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Yeah, So it's a little bit. And so cardiac tamponade. So what country and when to be suspicious of it and the clinical signs for it on. Then I said bad side echo is more reliable on d Not gonna try and see the video, Maybe show you after this video town and image of the heart of flailed around it. So you initially not even It's just a minty and cardiac. I put his your medium, so I'll be the legs looks. It's 85 years and then surgical repair is definitively the management for that. And then as Neil touched on And if you lose and your a pet, you may have to go on to resuscitate of store call me. But I'm not gonna talk history, You know, you could use, um hum that. So you're saying, doctor, and they're going to look in you for saying to shore concerns for blatant to external hemorrhages and easy to see you'll see on the floor you'll see on the patient but internal hemorrhoid to select a little bit more tricky. So breakfast is that you're gonna get a hernia. BP is very, very completely focus. Skin color and temperature. Any medical active service is that your pH and your doctor get these people have a high locked, it will be acidotic, and you're initial management is prevented, not lethal triage. So Brennan, hypothermia, prosthesis and quite well, but they prior to patient revolution prep, as we've talked about before, if preparation, preparation, preparation. So keep the results from warm well, because of the thirties and bodies on there and more my deflates and prop your blood warmer. Have warm and blankets available. Get your T X ai. Activate your major hammers, put a call in his grade and described earlier. That's a love it were chunky here on guys in other places. Um, your state team will act to control your external hemorrhage to secure vascular access. So that's IV are you? They're going to toss a sand in your bloods away, including your grip and cross much on duty BG's and checking calcium if you're gonna get bloods. This is important. Remember that, and actually it for your grace us to control my patients blood first, foremost get blood and if you need it, done the fight of signs of straw shot because he said, I am. Look for your evidence of your entire leverage on the patient. Don't have a pelvic pain drawn priority Arrival say Nicer. Very good at putting them undone. I would say Check the possession of it and if it's not on the pill it on if you feel like it's needed. And there's also been a time that if you go big and performances of Famer fractures and I want to tell them the like to try and adjust the lady from the Amazon, I'll you're Thomas ones. Are your Kendricks want to have it in the field? So multiple areas of trouble I could call circulation class. There's no mamma part of the body, you know, complaints, Really? So keeping all these remained and then acted this transfer to stop that bleeding or prevented bleeding further him. I'm not. We're all tree in the day and fast Kansas part of 80 training. I wouldn't claim to be an expert, but it can be helpful. And if it's not gonna, if you have the scale is it's not going along. You're saying to see you today. You can do any fast scan which could help trivial assignments or for your shots coming from and the faster extended fast gone and as five points a day recommend that you you look up on that's really hard to and take it on a par for presentation and bear to be told relief. So there's a couple. People are quite mostly consultants, probably talking three a fast gun. And if you have a patient in the department that you want to try and Scotland and we probably unethically used to practice on, there are other days a human that may have had some trauma, um, attended a young man and here, lion so and so we would practice on. That was a good starting point. So this image him here is your right upper quadrant view of your liver, your kidney? A. That's a normal kind of looking, um, ultrasound. A man. Most common place is kind of free fluid and more since March. You should also kind of get the called old type of the liver is well, that's your last upper quadrant. You explain kidney and again you can see the black areas. They're free fluid on there. Abnormal am you trips create and resource For these, there's lots of lots lots of that. He was like there. And lot of American resources are excellent, really kind of that. It's got a doctor sign and pelvic case, which are harder, harder to listen to our C free fluid in. And actually you've got your atomical variances in gender drink a little bit more complicated, but you're gonna do your long acting and short axis. You and the pelvis became looking for free fluid, um, and dip. It's safe briefly a barracks and write the uterus, which is abnormal on their books forms and then on the meals. You're looking kind of where the sound of the basals are. That's normal, um beneficial, larger, darker. That's really it. And behind the water came. So your subject fight or your personal long axis you help you look for any signs of that pericardial effusion Z. And if you're writing a company out, that's where they look up. They can be technically quite difficult to get again. The same age is I'm looking for less. It's, um, play time to say, Take CT will show us what's better. And then, uh, ultrasound of the lungs is part of the extended fast can actually is the one that I would do it more often than Arcus. It's much more accurate and you're looking again. It's hard to show you on a like I'm not gonna try. And he said he was crashed the computer again. But normal, long slide and we'll look like best. And they say it's like a sea shore. And then if you have a new with the racks you get, it's more kind of bar codes. I'm using the, um, moved and then simply have another one. You'll say this light and so kind of out slow walking along is normal. And if you have absent, then you'd be concerned about a pneumothorax. Um, again, not the liver, the point, grams 13 and major hemorrhage protocols with you. There's a nice kind of resource from the European trauma, said Emmanuel. And you know, like of traumatic when you're doing your major hammer transfusion. So, for example, grass it don't forget about it and discuss it a shin. Ideally, you're gonna get 111 ratio for blood platelets and FFP eight, which isn't always possible. And you're going to drop the transfuser is you're gonna split. Your fracture is you're gonna pelvic binder on your tourniquet and external bleeds gonna avoid crystalloid You never weighed hypothermia and damage control. Surgery of a base about Stop any hemorrhage decompress everything needs done. Decontamination and splinting met a regular blood gases to look for signs of a metabolic acidosis. You're gonna avoid it again. They talked about this. And so the way these the constructors a well increased mortality and major hemorrhage. But you may want to use it. Um, if it's a spinal cord injury or traumatic brain injury, that may be important that you use a fan. Your test your clotting regularly, honey. And to keep your platelets about 100 you're gonna get the CT and then calcium. So keep your because the sentry, it's usually the calcium in your transfusion. So you're gonna get 10 miles of 10% on every time when it says native. So this simple is our guys. Just keep all those things and get your face into CT. That's why Why do they want to talk about the taking thing? First of all those things that could go wrong, you're transfusing blood to your pin test runs and your interview patients. You need to be really clear, really calm. Communicate well with your team later on with your other team members. Make sure the sprays right and dying everything you're doing. So when drugs were given what drugs were given the strength? Simple things like if you've been interviewed on the the had rocuronium and then you come back after CT and someone like When was that road? Kevin, This patient's and longer paralyzed Just all those things are really important and not like communication is K. It's the big traumas or so really stressful. They're really a mood of everyone's adrenaline pumping. Everyone's voice gets lighter and lighter and lighter on you can just comes from neck, and it's not well controlled. So about I wanted you to kind of have an appreciation of what every team member was thinking about it and what they're doing. Even if you're not doing that task, be aware that the person on baby's doing something highly stressful. You do eat home team, make their job a little bit easier, and so high function tings have good results on walking away from it. You'll have a much higher kind of satisfaction from your job, and that's May and anything anyone wants to ask. Okay, Oh, case if anyone's gonna questions again if you were getting very minute questions for me, so I am pleased them into the child dinner. Or maybe for me to ask, going from outside thing that was really from 11. I get nicer of overview off trauma. I often think one of the most difficult rules is describe, um, it's a very like calm get quite front, like a noisy and the resource space. So one of the key things is to try and keep. Everything is calm and quiet. It's possible and and it's described, and it's very difficult rule. So one to practice on based on something decide, you know if it's her first time. Dinner is a is a nurse. Um, remember to use the original of trauma documentation, which send resource to document these cases. So no questions coming through s so it's quarter one. So let's take 45 minute break for lunch with the back for half. One. If you can all enjoy lunch and then we fight for half one, we'll get started with the next talk. Thanks, everyone