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Hi, folks. Um, my name is Catherine. I'm one of the Edf YT s. Can everybody see and hear me and can you see to be presentation? Just give me a wee thumbs up for perfect grand. Um Well, at seven o'clock, I'm sure people are probably coming late as well, but we'll just get started. Um As I said, I'm one of the E fy twos. I had originally done this lecture, I think two years ago um for foundations for finals, it was originally a poem lecture. So there's anesthetic slides at the end as well, but we'll not go through them because I know you guys have already had your anesthetics lecture. And so we'll just pop through emergency medicine stuff. I am currently working in, in the Royal and Matter. Um If there's any questions at any point, just stop me. A lot of the stuff is very algorithm driven. So a lot of it is kind of rote learning um which can be a bit boring to go through. So I'll try to try to go through it as quickly as I can really. Um But if there's any questions just popped into the chat or feel free to stop me. Oh, so, um this is going to move, sorry, my laptop is a bit temperamental these days. And, um, so we're gonna go through ABCD which I'm sure you're probably sick of hearing about. Um, and then uh the trauma version of it and then the management of some emergencies and then I've got extra slides at the end and just, I think Kira and, or want me to send the thing to them. So there's just some extra revision slides as well. Um I didn't delete the anesthetic ones. They're just sitting there at the end. So um can I just check, are your little videos blocking or like your names blocking the screen share? Can you see it? Don't answer all at once. Yeah, I can see it. Oh, thank you. So, um ABCD is organized by what's gonna kill you the fastest. So your airway needs to be dealt with first before your breathing before your circulation and so on. Um I think I took this, we summary from the AK Stop website. So I'd say Ay stop and ki medics are kind of the two best things to use to revise for Ed. Um There's not a lot of like, I don't think passed has emergency medicine questions on it specifically. I think ques meed does. Um but it's kind of difficult cause all the emergency medicine stuff is split up between the other specialties. So I find this quite helpful. So, a for airway is the patient conscious? Are they talking? Um Are they stri or? So, are they doing that horrible whistling wheezing noise? Um Are they tripod? And I'm assuming you probably all know what that means? Like, are they sitting with their hands behind them? Um That's obviously a really concerning sign if they're talking, their airway is patent. Um Usually I try and get a quick history of them at this point as well. So as you're kind of assessing the rest of it, so I use sample, I quite like to have frameworks. There's a lot of frameworks in this lecture. So sample symptoms. Just a quick like what's been going on the last couple of days? Oh, I've been really short of breath. I've been really wheezy and coughing. Um Do you have any allergies to the existing medical conditions? So, like people with asthma will volunteer that quite quickly. Um Do they have, when was the last time they ate or drank? That's all really relevant for like, um people who might need to be intubated or people who might need to go for surgery and what were the events leading up to this point? So that's airway breathing is fairly self-explanatory. Listen to their chest, get oxygen on. Um If you're worried about their breathing, treat it. So if you think they need oxygen, put the oxygen on, if you think they need nebulizers, get the nebulizer started. If you identify a problem. You need to treat it as you go. Um, don't identify that there's a breathing problem and then not actually address it. So, see, for a cardiovascular, I usually start at their hands. So are the hands warm and well perfused. What's the cap refill time? What's the pulse? Is it regular going on up? Is there like a hugely elevated JCP and then listen to their heart sounds and get an ECG if you can for D so that's disability. Um, there's a couple of different pneumonics. I like, I like tagged or TD, however you would pronounce that. Um, so t for temperature, A for apu glucose, um, or sorry, A for AU or G CSG G for glucose and then E for eyes, I usually do ears at that point as well if it's a trauma. Um just in case there's any CSF or blood. Um, and then D for drugs, um, especially if it's like if it looks like it could be a drug overdose, um, you know, check their eyes as the pinpoint people, that kind of thing. And then lastly a so a quick once over, check their abdomen, do a quick neuro exam and check for any wounds. Um, if they have any like catheters or drains or anything like that and check all those at that point. Um, as I said, if you find a problem, fix it. Um, and then when you're finished with ABCD, go back and reassess Um, and if at any point you feel you're out of your depth call for senior help because that will always be a mark in an ay, if it's, if it's an emergency medicine station, you'll always be saying I need to call for senior help. And the first thing out of your mouth should be, I will assess this with an ABCD approach. I'm sure you are probably sick of hearing that. So a trauma ABCD E is slightly different. Um A catastrophic hemorrhage is going to kill you before your airway does. So your catastrophic hemorrhage, the way to remember that is on the floor and for more and what I mean by that is on the floor is, is there obvious bleeding somewhere? So has their leg been chopped off and it's obviously gushing blood, you're gonna deal with that first. Um And then the four more are your chest, your abdomen, your pelvis and your long bones, your long bones are basically your any bones in your limbs. Um So a femur fracture off the top of my head, I think you can bleed about 2 L into your leg. Um If you break your femur, so you need to have a good look there. Um And you're going to treat the bleeding with either direct pressure, hemostatic dressings, tourniquets T Xa or surgical management. Um Just be careful with the hemostatic dressings. Celox is I'm hoping maybe you have heard of Celox if you haven't do, let me know. Um, but Celox is made of crustacean shells. So if somebody has a shellfish allergy, do not use it, you will, you'll be in severe difficulty if you do that. Um So that's catastrophic hemorrhage and then you continue on your airway. If this is a trauma, you need to protect their c spine. So you're gonna put them in a collar and blocks and tape that's called three point immobilization and then put them on trauma mattress as well. Um, I have a picture of that later on, I think. So. So has anybody heard of a trauma walk? And it's basically, you'll see people talk about tucking your hands in and putting your hands out like this. So you tuck your elbows in to your chest, I guess, and then you walk in like this and you put your hands on either side of the patient's shoulders and then use your forearms to stabilize the patient's head. So you look a bit like at Rex and you look really ridiculous. Um, but it's basically to stabilize their c spine temporarily while you're waiting for colors and blocks and everything. Um, and we'll talk a little bit more about c spines later, but these are the Canadian C spine rules. So if a patient's high risk, if they've met the criteria, which is if their age is 65 and older, if they've had a dangerous mechanism, so particularly falls from heights or what's called an axial loading injury. So that's things like diving injuries where people land like smack bang on their head and they hit this way, but obviously upside down. Um So diving injuries, we get a lot of those, you get a lot of those in the summer and when people are like swimming quarries and stuff and diving into things, they shouldn't be diving into essentially things that are too shallow. Um And then any sort of neurological deficit, those would all be high risk criteria. They absolutely need to be immobilized and get a ct of their c spine. So that's what it looks like. It's obviously not very comfortable for the patient, but it is necessary. Ok. So hopefully this diagram will ring a bell with you guys. Um This is the trauma triad of death, not a very nice name for it, but that is what it's called. So it's your hypothermia, your acidosis and your coagulopathy. And essentially, it's sort of a spiral. It gets worse and worse. The more acidotic they get, the more coagulopathic, they get, the more hypothermic, they get that. Obviously, if you go back to like your a level chemistry, um temperature obviously affects all the reactions or most of the reactions that happen in your body. So if you think of all the things involved in your coagulation cascade and all the enzymes involved, that's gonna the hypothermia is going to affect that and make you coagulopathic. And then the hypothermia will also affect your, like reversible equations with your, um, your ph reversible equation. So, as one gets worse, another gets worse and another gets worse and then it's just a really vicious cycle. So we have to intervene in that to try and stop it. Also, if at any point I'm going too fast. Or you wanna ask me a question, you can just unmute yourselves. Um, so G CS, apparently in your oy, you can ask for the G CS chart. Um I wouldn't bank on that, to be honest. I think it's quite reasonable to ask somebody to assess the G CS and to be able to do it confidently without a chart. Um, but yeah, it's just one of those things you have to learn and you do have to know it. It's not one of those things you learn and then forget after your exams. So, um, broken up into your eyes, your verbal and your motor response. So your eyes are scored out of four. Verbal is out of five motors out of six. So your maximum is 15. Um, if your G.