35 Burst results for "ten minute"

China Order Report Drops TSLA Stock

Tesla Daily: Tesla News & Analysis

01:53 min | Last week

China Order Report Drops TSLA Stock

"Everybody rob our here and today we of course going to be discussing the information's report on net new orders for tesla in china during the month of may this report was published a couple of hours before market closed. The stock dropped dramatically. And of course it was quickly picked up by other means. That's as well so we'll discuss my thoughts on that. Then we also have a couple stories on recall. Some news from cat l. expanding in china an update on gigabyte lynn an update on the plaid model s. As we await the delivery event. One week from that are so tussle stock today starting out the day just fine trading a little bit below yesterday's close but not too far in early morning trading and then in the afternoon we saw a report from the information this was a couple of hours before market closed on as this report came out tussle dropped sharply about three percent in less than ten minutes and then continued to decline into close finishing the day down five point three percent to five hundred and seventy dollars four cents that compared to the nasdaq down one percent on the debt so that report is where we will start. The headline for this piece is quote. Tesla's china orders have in may internal data shows as crisis deepens and quote. They go on to write that quote. The company's monthly net orders in china dropped to about ninety eight hundred in may for more than eighteen thousand april according to a person with knowledge of the data the sharp drop reflected a drastic shift in chinese consumers appetite for tesla whose founder elon. Musk has celebrity status. Their orders in january after the release of the motto sub and then slowly eased off before cratering last month. In march tesla had twenty one thousand that orders even on a week over week basis order so far haven't shown any signs of recovery. This person set and quote. The rest of the article is then pay walled. But i did read the full article. There's nothing new in the rest of it. It's really just kind of detailing. The situation that has been unfolding in china. All stuff that we've talked about with the shanghai auto show protest the government wanting to meet with tesla. I think back in march just to talk about safety all things that we have followed as they have unfolded so nothing new in the rest of it.

Tesla China ROB Elon Musk Shanghai
What's the Objective When Presenting an Oral Defense?

In the Classroom

02:15 min | Last week

What's the Objective When Presenting an Oral Defense?

"May thirty first twenty twenty one today. I want to talk about the main purpose of presenting an oral defense. Today we are basically concluding the sixteen week course doing research providing or designing and creating a thesis paper around a specific problem that relates to applied linguistics. And we've completed the paper and now we are trying to include the key points from that thesis paper into a twenty minute presentation allowing ten minutes for question and answer. We're at a point now where we have basically one week before we begin with or presentation so i think it's a good time at at this point to stress and just focus again on what our main objective is when we present an oral defense. The objective is simply to present a set of questions one question or two or three questions that relate to the problem to the key point of our thesis paper and in the results and discussion section to answer those questions. That's that's the key point. Make sure that at this point in your preparation. You're putting together ideas in your slides in your powerpoint presentation that number one you have included your research questions just before the method section number two that those research questions are in fact being answered in your results and discussion section. Sometimes it happens where at the end of this whole process. We still are going back to our research questions to slightly modify to tweak maybe tighten our research questions to make sure that we are directly answering those questions. That's very important sometimes. This might mean merging questions. Maybe you're combining two questions into one question maybe. In some cases you're completely removing

The Disappearance Of Girly Chew Hossencofft

Ghost Town

02:13 min | 2 weeks ago

The Disappearance Of Girly Chew Hossencofft

"Nine girly. Chew hodgson coughed failed to show up at the bank where she worked as a teller. Her co workers immediately became concerned about her welfare and reported her missing only ten minutes later. Investigators searched girl's apartment and discovered evidence of a violent struggle including pools of blood that someone attempted to clean up with bleach testing later determined that the blood and the apartment was from girly her estranged husband and a third identified source. Today were talking about the disappearance of girly chew hostile and coughed and the absolute absolute insanity that surrounds her disappearance and murder. Honestly this episode. Has it all girly. Chew hossan coughed was born on august. Twenty seventh nineteen sixty three in malaysia. She would periodically come to the us to visit on one such visit in the early nineteen nineties. She met a doctor deanne dan. Hopefully someone will correct me on that. It is not a name. I've seen very often hossan coughed. At seaworld they began to talk than they kind of struck up a friendship. Writing letters to each other and eventually girly moved to the us and married him in nineteen ninety-two daisy. What's called daisy daesean. And gurley were married in one thousand. Nine hundred three and settled in albuquerque new mexico you know seemingly a modern love story in january nineteen ninety nine girly moved out of the couple's home and filed for divorce after domestic violence incident where dasy and had smashed cars windshield but twice threatened to kill her as well. She knew that he had been unfaithful previously. But she wasn't sure what he was capable of curly also made contact with an fbi agent. Who is serving her which opened up the floodgates to a whole bunch of information that she had no idea about. She was scared she was paranoid. She began taking karate lessons for self-defence girly told her co worker. That if anything happened to her anything at all to immediately contact authorities and ask them to investigate deion he was not the person she thought he was so who was jazzy in hossan

Chew Hodgson Chew Hossan Deanne Dan Hossan Daisy Daesean Gurley Malaysia United States Albuquerque New Mexico FBI Karate Girly Deion
Why Tesla Stock Jumped on Monday

Tesla Daily: Tesla News & Analysis

01:49 min | 2 weeks ago

Why Tesla Stock Jumped on Monday

"Robin our here today. We're gonna be talking a little bit about tesla stock tests approach with their sensor suite. Plaid delivery timelines. We've got wells fargo. Picking up coverage of tesla stock. Some news on charging and batteries. Nice start to the week. Four tesla's stock today after a relatively quiet news weekend finishing up four point four percent to six hundred and six dollars four cents that compared to the nasdaq up. One point four percent tussle dead tail off a little bit towards the end of the though falling about one percent in the last half an hour well as luck would have it alanis tweeting about bitcoin and does in the last half an hour about eighteen minutes before market close. He tweeted quote spoke with north american. Bitcoin miners they committed to publish current and planned renewable usage and ask miners worldwide to do so potentially promising and quote couple minutes after that he switched over to doj saying quote. If you'd like to help develop those please submit ideas on get hub and read it and quote so inevitably you see that you see out. Great yuan taking the stock again talking about cryptocurrency. Someone already tag me on twitter suggesting this and if you're just casually looking at the stock yes absolutely looks that way but again it is not that simple if we pull up the minute by minute. Chart here tweeted again. Eighteen minutes before close dessel was at about six hundred ten dollars per share at that point in time it had already dropped from six hundred and fourteen before john even tweeted that if we flip over to the nasdaq you can hardly tell the difference there in the last half an hour with how those look the nasdaq trails off there as well and continued to fall in the last eighteen minutes. Just like tesla did in fact tests actually dropped more in the ten minutes before ilan's tweet actually more than two times as much of a drop their as it did ten minutes after tweeden about cryptocurrency even though the nasdaq performed worse in that second block of ten minutes after alonzo tweet so just like before. Yes tempting to throw that in as the narrative you see the stock falling right when you on tweets. But it's just not that simple and this instance is definitely not evidence of that being the case

Tesla Wells Fargo Alanis Robin Dessel DOJ Twitter Ilan John Alonzo
WFP Ramps up Support to Yemen's Famine Risk Areas

UN News

00:59 min | 2 weeks ago

WFP Ramps up Support to Yemen's Famine Risk Areas

"Turning to yemen to prevent a devastating famine in the country. The un world food program wfp is increasing. Its food assistance to the worst hunger. Hot spots the agency's ability to sustain its response to the end of the year remains uncertain. Nearly fifty thousand yemenis are already living in famine like conditions and five million people are in immediate danger according to wfp every ten minutes. A child's eyes of preventable diseases such as diarrhea and malnutrition. As the conflict. Escalates hunger increases with food. Prices rising up to two hundred percent above prewar levels the wfp country director for yemen lawrence. Because said that over the last year escalating conflict economic decline rising global commodity prices and covid nineteen have all contributed to an alarming increase in acute hunger

WFP Yemen UN Yemen Lawrence Diarrhea
Step up Your Foot Health

Dishing Up Nutrition

01:45 min | 2 weeks ago

Step up Your Foot Health

"Also want to mention another common foot issue. That i'll run across with clients and that many people actually struggle with and that is plantar fasciitis. It's actually the most common type of foot pain. And i am amongst those in that set of statistics. I actually had plantar fasciitis several years ago. And let me tell you for those of you who never had plantar fasciitis. It really is not a pleasant way to go about your day. Just a little bit of that background of what plantar fasciitis is if you can imagine. There's a thick ligament that runs it starts at your he'll at your heel bone and it runs to the base of all of your toes kind of starts bet. He'll and spreads out as it gets further down that foot and what happens is that kinda thick ligament that plantar fascia becomes irritated and inflamed and then it causes a lot of pain. So and oftentimes pain will feel like sharp stabbing pain in your. He'll and i remember that vividly. It's just remember especially in the mornings when you roll out of bed in your feet. Would i hit the floor. And i just remember cringing and kinda and and just kind of wincing every time My my he'll hit that for probably for the first five or ten minutes out of the day because it tends to be worse in the morning. When you're tight when you're stiff and things like that so you think about that ligament that being similar to a rubber band it needs to stretch and contract as you walk or take steps throughout the day so this ligament can become irritated and inflamed from overuse. Pretty is the most common thing but it can oftentimes come from a deficiency of nutrients as well.

Bob Dylan Celebrates 80th Birthday

The World and Everything In It

01:32 min | 2 weeks ago

Bob Dylan Celebrates 80th Birthday

"Robert allen zimmerman was born may twenty fourth. Nineteen one who you might ask in college. Zimmerman adopted a stage. Name bob dylan. He celebrates his eightieth birthday. Today brand is blowing in the way. In addition to musical chops the minnesota dylan became an artist writer producer and nobel prize laureate. He dropped out of college and moved to the big apple where his lyrical skill began to shine. He wrote blowing in the wind in just ten minutes and his song showed a deep complexity that caused the new york folks team to turn its gaze to the up and coming songwriter he told. Cbs is sixty minutes in two thousand and four that his creativity came from a wellspring surprised. Even him tro this there's a magic to that and it's not Siegfried and roy magic. You know it's a different kind of penetrating magic near fatal motorcycle. Accident in nineteen sixty six led to a long recovery the night shift in his music from folk to rock dylan reinvented himself over the years musically and religiously he grew up jewish then profess to conversion to evangelical christianity and nineteen seventy-nine. Then back to judaism again over the course of his sixty year career. He's been named many halls of fame and received many awards including a presidential medal of freedom. Tin grammys a golden globe and an academy award

Robert Allen Zimmerman Dylan Zimmerman Roy Magic Minnesota Siegfried CBS Apple New York Golden Globe Academy Award
Tim Cook's Bad Day in Epic vs Apple

The Vergecast

02:11 min | 3 weeks ago

Tim Cook's Bad Day in Epic vs Apple

"All about the apple versus epic trial epic versus apple. It's i i was safe backwards. Epic versus apple epics the planet literally the testimony portion of the trial wrapped up minutes ago from you and i are talking. There is sort of fake version of closing arguments on monday where both layers are. Just gonna get asked questions. Bu the judge from what. I understand which is probably going to be way more fun than normal closing arguments probably way more fun also the term. Everyone is using for that. Closing argument is a hot tub ing which is very funny. Laporta will be in the courtroom for the hot tub ing but the actual testimony all the witnesses on the stand all the presentations of evidence wrapped up today. This week saw phil schiller craig. Federici tim cook on the stand. There's a lot to talk about their but wish to start with what just happened. Because the absolute end of the testimony portion of the trial with tim cook on the stand was fireworks. It just went sideways. There was very boring for a week. Lots of experts that we're not even talking about because they were so boring and then the judge kind of just in the tim cook. What happened at he. Yeah so you. A judge yvonne gonzalez rogers who is gonna be writing the opinion on the case and who occasionally interjects with some usually pretty interesting but very short questions. They more or less finished examining tim cook. And then judge rogers two steps in with a question and she's like okay. Well it seems like most of the revenue in the app store comes from games. So what's wrong with telling people that they can go and making purchases elsewhere. And then that just kicks off this ten minute long discussion where she and tim cook this like surprisingly testy exchange over whether it makes sense that once apple put like once a developer put something in the store apple brings enough value that it should get a cut of like whatever happens in that out forever. Yeah and to me. This is kind of the central question at the heart of this. Trial is who is in control of your phone in apple's answer kind of nakedly. Throughout his win we are in control of your phone

Apple Tim Cook Phil Schiller Craig Federici Tim Cook Laporta Yvonne Gonzalez Rogers Judge Rogers App Store
Interview With Spiral Director, Writer, Darren Bousman and Josh Stolberg

The Q&A with Jeff Goldsmith

02:13 min | 3 weeks ago

Interview With Spiral Director, Writer, Darren Bousman and Josh Stolberg

"Darren josh. good to see you guys. How's it going good. Let's be you're so happy to be here so glad to have you guys the number one film in theaters this weekend. Which is quite an accomplishment as people are vaccinated and coming back into theaters. So congrats on that. Thank you I and we're gonna we're gonna get into a lot of stuff today but we always start with breaking in stories and it just kind of gives a good place for folks to kind of learn who you are what you do darren. I'm from city. It seems like you grew up in kansas as well. Where'd you go to high school. Went a shiny. Mr south to china mission north. About ten minutes from you. So it's iowa's i know i know it's crazy. I've met so many so many people out here now from kansas which is which is just crazy. That's that's awesome and what what made you move out here. Did you study film out here. What what brought you in los angeles. so i I went to ku. I majored in theater and film and keio I left after two years. It just wasn't my thing I just felt like if i really wanted to do it. I needed to get out of my comfort zone. And i think that you know being born and raised in kansas. All my friends were there. I needed to wipe the slate clean. Start over so. I went to florida. But how i got involved was when i was in kansas. I would answer every ad that i would find the paper about filmmaking and there was. There's there's a scene for filmmaking no matter where you live. I don't care if you live in boise idaho. y'all stay angeles. It doesn't matter where you are. People are making movies. So i i got on every set that i could came through kansas. There was a lot of really schlocky horror films which i was. I was on every one of them is like fourteen fifteen sixteen years old And then yeah. I went to florida to a place called full sail university. Which is a film. School did that. And then I left full sail and went to l. a. and for years it was the classic the classic store you hear about i. Was you know. I was a pa. I was an assistant. I was bad at both. I was fired from all And then i wrote. I wrote a script called the desperate. Which is kind of. It was kind of my therapy about my desperation in hollywood.

Darren Josh Kansas Mr South Darren Iowa China Los Angeles Florida Boise Idaho Angeles PA Hollywood
Golden Knights Surges Past Wild for 5-2 Win to Take 2-1 Series Lead

AP News Radio

00:45 sec | 3 weeks ago

Golden Knights Surges Past Wild for 5-2 Win to Take 2-1 Series Lead

"The golden knights scored five consecutive goals to beat the wild five two in game three and claim a two one series lead after the wild scored twice in the first they had a potential third goal called off after review showed it was offside the golden knights took over from there including a pair for their captain mark stone we got a fortunate challenged was outside and then ten minutes into our you know five five ten minutes in the second period we got a couple big saves it was a two and then we tried to call the game not totally really well gosh what you're going to transition the puck well and that's what led to our offense Patrick brown William Karlsson and Reilly Smith also got on the board for Vegas Ryan Hartman jewelers next scored the goals for the wild game four is Saturday night Kevin foremost Saint Paul

Golden Knights Mark Stone William Karlsson Reilly Smith Patrick Brown Ryan Hartman Jewelers Vegas Kevin Foremost Saint Paul
This Is Us (MM #3706)

The Mason Minute

01:00 min | Last month

This Is Us (MM #3706)

"The Maison with Kevin Nation. I guess you could say my wife is in the morning. As we just found out that her favorite television show. This Is Us is coming to an end. One more season to go, and that'll be it. I don't know if that means 10 or 20 or 30 episodes will find that out in a few weeks, but I know she's upset. We all have those little joys in life that we look forward to for some reason, my wife likes, this is us and while I haven't really paid attention to it, I've always paid attention to it. I always like to keep up with what's happening in the pop culture world. I know I'm on the computer, usually doing something else, and we're watching it, and I'll look up and kind of follow them for five or ten minutes and then go back to what I was doing. I don't understand the appeal of those types of TV shows and I don't even know what you call them. I know, my wife will enjoy and Savor the last few episodes, no matter how many there actually are, but it's still tough. When we find something that we love that occupies our time, that makes us Escape our lives, for just 1 hour, when it goes away, I don't begrudge her losing. This is us because I know there will be something else come along and she loved almost as much. It always seems to work that way. Doesn't it off?

Kevin Nation
This Is Us (MM #3706)

The Mason Minute

01:00 min | Last month

This Is Us (MM #3706)

"The Maison with Kevin Nation. I guess you could say my wife is in the morning. As we just found out that her favorite television show. This Is Us is coming to an end. One more season to go, and that'll be it. I don't know if that means 10 or 20 or 30 episodes will find that out in a few weeks, but I know she's upset. We all have those little joys in life that we look forward to for some reason, my wife likes, this is us and while I haven't really paid attention to it, I've always paid attention to it. I always like to keep up with what's happening in the pop culture world. I know I'm on the computer, usually doing something else, and we're watching it, and I'll look up and kind of follow them for five or ten minutes and then go back to what I was doing. I don't understand the appeal of those types of TV shows and I don't even know what you call them. I know, my wife will enjoy and Savor the last few episodes, no matter how many there actually are, but it's still tough. When we find something that we love that occupies our time, that makes us Escape our lives, for just 1 hour, when it goes away, I don't begrudge her losing. This is us because I know there will be something else come along and she loved almost as much. It always seems to work that way. Doesn't it off?

Kevin Nation
Star Wars: The Bad Batch Episode 2 Review

Kinda Funny Games Daily

00:56 sec | Last month

Star Wars: The Bad Batch Episode 2 Review

"Episode two of the star wars. The bad batch reactions also went up over the weekend. That's tim that's barrett. That's roger corneas given all them. Good takes about stalwarts the bad batch. It's also available as a podcast if you search for kind of funny reactions on podcast versus a new feed. Go check it out. Go support it. How you like bad batch like an episode one. Highly highly worth watching for everybody. I think because it's kind of a mini movie. It's an hour and ten minutes plus. Oh a really really fun. Cool star wars story. I'm not going to spoil what it takes place because it's cool interesting time. Think you're gonna like it is it. Does it not take place in the clone wars like that. I know that's another show. It's okay but do they connect in any specific way. Just the fact that they're stars yes they can act but you do a really good job especially the first episode of just understanding that people might have never seen that animated things before and it being totally understandable. It's good stuff.

Barrett TIM
Star Wars: The Bad Batch Episode 2 Review

Kinda Funny Games Daily

00:34 sec | Last month

Star Wars: The Bad Batch Episode 2 Review

"Episode two of the star wars. The bad batch reactions also went up over the weekend. That's tim that's barrett. That's roger corneas given all them. Good takes about stalwarts the bad batch. It's also available as a podcast if you search for kind of funny reactions on podcast versus a new feed. Go check it out. Go support it. How you like bad batch like an episode one. Highly highly worth watching for everybody. I think because it's kind of a mini movie. It's an hour and ten minutes plus. Oh a really really fun. Cool star wars story. I'm not going to spoil what it takes place because it's cool interesting time. Think you're gonna like it

Barrett TIM
Rhode Island Investigating Death of Man Handcuffed by Police

AP News Radio

00:44 sec | Last month

Rhode Island Investigating Death of Man Handcuffed by Police

"I'm Julie Walker the death of a handcuffed man while in police custody in Rhode Island is prompting an investigation Providence police released body camera video and say officers were called around twelve thirty AM Friday for report of a man who was outside screaming and possibly on drugs officers found thirty four year old Joseph entry rolling on the ground and called for medical help the body cam shows they spent more than ten minutes trying to calm him down before holding him down on his stomach for about ninety seconds while handcuffing him behind his back he then appeared to collapse it was pronounced dead at a hospital I'm Julie Walker

Julie Walker Joseph Entry Rhode Island Providence
Arsenal Stumble out of Europa League

ESPN FC

02:08 min | Last month

Arsenal Stumble out of Europa League

"How bad we're asking today. They will awful. I forty five minutes was terrible. Done for to make it. He wrote a leak fond. Louis no aggression about that. There was getting around the pitch. It was all really slow and pedestrian. Or i thought they had a decent going in the last ten fifteen minutes of the game but that was just desperation. They were way off eiffel over the two legs. I thought they would have went through. I thought it'd be to pacey l'oreal they will naive in the first leg. You try to be too small to cut up. Because that's playing a false nine tonight. You still awfully took young off with ten minutes to go brought lockers on one or play. The pair william came on had no effect whatsoever that brought eddie and are on on the not minutes for three or four minutes of the game so all in all to the real tell you deserve to go through. Explain this theory semifinal of the aropa league your only chance cancer the champions the and you come out and you in turgid performance. I'm afraid you have to look at the monitor. You know the fact that don't said other than a little florida with ten fifteen minutes to go at the end really in such a big game. I'm sorry we can. We can say that players have to motivate themselves. When they're on the field they have to get gone and this is their responsibility but say before the game the mine you should have been thrown the through every single one of them winding them up maintenance shirley new home important game was making shielding you important. It was to start the game war. Mccan shooting you important was to put pressure on villa. We up none of those things happen to fifteen minutes to go on. Shed mean not that has to be done to tetra coaching stuff. It's not a bad teams shot when you look at the qualities of expensive players arab bamiyan pathway thomas party of course soccer up and coming english attacker a lot of excitement around the him but there was just nothing nothing osmose perspective even a little excited about. Today

Louis Eddie Mccan William Cancer Florida Shirley Bamiyan Pathway Thomas Party Villa Soccer
So You're Going on a Trip...

The Cut

06:37 min | Last month

So You're Going on a Trip...

"Of the community but when vicious new upstart house emerges blanca and the rest of her chosen family must come together once more to uphold the legacy of the house of evangelist. Pose air sundays at ten pm. Only on facts. It is so hard to slow down and just find time to be especially right now. When i'm so looking forward to the future and planning ahead and making all these ideas and fantasies about what. My life is going to be like now that i'm fascinated. I just have to remember to put one foot in front of the other right now and won't seems counter. Intuitive to recommend an app of all things to help you stay present. That's exactly what i'm about to do. It's called head space and it can transform your habits as long as you have ten minutes to spare head. Space is an app loaded with guided meditations designed to offer a daily dose of mindfulness. And it's truly a cut above other meditation apps because it relies on clinically validated research. To help you feel better no matter what. You're up against their two sessions in particular that i knew had benefit pretty much anyone listening. There's a three minute. Sos meditation when you're just overwhelmed by the day and need a quick release and there's a wind down session for when you can't sleep at night much definitely beats staring at the ceiling. You deserve to feel happier and head. Space is meditation made simple go to head space dot com slash the cut for a free one month trial. That's head space dot com slash the cut for a free month with access to head spaces full library of meditations for every situation. This is the best deal offered right now. Head to head space dot com slash cut. Today the cut. The cut cut cut okay. We're gonna play a game. I'm actually playing a game with you. The listener so just play along here. So you're going on a trip and you have five animals a cow. A horse alliant a lamb and a monkey really picture each one a cow a horse a lion a lamb and a monkey all right now on this trip huron. We're going to have to give one of those animals away. Which one do you get rid of. I all right. You got which one you're giving away now get rid of another animal and then the next one and then the next one and then which one do you keep that last remaining animal. Just hold it in your mind's eye for a minute that's the animal that represents what you value most in life. Each of these animals are representative of the priorities in your life and like the lion is your pride in the horses. Your job and the cow is wealth and the Lamb is your significant other and The monkey is like a child. Michelle learned about this game from her aunt back when michelle was a teenager and the wish he thought about it back then was like okay. If the premise is that. I'm going on a trip. I need to pack really light and so i was like it's going to be a real pain in asks to like carpet lying around so like that's gonna go first and then like the cow is also like this really like large stubborn animals so like i can get rid of that and looking back it makes sense that michelle would immediately give up her pride in her hopes of striking it rich. Because you kind of have to. If you're going to grow up to be touring musician my name is michelle sonner and i also play in a band called japanese breakfast but before japanese breakfast was playing venues all around the world back when michelle was a teenager playing this game with her aunt the third animals she gave up was the horse and then as a real toss up between like the lamb and the monkey and when michelle played this game with her aunt. She was like wait a second. Have you played this game with my mom. What animal did she pick. Since you know choosing your child is an option why she better have picked the monkey. Although michelle wasn't a hundred percent sure that her mom would choose. The monkey felt was my mother's priority. But she was also kind of like somewhat of an enigma to me. And i think that that was why the type of game was so enticing to me because she could be very private and somewhat withholding as michelle writes in her new memoir crying h mart. Her mother wasn't what she calls a. Mommy mom my mom was by no means like coddling anyway. She was very present and very involved in my childhood but she was not easy on me in a lot of ways of every time i got injured. My mom would be very upset. Instead of like you know rushing to my aid and taking me to the doctor and sort of like telling me it's gonna be okay. She could you know she would get very angry and start yelling at me because she was just so angry that it happened. I think and didn't know how to track that energy. Even as michelle grew up her mom was always a source of tough love. I remember when. I got fired from my job at a waitressing and mexican fusion restaurant and i was so obsessed know worked really hard and and a lot of i've seen other moms we like you know it's their loss honey like you'll find another job or whatever. My mom's i won't show anyone can carry a tray. She just had this like very like cruel reality that she would hit me with in michelle's mothers defense. Michelle was kind of a handful. I was such a rowdy tomboy. I didn't take care of my things very well and that drove my mother crazy. My mom was someone who had like a twelve step skin care regiment and tony piece of clothing for twenty years and looked like it had never been worn and she took so such great pride in like self care and her appearance and fashion designer handbags. And you know. I was like a little punk kid that wore daniel. Johnston t shirts and patched overalls and wanted to like play rock music for a living. I was very angry and perplexed by my mom's decision to settle for

Michelle House Of Evangelist Blanca Michelle Sonner Tony Johnston Daniel
Interview With Reshma Saujani, Founder of Girls Who Code

Skimm'd from The Couch

01:40 min | Last month

Interview With Reshma Saujani, Founder of Girls Who Code

"Welcome to our mother's day episode of skimmed from the couch. Our guest today is rush. Mr johnny she is the founder of girls who code and today. We're going to talk about working moms over the past year. We have seen just how devastating this pandemic has been for women who are losing their jobs dropping out of the labor force at alarming numbers. Reshma has proposed a marshall plan for moms to get women back to work to create sustainable solutions for working women in the future inc. You so much for coming back on the couch with us today. This is actually second time on the show. I i think that's the first time we've ever had anyone twice a lot of a lot of history happening by really really excited to dig in here excited to be here. I love everything you're doing enough. Silk set a chat with you you while first of all as we can set up here just now we just spent ten minutes both like location setting up our zoom changing headphones. Changing voice note record. How are you like. How is this year ben for you. You know. it's been rough right. It's been rough. And i think we're this strange now where you know. There's a shift. But i think everybody i know feels really off and having a hard time like readjusting to whatever that new normal is and i've been like meditating on it and i think for me it's just i don't feel as motivated as i felt before i need an adrenaline rush. I think working with my kids under my feet. I feel like i just need to be at in a space place rachel constantly have sensory overload. Because that's really what i'm struggling with.

Mr Johnny Reshma Future Inc. Marshall BEN Rachel
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

03:01 min | 11 months ago

"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..

Adriana Energy Doreen Oregon
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

04:17 min | 11 months ago

"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..

penetrating trauma Speedo Liberte Connecticut Oregon
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

03:04 min | 11 months ago

"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..

Connecticut Energy Division of Science Studies wigan Ellen Newton Connecticut
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

03:15 min | 1 year ago

"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..

metabolic acidosis acidosis SANTITA Pre Hospital Poli Tori NFL Bradley Alexis
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

07:33 min | 1 year ago

"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.

respiratory distress respiratory arrest Pasha Dr Bill Young facebook American Heart Association COPD Park Samia Tastes Villa Tori braddock harding Progressive Cardiac Ross polycythemia Rauch Alveoli Lawrence Julie Diffusion Ostra
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

06:26 min | 1 year ago

"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.

Sicily drug overdose Wa
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

06:22 min | 1 year ago

"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.

respiratory arrest cardiac muscle Dr Bill Young American Heart Association Reisen Department of Para Medicine Lee Eastern Kentucky University knicks Jay US Canada left ventricle Chen Vic Anthony Use
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

09:36 min | 2 years ago

"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.

Numa thorax intercostal space penetrating trauma Boyle Louis Lee Broncos Alexis Interflora Ray Orix Alviela Russia ACLU Orage methotrexate Nick Technip Neil
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

02:43 min | 2 years ago

"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.

Emba Lhasa HFS bolles asthma oxytocin ninety five percent thirty percent ten minute
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

11:58 min | 2 years ago

"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.

Dr Bill young Facebook Ed NFL Nisar Jack officer Nick Joy Ella Nixon Dustin twenty two year ten minutes two seconds ten minute six years
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

10:00 min | 2 years ago

"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.

Dr Bill young Ayman South Carolina Arkansas state university United States Tommy Tommy Medicare Doctor Automic trey attorney leeann Goldstein Oreo Duceppe president Dallas ten minute ten minutes four hours
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

02:08 min | 2 years ago

"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.

epinephrine Bing Vice Construction ten minute
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

09:43 min | 2 years ago

"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.

IOT Dr Bill young Mt MS Amos instructor ten minute ninety percent five years
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

07:55 min | 2 years ago

"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.

TSA infarction tissue plasminogen activator Dr Bill young United States Lakewood Winston hemorrhagic shock Amy gas Intern TX Claudia Israel Debbie MSI
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

04:16 min | 2 years ago

"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.

liver disease Glueck Agung Vomiting Mounir Ivy Simpson hyperglycemia severe diarrhea seventy percent ten percent ten minute
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

06:18 min | 2 years ago

"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

diabetes Dr Bill young hyperglycemia patriots Langer hawn Polly Zia Beijing Georgia weak pulse Taylor Scher Levin Phil fifty percent twelve years ten minute
"ten minute" Discussed on Ten Minute Medic

Ten Minute Medic

08:59 min | 2 years ago

"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,

Tommy Dr Bill young Intel Alder mill hypertensive Tennessee Mallam Patty muscle paralysis diazepam Cajun Pasha Cain tremors Kentucky aspirin ninety four percent hundred percent ten minute