Post vaccine myocarditis

well a warm welcome to today's talk it's wednesday evening the 28th of april now let's start off with uh some confession and repentance from yesterday um now the good thing about this is whenever i make a mistake lots of people uh spot it which is great you are my peer reviewers and about 100 people informed me of yesterday's mistake and i must say all very politely so so thank you for that anyway let's get on to it because it is interesting as well so yesterday i was talking all sorts of rubbish about the rate these rates so this is the case fatality rate of the ongoing covered 19 pandemic and of course these reductions in rates here could not possibly have been as a result of vaccination because the first vaccination in the uk was not till december when these rates were already down and the first vaccine in the united united states was not until the 14th of december when the rates were already down i think the main reason that these case fatality rates are going down was the increased testing so here we see at that time the testing was increasing now i know these don't match perfectly but if we look at the sort of the the when when so it's may june for the uk for example and when did testing start increasing in the uk um well didn't increase that much but i think i think these are the main these are the main reasons why that went down so what was happening here is that there wasn't many tests so that the number of actual tests were relatively low whereas that the deaths were known then as the testing went up and up and up and up more people were testing positive and the death rates were staying roughly the same at least for a period of time so so it's increased testing that's responsible for that so sorry about that um it's funny the mistakes you make are often big stupid ones and and that was certainly one but but there you go you spotted it and i was julie uh corrected now we left a bit of a cliffhanger at the left at the end of yesterday's video didn't we so um this was related to the czech republic now lots of people so that was just that first one about the the vaccine dates now lots of people have been asking me about czech republic and the falling cases as related to vaccination and the introduction of a therapeutic so first vaccination 15th of january introduction of this therapeutic the 8th of march now what we're looking for here really is a temporal correlation is there a temporal correlation one related to time so here's the graph and it is actually quite interesting so um so this is a czech republic so um vaccination was introduced about here so the vaccination was introduced on the 15th of january and after that when vaccine was introduced we saw that cases went down and then started going back up again but of course the vaccine was a pretty low level then the therapeutic was uh legalized and put as part of the national um the doctors were allowed to prescribe this therapeutic and that was on the 8th of march and uh after that cases did start to go down really quite dramatically now of course this is a temporal correlation it's not indicating causality but it's interesting we'd have to run the other bradford hill criteria past it to try and adjudicate on that um but in interesting and likewise death so introduction introduction of the vaccine there again we know the vaccination numbers were lower so it's not surprising that things went down then went back again that's not surprising because of the low levels of vaccination then introduction of the therapeutic and we do see death rates go down so quite a few of you pointed that out and the rates in the uh czech republic have gone down more than in um some other adjacent countries and a lot of you pointed that out and there's the graphs uh intra interesting interesting i don't think we can say too much more than that um we are looking out for more data but interesting now um i've been talking to friends in india today and it really is quite bad that the video films that we see of people not being able to get into hospital are real people are dying through inability to get into hospitals for inability to receive oxygen and basic drugs now um i was talking to a friend today who's running a hospital in in mumbai and uh as of this morning he had enough oxygen for the next 24 hours at one point last week he was down to about two hours oxygen supply so they're having to greatly restrict what they were using and titrate the patients oxygen saturations down so the saturation of 90 or 92 was acceptable in that in that circumstance but they didn't actually run out but we believe other places have but the main problem is people simply can't get into hospitals they're being turned away the hospitals are totally crammed and people are dying unnecessarily and of course this is just completely distressing as we've said many many times deaths are one thing unnecessary deaths are really quite something different so um it's still bad and um the friend that the offender was doctor i was talking today he said they think that the cases are probably going to carry on increasing for the next three weeks well into may so unfortunately things could carry on getting worse now it's good to see international aid arriving from the uk from the united states we believe that the united states are liberating tens of millions of doses of the oxford astrozenica vaccine for use in india but of course the vaccines got this delay to it there's nothing it's hard to see anything now that's stopping this increase in cases we did do that um video of the couple of days ago on vitamin d deficiency in india so i really hope the indian authorities are taking that up it's a variable to eliminate but basically vaccines are not going to rescue india in the next few weeks only about five percent of the population of india is fully vaccinated they're giving out about 130 million doses of vaccine altogether but of course the population is over 1.3 billion so less only about 10 of the population have had one dose of vaccine so it is going to get worse and it's just appalling appalling to watch now in india new daily cases as we see unfortunately we've been looking at this graph for some time now this line here represents 300 000 cases per day that's officially diagnosed and uh we now see it surpassing that and really it's hard to see what's going to stop this increase in india one thing that was really um ironic quite upsetting really people clamoring for vaccinations of course they want protected from this wretched disease that's killing a lot of people but uh that they weren't socially distant in the vaccine cues and um that that that itself the vaccination centers could be a cause of spread as people clamour to get the vaccine and get protected as they're aware of how dangerous this disease is now um new new cremation facilities being built it's just it's just an appalling situation um a little on why it might be in a minute but um the the the the daily deaths now uh the total deaths now past 200 000 we know we know that that's at least half of what it actually is and it could be a quarter of what it actually is so you see some people saying that about 25 of deaths are actually picked up some people say it's 50 of deaths that are actually picked up we don't really know but i think what we can say is deaths of 400 000 making it the second highest death rate in the world and in but the death rate could be even higher than that so it could well be that even now india has a higher death rate than the united states in overall deaths but it is going to carry on for some weeks and there is now no question that uh there's going to be more deaths in india dramatically so and there probably be more deaths in india than anywhere any other country in the world so in terms of people dying it looks like india is probably going to suffer more from this pandemic than anyone else and those deaths a lot of those deaths are still to come deaths in india as we see that rate is increasing so this is the 3000 that's the 2000 line there that's the 3 000 line there deaths per day and as we see it's just peaked above the 3 000 a day mark now this is being driven by multiple factors and it's it's confusing because there was quite a few antibody surveys done in indian cities and there were about 50 or so antibody studies 50 of people have been exposed to the virus last january so it looks like there's probably some re-infections that the natural immunity has waned now if this is the case it looks like the vaccine immunity is going to last longer than the natural disease immunity at least in that indian situation but it looks like there is a lot of people getting re-infected um and and that well yeah we don't we don't really know but if people are getting reinfected means the natural immunity wasn't lasting for that long because if it's true that 50 of people were um serious positive in in some areas in in in january then you would expect herd immunity to be kicking in really quite quickly but there's no sign of it so more to come on that i know that's not scientifically satisfying answer but that's kind of what we have at the moment now um maharashtra it's lies with this indian variant b1 617 so maharashtra is like the mumbai area new delhi apparently um most of the cases at the moment the uk variant so a couple of things going on there um it's rather callous to say but but it will be interesting to see which one becomes predominant it's looking like at the moment well of course we know the b117 the uk variant is more is more transmissible than the old variant will this one out compete it will it be more transmissible we don't yet know there are some early indications that it is now these are anecdotal reports but i have heard reports from doctors in india saying that this obvious well obviously it's transmitting more quickly but it's also affecting younger people now is this because this particular variant is affecting younger people more it could be but we always know that a proportion of younger people are adversely affected anyway i think probably perhaps the main factor here is there's such a a tsunami of increased cases that a proportion of those will be will be younger people unfortunately so i think we just got massive community transmission in india at the moment absolutely massive this is the uh the these are the mutations in the b1617 so the 484th position on the spike protein the e amino acid is changed to a q the 452nd position on the spike protein the lsq change to the r form this so-called double mutation but there are other mutations around as well now if you're in india and uh you want to get away from it all then it looks like you can um on the when outboard flight uh wednesday the 28th of april so that one's already gone actually uh but but uh 20 20 yeah 9 30 p.m bombay time and that will take you to jfk is that new york i'm pretty sure that's new york isn't it jfk so that would be nice you could go for um you could go for around the statue of liberty or something um or there's this one here um this one's delhi to new york and that's leaving on oh that's left as well so it's in the air as we speak and so that'd be nice and you can go to new york directly from and that's a direct flight that just goes straight from delhi to new york long flight but it'll be nice when you get there i mean this is just unbelievable we have this mutant these variants we don't know their transmissibility we don't know their pathogenicity and yet there are still flights going directly from india to the united states this is pure madness in my view it is unbelievable and yet they're just two that i looked up this afternoon on the flight buying places i mean that that one there that's the area that's the i put the reference there that's the uh that's the air india website um why are the american authorities allowing this i am totally bemused and somewhat distressed on this channel we've been bouncing up and down about flights since uh last since january certainly early february 2020 saying that flights should be stopped out of china which would have truncated this whole pandemic and yet we seem to have learned nothing um immune escape looking good in india now as i said immune escape meaning that um meaning that the vaccine that the immunity if there's a lot of immune escape the vaccine and natural immunity wouldn't work but for the vaccine it's looking good it's looking like there's very little immune escape so the vaccine seems to be working now the natural immunity as we've said there's a question mark over that but for the vaccine data up to the 21st of april uh extremely low breakthrough infection rates so it's looking good so people that have been vaccinated do not and this is important people that have been vaccinated do not get infected or they do but very minimally basically they don't get infected with the new india variant or the uk variant so the oxford astrozenica vaccine which is the primary vaccine being rolled out from the pruner serological institute in maharastra um that that one is working the it it is giving immunity against the uh against the new variants and again i was talking to my uh friend who was a doctor in mumbai today and he said that they've had in his unit they've had 75 covered patients in every day pretty well since last march they've just kept going all the way through and he said he hasn't had one poorly patient who had had two vaccines so that's looking very promising for protection from disease looking like the vaccine immunity is better than the naturally induced immunity from that data we have from india so far now the actual rate of reinfection 0.02 so that's what that that's two in ten thousand isn't it to uh to four in ten thousand not a point nor not four percent are people vaccinated falling ill so very high protection against illness from the existing oxford astrazeneca or the india astrazeneca vaccine that's made in puna now this is not as good as the united states in the united states it's only 0.008 that's 18 10 000 isn't it people getting sick after vaccine but it's still pretty good so basically that works out at 0.03 percent of people that are vaccinated get ill so the vaccine providing a very high level of protection so really we need massive priority in getting as many indians vaccinated as possible now slightly concerning as well um pakistan again we've seen the waves in pakistan the new cases but pakistan things are going up just next to india of course and likewise in the beautiful but very poor mountain kingdom of nepal we see increasing cases a lot of uh fair bit of touring and throwing between india and nepal so um consid concerning trends in the countries around about india as well really hard to see given what's happening in india that they're going to escape now let's go to some better news um this is published today from uh public health england one dose of covered 19 vaccine can cut household transmission by up to a half so there's the references check it out directly that one is the government press release that one is the scientific paper depending on which mood you're in i went mostly from this one i must say being vaccinated significantly reduces your infliction of risk of infection hospitalizations and deaths so we know that that's good but what even scientists in the uk even up to last week they were very very reluctant to say that vaccination reduces transmissibility and it was patently obvious that it does but they wouldn't say so but now that the data's out so maybe they'll be less conservative now so um reduced risk of developing symptomatic infection four weeks after one dose of either vaccine is 60 to 65 so whether you have the oxford or the astrazeneca vaccine after one dose four weeks after the first dose you've got 60 to 65 percent less chance of getting symptomatic infection so so so that's the protection and it will go up a bit after i know it's after four weeks so so that's that's optimum there so so for example i've had one dose so far so this is the level of protection i have 60 to 65 less likely to get symptomatic infection um which is good for the individual but what about them transmitting on to others in their household those who do become infected three weeks after receiving one dose of the fires of bioentech or the oxford astrozenica vaccine so if if if you're in that what 40 to 35 percent minority that do get infected uh then if you're in that minority that do get infected so so that's the first chunk of protection less likely to get infected but if you do those who become infected three weeks after receiving one dose of the fires pfizer or oxford astrazeneca vaccine they were between 38 and 49 less likely to pass the virus onto their household contacts and this is people of course that they live with all the time so there's a fair level of protection against transmission after one dose so first of all you're 60 to 65 less likely to get it and of course if you don't get it you're not going to pass it on to others in your household but even if you do get it if you're in that unlucky 40 then you're 38 to 49 depending on the area in the survey less likely to pass it on to household contacts so this is clear post-vaccination pharmacovigilance surveillance evidence saying that one dose of vaccination does reduce your infection your transmissibility the likelihood of transmitting it to other people so it is there so this is definitely now confirmed vaccinated people are less likely to infect others and of course we would expect these to go up after two doses of the vaccine as indeed we know that this goes up after two doses of the vaccine that's after one dose so this is contributing towards the reduction in cases in the uk uh other shared accommodation weren't studied but we would expect that insured accommodation and prisons which of course are analogous to the households now this is based on pretty good data and of course this applies anywhere the vaccines are reducing transmissibility um 57 000 contacts from 24 000 households so pretty good and they compared those 57 000 contacts of people with infections with one million contacts of unvaccinated cases so um pretty good so so basically that's your experimental group natural control group so we can say this is definitely working matt hancock uh as seems to have worked out the significance of this not always the first sprinter off the blocks to be fair but he said comprehensive real-world data showing vaccines cut transmission so there you go vaccines cut real world transmission he's got that one uh dr mary ramsey head of immunization of public health england even if you have been vaccinated it is really important that you continue to act like you have the virus practicing good hand hygiene and following social distancing guidelines so this is not to make any difference to our behavior in the uk now there's a report from the united states from the centers for disease control that people with two vaccines can behave differently we might have time for that today we'll see how we get on before we do that i just want to follow up on that story of the heart problems after the fisa vaccine now there's been so much focus on the very rare side effects with the janssen johnson johnson vaccine uh so much focus on the very rare side effects after the oxford astrozenica vaccine but it turns out that there's also complications with the fisa vaccine and the moderna vaccine now this is not surprising there's an element of risk the risks are very very small but i think we have to see that there's an element of risk with both vaccine types now i've had my first fisa vaccine i am waiting with baited breath for the phone call from my surgery saying come and get your second i can't wait now lots of you have kindly said that you can just book a book a vaccine with the nhs website which normally you can but because i got my first one uh just from the end of a batch when i go on to the nhs website it says uneligible to apply by this process to talk to your surgery and when you talk to your surgery they say don't talk to us we'll contact you when it's there so we're just waiting for the batch coming in but i'll be around there like a shot for my second vaccine and i trust all of you are watching this channel will as well uh but um we have to be aware that there are very rare side effects now this side effect here myocarditis after the vaccine now uh myo muscle card heart itis inflammation of so like appendicitis inflammation of the appendix tonsillitis inflammation of the tonsils so inflammation of the pumping heart muscle now one of the reasons i want to mention this is if if people have any features at all of myocarditis and this is any time so we see myocarditis in clinical practice quite a lot in coronary care units usually caused by viral infection particularly a virus called coxsackie virus and it can be it can be a fatal condition but it's vital if there's inflammation of the myocardium that you do not exercise no vigorous exercise so very important that people don't take vigorous exercise if they're worried about this sorry if they're worried about this complication now put it in context israel 5 million people fully vaccinated there were 62 recorded cases of myocarditis mostly after the second dose mostly men under the age of 30. so does this mean that for men under the age of 30 the oxford astrozenica vaccine may be a preference i think that guideline may come out in time yes i do think that now cases in the u.s military so defense department is tracking 14 cases of myocarditis temporal association means that the myocarditis occurred after the vaccine indicating a correlation uh 2.7 million covered vaccine doses given that means the prevalence of myocarditis is 0.000516 so very very low prevalence i worked that out at 193 000 uh and developed after receiving either moderna or the fisa vaccine according to the american military um one patient tested positive for covert three months ago then developed myocarditis after the first dose indicating some immunological reaction there potentially the remaining 13 who presumably had not had the infection developed myocarditis after their second dose so interesting interesting so this patient had had myocarditi had covered 19 and developed it after the first dose whereas most patients developed it after the second dose the other 13 so presumably we're not told this in the report but presumably those 13 had not previously had covered 19. now in terms of vaccine split this seems to be correlated with the rna viruses modern 11 fisa 3 and of course all the israeli cases all the israeli cases that's the 62 cases out of 5 million people doubly vaccinated with a fisa vaccine because um fisa vaccine is the only vaccine being rolled out in israel all the patients develop chest pain 12 to 96 hours after vaccination that's that temporal relationship so now normally of course i would never use names but the these are in the uh report from the where was that report from actually it was the um the report was it was a military i think it was a military uh a military journal um and anyway i i i have put the references there at the start of this so you can click on them um no that's that's the other one anyway the references are there somewhere i'll i'll make sure i include the references but anyway what the point is i'm using a name because it was it was in the official report so they're put in this case studies so so steve 30 years old developed myocarditis after the second dose of moderna hospitalized at walter reed nearly three days in intensive care now very important of course that you seek immediate medical advice with this if you're gone for a jog instead of going to hospital you probably might not have made it but it's since back to performing duties with the national guard so we're delighted that you are back in uh performing normal duty steve um again it's in the report you can you can read it for yourself uh marcus 39 development myocarditis after his second shot another case study two days in hospital and as far as we know he is doing well but that's all the information it gave so um interesting follow-up from the american military there now this is the vaccination adverse defense reporting system in the states 45 cases of myocarditis following uh covered vaccines but of course they've given out what must be getting on for oh make something up don't make it up take an intelligent guess getting on for 200 million doses of vaccine in the states now about 190 million doses so very rare overall um but you can't alter the fact well in the military of course that the people are often young uh often young of not always of course but often young men that seems to be particularly affected by this it was young men in israel that were particularly affected by this um and and they were young whereas the national vaccination campaign of course is only getting down to the younger age groups now so 45 reports majority of cases after the second dose fizer 19 cases reported after the fisa vaccine 26 after the moderna so moderna was 26 cases in other words pfizer was 19 cases and moderna was 26 cases 62 in men mostly young mostly young vigorous exercise after vaccination well i think you should have a few days rest because basically your body is mounting an immune response whenever someone's ill i always tell them not to exercise especially if it's an infection you know if you've got a cold or something just don't run it off you want you want to rest if you have a viral infection so national bodies may change this they might say that vaccine choice younger women might be better with fires are due to very small risk of thrombocytopenia thrombosis syndrome with the janssen as recommended by the fda so the fda is a cautioning the use of the uh that the young in younger women so maybe younger women were better off with the fires of all the moderna from this as i say the guidelines haven't changed yet but this they may well change to this uh it would it would make sense uh maybe maybe they'll change to say younger men are better with the yanson or the astrazeneca due to the possible links with myocarditis and younger men in israel and the u.s military after the rna via after the rna vaccines so um as i say those guidelines haven't changed yet but i suspect the might so what is determining who gets what vaccine will probably be determined by minimizing the risk of adverse events rather than minimizing the best of the immunity results because the immunity results seem to be excellent in everyone basically which of course is good news so um remember these are very very rare very rare but um that they are that's the current understanding that we have now i was going to tell you about the new cdc guidelines today but i think we've gone over quite long enough um so what we're going to do is we're going to talk to nick i'll give you those i'll give you the i'll give you the new uh guidelines from the cdc for fully vaccinated people uh next time probably tomorrow um if you want to look it up yourself of course i will actually i don't mean to give you cliffhangers i'll i'll actually post the link so you can check it out for yourself if you want to um but let's listen to nick now nick um is a very uh open forthright guy we did talk from about a month ago you might remember and nick has this sort of condition really where um the the the effect of i guess it's the psychological effect of the vaccine or of injections and things has a very real physiological effect on him and induces uh sort of parasympathetic vasovagal responses that basically fainty tight responses so completely real um but it's just an example of someone who's faced his fears and um is prepared to share it with us and of course it's part of the human story of this of this pandemic so nick thank you for reporting it now i haven't listened to nick's reports i'm going to listen to it with you and uh if he uses lots of bad language and things i suppose i'll just have to edit it but we'll trust nick's discretion i think so nick thank you very much my friend hi john and to all your followers it's me nick from the south of england again uh just checking in to say hello and give you an update on my second jab which i had a week ago now um so i'm one week into my second dose of astrazeneca covid 19 vaccine um and i had my second jab literally 10 and a half weeks from when i had my first um so i'm happy with that um they gave me a call a couple of days beforehand like they did the last time and said they'd be out on the friday mid morning so i got myself ready and raring to go friday morning um did things a little bit differently this time um some of you may remember i'm really needle phobic and i almost always pass out when having a needle and i honestly thought this week well this time would be again no different to the last time um i was waiting for them from mid-morning um they didn't show until mid-afternoon uh which got my anxiety going and i thought well if anyone's going to pass out it's going to be me on this injection today um but the guy came here is a retired 70 odd year old doctor and come back just to do the vaccinations uh thank you very much big hero um and uh when i asked him you know i told him all about myself i said you know i generally have a situational reflex um vega vegas syncope uh passing out uh on needles um he said don't worry about it i've seen it lots of times before normally the big rugby players that do it they don't realize they're going to do it apparently but apparently i i'm good for saying so um i told him i wanted to get myself on the floor and can you inject me on the floor and he had no problems with that um and i also said please would you mind aspirating the needle for me and he just looked at me like i was weird i said i've always aspirated that's how i was trained i've been giving injections for 40 plus years um so that was no big biggie um in terms of did i feel anything different from last time when it wasn't aspirated to this time nope no difference at all i couldn't say if it lasted any longer the needle went in there was a sensation um i even this time tried to feel the the vaccine going into my arm i was not aware of it at all um but the good news is this time i didn't pass out not at all um and from what i understood from my previous syncope episodes is that i get really bradycardic my heart rate plummets my blood pressure plummets and it's all of that which makes you feel horrendous gives you a feeling of doom feels like you're about to die um it's obviously getting yourself on the floor can mitigate any any issues of falling over and banging your head or anything like that and that massive draining of blood from your your head just doesn't happen um but again like last time i was lying on the floor and i passed out this time however i thought well as it's bradycardia which means your heart rate goes slow um and my blood pressure drops i figured let's do some things to help stop that from happening so one of the things i did was isometric holds on all of my extremities so i had my hands like this once he'd given me the needle i had my hands interlinked and i'm pulling them apart like that as hard as i can this forces your blood pressure to go up stops blood from pooling in your hands and in your feet if you tense your calves and feet up and also increases your your heart rate um you can do this just by measuring your heart rate before and doing this for 10 seconds and then measuring your heart rate again your heart rate will probably be about 15 beats per minute faster once you've finished that um so just doing this for 10 20 seconds on and off for a few minutes i didn't get the slices feeling like i was going to pass out whatsoever in fact it was one of the best it was the best injection i've ever ever had um no passing out as i say my legs are up in the air on top of the couch i have my my feet tensed i have my calves tensed but i did everything i could to not tense my glutes and not tense my chest and by doing this is you're giving the opposite force to being able to tense your chest anyway and the idea is you want to try and keep as much blood flow flowing into your chest area and not getting trapped in your legs by tensing your glutes or tensing your chest up and stopping and restricting any blood flow from getting back to your heart or up to your head um so yeah that's brilliant so if any of you guys want to give that a go if any of you are vaccine or needle phobic and pass out just try this isometric hole just you know doesn't matter if you're there for five ten minutes lying on the floor 20 minutes doing this for 10 seconds on 10 seconds off it stops you from passing out and that's fantastic um in terms of my reactions this time to the vaccine i've rated the week because last time i was having some very minor arm reactions for a week and actually i could feel the sight for about two months um you know i could point to it um this time slightly sore arm for 24 hours uh it faded the next 24 hours after that was in 48 hours gone absolutely nothing um not a slightly not even slightly sore arm no itching like i had for the whole of a week last time um nothing at all um so i'd be quite interested to know whether people who receive the sputnik vaccine get the similar reaction to the first and the second because they get two different adenovirus vectors um i have a feeling that this one your body kind of kicks out a lot of what what it's supposed to be or they hope it would do but it probably does stuff to to other t-cells b cells and and and enhances your antibodies no doubt um so yeah um i'm happy i'm done again i'm not changing any of my my ways um my my family and everyone around me have also been vaccinated now we're all still being very careful um not until everyone has been done that we can kind of call ourselves kind of safe um yeah and uh that's really it for me i think um until we have any more updates or a next booster shot or anything like that um i don't expect there to be any further um issues or anything from my vaccines um i'm really hoping that my my fiance when she has a second estrogenic vaccine she's got um chronic fatigue syndrome and the vaccine really knocked her for six it took her out took it out for a couple of months and so we're really hoping that the second vaccine shot will not be the same and will be quite mild like it generally tends to be for the rest of the population um i've got one question to ask you john which i cannot find the answer to anyway why do some vaccines go in your deltoid and for example i've had a tetanus jab why did that go in my glutes immunological reasons i have no idea thank you very much john thank you for your help thank you for keeping everyone sane and thank you and stay safe to yourself and to all your followers nick thank you for your um openness and honesty uh it's uh it's very kind of you to share and it's interesting to get that that human story it's amazing the way the way that the mind and the body interacts isn't it it really is incredible what what nick is describing though is called a vasovagal response so it's vaso in that you vasodilate and that lowers the pressure in your blood vessels so so that's part of why the blood drains from your head because it goes into the peripheral vessels and it's also vagal now the vagus nerve is the 10th cranial nerve there's one on each side it comes down from your brain and it's called the vagus nerve because it's the wandering nerve it comes from the latin vague vegas for vagrant and it goes light down to your salivary glands then down to your heart then down to your stomach and and your intestinal organs but if there's vagal stimulation the vagus nerve is what you call a parasympathetic nerve and the parasympathetic is the rest and digest system as opposed to the sympathetic nervous system which is the fight or flight system so parasympathetic increased parasympathetic stimulation will slow the heart down that's what nick was talking about there about bradycardia slow heart rate bradycardia is technically any heart rate below 60 beats per minute and as well as slowing down the rate as well as having a negative chronotropic effect it will also make it pump less that's called a negative inotropic effect so it will be slower and it will be beat less and it will be beating into a dilated vasculature so the pressure is lower because blood pressure equals cardiac output multiplied by peripheral resistance in the presence of adequate venous return anyway that's enough of that um now to answer your question nick uh deltoid muscle here of course uh you've had a tetanus injection in your gluteal muscle upper outer aspect of the buttock can also go into the vastus lateralis muscle on in the thigh they're all intramuscular injections and basically doesn't make any difference so uh the last tetanus uh vaccine i gave personally i get in fact the last few have given i've always given in fact for the last three or four years i've given them into the deltoid muscle basically you give injections into the deltoid if it's less than one mil if it's the larger dose of uh fluid that you're putting in and i think the vaccines are about a third of a mil if it's a larger dose you can put it into the into the vastus lateralis on the upper outer aspect of the thigh um and where you actually put it depends on the policy so um some hospitals have policies that you don't use gluteal injections but i i've personally done gluteal injections all my life and the muscle in the buttock is is normally quite uh it's quite quite soft muscle and as long as you use the right technique it's fine so so to answer your question no as long as it goes into muscle i don't see any immunological difference whatsoever local policies and personal preference of the uh of the clinician do it during the vaccine no fundamental immunological reasons that i can think of nick and i'm delighted to see that the doctor uh aspirated and i'm also delighted to see that he was incredulous that you would think he would not aspirate it's unfortunately that is not the national policy if it was the national policy that would be one variable to eliminate but uh it's not unless you're in denmark of course when it is and you know we've talked about that quite a bit before so so thanks for honest uh report nick and we we will um if you if you feel there's something you want to share with us that then do tenon must be ten and a half weeks since your first since your first report so that's gone quickly and i'm glad to see that you've worked out these these health self help strategies okay that is us for today uh hopefully tomorrow i'll get my other camera working there's all sorts of technical stuff here i don't really understand and uh basically for me it either works or it doesn't anyway there we go um thank you for watching today's talk

Channel: Dr. John Campbell

Views: 463,132

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: tUyQ2luZAWo

Length: 44min 18sec (2658 seconds)

Published: Wed Apr 28 2021