Live 365 If he stood by your bedside to 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 to distill the land of the free and home of the free? 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. South, southwest, central and northeast. 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. We're also on AM&FM microstations, CB base stations, and alternate technologies both east and west of the Mississippi along with central and southern Alaska. And let's see, it sounds like we have some noise in the background. Who do we have there as a call in? This is Mike Lewis in Texas. Hey Mike, what's going on? Hey Mark, I just want to call one last time to tell about the field training exercise we're having this Friday night. We're going to be having a backpacking field training exercise. We're going to be dropped off out in the area of operation. Friday night we're going to get together. And then we're going to train all day Saturday. And we're going to work on escape and evasion and patrolling and scouting mostly. And then Sunday morning we'll get picked back up again and go to a roff of range for 100 yard qualification. And if anyone would like to go, this will be in the east Texas area. And to get in contact with us, you can go to 3wzn.hutari, h-u-t-a-r-e-e-dash-texas.net, n-e-t, find our email address there, send us an email, and we'll get back with you and tell you how you can attend our FTX. And again, go ahead and give all the contact information out two more times, and also we'll get to you in a few minutes again. This is by invitation, and if you go to our website and email us, we'll invite you. Our website is 3w.hutari. And of course we had five different states participant, by the way the first scrapbook. with a few of the shots from the exercises on the Hootari site there is a video or a couple videos that will be probably will be completed this week everything goes well I would assume that are going to cover that exercise and others so pay attention go to Hootari.com to check out the website and also check out the videos that they've generated and Mike again one more time they want to get hold of you okay go to our Hootari website it's three dozen dot Hootari H-U Thank you, sir. Keep a good work, Mark. We appreciate you. And it was Mike Lewis in Texas. And we of course now, Mike, we also have operations coming up in Oklahoma this January, don't we? That is correct. We're going to have an Oklahoma meetup in... The 8th to the 11th of January, we're going to be going over usually every evening at least, in addition to qualifications and shooting and things. Every evening, this is something that we've identified. A lot of people, they know how to shoot, and they know how to do this, but when they get up there and they get a jam or the function check, they're falling down. So this is one thing that we've identified in our previous trainings. So, every evening we are going to cover over clearing jams and function checks and people are encouraged to bring their firearms and we're going to go over all the firearms that are there. So, one night we might be covering an AK, the next night we'll be covering an AR, the next night we'll be covering something else. SKS. Then also, after we've become proficient in that, then everybody's going to get to put on their protective mask and start clearing jams and doing function checks with their protective mask on. Some of the other things we're going to be covering are intelligence collections and area studies, show you how to conduct your own training, the METTC and the metal for planning, setting up all the aspects an LPOP, they're going to be back into the NBC training. The previous NBC training we've done is, you know, the donning, the clearing, the maintenance, the inspection of the mask. This time it's going to be similar to that, but then also then we're going to bring a different section of masks, ones, not that one is better than the other one per se, but just to show you the different aspects of people that haven't purchased a precision of which is the best for that in medical. We're going to be covering knots, map and compass. We're going to be doing commo, a lot of radio selection, frequency selection, field expedient antennas. We are going to talk about supply caches and what to have and how to protect your stuff. Objective rally points and then we are going to start incorporating. After we have done all this it is going to all be incorporated into where we are going to go out in the field, have the objective rally point, do the medical stuff, the commo, the evacuation. We are going to be doing patrol formations. and field sanitation. We're going to be incorporating this during, instead of having one block of instruction, just about field sanitation. So during the training, we're going to be incorporating the disposal of your urine and feces, the pure cumin of the water, the trash, cleaning and everything. One of the things we don't want to make sure that This is all going to be done in the field. There might be one or two of the things that will be in the classroom environment, but 90% of this is going to be out in the field. We're not going to be sitting around in chairs and tables. So when we have a map and compass exercise, it's going to be out in the field. When we do a commo exercise, it's going to be out in the field. When we do the medical, it's going to be out in the field. So everybody, we're going to have extremely long days. They're most likely going to start well before the sun rises. You're going to get a hot breakfast and a hot dinner. It's going to be up to you to bring your own lunch, some of the things that you need to do. Well, obviously, you need to go to offthegridgirls.com. I'd suggest that you bring a state flag. Everybody needs to have a protective mask. Also, bring a plastic rifle or a handgun. You can bring an airsoft or go down to your dollar store and pick one up. You need a baseball cap. To be on the range, you need to have a compass, you need to have a Swiss seat rope, it's a half an inch rope, nylon twisted rope, a one half an inch in diameter and 15 feet long, 3x5 spiral notebooks so you can take some notes out in the field so you're not having to take a big three ring binder with you, safety goggles. or safety glasses. There's also going to be quite a bit of information available. So if you have a flash drive or some blank CDs or DVDs to bring those. Hearing protection. And also because Oklahoma, the weather is so unpredictable there and we're going to be out in the field, there could be a lot of rain, it could be cold, and there could be a lot of mud. So I'd suggest that you either bring some irrigation boots, some over boots or galoshes to go over your boots because if you get muddy wet boots on your first day then you're going to be miserable for the rest of the time. You need to go to offthegridgirls.com. You need to contact Alfie. The email address is asking the minimal cost of $50 and all that is is going to be covering the meals and the porta potty and those things. There's going to be a place to sleep. I'm going to be taking care of you but it's exceptionally long days. This is going to make the first Oklahoma one and the one in Flagstaff look like Choir Boy stuff. This is going to be extremely hard, extremely challenging and extremely long days. Mike, we got to go to break. Check. Collectors, outdoor enthusiasts, survivalists. The Army Navy Store from your memory as a child is just that, a memory. But there is still one place to find everything from gas masks to ammo cans and find it cheap. MainMilitary.com. Get hard to find objects like real wool blankets for under 20 bucks, canteens for just $2, or trioxane fuel for just a dollar a box. MAINE Military.com with free shipping on items over $150, not including heavy items. Find surplus items for cheap now. like 30 caliber cleaning kit for just $2.99 a piece or a dozen for $30. Flair pistols are only $25. Want to add a brand new Israeli gas mask to your collection? Kids in adult sizes are just $20. Get G3 Max for just $2 or a military fuel camp for only $16. Add this hyphen hose for another $7.99. Find it all online at mainmilitary.com. With shipping throughout the world, check out mainmilitary.com or call 877-608-0179. That's 877-608-0179. 0179 call today. The Bedfan's revolutionary design directs cool air between the sheets where it's really needed. No more tossing and turning to keep you up all night. The Bedfan's thin streamline design is simple to install and fits between your bed and foot board. And did I mention how much money you're going to save by turning down your air conditioner overnight? Please don't let another sleepless night go by. Get your Bedfan by going to Bedfan.com or calling area code 210-632-8280. On the battlefields of the day and into the future, regimental combat teams of the Colonial Marines are serving America. Not cheap mercenaries selling out to petty dictators under U.N. control, the Colonial Marines are there to protect and defend the Constitution and Bill of Rights of our nation. Not a globalist agenda for world domination. For more information, send a self-addressed stamp envelope to... And we are back. This is the Intel Report Live Liberty Tree Radio, LTR, and also PBN. As you know, WTPRN is offline. A lot of you that have switched over. Well, thank you for listening. And a quick reminder that we understand what's going on with the money. With the stock market, all I can say is, get out! Get out! No! That would be your best choice. And for those of you who are stuck in it maybe and are down to pennies on the stocks, you know the best thing you can do, don't sell your stocks. I'm gonna tell you something right now real quick, because we're gonna get on. I want Mike to continue to go over what we're gonna be doing out west in Oklahoma here this next cycle. But real quick, take your, if you're an electronic stock trader and you've been selling off your penny stocks, because that's what they become when they were dollar stocks, they went to penny stocks, keep them. Here's what I want you to do. I want you to go to your stockbroker, call up wherever it is you've been trading with. Tell them you want the physical stocks in hand. Somebody's got to turn down their radio there because they're coming right in just like they're in the office with us. Uh oh. Who do we have that's just plugged in? Oh hey this is Alan, South Dakota. How you doing Mark? Hey Al, we got you. Jump in there please. Well, I just had a couple of quick comments. Crazy world we live in, huh? Interesting times. But one of the things I noticed, there was a story about Iceland that Iceland is basically bankrupt. Just a matter of a couple days. And another interesting thing was there was a person who speculated that with all this craziness going on, that suddenly if gold shot up to $5,000 an ounce, would you sell? Those are things we probably ought to think about because a year ago who would have thought that we would be pumping in injecting a trillion dollars into our economy and now Congress is talking about injecting some more money, some more boondoggles and port bills. But yeah, definitely interesting times, things to think about, how to protect your wealth a little bit. Well, I think interestingly enough, the tie-in with the selling the gold I have a problem with at this point in time because, I mean, you could do a percentage, maybe, I guess, of a person wanting to, but you'd be switching it over into what? Federal Reserve notes in one form or another. That would be a bit of a problem. And the other issue is, he who has the gold is going to be making the rules. That's really what this is all about. If we can ride through the adjustment phase, which is why we have to have the food on the shelf, all the other machines in place, and even our own money system utilizing the coin and other currency, we can ride through it and we end up with the currency, the actual cash, so to speak, gold and silver, tactically dispersed amongst millions of people who are willing to fight to defend their property. See, that's the thing that they're hoping they can buy up all of the hard specie, pull it into one place, because they do have... you know, technically they have gold and silver is what they say. What it is is technically they have a whole bunch of BS paperwork that is worthless. They've overprinted on, they've extended it farther than they should have, they know this. Last Friday they showed you how they used a bunch of that junk paper. They took a bunch of the junk specie paper, it wasn't gold or silver. It was... Speculation paper. They dumped it in the market and turned around and used it to prop up the economy they thought. It just went... right on the skillet and the stock market still lost a hundred and some points. Oh yeah, it did popped up so many hundreds of points for a few minutes and then progressively sank right back down. It's almost like a bilge pump that ran for a few moments, but doesn't do any good because well the pump is, you know, even if it's a long pump, say what we call a stone pump, it can push hundreds of gallons a minute, but the problem is the hole, which is the size of half of a house in the side of the ship, is letting in millions of gallons a minute. That's where the problem is. It's like, and it's already gone again. And then by the way, the pump ran out of power or it blew a rod or one of the diaphragms failed, whatever you want to look at. And the water is still coming in and the ship is still sinking. It's like cooking a goose. You end up with a whole pan full of grease when it's all said and done. That's right. We don't want the grease. It's nice. We can use fat for things down the road. Sure. But right now, our biggest concern is to make sure we got the meat in hand to build, or shall we say the seed corn or however you want to look at it, to build up an effective and honest society when these characters collapse. Now, I still fully believe. with all the reports we're getting that they're going to try and use guns to steal our private property. Period. They're going to be stupid and try to steal the land. This is what these whole robbers are all about. So we need to be ready to make them understand that we're not going to put up with that. We're not going to put up with them taking our friends, our neighbors, or doing any nonsense like that. And we're going to stand together and beat them down. and I know they got all kinds of puffy shysters, little blue lodge buddies that are in uniform and this and that and the other and they're all planning on doing all kinds of wicked things. Well you know what? We are right back. In fact you know what? Them first. Exactly. I don't plan on being a fixed target for them when time comes. Everybody's going to plug in what they know how to do and do best. Go ahead please. Okay, well, thanks for taking my call and Mark and Mike take care. Have a great day and I'll be listening to show. Appreciate it. Thank you. Thank you. God bless. And just real quick here, that ties right in the whole idea that again, if you have gold and silver hanging onto it, of course, now you could take a very small sliver of it. I will say this, I guess there's one area. Let's say you want to become quasi debt free, Mike. One of the things you could do is take a sliver of that reserve, a small amount. Cash it out for the ludicrous amount that they're going to be using as an exchange rate and cash off on your loans of whatever kind Now this eliminates technical paper However, if you're understanding the straw man something we've talked about a couple times on the air you can actually recover the straw man take the millions of fictional dollars and digits that they have and Declare that they be used as the instruments to eliminate the fictional debt and they cancel each other out. Oh and you still aren't out your gold and silver. So there's a number of different options. That's one of the things we need to touch on more. I do not believe that it was an accident with the WTPRN issue guys that we covered for two hours the straw man issue and backed it up with a lot of technical information so people could do some searching. That is critical right now to understanding why we're talking trillions and billions and quadrillions and people are like almost like well, okay Well, we're just we're running those numbers The idea is to get the slave trade in place They've got to have the digit the debt digits match these fictional bonds then they cover they recover the bonds as slave trade documents and declare the American people the cross-referenced collateral against these fictional debt numbers that are so insane, you can't show me how to count them. I mean, you might as well go back to, let's just do 1s and 2s and 3s and be done with it and eliminate all the zeros, but they won't do that because the value of your lifetime is phenomenal. It is unlimited. And what they're doing is they're matching the numbers so that they can claim that they have a right to your lifetime over you having a right to your own lifetime. That's where this is all headed. And this is why the militia, this is why all of you need to be more cognizant about your form of government, what it's supposed to be, what wrongs are needing to be righted at this time, and part of the process is defending the brain trust people. The crown's forces came out to attack the people who were liberty oriented. The malicious job, which is the whole of the people, not a handful of people and everybody else sitting on their arse waiting to see what's going to happen, the whole of the people mutually defending each other. That's why the British couldn't leave to attack Concord from Boston without being known. One if by land, two if by sea. The strongest military force on the planet was trying to sneak out of Boston because it knew it couldn't move without being seen. And they had tried many times to come out of Boston like that. Well, what worked? A combination of the people as a whole working together and cooperating with the militia. Now that's where the training comes in. Mike, go ahead and pick up where you left off with regard to these up and coming training dates. Right. We've covered the subjects that we're planning on covering. We're already working on a training outline. Alfie's worked up his. I've worked up mine. I've got a copy to his. He's winnowing it down, picking and choosing which ones. We're obviously going to try to train the ones, the individual skills. Initially, so everybody's got those down, then we're going to combine those into the collective, the unit type skills to get those all going. The one deal that we need to cover is to cover the cost. The one Alfie put on in Oklahoma cost about $800. The one that we did here in Arizona out of pocket, it was somewhere between $700 and $800. So, Alfie and I cannot continue to do this ourselves. What we need to do is that everybody needs to pitch in. Many hands make for light work, so we're only asking a minimal $50 donation to cover for the food and for the porta-potties. We would like to have everybody to have $25 to Alfie by the 1st of December. This is a non-refundable. If something happens, you come up at the end and time becomes available, then it's going to be $75 at the door. It's going to save you $25 if you act on it now. You can either send cash or money order. If you send a money order, leave the pay to blank. So for the total of the four days of being fed and having a place to sleep and all the training, it's going to only cost you 50 bucks a day. So just about, you know, $10, $15 a day for the amount of training. Mike, we're going to go to break again. We're going to be back in about four minutes here on Liberty Tree Radio. How many of you remember that song? You remember the title of it? That was the Kinks, the 20th century man. In fact, that little piece right in the middle is quite notable. Some people recall that, that some of the hosts over the years have used that as an intro piece or as an entrance and exit piece from their program. But it kind of says it all. And what they were talking about there is exactly what's going on. That's right. People dressed in gray, especially since they're attacking our liberty and our privacy, not a surprise. Well, Mike, I'll tell you what. The exercise of the Alfe Omega is in motion. We are, of course, also covering medical and communications. First of all, anything happening down in your neck of the woods down there in Arizona? Well, the Highway Patrol was pursuing a van today. The van went into a housing area so they pulled back. The van continued at a high rate of speed. They went through a stop sign, collided with two vehicles, rolled over and surprise, surprise, surprise 20 e-legals scattered like roaches. They rounded them all up. That's still going on. Temperature weather wise, Remember we talked about it last week, we were having some big fluctuations going from 103 degrees down to the 50s. On Saturday, we had a lot of wind out here and temperature dropped and lately it's been down into the 40s at night. Out here into the desert, we're getting some massive fluctuations of the desert. So if anybody is planning on coming out this way, make sure that you have your proper gear. It's still getting pretty warm during the day, but it's getting really chilly at night. And that's about the extent of what's going on out here. So again, not a surprise, the illegals of course still flooding across the border. Although some are heading back the other way, the problem is that their mission is to milk the system for every dollar they can steal out of it before we have a chance to get anywhere near retirement. And that's the whole plan for all the rest of the same thieves that have set up a thievery that just took place with the stock market and has just taken place with the money system and the banks. Same potlickers, same bottom feeders, different day. So, for all of you listening, another reason that you need to be well prepared for what is coming. Now, Mike, what are we covering today in the medical area? Okay, today we're going to be talking about the treatment of shock in trauma and injury. One more thing to hear, I'll wrap up this deal about this Oklahoma meetup. Offthegridgirls.com, 8th to 11th of January. Now that we've been bumped off of WTPRN, it's going to be up to everybody to help spread the word. You need to contact ALFI by email, and then it's your responsibility to contact 10 other people and let them get that information out. Enough said. Right now, we're going to start discussing a little bit about resuscitation from shock and trauma and treatment of that. Now, your initial priorities, obviously the primary objective in the care of any injured person is going to be the preservation of life. The treatment of your airway obstructions, shock or cardio-respiratory failure, often have to be started without exact knowledge of the cause of the disorders. Now your diagnosis and your therapeutic measures are carried out concurrently rather than sequentially. So you're going to be doing multiple things here all at the same time. You're not necessarily going down a checklist going from these things. So your diagnostics and your therapeutic measures must be carried out concurrently instead of sequentially. And then once the patient's condition is stable, then we can go into a further evaluation and can be undertaken as the secondary objective to wonder what's going on and what was the mechanics of. Obviously, your primary concern is going to be to establish and maintain an airway. You're going to look for the signs of obstruction, stridor. That's a condition of the ribs, the muscles. The muscles that are in between the ribs are going to be pulling in a real resistant type of things. You'll often see that with dogs with kennel cough as restricted. uh... you can also have a wheezing or cyanosis that uh... wheezing obviously is the the long sound the cyanosis with the uh... a blue circles around the eyes around the mouth we're going to do is you're going to sweep your finger deep into the back of the throat and you're going to remove any clotted blood mucus vomit or any loose teeth or dentures or anything out back in the back what we're going to do is we're going to insert the oral fair and geolair way commonly referred to as a J-tube. It has a sideways, it's got a little flange up by the front, and it kind of goes down and then makes a little J at the end. And they come in different sizes. And one way that we are going to be able to measure that from the outside of the patient, generally people are using adults about a number of five. But just to be on the safe side, we want to measure that. And we want to measure it from the front of the teeth. and to the back of where the earlobe goes down. So we can hold that up next to the patients to the side of their face and if the front of the flange comes with the front of the teeth and the tip of the J comes down below where their earlobe is, then that's a proper size. What we're gonna do is we're gonna invert that so the tip of it is pointing towards the top of the head. So then as we insert that and then it goes up into the roof of the mouth where it it goes up inside there. And then as we get towards the back, then we're going to rotate it 180 degrees until that flange comes in contact with the front of the teeth. Because otherwise what happens is if you try to put it in the position of where it's going to be, it starts digging into the tongue and then you're going to get a lot of resistance and you're going to be pushing the tongue back towards the back of it. So you want to insert it up side down and then rotate it right at the very end. So this is number two on our establishing and maintaining an airway, is we're going to insert an oral fair and geo airway if the patient is unconscious or they might have unstable phase in the obstruction. And then when we start to do some ventilatory assistance with a mask, it's a lot easier. Now, if the patient makes an effort to sit up, allow them to do so because this action, it's a reflex response and it's going to help maintain the airway. Now, if the patient is comatose, we might even, and if we have the ability to put in an endotracheal tube, that's going to reduce the aspiration and it's going to facilitate the respiratory support. Now, if the patient's alert enough to make the endotracheal intonation impractical, a lot of times because you have your gag reflex when you put the laryngoscope in there, and you start trying to put the ET tube down in there, they're going to buck and it's going to be exceptionally difficult to put that in there. But so if we can't put an ET tube in, then we're going to have to make sure that we have close observation and then frequent suctioning of the patient. The next thing is we're going to examine for evidence of a sucking chest wound, a flail chest, a tension pneumothorax, or any type of pulmonary injury. And then we're going to treat the airway obstruction, whether it's through intubation and any respiratory insufficiency with oxygen or assisting their ventilation. And then direct injury to the larynx or the trachea, and they may make the endotracheal intubation impossible. And in a rare instance, you're going to need to be prepared or maybe even an emergency tracheostomy. And now the positioning of the patient is very important. There's going to be a possibility because again, we're not exactly sure. Say for instance, we just come upon a patient that's unconscious and unresponsive. We don't know the mechanism of the injury. So there's always the possibility of a certain injury. It's going to nest immobilization of the patient important and it's going to negate any other positional considerations. We don't suspect erychol or spinal cord injuries. We can keep the patient in a semi-pro, semi-foul position. In any circumstances, you really shouldn't lie or be restrained flat on the back. Now, then the next thing that we're going to have to assess pulmonary function. Now some of the things that are going to contribute to it are hypoxia, a low oxygen content, or acidosis. They can cause cardiac arrest. And I hear the music coming in and when we get back we're going to talk about hypoxia, acidosis, and cardiac arrest. I thank you for staying with us. Help spread the word about our change from WPPR and over here, the Liberty Tree radio and help spread the word and keep us on the air and make sure that you help support our sponsors. Pay attention to these commercial trees. On the battlefields of today and into the future, regimental combat teams of the colonial marines are serving America. Not cheap mercenaries selling out to petty dictators under UN control, the colonial marines are there to protect and defend the Constitution and Bill of Rights of our nation. Not a globalist agenda for world domination. For more information, send a self-addressed stamp envelope to Raider Company, H.H.C. P.O. Box 194, Dexter, Michigan 48130. That address again is Raider Company, H.H.C. P.O. Box 194, Dexter, Michigan 48130. Colonial Marines in all 50 states, serving America in America today and into the future. Are you losing precious sleep on these long hot summer nights? 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But there is still one place to find everything from gas masks to ammo cans and find it cheap. MainMilitary.com. Get hard to find objects like real wool blankets for under 20 bucks. Canteen for just $2. Or trioxane fuel for just a dollar a box. MAINE Military.com with free shipping on items over $150. Not including heavy items. Find surplus items for cheap now. like 30 caliber cleaning kit for just $2.99 a piece or a dozen for $30. Flair pistols are only $25. Want to add a brand new Israeli gas mask to your collection? Kids in adult sizes are just $20. Get G3 mags for just $2 or a military fuel cap for only $16. Add this iPhone holes for another $7.99. Find it all online at mainmilitary.com. With shipping throughout the world, check out mainmilitary.com or call 877- And ladies and gentlemen, we are back. This is the Intel report. Mike, continue with what you are covering and let's try. Are we going to finish up today, do you think, or are we going to pick up tomorrow? Oh, I don't know. No, we are not going to finish today. Absolutely not. Okay. But we are going to keep running at this. These are going to be continuous blocks of instruction. Each one is going to be built on the other one. We dropped off, we were talking about the assessment and support of pulse. cardiopulmonary function. Some of the contributing things that can lead to a heart attack, a cardiac arrest or hypoxia, that's a low oxygen content, and acidosis, they can cause cardiac arrest. Now, obviously if arrest has occurred, you're gonna initiate mouth-to-mouth resuscitation and your closed chest massage are gonna be started immediately. Then we're going to put in our oral pharyngeal airway and then we're going to be ventilating the patient with a mask. It's going to be very sufficient in most patients. So don't be all obsessed with we've got to get an endotracheal tube down. A good airway selection and placement and a ventilation with your bag valve mask is going to be sufficient to do that. We shouldn't waste time attempting any difficult endotracheal intubation during any of the early stages of resuscitation from a cardiac arrest. Obviously, if the chest wall is unstable because of a flail chest or if it's rigid because of emphysema, then it's going to be more difficult to do that. The next thing is the metabolic acidosis. We've discussed this numerous times in the past. There's some things that we can do to overcome that, but to bear in mind that we want to head these things off. We don't want the metabolic acidosis to occur, and that's going to be another cascading problem that we go after. the metabolic acidosis has got to be anticipated in every patient with any hypo perfusion. That means hypo means below and perfusion means the circulation of the blood itself. So if they're having a low circulation, which we can check with the blood pressure, and then we also need to correct the sodium bicarbonate, the acidosis that's given to them so we can give the sodium bicarbonate IV. And then also if it's possible and you happen to have a EKG machine, we can hook that up to the patient and we can monitor that patient to figure out the specific arrhythmias that is occurring there. The next thing is our checklist is the control of the hemorrhage in any bleeding. The external hemorrhage is best controlled by direct pressure over the site of the bleeding. We're going to maintain the pressure until we've gotten control above the vessel above of where the bleeding is coming from. Obviously, this is going to require more work than just putting direct pressure and things like that. Now, we've discussed also in the past about tourniquets and hemostats. But just as a word to the wise, the use of the tourniquets or any blind clamping in the depths of the wound is not really advisable unless you really know what you're doing because you can really cause some further injuries. Obviously, if somebody's got a traumatic injury, and you can't seem to stop the bleeding, then after we've tried the direct pressure and the pressure points, then we can go ahead and apply a tourniquet. But it should, a tourniquet or just sticking a haemostat down in the wound and trying to grab something, it's really not advisable unless you really know what you're doing and you feel comfortable with it. Now if they're having internal hemorrhage, now, We need to identify where that's coming from. If at all possible, now that we've moved the patient from the battlefield back to a MASH hospital, we're gonna put a nasogastric tube down, and then we're going for the lavage, the stomach contents, and see if there's blood in the stomach or anything like that. And then somebody that's experienced in that, they can observe that. And this is going to help increase the accuracy of your diagnosis. Now, also the next thing also in the control of the hemorrhage, because of the blood loss due to fractures, even without any major vessel injuries, can be really appreciable. If you have a fracture that is lacerated a vessel, even if it's a minor vessel, it can be bleeding out underneath there and before the extremity becomes rigid, it's really not obvious and then they can lose a large amount of blood because of that bleeding internally into that caused by a fracture. We'll cover fractures up here in a little while. The next thing is going to do, we're going to talk about treating of shock and I'm going to stress over and over again to the people. What we need to do is we are not going to wait until these things pre-holds, whether it's the metabolic acid bowl of the shock or the treatment of shock, we are going to anticipate to have metabolic acidosis. We're going to anticipate that the patient is going into shock. So it's not a surprise we're going to be ahead of the curve instead of playing catch up. So now your hypovolemic shock is best treated by a blood replacement. Any blood loss that's 1,500 cc's can usually be replaced with fluid solutions, hated ringers or something along those lines. But any greater blood loss should be replaced by a blood transfusion. Now any patients with a loss of more than 45% of their blood volumes, they're going to become severely, that means their blood pressure drop and they're going to be hypoxic. There's no more hemoglobin to carry the oxygen to be that. So you're going to have a hypotensive and a hypoxic, and then that is going to cardiopulmonary arrest if it's not resuscitated vigorously. Now, the essential tips and the management of hemorrhagic shock, you're going to insert intravenous. You're going to start an IV. You might even want to consider putting several. And obviously, they need to be done with the sterile technique. One catheter should be in the central venous pool. And we'll cover that up far. It's not going to be just in a normal IV, in an arm or something. You might even want to consider putting one in a large bore catheter into a subclavian artery or something or maybe even which would be a better is into the internal in the neck. The problem is with a subclavian is because it's so the possibility of a pneumothorax with somebody that's lost a large volume of blood, you know, 1500 start at least two or three IVs and if possible, one in a central venous place. How the vessels potentially involve the trauma should be avoided and the clinical situation dictates which veins to use. Usually they're always going to be above the nipple line. So you're going to be starting one down in the arm, at the wrist or in the back of the hand. It's going to be questionable if it's going to be effective because chances are the person's already gone into shock at that point and by the time you're going to have a hard time finding a vein, you know, remedy in the back of the hand. And then there's always trying to infuse is not going to be put into the central venous pool. Obviously, if you have the ability of drawing blood samples for snatching, that would be great. But as we've pointed out numerous times on the program, I'd highly suggest that everyone goes down and donates blood. good thing to do and also they're going to tell you what your blood type is so you will know as it is there.