Hi sir, one of the EI doctors just wanted to come see how you're doing so could I ask you what made you want to come to the emergency department five days ago on Monday. It got to the point where my chest, heart and ribs all felt like it was in a vise and I just I couldn't wait any longer. Okay so what had been going on before you came in what had been going on with you? Nothing really just I guess slowly got worse and worse and got to the point where I haven't been able to get out of bed for like a month. Okay and what do you mean what was getting worse? The breathing, the coughing, the pain. Okay so you had been having chest pain. What side was your chest pain? This side. The left side? Okay gotcha. So you were having left side chest pain, you were having some difficulty breathing and some coughing, right?  Okay but that's and it was constant, that's right it's kind of new something. Yeah and for how long had been going on? Since about a month and a half. Okay. Alright so I am going to stop sharing my screen right now. Okay so based on this patient's first initial symptoms. So you see he came into the ER with chest pain, worsening cough, shortness of breath, lethargy. What do you think could be going on with this patient right now? So I'm gonna pull I'm gonna put up our first pull and you should be seeing that pull and go ahead and answer what you think could be going on with this patient. I see lots of people answering and give you some more time. We're at 75% of our participants have answered. It looks like pneumothorax is winning the race here. We're about 90% answered almost all the way there. I'll just give a few more seconds for anybody who hasn't answered yet. So I am not going to end the poll but I am not going to reveal the answer just yet. I just I'm going to finish playing the video so we can collect some more information about this patient's and then I'll give you the results. How's that been going on? Since about a month and a half. Okay any trigger anything that started it for you? I had a tree branch hit me in the ribs and I think that might have. That's unfortunate. How long ago was that? That was at the middle of August when all the storms started happening. Oh gotcha. I was cutting trees down for my parents. Oh okay.  Okay. So stop sharing my screen. So we now know that this patient had some chest trauma. So I'm going to pull up a PowerPoint and I will share my screen about a little bit about chest trauma so we can learn some more about this. Okay so chest trauma. As we can see here chest trauma can be penetrating or can be blunt. Let me move this box right here hopefully so we can see. Okay so if the injury pierces through the skin such that would happen with a stabbing or a gunshot wound it would be considered a penetrating chest trauma. If the injury does not pierce the skin and muscle then it isn't the main cause of tissue damage you would consider the injury to be blunt force chest trauma. So car accidents and falls cause the most frequent blunt force chest traumas and gunshot wounds and strenuous cause the most type of penetrating chest traumas. Alright so I'm going to stop sharing my screen and before I do that I'm just going to reveal the results from our first pull that this patient did indeed have some chest trauma. So if you picked chest trauma in our first pull then you were correct but the rest of you aren't all the way far off so let's finish the video. Hey Leah, Janny jumping in here. I think we shared the second question of the pull so folks might be seeing slightly different answers than what Leah shared but just wanted to share that with you. Okay oh okay thank you so much. Well let's finish the video and we can always go back. Did you did you get medical help at that point? No, I just took a couple of ibuprofins all the day figuring out you know get better tomorrow. Gotcha. And then tomorrow turned into a week and we turned into a month. Yeah. A month and a half turned into me coming in here. Okay so that was almost one and a half month ago right? Yes. Okay so just a little bit more about like when you came into the ED on Monday your main complaint seems like was chest pain and coughing? Yeah. The difficulty breathing. Yeah the breathing, coughing, chest pain, yes. Yeah what was the pain like? Well pain was probably like around in seven in your eye system. Once they got the tube in and everything it was like a one. Gotcha. But I think it was just because it was hitting the infection and all that stuff. Yeah. Yeah. And anything that was making it worse for you the pain? Moving, moving. Okay. Breathing, coughing. Yeah. Anything was making it better for you? I'm sorry. What were the things that were making the pain better for you? Nothing. I mean they gave me like pain meds it made it tolerable. Gotcha. I think I just been so uncomfortable for so long. Yeah. That everything is extra tender, extra sore. Gotcha. I basically waited too long to come in. Yeah. But you know the pain medication made it bearable and somewhat comfortable. Gotcha. Any associated symptoms like were you having any nausea, vomiting? No, not since I've been in here. Okay. No when you came to the ED on Monday? Yeah no everything, everything was good. Were you having any fevers? Yeah oh yeah I broke into fevers I had pneumonia. Yeah. I was in and out of fevers. Yeah. For how long had you been having fever before you came in? In pretty much the whole month. For the whole month? Yeah I'd been in and out of it but then like two days I'd wake up and pull a sweat. Gotcha. Gotcha. You know but then it'd come back in like the next day. Okay. All right. Do you have any medical conditions? Just PTSD from work and stuff like that. Okay.  Yeah I just gave my left shoulder when I was in high school. Okay. That's about it. Nothing other than that? Nothing other than that. No. Were you on any medications? Well I used to be like on antidepressant and punch that stuff but I got off that. Okay. You got off of that. That's what I thought. That's what actually brought me in to the Guilford one was I thought that had something to do with my life. I thought that had something to do with it coming off of like the Lexapro or in all that stuff but then I started realizing this is more physical than mental. Gotcha. Yeah. Were you having any weakness fatigue? Yeah. I haven't been able to get out of bed in a month. Oh okay in a month? Literally a month in bed. Gotcha. What was your trigger that you decided that okay now you have to come to the ED? I just couldn't deal with it anymore it was just too much. Okay. Which one was the pain coughing or? The pain and the coughing. Both? Okay. Gotcha. Gotcha. And I haven't slept in my three weeks at that time so. Okay. Do some personal questions? Do you smoke tobacco? Like cigarettes? Occasionally. Occasionally. Obviously not since this all went down. Alright. Yeah. So it seems like four days ago you were in the emergency department you had this diagnosis of kind of like a pyrothorax or it's all like blood, some air and some purulent collection of bacteria and you got a chest tube in the ED. It seemed like it was not draining so you got admitted and then you went and underwent a video assisted procedure and you got three chest tubes put in. How do you feel today? Honestly it probably doesn't make sense but it feels better with the three tubes than it did with the one. Okay. Gotcha. I feel so much better. Yeah. I don't know if it's because they drain the stuff. I don't know but it's way less painful with the three than it is with one. Do you think you can see the site where the chest tubes are? Okay. So it's all covered with the dressing so we won't remove the dressing. Alright. That's good. You can put your gown back on. Just going to report the CT scan. Alright. So this guy seems like he's had quite a traumatic injury here. I'm going to let's look at these vitals and demographics. So we have a 40-year-old male. He comes into the ER. We know he has some type of chest trauma. And his temperature is 98. His blood pressure is 123 over 75. Heart rate is 95. Respiratory rate is 22. So the blood pressure is pretty normal. Heart rate is on the higher end of normal. Respiratory rate is definitely abnormal. And we can see here that he had trauma to the left chest, falling tree branch, left-sided chest pain, difficulty breathing, increased productive cloth. Now he has worsening fatigue, some nighttime chills, and pain. So I just want to take a look at, take a kind of a deeper look at chest trauma before we talk about what we would do for this patient. So I am going to pull up my PowerPoint here. So we know that he had trauma. He had blunt chest trauma. And it wasn't penetrating. This is blunt. And this is a sudden forceful injury to your chest and can be caused by a car motorcycle accident, blast injury, or fall. It may also be caused by a sports injury, such as a hit from a baseball. It may be painful to take deep breaths. It may cough and sleep. And so blunt force trauma can cause a pneumothorax, a hemothorax, and a hemo pneumothorax. So just keep that in mind. I am going to go back to our video for just a second and I'm not going to play it. I just want you guys to see something here. So now you know what happened to this patient. You see all the vital signs.  What kind of tasks are we going to order for him? What's the work I'm going to look like? What are we going to do to fully diagnose this patient?  I just want to see where you all are going, like how you're thinking and what your thought process is. The chat is disabled. Okay, I see. Janne, can you please enable the chat for us? Yep, it should be enabled now. Try again. Thank you. Thank you so much. So again, I would love to know what your thoughts are. What do you think is going on with this? I want to know what is your work?  So what kind of tasks are we going to do in the ER? Yes, I see ABGs. I love that. X-ray, CT, MRI, EKG, yes. All of those are correct. I love it. Keep it coming. You guys are definitely on the right track. Chest X-ray, white blood cell count, yep. Yeah, definitely blood work. Definitely for sure. Yes. So you guys are on the right track. I love it. And yep, absolutely EKG, CT scan, blood work, absolutely. Blood cultures, absolutely. Yeah, he has beavers, night chills. Yeah, blood cultures for sure. We need to know if there's an infection. All right, so let me share my screen again. Let me go back here. All right, so let's see what they actually did. Actually, so this is the patient workup. So this is actually what they did in the ER while he was there. This is what they did. So you all were on the right track. CDC, the complete blood count, CMP, we did a coagulation panel. I'll tell you about that a little bit more if you're unfamiliar with it. And the next here, shortly, a type in screen, EKG of course, chest X-ray, chest CT blood cultures. So you guys were definitely on the right track. You were, you know, definitely, definitely on the mark. Let me pull this up. Let's move on. And we can see that. Oh, let me go back. Sorry about that. So the medical diagnostic workup, you can see vital signs. So obviously, that's obviously that is number one. When you first come to the ER, we're doing all these vital signs, right? CBC is the complete blood counts.   And that provides really important information about the body's chemical balance and metabolism.  Also, the BUN, which is the blood urea nitrogen in the creatinine, and those are indicative will show how well your kidney is functioning. These coagulation panels, so that's when we're talking about the PTNINR, and that test measures the blood's ability to clot and how long it takes for the blood to clot. Type in screen, so the type in screen determines both the ABO and RH of the patient and screens for the presence of most common antibodies. So if you're in the ER, if you're working in the ER, these are all things, blood work that's going to happen with most patients. The type in screen has to be done before a patient's, well, I shouldn't say has to be done. Should it be done if it's possible before the patient receives a blood transfusion, but there are times in especially level one trauma ER when you don't have time to get a type in screen and you're just mass transfusing blood, but that wasn't the case here. But if there is time, yes, you definitely want to collect a type in screen. We're going to also do an EKG and that is an electrocardiogram records the electrical signals of your heart, the chest x-ray, of course, and then a chest CT. And that CT scan is obviously it's an imaging test. It's going to give you better pictures than a chest x-ray does. And what's different about the chest CT and it's very kind of hard to explain. So if you would imagine a patient is lying on their back, which is the supine position, the CT takes pictures of sagittal views. So it's like if a patient is lying on their back, the CT if you would just take a slice of a patient, a slice of a person. And then you're viewing it like this. This is that's how a CT scan reads. And I'll show you a little bit more about that. And I'm not a doctor. So I am not allowed to actually interpret those CT scans. But you know, being a nurse for so long, you just learn to look at them and know what how that is, how the pictures are taken. Okay, so moving on here. I did. I definitely wanted to move on to our blunt force trauma. So again, we know about this blunt force trauma can cause the pneumo, chemo, and hemi pneumo thorax. So what I know, what do you think the real diagnosis is for this patient. So I will stop sharing my screen and go back here. And let's see if we can pull up. So this was the first question. And we'll see if we can get to the second question. I don't know why it won't. So this was really the first question and we went backwards, but if for the first question, yes, chest trauma, rib fracture. And we went backwards, but yes, this absolutely this is chest trauma. For sure. And pneumonia is not wrong. He did also have pneumonia so if you pick pneumonia you are definitely not wrong. 76% of you answered I am going to end the poll here very shortly in a couple of seconds but yes chest trauma we know that. If you pick that you are not wrong either because yes he definitely did have a pneumonia. So we're all thinking you guys are all in the right track. For sure. So I am going to go ahead and end the poll. So chest trauma is great. I'm going to move on here. I'm going to share my screen. Close that door so the actual diagnosis for this patient after the whole workup that we did and you guys for all did so well with trying to figure out what kind of test we would give to this patient if you were the clinician in the day that night, or that day. So this actual patient's diagnosis was left-sided, loculated, infected, hemo, pneumothorax. So those are really big words right there. Loculated, we didn't talk about that yet, and hemo, pneumothorax. I want to pull up my PowerPoint here and I can see it. I kind of just put this here as left-sided, loculated, infected, hemo, pneumothorax, and this is a combination of two medical conditions which is a pneumothorax and a hemothorax. So a pneumothorax, which is also known as a collapse lung happens when there is air outside the lung, in the space between the lung and the chest cavity, and a hemothorax occurs when there is blood in the same space. You could imagine that now the lung is totally compressed and the lung cannot expand. So this man really could not even breathe on that side. So it makes sense that he had chest pain, that he had shortness of breath, that he had fatigue, because there was not enough, his lungs weren't making enough oxygen to refuse to the rest of his body. So now loculated, what does that mean? So loculated means having forming or divided into loculite or loculated pockets of fluid or pus, which is usually infectious in the lung. So if you said pneumonia, you aren't wrong with that because he did have pneumonia because there was an infectious component to this hemo pneumothorax. So I'm going to move on and show you some pictures of that as well. So here this will give you a good idea. So here all the way on the left hand side. An image of healthy lungs. The normal lung, the visceral pleura, the chest wall, where the diaphragm is, these are healthy lungs. Here's a pneumothorax. So again, this is when outside air enters, it enters into the lung space due to a disruption in the chest wall and the parietal pleura. Yes, you can see your image. I'm sorry, thank you so much. Let me go back. Thank you for that, Gianni. Can we see now? Yep, I can see it. Perfect. Okay. So let's go through this again. Okay, so here is an image of healthy lungs.  The next image is of the pneumothorax. So you can see there's air that enters into the chest wall and the parietal pleura because of some type of disruption. And that's when the lung collapse. You see how it kind of shrinks and shrivels up. The next is the hemothorax. And this is just when blood enters the pleural space and that can happen for the same reasons. It could be for chest trauma, blunt force, or penetrating. But this, this poor patient here, he got the double whammy. He got the hemo-nebothorax. And that's when both air and blood enters into the pleural space. So that is why this man was having such a hard time breathing. So how do we treat this patient? So now we know what his diagnosis is. We know what's going on with him. How do we treat him? So I will stop sharing my screen here. And I will go back to our video. So our standards of care. So we already talked about the workup. And again, you guys were all on the right page thinking about that. So the suggested treatment. So immediate chest tube insertion by thoracic specialists in the ER, it's mostly the trauma surgeon or the ER doc in this case that he's a trauma doctor. But in the setting of the loculated collection of VACs and antibiotics were indicated. So if you remember in the video, in the video it said that he initially had one chest tube placed in the ER and that can be done at the bedside. It's not an easy procedure. And the patient is usually awake when this happens. But you're doing that emergently to help reinflate the lung and to drain the blood off of the lung. But we now know that he ended up with three chest tubes and how and why did that happen. So before we go on to that, I just wanted to show you a little bit more about chest tube placement. So we see here that he had the chest tube placement to the left side and it's treatment for the hemothorax and that's obviously aimed at draining the air and the blood in the chest with the hopes to returning the lung to a normal functional capacity. And then the procedure involves placing that a hollow plastic tube between the ribs into the area around the lungs in order to drain the air and the blood. The tube may be connected to a machine to help with drainage. I just want to make sure that you all are being my screen. Okay. So he needed then to go on to have a vass procedure because he had the chest tube placed in the ER and apparently that wasn't draining enough. It wasn't helping enough. So he needed to have a vass. It's a video assisted thoracoscopic surgery. So this is when the patient actually goes to the OR.  Enduring a vass procedure, a tiny camera and surgical instruments are inserted into the chest through one or more small incisions in the chest wall. And the thoroscope transmits images of inside of the chest onto a video monitor, then where the surgeon or the thoracic surgeon can see performing the procedure so they get a really good idea of really what's going on with that patient. Just move on. And this is kind of what you can see a chest tube look like this patient. This is not our patient that we were just seeing on the video. This is another patient, but this is a patient with a chest tube. He has one. Our patient ended up with three. But this tube is then connected to this device here. It's called a porovac. It doesn't all look like this, but they mostly all do. This is just the most one of the most common. And then this instrument is connected into the wall in the patient's room where there is suction and it's kind of pulling the air and the blood out into this container and then you're measuring the drainage every eight hours. So, but as we saw in the video, our patient had three. He started off with one in the ED and then apparently that wasn't working and maybe it was like the next day they took him back to the ER. I'm sorry, back to, they took him to the OR to do the VATS procedure and just a little bit more about his treatments. So let me stop sharing here. I wanted to go back to the video first. So, what were his actual outcomes? So the left chest tube placement followed by the VATS, which we know, but then he needed frequent installation of TPA through the chest tube to help break down those locked relations. So, why did that need to happen? So this patient was pretty complicated. One, as we know, one chest tube was not helping to reinflate his lung and drain the blood out of the space. That's why he needed the VATS. And with that VATS procedure, the surgeon was able to have a better view with that camera to see actually what was going on in the lung and probably saw these loculations. And let me show you a little bit about that. So again, these loculated, having forming or divided into pockets of fluids. So these loculations can complicate a hemonomer thorax by preventing adequate chest tube drainage. So that makes sense that he had the chest tube place in the ED. Maybe the next day it was, they could see it really, he wasn't responding to that as he should. So he had the VATS procedure done and they could see that he had these loculations. And so how do they get rid of these loculations to help adequately drain the air and the fluids so we can return the lung to its functional capacity. So they instilled a TPA through the chest tube to help break up the loculation. So the loculations are very hard. The TPA is a very powerful naturally occurring protein found in endothelial cells and it activates the conversion of Plasminogen to Plasmin, which is an enzyme responsible for the breakdown of the plot. The TPA was then injected or instilled through the chest tube into the lung to break down these loculations, allowing the blood and the air to drain and return the lung to its best functional capacity. So let me go back to a video and we can see here that that is exactly what happened. The patient spent 20 days inpatient and that is a long time, especially this day and age. Nobody spends 20 days in the hospital unless you are really sick or you have a lot. There's a lot going on. So he spent 20 days in the hospital, but apparently he made a full recovery. So that ends our presentation here. I hope you all really, really loved it. I know there's probably a lot of questions, so I will open up the question portion of our session. I won't be able to answer all of them, but if you have questions, you can put them into the chat and I will try to grab on to as many as I can. Please, before that, don't forget at the end that we will provide you with that discount enrollment code for $300 off of enrollment into any one of our courses if you're not already a student with advanced clinical training. And also we have a post session survey. We would love for you to fill out. We'd like to collect, you know, just feedback from our audience about our webinar, how we can make it better and also if you want to suggest any topics that you would love to see us present in the future, we would love to hear from you. So what are some of your questions? So, I see was the pneumonia secondary to the trauma, I guess. So the pneumonia was secondary to the trauma. Anytime you have fluid collecting into the lungs, there is fluid or matter, I should say, there is potential for pneumonia. So, yes, the pneumonia was secondary to the trauma for sure. Any other questions? Let's see. I am trying to get to them. I can't, I see like there's more questions coming in. I can't see them all. I do appreciate you all spending your time here with us on a Friday evening and attending our webinar series. Again, if you're not already a student here with advanced clinical training, we'd be thrilled to have you webinar 300 is our discount enrollment code, Jenny, if you could please place that into the chat for everybody. That would be helpful webinar 300. So that is our discount enrollment code. You will also receive a certificate to the email that you use to sign up for the webinar for one hour of clinical shadowing because you joined us and we're so happy that you were here. Any other questions? Does anybody have any other questions? I do have a question. What types of symptoms should folks look out for when you're looking at possibilities for things like pneumonia or any sort of chest issues? And at what point should you go to the ER? We always tell people if you're having chest pain or shortness of breath, you should always just go right to the ER.  You know, you have chest pain, you have shortness of breath, you go right to the ER because that could be anything. But, you know, worsening lethargy, if you have a fever, definitely fever, fatigue, shortness of breath, all things pneumonia related. If you have a productive cough, if you're coughing up, you know, blood, obviously, even if it's just a small amount, people don't generally just cough up mass of the balance of blood. It's usually like, you know, the sputum is usually pink tinge and, you know, people don't think, well, maybe this is okay. I mean, it's not that bad. Definitely you want to go to the ER, but fevers, chills, lethargy, feeling fatigue, all of those things. Definitely you want to seek medical attention for right away. Thank you. Thank you for the chat as well. I don't see any additional questions. I know I see a comment about a question related to our training program. So if you can put that in the chat, we will do our best to answer it. If we don't have an answer today, we will follow up via email. But please feel free to post any questions related to either today's session, or if you have any questions about any of our certification programs. Yes, please do. So what happened? What would happen if there was no electricity? Anyone have been able to use the plurivac to drain the blood and air? So this patient was in the ER. That's a good question. This patient was in the ER. Probably a level one trauma center. If they weren't, they're being transferred to a level one trauma center. A level one trauma centers have backup generators. So if the electricity ever does go out, there's backup generators. So there is always electricity. There's always electricity. So it was maybe not draining the blood and the oxygen because of the loculations. And so that is what ended up having this patient go to the OR to have a VATS procedure. So this is another question. Is there any labs on the phlegm the patient was coughing? That's a good question. So there are things called, there's something called a sputum culture. And so usually the patient, if they can, they spit their sputum into a cup and they send it to the lab and any type of culture, whether it's a blood culture or a sputum culture, any culture, a wound culture. It takes at least three days for anything to grow. So we generally, if we think a patient has some type of infection like that, we generally treat them with a broad spructum antibiotic until the culture grows the specific bacteria. And then we know what specific antibiotic we use to target that bacteria. But yes, there's a sputum culture. Yes, we do use sputum culture. He said that it took him a month ago. Is that correct? It did take him a month to go to the ER. And we see this often.  It sounds like he was a young guy, 40 years old. He didn't have many comorbidities. He didn't have other health complications. So his body was compensating for a period of time and to the point where he just couldn't take it anymore. He went to the ER. He probably should have gone right when he had those symptoms that generally men in their 40s aren't running to the ER.  They don't think there's something wrong. They can handle it. And then this is what happens if you wait that long. What happens in volume after how much blood loss would blood transfusion be warranted? Well, that's a good question as well. It just depends on that what we call your H&H, a hemoglobin and hematocrit. If we have time to get that then usually if the hemoglobin is below 7.0 is when there's indication to replace the blood with a blood transfusion. But in this instance, but in the instance of a trauma where you know there's already been massive blood loss, you're not doing that blood work. You're just mass transfusing because you already know. A lot of good questions. I'm glad you guys are pointing things in the chat. I'm so glad to hear that you were so engaged. What preventative advice would you have provided to him? Well, I don't know if we could really prevent this type of injury. I mean, this was an accident, right? He was cutting down trees for his family or his parents because there was a storm. And so you can't really prevent these things from happening. Like you can't really fully prevent a car accident. You know, you can't really fully prevent an assault. I mean, you can try to keep yourself out of these situations, but sometimes they just happen. They're accidents, you know. Of course, there's preventative advice you want to give to everybody like you don't smoke. Well, if you, you know, likely if you weren't a smoker and you had this type of injury, you're going to have a much better recovery. If you are healthy, if you eat healthy, if you work out and you don't have comorbidities that are preventable, then your outcome when you have one of these accidents are going to be much better. So will the slides be posted in the email for certificates? So no, we're not going to post these slides. We do record these and we post them. I believe we post them on our YouTube channel. But you will again receive a certificate for one hour of clinical shadowing and that will be sent to your email that you use to sign up for this webinar. Leah, I just want to quickly acknowledge a question about full scholarships. Affordability continues to be at the center of what we do for pre-health and pre-med students. So we do offer discounts and payment plan options for people who are students who are looking for those opportunities. Unfortunately, we don't have full scholarship for those who are looking to enroll in any of our programs, but that's something that we are working towards in the future. Yes, yes, definitely. At this time, we don't offer any federal financial aid or our full scholarships, but our programs are priced to be very affordable and we do offer payment plans. And we do offer another assistance through another loan program that's kind of like a private loan, but that is, you know, we can certainly provide information, detailed information for that if you would like. Leah, I see another question in the Q&A box. What is the typical amount of time someone is in the hospital for and why do you think this patient stayed for a longer amount of time? Well, it's hard to say what the typical amount of time is for this type of injury because every patient is different. And with this patient, he had a complication, right? He didn't have just a pneumothorax or a haemothorax or a hemonymothorax. And the fact that he waited so long to come in, then he also had pneumonia on top of that. So he really, that was the complication and that's what kept him in the hospital as long as it did. You know, all of the loculations, having the three chest tubes, draining the blood and reinflating the lung. All of those things is what kept him in the hospital for 20 days and had he come in sooner when he started having symptoms. He, you know, would have been in the hospital for a lot less amount of time for sure. I'm going to give you something in the chat about what kind of discharge instructions would you give to the patient. So I'm sure this patient was probably sent home. He completed, I'm sure, at a course of IV antibiotics in the hospital. He's probably sent home with oral antibiotics. You always tell those patients, make sure you finish all of your antibiotics. Even if you start to feel better, you want to finish them until the end.  He probably his primary care physician and obviously the cardiothoracic surgeons that provided care with the chest tubes and the best procedures. Definitely not smoking. He might have had to do some cardiopulmonary rehab just to get that long working again. So just to follow up with all of, make sure he's following up with all of his appointments, refrain from smoking and being exposed to secondhand smoke, definitely immune support with through eating healthy foods and probably taking some type of vitamin supplement as well. And then also, of course, if he had any type of, you know, reoccurring symptoms, which would be the same like chest pain, shortness of breath, fatigue, fevers, seek medical attention right away. How do I feel about antibiotics being used in everyday medicine, although there have been reports of antibiotics killing gut flora. So that is a very, very good question. And there has been a very big shift. When I first started nursing, it was like everybody, you know, they had the fever, they had this like, you just put them on antibiotics. Now there's been a big shift that unless we know for sure that the patient has some type of infection through whether it's we've confirmed that through blood cultures or a urine culture or sputum culture or a wound culture, we're not just prescribing antibiotics because there is the concern of antibiotic resistance. And so that is why we are confirming with these types of cultures to make sure we're not over prescribing antibiotics for sure.  So it's killing the bad bacteria, but it's also killing the good bacteria in your gut and not some antibiotics are worse than others. And please don't anybody ask me exactly what the names on of those are, but I generally tell people if you can take some type of probiotic while you're taking your antibiotic that's always a really good idea to add some of that good bacteria back into your gut. While you are killing the bad bacteria that's causing your problems. Right. Yeah, I think we have time for one more question. And it is, what complications would we need to be aware of specific to the lung re inflammation surgically and medically. Um, so those same. Nothing new just worsening chest pain. Shortness of breath, a high respiratory rate and fevers chills. Low oxygen saturation. Those are all things you would look out for a high a fast heart rate because your heart's trying to compensate for your, your breathing so attack a cardiac would be one as well. fatigue so all of those things would be something you would want to look for in a patient that is not responding to initial treatment. So it is 559. I really just want to, again, thank everybody for joining us here with advanced clinical trainings web webinar series. I hope that you come back and see us again real soon. And our 300 is your discount enrollment code. If you're not already a student with advanced clinical training, please go over to our website and take a look at us. We would be thrilled to have you here. And again, you will receive that certificate for one hour of clinical shadowing and please don't forget to please don't forget to fill out your post session survey. So we can collect feedback from you and also please provide to us any topics that you would like for us to discuss in the future by everybody. I hope you have a wonderful weekend. Stay safe.


Today, I'm gonna show you guys how to get the best deals and have the best experience at sneaker resale shops. Let's go ahead and get into it. All right, tip number one, that is know your budget. When you come into a sneaker store, it's easy to get overwhelmed with all these crazy dope sneakers, the crazy price tags that you may see as you're looking at the shoes, flipping them over one by one.  And then from there, you'll be able to understand if you're actually getting a good deal or not. But how do you even know if you're getting a good deal? That takes us to our next step. Step number two, you need to do your research. You gotta understand the prices and the fair market value of all these shoes before you come into the store. I get it, you're not gonna know everything. There's a ton of different sneakers in every single store. But at the end of the day, if you have a baseline understanding of what the value is of a pair of shoes, it makes it a lot easier for you to now negotiate with the employees and the people here in the store because they're not gonna just look at you as like some type of rookie that they can get over on and make a couple of extra bucks on. But somebody that's more experienced and has a better understanding. And now you have more power when it comes to negotiations, which we'll talk about that a little bit later. So don't be up in the store looking at stock acts, holding every single shoe, trying to figure out what are these worth? What are those worth? What are these worth?  Do that before you get to the store.  And if you can't remember everything, it's okay. Just try to be low key, a little discreet when you check the prices. You know, like pick up the shoe and then maybe a couple of minutes later, check the price and then walk back to the shoe.  But really, you're actually looking up what the shoe is worth and then seeing if you want to pay that price or not. All right, tip number three, you got to make a sneaker hit list. No matter if you just started collecting or you've been collecting for a long time, trust me when I tell you, this is very, very important. It's easy to walk into a sneaker store, see so many shoes, get off track. Yeah, you got your budget, you got everything figured out. But then you're like, bro, I don't even know what I want to get. What am I looking for? What's coming out recently? What's coming out soon? What do I got that I need from the past? What shoe collection am I trying to complete? For example, let me show you guys real quick. I actually have the Dornbecher collection. I had the whole collection, then I got rid of a couple of shoes. I forgot which ones I got rid of and now I have a little note in my phone and it says Dornbecher collection. The fire emoji right here, those are all the shoes that I have. From the whole Dornbecher collection, I'm missing three shoes that I need to get in my collection. So because of that, when I go into a store, I say, hey, I'm looking for these shoes and their size and makes it a little bit easier for me if I want to hunt for that specific shoe. So I always have a hit list, whether it's for collections or just things in general that you're looking for. It makes it a lot easier for you to stay on track and get those deals that you need. Tip number four, bring some cash. I'm telling you right now, this is King. We talked about this in the sneaker com video, same thing when it comes to sneaker stores and why do I say that? It's easier to negotiate when you got cash. The reason why it's easier to negotiate, they have card processing fees when it comes to the business and that means they have to pay a fee for the transaction. If you can eliminate that processing fee and the transaction and they still get the same amount of money that they would have gotten and you can now save that money or potentially even get it for a little bit cheaper because of it, these are gonna be the things that help you get those discounts on the sneakers. Oh yeah, by the way, if you guys are looking to take your shoe game to a whole nother level and build a six figure sneaker head collection, I'm here for you guys. I built a full program with the eight week tutorial that breaks down everything that you need to know over all the stuff I've learned over the past 15 years and the best thing about it is we have a full community where we engage every single day with the community group chats and we have live meetups every single month where we go over goals and planning and helping each other grow their collections even buying real estate and taking ideas when it comes to loans and different property management as well. So not only just sneakers but I wanna help everybody grow in life. So if that's something that you wanna do, hit the link down below in the description. I would love to have you guys on the inside. And again, if you wanna take your game to the next level I'm here for you. Let me know, I'll see you guys over there. Tip number five, talk to the employees. This is very, very important. People walking to the store, they're all quiet, they're like intimidated. I don't know what it may be. You might be in your own little world and I get that. Shopping on a Saturday. You don't feel like talking to nobody, get your headphones in. Yeah, that's cool. But if you wanna build relationships with the stores and actually get those deals that you're looking to get, these are gonna be the best ways to do it. But get to know them. You have a lot of things in common. We are all sneakerheads. Yes, that's one thing we have in common but we may like sports, we may like food, we may like something else outside of that. Bring up those things in the conversations when you're talking to the employees at the stores. You'll build that connection. Step number six, post them on your social media. It doesn't take that much effort to walk into the store take a photo, post them on your story, tag them on IG. Not only does this help show you that you're supporting the business and with them saying, oh great, we can repost that and help them out. Not all these businesses are big. No matter how much we may glorify a sneaker store and all those things, they're all considered to be small businesses. These aren't businesses that are doing billions of dollars in revenue. So at the end of the day, help the stores out. They're gonna love it. They're gonna appreciate it because not everybody that comes in, think about all the foot traffic that comes into a store. Not everybody's supporting them. So when you do that, it helps you stand out.  He was the one that was posting on Instagram supporting our business. He came to our store opening. He came to those things. Those type of things help you get the better deals, get you the lookouts when they're trying to get you an early pair of shoes or whatever it may be. All those little things play a huge factor. Step number seven, look for used shoes. I know some people may be too bougie to wear a pair of used shoes from a sneaker store. You can get shoes for a way better deal if you find used shoes. Now, for example, we're here at Untied LA.  But does that mean they don't have used shoes in the back? They just might. So you gotta go over there and you gotta ask them, you say, hey, do you guys have used shoes? They might have some things in the back and it might be in your size. You guys have seen it plenty of times in my videos where I do what? Go back there. They got some old dusty pair of shoes. And now I can actually clean up the shoe, get it for like 80 bucks or 100 bucks. Next thing you know, it's worth $250, $300. All right, tip number eight, you need to ask if the store does trades. This is very, very important. We talk about this all the time on the channel. It's pretty simple. Say for example, you got five pairs of shoes, they all work for a couple of hundred bucks. Now you're looking at $1,000. Well, maybe the store is like, hey, we can sell those shoes. We'll wanna work some store credit or some trades and give you your grill that you're looking for. You're looking to get the Travis Scott or the Off-White or whatever it may be. Again, not every store is up for it. But if you don't ask, you'll never get the opportunity to see if it's worth it or not. So always say, ask the people if they do trades and come correct when it comes to the trades as well.  Like make sure you got a legitimate trades that are a good offer. Because look at this grill wall up here. They have a lot of bangers up here. And you all to see me come through here, sole steels, bunch of different places, and we didn't work some trades out. That's how I got my Air Mags.  So I ask those questions, it's very, very important. Again, trust me, you will love it because when the store says yes, you might just get your girls that you've always wanted. Tip number nine, look for shoes that are at or around the retail price. Now you know the shoes that everybody likes to call bricks. You can get the same shoe. Let's say for example, a pair of shoes, $190 retail at Full Locker. But you could come to a resale shop. They may have gotten a bunch of pairs in bulk and now actually selling them for right at the same price or lower. And now you can get those there compared to spending the money and buying them on StockX or Gold or whatever. And then you gotta pay the fees. Next thing you know, you bought it for that retail price plus all the fees tacked on and now you're paying it for that. But if you bought it at the store, that's what they actually have it marked at. Now depending on tax, depending on where you're at, you might have to pay that additionally. But again, if you add cash, you might be able to cut some of those fees out as well for the card fees. And then you could potentially get that shoe for even cheaper, or they might even have the shoe for cheaper than the retail price originally. All right, the 10th and final tip you guys. Ask the store if they do sourcing. Now what exactly does that mean? They have a huge network of a bunch of different sneaker stores, typically, typically. Most sneaker stores know a lot of other owners at other sneaker stores. And they're all friends with each other and they help each other move inventory literally throughout the nation and throughout the world. And because of that, it gives them access to more sneakers. So if you ask them to say, hey, I'm looking for this pair of shoes and they may have every size but your size, but they might know a friend with a store that does have them and they can source the shoe and get it for you in a day or two days or next week or whatever it may be. That's gonna be beneficial for you. So if you ask those questions, it can help you out a lot. But you gotta be ready to pay that money because the stores is not gonna take you serious if you're asking for this, asking for that, requesting this, requesting that. And the next thing you know, they're like, yo, we got the shoe for you. And then then you don't go pay the money. And then you come back next time and they're like, I'm ready to buy the shoe. It's gonna be like boy who cried wolf. You gotta actually come in, come correct, be ready to pay and get the shoe that you want. When you do this, what's gonna happen? Again, they're gonna start finding stuff for you faster. They're gonna get you the stuff you need and like I said, you got the hit list or whatever it may be. They're gonna be the stores that help you complete that hit list. We talked about that before, build a relationship with a store, work with let's say three, maybe five different stores that you like, go in there and build those relationships. Spend the money with those same exact stores and as you build that up, they're gonna be coming through left and right. Every time if you miss out on a release or if you're looking to get a good deal, we're trying to work that trade, it's hard to build that good, that plug deal with a new person every single time. But if you do it with the same people over and over and over again, it's gonna get better and better for you as you go throughout the time. Now I know you guys are, you know, been collecting for a year, maybe two years and some people have been collecting for a long time and haven't been doing these things. These are gonna be very beneficial to your sneaker collection, your, I don't know if you wanna call it your sneaker career or whatever you wanna call it, but it's gonna help you a lot in the long run as you build these relationships. All right you guys, that is gonna do it. I hope this video was helpful and you guys got a lot of value from it. Again, if you haven't already hit that subscribe button and if you wanna learn more or join the community, like I said earlier, hit the link down below in the description. I'll see y'all in another one. I would never let you down and send my DNA. The only choice I like to make what I'm aware today. I would never let you down and send my DNA. The only choice I like to make what I'm aware today. I was made for it, it's in the DNA.


Hello beautiful.  I would say I hope they do well, but I just know they're not going to today. I'm probably gonna be a little disappointed But let's see. Maybe I'll be surprised at some of the results up first. We have a video by Heather Hughes I think I'm gonna get my hair cut today. This is how long it is. Okay. Wow. All right. She was like Should we do it? Should we do it? Yeah, I'm gonna chop the whole thing and like a matter of two seconds Love it for you. For me. I don't know. She has very pretty hair. It's so thick It's so luscious and it looks so healthy. I'm excited for her to have a different look though It's a lot of weight. It's a lot of hair. Hopefully she put some layers in it Hopefully she doesn't just give herself like one chop, but she probably will. I think we're going here Imagine if I just took these scissors like right here and just was like Oh, oh I highly messed up on this one. I've got to say First of all, was there a plan at all? I'm just wondering like was there any kind of like thought of like how you should do this because it kind of didn't look like You'd plan anything you just kind of like chop something which makes me really nervous for the rest of the cut And secondly, I would highly recommend washing your hair before you do a haircut and cutting it wet It's just easier. Trust me. The hair clumps together. It falls to the floor It's easier to clean up and it gives you a better result in the end, you know Last time I watched like a tutorial, so I know how to do it now This is a tutorial on how to cut your hair at home from someone who has cut their hair at home once now twice Don't follow this as a tutorial any of you.  This is what we got. Is it crooked? Yes I feel like I need to cut the front one as well because now it just looks weird Sure Stop grabbing pieces and just cutting them. There's so many tutorials of mine that show you how to do these things I actually don't think I have a bob one. You can do a lot of my tutorials and make it into a bob We got it section the hair. We got to put elastics in we got to make sure everything's sitting In the right places and then we can start cutting it not before we got the front done now We just have to do them back. Oh, so we are getting a technique here. We're progressing slowly We did a little shock moment in the beginning when we are now doing sections So we are putting the elastics in and that is great. I love to see it Let's see if she manages to cut on top of the elastic instead of below the elastic because y'all love to cut Below it and let the hair fly everywhere and it doesn't make any sense to me This is what we got here are like four sections. Okay, there's an issue going on Does anybody see it basically when you do this sectioning in the back of your head You just make sure that you are putting the elastic in the way that the hair lays. Okay, so that lays this way You're putting elastic back here.  I don't know the ones in the back are longer than the ones in the front But why why would you want them longer in the back than they are in the front make it make sense explain it to us? Tell me. Oh, this is a tutorial you take your scissors and you just cut it What are those scissors? Those are not even cut your hair. No, and you're supposed to cut like that like this Give that who taught you these things because it wasn't me not this time.  I didn't think it's highly possible. I went way too short It is not long anymore. She's cutting below the elastic She's cutting above one of them, but below the other and we don't want to do that We're gonna cut above elastic. Oh, I was not paying attention. This is so bad You should probably start paying attention open your eyes because what's happening right now is not good Again, okay, tell me fair. I did a pretty good job You did a pretty good job where am I watching the same video? Where is the good job? Sorry, but like honestly, where is it? Oh, I did not do a good job. This is so bad Okay, I highly messed up one side one side is like two inches shorter than the other and the back is like Just like I thought it would be this is gonna be difficult to fix I just need to stop with the scissors. I don't even know what to say with that one I just did she just chop that queen or play that like what is she doing? Look at all this hair. Let's see how bad the back is. Is it bad? Just like what she said, it's definitely not good. Oh my god It's a massively crooked. Let's go back to my number one rule to make don't cut it too short I'm so sorry you guys, but there is no happy ending to that video because that is where it ends I don't think you should ever do that again ever in your entire life You should see a professional There was not one thing that I could say that was good about that haircut to be honest with you. Um, well, you did section But this result Not for me up next with a video by Janessa.   Well, this one's not quite a diy It's a I don't know I was gonna think of like an acronym for like your boyfriend does it But like boyfriend is going to help apparently which is good.  So that's good. I feel confident also really interesting hair texture You got it like looks as if it's straight on the top and then you have curls on the bottom Which I've never seen in my life usually the opposite like there's more heat damage on the bottom and it becomes straighter So I'm excited to like even out this texture that's happening and just cut off those curls You know just something how long my hair is That's how long Um, maybe like here. Yeah, like right too much and she's cutting it to her shoulder I don't know these just kind of scary I wish we could see the back right now, but I already know what's going on Like he just put all the hair behind her and it's just cutting a line across Which is a way of doing things but when she pulls it forward She's gonna have this a line bob like this not something that I'm a fan of personally If you guys like that go off. Do you think have fun for me a line bobs are dated and a little bit strange She is so confident in cooling this whole thing like how is she so like sitting there just so secure like uh Just kind of just do it What is that piece neither of them notice that there's like one little straggly hair just long as hell like What is that? I feel like the back is really short Okay Short in the back and it gets so long in the front like mm-hmm Then he's trying to layer the front of her hair with some angles The way he's doing it is by putting little steps into her hair and with a bob Like you don't really want angles in the front of your head Like it doesn't really make sense kind of ruins the structure of the bob and doing it like that is going to literally create actual like Layers not like I think she's going for like face framing like feathered and that's not going to give you the effect you want Okay, yeah, that looks cute Okay, she's trying to be a supportive girlfriend and the boyfriend's trying to be a supportive boyfriend And I appreciate it. I'm gonna come in here. I'm gonna interject a little bit and just say it's not quite there We should all just do things that we're good at And hair cutting it's not one for you. The stress has set in and but she's still committed to it Look, she's going for round three now.  Why is it all lined up and then we got a long piece just hang in there? Keeps getting worse So my hair looked really bad even though it was long it looked really bad. I was going to Kind of like Shape it out and like add some layers. Why are you taking chunks out of the front of your hair? We don't want more angling it like she now has like this rounded fringe thing going on with a bob It's getting wild. Okay, so that's the end result We're going to a salon next time. Okay. Do you promise me, please? Listen though, you look beautiful no matter what hairstyle you have you still look gorgeous Also the way you styled it in those end pictures. I'm so happy you did that It looks much much and much much better and it actually looks like you purposely cut it like that So I think in the end you got a beautiful look and you look stunned. I'm happy for you But um, you that was so scary Next time follow my tutorials and then we won't end up in these situations We need some texture in there. We need some thinning shears. It's a lot of hair It'll be much easier if you just styled too if you got rid of some of it, you know thin that thing out, babe Up next we have a video by Megan. I've been wanting to cut my hair for a while because it was getting kind of long And it's not like that.   What part of it? Come on We're doing the same technique as the first girl just taking a piece and chopping it off and just hoping for the best It's kind of choppy obviously because I'm the one cutting it Yeah, yeah Definitely choppy definitely me chalked off since you're just taking pieces and just chopping them up. Hello. Should I go like to right here? Sure. I mean listen at least give us a show if you're gonna do it Don't close your eyes while you cut it, you know if I can make one suggestion It would be to look wow you cut your hair look in the mirror Don't close and cut and I don't feel like I have to explain the reasoning behind that one I remember I did this like a few months ago And I just wanted to come in here. Oh wow, that's pretty short. Honestly. It's not that bad though I'm not sure about that one. Do you see this like it's like half and then like I cut like a lot of inches off You went for it.  I mean, honestly, she's really Really going for it. I have no idea how she's gonna cut the back of her hair You can't use that same technique of like pulling a piece and cutting it You're gonna end up with like all kinds of choppy in the back. What's the plan? Okay, so like this side is basically done. I don't know if I should go shorter or not. I'll decide I'm gonna decide for you. I'm gonna step in here.  So now to this side. All right. Let's see if she can make the other side the same length Probably not, but I'm so mean today. I'm sorry guys. I don't need to be so harsh It's just like I'm not seeing a lot of good stuff happen Gosh, this is taking forever. My hair is like thick. Really off. How did you manage to make it that off? Please be the same length. It's getting worse. Oh my god. Oh my god It's okay. We can fix this. She seems still very hopeful after she just demolished her hair I don't know if I can fix that I'm literally involved like as you can see you cancel all the layers down there I just don't know how it looks from the back and I don't want to see it Let's try and fix this Gosh, I hope I don't mess up Honestly, it looks even now we just have to see how it looks from the back What is that thing in the back? It's all a disaster I'm honestly happy she can't see it because I don't know what her reaction would have been Okay, I think it looks pretty uneven. I haven't seen it yet, but I can just tell by like feeling it The front is also not even what happened there, babe. So I'm gonna cut a little bit more. I think I got this I'm hoping this turns out like decently good. Just stop cutting I think it's pretty straight. I don't think I did too bad. I still haven't seen the back or seen how it looks I hope it looks okay. Somehow she loves it. Listen, you do you. I'm happy you're happy Objectively, I don't think it's a good haircut and there was a lot going on there I would just love to see some layering in there. We need to thin that hair out It's just sitting so heavy on the bottom with some shape to it. This bob would look spectacular on her The hair's sitting down here. It's too chunky. It's too big. It's blocking. It's strange But I'm happy you love it again. I'm happy for you now for me today. That was tortured. Now that was Something I'm still stressed out from all those haircuts, but I will recover. That's all for today guys Make sure you guys check out my haircare line and my hair color line linked below or go to xmodohair.com Thank you for watching and don't forget to live your extra life and I'll see you next time. Bye guys


So, let us start discussion on the circular failure surface. So, historically the circular failure surfaces are basically they depict the rotational failure of the slopes alright. So, these are this is the planar. Now, we are going to talk about a rotational failure. So, this is the slope and the failure is going to be along this surface, which is a part of circle or it could be a circle depending upon the material properties. So, the genesis of this analysis is 1916 is so old. Mostly this is subscribed to the people who are working in the sudden and Swedish group that is why we know we call this method also as the Swedish circle method by Pettersen ok. So, this is attributed to the Swedish geotechnical society this method. These are the societies of different countries like in India we have Indian geotechnical society which monitors and controls the activities of geotechnical engineering professions professionals in the country and the profession also. The basic philosophy here is now if I consider a failure surface like this a b c what are the governing forces on this block a b c one is the weight another one is the cohesion which is acting all along the surface. So, that means the cohesion which is acting on the surface b c all right. We show this direction as c in the form of force. So, I will use a capital C here as the force the direction of c is always taken as parallel to the chord b c this is the arc and this is the chord. So, the direction of c is assumed to be parallel to b c. So, one unknown is less the direction is known magnitude is not known. Now, suppose if I ask you to complete the triangle force triangle we have c prime and we have w what would be the third force the reaction which is acting at the base now there is something very interesting. Suppose w decreases or increases what is going to happen. So, basically w directly is proportional to the c prime or the c prime is what is c prime the cohesion which is getting mobilized on the surface fine. So, that means I can always say that w controls the magnitude of c the direction is known lower the value of w lower c is required. So, you remember what we did what we did when we were discussing about the tension cracks which are occurring in pure cohesive materials. This is the tension crack let us say from the lateral side there is no force which is coming on the block this block that means w is going to be balanced by the cohesion which is getting mobilized on the surface. So, if w tends to 0 c also tends to 0 correct if w tends to 0 c also tends to 0 that means a smaller the weight a smaller amount of cohesion is required or gets mobilized to stabilize the whole thing. So, what we can say is c upon w is a term which remains a constant any idea why we are using the term c upon w look at the fact stability number. So, stability number is defined as c over gamma h gamma h is associated with the weight of the destabilized block alright. So, can I write this expression as c m into length and what is length? Length itself is a function of h height of the slope and when you say c m what will be the c m value c m will become c u over factor of safety associated with cohesion because this becomes c m. So, c m is getting mobilized along the slip surface which is the function of h, h is the height of the total slope and what is w the w is a function of gamma h square. So, that means what we are going to get is a function I said. So, that means I am going to get stability number as what is the stability number c u over factor of safety against cohesion multiplied by gamma into h that is it. Incidentally this c m is also same as what we have written over there the interpretation was different the c mobilized is going to be the total cohesion under undrained conditions divided by the factor of safety why undrained conditions because the failures are going to be very quick instantaneous failures undrained conditions alright when these are undrained conditions we have to follow total stress analysis I am sure you are realizing how to interpret c pi parameter which we have got from different types of triaxial test and then how to include them in totality to depict a situation of failure normally these type of problems are defined as the short term stability problems alright this is part clear. So, what we are trying to say is c u upon f c into gamma h is a constant which is known as stability number for undrained situations where you have pure cohesive failures. Now yeah one more thing which you can maybe would like to understand is that this function will be equal to c m into length of the cord along which it is acting. So, length of the BC as a cord alright. So, this is the cord this hypothesis is attributed to Taylor name of the person who has proposed this and we call them as Taylor's stability chart first of all they will be applicable for total stress condition and truly speaking these charts have been derived based on the friction circle method which I will be talking about later on. You have done this friction bearings in your engine mechanics course is another application of this concept. So, by definition the way the Taylor's chart have been defined we use the term NS this stability number is defined as NS and this is normally written as equal to c u over f into gamma h. It is understood that f is basically associated with the factor of safety of cohesion and we take this f as the minimum value. So, that the factor of safety term or the stability number gets maximized as per Taylor this NS is a function of the slope angle beta and the phi u value. So, the stability charts which will be talking about they look like you know a relationship between this is the factor of safety or the stability number this is the beta value these are the values of f phi u which direction phi u will change suppose friction angle increases from top to bottom or bottom to top which one is correct that you have to think of. So, suppose friction angle is 0 is the top most line or the bottom most line for the same value of beta which slope is more stable stability number yes that means even the steeper slopes can stabilize can stand alone without any support if the friction angle is more. If the friction angle is less you require less steeper slopes. So, for phi u equal to 0 there is a special condition we will be discussing about this and normally the phi u increases in this direction and for phi u case it would depend upon there is something known as depth factor. So, suppose if this is a slope and this is a hard strata height of the slope is h inclination of the slope is beta one of the failure mechanisms which is going to be most critical would be you know the failure like this a slip surface which is circular particularly pure cohesive soils and if this is h we define this as d into h the depth factor. So, d is the depth factor I will show you these graphs so that you can use them for doing the analysis. So, these stability charts were proposed in 1937 by Taylor and how do they look like I am going to project it over here yes. So, this is the first stability chart you know there is a embankment or there is a slope and this is a critical circle which is passing through the toe of the slope there could be different cases the slip surface may not pass through the toe which is case one there could be an out crop. So, what you are observing here is the slip surface passes in such a manner through the foundation of the embankment or base of the embankment or the slope and then there is some out crop. So, this out crop is depicted as nx into h where h is the height of the slope beta is the phase value or phase angle. So, there are three cases the first case is passing through the toe second is touching the hard strata intersecting the phase of the slope this is what is known as phase failure this is what is known as toe failure and the case two is depicted as the base failure for the same height edge. Now, stability numbers are defined based on zone A and zone B sort of analysis alright. So, if you look at this line which is the dotted line which is passing like this is starting from about 25 degree the right hand side zone is zone A left hand side is zone B zone A is the critical circle passing through the toe and zone B has three cases the case one which we discussed critical circle through toe full line case two critical circle below the toe as the dotted line and the third is case three where we have a very strong strata what I have depicted there as d into h which again is the dashed line alright x axis is slope angle y axis is stability number ns the friction angle under undrained condition increases from top to bottom and for the first case you will realize you know it depends upon the depth factor. So, as the depth factor increases what is going to happen if the if the depth factor increases in this graph for phi equal to 0 you will have different lines in this direction the depth factor will increase. So, let me define this as depth factor there are some more cases of stability number which have been discussed over here phi prime equal to 0 corresponds to undrained or the total stress analysis depth factor is here treated as ND which I have taken as df into h will be the total d of the or what we call it as the depth of the deepest point of the slip surface you have the stability number we have ND value and then for Nx we can use the dotted lines for a given slope angle and then we can compute the factor of safety. So, you can use these graphs for analyzing the stability number for different types of slope conditions. Now, we will solve one problem to showcase to you how the analysis is done. So, one example problem would be suppose if I take a 60 degree sloping surface in embankment 6.5 meter the soil properties are 18 kilo Newton per meter cube 28 degree and C is equal to 20 kPa. Find the factor of safety with respect to strength shear strength and use Taylor's chart suppose for the sake of simplicity alright subsequently you will have to understand which charts to be used. So, depending upon the material property you might have to apply your intelligentsia to select the right chart and go ahead with the analysis. The general principle of analysis is like this that we always assume you know a value of F5 say 1.5, 1.6 this is a starting point. So, once you assume the value of F5 you can compute phi m yes tan phi prime tan inverse tan of 28 degree divided by 1.6. Now this comes out to be approximately 18.4. So, what we have obtained is we have obtained the value of friction angle which is getting mobilized out of 28 degree friction angle which is available the mobilized value is only 18.4. Now what should be done we can use Taylor's chart is beta known yes what else is required phi m we have obtained can you interpolate between the two lines beta is known here on this graph. So, beta is known for 60 degree go up 18.4 you have to come somewhere here can you obtain the stability number n is equal to 0.1 007 I mean you have to be very careful while you are using the numbers and usually you should go up to the 4 decimal place. So, it is always better to use the empirical relationships analytical solutions substitute the values and obtain it rather than seeing the graphs. But nowadays you need not to bother much because most of the softwares which are commercially available include these parameters which are inbuilt alright. So, if I know the value of n which is equal to Cu over fc into gamma H. So, what I can obtain from here I can obtain the value of Cu which is nothing but cm the mobilized value. So, this will be equal to 0.1 007 into gamma is 18 into H, H which is 6.5. So, this turns out to be 11.78 kPa what will the factor of safety for fm the total value of C is known as is this correct. So, this fm is basically fc factor of safety for cohesion and this is mobilized. So, this will be equal to 20 over 11.78 and this comes out to be 1.698 what this indicates this indicates that the starting point of f5 as 1.6 is not equal to fc. But it was not a bad assumption we started with f5 as 1.6 and we landed up with fc value as 1.698 what I should be doing then of course this depends upon the value of f5 which you assume to start with. Now, suppose if you assume f5 as 1.5 you might have to go for 2, 3 iterations to satisfy this condition that f5 is equal to fc. So, until this condition is obtained we keep on doing iterations. One of the ways to plot this is one of the ways to optimize this would be if I plot f5 versus fc ideally these 2 values have to be same correct. So, you keep on assuming the value of f5 and compute fc you get a point over here. The second trial what we will have to do is 1.698 and 1.6. So, I will do this whole analysis by assuming f5 equal to 1.65 let us say. So, from 1.65 what is the value of fc we are going to compute. So, you keep on computing this and wherever this 45 degree line is cutting this curve this is where fc is equal to f5. So, this was the first trial which we did this whole exercise is to be repeated until or unless your f5 becomes equal to fc. This is what in the most simplest form the application of Taylor's method is. Now, if you solve this problem you will be getting the right answer as 1.671 please try this yourself.


All right. This is my childhood monopoly board. It is the dot com edition. And there is a profound analogy here between this game and the Wheel of Samsara and how to break free. So I would like to start things off by diving in to this point. This point right here is like the axle hole, okay? And everything revolves around that axle hole. And so if we could just go as a piece around the board and collect $200 and then keep going and paying for these things along the way, like rent and food and other basic living expenses, then, and even luxurious items that we buy, what we're doing is we're endlessly running around in circles looking at external objects and reality and just bouncing around. And especially if we're only collecting so much as to then whatever we've generated as an input just goes out and there's when we're enslaved with handcuffs for the entire year, each year, year after year and we're not free to think and we're not really free to live. And so the entire process is basically questioning this wheel mechanism. Why am I running around in circles year after year doing this process? Earning this style of money whether it's whichever nation's currency and then why am I paying money to the people that own these different buildings off whether it's houses or offices. And then I'm trying to either earn my own houses or offices, my own property so that I can then charge other people for rent for these product services, offices, companies. So the point is to then if you want to go on this journey of breaking free of this wheel mechanism, one needs to ask what is it in this center axle hole? What is right here? And if I access this point, which is an inner journey, so you have to go in to be able to understand this. And if you do, does that kind of shake up relativity or the monopoly board enough to give you more freedom to feel more truth and love and reality inside of yourself? So one has to still themselves from the wheel mechanism.  What is this axle hole here? Does it have any features or is it just like empty space? And is it infinite in that sense? And is it pure love when it doesn't have any of these attributes? When I'm not focused on my name and my identity, my location, my time, my beliefs, opinions, politics, religion, sexuality, any of those things, those identifiers and attributes, when I'm not focused on those, I'm focused on just this axle hole at the center. What happens then? What happens to the board? What happens to my programming? Do I deprogram my tendencies, my conditioned tendencies around the board so that I can focus more on coming from this deprogrammed place of the axle hole of this empty space? And in doing so, are my intentions less so than about trying to acquire different properties and then charge others? But then my programming may change, it may become something like I want basic needs for everyone. I want to completely change the nature of the playground on earth so people can be free to be who they want to be. So I want decentralized water, food, energy, housing, well-being, joy, et cetera, freedom, creativity. So that these pieces don't have to run around the board ceaselessly doing this activity without ever asking themselves bigger questions and without actually being able to really love each other. So this is the how to break free analogy using the monopoly board along with Samsara and the wheel of existence.