A lecture-based teaching session for ISCE assessments, the focus being on acute history taking, management, and the SBAR communication tool. The session will begin by emphasizing the significance of structured history taking, outlining key components such as presenting complaints and past medical history. Next, it will cover initial management strategies and common investigations related to acute presentations, guiding students on how to select appropriate tests based on clinical details. The SBAR format will be introduced as a method for effectively communicating clinical information, with examples illustrating each component of SBAR. The session will conclude with a summary of the key points discussed and a Q&A segment to clarify any questions students may have.
Acute history taking and SBAR handover
Summary
This on-demand teaching session, led by Riaser, a leader of the SG 101 team, is designed for medical professionals who want to improve their skills in acute history taking and giving the perfect handover. The session, which also has moderators for Q&A, will be highly interactive with the opportunity for attendees to answer and ask questions. Attendees will be taught the basics of history taking, how to approach a full acute station, and how to provide a concise, accurate handover. This session will also cover common differential diagnoses, as well as advice on responding to patients and staying confident in high-pressure situations. By the end of the session, attendees will hopefully have a vast differentials list in mind for when a patient appears with a symptom such as chest pain. Attending this session would be beneficial for medical professionals interested in enhancing their acute history taking skills and those of providing accurate handovers.
Description
Learning objectives
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By the end of this teaching session, participants will be equipped with techniques to approach an acute history taking session efficiently and thoroughly, making use of tools and mnemonics to ensure all necessary information is acquired.
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Participants will learn how an acute history taking session differs from a non-acute history taking session and understand how to adapt their approach accordingly.
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Participants will understand the importance of effective, clear handover communication and will develop techniques, including SBAR (Situation, Background, Assessment, Recommendation), for structured handover.
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The session will equip participants with a clear understanding of common differentials and how to answer questions related to investigations and management, enhancing their decision-making skills in an acute clinical setting.
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Participants will become familiar with, and know how to avoid, common pitfalls in the process of acute history taking, including leading questions, forgetting to ask about allergies, and not responding to patient cues. They will also become more confident in their skills and abilities through interaction and practical examples.
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Computer generated transcript
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
No, on, um, apologies for the delay. We were just sorting out a few techno technical issues. Um So I'm riser, I'll be leading the session today. Um, and I'll be taking you through, uh, how to approach an acute history taking session or, or even just a full acute station, um, and how to do sa handover as well. Um We also have as, uh moderators here, uh, Ruth Yasmin, Catherine Joselyn who are also part of the SG 101 team. They'll be here to do, they'll be here to answer any of your questions on the Q and A. Um, so feel free to ask anything, ask him go through. Can you all hear me this fall? Like an A? Yeah. Ok. Brilliant. Um We're gonna try and make this session slightly interactive. So then it, I personally think it would be more beneficial if you're interactive. So, um, just anything, any answers probably it on the chat as well and then we'll go through them. Um Can you guys see my lights? No, no, we can't remember. Ok. Ok. I'm just gonna log back in because this normally helps. So while rsa's just logging in and out, I can do a little chat. I'm sorry, I can't um put my camera at the moment. Um But I'm one of the other um, helpers of is 101. Just to let you know, you guys know if you have any questions, please just pop in the chat. Um We can answer them obviously, Rsma while she's presenting, she won't be able to see the um or well, she, she won't be able to directly reply to each of the questions. But myself, uh I think is it, is it Ruth and Yasmin or do you have anybody else here? I can't actually check at the moment. Um There's a few of us here that we can answer questions if, if needed and if you have any other concerns about is in general, just let us know. Um You can always email us or whatever and we can do what we can to, to try and alleviate your, your anxieties and it's great that you're here already. Um The fact that you're here at this stage shows your, you know, um keen to do well, which is great. So yeah, just strap in and enjoy the, the shower. It's not usually this, we don't usually have this many technical delays at the start. So um this, it won't be like this going forward. This is, this is quite rare. So yeah, so let us know if you can do to help. All right guys and um looks like rhythm has come back in now. So see if we can get it sorted. Um Yeah. Now, can you all see the slides? Yeah, we can see the slides. Ok, brilliant. So, um so um I know this the uh I know it's only in beginning November now and um you guys are probably started or just about starting soon on preparation. So I'm not gonna go into too much detail. We're gonna take it slow and nice. But um at the end of the session, we will send you feedback forms. So if you think you wanted more details, you can also let me know if you want it slower, you can let me know as well. Um Both. Um So very quickly we'll go through the basics of taking history and then we'll actually also then talk about how acute se differs from a normal history which um you have all been used to from here to excuse. Um We'll go through small tips and tricks here throughout the sessions on how to actually um succeed in ta taking a short, quick suc succinct accurate history and then we'll go through a handlers and, and then we'll also go through common differentials and how to answer questions and investigations and management. So very quickly starting off with, we have a 55 year old male, um who came in with a sharp su sudden chest pain. What if you wanna give me one word? What are you all thinking, just pop it on the top or just brainstorming here? By the way, we're, by the way, I'm hoping that we're gonna improve your skills rather than spoon feed you as to what, what to memorize and what not to memorize. So, um because AKI is more of a skill based exam, so let's do a quick brainstorming or we, we, we've had some people say cardiac um some people say pe maybe uh uh what about cardiac, maybe a pneumothorax. Yeah. Yeah. Good shot. The Yeah, sorry, good. Yeah. What's the scientific word for a heart attack? Am I? Um So that's the other tip as well. So in an ey um when you're talking to a patient, you always try not to use a jargon. So yes, using words like heart attack and all of that when you then present, which we will also be covering today. So as soon as you turn to the examiner, try, if you can use more medical j jargons, then that would look a bit more um niche. So that's the scale we wanna try and develop as well. So, but great start right now. Keep that in mind because this is what I want you to do when you go into an EK as well, except don't be too narrow. So um hopefully by the end, you'll have a big whole list of differentials that you could think when a patient comes in saying I've got chest pain. So let's start off cause I'm, I'm pretty sure we need more um details in order to actually come with the um diagnosis. So quick history taking uh quick basics of history taking, always, always introduce yourself and with your full name. So when, when you practice with your friends, just make sure you keep like just try and use the same phrases so that over and over. So that by the time you come to your ay, it would be some, it, it would be a second thought basically. Um So II personally would say hello, my name is doctor or not doctor at the time for my med school. So hello, my name is Rosner Sin. I'm 1/4 year medical student. So see your role as well and then confirm the patient's name and date of birth. So could I confirm your name and date of birth? Um and then you go into your proper history. So with the proper history. Um So the basics would be, you need to technically click, click through all of these. So you need to ask why they're here and the history. So more details as to why, why they're there. If they say they've got chest pain, you need to know more about chest pain. Um So the Pneumonic to use would be Socrates, which we can go through later on. I'm sure you guys have um gone through it at some point. Um systems review. So what I would say is think of all the systems. So if you have chest pain, you need to also think about respiratory gastro, um, head headache, any of those. So dizziness, fainting, um, any numbness in the arm. So you go system by system. So cardio rest gastro, etcetera, then you need to go through past medical history and surgical history and then what medications they're taking as well on top of that, do not forget allergy. So I would put that drug history and then family history if relevant most like uh in a seven minute history, definitely you need to ask that. And social history. So that would be alcohol or smoking, drugs, mobility. Where, where do they live? Do they have carriers, acid Throid? And the big thing we tend to emphasize is the ideas concerns expectations because most of the time every patient would have some kind of idea and in an scenario, um when, where you're very nervous, where let's say, for example, you're having, you start forgetting everything. Hopefully you don't, oh, literally the ideas concerns expectations can actually help you because they can give you clues as in what they are thinking. And that will give you a heads up as to whether you wanna rule it out or whether you wanna include that in your differential. So always make sure you ask for ideas, concerns expectations to uh reason reason, top one reason why people could fail in an scheme is that if they forget allergy because that comes as a safety allert. So just whatever you forget, please do not forget about asking for allergies, very, very important. And if you're presenting in an sbar or if you're presenting after your history again, make sure you mention the allergies these days. Um Just very quick tips again um to help you manage timing now, um literally start, start with an open question. So just go ask, um, why have you come in today and then let them talk. So do not interrupt. There take at least a full 30 seconds, um or roughly around 30 seconds where you let the patient talk that will give you so much information and then you can build it up from back and then don't forget the ice, as I mentioned earlier. Um Common things, uh people make mistakes and um, if you, if you ask leading questions, uh like, like for example, if I ask you, oh, you haven't missed any doses of medications, have you, um, that kind of ruins the rapport? But also leading questions will make the patients say either yes or no, which won't give you a proper answer as well. So it's about but like it just anything just don't direct them to an answer, just leave it as open as you can when possible. Um And the common, common other mistake and I know I used to do it when uh when I was your stage as well. Um don't ask for multiple questions. So we like, do you drink or smoke is a common one. Um Do you have shortness of breath or nausea or vomiting? Um So do you have nausea or vomiting? So, um, patients can just say yes, but what is it? Do they drink? Do they smoke? They just said yes to both. Um So just keep it separate. Small quick questions are ok as well. And then big one just stay confident. You guys are all here preparing for your sys already. By the time you are in your actual sy, you will just keep that in mind that you have started your revision early in us. Be confident. And because yeah, you've been preparing um the other top tip I had was respond to patient cues and I always do um say this to everyone when, if it be, if, if the patient says um I've got pain or if they, when you walk in patient looks very distressed and in pain, you can acknowledge it. You can be like, oh you seem like you are in pain. Can I offer you some an analgesics or I mean painkillers? So respond to how they are. If they say something again, acknowledge it, respond it if they say I've got shortness of breath, but you're asking about chest pain, remember the shortness of breath and come back to it afterwards, whatever they say would be important. So just respond to the cues if patient has nausea or vomiting, um, make sure you also offer them anti sickness medications. Um, you don't have to give it obviously, but just offer it. Um, and that was the point. So. Right. That's a lot. How do we actually fit into four minutes? Cause acute station you need. You're expected to take a history, um, in four minutes in Cardiff and Banca. So that's the big question. Um, just a quick intro. So all that is for a acute history is that you'll only be tested on acute condition. So there is only a limited set that can come, you can't have like things such as oh arthritis or anything that's chronic where you have to go dig into how long it's been like you don't need to go into years of histories if something short and quick acute. Um But the big thing that you can do is you just need to make sure that you consider that a set of red flags and we will go through it by the end of the session. So hopefully that will help you as well. Um So by red flags, I mean, if you have headache, you need to think about any visual lows, any dizziness, all of that because those can cau those can even tho those can actually also mean that it could be something intracranial in the brain possibly. So those are things you need to rule out. Um And yeah, I've just listed down all common symptoms and red flags that could come up. So not the red flags. We'll go through the red flags but common symptoms that could come up in a acute history. So just for your vision, um, pain, vomiting, loss of consciousness, shortness of breath, cough, bleeding, like hemoptysis or hematuria, diarrhea, all of that. Um I'll be uploading these slides. So you um you are welcome to use these in the future. If you wanna go back when you practice with your friends, right? So back to our history taking because we were trying to figure out a way where we can fit all of these uh into four minutes. How we can do that is by prioritizing. So presenting complaint, you need it, history of presenting complaint. Yes, you need it. Systems review, I would say is very important because that's where you can help that. That that's the bit where I would ru rule out all the red flags as well. Um Past medical history, surgical history. Yes. Just very quickly one sentence. Ask what whether they have any medical history, uh past medical history or surgical. Um It's just more uh where in a seven minute you can go into more detail. Um acute history, you just need to know the answer very quick and short. Um But you do need to cover it. You do need to cover all of these. It's just more spending more time for presenting complainant systems review. And lesser time for things that may be less relevant. If a patient comes with respiratory problems, social history such as smoking would be very important. But then if the patients coming with um um something else where smoking is not relevant, then that may not be something you need to put more time into if that makes sense. Um So it's more about prioritizing. Um which is why initially, I started off with that case where you have, you have a prompt and you need to keep in mind the things you need to rule out and the red flags that you need to rule out so that you know where you're heading towards. So back to the um case. So 55 year old male, sharp, sudden chest pain. Um So if you were to approach this in your asking, you start with the pain. So presenting complaint would be you talk about the chest pain and then his history of presenting complaint and further um questions on the presenting complaint, you need to go through Socrates. So that would be side on character. Is it radiating anywhere any other associating symptoms and like is it worse or uh worse or better on a particular time or um I miss out e which is exacerbating some uh factors. So does it get worse or better on movement, inspiration, eating, et cetera and severity? Now, all of these in an acute station, you can actually use closed questions that might help you with the timing. Um And I have highlighted the associated symptoms because that's quite important with the SY systems review and the red flag ruling out. So that's the bit I would say. Um you might need to spend a bit more time in, but you do need to make sure you cover all these rates and this is a little table of all the differential potential differentials you can have. So you so s 55 ok? Ignore the age but sharp sudden chest pain or just any chest pain. You need to think about M I. So how can you rule it out? So you're gonna rule it out by radiation. So that's why it's important to ask that. Angina, you can uh um rule it out by knowing whether it's uh worse or better with rest movement, all of that aortic dissection, you'll know it based on the character onset, um and the severity pericarditis um as would be relevant with the associated symptoms. So you're looking for any fever, myocarditis, same thing. So you're looking for, again, associated symptoms such as fever or even family history. And pe again, you're looking for any kind of pain worsening and inspiration and any other risk factors such as hospitalization. And so that's where the past surgical or medical history would be relevant to. So, what I'm trying to say though is you need to keep these lists in, in your mind and make sure you rule out each of them. Um And that's why your red flag systems review comes in. So I'm just emphasizing that bit because that's so important in an acute station. Um Does that make sense so far? Uh Ruth, are there any questions or an anything that I need to clarify? No, there's no new questions. OK. Um We can go through um anything in the end too, but uh Ruth Ruth also and the as and cat there, um hopefully answering your questions as well. So, um we'll be that. Um Right. So, um anyway, you get feel free to use the stable if you want um cause these are the main differentials for chest pain. There are more as well. These are the ones that came to my mind. Um So, but it's something to start with one little pointer as well if you have someone with ABDO problems. So any abdomen pain, there are actually three systems you need to cover. You do not just think about abdomen and do not just think about gastro, it's actually obs and diy. Um Yeah, so obs and D gastro and urology, you and I think of them as a little triad. So you need to ask about their, if they have any dysuria or any uh problems with the urine, any problems with um discharge menstruation, bleeding from that um pregnancy check if they're pregnant and if they have any gastro symptoms as well. Um Again, these are just a few differentials uh I've left but ectopic preg pregnancy is also a common one that you need to always check in a young, young female who has come in with active pain, um just mindful of the time. So I will answer any questions you have. But again, headache, you start with Socrates and then again, there's a list of all the different uh conditions that can come up with headache and you need to keep in mind. Um So, and you just need, you just need to make sure you ask red flag questions that I can rule out all of these. Um Yeah, so um tension headaches. So again, position of the headache um that should uh give you the answer. GCA any associated symptoms, any visual problems, tenderness in the scalp, um trigeminal neuralgia, the classic uh com com uh symptoms on combing and um eating. Um Yeah. So I'm just trying to emphasize about the whole red flag bit and I've just also added little tables here and there. So you can actually go through the list of acute symptoms that are quite common. Um And these are the things you wanna look at. So um that differentiates between um the physiological headaches. Yeah. Um this would be the differential as for fall. So if someone comes in with dizziness or fall, yeah, loss of consciousness things you need to think about would be seizures, stroke, tia A. So you need to ask for neurological symptoms, um any intoxication. So that's where the social history would be relevant here. Any cardiac problems, any um palpitations, chest pain, family history of cardiac conditions. Um But with the whole accusation, my biggest tip would be um if you just to help you with the time you can go. Do you have any palpitations? Do you have any numbness or ting uh numbness in your fingers? Do you have any, have you had any loss of consciousness? So you can just go close questions cause uh that will give you the answer that also won't take too much time in a normal history which is not acute, try and use open questions as you can. Um um these are ophthalmological um conditions, so I'll just put it here so you can have a look later on. We'll be uploading the lights. Um It just for your revision. Really, I've just listed all the diagnoses um and just wrapping off with the whole history taking bit. Um Just start with open question and then follow it up by specific close questions. So you can rule out the red flags and system uh uh system review. Um Just keep in mind the relevant questions. So again, going through a system by system would help you. And um yeah, just have a couple of differentials in mind, but also try and be more wide. You saw how each of my tables had at least um 10, 10 differentials. I wouldn't say that out to the examiner that I've got 10 differentials. But these are things I would look out for um any questions so far. There's not any in the chart. Ok. Um I hope I haven't bored you guys but um, and I'm still. Yeah. Yeah. Um ok, so now once the history is done presenting, so keep the same format and then just state the positive findings first and followed by the negative with the negative one. So uh so by that, what I mean is positive, you say, oh, patient has nausea, vomiting, um ab abdo like left iliac fossa pain, um that's sharp and stabbing. So anything the patient has mentioned and what the patient has then mention what they don't have, but you don't obviously have to mention everything that they don't have. Just make sure you say the main, the main relevant red flag symptoms. So the what we said, so if someone comes with a chest pain, you need to say that it does not radiate anywhere. It it does not get worse on inspiration. Um And um there like there's no palpitations because if they do have palpitations that could mean something else. If it radiates to the arm, it could mean something else. So those are the red flag questions which would go under the negative findings if they don't have it. And then, and then offers several differentials. So don't like, yeah, so this would be a good way of ending the whole su succinct um pre, pre final presentation of a patient. So just say in conclusion, my top differentials would be a CS uh pe or uh pneumothorax. So you just list it or you can say my top differential is this and then say, but I would also like to rule out the rest of them. So just make sure you have at least three or more kind of thing. Um went. Yeah, and then you can follow it by follow it up by very quick investigation management. But just make sure that again, common student mistake, don't go through the investigations and management in so much detail if the examiner hasn't actually asked you yet because, um, they, they will ask you cause that's not the end of sensation. Um It just also make sure that you have enough time for the station. So that's just one little tip from our team investigations. Um So, uh, some of you may have heard it already, but we, uh usually in the morning, do you remember our structure, our investigation, we did B boxes. And the reason why we say B boxes is because those are the ones that are. So B for beds bedside would be more faster than the second one bloods. So that's the order in which thing things would be more likely to be done as well. So, so this is a good structuring um for your investigation bit. So be your bedside. What can we think of, you can bob it on the chat and if the team could kindly read it out, um, they've got response to basic observations, auscultation, urine depth, blood sugars, EKG really out but brilliant. Great. Those are all bedside. Uh 11 small thing, um which would make a big difference is also so you can do it properly, full examination cause, um especially if we haven't talked about examination and we've only done the history. You can always say you'll do a full cardiovascular examination. So that, that, that's the easy one to remember. But also if you, yeah, something that you can easily remember, but we'll get you the mark as well. Bloods, we'll go through that. Um So bloods the, this is our um less than we have combined, but I would say whatever bloods you're saying, list it out. So, iw if I, if I were you, I would say II would for this patient, II would then do blo uh full blood count, urine electrolytes C RP, elect the liver function test or thyroid function test. Um You might also need to know why you're doing it. And examiners do like it if you know why for sure. Um If you have the time, you can explain it, not in too much detail unless they ask you. Um But basically F PCU and ACR P is a baseline blood for pretty much most of the patients because that's baseline blo blood C RP. Normally for infections, you and me looking for any electrolyte abnormalities or AK I could be detected from it. Um FBC would show anemia, um, infections, et cetera. LFD. S. You do it if it's uh abdominal uh condition that you're thinking of or anything that could affect the liver. Um, if they're alcoholic, you would do an LFD T FD. Again, think of all the thyroid conditions. So, um, so you just need to know why you're doing it, but you do need to also say what exactly you're doing blood culture, you would do in a sepsis screen, um infections. Um You would also do group and same cross match and coag screen if it's a surgical patient or if they, if you think they will need transfusion or if they're at bleeding risk, um you, you will have access to this slide so you can go through all of these. Um because I've, we've written down the test and why it's being done. But um yeah, there's a little cheat sheet if you want. They are physis. So this includes uh swabs cultures. Um Any other tests like uh fecal calprotectin. So that would be for any uh bowel conditions. Um Yeah, um um vaginal swabs. Um uh yeah, you tend to get a bonus mark if you do know what type of swab. So charcoal or not. Um So depending on if it's for gonorrhea or chlamydia, what it is that you're looking for. Um um XX in boxes for x rays. So just work your way up starting from the least hassle uh radiology. So, ultrasound very fast. And then you go for X ray CT MRI and then endoscopy, colonoscopy, um Dexa and pet scan would be special. Uh Just one little top tip would be, don't say I would do a chest X ray. Uh because as an F one, you won't be doing the chest x-ray, the radiologist would be the doing the chest X ray. So um that just uh again, a common um tip, a student, common student mistake. All right, because this is what I will start um when I did my ski as well, um Just make sure you say I would request a chest X ray or I would request an ultrasound. Um So you just need to make sure you say what you would do S NF one, you won't certainly be doing an endoscopy as well. So all the things just make sure you say I would request the following. Um Yeah. Um in terms of special test. So this would include spirometry if the patient has co PD um biopsy, any tumors, e eg seizures, loss of consciousness, um any special blood test. So um all the weird wonderful hematology test and any biology screen. So anything for like HIV or TB, um those would come under a special test. So just make sure you structure your answer. That's the key message I wanted to say now this, I would say is a very useful slide personally. Uh because with any surgical patient, there are things you need to do. So if you actually keep these in mind, these would these are things that you have to do in any surgical patient? So are a lot of them who are admitted in. So never forget. Um So catheterizations uh for urine advi uh if they're going for surgery, you need to keep them little by mouth and saying that would get you the marks in a nosy um drip and suck. So if it's bowel obstruction, for example, um insert an IV candler, you can actually say that do medication review before surgery and never forget VT prophylaxis if you're admitting a patient and management. Um So we normally split management into conservative medical or surgical again, structure it that way and that will make your life a lot easier. Um So conservative things such as like physio ot diet, diet or lifestyle modification, um education. So yeah, um lifestyle education or education about contraceptives, um contact tracing anything like that. So that's conservative and then you need to go into medi medical. Um There are some things that would be very useful, especially in an acute scenario as well. So that would be analgesia uh antiemetics, oxygen fluids, make sure you say what fluids um we t prophylaxis as we said, never forget it. Yeah. So these are five things you need to keep in mind with medical management and yeah, and acute stations always. And I'm gonna emphasize this ABCD E even with investigations, make sure you say I would take a A BCA two E approach because that is the keyword in not keyword. That's the main biggest thing you have to do in a any acute state uh in any acute scenario as an F one. Um And then you also need to record a senior because remember last slide, I told you only say what you would do and a lot of things as an F one, you can't actually do it. So you need to also get the help of a senior, especially in an acute scenario. You won't be expected to manage it on your own. Um If you need a crash call or a cardiac arrest call, mention that too. And then you, yeah, and what you're expected to do would be to review a two e until the patient is stable or until a senior or the team or someone has come to help you. Um, again, common things to remember and anaphylaxis don't forget to remove the trigger because, uh there are a lot, a lot of times we tend to say all these medical managements that we always forget to remove the trigger. So it's a IV drug that the patient's anaphylactic to stop, stop the IV drug. Um, yeah, and medications again called, um, easy thing for you to say it's the best structuring and approaching an o check for allergy with the patient. And then you can also check it on the clinical portal. But you, you can also mention that you will check the B NS. So and that that is a very safe thing to do as a doctor because if you don't know something, you either ask for help or you check somewhere rather than blindly doing anything. So checks mention that you'll check B NF you. If you're in doubt, you can ask the pharmacist all of that, you're not expected to answer things that you don't know about or you're not expected to answer. Very complicated me. Um Very complicated issues. It's just more about approaching the issue, how you would approach the scenario rather than whether you know the specialist treatment. But the main thing with any acute station is to stabilize the patient, make sure they're safe, make sure you are safe. Um So again, as I said, a to a just summarizing the important things AAA senior support. Um very important. And if you are gonna follow any protocols, if you're gonna call any crash, any put any crash calls medicals, um major hemorrhage protocol, et cetera, any questions so far root, there's not any more questions in the chat. OK. Right. Just um so the next big thing to cover would be the sbar and this would sbar literally means situation, background assessment recommendation. You, well, it's very common to come because a lot of times you do have to hand over the patient um to a senior. So just starting off the situation again, common, common tips, uh tips and tricks as well. Make sure you always introduce yourself and confirm who's on the other side. The same way you would take in, in history where you confirm the patient and introduce you. You do that over the phone as well. So I would say hi. Um Can I hello? Can I just um check who I'm talking to? Because the last thing you would wanna do is um go through all the uh patient details and then realize you talked to the wrong person. So just make sure you confirm who's on the other side first thing and then introduce yourself and also see where you're phoning from. That is so important. I'm just emphasizing it right now. Um And then ask if they have any time to discuss the patient, I would say, oh would it be ok if I discuss the patient with you? I'm worried that they're acutely unwell and I'm concerned by this patient. Um It is a good idea to actually start with what the issue is in one sentence. So if you think patient septic, if you actually say the word sepsis, right at the beginning in situation, the person on the other side is more likely to listen to you um because it's an attention grabber. Whereas if you talk about the patient. And then right at the end, you say it's sepsis, there is a chance that they could probably miss out a few things. So it's just a good, um, nice thing to start with what the actual problem or why you're worried about the patient. And then you go into backgrounds and this is where you talk about the presenting complaint, history of presenting complaint. So follow the exact same tips we went through for presenting a patient where you go through positive uh symptoms and then negative symptoms, ruling out the red flags. And then you give any relevant history or past medical history, social history, surgical history or fa family history and never forget allergy and and then assessment, you go through your examination findings and you start, you don't need to say everything, just talk about the main parts and say what's more worrying. So if, if a patient has a, if you're worried that the patient's BP went to 100 and 10, but that would be uh well 100 and 10. Mm. But then if you, if you say, oh, a patient just dropped his systolic BP from 100 and 50 to 100 and 10 in like an hour, that could mean something. So if you are mentioning to say what happened, did they drop it? Did they um go up what's been going on? Um Yeah, so just any investigations, examinations you do put in your assessment and then r the big one. So again, say what your diagnosis is. Um if you have considered any other differential, say what you have done for the patient so far and then say, and then ask if they, they want you to do anything else. So I would say um so this patient had sepsis. I have started this sep uh sepsis six protocol. Is there anything else you would like me to do? And then, and then say why you're calling? So I would like you to kindly review this patient and also ideally say when um as soon as possible or sensible timeframe. Mm Yeah, always time in person as well and even the patient in the history. Um So just wrapping up um the just summarizing three main top tips for me, never forget allergies. Uh When you mention investigations management in an acute station, always bring up A two E and I will refer to senior for help. Any questions, no questions at the moment. Ok. Um And I hope it helped. We're, we're all here. So feel free to ask any questions or if there's anything you want me to properly go through it now. Thanks for my, I thought that was really helpful. We shared the feedback form. Yeah, if you guys can kindly do the feedback and if there's anything um else you need, um we'll the slide and the recording here so you can always come back, watch it. You can always go through those lights. Five also, I think next week is the next week, an in person session this month. Oh, yeah. And then our next session would be on Monday. So we'll be doing a hybrid session. So if you're online in a somewhere far from Cardiff or Bangor, you can join us online, but we would be doing examination practice as well. So if you can come face to face, that would be way more beneficial. But we are gonna keep an online component. So if you can't make it, you don't miss it, miss out on anything. And is there a sign up form for the in person? One? Ok. Thank you guys. I don't think there's any questions and thanks to the team as well for sorting out Q and A, is there a sign up for the next week? Yeah, if you can come in person, we'll send you a sign up just so we have a number of the numbers. Ok? We haven't sent it out yet. Yeah, just so we get an idea of what, what the room size. Yeah, that's fine. So we'll send out the in person, sign up form later this week. Probably. Yes. From previous sessions should be in as well. Um I think if you uh follow us and 101 and then go to this specific session, we've only had one session so far, which was the intro session. Um These lines would be on it or the recording would be on it and if not, then you can just email us, I'll pop our email in the chart. Ok. Does anyone have any other questions before we end the live session? Ok. Thank, thanks for coming.