Okay, we're back. We're live. I'm Jay Fidel. This is Think Tech and we're talking about community matters this morning. We're talking about what happened to the 21 containers that fell off the Young Brothers barge a week ago. Very important that we discuss what happened because it affects shipping and therefore the supply line to Hawaii, which is very important at the time of COVID. We had a ferry once and we lost the ferry. There's a lot of reasons for that, but Young Brothers knows what they are. And the problem is that now we only have Young Brothers among the islands. This is an interesting opportunity for us to look at it. We have Jay Friedheim. He's an Admiralty lawyer here in Hawaii. Practicing since 1922 and we have James Mercanti in New York City. Likewise an Admiralty lawyer. So we're gonna talk about the Young Brothers incident. Let's start with you, Jay. What happened? What happened on Young Brothers barge that 21 containers dropped off? Well, at Tuesday at about 4.30 a.m., the Ho-O Maka Ho, which is the barge, was being tugged from Honolulu to Hilo. And then somewhere close to Hilo, about 21 of the containers, their 40-foot-long containers fell off the back end. And nobody noticed. So there were, there's some questions exactly what it is. I'm only getting my information out of the newspaper ads. Newspaper articles excuse me. And it appears that this, there might have been, they might have been stacked five high on the stern, which is an extraordinary kind of configuration for it. And there were some descriptions that the state Senator Kai on the big island said that he learned that some of the lower containers appear to have been crushed. So there's some, there's some failure maybe in the way that it was lashed. Lashing is how you tie these things together and get the, you know, to get it stowed. Young Brothers has their own people doing the work of loading and unloading them. And so, you know, there's, I don't know the exact details of how and why, but basically 21 containers went overboard. And then 12 of them went missing for a while. And there's dangers there for navigation. Somebody could run into one of these things. They could go to the bottom. They could destroy marine life. Some of the containers apparently had cleaning supplies in them. And I don't know what else is in them. But then it becomes a big question about, well, if you own the stuff inside of one of the containers, how do you get a recovery? And that goes to things like the bill of lading. When you go to ship, you fill out this information about how much the stuff weighs and how big it is, and you declare value. The standard in the industry is $500 per package limitation. But Young Brothers graciously gives you $5,000 per package limitation. But the value of these things can far exceed $5,000. I mean, what the amount of stuff you can get into a 40 foot container is amazing. And in some of these situations where they're packed with brand new cars or big screen TVs or other things that are very vulnerable to saltwater, the losses can be astounding. But if you don't buy extra insurance, which they sell you at about 13 cents per hundred dollars. So if you don't put up a few hundred dollars as insurance, you're limited to this $5,000. And that's all you're going to get. Anybody investigating this? I would imagine the Coast Guard is investigating it, especially in view of the contaminants you described. And who else? Anybody else investigating it? The National NTS. National Transportation Safety Board. Yeah, they would be doing it too. You know, I think James Mercanti might have more experience with them. I'm not really. Okay, let's turn to James. James Mercanti, an emergency lawyer in New York City. You know, it's just a curse review of Google on this. You find that containers slip off container ships all the time. So where does this fit in the landscape of containers slipping off container ships? Well, as you said, Jay and Jay Friedheim, that was a good summary. This is not unusual, but it's very dangerous. Recently, containers slipped off the ship off the coast of Australia twice this year. A ship off Western Australia have lost containers overboard. It happens in the North Atlantic and rough weather all the time. And the problem is the danger because these containers, they have buoyancy and they tend to float right below the surface of the ocean. And they create a tremendous hazard to navigation, not only to commercial shipping, but yachting and sailboats. And so there's a potential liability exposure to the ocean carrier here, which is young brothers for further liability. If, you know, a jet skier or a power sailor or another commercial vessel runs into one of these containers in daylight or at night because they tend to creep and float right below the surface of the sea. And maybe it becomes a very, you know, a potential additional exposure to the carrier. Now, how these claims usually work, Jay and Jay, is the ship, the shippers of the cargo, so the people that have the cargo inside the containers, they have cargo insurance. And all they're going to do is that they're going to place a claim into their insurance carrier.   So it becomes when the insurance company, the term is called subrogation. So when the insurance companies end, so let's just say, as Jay Friedheim said, there's a shipment of Samsung TVs and I'm the shipper. And that costs me, those TVs cost me a million dollars. I have an insurance policy and I'm going to recover that million dollars from my insurance carrier. And then my insurance company is then going to go after by subrogation the ocean carrier to get their money back. And that's when these limitations of liability come into effect. Like Jay said, $500 per package or $5,000 per package. The big question here, Jay and Jay, is what the package is, right? That the package limitation, each TV could be a package. Each car could be a package. The big question is going to be whether the container is the package because you could have $15 million worth of cargo in a container. And if I don't know what a young brother's bill of lading says, but if they attempt to describe the container, this 40 foot container as a package, that will be challenged in the courts because packages are usually are usually the full container. Oh, very interesting. So do they have the right to describe what a container is or packages? Or is that something left to the Public Utilities Commission or the state government in general, in this case, because it's into her island, to decide to define to make a rule in some way, saying what a container and what a package is? Well, that's the key question, Jay. There is a contract of carriage, right? And I think Jay Friedheim is holding it up. The contract of carriage here is called the bill of lading. And the bill of lading has those terms. There's probably many, many pages of fine print that you need a magnifying glass to read. And in those bills of lading, ocean carriers do try to limit their liability by defining a container as a package. But there's certain cargo liability schemes that apply, you know, federal statutes like the Carriage of Goods by Sea Act, the Harder Act. And it depends which act they incorporate. And some of those acts, Jay, allow the carrier, the freedom to define what the package is and some don't. So those are usually a big part of a lawsuit.  And that becomes a big part of the lawsuit as to whether that will be contractually allowed or statutory allowed as a matter of admiralty law. It's a high stakes game. If I just say hypothetically that a container, the 21 of them was filled with televisions. Televisions are, you know, a high value item. And so I could put, gee whiz, I could, you know, the idea is to put as much as you can into the container, right? So I have hundreds of them in there. Now, if the $5,000 on the whole container applies, that's $5,000. That's not a lot of money. But if I have hundreds of televisions times $5,000, that's millions. That's millions. And so this is a big thing. And I guess the question also to get this out of the way is the liability for the $5,000 absolute, it's a kind of bailment where, you know, the carrier is absolutely liable for the $5,000 or is there a question of negligence there? Well, if that comes in the claims process, the first thing that somebody who's lost goods on one of these things has to do is called notification. You know, they got to let the company know, hey, I have this material and there's a time limitation to get that notification. And so a false alarm is easier to deal with than a late notice. If you're a late notice, you're passed like the statute of limitations. So the second step is information gathering. They start to work with a claims person and they say, hey, what did you have in that container? And they want original receipts. They want to see exactly what you got. Otherwise, they're going to do fair market guesses about what a thing is worth. And then the last part is called determination.  Is this something that the insurance company has to paint on? And then how much is the policyholder eventually going to be entitled to? Now, that process gets turned over through subrogation and insurance to highly trained professionals like Mr. Mercanti in New York and his people go in there and they survey the material and they figure out and they try to negotiate a deal that, you know, spreads the costs out there. This is just falling off containers. Here's there's ideas in maritime law, flotsam and jetsam.  And if those things float onto the shore, maybe they belong to the government or the state. It used to be the king got to claim it. Jetsam, that's when they say, oh, we're going down. Let's start throwing containers overboard. And that leads to ideas like general average and specific average in which some cargo is sacrificed to save the rest of the cargo. So there are these issues about there, you know, whether it's flotsam, jetsam or longan, which is when the thing goes down and is at the bottom or a derelict, that's when something's gone down to the bottom and nobody thinks they can get it. Remember Howard Hughes went and got that Russian submarine pretended he was going out there and picking up magnesium nodules. But they were really picking up this huge vessel and it was a very big undertaking to what what this company has done is they hired a salvor who's gone out there with a two hundred and fifty foot crane on top of a vessel to try to get these things up and out of the water. So it's a big deal. Well, let me go back to James now. I want to ask, is there absolute liability or is there a question of negligence? Because Jake was talking about lashing. Maybe it was improperly lashed and properly stowed. So if we find negligence, does that enter into the liability of the carrier for the five thousand dollar payment or is it absolute? It's another good question, Jay. It's not it's not absolute. What what I think that the carrier will do here is that is they'll tender the if it's five thousand dollars per container, I think what they'll do is tender that amount and not worry about fighting about their negligence or not. But to answer your specific question, it's it's not absolute. The five thousand dollars or the five hundred dollars, which is under the carriage of goods by Seac, it's a five hundred dollar per package and there's always disputes of what the package is. But you're allowed to increase that unilaterally. So apparently young brothers here have called it five thousand dollars, maybe out of the goodness of their heart, maybe for good commercial business relations. So it's it's not absolute liability. There still has it's a it's a it's a limitation of their liability. It's a cap. It's a cap on their liability if it's sustained. But let me let me go further than that. Let me say there are defenses. They would have defenses that they may not have to pay anything. Right. So what we suppose we find this was grossly negligent and reckless in, you know, in derogation of life and safety on the voyage and to the crew and to other vessels and what have you. Is there a possibility of getting more than the tariff amount, the tariff limitation by a claim of, say, I mean, I'm thinking non-maritime now. But say, treble damages or punitive damages based on gross negligence. Jay, I think you're mixing apples and oranges here because one of the questions is who the person is who owns it initially? What is their rights and their claim? And that's like an apple on oranges. What if those things went overboard in a marine sanctuary like happened off of Monterey a few years ago and these containers went down into this marine sanctuary and the shipping company then is obligated for pollution damages to the government and they jump in wholeheartedly and they do everything they can to protect the environment because they're in for everything. Well, yeah, I'm not talking about that yet. We need to talk about that. I'm talking about the liability of the carrier to the shipper who has lost the container worth of goods. And the question is, you're not liable for consequential damages. It's really the value of the goods in there. It's locked in. It has to do with contract law. What you're talking about is torts, you know, like an intentional act to harm people.  But that is really not. I don't think I've ever seen a situation in which I could address that. Jay, so in these kind of situations, if the carrier is not entitled to limit their liability, remember, these five thousand dollars, they're just limitations of liability. But if they have the especially under the heart of Iraq, if the heart of Iraq applies, which is when shipments are made between two U.S., like here, between islands in the United States or between, you know, two United States ports is called the heart of Iraq. The carriage is governed by the heart of Iraq. It's a it's an 1893 statute. And but carriers have a burden to prove like here that they properly equip the vessel. They use due diligence to properly man the vessel. So they make if they had an incompetent crew, if they didn't have suitable equipment and supplies like the lashings, if they own the lashings and the lashings were broke, then their limitations, their cap on liability is out. So then if you have your 15 million dollars of TVs in a container, the insurance company that paid the 15 million dollars to the shipper or the owner, they're going to be able to recover their 15 million dollars. But if the carrier meets their burden of proof and say, hey, look, we did everything right, we had a proper crew, we had proper supplies, we had proper equipment and we just got hit with the storm out of nowhere. And it's an act of God, which we don't know yet what their defense is. Then they'd be able to cap, you know, there may be no liability or at least a cap on their liability. So let me talk one second about it sounds to me like this was a crushing type incident where containers were collapsing. You know, the first thing that the Coast Guard or the NTSB is going to look at is the stowage plan. Every carrier has to have a stowage plan. And it's going to be the shape of the barge and each container. So if I'm the captain of that tug and you give me the stowage plan, I can tell you what's in the starboard corner, tier number four, third row and what's in that container. And I should be able to do that by the stowage plan. Can you tell the weight is the weight identified? The weight is identified as well. And that's where it becomes interesting because if they put like the equivalent of an automobile on top of a deck of cards, that would be negligence on behalf of the carrier. And so for example, putting five containers high on the back of the deck, that may be a mistake. Maybe in the past, they've only done four containers. But because of COVID and the fact that the shipping has been slowed down, they may be backed up, they may have had to put a lot more on each barge. Because of all the cargo that's been backed up, could have been perishable cargo that's being perishable. So I think that's a really good point, James, one one which council want to consider because this is the same company that is in the legislature saying they're not doing well because of COVID and the failure of the local economy and they need twenty five million dollars for a bailout. So I mean, if I were council involved, I would think that maybe they went slack on stowing these containers. And and we need to know more about that. Well, one more one second. One more footnote to that, Jay and Jay. The other thing is, too, they'll have to be looked at. Right. That the whole the fact that they may have been because of COVID, stowing more cargo on the barges than they should take. That would be the lack of due diligence.  And also, you have to look at these, not only the lashings, sometimes these lashings, they have to be maintained. They have to be oiled and greased. If the lashings weren't properly maintained and they and they broke, they made out of wires. The other thing is these containers, the containers have to be properly maintained if these containers are 15 years old and they start and they've been they've been on, you know, 800 journeys and they have corner posts. Each container has a corner post. So there's four corner posts and sometimes those collapse. So if you put a very heavy container on top of three light cargo containers, those corner posts can just collapse. And if they're using improper containers, that'd be another failure to exercise due diligence on behalf of the carrier. I want to go to one other point, Jane, you touched on it. And that is, you know, the problem of safety of life at sea, of the safety of other vessels. And James talked about it too. And I want to know how that works. So suppose I have a container, it's just at the surface because it's it's got air in it, it's floating or it's just under the surface. Can't be seen so easily. Maybe, you know, other other vessels are not looking for it and not equipped to look for it and it's a collision. OK. And this is unmarked, obviously, on the chart. It was not the fault of the vessel that collided into the container. Let's assume that what liability do we have? That's pretty serious, isn't it? Well, that's what I was saying from the beginning. There's a lot more exposure here than meets the eye. I mean, the first thing that everyone's talking about is cargo. And the loss of cargo. But as Jay Friedheim said, there could be pollutants in the water and there could be sanctions against the carrier. They're responsible if there's any pollutant in the water. And also, they'd be responsible if, as you said, a paracelor or jet skier or a tour boat or another commercial cargo vessel runs into one of these containers, they're not going to sue the cargo owner. You know, they're going to go after young brothers. So look, that's why young brothers, obviously, as Jay said, went out and spent a lot of money and hired a salvage crew with a big crane because it's in their best interest to get these containers, find them and get them out of the water. And they're not doing that, Jay and Jay, just to recover the cargo. Because whatever cargo was in those containers, 99 percent of them, the first of all, containers are not watertight. So whatever cargo is in those containers is most likely destroyed. So the reason they're getting those containers is to protect their own interests from pollution risks and liability for collisions. As you just said, you know, and the notion we Jay and I talked about this before is that suppose young brothers and its 240 foot vessel cannot find a given container. Suppose it's lost at the bottom of the sea. I don't know how deep this is. And somebody stumbles into it later. So in fact, somebody goes out there trying to make a buck. Somebody wants to use the law, the Admiralty Law of Salvage, and he has his own 240 foot vessel and he's trying to own, he's trying to get and own a container that's down the bottom that young brothers couldn't find. He finds it, he wants it, he raises it. Is it his? Does he own it? What about the law of salvage as it applies to these containers? OK, well, if it's just out there and it's free, it's one thing and if somebody finds it and they help to improve the property or save it, they may be entitled to all of it or some of it. But I think the bigger question is who is young brothers? And how did we get into this situation where they and Matson are the only people that are moving cargo inner island? Young brothers is really a company in Washington state, a family owned company that owns lots of maritime businesses. And they have been in the business of making sure that Hawaii doesn't get the step up into the modern century. The rumor is that it was young brothers that sunk the inner island ferry. If we had that inner island ferry, you could fill your pickup truck or your your van with goods or food or produce and get on the ferry and for 100 bucks, bring it in our island and have your own vehicle over there. At the very last minute, after hundreds of millions of dollars were spent to create this inner island ferry, it was young brothers, supposedly, who shot them in the back and got rid of the ferry. And as a result of that, people who can do this kind of stuff don't want to do business in Hawaii. Young brothers fought to get. Well, that's a tragedy, that story. And if it's your game, I would like to have that discussion on another show. It's a tragedy to shipping and our economy. And certainly we feel it now because of what's been going on and what happened with young brothers, but let me go back to the salvage question. So suppose somebody else lays a line on one of these containers and brings it up and and takes it away and young brothers is no, no, no, that's ours. And you know, and our shippers, who wins that? What are the considerations? Well, Jay, you ask me great questions. You really are the law of salvage is probably the oldest law in the land. There's been salvage. Since Rome, Rome started it. You know, the law, yeah, the laws of all Iran, the laws of all Iran. So but in Rome itself, right? Let me answer the question now. If if if someone were you, you get what you call an admiralty law, there's the law of fines and there's finders keepers, right? And and this goes back to finding treasure on a on a on a treasure vessel where you find the cargo. There's there's one called the I can't remember the name of the sailing wooden sailing vessel that sunk off the coast of New Jersey with a cargo of gold bullions. And it was found 80 years later and it still turned out that the insurance companies who insured it were entitled to the major part of the value of that gold because at the time they had no way to no technology to access the gold at that depth. So the question is going to become here. No one's abandoned the cargo. There's going to be a quick, a very important question of abandonment. Nobody's abandoned the cargo. Everybody's everybody's looking for the cargo. So first of all, the only way you're going to get any type of award and you can get a salvage award if, as you said, another tugboat company puts a line on a container and brings it in. They'll probably get quote unquote rewarded, but the reward is based upon the value of the goods that they save. So if there if there were a million dollars of Samsung TVs in that container that are now worth nothing, they didn't save anything. They may they may get an award based upon the value of the container and a 40 foot container in these days and they may be old containers, maybe worth, you know, four thousand dollars. So to answer your question, if you want to be a salvo or and I imagine there's a lot of people out there that are looking for these containers. First of all, they haven't been abandoned. The insurance companies haven't abandoned the cargo. Young brothers haven't abandoned the containers. But if they do rescue one, say, Jay Friedheim rescues one, he'll be rewarded for the value of what he saved. And he may have a percentage of the value when he saved the percentage. And it may be a percentage of four thousand dollars. So it probably is not going to be worth anyone's time to be out there and spending the expending the fuel costs in looking for these containers, other than out of the goodness of their heart to save further casualties. No, this would be determined by a federal judge sitting in Abrotee. Yes, arbitration, depending upon the agreement, if the salvage has reached it away, it was Marine Ordnance of scrawny TRI and I that said it said a reward, whether the whether the owner claimed the goods or not. So this is really ancient law and the Romans brought it in about whether or not it was abandoned. Abandonment is an intentional act. You have to say, I give it up by abandoning it. Otherwise, if you have certainly that hasn't happened here for sure. If you hook a buoy onto something that's going to the ocean floor, a piece of cork so you can find it, it still belongs to you. If someone else finds it and lifts it, they may be entitled to. And indeed, if you if you were counsel for young brothers, you would say, don't abandon this. It's not in your interest legally to abandon it. It's all the worst things. If you are going to write tooth and nail to make sure that these shippers don't get up any more than they're entitled to. They're just let's get to policy, Jay. We've got to get to policy. So what have we learned here? What have we learned by this remarkable event, which hasn't happened in Hawaii that I know of before, but which involves a large loss at a time when, you know, we're we're faced with other losses and young brothers is faced with other losses at a time when the supply chain is very important. And God knows what was in those. Can we don't really know what's in those containers yet? And maybe they'll be, you know, that'll be part of the investigation either by the Coast Guard or the National Transportation Safety Board. But what have we learned? What have you learned about inter-island shipping? What have we learned about the way we do business in in creating a reliable supply line and in establishing appropriate boundaries or maybe not so much boundaries to shippers for the value of goods. Going back a month ago, young brothers sought to decrease the number of voyages that they were mandated on their agreement with the state to do. They went, I think, from two voyages a week to one voyage a week. So what happens is they've got more goods and they take more risks. James Burkanti was talking about the stowage plan. Well, apparently they were stacking these goods on the stern of the vessel in a way that wasn't normally done. And I have a lot of clients who work for this company. And the scuttlebud is that the lashing was a problem. And that was, you know, but I don't know that and they'll look and find it out. But if they were taking greater risks because they're having less voyages, then that's a public policy matter that we need to look into. Those workers want to be working more and they're not being given the opportunity to do that by young brothers, which is really salt check. Which is a company in Washington. So you would ask the Public Utilities Commission to look into this and maybe make some standards for lashing, make some standards for the whole stowage plan to satisfy the concerns that arise. You know, the other the other thing, James, is that Admiralty, Admiralty, as Jay said, goes back to Roman days. Admiralty is really old and maybe in some ways too old. Admiralty is a whole body of law that's based, you know, the 16th, 17th, 18th centuries when the oceans opened up the international trade, really. Does Admiralty need to be changed here? Some of the rules you've articulated. I wonder if they're current. I wonder if some international body ought to take a look at this and an update Admiralty to shipping as it exists, as it is conducted today. What do you think? Yeah, I think that while the statutes that are being relied on here, the Carter Act, the Carriage of Goods by Sea Act are well over a hundred years old, they have been, you know, properly maintained and do govern well. Carrier, you know, I would think that the five hundred dollars per package is outdated and I'm sure that a young brothers knows that. And that's why, I guess, out of the goodness of their own bill of lading, they've increased it unilaterally to five thousand dollars.  They're not, they're not as protective of the carriers as they are of the shippers. They, you know, these statutes were enacted to allow shippers to recover against ocean against ocean carriers because there's an unfair bargaining power, you know, when you're dealing with an ocean carrier like Matson Lines and young brothers, you know, there's an unequal bargaining power.  But obviously some of the limitations of liability are outdated. But I don't think that there's going to be any big cry to change maritime law, because at the end of the day, you know, everyone knows what was in those containers, or at least the NTSB and the Coast Guard, and it will be discovered what happened. And if this if this was a complete breakdown of due diligence on behalf of young brothers, and we don't know that it may have been weather related, it may have been is a very important point. This may be shipper related. I mean, if I'm a shipper and I give young brothers my container and this happens and I say this container weighs 1,400 pounds and it's my mistake. It weighs 14,000 pounds and and I misdeclare it. You know, that's a shipper problem and young brothers wouldn't be responsible for that. So I'm just a member of the public on this, James. I don't know what equipment they have, but it seems to me that I wouldn't rely on a declaration of the shipper. I would have a scale scale is easy. You're rolling it on anyway, drop it on the scale for a minute and you can tell exactly what it weighs, right? And that's what they that's right. And that's what they should do. And and but we don't know if they have if when they lift these containers, some you know, because they have these container cranes that lift these and place them on the barge. And some of the new container cranes have the scales built into it. So that we don't know. But there have been cases where there's a misdescription of cargo, a misdeclaration of cargo where that so that that needs to be determined. Whether this is truly a young brother's problem here. And look, we don't know who supplied the lashings. They may buy the lashings. Sure. Sure. And then there's going to be findings. There's going to be findings from the NTSP. They'll be findings from the Coast Guard. And I'm sure they'll be made public. They'll be available to us. I know Jay will be able to see them very quickly. And I hope we can get together again, the three of us, and examine what comes out of this. But I want to ask Jay one last question. Jay, do you think that this ultimately will result in a change in the number of carriers that serve the inter-island trade in Hawaii and shouldn't? Well, it definitely should. Will it? It's a battle between Walter Dodds, who's running Mattson and Saltchick's people over in Washington state. They divvied up our little game here and they're getting to decide what the real deal is in terms of what it costs you to move things inter-island. It definitely should. Are we going to get it? It's very difficult because of the Jones Act, which requires the coast wise trade to be done by American bottoms. We can't have a Korean company come in here and start moving these things. It has to be done under the Jones Act, which requires American crew, American ownership, American American. All right. That's another show. Well, we've actually proliferated the issue to the number of shows. Yes, James. Yeah, I just because your listeners may be interested in that very good question you asked Jay about finders and keepers. I wrote an article on my firm's website in July 25th, 2016, on that very topic. As I write the column for the New York Law Journal, the Admiralty Law Column. And the title is Treasure at Sea. Finders are not always keepers. And that would be what we leave with our listeners today. Finders are not always keepers. There are many, many legal issues in this case and in fact, still factual issues. And I hope we can revisit with you guys after we know more. James Burkanti and Admiralty Lawyer in New York. Jay Freedheim, Admiralty Lawyer here in Honolulu. Thank you both so much. We greatly appreciate your appearance.


What comes to nursing school explained in this video on diuretics, specifically thiazide diuretics. Now in general diuretics work the same way by where they help the body to eliminate excess water therefore to diaries and when we think about losing volume in the blood vessels then we also will in turn decrease the blood pressure. Now diuretics in general work that way however there are three different types of diuretics and it is important to understand the three different types of diuretics and what's similar but also what are their differences. So this particular video will go over thiazide diuretics where there are two other types of diuretics which are potassium sparing as well as lube diuretics. So please watch my other videos about those as well. So for thiazide diuretics their ending is thiazide which is pretty self-explanatory a very commonly used example is hydrochlorothiazide. We're also chlorthiazide so those are very commonly used and diuretics in general and then ide. So that's something to remember whenever you see something ending in ide it is most likely a diuretic and then you'll just have to determine which type of diuretic it is. So these particular thiazide diuretics their mechanism of action is they increase the sodium and water excretion at the distal tubule of the kidney therefore we excrete more water we lose more volume and the blood pressure therefore drops. So indication for hypertension but it's also used to treat edema associated with heart failure as well as renal failure and cirrhosis because all three of those conditions can cause us to retain water and therefore we need to diurese that extra fluid away from the body. Now common side effects because whenever we deal with sodium and water regulation potassium is always involved so it can lead to hypokalemia which can be pretty dangerous. Certainly it can also lead to dehydration from over diureasing so if we lose if we excrete too much fluid now the patient can get dehydrated. They can also cause dizziness, rousiness as is pretty common with most anti-hypertensives. They can also cause orthostatic hypotension again pretty common side effect but diuretics or thiazide diuretics can also cause photosensitivity or Stephen Johnson syndrome so we need to educate our patients appropriately. Thiazide diuretics are contraindicated in pregnancy and then nursing considerations we always have to check the blood pressure before we give any medication to the patient that's going to affect their blood pressure. Also because of the risk or the indication to use for edema and treatment of heart failure and renal failure we need to keep an eye on the patient's eyes and nose as well as their weight. Check them for edema and their lung sounds because maybe if they're in fluid volume excess due to heart heart failure or renal failure or even cirrhosis they could have pulmonary edema and crackles in the lungs and then for lab certainly because they work on the kidney we want to make sure the renal function is appropriate as well as check the electrolytes to make sure we're not depleting their potassium or sodium stores by excreting them through giving them the medication. And then sometimes patients need to be on a daily or prescribed potassium replacement so we also need to teach our patients to take those supplements as needed. So thank you for watching this brief video on thiazide diuretics. Please also make sure to watch my other videos that cover potassium sparing as well as loop diuretics in the pharmacology playlist. Thanks so much for watching Nursing School Explains. See you soon.


This video is sponsored by GrooveLife.com. They make belts and I'm sure you've heard of the Groove Ring. They're belts you never have to adjust and have a 94 year warranty. They have many different styles and colors of rings. These are the only breathable rings on the market. Lose it or break it, they will replace it. Check them out at GrooveLife.com. Hey there friends, thanks for checking in at the range now. Today we're going to do a range comparison with the HK VP9B versus the CZ P10C. Both highly regarded handguns, polymer frames, striker fire, 4 inch barrel models. And I own both so I really don't have a bias any which way. Let's start with the HK VP9. I recently acquired this. I really do appreciate it. I love it. I enjoy HK handguns. A bit on the pricey side. You're looking at $750 from picking this up. It offers a lot but definitely a little more expensive than average. 17 round mags is not what HK offers with the VP9. They also make it optic ready. They ship it optic ready. This one is not. It does have a 4 inch barrel forward serrations. 3 dot luminescent sights. Excellent ergonomics. And they also offer additional back straps and grip panels so you can switch those out however you want. But it does have a 5 pound trigger pull. A very nice trigger. HKs are known for that. With a very short reset. Polygonal rifle barrel. It does have those cocking ears right there. That's what they call those cocking ears. Get a nice firm grip on it. But you're looking at about 750 bucks for a very fine handgun by the way. Love HK handguns. But you'll notice when I talk about the CZ that this is quite a bit more. The question is, is it worth it? Let's go ahead and take a few shots. Alright I don't know if I'm shooting in a competition here but I was going a little too quick. But there it is. Love this handgun. So happy to finally get one after shooting my friend's VP9. That is the B though. This has the firing pin block or not block the button. Push button correction. I wasn't sure if I mentioned that. But now we've got the P10C. This is a sweet handgun. Better round. Quite a while now. Both of them have. This has 15 round mags and also 3 dot luminescent sights. 4 inch barrel forward serrations. This has grip tape on it and when they came out with the P10C they made the texturing very aggressive. It is a fully ambigun with the slide stop and mag Z release on both sides. Lefties will certainly enjoy that. This has an accessory rail. One slot there opposed to the full pick rail that the VP9 has. But a great shooter. You know I think the trigger pull on this is equally as nice. Now the VP9 has a 5 pound trigger. This has a 5 and a quarter pound trigger. Hardly worth recognizing. But the reset is so short. Right there. Both have excellent triggers. You really can't go wrong either which way. And both are fine companies. Manufacturers there are huge fans of each. Now the price. You are looking at between $500 and $550 for the P10C. So if you get on the lower end of that you're looking at a $250 price decrease from the VP9. So you're looking at a much less expensive handgun. Now the NSRP is $579. However it used to be $499. But as you know I don't have to tell you this. But I'll say it anyways. Prices have increased. There we go. Both are very nice handguns. I have admiration for each. I'm a little bit more excited about this because I've had it just for a couple of weeks now. But I wanted to get it out and do a comparison. And I figured what better than the P10C to compare it with. Now having shot them side by side now for the first time I will tell you that both are extremely accurate handguns. Those who know these understand. Both have three dot luminescent sights. Which is an interesting thing for a comparison. Both have four inch barrels. Both have simple disassembles. Both have very nice triggers. Both perform great. The price is much more expensive. We always have to consider that. The price is much more expensive with the VP9B than the P10C. But if I had to choose one I'm considering the price I'm going with the CZP10C. I just think that the additional two rounds that this offers is nice. But both of them weigh right around 34 ounces. So we're looking at very common platform type of handgun and both are very nice. But if I had to choose just one I'm considering the price I'm going with the P10C. Having said that I really dig this. I really do. And I'm so happy to finally have one in my ownership. Let me know which one you would prefer. I cannot wait to hear your choices. If you like videos like this please subscribe and share. I always appreciate thumbs up button. Thanks for watching and you guys be safe.