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Okay, So and this was supposed to really is the last kind of like will Talk of the day on brings us back to something about more kids that were Fairy is well, and we're on span that we better time just talking specifically about a traumatic cardiac arrest. Um, to be fair, heading into northwest next week. That's that's maybe something that we will get. So you have Ah ah, writer. He comes off his bike, he has a cardiac arrest, and he may well be brought to their CD. Hey, are she a should say and another female riders, you know, next week. So I mean, the the other kind of, ah Northwest type type into casualties are more likely to be car t a relapse of going to the Royal, but and the cardiac dresses way might see coming in. Okay, so that's where it's just about every about time going through this. I think it also is really helpful because and I think that when I was a junior and one of the things I kind of worried about, it was just on the way home from work or one day off the boat to stop an accident on but the patients clearly, Dad, But really sure where we stand? Do we have to do CPR? What can we do? What should we do? What should we do? But this time, I should just have a house. Just clarify those points as well. But then they wake up. Today is just, um, go through. Higher priorities are changed and credit dressed when it's very gentle trauma, as opposed to a normal medical cardiac arrests, which one more used to dealing with. Okay, so it's based mostly on this document, which was produced by the Royal College of Expensive and 2019 Have a little of the website if you probably got it. But let's talk. This mostly left the street. Okay, So the premise here is that there are different processes that have Lantus cardiac arrest, and therefore there are different margin priorities, and consultant emergency medicine should be present for old dramatic cardiac arrests. Okay, so, uh, we should we should be present. It's not a small it should be called informed. It's not should find out the next day. It's on. The ampicillin should be present and Racists for ultrasonic cardiac arrest. So please full of some for a survey. Okay, so the first thing is, and those patients that we can just start back. So you stop on the road and you think this is a military, Um, usually just going to talk briefly about the ones that we can we could just stop by from. Okay, So the first start Congress. You are a lot of trauma, A bottle of survival. Okay, They're broken dining. Teo computation are part of the competition Hemi Corpectomy, where at least half of the building is message or separated or exposed. Brain matter. Okay, usar I'm sorry. And that's the context of cardiac arrest if the guy's pretty exposed matter, but the old card, like a rest, and obviously we'll try to resistive book, and they're in gardening. Grass is going smooth cream on it. And I don't need to do I think you need to stop by, okay. They're happy. New signs of life for 15 minutes. Okay, so I suppose that's where he, uh And that's something that has been with, um but the north three. Ondas was living with it and said that the stop breathing 10 minutes ago, when you check them they still don't have any out. But there's a traumatic event, then the produces there is super. If there's been new Bystander Station that you could just stop, Um, finally, if they're any signs of problems cardiac arrest and the signs are one the patent divinity, which is probably for the ones who have been laying overnight for a long period of time. You can then bruising with the discoloration that cells alone a the most inferior part of body that is there. So if you're lying on their back in a week to go towards their by their buttocks and on how the hum of thought we get regular morning, okay, so and if they are stuff on their dad and you can stop Okay, so that got told you that those he might find it might have a little bit of hope about it. So you think these are things that can give you a glimmer that you might have and positive I come? So if they've had any fail signs or signs of life at any time since the first metal contact, that's a good sign. And if they have short duration of cardiac arrest, not means last 10 minutes have cardiac contractility on ultrasound, so we are all set on. If if they've got some cardiac activity that helps, you could sign Really good sign. We generally say penetrate a Z better It comes compared to blunt trauma, although the majority of the trauma is blunt. Okay, so most of our it eases were blocked. And but people who have penetrated trauma, especially if it's thoracic, they have a cardiac arrest. The things you have a frantic a chance of survival compared to the others. Uh, just doing better Thought nobody to read the mobility. We get them left and in terms of medical card, that grass in terms of whether we're it's a shock about non tropical on. Okay, so the contacts of trauma if you find the effort, BT generally tells us that maybe there might be, uh, the atarax that precipitated the trauma. So by that I mean and the patient's be driving along. He's kind of her attacks going to be f um uh I think grasses car. Okay, but it may come as a tropical uh, India. Um, estolate is a very, very per prognostic indicator. That problem callousy that you're Behold the point of overturned and pee a way. Um, a bit more, uh, positive, Uh, vote, actually, majority of pa arrests and trauma productively. Actually, you're a very chronic post its. So what that means is that they're not actually cardiac arrest. We just think they actually come to the folks of the night. I'll be bringing everything. I actually, but, um, the I said in a pulse was completely so when we put the pads on, we can see what looks like it should have a polls on, but they're the ones that we can do better with, because often a refill level was a blood waking gambles. Okay, So Okay. This is, uh, chronic. Kind of priced. I'll get the couples. Are you off that document? Okay, it's it's really just dropped everything that we're on the way and I don't have a job. Pay so and the first that you're so anxious has got mechanism of trauma, uh, off haemorrhage energy. Normally, first is confirmed that cardiac arrest check for signs of life and shape for pulse was on the books. One is our initial lifesaving interventions. We'll see this very different. Teo r l s L A room for cardiac arrest, which is, you know, CPR. Okay, Over help. Puns. So this is not This is progress, then hemorrhage control. Couldn't find her old days observation of maturation. Have Oscar access. Perform my life with our close to my knees. Give rapid, warm blood confusion. Okay, One of that works that because their recess Norco today, especially at this party in trauma and, uh, that brings together tourist. And if you do, um, first time I come because they're transferring to theater for don't feel surgery because they're being suppressors and had a drape push Ross, Kate Warm address the quite go up they cause Ever see the imaging on a range I see drums for Well, it was the right And this orange box is there. Okay, So and you can go back to, you know, if you think it's drying and then going down your normal a rast algorithm, because the cause of that product, rice is probably hypogeusia or me back with me, it's been, uh, the effort you will be at The rhythm is B f. And you think and this is of the primary VFA rest with secretary troll. So you got a full of your Saturday last on? Yeah. And the normal reversible causes that we'll attribute at the contacts of trauma or one eye pokes here from one of our bank of the math. See, be problems hypovolemia from blood loss. Attention with your ex or cardiac company. Okay, so you're pregnant of those to just to tease from a normal for ages of these, they're pertinent. Teo trauma. Ah, highlight of prioritized books, one of dimensions. So those those five things we prioritize, we're gonna prioritize, did not know for sure because that gives us some really good information about the prioritize Get on a CD Defibrillation to be a suppressant. But Nasonex folks is recent Start called, um a Really you're doing that for those two indications the cardiac tamponade and we're a massive, you know, actually, both auras, which we will pick up on with ultrasound on that again it bone that just in terms of a decision to stop and station gonna be guided by the tool dressed of cardiac arrest that there's been a lot of response to those life saving interventions that we've done. Botox one. It's processed in the 100 outside through the result station attempt or cardiac standstill on this. So then we have a problem. Okay, so that's fine. Teo talking straight guys to get plans for a border border. You in these patients arrive. Okay, What we do is prioritizes Feinstein's. Okay, so that's that's what we've been talking about all day today. Really? Eso control that catastrophic extra hemorrhage with Iraq pressure. He must have the dressings tourniquets on or should choose if you if you got help. And we're sure that adequate oxygenation ventilation, the cross traumatic product rest. That means we're entropy in the patient. Get definitive Airway bent a little. We're going to buy that with her costly so as we eventually it. Then we're gonna be leaving on a post pressure ventilation. The machine is pushing the air and you know, to the lungs, and as it does that if there is a small the before I lose folder with writers would get bigger and bigger and bigger. So that's really why would you need about Africa or cost of these and that? That's anticipating that the patients who develop a Tennessee muscle racks purely because we've actually we're gonna minimize internal hemorrhage, and that means a binder all gives a t x A. Uh, we're gonna give him a rapid, warm blood transfusion. That means major damage through go. So the real changes. So things that, you know, this is what we're changing from our normal cardiac arrest and the decision to be made by every day. Consulting. Who's president of the time. Okay, so we made a site military chest compressions. I've been fighting a young person. He's in cardiac arrest because of blood loss. Um, Trask a pressure is not going to help you because the raises, their and cardiac arrest is because they don't have blood to put around your body. The blood is somewhere else. It's know, and the and the veins and the vessels. So therefore, if you're doing transcript, rice is on an empty heart. All your military has caused more trouble to the heart itself and underused team members that could be doing something else with my eyes to help. So we might decide to hold fast compressions until the double. It was five things with previous line, and we made site delay or hold. There's a pressure like ways for the same reason and we might don't give that Ritalin every other focal or every 3 to 5 minutes because and because there's no strictly in volumes of that rental that you're given a sucker set there. It's not leaving around the body. And then once you do get some blood or bored and you get the volume increased bladder and it's all when I had the heart without with a wish on. But you could cause, um, your subepithelial on the skin here it's what that's about. Think. So we may decide not to give that another one for the same reason. We might just decide to delay the fibrillations. So even if they're in a V F arrest and if it's true trauma, they are under Feldene. They're bleeding. Are they? Are they have blood? We might decide not to defend. Really. It's okay, but again, don't get to see just to be made by your heating consultants who stopped with that. No one's gonna have any issued a light if you know the time I get and three in the morning, the team have my sister on it Card. Actually asked by doing chest compressions and give adrenaline. Didn't defibrillation know was going any trouble for that. But these are just things that need a consult. My overall. What? We might be something definitely. Okay, So as a trial, it's very older. Sign. This is one of the Wellbutrin has a great benefit for us and there's really three things are gonna be looking for us. A wonder is contracting, and it's well, how well, as our actually squeezing well, that's even cracked. Open up. Can't we see a bag of fluid off blood to setting around the heart, which is impeding it from moving? So that's that's what happens is a very fine ballin, almost like structures that's around the heart. It fills up with blood, and then it compresses the heart of the heart No longer can confess up between cycles. Um, lastly and degree of cracked. Fine. So how well is is the is really the right atrium. Filling out between between contracts is a large. Okay, so, um, I mean, not the easiest to get most reviews on what we can and then 10 of years. Take attempts that sent 12th freeze free video on, then watch it back on. But traumatic cardiac cracks were really has a great little to play to help us know what? Three. Next. Okay, so wait a little bit. Comes with her colleges on that. After the chart, we talked about cardiac tamponade. A massive, you know, natural chemical rocks. Okay, so what? We have a capsule for company. It's very, very rare. Particularly cystocele being done on the ah, eyes done as ever. Emergency resuscitated, thoracotomy. Um, well, but also improve all if we see that Tampa Now, we knew we could maybe get a tubal out corrected. And likewise, if we see a massive you not for hemothorax, we're going to assume that one of the great vessels is injured. But it may well be, uh, laceration to the lung, which is good. So the timing's here are efforts. Patrons with the patient has been in a shot or stabbed in the chest. And then we say, crack on. If you were then half of a large half in our pantry and drama, You could you could try just if I open the chest. But we should end up having other than 10 minutes of cardiac arrest it possible on if it's from trauma, So rtc Ah, four from hate, uh, that we will consider the procedure if we put little friend on what we see that we have a company on ultrasound and on deaf again, probably for the blocked. Do you want to be the the tablets possible off cardiac arrest. And it's last like to see a student about troubles. Okay, so we're going to do well. Course we'll have against the chest. So and the way this is described to go back, it's like, actually so the way this is described as the chance itself just and it tends to open up. So we have our third cost of the stuff. That's part of our five things that we've done early. Teo, try and correct. Yes, we've got the holes made for a chest. Reines of both sides of the fifth intercostal space. What? Well, and is, uh, joined them up so on. And you could do this for the paragraph. Says he doesn't need to be on it right from the surgery. So yeah, mechanization. A cross between the two lines. And then you cut through the start, um, with a pair of scissors. But I say it's fairly easy to cut through. It's almost about, like a cool I want to do that. The chest itself sort springs up and you can just pull back The chest opens up on your feet, you know, to the heart of the pericardial sac you down to. Okay, so once you once you once you put the paragard outside and then you want to make a T shaped incision, you need Teo. Avoid front of nerve. Which ones? Alone? The heart sank. Ah, um, if you want to make me t c e t a decision on different virus actively conscripted even tomorrow. What about that's causing it and hopefully that will be enough. Teo, allow the heart to start working again. You should have had a lot of things, old background. So you should have, right? You must've had a hemorrhage protocol and progress of blood going in public by neuron. The airway should be intubated, which mentally, in the patient. Okay. And I wish we control getting internal hemorrhage with pelvic. My dramas. Well, if that's the case that what with and there is an internal cardiac massage, it's relative and CPR. You would do and you squeeze out the heart and what we kind of describe. But I've almost like 100 underneath the heart and the other hand on the top, you clap your hands together, Teo, squeeze the heart. Did CPR, But see after. If you don't get that, uh, a shock over 11 and you would still do external defibrillator in with the parts that was normal. And if it's hemorrhoids from the pool from the lung itself can do is you can squeeze the hilum. So that's the part where the connection to the mediastinum squeeze that cut them very privileged mint twist, the whole long run and itself by 1 80 degrees. Essentially, he was just, like, kind of thinking those it should stop and please, I could be able to complete that. Their site probably ground. There's cardiac wind. Is that what we need? But that is, as always, that's actually in the ventricle itself for the heart, and you could be blood squirting over. And what you do is put your finger on the wind, but not in the wood on. If it's better than a centimeter, you can put Foley catheter this year. The catheter in too blow the blood up and then put general pressure, but we don't have to pull up to close off the whole. If I was the case in you put the fully and then you can actually give your drugs and bloods directly into that fully catheter unlimited stripped of the heart and culture vessels. That tends to be well, I mean, it can be a cause of my screening for your X. And if there were, we could just clumped the most with set forceps and or put the right pressure. I'm finally great vessels. So you gonna she go in there and the order is is holding blood are and there's nothing he could do it in the toe defects that allow point You just recognized patients has has died. And it's nothing else that we could do to see if the patient on stage yeah, so then we're gonna get some up, so I screw. That's about it on the cheek. So if you if you do for a colostomy and you managed to get the heart going again and purples, then you need to get on AcipHex toe, get some sedation on board for the patient because you were on them waking up with her heart exposed Mention our stated paralyzed on dealer Best pieces going to do, like are lying central lines and that's least the last weight. Then it did organize transparent the Royal, and then our is. This is a situation that were before going. I'm trying to get their ambulance to come on, but it's not probably, Yeah, but I have are said, it's someone's go out. Don't your job of a of a journey did Belfast back in ambulance. Um, you may get a surgeon here to 10 theater. They start with Detrol surgery or from the cardiothoracic. I used to come up with a clear that you're here today, so we'll be jet and life saving surgery before kind of better. So when to stop. So, as we said, is this card next? I was telling the point of conversation. What about any time there's been no rush was returned it between us putting this regulation. There's been a lot of results to any of our a pack of life sitting interventions, but they're going to process it carbondioxide or if it's been a long duration of cardiac arrest. So those are the times that just just be sensible to stop. Doesn't say you need a consult with a new sessions up with bad. I decided not to toe open the chest ffxf if those things are old. Hell, is this patient smoke months revive? Yes. Okay. Okay. So just to summarize. And there are changed priorities after my cardiac arrest. Uh, those are there, so they all kind of have a baby somewhere then. So palate binder control extra. No bleeding blood provokes breathing. Nothing's and to reinvent, really? It performed last report cost of these, uh, your any consult to be present for all of these. We need to put a parent percent to help guide over day. And we may. It may be a rule for emergencies if instead of thoracotomy a There's tons of that already lateral loss of hemothorax. That's the end of