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Okay, so we've got something else. And so I will say, I was just thinking about their pediatrics sites, so because I might talk is on bronculitis on. So that span timer, it's just gonna be broken like this. The reason being is that we are in the middle of a muscle. Search this and just be graphic. Um, it just Rayna the black line. There is, um the normal RSP serves that They even say, you know what Her month, so weeks twice extra and I use the middle of their winter are somewhere. So that's not so five year average for RSV. The black line on the rattling is what happened in the past year with curried. So they have very rarely over and colitis not first somewhere. And then they got this massive spike and surgeon rsv bronchiolitis. And that's really what we expect to see you at the moment on. Do what we have been so concerned about a a surgeon of your latest on there are regional Onda escalation plans across my and in terms of trying to help us on be managed a surgeon or has be out so and bronchiolitis is normal cause but rsv rsv respiratory. Since that little virus the kinds for between 15 80% off all the colitis. Other viruses can cause bronchiolitis and language part influenza viruses, even that on your liver. Viruses, implants, Uh, right. And virus it in viruses. Um, all sorts RSV you would apply for the most, um, on, but they should be cool or nursed on the same miracle of patients ago. Thankfully, RSV gives us a very nice and predictable pathway normally so normally, nights two and three and picking the symptoms on the on this last for weight 7 to 10 days on the common symptoms that kids will have our coughing, sneezing rhinos were just appetite or feeding on the fever, and they then develop into widespread please take it. May, uh, increased work of breathing and cough may be kind of moist on with fevers on. The increased work of breathing often leads to the Cayston, or intake from of a dehydration. So it's just remembering that, and then if it's especially under six moments, there will get nasal breathers. So when the nose gets blocked up on the company through the nose, and so when they're feeling that come freeze through the feeding them takes milk. So just want to say, for for that chest X ray, we rarely as anything we shouldn't be routinely actually in these big ones. Okay? And remember the fine Mr She is a very problem, and it's it's settled radiation. So we shouldn't be doing unnecessary chest X rays. They don't have very much reserve. The X rays for the ones are reading were extremists on where you have, um, hi. Unilateral focus of crackles consistent with an evil man. So a little gets cold. Anything you for a mission and had normal these lab up normally, would you need last spritz and they're helpful to tape the virus that's causing them less. Book Don't generally onto the country Management has a mind of his old self demonic and but needs to find your last words are more diagnosis that concerned pre go ahead on the nurses in the pediatric words would be doing nasopharyngeal aspirate on to get this one. So in terms of a risk factor, So what? What makes us more concerned by along coming in with bronchiolitis and we'll really work a bit under one. Who has the other ones over diagnosing broccoli is, but we obviously I'm working certainly bit smaller kids. So under six weeks, especially six weeks, is about the cough. Would have more concerned for your bones. And if they've got back friend of heart disease or neurological condition or a chronic respiratory, unless like since it diagnosis, we're putting a pretension would be more concerned like ways. If there an extra me on different. And we want to think about their corrected age for gestation on, then the other kind of more rare things like embarrassing babble, is, um, try to take one every deficiency on. But I'm finally just want to say that previously hot, severe broke L. E. S or a broken like a sex with the required see pop or pa. See you. Obviously, with the more concerned look, it's worth know isn't and 50% off Children with severe bronchitis will not have any of these risk factors. So it's really important that we make a small child in front of us. In terms of our assessment, we're gonna assess the hydration status there. Auction saturations in the work of breathing risk about is on does reflect that the new piece and scoring systems. Primal concern. I don't think about that age can directly under under six weeks on really under six weeks of broccoli. I should probably admit it because there are a lot of increased risk of uptake episodes. You probably weren't a creative observation on auction saturation wondering during that period, I want to keep a close eye on the work of breathing hydration. Um, us, that he's going to progress quite clear up it really just worth noticing that, um, when we looked at saturations, we would normally like first outside of 94 on. But for those who have recently something and the association box and curve that aspirins new memories thicker but which you're on a a you that socks on and in February, child who becomes acid or like the like curvature to the right. So you do need and, ah, hire people to to maintain on seeing levels of saturations. So what that means is that there's some guidelines know, come right to say that, and several kids may totally it sounds about 92. I'm not sick to start personal 24 and but article circles would be really need sounds about 94% on day. Wouldn't be a distraction. Any kids with it's not less than a four. So what can we do? Well, they're all this. One is of any doctor that we got, um, oxygen. A few options, probably for us. We're going to think of every kind of words that can we got high from. There's a panel or or a CPAP Um, I was in extreme end of the illness. You'll and see, we want to get into that. Contain to be. I see you in terms of their hydration status way. Look up their feeding. So we did get an accurate and that sort of estimation off. How much for the normally taking on do it for a period of nasty? Asked what they've taken the most recent 24 hours, if it's lasting 50% of their normal, then that will be a concerning feature on. But also, if they had lasted, three went nothing's the ostomy for yours or no wet. Nothing for 12 ours on non salute. And those were saying that the child is dehydrated and requires a machine before either IV fluids or, um, energy chipped and, uh, in order to take them. So lots of other treatments that maybe suggested, but not much evidence for any of them. Weigh, say, don't yourself, you all because the Pathophysiology what's going on is not from a spasm. That's what's so most probably like just to make your mind on be more tachycardia on Detrol and not worry about that very well. So and so people it doesn't have a role and younger ones, and for the same reason we use a lubricant meters or if you're pregnant, there was about the flare. If it doesn't have to come back soon for a while again, that's been shown not having me and any, just in the fact we don't use corticosteroids either and healed. Or a world would have these undergarments because it's a viral infection. And since the the ME and therapies here our oxygen on insurance hydration, I'm giving a child's tying Teo cover. Yeah, lose that we can send home then these kind of things that we need to make sure we've we're happy with. Some of the child needs to be stable. Childhood be persistently Saturday and above my to you, but probably locally we would say 94 and they did have adequate or Lantus. That means more than 2% of the normal intake. I haven't planted what he's on. The parents need to be confident that the child as well I'm able to go home and along without parental covenants and lead to new parents. Know what the red flags would be A and went to return. And if they need to make sure that they have access to transport in order to get back on you, too. Now again, this is like we said earlier and talks, which is, um, you know, if if the final if it's Lisa night in the family, have quite far away from the hospital and you may help to just keep overnight, you can observe them grouped in the next day. So what are the red flags? Well working harder to breathe and out when I explained the parents were women. By that so tell, until the copay for rapid movements of the chest on skin been drawn underneath, the ribs were between the ribs and 50 and then take drugs Nice to 10% of normal. You don't have those wet out there for 12 hours or remember coming more fatigued. Maybe not waking up for feeds that happen on both mine is parental concern over. It's a pulse of parents are just not a happy child isn't getting better or getting worse. They should come straight back. And, you know, it's really, really important that were very clear that they and the guy says that old parents should get relief with, um other prompt relate us on. We should be discussing smoking with parents, too. And is that with parents or grandparents with With With the giant on? Do you usually use your opportunity to go about a public health message about the smoking on? But the common response you get will be the parents just okay side. That's important that you tell them that you know the small clinic with the equipment will still be affective Chinese who should stop smoking. Taken points here are needed A careful examination treat child in front of you. The careful feeding history from the parents. Um, careful, hydration assessment. Um, we're going to support of therapies that see, if discharged, you're very careful safe than that on keeping you see. Okay, so that's and then about we talk about the genetic questions and half to one, my eyes would be able Internet to talk