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Okay, so we'll just do a quick presentation on on Aflac cysts on because they're new guidance, really earlier this year. And this is just a quick update on anaphylaxis, which know some of you may have already heard on during the order and teaching sessions. So and the guidance, it should have been updated. Really. Teo and facilities that Anna Flex is sudden and rapid onset on what that means is that the symptoms should really have allover no longer than 10 minutes on, so it should be very, very sudden onset on rapidly progressive. I think that's going to be key. Take a message from this talk, which is Treanda flax. This is a very quick phenomenon. It's not something that that that's roof and develops with a number of ours and still see him principles, though that that needs to be multi system sometimes. So we look for more than one system from airway breathing or circulation, so we would classify every problems as very swelling could be through tongue or the sensation through is closing or difficulty breathing or swallow more. Strider Horse voice would also kind of current doesn't have a problem in terms of breathing with for increased work of breathing, bronchospasm or wheeze, tiring or fatigue? Loose outs, which may or may not, because on confusion or cyanosis. Ultimately US pressure arrest for circulation problems. We look for signs of shock. Pollard, clamminess and tachycardia, hypertension and the also signs of perfusion. So we're just GCS doesn't us on everything, man. Cardiac arrest. So we're looking for two of those systems to be a fact that, in order for it to qualify it on the flats, is interestingly, most of us would probably think that skin changes our president most cases on a fax US, but they can be absolutely 20% of cases on. So just because there's no arise that's know Mestinon off like this on Aflac Husband Cold or a Fair Teo, previously as the great Mask creator. Because it can run as as a myriad of other things on the classic, one is the last month. So we see a patient with bronchospasm wheezing. Um, I gotta ask you if it's a baby because they're not family on gradually anaphylaxis process going on but their minds and last month. So, for example, if you think of your child, he may or may not have a diagnosis of asthma. Already, they've had a few days off Urticarial. Sorry. A prescription infection really knows on. Then Suddenly develop kids of your weeds on the common and get nice. There's no transportation of asthma. And if you don't look or think about anaphylaxis, then you build up amounts. Francine, reason that apartment actual in terms of their margin of algorithm for treating our ass maturity as they moved down through the protocol. They do get Teo Adrenaline on in that algorithm because they don't want to mess on enough likes us. We didn't think about it. Then we'll miss a tree. Uh huh. It's just interesting. And table from the new guidance. Uh, sorry, guys. Not sure what's happened there. Not just trying to this back on again. So they recommend. Are they sort of estimate that on the flax, is she gonna have about 35% of your throat clearing? Well, we will extra busy it. And that's what causes the menactra lapse that we see in triage. Awful access. And so again, that that's, you know that this is something that's very cute and city year on this nature So what about is what I do on a B C d e approach on Do with any of our acutely on, well, patients. But the key thing is that we're gonna give him adrenaline, and they're gonna get Ritalin. Valium. Really? Okay on. But this is that one of the indications wear a nursing staff can PGD adrenaline. I am okay on that. That emphasis really is on adrenaline here. That adrenaline is your treatment from the Lexus earlier That's given the better. And I can be repeated then every five minutes. So this is a new poster that's definition of anaphylaxis to highlighting at the top that once you get your diagnosis, you call for help. Remove the trigger if possible, like the patient flat on with on legs elevated. Um, uh, if if they're more comfortable setting up, then maybe if you're very well, usually that may be more comfortable sitting up on Got pregnant by the moment side. Yeah, I am. Injection of the round of goes in as early as possible on the recommended the event of this eye. Establish the airway. Hyper oxygen on fire. Monitoring 100 ft. Adrenaline every five minutes. Um, they're probably gonna need a little It may not. They may not have a C element off there on, uh, flax ist, but they're probably need some fluids. Okay. And the fluid of choice would be a leader of normal certain of the young adult on you might just have the 500 this on their older on Children, they get terrible particular bolus off 10 maximum of 500 miles. And for those who don't respond to the adrenal and then So we've got this pressure for a factor. And I flex us Andrea leash moving on the best. Once you've given three doses off, I am adrenaline or thinking about infusion of IV adrenaline on D, which will be your evening consultant or carrot will be starting about. Okay, on those are the patients are gland up all intensive care. So they donate Worked up with central lines. No lines. Okay, So just to reiterate the dose of your adrenaline, you're adult Children or 0.5 mills of one of the face, and I am providing milligrams. Your 6 to 12 years old is 300. Makes either six months to six years, is under 50 makes on the under six month. Scared on another thing makes on. But I am okay. And so that doesn't have that more straightforward. It used to be I would be against those from your bones. A other thing we just want to highlight is my cell tract is so we need to take a mass effect. His levels for us to confirm this has been the three anaphylaxis. So your first summer face gets taken off as soon as possible with your first roll gloves. Uh, nobody a second level on to yours, and then we get their level at least wait for are doing the line. And that's to get your baseline level of trip to use. And I would just say you'll make sure that, you know it brings on the back it two in the morning before it went for that will complete until the next morning on that could be on the 36 order for you. Okay? And don't leave it to the idea, though, because the samples get held to be around the governor show and bring them back the next sort of sensible pain. Yeah, on less stable as the table that we were going to highlight because this is really helpful for us. Traditionally, what with, um, has kept anyone who gets I'm a grandma for sex. Ours observation in the 80. But we know we got this That enables us to discharge our consider some people for a fast track discharge. So that first called in the left hand side there, on Dilaudid. You did that. Start people up. TR's after adrenaline at the meeting criteria and so have a good response with a single dose of adrenaline s. So that means within five or 10 minutes they get improvement of her symptoms, and that has been given early on the onset of action. They have a complete resolution. Symptoms of two hours on the patient already has on your adrenal injectors, you know, try to use them. So for the us, that means we can get them some. Uh, EpiPen is to take a month, um, and get the pharmacy. You start the treatment, how to use them. And on a zone. Was it got someone home? Uh, thumb. So that always is just Teo. Consider some patients to give a nerd a discharge, too. On that will save us on four hours of bedtime. Yeah, and but anyone he has previously how to buy physical action or he has needed more than one dose of everyone should be kept for the sex ours on. But those places, the right hand side there should be kept for 12 hours on, but they need it more than 3 to 1 or severe asthma or a previous fracture. That was very good compromise on. Or if it's late tonight, or they have different access to on transport, for example, the hospital was greater than like nowhere, and keeping them was from about longer. So that's really just quick run three of the new guidance on to help you understand. If we are trying to discharge someone to ers, that and that, that's where that's coming from on. Tell me, going forwards Any questions from our quick look at the chart