Live 365. You read about the current news in a regulated press and you pay a tax you do not owe to please the IRS Your money is no longer made of silver nor of gold you trade your wealth for paper so your life can be controlled You pay for crimes that make our nation turn from God and shame You've taken Satan's number You traded in your name You've given government control to those who do you harm so they could burn down churches and seize the family farm and keep our country deep in debt. Put men of God in jail. Harash your fellow countrymen while corrupted courts prevail. Your public servants don't uphold the solemn oaths they've sworn. And your daughters visit doctors so their children won't be born. Your leaders send artillery and guns to foreign shores and send your sons to slaughter fighting other people's wars Can you regain the freedoms for which we fought and died? Or don't you have the courage or the faith to stand with pride? And are there no more values for which you'll fight to save? Or do you wish your children to live in fear and be a slave? O sons of the Republic, arise, take a stand, defend the Constitution, the Supreme Law of the land, preserve our great Republic and each God given right, and pray to God to keep the torture freedom burning bright. As I awoke, he'd vanished in the mist for whence he came. His words were true, we are not free, but we have ourselves to blame. For even now as tyrants trample each God given right we only watch in tremble too afraid to stand and fight If he stood by your bedside in a dream while you were asleep and wondered what remains of the freedoms He'd fought to keep what would be your answer if he called out from the grave? Is this still the land of the free? Well good afternoon ladies and gentlemen. This is the second hour of the afternoon intelligence report. I'm Mark Corky and I'm Michael Nasser. One day closer to victory for all of our brothers and sisters both on and behind the lines at occupied territories west, southwest, central and northwest. Well ladies and gentlemen you are listening to us on LibertyTreeRadio.4mg.com, PBN.4mg.com and we're on live 365 then go to Liberty Tree Radio. You will also find us on AM&FM major stations, AM&FM micro stations, CB base stations, and alternate technologies both east and west of the Mississippi. Well Mike, today's date is... 9 October 2008 Thursday. The stock market fell again. That is not a surprise for any of us. Of course, now it's in the 8,000 range. It could jump up. It could leap up 6,000 points again real quick. Okay, probably not. But the good thing is people are paying attention. They're listening to what we've been talking about and it's a great compliment. We were eating up the silver and gold out there across the country. That's a good thing eating it up as in consuming it and putting it in tactical deployment amongst the population It's not sitting in a vault somewhere where it's all in one pile and somebody can walk in with gunpoint carried away Now they're gonna have to be more criminal about it trying to steal it from us And we have more weapons than they do and we're not gonna let them take it. So That's how it's gonna work No, they're probably chirping and rubbing their hands, thinking, wow, this is how it is. Yeah, OK, well, you keep rubbing your hands and chirping. They got the stinkers. We got the thinkers. Today is Thursday and of course Mike's going to be covering medical and I'm going to have him take it over here in a second. But real quick, medical support. Why is it that we do this on the program? There are thousands and tens of thousands of you who are EMTs. So you don't have to tell us. We know what your profession is. We know what you're doing. And a lot of you guys out there deal with this every day. However, There are millions of you out there who may have to be the next guy in line next to that EMT because he's got his hands full. He's up to his eyeballs and gore, okay? He is overwhelmed. We cannot afford to lose people. Because of that, you need to be properly trained. You need to have the basics. And remember, the rule is this. Even if in all the times that you listen to this programming when we especially cover medical, if only one thing sank in. And you use it that one time, then all the rest of this operation is paid for itself with regard to your listening. Okay, but we know you do better than that. The nice thing about this is that we have archived all the work we've done on WTPRN and on Liberty Tree Radio. Now, on that note, I'm going to remind everybody of something. Mike's classes, Mike's programs go back through a number of days and many of you have taken notes progressively as we have done this. I would recommend that you go to the WTPRN site ASAP and pull anything off their archives that you think you need because we don't know how long those archives are going to be up. Okay? So I would recommend that if you have anything that you like that was on WTPRN, you all better make sure you go copy it. Go get a big disk carousel of CDs or DVD disks, or go get yourself some old VHS machine and a bunch of old VHS tapes. Put it on max. In other words, on long record. you know, extended play and what will happen is you can use the VHS tapes as recording tapes. Remember you can put six to eight hours depending on how big the tape is. So that makes for a long recording block. Create a library of your own. This is something that we talked about all through the day today and I'll repeat again. Create a library of your own. Now, we're going to go the next step here. Preparatory, especially with, and Mike, by the way, the subject today is? Burns. We're going to go a little bit heavier into it. Now we covered most of the highlights. last week or so and now we're going to kind of plunge into it to the next level and get into it a little bit deeper. Now what we're going to do here is remember also is Mike Ken will give you contact information or ideas about where you can go or what you can do to build up the medical support, the supplies needed to support casualties of this type. Now most important is immediate treatment with burns. One of the things immediate response in other words you can't be going oh my god. It's terrible now if a guy is crispy critters And I'm gonna get that's not exaggeration. We're talking burns here Then you're mixed as far as what you can possibly do or limited to a degree But a lot of the burns you're gonna run into people are gonna be scalding burns or their instant contact burns They don't cover all large large areas and may cover just an area immediately start In other words, if you had a bucket of water right there, cold water, somebody got burned, splashed with scalding water. And all you could do is you got a cold pot of water sitting there, throw it at them. start pulling the calories, countering the calories that are there because where the burn damage takes place with a boiling burn or with a hot liquid burn of any kind is the subcutaneous buildup of heat, the lower tissue heat. It continues to sit there even while you've cooled the surface off just through natural convection. Okay? What you want to do is you need to start pulling those calories out. Well, what do you use to cool down a car? water. Why? It's cheap, it's easy, and it's very efficient. It is an efficient radiating, you know, system. If you've got a nice chest, if you can put a person if they're a hand or a foot, or even if it's to a degree their face, the side of their face, their ear or something like that. If you can get their head stuck in there real quick where it's cold, cold, cold, yeah, you might get a headache out of the deal, but it's going to do more to help the injury in that it pulls calories out. Now you can't leave him there in the freezer and you can't leave his hand stuck in the freezer. But what you can do for as long as you possibly can to help reduce the overall long-term damage while you're preparing to move the casualty, you can change from putting his hand in the freezer to grabbing one or two bags of frozen peas and corn or a couple of bags of ice and throw them into another bag and prep everything. And you can have the person's limb wrapped in that to still continue to pull calories out while you're transporting the casualty to wherever you're going to go, if you can. Now in the field there are a number of problems there you may not be going anyplace The other thing is you have to be ready for these types of injuries, and you have to remember that you may have to improvise Okay, it is interesting to note down. You know forgive me. I'm sorry Mike Years ago my father brought this up to me because he was president of the burn Association at one time too I was president for one of the burn associations here and Years ago, do you know how they discovered saline water for immersion for burns? You know how they found that was a desirable treatment? You know what the it was interesting too. It all came from a fire that took place near the Atlantic on the on the east coast. People were in a warehouse fire. They were terribly burned. And what they found is that the people, of course, ran out into the ocean to actually relieve themselves. They were, you know, they're closed around fire. They put the fire out, but not only that, it extracted the calories or relieved the buildup of heat. And the minerals themselves actually helped to deaden the pain. It was an interesting combination of things. Well, the sad part about it was this, where they found the hardest part in dealing with these casualties was they would pull them out of the water and the people would physically fight them and run back into the surf. because it alleviated the pain. And eventually they actually had to wrestle them out of the water. They couldn't leave them there forever. And they had to wrestle them out of the water and actually go through the normal treatments and everything else that were required. But this is years ago. This is before we knew all that we know today. So anyway, now from that point forward, well we can do better than dip them in the ocean, okay? And we can do better than the icebox. But that's where Mike comes in. So Mike, we gotta deal with casualties. We're looking at burns. What are we gonna do? Okay, very good. Now, like I said, we covered pretty much front to back. in the last week or so, but we're gonna kind of overlap some of that information and some of the other things that are a little bit deeper in medical knowledge. The main thing is you want the history. You need a thorough history and you can obtain that in your initial contact with the patient and you can do this while performing your physical examination and your initial treating of the patient. Now some of the things in the history you need the following is definitely got to be determined. The date and the time of the bird, the method of the injury, whether it was a flame, electrical or chemical, how it was caused, was it a house fire, a scald, explosion, an airplane crash, whether it was suffered in an opened or a closed space, and any previous previous treatment should be determined. Now some of the additional things that are very important is to include the known allergies, any medication the patient is taking, any pre-existing diseases, especially diabetes or any prior operation. And then we want to start reviewing the systems and they can yield information concerning any associated injuries or any underlying diseases that the patient may not initially remember. Now, we kind of covered this and again we're going to deviate from the old rule of 9 to the rule of 20. One of the things we really want to do is estimate the severity and the depth of the injury. Like we said before, on our new rule of 20s, we'll make a little stick man. We'll have the head at the top and then underneath it there will be three boxes. and then you put the arms and the legs on it. And now the head will be labeled number one, the upper chest will be labeled number two, the lower chest will be number three, the abdomen will be labeled number four, and the legs and the arms are labeled number five. 5 times 20 equals 100. The only deviation from this is the head. Any burn of the head, we're going to consider that as 20%. Everything else will be the number 2, the number 3, the number 4, the number 5. The front will be 10% and the back will be 10%. So if you have a head and a front of an arm burn, well then that'll be 30% and so on. Before it was the rule of nines and you would have one and a half for this and eight for that and something else for that. Pretty soon you have to get a paper and a pencil to try to figure that out. We are just trying to do this for easy estimation on what the percentage is. And then the next thing we want to do is we want to classify the depth of the injury as either a partial thickness or a full thickness. Now your partial thickness injuries, they'll have the remaining epithelial elements. And if you protect these from infections, they'll spontaneously start to grow back again in the area of the bird. Now your full thickness injuries indicate destruction of all the epithelial remnants, and they're going to require an autographed wound type of closure. And the full thickness injuries They can be either charred or peri-white in color. They're anesthetic and they're dry with an underlying thrombose blood vessels. Children and young children commonly are fullness rather than portion. You're in general examination, a thorough physical examination to identify the associated injuries and clues are essential. So you know what we always said, you know, the main thing is to make sure that the patient is breathing. And then also, say for instance somebody was working on an electrical box. and they got shocked and they fell backwards and they may have broken an arm or broken a leg or fractured their skull or things. So don't just become fixated on the burn. The primary concern is to make sure that the person is breathing and then after, during your examination, you want to make sure that you carry out a good, thorough physical examination to identify any other types of injuries that may have occurred during that or any illnesses that the patient may have. Now, some of the things that you want to take into consideration to realize if it's real serious that they needed to be moved on up to a higher echelon of medical care. Number one is going to be patient with burns of the face, the hands, or the feet, or the perineum. Number two would be children with burns of greater than 10% of the total body surface or any component of a full thickness injury. Number three, adults with partial thickness injury greater than a 15% or a full thickness injury of anything grade anything. And that number four, patients with suspected inhalation injuries. Number five, patients with electrical burns, however small. Now your initial management, you want to... Access the adequacy of the ventilation, which we mentioned first. You want to make absolutely sure the person is breathing. Then you want to establish a secure IV line, preferably in an unburned area. You want to insert a Foley catheter and measure the urine output hourly. Now urine output in adults and children, it'll usually go from about .5 to 1.5 milliliters per kilogram per hour. Usually somewhere between 30 and 75 cc's an hour, but it's anywhere from a half to one and a half milliliters per kilogram per hour. And then you also might want to insert a nasogastric tube because you're going to get the gastric that will start swelling in their abdomen. So you want to decompress the gastric system, and then that's going to help prevent any vomiting or aspiration. Also, if you have it available as a tetanus immunization. Now, if there's no prior immunization against tetanus, or the prior immunization history is unknown, going to administer anywhere between 250 to 500 units of the human tetanus immune globulin IM for immediate passive protection in adults. Now in addition, you want to give 0.5 milliliters of tetanus poxoid to begin any primary immunization, especially if you haven't determined that they've ever been immunized against tetanus. And that's pretty much it. Now here's the other thing. Now we kind of covered on this the other day about your fluid requirements. Now there's always a variety of the resuscitation formulas have been described and estimated fluid requirements to replace the intravascular volume and they're going to restore the cardiac output. As we've mentioned before, what's going to happen is in this edema and then that's the swelling. the blisters that are going to be formed, and then also then you're going to have the capillary beds that are going to be thrombosed and there's going to be bleeding underneath the tissue. So what we need to do is pump that patient back up. We need to get the volume back in the veins and then that's going to help the cardiac output. Now, the assessment of adequacy of the volume restoration is based on frequent examination of the patient and some of the things you're going to take into consideration. The level of consciousness and the orientation, the vital signs, you're going to have the evidence of peripheral perfusion, you know, checking blanch in the nail beds, making sure that they're they're working properly. You're going to check the urine output and the body weight. And also, then if you have a laboratory available, you can check the value of the serum and the urine osmolality, the serum and the urine electrolytes and the hematocrit. And then after adequate urine output and the peripheral perfusion and the blood pressure established, then you're going to replace the fluids according to the need as determined by the physical examination and your laboratory determinations. Now, in the first 24 hours in both adults and children, the colloid solutions are no more effective for intravascular repletions than our crystalloid solutions in the first 24 hours post burn. I know in the past it was always the big argument about, well, are we going to give them saline? Are we going to give them dextrose? Are we going to give them lactated ringers and all this? These colloids are no longer recommended in the first 24 hours and the resuscitation fluids are calculated. What we're going to give is 4 milliliters of a crystalloid per kilogram per percentage of the burn in the first 24 hours after the injury. The IV fluid of choice is ringer's lactate without dextrose. And as I mentioned previously, just as an estimation on what is this might require, a patient weighing around 70 kilograms, somewhere between 140, 150 pounds, with a 50% burn, they may require as much as 14 liters of ringer's lactate in just the first 24 hours. So and now then we're going to have just as a word of warning to now your rapid administration of dextrose and water and children who have a relatively small intravascular volume and that can cause chemo dilation cerebral edema Swelling of the brain and convulsions and now your total salt and water requirements should be administered so that a rapid infusion of the solution is avoided. So be very careful on children who have burns. You don't want to give them too much fluid. Now, tell you what, Mike, stay right where you are there for the moment. We're at the bottom of the hour of break. Ladies and gentlemen, this is LTR, the intelligence report. You got Mike and Mark back in about four minutes here on LTR. Yeah, I'll be back in a minute. I gotta go to the shower. Hey, Tommy, what the heck is that in your locker? I don't know, it looks like some kind of a husk grown from some kind of a hybrid seed or a degenerate seed. If I've never seen it, it's big before. Tommy, Tommy, calm down. I heard these rumors, but I don't think so. It looks organic. It's probably safe. I don't know. I don't think so. I really don't know. I mean, I've seen a... You know, the cop on the corner, he had a dead glare in his face, and he usually talks to me all the time. I seem like some stuff, I think they got to him already. Tommy, he's always been like that. He's a liberal socialist. You should expect these things. You can pick him out in a heartbeat. I don't know what that... Wow, that thing's moving. That guy was like the straw man from the Wizard of Oz. He had nothing but hay in his head. If he only had a heart, no wait a minute, that was the will, or was that, wait a minute, that was a brain. Oh man, hey, that thing started to open up. You want to shut the door? Wait a minute, what's that on the side? It says cheap Chinese knockoff. What the he- Aw, man! Oh, the Galians have subcontracted on top of everything else! You know what? We could've prevented all this if you just listened to what I said, man! I'm telling you, if you just tuned in to Live 365 and then gone to Liberty Tree Radio, we'd all been fine, but no, you wouldn't listen to me! The husks are crazy stupid things! Look at that thing! It's as big as you are! Oh my God, where's the Treasury Department? I'm gonna- It's not a real one? Give me my gun. I'm out of bullets! Oh man! Okay, I'm either gonna use you for a club or we're getting out of here. We gotta tell people what's going on. We gotta go punch in to pbn.4mg.com. Either that or, I'll tell you what, if that's down, cause of what the heck, the lights are flickering. Okay, well if that's not that, we gotta go to libertytreeradio.4mg.com. Or, you, I want you to go to your place and check out blind365, then punch in to libertytreeradio. You gotta get on the system, man. You gotta know what's going on. I don't know, Mark. I'm really upset now. I'm gonna go hide under my bed and I hope I don't fall asleep again, ever. I will never fall asleep again. I don't want them to take my life. I don't want them to have my body. I want my heart to give up my MTV. Tom, you were saying that, but its mouth was moving with yours. Tom, what's happening to your eyes, man? Tom... Tom hey wait a minute hold on a second here. I'm sleepy mark. What the hell is this in my locker? Oh, no hey wait a minute. Well you guys playing around. Oh, we're out of here Tom. Let's go now Gentlemen we are back. This is the Intel report and the pod people remember the pod people oh Invasion of the body snatchers remember that one the dog was really ugly too. Yeah, it's almost like one of those politicians. We have in Washington Well anyway, I tell you what, we're back. This is the Intel Report Liberty Tree Radio. For all of you that are listening, please spread the word. We are up and online. Intel Report is live. Today is Thursday and we've got Mike Neser here covering burns. So keep your notepad ready. Mike, you ready to take it away again? Or jump right back on into it. Pick it up right where we left off, please. Okay, very good. Now we just did thrown in a little warning to try not to over-perfuse children because they've got such a small system. It's real easy to... They will rapidly put too much solution into their bodies. They are going to get hemodilation, in other words, too much volume in their system, a cerebral edema, a swelling of their brain, and then they are going to go into convulsions. So be very careful on that. Now during the second 24-hour period, we are usually going to administer half or two-thirds of the of fluid requirements that we did in the first 24 hours. There's a thing that's called tubular necrosis, and that's in the kidneys. the renal tubulars where the urine is actually collected, but it's the acute tubular necrosis, it seldom occurs in the early post-burn period in either adults or children. Now if you've got oliguria, and I'll spell that, O-L-I-G-U-R-I-A, and as you recall from the previous lesson, that meant a low urine output. Now, if you have a low urine output, it's most likely due to an inadequate volume replacement. We've told how to check for that. Also, digitalis, it's a heart medication. It shouldn't be given prophylactically, but it should be reserved for patients with a demonstrative congestive heart failure. Usually that's dropping the blood pressure, rapid irregular pulse, usually by atrial fibrillation, and a bubbling sound in their chest when you're listening with a stethoscope, usually the three signs of congestive heart failure. Now, your potassium supplementation is also contraindicated in the first 48 hours after the burn. Now, if it's administered, it can cause hyperkalemia, which is an elevated potassium level. The only patients that may require a potassium supplement are those who were potassium depleted prior to being burned. Now, after the 48 hours, And after the acute losses have been replaced, and the major need is to accurately replacement and the continuing evaporative losses plus the fluids for maintenance. Now, an estimate for an evaporative loss, we can use this formula. It's 25 plus the percent of the burn times the metered square of the total burn surface. And that'll be the estimate of evaporative loss per day in liters. Now just as an estimate in an extensively burned patient, they may require still 4,000 cc or more per day of D5W just to replace their evaporative loss. So that formula once again is 25 plus the percent burned times meter squared of the total body surface and that's going to equal the estimate of evaporative losses per day in liters. Then your potassium replacement now becomes critical. A lot of patients may excrete up to 300 milliquivalents of potassium per liter of urine. Then you need to check your urine and your serum potassium levels to determine the amount of replacement that you need. Potassium is a very critical factor in your heart function. Too low, your heart is not going to work right. Too high, your heart is going to stop. It's a very critical number. Also, another thing you might want to consider is whole blood or packed red cells. They're going to be given to maintain a minimum hematocrit of 35%. Your next consideration is going to be sedation and analgesia. Now the most common cause of respiratory arrest in a burn patient in the period of resuscitation is a narcotic overdose. Full thickness injury is not very painful, although the surrounding partial thickness injuries is. Now any agitation or distress in a burn patient should be considered is due to hypoxemia, that means a low oxygen level or a hypovolemia, a low volume until proved otherwise. And the effects of the narcotic administered IM to a hypovolemic patient is really unpredictable. We've covered on this before with the low volume. And then if you administer any medication, any pain medication, IM, it can sit there dormant in the intramuscular tissue. And then as the patient starts to come back around and starts to get pumped back up again, then all of a sudden then this narcotics that we've administered IM, then they'll all be swept in this system and then the patient can go into a narcotic overdose. So, if you're going to and if you have them available, the narcotics, if they're required, they must be administered IV in frequent small doses. Now, after the acute phase of the injury, some mild sedation may be required, and sedation should be judiciously employed, and the patient examines frequently for any evidence of any overdose. A somulant patient or patient that's real sleepy is not able to ingest an adequate volume of fluids or calories. And in addition, the sedatives and the hypotonics may accumulate and cause an respiratory arrest. Now, the next thing that you're going to consider is escharotomy. Now, in the extremity, any full thickness burns produce a non-elastic eschar- natured skin and when this extremity and it's going to develop a cutaneous or a sub-vascular compromise and then the result will be is a distal ischemia or gangrene. So what's happening here is this non-elastic scar that's formed kind of acts like a tourniquet and then is the swelling, the edema underneath that building and then it's going to cut off the blood flow to the extremity and then that extremity is going to start to die or it's going to, you're going to slide open for green. Now the eschatotomy, it's not for the faint hearted, but it's an incision of the eschar along the medial and the lateral aspects of the extremity. Medial means midline and lateral means left or right. The incision of the eschar along the medial and the lateral aspects of an extremity to relieve the vascular compromise and prevent the ischemia and the gangrene. The incision is made in areas of the folding, the injury, and is carried down only through the eschar and down into the muscle or anything. Just enough, we're going to incise that down through to relieve that tourniquet effect in the chest, It's indicated in patients with any encircling full thickness burns of the trunk with limitations of the skin. The decision made is in the anterior axillary line bilateral in the anterior and the axillary line, and we're going to do it on both sides, over the mid sternum and transversely at margins and the intercostal. In the inhalation injury, the assessment. Inhalation injury like we covered previously is very, very rare, but we're going to consider it as a chemical trachobronchitis, and that's going to result in the inhalation of toxic products of incomplete combustion. You're going to have hot gases that would have otherwise combusted, but there wasn't enough oxygen for it. You're going to have super-heated that are going to be inhaled in there. And it can occur, especially in patients in close or by the rapid combustion of patrol. seldom does a thermal injury in endotracheal or endobronchial, even though we have an imagination in our minds that somehow they've inhaled this and it's burned down in their trachea and down in their bronchial tree, is very, very rare. There's one exception again, there's live steam inhalation in a closed state, a true thermal injury. Now your clinical diagnosis of an inhalation injury is made in patients, again with your history that you've taken. They have maybe bronchospasms. They might become low- and also we talked about having a coarseness in their breath and coughing up the sputum and stuff. And there may or may not be a thermal injury about the nose or the mouth. There might be some changes in the inhalation injury and they can be delayed. So just because they don't initially display the signs and symptoms of the clinical classical diagnosis of inhaling superheated air, they may have burns around their mouth so we need to always monitor that. And if possible, of course, it would be nice to have a chest x-ray, but obviously nobody has any of those hanging around too much. So I'm not going to touch too much on that. And a lot of times your symptoms of your respiratory insufficiency, they may not occur for the first 24 to 72 hours after the burn. Now the treatment of an inhalation inhalation injury is graded according to the severity and the progression of the symptoms. Mike, you hold right there because you've started another thought process. We're going to go to break here for a second, ladies and gentlemen. You've got Mike Nesser. Put your pens down for a moment. He's going to pick right up where we left off. We're going to get this all in here today. This is the Intel Report on Liberty Tree Radio. 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That's 877-608-0179. zero one seven nine call today there's a great horse standing still that's so clamsin sadder one right they come there where mike can you hear me yes i can every go okay well we're back with gentlemen uh... That's okay, not a problem. We got again, we're working on this live radio ladies and gentlemen and a lot more going on but LTR is alive and well and The Intel report is up for you guys to listen to at your discretion or to find here I'll let other people know where to go. I know that we we are well, actually we've we've upgraded dramatically with regard to our bandwidth and We also have, if you go into the chat room for our friends, there are alternatives to help take some pressure off that bandwidth. And thank you to all of our guys that have done the work there. Mike, when we're talking about this type of a situation with a burn where we have a restriction, We're looking at some compounding situations here. People are going, man, this is looking really intricate. It's not that complicated, people. Basically, you got to remember, we're going to save the limb. We want to try and save as much of the tissue as we can. We don't want to have to worry about, you've always seen it in the old Civil War movies or World War I, we're going to have to break out the saw. Well, we know a lot more than we did then. Okay? And as long as we pass the working knowledge on, we're going to be able to save a lot more patients and save them from a lot more hardship. Doesn't mean that the burn's bad. And by the way, these burns don't have to occur because of combat people. How many of you have been through car accidents. How many of you have been through industrial accidents? How many of you have seen farming accidents? I'm in a farming community. I can think of two or three guys that have passed away working at their trade and each one was a different type of industrial accident. One of the saddest was simply the fact that every once in a while farmers make this mistake. They'll have gas build up in the silage areas. One guy will fall over and somebody thinks, oh he must have bumped his head. They turn and look back. Guys jump down into a pit area. Next guy falls over. What is it? Well the gas has evacuated the oxygen. In fact, remember it's displacing the oxygen the guy breathes in. and he falls while the next guy jumps in to help him not thinking right away about what it is thinking maybe it's a head injury or whatever he falls third person tries to help the other two and you can have a bad situation that gets really worse real fast So it doesn't have to be combat, it can be the fact that everyday life creates different situations and as we have technologies, those technologies, well, sometimes don't positively interact with the human body. So we need to be ready for that in addition to everything else. The system is going to be overburdened or simply isn't going to be there. We have to get the working knowledge out to where it needs to be. Now real quick on that note, when we're looking at these restrictions, just an overview real quick, Mike, for a simpler explanation of how they work and what we're doing here to relieve the issue. Okay, well if you'd imagine this is a constricting band or like a pernicate wrapped around here, the skin is non-elastic. And what's going to happen is then the swelling is going to occur underneath that non-expanding band. And then that's going to cut off the blood flow to lower on down, whether it's on an arm down into the hand or if it's up higher on the leg down into the lower leg in the feet. So what we're going to do is just cut that. tourniquet, if you will, perpendicular along the lines of the perpendicular to the burn itself, but only just through the scar tissue and not down into the muscle. It would be kind of down the length of the arm or down the length of the leg starting from the top and working towards the feet in a perpendicular deal. If you just sit there and watch it and then the nail beds aren't blanching and the hand is pale or the feet are pale, you're not feeling any pulses, then what's happening is the swelling, the edema is accumulated underneath the scar and then it's going to cut off the circulation, a vascular compromise, and then you are going to lose the extremity. And again, we're... Expressing this over and over again. It's the amount of equipment and time that's been put into this We've already talked about in leaders hated ringers without dexterous 24 hours and then all the other things with the sedatives and the our automations of cutting through the the scar tissue itself to alleviate cutting off the tourniquet effect in remedies or the upper ex now, let's see where did we We were talking about that now. Okay, that's right. We had dropped off on the inhalation injury. One thing, before we go any farther, I see we only have a few moments here. I hope everybody has their pencil and paper handy if you're not already taking notes. This is called the Manual of Surgical Therapeutics. manual of surgical therapeutics. It's very much in line with the Special Forces medical handbook. It's a little bit bigger, but it's along the size of what the new Special Forces medical handbook is. And it covers a tremendous amount of information. The ISBN number is 0-316-1. The ISBN number is 0-316-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-15286-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596-1596- Again, the name of it is the Manual of Surgical Therapeutics. Just to give you some of the ideas of what it covers in this book, it's resuscitation from shock and trauma, problems encountered in the emergency room, anything from ocular emergencies, heart problems, breathing problems, acute gastro urinary problems, head injuries and infections. comatose patient, abdominal injuries, chest injuries, cardiac arrhythmias, cardiac arrest, acute abdominal pain, upper gastrointestinal hemorrhage, intestinal obstructions, post-operative and pre-operative care, the routine orders, the evaluation of the renal, cardiac, and pulmonary functions, anesthesia, and anesthesia, pre-medications, care and drains of the tubes, post-operative fever, pulmonary aspiration, fluid and electrolyte therapy, surgical nutrition, acute renal insufficiency, respiratory insufficiency, surgical endocrinology, the diabetes patient, the patient on steroids, hypercalcemia, the thyroid insufficiencies, surgical infections, blood components therapies and transfusions, acute coagulation disorders, pulmonary embolus, management of burns, pediatric surgery, organ transplantation, venous disorders of the lower extremities. and a whole minor surgical technique. This is just a wealth of knowledge and I'd highly recommend the medical personnel that are listening that they obtain a copy of this. Again, it's called the Manual of Surgical Therapeutics and the ISBN number is 0-316-15286. Okay, now back to where we were talking about, we dropped off there, we were talking about the inhalation injury, and now there might even also be an indication for a tracheostomy. Now in your thermal injuries, patients are no different from those in any other patients. Now your upper airway obstruction, the inability to handle secretions, they might not be able to cough those things up because of the pain or the, the burn tissue that's inside the trachea, and the management of these associated injuries, the flail chest, again that's another type of an injury we haven't even covered at all. And that's basically what happens if somebody gets a blow to the chest and it breaks the ribs out all the way around so you have a peristaltic movement. So when the chest would normally inhale, then with the flail chest, then this segment of the chest will actually go in the opposite way. So when the chest would fill, then with the fit of those ribs and the tissue and the intercostal muscles will actually go inside. That's one of the things in severe inhalation injury caused by inadequate ventilation or evidence of any of these things. a good indication that the patient may need a tracheostomy and the mere existence of facial edema or burns unless there is a definite odd indication for the tracheostomy. And the tracheostomy should be an elective procedure performed over an endotracheal tube in an operating room with adequate suction, light, and with health. that you just want to jump into and pull your pocket knife out and try any of this. It's something that you're not going to just automatically do it. There's going to have to be a definite indication that you're even going to be forming any of this surgical type procedures. Now in the burn room, now general attention. is going to be turned to the burned wound after the adequate ventilation is ensured and the hypovolemic shock is being seen. The entire area is going to be performed, including the bereavement of any of the tissue, the dirt or clothing or anything that's going to there. Evacuation of foreign matters is a critical issue there. In fact, that's important with all of these injuries. Evacuation of what is considered to be bacteria or infection producing. It's going to continue to create more problems. We're going to go now. Mike, you're coming back with us at 8 o'clock, right? Check. One hour from now. As always, God bless the Republic. Death to the New World Order. We shall prevail, ladies and gentlemen. The M-Fire is on the run. And we are on the march both days and night, caring for our people.