Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

right. Okay, over. And we'll just wait for a few more people to get ma'am started. Were better, Lee and then we'll kick it off. Okay, Can everyone hear me? Okay. And see me if you look type in the chopped or mute. Yeah, Perfect. Thanks. Okay, So we're going to use it for my own, because I don't understand how to use Microsoft teams on this automatically records. And we can use a potent, have a bit more participation. And but few minutes past Well, with a minute so and we'll get it kicked off because I appreciate your time. And so today's session is gonna be session number two you and surviving the F one bleed. And it's, um, Doctor, my patient has fallen. Firstly, I'm I believe your finals, okay, Might last week your results. So congratulations on Hopefully everyone's done well. And so just for anyone, he maybe wasn't here last time. Reach a little bit after using the Belfast Trust. And Amy, the other guard he's doing this with me is on, like, quickly and so should be doing next week session. But I didn't have one of the Ulster I'm currently in any in Belfast roast moving onto medicine next week On next year, my plan is to look him and enjoy my life little bit more. And so the writing objectives for this week, Hopefully this presentation of indeed the entire weapon or Siris is say, how do you cope with oblique regarding a patient that's fallen? How do you tend the necessary information to do that? How do you see if we assess the patient for management? Brown. When do you sleep? Another specialty. And what other special do you think you maybe need to wait for something that's for so just going on for elastic? What is your sleep for? It looks like this has bottles that, nor knows what to do. It just needs a horrendous high pitched noise on. But if you press couple of buttons Oh, that always will eventually stop on the screen will be a five digit and number displayed know, since the extension your mental Kobach, whenever we've got a weight based on what your answer down to be able to tell you why they biggie and nine times out of town no one else just damp and so you just wear them, treat you again, but it should be. Sometimes it makes you cry, but sometimes it's called accessory. If you're maybe doing a half one on or if someone's called in sick, you got the arrest weight. We've got the surgery, but you've got the medicine under impression be. But it should really be for sick patients on urgent tasks. And anergic task should be sort of life threatening. Well, with a head injury over the broken have if you've got, you know, acute chest being acute shortness of breath or in the stress they should be the urgent task. You should be getting big. So if we go with today your own coal, it's maybe your second week is enough. You've just been, like, toward be how about a patient be and they've just hopeful I'm not this time. You've also just put your dinner into the mic brief. So you're starving in your mood. What do you gonna do? You're gonna be like this start and run straight to it. I think we're all guilty of be in the middle of pressure and crying every time you get a bleed, Where you gonna run home? Which evil? Sort of like being spoon from seems last. The first thing you're going to do is just think I think about who you're speaking to. You on the phone is patient on. Why have they bleed you? You know, they've had a full Okay. Was anyone with them? Whether that was the other injured. Think about. Do you need to get there straightaway? In other words, did have a deformity of the leg and the maybe have a knack of femur fracture. We could be nine o'clock in the morning. They've just sort of fall on the right list. Then maybe space in the theater list. Don't want to get to them quickly. Have that a head injury prone onto quite good. And they've gotten open had under which is obviously bleeding. Also think what what information can get in with someone You got the hospital number of the patient you could be beside a computer with or with Another patient is quite a while. And he gave you, you know, just couple minutes readings be asked to be able to look them up when it's your work. If they're on an anti coagulation and then new quickly, you're going to get to ask What were the room? Mm. Every hospital is, um, ese, especially when you first get there. So sorry, I asked what were you on and drink it. A quick background history off the pressure that's leaky. And sometimes that could be difficult because they might not know the patient themselves. Could be an agents, the member of agency star or, you know, healthcare system. Just we've been because the nurses are going to get a doctor originally, if you kind of the phone trying, get the new score or awesome for their GCS. And a lot of people freak out when the roster GCS because we all forget what the numbers are, what the score is. And you got to say that they're a layer of the respondent t other room and their eyes. Are they charging to you? Amount itself. Sort of like you're all. You can give you a quick indication of how quickly you need to get to the patient. And if they do, say, or the GCS is 13 just asking. Has that changed or they always like that. Quickly ask them, Have been injured themselves because gay and let let you quit. We won't see something also think can sort this out over the phone. You can't really assess someone who's had a fall over the phone. But for example, let's say baby and say, Look here in a bit of pee and the whole Could you come and see them? You could just say and yep, so sorry. The shot, They're committed slides and recording yet certainly I look multiple and metal up on me like this recording if I can work with him. So can I be done with the word before you get there and any sort of it over the phone. So if therapy and just ask the nurses, this should have prn parsi to mull prescribed European European relief prescribed gives him. Look, I got to live in 5 to 10 minutes. But if you're worried and that I'm going to split me, I'll come sooner. Don't say to them, you know you could you do a repeat set of bulbs if they don't have the access? Could you get that? Did you check the B M cause some people can fall off there, but hypoglycemic. Thank you, Jeeves. Try and get a line and stand up. Look, Pressure, obviously if they've had fallen, they've got no Aricept deformity. That's not gonna be possible. But if they're mobile, you could try in Austin trying at the me See gi, the math on arrhythmia. I'm not mad cause in full. If they have a catheter and you get set off a pathology sample or just trying to get a year and a most you're more step six from a catheter will be positive and think about any equipment you might need. You don't really need a huge month, and you're going to Saslow be sort of fall on awesome today. Side of your observations. Not true. Include they're GCSF the people's we going after a flight on and just Tyler there until the staff member of the phone that you're gonna come and see them on sort of what time frame you'll be there then. And if they're happy and often thought so. You've lost all the questions we realized person is not sick and you're gonna be able time. Do you eat your dinner once you get your dinner? You think right? Okay. I need to go see this person who's just pulling. What was your initial thoughts be when you're only way to assassinate. He's how awful. I can't think why I have a fallen, you know, to the trip over there, college or lead? Did they set really weren't fluffy socks? And I stepped out of bed, which is incredibly common in a ward with mental using the related, and they just couldn't get it in time. Or was there an emergency on the ward on the person's Want to be observing them Hard to remember that emergency, and then they found a bad. Are they on any blood thinners? If they are that my chance, I quickly won't see them were my change of monetary found patient you're under. There was a witness roller on witness Will Unwitnessed Balls are always were difficult than a witness. Full we could think is they're fools performer for this hospital. I know the matter in about stress of falls. Before my son said, you could have um, and when does he hope? I'm? I'm sure if the ward's in about how stressed. I haven't been on the words in the back of stress in terms of the Royal. If they have ah falls before, but just check, Ask your apples in the hospitals that you're in. If they have holes. Performer, just take a backdrop because I can give you a quick guide. If I use Astelin there and then when you're exhausted or when you're having a mind blink, that's sort of if you haven't had your dinner yet, you would be about an order. Have you pee? Do you have time to pee? And you always have time to be. So what do you do when you first get to the ward? Quickly, just eyeball the patient, walk past the bay there and see if there are a lot of stress or if they're quite comfortable. And if they're always industries, you have to assess things really urgently. But if they look quite comfortable, there's no obvious official winder don't hemorrhaging from their head. Then you've got a bit of time we can go in and actually assess him, trying to go around over from the person, that region and whether that could be difficult. It's easier said than done, but that nurse might be covered two days on, and they're being with another patient that might be on the brick and might be someone who doesn't know the patient trying to read their notes on Have a quick look at their new starting observation, said Gather any equipment is necessary is appropriate. That might know what on the ward might be trying to do. Any CGC might have to do that. Um, drinking a brief history on the media disaster. Different patient. So things to look out for things to ask when someone's had a full. We sort of go with who were what, why and how high did they fall? So you can ask the patient who you know, who watched you fall Or did anyone see you for When did you fall? And we're What's did you cold? It's full. It bad Did you hit your head? What happened to you before, During and after the fall? You know, Were you trying to go to the toilet? Need sippy socks on and you forgot to be your slippers on during the fall? Did you hit your head? Did you lose consciousness? Do you remember everything that happened and how long were you off to? The full? Asked me why you think they felt could be something a simplest separate socks. More. It might be delirious that could have dementia or Alzheimer's. And I don't have a true that they've even forward. And you could ask them how many times the fall over the last six months because that might be better intervention there on sort of a more in depth of you. So when you're thinking about falls assessment, obviously you've got there what we're when y and high you do want to ask him. When did the patient full ask the nurses to offer anything that was a patient? Did they see the patient for the day? Know what was the mechanism? Was it a simple mechanical hole where they pushed out of bed by another patient? Do they have a head injury? And have they lost consciousness at any point or have a seizure? Why did they fold? How did they figure before the fall with having just getting on the collapsed, You know, do they have a a weakness? And did they have a seizure on the seizure? Medicine for that bad really wasn't up. It's was highly feel after the whole The prefilled symptoms apply just just the post fall symptoms. Do they have any pee and you know how they fracture their hip. Do they have a number vertebral collapse? Were a fracture in the spine because of the whole, it could be very quick acting and to somebody about osteoporosis. And when they did for were they able to get up themselves because again, not given indication but someone's mobility things to focus on. On the past medical history, we've never been told that got either high BP or low BP or have never been told that got any BP when they stand up? Have they ever had you on arrhythmia or any issues with the heart or the lungs before? And I've never been told the pot of stroke? Or do they do themselves that they've ever had a strip? They're looking at the drugs sort of a medication history and a medication of use. One of the important things you could do for someone that's wonderful, most important drug whenever someone's had a well, is to check if they're on a empty, quite good being. You know, one of the new walks or do walks, and if they're on aspirin or keep it a girl, certainly in any way just animal had a head injury because wonder people somewhere like you to get a bleed. But the only any anti hypertensives, maybe their doses just rehired. Maybe the timing been a missed a dose. It's a 10 o'clock in the morning cause they were asleep. The deuce was given to o'clock in the afternoon. That's just cause him to have a bit of a BP drop. They don't any diuretics. I don't any. Beta blockers are man on tamsulosin on. Maybe the on opioids are sedatives that might have been a bit more confused and therefore phone because that that's the social history. And, you know, the detox. It could be a 45 year old who's an alcohol detox in the colon, because there how about a clear where they are because they're either in Catholic Catholic, they're just drunk or they're detoxing from what's their support, like a home under these, any mobility. It's like we said last week. Whenever you go to examine someone and little thing, we like to use the end of battleground. So if someone's falling check are they still on the floor? And if they are going to get the mobile, or maybe I need you know three or four of you to get them. They might need a moist if they've got a head injury and an actor and you, you're gonna have to get a script to get my own. But that should not happen in a ward. And today about any obvious Andris, for example, giving head into the muscle hematoma somewhere to the bruising to the ribs of the shoulders. Other compared to what happened when they try to settle. And do they have an obviously, um, deformity like extra irritated, slightly shortened leg? Be indicative of annuls and then you're 80. Assessment one sort of focus on exposure. Make sure you you if someone has had a full and they maybe hit their head, make sure you do. You try and strip knowing to their underwear on. Look for any bruising because they might not just need a CT scan of the head that might need a pants down if they had a it's been a significant for, or if they're on the floor for a long period of time. I don't forget. Just do a quick set evolves yourself and after someone's had a little while you're assessing, you know I want to focus in on a bit of a systems your recent cardiovascular. Think about their pulse. Think about their BP. It might not be appropriate time to do a prostate hypertension or lands on the BP check. You could certainly write that on your mom's from around for the morning and take it before I'd say most people's blood pressures, maybe slightly work, say, two o'clock in the morning so it might not be already got him to stand up with just pulling you with the respect redid. Have any increased work of breathing or the short of breath? Give me an signs of an infection? May have had a rib fracture when they fall on them. I have a bit of the name of the rocks just thinking about you. Want a quick neuro example them? Check the cranial nerves are intact. Check their heart their turn on their coordination again. You'll get better. Assassin people is you get home sometimes in your it's on my be appropriate in 95 year or two, husband John Ordinary would've already get commands. Oh, quick healer, that I may check if they're short. Mskube, one of the most important ones to have any injuries associated with it, so they have it all. Don't forget about it falling in the night stretch. Sound the way of giving yourself? We'll call these fracture on a computer with checking with of any ent history. Too many years disease. Do the vertical Not have been a reason for why they're full. So how you document them for a quick your documentation? We always write patients alert if their mother drives the, uh, the unresponsive to quick DC asylum. Check their people's of the equal reactive to light. Well, this is just a good table. Weeks I was in your surgery last and they told me this, and it's very quick. It documents and let's everyone knew what the neurology is like for the patient. Just right. Upper left up right now or in him. Laugh, Norland and your quick in your assessment. Just tones. Gonna be normal unless the Parkinson's check their pores. That 55453 out of five. But again, it'll has to be taken into context for the time of the night. Check their sensation. Coordination could be difficult, and you might not have a tendon hammer about to get through it, and for you, you can just use your finger on top of it and you'll feel a muscle contraction. What do you assess that you wanna review the notes and check? Why are they in hospital? Have they fallen before? Check their blood stick you have. That might be hyponatremia can confuse. This could be new, and that could've fallen because three, they're dizzy. That would have BP. Their studios are. You said, a medication. You could be one of the most important things you could do for a patient out of ours. It's not necessary for you to change any of the tablets, but he could just say you've reviewed the medication and write a note on your viewed 18. Please consider to reduce his patients dose of, say, amlodipine tamsulosin the metafolin because the hypoglycemic so you might want to reduce the morning or evening dose of insulin. What investigations are appropriate? So think about bedside investigations. Just a classic being an ACOG to do urine dip on them and think about getting a blood sugar check the GCS and I. Still, despite working on your surgery, cannot do a GC assets. Talking my head, Put it up on your phone, and that's fine. To do that, check the BP. If it's appropriate, think about blood test you might want to do. Um, sometimes they're not necessary. When someone's just had a full am. Sometimes it might be. If you realize that they're my short of breath having chest pain, you might want to send a problem. Nothing about imaging. So actually she goes, Get portable chest X ray. If someone's in extremists, Um, you don't really get a portable chest X ray. You can't get any other portable type, but they might need a pelvic X ray if they're complaining. Pelvic 10 or 15 if they fall on to be going over on the right. The limit me to get their ankles actuated tonight, and that's all fine to do that. Most importantly, if you put me on depression and they're on a blood thinner, a logical arguments aspirin for a pet ago or any of the new Oxford walks think about getting a CT. Bring on. That's fine. Doesn't want to do that. No, So think about a Qwest, so you've got patient be he's a 75 year old guy. He was made it four days ago. It was new. Confusion had a better lower up to pee in a couple of falls at home when he was in and he was diagnosed with Urosepsis secondary to urinary retention turns on the stuff, but I bph he was sort of Sometimes it works in about urology and eight me. He was catheterized. Any news commenced on gentamicin. His bloods are improving. He's improving use A little confused Was PML settled, but he still got a bit of an infection. It's one o'clock in the morning. You've just been in a rascal on someone bleeps you to say Just want to let you know this patient swollen kids come and review And please, what do you do? I'm going to try to get this tour suppression of every day. You wanna just try and cancer in there or let me know if the Poehler's I don't even responding. I appreciate someone here together. She might not be able to respond, but that's fine. We'll give you another couple of seconds here. My right, let's Most of you have the low, so yeah, you're right. Your truth. The second one. It was kind of a leading question, and you just said it looked less noble. There was anyone with the money fail. Could have just track of these hurt himself. Do you think differentials for someone? Whenever you're going to see this month, Does he have delirium? And has he had a strip? Has even had a seizure for a lot of bad? Or has he fallen out of bed and then have a seizure? And is he may be drunk or is he was drawn. And that's where he's falling cause he's very unsteady on the speak with the blood sugar with this man. Think about Did he have hippy? And? And that's a beautiful Is he someone on orthopedic award? He has had just had a separate place. Found he decided to get up and go to the bathroom. Self is going a little sedative medication. Well, think about it. Okay. Maybe have a bleeding this brand because of this fall. So this is your mom patient, be you go to see him and my heart works a polling. So this little Randolph is meant to be a hematoma, you see is connected a player toe like a fluids on. He looks like a nail growing. Well, so that's what you go to see. See what s s, um you don't You're under your battleground. So he's in bad. He's got over his head and drinks and it's gonna left from a hematoma. He's starting out and saying that he's had hurts these no other obvious and juicy you can see. And she assassin, you got his GCS is 14. It effecting Sam. It's been like that since he came in. Do you want to try and ask him to see you? He found out he was an old one. Every fail, he fell within the last 30 months. Ma'am, you were busy, so you will do assassin right away. He was trying to get up to go to the bathroom and fell against the wall in different you. Forgot to use is related. He had a settle and has had a whole and you need help to try and get up. The reason if you already had his catheter and any for body needed to relate er when they said multiple holes at home recently. So when she continuous ask him and that's our That's just it. It's juicy s sportiness. BSI inspecting. I just say he's got a large from team. It'll with this new other injuries. He has a known witness fall. And you recently noticed he was in hospital about five weeks ago. Didn't read me the point. Discovered to be a commenced on the docks about. So we should have another poet here. I could get this tour. Um, so based on your assessment, what investigations do you think that patient would need? Did anyone wrong answer here? Perfect that most of you have responded there, so we'll just send the goal here. I'm trying to share these results yet. See Overthrown Answer am. Obviously no investigations is wrong. Your hopes for 24 hours normal really short you for doing that for a nephew one. But if you're thinking about that just trying for the senior and ask them and say, Look, you've had no but the small on the docks of mind, I think I should probably get this down. You answered the the question correctly. So he needs near robes for it. Least 24 hours he's gonna need to see to breathe and out of ours in depending on the result of the brain. He might need a discussion with neurosurgery. So you decided you get the CT brain results. Let's say you're on the Ulster. You realize that you can't get a CT. Brain was little like speaking to Radiologist. So you will call the way down to radiology to discover the actually from the Royal. Get the Radiologist 30 previews town. So you found them equal in the history. You said, Look, this is 75 years. He's had no menace full on the doctor about it, sort of large from the hematoma I missed. You see, as a sport teams from the baseline 15 could get him sound. They'll say Yes and Bowler. So a CT Brean it's use a smaller kids subdural hematoma on the left on the side with a large left frontal hematoma. There's no med line ship, no signs of Hydro Caplis. He's a bit of atrophy for his age. So what you should do, not instance, need to discuss it with your surgery. Even if it's four AM, he's 75. Is that a small subdural? They will not take him, but you still have to discuss about whenever you do from your surgery, so there's really wouldn't move my number. You just need to go through such board in the Royal where that induction up that we recommended last week, it will have the newer surgery number on it. Your surgeon that you're gonna wanna do the mechanism of injury, what his GCS is like currently on. They were lost me for the breakfast, so it's easy enough to say 14 15, but they're going to want to break it. Dining toe eyes. I am verbal on motor, what the response is and what the number is in each category. They're gonna wanna do with the CT brain report when they're going to be able to see the CT brand. So just pass them over the health center number. They don't move. Just it's the patient on blood thinners on what his baseline is like. Is he normally mobile at home? Is he eating healthy would be really be an I C comes down? No, that isn't something you're going to do is an Afrin, even though I sometimes it's hard for us, is after use to know if somebody's and I see you come to it, it's someone that your surgeon something you're searching my trim work out themselves. But depending on the scan results, depending on the patient. If it's, um, awesome subdural bit of midline shift, they might accept the patient and for intervention and take him across to the royal. What does say that's what I'm looking for. Another job. A person who has a very small subdural, what they will typically recommend. And if they're on a blood thinner, they might recommend you reverse it on. It might be in discrete about what they say. Somebody get you Just discuss with hematology. I know some of the duloxetine reversing agent, and but most time we end up just using OptiPlex will probably tell you to hold down to quite get a specify period of time, depending on what the days. If it's aspirin them it's a window for 24 48 hours. If it's a picks about our talks about, um, they might say, hold it for two weeks and then they can restart it and they'll say to do neural for 24 hours if the person deteriorates rescanned in the complex. It's very important if you're speaking to your surgery and even especially document. Do they still kick start? You spoke to you about the advice was, and it's documented very clearly. Say spoke to ritual of your surgery, Reg AM advised reversing the docks of our own. Discuss with hematology or a reversal agent. Hold onto quite a bit for two weeks, re scan of deteriorates and re contacted Deterior. It's just leave the right. It's lesser advice. Just take their advice. So this is a head injury chart. We use an ANI, but the principals apply for any words. It could be on or anywhere you. What is that? Someone with a head injury. So it's important just to you can spend with this perform on it might give you a performer were you can, at least right during certain things if someone's had a full So you want to know have the vomited after they've fallen. If they're GCS is less than 13. If they've had a seizure after anyone who's bowling on the ward, it younger roomed got must have a really bad headache if they can't remember what happened before the fall for it least 30 minutes before the full 10 you to stand at the foot of falls from hyper fold on stairs, a full from height. Yes, a meter, but on the repression, pulling out a bad. Is this a definite mechanism of injury? For them, it's just the Have any of those limiting a GCS less than 13 year seizure? They need to stand within an hour, regardless, if they run any on or award if they felt one of the orange criteria is this still need a style? It's just whether these sound right there and then within the order over the you can wait. The adores just come. You know, the possibility history what their social circumstances were like Judy CS on them. And whenever you're assassin, someone who's had a full of a hat and genotypes of, um, it's very important to slip in the ear if they have blood coming from the ear could be a sign of skull fracture, in which case they need a CT. Had I am on a CT brands to check out the bones, obviously as well ask them if they've had any funny drugs coming on the news if they were testing them, my kidney and and indicative of CS athletes, but again It's very patient, specific. Try and draw ahead. Orpheus. Sometimes you could roll on under. It's very difficult. Everyone's heart. Those were pulling. And if you can, you just write. It might be very always a large that from the hematoma journey one place that could be whenever someone's had a head injury. It's always important. Just ask them if they've had any neck and injury as well. And I've got any tingling in their hands and, like a be signs of, say that they might have a bit of a ligamentous injury. Might have a spinal injury. Might have a knack fracture, in which case you might need to mobilize thumb to get them sound, and sometimes it'll be noncompliant with it. That's fine if they're moving your head. I'm not saying that Pa and people are well within the rights to refuse mobilization. Refused, sort of going into a caller, and that's funny if they've got a wings on their head as an apple. Um, no one's gonna expect you to know how to suture, But if you knew how to suture and you've done a basic surgical skills, give it a go and certainly for had injuries on the scalp and any other neurosurgeon we just staple them can be doing an anesthetic or you just be a quick fire staples under. Fine. If you're going to start, you someone, do you give him a bit of a plan? A static being 1% lidocaine. They could have a maximum 10. That was sort of her head and draped Shouldn't really need anymore. But as I said, they're investigations. Any any anything in red here would be an immediate indicator for Stan. If the GCS is falling. Works not improving, say, despite a bit of intervention if they might have a pound. I see you have any bruising in behind 30 years they need to see to bring immediately. If they're GCS doesn't improve to 15 and under two yours, then you just down. If they've got. If they're on a blood thinner than you to scan and if they have a new focal neurological deficit, they will also new discount night. Let's say someone doesn't really is on aspirin and isn't own apixaban looked. They're helpful. The greater than 65 they gotta stand. If it's a dangerous mechanism of injury, that would be, you know, full from a lotta over if they got to stand. If someone has had a full or how have you been drinking, the can't remember what happen to them. But if we can't remember what they were doing the 30 minutes prior to getting injured, then you just kind of what? So this is just a nice criteria and for when you should perform a CT stone and sort of summarizing the previous one. But the GCS of less than 13 on initial assessment says here in the emergency room, but also the ward they must get a scan on your GCS is less than 15. After two hours after the injury, they got us down. If you suspect that, go under better depressed, still fracture, stand them. And if they got the pound eyes, if they got blood coming from your ear. If you had a seizure after the event, stand them. If there's more than one extra vomiting, scan them because they could have a bleed, which starts in good capitalist reason. They're ICP, and once you have the radiology will not be in the hospital and they will not come up this aspiration. So it's all done on what you want. Your assessment. If you think it personally this time, tell them that you think they need the scan because of this criteria. Sometimes you feel you could be very busy because they might cover a couple of trust Super Night. And but if you just ask the patient, just tell him the needs kind and bacon For and again. This is the criteria for what you should for Ms Contin. Within a day or so, let's say someone's had a head injury Over night they fall on the on the picks of them, but they're over 65. They should get a scan the next day just to make sure nothing else is going on if they got any clotting disorders. If it's a dentist mechanism, have been dreaming. If they can't remember what happened 30 minutes part full. Do you wanna document you want to make a really good entry in the notes when you've seen someone, then he's had a false you dipped. Write the date and the time that your system write your name on your jams. The number um so you also asked, See patient regarding for patient, a patient, be there were admitted with urosepsis Thursday for post gentamicin on Capitol. Yes, it was trying to mobilize to the bathroom. Forgot his recorder. He had a knot minutes for with a head injury on apixaban, a doctor on rivaroxaban whatever, until quite into walls. Document your assessment. You're 80 assessment. Document your your assessment. That little table demonstrated quick system TV and document. You've checked the medication, and if they're on apixaban your office, even stand them, save organized CT pre and then write the results about it. If there's new, say bleed and And if I did to say nobody did ent, if I'd then discuss it with your senior. And if it doesn't, if you don't need a discussion with your sugar to just discuss it with your senior, if you're not sure, but everyone who's had a head and we should ideally that year olds 24 hours after, right your clinical impression that the person fall because they just didn't use the rollator I am so could just be a simple mechanical full plan would be further routine. Busy assassin in the morning on ready it to the patient. Just try and stand bad over the channel wonder. Don't remember to use the rotator. Now let's say if you need to make a referral, just still seeing me a referral and if you're not sure you're terrified, isn't a moment. Need it? One A. From years of you, that's completely fine. No one would expect you to use an athletic, but certainly just I just started up a senior, and then my offer to do it, or if they're very busy, the might save it. McCall. Don't be weird to you. See what their advice is. So Esther and testing you're the same. It's not. If you're very worried about a patient, it's never too early to gets in your health. Let's say this mound. You want one C patient. Be here before with the head and drooping GCS is it? You're well within your rights to phosphate your acid reflux. Last BP Reg breakfast. If you're really, really work with, um, just putting their sleep if you need people there quickly, Um, if you're if you're not able to get anyone, that could be another arrest. And if they're very busy, cold, a critical car reaching, they're fantastic for advice. It's not urgent. You don't sure what to speak to you again. It's picked us a true speak to you after you. Sometimes the nurses will do a lot more than you know wasn't half one and a D and even is enough to arrange. They have been there for 20 years. You know what happened with the ward's? Ask them if you're not sure what I do in this story, and if you think it is an actually an emergency, just heard of the balls there. It's terrifying the moment but your rebel, then your rights to do it. If you're concerned about a patient and once you put the buzzer, make sure you ask someone to call productive cardiac arrest. School is well, those are a lot of money to go to the sleep, and I'll give you the room number on the ward's of depressions on but switchboard need to do with a cardiac arrest. It has been pretty good so that they know we're not strongly mattered to say 10 minutes after a cardiac arrest is going right, so it's 6666 and returned again. I think it's 2222 in the AM allergic and Scotland, but I'm not entirely sure if you go down aesthetics. They're not part of the arresting. The Northern Ireland were arrested any last night on the next just sort of part of the team. So if you need to be, have to fast for it once that X to your location. Um, ever rest, make a is have anesthetic. So sport of 13 when your hand over informations that well, don't admit it to be under your shift units, then to your night shift. What information do you need to pass on? Use a possible anyone that's on Raylan. Anyone in the ward you're worried about for patients to be a world? So, for example, let's see. You haven't been able to get a porter to bring the patient time to see T. It's gotta talk in the morning night. I haven't been in for the CT yet. You also need to have the one common sleep. Just let the person let the Russian charge know in the war that they need to go for a CT brain. Soon as someone's able to take unless if it's a weekend left, they have one where they have to your the regimen that someone on that word is going for CT brand the chest. The results under that. Rather not be discussing your surgery or not any tasks that are sounding investigations might be chasing. For example, troponin CT prions, gent levels number puncture results. Thorough, important things that you need to hand over the game, just like last week. So some of the apple essential There are some of the Afrin essentials that will help you survive and certainly get you through pocket. Doctor. Fantastic. I think it's 3 94 99. Was everything possibly the hottest arrive here? A phone call, all the drugs you need All the doses which drugs gave in which scenario in palliative care guide Think the polyps are guidelines on that as well? So it is. It gripped up. You'll be an F is also very good for him and getting that magical. It's fantastic. I recess. Has all of your Allegra didn't. So if you're with someone that looks like in science talking what you didn't try to do with it? Micro Guide is fantastic, Emma. Same. Which trusts you. Some antibiotics. Some of them have a different protocol for certain infections. We just go with you in just violence. Condition doctor is great. We've got a lot of information for these folks. From that, uh, it will look like the red stethoscope on the APP store. I think it's free and that could be lying. I'm not entirely sure, but it tells you how to do with an assassin definition when it tells you. Heard what the monitoring pollen should be and give jetty is what you need to think about and inductions, but would be the best. Stop it, uh, varies in there. And you just you grit in the kind of saying which hospital you're in a kid, she every bleed number and every number you could possibly need for that hospital. The world numbers on who to contact. So that was probably you guys have been under your finals and it'll definitely be you guys at the end of your first shift doesn't happen. And but it gets better. And so thanks very much for joining into the right. But I hope it hasn't taken up too much of your time. It's messing with her so afternoon. If you wouldn't mind just a glass Vicks down in the key or crude I'm just feeling a quick feedback form for us and appreciate. Last week someone said they wanted to importance, and I've been reported with my shifts. We're trying to work out how to do that has been difficult, but we'll get better with them every week. So you have any recommendations? But he's just that doesn't work. You like more participation again, that is new. Any particular help it feel covered. And again, just write it in the feedback sheikh. These air this suggested ideas for the next 10 sessions will be going to do. Some of them might be combined. And But if there's anything else you want to, we'll just type in the feedback for me. We'll certainly look for you so I don't have any questions and feel free to type in the chopper a mute and otherwise have a lovely flower show in the sun shining. So thank you all for coming on Legs day. Thank you