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Ok, grand. Now I to share again. No good. Ok. Hopefully you can all see that if you can't, um, drop a message in the chat and I will try and fix it. Um, ok, so tonight's session is, um, leaps that are about high news scores and unwell patients. So I think most of us can agree. This is probably what you are most nervous about getting called to someone who is really unwell, know a lot of the, um, recommendations or the, um, questions you had through the, um, survey were things like what am I expected to do? What do I do when I get called to these? When do I escalate? What do I actually do? Um, so we're hopefully going to try and cover that um, tonight. So the first thing then is answering the bleep before you spring into action and run off like this lad is doing in his nice shiny white coat. Uh What questions might you want to ask while you take the bleep call? So, um, like I was saying, when you get the bleep and you ring them back and the nurse answers and says, hi doctor. Um, I was wondering, can you come and see my patient? They have a new score of nine and often they'll finish there and that's all they'll say. What are you going to say on the phone call that will help make your triaging office better? So if you want to fire some things in the chat, I admit some more people from the waiting room, apologies if you've been in the waiting room for a while. So yeah, put in the chat sort of things like what would you answer? So the nurses called you, they've said I have a patient with the news of nine. Can you come and see them? Um, what type of things are you gonna ask? Um, ok, so someone is saying confirm patient details. Yeah, absolutely. You want to know who this is? Who am I coming to see? Location's great. Yeah. Where are they? Because even though you're getting a bleep from a ward, um, usually, you know, whenever someone answers the phone, they'll say hello for North. But usually by the time you've heard the phrase, they have a news of nine, you have panicked and you've forgotten where it is. So always ask, where are they, um, most recent? A Yeah, that's great. Anyone, any other ideas of things that you might ask before you go running off to that person? What are they in for? Yeah, absolutely. Why are they here that can impact, um, your thought process a lot? Um, I know. Yeah, a brief medical history. What are you dealing with? Is it a normally well 30 year old who has no past medical history or is it like an 89 year old woman who's incredibly frail with like a past medical history? That's like super long someone's mentioned. SB A Absolutely, you're taught SB a lots. But I'll be honest, it is so poorly used, at least in my experience um often, you know, you're literally just given a problem or you're just given a whole history and then sometimes I find myself asking what is your question. But yeah, ideally, you want an SB a hand over, you want some information? Perfect. OK, let's move on. So here are some of the thoughts that I have on what you should be asking. So, first of all, like we said, who and where? So what is the patient's name? And you want full name because especially in northern Ireland. Um If you were on to a ward and go hi, I'm looking for Mary. You know, there could be four Mary's in one bay, never mind the whole ward. So you want to know who exactly the patient is and where you can find them. So sometimes I'll say, especially if they're a sick patient. Um I'll be saying on the bla great and where exactly are they? And they'll say, oh, they're in ba three, I'm like great front or back. And then at least when I walk onto the ward. I know exactly where I'm going and you kind of look like, you know, what's happening a bit more, um, at least give the impression that, you know what's going on, which is always helpful. Um, what are they admitted with? Yeah, somebody said that in the chat. Perfect. Why are they here? Um, what's their background? Are they pre-op and likely very sick? Are they post-op and might have some complications? Are they admitted with heart, um, you know, a heart attack and now they're feeling chest pain. Um, you know, what, what are they here with that will really help guide um, your thoughts when you're on your way there. The other question I always like to ask is, well, what was their news score before this? So you're getting a phone call of a news of nine and this happens quite a lot. I'm just letting you know this patient has a news of nine. Ok. Well, what was their news score before that? And somebody says, oh, it was, um, it was an eight all day. I'm just letting you know what's going up. Well, I'm less worried about a news of nine if it's been an eight all day. Um, whereas if they tell you, oh, it was a two earlier and now it's a nine. Well, that's a very different level of urgency and that's going to help you triage your bleeps. And then what are they scoring for? Um And I'll talk about this more on the next slide. Um that can also help you figure out how quickly you're going to get there and how important it is that you get there immediately. And then the final point is about asking for interventions on this phone call. And I'll cover that more in a few minutes. But if you can ask for things to be done before you get there, it will really help. Um So first of all though, what are they scoring for? So this is a news chart that you're all familiar with, like I said at the start. Um the disclaimer is that I work in a Northern Irish hospital and I'm assuming most of you guys are going to be working in a Northern Irish hospital. Um This is the news chart we use, this is what you'll see all the time. So these are two different cases. Both are scoring a nine, but both are very different. So the first one has saturations of 95% on two liters. So they're scoring three for that first line, but 95% is not that bad and two liters is fine if they've been on it for a while. Um their heart rate is 94. Yeah, that's high, but I'm not hugely concerned, their BP is a little bit low. So it's scoring but it's not horrendous. Confusion alone gets you a three, but you want to figure out is that new confusion? Because old confusion like a dementia patient is always going to score a three and that can artificially raise your new score and they have a temp of 38 1. Well, fair enough. Um They are having a fever but that's not something that I'm like incredibly urgently worried about. So that first patient, yes, they're on well. But you know, if I'm in the middle of doing something on a different ward, I'll probably finish what I'm doing before I go and see that patient. Whereas if you look, then at the second case, someone who has a re rate of 22 they're 92% and they're not even scoring for oxygen yet because they're on room air. Their heart rate is up at 125 and their BP is very low at 89. That's the type of person where um I'm going to go straight away and see them. So by getting that information on the phone, it helps you figure out how fast you're going to go there. And also on your way, you're thinking right? Well, what am I going to do to fix these things? Um And it also then helps when you're asking for interventions, which is the next thing we're going to talk about. Um any questions on that in terms of asking about what they're scoring for. If you do unmute yourself or stick in the chat, give me a chance to get a we sip of water. Me grand, I'm going to keep going. But if you have questions, I will um I'll keep an eye on the chat. So just let me know. So then the next thing I said about while you're still, at this point, we're still taking that original phone call. Um What can you ask the nursing team to do in advance of your arrival? So have a think put some stuff in the chat. What type of things can you ask for on the phone before you get there? That would make your life easier. Does anyone have any ideas? Blood? Yeah, absolutely. If you can ask them to send some blood. So if anyone's telling you about a patient that has a fever, you're instantly going to be like, ok, go ahead and send blood cultures. Um Yeah, put a cannula in and take bloods. Absolutely. And depending on what hospital you're in, you might have um phlebotomy like teams in the Southern Interest, they're called MS or medical assistants or MST S the medical student takes and these guys are going to be like invaluable. Um And you can literally say to them, look, I'm going to come and see this patient. Can you bleep the ma and get cannula bloods in advance of me coming? Um updated aub Yeah, absolutely. Sometimes you can say like, will you just recheck them for me and I'll be there so that when you get there, you've got a totally fresh set. An ECG is a very good one. It's really important because this is the thing when you, like, we've all done crazy amounts of simulation in advance of completing our medical degrees. But when you ask for something, um, when you ask for something in, in a simulation, you're like, can I have an ECG? Someone turns around and hands it to you. But in reality, when you're asking for an ECG, the nurse first spends five minutes trying to find it on the ward. If there is one or else they have to run to another ward and borrow one and then it takes you just to actually put the leads on. And so if you can ask for these things in advance, it really, really helps. And neuros. Yeah, that's a great one. Um, especially, yeah, if you're assessing a fall or they're telling you that, you know, they're new confusion or they're, um, you know, someone's ringing you about a concern. Um, you know, they're sleepy, they're less responsive than normal. Those types of things. Neuros is a great one. Ok. So this is sort of um, some of the thoughts that I had. So you can ask nursing staff to adjust oxygen. So either, ok, so they're 92% on room air. Can you put them on some oxygen? Can you put them on a non rebreathe mask? Can you put them on nasal specs, whatever? Um, or if they're on oxygen, can you turn it up and you'll assess it when you get there. But at least by the time you get there it might have improved things. Um, and it doesn't slow anything. Um, back to bed is one of my favorite things to ask nurses to do when they're beefing you about someone with low BP. I'll be like, are they in a chair? Yeah. Yeah, they're sitting up, ok, can you put them back in bed and put their legs up? Um, first of all, it keeps them safer so that if they're low BP and they're likely to collapse, they're not going to collapse out of a chair. But also, um actually putting someone in bed lying down with their legs up can bring their BP up enough because you have about a liter of volume, blood volume in each leg. So if you put that up and it all rushes back, then it can put, it can put your BP back up. So actually simply asking nursing staff to put a patient back into bed can have the patient so much better by the time you get there, uh utilize PRN S. Um, so if they're telling you, oh, the patient's feeling really sick or they're in a lot of pain, I'll say, well, what are they written up for in the back of the car in the PRN section? And is there something you can give So they're feeling sick. Give them on Dansetron or Cyclizine or they're in a lot of pain. Ok. Well, are they written up for code or Shote or something? Um, go ahead and give that. Um, again, there's no benefit in keeping someone sore for the, you know, 10, 15 minutes. It might take you to get there. Um, that might as well be acting and in place. Um, and especially when someone, you know, if they're calling you about a high heart rate, a lot of high heart rates are pain driven. So if you can get them something for the pain, then their heart rate will hopefully start to come down. Same with fevers, give some paracetamol, um, and try and break the fever a bit. Send bloods like somebody suggested. Great. Absolutely. And even if you don't know what you want them to send you, you can say, look, can you take bloods, keep the bottles, you know, get me a purple green and a blue top and I'll decide what to send before they get sent off. But at least the task of getting the bloods is done and sorted. Um, on a BP point of view again, encourage fluids. So, you know, put them back in bed and give them two glasses of water. You'd be amazed how quickly that can bring someone's BP up as well. Um, get an ECG like someone suggested. Absolutely. Get that done because it's so time consuming and at least when you walk onto the ward and somebody hands you that you can stare at it for a few minutes in panic and get yourself time to gather and you look like you're really focused and it can help hide how nervous you actually are. Uh, look, we've all been there. I remember how scary it can be. Um, when you get these calls at the start. Um, but you know, if you can get yourself a few focus things what you're doing at the start, um, then at least things are happening and the other thing is call a senior. Um, you can ask nurses to do this. So if they're ringing you, especially in the first few weeks, if you're getting someone bleeping, you saying, ok, um I've got a news of nine, you can say, ok, you know, put them in bed, increase their oxygen, um, get some bloods and can you please bleep the sh I'm still coming but can you let them know so that they can come too? And the nurses are very good at that and they'll go ahead and bleep. So first of all, it saves you having to do it and have the conversation. Um, and that's another thing done and they will come quicker rather than you going there seeing the patient and then calling the senior, obviously, the more confidence you get over time, um, then you'll maybe not leave a senior just as early, but at the start, like just go ahead and do it. You'd rather that they're there and you don't need them than feel stuck and be waiting on them longer. So those are all things you can do in advance. And then what happens when you actually get there? Well, this is the bit we probably all know the best. It's your assessment. Two seconds. Goodness, I do a lot of talking. Ok. Um, ed E assessment. So you all know this airway, to be honest, you really shouldn't be having airway issues. Otherwise that should have been an arrest call already. You know, if they don't have an airway, um, breathing, you know, just start from the top and work down and sometimes it sounds really obvious saying do an ed E assessment. But I remember the first, um, the first, like high news I got called to, it was like five o'clock on maybe the Thursday or Friday of the first week and going to see this patient and sort of just looking at them and was like, ok, yeah, they're there, they're breathing. I don't really know what else to do. I'm just looking at the news chart and thankfully there was an s nearby and she came and she was like, right, have you done an ad assessment? I was like, oh, yeah. Ok. Um, and sometimes it is hard just to remember the basics, but honestly, like, if in doubt there's an app and I meant to add my app sheet. I, I am doing a talk for you guys who are coming to the Southern Trust on Thursday with the N MD induction and I have a slide that's full of app recommendations and I should have dragged it in tonight. Apologies, but I'll put it in the event. Um Page Pocket Doctor is a really good app. Um, I wonder where's my camera? Um I don't know if you can see my camera. It is this little app and within it, there is, um, like all these different things you might get called to like high newses, high res rates different things and when you click into them, it gives you like a list of things that you should be doing. Um, and this app is honestly so helpful at the start. Um, it can make such a difference and it's called Pocket Doctor and it's like, um, I don't know if you can see it on my home screen. It's the one in the middle. It's like an orange tick. Um Pocket doctor is really, really good at the start. So even when you're walking from wherever you are to answer this bleep, I'll open Pocket Doctor and I'll have a quick look and it will give me a few pointers of what I'm doing. So it's really helpful. So, assessment look, I'm not going to dwell on it, you know what it is? You spent far too long prepping for Oy and knowing, it's just one of those things that in reality sometimes you'll freeze and be like, oh, I forgot the basics. But when in doubt, start head to toe, work your way down. And the biggest thing is to treat as you meet. So first of all, walk up to the patient and introduce yourself. If they talk back happy days, they have an airway. Perfect. Um, then move on to breathing often. What you'll find is you'll walk on to the ward, you'll go to see this person and they're all curled up in the bed in a horrible position. Um And you're like, well, no wonder their um os and saturations and things are so low. So sometimes then I'll say right, nurses to the nurses and staff, can somebody give me a hand and we'll reposition them and as they reposition the patient, sit them up, listen to their chest and then get them sat back down. Because I remember one of the hardest things when you go to see a patient is how do I actually sit them forward? Because all your os patients are, you know, they're very compliant. They'll sit up for you. You can listen to their chest with no bother. But when you have like a heavy older man who has no upper body strength to sit up in the bed or they're really unwell and they can't sit up in the bed, you're suddenly trying to figure out how you're actually going to listen to their chest. Um So don't be afraid just to ask the nursing staff just to give you a hand. Um and yeah, treat as you meet. So if you meet them and their oxygen sats um are in the low nineties or worse, you're putting oxygen on straight away. Um and you can address whether they're co2 retaining later. Um That's not an urgent issue. Um So yeah, treat as you me um same with circulation. Um thinking about heart rate, you know, is it fast? Is it slow? Do they have chest pain? What's happening, what's going on? Um And personally any heart rate over 100 and 10, I get an ECG. Um if it's particularly high, you're thinking things like SVT and you're wanting an ECG very, very quickly and maybe the crash car coming over. Um but as soon as somebody is calling you and telling you that the patient has a heart rate of over 100 and 40 you should be getting a senior there immediately. Like even yesterday, I was on shift and we had, we were sitting at lunch and got a call about a patient with a news of 10 whose heart rate was 100 and 80 I was like, ok, that's great. But immediately I'm leaving the seniors because I'm not dealing with that on my own and they were an SVT, but those are the type of things the seniors will have. Absolutely no issue in coming straight away um to help you deal with. Um, so grant other things blood sugar, never forget the blood sugar. Um It's amazing what can be fixed with a bit of sugar. Um You know, check their temps, those things will all be given to you on the obs chart. Anyway, if you started a G CS, when you were speaking to them, finish it off, have a look at their pupils never underestimate um opioid overdosing in hospitals, particularly surgery wards where they're put on big wax and morphine or oxyCODONE. Um always check the pupils and be thinking about toxicity. Review the card. E have we given them something new? Something weird, something wonderful. Um Is that what's caused the problem and then always a head to toe and I will say like, don't forget the legs. So before you're thinking about giving fluids and things, I mean, if their BP is really low, go ahead and give 2 50 mil bolus, but always have a quick look at their legs. What's their fluid status? Are they massively edematous? And then when you're there, you're also thinking pe have a quick feel, are they tender? Is one red hot and swollen? Um Just don't forget that the legs exist. Um We're very good at remembering um all the organs in the thorax and forgetting that you have two legs that can have a lot of issues as well. Grand. So once you've actually um, seen the patient and you've got, um, your list of to dos, um, like I say, in the first weeks, especially, you're going to be calling seniors to these people. Um, now I probably would see, like news of tens on my own and that's fine. Um, depending on how sick they are when I get there. Um, I'll maybe not call immediately but you guys will be calling seniors immediately just for the support and the back up and that's fine. They'll be totally on board with that. Um One caveat is if you're working in surgery first, just a heads up that surgeons are not the best at coming, particularly if they're in theater. Um but still ring them, still speak to them. Even if they're in theater, you can still get the nurse to put you on speaker phone or get the the theater nurses to relay an information to the team. And if you feel like you're not getting enough help from the surgical team, call the medical team, they will come, they'll be a bit annoyed, not with you. They'll be annoyed with the surgical seniors um because they should be helping you, but ultimately, they will still come and help. Um So like just be shouting at someone. So by the time you've done your A to e assessment, um you should hopefully have somebody there to help you discuss interventions. Um So usually what happens, you're halfway through your it assessment when someone turns up, um which is great. So then you still have this discussion together. Um But if for some reason they haven't turned up, what is it that you're going to do in the meantime? Well, um you can also do similar things. So the things we talked about with asking the nurses to do interventions so you can adjust the O2, turn it up, consider an a um for most people with new oxygen requirement, you probably will want to do one. There's never any harm in doing one. To be honest, like you're better just to have one. but if there are bigger issues, you can always come back and do it. Um move on and treat the big things immediately. Uh chest x-ray, nearly everyone with a high news gets a chest x-ray whether they have respiratory symptoms or not, even if you're listening and their chest is completely clear. Put in a chest x-ray request. It's nice when you ring seniors to say you've done something as well to say, oh and I've ordered a chest xray just part of like septic workup, like when you're putting the request in and just say like new news of 10. Um you know, if it is a drop in sat or increased oxygen requirement or whatever and just, you know, needs x-ray as part of septic workup. Um If they're very, very un well, you will ring x-ray and get them to come and do it as a portable, if they're fine enough, you know, they're stable. You're not really worried about that. They're going to go off or anything. They're only on, you know, anything less than five liters of oxygen. They're fine. They can go on a portable oxygen tank down to your x-ray department. But if they're on like 15 liters of oxygen, you're better ask an x-ray to come up. Um, depending on who you get. Most of them are totally fine about it. Some of them can be like, why can't they come down? Just stand your ground and say, look, I'm not happy for this patient to leave the ward, you need to come um and they will, they will come. So um by that stage, you will have a senior, hopefully you'll have fixed everything and it will be great. Um then comes and one of the really important questions that was raised through the survey was about documentation. How do you actually write these things all down? And what do you need to write down? And when don't you? So what I was to say is you're better to document too much than not enough. So if in doubt and you're thinking, do I need to write this down? Just go ahead and write it down. So some of the things that you'll get to like come and prescribe this gentamicin dose, that's fine. You go. Usually the nurses have already looked up the gent level and will tell you like, oh, it's 0.4 you're like, happy to, it's less than one and you'll just complete the. So, like I say, in Northern Ireland, all of our prescriptions are paper. So you'll complete the Gentamicin prescription sheet that says, you know, you'll write it all in. That's fine. You've prescribed the drug, there is a written copy that you've prescribed it. You don't need to then go to the notes and say I reviewed the gent dose and have prescribed the next dose. Like that's fine. Don't worry about that in these situations, you're definitely going to document it. If you speak to family, you're going to document that and don't be afraid to speak to family like as an F one. Um Sometimes you feel like, well, maybe I'm not good enough to speak to family. You absolutely are like, if you've seen the patient and you know about them, like go ahead. But equally don't feel the pressure that you have to speak to the family. Um Sometimes I don't speak to family because I know they're going to ask me a question that I don't have the answer to. So I'm currently working in surgery and you know, a family member the other. So I've just worked a long weekend and a family member wanted to speak about the surgical procedure that their family were currently away for and it wasn't like a simple appendicectomy. So I was like, look, I can't have that conversation because I won't be able to give them the right answers. But if it is something simple, like go ahead and just speak with them. But if you do speak with family, just jot down in the notes. Look had a conversation with a family member if you did get the name of the family, family member or their relations. So like spoke with Sarah brackets, sister updated on current management, um answered all questions, family happy with update and just sign it. It just means that later if the family come and say no one's ever spoken to us, then at least you can say, well, actually look, it's documented that you did speak with the doctor. Um So yeah, when and I document so now that you've fixed the patient, what are you actually going to do and what are you going to write? Um So first things first is you're gonna whack on a patient's sticker onto the notes and date and time, then you're going to put your name and importantly, your job role. So I always start Rebecca Riley brackets F one. And then why was I called? So why am I writing in the notes at 4 a.m. in the morning or why am I writing in the notes at 20 past seven at night? It's fine in ward round. It's obvious why you're writing in the notes. But I always say, ask a TSP or ask to see patient and then the reason why, so I was asked to see the patient because they were in news of nine and then I put in what their stats were at that time. So put all the information in. So you can say I was called at this time because of these issues. Um then move on and put your whole assessment. This is how I like to do it just so I don't forget things. So I'll just put my ada assessment, write everything in. Um So as you see at the top, I put the original um original numbers in when I took the phone call, then I'll, I have told the nurses look, can you put them on some oxygen, put them in bed and put their legs up and then when I write my assessment, I then write the second set of s so as you'll see, some things are better. So um Respi rates down to 18 and their SATS are up because they're now on two liters via nasal spec, then write in your findings. So they had bilateral wheeze and bi basal creps or lungs were clear. No wheeze, no rebs, you know, just whatever negative findings are also important to write down. So it looks like it's clear that you still assessed it. Um Whereas if I just didn't write anything, they might think, oh, she didn't even listen to the chest. So remember to write down the negative stuff as well. So like there was no ways there was no Stridor, there was no, you know, those sorts of things are important as well, but you'll get, the more you do it, the more you'll get used to it. Um And then same with, um, you know, your cardiovascular assessment, sometimes I'll write things like patient in bed with her legs elevated. So like it looks like I have done something. Um and it, you can see that it's improved the BP a bit. Um And then apologies for the state of this next slide because I had to draw it to use my computer. But I always like to put this little diagram in. Um It looks like a little person which I think is funny, but also it helps you to document all your findings and at a quick glance. So the next morning when you're on the ward round, someone could quickly glance at it and see what your findings were. So draw some lungs and put little Xs. If there's like crackles or creps or whatever musical notes, there's like wheeze. Um and then abdomen. If there's pain or tenderness, I would put a little X in the area that there's pain or tenderness. And then if there's nothing, you just put an arrow through it. And then I mentioned earlier that I always like to assess the legs. So I'll always put them in there too. Usually with a comment like snt so soft nontender and no pitting edema or pitting edema too and then say what level the pitting edema came up to. So it's all helpful for monitoring. Um Then I'd also like to add a line at the bottom. As you can see, patient admitted with acute cholecystitis and is currently on um amoxiclav orally. So if you can say what they're in with some people put that further at the top, you put it somewhere, it doesn't really matter. Um, and it just says, you know, why were they admitted? What are they currently on? So that when you come to your plan, you can say why you've changed things or what you've changed. Um, if you end up going on to a new page, just put your name again and I usually just put continued, I should also have a time and date on that page which I haven't. But, um, these are the things you're going to want to be adding. So I usually like to say what's got better. So news now improved to four. or, you know, if it does get worse, say news now worse at whatever level. And then I like to write my plan down with a P in a circle. Um, and all the things that I'm going to do some of these I might already have done before I get round to writing. So I might already have ordered the chest x-ray. Um, I might already have increased. Um, you know, given them a fluid bolus or whatever. Um But I just write it all in my plan and then I can, when I come back to reassess the patient after then you can, you can write that all in. So put your plan down and then when you contact a senior also, always document that. So um this is I wrote this all earlier and then I thought, well, this is how I would do it now where I'm contacting the sho at the end. So I'll show you in the next slide how you guys will probably do it because you'll be calling senior sooner. Um So, like I said, at the end, so contacted on and then put their bleep if you know their name added in too. I'm really bad at asking people their names. Um Usually you'll know within your team like I know all my so names now, but at the start, you probably don't know their name or they might not have told you their name on the phone. Um So I just put, you know, so contact on the number that you contact them. So that for example, that ob is 10 30. Um And then I'll just say what they said. So sho contacted on 10 30 happy with current plan or sho contacted, advised also to organize a CT scan or um you know, they advised they will review the patient urgently or they, you know, whatever they say, write it down equally if you bleep them and they don't call you back, you document that too. Sh ho contacted times three, no response or sho contacted in theater um updated via theater nurse. Um So just whatever happens, just write it down. Um At least that way you're covered and if you don't write it down, someone can come back and say, well, the f one saw the patient and didn't tell anyone. Um even though that's not true because you definitely will be telling someone. Um So this is how I would document at the minute because I will happily see a patient like this on my own and then just, you know, update or inform a senior. Whereas um when you guys are seeing someone, you will probably um you will probably be calling them earlier and your notes might look something a bit more like this very, very similar. But, you know, after you've put your initial like asked to see patient, you'll then have, you know, contacted. So who says they'll attend ASAP and then further down whenever they arrive, I've then documented, you know. So now in attendance agrees with current plan. Now, usually when the ss attend, they'll then take over and start writing the notes in which case. Happy days. That's grand. Um I personally like to write my own notes and my own assessment anyway. Um Just so it's clear that you turned up and you did something. Um But yeah, that is everything I have on um what you should be doing when you come to an ad assessment, I'm aware I've talked already for 50 minutes and I'm so sorry. So I am going to stop there, give you guys time to um put any questions you want in the chat and uh I am going to have a drink and we will um I'll answer any questions you have or anything. I'm aware that I've gone through some of that quite quickly. So if you have questions, I actually feel like I didn't go through this slide particularly. Well, um I talked about oxygen and a BGS and getting chest xrays and then I don't think I covered the rest of the loop. So Rx prescribing, what are you going to prescribe? What are you going to give the patient? So, for example, salbutamol nebs um pain relief, oxygen fluids, that's where you actually prescribe and give something. Um blood, don't forget to send blood cultures. And when you're working in surgery, V BGS will become your best friend. Anyone with abdominal pain, especially post-op abdominal pain where you're worried about POSTOP complications. Um getting a VBG and checking the lactate can be really reassuring. Um So don't underestimate the power of a good VBG. Um and then escalate and inform, so escalate to a senior and or inform them of what you've done. Um So as you progress through F one, you'll be more happy doing these things on your own. Um in which case you may be just informing them. So like I'll ring a senior and be like just a heads up. This wee lady has become on. Well, um I've done this, this and this um just letting you know, is there anything else you want me to do or are you happy with that? And if they're happy? Perfect um or they might say then they'll come and see them or whatever, but it's just so that you let them know. Um But at the start when you guys um are you know, getting used to it and being sort of less confident, then you'll be sort of asking can you come and see the patients? Um Lovely. Ok. Um We'll run through the slide and then I will answer the chat questions. Um So to finish in summary of what we were saying there um about today is a bleep tip of the day as such is about getting the most out of that original call. So when you call someone, you want all of their details, you want where they are, you want the whole story. Um Actually when you first take the call, you think, oh, it's someone's unwell the quicker I get there the better. But actually taking that time in advance to get information, gives you more time to gather your thoughts. And then when you're walking to the patient, you can be thinking of what you're going to do um because you have all this information. So get your story first and it will save you time. Um Also insist on getting a patient name even for little things. It's a pet peeve of mine when you get bleeped for something like, oh, can you come and prescribe Gent? And then you say, ok, what's the patient's name? And then they don't know and you're like, oh, hold on and then they're roughing the handover sheets. Um personally drives me a little bit insane. I'm like, you should know your patient's name. Um So always make sure you get a name also because there could be multiple patients needing that and then when you turn up, you haven't actually dealt with the original call. So get the patient's name the whole story. Um The other tip about calling back is always get exactly what the list of the jobs are. Um nurses have a really bad habit of saying, oh, I have just a few wee things for you to do up on Forsyth and you're like, oh, ok, get a list of jobs, get specifics. So I will say, ok, what are they? And they'll say, oh, there's just a few things and I'm like, no, no. Can you tell me exactly what they are? Um and get the list, write the whole list down because it helps you triage how soon you're going to go there. What on the list is urgent? What can wait and also importantly, are you going to go get stuck on that ward for an hour or more? Um There's nothing worse than walking onto a ward thinking you're going to do one job and then seven more jobs arrive and you get trapped there. So you want to know, don't accept bleeps that say I have just a few wee jobs, get the details, get specifics and then as we were saying, ask for action in advance of your arrival. So can you put on oxygen? Can you get an ECG? Can you send bloods? Can you get a cannula? But also for less urgent and less stressful things. If you get a bleep about someone who needs a catheter or who needs a cannula and everyone has tried, then I'll say, ok, no worries, I'll come and do it. But can you set up the catheter trolley and have everything ready for me? And if you say it in a nice way, no one's offended, but it means that when you get there, you can just go do the job, get it done and carry on with your list because you're covering a lot of words, you're very busy. Um And the nurses don't mind doing it because they've obviously they need the job done. And the other thing is when you're working across lots of different wards, especially at the start when you're on wards, you don't know every ward is let out differently. Everyone keeps their catheter supplies in different places. And like, to be honest, you don't need to spend 20 minutes hunting for a catheter pack when a nurse knows exactly where it is. So, if they're, believe you to do those sorts of things, say, yeah, of course. No problem. I'll come, do you mind just having everything set up for me? Um, and then it just makes life so much easier? Ok. Let's have a look at the chat. Where did it go? Oh, there it is. Um ok, if you go to a patient with a high news but felt confident in their management, should you still inform a senior? For example? Um If you saw someone and felt like they had pneumonia prescribed antibiotics, do you need to let anyone know about that? Yeah. Um Totally fair. Like if you go and you're happy that like, ok there, but it sound like there's a chest infection. You've got a chest x-ray, you've looked at it, there's like a big, you know, lump of consolidation or you've lost your bases or whatever, that's totally fine. Put them on antibiotics, follow the trust guidelines or um if they're on certain antibiotics, you maybe escalate their antibiotics. So quite commonly. Um I had written in that last documentation example um was um where is it is not gonna change for you guys? Yeah. Um They had been on oral Co Amoxiclav but now I'm probably going by the signs of this case. It sounds like, they have a chest infection. I'm probably going to escalate it to Tazo when and out Tazo providing. They don't have, um, a penicillin allergy obviously. But, um, yeah, like, if you're happy with your plan, they're well, and, um, you've done action, that's totally fine. Um, like if I was to ring an s now and tell them, oh, by the way, I've started someone on antibiotics for a chest infection. They'll be like, Rebecca. Why are you telling me this? Um, so like, yeah, totally fine. You don't have to. But at the start, I guess when you're unsure or you just want to double check that they're happy. Um, they'll not mind you ringing them. So it's just up to you. Um, sometimes the safest thing is just to say that you've let someone know, but if it's something small and it's a low news score, like less than six, totally fine. Um, but if they are going to be on well with a higher news, I think you're better just quickly running it past someone even saying, look, here's everything I've done. Here's my whole plan. Are you happy with it? Quick phone call? And it just means you're covered. Um Can't find the Pocket Doctor app. Oh, no. Has the logo changed? Um It hasn't for me, but that's not to say that it hasn't changed. I wonder what it's called. Does the app have a different name? Uh, then it comes up on um, I will try and share it in the, um, um, in the chat later or in the event thing. Um, but yeah, I think that's, um, it's very helpful if you can. Um, I'm going to put this quick up just because I know people are probably wanting to get on and enjoy your life. Um, thank you so much for coming. I hope this was helpful. I'm sorry, it was quite long. Um, If you can just scan the QR code and fill in the quick survey, I'd really appreciate it. It just means that um we can get some feedback while Mi self and Kerry love teaching and totally understand how we felt last year. We are also both hoping to apply for surgical training and quite keen to get teaching points and therefore need feedback. So it would be um just to be honest, we would quite appreciate some written feedback. It is only a few slides. So are a few questions that are like two pointers. So like just fire them on. Um Yes, I will. So I've recorded them. So I'm hoping to upload them. I think probably onto med all or somewhere that you can access the recording so you could rewatch it if you want. Um And yeah, I'll probably put the slides all into like a PDF or something that you can um that you guys can access. I'm I'm glad this has been helpful. Hopefully, it has um I'm aware that I've just talked a lot. Um Hopefully that's helpful and has made it a little bit less intimidating. Um You guys will be great. You'll be fine like you will. Um And just always like ask for help when in doubt. Um But hopefully it's uh it'll be good tomorrow night then is about falls and fall assessment and some bleak tips on triaging and stuff. Um But yeah, if you have any more questions, either put them in the chat now and I'll happily answer them or submit them via the link um, on the Facebook page and we can, um, answer them like anonymously through the throughout the week. Hopefully you guys will come back and watch the rest, um, or catch up with them at another time. I know five nights in a row is a bit much. Um, but it is nice just to sort of condense it all. Um But yeah, thanks so much guys. Ok.