35 Burst results for "Ten Minute"
Is Mourinho to Blame for Spurs' Poor Form?
"It's thursday. i'm gap. He's jewels jobs. We got so much stuff going on because mountie. She'll put your gino winning his first trophies manager. I think his first kofi ever i. We'll be joined by franklin buff to talk a little bit about that in a minute. Manchester united top of the league first time in january. First time since the sir. Alex ferguson era by your munich. Out of the german cups is i don't mean the be. Let's start with tottenham hotspur because we've been talking about their chances are they're going to be better worse than last year. How they're pushing. I feel like i've seen this again. I think they've dropped ten points from leading positions. They played fulham last night. You figure you know not easy but full no time to prepare as well. We'll get to that in a minute. And there's more count sempe gab. They take the lead the play well for twenty five minutes and then they stop the talking and they just want to protect that lead. They want to control the game to manage the game. But there's another hour to go. But he's not a bad idea necessarily when you've sawn and harry kane and all these counter-attackers but you don't even counterattack. You do nothing. You just sit deep and you just wait and we saw that against wolves. What wolf scored in the end we against palace. Guess what in the end and now we see that a home at home against fulham where you just stop playing hurricane. One sean tonga. The whole game. That's his goal twenty minutes in after that. Nothing just nothing and i just don't understand why i'm more for protecting your lead in the last ten minutes you bring another center box in or i don't know you you put back five and you you make sure that you don't leave to more space and etc but no one. There's an hour to go. Don't give not extra confidence to the opposition team. Don't invite pressure. don't let them play. I i take your point. I'm wondering if maybe this was a game. Where i thought was very good when he was on the pitch. This is maybe a game where i always mentioned him. But if you have a lasalle so that you can bring on that may be all of a sudden you can keep the ball more. You can keep the ball further away. You can be a little bit more balanced in in how you do it. You know rather than going. I mean if you're if you're just right now do you go and you knock it down. Levi's store and say look. Don't look at me. This is the best i can do in this thing. That's true i don't. I'm sorry. I don't think that's the best you can do. I don't know the price. I lease the last time i spoke to some of them. They were happy but since december the six when they went top of the table the seven in the league. They lost two hundred four. I mean this is. This is not good enough. This is just not good enough. And i think you could say your needs better player or you need different profiles there and they're still. I still think that he gets his wrong. That tactics is wrong because the pleasure doing what he says. he's saying. Okay win the lead saw against arsenal in a second of and they were up and that was fine and they managed to get out and okay good but as we said against war against pilots against on this. Just not good enough. I'm sorry you keep talking. Last night. In a game against tim against fulham who had played three days three days before with the strongest team in the africa because he didn't play again for another week.
Can we build 15-minute cities where we live?
"I'm jordan heath rawlings. This is the big story. Alex zekovic is a staff columnist and the architecture critic at the global mail. Hello alex hey jordan. Why don't we start. I was gonna say with a simple definition. But but maybe it's not that simple. But what is the fifteen minutes city. Where does the concept come from. And what does it describe. So the idea is actually an old idea It goes back at least fifty years in the world of city planning and really it hearkens back to previous models of cities built before the car and the basic idea. Is that everything you need for. Daily living is within walking distance of your home so the idea is not a new one. The rhetoric or the phrase of fifteen minutes city was popularized by the mayor of paris. Over the last few years. I need. I'll go Because she is interested in pursuing the fifteen minutes city returning peres into as much as possible. A fifteen minute city so. This is kind of a familiar idea. That has fresh relevance today. How do you define it for analysis purposes. When you're looking to see whether a certain city or neighborhood would qualify so there are a bunch of different definitions of the term and the one that paris uses actually includes workplaces or generally tries to include workplaces with other things. If you include workplaces this becomes a little bit trickier because trying to find to link up. Everyone's home and everyone's workplace in a large city is very complex. The more familiar and lord sort of less controversial definition is that you have the necessities of daily living within walking distance of home for the article. I did for the global mail with some colleagues a little while ago. We used a measurement called amenity density developed by statistics canada and see 'em each see and that defines it as having a grocery store a pharmacy and a public transit stop within one kilometer and having a daycare a primary school and a library within one and a half kilometers. And then there's a larger circle for health facility and larger circle for places of employment. So you know the least the most straightforward way is to say you know. Pick up a prescription go shopping. Be able to catch a bus or train. You should be able to do all of this things within roughly a ten minute walk of where you are. Why is that set up so desirable. I'm sorry if that sounds like an obvious question but just you know what does it impact. Well yeah i mean it is. It sounds really straightforward. Because when we think of our cultural ideas of what a city is or how people should live. I mean you. Think of sesame street It seems easy but the fact is that most people in north america don't have that at all. I mean the large majority of people in canada as is also true in the united states live in what planners will call car oriented suburbs or car-oriented places. If you have that then you know you. Effectively are limited to being able to survive comfortably to having a car. If you don't have a car to available to do those basic things you know your life becomes much more complex you effectively become a second class citizen and this is obviously -cations for youth and teenagers. It has obvious implications for anyone with disabilities And and there's a strong overlap of course between people with disabilities and seniors but You know this is a very large in growing issue for many canadians. Many north americans. Who are egypt in places where they need to have cars and may not always be able to
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How to get a good night's sleep
"You'll sleep isn't quite right harrison. Things i think might be helpful to just get things back on track and before we get into tips though i just wanted to say do you feel as though sleep is the first thing to go when we experienced any kind of stress for me. It's really good. And it's just an indicator that i have a few more taps open in my brain than i can adequately cope with and that means that my thoughts begin wearing at three o'clock in the morning or my quality of sleep over the course of an entire evening just isn't good enough and sometimes it can be just because i've got too much on my mind and this leads me nicely into one. So if you are waking up worrying and then it becomes impossible to switch off and go back to sleep or if you find it a struggle to get to sleep because you're thinking all the things a on your plate essentially then making a list of all of them making a list of everything that's on your mind before you go to bed might help. It's been proven. I've spoken to several sleep therapists and sleep. Experts said that just the act of making a list of all the things that you on your mind can take the magnitude out of these things that seem really big because you attach all the other things to it like. Oh i've got to my taxes for example. And if you don got to do. My taxes means speech my accountant. I get really stressed. When is mike has an all. Will he have time for me. All of those things actually making a less kind of gets rid of a lot of that chatter and just makes them feel much more doable and is also really good. The next morning right. That's my to do list. They were with me yesterday. They were my mind. I'm going to do something today to make sure that that's not worrying me tomorrow. And it's been proven that a few minutes of mindfulness can take the edge off and make it much much easier to fall asleep so if you get into bed you're white awake will now. What actually whether you use an up whether you use a prompt of some sort a youtube video just counting your breath and just slowing down your breathing. But if mindfulness whether it's guided or not can we really make that difference to just get in your mind and body out of that mode to. Yeah you know what yes sleep. The seem like a good idea but this is also one the idea of writing down your warriors the idea of organizing your worries into something that you can then work through methodically and logically. This is also what you can take a little bit of a run-up i wouldn't be doing it. I'm not talking about making a list bed but if you are lying awake thinking about paperwork finances or feel as though everything's calls nita's organized than actually some time in the day to do filing to file things properly to get on top of your admin or just create an organized environment where you know where everything is that can have a really positive. Knock on effect of softening those concerns when you're trying to get to sleep so okay. I know this might make me sound a bit weird. But if you're a long-time listener you'll be no stranger to that. But i leave my office night but only a my office being my second bedroom but i leave my every night but only once. I've made sure everything is tidy. So i my desk so i've got my record. I'm obviously recording right now. So all my recording equipment out of my wires everywhere. I make sure that then nicely neatly wound up and put back in the drawer where they are recording device back ninety degree angle on my desk and when i leave at the end of the evening i use my call brush to like clete to rake through the copy or vacuum the carpet and anything i've taken out or use during the day. I put it back to how. I would have it if i had guests coming over the next morning and mentally. It ends my working day really neatly but the payoff is the next day. I am always and i mean always delighted to what to set foot back in my office. It feels like oh this is this is a place. We're going to do really good work today. And i know i said you know. Make it presentable as if someone else's coming around to see it but i'm seeing it and it's important that i have that feeling and that genuinely when i wake up in the morning at i think goku can you office today. I'm actually excited to get into the office. So that has definitely been one of the things that i have started to incorporate in the last couple of years that makes all the difference. The second tip is this one might sound really obvious. but it's dope nap and maybe it sounds really obvious for me. Because i've been working from home for eight years and so i've learned the hard way but if you're working from home for the first time or maybe the third time if you're in the uk and you're on your third lockdown but if you now have been working from home for substantial amount of time since we went into various stages if restriction around the world then. It's definitely tempting to have a quick snooze when you normally pep yourself up with a coffee or sneaky chat with a colleague in the canteen or out for quick walk. Whatever but while we're living and working in the same space it's easy for entity to drop and to think fifty minutes won't hurt and oversee no one's gonna see no one's gonna see you have a quick nap who cares but unless you're a great napa and that awesome effective ways to make napping efficient and actually work for you but let's revisit those in another time when another episode then give napping a real mess so like i said i've been working from home now for nearly eight years and nothing is a very very easy to fall into trust me. I've done it so so many times. But now i make myself go outside and walk around the block. The truth is that my body saying oh we need to sleep or or wouldn't wouldn't not be nice but the truth is the thing that's going to serve me better. Brain and body is a stretch. Probably some fresh air or just moving around. Because i've been sitting at my desk for hours on end my my heart rates will be slowed down. And that's why my body's like we haven't done much moving. Let's go to sleep now. Moving around for a bit. Even if it's just in another room even a bit of yoga will actually support a better night's sleep or more likely likely give you a burst of energy so if you get that i that three o'clock low what you think all honestly i could just kick off my shoes now and i could just go and put my feet up on the so. I just have a quick nap. No i find. If i walk around the block i come back and where i think. I was almost ready to finish my day. I've definitely got another few hours in me. And it's extraordinary. How many good ideas pop into your head when you out for a walk or you're in a downward dog come on. Who else has been there where you at your desk all day even working team. I've got. I've got to have an idea for this or i've gotta to do this. And you're trying to troubleshoot something and you at your desk in your in work mode. It looks like you're working really hard. You get up. Have a cup of tea or take a walk around the block pops into your head. That's me clicking. By the way the idea pops into your head a little bit of movement london he makes the body feel good but can sometimes just be the little bit of the release. The brain needs in the way. That when you're thinking of a word and you think really hard and then the second you start thinking about it pops into your mouth that kind of thing. The third thing make a nest and i mean literally obviously but just make your bed the most comfortable place you spend time so that it's an environment that lends itself to sleep and this is really important if your sleep begins to go out of out of wack. This isn't just about having nice bedsheets about the lighting in the room the temperature. I know it might sound nuts. Especially right now because we're in the depths of winter but i from my window for about five to ten minutes before i get into bed because i love the air in the room being being a little bit chilly. So that when i'm under the covers i can feel nice and cozy and i usually fall asleep listening to a podcast on a very very low volume and i use an. I'm ask so. I've got myself sort of prompt in with Coin she pillows but you know how many close your own thing. But i have myself mostly packed in with some pillows. I put an moscow on. And i have a pug 'cause playing and i spritz my bed liberally with some really nice leap spray so i used the one from a remarked if i use the one from this. I loved the one from the sanctuary. I always put the podcast on auto turn off. Say that it'll finish the end of the episode that i'm listening to on it's rare. It's really read by more than ten minutes of a show so that really works for me so that is just an. I sent in the bed opening the window for five to ten minutes. So it's nice and cool making sure that my bet is really comfortable that i've light blocked out and i've just got something quiet and gentle to listen to. That will help me get to sleep
Laughter Is The Best Medicine
"So entity parenti. Moment i want to focus on was called laughter and i'm going to read it. Comedian steve. martin reportedly reportedly lasts for five minutes in front of his mirror every morning. Explaining his goal is to jump start. His creativity begin the day on a high note. So just picture that. I care but you but i just wonder how often what does that urban legend and if that's really was from his memoir a believe it but there's gotta be it's that's a lot to ask five minutes of well. Do you think he d he could do it. I mean people meditate for ten minutes a day. I'm sure he can laugh for five minutes. And i think it's all relative right like even people who say they meditate everyday miss days. I think his point is sometimes gotta get yourself worked up to the place where you like. I've been bright. You know you know. I write every morning and lately. I've just been saying Good morning how are you talking to myself. Will i keep doing that. I don't know. But what i'm trying to do is engage myself. Tim totally engaged my thinking so he may do something else to make himself last. You go on to say children. We left hundreds of times a day but as adults we take life so seriously that laughter becomes infrequent it is in our best interest to seek out opportunities for good humor us better inside and out. Laughter is one of the best things we can do to strengthen our immune system decrease pain and keep our mind out of worry mode. Nothing works faster or more dependable to bring us back into balance then laughing enclosing. It's more than just a break from sadness and pain. It's actually a path back to hope. A humorous perspective creates a psychological distance. That can make situations feel less. Threatening and more manageable. Laughter is medicine offsetting the physical and psychological impact of stress and increasing our ability to feel joy. Yes there's the moment. Yeah so. I think the reason you played the Indigo girls was because i used that quote from that song. Exactly right yeah well. It's only life after off. And just because i've played this clip a million times. I'm gonna play two million in one. This is the this is audio of the infant baby laughing at his dog or her dog eating popcorn. I think that would be more productive than in the mere. Like if i feel like that should be in my to do list. Every morning is look at this baby laughing. Yeah yeah that's a way to start the day right. They're not cnn or fox or msnbc. That's the way to start the yes. Yeah i agree. I mean and i think that it It comes from that baby that comes from the gut. That's a good laugh. It's very like solely focused on what's funny in you like. As adults we start to like lose our good laugh laugh becomes more like. Yeah but i got focused here like we are. We don't really like focus in on the thing. That's funny and i think memories are often created around really deep hard laughs like we have stories where we were laughing so hard that we like either felt sick or like we're doubled over and that creates a memory. You know what i mean. I do
Looking back: Tottenham Hotspur vs Liverpool, 1995
"Fa cup like little bit sparkle so far. So we thought we'd take you back to one. Thousand nine hundred tottenham against liverpool anfield jurgen klinsmann score in the winter to see spurs book. A place in the semifinal yorgen and robbo back with me. What was striking when you take a look at the goal is the celebration in the complete ecstasy from those on the bench for the spurs fans in attendance. It kind of brings you back to more of a day where you feel the. Fa cup was was more. Relevant was a bit extreme. I think you know. Obviously if the fans in the stands it's a whole different game and all suffering covid at the moment but but I i mean the experience. I had In those years in in england definitely river meaningful in terms of the fa cup Is a religion fully english. People is is is so important. Sometimes i mean. At least a tottenham my days it was almost more important than championship and And then when it happens maybe by accident that you win you know a quarterfinal game at liverpool. And they haven't won for many years and enfield road then then things are going bit out of control but you can just. You can just see how much it means to you to the fans to your your teammates as well it was going to be when goals spurs and when you're looking back not only. It was a very special moment that you obviously won the game identity. But but i never will forget that at that situation at that moment was just the way. The liberal ville faints basically on so we went to our corner. A lot of tottenham fans were and we we think them and applauded them. And and i will never forget. I turned around and i thought okay. The rest of the stadium is probably gone by because out there for ten minutes or something but they weren't there at the stadium was still packed and then we turned around and walked towards locker room and the whole stadium stood up and gave us standing ovations to liverpool. Fans did that. And that's what kind of i never experienced anything like that before. My career never ever afterwards because It shows you the understanding of the english fans when an away team is that given day a little better and then comes away with a win and they they all know al performance and there was something very unique in my my time when you speak to anyone who's played of that generation genuinely they say it was on a par with championship. Is that fair. It was it was above the championship. I'll give an example. If we played mentioned united home at highbury in a league match. You'd get thirty. Five thousand in the faa get sixty thousand and My biggest memory is an biggest atmosphere. That i played in was an fa cup semifinal against mentioned united played at villa park there was sixty thousand there and when we arrived to the ground to hop us one went out onto the pitch. At two o'clock the ground was full. The atmosphere was unbelievable. It was it was. It was meant to be a tough game. Pitches weren't particularly good. It was played on a bumpy pitch but the atmosphere was incredible. It was it was really what everybody wanted to win. And we could. We get to the fun on fortunate. We lost the game two one but it was It was always sticks in my memory will be the atmosphere both hostile and in terms of the just the noise that came out the ground.
SolarWinds - The Gift That Keeps On Giving - DTNS 3943 - burst 04
"You're unique and so are your taxes. Turbo tax live has experienced tax experts. Who listen to you. Learn about your unique tax situations and answer your questions and on top of all that they can do your taxes from start to finish. Maybe you started investing and want some reassurance from an expert that you're doing things right maybe you're now self employed and needs some expert advice on what qualifies as a home office deduction or maybe it rather have an expert file your taxes for you so you can focus on what matters most no matter what. Your situation is turbo. tax live tax. Experts can answer your questions. Give tax advice review your return before you file or even do it all for you. Turbo tax live. Gives you confidence that you're uniquely you. Taxes are done right into a turbo tax. Live file with the help of an expert or let an expert file for you coming up on how to clone someone security key roku by some qube and we'll make the apple cars. This is the daily tech news for friday january. Eighth twenty twenty. One in los angeles on tom. Merit and from studio redwood on sarah lane from studio colorado. I'm shannon morris drawn the top tech stories in cleveland. I'm lynn per nine. The show's producer. Roger j we were just talking about a cas product that makes you ice cream and ninety seconds whenever you wanted and why roger never cries wider conversation join our expanded show. Good day internet at patriotair dot com slash dpd s. Let's start with a few things you should know. Amazon has discontinued its prime pantry. Grocery and household item service products previously available in pantry will now be available like any other products on amazon. So it's not going away to gather but the service itself prime pantry launched in twenty fourteen offering reduced shipping on up to forty five pounds of household goods for a monthly fee. Amazon node vied prime pant pantry subscribers about the closure in december and then issued refunds the. Uk's competition and markets authority launched an investigation into google's privacy sandbox. That would block third party. Cookies in chrome regulator received complaints from the marketers for an open web coalition saying the plan would abuse google's dominant position in online advertising. So the investigations going to evaluate. If the privacy sandbox changes would concentrate advertising spending market share with google samsung launched the galaxy chromebook to a cheaper version of the galaxy chromebook at launched last year so instead of four k it has a ten eighty p lcd screen with less storage fewer cameras less ram. It's also heavier and thicker overall but it also now starts at five hundred forty nine dollars instead of one thousand dollars. That has a thirteen point. Three inch nineteen twenty by ten eight hundred sixteen nine. Lcd touchscreen with the dual core intel seller on five twenty five you upgradable to an intel core. I three ten ten eleven ten one. one zero. You eight gigs. Ram and one hundred twenty five gigs of storage for six hundred ninety nine dollars a shortage of semiconductors affecting automakers. Volkswagen said last month that they needed to adjust first-quarter manufacturing plans around the globe because of the shortage. Now honda says it will cut domestic output by about four thousand cars this month at one of its factories in japan nissan is adjusting production numbers for its note hatchback model and ford has moved up previously planned downtime at a kentucky plant for its sport utility vehicle factory to the jin chips all right. Well we're talking about cars. Let's talk about the the apple car. Yeah a lot of rumors as of late will really over the last few years. But but but the rumors had resurfaced recently and hyundais. Now talking to apple about kerr's so says the company hyundai representative told cnbc quotes. We understand that apple isn't discussion with a variety of global automakers including hyundai motor as the discussion is at its early stage. Nothing has been decided. Korean economic daily said that apple suggested the arrangements and hundred was reviewing the terms that involved e production and also battery development hyundai has had his own battery platform called e. g. m. p. going into production later this year. So might be saying what you're doing. Reuters sources say that apple would like to produce a passenger vehicle by twenty twenty four however might not be that date bloomberg's mark gurman reports in thomas e. v. from apple is five to seven years away and michio recently said he wouldn't be surprised if it takes until twenty twenty eight. Yes what's probably going on. Here is apple and i think this significant part has decided to start investigating how they would build. Whatever it is. They're going to build whether it's a whole car or an integrated platform and they're going to different manufacturers and parts suppliers and folks like magna including hyundai. And saying what are you got. How can you help us with this. And is a great company for this because they make parts they make systems. They make full cars. There's all kinds of services in the conday company that could play a part with apple so it may not be. That apple knows what they want from hyundai. It may just be that they're going and saying hey let's talk. You do a lot of the kinds of things that we think we're going to need. I'm pretty excited about this. I just got my first hyundai ever this year and my perception of this story was weight but hyundai currently uses android auto and a lot of their their cars. So i would love to see. How apple would integrate Hyundai's current technologies into something that is very useful for that apple ecosystem not just looking at e itself but also the The the systems inside of it the controls in how they would manage that four a driver and a passenger in the car. Yeah i mean. I think that's one of the big questions that i have is okay. Let's say let's say it's hyundai that that applet ended up working with with clearly not set in stone at least from what we know at this point. But let's say it's the companies for kicks. Let's imagine that that's what it is. Yeah it is. It is an apple car that hyundai produces a lot of parts for the way that works with lots of other companies to produce other hardware for apple. I mean that that's the loftiest kind of goal that we're looking at and maybe that would take till twenty twenty eight at you know if if apple was lucky. I think it probably has more to do with like you said shannon not that you know android auto wouldn't still be prevalent in a lot of passenger vehicles but maybe at some sort of it's a special relationship. It's it's a special kind of os inside a car that is supposed to you. Know i don't know move some merch because What apple is providing on the software side is is. Is that much more interesting. I really don't know if you look at that. Bloomberg article mark gurman sources are saying that Tesla people that apple has hired are working on things like interior exterior. Drive train stereo. Desist the kinds of things. You need when you're building a car not carting a software platform so then the question becomes is it the apple car period. Maybe hendaye makes it. Maybe somebody else makes it. And you know they'll figure out how to distribute it or is it the apple car by sunday and you go to hyundai dealership to buy it the way you went to an. At and t. store to an apple iphone but it's really apples car in cooperation with sunday. Are there multiple partners. I mean that's all the kind of stuff we're waiting to see but it really does feel like we have gotten to the point where this is no longer just yeah. They're working on project titan. They don't know what they're gonna do to. They have an idea. It's more than just software and they're working out the details. Maybe they don't even know that yet. Well i'm interested to see what happens but we also have some other news. Security among the systems impacted by the solar winds attack is the electron filing system. Used by the us federal courts at investigation is underway to determine if confidentiality of documents filed with the courts was breached and as a result starting wednesday confidential documents filed with the courts will be stored on standalone systems. Not uploaded big difference so these are documents sealed from public access because they contain sensitive information like investigative techniques identities of informants and a lot more other. Us federal agencies affected included the justice department the state treasury and energy departments as well solar winds has engaged. The krebs stay most security consulting group to help deal with this attack. That firm was formed by alex. Stamos the former chief security officer at yahoo and facebook and chris krebs the former director of the us cybersecurity and infrastructure security agency or sisa. So krebs was fired last month. By the president after finding no evidence of with voting systems in the twenty twenty election. Yeah stamos first of all brilliant for those two to team up and smart for solar winds to engage them for what they say is Helping with transparency with companies that are affected But this we we are not done finding out how bad this is. There are reports that there may have been other ways that this whoever is behind this intruded beyond just solar winds. They're finding evidence of that. They have not been able to root out the people that got into this vulnerability from all systems yet. They're still in there in a lot of cases. And you know this. This kind of confidential information is exactly the kind of thing you fear that someone would get intruding into a government system informants investigative techniques that you can now learn from to evade being prosecuted or caught yourself. That's that's crown jewel type stuff it's it's very interesting. In fact krebs spoke on record saying that it could potentially take years to figure out how deep the solar winds attack actually went and how many different kinds of infrastructure. You know brands and everything that it might have affected so this is not something. That's going to die anytime soon. I'm glad that they are reaching out. Craig's and stay most though because that i agree with you tom. It's excellent. excellent team roku made a few interesting announcements roku says. Npd data shows that the roku s was the top selling smarter operating system in the us and canada in two thousand twenty thirty one percent market share in canada. Thirty eight percent in the united states That's pushed the samsung's tizen number two. At least we don't actually know samsung's ties and was number. One in two thousand nineteen also announced a wireless soundbar reference design that uses wifi for its roku. Tv ready program remember. Last year roku announced the program which had a designed for wired. Sound bars. The program includes tcl. Pokemon on an element has just announced. They'll join as well with two point. Two point one ready sound bars roku tv ready to expand internationally later this year as well. But here's the big roku news roku has agreed to acquire exclusive global distribution rights to more than seventy five Shows documentaries some of which had not been released before qube shutdown. So there'll be some new stuff that nobody's ever seen after their exclusivity deal expires. That'll happen in a bit more than a year. Depending on the show roku will still have the rights to show the content just not exclusively until thousand twenty seven the content will have to be presented in original increments of ten minutes or less. The deal doesn't let them stitch it altogether. The content will be added to the more than forty thousand movies and tv shows already available. In the roku channel shows include from Be anyway punked. Murder house. Flip and dummy which stars anna kendrick. I never watched the new punk. I heard had its moments. The whole qube thing. It's really interesting to me because it was sort of like. It crashed and burned so quickly. And there's a lotta shot and friday around folks in the industry about it. And i think that's not because qube was doing things wrong. It was because the company had raised so much money time. Because you know. They had meg whitman. Jeffrey katzenberg who are you know. Heavy hitters and there was a little bit of like you are being to embassies and therefore you shall fail. The company did fail and the idea that some creators will have a new life on another platform shows. That just don't even saw but people still worked on. And maybe you're really good. I think this this makes a lotta sense and good for roku to get exclusivity for at least a few years so does roku have to wait at all in order to start showing this content or can happen immediately. I don't know when the start date. Whenever the deal is you know goes into effect. Then they'll immediately be able to to show it so you know within a month or so it would be my guess anyway but no they. They don't have once. The deal is actually in effect. They don't have to wait. What's going on here. is that the baby. Production companies own the rights to their own stuff but they have a two year exclusive for each one of their shows with qube and those two year exclusives are now being transferred to roku so roka will be able to have the exclusive for the remainder of whatever. The period was with quick. That's why it's more a year. Exclusively goes away then they still have the right to show it until twenty twenty seven but the production companies that made it can now start shopping at around to other places as well so the production companies do hold the content and remember this is just the content. Qube is still in a over. Its turnstile technology which is holding it up from selling its technology and i would expect once it resolves that lawsuit should resolve it in a way that they still hold their technology. They'll sell that to so this isn't the last you're going to hear could be selling off a part of it. I would imagine. Gotcha yeah that whole. The whole technology part of qube was again was an ambitious thing that was released at a very inopportune time in twenty twenty when everyone was like. We're just sitting at home like we don't need this like mobile phone technology. It's like cool that you can shifted around but you can't even cast thing. I mean the company did fix that pretty soon after allow about she was just. I mean it's just did. The timing couldn't be worse but that technology when you think of it in a variety of other form factors such as monitors that swivel talked about some of those yesterday. I don't know that qube or tiktok or snapchat or all of the stuff where we're like. Oh yeah that's the. That's the portrait view. Rather than landscape view. That works for certain apps is is is all that this is four. I think there's more to it So we'll see what happens and there's patents and things that are always valuable because you can use those to extract some concessions and money and stuff. So yeah expect that all to come join the conversation in our discord which you can join by linking to a patriotic. Can't get in there and talk about your favourite qube shows with all the other discord folks. Just lincoln to your patriotic out at patriotair dot com slash. Dpd s all right shannon. How do you clone a security key. Well i i will say please do not stop using your security keys because of this story i will explain it. Researchers from ninja lab published a paper on thursday showing how you could clone a google tightened security gate this is a two factor authentication key which is very similar to a you. Be key that you have to plug in or tap in order to access an account after putting in your username or your password credentials. Were both so in order to pull off the clone. You would need physical access to the key for about ten hours. Sometimes a minimum of ten hours just kind of depends on how good you are at this. About twelve thousand dollars worth of equipment physical equipment and custom software and some advanced skills in electrical engineering and cryptography as well. So you have to remove the chip and then take measurements of it at a being registered on each account that you went to attack the measurements observe electro magnetic radiation as the chip generates digital signatures that let the attacker slowly deduced the private key so measurements take about six hours per account. That's not including taking apart. The original tighten security key putting it back together. Then you need to seal the chip back into its case. You also need the targets password in order for this to work. So the reason it works is because of vulnerability in the security hardware chip residing within the google titan key and that is called an eighty seven hundred x by this company called. Xp if it's exploited in attacker could grab the elliptic curve cryptographic private key for the account and the same chip is actually found in other two factor. Authentication physical tokens as well like There's a ubiquity that it's found in but chances of attack or very very minimal given the scope of the attack so if you do all of this without the target ever noticing then they would never duplicated key but again given the scope given how much it costs and everything behind the scenes probably when it happened to normal user. The point of these security keys being the best way to use For two factor. Is that you can't even get at your private key right you. Nobody has to be able to get in there like the chip. Just doesn't make it available so the fact that they were able to get in there and get it is huge. You know the fact that they were able to do this is significant. But i mean if you're not a target of an advanced persistent threat. You don't need to worry about this. No one's going to go to the trouble to do this. And even if you're a target. I would guess shannon that most of them probably would be able to notice if someone took their key for ten hours or more you. You likely likely would especially since a lot of people with hardware tokens like google titan will stick them on a on their keychain for example like with their house keys or whatever wherever they keep all those personal physical devices that they don't want lost or stolen they keep them all on engaging so if somebody was to take one of these out of your purse out of your gym locker wherever it might be and remove it for like ten hour street minimum. You would likely know that this would have happened. the neat thing about these chips inside of these. Google tightened security keys. And any other cryptographic hardware tokens like these is that. Even the manufacturer doesn't know the private key so the fact that they were able to find vulnerability on these specific chipsets is really interesting. And i think that's the important bit of that. Is is even though the google titan like the end all be all of really excellent. Two factor authentication. There's always. The potential that vulnerabilities can be found. So i'm happy that this research came out. It's so fascinating and it's so interesting in this means that an x. p. and other security chipset manufacturers that sell these teeny tiny chips to google or whoever the company might be They can build on this. They can research and figure out what the next version of their chipset needs to entail in order to not be vulnerable to this again in the future. Yeah i mean this is really a good security story right. We finally figured out because there's always a way right. We finally figured out the way you get the private key out of a security key and guess what it's really hard takes a long time and now that we know it we can make it even harder and hopefully you know push that barrier out even further and even if somebody did have time to do this and you didn't notice i was reading the paper because i'm a huge nerd and they go as far as using fuming fuming nitric acid in order to get like melt the epoxy off of the original google titan. How are you going to put that back together. In order for somebody to not notice like there's a lot of intricacies with this attack in order for it to actually be pulled off so chances are very very slim that somebody would be able to pull off so again as i said at the very beginning. Don't stop using your google tightened security key if you have one keep using it because chances are you would never be attacked with this. Just just know if you haven't seen it in ten hours look together strange. This is going to be in a movie though. I'm calling that shot right now. We're gonna we're gonna see this movie. Where like i hope so. Somebody goes into surgery and they take his key and they go out and do all this and they slip it back in because ten hours later. He wakes up from anesthesia on something like that. I just hope they talked to the researchers so they actually show it off right. Yeah Sony tv and audio announcements Starting with details for its own tv lineup. Sticking with lead ravi x four k and k. Tv's will support four k at one hundred twenty hertz variable refresh rate vr as well as a l l m low latency mode and e arc. These are all things that are important. If you've got a ps five now you've got sony. Tv they can go. That sony also has an improved a chip that is going to improve the picture and sound positioning. So it aligns with what you see on the screen. Sony's master series. Tv's will come with a sensor that adjusts white balanced immense. Your ambiente color temp. You don't have to do anything they'll just do it. Also an aluminum heat shield. That will make for brighter. All the sets will support. Hdmi two point one. Another big one for ps five dolby vision hdr angle tv. Sony also announced. It's three hundred sixty reality audio platform if you're not familiar with three hundred sixty degree audio places instruments and vocals in a virtual sound field around your head but using just the one speaker so you can do this in an amazon echo or google. Home sony will start streaming video with three sixty audio later this year. Starting with concert from zara larsson on january eleventh. And somebody's gonna make speakers that support this. It'll be may supported by other speakers as well. But sony is going to put out the are five thousand and three thousand They've got that dark cloth. Surface that all these speakers seem to have these days with either bronze or silver accents. Work with google and amazon assistance and can connect to select sony abroad via. Tv's as well as supporting wi fi bluetooth. Spotify connect in google cast. The speakers do automated calibration to the room. They're in donut. The press a button for that. Either and we'll simulate three hundred sixty degree audio for stereo tracks as well. The five thousand cost five hundred pounds or five hundred ninety nine euros no. Us price yet on the three thousand two hundred eighty pounds. Three hundred fifty nine euros. This seems this. Seems like it's shaping up to be one of the trends. Is this the sort of three hundred sixty degree audio while you're listening to your black bank and it's just one speaker or potentially a couple of speakers ativan. Maybe yeah yeah already supported. Yeah there's less of kind of like What do i have to do. Five point one surround or at least get a couple of speakers and make them a stereo pair type thing. I really haven't heard this in. I don't know. I used to hang out at magnolia at best. Buy all the time. And just like geek out on stuff like this. of course. this technology wasn't around at the time. But it's really come on. Let's turn on some stuff and see the speakers. Do it works well. Then that's awesome my first reaction because i got rid of my kind of pants speakers some years ago because friend of mine needed them more than i did and i didn't have room in my apartment but i miss that i'm also an a. A permanent now that's smaller and kind of has a lot of weird angles and i find audio bounces off walls in wiz. That wouldn't if it was more of a square box broom So i'm not sure that i'm the perfect target market for this. You're the you're the one puts this through its paces and sees if it really works. Yeah if i could actually work as advertised again with some funny angles in a big old frame. Then i'm i'm really into this and i've always been. I don't have a sony. Tv currently sorry zony. But i was abroad. Bravi a person for years. Nears i think what the new bravi line is coming out with. Looks really nice. And i mean not totally in the market for a new tv. But i like the fact that i might get a new sony again paired up with a sony speaker. You got three six. Yeah already got all this stuff. It's going to be a messed anyway. You slice it. But i like. I like this to be sixty reality audio platform. What would you have set up in your house. I was straight up going to mention sonos because if if it doesn't have the connectability to be able to work with all of my other platforms that currently have invested in. Then chances are i wouldn't buy it. So i do have sono says in my house and i do have some issues connecting those with other speakers in the household to like like my google hub for example so the fact that this works with google and amazon assistant the speaker specifically The audio speakers. I think that's pretty cool. I like that. They are bringing that in and i am interested because i do live in a household. That has very high ceilings. How this would work in that kind of environment. So yeah. I'm very interested in the audio aspect. Well you might also be interested in what colour has come out. Oh yes the folks who make things like toilets and and sinks and lots of appliances however. Been a real. Cas mainstay for the last few years for some cool innovations and this year is no different. Even though we're not in vegas koehler has a new smart bathtub called the stillness bath. That lets you use an app or use your voice using google or amazon's assistance to fill up the water or perhaps set the mood by changing the color of the lights around the tab or even add some fog. You know you wanna kind of pretend like you're in the then present routines also turn on features in a certain orders if you wanna get kind of creative. that's cool. Yeah the certain amount of limitations with the base model and the base model is not cheap so temperature and depth control models alone will cost around eight thousand six hundred ninety eight dollars. That's right it's almost nine thousand dollar bathtub. If you want the experience tower that lets you activate fog and aromatherapy. That will run you just over ten thousand dollars. Both models are available in july. There are real things and if you want the version with lights and floor grades for overflow fifteen thousand nine hundred ninety eight dollars available. This october signed me off. I won't be buying those. Nope not even a little bit but we could have taken a bath at s in the new in the pre show roger was like. Why would you want fog. It's like this. Why does anyone want to be on. Yeah racist luxury suites in hotels for sure as well as apple's houses sure yeah something well. Yeah it's it's that like hey look at what my bath can do people go. Wow very fancy and then you know ten years from now will be like remember when we thought it was fancied to talk to your bathtub so that it would start filling up without touching it but Yeah it's it's somewhat silly because of the price. But i'm not really much of a bath person but they do look very nice all right. Let's check out the mail bag but ads do it. Nick wrote in with a pronunciation. Ramps own neck. You are not alone he says. Ac's rog is an initial list. Because it's our og like fbi or cia. People say ron yet. They're lower end gaming brand tough not initially them. It's an acronym like scuba or produce you f but pronounced off. It's like ace's can't make up their name minds. Then there's strict which is our subbrand strikes as a word it's a completely nonsensical made up word. But it's a word and you pronounce it as such nick as honestly as somebody. That buys a lot of hardware. Because i've rarely had a bad experience with them over the past twenty years. I am baffled by some branding decisions. The one the bugs me. The most is the strict subbrand. Sometimes acis makes the tricks products. The high end product in the product stock yet other times. It's a mid range product. Would it be too much to ask for consistency and product. Branding twenty twenty one. Yes apparently apparently we feel your pain. Nick i love the dichter's just like i just need to vent you guys. Let me let me let me get this up. Just we appreciate that. Yeah i mean i. i'm with you nick. Everyday is a fresh new hell when it comes to reading out some model numbers but what is not is shouting out our patrons at our master and grandmaster levels. Today they include christmas merton james and digression daniels and of course landon peralta back and illustrating the show. What have you drawn for us today. Len well you know. I'm really excited. Say that we've have the first image of the ample car the car. Which i'm that's what i'm calling it. I'm sure they're gonna take my advice. Coming around twenty twenty seven ish or so maybe You know you may. If you're a fan of richard scary busy world a you may be very familiar with the look of of the apple. Ii car I think it'll be a big hit with with fans of people who have kids So check it out. this is called meet. I car And this is available right now. My patriot on which by the way has to new levels. If lets me be your Let me be your teacher. Your mentor with your artwork. I can give you some help that way. And patriots dot com forward slash. Len plus i also just launched a new product called flip face max which is over at lend store dot com. And i i want to show you what that looks like. I did something special. for For our friend shannon for snubs. This is a this is what the flipping flipped. Face masks. looks like This is It's a little bit higher Higher end than the normal flip sister used to But those are on the front page story on pro dot com. But this is for you shannon. If people wanna see that because most people are just listening to this what should they do. Go to well right now. It's going to be on twitter instagram later. But just go to lend dot com. You'll see all the ones i've done over the past couple of weeks and including including shannon's so it's really lovely. Let it's yeah. That's adorable shannon morris First show of twenty twenty one certainly not the last. I know you're a busy lady at. Where can people keep up with your work. Oh my gosh. I have been busy. Youtube dot com slash shannon morse. Just like name. I just did at tech predictions video and it was so cool. I got like eighteen up and coming tech youtubers to their twenty twenty one tech predictions for the year. And there's some names in there that you that you definitely know. Aunt pruitt Miriam take rene ritchie. So i had a whole bunch of people joining and kinda give me their thoughts and It was very very optimistic. And i was really happy to see that. So if you want to see that video and the rest of mine check out my youtube channel. Hey folks if you need. Just the headlines. It's okay to skip eighteen s. Know you get busy. Check out our related show daily tech headlines all the essential tech news in about five minutes daily tech headlines dot com. We're live on this show. Monday through friday at four thirty. Pm eastern twenty one. Thirty e. c. And you can find out more at daily tech news show dot com slash lives. We back monday with chris. Ashley have a gray weekend. All this show is part of the broadband network. Get more at frog pants. Dot com club who've enjoyed this broader.
GitHub alumni are building Rewatch, a solution for your Zoom fatigue
"Gonna kick off actually with some good hub alumni. That are trying to save us from the thing. We're all suffering from most in the last couple of quarters. Zoom fatigue the dawson. What's going on. So we're seeing a precede company. Come out of get hug. But connor sears. And scott goldman have teamed up to create yet another solution zoom fatigue. I think that's been on top of mind for almost any engineer right now in the valley or in startups and so their bet is that they're going to create an internal youtube of sorts. Which was an internal hub tool that. They're now making to accompany the goal of dot. Is we do a video conferencing. Call alex on the call because he's recording equity but he can go back after the meeting check and see if he was mentioned see if he has nothing to deliver and kind of chime in after search through old meetings. Making live meetings into more as greenwich meetings. Does that make sense. It does but the question about this. So let's imagine that tasha team. And i are not we both have ten people on our teams instead of having like eight of twenty people. Get into a room. You and i could meet record. It make it available to our teams and they can literally just watch our decision making process and then we wouldn't have to have. Everyone stopped work to come to the same meeting. Is that the kind of advantage to this. Yeah and the interface include transcriptions. You can tag people so quite literally. You'll get a notification through the watch channel to see if you were mentioned. The idea obviously is all in calendar. Hell because of remote work. And so this could maybe make you watch the all hands on a slow moment in the work day instead of stopping during breaking news definitely apply with way too much to journalism but juniors and start up clients for rewatch so far. I think the key obviously is going to be the transcripts and summaries ation tools particularly in large companies. Oftentimes these all hands meetings. Go on for a very very long time. And since the pandemic it there are more and more all hands meetings all around the weakest people. Try to synchronize communications and so my hope here is that they also are helping people communicate better because i have this theory that like all content should be reduced by one format to like an hour long. All hands meetings should be like a ten minute phone. Call ten minute phone. Call should really be a to email a minute. Emails should be like a tweet. I think the more that we can try to get efficient communications that to me is the hope was rewatch. It doesn't just become a video library and a youtube channel but it really becomes a for the thinking around what the company is doing. I think the question that a lot of people in remote work are trying to answer. A lot of different ways is can we see consumers who are now tired of zoom which is what we're comfortable with them becoming people who are comfortable with coming back to a meeting once it's already been done like we'll consumers actually be not lazy people and go back to the designer up and given their two cents and more importantly will the designer lead. Look at those comments. Once they are made. Possibly i will say guilty of. I think we record all of our meetings here and i've only been to one and it was just to see if i was fired or not and i can confirm because i'm on this show was not But that was the only reason i went to maybe the fear of missing out. Maybe the fomo effect using tagging and trying to get people involved in this communications but also be interesting over time if it goes from just like. Here's the recording of what happened to an actual edited video meeting. Hey maybe we should change parts of this space on other feedback from other team members and again it becomes kind of this artifact that that adapts based on the team's feedback
Los Angeles County Reports 20,414 New COVID-19 Cases, 290 Deaths
"While millions are receiving. The corona virus vaccine cases continued to spike across the nation. Fox's claudia cohen reports from california. After months of serving as a role model in the fight against covid nineteen california has seen infections race out of control for weeks and remains the nation's epicenter of the current surge with people thirty to forty nine years old driving the spread of the virus los angeles county more than doubled. Its own record of one day deaths in just a week. Two hundred ninety new deaths were reported on new year's eve prompting the health department to launch a grim public awareness campaign about the rate of deaths. Tweeting every ten minutes the description of someone who could die next.
Boeing 737 Max passenger flights resume in U.S. after nearly two-year ban
"Good evening thank you for joining us. Grounded no more the boeing seven. Three seven max. Take fighting the us again tomorrow. This coming after two crashes in the last two years still fresh in the minds of loved ones demanding answers and accountability. Here's abc's bob woodruff brand new model. Who called ongoing seven thirty. Seven max eight. They didn't understand the danger that they were walking into. What started out as routine flights up quickly became pilots worst nightmare. A plane had flown into the at full speed with two airplanes down. Three hundred and forty six people killed by two thousand nineteen boeing becoming the focus of global firestorm. Now nearly two years. After being grounded boeing seven thirty-seven max with significant changes is set to carry passengers once again. The max was born out of boeing's need to keep up with its closest competitor airbus instead of developing an entirely new plane to catch up with airbus. They decide to take a shortcut and revamp a model. That's already on the market saving them a lot of extra time and money. One of the big customers early on was young budget carrier in indonesia calls lion air. It was a huge deal. Lion air had asked boeing about later training for their pilots and boeing dissuaded. Them from this now. According to internal boeing documents one of their employees ridicule the request in a message to colleagues saying now lionair might need a sim to fly the max and maybe because of their own stupidity i'm scrambling trying to figure out how to unscrew this now. Idiots will they were mocking them. Because if lion air required simulator training than other airlines. And say well wait a minute. Wait a minute. If they're requiring it maybe we need it than the whole house. A car with start to fall apart on the early morning of october. Twenty ninth two thousand eighteen at the airport in jakarta the capital of indonesia lion air flight. Six ten was getting ready to take off. Its destination was the city of panko. Penang which is located on the indonesian highland a bunka very shortly after the flight takes off near. The pilots are struggling with the plane. The stick shaker pops off it is loud and it is rattling in the captain's hands just ten minutes later. A tugboat captain was out on the java. Sea just east of jakarta maranatha. Did you go to the president. Data news of the crash broke. I immediately flew in from beijing. Where i was based at the time so the sun has just gone down and you can see all the police officers along this doc this cruise been pulling up and carrying out debris piece by piece. There is no anyone could have survived the box. We found that the rep was pitchy up and down down and up and down up. It's up and down for about twenty four times. It was revealed. That pilots were rifling through the pilot. Trying to apparently figure out. What new turns out that. Boeing had installed a flight control system on the seven thirty seven. Max that had the power to take control of the plane from the pilots without them. Even knowing about the program was called m. cass m. cass maneuvering characteristics augmentation system and that this system under certain circumstances can trigger in such a way that it will cause the airplane to nose down so the reason they put 'em on airplane was because they put these brand new huge engines on an old airframe and that changed the way the airplane flew this affected. The engines came in airplanes starts to want to pitch up all by itself. The idea was to provide something that would offset that pitching moment or causing the nose to come up. The pilots have no idea why this plane is going down against their will so they tried to fight it and the way m cast was designed. It was given the control authority to do it as many times as necessary. In other words it was given the power to try to kill them essentially until it finally succeeded
It's a Wonderful Life With Gigi
"All right. Today's interview is released. Special gee-gee langer has been sober for thirty. Four years used a twelve step program but what is so wonderful about. Her story is all of the other resources that she's used to do. Even deeper healing. We talk about energy work. Inner child healing topping Rural linguistic reprogramming. Meditation cranial sacred healing and outta jillian really incredible books to read all of which are linked in the show notes. This is proof that healing goes on forever and that your recovery won't look the same forever. Either she is the author of the book fifty ways to worry less now and is retired in florida with her husband. It was an absolute joy to get to know her. Here's digi langer hygiene. How are you. I am great. I'm so glad to be here. And yeah i'm so excited to be having recovery. Happy hour with you today. Thank you for taking the time to to share your story of recovery. I'm going to start this interview. The same way i start every interview and that is what is your name and your sobriety date and would you have described yourself as a high or low functioning drinker when you were drinking langer smy name and my sobriety date is february. Eleventh nineteen eighty six. And i was still a high functioning. I except in the area of romance in the area romance. I was extremely low functioning. I mean are we ever high functioning their love and logic those two things. Just don't mix well well. Why don't we just say that to other people. It looked like i was high functioning dairy cow. Mary go. I think i'll i think all of the above is super relatable before we get into your story. Tell me real quick just about what you're doing right now where you live. How old you are what you do for a living family hobbies anything like that. I'm retired. And i'm a little over seventy and i live in southwest florida. I grew up outside of chicago area and then travelled all over in my rambunctious years twenties and thirties. And most of my time. I've lived in michigan for the last several years just this summer. My husband and i moved down to florida. We have a little condo here. We have our kitty with us. And i don't have any children. Because i couldn't stay married long enough and snow grandchildren. So yeah life is good. I don't know what else you asked me. I think that hobbies. What do you like to do for fun right now. In south florida. Play a little golf You know. I have a blog and a lot of service work and a a nonprofit. I'm on that helps. Connect women in sobriety and i do a newsletter and i'm working on another a workbook for how to worry less and my husband and i play we. We just have a good time yeah. I'm very grateful that is fantastic. We'll let's get into your story and in five ten minutes or less. Tell us how long you drink. Tell us how long it was a problem and why you decided to stop you know. It really wasn't a problem for a long time in high school. I got drunk really drunk once and got deathly ill and had a blackout and everybody said how fun. I was a couple of times in college. I got drunk and did not stupid things. And and then i got married and started a teaching career and and he didn't really drink so i drank very little toward the end of that that it. It's kind of a long story about that marriage. But anyway i was very desperate at the end and i discovered marijuana so in my you know. Twenty three or so. I discovered that marijuana killed the emotional pain that i was going through. I really preferred marijuana. I could drink about six. Or seven beers. You know and i got through grad school by getting high and at night to ease the stress and it was really when i was around thirty four years. Old let's see. I had already been divorced twice. I was finishing my doctorate. I had gotten through that with the aid of drugs and alcohol just to calm anxiety and And i lived with two other guys long term. And so i met this guy who was different from all the other guys and i thought. Oh this is. The john and i moved to michigan and we got married very fast and within nine months of marrying him. I went to a bar picked up a stranger and he had marijuana and i started having this affair. You know with this guy. And and i went out to bars a couple of more times when my husband was traveling. My third house but my new you know went home with strangers. Finally i went running to a psychologist. I said what is wrong. With this problem. I have a brand new phd from stanford. And i have this private cd life and my professional life is looking better and better in my private life was worse and worse and he said well you're in the early stages of alcoholism you know. He got my family history and He said just try for a month or two. Try having one or two drinks but stopping and see what happens. Well sure enough. I tried to do his experiment. And sometimes i have two drinks and stop just like a normal drinker. Other times i would have the two drinks and then it was third drink and fourth rank and pick up the stranger and do crazy things that no one could get me to leave and eventually it. I could see the pattern very clearly. That if i had even one drink i could not trust myself to do really dangerous things for myself and other people
Why the 2020 census matters
"Kwanza in an earlier episode of the ten news. We learned about the. Us census the once every ten years event where every single person living in the us and its territories is counted recently. The supreme court decided to postpone making a decision about whether undocumented immigrants should or should not be counted in the census. It's a big deal because the numbers help determine how resources get distributed to communities as well as how many seats dates have in the house of representatives and their number of electoral college votes. We'll have to wait and see where this decision goes. But in the meantime let's revisit our previous story from correspondent. Pamela kirkland all about the twenty twenty census. It happens once every ten years and it's old like really really old but it's also something very important that every person living in the united states is encouraged to participate. In what am i talking about. It's the census but what is it. And why should you care if you're counted. We asked alex and her mom yasmina boa. Who know an awful lot about it to make sense of the census. Hi i'm alex. I am a student and i'm twelve years old. Hi my name is. Yes men in. I in alex's mom and i became interested in twenty twenty senses. Be some work. That i was doing at count the nation which is associated with the usc annenberg innovation lab. What exactly is the census for people who don't know so it's a survey that happens. Once every ten years of everyone who lives in the united states for example they count newborns children. Teenagers adults teachers parents and grandparents basically everyone the first census an seventeen ninety. That's a long long time running in. Why does the census count matter. The census data matters for kids and families because this is how the government gives money to our communities base up. The number of people who live in a city or state also called our population. The money pays for funding for schools and teachers libraries parks health clinics breakfast and lunch programs at some schools and college scholarship money for some students. The census money pays for a lot. Which is why. It's important for our family to participate and for all of us be counted. No senses numbers also determine how many representatives go to washington dc to represent us in our needs. So i live in california. And they're almost forty million people who live in the state which is the largest population in the country and california has fifty three representatives out of four hundred thirty five but this may change based off of the two thousand twenty cents census numbers. Where did this passion for the census in the census count. Come from well. My mall would not stop talking about it because she worked on it. She got me super interested in it after the many times. She's talked about it. Okay mom so how much were you talking about. The census to alex ally in. It's something that i wasn't really too aware of Myself they didn't realize how important it was to everything that we do all the services that we use in our communities. So when i learn more about it than i thought it was really important for a alex to realize that into be able to talk to her friends in her peer group about why it is important that everyone participates. If you are a kid. How do you participate in the census. So you can help your parents fill out. The census online by going to my twenty twenty census dot gov. It takes less than ten minutes. If you aren't counted now you won't be able to be counted for another ten years with super important if your child is ten years old in their parent forgets to count them. They can't be counted again until they're twenty years old. So the importance of being counted over the next ten years really affects. Everyone's lie every single day so working together to make sure. Our communities in schools are stronger by doing something that takes seven minutes over. The internet is something that i think we should all try to do. The younger generation has so much power. And by just asking your parents to the census can do like make a big difference and even just like going on the internet and researching it on your own can be very interesting and beneficial and you could tell your parents about it and at the end of the day is it's a really good thing to do. The census count is currently closed. And the next time it comes around in twenty thirty you may be filling it out yourself. Have you heard about. The world's loneliest. Elephant name is calvin and he lived alone at a zoo in pakistan for eight years and that was until early december
New COVID-19 variant in L.A. County: What do we know?
"In los angeles. Health officials have begun testing patients for a new more contagious strain of the corona virus. I discovered in europe. They're trying to figure out why we're seeing a surgeon cases here one person dies from the virus every ten minutes in la county and hospitals are rationing care urging people to avoid going to the er unless they absolutely have to for the latest. We're joined by. Dr n remind professor of epidemiology at ucla. Welcome dr hi nice to be here yes so. La county as i mentioned testing whether the variant of the virus like the one in london south africa and korea could be spreading here. What do we know about these efforts in this new strain. Well this is very important Los angeles county. The laboratory is active or laboratories are actively sequencing strains and it's not only important to be looking for this Uk strain and the south african Strain variant should. I say but others as well. We're we're far behind here in the. Us and sequencing efforts and viral surveillance is a critical component of public health surveillance. And this is a very very important moment to be doing it. We're seeing a huge spread here in los angeles. There are a variety of reasons that this could be happening but it is critical to be doing this kind of viral surveillance. Well let's talk a little bit about the variety of reasons why this could be happening. If a new strain is spreading locally. How did it get here. And what what. Additional action should be taken to limit the spread. Well if the strain is if if this if these particular strains the uk the again the variance the uk variant or the south african variant are actually spreading here in los angeles which would make good sense Then they probably arrived through travel somebody. They're coming from europe or Somebody coming going and coming back from europe but but the thing is it isn't just about the uk it's not just about south africa. We are seeing many many european countries outside the uk of recorded cases denmark france germany italy the netherlands spain sweden. It's been detected even in toronto in a couple with no history of travel exposure or high risk contacts. So these this particular. Uk very int- is spreading. And because we here in the united states have been sequencing less than one percent of the of the cases that we that we have here as opposed to seven percents or more in the uk fifty percent in new zealand and australia. We're very very far behind. So the bottom line is it's very likely that either these particular variants or other variants. That are similar are spreading in our community and we just have not been looking for them and thank you for that distinction between strain and variant. We're talking about variants gear variants. Yes we we understand things like holiday gatherings and possibly this new variant of the virus could be accelerating the spread but what else could be the reason. The surge seem to happen so quickly here in los angeles here in los angeles. We have one of the most. We have the most populous county Here in the us and and so you have a lot of opportunity for spread. We know that people are fatigued and that they have been getting together. A lot of people got together for thanksgiving. And so we're seeing the effects of those thanksgiving get togethers now and i think that here in la county. We have a lot of multi generational households as well a lot of essential workers. So there's plenty of opportunity for spread and once this virus gains momentum. It's like a snowball rolling downhill. It's just gains momentum it gets bigger and faster and harder to stop so some of the force of infection perforce of infection. There's also this new data out in la county that shows that some grocery stores are hot spots for the virus. And that's alarming because going to the stores a trip that most people take because the risks seem low. What is your advice on how to stay safe. And what is now some of the darkest days of this pandemic. i think the key here is everything that you're doing today here in los angeles is more dangerous than it was a month ago. Every type of activity. I've seen estimates of anywhere between one and one hundred and one and fifty people in los angeles are infected. And so even if you're just going to the grocery store for example going to the bank or doing anything where you're going to be in contact with people outside your household. There's a higher chance today than there was a few weeks ago that you'll be exposed to covid nineteen so i think the key here is just because you can do something doesn't mean you should. There are a lot of things that are still permitted here but they may not be the right thing to do because they will carry risks for you and the people around you so my advice to people is stay home if you can. If you must go out make your plans ahead of time be very targeted. Go to the grocery store have a list and break it down by the sections of the grocery store. He know where you're going. Make it quick in and out. That's dr anne remind professor of epidemiology at ucla. Thank you so much. It's my pleasure.
How Quibi crashed and burned so quickly
"So equity was always the odd duck all the new streaming services that immersive last year for just for listeners who don't stand top of the streaming rewards just give quick description of what could be is and what's happened to it. Quimby was a mobile initially mobile only than kind of transition to be mobile centric streaming video service. That made cereal like tv. In very short episodes everything was like ten minutes or last and it was very very expensive programming. They made big budget programming with really big stars. So it's pitch was that it was kind of like a curated. Youtube only with like the biggest and brightest of hollywood involved. The problem is they launched the service that was designed to be watched. Moberly on the go in those like brief much of your day where you have a spare ten minutes to watch something getting coffee. Waiting for us. Launched it at the beginning of all the lockdowns keeping people trapped in their homes so they had a mobile on the ghost service launching when nobody was mobile or on the go. That's one of the problems with but there's underlying consideration that. The premise of the service given that people already have youtube and they can watch other things on the go to netflix on the go on their mobile phones that the premise of this being a service at all was flawed from the beginning. So what's happened. At least as far as we know right now is that would be instead of trying to survive after six months is going to just shut down. We don't know exactly win but at some point the service is going to go dark and this programming is going to. I don't exactly know what's going to happen. So all this stuff that they made. Yeah i wanna get into that but it just. It's interesting just sort of looking at the background of their the foundation that this company was built on one point. Seven billion dollars in funding of meg. Whitman from hewlett packard. Lots of a-list talent But medina think looking back at this now it was was the model just fundamentally or was it just a matter. Bedtime may and launching in the middle of a pandemic. i remember maybe even before they had a name. I believe they katzenberg jeffrey katzenberg. The hollywood Whitman as you mentioned the ceo of the service they went to south by and they had this whole presentation. And i remember coming out of this presentation being like these people have no idea what they're getting into you know. They had really really ambitious goals. They talked a really big game but they're getting into something. That is really hard to break into going up against something like youtube. Which has two billion people watching it every month. So that's one way to kind of put in perspective whether or not the pandemic was the real. You know silver bullet that killed qube but also mentioned that i did. I did a poll on twitter. Asking people this exact question because they make whitman. Jeffrey kassenberg worth open letter. The apologized for disappointing. Their investors their workers their talent and they said in there. You know it we may never know what was the problem here was timing or was this a bad idea to begin with and so i had a poll on twitter quoting that portion of the letter and saying well which was it could be equals a bad idea or timing and i think eighty six percent of people could be was just a bad idea to begin with so
Wonder Woman 1984 Review: DC Sequel a Major Step Down From the Original
"Hbo max yes we we just we said. Let's all sit down the four of us and watch this for christmas dinner after christmas dinner. No spoilers not going to give anything away his early get it literally Follow the path of good old. Dc's i'm concerned okay. In a bad way in a bad way in a bad way. It's it's way too long to over. Two and a half hours story seems to be canada all over the place. Especially you know. We don't even need to talk about special effects the effects a fine. Well the facts okay. There even helps when she's running and doing her her superhero type things. Where it's like. This could have looked a little better disappointed. The linda fell asleep halfway through our robin. His girl here he got up walked out before it was like she was looking at her fallen. I would i stay with the justice. Stay with it can't in much better. We can you talk about one of the villains. Pedro pascal from mandalorian men learning. Yeah this is the season was it a waste it. Yes unless he was. I mean he. He played his. He played his part but there was no. There was no body to the part. Sure the bad guy. He's doing what he's doing. I never felt invested in it and the the whole the whole storyline is is shaky at some point. You like well. Why is the wonder woman. Character really involves missing first place from the beginning. And just the whole premise. The whole premises is just just off. Sorry this is you know. I always like to just to have them same thing again. I by blue raisins cavill library. So i can go watchings anytime this eller even watch it again. I will tell you the post credits. Scene was the best part of the movie. You saw it today. Okay so today. I said to myself you agree with me. I was like. Where are we going with this way where we where are we going with this and number number two was the post credits. Scene was the best of it took the opening scene. That i was the ten minutes. Maybe i enjoyed that. That was okay. Let's the action and running around and blah blah blah little little diana l. That was fine. No problem with that. That's where it all came apart from iran. But yeah you're right at the end game which i almost skipped. I said we the second not walk. i didn't know about it. i didn't know about it either. I didn't know about it. I was kinda avoiding the Spoilers were ww eighty four was the best part. Was like all my goodness yeah. That was nice so bs. That's all. I got to say there
Talking About Jewish Wealth With Danielle Durchslag
"Durch schlock welcome to judaism unbounded so great to have you thank you so much. I'm glad to be here. I remember. I think i was on a car ride with my family when your article came out about a year ago and somehow i remember sitting in the car and it popping up and saying oh this is going to be interesting and i read your article tablet and i was like. We're going to have to have you on the podcast because this is the conversation that that we want to have. And i mean there was a particular line where you say. The time demands that we as jews train our frank gays on our own discourse about ourselves and money and i was like yeah. Let's do that can create start by just asking a little bit about when you wrote that article. What what was it that you were trying to say. And what was it that you are trying to achieve. So i wrote the jewish one percent in part because the silence around jewish wealth is well earned an understandable but i think actually quite problematic obviously antisemitic conspiracy theories obsessively focus on kind of outlandish amounts of jewish affluence and influence. That's really the main trope of those hateful conspiracy theories and as a result you know our fear of even touching the subject is so seismic. Because we're really concerned that we will somehow validate those hateful fantasies that we just don't go there and to not go there on a subject as important has jews and money jews and capitalism And how those things intersect with. The state is really a loss especially for a community that is so dedicated to questioning too tough discourse and culturally and this is something i reference in the peace. Tim bluntness you know. One of the things. I love about us. Culturally is that we're willing to go there even when the subject is hard or tough or scary to give you a sense of how tender this area is just the title of the essay jewish one percent. Got me push back. I was told by some you know. Obviously there's a big generational gap here. This tends to be older audiences. Where i get this kind of feedback. That title itself is anti-semitic just acknowledging. The jewish wealth exists is problematic. I i have felt all of this for years. Why did i want to write this article now. In this era a cousin. Jews are disproportionately present in this administration in running the country. You know in the white house and the jews who are there tend to be from quote unquote very successful families. Right which is the language is in our community to mean rich there from wealthy jewish families most of them so i thought it was a really important moment to talk about. What has success wrought you know. Is this what success fundamentally should and does look like in our community for those who made it this time for me to have that conversation so i'm curious from your own experience before we get into what you have to say about it. I'm curious about when you try to provoke that conversation through this article. Was it provoked like. Did you feel that people started to have the conversation that you wanted them to have or do you feel like that conversation is still not being had. I think it's mostly not being. Had you know i did get surprisingly kind of enthused response from people. Sort of i'm. I'm turning forty this winter people sort of my age and younger. I got a lot of feedback. That was great. Want to have this conversation. It has felt off limits for so long. It shouldn't be. I got some pushback from older generations. But fundamentally i think the the bring up the essay is still are not really being dealt into in a public way. We are so trepidation about touching these topics which is partly why as visual artists. They're really where i make. My space might really write creatively. Go because there's so much to say. And it's so vitally important and it's really there's a couple things that arise from me in a title like the jewish one percent one is it only makes sense to people that title only works to people at and communicate something because we have a concept of the one percent generally in society. That's not jewish specific. And so i'm actually thinking a lot about the ways in which the generational divide you describe is sort of specific to judaism like we could talk about trauma and fear connected to the holocaust. There's all sorts of ways that like older generations of jews absolutely has some distinctive relationships to wealth that that are important to talk about. And i think that there's a broader conversation beyond just jus about how different generations do and don't talk about wealth like honestly. I think my parents and especially like my grandparents forgetting the jewish friends there non-jewish in general. It was kind of off the table to talk about wealth. I think what you hint at with people under forty or wherever. We're gonna draw the line. Like i think i don't know the millennial generation in quotes part of it. Whatever but like. I think we have recognized that the lack of talking about money isn't just some like benign choice. It has an impact when employers for example. Don't want people talking about the amount of money. They make that actually serves a purpose and leads to the employers being able to have a lot of control and and serve injustice in a variety of ways. And so i'd love to ask sort of about those two pieces like what about. This is a very specific set of jewish questions like the jewish relationship to wealth. And what about. This is actually a broader set of faux pas taboos that we have as a society about talking about money. It's a great couple of points i would say. All americans struggle with open discourse about class. Right it's not what we're famous for is talking successfully and in a nuanced fashion about money so clearly. Jewish americans were part of that culture. There's a lot of fear general around kind of going there. I wanted inactivity In a sort of arts group. That i was part of where we had to line up physically by class. So they said you know the poorest of the poor this side of the room the wealthiest of the wealthy opposite room. Everyone else figure it out and can you guess what everyone did probably went to the middle to start exactly right so i march off to wealth to people who were really strongly identified with and proud of having come from poverty. Go to the other side of the room and everyone else and this was probably a room full of like thirty forty people. They crowd in the middle and they are fighting it out over. How many. Tv's what kinds of tv's one car to kars any cars right. And so those of us on the extreme ends are watching. This really pained discourse as people try to place themselves and it takes a long time after we complete the exercise the people who lead it said to us in the uk. This takes ten minutes. Everyone knows where they are in the class. You talked about it. Their whole lives they line up and then we move on. That's a portrait. I think about a lot in terms of general. What your class discourse in this country
Wonder Woman 1984 movie review: Patty Jenkinss sincere sequel soars despite its flaws
"I'm so glad you can be here with us to talk about wonder woman. Nineteen eighty-four now. To set up the plot of this movie as best i understood. It wonder woman nineteen eighty-four revolves around magic rock. That grants wishes pedro. Pascal plays maxwell lord huckster who wants of course ultimate power over the universe. Kristen wig play nerdy anthropologist Who will later transform sort of. She's all that style into the frightening nemesis cheetah. And if you're wondering how. Chris pine is in this movie considering how wonder woman ended. Just do not worry about it because it will become a somewhat clear. Glenn we were all i think. Fans of the twenty seventeen wonder woman. What did you think of this. Well i think this is It's bright it's entertaining. It was frequently funny. Which i enjoyed. It can't help but lack the kind of simple story power narrative power of that twenty seventeen film because that was our first real glimpse of the character was an origin story and the villain was so unambiguously evil. The kaiser chemical weapons the god of war. What i like about this film. Is that the tone in the first half. Seems like a direct image to the nineteen seventy richard. Donner superman at some people. Have pointed out and i'm all for that but this had its own story to tell it does lose. Its way about halfway because that's when some pretty dark and muddy. cgi takes over. Which i couldn't really get over because this film has been sitting on the shelf for while had lots and lots of time. And the fact that the siege. I still look so weightless in this kind of surprise me and look the superhero film has been around for over half a century now and we still haven't learned it's important lesson which is that more is less one villains enough people if you know what you're doing pick one and stick with it. I mean these characters work when they're coming from a place of moral clarity and they're standing against someone of equal and opposite. You know immoral or amoral clarity. Now you can say the two villains who worked in batman returns because those villains if you're or call were the penguin and cat woman. They already had a cultural footprint. They were firmly planted in the wider culture. You just can't say the same thing about the cheetah and maxwell lord they just don't have that kind of i hate this word. Stickiness essential stickiness. I do have a theory. Why this movie was so light on. Big action set pieces. I think has to do with essential makeup of the character. I'll get to that later. But look all you gotta know is i grew up with lynda carter wonder woman and the super friends and something happened at the one hour and ten minute mark and assume that may be stand up off mme couch and
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"ten minute" Discussed on Ten Minute Medic
"So as relocated this within any vehicle Asian, there are multiple sub collisions that are going to occur both within and. Of Vehicle. So first of all, we have the vehicle collision itself car versus tree impacts the tree the car then stops during this motor collision when the car strikes another Adriana Energy is transferred from the moving vehicle to the non moving object or to the of a car. Now, that's going to be really important particularly when we're talking about. Vehicle versus vehicle. Type of auto impacts. Thankfully, they cars are not the tanks that they used to be back in the late sixties and seventies, but they're now designed crumple-zones particularly in front of the vehicle. So as to absorb as much of the energies possible. Now, the important thing about this absorption of energy is that. If. It's absorbed in to the vehicle and that means as not being absorbed into the patient's body, which ultimately results in lastra trauma less potential if trauma for the patient, although the vehicle is stopped the occupants even if they are restrained are continuing to move along at the same speed at which the movie. And the Monte collision is the second aspect of collision that occurs and this happens when the body strikes the interior of the vehicle including the restraint devices, the airbag, the seat belts, or anything else that are found inside of the vehicle. As your patient makes contact energy contained in the patient's bodies now transformed energy that will damage or potentially cause damage to the patient centered or. The body stops but as we spoke earlier organs, themselves will continue to move forward until they impact the bony structure of muscular skeletal system that will help to stop the. Tissues and organs the patients body will continue to slide in a forward direction impact in either each other which can cause some or bony surfaces of four actual pelvis. This phase collision can cost compression stretch were sure injuries as Oregon's continue to move forward with about the same amount of force as was originally in the vehicle secondary collisions occur anything loose within the vehicle now strikes the passengers. On a professional mill, this is why that is so very important that loose out be secured in the back of an ambulance. Last thing you really want is a monitor sliding around in the back of the ambulance upon impact. Thanks for listening to this week's offering of ten minute medic. In next week's section will take a look at the different pathways or patient can take Doreen. Motor vehicle trauma as well as how understanding more about making of injury can raise your degree of suspicion for unseen trauma. Sure hope is join us. Thanks again..
"ten minute" Discussed on Ten Minute Medic
"The amount of kinetic energy increases to almost one hundred, twenty, thousand K. You. And when they say speed kills the really do minute. American energy increases were the white as a person goes from one hundred and fifty, two, hundred, eighty pounds. But really not quite that much. Understanding the anatomy of the human body coupled with basic grasp of Connecticut Energy You can begin to develop type six cents about the things that are going on with your trauma patient. Keep in mind outside out of mind, can often caused some real issues as far as having an effective assessment towards a patient of trauma particularly, any type of internal injuries we are looking at her patient and we begin to compare what has happened with the mechanism injury with injuries that we're seeing as well as the potential for injuries that are unseen we call busy index suspicion. Is Index of suspicion or your gut feeling will become much more accurate as you get more experience understand that early on your basic mistakes as far as what your gut is telling you. But that's okay. That's all in how you get your experience in your education as far as you're moving along and as you see more patients and USS more patients, the better off, you will get it this to understand the Bob Mechanics of trauma. We need to settle upon just a few definitions as we're moving through here. Now, for some of these definitions are going to be a no brainer. There may be others that you may or may not be familiar with it. That's that's okay. So, say penetrating trump penetrating trauma happens when objects such as a knife or a bullet or any other objects for that matter Pearson Protective Barrier of the skin and enters into the body. Any subsequent injury may be caused either directly or indirectly by the spin attraction will. Particularly Take A stronger deeper look at this type of injury causation. Particularly, we take a look at gunshot wounds a little bit later on. Compression happy injuries happened when a body stops abruptly while the internal structures are still moving forward. Now. The most common type of injury that we would see this in is a head injury with a coup contract injury to where the brain sloshes forward. You have an injury about the interior and sloshes backward and you have an injury on the post here. Stretching injuries are just opposite of compression these occur when part of the body is pulled away from from another in particular, you can see these types of injuries when you have sprains. In particular the ankle and the knee win differently, ovens and tendons begin to get stretched a porn. Now, a very medieval example of this occurred people were stretched on the rack is a type of punishment or torture or to exact a confession. In a share type of injury, the internal organs continue to move forward at varying rates Speedo. We talked about this while ago. When we were speaking about the car that stops the body shop's internal order themselves are still continuing to to pass on forward as the as the body of stopped. Win The body itself stops any type of limit or tendon that crosses the Oregon will cause it to be lacerated this quite frequently with liver lash rushes do the foul. Some four ligament crosses the interior surface of liver, as well as with injuries too theoretically or particularly within the lever. This fast inform legemaate acts much like a cheese cutter and that is very tough. It's very. Fibrous and it literally, the liver will continue to go around it on both sides until Liberte south could can become lashing right in the patient of lead to death. There are three phases of a traumatic event that we're GONNA take a look at in depth here..
"ten minute" Discussed on Ten Minute Medic
"Here's your host thought tax bill young. We're going to take a look at some of the physics. Travel and how this would be important to you. In order to fully understand forces that going into causing trouble we're going to have to take a little bit of a look at physics itself. A physics is defined as the Division of Science Studies motion and Energy Exchange between objects that collide between each other and how that energy is changed shared modify knowing this will help you as per medics to have a better grasp on both seen as well as the unseen trauma that will occur within your patient. Your describes a Noushin. As a two-part long, it's stated as a body in motion will tend to remain in motion less something else asks opponent to slow it down. Ellen reverse is true as well for bodies at rest ill tend to stay at rest unless there's an outside force. Forces it to move upon now, this first laws known as Newton's first law. Of, this. If a bullet is fired from a gun continued move in a straight line until something impacts, it or revenue begins to. Move at that time, it leaves the stoff or change directions according to new energy is the ability to do work work in its simplest form is considered the ability for movement between two objects. Since, the law of conservation sites at energy can't be created or destroyed. It can only be changed from one form to another or transferred from one object to another wigan. Center that energy is simply being transferred from in this situation from a car into the tree. Now. This is the impact of wind any type of an auto impacts. An moot will object the energy from which the auto has about movement is transferred into the tree, which is then moved on to the grail. We referred to this energy as Connecticut Energy or for sure K.. E. IS DEPENDENT upon several variables including how much it weighs as well as how fast travel. Now, these are going to be some pretty important concept that you're going to pay attention to interest in particular because one of them is going to carry more of an impact than the other. You don't need to use a formula outlined in the book to determine Connecticut G. must keep in mind. that the speed of an object has an exponential effect on the amount of energy that's available and that's what I was just speaking about speed definitely has more of an impact than does the white of. Away. Of example, let's take a look at this hundred fifty pound person who's traveling on interstate the amount of kinetic energy that's available with a movement that person while traveling thirty miles an hour. Is Sixty, seven, thousand, five, hundred K. E. units. If we speed that same vehicle up I, only about ten miles per hour..
"ten minute" Discussed on Ten Minute Medic
"Do not live a low blood. Sugar sneak up on you. As the child is compensated shock respiratory rate is going to naturally go up this may result in a transient period of respiratory alice. Carbon dioxide is blown blown off as a child against tire from the SANTITA. The rapid breathing in breathing begins to slow. She made transition over into a state of metabolic. Pollick acidosis now. It might seem logical to administer sodium bicarbonate offset versus but this is not indicated. The key here is to use fluid lewd resuscitation restore perfusion body is designed to tolerate metabolic acidosis for a short period of time and the administration of by car would be harmful for your patient strays Asian over discussion of distributive shock. And what it does to the body distributive shock. You may hear a call. Visiting shot comes. `Bout Win The dilation and constriction of the vascular has been impaired. The big issue isn't so much that the arteries dilate because they do they're simply unable to constrict as a result. You have a much larger container with less lewd pressure inside the pathophysiology of this is something like this I I because of the massive Basal dilation peripheral vascular resistances decreased often drastically. This results had Poli- within the veins. Import tissue perfusion because of this pooling Venus return to the heart is reduced as well is the cardiac output the three primary causes of distributive shock include. NFL Alexis an injury. The central nervous system or sepsis sizes simpleton distributive shock can be misleading in that in the case of a nervous system. Injury your patient maybe in compensated shock yet had a normal or Bradley carded heart rate heart. Association's Pals Course Discusses Three types of distributive shock. Septic Genyk the single brief look at all three of these now. semper shock occurs because of a reaction to it infection that at least an instability in the perfumery status of your pediatric patient. It is the most common type of distributor shock senior children earlier that you diagnose sipped shocked the easier. It is to deal with and leads to minimize of organ damage. Septic shock tends to occur in a two phase process beginning any with peripheral Basal dilation. The first phase is often referred to as warshaw this comes about toxins. Caused by the infection. Prevent the catecholamines immune system from inducing vase on construction the heart rate increases in order to maintain cardiac output. The capillaries will also begin to become permeable allowing in fluid. Move into the interstitial tissues. Essentially shock continues unabated. The patient enters the second phase known as coach on the heart and respiratory Tori right will still be elevated but cardiac output continues to decrease at some point bodily systems began to fail affecting the kidneys and liver early on the goal of treating. Septic shock has identified the columns and eliminate. Obviously that's not going to be possible. Pre Hospital perspective. Our primary focus this will be the support perfusion for the body by giving them..
"ten minute" Discussed on Ten Minute Medic
"Welcome to the ten minutes host Dr Bill Young before we beginning presentation. I WanNa take a moment to thank you for taking the time to listen to this. PODCAST is over the publication of this episode. We have over three hundred fifty followers and in two thousand thousand in nineteen just a little more than thirty two thousand downloads. That is awesome and I just want to say thank you. I'd also like to know what topics makes. You liked it here in twenty twenty. Please visit our facebook. Page the ten minute medic- let us know what you would like to hear in this. The final podcast two thousand and nineteen. We'll take a look at the recognition respiratory distress and failure respiratory distress encompasses both breathing too fast as walls too slow to maintain retain life. It's important to paramedic be able to recognize entreat both simple and complex admirable respiratory conditions in infants and children children as we stated earlier podcasts positive responsibilities treatments is often quite dramatic. It's quite common that a good outcome is seen after a risk where risks I would not so much a cardiac arrest. You will improve the chances of Rauch by being able to identify early at your assessment respiratory distress in the pediatric patient Shen and aggressively treated briefly review. The physiology of Vittori System Immolation about the adults and the pediatric patient is an active process. Ross both intercostal muscles and the diaphragm contract thereby lowering the pressure inside the lungs somewhere between three to five millimeters of mercury because of this lower pressure is compared to the outside atmospheric pressure. Air Rochas in gas exchange takes place in the which are covered by multiple strands of capillaries is because the gas in the Alveoli Lawrence high oxygen and according to the law of Diffusion Ostra will move out of the lungs and attached to the hemoglobin ago because of blood capillaries is high in carbon dioxide. The reversal happened with that. Carbon Dioxide is expelled to the air when the patient sales The metabolic rate pediatric patients is about fifty percent higher than that of an adult as a result. Pasha can have a much more rapid onset in the pediatric the education then the adult four are still nations present. According to the American Heart Association axios defined as a decreased arterial oxygen saturation zachery detected by pulse luxury or direct measurement of oxygen saturation in an arterial blood gas sample in our assessment of patients as we. Julie consider how `bout exist the pulse. Ox is less than ninety four percent. Now all we're looking at issues of Pasha. We must know the difference between how Park Samia Tastes. You have parts you as we said earlier. How does having a pulse ox? Symmetry of less than ninety four percent tissue have actually occurs when a particular region the body where it could be the body as a whole does not have an adequate oxygen supply. It's important to remember that is not the same thing as tissue hypoxia you nor does have always lead to tissue partial one. Good example of this is the patient who has a chronic condition with the amount of oxygen in the blood is low over a long period of time such as may be seen in the adult. COPD patient body may respond with a condition known as polycythemia. Yeah this is an increase of red blood cells help to maintain the oxygen content of the body by an increase in the amount of hemoglobin available. Let's take a look at hyper Arbia or an increase in the amount of carbon dioxide in the body. It's important to remember that when your patients hydrocarbon. The dilatory process is inadequate. It's also important to remember that. Carbon Dioxide is not a bad guy here just a byproduct of metabolise. Let's like everything else in life though too much. Carbon Dioxide can lead to robs any increase carbon dioxide will increase as doses. In your patient the most common bodily reaction to this is an increased respiratory rate the increased rate and depth occurs in attempt to blow off the excess carbon dioxide. After a while the child becomes so fatigued with this effort of breathing that he begins become sleepy at this point respiratory failure is just a few moments away with potential for respiratory arrest being very high a decrease in the patients love of consciousness. Office is an important symptom that clues you into an inadequate Villa Tori effort. The pediatric patients often go from being very anxious and educated to becoming. I mean very quiet sleepy. And just a few moments other symptoms that may occur with this condition include nasal flaring as wells retraction of the intercostal muscles there is a difference between respiratory distress and respiratory failure respiratory distress is often marked by an increased breathing rate as well as a greater effort in work. Breathe new your patient. Restaurants air comes about as those compensatory make noodles began to fail. Lead to inadequate oxygenation inadequate ventilation In respiratory distress your patient may be agitated Wallin failure. They may become very lethargic and sleepy the pediatric patient Ristori failures often preceded by respiratory distress. But not is important to keep this amount. When you're assessing the chop some of the symptoms of respiratory distress included an increased respiratory rate diminish bristles especially in the distant ally an increased heart rate a low pulse ox and the potential for cyanosis? Now keep in mind that cyanosis lakeside. And she should not wait. Until its appearance. Before you begin to take your patients nations respiratory status very seriously signs of respiratory failure include extreme tech in cardiac followed by Brand Cardi. Your patient may exhibit dangerously usually low pulse ox symmetry level. You'll often see them begin to Bob Their head or act as if they're going to sleep this point they're becoming exhausted new must act quickly quickly respiratory failures life reading state that requires aggressive intervision. The part of the paramedic or else it will deteriorate cardiac arrest as we discussed earlier. Aggressive intervention on your part is needed to prevent the child from Progressive Cardiac arrest if the child is conscious and responsive allowing them him to determine their position of comfort will help ensure by narrowing the child's not able to maintain their own airway. Use the head Tilt Chin lift. Open it in the event of of a potential spinal cord injury you should use the jaw thrust maneuver keep in mind that just method of opening the airways difficult to maintain for long periods of time. Do the strain to places is on your failures from pushing the jaw forward. Consider the use of an advanced airway curse there is in the airway suction it until it's clear important that you remember a couple of things about sectioning. I when you're applying such thing you're decreasing the amount of air available to the patient. The normal circumstances this would not lead the major problem. But you're dealing with child so this is anything but normal secondly prolonged section and can lead to braddock harding for child who's teetering between green risk for distress and failure bread at Kearney could be disastrous provide oxygen. And make sure it's possible that it's humidifier humidifier oxygen. It'll help decrease the inflammation in the bronchial tree as well. As break-up secretions found. They're making it easier for the child to cough up use the Bravo. Dial later.
"ten minute" Discussed on Ten Minute Medic
"However we should place establishing of a patent airway along with relation oxygenation as a priority. That is just. This is important wintry children sudden cardiac arrest is rare the pediatric patient. When it does occur is often seen conjunction with athletic and sporting events couches couches? Other school officials should be able to recognize when a child is in distress. Notified now will want early as well as being able to provide rudimentary cardiac care including high quality. Cpr We are and the use of an ad patients in cardiac ranch are associated with a Sicily veep impulsively tact the children younger than twelve years old. PA SYSTEM THE MOST COMMON RHYTHM SING on the other hand pulses Batak are usually seen your children older than twelve or or those with an underlying cardiac condition. Keep in mind. The survival rate of pediatric patients that present a V. Fiber pulses attack as the additional rim have a higher survival survival rate than those who presented a Sicily or yet the provision of early defibrillation may have an important role to play their return of spontaneous circulation. The the patient may present impulsively tags. Montemar fake or Polymorphic V. Tag or commonly known as for socks dressage is usually caused by long q t Interval Colin imbalance of the electrolyte levels or drug overdose. Touches we'll cover the treatment of dressage later on odd cast once you've identified that your patient shipped zinc cardiac arrest high-quality. CPR's chorus of treatment has been shown along with early defibrillation to improve the chances that a patient will experience rocks in doing so. It's imperative that any delays of beginning compressions be eliminated one of the primary culprits of delay of compressions is the insertion of an Intra tracheal tube. It's no longer acceptable to stop compressions. While inserting an advanced airway use the paramedic are able to innovate Wa- compressions are underway the use of bodily inserted airway device should be used the components of equality. CPR is false. I don't push fast the right that you're targeting is between one hundred and one hundred twenty compressions permit regardless of the edge of your patient. Second push hard drake abrasions. You should compress the chest about one third of its diameter. This is approximated.
"ten minute" Discussed on Ten Minute Medic
"You're listening to two minute mic Lee podcast for busy paramedic students. I'm your host Dr Bill Young in my role job. I'm associate professor. The Department of Para Medicine at Eastern Kentucky University students will be taking their pediatric advanced life support course when they return in the spring so the next few podcast focus on topics from that course. This week's topic will focus on basic life support for the pediatric cardiac arrest patient. The initial assessment of the pediatric Edrich patient is very similar to that of adult. What you've determined that the patient's level of consciousness move quickly to assess in Pulse N.? Risk rations the save time assists both of these simultaneously. Keep in mind that you shouldn't take any longer than ten seconds to evaluate both of them to Jay for breathing. Look for Reisen. Follow the patient's chest. Your patient is breathing and doing so adequately with good title simply monitor the patient and transport to the nearest appropriate facility. If your patience number. We're if breathing is inadequate such gasping report TATO volume your patients considered to be in respiratory failure or respiratory arrest. Made sure that you addresses this. Is Life threatening problem before you move on. In your patient assessment. It depends on the age of the child has to where we will assess their pulse for patient as an infant. Somehow faith the break you'll artery at either one of the arms if your child is older such a school age or older you may for karate kid or ephemeral false. Sometimes it can be difficult to determine whether the patient has a pulse or not. This is even more so in children especially if they're overweight. If you don't feel a pulse within ten seconds can she must begin. CPR immediately even if the patient has a pulse. But if it's less than sixty beats per minute or if the patient shows an inadequate cardiac output you should begin in Cpr away pulse checks should be limited to duration of ten seconds every two minutes. It is imperative that you do not interrupt CPR. We are unless it is absolutely necessary. In an effort to make it easier to remember the American Heart Association has mandated a goal of one hundred to one hundred hundred twenty compressions per minute for all patients. Just a little hint here. If you're taking the pediatric advanced life support. Course most likely be a survey questions regarding this right if you do by yourself ratios thirty compressions to relations in all patient populations adults children and infants. You have a second rescue prison. Your compression ventilation. Right is fifteen corporations to to violations for most children cardiac arrest. You'll either US one or two hands to compress the chest in the event of cardiac arrest Anthony Use of the thumbs on the sternum with the rest of the fingers and circling the backs. Preferred the primary reasons for this are one. It provides a better blood supply to the cardiac muscle. Say Only it also helps to maintain a consistent depth as well as S. force of chest compressions and lastly some research studies show that it may indeed bring about an increase in blood pressure which improves perfusion to the brain and the heart he sent you compress the tissue compress about a third of the diameter of the chance to in order to provide an adequate ojection fraction of blood from the left ventricle. Then allow the chest fully recoil so that the heart and refill the blood for the knicks compression allowing the chest to fully recoil is just about as important a part Harda. CPR is compressing the chest and having the right compression rate if you happen to be alone during the cardiac arrest and the child is small enough to carry with you to the phone. Do just that child with you as you call for help. The child is too large security. Performed two minutes high-quality CPR and then activate now one above all else made sure to maintain consistent compressions although compression gets the top billing in any type of resuscitation effort. It's important to remember that. You must provide adequate ventilation for your patient as well. In order for ventilation be -ffective you must have an open patent airway. Part of the challenge with children especially very young children is that they have very large posterior Oxford. If you allow the child supine on the floor or a bed. This part of the hill pushed Chen four were causing the airway to become included. Make sure that you put the child in a neutral position padding underneath shelters one way to measure. This would be to make sure that the external ear canal is aligned. With the superior part of the child's shoulder when a child goes into cardiac arrest in most often is preceded by an occurrence of respiratory figure. Vic this is unlike many adults who have some type of cardiovascular event or disease that precipitates their cardiac arrest when the adult heart stops the oxygen content of the blood is still sufficient to fulfil the auction workload demands of the heart for a few moments after cessation pulse. Most of the time children do not have this oxygen reserve. It's very important that you provide high-quality compressions and Malaysians during cardiac arrest especially for infants and children. Because how's this very reason during a cardiac arrest and you may be called upon to use an e. It's preferable to actually use pediatric size pads. If they're available they're not inviolable. Viable use the adult pads. Come with the favorite later in this situation would be probably best to use the anterior poster position the patches on the chest I and the patients back. You do not want the pads touch but you should not trimmed past. Try to make them fit the patient apply. AD as soon as possible possible is studies. Show that the early fibrillation is most effective especially in children in a situation where you must provide defibrillation for an infant. If you have a Emmanuel Monitor defibrillator violence preferrable to use that rather than a the primary reason here is demanding differ blazer can provide a much lower energy energy content for defibrillation in an infant in Canada. You date however should a day be all that you have than make sure that you use it most situations of pediatric cardiac arrest come about as a result of airway involvement breathing abnormalities or both be aggressive in dealing with these that your patient. We'll have the best.
"ten minute" Discussed on Ten Minute Medic
"Today's podcast will do with the issue of chest trauma in general. Enuma thorax in particular, as you should always. Let's start with a review of the anatomy physiology of the respiratory system. The twelve pairs of ribs, connect posterior Lee with the spine and interior Lee with the sternum the ever part of the sternum is called the angle of Louis in his will be helpful when we're judging whether there's been any movement of the trachea. The space between each Ray was known as an intercostal space, and we'll be wear should we need to will insert needles or other devices to decompress the chest, the muscles that lie along, these intercostal spices are important towards increasing the rate, and touto volume when the work of the diaphragm is overwhelmed, the diaphragm is a translucent muscular organ, that forms, an airtight, seal between the thrash, cavity and the abdomen. It contracts dour with inspiration and relaxes upward during actually is one of the most important organs, braving, the action or physiology of breathing. All depend upon a change in the atmosphere pressure, both inside and outside of the thrash, e cavity. First thing that you as a payer may Stu must remember is that nature will try to equalize vacuum. That is one location that has a lower pressure than the other gas flow into the lower atmosphere. Ick area in an attempt equalize the pressures, the pressure fan within the alveoli I will change depending on whether your patient is inhaling or exhaling, the wire connected to the outside atmosphere, by way of the Broncos the Bronco and the trachea as such the pressure within the vehicle. I will equalize with that of the pressure found outside the body. The pressure fan within the Interflora space that is the space between the visceral, and proud of pleura varies. Normally it's about four to six millimeters of mercury lower than that found in the Alviela and by association that of the atmosphere, ick pressure, when the diaphragm contracts downward, the space within the threats that cavity increases according to Boyle's law, when we make container larger without change in the amount of substance with. Within the container the pressure within that container. Lowers think of this way, we blow up a balloon to diameter of six inches measure, that pressure then transfer all the contents of that very balloon into another one with a diameter of twelve inches what'll happen to the pressure fan within the second Bologne. That's right. The pressure will be less going back to our statement that mother nature does not like it. When there's a Bank, you, she'll try to fill that bake Huma something. So as depressure equalize air will rush into the lungs. The body contains barrel receptors that will measure the pressure within the lung. So as to prevent over inflation, and almost always eliminate the danger of too, much air going into them, keep in mind, that in the Stupar process of inspiration and expiration, the inspiration processes, the active of the two an exhibition is a passive process, the passive process of excellence, does not need any energy. Spill air from the lungs as the chest wall muscles begin to relax the. Diaphragm does the same returning to dome like shape. The pressure within the thrash cavity increases to about four to six millimeters of mercury greater than that of the outside atmosphere. This is the opposite process of her balloon example earlier, instead this time, we're taking air from a twelve inch balloon and return it to the six inch diameter balloon again, because a Boyle's law, we have decreased the volume of the container and increase the pressure, this inequality of pressure as related to the inside of the alvie lion. The outside atmosphere, cause air to flow our until the pressures are equalized blunt force trauma, is any injury this, 'cause Connecticut energy is transferred through the tissues of the chest wall, generally without leaving an opening penetrating trauma happens when an object such as a knife, or a bullet, enters the chest either these making can lead to simple or tension with authorities. Let's take a closer look at each of these. A Numa thorax occurs. When there's a tear in the lung tissue that causes air leak out of the lung and into the pleural space, depending on how much air scape, this may cause a partial or total collapse along. It's not the same thing as tension with Orage, one of the most common causes of simple, new with or ashes of fractured rib the ends of the river sharp and the movement of the lung pleura beneath the fracture can cause it to be punctured. Patients also have non with or acts, as a result of blabs or weakened areas on the surface alongs. There are several factors that go into patient's presentation with a simple with Orix these include how severe the patients. How Pasha is as well, the amount of lung that has collapsed treatment for a simple, Numa thorax is primarily supportive. Get your v started apply oxygen and watch for the possibility of at progressing to attention, Numa thorax, which you will discuss in just a few moments. The use of pulse. Ox, symmetry white form cap Naga is essential transport your patient in a semi Fowler's position and constantly monitored them for progression to a more severe tinged with orange the second happened Numa for actions that of an openness with orange most of the time the mechanism of injury for this type of wound is penetrating trauma, that allows a direct passageway from the outside atmosphere into the thorax air will tend to follow the path of least resistance when the patient tries to breathe, and a considerable amount of air from the outside atmosphere will enter directly under the thorax because of this many times, the wound will have type of flutter valve made up of tissue from inside the body. This prevents air from being expelled. When the patient tries to tell the mechanics of inlays should begin to be hampered as the long on the injured side begins to be collapsed. This least of the collapse of alveoli, I'd known as at Alexis not only is the physical aspect of innovation compromise because of. This at Alexis the exchange of carbon dioxide and oxygen at the elbow, or level has hampered the initial treatment of an open Numa or actions to silly by placing your gloved hand over the opening. You can then apply. One of the commercially available chess seals or in the absence of those improvise one by using foil or plastic and sealing it with tape watch for the progression of the new authorities patients commonly have a secondary injury to the lung. If the patient begins to complain of in Chris dismissal. Technip Neil or tack cardia opened the dressing allow in the air that may build up in the thorax to escape. Once again, be sure to observe your patient for signs and symptoms. That might indicate that they have progressed attention in thorax. Attention new methotrexate is a true life and death emergency that occurs as air continues to be trapped within the thorax with no method of escape this increased pressure lease to shift in the organs and vascular. Within the media Steinem the spices, greater pressure on the lung on the injured side, leading to an even greater area of collapse. In addition, the shifting of the heart will place pressure on the Vena Cava causing reduction in the blood flow to the heart this reduction in the prelude causes an overall reduction of the cardiac output during your assessment or these patients, they will, obviously complain of chest pain and difficulty breathing, as cardiac output in preloaded decreases, there will be a decrease in overall oxygenation in general, and to the brain in particular, this will lead to increased agitation as well as. Zayed these early signs of your patient being in compensated. Shock don't overlook them, although the classic sign of diminish breath. Sounds on the effect aside are accurate is often very difficult to determine whether they're prisoner. Absent in the noisy pre hospital environment. Accompany this tracheal deviation away from the side of injury. We tend to make a big deal of this time. But keep in mind if it is present it is. A late San in addition when you're a for the signed be sure to look for just above the angle of Louis the sternum any higher up. You may be led to a false negative as trachea as anchor, by strong muscles in the Nick watch for your patient, progress in a d compensated shock your goal in the treatment of these patients is to make an attempt to equalize the internal and external air pressures, this may be accomplished by the use of needle decompression. The research shows that this is I safe procedure for paramedics to do. Newly compression is done by the introduction of large. Ten to fourteen gauge needle with a catheter over the needle into the pleural space of the chest, the minimum length of your NATO should be eight centimeters longer. If available, there are two insertion points that are used one would be the second intercostal space in the anterior part of the chest. And the second would be the fifth intercostal space of the mid actually, part of the chist, once a needle has been inserted is should be removed leaving only the Teflon catheter. You may hear Russia air escaping from the thorax if the pressure found, there's excessive there's some positive negatives to both locations. Some studies show that if there is a greater failure of decompression when used in the mid clavicle area because of a greater amount of fatty tissue in this area, the issue of the use of the mid actually line, is that when a patient has been packaged for transport to the trauma center, their arms, may either ACLU the catheter, or hot is so that you may not know if it's become dislodged some agencies advocate for.
"ten minute" Discussed on Ten Minute Medic
"Decisions. Fetal viability are made on the basis of the best stationl age available. When estimating the fetal age of the resuscitation area. Rough guide might be that when the Fundus of the uterus extends beyond the Emba likes. The feta's is potentially viable. Let's take a look as treatment modalities the prime directive of the paramedic. Can dealing with a traumatic OB patient is to ensure the oxygenation of both a mother and the baby using pulse. Ox administrartion to maintain an Oto saturation of greater than ninety five percent. It's important to remember that signs and symptoms. The shock maybe hidden from you until massive loss takes place. The mother could have a blow Lhasa thirty percent and without it showing the traditional and symptoms of shock. Always work out the assumption that your patient is either in shock or will shortly go into shock while carrying four biologically. The body is designed to shunt blood from the fetus to maintain the life of the mother, you'll hear me repeat this over and over the best hope for the baby survival is aggressive treatment of the mother the protocol for the treatment of pregnant trauma patient remains similar to those for a non-pregnant one assess the abdomen determine if it is rigid or board like if either they symptoms are present, you might they might indicate an abroad. Tailless enter a rupture uterus. Both are life threatening to the mother and the baby. If your patient is bleeding vastly do not place any bandages dressings in the Janet south. But across the opening the administration of bolles twenty-six per kilogram will stimulate the production of anti-air etiquette. Hormone also known as as a present for the Postino pituitary land. This is also the same area from which oxidised greeted therefore in addition to provide a fluid Belus which will increase circulation volume as well as a pre load. The spouse will also stimulate the production of oxytocin, which will cost some degree of as a construction thus reducing the amount of bleeding dealing with trauma. The pregnant patient will be one of those stress because it you'll ever run my advice, providing the best care both mom and baby is to focus on what's best for the bomb in doing. So you'll sit of the best possibilities for survival of fitness. Thanks again for listing with this episode. We launched. A new feature fan in her show notes tunnel the ten minute medic review with HFS owed will include three to five national registry type questions. In addition to the answers will give a rationale for join. I hope you enjoy it next week's podcast will review the threefold pathophysiology of asthma, and how you should respond to patients suffering from an exacerbate tion of you see you next week.
"ten minute" Discussed on Ten Minute Medic
"Magin that you're you're running a scenario. You've got a twenty two year old male patient that law enforcement is college you on they're not entirely sure what's going on. When you get there. You've identified. Guide. The patient is has history of autism. Give us some ideas in your patient assessment and your interaction with the with with this patient. How would you speak with them? How would you minimize not having multiple steps in what you're asking the patient of do or what you're telling the patient that you're going to do as as part of your assessment? I always like say it's kind of like going low and slow guy Asian you wanna get down yacht. First of all you want to reduce all the the sensory. Stop may be at light speed people. Did you know noise, everything you wanna limit that next all the things that we have on on emergency saying absolutely good and not to get off topic. But if he can teach the family, what we need to know after your first contact saying, look, you know, if we knew the child was on Tissot. We'd learned how to adjust our response. Okay. If I that's a great way. 'cause 'cause I tell my students said families are secondary patients that can be your your best friends or your worst enemies, and there are a lot easier. And you get a lot more information from them when they're your best friend. So I think what you're saying. There is is outstanding information. Well, yeah. And if you think about it that way to that with a an autistic person, it's it's that in space in oh, not gonna react. Well to an adversarial and of approach or or you know, coming in guns blazing. You know, we got our kits. We got our firefighters with us. We're just, you know, go from zero to sixty in two seconds on. It's not going to do anybody. Even neuro typical person any good you're gonna you're gonna grant them up with an autism person. You're really going to Jack up and then you're working on a meltdown. You're not getting anything done. So you know, sitting beside. Them talking softly. Finding out if they light-touch don't like touch. That's key giving them time to respond to your questions. Not all very often, especially new medics, as you know, we're often thinking of the next question before we heard the answer to the question. We just yeah. Yeah. Don't do that. Because then you're you're not going to get anywhere with any patient. But certainly not person you just got to ask the question watch their reaction give him time to respond if they can respond NFL nonverbal. There are other ways to do it. Do they have a night at do? They have you know, a tablet of some sort that helps them communicate or or you're going to have to use some other other things, you know, the county they point to things, you know, it's it's you know, how he amasses man, you just gotta adjust. So the question has to be as then I mean, we we beat into the students head what I called the BS seen safety dance. What is the likelihood of danger for someone to get hurt? Either the patient or one of the responders if you're doing everything that you're supposed to be doing your shutting down lied. You're you're clearing the room out. You have minimal number of people. What's the likelihood of a patient that has autistic of becoming violent? Well, you know, it's always there. I mean, there's a lot of aggressive autism. But I think a large majority of assistant, April are more huggers. Okay. Than an aggressive. But you know, you have to use your Spidey senses. You know, you have to get that history. From your your your family good in a bait. They mentioned that a child can be aggressive. Well, maybe you don't want to be in there alone. You know? And maybe that's a good reason have law enforcement on scene. But the last thing you wanna do is is restrain an autism person. Right as oh. From bad. Do a whole lot worse really quick drying restraint. And obviously sometimes we have to restrain bit hemicycle restraints with I said, or did, you know, a physical restraints, but onto stick people aren't developed the same way. Neuro typical people are in. There have been more fragile on the have less upper body strength. So you know, you really opening up a can of worms by trying to restrain or being aggressive in your approach. And you know, you can very easily without intending to do everything wrong. You're make us get may make that one outcome really bad. So all future outcomes for whoever response to this person in the future are going to turn out the same bat.
"ten minute" Discussed on Ten Minute Medic
"Welcome to the ten minute. They podcast for busy paramedic students. This is a podcast where we take one subject discussing for a maximum of ten minutes. I'm your host Dr Bill young. One of the areas. It's commonly failed while taking the national registry. Makings Ayman's out of IMAS operations, the problem with this is that we tend to cover evils operations at the beginning of class. Never to be mentioned again until you're sitting in front of the computer screen taking your exam. It literally becomes out sight outta mind. One of the things that I was suggested you do a good paramedic student this to periodically review. The miss opperations sanction in particular, dealing with incident response and the level of ethicality of how you treat a patient's as we podcast. We'll take a look at one of those issues focusing on. What is the right time for us to not transport a patient to the hospital, I gave a little ham. If you'll always do what's in best interest of your patient. Honestly, doing what's in the best interest of your patient? You're rarely around as podcast was recorded in April two thousand nineteen not long ago. They must roll the surprised dismayed by the report of a man who was berated treated poorly by EMS agency in South Carolina. According to news reports a patient had a history of schizophrenia. However, they invest crew responded to a report him running up and down interstate ninety five while naked ultimately released him four hours later, he was struck by vehicle and killed. On the highway the instant with paramedics show in the lack of compassion was cut a body. Cam video of the responding deputy podcast will not address lack compassion or professionalism shown on the video by the mess group. Instead, we'll take a look some of the legal aspects of releasing patients at the same than how to minimize your legal liability. Keeping my I am not an attorney nor to play one on television. Racially exciting announcement was made by Medicare under a new project. EMS is now going to be reimbursed for treatment without transport in certain situations. This Saturday at the same time causes me. Great fear, one of the areas that EMS has the Duggal sacred in as have no transport of patients who led her own show to need between transport. Let's take a look and review the criteria. Which legal ability is minimize in doing. What is best for the patient is maximized when faced with weather to transport ship patient of hospital or not after we use the word, competency when dealing. With a patient's ability to make health care decisions for themselves. More accurate term would be capacity to make decisions however, because competency is generally will be using that word Kamla within the United States hopes that patients have the right of self-determination in regard to whether or not Duceppe medical treatment, one of the greatest most basic rights humans have and must be protected as that of Tommy Tommy can be defined as the right to make decisions that are once best interest. All patients are considered to have competence to make legal decisions about their care until preventable is now in order to make those decisions the patient has to have the right to either give or withhold consent for treatment any adult that has been determined of been found competent is able to tell you whether or not they want treatment even further if a patient desires to be treated, they are right to tell you to what degree they want the treatment to continue or stop. This would include withholding particular medicines. Or trey. Tement while civility accepting transport of the hospital. Challenge rises when the pre hospital care is needed patients that may or may not be have the ability to understand their condition, and we're not sure if they're capable of making the best decisions about their care key in this. Doctor Automic is that the patient must be competent a wish that there was a tried and true method, but which you could determine competency at all times, unfortunately detail, you that would be a lie. So how do we determine whether patients comment to refuse treatment and or transport well begin with the very basics is your patient awaken alert. Now, it's important to remember that being awake is not the same thing as being alert some factors that you must take into consideration when dealing with patient carbons the to refuse treatment should often include involving the patient's family when available to determine the agree to which the patient is acting normal. Keep in mind that your patients family can become your greatest ally. Where you're worse. To enemy the treatment of the patient. Now, we sometime on the legal aspects of patient competency. Let's turn to the clinical side of it stated earlier than determination of competences, not a science, but more of an art it's important to take into consideration vase and culture the patient when trying to determine this comments can be influenced native white by the presence of dementia delirium alcohol into drugs. However, it's important to remember that simple because a patient smells of alcohol. Does not mean that they're incompetent to make their own decisions in the paramedics action of determining confidence. The history is often. The most important tool that we have must be the place where we first him as discussed earlier determinative patients normal based on this critical. The second step is to explore whether or not any change in the patient's Covent of ability is related to her versatile 'cause all patients, and I mean, all patients who exhibited change on a level. Cognition should get a finger. Stick glucose to check for Hubble glassy Mia fill raid. Listen to an earlier ten minute medic podcast, entitled you're so sweet on the approach into paramedics should take the diabetic patient determined that the impairment is not going to improve your next step should be to find out. If it's getting worse as well. As to what degree the impairment has on your patients decision making ability. Make sure that you're able to differentiate between a patient with dysphasia or difficulty in speaking from the one who is speaking gibberish, stroke patient will often have some problems speaking, clearly, but will retain the ability to make cognitive medical decisions. A the Monica can be helpful and do the detailed assessment on the middle. Competent patient is asset A S S E T A for appearance s is for speech esus for censorial is for emotional state and tears for thought process. Take a deeper dive at each of the. These look at the appearance of your patient. Although each patient will have a different socio economic status and don't let this by sheer assessment look at how they're dressed as well as the personal hygiene. If the patient is to shoveled explore the reasons why based should be assessed for proper pronunciation as well as normal patterns s. Also sounds for since Oreo does your patient know where they are the time of the day things like that one word of caution here beware of asking any patient regardless of their chief complaint. What time of day it is if you respond to them after midnight, even the best of us will have a challenge. Intranet question we've been awake in the middle of the night is their emotional state appropriate for the moment. Does the patient seem depressed or in a state of mania? Lastly, look the thought process SM them simple questions that they should be able to answer such as who is the president in. What is to listen to the like is it possible that a patient with dementia? Could still be able to make some or all of their medical decisions. While a short insures. Yes. Patient with diagnosis of dementia may require the prayer made to take a much closer look and evaluation at the mental status of him. But each situation is different take an individual approach each of these situations as you deal fairly and compassionately with each patient and their family if you have any Dallas to the patient's capacity for decision-making default in the conservative broach. This however must be done in conjunction with patients family as well. From the point of wellbeing for the patient in an article from the stat pearls website, leeann Goldstein suggested the following regarding the decision making criteria for patients. The patient must have sufficient information from the provider regarding the medical condition in the associated risks to health in person. The patient must understand that a decision has to be made. The patient must understand the rich burden. And benefits of all options, including that of doing nothing. The patient must be able to use the information to make a decision in the setting of his values and belief systems. The patient must be able to communicate his choice to the provider, and they must be acting without coercion or undue influence, including from family, friends, or even you as the provider in his responsibility of the emergency responder to identify loss of capacity for medical decision. Make it is not the patience responsibility to prove that they retain such capacity. You can find the full citation the full article in the show notes in conclusion taking the approach that you will do the very best for your patience is the best route of care for them as well. As the best source of legal predation for yourself, you're gonna wind up on video on the internet. Why not make for some form of compassion state? Need care for your patient. Thanks again for joining the ten minute medic. I'm. Excited about our next topic as it was chosen by their request from the paramedics students at Arkansas state university are Dixie stations will address IMAS interactions with autistic patients the first long will deal with what autism is. And the second will provide some ethics of dealing with these patient interactions. The best way to ensure that you hear these off your episodes follower podcast on your favorite player. Thanks again for listing.
"ten minute" Discussed on Ten Minute Medic
"Processes. Wells protecting the airway. Should he vomit? The first line drug should be considered for your inflected patient is epinephrine. Apias classified as a sympathetic agonise? Which means it will increase the heart rate result in peripheral Vice Construction and improve the cardiac output as it works to constrict the blood vessels. It'll also help to stem the plasma that his Laking from a basket jer leading to an increase in a patient's blood pressure. It's also a faked it for the reversal of the broncho constriction so common in these patients. You're dosing regimen for epinephrine zero point one zero point three of a one to ten thousand concentration solution of epi. This should be given IV this translates into three to five milliliters of this one to ten thousand concentration. Deafened hydra mean more commonly called Benadryl is more frequently administered in the allergic reaction or an flight to patient than any other drug. It is an h one and h two blocker that is effective at neutralizing the effects of history, the standard adult doses to give twenty five to fifty milligrams IV, or I am keep in mind that when administering hydrated is very painful, the paint can be lessened by ministering, slowly, the primary Sada faith from its administration will be sleeping on the part of your patient. Having a severe ineffective reaction is very frightening experience for anyone remember to remain common, compassionate with your patient the side effects from the administration of epi. And deafen Bing can add to that fear as you should with all your patience, be sure to tell them about the side effects. So that when they do begin to exhibit them their anxiety is lessened support in the emotional status of these patients is portent as. Oh pouring their physical needs. Thanks for taking time to listen to this week's ten minute medic in next week's episode will transition over to look at some of the issues behind patient consent. And why this could be a particularly thorny issue for the paramedic. Thanks again. For listening.
"ten minute" Discussed on Ten Minute Medic
"Uh-huh. Welcome to the ten minute. Medic the podcast for busy paramedic students. I'm your host. Dr Bill young is that time of the year. Again, when students begin to be paid for the national registry of EMT certifying exam. You spend many hours studying about the body, and how to treat it when it malfunctions why not spend a little time studying the exam that will lead to your licenses in the professional in today's podcast. We'll take a look at the exam and how you can best prepare for it. National history. Test questions are multiple choice with four potential answers. There's a popular urban legend that all the answers are correct. And the candidate must choose which one with registry believes as the most correct? This is false. The question you'll see are developed and reviewed by panel of experts from around the world who are not employed by the national registry. They must come to a consensus to question agrees with the practice analysis study determining the activities of EMS responders. They made sure that there's only one correct answer. Now, the other choices may have some great truth in them. But they are indeed incorrect now while this might seem like a process of trickery it actually serves to evaluate your level of critical thinking ability each answer must be referenced by the most common to Mt textbooks that are used in the nation today. The computer based exam that a national registry is now utilizing this call cat or meter deftest testing and sees Amos tailored specifically to the individual student candidate. This means that the exam that you take will be personalized for you, and you alone. This testing method uses a process called IOT or I don't response theory. I don't response theory testing is used in almost all other health professionals testing for licensor IOT is raking is scientific method to help you measure, your degree of competency that is based on the fact that the likelihood of testing candidate answering a question correctly is directly related to their. The ability and the difficulty level of question, computer. Adaptive national registry exams will deliver questions one at a time to the candidate. And are not randomly generated. They are rated along the same ability scale as the candidate exhibiting proficiency. In other words, the exam will measure your proficiency and give you questions at straight. You almost everyone that comes out of the exam feels that they've done poorly. The first questions on the exam are generally just below the passing standard. If a question is asked that is below the candidates level of ability. The probability is high that the candidate will answer the question, right? Additionally, there are some questions that'll be asked that are considered pilot questions for future exams. They are absolutely no bearing whatsoever on whether you're on a pass or fail. If a question that's asked is missed by the candidate, they'll received a slightly less difficult questions. Their next one the students fistful answering the question correctly, then somewhat more difficult question will pop up as a questions get more difficult. The student will be in a missile at that point the question's gonna bit easier until your successfully injuring them again at this point in the exam. The application software determines the ability estimate for the student and begins delivering questions that are slightly harder or slightly easier than the candidate's ability. Question. Difficult is determined by whether you answer them correctly or not as the CAT exam progress is this estimates more and more precise as the pattern of right or wrong answers, really begins to show, whether you have entry level competence. The example end at the point where there is a high degree of certainty that to candidates true ability is above or below the passing standard CAT matches. The question difficulty of the candidates perceived level of ability, and this limits the number of questions delivered as well. As increases accuracy. No more of the days of sitting is taking one hundred eighty multiple choice question by paper, you cannot skip a question and come back to lighter the stress some people crazy the nature of the cat exam. Requires that you answer each question. Individually before any individual questions are delivered. So what should you studied to prepare for the national registry exam? When I was completed my doctoral studies, I was required to take a comprehensive exam at the end of the course, I asked my adviser as to how this study, and what I should know his reply was that I needed to know everything about everything that wasn't much help. But also pretends to the registry exam, technically, you should know everything that was covered in the EMS course materials, there's no secret methods or inside can replace proper test preparation. But there are some things that are common. The tests are heavy and the basics. Let's take a look at some of these areas of study, no CPR in shock as well. As all the same categories of the test itself. It's broken down into multiple categories that include airway breathing cardiac medical trauma, OBM pediatrics in operations. We'll talk more about operations in a minute. Now, the major components of the airway and the normal rate. Inches of respiration for adult in pediatric patients. Keep in mind that registry will not ask you what a normal respiratory rate is, but you must be able to determine what is abnormal in how to develop a treatment plan to address. It be familiar with diabetic emergencies in the various causes of syncope. There is a large portion of the exam that's related to operations in many students overlook this since September eleven great effort has been made to incorporate more education about in them's and ICS with regards. The MS understand how these systems work and how they might applied to a mass casualty incident, and you'll be a step ahead of the other candidates. This is a commonly failed section as EMS operations are typically covered at the beginning of the class never to be referred to again when you're getting close to the end of the class. Make sure you go back and refer to it. The national registry exam is not based upon the textbook that you used in your class and. Is not based on. How you provide cap preoccupied care and your state the exam is based upon the national registry. Practice analysis done every five years the exam questions are written to fall within the department of transportation education guidelines, and as such cover the national scope of practice EMT books on the other hand give you their interpretation of the standards. So what are some strategies for you and taking the exam? Well, I read the whole question all the way through at least a couple of times and formulate the answer in your head prior to look at your answer choices. National register test questions are typically only two lines or lists and length each word is important. If you look at the answer choice prior to understand the question completely. You may be led to choose an incorrect answer also be sure that you know, where you are in the scenario there's four potential answers two of them can be eliminated. Right away after reading the question a couple of times. Now, you just have to decide the best choice between the remaining two. Now, knowing where you are in the process of assessment might make you select airway when you are actually plot down in a section that is beyond where you assess the airway. It's time to be honest here. Most of the questions that you're going to get in some of the training programs are in the knowledge category. Eighty to ninety percent of the time. These are the questions that you're going to see in your class. Respectfully, ask your instructor how they construct the questions if they're getting all of them from the publishers test Bank. You may have some challenges when you get the registries exam. These knowledge questions are not bad. But if that's all that you see then you're going to struggle when you get into the higher level critical thinking questions don't complicate the scenario of the situation when you're looking at it in other words, don't play the well, what if don't ring elements into the questions that aren't there this because you overlook basics, which is probably what the question is testing for relax. Relax. Relax and don't forget to breathe. Finally, don't rush. You have got more than enough time to answer all the questions that you're going to get and it's more important view that answer each question accurately, rather than quickly nother legis is that you can tell whether. You've passed by the number of questions, you get this is also false. Remember from earlier in our podcast, we discussed how software determines what question you'll receive. As was how difficult it'll be this is what determines whether you pass or not whether you get the minimum or the maximum number of questions only says that he took the minimum or maximum number of questions do determine whether you passed determined that you're competent or failed determining that. You are not competent. We here at the ten minute medic one wish you good luck. As you get closer to taking your certifying exam. We have a whole host of pot cash that will help you to prepare for those. So we encourage you to go back into our library. And listen to those today. Thanks again for listening.
"ten minute" Discussed on Ten Minute Medic
"Now, you're listening to the ten minute medic the podcast for busy paramedic students. I'm your host, Dr Bill young as of this podcast. Trouble continues to be one of the leading causes of death in the United States having a mortality rate of us highest forty percent. This doesn't even begin to address the mobility issues. The caution of off to the patient during the recovery process. These cops can easily run into the hundreds of thousands of dollars depending on the severity of the trauma and the degree in length of care required. The activation of the lethal trauma. Try that includes the patient developing doses the onset of hypothermia as well as excessive non Arshi carrying fluid resuscitation can accelerate quarry allopathy maybe prison as soon as the patient arrives at the emergency department, or in many cases, while there were the amiss according to an article by Winston in military medical research journal, uncontrolled hammers from coagulation dysfunction is one of the main potentially preventable causes of the mortality in both civilian and the military settings. This condition can be made worse with the administration of large amounts of blood products as such it's important. We explore the utilization of all options both inside and outside the hospital tale the patient survive until they can arrive at a facility that has surgical capabilities is the administration of TSA in the pre hospital setting a potential game changer for trauma patients current research. Seems to indicate the terrorists and definitive benefits win given early trans Amy gas. It is one of the drugs that EMS should take a very close look at and consider implementing within the protocols when dealing with patients is severe and life threatening trauma. The quiet relation of blood is one of the most important body functions that humans possess, the physiological development of clouds with fiber is offset by the anti coagulation process. One of the largest concerns of the patient who is hemorrhaging during trauma is the breakdown of blood clots specifically, the breakdown of fiber strands this process begins when an enzyme by the name of plasminogen, that's produced by the liver and attached to the fiber stands that hold the clot in place. The substance is now known as tissue plasminogen activator TB. Yes, very similar to the TV that is used to dissolve a clot during my car. He'll infarctions is released by the end of the'll. Sales of the vascular converse plasminogen into plasma n- that accelerates. A breakdown of the clot these into filial sales are found in the lining of the vascular throughout the body. This breakdown of the clock sales is known as fiber analyzes anytime that there's any trauma to the body of fiber clock begins to form as a result of its response to the bleeding the clock starts out as a Lakewood the begins to transform into a gel like substance, eventually forming a clot. When the body is working correctly, or the bleeding is not massively severe this results in a plug being formed at the site of the blading causing it to stop. Cooperation, which is simply another name for Claudia begins almost the instant the body suffers an insult resulting in David. So the empathy lining of blood vessels. As a result of blood being exposed to the space underneath epithelial. There are to making his to begin to take place I structural and chemical changes in platelets, causing them to become very sticky. And they begin to adhere to each other. The second change that occurs is the exposure of tissue beneath epithelial cells to plasma this. Intern results in the development of a substance called fiber, simply put the platelets four of the plug and fiber and wraps around this platelet plug to help ensure stabilization and decreases movement studying on his crash to was a research trial that evaluated the healthfulness of TSA over twenty thousand adult trauma patients were treated either with a placebo or given ta say result. It showed that the death rate after four ways was significantly lower in the patients who received the TSA. The researchers found that when TSA was given within an hour of injury. The risk of death was reduced by thirty three percent. When the initial dose of TX was given three hours or greater after the trauma. The effect was not nearly as dramatic. The researchers found that there was not an increased risk of an inclusion of an artery that would lead to native outcome. The Kurd treatment guideline for trauma centers for patients that present to their facility include the administration of blood in order to maintain perfusion, including the delivery of oxygen and the removal of waste products. The administration to TSA has also been shown to reduce death rates by inhibiting Fabri, analyzes one of the major major criticisms of the crash to trial was that. There was no inclusion criteria developed from a definitive research perspective, basically, it was based upon the decision of the trading physician who decided whether the patient would receive TSA or not for some this was a research design flaw. There's some. Undefinitive benefits to the administration of TSA in the pre hospital setting. So these include the cost depending upon where it's purchased the cost of essay in America ranges from twenty five to fifty dollars per one gram dose in addition since current recommendations are the TSA be given within three hours and preferably within one hour, then administration by paramedics at the scene or while in route to the hospital is the ideal opportunity for the administration of stroke. It remains to be seen if the survival rates referenced earlier would be even higher. Hopefully, this'll be researched soon the protocol for TSA administration varies as most protocols do but should be similar to the volleying. I your patient must present with profound hemorrhagic shock vital sign parameters should include a blood pressure of less than ninety millimetres. Mercury. Stolac a heart rate of great greater than one hundred ten or a combination of both you should administer one gram of TSA over ten. Minutes for your initial dose mixed the TSA and fifty milliliters normal sailing and infuse if you have access to it or using fusion pop your pop dosing rate should be set at three hundred sixty milliliters per hour. Although it's highly unlikely that you will minister a second dose. If your patient is being transferred from a lower level of care to a trauma center, you may need to observe a maintain the second dose. This is one gram of TSA in one hundred milliliters normal sailing to be infused over eight hours. This may require direct order from your physician ticks is not recommended for use in pediatric patients younger than twelve years of age adverse reactions or side effects that may company say ministration include habitation. If the medication is infused too fast affiliate of euphoria on the part of the patient, diarrhea, nausea vomiting and blurred. Vision is contraindicated in patients who are allergic to the medication. Though suffering from a mile Cario, infarction, CVA or pulmonary embolism. In conclusion TSA should be administered to trauma patients who are suffering from severe hemorrhages soon as safely possible. This is bordered by a large amount of American international research says that include the Israeli defence force. The megani Debbie MSI, also in Israel and in various countries in Europe continue say make a difference if given the pre hospital arena, the research says yes, the benefits clearly outweigh the risk. Thanks again. For taking time to listen to the ten minute medic.
"ten minute" Discussed on Ten Minute Medic
"Infiltrates while you're giving it it can cause blood sugar levels to rapidly spike, which can bring around problems of its own therefore, most physicians recommend the administration of ten percent dextrose in water. If you're not able to get an Ivy started Glueck Agung can be given either intramuscularly or via international keep him on the glue gun raises the bug sugar about stimulating the break down and release of glycogen stores found in the liver. These patients must be transported to the hospital as they have. No reserve follow back on should the blood sugar level drop after you've left book gone may not be effective in patients who suffer from liver disease who are Mounir nourished or elite athletes diabetic dough acidosis also known as decay is most frequently seen in patients who suffer from type one diabetes. If you were. Call type one diabetes comes about it because of a resistance to or inadequate production of the levels of insulin. Because of this the blood glucose levels begin to rise as glucose is not able to enter the sale the sales now becomes starved. Even though there's plenty glucose circulating within the body. The insulin receptors will not allow to enter into the sales this which over to fat metabolism. Some products that are produced by this fat metabolism include fatty acids and lesser all the glycerin inadequate form of glucose, and thus provides a little bit of energy to the sales. As a fat continues to be metabolized waste products known as Kito acids begin to form and your patient begins to come every. Because of this acidosis pedestrian moved from the intracellular space into the intervention killer space as a patient suffers from an increase of urination. This potassium has passed out of the body causing a deficit. Sodium has also moved out and replaced by hydrogen this increase in hydrogen ions, only serves to make the acidosis worse. Vomiting is very common. This massive urination accompanied by the vomiting least, dehydration and hypoglycemic shock your patient has a net loss of potassium. But he or she may remain hyperlink. Look for EKG changes that include a longer than normal PR, interval, a wide cure s and tall. Peak t ways your patient may progress to having seizures generally these patients are in a deep coma. Your treatment for them is limited to fluid replacement to try to offset had hydration we don't administer insulin pre hospital doing so. Could lead to a rebound hypoglycemic spacious will be admitted to the intensive care unit and insulin will be administered over hours if not days in order to try to normalize their blood sugar levels and hacker molar hyperglycemia state as we said known as I s glucose passes into the urine causing severe diarrhea sus. This results in the patient becoming dehydrated in this disease. You'll often see blood sugar levels of thousand milligrams per deciliter or higher quite often. When you do a stick on your glucose, monitor it will simply read high the difference. Here is still enough insulin. That's active to prevent your patient from tab in fat and producing heat dome. Bodies your area of treatment for these patients is fluid replacement. These patients are truly an emergency state have in a death rate as high as seventy percent, this may be because symptoms are very subtle in the early part of the condition and may only become a. To the patient or family as your patient prepares to crash is normally seen in geriatric patients early signs. Simpson's include include urination as well as thirst the mucous membranes become dry and sunken patients present attack cardio. We will generally not see the couse smiles respiration because your patients not as toxic treatment for says fluid replacement and rapid transport to an appropriate facility. Thanks again for joining the ten minute medic next week's podcast. We'll take a look at the X rated medication that we give in trauma more commonly known as transatlantic acid again. Thanks for joining.
"ten minute" Discussed on Ten Minute Medic
"This is the ten minute. Medic the podcast for busy pair may students. I'm your host Dr Bill young today. We're going to take it look at diabetes. Type one diabetes comes about one. Beta cells are destroyed resulting little to no production of insulin by the patriots. Now, this type of diabetes may be known. Also as insulin dependent diabetes mellitus or ID him. The good thing about this is it is less common than type two. But the bad thing is is much more serious. Heredity does play a role in whether a person is at risk for the development of type one diabetes. The causes a type one diabetes are not clear, but it does appear the antibodies are produced that attack the cells and destroy them. Keep in mind that these beta sales are found within the islands of Langer hawn's that we discussed in the last lecture because there's no insulin or inadequate amount of insulin. Blood sugar levels will continue to rise. It's not unusual for a patient to have a butcher level of four hundred or higher because portion of this glucose spills over into the year in your patient will begin to diaries, large amounts of fluid leading to hydration. In addition when the body is not able to utilize glucose circulating in the blood because there's little to no way insulin to allow to you into the cell metabolism of fat becomes the method. Which the body attempts to provide energy this catabolism fat Mesa? Dehydration worse as at least to constant thirst also known as Polly Zia massive urination known as Polly urea in white loss, regardless of how much the patient eats. If left untreated to patient can progress to diabetic Kito acidosis a life threatening condition that will talk about in just a few moments as we stated earlier heredity may also play a role in whether a patient develops type two diabetes or not. Is well known patients who are Abass and inactive are much more likely to develop type two diabetes at one point type two diabetes used to be known as adult onset diabetes. This is no longer at anchor description as it can be manifested impatience as young as twelve years old. The onset of type two diabetes is not nearly as dramatic as what we see with type one for the most part blood sugar levels are not as high as seen in type one. A second reason is there still enough insulin is being produced and as effective enough to for stall the metabolism of fat as a primary source of energy. We don't see diabetic Kito acidosis in these patients, very often either. However, there is a condition known as hyper ause bowler, hyperglycemia state shorten to h h s will discuss in this podcast as well. The initial treatment for type two diabetes is lifestyle management with reduction of carbohydrate intake as well. As an increase in exercise. The patient is strongly encouraged to try to bring white down to a more normalized state. This doesn't work independent maybe placed on oral hyperglycemia medications. That's important to remember that this is not an oral form of insulin. As inside would be an activated by the acid in the stomach. Instead these medications have a two fold process. Yes. I the attempt to improve insulin secretion and second that tamped increase the number of insulin receptor sites found on the cell wall. If this fails or if your patient is non compliant with lifestyle change, which is not unusual the last line of defense or treatment is the administration of insulin regardless of whether it's type one or type two diabetes. There are a number of native outcomes. If the condition is not managed these include the depletion of protein in the body that leads to the whiting muscles, the increase use the fat for energy sources which can result in diabetic to acidosis. And lastly because serum glucose narrow -duced the amount of glucose circulating the vascular remains high this results in a denigration of the lining of the vascular system in general and the arteries specifically if left unchecked your patient could suffer blindness Schroeck, heart disease and renal Taylor. Let's take a look at some of the diabetic emergencies. It can come about hypoglycemia is. Edition results when there's dot enough serum glucose circulating within the body. Generally, we see symptoms that begin to manifest themselves. When the levels dropped to below sixty milligrams per deciliter, keeping by the some type one diabetes can have much lower blood sugars and still remain conscious several years ago when I worked in Georgia. We had a patient who has a type one diabetic. She would regular college on the nonemergency line. Simply asked us to come over checker blood Scher us, she just in Phil, right? Having become very familiar with this Beijing, we'd always run emergency her house, even though she had called on the nonemergency line. And the dispatcher said that she sounded awake alert and coherent. It was not unusual for us to get there to find that she had a blood sugar level of twenty and still be functioning normal cognitive level there. Several reasons why patient may become hypoglycemic. These include patients who take a higher than normal dose of insulin. Those who don't eat because they're sick patients who engage. Unusually vigorous exercise without eating afterwards as well as some antibodies the most common antibodies that can bring this on include Levin, arith- romance and inseparable signs and symptoms of hypoglycemia include anxiety or nervousness, combative behavior. Confusion, a rapid weak pulse. Accompanied by cold, clammy skin. If not treated rapidly your patient Cam progressed, having seizures and subsequently cardiac arrest, hypoglycemia should be suspected in any patient with an offer middle status. Therefore, all of these patients who present with an Alder mental status. She get blood glucose level check, regardless of their history. Patients with diabetes, usually become very good at recognizing the signs and symptoms of hypoglycemia because of this they will generally carry some type of snacks such as candy or cracker. So that they can offset the drop of blood sugar when they sent him and on until they're able to eat some protein and complex carbohydrates. In the past all patients, hypoglycemia received an amp of fifty percent, dextrose keeping my dismay -cations various CITIC and can cause necrosis if it infiltrates
"ten minute" Discussed on Ten Minute Medic
"You're listening to the ten minute medic the podcast for busy paramedic students. I'm your host Dr Bill young in last week's podcast. We took a look at the airway and the trauma patient and how you should go about approaching it from a basic perspective. This week's podcast will take a little bit more in depth. Look at things such as sectioning position to your patient as well as win to and just as importantly when not to use or consider drug assisted or rapid sequence innovation. Luckily for both you and your patients most of the time the airway can be managed with simple skills. It's important for your way, the benefits versus the risk of when you're moving to more advanced skills in equipment and maintenance of airway the use of simplest tools that are of the most effective the situation will generally be the best for your patient. The trauma patient that is coupled with an Alder mill status and being us upon position that has copious amounts of facial blading can be one of the most difficult challenges in airway maintenance that you'll face the ability to you suction ineffective mannequin determine whether your patient survives or not the biggest challenge that you'll need to keep a man win such thing is causing your patient to become hypoxia because of extended time of sectioning. I wish there was some way. I can tell you fixed amount of time to suction but much of that will depend upon the amount of blood or vomit us that your patients producing these preoccupation win suction. He will help offset any of the hypoxia that may develop if you're able even if your patients backboard roll the patient over their side, gravity, your friend. This'll help much of whatever fluid is in the patient's airway to exit the mouth and not wind up in the lung. If your patient has massive amounts of blading vomiting, don't waste your time using a soft suction catheter. Get the largest heart catheter that you can find that will move the most fluid from your patients airway when section of your patient. Remember the steps first pre-accident your patient by ministering hundred percent oxygen next insert your catheter without the suction being applied the seltzer adduced amount of hypoxia that patient may spirits as well as if you use a soft catheter the catheter may adhere to soft tissue on the way in of suction applied. Lastly as soon as you're finished sectioning, reaction nature patient, beware of hyperventilation for the reasons that stated earlier in this lecture in addition to bleeding vomiting. There are number of other issues that may come of that made it difficult for you to major the airwaves trauma patients. Some of these include patients who have short action large tongues. One way of minimizing in the native of face of the large sunk sizes using the Indo tracheal Laurien scope blade this wider, the normal this house to lift and move the tongue up and out of the way. Day. One method of identifying whether a patient may be difficult to innovate is by the use of the Mallam Patty score to do this. It works best. If you're patient sitting upright with the head intro position gave him this'll rarely been the case with your trauma. Patients have your patient opener mouth stick their out. Look the structures of the back of the throat to see how clearly they are able to be saying in a class. One Malam potty the best of all of them. It exists when you're able to see all the structures of the soft palate, including the villa. Clash is present when you're able to see the Euboea, but no soft palate a class three. And you're able to only say the base of the villa from where it 'attaches. A class four exist. When no extractors are violent, and is the most difficult indicator of all unreal. Cajun's you may be called medically induce your patients so that they are sedated paralyzed innovated in a person who is proficient in this practice is the safe tool to use. However, and I must stress this. This should be practiced on a regular basis, you should review the drugs and the ministration protocols in order not to make a better way situation. Even worse. These pharmacological agents to assist in the innovation process falls into two categories. One is called drug assisted innovation or DA the cygnus called rapid sequence interbay tion or are sl. Let's take a look at each of these these medications such has been dazzling him fennel or diazepam used with the goal of relaxing, your patient enough to allow you to introduce the entertain to into the trachea the purposes relax the patient, but not to cause the protective mechanisms of the airway been negated in rapid sequence innovation or. Sl. The patience for sedated, the paralytic agent Zena minister to the patient that causes muscle paralysis and removes the patient's ability to protect his own airway. Some studies have shown that patients tend to be revealing more this procedure lead into a poor outcome. Other studies show little or no difference between this and other methods of airway maintenance more study is needed indications for other drug tested innovation or rapid sequence interbay shin, including those patients who are need of secure airway and are combative because of a hey Andry or severe how boxy Mia you must be confident as well as realistic in your assessment of your ability to innovate the patient. If you're going to go this route failure to be able to manage the airway can lead to how Pasha as a result of aspirin or death from hypothalamus of crisis the drugs that you will a minister to do. This are almost all universal in the Saudi fate of causing a drop in the patient's blood pressure. The follow is the protocol approved by the Kentucky board of emergency medical services for the use of drug assisted innovation or rapid sequencing innovation. Please refer to the board. The miss website for more details on this protocol, keep in mind that it is a restricted protocol and providers must be pre approved by the board prior to doing this procedure. I may Shas you have all the equipment that you're going to need to accomplish a procedure, including suction, establishing IV of at least assize of an eighteen gauge all patients should be on entitled. CO two monitoring pre-auction night your patient in a tap to raise a pulse ox up to ninety four percent or higher administer Lada. Cain one and a half milligrams per kilogram. Every push to independent who is suffering from a hit injury stroke or hypertensive crisis. Your patient is going to be given a drunk and ministered zero point zero one milligrams per kilogram of recounting to help with decreasing the muscle facilitations that come about as a result of some of the drugs facilitations are slight tremors in our sl. Sedate the awake patient with Tommy date with zero point one to zero point three milligram per kilogram. IV push at a maximum of twenty milligrams or Maderas lamb zero point one milligram per kilogram. IV push with a maximum of five milligrams. Us lower doses. In the hypertensive patient or the overly patient sedation. Drugs can be omitted in the unconscious by shot. But please make sure that your patient is truly unconscious. Paralyze will sucks coaling the doses. One point five milligrams per kilogram IB, pushing adults and two milligrams per kilogram IV push in children flush the IV with Tennessee. Tennessee's of IV fluids fallen any Drug administration. If you using drug assisted innovation sedate, the patient with Tommy date at zero point one zero point three milligrams Ivy push at a maximum of twenty milligrams or Mme zero point one milligram per kilogram. IV push again, follow the Drug administration by flushing the line with a bowl of fluid to make sure that the drug is into the central circulation in the past silica maneuver was a favourite appear. Mish to either clued the softness or reduce the potential for vomiting to bring the trachea interview research shows that is really not very effective even make it more difficult for the person doing innovation to see the trachea one of the big challenges of paramedics and industry unabated as verification that the tube is indeed in the right place. One study showed that one out four to were in this office, especially with the availability of Intel seal to monitoring this is inexcusable but the methods of tape placement. Advocation include direct visualization of the tube as it passed. The cords seeing the chest rise and fall with each village in prisons, bilateral breast sounds in four areas. Over the chest Fargo,