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Okay, So and let's talk is gonna be just going to be more on the circulation aspect of the primary survey. How about worth again in detail. But what we do there. So what was it before you going to be elevated to certain rules on you'll have predictable while kid Teo do circulation. The first thing about it is started the hands and feet. If they're cold or warm, suppose it could be cool. Cool, because the patient is hypothermic. Or it might be cool because the patient a shot, a shot down on pieces are often hypothermic of the time to get here just because. And they had a prolonged extrication from wherever they have the drama or they've been lying and on call the way around for for a long time. Okay, yes, we started the house. But if they're cool or if they're war, uh, fill up the arm, find that Elavil, which ah, uh, and becomes warm again. That's quite helpful. Way just for us to teach her the patient on, see how they respond to treatment. Really a pulse. If you can feel it, you probably have the pressure or anything. The systolic was helpful for you and think about his character. Is it fast, Freddy? Or is it is it slow and steady? Take a couple refill time s. So just to recap that's holding for five seconds until your blood just the skin And then currently how long it takes for the color to return to normal on last time. Two years normal. Do that with centrally are very preferably on centrally. It was great, helpful again just in terms of molar and reassessing high. The taste is just I responded Today are treatments, then your priorities A are about some of the access on. So really, we advocate that, you know, these places would have at least two wide for cannula on. Come get this now access because patients not going Do you think about your easy Oh, the car lot of lettuce three this morning and the numbers on the ball of blurry or your box from flu rates of bills permanent off of these kind of, uh so you know, there's no point, probably or a controller. And we want to see you again. Up towards the gray or the orange is okay so that you can get get get volumes quickly. Okay, well, it's hard to say if you're not able to get those big, big cannulas. Um, because the basement shot, though Then do you think of it easier things that so So we're finally a Jonathan has been used in there as well, but it's a big heart line and arterial line on more formal training on some, uh, some place that's really helpful, but it wouldn't be your first primary day. That may be something we Diovan later on. Other big thing we think about is can you know, tests off on again? You may not get you a little bit off with their shutdown, so your priorities there are getting across my job because we need to get a sample off before we start transfusion the patient on. Then after after you put it, your cross my system, then you think about a full blood count. I mean, this gas usually has boomed on quite a nation screen. Oh, and a lot of pressure. I can't just go back to toe. That sort of basic problem. Care, which is getting struck by the skin, makes people pressure. Cough is against the schedule. Work locally and make sure Cuff was, well, couple towards the chest. Them again just sort of got no job has touched on that as well. But looking for those to send it make things which might be assigned a cardiac problem. How the next try and so again, with, like, the job giving this distension already on thinking of a little heart sounds a little That's ridiculous. It difficult to hear in a busy recess s so I would put so much we all know on hypertension, hypertension is a funny one. Because of my patient. I know I should be hypertensive, even if they've got a good, good company. And when you see the status is narrowing of the polls pressure, that's a darling of the the difference between your sister look in your little pressures on so that might be not were sold out about warnings to sort of pick up. I'm really it's just about you stopping the thinking on where is my patient bleeding from? Because that's that. That's really what your role and see here is to do. So where is my patient leaving from and oversee? As we said, I started my talk earlier. We've got external and internal. Start with that because it so that you could easily, usually about right there and then it's was really centers over a splitting You want time. Five direct pressure dressings own kind of turn it if you need to on. But if it's that scalp one, that's just holding. But But you may need to get out for a few centuries to throw throw up and just trying to get living to stop for you. I'm a car for board, so we'll start with calisthenics. That's probably that make it the most of these late. Uh, your patient probably will have a pellet I drove from from the prehospital guys and, you know, so, uh, think about public buying there. I think I'm not one of these things that starts is the patient has been transferred. Old are trolling moderate. If they haven't already go pellet by their own, I might put the binder doing on the bad before I put them on top. And just so that once we get them off there and the Vicodin matter is, we could just clotheslined around your pelvis. Okay, but again, it's just that we're trying here. Had to close up a little spike over to try and limit the amount of bleeding into the into hospice going forwards, Much as you can do about that bleeding on the day eso they either get a favor for their exerted is tow. Fix the pelvis or calm, sometimes get intervention. Radiology center there oil. What? I just, I realize off the battles are bleeding, and so that's that's alternative option toe effects of the pelvis immediately. And like the chest and Gianni's all right cover. This is well, just in terms of the methotrex. And so it can, especially every about point off. Do you know, let the A breathing person to start progesterone and we'll tell you have blood rolling. Three. Your bank whiteboard, cannula or your right easy. Oh, okay. So as the same person, you might be food based on that, but But you need to have a week. Have awareness that you're being personal is doing. Do you know that little bit that just until you've got blood running in three cannula? It's okay. Um because if he dreamed up massive hemothorax and he didn't happen overnight of your patient and is liable to just a class with a cardiac arrest on you. Just dump two years of blood into the dream that no time at all that you get yours up to three years, then it's probably tell you to go about it. And then it's really great wall a great vessels in the chest on the only way that basically survive is getting a cardiothoracic surgeon getting a chest open. So again, it's just been aware, you know, trying to be aware of what's going on, but not very. And we could try much as best we can with a major happens protocol. But and as time takes on, that pace will become more quickly with a thick, more acidotic. I'm gonna bleed more or more so, and if that place to go to survive, they need to be on the oil with the surgeon. So come the abdomen and you'll find that your your conditions of eating well, beating fast grams are you, uh, we may decide, noted in the fast kind of city are ready and right with the CT and the patient is stable. To go there with the patient is very often stable. There's about it disappear, But where the base is moving to you. That sometimes just gonna pose the fasting might be enough to get your surgeon toe the direct into theater for you. So it does have body, but it should do a a stable patient on the CT and the diagram in laughter shoes. The areas we we look at with her fast cancer faster is focused Abdominals number for trouble s 01 is have over on the right hand side, right, recorded. That's the view that you can see there on the right. So you've got liver and the kidney, and then you got this black. As for a sliver between them, about is free fluid in the belly. Uh, unless I look at my birthday, which is the left of recorded? Uh, yeah, similar of you, but with sleeping on left today and again, you're looking for that. That sliver of black for free fluid three is a suprapubic gene. When she looked for flutter and the bladder on the number four as a safety started of you and which looks towards the heart for dumping up, you will find the and certain specifications and drama you're eating. And so we'll do your fasting. I'm on the bad side. And because that does have value and start select proportion of trauma patients boxes that before it should know delay your transfer to see Tina Patient is stable to go through this calmer finally, last area that we treat isn't here. Low Bull just said before. Okay, so and a lot of volume dear Thank you, Barbara. So at the last minute high. But it's a patient can lose until outside. And for those we have seen a sort of softer femur fracture before high school. And if I can become and are they how much breathing spaces come a couple days in line? And after, uh, I started, drain the thigh and that's so much breathing really concerned, and you bleed a little of that department we need to adjust. That fracture tried just about bleeding. That splint that's supposed to set before you're going to think about your Kendrick top of slumped. You do need Teo uh, as a pain relief for that. Your paces don't want to order that very, very well, told it, so make sure that patients get some pain relief. Consider an F I block of fascia lack of look stable. You get a splint on and with patients. Yeah, so I don't have the form of stolen trouble trying to death. And so, uh, when I when I take this off the a pls course, I always like them to the Deathly Hallows for my shoulder. And ah, but really, you're going You want me to just looking for this. You will see patients who get the third costume a and then they just have this continue and maybe just for a month or X, But they get this continual lose of blood from the from the site. Give that you haven't started the chest area and or for bones. You take it continually. Use of blood on that's that's extra clinical saying that you've got quite pathic process is going on. You need to get back. Get all of that as early as possible. And this is also why we don't ever, ever give ceiling and trauma okay. And normal saline that will make your patient more acidotic more quite perfect were just there. There are. So I increased them are better than mortality. Well, sometimes I mean, I think it's easy for you for us to say that a cool like a day, and by being in a situation where your blood doesn't hear you've you've activated mention of protocol of the blood has arrived. Yet the patients prior arrest or from a view of the key issue may decide to give them a small bowl of of crystalloid just to tide him over and have a bladder eyes. So, you know, like the patient that cardiac arrest just because you know what to get silly and you can't and seeing if you have the absolute most. But we will. You'll see us try and hold off. We'll off until we get the blood products to get him out. Instead, the blood products won't have the same effect of off your face. Now. I don't think that should help. So in terms of that, you have a pro cold from a talk a shortly to talk that great give previous day as well or better numbers protocol on. But we need to be even for a 1 to 1, the one issue as close as we can. Now you're nobody. Anybody hear that with our current event, have a protocol and but it's one of the one the one of piped red cells to FFP to platelets. I, um, get platelets if you're looking after it. Got if the lab have the hospital is open on site for something else. Better suitable, but otherwise to play. This comes about last. So you're not gonna get platelets for it for quite a long time. But you will get lots of pattern cells on some FFP a safe. But I mean, for one, the one the one issue as quickly as you can. The really important aspect of this is the These are given warmed to pull the temperature. Okay. Did not give these schools, because again, you got to You're trying to death you Do you know what? This patient began getting more. I thermic we say, Well, if you give them a cold blooded arrives, okay. So really What? We warm up, and you could put it three at one of our as food warmers rangers. And sometimes it's just for my kids. Teo three, we top into the circuit. Just that you can't be sure it is through the blood. Give about faster on. Uh, if that's not gonna be quick enough for you that you can use the level of infuser where Soviet Union will have say they were used before. It's something you don't use very often, but this is a device. And when she can essentially load up your products into the two, you containers top there before the side. The special coming set that comes through there being body. Oh, but, uh, it was level your your blood for rapidly on the form. Um, so But you, uh, if you haven't used that before, you need to be asking the years and you're taking tea for your sweetheart. What is this that before your patient is between, like the Catholic using from those woods, Then I think it begins with calcium. You'll you'll hear It's getting calcium in that situation. And I could help again. Just go by. I suppose that, you know, once we've done all of us, are you gonna go back to going to reassess what's going on? What's happened, how the patients respond to what you have done and going forwards. So are there any questions on that one? Yeah,