 24.54 3.792 25.017 4.269 25.606 4.269 C 26.196 4.269 26.673 3.792 26.673 3.202 C 26.673 2.613 27.151 2.136 27.74 2.136 C 28.329 2.136 28.806 2.613 28.806 3.202 L 28.806 4.782 C 28.806 5.261 29.126 5.682 29.588 5.81 C 33.275 6.831 34.024 9.332 34.149 10.684 C 33.992 10.689 33.848 10.704 33.694 10.712 C 32.897 10.749 32.099 10.817 31.309 10.933 C 31.033 10.973 30.767 11.021 30.504 11.07 C 30.287 11.112 30.066 11.152 29.856 11.2 C 29.599 11.259 29.353 11.328 29.108 11.397 C 28.915 11.451 28.719 11.504 28.534 11.565 C 28.292 11.643 28.065 11.735 27.836 11.826 C 27.671 11.892 27.498 11.954 27.34 12.025 C 27.11 12.129 26.898 12.246 26.684 12.362 C 26.546 12.436 26.403 12.504 26.271 12.584 C 26.045 12.721 25.837 12.873 25.631 13.025 C 25.532 13.098 25.422 13.163 25.326 13.24 C 25.035 13.473 24.761 13.725 24.505 13.996 C 22.018 16.634 22.223 20.082 22.359 22.365 C 22.38 22.731 22.406 23.1 22.406 23.467 C 22.406 24.088 22.354 24.713 22.252 25.324 C 22.152 25.962 21.972 26.585 21.716 27.177 C 21.58 27.467 21.417 27.748 21.235 28.002 C 21.156 28.115 21.077 28.231 20.989 28.334 C 20.806 28.544 20.601 28.735 20.379 28.903 C 20.076 29.136 19.738 29.301 19.396 29.467 C 19.074 29.591 18.741 29.684 18.402 29.744 C 17.407 29.928 16.373 29.888 15.37 29.803 C 14.569 29.734 13.753 29.597 13.027 29.233 C 12.972 29.205 12.92 29.173 12.867 29.142 C 12.765 29.085 12.666 29.023 12.57 28.956 C 12.496 28.901 12.429 28.838 12.36 28.778 C 12.296 28.722 12.228 28.671 12.169 28.611 C 12.044 28.479 11.93 28.337 11.828 28.187 C 11.795 28.137 11.766 28.08 11.735 28.028 C 11.663 27.911 11.596 27.791 11.536 27.668 C 11.499 27.589 11.464 27.502 11.43 27.418 C 10.955 26.265 10.829 24.959 10.77 23.73 C 10.87 22.988 10.692 22.105 10.681 21.352 C 10.677 20.999 10.673 20.649 10.673 20.268 C 10.673 19.779 10.709 19.302 10.745 18.826 C 10.761 18.636 10.773 18.457 10.795 18.249 C 10.893 17.389 11.057 16.536 11.283 15.7 C 11.346 15.467 11.398 15.227 11.47 15.001 C 11.539 14.781 11.627 14.574 11.704 14.361 C 11.823 14.039 11.941 13.717 12.079 13.409 C 12.155 13.235 12.243 13.07 12.327 12.902 C 13.243 11.003 14.604 9.353 16.295 8.093 Z M 7.355 13.108 C 7.604 12.904 7.917 12.795 8.239 12.801 L 10.005 12.801 C 9.567 13.843 9.229 14.923 8.996 16.029 C 8.946 16.261 8.906 16.496 8.864 16.733 C 8.844 16.845 8.82 16.954 8.801 17.068 L 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28.806 3.202 L 28.806 4.782 C 28.806 5.261 29.126 5.682 29.588 5.81 C 33.275 6.831 34.024 9.332 34.149 10.684 C 33.992 10.689 33.848 10.704 33.694 10.712 C 32.897 10.749 32.099 10.817 31.309 10.933 C 31.033 10.973 30.767 11.021 30.504 11.07 C 30.287 11.112 30.066 11.152 29.856 11.2 C 29.599 11.259 29.353 11.328 29.108 11.397 C 28.915 11.451 28.719 11.504 28.534 11.565 C 28.292 11.643 28.065 11.735 27.836 11.826 C 27.671 11.892 27.498 11.954 27.34 12.025 C 27.11 12.129 26.898 12.246 26.684 12.362 C 26.546 12.436 26.403 12.504 26.271 12.584 C 26.045 12.721 25.837 12.873 25.631 13.025 C 25.532 13.098 25.422 13.163 25.326 13.24 C 25.035 13.473 24.761 13.725 24.505 13.996 C 22.018 16.634 22.223 20.082 22.359 22.365 C 22.38 22.731 22.406 23.1 22.406 23.467 C 22.406 24.088 22.354 24.713 22.252 25.324 C 22.152 25.962 21.972 26.585 21.716 27.177 C 21.58 27.467 21.417 27.748 21.235 28.002 C 21.156 28.115 21.077 28.231 20.989 28.334 C 20.806 28.544 20.601 28.735 20.379 28.903 C 20.076 29.136 19.738 29.301 19.396 29.467 C 19.074 29.591 18.741 29.684 18.402 29.744 C 17.407 29.928 16.373 29.888 15.37 29.803 C 14.569 29.734 13.753 29.597 13.027 29.233 C 12.972 29.205 12.92 29.173 12.867 29.142 C 12.765 29.085 12.666 29.023 12.57 28.956 C 12.496 28.901 12.429 28.838 12.36 28.778 C 12.296 28.722 12.228 28.671 12.169 28.611 C 12.044 28.479 11.93 28.337 11.828 28.187 C 11.795 28.137 11.766 28.08 11.735 28.028 C 11.663 27.911 11.596 27.791 11.536 27.668 C 11.499 27.589 11.464 27.502 11.43 27.418 C 10.955 26.265 10.829 24.959 10.77 23.73 C 10.87 22.988 10.692 22.105 10.681 21.352 C 10.677 20.999 10.673 20.649 10.673 20.268 C 10.673 19.779 10.709 19.302 10.745 18.826 C 10.761 18.636 10.773 18.457 10.795 18.249 C 10.893 17.389 11.057 16.536 11.283 15.7 C 11.346 15.467 11.398 15.227 11.47 15.001 C 11.539 14.781 11.627 14.574 11.704 14.361 C 11.823 14.039 11.941 13.717 12.079 13.409 C 12.155 13.235 12.243 13.07 12.327 12.902 C 13.243 11.003 14.604 9.353 16.295 8.093 Z M 7.355 13.108 C 7.604 12.904 7.917 12.795 8.239 12.801 L 10.005 12.801 C 9.567 13.843 9.229 14.923 8.996 16.029 C 8.946 16.261 8.906 16.496 8.864 16.733 C 8.844 16.845 8.82 16.954 8.801 17.068 L 8.216 17.068 C 7.908 17.073 7.607 16.969 7.369 16.773 C 6.787 16.337 6.433 15.662 6.407 14.935 C 6.433 14.214 6.781 13.544 7.355 13.108 Z M 3.538 24.068 C 3.192 24.134 2.835 24.04 2.566 23.812 C 2.241 23.541 2.085 23.118 2.157 22.701 C 2.229 22.284 2.518 21.937 2.915 21.791 L 8.55 19.708 C 8.52 20.575 8.546 21.444 8.572 22.311 C 8.577 22.469 8.58 22.638 8.586 22.791 C 8.355 22.949 8.124 23.111 7.895 23.275 Z M 5.028 28.488 C 6.193 27.326 7.444 26.252 8.769 25.276 C 8.789 25.433 8.815 25.577 8.836 25.727 C 8.858 25.873 8.878 26.022 8.902 26.16 C 8.919 26.256 8.94 26.342 8.957 26.434 C 8.987 26.588 9.019 26.74 9.05 26.894 C 9.08 27.024 9.117 27.145 9.15 27.269 C 9.2 27.451 9.247 27.633 9.303 27.804 C 9.33 27.882 9.361 27.954 9.389 28.031 C 9.543 28.479 9.748 28.907 9.999 29.309 C 10.149 29.548 10.318 29.777 10.505 29.987 C 10.539 30.025 10.571 30.066 10.606 30.103 C 10.643 30.142 10.684 30.178 10.724 30.216 C 10.803 30.295 10.887 30.37 10.972 30.443 C 11.028 30.491 11.082 30.541 11.139 30.586 C 11.243 30.665 11.353 30.738 11.462 30.811 C 11.587 30.892 11.714 30.972 11.849 31.045 C 11.901 31.073 11.957 31.097 12.012 31.124 C 12.094 31.165 12.175 31.208 12.261 31.246 C 12.372 31.295 12.489 31.337 12.605 31.381 C 12.7 31.415 12.79 31.453 12.888 31.484 C 13.023 31.528 13.167 31.565 13.309 31.602 C 13.398 31.626 13.483 31.652 13.575 31.674 C 13.752 31.715 13.942 31.749 14.133 31.782 C 14.198 31.793 14.258 31.808 14.325 31.818 C 14.45 31.838 14.587 31.851 14.718 31.867 C 14.856 31.884 14.989 31.904 15.132 31.916 C 15.245 31.928 15.367 31.933 15.483 31.942 C 15.643 31.954 15.801 31.968 15.961 31.975 C 15.59 36.508 12.872 44.387 5.885 44.78 C 5.337 44.126 4.836 43.434 4.384 42.709 C 4.337 42.633 4.282 42.558 4.236 42.481 C 4.073 42.209 3.928 41.934 3.783 41.658 C 3.705 41.509 3.624 41.361 3.551 41.211 C 3.135 40.354 2.807 39.456 2.572 38.533 C 2.518 38.322 2.464 38.111 2.421 37.899 C 2.367 37.626 2.322 37.352 2.286 37.077 C 2.262 36.907 2.232 36.738 2.214 36.567 C 2.166 36.113 2.142 35.656 2.14 35.2 C 2.14 32.284 2.539 30.977 5.028 28.488 Z M 14.94 57.6 C 14.94 59.956 13.03 61.866 10.674 61.866 C 8.317 61.866 6.407 59.956 6.407 57.6 L 6.407 48.412 C 6.683 48.668 6.964 48.918 7.246 49.166 C 9.664 51.271 12.236 53.194 14.94 54.918 Z M 16.136 53.121 C 15.814 52.914 15.494 52.707 15.183 52.5 C 12.556 50.758 9.992 48.862 7.699 46.691 C 15.005 45.203 17.769 36.911 18.104 31.944 C 18.206 31.934 18.299 31.917 18.397 31.904 C 18.897 31.84 19.389 31.725 19.866 31.559 C 19.954 31.529 20.046 31.501 20.132 31.467 C 20.347 31.384 20.558 31.288 20.764 31.182 C 20.789 31.169 20.817 31.158 20.841 31.145 C 21.707 30.687 22.451 30.028 23.011 29.223 C 23.05 29.249 23.099 29.267 23.142 29.292 C 23.535 29.546 23.949 29.767 24.379 29.954 C 24.415 29.969 24.453 29.981 24.487 29.995 C 24.932 30.176 25.388 30.327 25.853 30.448 C 25.945 30.473 26.033 30.499 26.128 30.522 C 26.65 30.646 27.177 30.739 27.71 30.803 C 27.822 30.816 27.938 30.825 28.053 30.837 C 28.658 30.9 29.266 30.932 29.874 30.934 C 35.177 30.934 37.56 29.867 38.608 29.05 C 43.506 37.793 45.378 45.941 42.78 61.121 C 40.785 60.943 38.914 60.8 37.34 60.8 C 30.247 60.8 22.304 57.07 16.136 53.121 Z M 54.407 61.866 C 53.561 61.866 52.713 61.846 51.868 61.813 C 51.588 61.802 51.313 61.783 51.034 61.768 C 50.468 61.743 49.902 61.712 49.336 61.675 C 49.025 61.655 48.72 61.63 48.412 61.606 C 47.876 61.567 47.338 61.526 46.814 61.482 C 46.167 61.427 45.539 61.37 44.918 61.314 C 47.604 45.464 45.434 36.733 40.242 27.591 C 40.341 27.611 40.432 27.62 40.528 27.635 C 40.892 27.692 41.246 27.73 41.607 27.734 C 42.002 27.731 42.397 27.7 42.788 27.641 C 42.906 27.623 43.019 27.6 43.135 27.578 C 43.748 27.465 44.348 27.287 44.924 27.046 C 44.996 27.017 45.072 26.99 45.141 26.959 C 45.426 26.832 45.689 26.699 45.929 26.565 C 45.991 26.53 46.041 26.497 46.099 26.463 C 46.522 26.218 46.924 25.94 47.304 25.634 L 47.347 25.638 C 47.421 25.649 47.498 25.671 47.573 25.689 C 47.652 25.708 47.731 25.725 47.815 25.751 C 47.892 25.775 47.973 25.808 48.054 25.839 C 48.138 25.871 48.221 25.9 48.31 25.939 C 48.392 25.975 48.477 26.02 48.561 26.062 C 48.65 26.106 48.738 26.149 48.828 26.2 C 48.914 26.247 49.003 26.302 49.092 26.355 C 49.183 26.411 49.276 26.467 49.369 26.529 C 50.97 27.579 52.316 29.023 53.531 30.487 C 54.736 31.95 55.834 33.498 56.815 35.12 C 58.076 37.175 59.153 39.337 60.032 41.582 C 60.096 41.746 60.16 41.907 60.221 42.071 C 60.288 42.253 60.351 42.436 60.415 42.617 C 60.472 42.778 60.53 42.94 60.584 43.101 C 60.645 43.285 60.701 43.467 60.758 43.65 C 60.808 43.811 60.862 43.973 60.909 44.133 C 60.963 44.317 61.012 44.5 61.061 44.684 C 61.105 44.842 61.151 45.002 61.191 45.16 C 61.239 45.347 61.28 45.534 61.323 45.721 C 61.359 45.874 61.397 46.028 61.429 46.18 C 61.469 46.372 61.503 46.561 61.537 46.751 C 61.565 46.899 61.595 47.046 61.619 47.191 C 61.652 47.392 61.677 47.59 61.703 47.79 C 61.721 47.923 61.743 48.056 61.758 48.189 C 61.783 48.411 61.799 48.632 61.817 48.852 C 61.825 48.958 61.837 49.065 61.844 49.17 C 61.864 49.494 61.874 49.815 61.874 50.132 C 61.874 59.87 58.888 61.866 54.407 61.866 Z" fill="rgb(0, 77, 153)" height="64px" id="Q2tyxfE8l" width="64.00637410986974px"/></g></svg>)
Die akute Herzinsuffizienz ist eine rasch einsetzende oder sich verschlechternde Herzfunktionsstörung mit Dyspnoe, Lungenstauung und eingeschränkter Organperfusion. Sie zählt zu den häufigsten Notaufnahme-Diagnosen und ist mit einer hohen Krankenhausmortalität verbunden. Diese SOP strukturiert das Vorgehen von Ersteinschätzung über Diagnostik und Diuretikatherapie bis zur nicht-invasiven Beatmung und hämodynamischen Stabilisierung – evidenzbasiert und praxisnah.
Die akute Herzinsuffizienz ist eine rasch einsetzende oder sich verschlechternde Herzfunktionsstörung mit Dyspnoe, Lungenstauung und eingeschränkter Organperfusion. Sie zählt zu den häufigsten Notaufnahme-Diagnosen und ist mit einer hohen Krankenhausmortalität verbunden. Diese SOP strukturiert das Vorgehen von Ersteinschätzung über Diagnostik und Diuretikatherapie bis zur nicht-invasiven Beatmung und hämodynamischen Stabilisierung – evidenzbasiert und praxisnah.
Letzte Revision
Letzte Revision
Letzte Revision
Disclaimer
Unsere Leitfäden sollen dich in deinem medizinischen Alltag unterstützen. Sie erheben jedoch keinen Anspruch auf Richtigkeit sowie Vollständigkeit und sind daher ohne Gewähr. Insbesondere sind sie in keiner Weise ein Ersatz für professionelle Diagnosen, Beratungen oder Behandlungen durch approbierte ÄrztInnen & dürfen deshalb nicht als Grundlage für eigenständige Diagnosen sowie Behandlungen oder Änderungen an einer bereits empfohlenen Behandlung herangezogen werden.
Disclaimer
Unsere Leitfäden sollen dich in deinem medizinischen Alltag unterstützen. Sie erheben jedoch keinen Anspruch auf Richtigkeit sowie Vollständigkeit und sind daher ohne Gewähr. Insbesondere sind sie in keiner Weise ein Ersatz für professionelle Diagnosen, Beratungen oder Behandlungen durch approbierte ÄrztInnen & dürfen deshalb nicht als Grundlage für eigenständige Diagnosen sowie Behandlungen oder Änderungen an einer bereits empfohlenen Behandlung herangezogen werden.
#Medizinischer Leitfaden
#Notfallmedizin
#Akutmedizin
#Medizinische Leitlinie
#Qualitätsmanagement
#Notaufnahme
#Intensivstation
#DGINA
#Handlungsanweisung
#Behandlungspfad
Von Medizinern. Für Mediziner
Von Medizinern. Für Mediziner
Entdecke weitere Leitfäden aus der Kategorie Kardiologie
Entdecke weitere Leitfäden aus der Kategorie Kardiologie
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Von Medizinern. Für Mediziner.
Von Medizinern.
Für Mediziner.
2026
SOP Notaufnahme