all right recording is in progress so uh today we'll be going over chapter 28 soft tissue injuries soft tissue injuries um it's a little bit longer than uh what our what we have been lately but that's okay we're gonna we're gonna push through it and learn together all right all right so the skin is the body's first line of defense against external forces okay uh although the skin is relatively tough it is still susceptible to injuries from bruises or abrasions to lacerations amputations or burns soft tissue injury may result in exposure of deep structures such as blood vessels nerves and bones and applying dressing advantages to so we'll have to apply dressings and bandages to control the bleeding prevent further contamination and protect from further damage so get it covered up stop the bleeding get it covered up all right so the soft tissues of the body can be injured through a ton of different types of mechanisms um like a blunt injury occurs when the energy exchange between the patient and an object is more than tissues can tolerate a penetrating injury when an object breaks through the skin and enters the body and then burns may also result in soft tissue injuries as well soft tissue trauma is a common form of uh injury and then death resulting from soft tissue injury is often related to hemorrhage or infection uncontrolled hemorrhage can quickly result in shock or death as we know so uh you got to make sure that you control that control the hemorrhaging however you can when the when the skin barrier is breached uh also invading pathogens can cause local or systemic infection and infection can be life-threatening or limb threatening even so preventing soft tissue injuries is gonna involve simple protect some simple protective actions right you're gonna you're gonna the use of gloves when working with abrasive materials uh workplace safety measures and then you gotta teach children to avoid or request for help when using sharp objects to prevent them of course they don't always listen and then they end up getting cut scrape burn falling everything else mind sure as heck don't listen text after his mama so uh anatomy and physiology review skin struct the skin structure and function all right you got two principal layers gonna be the epidermis and the dermis uh the epidermis is the tough external layer that that forms a watertight covering for the body and it contains several layers in it the dermis is the inner layer of the skin that lies below the the germinal the germinal cells of the epiderm epidermis it contains so the dermis is going to contain hair follicles sweat glands and your sebaceous glands like the oils sebaceous oil glands and all that sebum uh blood vessels in the dermis provide the skin with nutrients and oxygen that's how they that's how they get that their color so the skin it serves many functions it's going to protect the body by keeping pathogens out and fluids in uh nerves in the skin report to the brain on the environment and on many other types of sensations uh and then it regulates body temperature as well there's an awesome picture that picture looks like it came from the 80s look how pixelated that is that's terrible push it on man probably a better picture in your book so anatomy and physiology review skin skin tension lines the skin's arranged over the body uh or is arranged over the body structures in a manner that that provides tension the this this tauntness varies by body region but occurs in in patterns known as tension lines static tension develops over areas that have limited movement and uh lacerations occurring parallel to the skin tension lines may remain closed with a little or no intervention dynamic tension is found in areas that lie over muscle okay so open injuries to dynamic tension lines uh interfere with healing because they disrupt the clotting process that the that's in the tissue repair cycle so soft tissues are often injured because they're exposed to the environment so there are types of the the types of soft tissue injuries could be like your closed injury open injury and burns closed injuries are going to be characterized by a history of blunt trauma uh pain at the side of the injury swelling beneath the skin and discoloration a contusion or bruise is an injury that causes bleeding beneath the skin but does not break the skin so this can result from blunt force striking the body so the blue and black discoloration we call echomosis echimosis the hematoma is a pool of blood that's collected within the damaged tissue or in a in a body cavity a crushing injury occurs when substantial force is applied to the body the extent of the damage depends on the amount and the duration of the force application my dog is going nuts for whatever reason and nobody's answering all right so closed injuries in crush syndrome tissue necrosis develops and results in the release of harmful products into the bloodstream when the limb is freed with entrapment we've talked about that right a traumatic rhabdomyolysis so this is this is just another form of renal failure that can develop in the kid as the kidneys attempt to filter out the harmful products associated with the degradation of dead muscle tissue so we talked about that another form of compression can result from the swelling that occurs whenever tissues are injured and at that point you get what's called compartment syndrome so that's going to be characterized by pain that's out of proportion to the injury so open open injuries can produce extensive bleeding also contamination the presence of infections or infectious organisms or foreign bodies you got to be prepared to manage several types of soft tissue wounds including abrasions lacerations avulsions amputations penetrating wounds bite wounds and blast injuries at times abrasion is going to be caused by friction when a body part scrapes across a rough or hard surface typically it doesn't penetrate completely through the dermis but blood may still ooze out of the injury uh the capillaries in the dermis lacerations may indicate possible underlying injuries also so laceration oh boy they got jugged up so it's going to be a smooth or jagged cut caused by a sharp sharp object or a blunt force that tears the tissue the depth of the injury can vary extending through the skin and the subcutaneous tissue even into the underlying muscles and adjacent nerves and blood cells or blood vessels sorry it may appear linear or still it and uh it may occur along with other types of soft tissue injuries as well all right so effulgence an injury that separates the various layers of soft tissue so that they become either completely detached or hanging as a flap that's going to be an avulsion so a completely evolved body part is considered an amputation if it's completely evolved that's considered an amputation all right animal bites so you got to consider all animal bites as contaminated and potentially infected wounds that may require antibiotics tetanus prophylaxis and suturing as well so this goes from spider snake dog you name it so we got to regard any human bite that has penetrated the skin as a serious type of injury because humans are nasty so a penetrating wound as you know is an injury that results from a shock or a sharp or a pointed object so some so an open wound in the abdominal cavity may expose internal organs as you can see here then open neck entry as you can see here be life-threatening as well shhh trying to see what that said around around the wound on the abdominal injury it looks like a word there like whatever penetrated here i can't tell what it is though or what it was anyway so uh open wounds caused by crushing injuries may involve damage um it may involve damaged internal organs or even broken bones uh blast injuries may also often result in multiple penetrating injuries as well from the shrapnel so infection any break in the skin service can result in infection okay larger openings and deeper penetrations result in higher level risk for the development of an infection uh you have things like uh staphylococcus and streptococcus bacteria that account for the most bacterial skin infections visible clues of skin infection are going to include uh erythema plus warmth edema and local discomfort so again green all green gangrene is dead tissue it's dead so it can be caused when blood supply to tissue is interrupted or stopped uh diseases such as diabetes and arthrosclerotic peripheral vascular vascular disease can be a cause of it it can also be caused by dramatic or traumatic injuries uh gangrene may have a bad odor to it so you can smell it because it's necrotic so some late signs of gangrene will be characterized by a discoloration of the limb to black or blue or red uh if it's not treated the skin will become necrotic and the infection may result in sepsis all right so tetanus caused by infection with an anaerobic bacterium so it's going to be uh clostridium clostridium titani or tetany tetany tetany so uh it's gonna cause the body to produce a potent toxin which results in a painful muscle contraction that are strong enough to fracture bones that's crazy so it's become a rare cor occurrence because of the available the availability of the vaccine uh muscle stiffness with tetanus may be noted first in the jaw or the neck with a progression down the remainder of the body necrotizing fasciitis so fasciitis is the inflammation of the fascia on the skin right so the most the most serious form of this condition is going to be called necrotizing fasciitis [Music] it involves the death of uh tissue from bacterial infection so look for a history of vector transmission like uh insect bites or jellyfish stings excuse me uh skin at the site may be reddened and warm additional symptoms can include fever night sweats chills vomiting and even diarrhea [Music] so we know we know the assessment of closed and open injuries nothing new there nothing new there may want to provide oxygen if you need to sample an opq rst so when we're doing our sample for medications if they happen to be taking any anticoagulants such as warfarin they're going to need to be a higher priority secondary assessment we all know that if there's been significant blood loss and then you know ivs make sure you're given ivs even fluids so close injuries you got to treat them with uh injury by applying the mnemonic rices rest ice compression elevation and splint rest ice compression elevation and splint so extremities that are that are painful swollen or deformed they should be splinted you got to be alert for signs of shock if the patient does have signs of shock you've got to get the patient supine give it an iv high flow o2 and then give them diesel provide prompt transport open injuries it tells you how to treat them [Music] you may possibly need to use uh for severe bleeding you know direct direct even pressure pressure dressings then tourniquet so all open wounds are assumed to be contaminated and present at risk of infection all open wounds chemical burns should be they should be the contamination it should be flushed to remove any remaining chemicals after the wound has been irrigated you're going to apply a dressing over the site and then you want to neatly wrap over the dressing wrap a bandage over it so dressing and bandaging its main job is to control the bleeding protect the wound from any further damage and to prevent further uh contamination and infection so your conventional dressings you can see there your four by fours and your four by eights so occlusive type dressings are going to prevent air and liquids from entering or exiting the wound so there's some bandages there so some complications of improperly applied dressings and proper application of addressing and advantaged material uh can result in some pretty substantial complications uh hemodynamic complications include the possibility for uh continued bleeding and then so frequent assessments will help you prevent any unchecked blood loss and uh any other type of hemodynamic complications so any improperly applied bandage that impairs circulation can result in additional tissue damage or even the loss of the limb so always make sure you check the limb uh distally to to the bandage for uh signs of impaired circulation or loss of sensation also so avulsions if it's possible you want to try to replace the evolves flat in its original position if the avulsion is complete then you want to you want to wrap the separated tissue and a sterile gauze and take it in with you the ed in the event of an amputation can involve it can involve large areas of muscle mass you want to treat the patient also you know you may need to uh apply a tourniquet you will need to apply a tourniquet and treat the patient for a hypovolemic shock so make sure that you provide the correct pre-hospital care of the amputated part it's going to be you know vital in the if it's successful in a reattachment and uh partial amputations you want to immobilize the part with a bulky compression dressing and a splint to prevent any type of further injuries so bite wounds in the case of an animal bite you want to place a dry sterile dressing over the wound and properly transport to the the patient to the ed rabies infection can be prevented only by a series of special vaccine injections that must be initiated soon after the bite also you shouldn't enter the scene with the animal until the animal has been secured so some of the treatments for bites are going to be control the bleeding apply stair uh apply a dry sterile dressing you want to immobilize the area with a splint or a bandage and provide transport to eb it's going to have to get cleaned out and some antibiotics to prevent infection so penetrating wounds you want to assess patients carefully doing a to identify all of the wounds uh engine entrance wounds and exit wounds are they're pretty difficult to distinguish in the pre-hospital setting unless unless it's obvious so it's better to count the number of wounds and leave the distinction between the entrance and the exit wounds to the hospital staff um patient care is going to be your first priority we're not reconstructing the scene gsw's here's a few here dsw gsw gunshot wound right abdominal wounds if internal organs are protruding through an open wound try not to touch or move the exposed lungs exposed organs you want to cover the wound with sterile gauze compressed moistened and the compresses sorry so it's going to be with uh it's going to be moist with a sterile sterile saline solution man i'm tongue tied today you want to secure it in place and uh with an occlusive dressing as well if the patient's legs or knees are uninjured you may want to flex them flex them up to relieve pressure on the abdomen so impaled objects so if the object's very long you want to cut off the exposed portion um first securing it to minimize the the motion and then do not try to shorten an impaled object unless it's extremely cumbersome okay so after the object's secure and the bleeding is under control we're going to provide problem transport after that open neck wounds so to control the bleeding and prevent a possibility of an air embolism you're going to cover the wound with an occlusive dressing an occlusive dressing and then you want to apply manual pressure but don't compress both carotid arteries at the same time that wouldn't be good right compressing them both cause issues nice burns so a burn is going to occur when the body or a body part receives more thermal electrical or chemical energy or it's exposed to more radiation than it can absorb without injury burns are sometimes not simply isolated soft tissue injuries but they can also be systemic injuries as well damaged cells is going to release vaso vasoactive substances and it's going to create an inflammatory response and increasing capillary permeability as well so massive edema is the result of a fluid shifting from the intravascular space into the extravascular space so tissue damage reduces the ability of the body to regulate its core temperature and hypovolemia causes a decrease in cardiac output resulting in hypotension as the burn destroys skin a tough leathery substance known as eskar is produced a circumferential circumferential escar around the extremity can cause circulatory compromise and may require an escrow harmony escarotomy ascarotomy to say it three times get it right all right so hypovolemic shock so burns can affect the cardiovascular respiratory renal gi uh hematologic and endocrine systems hypovolemic shock occurs because of two types of injuries fluid loss across the damaged skin and a series of volume shifts within the rest of the body so depending on the nature of the burn coagulation disorders may cause the patient's blood either to clot more easily which can result in an emboli or to fail to clot causing excessive bleeding so hypovolemic shock is going to involve the entire body not just that burned area so some complications of burns there are high risk of infection hypothermia hypovolemia and shock you know for hypothermia it's because your your skin loses its ability to thermoregulate loose loose mucosa and the hype and the uh hypopharynx can swell and rapidly result in an airway obstruction uh you'll be listening to things like some hoarseness when they speak strider anything like that you'll be listening for that if you see any soot or anything around the mouth nose or you see any type of smoke inhalation injuries or any type of burn injury around the face you can always guarantee that you're gonna have breathing issues or airway issues if not then it's probably coming so burn zones the skin nearest to the heat source is going to suffer the most profound sailor changes uh burn wounds can have been described by three pathologic progressions all right you got the zone of coagulation uh the central area of the skin that suffers the most damage you got the zone of stasis the peripheral area of the skin surrounding the zone of coagulation and then you got the the zone of uh hyperemia and it's the area least affected by the thermal injury [Music] so as you know the greater heat injury the deeper the wound is going to be um superficial burns may inquire only the epidermis whereas deeper burns extend into or through the dermis and subcutaneous tissue muscle and bone [Music] you got the severity of burns is going to be classified according to its depth yes superficial burns which are first degree burns or what they're called what they used to be called first degree burns but now we just call them superficial burns it involves only the top layer of skin of the epidermis you have partial thickness burn which would be the equivalent of like your second degree burn it involve the epidermis and some portions of the dermis and then you got full thickness burns okay that extends through all skin layers and may involve subcutaneous layers muscle bone and some internal organs as well so additional categories of burns do exist such as a fourth a fifth and sixth degree burn uh for for describing deeper destruction it's impossibly it's impossible to accurately estimate the depth of a particular burn especially on the field so with these bad burns you do not want to spend a substantial amount of time categorizing burns in the field why uh you can categorize the burn prop or categorize the burn to properly determine the level of care that the patient is going to be required to have some different types of burns here one two and three one two three so they're yeah yeah she is so there are five factors uh we have we have central it's uh up near jackson but you also have it's not in you have central there but you also have um where is it where's our nearest burn center usa yeah usa there central i'm talking about central up in jackson you know what i'm talking about they have a whole burn wing it's actually pretty nice now the rest of the hospital not so much the rest of the hospital is kind of hinky but uh central's got a got a pretty good burn unit up there in jackson but usa you can send them there uh i guess it's in brandon it may be in brandon i did uh i did a rotation there when i was flying with air back i did a rotation through there yeah yeah the rest of the hospital is pretty sketchy except the burn unit the burn unit's actually pretty good and it's and it's like walking into a different environment you when you walk in you walk from the burn unit into the rest of the hospital it's almost like it's almost like you you've walked into a third world country as comparatively to hospitals but when you go the other way it's it's a definitely a big step up they just they just attached a brand new state of the art facility to this crap building [Music] yeah yeah yeah we did a rotation through there i did a rotation in the er there and then while i was there i did a rotation in the burn center the the er in there was crazy no the best one i've ever seen is in uh san antonio the intrepid it's uh it's where the it's where the military uh sends burn patients as well they have a really nice burn wing there at it's samsy used to be called bouncy b-a-m-c now it's called s-a-m-m-c it's a level one trauma center there in san antonio i did my i did my full rotations there at san antonio at samcy and it was uh it was really nice their er is really nice as well it's like a spaceship when you walk into it which that's the way i felt compared to you know other places that i've been hello memphis all right so the burn extent rules of nine so it's the fastest most universal mechanism of calculating the uh the tbsa burned what does tbsa mean anybody know that tbsa so tbsa is going to mean what that might be a good one to look up if anybody comes with it no it's not a tv station yes total body service area or total burn surface area i've heard it i've heard it total burn surface area and i've heard total body surface area we always use this body surface area total body because you the total body surface area is what you're adding to all right so uh it's going to be it's going to be based on dividing the body into 11 sections uh each representing approximately nine percent of the tbsa all right so next is going to be the rule of palms so it uses the size of a patient's the patient's palm uh including the fingers so including the fingers to represent approximately one percent of the patient's tbsa okay so it's pretty helpful when the burn covers less than 10 percent of the tbsa or is irregularly shaped so the rule of nines can be a quick way to estimate the amount of surface area that's been burned like we're talking about divides it into 11 sections so there's your scene size up stuff there you know it before we get too far into this let's take a 10 minute break all right so let's take a 10 minute break and we'll be back i wasn't talking i was i wasn't talking i was just lippering all right so some things you're gonna be looking for it's like your uh signs of airway involvement mainly with this so hoarseness cough any type of cough strider uh singed nasal hair or facial hair around there carbon in the sputum or soot in the sputum or soot around the nose or soot around the mouth uh and then if you were if the burn happened inside of an enclosed space you may be uh maybe pretty suspicious to you as far as airway compromise coming soon so you can guarantee that if you see any of those signs or hear any of those signs you are going to have an airway issue shortly so get ready so some things you may want to ask yeah um i mean if they're not conscious there's nothing you can do then give it some time though but uh high flow o2 anything like that may help uh o2 does what to your blood vessels what does o2 do o2 is a vaso constrictor so you may want to you you may want to use that it may help you for a short amount of time but i mean even if you were to get an oral adjunct on them and and bvm it still can get very hard they need a they need an et tube yep it can help reduce swelling so uh they need an et2 they need a definitive airway is what they need uh really what they need is to be put down by a helicopter or you know what have you buy an er or helicopter crew give them some sucks and get them into beta that's what they really need some rsi and rsi treatment all right so uh some reassessment stuff it's all the stuff that we've seen before right so your big goals are going to be to stop the burning process assess the tree assess and treat breathing support your circulation and provide rapid transport that's going to be your big goals no it's uh my son's using the restroom and he'll sit in that restroom for a long time but what he does is he'll bring his little he'll bring his little video game in there and then he just sits on the throne and plays his video game or watches youtube videos on it and so his mama was telling him you know you can watch if you can watch youtube videos in your room you don't have to sit on the pot to do that so that's the entertainment in in my home yeah i don't understand it how they the videos that they watch and everything he will watch a video of somebody playing a video game that he is currently playing so he'll set the video game he'll set the youtube video up and then play the video game i don't know i mean i guess if i was his age i'd probably done it actually if i was when i was his age i didn't have video games i wasn't allowed to uh all right so you may want to look at any type of lengthy transport times call meg control and order iv meds or iv i'm sorry order the administration of iv fluids so here's the thing for long terms or long times in there um has anybody ever heard of uh has anybody ever heard of the brooks formula or the parkland formula or the brooks parkland the modified brooks parkland formula somebody look that up and then uh put in the chat what the what the formula is for everybody else to see uh somebody looking it up or did y'all just give up on it all right now we're not gonna do that and what times what are the time rates that that's given you have that by any chance yeah so the first half of the volume is going to be over the first eight hours and then the second half is the following 16 hours of a 24-hour stint is how it works so in adults it's going to be two to four uh two to four mils per per keg body weight times for the parkland formula uh times the percentage of the burns all right for children it's going to be three to four mils per keg body weight times i'm sorry three to four mils of lactated ringer or or whatever you're using times the keg body weight times the percentage of burns uh difference between adults two to four and then children three to four so you're gonna give the first you're going to give the first eight hours the first volume over eight hours and then the second half over 16 hours you see that you got to give some you got to get some pretty good amount of fluids in there pretty quick and then also if you have a long transport for those type of patients you want to make sure to keep up with their input output input of fluids output of urine eyes and o's so depending on which and what you're using if you're using like a the the evans formula you know or if you're using the if you're using the 48 hour schedule using the evans formula or the brooke or the parkland um the way it works is you do so about 70 kegs so 70 kegs for example 70 kids for 40 percent tbsa burn a total fluid in 48 hours you're going to be given 12 400 cc's uh to 13 200 cc's depending on what formula you're using so as you can see a lot a lot good stuff all right so thermo thermal burns they're caused by heat thus the term thermal so a flame burn is often going to be a deep burn especially if a person's clothing catches on fire so wrapping the patient a blanket or other material can also can also smother the flame that you're looking for you also have hot liquid burns that produce scald injuries coming in contact with hot objects produces what's called a contact burn a steam burn can people can be produced can produce a topical type of skull burn i've been steam burned tons of times um it's no fun i used to in the training building used to get steam burn quite a bit i would come home and my ears would be bubbled up and my shoulders would have bubbles on them my wife would be like y'all been in the burn house again or she would say training recruits again yep training recruits or volunteers depending on where we were at a relatively rare source of thermal burns is a flash burn that can be caused by an explosion so lightning strikes can also cause flash burns as well as you can see so we've talked about inhalation burns so carbon monoxide intoxication which can cause permanent damage to the organs including the brain and it it may it may occur it may occur if a patient isn't rescued and treated promptly so uh it should be considered whenever a group of people in the same place all report a headache or nausea uh you got to be suspicious of pulsometer pulsometer readings uh when you're dealing with the patient who's suspected to have carbon monoxide poisoning because it may read a hundred percent right the uh the hemoglobin is being bombarded the red blood cells are uh bombarding or being bombarded dead so some scientists signs and symptoms of other things like uh cyanide poisoning so it's going to involve the central nervous system respiratory and cardiovascular so you're looking for things like faintness anxiety some abnormal vital signs headaches seizures paralysis and even a coma so in your burn patients or your patients that were that inhaled a lot of smoke smoke inhalation patients that's some things you'd be looking for so chemical burns so wear your ppe when you're caring for a patient with a chemical burn so also in the case of chemical burns or exposure you may want to consider mobilization of a hazmat team so there's some uh the severity of a chemical burn what it's related to so to stop the burning process you gotta remove any chemical from the patient right so always brush off dry chemicals always brush it off the skin and clothing before you flush the patient with water okay after brushing off the chemical begin to flush the burned area with large amounts of water copious amounts of water so more damage may be caused by chemical reaction of the antidote or neutralizing agent with the contaminant you want to prevent that as much as possible using the handy dandy shower so does or preconnect yep or pre-connect that's right so to uh yeah so to stop the burning process remove the chemical from the patient like we said uh brush the patient off before you do anything so some other management techniques here you see the dry line you're gonna flush with copious amount of uh garden hose or shower or uh preconnect you can use that sodium metals you're going to cover this type of burn with oil hydrofluoric acid you're gonna calcium gluconate gel is the uh preferred treatment for that gasoline or diesel fuel most hydrocarbons gonna be effectively removed with soap solution hot tar you're going to immerse immerse the affected area in cold water what method are they using there ty in that picture what is what are they using to flush it that's right using a drop set you use a 60 drop or a 10 drop so electrical burns so when your body completes the circuit that's what's going to create the electrical burn all right so you're connecting from the power source to the ground source so you're gonna have two you're gonna have two burn injuries not just the internals but you're gonna have an entrance wound and an exit wound yep they can be nasty it's also a wide area too it can be the exit wound can be really wide so any type of electrical burn or electrical electrocution or anything like that first thing you want to make sure is that the power is off that may be good before you get in there if you if you can you may uh try to determine excuse me try to determine the uh the voltage and the type of current if it's at all possible [Music] uh if you can if you can find out if it was brief or if it was sustained contact yeah i'm sure that wouldn't be good make sure you always assess that heart rate for any type of arrhythmias all right so radiation burn so determine whether uh ongoing exposure still exists the three most common types of ions i ionizing radiation is going to be your alpha beta and gamma some of the basic exposure pathways are going to be inhalation ingestion and direct exposure then acute exposure to radiation may result in burns and radiation sickness or radiation poisoning depending on what's going on the best protection for radiation burns or the best protection for you is going to be uh do bone photographers get radiation burns i don't know let me see let me see if it's i know that over long term uh you can end up with radiation injuries over long term if you're not protecting yourself or what have you a lot of times it happens in their hands you know why because sometimes they'll hold the patient or they'll hold something and then you know all this is covered but this won't be covered and it'll hit hit hit so some of your older people let me see air for like an hour and a half and constant radiation yes okay or if you raise the dose so high there was a little boy i don't know if you know about this story it was a little boy i want to say was in california and he went in for a head scan and the ct tech was not watching what she did and she said it she picked a protocol and it was the wrong protocol and gave the little boy like a horrible horrible amount of radiation than what he was and he went home and his skin started peeling off and blistered and um [Music] she saw apparently she shot him like 65 times at a massive amount of radiation in the same spot he lost all of his hair and everything like that then they sued the hospital and then this happened maybe about within the last five years because then they sent somebody out to our every hospital and they had to put some kind of calibration on the machines and some kind of tracker so now it's tracked nationally um how much radiation we get to each patient per scan hopefully vocally are you sure that's not one of those stories like no you could look it up you could google it because i mean we we have horror stories too no you could google it okay it's possible if you don't know what you're doing yeah okay that's all i wanted okay all right thanks and horrible horrible amounts of radiation is a is an actual measurement radiation apparently all right there it is horrible horrible horrible amounts of radiation that's when the the rads exceed a certain amount then it's officially called that all right so for that hazmat teams time distance shielding for radiation depending on how it was given uh and then establish iv access give fluids based on the patient's presentation all right it's a two-year-old boy who was subjected to 151 ct scans while in the machine for 65 minutes 151 ct scans he was in the machine for 65 minutes when she go to lunch a ct scan or a two-year-old head normally takes maybe about 30 seconds so he had radiation burns on his face and his head it was in mad river community hospital in northern california california he also has a possible increased risk for cancer you don't say damage to his gastrointestinal or hematological systems even he suffered uh chromosome damage um after analyzing his blood uh let's see skin inflammation sunburn on the boy's face blah blah blah blah blah and then the guy was fired the guy was fired and lost his license well we know he didn't work locally all right and that was that all right so into the slideshow uh so does anybody have any questions about anything we went over tonight simple and easy tissue injuries simple and easy okay no questions let's stop the share stop that too all right all right so if there are no questions then what i will do does anybody have any questions about anything with the class i'm gonna go ahead and stop recording