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I just thought I'd say we just said we're gonna wait a few minutes for everyone to arrive and then we'll get going if that's ok with everyone currently in the meeting. Yeah, so it's nearly five pass. So people probably just trickle in as they come. Um So I could introduce. So hi, everyone and welcome to this week's NTS which is gonna be on emergency anesthesia. Um, I'm Rose, I'm the president of the Plymouth Anesthetic Society. Um And it's my pleasure to invite doctor he and doctoring who's gonna be talking to you guys tonight. Um And just a huge thanks on behalf of all the students today um for giving up your time to talk to everyone. Um And I'll pass over to you guys to get going excited to hear the talk. Um Yeah. Right. Good evening everybody. Um on behalf of Lawrence and myself, thank you so much for inviting us to be with you this evening. Um And yes, we are gonna be talking about um emergency anesthesia. So what how we're gonna play this? Um I'm gonna do a brief introduction of sort of some of the common factors to uh emergency anesthesia sort of across all specialties. And now I'm gonna be talking a little bit about, um, about emergency anesthesia in adults. And then I'm gonna hand over to Lawrence who's going to, uh, talk about emergencies in pediatric er, anesthesia. Uh, and then we'll take some questions at the end. Um, so please feel free to ask anything, uh, and get involved in the likely discussion. So, emergency anesthesia, obviously, this is a massive topic. Um and obviously an emergency is anything that is unplanned. So obviously, if we have planned surgery, we have time and time is obviously key, it means that we can plan, prepare and optimize whereas in an emergency situation, li time is limited and de and it depends on the urgency of the surgery as to how much time we have. But there are a number of other factors that play into um emergency surgery and emergency anesthesia. You know, we're all acutely aware at the moment of the pressures that are on both primary and secondary health care at the moment. And that means that often patients are delayed in presenting to their GP, they haven't been able to get an appointment and then even if they have not gone via their GP, they've managed to get an ambulance, they're often sat outside in our forecourt for sometimes, you know, 1224 hours getting to A&E. So we're often seeing these patients much more delayed, which almost puts more time pressure on us to act quickly because we've lost a lot of the time that sometimes we could have made up earlier in the process. Along with that we've got increasingly complex populations. You know, the rates of diabetes are going up. We're getting increasing BM I across our population and just general co morbidity, particularly in the adult population is going up. And because of all of this, we really would benefit from having a multidisciplinary input to look after these patients to really give them the best possible outcome. But then you throw into the fact uh that a lot of emergency surgery and anesthesia happens out of hours. So we don't have access to physios, occupational health, some of the consultant expertise that you might get, you know, in on a 9 to 5 during the week. But this is a massive part of our workload that happens, you know, actually, it's about 40% of the surgical specialty workload. Obviously, that varies depending on which specialty you're talking about, but it's a big part of, of, of their workload. Is it um it yeah, amounts to about 40%. And despite all the number of theaters that we have, most hospitals have one or maybe two dedicated theaters to deal with these patients. And it is, it's great that we've got emergency theaters dedicated to these patients, but we're sharing them across multiple specialties. Um So not only is there a bit of a conflict and a sort of balance to be gained by sort of getting the right patient in, you know, ahead of other specialties. But we're also balancing all this this other complexity that's going on with the patients, whether they're optimized. So it really is a really complex balance and it's a really cognitively challenging day to actually be working in the emergency theater because your um leadership scales go beyond just looking after patients. It's also dealing with all of this stuff that's going on at the same time. Uh Right. So what has been created is a formal sort of uh classification to prioritize um emergency surgery. And as I say that the the main, the main objective of that is to facilitate clinical prioritization. But obviously, by doing that, it also um improves communication because there is a a universal language. So um the first category is damage control surgery. So if you work in a major trauma center, you may have come across this sort of terminology. Plymouth is a major trauma center. Uh And these are the sorts of patients that come in so unstable that they are basic, often, not even suitable to go to a CT scan. So an example of that may be someone who's been stabbed in the abdomen. Uh They're hypotensive, we're managing to maintain a BP with continual infusion of blood. But putting them in the CT scanner with the effectively putting them in the donor of death, what they need is to have their abdomen opened and the, the bleeding controlled. So that is damage control surgery. Then you have category one. So, uh that could be uh things like limb amputations, um you know, life or limb threatening surgery, but they do have time for limited numbers of investigations. So things like CT S uh CT angiograms but fairly rapid progression to theater. And you've got category twos that tends to be sort of laparotomies. And then category threes are things like fractured mandibles, uh abscesses, you know, we should be getting on with them, but there is no immediate threat to life or limb. So what obviously has before you can get emergencies in virtually every surgical specialty. Uh Obviously, we're gonna, and what we're gonna do is, is, is try and illustrate some of some cases today um through some of these specialties. But broadly, you can get emergencies in any sort of uh subspecialty of surgery. But we're going to limit our uh discussion today mainly to general orthopedic airway and pediatric. It's probably outside of the remit today to go into obstetric emergencies, vascular and neurosurgical cos they will probably be covered in talks in the future. So, what are the main sort of