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Ok. Um So we're now alive. Can I just double check? I can't hear you might be. Hello, my name's Sarah mckelvey. Um I've come up as Sarah Griffiths, my married name confusing. Um and I am a, a Jerry's Registrar in Oxford United Hospitals. Um We've just had af er the platform is, is new to us both. So we've just been playing around and I need to know if you can hear and if you can see me. So if you may be right in the chat, so it should be on the the right hand side and if people can hear and see then I'll stop. I've got Charlie, he said yes, but I don't know if, if Charlie could hear um Jess for me. That's good. Yeah, so cheap people can hear. Ok. So what I might do then is I'm now gonna go to er click on my lecture which will be sharing a screen and hopefully you can all see a screen that says orthogeriatrics, fra fragility and frailty. Um And I'm gonna see if it works. So we're gonna use um mentor meter. Ok? So hopefully you've all got a, a phone um or a, a tablet or a laptop you can use as well. And what at the very top it says you go to menti.com, so M Ent i.com and then you enter that code 7527 2507. So that's here that I'm hopefully circling and that question should come up and then that means that I can see your responses and we're gonna make it a little bit interactive. Um And I don't know who's writing what, so you can write anything you want and there's um no such thing as a, a stupid um answer. So, um if maybe people could do that, like I said, if it's working and I'm gonna just text just to make sure that if she thinks it's working, I haven't got any responses. Yeah. Ok. So can you see just call and see if she can? Oh, I pass yay brilliant one past the night show out checks. Um So the reason I'm gonna make it a bit interactive again, I don't know who's, who's answering and who is um who's saying what? But it's just more about sort of active thinking and if you're thinking about the answers, you're much more likely to remem remember. So here men.com and then 75272507, I'm gonna just have a look at the chart and see if people can. How's that? How they managed to work? It? Have a go. Ok. So um as I say so or geriatrics, what is it? It is the the subspecialty of geriatrics which is involved with looking after those with fragility fractures. So we are looking after um frail patients, older patients who are frail and um those who've got fragility fractures. So two but two different problems. So it makes it all quite complicated. Um and always lots to think about a fragility fracture. Um The most well known is a, is a neck of feur fracture. So a kno as we call it a neck of feur fracture. Um and the definition of that is that it's a fall from standing height. So it's a fall where you wouldn't normally expect to have an injury, you wouldn't injure yourself. Um But an older person would fracture because their bones are frail and that's why we get involved looking after these patients. And I think the best way to kind of um to teach about this is to use a case. So I'm gonna use a case of a um somebody who's male who has fractured a hip based on a true case. And it's hopefully gonna bring together a lot of the geriatrics that you have done in um the other lectures of the series. Um So we won't spend a long time on each thing, but you'll see that basically, it's just really the whole of geriatrics. We're going to bring together everything that you've, you've learned. So, um how did it all start So what used to happen with hip fractures is that you were basically combined to bed. So if you were younger, you'd get, have an operation. If you were older you'd be on bed rest. Um, and then have a, like a weight at the end of your leg and be on traction for three months. And um unsurprisingly, people did really badly and it was often a death sentence. People died. And then this Jolly Chap here, Lionel cousin was a um a surgeon in World War Two. And he just, he thought, well, there must be a better way. Let's start actually operating on these people as if we were um on younger people. So we started doing that and he had a massive, this is how sort of orthogeriatrics was born. He there was a massive kind of turnaround in um length of stay and mortality and complications. So that's where people realize actually leaving people in bed is a really bad thing that goes to the whole of geriatrics, leaving people in bed generally is bad. Um And actually Lana coffin. Uh we've got a, a lovely ward named after him Oxford. So he's kind of the father of geriatrics so bad work. So I'm gonna talk to you about Mabel who is an 81 year old. Um and she fell over and broke her hip. So she fell over and she had hip pain. Um and the referral from the emergency department was that she just tripped and, um, then she couldn't get up and therefore it was referred as a mechanical fall, which probably, I don't know, 20 30% of our referrals are mechanical fos the percentage of those which are mechanical fools, uh, is very low, you know, less than 1%. What does it mean mechanical fall? It means you, I don't know, the mechanics of your leg went wrong. There's usually other reasons for falling. And that's our job as geriatricians to find out why they fell and what we can do about it. So it doesn't happen again. So anyway, she, um we don't really know what happens cos she couldn't tell us anything. Um She'd been on the floor for quite a while according to the ambulance staff, no one saw it. Um And she was found by her neighbor. So uh we haven't got any more history. Um But we've got her past medical history from the GP records and um from uh the ambulance records. And so, so we know that she's got high BP. She's had um a heart attack. So sorry about the abbreviations, but an M I heart attack in 2012 and had intervention for that. Um So she had apa percutaneous coronary um angiogram and she also gets some reflux and ingestion. She's got, she's in incontinent occasionally. She's got long standing back pain. Um And she's, she's got a bit of cognitive impairment. So she hasn't got a diagnosis of dementia yet, but she has been referred by her GP because of family concerns to the memory clinic. Um So we know that she's not, her short term memory is not brilliant. She's also got some visual problems. So, macular degeneration, very common in this age group and some cats. So that's quite a classic case. A classic 81 year old might see these are her medications. Um again, a typical list of medications we don't expect you for finals to know the doses. I think probably aspirin dose is worth knowing. Um, it's a small dose and a big dose that you have straight away if you have a heart attack or a stroke. Um, but just to give you a flavor of the medication. So she's on Aspirin for her ischemic heart disease. She's on oxybutynin, which is a anticholinergic medication, which she's using incontinence and then she's on lots of cardiac medications and BP medications. So, Ramipril an ace inhibitor, Atenolol, a beta blocker, quite an old fashioned beta blocker. AmLODIPine for BP. Um, she's on flusemide, just a tiny dose. Has she got heart failure? Probably not, she's probably just got some ankle swelling from the amLODIPine and that's a bit of a, you know, prescribing cascade, but we don't know at the moment. Er, and she was on a statin after her heart attack. Um, she is on amitriptyline, which is a, um, antidepressant and a pain medication So she's probably on, on, on it for her back, maybe help her sleep. She's got lots of anticholinergic side effects and she's also on Doxazosin, which is an alpha blocker and another, um, antihypertensive. Ok. So how's social history? She, um, she lives alone in a, in a flat. Um, but she's got a warden, so she's got a, she's in a warden control.