Tracheostomy Primer, by Dr. Steven Rosenblatt and Dr. Nikolaus
Wolter.
My name is Steven Rosenblatt, and I'm
a pediatric otolaryngologist.
The goal of this lecture is to provide some basic background
information about tracheostomies.
At the end of this video, the viewer
should be able to understand basic airway anatomy
relevant to a tracheostomy, indications
for a tracheostomy, how a tracheotomy is performed,
the working parts of a tracheostomy tube,
and common tracheostomy accessories you may encounter.
Basic Airway Anatomy.
Normal respiration requires air to pass through the nose
and mouth into the pharynx, through the larynx,
and then down to the lower-respiratory tract.
Obstruction at any of these sites
can lead to respiratory distress.
And depending on the site of obstruction,
can prevent intubation and necessitate a tracheostomy.
A brief discussion of the basic anatomy of the upper airway
is important for understanding complications
relating to tracheostomy management.
The larynx itself is divided into three contiguous areas--
the supraglottis, which includes the epiglottis,
false vocal folds, and arytenoid cartilages,
the glottis, which includes the true vocal folds themselves,
and the subglottis, or region immediately
below the true vocal folds.
The subglottis is the only part of the airway that
is made of a complete cartilaginous ring that is
called the cricoid cartilage.
The trachea is made of a series of U- or C-shaped cartilages.
The pediatric larynx differs from the adult larynx
in several important ways.
First, the pediatric larynx is funnel shaped,
with the most narrow point being the subglottis
within the cricoid cartilage.
Whereas in an adult, the narrowest point
is the glottis itself.
Another important difference between the adult
and pediatric larynx is that the laryngeal structures
overlap in an infant, almost like sections of a telescope.
The hyoid bone sits over the thyroid cartilage,
and the thyroid cartilage overlaps the cricoid.
This will stretch out with age.
But in an infant, the hyoid bone can
make palpation of the thyroid cartilage landmarks difficult.
And because the thyroid cartilage overrides
the cricothyroid membrane, cricothyrotomy is generally not
possible in children.
Finally, the pediatric larynx sits higher and more anterior
in the neck than in an adult patient.
Indications for a Tracheostomy.
Oftentimes, you'll hear the words
tracheotomy and tracheostomy used interchangeably.
However, a tracheotomy is the act
of making a hole in the trachea, whereas a tracheostomy
is the actual opening created from the skin to the trachea.
In general, there are three main indications
for performing a tracheotomy--
one, acute or chronic upper airway obstruction,
two, prolonged mechanical ventilation,
or three, the need for pulmonary toilet.
Understanding why your patient has a tracheostomy
is critical for dealing with tracheostomy complications.
In an emergency, patients who undergo tracheotomy
for prolonged mechanical ventilation or pulmonary toilet
can usually be reintubated from above if necessary.
However, if the indication was upper airway obstruction,
careful consideration needs to be given to the situation
to determine the best course of action.
Performing a Tracheotomy.
During the procedure itself, the layers of the neck
are carefully identified and separated,
creating a tract down to the trachea.
Prior to finding the trachea, the thyroid gland
is usually encountered.
The surgeon may choose to move the gland out of the way
or divide the gland to expose the trachea.
In a child, two stay sutures are usually
placed through the second and third cartilaginous rings
on either side of the trachea where the tracheostomy incision
will be made.
The purpose of the stay sutures will become apparent
in the next video.
A vertical midline incision, parallel
to the long axis of the trachea, is
made through the second and third cartilaginous rings.
And the tracheostomy tube is inserted with an obturator.
The obturator is similar to a stylet
that sits within the tracheostomy tube itself.
The thin, rounded end of the obturator
protrudes just slightly beyond the tip
of the tracheostomy tube itself and facilitates insertion.
Once the tracheostomy tube has been inserted,
the obturator is removed and the position
is confirmed by CO2 return or by direct visualization
with a bronchoscope.
Typically within three to five days,
this tract will scar and mature.
But prior to this, reinsertion of the tracheostomy tube
must be done carefully and by experienced personnel
to avoid inserting the tracheostomy tube
in between these layers, creating a false passage.
Tracheostomy Tubes.
A tracheostomy tube is a curved ventilation tube
that sits within the trachea below the level of the larynx.
The tracheostomy tube usually has
two main components-- the tube itself
that serves as the airway, and the faceplate.
The faceplate has two flanges that
allow the tracheostomy tube to be
secured in place by neckties.
The faceplate also usually has information
printed on the surface that describes the type
and size of tracheostomy tube.
Multiple models and different brands are available,
but generally speaking tracheostomy tubes
can be divided into two broad categories.
The first is the presence or absence of a cuff.
Cuffed tubes have an inflatable balloon
at the distal end similar to an endotracheal tube.
When this cuff is up, all of the air and pulmonary secretions
pass through the tracheostomy tube itself.
A cuffed tracheostomy tube is necessary
if a patient requires mechanical ventilation in order
to maintain a closed circuit.
The second broad category is the presence or absence
of an inner cannula.
Inner cannulas are not commonly found
in neonatal or pediatric tracheotomy tubes,
but will often be seen in older children
with adult-sized tubes.
Common Accessories.
You may encounter various tracheostomy accessories,
like a Swedish nose or speaking valve.
The Swedish nose is a type of HME,
or heat-moisture-exchanger, which
helps make up for the fact that the nose and mouth are
no longer humidifying and warming inspired air.
Small sponges capture expired moisture
and help to warm and humidify inspired air.
A speaking valve, or Passy-Muir valve,
functions as a one-way valve at the end
of the tracheostomy tube.
When breathing in, air passes through the tracheostomy tube.
But when breathing out or speaking,
the valve is forced closed and the air
travels around the tracheostomy tube and out of the mouth.
It is important that a speaking valve must never
be used with an inflated tracheostomy tube
cuff, as air trapping will occur and patients
can develop a tension pneumothorax,
which can be fatal if not recognized promptly.
Lastly, a tracheostomy tube must be secured snugly,
and is typically done so with a soft Velcro tie.
Loose ties can lead to movement of the tracheostomy tube
within the stoma.
This can cause bleeding, granulation tissue formation,
or displacement of the tracheostomy tube
into a false passage or out of the trachea.
These complications are easily avoidable by ensuring a snug
fit at all times.
This concludes our instructional video
regarding tracheostomy basics.
In this video, we reviewed basic airway anatomy relevant
to a tracheostomy, indications for a tracheostomy, how
a tracheotomy is performed, the working
parts of a tracheostomy tube, and common tracheostomy
accessories you may encounter.
Thank you for watching.
Please help us improve the content by providing us
with some feedback.
For more infomation >> "Tracheostomy Primer" by Steven Rosenblatt and Nikolaus Wolter for OPENPediatrics - Duration: 8:23.-------------------------------------------
Car Servicing Maidenhead for your car at Harper Motors 01628 500999 - Duration: 1:11.
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Candidates Running For Elected Office In Cook County File Nominating Petitions - Duration: 2:44.
For more infomation >> Candidates Running For Elected Office In Cook County File Nominating Petitions - Duration: 2:44. -------------------------------------------
How To Use YouTube Ads – Is A Video Ad Right For Your Business? - Duration: 6:27.
Welcome to this video: "How To Use YouTube Ads -
Is A Video Ad Right For Your Business?" Now, this is all about when using
YouTube video ads is a good, and sometimes, a not good idea. So setting
up your own YouTube video ad - is this a scary thought....or is this a scary thought?
And if you'd like to know the questions to ask yourself to determine if a YouTube
video ad is right for your business.....or to be avoided like the plague, then carry
on watching this video. In the meantime, be sure to watch the video to the very
end so you can download the free pdf called: "Top 10 Tips For Beginners To
YouTube Ads". Hi, my name is Jeff Laming of Video Cashflow and in this video
we're going to look at why and when YouTube video ads are a good and a
not so good idea for your business.
Now this is a two-step process. Firstly, ask yourself: 1. What do you want your
video ad to achieve?; 2. Do you know who or what your target audience is; and 3. Are
you comfortable investing X dollars per day up to a weekly or monthly budget set
by yourself? For example, if you're prepared to invest, say, 150 dollars for
the month, that works out at about 5 dollars per day. Are you prepared to
invest 5 dollars per day into your business (and if need be, forego one or
two cups of coffee a day) to achieve that? if you answered "Don't know" or "No" to any of
these questions then YouTube video ads is not the right strategy for you at
this stage. So go back and address the relevant question until you're at the
stage of answering "Yes" to all three questions. Okay, if you did answer "Yes" to
all three then the second step is to ask yourself the following: 1. Is your
website fit for purpose? In other words, is your website or landing page set up
in a manner that directs your visitors to, for example, an opt-in box for them to
enter their email address so they get access to your free offer such as a PDF
download. If the answer is "No" then now will be a good time to invest a bit of
effort to bring your website or landing page up to scratch. 2. Are any of your
competitors promoting their own videos on YouTube? Unless you can easily tell if
their videos are video ads, then this could be a little difficult. Check to see
if they have a YouTube channel and whether they've uploaded videos on the
subject that you're wanting to upload and release. If you can determine that
they are promoting their own videos, then it might suggest that YouTube ads are
working for them...and a market exists! It will also give you a great
opportunity to find out how their process works
i.e. the way the video is set out; the landing page or website page layout; and
so on. Also check out their Facebook page to see if they're promoting the same or
a similar video there. If you can't find anything to suggest that your
competitors are promoting their videos on YouTube then this could be a good
thing as it could mean that you can take advantage of being the first to promote
to an "untapped" traffic source. However, check to make sure that your initial
research to the earlier questions is sound i.e. you know who your target
audience is; you know what their problems are; and you have a viable solution or
solutions. And 3. Are you already getting visitors to your website or
landing page or blog? In other words, are you receiving traffic from other sources
such as social media platforms; Facebook advertising Google Ads and so on? If you
are, then good. This could help you niche down or laser-target people with certain
attributes who you want to view your video ad. Whether those visitors are
taking action or not will help determine whether you need to improve your website
(please refer back to the "Is your website fit for purpose?" question). If the answer
is "No" i.e. you're not already getting visitors to your website or landing page
or blog then, again, please refer back to the "Is your website fit for purpose?"
question. Finally, you may be wondering what type of business is NOT suitable
for YouTube advertising. I believe there are two answers to this: 1. From a legal
perspective, you may want to refer to YouTube's own Terms of Service. You'll be
able to find the URL link in the Description box below this video; and 2.
from an operational and business model perspective, I cannot see any reason why
any business cannot use YouTube ads as long as the previously mentioned checks
have been undertaken and implemented to your satisfaction. Even if you are an
off-line business with no online presence whatsoever, what's stopping you from
starting the process of producing a video or two with the intention of
eventually promoting those videos on YouTube? Promoting a YouTube video ad may
not be the right time for your business right now but it can still be the right
time.....at a later date.....and when you're ready.
So, just to recap: Step 1. No. 1. What do you want your YouTube video ad
to achieve?: No. 2: Do you know who or what your target audience is?; and No.3
Are you comfortable investing X dollars per day up to a weekly or
monthly budget set by yourself? Step 2 No. 1 Is your website fit for
purpose?; and No. 2 Are any of your competitors
promoting their own videos on YouTube and/or Facebook?; and No. 3
Are you already getting visitors to your website or landing page or blog? In the
next video we'll run through the steps of setting up a YouTube ads account.
Thanks for watching. Look out for another video on video marketing and YouTube
coming your way next week.
Here's a link for you to download your free copy of: "The Top 10 Tips For
Beginners To YouTube Ads". You'll find the URL link in the Description box below
this video. Enjoy! Until next time, bye for now......
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5 Reasons Why Russia Is No Match for the US | Stephen Walt - Duration: 5:44.
The United States is much stronger than Russia, and will be for the rest of my professional
lifetime, and I would guess for the entirety of the 21st century unless we commit a series
of almost unimaginable self-inflicted wounds.
The United States first of all has a much larger economy.
Our economy is now about $17 trillion, Russia's is less than $2 trillion and has actually
been declining in recent years.
So we are already close to eight or nine or ten times stronger economically.
The United States is much more powerful militarily: We spend four or five times more than Russia
does on defense every year.
We have much more sophisticated weaponry than Russia does.
The United States is still blessed with allies in many parts of the world.
These allies are for the most part rich, relatively powerful and stable.
We're talking about countries like Germany, Japan, the United Kingdom and others.
Russia by contrast has no allies of any real consequence.
It has something of a friendly relationship with China, but it's not really an alliance.
And lastly Russia has a terrible demographic situation.
Its population is much older than ours on average, and it's aging rapidly; the population
is projected to decline dramatically by 30 or 40 million people over the next 50 years
or so.
So for all of those reasons the United States has far more power potential.
Last but not least, Russia's only real economic asset now is oil and gas.
People are not lining up to buy the next Russian smartphone or anything like that, so Russia's
long-term potential strikes me as not nearly as promising as that of the United States.
Well, weaker states can still do a lot of things that cause trouble, and what Russia
did in the 2016 election—the full extent of which and the importance of which we are
still trying to figure out—certainly has roiled American politics in a variety of ways,
so it does show that even much weaker powers can find various ways to interfere or cause
problems.
Now, it was in part because we were vulnerable to that kind of manipulation, and that's
our fault, not theirs.
I would say a little bit more about this too, though: what Russia did is not unprecedented.
The United States has interfered in democratic elections in lots of countries around the
world, and you could argue that we've been doing a variety of things to try and encourage
democratic forces, promote civil society, both in Russia or in countries close to Russia,
in ways that they regard as alarming.
We might think that we're doing the right thing, spreading our values in various places,
but you could certainly understand how Russia might regard that as threatening, and might
even view what they did in 2016 as a form of payback: "If you want to manipulate politics
in Ukraine, if you want to interfere in Russia in various ways, well we can do things to
you as well."
So again, without knowing the full extent of what Russia may or may not have done we
shouldn't view this as unprecedented, and we shouldn't view it as coming completely
out of the blue.
It doesn't mean we have to like it, but it's important I think to keep just how
heinous it may or may not be in some context here.
Again, Russia is simply not the kind of global superpower that the Soviet Union was.
It doesn't pose a significant ideological challenge to us, it seems to me.
And to the extent that the United States is going to worry about a rival/peer/competitor,
it's not going to be Russia—it's going to be China.
But having said that, you can imagine circumstances where a confrontation between the two countries
could begin to spin out of control, conceivably over what's happening in Syria.
If things in Ukraine were to heat up again and the United States got more actively involved
there, one could imagine some kind of clash arising.
I don't think that leaders in Washington or leaders in Moscow actually want something
like that to happen—Remember, we are still talking about two nuclear powers with thousands
of nuclear weapons that could still be fired at each other, but I don't think you can
completely rule it out.
Will it become like the Cold War?
No I don't think so.
But it is something I think that bears watching.
And it's also unfortunate in a different sense, because there are still some issues—whether
it's counterterrorism, how to deal with Iran, what to do about the Civil War in Syria—where
collaboration with Russia might be useful.
And one last point: if we really are worried about China over the long-term, if that's
really the rising power that we need to keep our eye on, the last thing we should be doing
is anything that drives Moscow closer to Beijing.
Russia and China, when you look at just the geography here, are not really natural allies,
they have many reasons to be weary of one another, and we should, in fact, be trying
to get Moscow to be more on our side and less on China's side over the long-term.
So spinning up a new Cold War with Russia doesn't make a whole lot of sense from a
larger strategic perspective.
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Pikachu Family baby crying crashed fidget spinner helicopter toys Song for kids| Episode 31 - Duration: 10:18.
Thanks for watching *__*
Please like and subscribe :))
-------------------------------------------
Crew Of USS Constitution Welcoming Public For Tree Lighting - Duration: 0:21.
For more infomation >> Crew Of USS Constitution Welcoming Public For Tree Lighting - Duration: 0:21. -------------------------------------------
Romelu Lukaku escapes FA ban: Man Utd star available for Arsenal and Man City clashes - Duration: 1:38.
Romelu Lukaku escapes FA ban: Man Utd star available for Arsenal and Man City clashes
The FA investigated claims the Manchester United striker kicked out at Gaeteng Bong during the clash at Old Trafford on Saturday. The incident during Uniteds 1-0 win over Brighton appeared to go unseen by the match officials.
Television replays appeared to show Lukaku kicking Bong during the second half corner which led to Uniteds winning goal from Ashley Young. The incident was referred to an independent panel of ex-referees because match official Neil Swarbrick and his colleagues missed it.
But the panel failed to reach a unanimous decision that it was a straight red card offence after studying video footage. It means Lukaku will not be suspended and the news is a huge boost for United boss Jose Mourinho.
If the panel had all agreed it was a red card offence then Lukaku would have been hit with a three match ban.
The Belgium ace would have missed tomorrows trip to Watford, Saturdays clash with Arsenal at the Emirates and the explosive derby showdown with City at Old Trafford on December 10.
Losing Lukaku for crunch games with the Gunners and Pep Guardiolas league leaders would have been a massive setback to Mourinho.
United are clinging to the coat tails of their bitter-rivals and neighbours and the Portuguese knows losing the derby would all-but end their title challenge before Christmas.
Lukaku has made an impressive start to life at United following his £90m summer switch from Everton, plundering 12 goals in all competitions to be their leading scorer.
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Moving U: Dadeland Walkers Flock To Mall For Aerobics - Duration: 3:00.
For more infomation >> Moving U: Dadeland Walkers Flock To Mall For Aerobics - Duration: 3:00. -------------------------------------------
An Enchanted Evening just for you - Duration: 3:35.
For more infomation >> An Enchanted Evening just for you - Duration: 3:35. -------------------------------------------
Police Ask for Help Finding Inflatables - Duration: 1:39.
For more infomation >> Police Ask for Help Finding Inflatables - Duration: 1:39. -------------------------------------------
Famous Rocker Says He'd Do The UNTHINKABLE To Trump 'For The Safety Of Humanity' - Duration: 2:36.
Famous rock star — a phrase used lightly here as this particular musician hasn't
actually contributed anything memorable to the rock scene in decades — Morrissey has
come out and made a rather ominous statement about President Trump that warrants further
investigation by federal authorities.
The former lead singer of The Smiths, who had his prime back in the 1980s, seems desperate
to make up for his lack of fame by saying outlandish things on social media, the go-to
strategy for anyone looking for a quick way to appear relevant.
According to The Daily Wire, Morrissey was quoted by the European press for blabbing
about the recent sexual harassment/abuse scandals flowing out of Hollywood, stating that folks
like Harvey Weinstein and Kevin Spacey were more or less victims of people who felt let
down after having sex with them.
Yes, he's really saying that these scumbags are victims of revenge plots by people who
weren't happy with how they performed in the sack.
However, that's just the tip of the iceberg.
Morrissey stated in an interview that he'd murder President Trump "for the safety of
humanity" if he could actually do it and get away with it.
Der Spiegel asked the singer "If there was a button here and if you pressed on it, Trump
would die…would you push it or not?"
"I would, for the safety of humanity.
It has nothing to do with my personal opinion of his face or his family, but in the interest
of humanity I would push," The Smiths singer said.
"Trump has received so much attention, especially when compared to other candidates — Bernie
Sanders, for example.
Although the media said he would not win, every day, all the headlines: Trump, Trump,
Trump, Trump!" Morrissey stated.
"The American media helped Trump, yes, they first created it.
Whether they criticize him or laugh at him, he does not care, he just wants to see his
picture and his name.
The American media have shot themselves in the leg."
Morrissey went on to slam the president further by stating he has "exhausted the world"
and that he "grabs after everything like a little child."
It seems that Morrissey must be a little confused, because it certainly seems as if he's describing
himself a little bit, doesn't it?
This should be common sense, but it's never really a good idea to threaten the life of
an American president, and even if the threat made is one that obviously will not be carried
out, it should be investigated by the Secret Service.
There are plenty of ways to discuss political disagreement that doesn't involve going
right to talk of murdering someone.
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The Sacramento Bishop's Corner - A message of thanksgiving for the CLN - Duration: 2:48.
As we approach the end of the year and
the Solemnity of Christ the King and the Advent season
where the theme is the approaching of the kingdom of God,
I want to take this opportunity to thank God and to thank all of you
for your participation in the Catholic Legislative Network.
The Network is the way we as Catholics bring our voice into the State Capitol
for our legislators as well as the governor.
We bring the voice of reason as well as the voice of faith.
We also bring the voice of hope.
And thank you for being
consistent and positive in participating in making the Network
a powerful presence in the State Capitol.
In a special way, I want to give you one example where that was very effective
and that was in having the governor veto AB 569.
That particular bill would have made it more difficult
for religious employers, Catholic employers
to be able to hold to our principles regarding
regarding life, regarding human life, and it was a way to sneak into the labor code
provisions that would've made it difficult for
for religious employers to be able to
to continue to not provide abortions or to not provide contraceptives.
This was promoted a lot by NARAL and by many legislators who
who work with NARAL and pro-choice organizations.
Our work was able to convince the governor to see that
it was important to maintain
the conscience rights, the conscience protections
necessary so that religious employers
can do their work, can do their ministry with integrity.
So again, thank you for writing the governor and
for lending your voice, the voice of reason, to convince the governor
that there is no need to undermine the integrity of religious organizations.
And that we can work together to promote the dignity of human life
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Best microphone for Youtube + Test at the Youtube Pop Up Space (FR Sub) - Duration: 6:12.
The most important thing for vlogging is a good microphone .
the camera comes in second place
nobody will follow you if they cannot hear you well !
Bonjour ! Céline here ! I'm a fan of new technologies so if you are new and you want to see more reviews
Please consider subscribing .
At any point in this video check out my links below if you want to know more about the microphone
I'll be talking about in this video now. Let's talk Geek and let's see if you can hear me
I just want to test if, in a crowded area, like in here, you hear me pretty well...
The sound is TERRIBLE!
Most camera have a building microphone so a lot of people tend to think that it's enough to record good quality video and sound
Believe me. It's not
Here, let me do a test. Now you can hear me pretty well with my microphone and now without it.
No need to comment right?
Why do these high quality cameras don't have the best microphones because the built-in microphones are omnidirectional
The recorded ambient sound can get louder than your voice unless you put the microphone near you.
As some of you know, I'm a TV journalist, and I've been using for the past 17 years professional cameras microphones lights for my reports
But what about finding cheaper stuff but with great quality I?
Have two microphone a shotgun microphone that I can clip on my DSLR and take it everywhere and a small microphone
that I can clip on my clothing
My favorite shotgun microphone is the rode videomic because it has a great quality, and it isn't too expensive
The shotguns microphones are the most common microphones that can be connected to your DSLR
They have a really narrow area to capture sound in the front
And they cancel sound waves that comes from other directions
They don't amplify sound like most people think . They are really good for recording from long distance, but it has some limits
Let's see
So because I have experienced some terrible moment with this shotgun microphone from a distance
I've decided to make a microphone from it a hand microphone
I have bought for around 10 euros this cable to
Extend the one on the microphone and also this adapter because the tripod has a different size from the shotgun microphone
it's easy because you just have to plug it in straight to your DSLR, and you are good to go I
Went to the first Youtube pop-up space in Brussels here in Belgium
It's a gathering of Belgian youtubers, and I've tried my DIY hand microphone there. Let's see if it's working
Another new friend from YouTube this is Luca
That's your signature, this is how people recognize you right?
Yeah, that's from YouTube you know! So you're a vlogger ?
I'm an Egyptian, I live in Belgium
You're telling me that you are showing people in Egypt
How it is to live in Belgium? So you're speaking Arabic in your YouTube?
No I do it in French with Arabic subtitles
Nader! yes! I'm gonna put his link in the comments below.
Can you imagine he is studying and he is vlogging...hum...
I mean vlogging he's doing... he has a YouTube channel, and it's very hard to do both. Yes. It's it's very hard
We have to be very organized and if they tuned for the next videos. She does good work. You're so sweet
So as you can hear it's crowded. There are a lot of people around me, but you can hear my new youtube friend pretty well
If you like this video, please click on the thumbs up
just down below and subscribe to my channel
Could you leave just just two seconds just leave please
Because people need to subscribe and you're taking too much space
Thanks ! Click on the thumbs up button and subscribe and look at the other video. I have other reviews. See you next Monday ciao ciao
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Bed Time Drink: for Weight Loss (Overnight) - Duration: 3:46.
bedtime drink for wheter loss overnight
getting a negative nighttime sleep doesn't just make you cranky it may
additionally make you fat research indicates logging less than eight hours
a night I'm will increase your tears of the strain hormone cortisol which
negatively influences the microbes for your intestine slowing your metabolism
fortunately you could opposite path and preserve your metabolism cranking
overnight with those simple steps
one lifts weights at night after work had straight from your desk to the
dumbbell rack and you can boost your metabolic rate for 16 hours according to
the International Journal of sport nutrition
you
to upgrade your protein shake feed your hungry muscular tissues via trading
wafer casing to your published exercising shake this slow release
protein is progressively digested over eight hours and keeps your metabolic
fires burning through the night dutch researchers additionally say that casein
complements protein synthesis which helps you cut an additional 35 calories
an afternoon for every pound of new muscle one
three freeze your butt and gut off an icy shower does extra than flush out
lactic acid after the gymnasium research and clothes went under step a thirtieth
second freeze is all it takes to set off your body's brown fat which whilst fired
up melts as tonnes as a further four hundred calories in bed and sure you
stick your head below the faucet extra brown fat is saved within the returned
of your neck and shoulders
you
for drink a different kind of broom the flavonoids found in green tea boosts
your metabolism and if it's your third cup of the day you'll burn 3.5% more
calories overnight according to the American Journal of Clinical Nutrition
don't worry about caffeine content green tea will help keep you up for the news
at 10:00 but not all night
you
five sleep in a cool room cranking the radiator at night burns through little
more than ER gas bill research from the National Institutes of Health says that
turning down your thermostat to a cool 66 degrees Fahrenheit cut 7% more
calories as your body burns fat to maintain its core temperature
you
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Best Tripod for making video - Duration: 5:17.
For more infomation >> Best Tripod for making video - Duration: 5:17. -------------------------------------------
Entertaining for the Holidays - Duration: 3:13.
For more infomation >> Entertaining for the Holidays - Duration: 3:13. -------------------------------------------
How To Handle Homebuyers Who Don't Qualify For A Home Loan | CA Realty Training - Duration: 8:09.
Hello ladies and gentlemen.
My name is Robert Rico California Realty Training, hoping to bring some good information to you,
if looking to get your feet off the ground in the real estate world.
Hey, do yourself a favor, listen to some of these
tips we give you, it might come in handy.
For example, today we're going to discuss how to handle a buyer who does not
qualify for a home loan.
Now what do we do when one of our home buyers doesn't qualify for a home loan?
First off, I wanna remind you ... remember 2007, 2008, 2009, in the real estate world.
What happened in those years?
That's right, we had a huge recession in this country, a huge recession.
Home values were just decreasing like crazy and
it was going on immediately, it wasn't a slow decrease, it was like almost overnight.
It was very, very substantial, and it was very, very quick.
That being said, a lot of people's credit score was effected
for the years to come after that.
So that being said we're here today 2017, you have a buyer who's excited and
they wanna buy a home, it's their first home and it's an emotional time and
they're gonna share this time with you.
They've picked you as their realtor.
It's nice, it's exciting, you're gonna be a big
part of this deal.
So you take them to the lender, whether it's your preferred lender
or their preferred lender.
You sit down they offer you a cup of coffee ... Hey,
Lender, How you doing?
And the lender, of course does his financial analysis
of these buyers, he checks their credit, checks their employment, checks if
they have any money in the bank.
Two of the three is okay, one is not okay and the one that's not okay is the
credit, they just assume.
So because their credit isn't the best, the lender says no can do.
This isn't gonna happen.
They are not approved for a loan.
So you get upset as an agent, the buyers, of course are even more distraught
over this.
They're like, Oh no, but we just found a house we really wanna buy.
So now we have a bit of a situation, here.
So what do we do if the buyer doesn't qualify for a home loan?
Well, there's a couple of things we do.
The ideal thing, of course would be if had a buyer who
had all cash.
That happens rarely and it's far and few between.
So if you don't have a buyer cash, of course you're gonna
need a home loan.
So now we got the home loan that gets denied, so what do we
do?
There's a couple of things we can do and there's a couple of reasons why
home loans get denied.
Number one reason why most home loans get denied is one
of three things.
First one is the credit score.
The credit score isn't the best, but that can be fixed
properly if we just stand back and just reason this thing out.
Think about it, the lender's gonna help you fix this.
The best thing to do is this ... the only way to fix
something is if you know what's wrong with it.
So what you do is this, you sit down with the lender and the lender gonna
show you, they're gonna actually How To Handle Homebuyers Who Don't Qualify
For A Home Loan Page 3 of 5 show you what your score is and how this score
got to be ... I don't know ... 550.
550's a pretty poor score and the lender's gonna show it to you, right there in
back and white.
The reason you have a 550 is because this, this, this and this.
Well, now knowing this information as a home buyer, you can go back and fix
these items.
Now, typically to fix this stuff might take months, could take years
and you talk to your wife, your spouse, your husband ... well, now you say,
Honey, I guess we're gonna have to go do this, and pay this off and do this, this,
this and that can take months, years, but you're excited, you wanna get it done,
now.
Well, sometimes that score, that FICO score is this close to getting a home
loan.
It's this close, you're just shy of that pre-approval stage because your score
is a smudge to small, too low.
So what do you do?
That's why it's great to have a great lender in front of you.
Great lender will tell you, well, listen, I just reviewed your credit report and if
you go fix this, this and this ... what about this here, Mr. Buyer, was this you
back in 2014 and the buyer says, No, that's not my account and the lender says,
well, we need to get this removed, if that's not you we have to dispute this and
the good thing nowadays is that we have what's called a Rapid Rescore and a
Rapid Rescore is exactly the way it sounds.
They rescore your credit score rapidly.
Let me explain, you get a 550 FICO score and on your credit report there is an
entry there that doesn't belong to you and that entry is affecting your credit
score negatively, substantially.
It's really bringing it down.
It's something that happened back in 2014, now you wanna have
that removed, because by having it removed, that will increase your FICO score
enough, just enough to get that home loan.
So, typically, of course, the possible home buyer would go and
contact the three credit bureaus, ready?
TransUnion, Equifax and Experian and they will inform these three credit bureaus,
Hey, please remove this item.
Here's the proof that it's not my item or here is the proof that it was paid back
in 2014.
Please remove this from my credit report, cause I'm looking to buy a
house.
Now you try telling a home buyer, Hey, well you're gonna have to wait 30 to 60
days, maybe longer for us to remove this.
Uh-uh, a home buyer wants it done quickly, cause they wanna get into the house.
So the buyer asks if the lender ... can you please have my credit rapid rescored
and the lender will say, well sure.
Now with the rapid rescore, what happens is the lender submits the evidence
that the debt was paid or it was disputable.
The disputable debt should be taken off with the three credit bureaus and the
lender can have that removed within the 3 to 7 days, sometimes.
It happens quickly.
Which is great because now the buyer can get back in the real estate game,
then go out a purchase their home knowing that their score has increased all
because of the rapid rescore.
The rapid rescore did great for them, which is fantastic, everybody's happy, you
now have a client who's ready to rock and roll.
The lender's ready to loan the money out to the buyers, the buyers are ready
to go out and purchase their How To Handle Homebuyers Who Don't Qualify
For A Home Loan Page 4 of 5 property and everybody's honky-dorky.
It's a beautiful world all over again.
So there's options out there.
Another reason why some buyer's don't get their loans approved right away is
because, of course they haven't been at their jobs long enough.
Some buyer's don't get their loans approved because their
debt to income ratio is much too high.
Sure they make a lot of money, but they have a lot of debt which is a
[Spanish 00:05:41].
Ready, there's a couple of things I also want you to know, another couple of
options when it comes to buyers who are not getting approved immediately.
They can also go to a mortgage broker.
Mortgage brokers don't have any money to lend, that's why they call the brokers,
cause they're broke.
What they do is they originate.
They originate loans, which means they just begin the loans,
right?
But the cool thing about mortgage brokers is they know tons of people in
the lending industry, which means they know tons of lenders who are willing to
loan, with different criteria.
Sure Bank of America, or Wells Fargo, or Chase all these big huge banks may
have the criteria that of you wanna borrow from them you gotta meet these
criteria but there might be other lender's out there who are much smaller, who
have criteria that's down here and you may qualify with a slightly, not so strong
FICO score.
You may qualify for their loan with not so much income, you may
qualify for their loan without being at your job for two years.
These mortgage brokers have the ability to contact tons of
lenders and they may find one.
They may find one that will accept your buyer's
financial situation.
Last but not least we have what we'll call hard money lenders.
They can provide a loan to the buyer, sure, a short term loan
for high interest rate and the buyer then has the ability to go buy his house,
but he's gotta return that payment pretty darn soon and if not, that interest
rate is extremely high.
Got it?
So there's a few options.
So if your buyer right away doesn't get qualified for a
loan, do me a favor don't hesitate and don't let them walk away.
Do yourself a favor, do them a favor ... help them get a
loan.
How?
By showing them the avenues of getting there.
How?
Showing them a lender who can help, maybe a
mortgage broker, maybe a hard money lender ... but ready, wait for this ... most
of the time a great lender will sit down with them patiently and explain to them,
listen, if you do this, this and this your FICO score will increase tremendously
and it will help you ... the buyer, get that home loan you've always wanted.
Hope this helps you out, don't let any buyers get away.
The lender will decided if they're worth keeping or not.
Help them, help them, help them!
This is the business of not making commission, but this
is also the business of people, which means you gotta help, help, help, for
their benefit, not just yours.
Hope this helped you out.
Have a great afternoon, if you have any questions or
concerns do yourself a favor and us a favor and leave it down below in the
comment section.
If you have any questions, let us know and don't forget to
subscribe to our channel.
Have a great day, see you next week.
-------------------------------------------
How to register for a CE course at Humber - Duration: 3:54.
- [Instructor] Welcome to continuing education
at Humber college.
Today, we are going to take you through
a series of steps you can follow to register
for a continuing education course at Humber.
Step one: when registering for a course,
we recommend using Google Chrome or Safari.
To download Google Chrome,
go to their website at google.ca/chrome.
Press the download Chrome button.
Read the Google Chrome terms of service
and then press accept and install.
After you install the application, you'll be able
to find it in your applications folder.
Step two: visit the continuing education website
at humber.ca/continuingeducation.
Here you will have the option of
searching for programs or courses.
Search by keyword and filter by
area of interest or start date.
Step three: when you find a course that you would like
to register for, take a moment to read the course
description on the left-hand side of the screen.
You'll notice a brief course description as well as
the prerequisites, contact information,
and an option to share this course with a friend.
Use the how to register section to find the desired
start date and location, then select the register link.
Some programs have multiple start dates
and campus locations.
Take the time to make the selection that suites you best.
Step four: you will need to install Flash Player
to continue with the payment process.
To install Adobe Flash Player,
go to their website at get.adobe.com/flashplayer.
Read the Adobe Software licensing agreement
prior to downloading the software.
Press the yellow download now button
on the bottom-right of the page.
Open the Adobe Flash Player installer and click on install.
Wait while the software installs on your computer,
it can take up to a minute.
Once the installation is complete
click on the finish button.
Return to the continuing education registration page.
If you have flash player installed you will be taken to
the schedule builder page, where the details
of the course will be displayed.
If you would like to confirm the course details,
click on the magnifying glass.
To add the course, either click the add button
or drag your selection into your schedule.
Step five: once you've added the course, click register.
You will be directed to create a new account
or to sign in with your Humber credentials.
To create an account you will need to fill
in the form with your details.
Once completed, a new screen will show your registration
results where your course will be displayed.
Step six: a pop-up will appear and ask you
to accept the registration disclosure.
Please read carefully and click accept.
Step seven: proceed to the payment page
and select a payment option.
You will then be taken to a payment gateway.
Fill in the payment information
and click process transaction.
Check your email for a confirmation of
the course you've registered for.
If you run into any issues with your registration,
contact us at 416-675-3111.
If you have any issues with your login credentials,
you can contact IT at 416-675-6622,
extension 8888,
or visit its.humber.ca.
-------------------------------------------
Jane Goodall sees "Me...Jane" for the first time! - Duration: 0:34.
I was just blown away by this amazing, amazing performance.
I think the cast - wow - they're amazing.
The way the cast played the different animals
and the way the messages, my messages
came out for young people in that setting.
Very different, very unique,
and I think it will touch many people.
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