Live 365. Now, back on the 24th we were talking about it and I called back in on Friday on the last hour after I had watched the national news on channel, the NBC channel and they said that at that time on the 24th that there were 1,000 cases in Mexico and there were 900 cases just in Mexico City. So, I think somebody needs to give this ticker a kicker. Because how do you go from 1,000 cases back on the 24th of April, and now there's only 787 cases worldwide here in the 2nd or 3rd of May. So I'm a little pleased on that. But anyway, that's kind of the commentary. We haven't got our digital converter box right yet. And the local PBS channel is switched to digital, so I am without BBC international news for the time being, so that's kind of what's going on with that. I also mentioned the Flagstaff Meetup information at alphioomegetraining.com. I mean, I still have, is there anything else you'd like to cover, Mark? Well, we're going to get you into that right away as quick as we can. So remember, everybody, keep your pen and papers handy. But I will remind everyone that we have a lot of work to do with regard to chemical protection. Hey, if they're telling us that we need to watch public gatherings unless we're protected, guys, we could all go to these protests where their gas masks gone. Or for that matter, with a respirator, lower respirator, you're just covering half of your face. Oh, would that not frustrate the bad guys? because they always want to know who everybody is. Should we go to the gas match to the football games? No, no. Football games are way out. It will have to be the baseball games. You have to use the wide lenses so you can see better. Anyway, point is that we do need to make sure that everybody is fully defended, NBC-wise, and it's not that hard a process. Once you buy the stuff, you got it. MaineMilitary.com. MaineMilitary.com. MaineMilitary.com. That's M-A-I-N-E military dot com. Go to the site, check them out. They've got chem suits, both the Mark 3's and the Mark 4's. I've used both of those. They're both very serviceable. Don't pull them out of the package. Once you confirm the size, make sure you know what size you've got there. You may want to use one for test and for training. So you compromise one, but I would keep all the rest in their compressed containers. The nato type chem suits guys are squosed in and they're under vacuum. When you open them up you will not fit them back into the bag they came out of. Trust me, Mark has a lot of experience with this. Hey they don't squeeze back in! Well you don't have the pressure outfit necessary and you can't squeeze. it tight enough to really make it work. So if you're going to use one for testing, that's not a problem. Just figure that's an expense you're going to have to make. And then still, that chem suit would offer some protection. It's just that again, it's degraded as it's left out. And because when you use it, you're shaking out part of the charcoal, filament, et cetera. With the gas mask filters, it's purely a matter of how far you want to upgrade. Remember that there are adapters, as we're just talking about here in the chat room, there are adapters for the finished masks or for any of your 60mm masks. A lot of you guys have the German combat masks with the large eyepieces that have the 60mm filter intakes. They will take the adapters. A lot of you may have the British combat infantry masks. that are the newer ones but not the absolute newest and they will take that 60 millimeter adapter that's available from main 2. So you can use both The 60 millimeter filters that you have and if you are not able to get them or if you want to say switch to a Ultra high grade 40 millimeter you take off the enemy space or out of their gear Well guess what you take the adapter put it in you take the filter screw it into the 40 millimeter point and now you've got it upgraded to the you know to the odds and into the next century here Not a problem at all. So there's a lot of masks that have been purchased that are excellent systems In fact, there's none that it should go to waste I will throw no gas mask away. In fact, there are other missions for them even if they can't be used for as gas masks if they're compromised because of weather conditions or whatever. Or just age. I mean everything gets tired guys and you're going to have to replace it eventually. But most important is everybody gets something. They have children's masks, they've got masks in varying price ranges depending upon your income. Remember, you don't just want the masks for yourself. You may want to pick up spares for other people that show up. Well, buy the cheaper masks for handouts. Not everybody needs to have a really great voice meter. Most of the Eastern European masks do not have a voice meter for voice projection. This is critical. You must understand this. The Russian concept was you are going to be receiving orders, not talking back to the Sergeant, right? So these are simple masks. They're less complicated. They're very easy to use. In general, all gas masks are once you're taught a few things. And even the average person can put a gas mask on and pretty much make it work with no training. They figure out real quick. But important is that we have the technology and the information to get the job done. Another thing to support the station, LTR, we have the two-disc NBC equipment tape that's done. And it's a two-disc system. Disc 1 and Disc 2 covers an extended briefing that was part of a five-point series of classes that were given during a mutual training exercise with militia at large, Wolverine militia, and also Ohio militia, and there were some guys from Indiana too. There were about 120 to 130 people per class and basically there were massive tack lanes. As soon as one set of classes or all the classes were done to a certain point, everybody shifted from one chamber to the next and went on to the next class. A number of other subjects were covered, but this NBC course was the standard and it was given in repeat, and repeated several times during the day. So, the guys did a fantastic job. Everybody got a chance to participate. And everything was covered short of a very small number of items. All of the newer masks were covered. Now, you can cover enough on that. You're going to find out when you watch it if you want to help to support the station. And yes, we do need assistance there. So, check out the PayPal account, guys, on libertytreeradio.4mg.com. But if you want to set up these disks, then your solution is to go to, well you can order it by going to PBN. First of all, the address is PBN P.O. Box 194, Dexter, Michigan 48130. That's PBN P.O. Box 194, Dexter, Michigan 48130. And what you do if you want to use a checker money order, you make it out to Nancy. Last name, K-O-E-R-N-K-E. Nancy, K-O-E-R-N-K-E. And it's $20, post paid for the two disc set. And it comes in a box. Everything's nicely appointed, so it's kept clean. If you want to make copies of it, you go ahead and make copies of it. That's the only thing we ask is, if you make copies, that you copy it in its entirety. Leave nothing out. That's all that we ask. Otherwise, again, you want to help to support Liberty Tree Radio. You want the technical information. We have other supplement videos, and we're going to continue. In fact, we have more schedule, we have time to get up right now. But we're going to continue to work on that. We have a number of videos on YouTube. You can go there and get additional information that is designed to bring your troops up to speed. And then this is the advanced course. This covers everything from decontamination to how to put the mass on, how to use the chem suits, proper step-by-step usage, showing the radiac meters, dose meters, detection paper, detection scanners, advanced sensors. Everything you can think of is pretty much in there. The instructors did a fantastic job and they were very, very patient. They did, I think, a thorough job with regard to the information. So it's $20, post paid for two disks, NBC equipment tapes, equipment video, there we go. And the address is PBN, PO Box 194. Dexter, Michigan 48130. Yes, it's designed to help keep the lights on. You send a gift and we're going to send a gift back in response. How do you like that? So, PBN PO Box 194, Dexter, Michigan 48130. $20 for a two-disc set. We've been sending them out quick as we get the orders, but again, there's a little bit of a backlog there. We'll take care of that as we go. and not that major, it's just a guys we got to keep plugging away at it and this was a busy weekend but we want to make sure that you have the technical information and wherever it goes just make sure you spread it in all directions and by the way don't be surprised you might find an extra disc in with the order if you do I definitely beg that you copy that disc and spread it everywhere You'll know what I'm talking about when you get it. Again, you guys work on this. Help us out. We'll help you out in the process. Mike, you take it away because we've got a lot of work to do and we've still got about 30 minutes plus to do it in. 30 minutes. There we go. Okay, IED 25 and 5 meter scan. You want to clear the area. You want to confirm the EOD. You want to cordon off the area. You want to control the perimeter and check for secondaries. That's clear, confirm, cordon, control, and check. You'll always want to conduct your 5.25 meter check to avoid stopping near a kill zone of an IED, and you want to scan outward continuously at all times. The driver and the gunner should remain inside the vehicle for security purposes. Now for the five meter check for a short halt, you want to identify the position to halt. You want to search five meters out from the vehicle through the window. You want to conduct visual checks using binoculars or any other type of optics you have. You want to check for abnormalities, disturbed earth, suspicious objects or loose bricks and walls and security ties. You want to work from the ground up to above head height. and for the 25 meter check for a long halt, after conducting your 25 meter check, if necessary, to exit the vehicle, you want to close the door to protect the occupants from potential blast or sniper threats. You want to search under the vehicle. You want to continue clearing out the 25 meters, check for potential IED indicators and anything out of the ordinary. and the patrol is going to remain focused outward, searching from far to near, and you want to look for suspected enemy activity, trigger men, cameramen, or any snipers, things like that. So that wraps up that block of instruction on our continuing saga of the IED. Now we're going to switch gears here. We're going to go back to ACLS and our airway management. And we're going to kind of make an overlap here. We started this off the other day with an overview. We talked about the oral pharyngeal airway and the nasal pharyngeal airway. And we just kind of got started on endotracheal intubation. So to start over with endotracheal intubation. the description and the function. This is a procedure and it's going to consist of passing the tube directly into the trachea. The tube is open at both ends and it has a 15 millimeter adapter at the end that hangs out of the mouth, the proximal end, and usually a cuff at the distal end. Now, cuff tubes generally are unnecessarily for children under eight years of age. And the tube allows for attachments of devices for delivery of a positive pressure ventilation, you know, like a ventilator or your valve mass resuscitate or things like that. And it should be performed as soon as peracitative efforts by trained person. Now the advantages of it, it's going to isolate the airway. It's going to keep the airway open. It's going to reduce the risk of aspiration. It ensures delivery of a high concentration of oxygen. It permits the suction of the trachea. It provides a route for administration of certain drugs. And that's alone. We discussed that before. It would be atropine, lidocaine. O is oxygen, Narcan, and epinephrine. We just remember it by that acronym, A-L-O-N-E. And then it's going to ensure delivery of the selected tidal volume, usually about 10 to 15 milliliters per kilogram to maintain your lung inflation. Now the indications of why you would want to resort to this, it's the inability of the rescuer to ventilate the unconscious patient with any of your conventional means. The inability of the patient to protect their own airway, whether they're having a coma or cardiac arrest or something like that. There's also a cardiac arrest with ongoing chest compressions real hard to kind of ventilate people while somebody is squeezing on them. Once the ET tube is in place, ventilation need not be synchronized with your chest compressions and the ventilation should be performed asynchronous at somewhere between 12 and 15 ventilations per minute. And also another indication would be the inability of the conscious patient to ventilate adequately. Now the techniques is you want to check the endotracheal cough for leaks. You've got to test to insertion. So you're going to try to fill the, see if it holds and then pull the air back out of it with your syringe. Now a stylet, that's down to about what, it can be inserted inside the endotracheal tube. and it's going to be used to facilitate insert of the tip of it. It should be back in the recessed about one half an inch from the end of the endotracheal tube. This is going to avoid any trauma to any of the anatomical strum. You want to connect the laryngoscope blade in the handle. Now if you have a curved, a Macintosh blade to the mouth, it was then lifted in the robotic opening, the space visualized, because it's got like a little flashlight bulb on the see down in there and you'll be looking at an inverted V. Those are the vocal cords and then right underneath that there's a little and that's going down into the trachea. It's a Miller blade, a straight blade, or the glottis. And you want to check the blade so that you've got a good white bright light on there before you go. You don't want to get ready to intubate somebody and then snap it open and then realize that you need to change the batteries on there. You want to size of tube. Usually females are going to be about seven and a half. Males are usually eight point less to have, one half size larger on hand. You want to attain the position real good visualization of the larynx. That would be the mouth and the trachea, so you don't want to have the head bent or anything like that. And you're going to accomplish this when the head is placed in the sniffing position. The head is going to be able to ventilate the patient with a 100% oxygen. And then with the laryngoscope handle in the left hand, you're going to insert the blade to the right side of the mouth, and then you're going to sweep the tongue to the left, the teeth as official down in there on the vocal cord, played in, and then you're going to, you're not going to visualize the epiglottis and then the vocal corner of the mouth through the one and a half to one inch beyond the enough edge of the package. It'll say, you know, 10 milliliters of air, but that is cuff inflation. at the distal end of the endotracheal tube, a little tiny tube that's on the side of the ET tube itself. And then there's like a little pigtail where the syringe adapts onto that. And right as you inject a little bit of air, maybe 3 to 5 cc of air in there. And then you want to squeeze on that little balloon by the, just in front of the hub where you're hooking the syringe on. should give a little bit, but it shouldn't be rock hard. And then you want to hook your ambu bag up and bag the patient and put your ear down. And here, if you can see or listen to see if there's any air escaping when you're bagging the patient, if there's any air escaping out, and that's going to tell you that you don't have quite enough air. So you might want to inject a couple is what I'm describing. And you're not going to read this on the package at all. It says that it's tense in the cough and you somebody in Colorado who's got too much air in there and making that cough rock hard out against the trays. Make sure you only have the minimum amount of air in that cough. You're going to listen with your step down in the epigastrum right where the chest is, where the stomach is, right below where the ribs are and where your stomach begins. The ribs and that V come together. You put your stethoscope down there and then bag the purse and squeeze your bamboo bag and if you hear any gurgling then there's a very good possibility that you have the tube down in the esophagus and not in the trachea. So now you're going to have to pull the air back out and bag the patient a couple more times to get their O2 saturation back off and then try to intubate them again. But the main thing is, one is don't use the front teeth as a fulcrum when you're trying to visualize the vocal cords. You only want to inject really enough air into the cuff of the ET tube, or you don't want to inject all 10 Cs on there because where that little pigtail is, where the hinge comes in contact on that little tube, then you can down in the cuff want that to be. Then you want to inflate the cuff, then you want to ventilate the patient by attaching your BVM. to the ET tube, you shouldn't take any more than 30 seconds to complete this. The rules of you to somebody is that you hold your, and then if you start running out of air, they need to back off to get their O2 sat pack, try it again. So, and then you want to confirm placement of the endotracheal tube. You want to observe the rise and the fall of the chest. The oscul take the breath sounds of the left and the right lung fields that are listening with your stethoscope. right underneath where considerations are working on the side of the ET tube because it will have it marked off their centimeters. And you want to measure that right at the transportation the tube gets pushed and you'll know where it actually, and it's usually going to be between about 19 and 23 centimeters in the average adult. And then you're going to take the endotracheal tube off their cheek, bring the ET tube, you want to reassess to baiting the gurgling is heard over the epigastrum, you're going to, again, you're going to assume that you've inadvertently intubated the epiglottis into the esophagus. You want to deflate the ET tube cuff, remove the tube, hyperventilate, and then try it again. Now, if the breath finished on the left after intubation, present on the right side, you want to assume that you're in the right main stem bronchus. It's very common to do that because the right down in the trachea from in the back of the throat past the epiglottis, then you go into the trachea and right after that is then you'll have the bronchus branch off to the left, to the right side. You'll be hearing breath sounds on the right, to the left side. Take the ET, cough it and reevaluate your breath sounds. I've heard another technique instead of there's also a carotid pressure by the Adam's apple. If you have somebody that can assist, they'll take their thumb, their index finger and their middle finger. kind of in a triangular type of effect and they'll be pushing down with not real hard, kind of a gentle type of what's going to happen. It's going to help align looking down there with your laryngoscope, be able to visualize the vocal cords a lot better. They'll be set a little bit forward and then you're not going to have to lift up so high on your laryngoscope, visualize the vocal cords. of carotid pressure on there, only about, oh, I'd say maybe three to five pounds, just putting your fingers on there, but you want to slightly depress the Adam's apple a little bit, and it should be applied to minimize any gastric distention, and it's going to really ensure the placement of the endotracheal tube, brachial opening, because it's really going to help the person to visualize the vocal. The carotid pressure should be maintained until the ET to the tube is achieved. take any more than 30 seconds. The implications of your endotracheal intubation is aspiration. If you get it out down into the esophagus or into the epiglottis, the tube that goes down into the stomach, excuse me, and then that's going to cause the stomach contents to come out and then get into the tube and it's a real mess. There's a possibility of trauma to the lips, the teeth, and the tongue. There's a possibility of laryngeal spasm, which I already talked about, about not overinflating the cuff. Bronchospasms, where the bronchos will start to spasm. The inadvertent esophageal intubation, the inadvertent right men's main stem of bronchos intubation. Hypoxia, due to prolonged or unsuccessful intubation. Dysrhythmias, the endotracheal tube, off leak. in the intra-cream kind of also as a that about into one other tech-serve package and then you're going to tie it, excuse me, in a simple knot, a hand knot, but you're not going to pull it real tight. It's going to be the tube cross of the knot is only going to be about two, two and a half inches and you want to leave it there for a couple of minutes depending on what the ambient temperature is and then when you go to put it in, is going to already naturally be thing is that you want to make sure if there's a possibility that the person is going to be intubated for a prolonged period of time, and I mean weeks or something like this, you definitely need to consider putting the tube down in their nose and now down in their mouth. Somebody that's been intubated in their mouth for going to dry out, you're going to have to swab their mouth frequently to keep it moisturized because the mouth can't decide if the tube is taped, ugly, open. If you're a tube in the person for the first time and you suspect that they might be a verbal amount of time, we want to consume down their nose and not into their mouth. And eventually, if you don't, then eventually that's a little bit harder. You can still use a The laryngoscope to help open it up and then you can visualize the cords even after you've passed it into the nose and then down through because then in the back of the throat then it's going to pop out and see it. You get a longer eyelet, it's called a bougie tube. Instead of your normal dotracheal, actually about, oh I don't know, about a little over a foot, maybe 14 inches long. The bougie tube is about two feet long, so if you ever have to change an endotracheal tube, bougie tube down in the center of the endotracheal tube passes down and that's going to be your stilett, your guide, into the trachea itself and you're going to slip and then slide that back down. In an instance you have to change the endotracheal tube because it's big enough or it develops a leak on the cough and the cough keeps there for it and you have to, you might want to consist. See we've got about 10 minutes left. I have the This is going to be a fairly quick one. This is going to be your ministering stuff with your nasal cannula, the little nasal prongs. The description of the function of those, it's up to tubing with two-dimensional oxygen. Through the liver oxygen, it's somewhere between 25 and 45 percent nasal cannulas at one liter per minute. That is going to give you an oxygen concentration of 25 percent, up to 9 percent. three liters, it's going to be 33%. Five liters, it's going to be 41%. Six liters, it's going to equal 40%. Some of the advantages, it's well tolerated by most breathing of any of the expired air, particularly valuable in patients with COP2 concentrations are desirable. Some of the disadvantages, it can only be used in spontaneous. The actual amount of inspired O2 depends on the respiratory. in the nostrils if you have a patient that's unconscious, some people are mouth breathers, so if they're too, hold their mouth, close them to breathe through their nose, then just take the nasal cannulas and put them in their mouth, just kind of unplug it from their nose, put it in their mouth, and then their O2 saddle come right up within the O2, really breathing it instead of trying to fuss or trying to, I see how that only took a couple of, Mark, do you have any questions? any of the things, the nasal cannula, the OPA, NPA, anything like that? Well, Italian with that, number one is procedure. Now, something you did here, and I think everybody needs to pay attention to this when you're giving these classes, is you are reading down a checklist. Now, guys, I know you can get better at this, become faster at it, but the basic rule, even if you accelerate your process, Mike, is still to go through every step, step by step, so that you do it right, correct? On the checklist. hours, but every time he gets into that thing he goes through the checklist. The big thing here is that you're going to have to, to a degree, have a little bit of tunnel vision whenever you're dealing with this. Ladies, same thing. And I know you're all good at it. A lot of you people are into hobbies that require focus, model builders, people who tie flies, ladies that knit or you sew. You have to stay focused. You're in a meticulous project that takes detailed work. And you have good hand-eye coordination and incredible dexterity. But when you're in a situation, the other problem that's tied into this is you usually don't have your model or your fly, your tie fly or your sewing kit trying to dance off the operating table or trying to get away from you or wiggling around because it's in pain. So you've got to get used to the idea that you have to focus the same way. You're going to have to peel out a certain amount of response. And you also, still in the process, have to keep that mental inventory in place. Because we don't want to have to come back and correct. So you don't want to. It's not going to be me. It's going to be you. And you're only going to have so much time. You know, and you want to do it right. But you may have other casualties to deal with. You may have other elements of that casualty problem that needs to be dealt with. So, the basic rule here is you have to learn just as you've done with tying that fly and being very patient, working the string and wrapping the shaft and wrapping the feather. Or if you're dealing with model building and you're doing ships in a bottle or if you're doing a piece by piece model, the better the quality means of focus and everything has to be done right. You don't do it right. You've got chips, chunks, and pieces. Paint job looks a little wiggly. Well, you can get away with it, but was that why you put the model together? Same is true when working with a patient. There are certain things you just must do. Now, get better at it. Repetition, repetition. Just like anything else, when you bring that rifle to your shoulder and you put your face to that comb, cheek weld, shoulder weld, breathing, squeeze, boom, all that's tied into that people is through repetition and conditioning. It becomes automatic. The same is true when training your medics. And this is why some people are like, well why do you guys go over compress and dressing applications so much? We want it to be second nature. The other issue is you may have more than one casualty. It's also true with applying special technologies like this to deal with keeping people alive. The sooner you get done with that patient and the better you are at doing it, the less follow-up maintenance has to be done. And the sooner you can get on to the next person that needs your assistance. Keep that in mind. Always think that way with everything you're doing. And Mike has done a fantastic job and I know Alfie does great work. You guys have got all kinds of compliments from the people who have been to your meetups. So I will stress again guys, stay focused on the task. I know there's all kinds of things going on, but stay focused on the task. When these guys get you in the field, you're going to be squared away when you're done. Take that back to your people. Take the discipline and the expertise that you're going to get out of this meeting. Take it back people. That's what we're doing this for. The whole purpose behind our side is to keep people alive and to preserve our liberty. The bad to the thieves. All the nonsense you've seen done, all the BS they've mixed up, all the stuff that they've stirred. Looking just last three or four weeks. They have shifted gears so many times out of desperation as far as I'm concerned. They're reacting, not responding. We're in response mode and we're just chugging away, but the reason is for the same reason I brought up here a moment ago, Mike. We're staying focused on the task. So I want to say thank you for that because, again, you've got to work this out amongst your people and you've also got to be sub-training so that everybody has the same mindset. It is not fun to work on a person screaming. It is not fun to work on a person you know who is not breathing and that you have to get going again. There are a whole bunch of things you better be prepared for and it means you are going to have to gird yourself. Remember that term from the Bible? Mike you are familiar with it. You must gird yourself. That is what you have to do as a medic because when you wade into this you wade into it up to your armpits don't you? Oh absolutely, and especially you were kind of making an analogy there about people tying flies and everything, but we have to remember that that's usually in your environment, whether it's in your garage or your workshop or everything, where your tools are on the pegboard and you have this and you have that, but often times... What we are dealing with here is doing it out in the field. You are working out of your aid kit or a bag and somebody might even be shooting at you. So you are not going to always be able to, if you will, call the shots on this stuff. And also, yes, and another thing that you had mentioned about going down this checklist, yes I am. I am making sure that I touch all the bases. But also this comes in with a lot of practical experience. I had quite a bit of time in the operating room where that's all we did all day long is intubate people over and over and over again. I have no idea thousands or two, three thousand times I've seen people intubate it over and over again. And some of that stuff that I gave you about the boogie tube and the doing of the cuff and not filling it up. to 10CCs. That's not in this checklist. The oesiologists, while they work near your ACLS study guide or anything like that, you are only going to get this one. All right, well I hear the music guys. And again, Mike will be with us on Thursday. How about tomorrow? Oh, wait a minute. I was thinking it was Tuesday already. Oh, thank you for slapping me in the microphone on that one. You'll be with us tomorrow then for sure, right? Same bad time. Merry good sir. God bless the republic. Death to the New World Order. We shall prevail ladies and gentlemen the Empire is on the run. And we are on the march both day and night. 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