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This week on Challenge Accepted, I'm going to see what it's like to be a triage officer in an emergency room during a mass casualty incident.
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How about this come down?
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Sounds good.
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The catch is, I'm not a doctor.
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And this entire hospital, it's not real.
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We're putting Michelle through a real -life simulation of a one -hour mass casualty incident.
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This is where real doctors, nurses learn we've essentially designed a live -action hospital video.
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Over 30 actors playing patients, real nurses, and doctors.
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Where Michelle will have to make split -second life or death decisions.
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I'm worried about her.
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Her airway's closer.
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Can I make the vertical incision?
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How do you tell someone that someone has died?
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We've seen it a million times on TV, but how close is it to the real thing?
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Everyone needs a tag.
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Everyone needs a tag.
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Find out on this week's episode of Challenge Acceptable.
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Simulation starts in three, two, one, two, one, two, one.
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One.
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One.
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We want to get to Southern California on alert this morning after getting hit by the largest earthquake there in two decades,
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sparking more than 160 aftershocks.
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You can see the damage of 500 people were hurt.
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All right, there's an earthquake, so we're going to get people coming in left, right, and center.
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Ambulances, people walking in, crawling in, personal cars.
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Do we know how many are coming?
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We have no idea so we have to prepare for anything
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and that's where your triage skills are really going to be essential
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That you need to sort all these patients
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that are coming in My role as a triage officer is to quickly assess the patients arriving at the emergency department
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And assign them a color based on their injury severity level with the hope of saving as many lives as possible So
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if you've seen the pit what Michelle is going to be
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experiencing today during an MCI is very similar with one big distinction They're actors.
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They have lines.
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Michelle does not know what she's walking into.
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She has to rely on this one -day quick education that we presented to her.
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So I don't envy her.
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Dr. Mike, good to see you again.
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Good to see you, yes.
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I'm Dr. Mike Varshavski, board -certified family medicine physician and content creator online, especially on YouTube.
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Star chest impressions!
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One of the most influential medical educators online.
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25 million followers, the legendary Dr. Mike Marschewski.
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Yes, Dr. Mike is in our video!
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So Dr. Mike has the incredible experience of not only being a healthcare and science communicator,
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but also practicing every single week in the field on real patients.
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So I asked Dr. Mike to come in and make this simulation as real as possible.
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In one day, we're going to try
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and simulate four years of medical school to teach Michelle what to do during the MCI.
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What you're going to be going through tomorrow is very similar to what we train all our emergency department staff on.
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Yes, I'm a doctor.
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I'm a family medicine physician.
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So the training I have doesn't really prepare me fully for an MCI.
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It's the experts like Ryan, like Brett.
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They're the ones who have the experience to not just practice it in real life,
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but also to teach it on a very high level to doctors like myself.
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So I'll be getting a lot of value today, too.
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So we're going to teach you how to sort patients so
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that we make sure that we can do the most good for the greatest number of patients possible.
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How do I do that?
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So there will be four categories I can sort patients into.
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Whoa!
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What the?
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We have a simulated patient here.
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I can do it.
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Fortunately there's a tool available.
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It's called Start Triage and we have a flow chart here that will direct you through the algorithm.
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I love flow charts!
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The Start Triage flow chart gives medical professionals a starting guideline
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to quickly assess patients as as they are brought into the emergency room.
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Starting with the green, we have the patients that are gonna be your most minimally injured.
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The first question is, is the patient able to walk?
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If yes, they're immediately assigned to green.
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Please walk towards me.
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Yes, that's already green.
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Easy.
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Bam.
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We're done.
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Ow.
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Going on to yellow, this is called delayed.
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So the patients that are definitely going to need care, but they don't need it right away.
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Yellow means the patient cannot walk, but might still have stable vitals and mental status.
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Breathing, they are breathing.
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Respiratory rate is less than 30.
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Okay, perfusion.
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When you check for perfusion, you push down on their nail.
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And when you let go, if it goes from white to normal color in less than two seconds, we move on to check their mental status.
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Can you wave your hand?
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Okay, so, you have a final answer.
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The red patients are gonna be your most critical patients, the ones that need immediate medical care.
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They have something that you're detecting is abnormal in either their breathing rate, their perfusion.
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or the way that they're responding to you and following commands.
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They're not walking.
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Heavy breathing.
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Respiratory rate is...
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40!
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High respiratory rate.
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That's red.
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These are the patients that have the most emergent needs.
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The black category are the patients that are either deceased or, unfortunately, there's not a lot that can be done to save them.
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It doesn't mean that we ignore them.
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We're still going to provide palliative care, but unfortunately, just there aren't the resources available like there might be on a daily basis.
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He is not walking.
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Okay, are they breathing?
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He is not breathing.
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Can we position their airway?
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So you would go over there, do a head tilt, chin lift.
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This does not include CPR.
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Unfortunately, again, because we only have one minute, and we don't have the resources to devote that many people,
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that many resources to a single patient at this point.
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But I like where you're going.
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Okay.
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I like that you're thinking about it.
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Okay.
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So unfortunately, we're going to have to tag this patient into the black category. That sucks.
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I hesitate to put the black wristband on a patient.
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It can be extremely challenging, and this algorithm helps you do a calculated evaluation on them that takes the emotion out of it.
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After the incident, people start to break down.
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They have big emotional outbursts because they were putting away their emotions for so long.
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So expect after your simulation tomorrow to feel quite stressed out.
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Simulation starts in three.
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Two.
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One.
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Let's get started with our first set here.
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My first challenge is to perform triage on an incoming wave
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of patients who were injured in a collapsed apartment building during the earthquake.
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Ma 'am, are you injured?
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She's walking, so it's green.
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I'm just gonna put this here, but if you're able to walk, go ahead and hit this way.
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Excuse me?
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Where do you feel pain, sir?
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My knees are all cut up.
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Okay.
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Hi, are you able to walk towards my voice?
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Yeah, I'm okay.
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You could probably help somebody else while you help me.
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Okay, okay.
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Well, I'm just gonna tag you here.
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This is gonna tell us how to treat you in the hospital.
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Please head in this way.
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Can you pull this thing out?
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No, do not touch it.
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So the first couple of people I see, they're walking, they're breathing, they're talking, they're responding.
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I'm green.
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Are you able to walk towards my voice?
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There's confusion here.
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There's confusion.
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Why?
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What is happening?
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She's airways.
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She's breathing.
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She has airways.
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Yeah, she's talking, but there's confusion.
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I don't know what to tag her because she can walk, but her mental stats, I'm going to say yellow.
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You have another patient.
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You have to be quicker.
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Get your staff out.
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Michelle, your patient is leaving.
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Oh my God.
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But then the cases start to become trickier and a little more complex.
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Like a patient who appears and they're able to walk, they're able to talk, but they don't seem all there mentally.
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Trying to triage this patient is sort of like trying to have a conversation with someone
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while also doing a math problem in your head
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because I am trying to calm down the patient at the
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same time trying to visually remember what the flow chart looks like and how I'm supposed to assign them.
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Ma 'am, you have lots of cuts.
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What?
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I have cuts?
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Yeah.
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I have cuts?
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Ah!
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These are humans, so they're going to give you imperfect answers at times.
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So when you're trying to evaluate someone's mental status, you say, give me a thumbs up.
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They don't give you a thumbs up.
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You can miscategorize them.
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Hi, what are you working with here?
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Okay, can you hear my voice?
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Their guts are coming out of there.
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Yeah, yeah, not important.
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Okay.
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What's important?
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They can't walk.
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Okay, I'm gonna put a red on this.
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Okay, based on what?
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Based on short of breath, can't walk.
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What are we getting breaths -wise here?
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He's breathing really slow, actually.
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He is breathing really slow.
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Okay, so you're going red, okay.
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Okay, I'm just gonna use it.
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That's okay.
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Patriage isn't my only responsibility.
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It is also my job to perform procedures on the patients that are most high risk that I categorized as red.
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When you're in front of the hospital, you're triaging.
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When you're inside the hospital, you're treated.
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This guy's got an evisceration.
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He's full blown on oxygen.
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Still able to wake up a little bit.
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Sir, are you still with us?
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What do you think of the vitals so far here?
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His heart rate is somewhat elevated.
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Yes, he's tachycardic.
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But what is the issue right here?
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We need to cover it and dress through it and call surgery immediately.
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Yes, you should love it.
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So we're going to take a look at a patient that has an evisceration.
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And an evisceration happens when you cut to your abdominal wall and some of your bowel comes out.
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It's a really bad day.
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It is a bad day.
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You do not want to ever push the abdominal contents back in
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because forcing them back in is actually not the correct move.
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So this patient is going to have to go to the OR and see a surgeon to get it put back in.
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But what you're going to do is you're going to try to preserve the bowel.
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All of the medical professionals in this simulation are actual doctors and nurses who have been instructed to carry out my commands, even if I'm wrong.
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What you want to get first is a big trauma dress.
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This is sterile saline, and you're just going to pour some in there.
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Now go ahead and pull it out and cover the bowel with that.
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We are just going to cover the wound for now and prepare you to go into surgery.
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Now this is like an inclusive type dressing.
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It's going to help keep that moisture in.
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Oh gosh, it has a very strong smell.
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Yeah, there we go.
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Let's put one there.
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Now I want you to grab that roll of tape.
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Perfect.
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Okay.
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Yeah, there you go.
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Thank you for the assist.
229
Okay, did we call the OR?
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Can we call him?
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Yep, I'll call the OR.
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Thank you.
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OK, we'll get there all our prep.
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OK, move on right away.
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How are we doing in here?
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We're done here.
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The real Dr. Kare is actually not me.
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It is my dad.
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Growing up, I was actually on a course to become a physician, just like my dad.
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Instead, I became a YouTuber.
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So doing this episode is my one opportunity to hopefully make him proud.
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Also, my dad says to subscribe.
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So doctor's orders, you better subscribe.
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The biggest issue that I'm seeing in Michelle right now is that she's making mistakes triaging patients.
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Sir, can you hear my voice?
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Yes.
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OK, Brad.
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I'm starting to see emotions creep up, panic set in.
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She's freezing.
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Can you walk towards my voice?
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Can he walk on his own?
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Yeah, yeah.
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OK, OK, OK.
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That's a green.
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Yeah.
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OK.
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Green?
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You see that?
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Well, OK, chest injury.
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But he's walking.
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But he's not walking by himself.
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Does anyone know what they're doing around here?
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Red, red, red.
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OK.
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I'm just going to do red on that.
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Once you miscategorize a patient, You're starting to give resources to that patient they didn't need.
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You could be losing resources for people who can be helped.
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This is the domino effect that if you make a mistake early, it can cause you a lot of harm down the line.
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Hey.
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Hey, can we get some help?
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Can you walk towards my voice?
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My wife cannot walk.
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Okay.
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Okay, they can walk so they're both green.
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Somebody over here, please.
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Okay. Where?
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Okay.
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Hey, my name is Dr. Kari, and we're going to treat you inside.
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Keep going inside.
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After I assign a color to each patient, they will be put into a room based on that color.
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Now each of these rooms have limited beds, staff and resources.
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And the problem is, if you mis -categorize someone, it creates a chain reaction of problems in the future.
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For example, if a patient is over -categorized,
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that patient will end up taking resources from someone who needs them more.
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And a patient who is under categorized will ultimately not receive the resources they need and thus be at risk of death.
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So this is kind of like a resource allocation challenge.
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It sure is.
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Okay, how do you feel?
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That was so overwhelming.
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Remember, you have secondary triage always after the fact.
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Okay, I'm going to be more confident.
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Okay.
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While mistakes are bound to happen because patients are going to be changing their severity level, usually that severity only gets worse.
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That's why there's always a consideration made for secondary triage where we can adjust for that and catch those mistakes early.
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We're just sort of wondering when we can be seen.
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We're getting around some vitals.
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Maybe just see if any of those guys found their money.
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When inside, try not to run.
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Very easy with charms to get hurt.
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Okay.
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Remember, take care of yourself first.
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All right, start.
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Vomiting with head trauma.
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Can you tell me what happened?
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Something fell like a beam.
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ABC, you have patience.
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I'm going to teach you this basic trauma assessment.
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It's called the primary assessment.
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So first thing you want to know is just, do I have an airway?
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So that's A.
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Airway clear.
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I'm going to check breathing.
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The next one is B.
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It's breathing.
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Now we're seeing if their breathing is effective.
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Breathing is OK.
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You hear good breath sounds on both sides?
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Yeah, I mean, do you want me to double check?
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Yeah, yeah.
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And then after that, we're going to move to circulation.
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There's two big things you want to know about circulation.
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One, you want to know if they have a pulse.
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Then the second thing we're going to check is we're going to look for any major bleeds.
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So now we've done airway, breathing, circulation.
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Most of our problems are gonna happen in those three areas, and we'll have to address them to save that person's life.
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Is there a reason why you classified her as red?
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We could secondary triage her and change it.
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I think we need to move her down to yellow.
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We only have so many beds.
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Yeah.
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So I just wasted two gurneys.
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Yep.
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Make moves.
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If you put someone into the red zone where they should be in the yellow zone,
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just switching them could cause people to lose their lives you're using staff to mobilize those patients, and that can be really difficult.
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It's gonna be this female right here, so she's been complaining of blindness in her left eye and some pain.
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And I just have a lot of pain, and also my right ankle, I can't.
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She cannot walk, she's blind in one of her eyes.
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She's got glasses sticking out of it.
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And the pain's really starting to kick in.
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Like, is this gonna be, like, forever thing?
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It may not ever gonna be able to see out of my eye.
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I'm just freaking out a little bit.
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Okay.
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Yeah, yeah, I understand.
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Can we get some care, like, now?
347
So right now, are you okay if I just put an IV hand in and give her some pain medications?
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And we'll get some morphine again?
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Okay, great.
350
We'll get some morphine and it'll help with the pain.
351
Okay?
352
It's gonna be...
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I try not to lie to patients, right?
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I don't say you're gonna be okay but I do try to, I think reassurance is very important during this stuff.
355
It's going to be, it's, uh, we're doing the best we can.
356
Okay.
357
Thank you so much.
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Okay, this gentleman here has some abdominal trauma.
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I'm fine.
360
Just find my people.
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He's saying he's okay.
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I need pain medications and a CT scan.
363
Okay, that sounds good.
364
I agree with that.
365
Four milligrams sounds good.
366
We're just waiting on that.
367
What are you doing here?
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Nothing.
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Literally nothing.
370
Keaton Everett.
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He was the lead in the construction site and he's concerned about his med.
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Okay, we'll just give him something for the anxiety.
373
Anxiety?
374
What, distress? For pain?
375
Four milligrams of morphine?
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Okay.
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I'm fine!
378
Is he allergic to morphine?
379
Are you allergic to morphine?
380
No, I'm...
381
That's like, I think we need to prioritize the patient's.
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Okay, then do it.
383
Oh my God, okay.
384
Okay, what are you doing?
385
What are you doing?
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Ask questions, ask questions.
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She's unresponsive.
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If you need to manage your airway on the EMS currently, feel free to do it.
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Mike, I'm...
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You wanna listen?
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Do you want to listen first?
392
Yeah, yeah, yeah.
393
Listen?
394
Yeah.
395
Get some vitals.
396
So there's a lot of things that could be happening that are disruptive that you can't even plan for.
397
Being pulled in one direction then another direction is really difficult.
398
How much should they be squeezing?
399
Okay.
400
Um, every six seconds, right?
401
Yep.
402
Okay.
403
And then we should prep an IV for intubation so that we can give her medication so we can intubate.
404
Okay.
405
I'll get an IV started.
406
Okay.
407
We're gonna work on intubation, and that's where we're gonna secure somebody's airway.
408
We would have to put a tube down their throat to help them maintain their airway.
409
But the other thing it could be used for is breathing, too, because if somebody's not breathing, we could breathe for them.
410
Your vital signs are coming up.
411
Our sats are terrible.
412
Okay, sats are terrible.
413
You need to get an IV in quickly.
414
Non -dominant hand.
415
There we go, because you want to control the tube with your dominant hand.
416
And this has to be in a place that you can see it, not where the nurses can see it.
417
I am ready, yes.
418
Okay.
419
120 sucks us in.
420
Okay.
421
You have your monitor.
422
What are you looking for?
423
What do you see?
424
I'm looking for the epiglottis.
425
And then just slide that in there.
426
Nice.
427
You see, that's the epiglottis.
428
There you go.
429
Try to hit in the middle of the epiglottis.
430
Back up.
431
Oh, I heard teeth.
432
Oh!
433
I just broke someone's tooth.
434
Malpractice.
435
Okay.
436
Oh, my God.
437
And you're going to take that.
438
And then this is the twisting thing once it's in there.
439
Twist it.
440
There you go.
441
Push it just a little bit further.
442
Boom.
443
Okay, good.
444
Now then, pop this out with your thumb.
445
Out towards the stomach.
446
Out towards the stomach.
447
Out.
448
Then bring it forward.
449
Grab it with your other hand.
450
This.
451
Good.
452
So then I will come up here, and bagging it means assist ventilations.
453
Attach.
454
Put on your stethoscope.
455
Put on your stethoscope.
456
Quick.
457
Check the stomach first.
458
Okay, it's not on the stomach.
459
Okay.
460
Chess rises present.
461
Good on the left side.
462
Good on the right.
463
O2 sat's coming up to 94.
464
Okay, that's good.
465
Okay, do you want them to secure the tube?
466
Yes, secure the tube.
467
She's stable.
468
What do you want to do?
469
Now we need to push 50 micrograms of fentanyl, 2 milligrams of Versed, and a propofol drip, please.
470
Can someone repeat that back to me?
471
Okay.
472
50 of fentanyl, 2 of Versed, and propofol drip.
473
Yes.
474
Thank you.
475
Okay.
476
During an earthquake, you're having all sorts of scenarios happen at the same time.
477
But then you're also having really surprising incidents.
478
Seeing a young child, someone you feel bad for.
479
Hi.
480
Can you hear me?
481
Can you come towards me?
482
Okay, she's able to move.
483
Let's see if she can walk.
484
I can't walk.
485
You can't walk.
486
Let me feel her pulse.
487
Let me see your wrist. Does that hurt?
488
Okay, you have multiple patients.
489
Okay, got it.
490
There's lots of different people speaking lots of different languages.
491
Sofia, mi hija Sofia, donde estas?
492
Okay.
493
Lo siento hablo espanol.
494
Muy malo.
495
Uh...
496
Can she walk?
497
Can she walk?
498
Sabes donde eres?
499
No. She doesn't know where she is.
500
Mi hija Sofia, donde estas?
501
What do you think about that?
502
Fracture, which she can breathe.
503
She has a pulse.
504
I think it's yellow.
505
I think it's yellow.
506
Okay, fair.
507
Tell your staff.
508
And that's why during an MCI like this, you have to be prepared for absolutely anything.
509
My water broke about 20 minutes ago.
510
Wait a minute.
511
Okay.
512
Can we get a stretcher for her?
513
Her water just broke.
514
Michelle, there's two people.
515
We're still going to have patients that are coming to the hospital for other things
516
that were not related to this specific incident.
517
We should still triage them because we're overflip.
518
Correct.
519
It's for everyone because it is balancing the resources
520
that are available for everyone with the number of people that are coming in.
521
Hi, can you talk to me?
522
Yes.
523
Tell me what your name is.
524
Genevieve Fink.
525
Okay, what's going on?
526
My water broke 20 minutes ago.
527
20 minutes ago.
528
Are you having contractions right now?
529
Yes, right this morning.
530
How far apart are they?
531
Two minutes.
532
Two minutes.
533
Okay, yeah, let's proceed with green.
534
The ladies are going to deliver a baby, I think.
535
Do we have OB room a bit?
536
I called OB.
537
You want to put her in a room?
538
Call Dovey.
539
And any response?
540
No. I'll call him again.
541
We need to have the 11.
542
Why did you change to Rhett?
543
Because she's about to deliver a baby.
544
Okay.
545
That's not on the algorithm.
546
I don't know what to do about that.
547
So this patient.. is about to give birth.
548
But because of all of the mistakes I've made, over categorizing people, all of the operating rooms are now full.
549
See, her contractions are getting closer and closer.
550
Like if she starts to deliver, I told her we're gonna have to cut her pants off.
551
I just, we're out in the open, so.
552
Meaning I now need to perform a procedure on one of the red tagged patients so that I can create space.
553
Um.
554
Yeah.
555
I'm seeing what I'm seeing.
556
I got another co -worker I still haven't been told what's going on with him.
557
This was not going well.
558
I'm worried about her.
559
Her airway's closed enough.
560
Her airway's just swelling up.
561
We need to do rapid intubation.
562
Yeah, I mean, we could try.
563
She's got a lot of swelling.
564
Can we go through a cry?
565
That would make sense.
566
Then we need to prepare for a cry.
567
Okay, we're waiting for you.
568
When you're ready, he's ready.
569
Okay, great, great, great.
570
I need the scalpel.
571
There you go. And this.
572
All right, now I'm going to be feeling for the thyroid cartilage.
573
Good.
574
And I'm going to make the vertical incision between thyroid cartilage and the cryo ring.
575
Okay, I'm cutting through the skin now.
576
Okay.
577
It just seems like after the pain medicine, she started to feel really dizzy.
578
Ow!
579
Sorry, my dear.
580
We're going to get her into the yellow.
581
We need to work with her lining.
582
We're right.
583
Okay.
584
I think this is right.
585
How far are you going to push this in?
586
Just a few inches so that we don't go down into the lungs.
587
Correct.
588
Is that the direction?
589
Thank you.
590
Can somebody pay attention to me please for a moment?
591
Hey!
592
You're last in line, bro!
593
Dude, I got here before you.
594
I don't care.
595
He can't feel his legs.
596
She can't see.
597
Okay, can we prepare a syringe so I can inflate it?
598
Tube.
599
Put it up on the tube.
600
No!
601
No!
602
No!
603
Can we just have you sit down?
604
Now this comes out.
605
Now this comes out.
606
Now this comes out.
607
And switch the CO2 onto that.
608
Okay.
609
And I promise I will call them and we'll make sure that she's taken care of.
610
You will call them?
611
Yes.
612
And they have not been called?
613
The longer that I speak to you, I can't get on the phone.
614
Okay, but can you...
615
Please take a seat and I will call to you.
616
How have you not called when we talked about it like 20 minutes ago?
617
Oh.
618
Yo, dude, dude, dude.
619
Get back in bed.
620
Oh my God.
621
The baby's coming.
622
Get back in bed.
623
Oh.
624
Hey, what's going on here?
625
Get back in bed.
626
Hey, real quick.
627
I got this.
628
Okay.
629
Okay.
630
Gold is good.
631
Let me listen to see if it's working.
632
Okay.
633
What are you listening for?
634
I'm listening to make sure that it's both lungs and not just one.
635
Oh, wait, I think I know you.
636
Wait, I know her.
637
I know her.
638
Why are you just kidding me?
639
What is happening?
640
Come on.
641
Repeat back.
642
I think it's working.
643
Okay.
644
Brad, do you feel good?
645
Yeah, I'll check it out.
646
Okay.
647
Hey, can we get the OB kit?
648
We have got to get her jeans off because that baby can help.
649
Yeah, I think she's going to deliver any second time.
650
What do you think?
651
Should we cut our jeans off?
652
Where's my doctor?
653
Get the scissors.
654
All right, come on.
655
Okay, okay.
656
Um...
657
We did a video on how to deliver a baby two years ago.
658
But that was two years ago.
659
I don't remember anything on how to do this.
660
Um...
661
Do your best.
662
Open the kit.
663
Start the process.
664
Ma 'am, Dr. Kari's here.
665
She's going to do a great job.
666
My back hurts so bad.
667
She's going to cut your jeans, okay?
668
Set this up.
669
Set this up.
670
I, uh, this is crazy.
671
This is actually crazy.
672
So we should cut her clothes off.
673
Yes.
674
Hey, listen real quick.
675
Obi just called.
676
They are upstairs.
677
The doc said he'd much rather deliver this baby upstairs.
678
I would much rather that, too.
679
Are you okay?
680
Is she stable enough for that?
681
Yes.
682
Or do you want to deliver here?
683
I think she's got to go see an upstairs.
684
Yeah, the doc says it's much better upstairs for this.
685
Tell the patient.
686
Okay.
687
We're headed up now, okay?
688
Give us five minutes.
689
We'll be there in five minutes, okay?
690
Okay, thank you.
691
Oh, thank God.
692
Easy breaths, easy breaths.
693
You're doing well.
694
But the chaos still isn't over.
695
While I was treating my patients, my staff was triaging even more patients who were now flooding into the hospital.
696
Mom!
697
Mom!
698
This is Mom.
699
Hey, Mom.
700
What's Mom's name?
701
It's Ruth.
702
Hey, Ruth.
703
It's Jack.
704
Hey.
705
The hospital is quickly approaching critical mass with every room at full capacity.
706
If my wife goes blind, I'm gonna f*ing sue you guys.
707
Like, I don't know what to tell you.
708
We get it.
709
You're important, right?
710
We get it.
711
You're the most important.
712
We've been here four times longer than you do.
713
I just checked in on this.
714
You're still in line.
715
What position in line?
716
When, when, how do I know if we're moving closer or farther?
717
And all these people are coming, we just get bumped down again and again.
718
And my wife's gonna go f*ing blind.
719
I just checked in and that's the best for you.
720
Michelle, this patient doesn't look good.
721
Do you want to check vitals?
722
That's the best you could do?
723
It's the best we can do.
724
There are tons of people here.
725
Yeah, I see that we've been here longer than all of them.
726
I think what's really difficult to grapple with is that on a normal day in the emergency room, many of these debilitating injuries could be resolved.
727
But because it is a mass casualty incident, you have to pick and choose and ultimately try to save the most number of lives possible.
728
This means making really difficult decisions like choosing to allow a patient to go blind
729
because those resources need to be used to save the life of someone else.
730
This is a patient that I miscategorized.
731
Maybe she could have gotten treatment sooner if I hadn't messed that up.
732
I'm leaving.
733
Sir.
734
I have scratches on my legs and I have a dog that's locked in.
735
These are all her current vitals.
736
She got two milligrams of morphine and she has an IV in place.
737
It's me.
738
I'm so fan of this stuff.
739
She's still looking for a child.
740
Did we call...
741
What about the young child that came in earlier?
742
Could that be her child?
743
Please, Michelle.
744
Michelle.
745
Michelle, they want a CT scan.
746
Okay, we got a CT scan.
747
Ma 'am.
748
It's very easy to freeze, to feel overwhelmed.
749
And I'm worried about Michelle feeling that emotion in the midst of all of the drama that's ongoing.
750
Patients screaming, family members getting angry about time.
751
Hello?
752
Oh, s*.
753
I didn't close it.
754
Sir, if you continue to raise your voice, I'm going to have to ask you to leave.
755
Please, please, please cooperate with that.
756
Come on, squeeze, squeeze, squeeze, squeeze.
757
You need to be able to snap yourself out of it quickly in order to respond to the call
758
that is your patience.
759
Can you talk to us?
760
Can you start a BBM?
761
Can you wake up?
762
So we just could have been down a couple more inches, get her out, and then we can put in there.
763
I want to take a look.
764
You call them red, but he's agonally breathing.
765
He hasn't been responsive since you've seen him.
766
Then I think we have to move into black.
767
Okay, make choices, make choices.
768
Due to my mistakes, every red room is completely full.
769
And there was a chance that if I had been more efficient with my resource allocation, there would have been space available,
770
and we could have saved this patient.
771
But I didn't.
772
And so I have to make a really difficult choice to give him a black tag.
773
Having to be so objective about black tag is horrible, especially in a situation where if it wasn't an MCI,
774
we could have done chest compressions to try and save them.
775
But to, like, actively have to say, we have to walk away from this person.
776
That's so hard.
777
So we will have to get the name, which I'll go get with the ENTs, just for the toe tag.
778
I feel so overloaded with stimuli and decision -making fatigue
779
that I feel like I just need to sit in a quiet room and look at a wall for a few hours.
780
I have no good news for anyone,
781
and like, emotionally, not being able to provide closure is very difficult for me, and in general.
782
Brett?
783
Yes.
784
The black tag patient that came in.
785
Yeah.
786
Was he at the construction site with the other two?
787
They are.
788
That is part of the construction crew.
789
With HIPAA, are we allowed to tell them?
790
Just making sure.
791
You're a call on this.
792
Sir, can you hear my voice?
793
They did recover Brunson.
794
He came to the hospital, but when he arrived, he was unresponsive.
795
He's unfortunately passed.
796
I just wanted to tell you...
797
...because you were asking about him.
798
Thank you.
799
I'm...
800
I'm very sorry to tell you this news.
801
What we're going to experience and show the general public with this MCI is happening at scale with our healthcare system.
802
We are facing a tremendous shortage, stress, difficulties trying to give them care with limited resources.
803
So if you don't want this MCI style of healthcare, we need to make changes.
804
And I'm hoping that it starts with being kind to healthcare frontline workers,
805
being gracious when you're going in and understanding that they too are humans first and are under tremendous amount of stress.
806
Second, understanding how beautiful and limited life is, that it can be pulled away from you at any moment,
807
and you need to be grateful for it.
808
You ready for your grade?
809
Okay.
810
If we had to break up the categories for which we grade Michelle, we start with triage.
811
So we're going to have to give her an F on that one, because there were times where she was a bit panicked.
812
She was starting to get caught up.
813
Treatment, I'll give her a B minus.
814
She didn't know exactly what to do in a lot of the scenarios, not surprisingly so, but then where she really was shining is in communication.
815
Just being able to work with your team and to move people around and to prioritize and to keep checking in,
816
that is really what would save lives in a situation like this.
817
For a human being to have to be the decision maker,
818
even just today having the microscopic taste of what that means and what that feels like,
819
I have infinite love and admiration for anyone who does this profession.
820
Most people at any given moment are not sick.
821
But I can say with 100 % certainty, there will be a moment where they will be sick, where they need care.
822
Think about habits that you can change in your life, that you can improve your health, to perhaps have a better quality of life for longer.
823
This episode is dedicated to healthcare professionals everywhere who save lives every single day in real life.
824
If you enjoyed this episode, please consider subscribing.
825
And you can check out this other episode
826
I did where I worked a real 24 -hour paramedic shift in a real ambulance.
827
If you enjoyed this episode, I think you're going to love that one.
828
Till then, I'll see you in the next challenge.
Tải Ứng Dụng
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Từ vựng và ghi chú luyện nói cho bài học này
Bài luyện nói này dựa trên video “I Tried Working an Emergency Room”. Video này có 827 câu và 5814 từ để luyện shadowing. Phần lời nói dài 30:54. Người nói nói nhanh, khoảng 188 từ mỗi phút, nên sẽ có nhiều chỗ nối âm và nuốt âm. 85% số từ nằm trong 3.000 từ tiếng Anh thông dụng nhất; phần còn lại nên xem trước khi luyện. 132 trong 827 câu là câu hỏi, nên bài này hợp để luyện ngữ điệu câu hỏi và cách trả lời ngắn.
Từ vựng quan trọng trong video
15 từ đáng học trong video, kèm phiên âm và nghĩa:
| Từ | Phiên âm | Nghĩa |
|---|---|---|
| breathe động từ | /bɹiːð/ | thở, hô hấp |
| vital tính từ | /ˈvaɪtəl/ | đời sống |
| tube danh từ | /tuːb/ | ống, lọ |
| chart danh từ | /t͡ʃɑɹt/ | biểu đồ, đồ biểu |
| stomach danh từ | /ˈstʌmək/ | dạ dày, bao tử |
| nurse danh từ | /nɝs/ | y tá |
| emotion danh từ | /ɪˈməʊ.ʃən/ | cảm xúc |
| earthquake danh từ | /ˈɝθkweɪk/ | động đất |
| trauma danh từ | /ˈtɹɔm.ə/ | chấn thương |
| squeeze động từ | /skwiːz/ | đè, bóp |
| stable danh từ | /ˈsteɪ.bəl/ | chuồng, chuồng ngựa |
| physician danh từ | /fəˈzɪʃən/ | bác sĩ y khoa, bác sĩ |
| medication danh từ | /mɛdɪˈkeɪʃən/ | phép trị liệu |
| pulse danh từ | /pʌls/ | mạch |
| algorithm danh từ | /ˈælɡəɹɪðm̩/ | thuật toán |
Cụm động từ bạn sẽ nghe
| Từ | Phiên âm | Nghĩa |
|---|---|---|
| wake up động từ | /ˌweɪk ˈʌp/ | thức dậy, dậy lên |
| back up động từ | lùi | |
| break down động từ | hỏng, hỏng hóc | |
| check out động từ | tính tiền, trả phòng |
Những câu đáng luyện lại
Các câu ngắn, trọn ý trong video mà bạn có thể dùng lại khi giao tiếp hằng ngày:
- Can I make the vertical incision?
- Do we know how many are coming?
- How do I do that?
- Can you wave your hand?
- That's the best you could do?
Ngữ pháp trong video
Những cấu trúc người nói dùng nhiều nhất, kèm đúng cụm từ trong video:
| Cấu trúc | Trong video |
|---|---|
| Thì hiện tại hoàn thành have/has + quá khứ phân từ — việc đã xảy ra nhưng còn liên quan đến hiện tại | We've seen · you've seen · have been instructed |
| Câu bị động be + quá khứ phân từ — nhấn vào việc xảy ra, không phải người làm | were hurt · are brought · is called |
| Mệnh đề quan hệ who / which + mệnh đề — thêm thông tin về người hoặc vật | ones who have · people who can · someone who needs |
Phát âm cần chú ý
Người nói dùng 197 dạng rút gọn, ví dụ I'm, we're, you're. Hãy nói theo dạng ngắn đúng như bạn nghe.
- Âm “th”: breathe /bɹiːð/, earthquake /ˈɝθkweɪk/, algorithm /ˈælɡəɹɪðm̩/, thumb /ˈθʌm/, thyroid /ˈθaɪ.ɹɔɪd/
- Âm “sh” và “zh”: simulation /ˌsɪm.jəˈleɪ.ʃn̩/, emotion /ɪˈməʊ.ʃən/, confusion /kənˈfjuːʒən/, physician /fəˈzɪʃən/, medication /mɛdɪˈkeɪʃən/
- Từ dài — đặt trọng âm cho đúng: medication /mɛdɪˈkeɪʃən/, circulation /ˌsɝkjʊˈleɪʃən/, respiratory /ɹɪˈspɪ.ɹət.ə.ɹi/, severity /səˈvɛɹ.ə.ti/, casualty /ˈkæʒu.əlti/
Những âm người Việt thường gặp khó:
- Cụm phụ âm cuối — đọc đủ từng âm, đừng nuốt âm cuối: chart /t͡ʃɑɹt/, upstairs /ˌʌpˈstɛɹz/, jeans /d͡ʒiːnz/, pulse /pʌls/, assessment /əˈsɛsmənt/
- Âm /tʃ/, /dʒ/ và /ʒ/ — tiếng Việt không có, đừng đọc thành “ch” hay “gi”: chart /t͡ʃɑɹt/, confusion /kənˈfjuːʒən/, jeans /d͡ʒiːnz/, casualty /ˈkæʒu.əlti/, procedure /pɹəˈsiː.d͡ʒə/
- Âm /æ/ — mở miệng rộng hơn âm “e”: scan /skæn/, algorithm /ˈælɡəɹɪðm̩/, casualty /ˈkæʒu.əlti/, abdominal /æbˈdɑm.ə.nl̩/, anxiety /æŋˈzaɪ.əti/
Cách luyện với video này
- Nghe hết video một lần, chưa cần nói, và ghi lại những từ bạn chưa biết.
- Bắt đầu ở tốc độ 0,75×, nói đuổi từng câu, rồi quay lại tốc độ bình thường khi đã quen.
- Ghi âm giọng mình rồi so với bản gốc, chú ý các từ như breathe, vital, tube.
Phương Pháp Shadowing Là Gì?
Shadowing là kỹ thuật học ngôn ngữ có cơ sở khoa học, ban đầu được phát triển cho chương trình đào tạo phiên dịch viên chuyên nghiệp và được phổ biến rộng rãi bởi nhà đa ngôn ngữ học Dr. Alexander Arguelles. Nguyên lý cốt lõi đơn giản nhưng cực kỳ hiệu quả: bạn nghe tiếng Anh của người bản xứ và lặp lại to ngay lập tức — như một "cái bóng" (shadow) đuổi theo người nói với độ trễ chỉ 1–2 giây. Khác với luyện ngữ pháp hay học từ vựng bị động, Shadowing buộc não bộ và cơ miệng phải đồng thời xử lý và tái tạo ngôn ngữ thực tế. Các nghiên cứu khoa học xác nhận phương pháp này cải thiện đáng kể phát âm, ngữ điệu, nhịp điệu, nối âm, kỹ năng nghe và độ lưu loát khi nói — đặc biệt hiệu quả cho người luyện IELTS Speaking và muốn giao tiếp tiếng Anh tự nhiên như người bản ngữ.