Understanding Face and Neck Injuries

All right, so we are now recording. So we'll be going over Chapter 29, which is face and neck injuries tonight. Face and neck injuries. If everything works out right, I will be able to hook up to the to the screen itself. Maybe make some drawings or something. The past couple of classes, I've been trying to get that done, but life, life got in the way. But this one is not a very, this one's not a very big chapter since it's only face and neck, you know, but there are, there is a lot of things that can happen to the face and neck. A lot of things that can prevent you from making certain life-saving measures or that can maybe open an opportunity for a life-saving measure, quite possibly. We'll learn some tips and tricks and all that good stuff as well. All right, so moving on. See the National AMS Education Standards Competencies. That's all of it right there. All right. So the face and neck are frequently subjected to traumatic forces as they're the most exposed regions of the body, right? So soft tissue injuries and fractures to bones are common and vary in severity. Some injuries are life-threatening. Some are. Many are going to leave disfiguring scars if they're not properly treated. Penetrating trauma to the neck may cause severe bleeding, as you would imagine. And an open injury may allow an air embolism to enter the circulatory system. If a hematoma forms in this area, it may stop. or slow blood flow to the brain causing a stroke. Okay. So like you see some of my strangulation or strangulation, you'll see ligatures or bruising at the neck. And those can actually cause their own problems as well. All right. So to prevent an air embolism and a neck injury, what do you as an AMT, what can you do? Or what should you do? to a neck injury. How would you do that? An occlusive dressing. That's right. A four-sided occlusive dressing. Occlusive dressing. Okay. Remember that. I will seal that. I will seal this up with a four-sided occlusive dressing. Sound like something you might hear on a practical, right? All right. So as an AMT, you're going to your your main objectives or your main job is going to be the prevention of further injury. So particularly to the cervical spine, because we're talking about head and neck injuries, managing any acute airway problems. We'll go over some of those and then controlling bleeding. So there's the anatomy and some landmark areas. see a lot of muscles also some some big arteries and veins right so the principal structures of the anterior region of the neck uh include the the thyroid and cricoid cartilage, the trachea, and numerous other muscles and nerves you can see here. The cricoid cartilage is a firm ridge of cartilage that's found below the thyroid cartilage, okay, as you can see right here. And the cricoid thyroid or the cricothyroid membrane joins the thyroid cartilage and the cricoid cartilage right here, right? Why is it important to know that? Why would you think that? What's important about this cricothyroid membrane? Yep. Cripe pressure, but also what else? Think above your level. Think a little bit above your level, just one level above your level. What that can be used for. Can't spell what other word. The, uh, yep. That's right. And you would use a Cri-Kit for that, right? Use a Cri-Kit for that. All right. So the way you cut, pop it this way or you pop it this way. More of you pop it this way. You go for it. Some training classes they used to teach in like our in our TCCC class. that I took they told they wanted you to cut this way you cut this way I've been in other classes where they want you to cut this way all right I never agreed that it should be cut horizontally like this because if you miss it or you're not in the right spot guess what you got to do you got to come down and make another cut whereas if you cut up and down first off you're going to bring up your chances that you're going to hit that crackle with thyroid membrane. And another one is if you need to go down or up a little further, all you got to do is cut up or down a little further. And it's just one sewing up area instead of several sewing up areas. Okay. All right. Anyway, that's pretty good. Oh, look, I could have just looked right here. There's a bigger picture. I don't know why I didn't see that or pay attention to that. All right. So that crack pressure that you're talking about, what is that for? What is crack pressure supposed to be for intubations? And what, why would we use crack pressure when a patient is what? when their structures are anterior. That's right. They ask for a little crack pressure. What's another maneuver that's used to help with your intubations? There's another term that's used. Crack is one, but there's another move in that same. that same area same area the same style that you actually use does anybody remember this could help you on your ride alongs or what have you so it's called the burp the burp maneuver so uh burp b-u-r-p which is going to be backward upward rightward and posterior pressure on the larynx. Back, up, right, posterior pressure. And that's supposed to help with your anterior patients as well. All right. Moving on. All right. So there's the eye. So the globe shaped, it is globe shaped, and it's approximately about one inch in diameter. It's located within the socket of the skull called the orbit, called that the orbit. The eyes, they're going to be held in place with a loose connective tissue, and then several muscles are going to hold it in place. Therefore, making it pretty easy for it to pop out too. The oculomotor. nerve it innervates the muscles and uh carries parasympathetic nerve fibers so the optic nerve is gonna is it provides i'm sorry the optic the optic nerve uh provides the sense of vision all right so let's talk about the orbit so the orbit itself it forms the base you of the floor of the cranial cavity. Okay. It's direct, uh, directly above it are the frontal lobes of the brain directly above the orbit. So now the eyeball, so the eyeball is also called the globe. It keeps its global shape, uh, as a result of pressure. from the fluid contained within its two chambers. Two chambers. The anterior chamber, you can see there, is filled with a fluid called what? Does anybody remember what the anterior chamber is filled with? Okay, so the anterior chamber is filled with aqueous humor. The posterior chamber is filled with vitreous humor, okay? So one way I used to remember that is anterior, aqueous, A-N-A, and then posterior, vitreous. Posterior meaning posterior. You know what posterior is, but ventral also means posterior. So ventral. And vitreous, V-I-T-E-R-E-O-U-S, for anybody wondering how it's spelled. The white of the eye, what do we call the white of the eye? What is that called? It's called the sclera. The sclera, S-C-L-E-R-A. Do you see the whites of their eyes? All right, so the inner surface of the eyelids and the exposed surface of the eye itself are covered by conjunctiva. Conjunctiva are kept, conjunctiva are kept moist by a fluid called the lacrimal, or it's a fluid produced by the lacrimal glands. And they're often called the tear glands, right? The opening in the center of the iris, the opening is called the pupil. You'll know what that is. So the pupil. It becomes smaller in bright light and larger in dim light. And we measure that, right? We look at that on every patient. So if a person is born with pupils that are not equal, if they're born that way. What do we call that? What is that called? Born with pupils that are not equal. We did. We did. That's right, anisocoria. Anisocoria. Anisocoria. All right, the ear. So the ear is a complex organ that's associated with hearing and balance. It's divided into three parts. The external ear is composed of the pina or pina. However, I think it's pina. You heard me. And the external auditory canal. The middle ear. contains three small bones in it. Three small bones. The malleus, the incus, and the stapes. And then you have the inner ear that's composed of bony chambers filled with fluids. So the, as you can see, the malleus, incus, and stapes make up what's called the ossicles. So injuries of the face and neck can often lead to partial or complete obstruction of the airway. There are several factors that may contribute to the obstruction. So direct injuries to the nose and mouth, the larynx and the trachea are often the source of significant bleeding and respiratory compromise. So because of that, you may need to suction the airway if you're unable to control the bleeding. So some of these injuries may cause the teeth or the dentures to become dislodged in the throat. Always check for dentures. Always check for dentures. I had a doctor in a hospital. I don't know if I told you guys this or not. I may have. I had a doctor in the hospital on my very first intubation as a student. Very first intubation. He calls me in there and he says, he says, hey. P-School student. He's like, I got one for you. So I come in there. He'd already given this patient whatever, knocked this patient down. He said, you ever give a, you ever drop a tube? You ever do an ET tube? Do you need to check off on ET tube? I said, absolutely. It'll be my first one. He's like, great. Come see me. Awesome. So I go in there. I see him. And he there's a patient knocked out. He hands me he hands me the E.T. tube ready to go and hands me the the blade ready to go. And a suction stuck underneath the shoulder. I was like, all right, set me up for success already. So I get down there. I enter in with the blade. And just as I'm starting to drop the tube because I got to. a perfect sight glass. I can see perfectly. I can see the cords, nice, shiny white cords. I'm going to nail this. And just as soon as I go to drop the tube, this woman's teeth go and they fall in. And when they fall in, it jacked me up because then I lost sight. I lost sight of the lost sight of the cords. And then I was, I was already nervous. You know, I was already nervous as all get out. And this doctor starts laughing and he's like, oh, sorry, I'm sorry. He's like, I'm sorry, I'm sorry. I had to do it. He said, I knew she had dentures. And he's like, I should have told you, I guess. And so I reached in, I pulled the dentures out, set them aside. I went back in and I could not find them cords worth of crap ever again. And I ended up missing the tube when I thought I saw the cords or when I thought I was straight on it. Cause I would now I'm all flustered. He jagged me up my very first ET tube, but I got to make it up later on that day anyway. So, uh, sure enough. Dr. Marsh. Dr. Marsh. He was at Garden Park back then. He had long hair and a ponytail. So swelling that accompanies direct and indirect injuries to the soft tissues can also contribute to airway obstruction. The airway may also be affected when the patient's head is turned to the side, right? So it's possible that injuries to the brain or cervical spine may be associated with facial injuries as well. If the great vessels in the neck are injured, significant bleeding and pressure on the upper airway are often common, very common. So depending on the injury or MOI, there may be a cervical spine injury as well included. Make sure you're looking. That looks like it hurt. All right. So soft tissue injuries of the face and neck are very common. The face and neck are extremely vascular, so you'll get a lot of blood swelling in this area. It may be more severe because of all the airway and everything else. And then also, you know, you got the eyes, it being so vascular, the swelling is going to really take effect. So even a... minor soft tissue wound to the face and neck may bleed pretty profusely. A blunt injury that doesn't break the skin, it may cause a pretty big hematoma. And the presence of that hematoma may suggest a potential for more severe injuries. So pay attention. So always make sure you maintain a high index of suspicion when closed soft tissue injuries to the face because of the risk of airway compromise. It's it's a far greater consequence in this matter. And also remember, also remember that blood is a gastric is a gastric irritant. So if they swallow too much blood because it's in their mouth or nasal area or what have you, and they swallow it. they may vomit. You may end up with a little bit of emesis on your hands, figuratively and for real though. So facial fractures occur when the facial bones absorb the energy of a strong impact. The magnitude of force... required to fracture the maxilla. It'll produce closed head and cervical spine injuries. When assessing a patient with a suspected facial fracture, you want to protect the cervical spine and monitor neurologic signs, specifically the level of consciousness. So some general signs and symptoms of facial fractures are going to be your deep facial lacerations, pain over a bone, ecchymosis or bruising, swelling, pain on palpation, crepitus, the misalignment of teeth. Can you hear me now? What if I do this? Can you hear me now? Is it just your phone? Can everybody else hear me? You know better than that. I really don't know. I really don't know Brian Beach that well. Yeah. Yeah, I got this fancy microphone here that I use. I don't know if y'all have ever seen it off to the side there. I can get as close to it. Or I can come far away or I can talk however I need to on it. It's supposed to be fancy. Supposed to anyway. I've never really messed with it enough to mess with the settings. I'm sure if I did, I'd probably get a lot better quality sound. But I know that if I... If I mess with it, I'm liable to jack it up and then you won't be able to hear me, period. So I don't mess with it right now. That's that was unnecessary. And that's why that was unnecessary. All right. Moving on. So we'll go over some more pathophys, characterized by swelling. So, sorry, the nasal fractures, it's the most common facial fracture. It's characterized by swelling, tenderness, and crepitus when the nasal bone is palpated. So deformity of the nose, if present, usually appears as a lateral displacement of the nasal bone from its normal midline position. So somewhat that way, right? And it's often complicated by the presence of anterior or posterior nosebleeds. Or what do we call, what is another word for nosebleed? What's the medical term for it? epistaxis. Awesome. And whenever we treat a nosebleed, how do we want to position the patient? With their head leaned back and the bridge of their nose pinched or how? Forward. Awesome. Yep. That's it. That's right. Face forward. Yep. And possibly suction. I don't know if I still have a patient picture of a patient that I had at one point. The eyes were blacked out and everything. It was a it was a picture that I used. It happened. It happened while working. But I got the picture set up to where I could use it for teaching. There was a guy that had taken a 40 caliber and tried to he tried to off himself. Tried to commit suicide and it blew this part of his face out. Just boom. It just blew out right here. This whole this whole area right here blew out or actually like this. Has anybody ever watched Stranger Things? Dude look like a Demogorgon. You can see his eyes. You can see his eyes. But this this right here to right here was just gone. OK. So he was still awake, still awake when we came in, feeling all over the table for the pistol. because he fired it and he dropped it. So we got there along with the police officers. He was still looking for the pistol or something. And of course he can't hear you because he just had a, he just had a 40 caliber pistol, you know, right next to his face. So go off right next to his face and blow his face up. So he really couldn't hear you that well. But all we really had him do is, you know, I looked. And you could see, yeah, we got there really quick. I looked and you could see the, I knew he was breathing because I could see the bubbles. You know, I could see the frothy bubbles coming from his neck hole. And at that point I was like, okay, he's breathing. He's breathing normally somewhat. And so all I had him do was take the, I took, wrapped his eyes up and everything to put his, try to keep his head together. And his neck hole and then wrapped it, wrapped his eyes up and all that, and then handed him the suction device and then yelled in his ear and said, when you feel like when you feel like there's a lot of blood, just suction your neck hole. And that was about it. And I let him hold that all the way to the hospital. And he he did that all the way till we till we got to the hospital. But very survivable. But the reason why it blows out, too, is because there's a lot of sinuses right here. And it's like balloons. That's why the fractures of it are so traumatic because of all those sinuses in your face. So you get some high trauma. Yeah. Yeah. And he was, he was fine. He ended up surviving and they were able to close it up because we had him as a patient again, but they were able to close him up, get him sewed up and everything else. And he looked, uh, not, not normal, but, um, you know, he was normal shaped. Yeah, this one, he did not. He never coded. He was sitting up. He sat up the entire time. There was a time we were running a lot of those. In Poplarville, we ran a lot of those at one point back in. 09, 08, maybe 07, 08, maybe. But it was a, there was a lot. All right. So mandibular fractures. So second only to fractures in frequency. Typically it's a result from a massive blunt force trauma to the lower third of the face. And it's common following an assault injury. All right. What's up, Matt? you had a story i thought you had a story no i don't have a story i just clicked something and it went crazy your mic opened up gone now yep so uh The fracture site itself is most commonly located at the angle of the jaw. Okay. And it should be suspected in patients that have a, with a history of blunt force trauma to the lower third of the face, you know, popped. Somebody got hit, got punched. Numbness of the chin, malocclusion, something like that. inability to open the mouth, that can be all signs for it. So point tenderness and pain on motion can identify the injury that patients might not have otherwise reported. All right. So maxillary. Maxillary fractures occur with mechanisms that produce massive blunt facial trauma. So what we call those, you see here, they're Laforte, Laforte fractures, and they're classified into three categories. You have the Laforte 1 fracture, which is the horizontal fracture of the maxilla. Okay. right here, right across here. It separates the hard plate and the lower maxilla from the remainder of the skull. You have next, you have a Laforte 2 fracture, which is going to fracture. It's a fracture involving the nasal bone. And then the inferior maxilla, I'm sorry, come right here, and it's going to come down, and it's going to come right here, right there in the tear area, almost like the tears area. Okay. And then next, you're going to have a Laforte 3 fracture, which is a craniofacial disjunction. craniofacial disjunction, no MPA. You'll be directly oxygenating the brain quite possibly if you try to MPA that. Direct, direct cranial oxygenation. That's going to be so a Laforte 3 fracture craniofacial disjunction. That's going to be a fracture of the mid facial bones. OK, so coming across here. All right. Separates the entire mid face from the cranium. So Laforte fractures can occur as isolated fractures like a Laforte 1 or in combination. As in like Laforte 1 and Laforte 2. So Laforte 1 and 2. It's depending on the location of the impact and the amount of trauma that you've had. All right, so orbital fractures. An example of that would be like a blowout, what's called a blowout fracture. Some signs and symptoms of that can be double vision or diplopia or diplopia. and then the loss of sensation above the eyebrow or over the cheek. It may cause the patient to have a reduced sensation to areas that are innervated by the infraorbital nerve. Awesome. All right. So as you can see here, massive nasal discharge may occur and vision is often impaired. So it's going to be quite nasty and it can cause paralysis of the upward gaze as well. I'm going to get my wife to buy me a new chair for Christmas. I want to get robbed to buy me a new chair for Christmas. The zygomatic cheekbone fractures. So a common result from blood force trauma and MVCs and assaults. So some signs and symptoms of this are going to be the side of the patient's face is fractured, appears to be flattened, loss of sensation over the cheek, the nose and the upper lip, paralysis of upward gaze as well. So some associated injuries and conditions can include. Orbital fractures can associate with this. Ocular injuries. And, of course, our favorite, epistaxis. Dental injuries. All right. So fractured Niveau's teeth are common following facial trauma. Dental injuries may be associated with mechanisms that cause severe maxillofacial trauma, or they may occur in isolation. Always assess the patient's mouth following a facial injury. You want to make sure there's no teeth in there or anything that can create an airway obstruction. So we want to make sure that we can remove that if we can, what have you. And then if they're well-fitting dentures, leave them in place. Yeah, if you can give them a tug and they're not moving, you may be good to go. But by Lord, I'll tell you that if you can tug them and they move, you may want to snatch those bad boys out. All right, patient size up or scene size up. All right, something I see different here is, you know, with these facial injuries, is making sure that you bring along with you several pairs of gloves in your pocket, in your pocket, because it is quite a messy scene sometimes. So you may be changing out gloves often. So your main focus is going to be to identify on your primary survey and managing life-threatening injuries and also make sure your suction is ready. Make sure your suction works, charged, ready to go, micron filter in place, bucket in place, lid in place, everything put together. It's crazy. Some people don't get it. All right. So remove, remove teeth fragments. We already talked about that. So with this, so with this, just know that. It is quite controversial to use a nasopharyngeal airway in these type of injuries, though it should not be used in any patient with suspected nasal fractures. Definitely want to make sure that you assess for adequacy of breathing. Get you a good sample history if you can. Check for the good old DCAT BTLS. You want to perform a full body exam. Ensure to control. Make sure that bleeding is controlled. Look for any type of deviations or any type of foreign matter. Look at the pupil. Make sure they're equal in size and reactive to light. Also, cataract surgery may cause unequal pupils as well. Don't forget about that. Also, you want to check to see if a patient has the ability to follow your finger. You're not giving a sobriety test. You're trying to make sure that their gaze, where their gaze is. Check that manual blood pressure. Get you a BCG. BG. BCG blood glucose. Yeah. CBG. CBG. Losing it. I have to go back to the county, start working again, get back on the truck. Reassessment, check and recheck, right? Check and recheck. Make sure you document correctly. So soft tissue injuries, want to make sure we assess our ABCDEs and care for life threats first, right? Depending on what's going on, we may want to consider using the jaw thrust maneuver to open a patient's airway and then suction the mouth. Boom, tufas. He got some tufas problems right there. And you can almost see his thoughts, some white skull right there. So like we talked about avulsions before, if you can. kind of slap it back in place wrap it up so moisten that stuff down with saline if it's uh if it comes apart you got big chunks of it put in a plastic bag cool temperature it's just like an amputation right don't don't place it directly on ice all that good stuff Make sure that you label it with the patient's name to the ED along with the patient, bring it along with the patient. Injuries to the eyes can produce lifelong complications. So abnormal pupillary reactions can sometimes be a sign of brain injury rather than an eye injury. So keep that in mind. So you don't want to aggravate any problems. Look for any specific abnormalities or conditions that may suggest the nature of the injury. Look for foreign objects. So the orbit protects the eye from penetration of large objects. Moderately sized and smaller foreign objects can enter and cause pretty good damage. And the eye heals very fast. So it can get something in it and then it heal over it pretty quickly. So if the conjunctiva becomes a flame and red, you get a condition known as conjunctivitis. Itis meaning inflammation, irritation. And at that point, once you get that, the eye is going to try to produce tears and attempt to flush out the object. And then irritation of the cornea and the conjunctiva, excuse me, it can cause quite severe pain. So something to think about is that irritation is aggravated by bright lights. So a patient may have a difficult time keeping their eyelids open. So you may want to dim out your truck back there. So sometimes a foreign body, it's going to often leave a small abrasion on the surface of the conjunctiva, which is going to cause its own problems. Hey, look at that. We see it again. Man, that just must have been popular. That was Andy, right? If there's only one eye infected, you want to take care to avoid getting contaminated water into the unaffected eye. So you want to make sure their head's leaning away, right? You don't want to get anything in there. So you want to flush from the inner corner of the affected eye towards the outside corner. If the burn was caused by an alkali or a strong acid, you want to irrigate that eye for about 20 minutes. That looks nasty, man. That's terrible. These are chemical burns to the eye. There it is there. So thermal burns during a fire, the eyes will close to protect from heat, may lead to a burning of the eyelids. You can see there, it's going to require very specialized care. It's best to provide prompt transport to that patient because there's going to be a lot going on. You want to cover both eyes with a sterile dressing, moistened with sterile saline. And you may apply eye shields over the dressing as well. Over the dressing. So some light burns, light type burn, light burns. So infrared rays, eclipse light, laser burns, it can all cause significant burns to the eyes, especially if they become focused on the retina. So retinal injuries caused by exposure to extremely bright light are generally not painful, but may result in permanent damage. So super... superficial burns of the eye can result from ultraviolet rays. from an arc welding unit and light from prolonged exposure to a sun lamp or reflected light from a bright snow covered area can also cause it. So these are at the time, yeah at the time it may not hurt. but about three to five hours later is going to hurt. All right, so lacerations of the eyelids. So it may require a special repair, careful repair. So I'm gonna go ahead and say that we can't do it. Heavy bleeding, it can be controlled by gentle manual pressure. If there's a laceration to the globe itself, Apply no pressure to the eye so compression can interfere with the blood supply to the back of the eye and result in a loss of vision. You don't want that. It also may squeeze the vitreous humor, iris lens, or retina out of the eye. You don't want that either. So you don't want to ever exert pressure or manipulate the injured eye or the globe in any way. If a part of the eyeball is exposed, gently apply a moist sterile dressing to prevent from drying and then cover the injured eye with a protective metal eye shield. So dressing first then eye shield. His eyeball done popped out. Well, that's not even an eye injury. That's a brain injury. Looks like it. So blunt trauma to the eye. The injuries can range from ordinary black eye or a severely damaged globe. So hyphema. So hyphema is, you see it there. is bleeding into the anterior chamber of the eye and obscures all or part of the iris. Okay. You can see there on the picture on the left. So it may, it's common in blunt trauma and it may impair vision. So in this instance, something that you can do is elevate the head to of the backboard to approximately about a 40 degree angle to increase, to decrease the intraocular pressure. So elevate the head of the backboard approximately 40 degrees. And then you want to discourage the patient from doing anything that may increase intraocular pressure. Like messing with it. Orbital fractures, we're talking about that paralyzed gaze, upward gaze. There she is right there. And then you want to cover the other eye to minimize movement. Retinal detachment. It's a possible result of a blunt eye injury, the separation of the inner layers of the retina from the underlying choroid. And it's often seen in sports, especially boxing. It's painless, but it produces flashing light or specks or floaters in the field of vision and a cloud or a shade over the patient's vision. So this requires urgent medical attention if that. That happens to preserve their vision. All right, let's find this is a good stopping point right there. one blowed out pupil and let's take a 10 minute break while y'all are y'all's 10 minute break uh take a look at your calendar after monday october 11th so look at your calendar and your schedules and start thinking about who you want to do your ride alongs with and then start scheduling out for after the 11th of October. So we're going to look we're going to look at that and that's why I want to get everybody into FISDAP. That gives us a couple ways to get everything set up get your thought process set up within the next one or two classes though. We want to make sure, I'm hoping by Monday, that we can get some hard dates and who or what service you want to ride with. So we can make sure that it can happen. Welcome to Disney Plus. Who Plus comes on all your screens. Who Originals. I was telling them to start thinking about their ride-alongs, what service you're going to ride with, and after October 11th, we'll be scheduling. So start making your schedule for after October 11th. Yep. And we want two. I want to see two dates. Two dates at first for the starting point. Just two. So start thinking about that while we're on our break. And once I get this figured out, I will be able to put y'all on break. And away we go. Yeah. Thank you. Thank you. All right, continuing on with injuries to the eyes. Blast injuries. So some signs and symptoms of blast injury range from severe pain and loss of vision to foreign bodies within the globe. Before responding to a patient after the blast, ensure the scene is safe, of course. And then management of a blast injury to the eye depends on the severity of the injury. If a foreign body is embedded within the globe, don't attempt to remove it. Use a clean cup or a similar item to protect the area. And then if only one eye is injured, follow local protocol for that. So this may include covering the other eye to eliminate sympathetic motion. Patients with a sudden loss or a decrease in vision, they'll need verbal instructions on which actions are taking place around them, okay? So if the patient has a severe swelling or hematoma to the eyelid, don't attempt to force the eyelid open to examine the eye either. So it's talking about contact lens artificial eyes, hard or use a, there's a small suction cup with a moistened end with saline to possibly get that hard contact lens out. To remove a soft lens, you want to place one or two drops of saline in the eye to get it all moistened up and then pinch the lens with your gloved thumb and index finger and then lift it off the surface of the eye. huh All right. So nosebleeds are categorized based on the bleeding area. One of the most common causes is digital trauma. Okay. So their nose, you have an anterior, anterior nosebleed usually originate from the area of the septum. And the bleed is fairly slow. So it's usually self-limiting and resolves pretty quickly. Posterior bleeds are usually more severe and often cause blood to drain into the patient's throat. So trauma to the face and skull can result in a basilar skull fracture, which often cause posterior wall of the nasal cavity to become unstable. and cause vomiting. That's right. Attempting also to place an MPA or a nasal pharyngeal in an airway with a suspected basilar skull fracture or with a facial injury is relatively contraindicated in the presence of a mid-face trauma. One way to do that, you can do the same thing with the with the halo test right so in this picture it shows two chambers uh two chambers of the nose divided by the septum each chamber is going to be composed of layers of bone called the turbinates And above the nose are the frontal sinuses. And on either side, the orbit of the eye. Orbit of the eye. There's Epistaxis. We're not going to beat that dead horse. We already did it. Some tips and tricks for ear injuries. So if CSF drainage is suspected or is noted, then you want to apply a loose dressing. So all foreign bodies should only be attempted to be removed by a physician in the ED. Not by you, by a physician in the ED. Don't try to manipulate the foreign body because you may press it further into the auditory canal and cause a perforated or perforation of the tympanic membrane, the eardrum, and you don't want that. That don't look good. That's what I was trying to figure out. Looks like a, that's a strap. That's a strap there, I know, but I don't know. but from I can't tell. Try to look at it from the side see if I can make a make recognition what it is. They need like a little caption or something down here. It'd be a ratchet strap. So whenever you tighten that ratchet strap down on your truck and you reach up there and you shake it to say, you know, in dad fashion, that ain't going nowhere. You may want to watch it because if it does go somewhere, it's going to go in your forehead. Yeah, I see the stitching. All right, moving on. So facial fractures alone are not acute emergencies unless they're serious bleeding. Old boys jacked up teeth. Uh, so remove and save any, any loose teeth or bone fragments in the mouth. You want to remove any loose dentures as well to protect from an airway obstruction. Yep. He's going to be messed up for a while. That's going to hurt. Oral and dental injuries. So it's commonly associated with facial trauma as well. So these injuries can affect everything from eating to smiling. So you want to keep that in mind when you're providing that patient care. Try to be as careful as possible. Always suspect airway compromise that could be soon happening with any of these. Keep suction nearby as well. So as you can see there, suction the airway for 15 seconds and provide ventilatory assistance for two. minutes. You want to suction on the way out, right? Leave any impaled objects in the face, properly stabilize them if you need. Injuries to the neck, injury to the neck is serious, it's life-threatening. Talked about that earlier, what the bruising could mean. Biggest thing you don't want is the leakage of air into the soft tissues of the neck. So subcutaneous emphysema, got a crackling sensation. produced by the presence of air in the soft tissues of the neck. If you feel it when you're palpating the neck, maintain the airway as best you can and transport immediately. Because that means somehow they're getting air that's not going into, they could have a tracheal tear or something like that. to lord So primary threats from penetrating neck trauma are massive hemorrhage from a major blood vessel disruption and airway compromise, secondary to soft tissue swelling. Penetrating injuries to the neck can cause profuse bleeding from a laceration of the carotid arteries and jugular veins. Injuries to the carotid arteries, jugular veins, and the neck. can cause the body to bleed out. So this is, this is what we call it. So they call it a phenomenon known as exsanguination. And that's when it just sprays out. Insanguination, they just bleed out from injuries in the neck. So one thing that always something to think about with neck injuries, the possibility of a fatal air embolism. So a large amount of air entrained into the right into the right atrium and the right ventricle of the heart can lead to a cardiac arrest pretty quickly. So you immediately want to seal that open neck wound with an occlusive dressing. and then use caution to avoid constricting the vessels and structures of the neck as well while you're doing that. And then be alert for any expanding hematomas or swelling. high flow oxygen vascular access y'all know the drill laryngeal injuries laryn laryngeal injuries literally yep you know so blunt force trauma to the uh larynx can occur when you have an unrestrained driver striking the steering wheel. Less likely around here, it says a snowmobile rider or an off-road biker strikes a clothesline or a fixed wire or somebody running and strikes a clothes wire or a fixed wire. The larynx, it becomes crushed against the cervical spine and this results the soft tissue injury fractures and or separations of the fascia. So again, don't remove anything. You don't want to do that. We had a patient sometime back that he was a murder suspect. He was a murder suspect, and he tried to kill himself and took a shotgun. right about here blew a hole blew a hole in his own in his own neck right boom i'm talking about all the way through uh and uh we're pretty sure what killed him is you know somebody i saw you can't put a tourniquet there so when you can't put a tourniquet on profuse bleeding what do what do we try to do junctional It's a junk. They can say it's considered a junctional injury possibly. And you may want to try and stuff it with the hemostatic dressing. Well, they did. They stuffed the gunshot wound in his neck with hemostatic dressing, which he could have probably survived the shotgun wound. It was clean. I mean, you could fit a half dollar. You fit a half dollar. He's perfectly circular. He may have actually somewhat survived it had it not been for the fact that somebody, a police officer, had tried to stuff hemostatic dressing into it and, of course, stuffed it into his airway at the same time. So he didn't quite make it. I'm not saying that's what killed him, but it sure didn't help. It happens. So there's all the signs and symptoms for larynx injuries. All right, so to manage a laryngeal injury, so esophageal perforation can result in what's called mediastinitis. So think mediastinum and then itis, mediastinitis. It's prudent. to ask the patient to refrain from speaking to allow the vocal cords to rest and recuperate, right? So the patient should avoid shaking his or her head when responding. So make sure you announce that first. Your primary focus when caring for a patient is always to treat the most rapidly fatal injuries first, right? So to manage this injury, you're going to provide oxygenation and ventilation. preferably with careful two-person bag valve ventilation. Apply a C-spine immobilization, cervical immobilization at this point. We know what that is. Completely immobilize it. Avoid the use of a rigid collar. That's when you don't want to use a C-collar. Create issues. And then be alert for the need of frequent suctioning. Don't delay any transport. And then it's going to need immediate surgical intervention. So you may need to get a paramedic rendezvous for advanced airway management, especially if the patient's apnea. All right, Ben. So muscular injuries. In response to strains in the neck, the muscles contract as they attempt to support the neck. Maintain a high index of suspension, suspicion for cervical involvement in this, in this instance. So a strain, a strain is a stretching or a tearing of the muscles or the tendon. The most common form of cervical strain is also called whiplash. I've heard of that. Although whiplash is rarely life-threatening, morbidity can occasionally develop in the form of persistent and chronic cervical pain. So, recommended transport patients to the ED to get x-rays or CTs and take a good look at that. And then you want to assess for any visual signs of soft tissue trauma as well. All right. So it's essential to check for distal pulse and sensory and motor function before and after a full body splint. If you have to do that for muscular injuries and then document all your findings in your patient care reports, document them up. Injury prevention. So helmets, face shields, mouth guards, safety eyewear help to prevent injury, right? There have also been many advances in motor vehicle safety, better occupant safety, restraints and airbags help to prevent all that good stuff. All right, let's end this. All right, so do we have any questions about any of that? We got the test out there today or this evening. Other than that, does anybody have any questions about what we went over today? No. OK, if not, then I have your code here for tonight's test. Your code is going to be five, six, five, six. Five, six, five, six. That is correct. But what I did want to talk about was. Does everybody know who they who they plan on writing with? No, I did not. Can I do my ride alongside with anyone? Hold on right quick. Hold on. Slow down. Trying to see. All right. Who's in MMC? Break that down for me. They have an ambulance service because apparently we're not doing any hospital rotations. I did not stutter. We're not doing any hospital rotations. Yep. COVID-19. COVID-19. Ralph, have you thought about Acadian? Okay. And Ty, you doing AMR or AAA? Which one you going to do? Or who? It don't matter. If you want to do Acadian, you do that too. Maybe George County? I don't know. And Jody's going to be your preceptor the whole time. yep that's it that's what rob said rob said that's who your preceptor has to be no questions or or you shall not pass uh cole so Can you use your employer if they don't pay me? I don't know. That's a good question. Who's your employer? No, I'm talking about Cole. We got to see if we have something set up with them first. So Cole Ladner, who is your employer? Where is my... Where are they out of? All right. Oh, I'm writing all y'all's names down. You know, I'm a fireman, so spelling isn't my strong suit. Ralph, do you ever work with the Louisiana State Fire Marshal's office any? Okay. Just curious. All right. Who else we got? We got Matt Wade, AAA for you. Okay. So, so far I have Cole, Ladner, Ty, Ralph, and Matt. Who am I missing? Torrance. Amen. out of gretna i just have to check um all right miss genevieve you still there lost her all right who else we missing that's one two three four five six who else am i missing seven miss church and hannah I'm missing Hannah. All right. So what I'll do is I'll, uh, she does. Okay. I'll check on those for, uh, for church. So AMED or West Jefferson. Um, and I'll check on AMR for Hannah as well. Shouldn't be an issue. Oh, boy's getting in trouble, getting in trouble. All right. So right now, correct me if I'm wrong. I got Cole Ladner, Medivac International, Mobile. I got Hughes, North, North Mississippi Medical Center in Tupelo. I got Walker with AMR SMS or AAA with Jody, Jody only. I got Ralph with Acadian. I got Wade with AAA. I got Torrance with AMED or West Jefferson if we can't get AMED. I got Hannah possibly AMR. I got Genevieve Church AMED or West Jefferson possibly. Does that sound right? That I don't know yet. That I don't know yet. And I asked that question. And since this is a deal where we're not doing it because of COVID, we're having to see how many rides we're going to get. What I want to try to get up in the near future before the 11th, like the 11th should be one of the start days. So if you can get days from your people, that's fine. So AAA does have an onboarding process, but you can do it whenever you get there. Acadian has an onboarding process right now. they so Acadian has an onboarding process that you'll have to do beforehand um I don't remember who it was we had a few people that there was a someone else that wanted to talk to us at some point if that or likes to talk to them you won't be able to do October the whole month You can't do it in Alaska? Like they don't have any other possible ways of doing it? No, not on the clock. Okay. So, so yeah, so we'll just have to check and make sure, and I'll get back with everyone as soon as possible. That shouldn't be a big issue. But we'll get Cole figured out. We'll get you figured out. No problem. Just remember that, you know, November is when we're ending the class. So. Let me get back with you on this, figure this out, and then we'll tackle that out. Sound good? Okay. So we want to make sure that everybody gets on FizDap. Lawrence and Ralph, as soon as y'all get on it, send me a message in Discord or on email or on Navigate or whatever. It doesn't matter. Send me a message saying that you're on it and then I'm going to try and get everybody set up. They were going to do paper. It was going to be it was going to be paper stuff where we have to do our all of our documentation on paperwork and everything else. Um, but then after we get FSDAP up, then they wanted to then transcribe it over rather than do that. Um, okay. Rather than having to do all that, I would like to get it set up here pretty quickly so that we don't have to do any transcriptions or any junk like that. We can just jump right into it and we'll be ahead of the other class at that point as well. Uh, just to let y'all know, just to give y'all a little kudos is that we have the highest class. class average out of any class that's being held right now. So, you know, I would, I would like to say that I, I want you to, so I want you to pick one and stick with that. So chart DM is definitely what I like. Uh, that's, that's what I like to see, but here's something, here's something good to try out too. Uh, whenever, if you talk to your, if you talk to your people, ask them which method is what they use, like where you plan on getting a job at is what they use. And I will grade those that way. Um, I think it would be, it would be silly of me to stick with one and it not be, or it'd be something that you may not even use, but I would like it for it to be a method. So chart. So either chart. or some of them use, you know, there's some other ones that other people use. Just let me know at your service that you want to work at or that you're thinking about working at. Maybe a good little research thing to what you would rather use. Also, do some research yourself and put on there. I might even put a discussion question out as to different types of documentation and how they differ and what works the best. And it's going to help you out. Documentation. So all this medical stuff and everything, you will learn, you know, after you pass this test, after you pass this test, you're on your own, right? It's up to you to remain to keep your training up. It's up to you to further your training. It's up to you to make yourself better. The documentation is the stuff that keeps you with a job. This keeps you gainfully employed, as well as it keeps you out of trouble. So knowing how to document will really help you out. Yeah. So, uh, yeah, most definitely, but yes, uh, we do have the highest class average right now and, uh, it's, and we also have the best attendance record, um, out of all the other classes as well. So I think that's a, I think that's amazing. You guys have done a fantastic job. So I really appreciate that. That makes me look good when you guys do as well as you have. So I really appreciate that as well. Um, if you ever need anything, let me know. And I will definitely see what I can do. I stay just as busy. So I understand. If anything, you know, I understand definitely how lives go and everything else. So I'll help you out as much as I can. Um, but yeah, so I'm gonna look to have you an answer very soon, if not by Monday, um, during our class. So if I don't get in contact with you. um before monday it's okay on monday i should have a pretty good answer i'm gonna start throwing out stuff i don't know i don't know cole he's killing it he's getting he's he's toting the whole class no i don't know honestly um I don't really pay attention to the whole class average thing or anything, but everybody's doing, everybody's doing well. So, but, uh, yeah, you're doing good. There's no, there's no hanging nineties and a come on now. Uh, so anyway, I will let y'all go. I appreciate y'all very much. And if y'all need anything from me, don't forget class code is. five six five six and uh i will let y'all i will let y'all know if anything changes or anything gets added on other than that y'all be safe and hopefully i'll see y'all out there one day take it easy bye

Maybe make some drawings or something. The past couple of classes, I've been trying to get that done, but life, life got in the way. But this one is not a very, this one's not a very big chapter since it's only face and neck, you know, but there are, there is a lot of things that can happen to the face and neck.

A lot of things that can prevent you from making certain life-saving measures or that can maybe open an opportunity for a life-saving measure, quite possibly. We'll learn some tips and tricks and all that good stuff as well. All right, so moving on. See the National AMS Education Standards Competencies.

That's all of it right there. All right. So the face and neck are frequently subjected to traumatic forces as they're the most exposed regions of the body, right? So soft tissue injuries and fractures to bones are common and vary in severity.

Some injuries are life-threatening. Some are. Many are going to leave disfiguring scars if they're not properly treated. Penetrating trauma to the neck may cause severe bleeding, as you would imagine.

And an open injury may allow an air embolism to enter the circulatory system. If a hematoma forms in this area, it may stop. or slow blood flow to the brain causing a stroke.

Okay. So like you see some of my strangulation or strangulation, you'll see ligatures or bruising at the neck. And those can actually cause their own problems as well. All right.

So to prevent an air embolism and a neck injury, what do you as an AMT, what can you do? Or what should you do? to a neck injury.

How would you do that? An occlusive dressing. That's right.

A four-sided occlusive dressing. Occlusive dressing. Okay. Remember that. I will seal that.

I will seal this up with a four-sided occlusive dressing. Sound like something you might hear on a practical, right? All right.

So as an AMT, you're going to your your main objectives or your main job is going to be the prevention of further injury. So particularly to the cervical spine, because we're talking about head and neck injuries, managing any acute airway problems. We'll go over some of those and then controlling bleeding. So there's the anatomy and some landmark areas.

see a lot of muscles also some some big arteries and veins right so the principal structures of the anterior region of the neck uh include the the thyroid and cricoid cartilage, the trachea, and numerous other muscles and nerves you can see here. The cricoid cartilage is a firm ridge of cartilage that's found below the thyroid cartilage, okay, as you can see right here. And the cricoid thyroid or the cricothyroid membrane joins the thyroid cartilage and the cricoid cartilage right here, right?

Why is it important to know that? Why would you think that? What's important about this cricothyroid membrane?

Yep. Cripe pressure, but also what else? Think above your level. Think a little bit above your level, just one level above your level. What that can be used for.

Can't spell what other word. The, uh, yep. That's right. And you would use a Cri-Kit for that, right? Use a Cri-Kit for that.

All right. So the way you cut, pop it this way or you pop it this way. More of you pop it this way. You go for it.

Some training classes they used to teach in like our in our TCCC class. that I took they told they wanted you to cut this way you cut this way I've been in other classes where they want you to cut this way all right I never agreed that it should be cut horizontally like this because if you miss it or you're not in the right spot guess what you got to do you got to come down and make another cut whereas if you cut up and down first off you're going to bring up your chances that you're going to hit that crackle with thyroid membrane. And another one is if you need to go down or up a little further, all you got to do is cut up or down a little further. And it's just one sewing up area instead of several sewing up areas.

Okay. All right. Anyway, that's pretty good. Oh, look, I could have just looked right here.

There's a bigger picture. I don't know why I didn't see that or pay attention to that. All right.

So that crack pressure that you're talking about, what is that for? What is crack pressure supposed to be for intubations? And what, why would we use crack pressure when a patient is what? when their structures are anterior. That's right.

They ask for a little crack pressure. What's another maneuver that's used to help with your intubations? There's another term that's used.

Crack is one, but there's another move in that same. that same area same area the same style that you actually use does anybody remember this could help you on your ride alongs or what have you so it's called the burp the burp maneuver so uh burp b-u-r-p which is going to be backward upward rightward and posterior pressure on the larynx. Back, up, right, posterior pressure.

And that's supposed to help with your anterior patients as well. All right. Moving on. All right. So there's the eye.

So the globe shaped, it is globe shaped, and it's approximately about one inch in diameter. It's located within the socket of the skull called the orbit, called that the orbit. The eyes, they're going to be held in place with a loose connective tissue, and then several muscles are going to hold it in place. Therefore, making it pretty easy for it to pop out too. The oculomotor.

nerve it innervates the muscles and uh carries parasympathetic nerve fibers so the optic nerve is gonna is it provides i'm sorry the optic the optic nerve uh provides the sense of vision all right so let's talk about the orbit so the orbit itself it forms the base you of the floor of the cranial cavity. Okay. It's direct, uh, directly above it are the frontal lobes of the brain directly above the orbit. So now the eyeball, so the eyeball is also called the globe.

It keeps its global shape, uh, as a result of pressure. from the fluid contained within its two chambers. Two chambers.

The anterior chamber, you can see there, is filled with a fluid called what? Does anybody remember what the anterior chamber is filled with? Okay, so the anterior chamber is filled with aqueous humor. The posterior chamber is filled with vitreous humor, okay?

So one way I used to remember that is anterior, aqueous, A-N-A, and then posterior, vitreous. Posterior meaning posterior. You know what posterior is, but ventral also means posterior.

So ventral. And vitreous, V-I-T-E-R-E-O-U-S, for anybody wondering how it's spelled. The white of the eye, what do we call the white of the eye? What is that called? It's called the sclera.

The sclera, S-C-L-E-R-A. Do you see the whites of their eyes? All right, so the inner surface of the eyelids and the exposed surface of the eye itself are covered by conjunctiva.

Conjunctiva are kept, conjunctiva are kept moist by a fluid called the lacrimal, or it's a fluid produced by the lacrimal glands. And they're often called the tear glands, right? The opening in the center of the iris, the opening is called the pupil. You'll know what that is.

So the pupil. It becomes smaller in bright light and larger in dim light. And we measure that, right?

We look at that on every patient. So if a person is born with pupils that are not equal, if they're born that way. What do we call that? What is that called?

Born with pupils that are not equal. We did. We did.

That's right, anisocoria. Anisocoria. Anisocoria. All right, the ear. So the ear is a complex organ that's associated with hearing and balance.

It's divided into three parts. The external ear is composed of the pina or pina. However, I think it's pina.

You heard me. And the external auditory canal. The middle ear.

contains three small bones in it. Three small bones. The malleus, the incus, and the stapes. And then you have the inner ear that's composed of bony chambers filled with fluids. So the, as you can see, the malleus, incus, and stapes make up what's called the ossicles.

So injuries of the face and neck can often lead to partial or complete obstruction of the airway. There are several factors that may contribute to the obstruction. So direct injuries to the nose and mouth, the larynx and the trachea are often the source of significant bleeding and respiratory compromise.

So because of that, you may need to suction the airway if you're unable to control the bleeding. So some of these injuries may cause the teeth or the dentures to become dislodged in the throat. Always check for dentures. Always check for dentures.

I had a doctor in a hospital. I don't know if I told you guys this or not. I may have. I had a doctor in the hospital on my very first intubation as a student. Very first intubation.

He calls me in there and he says, he says, hey. P-School student. He's like, I got one for you.

So I come in there. He'd already given this patient whatever, knocked this patient down. He said, you ever give a, you ever drop a tube?

You ever do an ET tube? Do you need to check off on ET tube? I said, absolutely. It'll be my first one.

He's like, great. Come see me. Awesome. So I go in there.

I see him. And he there's a patient knocked out. He hands me he hands me the E.T. tube ready to go and hands me the the blade ready to go.

And a suction stuck underneath the shoulder. I was like, all right, set me up for success already. So I get down there. I enter in with the blade. And just as I'm starting to drop the tube because I got to.

a perfect sight glass. I can see perfectly. I can see the cords, nice, shiny white cords.

I'm going to nail this. And just as soon as I go to drop the tube, this woman's teeth go and they fall in. And when they fall in, it jacked me up because then I lost sight.

I lost sight of the lost sight of the cords. And then I was, I was already nervous. You know, I was already nervous as all get out. And this doctor starts laughing and he's like, oh, sorry, I'm sorry.

He's like, I'm sorry, I'm sorry. I had to do it. He said, I knew she had dentures. And he's like, I should have told you, I guess.

And so I reached in, I pulled the dentures out, set them aside. I went back in and I could not find them cords worth of crap ever again. And I ended up missing the tube when I thought I saw the cords or when I thought I was straight on it. Cause I would now I'm all flustered. He jagged me up my very first ET tube, but I got to make it up later on that day anyway.

So, uh, sure enough. Dr. Marsh. Dr. Marsh.

He was at Garden Park back then. He had long hair and a ponytail. So swelling that accompanies direct and indirect injuries to the soft tissues can also contribute to airway obstruction.

The airway may also be affected when the patient's head is turned to the side, right? So it's possible that injuries to the brain or cervical spine may be associated with facial injuries as well. If the great vessels in the neck are injured, significant bleeding and pressure on the upper airway are often common, very common. So depending on the injury or MOI, there may be a cervical spine injury as well included.

Make sure you're looking. That looks like it hurt. All right. So soft tissue injuries of the face and neck are very common.

The face and neck are extremely vascular, so you'll get a lot of blood swelling in this area. It may be more severe because of all the airway and everything else. And then also, you know, you got the eyes, it being so vascular, the swelling is going to really take effect. So even a...

minor soft tissue wound to the face and neck may bleed pretty profusely. A blunt injury that doesn't break the skin, it may cause a pretty big hematoma. And the presence of that hematoma may suggest a potential for more severe injuries.

So pay attention. So always make sure you maintain a high index of suspicion when closed soft tissue injuries to the face because of the risk of airway compromise. It's it's a far greater consequence in this matter. And also remember, also remember that blood is a gastric is a gastric irritant.

So if they swallow too much blood because it's in their mouth or nasal area or what have you, and they swallow it. they may vomit. You may end up with a little bit of emesis on your hands, figuratively and for real though.

So facial fractures occur when the facial bones absorb the energy of a strong impact. The magnitude of force... required to fracture the maxilla. It'll produce closed head and cervical spine injuries. When assessing a patient with a suspected facial fracture, you want to protect the cervical spine and monitor neurologic signs, specifically the level of consciousness.

So some general signs and symptoms of facial fractures are going to be your deep facial lacerations, pain over a bone, ecchymosis or bruising, swelling, pain on palpation, crepitus, the misalignment of teeth. Can you hear me now? What if I do this? Can you hear me now?

Is it just your phone? Can everybody else hear me? You know better than that. I really don't know.

I really don't know Brian Beach that well. Yeah. Yeah, I got this fancy microphone here that I use. I don't know if y'all have ever seen it off to the side there. I can get as close to it.

Or I can come far away or I can talk however I need to on it. It's supposed to be fancy. Supposed to anyway.

I've never really messed with it enough to mess with the settings. I'm sure if I did, I'd probably get a lot better quality sound. But I know that if I...

If I mess with it, I'm liable to jack it up and then you won't be able to hear me, period. So I don't mess with it right now. That's that was unnecessary. And that's why that was unnecessary. All right.

Moving on. So we'll go over some more pathophys, characterized by swelling. So, sorry, the nasal fractures, it's the most common facial fracture.

It's characterized by swelling, tenderness, and crepitus when the nasal bone is palpated. So deformity of the nose, if present, usually appears as a lateral displacement of the nasal bone from its normal midline position. So somewhat that way, right?

And it's often complicated by the presence of anterior or posterior nosebleeds. Or what do we call, what is another word for nosebleed? What's the medical term for it? epistaxis.

Awesome. And whenever we treat a nosebleed, how do we want to position the patient? With their head leaned back and the bridge of their nose pinched or how? Forward.

Awesome. Yep. That's it.

That's right. Face forward. Yep. And possibly suction. I don't know if I still have a patient picture of a patient that I had at one point.

The eyes were blacked out and everything. It was a it was a picture that I used. It happened.

It happened while working. But I got the picture set up to where I could use it for teaching. There was a guy that had taken a 40 caliber and tried to he tried to off himself. Tried to commit suicide and it blew this part of his face out. Just boom.

It just blew out right here. This whole this whole area right here blew out or actually like this. Has anybody ever watched Stranger Things?

Dude look like a Demogorgon. You can see his eyes. You can see his eyes. But this this right here to right here was just gone. OK.

So he was still awake, still awake when we came in, feeling all over the table for the pistol. because he fired it and he dropped it. So we got there along with the police officers. He was still looking for the pistol or something. And of course he can't hear you because he just had a, he just had a 40 caliber pistol, you know, right next to his face.

So go off right next to his face and blow his face up. So he really couldn't hear you that well. But all we really had him do is, you know, I looked. And you could see, yeah, we got there really quick. I looked and you could see the, I knew he was breathing because I could see the bubbles.

You know, I could see the frothy bubbles coming from his neck hole. And at that point I was like, okay, he's breathing. He's breathing normally somewhat.

And so all I had him do was take the, I took, wrapped his eyes up and everything to put his, try to keep his head together. And his neck hole and then wrapped it, wrapped his eyes up and all that, and then handed him the suction device and then yelled in his ear and said, when you feel like when you feel like there's a lot of blood, just suction your neck hole. And that was about it.

And I let him hold that all the way to the hospital. And he he did that all the way till we till we got to the hospital. But very survivable.

But the reason why it blows out, too, is because there's a lot of sinuses right here. And it's like balloons. That's why the fractures of it are so traumatic because of all those sinuses in your face.

So you get some high trauma. Yeah. Yeah.

And he was, he was fine. He ended up surviving and they were able to close it up because we had him as a patient again, but they were able to close him up, get him sewed up and everything else. And he looked, uh, not, not normal, but, um, you know, he was normal shaped. Yeah, this one, he did not.

He never coded. He was sitting up. He sat up the entire time.

There was a time we were running a lot of those. In Poplarville, we ran a lot of those at one point back in. 09, 08, maybe 07, 08, maybe. But it was a, there was a lot. All right.

So mandibular fractures. So second only to fractures in frequency. Typically it's a result from a massive blunt force trauma to the lower third of the face. And it's common following an assault injury. All right.

What's up, Matt? you had a story i thought you had a story no i don't have a story i just clicked something and it went crazy your mic opened up gone now yep so uh The fracture site itself is most commonly located at the angle of the jaw. Okay.

And it should be suspected in patients that have a, with a history of blunt force trauma to the lower third of the face, you know, popped. Somebody got hit, got punched. Numbness of the chin, malocclusion, something like that. inability to open the mouth, that can be all signs for it.

So point tenderness and pain on motion can identify the injury that patients might not have otherwise reported. All right. So maxillary. Maxillary fractures occur with mechanisms that produce massive blunt facial trauma.

So what we call those, you see here, they're Laforte, Laforte fractures, and they're classified into three categories. You have the Laforte 1 fracture, which is the horizontal fracture of the maxilla. Okay.

right here, right across here. It separates the hard plate and the lower maxilla from the remainder of the skull. You have next, you have a Laforte 2 fracture, which is going to fracture.

It's a fracture involving the nasal bone. And then the inferior maxilla, I'm sorry, come right here, and it's going to come down, and it's going to come right here, right there in the tear area, almost like the tears area. Okay. And then next, you're going to have a Laforte 3 fracture, which is a craniofacial disjunction. craniofacial disjunction, no MPA.

You'll be directly oxygenating the brain quite possibly if you try to MPA that. Direct, direct cranial oxygenation. That's going to be so a Laforte 3 fracture craniofacial disjunction. That's going to be a fracture of the mid facial bones.

OK, so coming across here. All right. Separates the entire mid face from the cranium. So Laforte fractures can occur as isolated fractures like a Laforte 1 or in combination. As in like Laforte 1 and Laforte 2. So Laforte 1 and 2. It's depending on the location of the impact and the amount of trauma that you've had.

All right, so orbital fractures. An example of that would be like a blowout, what's called a blowout fracture. Some signs and symptoms of that can be double vision or diplopia or diplopia. and then the loss of sensation above the eyebrow or over the cheek.

It may cause the patient to have a reduced sensation to areas that are innervated by the infraorbital nerve. Awesome. All right. So as you can see here, massive nasal discharge may occur and vision is often impaired.

So it's going to be quite nasty and it can cause paralysis of the upward gaze as well. I'm going to get my wife to buy me a new chair for Christmas. I want to get robbed to buy me a new chair for Christmas. The zygomatic cheekbone fractures.

So a common result from blood force trauma and MVCs and assaults. So some signs and symptoms of this are going to be the side of the patient's face is fractured, appears to be flattened, loss of sensation over the cheek, the nose and the upper lip, paralysis of upward gaze as well. So some associated injuries and conditions can include.

Orbital fractures can associate with this. Ocular injuries. And, of course, our favorite, epistaxis.

Dental injuries. All right. So fractured Niveau's teeth are common following facial trauma.

Dental injuries may be associated with mechanisms that cause severe maxillofacial trauma, or they may occur in isolation. Always assess the patient's mouth following a facial injury. You want to make sure there's no teeth in there or anything that can create an airway obstruction.

So we want to make sure that we can remove that if we can, what have you. And then if they're well-fitting dentures, leave them in place. Yeah, if you can give them a tug and they're not moving, you may be good to go. But by Lord, I'll tell you that if you can tug them and they move, you may want to snatch those bad boys out.

All right, patient size up or scene size up. All right, something I see different here is, you know, with these facial injuries, is making sure that you bring along with you several pairs of gloves in your pocket, in your pocket, because it is quite a messy scene sometimes. So you may be changing out gloves often.

So your main focus is going to be to identify on your primary survey and managing life-threatening injuries and also make sure your suction is ready. Make sure your suction works, charged, ready to go, micron filter in place, bucket in place, lid in place, everything put together. It's crazy. Some people don't get it. All right.

So remove, remove teeth fragments. We already talked about that. So with this, so with this, just know that. It is quite controversial to use a nasopharyngeal airway in these type of injuries, though it should not be used in any patient with suspected nasal fractures.

Definitely want to make sure that you assess for adequacy of breathing. Get you a good sample history if you can. Check for the good old DCAT BTLS.

You want to perform a full body exam. Ensure to control. Make sure that bleeding is controlled.

Look for any type of deviations or any type of foreign matter. Look at the pupil. Make sure they're equal in size and reactive to light.

Also, cataract surgery may cause unequal pupils as well. Don't forget about that. Also, you want to check to see if a patient has the ability to follow your finger.

You're not giving a sobriety test. You're trying to make sure that their gaze, where their gaze is. Check that manual blood pressure. Get you a BCG.

BG. BCG blood glucose. Yeah. CBG.

CBG. Losing it. I have to go back to the county, start working again, get back on the truck. Reassessment, check and recheck, right? Check and recheck.

Make sure you document correctly. So soft tissue injuries, want to make sure we assess our ABCDEs and care for life threats first, right? Depending on what's going on, we may want to consider using the jaw thrust maneuver to open a patient's airway and then suction the mouth. Boom, tufas. He got some tufas problems right there.

And you can almost see his thoughts, some white skull right there. So like we talked about avulsions before, if you can. kind of slap it back in place wrap it up so moisten that stuff down with saline if it's uh if it comes apart you got big chunks of it put in a plastic bag cool temperature it's just like an amputation right don't don't place it directly on ice all that good stuff Make sure that you label it with the patient's name to the ED along with the patient, bring it along with the patient. Injuries to the eyes can produce lifelong complications. So abnormal pupillary reactions can sometimes be a sign of brain injury rather than an eye injury.

So keep that in mind. So you don't want to aggravate any problems. Look for any specific abnormalities or conditions that may suggest the nature of the injury.

Look for foreign objects. So the orbit protects the eye from penetration of large objects. Moderately sized and smaller foreign objects can enter and cause pretty good damage.

And the eye heals very fast. So it can get something in it and then it heal over it pretty quickly. So if the conjunctiva becomes a flame and red, you get a condition known as conjunctivitis. Itis meaning inflammation, irritation. And at that point, once you get that, the eye is going to try to produce tears and attempt to flush out the object.

And then irritation of the cornea and the conjunctiva, excuse me, it can cause quite severe pain. So something to think about is that irritation is aggravated by bright lights. So a patient may have a difficult time keeping their eyelids open.

So you may want to dim out your truck back there. So sometimes a foreign body, it's going to often leave a small abrasion on the surface of the conjunctiva, which is going to cause its own problems. Hey, look at that. We see it again.

Man, that just must have been popular. That was Andy, right? If there's only one eye infected, you want to take care to avoid getting contaminated water into the unaffected eye.

So you want to make sure their head's leaning away, right? You don't want to get anything in there. So you want to flush from the inner corner of the affected eye towards the outside corner.

If the burn was caused by an alkali or a strong acid, you want to irrigate that eye for about 20 minutes. That looks nasty, man. That's terrible. These are chemical burns to the eye. There it is there.

So thermal burns during a fire, the eyes will close to protect from heat, may lead to a burning of the eyelids. You can see there, it's going to require very specialized care. It's best to provide prompt transport to that patient because there's going to be a lot going on.

You want to cover both eyes with a sterile dressing, moistened with sterile saline. And you may apply eye shields over the dressing as well. Over the dressing. So some light burns, light type burn, light burns. So infrared rays, eclipse light, laser burns, it can all cause significant burns to the eyes, especially if they become focused on the retina.

So retinal injuries caused by exposure to extremely bright light are generally not painful, but may result in permanent damage. So super... superficial burns of the eye can result from ultraviolet rays.

from an arc welding unit and light from prolonged exposure to a sun lamp or reflected light from a bright snow covered area can also cause it. So these are at the time, yeah at the time it may not hurt. but about three to five hours later is going to hurt. All right, so lacerations of the eyelids.

So it may require a special repair, careful repair. So I'm gonna go ahead and say that we can't do it. Heavy bleeding, it can be controlled by gentle manual pressure.

If there's a laceration to the globe itself, Apply no pressure to the eye so compression can interfere with the blood supply to the back of the eye and result in a loss of vision. You don't want that. It also may squeeze the vitreous humor, iris lens, or retina out of the eye. You don't want that either.

So you don't want to ever exert pressure or manipulate the injured eye or the globe in any way. If a part of the eyeball is exposed, gently apply a moist sterile dressing to prevent from drying and then cover the injured eye with a protective metal eye shield. So dressing first then eye shield. His eyeball done popped out.

Well, that's not even an eye injury. That's a brain injury. Looks like it. So blunt trauma to the eye. The injuries can range from ordinary black eye or a severely damaged globe.

So hyphema. So hyphema is, you see it there. is bleeding into the anterior chamber of the eye and obscures all or part of the iris.

Okay. You can see there on the picture on the left. So it may, it's common in blunt trauma and it may impair vision.

So in this instance, something that you can do is elevate the head to of the backboard to approximately about a 40 degree angle to increase, to decrease the intraocular pressure. So elevate the head of the backboard approximately 40 degrees. And then you want to discourage the patient from doing anything that may increase intraocular pressure.

Like messing with it. Orbital fractures, we're talking about that paralyzed gaze, upward gaze. There she is right there.

And then you want to cover the other eye to minimize movement. Retinal detachment. It's a possible result of a blunt eye injury, the separation of the inner layers of the retina from the underlying choroid. And it's often seen in sports, especially boxing. It's painless, but it produces flashing light or specks or floaters in the field of vision and a cloud or a shade over the patient's vision.

So this requires urgent medical attention if that. That happens to preserve their vision. All right, let's find this is a good stopping point right there. one blowed out pupil and let's take a 10 minute break while y'all are y'all's 10 minute break uh take a look at your calendar after monday october 11th so look at your calendar and your schedules and start thinking about who you want to do your ride alongs with and then start scheduling out for after the 11th of October. So we're going to look we're going to look at that and that's why I want to get everybody into FISDAP.

That gives us a couple ways to get everything set up get your thought process set up within the next one or two classes though. We want to make sure, I'm hoping by Monday, that we can get some hard dates and who or what service you want to ride with. So we can make sure that it can happen. Welcome to Disney Plus.

Who Plus comes on all your screens. Who Originals. I was telling them to start thinking about their ride-alongs, what service you're going to ride with, and after October 11th, we'll be scheduling. So start making your schedule for after October 11th.

Yep. And we want two. I want to see two dates.

Two dates at first for the starting point. Just two. So start thinking about that while we're on our break. And once I get this figured out, I will be able to put y'all on break. And away we go.

Yeah. Thank you. Thank you.

All right, continuing on with injuries to the eyes. Blast injuries. So some signs and symptoms of blast injury range from severe pain and loss of vision to foreign bodies within the globe.

Before responding to a patient after the blast, ensure the scene is safe, of course. And then management of a blast injury to the eye depends on the severity of the injury. If a foreign body is embedded within the globe, don't attempt to remove it.

Use a clean cup or a similar item to protect the area. And then if only one eye is injured, follow local protocol for that. So this may include covering the other eye to eliminate sympathetic motion. Patients with a sudden loss or a decrease in vision, they'll need verbal instructions on which actions are taking place around them, okay?

So if the patient has a severe swelling or hematoma to the eyelid, don't attempt to force the eyelid open to examine the eye either. So it's talking about contact lens artificial eyes, hard or use a, there's a small suction cup with a moistened end with saline to possibly get that hard contact lens out. To remove a soft lens, you want to place one or two drops of saline in the eye to get it all moistened up and then pinch the lens with your gloved thumb and index finger and then lift it off the surface of the eye. huh All right.

So nosebleeds are categorized based on the bleeding area. One of the most common causes is digital trauma. Okay.

So their nose, you have an anterior, anterior nosebleed usually originate from the area of the septum. And the bleed is fairly slow. So it's usually self-limiting and resolves pretty quickly. Posterior bleeds are usually more severe and often cause blood to drain into the patient's throat.

So trauma to the face and skull can result in a basilar skull fracture, which often cause posterior wall of the nasal cavity to become unstable. and cause vomiting. That's right.

Attempting also to place an MPA or a nasal pharyngeal in an airway with a suspected basilar skull fracture or with a facial injury is relatively contraindicated in the presence of a mid-face trauma. One way to do that, you can do the same thing with the with the halo test right so in this picture it shows two chambers uh two chambers of the nose divided by the septum each chamber is going to be composed of layers of bone called the turbinates And above the nose are the frontal sinuses. And on either side, the orbit of the eye. Orbit of the eye. There's Epistaxis.

We're not going to beat that dead horse. We already did it. Some tips and tricks for ear injuries.

So if CSF drainage is suspected or is noted, then you want to apply a loose dressing. So all foreign bodies should only be attempted to be removed by a physician in the ED. Not by you, by a physician in the ED.

Don't try to manipulate the foreign body because you may press it further into the auditory canal and cause a perforated or perforation of the tympanic membrane, the eardrum, and you don't want that. That don't look good. That's what I was trying to figure out.

Looks like a, that's a strap. That's a strap there, I know, but I don't know. but from I can't tell. Try to look at it from the side see if I can make a make recognition what it is.

They need like a little caption or something down here. It'd be a ratchet strap. So whenever you tighten that ratchet strap down on your truck and you reach up there and you shake it to say, you know, in dad fashion, that ain't going nowhere.

You may want to watch it because if it does go somewhere, it's going to go in your forehead. Yeah, I see the stitching. All right, moving on. So facial fractures alone are not acute emergencies unless they're serious bleeding.

Old boys jacked up teeth. Uh, so remove and save any, any loose teeth or bone fragments in the mouth. You want to remove any loose dentures as well to protect from an airway obstruction. Yep. He's going to be messed up for a while.

That's going to hurt. Oral and dental injuries. So it's commonly associated with facial trauma as well.

So these injuries can affect everything from eating to smiling. So you want to keep that in mind when you're providing that patient care. Try to be as careful as possible.

Always suspect airway compromise that could be soon happening with any of these. Keep suction nearby as well. So as you can see there, suction the airway for 15 seconds and provide ventilatory assistance for two.

minutes. You want to suction on the way out, right? Leave any impaled objects in the face, properly stabilize them if you need.

Injuries to the neck, injury to the neck is serious, it's life-threatening. Talked about that earlier, what the bruising could mean. Biggest thing you don't want is the leakage of air into the soft tissues of the neck. So subcutaneous emphysema, got a crackling sensation.

produced by the presence of air in the soft tissues of the neck. If you feel it when you're palpating the neck, maintain the airway as best you can and transport immediately. Because that means somehow they're getting air that's not going into, they could have a tracheal tear or something like that.

to lord So primary threats from penetrating neck trauma are massive hemorrhage from a major blood vessel disruption and airway compromise, secondary to soft tissue swelling. Penetrating injuries to the neck can cause profuse bleeding from a laceration of the carotid arteries and jugular veins. Injuries to the carotid arteries, jugular veins, and the neck. can cause the body to bleed out. So this is, this is what we call it.

So they call it a phenomenon known as exsanguination. And that's when it just sprays out. Insanguination, they just bleed out from injuries in the neck.

So one thing that always something to think about with neck injuries, the possibility of a fatal air embolism. So a large amount of air entrained into the right into the right atrium and the right ventricle of the heart can lead to a cardiac arrest pretty quickly. So you immediately want to seal that open neck wound with an occlusive dressing.

and then use caution to avoid constricting the vessels and structures of the neck as well while you're doing that. And then be alert for any expanding hematomas or swelling. high flow oxygen vascular access y'all know the drill laryngeal injuries laryn laryngeal injuries literally yep you know so blunt force trauma to the uh larynx can occur when you have an unrestrained driver striking the steering wheel. Less likely around here, it says a snowmobile rider or an off-road biker strikes a clothesline or a fixed wire or somebody running and strikes a clothes wire or a fixed wire.

The larynx, it becomes crushed against the cervical spine and this results the soft tissue injury fractures and or separations of the fascia. So again, don't remove anything. You don't want to do that. We had a patient sometime back that he was a murder suspect. He was a murder suspect, and he tried to kill himself and took a shotgun.

right about here blew a hole blew a hole in his own in his own neck right boom i'm talking about all the way through uh and uh we're pretty sure what killed him is you know somebody i saw you can't put a tourniquet there so when you can't put a tourniquet on profuse bleeding what do what do we try to do junctional It's a junk. They can say it's considered a junctional injury possibly. And you may want to try and stuff it with the hemostatic dressing. Well, they did.

They stuffed the gunshot wound in his neck with hemostatic dressing, which he could have probably survived the shotgun wound. It was clean. I mean, you could fit a half dollar. You fit a half dollar.

He's perfectly circular. He may have actually somewhat survived it had it not been for the fact that somebody, a police officer, had tried to stuff hemostatic dressing into it and, of course, stuffed it into his airway at the same time. So he didn't quite make it. I'm not saying that's what killed him, but it sure didn't help.

It happens. So there's all the signs and symptoms for larynx injuries. All right, so to manage a laryngeal injury, so esophageal perforation can result in what's called mediastinitis.

So think mediastinum and then itis, mediastinitis. It's prudent. to ask the patient to refrain from speaking to allow the vocal cords to rest and recuperate, right?

So the patient should avoid shaking his or her head when responding. So make sure you announce that first. Your primary focus when caring for a patient is always to treat the most rapidly fatal injuries first, right?

So to manage this injury, you're going to provide oxygenation and ventilation. preferably with careful two-person bag valve ventilation. Apply a C-spine immobilization, cervical immobilization at this point.

We know what that is. Completely immobilize it. Avoid the use of a rigid collar.

That's when you don't want to use a C-collar. Create issues. And then be alert for the need of frequent suctioning. Don't delay any transport. And then it's going to need immediate surgical intervention.

So you may need to get a paramedic rendezvous for advanced airway management, especially if the patient's apnea. All right, Ben. So muscular injuries.

In response to strains in the neck, the muscles contract as they attempt to support the neck. Maintain a high index of suspension, suspicion for cervical involvement in this, in this instance. So a strain, a strain is a stretching or a tearing of the muscles or the tendon.

The most common form of cervical strain is also called whiplash. I've heard of that. Although whiplash is rarely life-threatening, morbidity can occasionally develop in the form of persistent and chronic cervical pain. So, recommended transport patients to the ED to get x-rays or CTs and take a good look at that.

And then you want to assess for any visual signs of soft tissue trauma as well. All right. So it's essential to check for distal pulse and sensory and motor function before and after a full body splint.

If you have to do that for muscular injuries and then document all your findings in your patient care reports, document them up. Injury prevention. So helmets, face shields, mouth guards, safety eyewear help to prevent injury, right? There have also been many advances in motor vehicle safety, better occupant safety, restraints and airbags help to prevent all that good stuff. All right, let's end this.

All right, so do we have any questions about any of that? We got the test out there today or this evening. Other than that, does anybody have any questions about what we went over today? No.

OK, if not, then I have your code here for tonight's test. Your code is going to be five, six, five, six. Five, six, five, six.

That is correct. But what I did want to talk about was. Does everybody know who they who they plan on writing with?

No, I did not. Can I do my ride alongside with anyone? Hold on right quick.

Hold on. Slow down. Trying to see. All right. Who's in MMC?

Break that down for me. They have an ambulance service because apparently we're not doing any hospital rotations. I did not stutter.

We're not doing any hospital rotations. Yep. COVID-19.

COVID-19. Ralph, have you thought about Acadian? Okay.

And Ty, you doing AMR or AAA? Which one you going to do? Or who?

It don't matter. If you want to do Acadian, you do that too. Maybe George County? I don't know. And Jody's going to be your preceptor the whole time.

yep that's it that's what rob said rob said that's who your preceptor has to be no questions or or you shall not pass uh cole so Can you use your employer if they don't pay me? I don't know. That's a good question.

Who's your employer? No, I'm talking about Cole. We got to see if we have something set up with them first.

So Cole Ladner, who is your employer? Where is my... Where are they out of? All right.

Oh, I'm writing all y'all's names down. You know, I'm a fireman, so spelling isn't my strong suit. Ralph, do you ever work with the Louisiana State Fire Marshal's office any?

Okay. Just curious. All right. Who else we got?

We got Matt Wade, AAA for you. Okay. So, so far I have Cole, Ladner, Ty, Ralph, and Matt.

Who am I missing? Torrance. Amen.

out of gretna i just have to check um all right miss genevieve you still there lost her all right who else we missing that's one two three four five six who else am i missing seven miss church and hannah I'm missing Hannah. All right. So what I'll do is I'll, uh, she does.

Okay. I'll check on those for, uh, for church. So AMED or West Jefferson.

Um, and I'll check on AMR for Hannah as well. Shouldn't be an issue. Oh, boy's getting in trouble, getting in trouble.

All right. So right now, correct me if I'm wrong. I got Cole Ladner, Medivac International, Mobile. I got Hughes, North, North Mississippi Medical Center in Tupelo.

I got Walker with AMR SMS or AAA with Jody, Jody only. I got Ralph with Acadian. I got Wade with AAA.

I got Torrance with AMED or West Jefferson if we can't get AMED. I got Hannah possibly AMR. I got Genevieve Church AMED or West Jefferson possibly. Does that sound right? That I don't know yet.

That I don't know yet. And I asked that question. And since this is a deal where we're not doing it because of COVID, we're having to see how many rides we're going to get.

What I want to try to get up in the near future before the 11th, like the 11th should be one of the start days. So if you can get days from your people, that's fine. So AAA does have an onboarding process, but you can do it whenever you get there. Acadian has an onboarding process right now. they so Acadian has an onboarding process that you'll have to do beforehand um I don't remember who it was we had a few people that there was a someone else that wanted to talk to us at some point if that or likes to talk to them you won't be able to do October the whole month You can't do it in Alaska?

Like they don't have any other possible ways of doing it? No, not on the clock. Okay. So, so yeah, so we'll just have to check and make sure, and I'll get back with everyone as soon as possible.

That shouldn't be a big issue. But we'll get Cole figured out. We'll get you figured out.

No problem. Just remember that, you know, November is when we're ending the class. So. Let me get back with you on this, figure this out, and then we'll tackle that out. Sound good?

Okay. So we want to make sure that everybody gets on FizDap. Lawrence and Ralph, as soon as y'all get on it, send me a message in Discord or on email or on Navigate or whatever.

It doesn't matter. Send me a message saying that you're on it and then I'm going to try and get everybody set up. They were going to do paper. It was going to be it was going to be paper stuff where we have to do our all of our documentation on paperwork and everything else.

Um, but then after we get FSDAP up, then they wanted to then transcribe it over rather than do that. Um, okay. Rather than having to do all that, I would like to get it set up here pretty quickly so that we don't have to do any transcriptions or any junk like that.

We can just jump right into it and we'll be ahead of the other class at that point as well. Uh, just to let y'all know, just to give y'all a little kudos is that we have the highest class. class average out of any class that's being held right now. So, you know, I would, I would like to say that I, I want you to, so I want you to pick one and stick with that.

So chart DM is definitely what I like. Uh, that's, that's what I like to see, but here's something, here's something good to try out too. Uh, whenever, if you talk to your, if you talk to your people, ask them which method is what they use, like where you plan on getting a job at is what they use. And I will grade those that way.

Um, I think it would be, it would be silly of me to stick with one and it not be, or it'd be something that you may not even use, but I would like it for it to be a method. So chart. So either chart. or some of them use, you know, there's some other ones that other people use. Just let me know at your service that you want to work at or that you're thinking about working at.

Maybe a good little research thing to what you would rather use. Also, do some research yourself and put on there. I might even put a discussion question out as to different types of documentation and how they differ and what works the best.

And it's going to help you out. Documentation. So all this medical stuff and everything, you will learn, you know, after you pass this test, after you pass this test, you're on your own, right?

It's up to you to remain to keep your training up. It's up to you to further your training. It's up to you to make yourself better. The documentation is the stuff that keeps you with a job. This keeps you gainfully employed, as well as it keeps you out of trouble.

So knowing how to document will really help you out. Yeah. So, uh, yeah, most definitely, but yes, uh, we do have the highest class average right now and, uh, it's, and we also have the best attendance record, um, out of all the other classes as well.

So I think that's a, I think that's amazing. You guys have done a fantastic job. So I really appreciate that.

That makes me look good when you guys do as well as you have. So I really appreciate that as well. Um, if you ever need anything, let me know.

And I will definitely see what I can do. I stay just as busy. So I understand. If anything, you know, I understand definitely how lives go and everything else.

So I'll help you out as much as I can. Um, but yeah, so I'm gonna look to have you an answer very soon, if not by Monday, um, during our class. So if I don't get in contact with you.

um before monday it's okay on monday i should have a pretty good answer i'm gonna start throwing out stuff i don't know i don't know cole he's killing it he's getting he's he's toting the whole class no i don't know honestly um I don't really pay attention to the whole class average thing or anything, but everybody's doing, everybody's doing well. So, but, uh, yeah, you're doing good. There's no, there's no hanging nineties and a come on now. Uh, so anyway, I will let y'all go. I appreciate y'all very much.

And if y'all need anything from me, don't forget class code is. five six five six and uh i will let y'all i will let y'all know if anything changes or anything gets added on other than that y'all be safe and hopefully i'll see y'all out there one day take it easy bye

Transcript for:Understanding Face and Neck Injuries

Transcript for:
Understanding Face and Neck Injuries