Home
This site is intended for healthcare professionals
Advertisement

Hypoxic Emergencies Webinar

Share
Advertisement
Advertisement
 
 
 

Summary

This on-demand webinar is a great opportunity for medical professionals to learn more about hypoxia and how to handle hypoxic emergencies. We have two knowledgeable speakers who will be talking about the various aspects and answering questions during the course of the session. There are also additional resources such as a student support pack, an employment guide, and an industrial disputes officer to offer guidance and support. Additionally, we're offering a contract checking service which can help save time and money in detecting any discrepancies, as well as a weekly newsletter to stay up to date. Don't miss out on this excellent opportunity!

Generated by MedBot

Learning objectives

Learning Objectives:

  1. Understand the importance of using the BMAs membership and services to support medical students and doctors.
  2. Identify the key features of the BMA member contract checking service.
  3. Describe the various services and resources provided by the BMA for medical students and doctors.
  4. Analyze the different tools available for improving medical learning and understanding.
  5. Utilize the appropriate resources available through the BMA for support and guidance on medical contracts and wellbeing.
Generated by MedBot

Similar communities

View all

Similar events and on demand videos

Computer generated transcript

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

Okay, so I think that's what's going live. Now on. Good evening, everyone. Welcome to today's mind, Oblique Webinar on hypoc Sick emergencies. We're really lucky to have Samsung and Annabelle here today. They're both ones talking about hypoxia. Just a reminder that will record this session. It will be uploaded to our Facebook page and we'll send out the link on materials. If you're registered at mind, believe dot com forward slash webinar registration. I'll put the link in the chapped on. Remember to ask you lots of questions during the during the webinar. We'll try to get to all of thumb on. If we don't, that will answer them in the comments on make sure you feel in the feedback for when it comes you'll get a certificate of attendance, which is which is also great for you guys. So just to start with, I'm going to hand you over to dance. Tyler from the B m A on who are very kindly supporting our webinar. So over to down. Thank you. So you should be able to see see the presentation and on him, you know, um so yeah. Ah, you just seen Hopefully, maybe they're not there yet, but there's there's a few links under underneath the webinar. So yeah, these these links. And also there's there's a cure it on screen. Eso with those If you've used those, will send you a free digital sport pack, so it doesn't mean you're signing up to membership from the BMA. By the way, I should should mention that it's just a free support back to you. So regardless of whether you're a member, know so with that, you'll you'll get employment guide, which is which is really useful that can have, um one. We negotiated the contract, so we so we know what should be in it. And we saw, you know, inside out on Guy breaks it down. Um, you also get ah student support pack, featuring some some like revision tips and tricks, so that may still be useful to you guys. Also in there's, like ethics. Talk it on some other bit, so there's something for the remainder of your studies. It's just still got studies on also the F one guy. So again doesn't mind, you remember? Know it's just some some free guidance and info that we would like you to all have on be useful when it comes to, um, one on that also will see Now, uh, now you're you're still in school. Secular code will be on the top left of the presidential in while I'm just doing my little bit. So you feel free to do it while I'm talking or again, you can follow the links in the chart, so yes. So I'm done. Ah, just speak about being a membership. Won't take too much time. I'm sure you remember you being a member at some point. So you know a bit about what the BMA does. What you what you saw Get a members. Well, so you treat this is the refresh and hoping you might find out something new as well. Um, so with the leaving Trade union and fresh association for For Medications and doctors in the UK we act as the voice fashion representing you on an individual local a national basis on a lot of issues that affect you. Eso So what will be your job to the car to patients? It's our job to look after you. So when On indemnity company. So we're not like m d u m ps we do get that computer and quite a bit, but we don't deal with patient and plates were here. Somebody took after you're working tissue. And so things like pay contracts, your wellbeing and also your your pressure on the Ventolin. Um, so we'll send something she you may encounter, particularly when when you come in, if one on we can give you advice that's pulling on any issues that you face eso again this computer on anything from from working hours to raise ships with senior staff or any responsibility you have you don't quite feel comfortable with, Um, So yeah, so it's just good. Just keep it in mind. We can take some of the pressure off you. If you're facing anything, you feel that you need support with, um, we've seen most, most things before. There's no much can't help with on We have relationships. Uh, very trusting UK. And it's our jobs. Look after you. Make sure the trusted being fair. So he's trust is where we also have an industrial dangers officer are based there. So so somebody to sort of look at the local issues. I'm going employment adviser that that will be based every trustee you speak to us and again independent of the trust that. But we have relationship with the trust, eh? So you may have heard of our contract checking service, which can save you time, detective. Quite big money. So it's probably the key to of ours you you'll need this year if you if you go on this one, Um, so we'll check your rotor. Sorry. Check your contract. In five working days, I'm comparing it to the national model on. And if there's any problems, we can help you. That's all right. So they don't mean to, but trust condoms, Consent time, step in extra things. You're contract. Or it's also changed the wording to mean the opposite of what should be on. Just want to make sure your contracts are or what they should. They should be 20% of contracts we checked last year for the F ones were incorrect, so it should be pretty standard, but But they've made a bit of a rash of it. So that's one in five that we checked. Um, and it's just a bit too high on we negotiate contracts early. We know it should be in it. so we just don't try and putting any fast ones or mistakes. Whatever. Whatever the reason was, um, So it was that you can take your rose complaint by using. All right, we'll check er, so with that, when you just entering your railroad for online tool flag up to it was wrong. But again, it should be pretty standard. You know, your razors, as most of you guys should be funny, is I guess, ah on this. So you're actually eligible for the weekly since you're so the BMJ, that's part of membership. So the actual doctor of agents or not, the North student BMJ. Um and that's the difficulty Friday to address you have registered for your membership. So you never park for for finally, is if you're not getting it is because it's not in service. So you just need to drop is anemia and say I'm a member. What gives the phone call and say, Yep, But I remember I would like to get the BMJ weekly and we'll start sending out to you. Um, I'll tentatively to that if you if you are getting them every week, you know, and you don't want them every week you can you can stop them by phone in a swell all of the copies available to all year groups. Ah, you know, medical students and all doctors on the BMJ up anyway. So? So I would rather just read them on your phone. You can do it's part of memory loss to get access to kind of call non chemical learning tools. So you got full access to be empty. Learning, which has ever 1000 clinical non clinical models on their courses, are models helpful for getting Ah, you're your portfolio when you begin your left. One. Um, there's always a interactive and kept up to date with practice changing developments on this list of audio and video video modules as well to help you learn it's a lot more simulate environments. Um, and Freaks model. Do you can print off stiff for Is this proof of learning? Um, so being the library has 1000 e books and needles you can access from anywhere. Library Selves closed at the moment with the copay is still but but you can. Like I said, you can access those e books in journals. Still for your phone. All that's all on We also have a series of webinars that you can watch for out the year life. And if you can't watch them live, you can watch them on demand, as I'm sure some of you watching it from the month. Um Ah, And if you're thinking about your special options already, you can think you can use especially explore. It'll on that. That helps you get a better picture of what's suits you best. So it's an online psychometric. Testing takes about 20 minutes complete. I'm in last course will work life balance questions. Then at the end of give you a detailed report misting the top specialties according to the onset of given. It's really easy to use and covers all the specialties on the reports of always a very thorough with lots of analysis of the honestly given, um, need them for me. So, uh, just just one thing I want to mention is if you feel you like to speak to someone any time about your well being, we have services. They're open 24 7 all students and doctors, and it doesn't matter if you remember or not. Um, and you have the choice of if you speak to a counselor, appear sport doctor says telephone based service, and we do a video. Cools is what if you fell out, I'm gonna make sure you sleep the same counselor again if it's more on the singular call to the service. So, like I said, it doesn't matter if you remember. Know anyone can use this and it's it's open 24 7 and completely confidential, independent of any trust or medical school. Um, say wrap it up for me. Um, if you're know, if you're not a membership and you want to join, you can use the think that's that's below in the in the comments, um, and you you get the attempt sometimes about you. This works if you're joining for the first time. Also rejoining on biopsy. You're free to the is you wish. A membership for finding of students is 3 lbs 66 months. So the doctors thought that was about three months on. If you're starting, uh, be on statin is left one in July. You actually still pay that 3 lbs 66 a month for free until October. So if you want to join now, you still joins phone here. Um, and once once so becomes it would go up to 7 lbs 80 lbs, something on 80 a month after tax relief. So you must use that that I think, or the QR code on the screen to get the voucher of Why is that? Just joined food there through the website. You won't get about. Okay. Ah, last night for me. So, Yeah, same as the first one. If you feel ready to sign up, we don't sign up. But you want to stay in touch. That's fine. You can just use, like, your code or the link that Lincoln mention that start on and you'll just get some sort of some, like, timely messages from us about your f one transition on. Also, get another sort of like membership. Awful close the time. It's advisable to join. Like said 51 and five of the contract protect last year were wrong, So yeah, I just hope the joint and get a contract Check that at least I'm thanks. And that's it for me. Still sharing. Thank you so much down and thank you very much for your support Is everyone is really important that you you sign up. TOBA me a sample. We there? Yes. Hello. Hi. Would you mind? You said sharing you sharing your presentation? Forget. Okay, on good. We have just the mg use light and then you can go back to this one. All right. Well, uh, along with the BMA, we're very lucky to have the m d u The medical defense unions wants us to So just a very quick shoutout to them. And it's really important that you sought out your MD you foundation membership before you start shadowing on. Unless you filled in a foundation application form, your student membership will cease in the summer. It's essential that you have indemnity cover. So check out the sign up things that I'm gonna post in the chat. Ondas done Just said at the B m in the empty, you do different things. That's a natural that you signed up to both Thank you very much. Back to use them. So thanks, guys. Thank you very much. Okay. So just introduced myself money of some. So I'm an f one doctor working in the West Midlands on this lecture will be on tac sick emergencies. So how to deal with them what they are, what you need to do as any phone. So I'll talk through some scenarios on how to manage stand. Okay, so, uh, let's get going. So now why do you guys think they're important? Another thing to mention is if you guys have any questions throughout, pop them in the in the comment box on We've got Annabelle, another F one who will keep an eye out. Let me know if there's any questions on wave. Also got clinical cases as we go along to keep you guys or, um, t make as interactive. That's possible on. But we can always address any questions that you have. Okay, so I'll just carry on. So why is that poxy are important? And why are high pox sick and murders? He is important. You'll encounter them a lot of them If one, as I have working under a spiritually I've been in control of my pox of patients, Um, hypoxia can be life threatening on, but I love to the time it can be a sign of the two you aeration. So you need to think about Is this a sign of material rating on what do I need to do to assess and manage these patients. Okay, so how can it present? So I want you to have a think for me how you think I proxy is so low. Oxygen saturations were present. So these are the different ways that type of 10% it it's come become agitated. It can become confused. You'll see on the situation probes that saturations are low. You might seen signs of poor profusion. So where the blue where the lips of blue You might check for looking at their hands Whether they're being refused on, they might have difficulty in breathing as well. So visible signs off box Yet now you need to remember that hypoxia is a medical emergency on, but it's actually one of the most important things that you will encounter as an F one. You really need to know how to identify a sessile manager. So remember that a lot of the time you know what you need to do every time is your 80 year pope. So that's airway breathing circulation, disability exposure on. Remember, if you're concerned, you must must contact your senior on. But if the patients really unwell, you to put out a matter call, which is a medical emergency city in port. Okay, so let's have a think. How about the 80 assessment I was mentioning on day I'll speak about things in terms of safety hours, encountering a patient, what I would do. So if I find a patient who was high pox sick, how how would I put in? I would go to them and I would try to do an 80 assessment. So I'm sure many of you know what 80 assessment consists off. I want you to have a quick think, and then we will go through. So just couple of key points that you mentioned you should be able to start the basic management. And often what this will consist of is if the patient is quite hypoxic. So the situation quite low saying the 19 say it's I see a patient who has COPD, and they're saturations are maybe 89% or 89%. Maybe about 85% or 80%. That's low for them. Not met with low for them. So what I'm going to do is if a long as the Airways Okay, they're talking to me. Okay? I'm thinking about their breathing and it's respirations, and I will put a roof if thine liter, not really breathing mask unto them, and I'll ask the nurse to do that if possible. On. That's a life saving that's going to give them the oxygen oxygen that they need on. Really, hopefully pick that saturation up quickly as possible and remember that it's not going to be forever. That 50 m has to pick them up during that phase where they're deteriorated on. After that, you can decide what to do next, because at the end of the day is the high pox here that will kill them before the hyper cap. Here, I took up near being called high carbon dioxide levels, so you need to give them the oxygen. And that's what's going to really save their lives. So airway. So I hope you had enough time to think that, um, I'm sure you did. Now, Airways, I think about what? What types of issues I'm writing. I might be in country so I might come to someone who's sitting on the bed there, breathing noisy, so I've got some sort of obstruction. Are there coughing? Have they aspirated something. Are they turning blue in the face of the the I did that compromise that they're now looking sign, nosedive, struggling to breathe. Think about all of these different things now moving onto breathing. So, um, now are they? Are they having difficulty in breathing? Are they having to use their neck muscles there? Accessory muscles to breathe? Do they look tired? Do they look like they've been panting away? And now the deterioration so much that they're tiring and tiring is a really, really important and sign that you need to be able to identify. Because if someone's tiring, they're not going to be able to breathe in August and they won't be able to breathe out carbon dioxide and essentially that that will cause significant deterioration. What's their respiratory? Are they wanting away in front of you on one of those situations? So things that you might do to try and improve it, like I said, is the 50 m Nonrevealing Mosque? If you don't remember anything from this lecture, I want you to remember that if someone is deteriorating, they got low or two that situations, whether that be 80% or what that even be say 90% for someone who's usually 98% saturation. You to stick them on that 15 liter, none really. Mosque on. Get them back up to the saturations on then. Obviously, it's a consult of seniors and think about what oxygen They're going to go back on. Okay. And sit them up. Remember, sitting up can help with them. Teo. Really expand that chest and use all those different muscles to help the breathing. No, let's think about escalation. So, um, you're only on a form on. You really need to escalate the patients that you're worried about patients who are poxy that box. It is a life threatening emergency on these patients. Need to be discussed with your seniors. Okay, remember, you're working in a team on Remember your seniors in there to help you. Okay, so if you're worried or concerned about something, contact with your senior, whether that's your one of your colleagues registrars flavor, it might be. Now, let's think about how you're going to assess the placement, assess that patient in general and what things you be looking for. So I've got a patient on the respiratory ward on There are They're on their bed pointing away. They've got They've got a low saturation of oxygen I'll have a look at their own. A drip did have an IV fluids running. Have they developed any edema? Do they look like they're fluid overloaded and I'll have a look at they're at They're called the ankles. Have they got fluid? They have any edema. How do they hands? Look today, Have a demon there on and remember, Have a look at their JVP so that will give you an idea again off the cardiac function on whether the fluid overloaded have they got a history of aspiration? So is this patient known to have difficulty in swallowing Have been eating well when they're not meant to be eating other needle by mouth because of risk of aspiration. So I think about these things. Do they have any CD going on? Do they have a cardiac event? Because something like a myocardial infarction, a heart attack. These types of things can precipitate hypo Qsymia. So remember, you might want to look forward for arrhythmia or a problem there. And if they're on an IV, which is where you have, it's called noninvasive ventilation. A. Despite your enough when you really need to be contacting your Syria on did really putting out a medical emergency court? Because if someone is on an IV entity, irritating, it's a it's a bad sign and you need some senior help. Okay, so just moving on with the examination, some of the things I don't think about is running 80 so I'll be palpating the trickier. So is it deviated? Is it central? We listen to the chest on both sides, has their bean new sound. I can hear other crackles is the signs of fluid fluid in the lungs. Have they got a We've We've got to think about one of these things. Is it that now I can't hear lung sounds on one side, but I can hear someone the other side. So has this patient developed a spontaneous pneumothorax? And the other important thing is, you need to do an ABG, so that's an arterial blood gas. This is probably one of the most important thing you need to do in a patient who's hypoxic. Okay, so this will give you some key information on the p 02, which is the oxygenation, and that PCO two which is a carbon dioxide levels in their blood and oxygen levels in the blood. And remember, you won't be able to do all of this up at once. Okay, so you've got a team with you, so get your your essential get your register, or if needed. Okay? I work together with your with your multidisciplinary team on. That'll be doing things to help for the patriots benefit. Okay, So remember, in some cases, a saturation machine might actually tell you that this patient is that you're eating 80%. It might be so low that the saturation machine can't pick up the SATs on. That's when the ABC is going to come in really handy. And remember, you need to be conscious of how much oxygen that patients on a chest X ray as well would be very, very useful that you may need to order. So it might be a portable chest X ray. Whether the staff come to the patient and do the chest X ray in emergency. And remember, try to address things in your eighties assessment as you go along. So if there's a problem with the airway, you were dressed up with four going to be leaving with problem with breathing. You addressed that before going to circulation. So, uh, okay, so let's think about oxygen pockets now. So, generally for most patients or not for most. But a lot of patients will be aiming at 94 to 98%. So for you and you and me, for example, with no respiratory disease, our situation most likely will be 94 to 98% that we want those options levels to be a patients who, um, may her talk may have target saturations of 88 to 92%. These patients are those at risk of type two respiratory failure. So those who are risk of retaining carbon dioxide now the problem is to put into simple terms you and me without respect your disease. If we had a buildup of carbon dioxide, our bodies would stimulate us to breathe, okay and way would breathe. Have these patients who struggle to get rid of the carbon dioxide in the blood. They retain carbon dioxide, and that's over months, years they have in their blood, and they used to it, and therefore that's not the thing that stimulates them to breathe. What stimulates them to do is they're oxygen levels. And that's why we, with their extra levels being slightly low in the 88 92% region, that's what's going to stimulate them to breathe I/O. Okay, So for the patients who are going to retain carbon dioxide patients who, for example, have COPD say, severely obese patient who doesn't breathe so much hyperventilation, or those with some new, logical sort of Sometimes they had to come outside. So you'll be aiming for 88.6. And I hope that explains and Remicade you an ABG to confirm that they retain carbon doubt that you have any questions about that. Pop it in the comment box. I know it is a little bit of a complex idea to head around. Okay, so let's see how to switch down. Everyone is, um I'm for you. So this is a clinical case. Um, so we've got eso saying I'm in F one, um, on the ward on. We've got Mandy, you the 71 year old. She's got a back kind of COPD. She's got some heart disease. She got stable angina. She's got she's got an increased. Be, um, I and she has obstructive sleep apnea. So she's an award. I'm doing the war drawn or poverty, you know, water, actually, acutely deteriorate. So okay, Respiratory. It has increased significantly to 31. She's tachacardic. Her BP is okay, but her saturations about 80%. Okay, so that that's quite low on four liters of oxygen, and she doesn't look very well. So I think that she's having a nexus Sedation of a COPD. So I want you guys to have a think How would you assess this patient? And what investigations would you want to do? Okay. Remember, you saw your bedside, okay? And you will start from this on examination, so four. So I'll, uh, continue. Okay. So, like I mentioned, we'll start with your 80 assessment, as you would do the other patients who have deteriorated. Okay, you will, um do you probably some blood tests. If they haven't already been done, we'll need an arterial blood gas. So you need to do in a beauty, and you probably end up requesting a chest X ray as well. Remember, you will be a point of the multi disciplinary 18. So you have your different different members of the team helping you to do these different things. Okay, Now, another question for you guys. I want you to interpret this ABG. So this is of the same patient. Okay. Who has deteriorated with saturations of 80%. So I've been in a BG. Actually, I would want it. And ELISA on this is what it shows. So ph is 7.27. So that's acidotic. Anything below 7.35. He's actually don't take, um, anything above 7.45 is alcohol trick. And I have a look at the other bodies. So, Pa Oh, 275. So two of a 20.8. And by cover 26. Now, those are the normal range is in the square brackets, so I'll give you a couple of seconds to think about that, and then we'll move on. Will explain. Okay. So I know that there is a bit of the air is a bit of a light on Facebook life, so I will continue to tell you what the answer is. Um, and in fact, the the answer is that is a respiratory acidosis. Okay. Like a mention. The p hated 7.27. That's massive doses. It's a respiratory acidosis because the colonoscopy side is high. Okay, on the oxygen is low. So as well as a respect for acidosis is this is a type two s spiritually failure. So where that patient is both hypoc sick on hypercapnic. Okay, Onda, I know that this is probably a cute because the bicarb was not raised. The bicarb is just on the normal range of Case 26. If it was raised to say if it was around 30 31 I'd be thinking more. This probably a chronic thing because, um, chronically compensated by okay, He's in by by car compensating for that. So? So, in summary, this is a type two respiratory failure or sputum acidosis. Okay, No, just continuing with that case, you're still awaiting the chest X ray, because remember, these things don't come back immediately on your weight in the blood as well. So, on your examination, you notice that bilaterally there's a there's a week and you've got reduced Aaron treat both the lung bases. So what are you going to do is to manage this patient. Okay, So and have a think on, but I will continue, um, to tell you what, Uh what What? Have you minus this situation? Okay, so I'm sure many of you would have got this. So it's remember 15 liter, none rebreather mask. This patient was saturating 80% of four liters of oxygen, so they had pox sick on a low amount of oxygen. Are you going to pick that up? So I put them on the 15. Need a mask that would really pick up that saturation quite quickly. Probably within minutes on, but, um, nebulizers can be quite helpful than six. Your pt example exacerbation. So you can give themselves utilize, and I patrol cream nebulizers on. But of course, if they're not responding, you can give them that back to back. So once that finishes, you could get them again on nebulizers Last, probably around 20 minutes. So assess the response after it. And remember, you need to contact your seniors early, especially with the tear it in patients like this return to the longer term management. You probably start prednisolone on. You could speak to your seniors and read the pages and mind the sleep. Teo, have a read about the longer term management of things like COPD exacerbation. Okay, right. So now let's just quickly go through some of the really common findings and situation your come across as as the left one. So let's think about the differential diagnosis according to the examination finding. Okay, So, um, just spitting it up here, we'll start with a week. So in what patients might use, expect a week. You can get it in patients with asthma, COPD and even permanently. Dean. On the in fluid overload, you might hear a wheeze a basic. You're awesome with the nose on a normal breath. Sounds on. You might find a patient with a pulmonary embolism, and we'll discuss formal embolism a little bit later. Crackles. Remember that this will be the result of secretions. Could be because of fluid overload on. Remember to think about pneumothorax. If you're not hearing oxygen on one side, I remember on the woods you won't be able to know what the differential diagnosis is. Immediately it might be a number of things going on. So have have have that cup on what you're thinking about multi factorial, different types of things on. You know, you have a team. So address the different things that you might need to give you a diuretic. It might get me to get some IV furosemide. A stat dose, 40 mg. If you If you see then fluid overload and palmer edema, they also might have an aspect of COPD exacerbation. So you might need to also give them some nebulizer. And, of course, the real important oxygen. So just have a think off everything you do. So just a few important thing is to remember and things you come across so pulmonary edema. So this is an example of a chest X ray shin from Dema. So remember you think about the cause. Is is a cardiac cause presentation. Are the coughing things up? Big arteries? What's the Saturations Onda? If I've got a project popular demand on my sees that there's fluid in there in the arms and the legs, and I have a reason they might. They might have some degree of cardiac failure on, but if I ask what the CD I might I might see some finding it might be that they have some two waves indicating previous am I or things like this, they might have a new um, I So this is these important thing is you need to get done on a BG, remember? You need to look at the oxygen saturations a c or two levels as well. Remote chest X ray will be useful bloods on BNP. So unnatural chick peptide will be helpful in terms of showing that strain of the hot. Remember you immediate management will likely be oxygen. Okay. On furosemide, which is a diuretic. Get this here is involved on. But they will discuss with you the further management. Okay, so just moving on to acute asthma. So, um, remember, you need to rule out different differentials like I mentioned. It might not be that a patient with asthma hasn't. I'm having an asthma attack. They might be having an anxiety attack that might be having a michael infection. So think, think broadly. Okay. When your portrait patients on the ward. So Arimidex, Same in with these with these patients again oxygen, nebulizers and and seeing a port. So So. Those are good. Some of the important things. And just just to mention, okay, severity of ask me is very important. Someone is having a severe asthma attack okay. Or life threatening asthma attack. We'll probably need to put out an emergency call. Okay, so you probably put a medical amounts of trauma. Call a record. A medical emergency team called a Met Call out because this is a life threatening emergency. Okay? And you really need the whole medical team. So that call will get out all the medical team from the hospital from wherever they are. They come to you to come to that patient and really help. Okay, so remember that if they have any one feature in these different categories, okay, they Babel fulfill that criteria. So if my patient looks exhausted on be tired on this is not retaining carbon dioxide and has a normal PST or has what we call a normal pace 0 to 46 that's actually a life threatening side. Okay, so so remember that now moving into COPD. So I know we discussed that a little bit before, so remember your different, but I notice you're 80 assessment your investigations and your seniors for any management. So your oxygen in nebulizer is. And remember, if it's an insulin effective exacerbation, have they got a fever? So I'm going to check this patient's temperature. I'll ask. Ask the recipe in so I can ask that message. Do you mind doing temperatures? Check for me. They got a few. I'll have a listen. Do they have any crackles? This is an effective exacerbation. Are they septic? Now? I'm sure you won't know what the sex of sixties, but I'll run through it with you. And the way I remember it is through the word buffalo. Okay, so remember three and three out, So give three and three. So be for blood cultures. Okay, you for urine output. So I want to measure your your hourly urine output through a catheter if needed. Fo fluid resuscitation might be the BP is low, maybe 100 over 50 on it. If you're a bonus off, maybe 250 miles status. They had heart failure. If they have a degree of heart failure, heart problem or 500 mL, start bolus, um, normal saline on if they don't have any concerns. Mints regard to fluid overload of heart failure. That's F eight antibiotics. I might be just on board back from antibiotics, but of course, follow those guidelines. Healthful lactase. That's where you need either an A to a big castle. Venous blood gas. Okay, on off oxygen. So remember when you need to provide them the oxygen on Remember senior support because patients who have a degree of heart failure, it might be a little bit tricky. Do I give them fluid or do I give them a diuretic? So So I think about these different thing, and that's why it's so important to have a senior now. Quick question for your old. So this is a patient who has an exacerbation of COPD elderly job. Gentlemen, He had a simple face mosque or that has been on eight liters but a past few hours. Okay, he's not drowsy and your arms to review, you know, by the next. Okay, so he's rest for it is 10. That's no blood. Pressure's okay, SATs and 99% on have a look at his A B. C's 7.11. He hates covered nuts that are 9.9 oh, Austin of 18 and by half that one. So just normal range is again. PH normally is 7.35. Simple for five. Back side is 46 box itchin is greater than 11 or so and bicarb is around 22 to 26. So just bear in those things in mind. What do you think? The first thing as an F one. Where you going to do when you come to see this patient? Okay, so the first thing to do okay, is where do you succeed? The thing you need to bear in mind here is this patient has COPD. Okay? They are retaining carbon dioxide. Clearly, the carbon dioxide is high on the gas. It's 9.9. They are very oxygenated. In fact, the oxygen levels are too high. There you go to 18.1. Okay, on the saturation, 99% likely this patient who has COPD has some degree off common duct said retention in the long term on now because the common duct it is so high on the oxygen is so high, there's nothing to stimulate the breathing on this is wine carpet in patients with COPD and at risk of carbondioxide retention, we need to aim for sets of 88 to 92% so that that hypoxic drive is what stimulates some Tobry. Okay, So, by reducing the oxygen. It was simply that hypoxic driver. We'll get that a respirator up. Okay, on it will hopefully sort out that carbon dioxide. It will help them to blow it off on down my oxygen as well, and then not not need so much oxygen. So remember, you need to speak with your seniors about this as well on speak with the nurses. They might not realize what the target sites are. Remember, it's a team effort. Okay, So, like we just explained, that's that. So just definitions Quickly. Hypoxia, eyes. Where? On the arterial gas. It's less than 10 on. If they severely high pox it, it will be less than eight. So essentially, they have low oxygen saturations. Okay, Now type two s spiritually failure is where they have a policy and hypocapnia. So we didn't discuss the earlier So Pa or two is no on down there. So two is over six. Okay, so that's hard on. Right? So coming towards and now, guys. Okay. Almost finished. So vesicular. I know that sounds, um you need to think about a pulmonary embolism. So these patients who may have come across a lot of patients a problem and Melissa, um, on the chest X ray will be absolutely fine. Okay, there, the lungs will, Will, Will, When you are still check the lungs. There will sound completely fine. However, they might have chest pain that might have pain on breathing in. Okay, which is which is along with a Sinus tachycardia on the CT to it could be a sign. A pulmonary embolism. So, in these patients you to determine you speak with your seniors, they might need to get a CT, pa. So that's a CT scan of the lungs on drum, then on going to manage with heparin or so on so forth. You discuss with your seniors? Okay? I think like respiratory depression, remember? Have a look at the structure was very important. If there aren't, say morphine on 10 times how much they're normally on with airport stuff, and they just have a lots of lots of morphine. Despair in mind? You might There might be an Okay, toxicity. Get me that meloxicam. Okay, so, um, don't forget just just finishing up. Don't forget circulation. See on Got a brilliant lecture that's going to be delivered next week on fluid prescribing, which will be really, really 100. I really recommend watching that. And it would be helpful for for, um, thinking about what? To give you how much foods you should. You should give them what you need to think about defect disability effects. Probably remember that if someone seriously deteriorating and may not survive was really well, someone from the team conduct the next second. Didn't need to be the doctor's. It can be amenities with the help of healthcare staff. Okay. And I remember 50 needs a non me breathe mosque is a vital Okay, it's very, very important. So give that and we should have someone hypoxic. You won't be leaving them on that. Okay? So don't worry about that. You're going to read after that and reassess them to see how they responded quickly. So that's it for me. I've got one a couple size after this on what I would really like you to do, if possible, is be, please fill in the feedback. Okay. Iraj will put in the web link in the in the chat box in the comment box. You can scan as well. Okay. And give us a few back. Really need it for our portfolios on. You need it for your port for you Because you get a certificate and that if you are interested in finding out about your portfolios, do you go ahead and watch the weather. Now that I gave a few weeks ago, it's recorded. It's on the mind that Facebook page on, but that should be handy. Okay, so I'll give you a bit 20 teo scan that you are code I know of with through that, if you have any questions, please put them in the chat back, chatterbox. We're gonna be on the right or keeping on that. Please do a detailed feedback way. We hope this has helped you. If you have any other questions, just let us know. Um, Andi? Yeah. Hopefully you you have benefited. You receive a certificate you can put in your portfolio, which will be good for you in the next form on all this. Hopefully will help us. Okay, So just the final thing. Remember, if you're not sure, contact with Syria because I pox is is life threatening. Okay, So any questions on hand it to Neeraj and animals, there's any questions. Thank you so much for that some cell. That was brilliant. We've got a couple of questions. So starting off with one about life on the ward's So we have one from a user is staying. Where would we expect to see and I d being used? Is it only on respiratory wards or is it somewhere else is well, really good question. So you'll see an IV. Often it will be used in intensive care. Okay, so in I t u the hedge to you, that's where you're primarily used and I be And it's not. Energy is one of those where if they need it, they really need some, uh, close close supervision and probably are quite unwell so that it would likely be in i t u hate to you. Okay, But like, say, a PSA left one, you won't really be managing I d patients. That would be something of seniors will be doing most on if you have anyone who is in the Navy you're worried about, you know, always speak with your seniors. Yeah, that's really helpful on the next question that we've got here is more about the next lecture. Really? It's Will you cover plasmalyte in the fluid lecture. Okay, I'm not sure exactly the content, but, you know, just go ahead and attended, and I'm sure you'll find out. I think what you said about always making sure you think of circulation causes for breathing problems is so important. Especially when, as you say on the ward, you don't have the diagnostic capabilities that you do when you're doing a scenario on exam question, because your extra hasn't come back yet. Someone is running your ABG or your VBG and you just don't know yet. You really got to keep an open mind as to why people hypoxic think that was really helpful. Very true. Very true. It's It's really good to just open mind like, say, on drink about the different things you need to assess. Often, patients don't have just one problem. There's many things you need to assess. So, um, in in real life, like you say, I'm very mind the different possibilities and try and target those. Definitely we've got another question come in saying might sound silly, but how many liters of oxygen would you normally start with? For any patient who might require oxygen support in any? Okay, really Good question so it's going to really be dependent on what? Your saturations. Okay, so, um, say they're saturation of 95%. You can always try them on 1 m. Is that going to want to go on? Is 95% is within the normal range off in general. But you always want to in generally, probably a me. If someone has target sets of 94 to 98% then then fax. That will be fine. Say, someone's having saturations of 90%. You can try a couple of liters, maybe two liters. And maybe that will be enough to get them back into the 94 to 90% range. So, you know, it can start off with nasal cannula wanted, wanted to want to re liters. And you can go up from there. Really? But it depends on what their targets up on depends on how fully they are as well. Okay, it might be that you need to get a 50 m run me really mask immediately. And then thereafter think about titrating it down. Maybe so simple face mask. And then Teo makes a candida so so that so. It really Japan is really Yeah, I don't really Great question. Definitely. Also the question. No, definitely. No. So the question lovely. I think that's all the questions. We haven't the moment thie those initial questions saying, Well, a stiff could be provided this webinar and the answer is yes. After in the way to get it is you just fill out the feedback form on. Then afterwards, it will generate a styptic it for you for coming to the webinar, which I think will also work, presumably after we finished going live. Um, so that's a little answer to that one on for the moment, that's all the questions we've got. Ah, follow up question. So Okay, so the previous user has asked about the any What? How many liters do you start on? So follow up question. Does that mean it's more of a trial and observe method than a rigid structure to follow? Most definitely. Exactly. It will be dependent on each patient on their requirements on digs Actly. It's whatever they manage. So some patient minded viably to some vision my new one liter some patient might not need anything. So we really depends exactly you assess that you re assess their saturations whenever you give them oxygen on titrating as you need to. Brilliant. Yeah. Um, we got another question here concerning a clinical examination. So if there's so this'll uses asking fluids, fluid fills up the base of the lungs first. Does the fibrosis of the lungs also start at the base? Good question. Um, I'm not too sure about that. Um, I think, yeah, I think it's an interesting question. I think I guess how I would interpret that is what you're listening for on examination, because I think if you hear fibrosis, it tends to be like throughout the lung tissue rather than just a the bases. So if I broke, this chest will kind of sound like light or fine crackles throughout the chest rather than right at the bottom. But fluid at the base of the lung will feel Will sound like course crackles at the base of the lung. But the issue is exactly a sound. So said you've got consolidation. That sounds like course, crackles, but also fluid Sounds like course crackles. So that's why I got to keep an open mind when you're listening for it and you use things all together like the ABG, the chest X ray advice from your seniors and other elements of the clinical examination. A sample mentioned in the 80 to kind of give you an idea of why their chest is crackly. Yeah, Brilliant answer. You know, I agree. Exactly. Uh, we got another question. Um, so it sounds a dual stoops. COPD patients always have target sat of 88 above. No, not not always. Not always. It's important to find out if they retain carbon dioxide. That's why I often when patients are you $2. But with COPD, they have an a B D. Done on def, they are retaining carbon dioxide. Then that's when you would put them on that on those target situations of 88 to 92. If in doubt, contact your senior and generally, from what I've seen, most patients with COPD have been on 88 to 92%. But not not all patients are okay on drum Ember. Much of COPD patients, my patients with other types of respiratory disease who are targeting 88 92. So So Yeah, that that's the answer to that resemble. Can I just ask the question actually is narrowed. So this is something that always catches me out, an exam just following on from the 88% thing. So if you're unsure about so you know, you know that you have a patient COPD, but you're unsure about whether they're retainer or no, but they're profoundly hypoc sick. Presumably, you would just give them high flow oxygen because the high proxy and could kill the quicker than the high. The cap me a kid. Is that right 100% in your legs? That's exactly the right answer, even if they retain, if they return in carbon dioxide. If they're high pox sick, it doesn't matter if they're if they're a COPD retain. And if they have low target saturations, you really need to pick that oxygen up. So it's it's a it's like 80% or something like that. Get them one. That 15 need to re breathe mask because it's the high pockets here that's going to kill them first before the hypocapnia before those carbon dioxide levels high pox that can kill someone without a minute with within minutes, I percuss me a takes longer. Maybe, you know, I was along with longer than minutes. So you really to mind, Is that high proxy up with the 15 you to repeat mosque? Exactly, right? Yeah. Anything. That is a really important question. Because especially when revising for exams. And you hear about this quite counterintuitive point that if you give too much option to someone to see you two retainer, you're gonna hurt on it exactly as you said. Hypoxia kills before I can hear, but often trips people up because they think, Oh, well, in this and I won't give up yet because what if they're retaining? What if? What if? But actually, you gotta always go for the basics, which is hypoxia can. And I got exactly hypoxic use and minutes. And, Captain, you will take hours. And so I think, really, really important question to go through. That's a lot of questions that we've got the moment up to date. Was there any yunky aces that you've seen recently? Some soul, but made you include certain things in your lecture. Um, so So there's some other things that I mentioned today. Yeah. So the things that I've encountered something probably mentioned is that as if one's you even come to a lot of different cases on, but you might not feel so confident now. But, Aziz, you pain. And as a practice over the next one, you'll become a lot more confident. And this is providing you the basis off your knowledge and on just from a revision of some really important topics, Remember the mind that looks like a lot off different, really good resource is so, um, you know, didn't give everything to read on DA Uh, yeah, that these cases definitely had things that I've seen on. They are common. So remember, you're 80. Assessment your basic 15 m to get one patients, I pox it on. And remember your own uniform. You need to speak with you seem really based things with your team members and put out an emergency call if you are concerned. Okay, so that's 18 take home points really in. You know, I think that's a really, really good point to end on. Exactly. Say where you know you've got a team escalate. If you're not sure, go back to basics and you'll be absolutely fine and lost to learn, as always, seven. Hopefully. So shall we leave it there in that case. Yeah, I think that's a good idea. Thanks very much, guys. Um, I think that was a really, really interesting lecture on thanks for the audience to sending in lots of very useful questions. If you have any more And please do keep commenting on Facebook, we will pick them up on make sure you join us next time for our fluid prescribing seminar. So thank you very much, guys.