WEBVTT 00:00:07.880 --> 00:00:10.759 You're in the bay. Once you get over to the bed, 00:00:10.919 --> 00:00:13.560 we'll give you the story. Everything's going 00:00:13.560 --> 00:00:17.339 to happen super fast. Welcome to the emergency 00:00:17.339 --> 00:00:46.700 room. I wanted to get on here. I wanted to touch 00:00:46.700 --> 00:00:50.500 on something. that I believe that most of us 00:00:50.500 --> 00:00:53.320 nursing students, if you are a nursing student, 00:00:54.439 --> 00:00:57.039 kind of feel frustrated about whenever you're 00:00:57.039 --> 00:01:00.439 in nursing school. And this kind of came up yesterday 00:01:00.439 --> 00:01:06.400 after we had a really rough exam in the mom baby 00:01:06.400 --> 00:01:12.719 section of our program. And so it is anticipatory 00:01:12.719 --> 00:01:16.260 stuff, not anticipatory guidance, like in pediatrics, 00:01:16.359 --> 00:01:20.480 but just like the questions of the nurse will 00:01:20.480 --> 00:01:23.219 anticipate this or the nurse will anticipate 00:01:23.219 --> 00:01:27.140 that you know so i want to kind of talk on that 00:01:27.140 --> 00:01:29.819 a little bit so i would like to kind of talk 00:01:29.819 --> 00:01:35.480 about that just a little bit so um it's a trauma 00:01:35.480 --> 00:01:40.519 story and it was a very interesting story so 00:01:40.519 --> 00:01:46.780 um in our particular trauma center we or emergency 00:01:46.780 --> 00:01:51.920 room trauma center. We have our E .R. kind of 00:01:51.920 --> 00:01:54.579 segmented into different sections. And so you 00:01:54.579 --> 00:01:58.000 will have a critical medicine side. You will 00:01:58.000 --> 00:02:01.719 have just a you're not dying medical side. And 00:02:01.719 --> 00:02:05.280 then we have a pediatric emergency center. And 00:02:05.280 --> 00:02:09.199 then we have our trauma center. And even within 00:02:09.199 --> 00:02:12.219 those categories, we have it broken into little 00:02:12.219 --> 00:02:17.039 subcategories like we have like big rooms. And 00:02:17.039 --> 00:02:20.960 then we have just kind of like rooms. And so 00:02:20.960 --> 00:02:26.680 let's just say on the trauma side, the way we 00:02:26.680 --> 00:02:30.120 have it set up is our trauma rooms wanted to 00:02:30.120 --> 00:02:35.460 those Yes, are typically going to be used for 00:02:35.460 --> 00:02:39.280 kind of like holes in waiting to get sent upstairs 00:02:39.280 --> 00:02:43.599 to some type of trauma floor. And then we have 00:02:45.319 --> 00:02:49.400 Like our big trauma rooms which are going to 00:02:49.400 --> 00:02:56.259 consist of three four and then five is our pediatric 00:02:56.259 --> 00:03:01.919 trauma room like OB traumas and pediatric traumas 00:03:01.919 --> 00:03:07.639 under the age of like 16 17 Go into the pediatric 00:03:07.639 --> 00:03:09.639 trauma room and that's where we have like all 00:03:09.639 --> 00:03:12.780 the pediatric stuff the bras low chart You know 00:03:12.780 --> 00:03:17.520 the crash cards dose for pediatrics and obstetrics 00:03:17.520 --> 00:03:22.180 We have a little Wormer thing for the for the 00:03:22.180 --> 00:03:25.599 neonates That way if they come out and we need 00:03:25.599 --> 00:03:28.259 to resuscitate them we can do that or if they 00:03:28.259 --> 00:03:31.879 have trauma we can Work the trauma angle that 00:03:31.879 --> 00:03:37.460 way And so like that right there is all in room 00:03:37.460 --> 00:03:42.439 five. And then you have six, seven, eight, six, 00:03:42.520 --> 00:03:45.060 seven and eight are going to kind of be like 00:03:45.060 --> 00:03:50.360 holds areas. Again, just waiting to kind of go 00:03:50.360 --> 00:03:53.740 up to the floor. And then trauma room nine is 00:03:53.740 --> 00:03:58.659 going to be like a geriatric trauma room, but 00:03:58.659 --> 00:04:03.240 it's getting more and more used. Four different 00:04:03.240 --> 00:04:07.139 things now, too. And then we have 10 and 11 and 00:04:07.139 --> 00:04:11.139 12. Those are specifically for geriatric traumas. 00:04:11.340 --> 00:04:14.599 And then 1314, those are going to be your mental 00:04:14.599 --> 00:04:18.420 health people. So they have no trauma whatsoever. 00:04:18.420 --> 00:04:21.399 They're just looking for attention and probably 00:04:21.399 --> 00:04:25.939 just hot and hungry or cold and hungry. And then 00:04:25.939 --> 00:04:31.420 15, 16, 17 and 18 are also your big trauma rooms. 00:04:32.079 --> 00:04:37.980 And so this story takes place in trauma room 00:04:37.980 --> 00:04:41.959 nine, which is traditionally a geriatric trauma 00:04:41.959 --> 00:04:46.399 room, but it's slowly shifting out of that range. 00:04:47.000 --> 00:04:52.879 And so and this particular story, it is not a 00:04:52.879 --> 00:04:55.540 trauma story. I mean, it is not a geriatric story. 00:04:56.120 --> 00:05:01.930 It's it's a fucked up story. So we It's probably 00:05:01.930 --> 00:05:06.529 nine, 10 o 'clock at night and EMS, HFD, because 00:05:06.529 --> 00:05:09.149 here in my particular county in the state of 00:05:09.149 --> 00:05:12.589 Texas, it's Harris County. The fire department 00:05:12.589 --> 00:05:16.750 doubles up as paramedics before they can even 00:05:16.750 --> 00:05:19.430 go and put the wet stuff on the hot stuff. Right. 00:05:20.430 --> 00:05:25.220 So. And I think if you if you like to watch like 00:05:25.220 --> 00:05:28.120 Chicago fire or something like that, I believe 00:05:28.120 --> 00:05:30.500 like maybe more counties are kind of going this 00:05:30.500 --> 00:05:36.459 way because yes, you know, you need your guys 00:05:36.459 --> 00:05:40.740 putting the water on the fire. But you also have 00:05:40.740 --> 00:05:44.639 like this need for faster response times when 00:05:44.639 --> 00:05:47.459 it comes to like 911 calls and stuff like that. 00:05:47.980 --> 00:05:53.259 And so it just. seems to be a better use of taxpayer 00:05:53.259 --> 00:05:56.720 dollars. I know that firefighters will probably 00:05:56.720 --> 00:05:58.740 sit there and push back on that. But guess what, 00:05:58.860 --> 00:06:01.540 dude, like there aren't that many fires happening. 00:06:03.540 --> 00:06:11.439 So. So HFD, at least in our particular area of 00:06:11.439 --> 00:06:16.459 town, it can be hit or miss with performance. 00:06:16.959 --> 00:06:21.459 And so this one was not the best. And when I 00:06:21.459 --> 00:06:23.759 tell you this story, you're going to be like, 00:06:23.899 --> 00:06:27.459 how did you miss this? And everyone like in the 00:06:27.459 --> 00:06:30.180 trauma bay thought the exact same thing after 00:06:30.180 --> 00:06:34.779 the x -ray showed. So HFD brings the guy am auto 00:06:34.779 --> 00:06:37.220 pad. And if you're not familiar with ER terminology, 00:06:37.500 --> 00:06:41.579 auto pad is auto versus pedestrian. And so the 00:06:41.579 --> 00:06:48.209 guy was riding his bicycle. And He was crossing 00:06:48.209 --> 00:06:50.769 the street. And then I guess the guy either ran 00:06:50.769 --> 00:06:55.810 a stop sign or ran a red light or something and 00:06:55.810 --> 00:06:59.029 get ready for it. Hit the dude going 30 miles 00:06:59.029 --> 00:07:03.209 an hour. OK. He hit the guy going 30 miles an 00:07:03.209 --> 00:07:05.350 hour. Now, if you get hit in a car doing 30 miles 00:07:05.350 --> 00:07:07.269 an hour, it's not a big deal. You know, you might 00:07:07.269 --> 00:07:10.589 get a sore neck if you really, you know, top 00:07:10.589 --> 00:07:13.750 heavy. You might you might have like a severe 00:07:13.750 --> 00:07:19.790 neck injury. But the just regular basis. It's 00:07:19.790 --> 00:07:22.029 just going to be a sore neck, maybe a sore back, 00:07:22.170 --> 00:07:24.509 nothing crazy going on. Even if you get T -boned 00:07:24.509 --> 00:07:27.290 at 30 miles an hour, it's not going to be detrimental. 00:07:27.449 --> 00:07:32.470 It shouldn't be. But this guy was riding a bicycle 00:07:32.470 --> 00:07:35.569 and crossing the street and he got hit doing 00:07:35.569 --> 00:07:42.949 30 miles an hour. Now. He got hit and drug. OK, 00:07:43.250 --> 00:07:46.720 so he got hit doing 30 miles an hour. and then 00:07:46.720 --> 00:07:51.899 drug 100 feet. OK, now to give you an idea of 00:07:51.899 --> 00:07:55.480 how far 100 feet is on the road, whenever you're 00:07:55.480 --> 00:07:58.720 driving down the road and you see the hash line. 00:08:00.579 --> 00:08:03.500 You see the hash lines in the middle of the road. 00:08:03.980 --> 00:08:07.259 Each of those hash lines is about 10 feet long. 00:08:07.459 --> 00:08:09.519 All right. And you're in your car. It doesn't 00:08:09.519 --> 00:08:11.800 seem like it, but each of those hash lines in 00:08:11.800 --> 00:08:15.060 between the road or in between the lanes. About 00:08:15.060 --> 00:08:20.300 10 feet long and so he got drug 10 of those Okay 00:08:20.300 --> 00:08:27.839 So That's the story His pressures were stupid 00:08:27.839 --> 00:08:34.120 soft, okay And so when you get hit by a car I've 00:08:34.120 --> 00:08:37.559 never been hit by a car before but I would imagine 00:08:37.559 --> 00:08:43.759 that if I got hit by a car I would To be pretty 00:08:43.759 --> 00:08:46.940 fucked up and so this guy was his pressures were 00:08:46.940 --> 00:08:50.879 super soft and for you guys who are not Trauma 00:08:50.879 --> 00:08:54.139 or er or maybe not even wanting to go trauma 00:08:54.139 --> 00:08:56.720 or er or listening to this and thinking if you 00:08:56.720 --> 00:09:04.340 do a pelvic fracture is the one of the worst 00:09:04.340 --> 00:09:09.899 injuries that you can sustain It is a big bone 00:09:09.899 --> 00:09:12.860 it's like a pretzel so When you think of like 00:09:12.860 --> 00:09:16.840 a pretzel, like a rolled gold pretzel or something, 00:09:16.840 --> 00:09:20.519 you can't just break one side of it. Right. Like 00:09:20.519 --> 00:09:21.919 if you're trying to break it down the middle, 00:09:21.919 --> 00:09:23.779 you can't just break one side of it, because 00:09:23.779 --> 00:09:26.279 if you do, you'll break another side of it. And 00:09:26.279 --> 00:09:30.279 the pelvis is exactly the same way. And so when 00:09:30.279 --> 00:09:32.899 you start twisting it and moving it like one 00:09:32.899 --> 00:09:35.000 side is going to break and the other side won't. 00:09:35.059 --> 00:09:39.220 Right. And so one of the worst pelvic fractures 00:09:39.220 --> 00:09:42.980 is what they call an open book pelvic fracture. 00:09:43.000 --> 00:09:46.220 And that's when the center of the pelvis is broken 00:09:46.220 --> 00:09:50.059 and flayed out like a book. Now, the significant 00:09:50.059 --> 00:09:53.820 of this flayed out like a book kind of picture 00:09:53.820 --> 00:09:58.240 is that your body is going to dump leaders and 00:09:58.240 --> 00:10:03.580 leaders and leaders of look a minute into this 00:10:03.580 --> 00:10:09.070 cavity now. And so it is a very very life -threatening 00:10:09.070 --> 00:10:13.450 condition and it will it will kill you within 00:10:13.450 --> 00:10:21.169 minutes. Okay, and so Like the guy comes in hit 00:10:21.169 --> 00:10:26.350 30 miles an hour drug a hundred feet and just 00:10:26.350 --> 00:10:31.009 on the surface the this the dermatology the dermatology 00:10:31.009 --> 00:10:35.840 is just fucked because he's got gravel and And 00:10:35.840 --> 00:10:39.379 rocks and stuff embedded into his to his skin 00:10:39.379 --> 00:10:43.019 probably already tattooed if you are familiar 00:10:43.019 --> 00:10:45.379 with the term like usually tattooing doesn't 00:10:45.379 --> 00:10:48.679 occur until after Something's left in the skin 00:10:48.679 --> 00:10:52.279 and it kind of heals over Or if it gets embedded 00:10:52.279 --> 00:10:55.120 deep enough, you know, like it it'll like instantly 00:10:55.120 --> 00:10:59.240 get tattooed So some of this stuff was already 00:10:59.240 --> 00:11:02.419 kind of embedded really really deep and so me 00:11:02.419 --> 00:11:05.970 and a nurse This is like one of the most beautiful 00:11:05.970 --> 00:11:09.970 things that I love about you know working in 00:11:09.970 --> 00:11:14.629 like the trauma setting is We work super super 00:11:14.629 --> 00:11:19.470 super well together like when we just flow amazingly 00:11:19.470 --> 00:11:24.029 well and It's funny because when you look at 00:11:24.029 --> 00:11:26.669 the political stance of both of us of both of 00:11:26.669 --> 00:11:29.769 us like we are completely opposite of what we 00:11:29.769 --> 00:11:33.059 believe politically and probably a lot of other 00:11:33.059 --> 00:11:35.700 things. But when we come together, together to 00:11:35.700 --> 00:11:39.840 work, we work very, very, very well together. 00:11:40.539 --> 00:11:44.639 And so we're sitting there and we're providing 00:11:44.639 --> 00:11:46.820 care to this dude and we get them over to the 00:11:46.820 --> 00:11:50.639 to the stretcher. And it got paged out as a level 00:11:50.639 --> 00:11:53.279 two. So there was no one in the room but me and 00:11:53.279 --> 00:11:59.690 her in EMS. And so in, of course, the trauma 00:11:59.690 --> 00:12:02.649 resident that was in the room. And so we call 00:12:02.649 --> 00:12:05.629 for the chest for the pelvic x ray because there 00:12:05.629 --> 00:12:09.210 was no pelvic binder applied. We call for a pelvic 00:12:09.210 --> 00:12:14.429 x ray. Shoot the x ray. We see a pelvis fracture, 00:12:14.429 --> 00:12:17.450 a pelvic fracture that was so wide that you can 00:12:17.450 --> 00:12:20.190 literally stick a textbook through it. Right. 00:12:20.269 --> 00:12:24.230 That's how wide it was. And so when we saw that. 00:12:24.519 --> 00:12:28.179 This is where that anticipatory stuff starts 00:12:28.179 --> 00:12:34.039 coming in to play, okay? So we see that and all 00:12:34.039 --> 00:12:37.580 of us in the room are like, oh fuck Like it wasn't 00:12:37.580 --> 00:12:40.840 oh shit. It was oh fuck like this dude. No wonder 00:12:40.840 --> 00:12:45.919 his pressures are like 60 over 40 and Like he's 00:12:45.919 --> 00:12:48.799 not able to breathe. Well, he looks pale cool 00:12:48.799 --> 00:12:51.899 diaphoretic and this dude was a black American 00:12:55.060 --> 00:12:58.139 Like like this shit literally just hit the fan 00:12:58.139 --> 00:13:01.500 as soon as that image came up on the screen And 00:13:01.500 --> 00:13:04.100 we knew like we are now running against the clock 00:13:04.100 --> 00:13:08.820 so knowing this What are you anticipating as 00:13:08.820 --> 00:13:10.759 a nurse, right? Like this is where that annoying 00:13:10.759 --> 00:13:13.779 shit on these nursing exams comes up What are 00:13:13.779 --> 00:13:18.820 you going to anticipate right? And so Like I'm 00:13:18.820 --> 00:13:21.019 like I look over at the nurse. I'm not gonna 00:13:21.019 --> 00:13:23.519 say your name. I was like yo like Like I'm going 00:13:23.519 --> 00:13:26.340 to probably start these two large bore IVs or 00:13:26.340 --> 00:13:28.919 do you want me to put a makeshift pelvic binder 00:13:28.919 --> 00:13:33.019 on? She said I'm gonna grab the IVs. I want you 00:13:33.019 --> 00:13:35.419 to go ahead and place a makeshift pelvic binder 00:13:35.419 --> 00:13:38.559 on So I literally just kind of like take the 00:13:38.559 --> 00:13:41.539 sheet and kind of pull it down from under him 00:13:41.539 --> 00:13:44.019 Like because we put like a fitted sheet on and 00:13:44.019 --> 00:13:46.379 then we put like a white sheet on under them 00:13:46.379 --> 00:13:50.779 to act as a draw sheet EMS was still in the room 00:13:51.389 --> 00:13:55.750 They didn't bother bother to help. So thank you 00:13:55.750 --> 00:14:01.309 HFD So I take the sheet from the top of the stretcher 00:14:01.309 --> 00:14:03.850 pull it down to the waist and then I take the 00:14:03.850 --> 00:14:06.289 bottom of the sheet From nearest feet and then 00:14:06.289 --> 00:14:11.590 I shove it up towards now They eat like a lot 00:14:11.590 --> 00:14:15.029 of times in EMS like I'm not a paramedic So I 00:14:15.029 --> 00:14:17.110 try not to rag on you guys too much because I 00:14:17.110 --> 00:14:21.549 don't know like the situation on my When and 00:14:21.549 --> 00:14:23.730 how the like the patient was positioned when 00:14:23.730 --> 00:14:26.330 you put the pelvic binder on? Because when we 00:14:26.330 --> 00:14:28.750 put it on it's in a controlled environment on 00:14:28.750 --> 00:14:33.690 a flat stretcher but You shouldn't put a pelvic 00:14:33.690 --> 00:14:36.909 binder on by the knees. It's not a knee binder. 00:14:36.909 --> 00:14:40.789 It's a pelvic binder So the easiest way for me 00:14:40.789 --> 00:14:43.669 to think of a pelvic binder is you either want 00:14:43.669 --> 00:14:47.690 your? Your closure to go around like over top 00:14:47.690 --> 00:14:50.500 of the genitalia So if you got a guy, you're 00:14:50.500 --> 00:14:52.120 going to sit there and you're going to make sure 00:14:52.120 --> 00:14:54.759 that the securing mechanism is over, you know, 00:14:54.980 --> 00:14:59.639 his penis and his scrotum area. And then like 00:14:59.639 --> 00:15:03.100 for the for the females, it's going to be over 00:15:03.100 --> 00:15:05.779 the vagina. Like, that's kind of like a good 00:15:05.779 --> 00:15:10.899 a good landmark to aim for your pelvic binder 00:15:10.899 --> 00:15:15.919 that the securing mechanism to land. Okay. And 00:15:15.919 --> 00:15:18.620 so I grabbed the sheet I kind of like fold it 00:15:18.620 --> 00:15:20.960 fold it fold it fold it like all the way down 00:15:20.960 --> 00:15:24.059 you know without moving this guy too much and 00:15:24.059 --> 00:15:26.799 Like I like tie it over his dick and then I kind 00:15:26.799 --> 00:15:30.460 of keep moving right and like I'm really I really 00:15:30.460 --> 00:15:34.519 sensed it down to where Whereas his legs were 00:15:34.519 --> 00:15:37.840 kind of like flayed out like a like a rotisserie 00:15:37.840 --> 00:15:41.120 chicken like it was just an unnatural position 00:15:41.120 --> 00:15:44.029 and so like When I tied it, I kind of brought 00:15:44.029 --> 00:15:47.710 them back up to an alignment situation, tied 00:15:47.710 --> 00:15:50.350 it real quick. Everyone starts pouring in wanting 00:15:50.350 --> 00:15:54.149 to know the story. We tell the story when everyone 00:15:54.149 --> 00:15:57.090 starts coming in and we start repeating the story. 00:15:57.330 --> 00:16:01.830 Guess what? EMS just kind of floats on out the 00:16:01.830 --> 00:16:04.110 room, you know, because they knew they fucked 00:16:04.110 --> 00:16:07.840 up. because again who the hell gets hit at 30 00:16:07.840 --> 00:16:11.379 miles an hour and drug a hundred feet and you 00:16:11.379 --> 00:16:14.139 don't think like you don't think that you're 00:16:14.139 --> 00:16:17.299 gonna have some sort of pelvic injury you know 00:16:17.299 --> 00:16:20.620 like because you don't see a broken bone out 00:16:20.620 --> 00:16:22.620 of his leg that you just think like oh it was 00:16:22.620 --> 00:16:25.340 just a clip and then he was good no man like 00:16:25.340 --> 00:16:30.679 you fucked up and so everyone starts coming in 00:16:30.679 --> 00:16:33.559 and then the uh the trauma attending was like 00:16:33.549 --> 00:16:36.149 Why was this paged out as a level two and he 00:16:36.149 --> 00:16:40.450 had the same exact thought that everyone in the 00:16:40.450 --> 00:16:44.809 room had, which was why was this not paged out 00:16:44.809 --> 00:16:49.230 as a level one when you got hit doing 30 miles 00:16:49.230 --> 00:16:53.070 an hour? Now, I'm not a physicist by any means, 00:16:53.409 --> 00:16:58.019 but I'm assuming that. If you get hit doing 30 00:16:58.019 --> 00:17:01.860 miles an hour the energy is not at 30 miles an 00:17:01.860 --> 00:17:04.460 hour I'm assuming that energy is going to be 00:17:04.460 --> 00:17:14.799 closer to 60 miles an hour so Sure, but We I 00:17:14.799 --> 00:17:18.460 get the pelvic binder tied on we secure it and 00:17:18.460 --> 00:17:21.150 me and The nurse like we're sitting there. We're 00:17:21.150 --> 00:17:23.230 running our stuff. We get blood. We get blood 00:17:23.230 --> 00:17:26.190 pressure like she's getting another IV. I'm getting 00:17:26.190 --> 00:17:29.069 a blood pressure on the other arm. You know, 00:17:29.289 --> 00:17:32.569 the the trauma residents calling for a rock and 00:17:32.569 --> 00:17:36.930 a Tomadei. They tube the guy and we start empty 00:17:36.930 --> 00:17:43.549 ping blood immediately. Now a little side note, 00:17:43.569 --> 00:17:46.170 like at our hospital right now, we have a little 00:17:46.170 --> 00:17:49.529 debate going on amongst practitioners. including 00:17:49.529 --> 00:17:54.589 nursing is, you know, whenever you're empty paying 00:17:54.589 --> 00:17:57.369 blood, like, do you use the J loop? Or do you 00:17:57.369 --> 00:18:01.009 just go straight to the IV hub? And the consensus 00:18:01.009 --> 00:18:03.769 is like all over the place, because you have 00:18:03.769 --> 00:18:07.589 the argument of it's the catheter link that is 00:18:07.589 --> 00:18:09.789 going to determine how much blood you can push 00:18:09.789 --> 00:18:12.269 through it. And then you have people that are 00:18:12.269 --> 00:18:14.720 like, well, it's going to be the J loop. you 00:18:14.720 --> 00:18:16.819 know, thickness that's going to determine how 00:18:16.819 --> 00:18:19.980 much blood that you can push through it. Me, 00:18:20.000 --> 00:18:23.420 I'm at the point where it's like, as long as 00:18:23.420 --> 00:18:25.920 you get the damn blood in, I don't care how fast 00:18:25.920 --> 00:18:32.200 it's going. Because we use Belmont, massive transfusers. 00:18:32.500 --> 00:18:35.940 And like you can like deliver like a crazy amount 00:18:35.940 --> 00:18:38.460 of blood in like a short amount of time. We're 00:18:38.460 --> 00:18:41.119 talking about like, you know, don't let me lie 00:18:41.119 --> 00:18:43.599 to you. If I'm not mistaken, it was like five 00:18:43.599 --> 00:18:45.980 liters of fluid in like a few minutes or something 00:18:45.980 --> 00:18:47.940 like that. If that's how you have it set up. 00:18:48.980 --> 00:18:52.240 I don't know, don't let me lie to you. But it's 00:18:52.240 --> 00:18:54.339 a crazy amount of fluid in a short amount of 00:18:54.339 --> 00:18:59.960 time. And so but that there's kind of like an 00:18:59.960 --> 00:19:02.920 inner debate at our hospitals, like, is it the 00:19:02.920 --> 00:19:05.339 J loops fault that we can't get get any faster? 00:19:05.339 --> 00:19:08.599 Or is it the catheters fault? And then a good 00:19:08.599 --> 00:19:11.700 argument is when you look at the IV catheters 00:19:11.700 --> 00:19:15.440 up in their packaging, the longer ultrasound 00:19:15.440 --> 00:19:18.400 guided, you know, catheters, it'll tell you like 00:19:18.400 --> 00:19:24.059 it's like 60, it might be like 60 80 mls a minute, 00:19:24.140 --> 00:19:26.500 you know, for an 18 gauge and then on the 18 00:19:26.500 --> 00:19:31.279 gauges, like on a normal IV, it's like 120, you 00:19:31.279 --> 00:19:34.700 know, something like that, don't like it's something 00:19:34.700 --> 00:19:40.650 crazy like that. Okay. So we start empty peeing 00:19:40.650 --> 00:19:43.190 this dude with blood we get the blood pressure 00:19:43.190 --> 00:19:47.630 his blood pressure on auscultation Was like it 00:19:47.630 --> 00:19:49.470 was still mimicking what the monitor was saying 00:19:49.470 --> 00:19:52.690 it was like 60 over 40 60 over 20 something stupid 00:19:52.690 --> 00:19:58.289 low and so like we run it and then By the time 00:19:58.289 --> 00:20:01.730 that everyone gets into the room to kind of help 00:20:01.730 --> 00:20:08.369 us out me and the nurse For the RN Me and the 00:20:08.369 --> 00:20:10.869 nurse that were in the room. We had already done 00:20:10.869 --> 00:20:13.730 everything So the only thing that needed to be 00:20:13.730 --> 00:20:17.269 done was rock and a tomodate and then like kind 00:20:17.269 --> 00:20:19.970 of get the monitor set up that way we can go 00:20:19.970 --> 00:20:25.809 to scanner and The pelvic fracture was so bad 00:20:25.809 --> 00:20:29.950 that the trauma attending like walks in as we 00:20:29.950 --> 00:20:33.650 have the monitor The brain on the monitor ready 00:20:33.650 --> 00:20:35.250 to go to scanner. He was like you guys are going 00:20:35.250 --> 00:20:42.769 straight to the OR Shit, okay, so Like if you 00:20:42.769 --> 00:20:46.210 work in the OR go to hell, okay And that's all 00:20:46.210 --> 00:20:48.109 I'm gonna say about that because the story kind 00:20:48.109 --> 00:20:52.190 of continues this that that mentality So we got 00:20:52.190 --> 00:20:54.910 this dude like he's literally bleeding everywhere 00:20:54.910 --> 00:20:57.490 at this point, you know, he's not in DIC But 00:20:57.490 --> 00:21:01.769 he just has open holes everywhere bloods just 00:21:01.769 --> 00:21:04.549 kind of pouring onto the stretcher, you know, 00:21:04.769 --> 00:21:07.049 and like we got blood going and we got fluids 00:21:07.049 --> 00:21:09.430 going and like we're hitting them all different 00:21:09.430 --> 00:21:12.549 types of liquid stuff to kind of prop up that 00:21:12.549 --> 00:21:18.609 volume. And so we get up the ORs for us are like 00:21:18.609 --> 00:21:22.569 one or two floors up and we have a special elevator 00:21:22.569 --> 00:21:25.730 dead designated for those types of events where 00:21:25.730 --> 00:21:27.589 we could just hit it hit a button and it goes 00:21:27.589 --> 00:21:29.529 straight to the ORs and that's where we're at. 00:21:31.330 --> 00:21:34.690 so We get we get on the elevator we get to the 00:21:34.690 --> 00:21:38.789 OR and They see they see you guys at work in 00:21:38.789 --> 00:21:42.589 the OR you see us Walk in with this dude that 00:21:42.589 --> 00:21:45.029 has all this stuff, you know, cuz it's like an 00:21:45.029 --> 00:21:51.049 entourage of us coming into the OR and You guys 00:21:51.049 --> 00:21:53.799 want to sit there try to hold us up because we 00:21:53.799 --> 00:21:57.079 don't have a little hat thing on a little bouffant 00:21:57.079 --> 00:21:59.019 and we don't have little booties on. And we're 00:21:59.019 --> 00:22:03.559 walking into your O .R. like, dude, we are literally 00:22:03.559 --> 00:22:08.259 keeping this dude alive with. All right, we have 00:22:08.259 --> 00:22:12.359 literally lactate ringers and blood keeping this 00:22:12.359 --> 00:22:13.839 dude alive. And you're going to sit there and 00:22:13.839 --> 00:22:15.579 tell us you need to grab a bouffant. Get the 00:22:15.579 --> 00:22:19.819 fuck out of my way, dude. So we we get in there 00:22:19.819 --> 00:22:22.420 the whole or team is trying to throw a fit and 00:22:22.420 --> 00:22:24.099 the surgeons like yo We need to get him over 00:22:24.099 --> 00:22:25.539 and we need to get going quit worrying about 00:22:25.539 --> 00:22:27.259 what they're wearing We'll worry about that with 00:22:27.259 --> 00:22:30.900 some vancomycin and I'm like, thank you Thank 00:22:30.900 --> 00:22:33.900 you, you know, like you're gonna throw antibiotics 00:22:33.900 --> 00:22:37.140 at this dude. Anyways, so just throw some more 00:22:37.140 --> 00:22:39.099 antibiotics at him Don't worry about what the 00:22:39.099 --> 00:22:42.680 hell we got going on because he's laying in rocks 00:22:42.680 --> 00:22:46.480 and grass You know the stretcher has literal 00:22:46.480 --> 00:22:53.279 rocks and grass on the sheet so So that right 00:22:53.279 --> 00:22:57.859 there is the story right and The anticipatory 00:22:57.859 --> 00:23:00.500 stuff of hey when you have something like that 00:23:00.500 --> 00:23:04.720 that shows up it shows up in in whatever you 00:23:04.720 --> 00:23:09.140 got going on That's where the nurse anticipates 00:23:09.140 --> 00:23:14.539 this I was anticipating Two large bore IVs. I 00:23:14.539 --> 00:23:18.940 was anticipating fluids. I was anticipating blood 00:23:18.940 --> 00:23:23.500 and I was anticipating on Closing this pelvic 00:23:23.500 --> 00:23:26.339 this pelvis long enough for us to get to the 00:23:26.339 --> 00:23:31.160 OR those were the anticipatory things that The 00:23:31.160 --> 00:23:35.000 doc didn't need to say now that right there is 00:23:35.000 --> 00:23:37.819 where that stuff comes into play in real life 00:23:37.819 --> 00:23:43.490 It's not you know A stupid question always like 00:23:43.490 --> 00:23:47.289 the nurse is going to anticipate, you know, ambulating 00:23:47.289 --> 00:23:49.710 the patient to the bathroom, like it's not it's 00:23:49.710 --> 00:23:52.029 not always going to be stupid shit like that. 00:23:52.549 --> 00:23:57.069 You know, it's going to be, you know, it can 00:23:57.069 --> 00:24:00.710 be not going to be, but it can be. Hey, you know, 00:24:00.710 --> 00:24:03.190 you got this patient, they got hit by a car going 00:24:03.190 --> 00:24:06.029 30 miles an hour and he was drug 100 feet. What 00:24:06.029 --> 00:24:09.430 are you anticipating? It's going to be stuff 00:24:09.430 --> 00:24:14.089 like that. You know, so I just wanted to hop 00:24:14.089 --> 00:24:16.509 on and kind of talk about that real quick, you 00:24:16.509 --> 00:24:20.289 know, because yesterday, like our our cohort, 00:24:20.410 --> 00:24:23.970 we had a really rough pediatric pediatric OB 00:24:23.970 --> 00:24:28.750 exam with a really rough OB exam. And we all 00:24:28.750 --> 00:24:31.190 kind of like walked out of there mad as hell. 00:24:32.029 --> 00:24:36.369 So it just brought up like, man, this anticipatory 00:24:36.369 --> 00:24:38.890 stuff like I know it's applicable, but the way 00:24:38.890 --> 00:24:43.150 that they're using it is not. So I just wanted 00:24:43.150 --> 00:24:45.470 to talk about that as a story and there's like 00:24:45.470 --> 00:24:48.710 a meaning behind it. So there you go. All right, 00:24:48.809 --> 00:24:51.049 guys. Thank you for listening and keep enjoying 00:24:51.049 --> 00:24:52.589 the educational material.