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The magnitude of current and voltage affect the severity of electrical burns. Low voltage from a battery is generally safe, but high voltage can cause extensive tissue damage. It is important not to attempt to remove someone from an electrical source unless trained. Electrical burns can cause entry and exit wounds with significant tissue damage in between. Reverse triage prioritizes patients in cardiac or respiratory arrest. Taser injuries are generally non-lethal but can be dangerous for those with underlying health conditions. Radiation burns can cause illness and death, and there are potential threats from the use and transportation of radioactive isotopes. Alpha, beta, gamma, and neutron radiation have different levels of penetration. Fusion reactors have the potential to be a sustainable energy source. Hazmat teams should decontaminate patients exposed to radiation. the magnitude of current and the voltage have effects on the variances of the volt. That's one of the reasons why you could technically, you can grab a battery and not get electrocuted because the battery has such a low volt. It doesn't, the battery does not, that voltage difference does not break the impedance of your skin. So, you can trust that. The type of electrical current, we said that already, your safety is of particular importance. Never attempt to remove someone from electrical source unless you are specially trained to do so. If you're getting electrocuted and I do this, then I'm going to get electrocuted. I can tell you that because I can remember a couple of times fighting with patients and the officer decided he was going to tase the patient as I'm fighting them. So, guess who got tased? I did. It worked. So, a burn injury appears where electricity enters and exits the body. There may be a large amount of deep tissue injury in between. So, what happens is, let's say I go to touch a switch right there. This is my entry point. It might be just a small burn. The electricity is going to travel through my bone marrow, my blood vessels, and my nerves, maybe across my heart causing cardiac arrest and then go down from my foot and have a big blowout wound at the bottom of my foot because electricity comes in at a fine point but goes out spread wide. And that's one of the reasons why we talk about reverse triage. Somebody that gets electrocuted, if they're still talking to you, yeah, they might have some tissue damage, infection, and things, but they've survived. It's the patient that's in cardiac or respiratory arrest that you need to work on right away. Those are the ones you need to focus, which is reverse triage. So, that's an exit wound at the bottom of the foot. Now, his finger might only have a small burn in the finger, but the electricity had a blowout at the bottom. So, again, that's the reason why we talk about fourth degree because electricity will burn inside. You could have your entire arm just be completely shattered inside. All the nerves burned out, all the bone marrow burned out, and end up with an amputation. But you would notice it by looking at it. I can remember one time when I was in high school, my favorite teacher ever was Alex Gromyko. He was a lieutenant commander in the Navy, and he ran a maintenance section on a ship. And you know how they used to test the circuit breakers on ships? They used to do this. And if they got a shock, then it was a live circuit. Well, this particular guy, one time, he tells the story. The ship was swaying, and he did this, and he lost his balance, and he went like that, and he made the connection between there. And he heard an instant arc, a flash of light, and his arm split like a hot dog. And he ended up having his arm amputated. Anyway, so what do we want to do for electrical burns? If indicated, start CPR and AED right away. That's why for people that work in linemen, like the cable company, the electric company, and the phone company, where they work in the lines, it's technically supposed to be two people there, and one of them has to have access to an AED. Anywhere you go, God bless you. I don't know if they always follow that, but they're supposed to do that. That's an old trademark. Prepare to defibrillate. Start CPR, defibrillate right away. Get supplemental oxygen. Treat soft tissue injuries with rice, cereal dressings, and quantum transfer. Taser injuries. In recent years, law enforcement has increased its use of tasers. Tasers, no matter what they tell you, is non-lethal. People die from it, it does happen. They have cardiac conditions, fibrillators, asthma, and they can die. But tasers are used millions of times every year. Very few injuries and fatalities happen from them. So it is very, very non-lethal. In Massachusetts, if a cop tasers somebody, you are not allowed to remove the taser from them. Only the police officer can. And it's not that it takes any special skill, because he's just going to walk up and go and yank him right out. The reason they don't want you taking them off is because he takes them off when he knows he's subdued and handled the patient. You pop them off, what happens if he still has to use them? Now he's got to redeploy the taser. Or, worse comes to worse, he can redeploy the taser, now you've got a fight on your hands. So you don't take out the taser prompts, only the officer does. And then you take the patient to the hospital. Radiation burns. I kind of alluded to this before. Radiation burns will make you sick. If you ever want to see two movies that I recommend highly, Chernobyl is one. And number two is K-19 Nuclear Maker with Liam Neeson and Harrison Ford. It's about the first nuclear-bombed Soviet submarine. It's a great flick. You'll love the flick. But both of them depict radiation burns in various stages to the point of minor to death. And it'll show you the burns, very realistically, the illness, the sickness. So I highly recommend watching them. Because if you really want to see what radiation burns and illness looks like, it'll show you. So potential threats include incidents related to the use and transportation of radioactive isotopes and intentional release of radioactivity in terrorist attacks. I'm not so worried about the terrorist attack and the dirty bomb. I'm worried about any given day there are hundreds of pounds of radioactive isotopes being transported in the roads and railways in this country. You know, colleges and universities, hospitals, medical facilities, MRI facilities, CAT scan facilities, chemotherapy and radiation. All of these places need radioactive isotopes. Literally, it's a guy driving in a little Hyundai and delivers it in a lead container. As a matter of fact, they call it the elephant's foot. There's a part at the very bottom where it melted through, where the core melted through and made what they call an elephant's foot. I think it gives like 50,000 Redkins. It is 30 seconds of exposure. It's like lethal. And you won't be able to go there for 20,000 years. It'll half-life in 20,000 years. It's easier. So it's 20,000 years before it has a half-life. So there are parts of it. It's in a sarcophagus. And then they're going to have to build another one around it. They're going to just have to keep building sarcophaguses because it's going to break down for the next 20,000 years because you'll never be able to get near it. So three types of radiation, alpha, beta and gamma. Alpha radiation and beta. UVA, UVB. If you've got a good sunblock that blocks UVA and UVB, you will get little to no radiation poisoning from these. UVA is stopped by the skin. Yeah, you'll get a burn, but a shirt will block it. UVB will actually penetrate through that. I don't know if anybody's ever been outside on a really hot sunny day with a white t-shirt and you still get a sunburn? Go burn a t-shirt while you get a sunburn because UVB can penetrate that. Gamma penetrates through everything but lead and thick concrete. That's x-rays, the gamma rays. And then there's another type called neutron radiation. How thick is the concrete in the studio? What's that? How thick is the concrete in the studio? Depends on the concentration and direction of the gamma rays. Like a basic building? Yeah, we'll protect you. Neutron radiation comes from fusion reactors. The only operating fusion reactor right now is the sun. So the sun is releasing these neutron radiation, these neutron particles we call neutrinos. And they travel through the Earth and pass through us right now as we speak and just go through everything. You know the developing one in Devon? Yeah, I know. They actually have a couple of them. Yeah, they have a prototype. They've got the Tokamak reactor. That's the one that they've got and that's the one that they have the most. I believe in the next 20 years you will see fusion reactors. Fusion reactors is very hot but it has no waste product. So fusion reactors is the future of energy. It's more easily sustainable. Yeah, and it doesn't have waste products. The joke used to be fusion energy is the future and always will be. It seems like there's a company in Devon that actually has positive, net positive energy. They have small fusion reactors they're working on. The problem is up until this point it took more energy to get it running than it put out. So it was a net negative. But you're right, now they have small fusion reactors that have a positive output. Maybe it's only one watt but it's putting out more than it's taking in and that's a positive. It was funny, I read this article about this and the building inspector for whatever, Devon, I just imagine this guy has no idea how to contain this thing. They're building 10 foot thick concrete walls and it's all like flying blind. And those reactors burn it and they can reach temperatures of 10 million degrees. What happens if it explodes? It'll be a bad explosion. I wouldn't want to be near it. Those reactors can reach 10 million degrees and what they do is they use magnetism to sustain the, literally, anybody ever see Spiderman? With Doc Ock, right? The guy with all the arms that he controls? That's literally what it is. It's a reactor that's surrounded by magnets. Very, very strong magnets. And the magnetism holds the reaction in so it doesn't break out. Because if the 10 million degrees breaks out through the reactor it'll melt through everything. You have to hold that in. That's the biggest thing is keeping the reactor controlled. That's fascinating. Read about it, it's fascinating. Anyway, management. Maintain a safe distance and wait for the hazmat team to decontaminate the patients. Once a patient's decontaminated they're not going to off-gas radiation. So you're okay. The idea is you don't want them to get in your ambulance irradiated. Because you're going to be exposed in a closed area, you're going to get radiation poisoning. The rule of thumb for radiation, we always say safety, time, distance and shielding. The less time you're exposed, the further away and the more you have between you and the radiation, the safer you'll be. Time, distance and shielding. Notify the emergency department, oh please do, do not walk in with an irradiated patient. We'll set up all ERs in the United States, I have a Geiger counter right at the door. And if you set that thing up when you go in, you'll have everybody all over you on that one. If you're bringing in a patient with any kind of radiation sickness, let them know before you walk in. Identify the radioactive source and the length of the exposure, the duration. Make sure you increase your distance from it and shield yourself. Dressing advantages. Easiest rule of thumb, a dressing dresses a wound, a bandage bandages a dressing. Now unless you want to talk about a band-aid, a band-aid is a dressing and a bandage, right? But a bandage bandages wounds and a dressing dresses wounds and a bandage bandages the dressing, right? So things like 2x2s and 4x4s and 5x9s and abdominal and trauma dressings, those are all dressings that go right on the wound. And then you have bandaging that go around it. Some things like Curlex, this is cotton, this is a bandage and a dressing. You can use this to pack wounds directly. I can take this roll, put it on a wound and then wrap something around it. It can act as a dressing. Sometimes I just take this Curlex and roll it around the wound directly. It's its own dressing and bandage at the same time. There's no such thing as a bandage place. Nobody's going to say you use the 4x4, you should use the 2x2. There's no such thing. So be familiar with the type of dressings you have in your ambulance, where they come, what the package is. And then just use whatever. It's cheap. A 5x9 costs about $2. So rip the package open. And if you put a 5x9 on something that could have been used on a 4x4, so what? So dressing's advantages have three functions. Control the bleeding, that's first. Protect the wound from further damage, that's second. And further contamination is third, and that's actually switched. It's control bleeding, prevent further contamination, and then protect the wound in that order. Most wounds are covered by universal dressings. Things like 4x4s, 5x9s, 2x2s, 4x8s. Assorted small adhesive dressings and roller gauze. Never use an ACE bandage, that's an elastic bandage you put on sprains. Never put that on a wound because what happens is that inflammatory response, swelling, it'll become a tourniquet. Gauze pads are appropriate for smaller wounds, adhesive type dressings for minor wounds, band-aids as it were. Occlusive dressings prevent air and liquid from entering or exiting the wound. Occlusive dressings will seal up the wound from the neck to the umbilicus all the way around. Keep dressings in place, use soft roller bandages, rolls of gauze. Triangular bandages, you can tie those on a bandage and hold it in place. And adhesive tape. I'm not a big fan of taping wounds directly to the skin because when you pull the tape off, what do you do? You open up the wound again. I'm not a big fan. Self-adherent roller bandages are easiest to use. You just roll them and you can make a slice of them and you can tie them. Adhesive tape holds small dressings in place. If you're going to tape a dressing in place, tape around so that the tape goes back on itself. Don't tape on skin. Do not use elastic bandages, ACE bandage type of thing. Splints are useful in stabilizing broken extremities. You all know about splinting, right? You guys did splinting. I don't have to cover that. If a wound continues to bleed, put another dressing on it. Don't remove the old dressing. And if it continues to bleed after that, put on a tourniquet. So a young male was struck in the forearm with a baseball and complains of pain to the area. Slight swelling and ecchymosis are present but no external bleeding. What is this? Concussion. It's a concussion. It's a bruise. It's a bruise. Ecchymosis. The contusion or bruise is the injury. Ecchymosis is the discoloration. You have a lovely ecchymosis. A compression injury that's severe enough to cut off blood flow below the injury. Remember that? It has that passive stretching pain. Compartmental syndrome. Compartmental syndrome. Yes. Absolutely. A 45-year-old convenience store clerk was shot in the right anterior chest during a robbery. Your assessment reveals the blood has blood bubbling from it every time the patient breathes. It sucks in chest pain. What do we do? What do we do? Is that the patient's vaginal exit wound? Wait. Hold on. They got shot? They got shot. I heard A and B. A. Air. A. A, right? Occlusive dressing. I got to stop the air from getting in. I could put a bulky dressing over it to stop the bleeding but I have to put an occlusive dressing on top of that. A gut to seal the wound. Should we check to see where the bone has come off to? And if you have an engine wound, put an occlusive dressing on that. You carry two of them on your ambulance. And you can cut them in half if you have to. They're completely sticky and suck the area with it. Wait. You only carry two in an ambulance? What if there's like a multiple victim getting shot? You'll have to call another ambulance. You can cut them. You can cut them. Yeah. They carry only two as well. They carry two as well. Do those have those valves in them? Right. Exactly. Are those the ones with the valves in it? But in other words, you can cut. Like let's say I've got four or five penetrating wounds. I can cut pieces off of it to seal up a wound. Yeah, it's not going to have a valve but at least it's sealed. Okay. So if you have one patient with multiple... Wait. Remember that. The occlusive dressing is this big. Oh, I was thinking... No, it's big. So two occlusive dressings will cover most of the chest. You'll see. Okay, I was thinking like... So it'll seal up alright. And it's sticky as hell. What effect will the application of ice have on a hematoma? D? D. Basal constriction. Cold constricts blood vessels. And with basal constriction you'll have decreased bleeding and swelling. The primary reason for applying a sterile dressing to an open injury is to... What's the main reason to do it? Prevent contamination by controlling external bleeding. Control external bleeding. D. Very good. The most appropriate way to dress and bandage an open abdominal wound with a loop of valve protruding fissuration is to... Moist... Apply a moist sterile dressing along the occlusive dressing. D. Apply a moist sterile dressing and then an occlusive dressing over it, which is C. Very good. The 22-year-old male was attacked by a rival gang and had an enlarged knife entailed in the center of his chest. Your assessor reveals these pathic impulses. You should... Give him the sign of the cross. And then what are you going to do? Stabilize the knife and place... No. Can you stabilize it? Do CPR? No. What do we do? Carefully remove the knife. Carefully remove the knife. Put a... Remove the knife. Remove the knife. Carefully remove the knife. Apply a occlusive dressing. Apply a occlusive dressing and then do compressions. And he's probably not going to make it, but you give him every chance. Which of the following is considered a severe burn? A... A... A 30... And I will tell you a 30% partial thickness or 20% full thickness burn are both considered severe burns. There's a 30% A. Is that what you're saying? So if I have a full thickness burn on the tip of my finger, that would be severe. C. Which one? C. Why D? D 5% full thickness burn. Because it's multi-system. I got a fracture. Good job. It's multi-system. Multi-system. It's automatic. Yeah, yeah. We just pretend. That's true. That's right. You didn't read the question to answer the one that's standing. A 5-year-old boy was burned when he pulled a barbecue grill over on himself. Has partial or full thickness burns to his anterior chest and circumferentially in both arms? What percentage of his body surface area has been burned? Partial and full burns to anterior chest. 18 and... 18 and... 18 and... 18 and... 18 and... And 36. 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