Opioid dependence is a medical condition many people struggle to overcome. That too many try to handle on their own, alone. But they don't have to, and neither do you. Treatment is available in the privacy of a physician's office. Click on the banner and visit turn2help.com. Live 365. The freedoms we secured for you, we hoped you'd always keep. The tyrants labored endlessly while your parents were asleep. Your freedom's gone, your courage lost, you're no more than a slave. In this, the land of the free and home of the brave. You buy permits to travel and permits to own a gun. Permits to start a business or to build a place for one. On land that you believe you own, you pay a yearly rent. Although you have no voice in saying how the money's spent. Your children must attend a school that doesn't educate. And your Christian values can't be taught. according to the state. 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 and you've 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 burned. 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? Oh, 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 torch of freedom burning bright. As I awoke, he vanished in the mist from 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 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 this still the land of the free? Good evening ladies and gentlemen. This is our intelligence report. I'm your host Nancy Cornke and I'm Michael Nasser On this, the 14th of October, we get it straight this hour. This is the second hour, of course. And the time is 6.07 PM Eastern Standard Time. While we've been talking about this has been Communications Tuesday. Michael, did you have anything on the agenda this evening? Well, yesterday we kicked off another chapter here talking about resuscitation from shock and trauma. I am prepared to discuss monitoring of the central venous pressure and other treatments, addressing the wounds, mobilizing the fractures, follow up, and then talk about the pathophysiology of shock on what's actually going on down to even the cellular level. to try to help people understand what's going on in the bigger picture. Very good. Why don't we continue on with that? Again, we need to communicate this information to folks because of what we discussed in this last hour. Michael, I don't know if you've been aware that the Chinese demanded, cashed out the greenbacks that we had, the 800 billion dollars they were sitting on. So on top of that... No, I hadn't heard that one. Oh yes. They won it all at once or... All at once and they got it. And they got it. Okay, and the thing is that two years ago, good old B.P. Chaney was in England when he was asked about that debt, what are you going to do? It's going to bankrupt America. He says, oh don't, well we're not worried about it, we'll just declare martial law. What did they do? Not you know that the oh no no it's not it's not martial law the way you think it's martial law This is martial law for Congress. This isn't for the people Gee, what do you think happened that day? They paid up okay, but they paid up 800 billion dollars in a marrows Printed I should say minted in 2007 Okay And all of a sudden we have a shortage of gold and silver to the point that the U.S. Mint is no longer minting half or quarter gold or silver pieces. And the one ounce rounds are only to be struck on the demand of the silver and gold dealers. That's it. So yeah, that tells me a whole lot. There wasn't such an influx of American people buying up gold and silver, but that money went overseas. The gold and silver, that's where it went. It went and it was already done. They were already printed up into a Maros and it's gone. That was paid off and that's done. We are under martial law. There is also, they've given a date, it's in February, if you go to HalTurner.com you can find this information, but it talks expressly about martial law taking effect in the month of February next year, doing the door to door. So, prepare for true folks. That's the bottom line. So if you haven't listened intently before to what Michael has been telling you, you better do it tonight. Get your notepads out, get your pen and paper folks, and start taking note because you need this information in order to ensure the safety of your family and of your friends, of your units. Listen up and listen well. This is a class, and that's a way to treat it. This is a class that is invaluable information you need to know. I'm going to leave it this hour, this the rest of this time. Over to you, Michael. Go for it. Great. I just have a couple of questions. You say we can get that information at HalTurner.com about the pay off. He's got a blog. He has a blog and it's on there. He has been pulled off air, ladies and gentlemen. He gave this information out and they pulled the plug on him. Much like you saw WTP RM pulled after we talked about the penal bonds and how they're going to foreclose Not on your property not on your house not on your car, but on you personally now mind you the Chinese we had 800 billion dollars And greenbacks that we make good that's something that by law we have to do But they also were into the bond market and into the stock market and they want their money. We're talking into the trillions. Okay? Basically, this country is bankrupt. They haven't declared that yet. But that is the fact of the matter. Now, that's monetarily, not morally, and physically, and spiritually, right? That's right. So it's time to get angry. If you aren't angry, if you haven't been affected, you will be affected within the next six months. This election is a sham. This is vote fraud. This is wrong. And this is where we have to take and wipe the slate clean again, reinstate our Constitution, our Bill of Rights, and we have to take the rights, our God-given rights, and demand that they be honored. We are not property. We will declare a Jubilee, ladies and gentlemen, to clear the slate. We have time and time and time again as a nation, forgiven the debt of other countries to us. And now that we are in debt, and this, I'm sorry, this is a war. It is an economic war waged against the American people. And I'm sorry, ladies and gentlemen, we have been betrayed by our leaders. by those in the Council on Foreign Relations that have become president and vice president and senators and congressmen that have bowed down and taken the oath to the Council on Foreign Relations. I'm sorry, I used up the whole first segment, Mike, but that's where we're at today. Understand that. Know it's time to fight. We'll be back after these messages from Liberty Tree Radios, ladies and gentlemen. 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. Canteen for just $2.00 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 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 877-608-0179. 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 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 us self-addressed stamp envelope to... Ladies and gentlemen, we are back. This is the second hour of the Intelligence Report. Today's date is the 14th of October, 2008. It's a Tuesday. You've got Mike and Nancy on today. And we finished up the first segment. We're talking that this country is in the toilet. and they've already reached for the lever and it looks like we're all going to have to go down under all. Anything I'm going to say is when you go underwater, make sure that you've got your mouth shut. You don't want to have anything going down your throat, if you know what I mean. And it's not going to be pretty. You know, before we launch into this next segment here, you know, in this first year that we've been covering these, we've been keeping along the lines of just general medical things. Now we are entering into our second year and we are going to bump it up a couple of notches and we are going to go into this. I understand that there is some friction and people are trying to turn us all into medics and everything. One thing that we have pointed out before is that in Closing and engaging the enemy with your firearms is only about 10% of the battle. The other 90% is surviving out in the field, whether it's with field sanitation and procuring clean water. disposing of your urine and feces and all your map reading and your compass and all the techniques that are involved in the night vision and everything else like that. So we're just trying to in lighten and paint the picture a little bit bigger. What we all need to do is maybe take two or three steps back from the painting because we're standing so close to the painting all we can see is one brush stroke. We need to all step back and view the entire picture of what's going on. And I understand that sometimes when I start talking about hypovolemic shock and central venous pressure and and all kinds of these great big words and things that we might have only heard about on MASH or on ER or something that what we're trying to do is step back and take a bigger picture and maybe these blocks of instruction aren't going to be for everybody. But the idea is that if you understand what is going on and what is to anticipate, well just with the simple thing of uncontrolled hemorrhage, how that leads to one thing and then that leads to something else is what we discussed yesterday. And that's what, you know, it's not just throwing a bandage on somebody and hoping for the best. There are a lot of things that are going on, so then we decide to pump up their volume with the transfusion of some IV fluids, but what else is going on there and things. That's what we're trying to do here on this. To kick this off, we're talking about monitoring the central venous pressure. I understand that we don't always have access to catheters and being able to hook them up to transducers so we can actually monitor the central venous pressure. But we can get a pretty good idea of what the, when I say central venous pressure, that means the main body of blood in the veins itself, in the core, the blood pool within the body, not necessarily what's happening out in the extremities or things, whether it's their toenails or blanching or their fingernails or how their blood pressure is doing. Just to understand this, so I might describe some terms here that will be beyond our realm, but paint you a bigger picture of understanding. I am going to mention this. So by monitoring the central venous pressure, it's going to require some really close observation of the changes while we're doing our fluid replacement. Now, the absolute value of the CVP is measured in the hypovolemic patient is less meaningful than the change of the CVP with the therapy. So we can't become fixated whether it's on the CVP or on the systolic or the diastolic blood pressure when we take somebody's blood pressure with a cough. So what we want to do is when we initially, on a patient that's had some trauma and they've lost some blood, and we initially take their blood pressure, we're going to note that it's low. And then as we start to transfuse the patient, whether with you know, the either whole blood or with some ringers lactate then we're hopefully then we're going to see a corresponding rise in that central venous pressure and that'll also be reflected with our blood pressure cost. So then we're going to see a rise in the systolic blood pressure. And so just with that said, just the absolute value of what the blood pressure cost is saying should see a corresponding, a meaningful change in that there's a rise in the central venous pressure and that's paraffin of the cystopressure and that's going to reflect an adequate volume replacement. Now if they have a low pressure, even after the volume replacement is started, that can indicate that there's continued bleeding, possibly in the abdomen, possibly in the intestines and stuff. Now a significant elevation. in the face of the continued hypotension. So we're trying to transfuse the person, but their blood pressure is still low. That can suggest a couple of three things. It could be cardiac tamponade, they could be having a myocardial infarction, or they could be having congestive congestive heart failure. Now cardiac tamponade, that would be usually associated with motor vehicle accidents and especially with the driver when their chest strikes the steering wheel and then you'll get a bruising on the chest but it's deeper down in and then you have around the heart you have a pericardium. It's filled with fluid and then it acts as a shock absorber and it helps reduce the friction of the beating of the heart. But if there's bleeding inside of there, then what happens is the pericardium starts to fill with blood and that's putting pressure on the outside of the heart. You'll usually see that corresponding with if you're taking a blood pressure manually with a blood pressure cuff. that you'll actually see the systolic, that's the top number, say for instance 120, and the lower number, the diastolic, say 62, you'll actually see those numbers becoming closer to closer together. So, all of a sudden you won't have a systolic or a blood pressure of 120 over 62. All of a sudden they'll be closing in on 80. And that's a very good indication that they're going into cardiac tamponade. And then also what we also mentioned is they could be having a heart attack. and then also they could be having congestive heart failure. So enough said about that, but what I'm trying to get across is just because somebody's had some trauma, somebody has gotten some fluid replacement, hopefully we're seeing a rise, a corresponding rise in their blood pressure, but if If they're not, then it could be, oh, they could be bleeding internally into their intestines, they could be passing blood from their rectum, they could be having cardiac tapenade, they could be having a heart attack, or they could be going into congestive heart failure. So we always need to bear these things in mind that it's very much possible that this thing is going to occur. The next thing we need to do is try to get a catheter into the bladder of the patient so we can measure the urine output hourly. Now a decreased urine output with elevated specific gravity and that's usually above 1.03. and that can reflect hypovolemia. Still, their volume is low. And then later on, low urine output with a low specific gravity, but they have normal vital signs, that can reflect in a renal tubular damage in the kidneys. You have glomerularis capsules. If you picture in your mind it's a knot of blood vessels. And as your blood pressure is pushing that blood through there, you have a semipermeable membrane. It's small enough that it's going to let the actual individual molecules of the byproduct, the urine, come through that semipermeable membrane and then it's collected in the nephron tubules and then when it becomes full enough then it drains down into your bladder. But there's a good possibility that if you're not, if Again, if you have a low urine output and a low specific gravity, but you have normal vital signs, then that could be a possibility of renal tubular failure or damage. The one really important thing, and again, it's being able to I hear the music coming in and when we come back we'll describe a little bit more about the renal tubular damage and then we're going to get on into immobilizing fractures and dressing some soft tissue wounds. Thanks for sticking with us and thanks for supporting this radio program. I'm back in the USSA United Social Estate I'm back in the USSA New American Way I'm back in the USSA, yeah I'll leave you the place, give you whatever I call I'm back in the US I can assure you ladies and gentlemen the cause of freedom is in good hands. And the idea of supporting a federally controlled 132,000 page document bureaucracy, we're talking about adding to or increasing 200 new programs. And we're back with the intelligence report. I'm Nancy Kornke and we have, of course, Michael... Michael Nifter. There he is. Would you please continue where you left off? Okay, very good. We were talking a little bit, we kind of took a sideline about, we were talking about catheterization as a bladder and trying to explain what's actually going on. So what happens is when a patient loses a large volume of blood or maybe they're dehydrated or something or through a heart attack where they're not having that good blood pressure You're not banging those kidneys open and pretty soon you're going to go into kidney failure. Again, this is another thing that's occurring on there. It's a lot deeper than just whooping a bandage on somebody and turfing them off to somebody else to do that. Because bearing in mind, and this is another reason why we're doing these programs, is you may be cut off. from your next level of medical support. And you may have to be able to monitor and treat the patient for a prolonged period of time, maybe a day, maybe two days or a week or so. And you need to have at least an understanding of what is really going on inside the body. The next thing that we need to do is obviously we need to immobilize any fractures. The old adage about splinting them where they lie, it always remains the best rule. We need to protect the associated soft tissue and especially any of those, the neurovascular structures and that's of prime importance. You've got these jagged ends of the bone and you're going to be pulling the person around. that's going to start lacerating the nerves or the vessels and then you're going to run into another bigger problem. Then we need to address the soft tissue wounds. Now, elevation and compression of sterile dressing, this is going to help protect any further injury and contamination. Now, definitive therapy can be carried out when anesthesia is available for the adequate debridement and repair. But we have to always understand that it's going to be up to us in the field to make sure that we immobilize the fractures and dress in the wounds. And then the next step is then we're going to establish the cause of the shock. And now the inability to restore the blood pressure and the circulating volume by a good adequate The blood volume replacement indicates that the source of uncontrolled hemorrhages is present. Say for instance, we've dressed the wounds and we've started an IV, we've started infusing fluids in here, but for some reason there's They're still having a low blood pressure, so that's going to be a good indication that there's some other bleeding going on that's not really obvious. Now, we've mentioned before about catheterizing the bladder. Now, obviously, if there's any blood in the urine, it's chemoterea. Any of that's going on, any hemoptysis, a person is coughing up blood. If there's any bloody nasogastric secretions, or if they have any rectal bleeding, This is going to really be a good indication that there's internal sources of blood loss. We need to really pay attention of what's going on there, especially somebody that may have a pelvic fracture. It frequently accounts for occult blood losses as much as 10 units of blood, and then any continuing major hemorrhage usually is going to require an exploratory operation and prolong preoperative attempts to stabilize the circulation in this kind of a patient is going to result in a failure to resuscitate the person. Now, the next step is there's going to be immediate follow-up. We need to make repeated examinations of the patient with special attention to the pulse, the pulse rate, blood pressure, skin temperature, and their color, and their state of consciousness. Take that again. We need to pay close attention, skin temperature, and their state of consciousness, skin so we get our nail dead. and continuous observation and general evaluation to the note that changes in the level of the consciousness. There's going to be a spontaneous motion of the extremities. Then there's going to be a returning of your abdominal habits where you're going to be able to listen with a stethoscope. You're going to hear the normal bowel sounds. Now if a nasogastric tube is inserted and then you're going to to draw off any of the fluid out of there and then you need to inspect it and see if there is any blood in there and then we want to empty the stomach and then we want to keep that on an intermittent such possible. How the next step would be that all patients must be completely disrobed and then we're going to have a rapid assessment of the extent of the injuries is going to be performed by gentle but real firm palpation of all the body parts. And especially those areas where there's injuries or obvious injuries or where injuries may be suspected. Now any obvious deformities, asymmetry, lacerations and contusions are going to require some special attention. And then we're going to palpate the scalp, the facial bones, the trachea, the vertebral column, as well as gentle compression of the thorax, the pelvis, and the extremities. And usually, then these are going to elicit signs of any hidden fractures or dislocation. And then there's going to be a careful abdominal evaluation and examination is really mandatory. Particular attention we're going to pay to the presence of tenderness and the character of the bowel sounds. There's need to be a rectal examination that's going to be performed in all patients with particular attention to the presence or absence of blood. And then we're going to check the peripheral pulse and the neuromuscular status of the extremities are going to be assessed. So don't just check the pulse in the radial artery or up at the ulnar. That's the place where they put the stethoscope when they do a blood pressure. But check the pulses down. There would be on the inside of your leg, by your ankles, and then on the top of the arch above. on the top of the foot opposite of where the arch of your foot is and you'll be able to feel the pulse there. So don't just check the pulse on one arm behind the thumb there where the normal place is where you check a pulse. You need to check that on the left and the right upper extremities and to check it on the left and the right lower extremities all the way around. And you need to do this frequently. And then again the peripheral pulses and you want to check on the neuromuscular status of the extremities. And then you also want to listen to the chest with your stethoscope and all the different quadrants to make sure that the left lung and the right lung are both You have breath sounds in both sides of the lung. And then you can also use percussion as to where you've seen how the physician lays his usually the middle finger over that and then taps on the back of it. And then with a little bit of training, then you'll use of that, then you'll start to understand what you're feeling on your hollow organs, your lung and your liver and things that will give you kind of a hollow type of sound. And then this could be a good indication that they're working properly, that they may have it filled with blood from any type of trauma and things like that. You need to use this with the chest oscultation. That means, oscultation means listening with your stethoscope and the percussion. And these things could demonstrate signs of a plural collapse, an effusion, as well as any cardiac changes consistent with the type of injury. Next thing we need to do, and again, when I go down this checklist, this is not, Like we mentioned the other day, these things are all done concurrently. It's not sequentially where we go to A, B, C, D, E, F, G, and right on down. These things need to all be running at the same time. So we need to obtain a real thorough history possible. Any taking into specific account any previous medical problems, allergies? any medications that the patient is on, and as well as the conditions concerning the accident itself are really important. And then we need to tap in the sources other than the patient, and they may be necessary to get a good adequate history. You know, you may have a loved one, a family member, a close friend, or something like that that they've shared these things with because we may be treating a patient who's unconscious And we may not know about any of their medications that they're on or any allergies that they have. And this is one thing that we've talked about and done with our training also that over in Oklahoma and here in Arizona that we've stressed this over and over again that somebody in the group hopefully the medic has sat down with each person individually and interviewed the person what their name what their medical plan what their blood type water their allergies what medications on their there are no it what is their pre-existing conditions uh... you name it what uh... who do they want to be notified of the next of kin water their treatment wishes today Do they wish not to be treated? Do they want to be put on a ventilator? Do they want to be defibrillated? Do they want to have kidney dialysis? We've all heard of that girl over there in Florida, Skyvo, that one side said this and the other side says that and it turns into a big giant battle. But if somebody had sat down with someone and said, these are my wishes ahead of time, And then that could be brought up and then that would be the definitive treatment on what is going to be done and then there's what is not going to be done. Now, the next thing is, we're going to talk a little bit about the pathophysiology of the shock itself. I think we might be coming up here on a break, but just to give you a quick definition of shock. Now, a shock is a state of hypoperfusion. A hypo means below, so we're going to have a low perfusion. There's low blood being circulated secondary to a decreased effective circulating blood volume. We're at the break here, Mike. Yep, yep, I do want to remember remind everybody Milit main military comm is sponsoring this program and we would ask that you please Support our sponsors both main military the bed fan guy And we're working on a few others here folks so hang in with us, and we'll be back after these messages from Liberty Tree radio Are you losing precious sleep on these long hot summer nights? Are you paying outrageous energy bills trying to stay cool while you're sleeping? If so, have I got great news for you. The Bedfan is an amazing device that installs at the foot of your bed and circulates cool air between your sheets. Your average body temperature is over 98 degrees and your air conditioner simply can't penetrate your blanket or your body heat is being trapped. 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 us self-addressed stamp envelope to... Collectors, outdoor enthusiasts, survivalists. The Army-Navy Store from your memory as a child is just that, on 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. Canteen for just $2. Or Trioxane fuel for just $1 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 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 877-608-0179. That's 877-608-0. And we're back with more of the Intelligence Report. I'm Nancy Kornke. And I'm Michael Nasser. And where we dropped off, we were talking about the pathophysiology of the shock, and we just started about the definition of the book definition that now a shock is a state of hypoperfusion secondary to the decreased effective circulating blood volume. So in other words, we've lost the effective blood circulation and then that's going to have low perfusion of pushing the blood into the vital tissues and into our brain, into our kidneys, into our heart and everything like that. So that's kind of a layman's definition of that. Now then the next thing is, is then you're gonna have a sympathetic neural response and then that's going to divert the blood so that the perfusion to the vital tissue is maintained and then it's going to produce a physiology and metabolic changes in the poorly perfused tissue that eventually you're gonna have a real profound general effect. So we have a cascading effect. So if we have bad heart is not circulating or we have a low volume because of somebody's lost a lot of blood, then the nerves are going to shut off the blood to the lower extremities and stuff, so then it's going to pool. the blood into the vital organs, but what's going to happen is you'll see here is then you're going to start running onto other problems and they're going to start cropping up into those extremities where they're not getting properly profused. Now, the classifications of shock associated with trauma is going to be primarily hypovolemic. Then we're going to have associated problems may induce other forms of shock concurrently or subsequently. The primary one is going to be your hypovolemic shock. It's going to be due to a loss of the blood volume either from hemorrhage of whole blood or from the third space losses of the plasma seen in things like peritonitis, pancreatitis, and intestinal obstruction or burns. The next one we could have is an endotoxic shock, and that's going to be as a result of the peripheral pooling of blood in the primary blood vessels. And then there's going to be a decreasing in the effective circulating blood volume without an actual blood volume loss. And then we could have direct myocardial, that's the heart muscle, and the peripheral effect and then they're going to add significantly to the complexity of this whole picture we're talking about. Another type of shock would be cardiogenic shock, and that's going to represent the pump failure, the failure of the heart with an inadequate output. And then therefore, then there's going to be an inadequate tissue perfusion in spite of a normal blood volume. Another type of shock is going to be neurogenic shock and it's going to be caused by a loss of your sympathetic control of the resistance on the vessels, the blood vessels. They have little muscles around them that weaves in or let out and that's how that regulates your blood pressure with that. So if you go into a neurogenic shock, you're going to lose the nerves that are going to control the blood vessels and then There's going to be a dilation of the arterioles and the veins, and then there's going to be a decrease in the effective circulating volume, and that's going to produce shock. hypotension, a low blood pressure, is due to spinal anesthesia. That's just an example of low blood pressure. Somebody's had some spinal anesthesia, and then that could be an example of that type of phenomenon. Now, the next thing that we, I'm not so sure that we're going to cover, but it's going to be the endocrine response. And bear in mind, each one of these things are happening all the time. You're going to have a release of the ACTH and the antidiuretic hormone and aldosterone during the hypotension. They're going to result in a renal retention of the sodium, the chloride, and the water. and then your potassium is going to be lost and then there's going to be a decreased urine output. But that's kind of another lesson to understand these deep concepts or these things that are going on that again, I'm going to stress this over and over again, this is not just whooping a bandage on somebody and throwing them into an ambulance. and turfin them to somebody else. You must understand these things that these things are going on, whether you want them to or not, and whatever the cause of the accident, whether it's from a gunshot wound or a vehicle accident or anything like that, but then there can be the hypovolemic shock, the endotoxic shock, the cardiogenic shock, or the neurologic shock. Each one of these things can be happening by themselves or concurrently as the body is starting to shut down. It's trying to shut the blood from out in the periphery and making sure that your brain and your kidneys and your lungs and your heart are staying perfused. Does that make any sense, Nancy? Absolutely. Yeah, it does. I'm sorry. It's just... It's just one big, giant domino effect. If we don't stop that, even your heroic measures whether we're going to split the wounds and put a dressing on it, that's not going to do nothing because what we're talking about is the things that are going on at the cellular level that you cannot see, that only you're going to see the manifestation of that through everything's falling apart before your very eyes and there's nothing that you can do. But if you have a working knowledge of what to anticipate, is going on, then we can better treat the patient and stay ahead of these problems because otherwise you're going to just be playing catch up and you're going to be using a massive amount of first aid supplies and then the patient's going to die anyway. And then you're going to beat up on yourself about, oh, I should have known better, oh, I'll be better next time, oh, all this, oh, all that, no, I'm so sorry and everything. Yeah, but I'm sorry, sorry, it just doesn't cut it. Let's be honest, sorry doesn't cut it. When you have, this is what this program is about, getting the knowledge necessary to be there to save lives and where seconds count. You can't wait for somebody to move up 10 minutes from behind you or five minutes or even three minutes. The seconds count when it comes to dealing with injuries. and shock is no different. You've got a treat for it. Simple. Absolutely. Maybe I'm hearing things. I thought I heard the music playing in the background. Nope. You're good. We've got a few more seconds. We've got a few more seconds. Okay. We told you this a long time ago that this isn't going to be easy and you've been able to go along pretty good for the last year, but now we're definitely bumping it up to the next level. We gave you the A-Bs and Cs and now we're up into the LMNOPs. If you aren't familiar with those things, I'd highly suggest you go to WTPRN and listen from about the 18th of October forward where we've been covering a lot of these other things, the basic field sanitation. I'm going to do one better, folks. It's just real simple. You got any questions about first aid? I have run into more doctors and nurses that do not know how to wrap a bandage. Something I learned when I was in sixth grade, my sixth grade phys ed teacher brought in the American Red Cross and they taught us how to wrap bandages. So now I'm teaching doctors and nurses how to wrap a bandage. This is ridiculous. Honestly, just last week they changed the dressing here and the girl did not know how to do it, the nurse. taught her how to do it. Guess what? She was thankful. This is something you need to know. And it's not something, doing it, okay, helps to make it sink in. So get to your American Red Cross, go take a first aid class, basic, then intermediate, you know, right on up the line. Do that and come back, get to the archives, and learn. Because minutes, seconds, count in the field when somebody is injured. That simple. We're at the end. We'll have to continue on with this tomorrow. Now I hear some music. It's here. As always, people, God bless the Republic. And just to the new world order. We shall prevail, ladies and gentlemen. We'll be back in an hour here on Liberty Tree Radio with more of the intelligence report. Thank you, Michael. Are you losing precious sleep on these long hot summer nights? Are you paying outrageous energy bills trying to stay cool while-