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that we got. Yeah. Hello on. Welcome, teacher to healthcare Siris. I think this is playing good. Uh, man, it's really good, but I'm going to be your co host for this evening. Just gonna introduce our evening and I'll leave it over to Josh. This is our pediatrics session. It's going to be talked by the 1 ft doctor. Each job shall leave him to explain why he's doctor ish on this is because I wanted a photo of him, but they just doesn't exist Photos off him. So I had to sort of make him out of Lego and Microsoft paint You conjugate how? Well my leg Oh, man resembles him in a minute. Ah, Every six months he had this making the most part sessions. Please do feel free to take notes. A really good way to help remember things and still things your memory and help improve it. Learning. Please do ask questions. We love it when you guys participating farmer. Interesting for us. But also it's it's really good for you to sort of improve what you get out of this session. And finally any bits that you enjoy or you want more about feel free to get in touch, fire email, or we can send you some further resources. You look at anything like that. Inquiries? That's my email address. Most you probably already have it because I've sent emails about this. We also have an instagram that I'm appalling, it updating and a Facebook that I do update. But it's only me. And then just briefly, some of the other stuff we have coming up. These are the sessions we have coming up over the next couple of months. Just putting them in here. So think about things. You want to come along, too. But without further do, then I will hand this over to Josh. You want to share your slides? Yeah. We'll just figure out how to do that. So it's a good thing when I can hear you start a session. Uh, let's go for this one. This'll might work. What can you say? Uh, it says like an add Come out. There you go. That's your slides in my face. Right? I'll get rid of my face. That's that long. Today, off you go. There we go. So hello. My name is Josh. As Freddie is introduced me, I am somewhat nearly almost, Doctor. Sort off finish med school this year. You to start one any about two weeks. Fine on. But I'm gonna be talking today. Don't you to have a little bit about pediatrics on dot How we assess a child on some other kind of keep repeat, this session is kind of going to be kind of roughly the level of, like, a med school or making kind of just before then, if you're keen, that kind of thing or maybe kind of f a r a faith from syndrome ambulance. So just going over what we're going to kind of cover, we're going to learn how to assess things that I'm allergic, child. We're going to todo spots and kind of keep presentations in pediatrics, and we have to investigate a little bit. And then we're going to do a brief overview of pediatric resuscitation on, then end on and I said quiz. If your voice goes or a cough that point, I apologize. I do have covered that will make a day. If you have any questions at any point popping in the chart, either Freddie will answer them directly. Or Freddie Workshop that to me, that's a point. But ask questions as you go along, so we'll start off by looking at the assessment of a child, which is a little bit different, but also kind of very similar to assessment of an adult, which I'm sure some people are kind of very aware off and that we follow kind of this structure. And this is something that gets drilled into us in medical school is quite helpful thing to kind of keep your mind and phrased on what they're doing. So initially, you want to be able to kind of take a history from the patient that should be. Basically, you'll start, and you should get pretty much all of the information you need from the history itself. You don't go on on exam in the patient, doing whatever you need to do. You take some observations that could be things like your heart rate, your BP respiratory rate on then in hospital and it gets kind of on the road. But more so in hospital. You do some investigations, start off things that bedside, maybe some blood tests and read, and that's, um, radiology. And then he'd walk on and do your management and treatment patient on, but there's obviously time. So we kind of skipped little bits of your back and forth so acutely unwell. Patient will kind of do our examination opposite management or the same time, and then go on to your history later on that this is the structure like to stick to. So it's starting off with taking a history in second, but also in kind of acute settings. We have what we is kind of known as a sample history. So s a M p m e. Unless is basically a way off us kind of structure your history and making sure that we know everything in medical school would thought kind of present complaint. History is under complained past medical history, drug history, allergies, that kind of thing. This covers that. But then I saw him, which we like, So this stands for signs and symptoms. So you want to know what some symptoms the patient actually has? What if they come in with you can ask a lot of questions about that which will cover in just a second you think got your allergies? So what is the patient Allergic T But also what happens when they have that. So if they're allergic to, let's say pollen and they just get sniffly. I don't really care that much that if they're allergic to peanuts on, do they stop breathing? I can't quite a lot. You don't have medicine. So what medications are they taking? Both. That could be regular things. So things prescribed by the doctor. But I think they're getting over the counter or any herbal medicines, but also then things that they've taken today. So if they're coming for headache and what were you taking part in tomorrow, then press with your history? So what medical problems do they have? Do they see the GP for anything? Are they have any surgeries in the past? That kind of thing? The last end and outs. So last in. So when did they last house and water on also, um, kind of food? What I've eaten that day a sweat. Is this kind of have eaten anything dodgy? Have they take having alcohol had any drugs? You might think it's not relevant for pediatrics, but actually like some kids age 12, taking drunks, so we need to know about that on then else again. He wouldn't ask it for all patients on adult in pediatrics. You would ask about out. So are they doing fine? Other going fine. And then event history. So what's actually happened? Can we get that the time frame? So, in terms, off sides and symptoms, we can kind of turn this in, turn our pain history into how we go about discussing signs and symptoms because most of these things relevant. So we, uh I kind of know how to take a pain. History of Socrates. Other people might know. It is peculiarity that this isn't she stands for site and whereabouts is the pain or what's that other symptom they're getting? When did this start on? How quickly that come on, What's the character of it? So how they describe the pain? Is it kind of dull crushing? Is it stabbing? That kind of the radiation doesn't spread anywhere. Associated symptoms. What else is going on? Same time timing. So how's it changed over time? Does it come and go? Does it get better? Get worse, then exacerbating on relieving factors. So what makes it better? What makes it worse? And the severity a lot of these you can kind of applying to any sun isn't really like, if you much in fishing. Um, see with a rash. Okay, where is the rash? Where did it start? Can you describe the rash to me? Have the rush bread new, Uh, is it itchy? Is it bleeding? Is it weeping? Has it compatible? Worse. What makes it better or worse? And how bad is that? Like it all applies total different symptoms. The main difference between adults and pediatrics is that usually adults can answer these questions. Some kids might not be able to. You have to find different ways off, converse in with the child to be able to actually ask these questions and get this information. You can ask the parent, but it's usually better kind of for the child's sake to ask the child. Most of the questions just have the parent kind of supplement or agree, but you should be able to get a lot of this information. But you'll just be really careful with your phrasing as well. Because if you go, uh, what is the character of your pain? The kids could have no idea what you're on about. Then there's another come specific things that you have in a pediatric history, which we don't tend to have in another one. That's actually really important questions to us. So especially in younger Children, definitely babies, probably toddlers, even maybe up to kind of really teenagers. Really, We need to ask about the birth because they give us a lot of information about what actually is going on with this patient. Is this submit that could have happened in Started Isn't you before they were born, so you can split this up into three. The first section is in terms of the pregnancy, so you usually ask the parents this. So whether any problems during the pregnancy, nice open question. Is that anything going on? How the scans did? They have said it's normal mothers to kind of have two scans. So wanna roughly 10 to 13 weeks and one at 20 weeks. But any more scans suggested that's just it might have a medical condition or something that might have kind of popped up on those guns that we need to be aware off. Did they take any medication during pregnancy? So it's absolutely brilliant. If they've taken a low dose off photo kassid. That's pretty. That can help prevent that kind of issues with the spike. However, if they've taken higher dose, so what? The 5 mg rather than 400 micrograms, then it's just that might have a medical problem. Or the kind of this is risky if they're taking BP medication. It's just in my had preeclampsia or insulin for diabetes, that kind of thing. Give us an idea about what might be going on and then the birth itself. So how was this baby born Onda? Kind of. How long did it take? And also what, Yes, station were they born up? So babies who are born that kind of sub 30 weeks kind of early thirties and they are probably gonna have a stay on Nicky and they probably have problems breathing. They have lots of little kind of problems that might carry on and present a little bit later. So, for example, a child, he they have a prolonged delivery that's early on that ends up kind of go to C section. They might have a high pox sick injury, so they don't get enough blood to the brain and then develop. Probably called cerebral palsy. That is something that could happen. Any admission to NICU or Scurvy, which stands for the special care baby unit? Why would they admitted they're they're all helpful things there from the birth history was something that you kind of ask about younger Children. This is something you kind of go for. The older Children can maybe turn on words, but this, I guess, is the lower limit definity majors. It's social history. And actually just tell you a lot of one key thing to kind of say about this is that you don't want to do this with the parent present, because in this you're gonna be asking about things like sex and drugs and alcohol. They're never gonna be honest with their parents there. So it's really important to kind of get a parent away on, Then ask these questions separately. You gonna need to think that really kind of a clever way of asking it. So it's not too blunt. So we use the structure. Heads with three s is not going through what these mean a Z 03. So start off the hatred, brother. Home life. So what's going on at home? Who do they live with? What kind of house do they enter then? Did they get on with? People are home. Do they fight? This'll kind of thing. Are they care of for anyone at home? Education or employments? And where did they go to school? Did they enjoy school? Does anyone belly them at school? And I have friends. What kind of subjects? They're doing what they want to do with their life as well. A school that I have a kind of a job they do on the site. How much you think I paid for it? What did they do? Activity. So what kind of things that they enjoy doing? Do they have any hobbies that they do? Any sports? Drugs and drinking? So do they drink any alcohol? Do they regulated the do it with our friends? Do they take any drugs? Have they ever tried any drugs? Also, you gotta think if they're doing these things, someone has to have supplied thumb Onda. If they're supplying them, you want to make sure the kid isn't being exploited. If they're 16 year old and I just getting drink in the park with their friends, that's probably not too much of a big deal need that kind of words about it. But actually, most teenagers do that. However, If there are 15 year old who's being given alcohol and drugs body lets a 40 year old in exchange for other things, then you're starting to get worried about my business kind of exploitation going on here. And that kind of leads onto section relationship. So are they. Do they kind of have a partner? Have they been in a relationship who, with with a similar age, kind of that kind of thing, mental health thing so so far depression, suicide in, obviously in kind of a very sensitive way. But how do they feel in terms of their mood? Is that good? Is it bad? How does it vary if they ever seen any help for and then safety? So do they feel safe at home? Do they feel safe at school? They feel safe on line is what he thinks, like social media can kind of really get kids down. So this is a way we structure a social history, which, if you got time to take quite a while to do and it should be more of a discussion with the kids. Teo really get an idea about kind of what their social life is like rather than kind of very specific questions. And then there are some very specific questions that you do need to ask which all pediatricians love So Internets, what they have in in terms of fluids and food. If a kid's l that probably not gonna be eating as much, but and they probably won't be drinking as much, but that's probably quite normal as long as they're getting something on board. If their baby, how they felt they breast fed the exclusively breast word they formula fed a bottle fed with breast milk are the kind of wing improving normally. So if a kid's not wearing a much you've got left feel wet nappies, it's just it might be dehydrated. Did they see their normal self is really interesting? Want to ask the parents because that's usually the first thing. The first kind of marker that will give you something might be going wrong, that they're just not a normal self, and we'll see you in a little bit, actually, that contribute towards actually worrying a little bit about child development. So what's their milestones? Ben left so far, You have an acute problem, but definitely for a chronic problem. Is this kid growing? Normally? It was like great history that also other meeting the milestone. So were they sitting at the right time, where they talking, walking into socialized all right times. There's no need for you to know these how that that kind of things that we might ask and then the growth history so you can see kind of like where they growing normally or actually have. They has the growing stunted, and you can look at a thing called the Rent book, which is a kind of little book that parents should carry around with, Um, all of the time, it should also have that. I think there is also an app, but this contract, things like immunizations, but also their growth. So is this kid growing and normal, right. Are they going to quickly work here? They're going to slowly and that kind of start to taper off. Um, and that way we might worry that there's some sort of underlying disease going on. So these are all things that we can ask a pediatric history. Loads of questions obviously don't need all of them all of the time. But there's things that we can ask to try and get a good idea about what's going on with this child taking a history, we obviously to examine the child on in order to kind of show you a concept, I'm going to show you kind of some videos. Now. Hopefully, the sound works. But if the sound doesn't work, it's not too much of an issue. Um, what I'd like you to do is just have a look at these videos and note down for the three Children roughly how sick you think they are on why you think that what things you spotting that make you think of this child is kind of sick or not very sick. So here's the first one. I feel light. Uh huh. It's moving. I got that. Yeah, Kerry's maybe a younger kid. That was a comment about the one on, and then I take a look in the ears so years could be a particularly challenging piece off the exam. So here's the order. It'll did sort of neck defeat. Now you the whole hee ent exam eyes, nose, throat. And then here's so some Children go crazy. When you look in their years, some Children let you look in the ears. You're crazy going. Alright, so he's going crazy. So I say, Oh, man, this is gonna be really cold. Your exam. But I gotta look, you're infected. Probably those common in this age group. And so, yeah, that was the first one. Um, Freddie, can you hear the sound from these? Yes, actually. Pretty good. Yeah, she was quite unmuzzled. A swell was quite impressed. So here's liberty. That's number two. And then chart number three. Okay, so that was kind of the three Children. What? Like, you know, it's just sort of tell me what's, um, differences. You notice between these kids on just for the sake of everyone watching. So you don't know if you know where Microsoft Teams is? About 32nd delay between us speaking and you hearing. So we'll give it a good sort of 60 seconds at this point just to make sure you guys were going to hear that And think before we start having with, um, answers, I must have it with some of these videos. I always do. You wonder why people are filmed filming their Children at that moment in time because some of these kids I'm sure you can appreciate are quite sick. Yeah, it's a bit concerning that. That actually filming them and not just off actually getting some treatment. Um, sometimes, where is that helpful to film? Okay, so, like, if they're having a seizure on, don't have seniors, but you don't know what's going on, and it's never been caught on camera. Sometimes the doctors will say, like, let them have the seizure for a bit and then film it just talking to your topic. But for these, like he's getting treating well, we finally got our first one. We got a child one well, child using distraction to get an examination. And it's on a split. First child is active alert and seem to have a very minor illness. And then we got, uh, but the same person is put a second child appeared Tests of the truck, your hug and wow. Uh, increased market breathing. That Okay? Yeah. So the first child, you can see that kind of moving around that playing they're happy that smiling there, interacting this kid's is probably not that sick. They might be in for a little problem, but actually that might be finding, Um And then we said Charlety, yes, you've definitely got some increased work of breathing on what? You can see that on their stomach. Is that reps kind of tugging in under? That's no, it's kind of a sub costing recession that basically sign that there. Really using a lot of muscles to black. Hard to breathe. Yeah, So it's almost puts the accessory muscles usage second child on then for child three Someone's put stride or yeah, so that can had Strider pronounce it. Strider, Strider, Strider, Strider Strider! I thought so. Yes. That kid is working really hard to breathe on if maybe if I go back to just kind of player, But all they go, I'm looking at this kid. This kid does not look well at all. I can't remove that barrier for some reason, but yeah, you can see this kid is really struggling to breathe destroyed or they just sort of lying there with our gym. Not really doing anything. This'll kid looks sick. Um, and they're clearly struggling to breathe on this thing mentioned on the video that was seasonal breathing is again. It's like another guest regulated way of breathing. They're using every muscle physically possible to try and breathe. This is kind of it's basically a terminal sign. This kid is sick and it happens. Really trouble with that breathing? Got anyone else? It looks like you're on. So this is what I came up with, um, using kind of a structure. So in child one, there's a normal tyrant that it will hold themselves up right there, interrupting. They're looking around the communicating with everyone in terms of the breathing. There's no obvious extra sounds in here. It doesn't look like a struggling to breathe, and they're sitting quite normal position on. But they are good current there. Well, perfused and kids to the baby. They're not really using their loans. That kind of line, they're not moving. They're not really interacting with the world. Normally, you'd expect a baby to kind of be kicking about whatever. I'm not crying, which is the thing babies do. A lot of generally a crying babies are fine, baby, we don't really worry about them, but a quiet baby is a quite concerning baby, you can tell that Trying really hard to breathe and they've got these retractions under their reps and they're flushed kind of bright pink. And you got kids three who are looking out of, um, if you just looked at this kid and when you kind of be able to say, this kid is sick, they're very sick, that pale. Then what? Interacting. They're basically on responses because they're just focusing on breathing, and they're not doing that very well. They've got a paradoxical breathing so that breathing I/O, um, they're kind of stomach is breathing in the sea. Salt person. They're really struggling to breathe. And they got this by phasic stridors. So they have strayed off, or what's suggested, like an upper airway obstruction when they both breathe I/O. And there was a very pale as well. So these are things that kind of spot it on these I could have got this idea from What's the thing is the pediatric assessment triangle, which is a nice little way of kind of assessing kids using three very basic things just by looking at the kid really on this will tell you enough information to figure out whether this kid is sick or not. So it's starting off in parents. Basically, one of the kids look like on you can helpfully kind of break this down into the Akron Tickles, which are like eso tone. How is the kid holding themselves? Are they flailing around or are they just kind of lying? Floppy? Are the interrupting with the world? Will they play? Or will they just sort of my They're not really caring? What, what's happening and consolable So are they consolable by you? Considerable Bye, Mom or a parent? Or actually, they're not controllable whatsoever. You can't get him to calm down. How are they looking at world? Kids should kind of follow things around. Look at everything on the wall. If there's a picture of something that spot up but a sec, kids might know and then ask the speech or cry. Are they just screaming continuously? Are they crying? Are they talk to you that kind of thing and then black of breathing. So this kind of is a bit like a B C, but his appearance know airway. So how is that breathing other, any weird sounds that you can hear. So, like Strider in that third kid, are they positioning differently? So, kids, for example, having the asthma attack might do something called tripoding, which is where they will set forward because that's the best way they can open up their lungs. Well, they have the tractions. They could have the tractions at the track here. This track your tub, they might have intercostal subcostal recessions on. They might be flaring or nostrils. This is classic having babies. Do you have to see their nostrils flare open with as they take a breath in? Not to sign them up to struggling a little bit to breathe and then circulation so often? This is just kind of How does the skin luck developed tail? Do they modeled? So that's that kind of webbing pattern you can get in the skin. Sometimes do the X I a nose or blue, which, actually that second, the second baby does around the lips, even with the pink and all they flushed. It's a bright red, so lots of things you can look at and actually you can tell just by looking at this. Is this kid really sick right now? Or actually will that be okay for a little bit once we figured out. Actually, the kids. Okay, we often if we think about 80 you've got early breathing circulation there. We got disability, and that's usually our neurological function. But I'd like to know, How would you assess urological function in, Let's say, two year old or another child again, We'll give it a minute for the responses to come through. If anyone's got any other questions at any point that you just throw them on and either Friday or I can answer them comment but still right at the top, which was put there x 24 weeker and that they they still have to explain that every now and then, even though they're post 18. Yeah, and I was like, 24 week is a pretty, well, pretty rare. I think it's fair enough to ask questions, especially being kind of 18 plus years ago. Oh, yeah? Well, I think youngest baby is like 23 4 leaf. Well, 33 and six like kind of thing, So yeah, 24 week. Very rare back in the day. So I got some answers for you here if you'd like for this one. Assessing neurofunction in two year old, someone suggested a pediatric adaptation of the GCS, which is nice idea. And then there's GCS Niro obs, monitor at your labs, motor response and people response. Normal set of labs, too. How you that's the answer is this far anyone's gonna add, just get a, uh, making that the 10 seconds, if anything else going on three. But yes, the people said GCS definitely in older kids GCS, However, in a baby, for example, I believe there are pediatric. You see, it's kind of equivalent, but in a baby, how are you going to tell them to move your arms? They're not Have to understand that and also don't have toe be orientated and have a conversation with you in order for you to mark kind of voice. But if there is a pediatric adaptation, GCS but not too sure what it is, these your the's airway beyond what I was thinking. So actually, their ovary medical things, but actually with pediatric, you get really creative. So if a kid is running around on, do waving a phone, sort on shouting, they're basically urologically intact because they've got good motor function, they're able to run around and hold things, which means the sensation is probably okay on. But they're shouting is that voice is okay on We worked with this question. Just it takes a little bit, but I'll talk about after. Just watch this kid kind of run around and play this. Oh, like bubbles. Oh, but yeah, if you think what kind of watching this can, in terms of the arms kind of wave, thumb around, grabbed things, reach out the bubbles. So you got good power and she looked good tone. She's able to move thumb on. She got really good coordination. Is working good for actually hit these bubbles in terms of lower limbs? That's big concerns about, you said You run around and walk around. He's got a little bit of what's called this like toddling gait, which is a little bit disorganized. But she's a toddler that's to be expected, and then nerves that the head neck So she had to speak of facial expressions, that kind of thing, so, actually probably neurologically intact. Do you really need to do all these like fun tee tests? Because you can just look at a kid on, There's a company on nine I had spotting the second child, which how has developed this basic child assessment, which is roughly a three minute assessment. To get all of the information you need to try to go with the kids sick on up and also to figure out roughly what's going on with them. It requires a couple of skills that a lot of people that have been trained in it you won't have things like looking in the ears. So I've created my own version, which is kind of adapting it for refuge for first aid or work level. So first of all, you do your assessment triangle. You just look at the kid on you. Look at how they look in terms of the parents that work of breathing and the circulation and the A so airway. Talk to the child, see if they can talk back. Is the airway patient be? So count the rest of tree right, Um, and that's how quickly that breathing and look for any increased work of breathing in any airway noise is eats a temperature of the periphery. Just have a feel of the hands on a cold of the war. Do a pessary refill time so you can squeeze on the nail bed for five seconds and see how quickly the color comes back. It should come back in about two seconds. Do that both kind of on the hands or the feet and then also the chest as well. And then you can cut their heart rate as well in terms of your article function, see if they could move their arms and legs, convict or facial expressions going to be high fives, that kind of thing and then have a good look kind of rashes and skin lesions and have a quick product that tummy is up on. This will give you a good idea of maybe what's going on with this kid. If you are trained to do so, a lot of the times we'll listen to the chest as well. Just see if there's any extra noises on. Do you have a listen? Have a look in their throat and also the ears, which they really hate? That a lot of times kind of unwelcome have just a simple viral kind of respiratory tract infection, and we'll pick that up from that. So once you got on from doing your examination. Need to move on to our observations on, but observation is on their own kind of helpful. But actually, if I told you a four year old kid had a heart rate of 120 do you know if that's good or not? Is that high? Is, like, low? Is that normal? I don't know myself. Look for you. Yeah. Roughly 124. 25. Got a graft on the next page. But look, that's about right, actually, um so with kids, their jobs change. We have kind of the age, but also they change with sickness. So if you look at this graph that I made, we've got a job. The bottom on, be kind of the ob Stand aside, This is just a rough idea, and you can see that heart rate, which is this blue line when they're born with 1 50 is actually pretty good on. Then it decreases roughly until the age of 12, when it tends to be similar to adults on that part of the eighties about right. You don't see that BP, we'll start real low. You think it's a tiny little baby you don't meet need much of a pressure to pump blood around the tiny little body. But when they're in adult or 12 and above, they're going to need a little bit more, uh, BP to kind of get that blood around the body that they respirator. You think time a little bit. Your lungs are going to breathe really quickly to get the oxygen, whereas nice, big kind of basically adult lungs don't agree that quickly to these. This is roughly how they change, so heart rate gets lower. BP goes up on respirators down things like temperature, oxygen, saturations on blood sugar shouldn't be the same. They don't change on, but it's a well. I've been having these observations, but you need to stop. Turn them into a score to figure out maybe how sick this Kidder's. So there's a think of the pediatric early warning score, which is very similar to the national early warning score or the news score on you Stay that you might have heard off, however, because the's labs change with the age you needing aged specific pews chart in order to bed kind of have accurately, so if you have a 12 year old with a heart rate off. Let's say 70 but you put my newborn chart. It's going to say that world in time Codec, So even though that's normal for them, you need the right chart for them on. And then there's just one extra thing that I wanted to kind of pick up on, which is kind of reference to earlier with this kind of how the parent sees them. So there's a thing called a nice traffic light guide, which is essentially for any kid under the age of five who has a fever. It can give you an idea of whether you're not so worried about them so green. Low risk, whether you're just worried about them all with your quite worried about him. So you look at things like color, so that's gonna be in our appearance or a circulation. Are they normal? Color of a pale if they look pale to you? Is the medical professional that's a brand that's fair risk if the parent goes, I'm not sure something a bit wrong, but you don't really notice it. That's gonna be kind of into media know what things are activities How are they responding? Respiratory. So are they bring normally at a kidney IQ? Are they grunting? That's the new facility that you're struggling. What's the circulation like? Do they have kind of normal eyes and skin moist mucous membranes? Is the inside of their mouth quite moist? Or is it dry and then, actually like, Is that even really high? And they're quite young. Have they had a fever for more than five days? You start to get worried about Middle Kawasaki disease, which is like an inflammatory disease that can often affect the heart. Estimate. No need to get checked out for if they have a fever more than five days on other things. So these are you, like your meningitis signs. So these are things that make you think, Actually, is this kid with a fever fine Or are there quite a while? It's another thing can use if you just google nice traffic light system. It'll come up. Oh, kind of assessing a child as focused. This on a little pretty hospital. E. I'm not really gonna go into investigations of management too much, but there's a little bit in the next section, so I'm going to go over four conditions, the first one of which is seizures. So your first data that took him you're walking back from lunch on. Did you hear a lady screaming? You walk over just a bit, a bit nosey, and you see a two year old child on the floor season. There's a crowd gathered, better watching. But actually, no one seems to be doing anything and then wanted you stood there holding a spirit. What you gonna do for this patient? While they're given this to pull 3 60 seconds, there's a question here. Which is how do you combat the fact that isn't a nationalized pews system? Yeah, Uh, just because it's the it's just use your local guideline. Yeah, do what you're told your local authority, but they're all going to be basically the same. Um, so every trust will have a version. I imagine they will will be pretty much identical. And if they're not, it literally like the heart rate is maybe, like I five beats different in each category. Whatever. That really doesn't make too much of a difference. Um, because, uh, if you have, like a baby a heart of 150 vested 155 is not very different. Yeah, so just use your local fuse or just Google, Eddie. Like if you google a Penis chops whatever age, I'll come up and it'll be fine to use. Really? Yeah, I figured that part of the answer any other time. I think it's interesting the what happens when you're transferring sick kids across trust lines, but I guess that that's something more to worry about. Generally, I guess the key is known to be sick. So you just get this a sick child kid is sick and you've looked at them and you've gone to their sick. You're going to expect that Obstipation that off? Um, there's really ever gonna be a kid that has a really high P score that actually looks fine. Um, so there's different ways of kind of telling. And really, if they're sick enough to need transfer between hospitals, I don't think it matters so much that there peaceful changes by one or two just because of the guidelines. Think you have some answers? Yes, we do. So, uh, for my first comment that we got check the safety of the child and the surroundings. And sure they have space and no one holds the jaw. That's anything in their mouth. Time the seizure. Find out if previous seizures and if they need hospital care and someone else. But start timing this seizure. Secure the scene. Moved bystanders back cetera Until the child isn't risk. Hurt themselves on environment. Remove the spoon. I I thought the spoon was being held by an idiot. Yeah, but still, get out that situation. Spoon in, In in. Uh, that's good. I fully agree. They were both fantastic answers on definitely things he would all do, and actually mostly in the order. So if you're much in the situation you've got loads of people around. They don't need to be seeing this. It's gonna be bad enough for the kind of the parents and a kid. Anyway, all those people who go away, if they happen to be a pediatric doctor or pediatric nurse, whatever sure they can stay there, can hang around that can help. Everyone else could better off. If you want to be a kind of get some help, because if they're seizing, you don't want to go to stop. You want to make sure you're getting some help. You want to protect them from harm, which would step. So you got a coat under their head, Not your own. Coat your own world. That comes what comes. First. Get some answers. Coat. Put it under their head just there. It's market. Don't put anything in their mouth. Used to be a thing that, like they said to put like a student or something in someone's mouth so they don't bite tongue that What's worse, a slightly better tongue or choking or spoon. I'll let you figure out what kind of you're you're dealing with the several fragments of teeth when you've bitten down very hard or there's a metal. Yeah, anything like that, I think a better and tongue is flying is gonna hurt a little bit, but whatever. Um, then, yeah, time the seizure site on. And when we do intervention kind of in more of a medical term. Lesser 1st 80 kind of tab. We look at timings of seizures. Usually Teo figure out roughly. We're gonna give things, so if it lasts more than five minutes will probably start to do something about that. Yeah, protected from home time. It and figure out what crowd staring. So when they stopped, you don't need to figure out actually what's gonna happen. So this is where your history comes in a little bit. I will cover this in kind of a little bit next. But one of the courses of seizures is Aloxi, which is a really common condition. Kids, which is basically, yes, a list of different ways that kind of seizures can pop up on. It's just one kind of collective condition that basically means that your brain, the electricity in your brain, is doing this and funky things. It's not quite doing what it should do on do. Occasionally you got big wave electricity and areas because you have a seizure flow the different types on D. Actually, some kids can have hundreds of seizures a day on, but it's really caught kind of important here to go there. What apparent saying If the parents are saying that kind of, Yes, this is that normal, that usually have a four minute seizure. They sleep for 20 minutes, then they're fine. Whatever. I don't care. I carry on your thing like they you're the mom, you know you're there and We're here to help if you need us like whereas if it's the first seizure, that parents gonna be quite panics, and that's way you can kind of help out. There's lots of different times that you used to describe seizures so generalized. This is focal. It means is the entire brain involved or it's just a little bit of brain involved for having a big shrinky tonic clonic seizure. That's gonna be a generalized seizure. But if it's just that having twitching, that's probably focal, you've got complex. This is simple. So complex means that their consciousness is impaired. So again, like a tonic chronic, a big, shaky seizure on absent seizure, that kind of thing. That's a complex seizure. There's a simple one is just one where the hand again the hand is twitching, but they're still aware that still able to talk to you specific types. So you got tonic clonic, which is your big kind of you go step and then you go shaky. You got your absence seizures, which you have very common in kids, so they'll be done. Just stop doing whatever they're doing is start off into space. Something carry on your myoclonic seizures, which you like. You're shaky, hands on your atonic. So drop seizures, which is where kids basically just go immediately floppy hit the ground and they kind of come back in their fine again. Uh, the two that you kind of need to be aware of the tonic clonic the absence. Really, That's one of the epilepsy, another really common cause off seizure kids. This thing called fever convulsions on. So this basically means that little babies and younger kids don't really have a way of sweating or regulating their temperature to are. So if they get an illness or if they're wrapped up to type. Actually, their body doesn't really know how to cope with that fever. And I can't really do much about ER, so sometimes that brings us go. Oh, you know what? I'll have a seizure. It's just a weird coping mechanism, for usually they're not massively harmful for the kids. They're going to go to hospital anyway, just because they've had a seizure, They they need to make sure it's not something else, but nine out of 10 times. This will be a fever. Convulsions, especially got fever. I'll play the video shortly, which kind of explains. Everything you need to do is quite good video, but the main things are called them down slowly. So take off running out outside layers, open some windows. Don't use things like wet towels to calm down, because that will call them down too quickly on. And then yes, and I left the hospital. A lot of kids who have a fever, fever, convulsions will go on to have another seizure at some point. Usually it's another fee bronchiforce that Onda. Some of them will go on to actually develop epilepsy, but not the majority of the minority. Maybe a couple of percent will actually develop seizures later on That this they're not really linked is more of a coincidence that they're kind of like this. We'll play this video. It's warm in here. Emily. Protect them from injury. Do not restrain them. Reduced their temperature by removing clothing. All right, I think I maybe got okay. It's not cooling down, honey. Okay. When the seizure is over, help him to rest on their side with their head tilted back. Remember, protect them from injury and reduce their temperature. Okay. And also send in the hospital, which they failed to mention that they're probably going to go in just for a checkup, then generally the seizures. This is roughly how we monitor so you, no, all patients who have a seizure needs go to hospital. If that epileptic and they have 10 see for the day and this is just a normal CT here for them, they're not going task for 10 times a day, like that's really no, it's not a good use of the time. They don't want to do that. They don't contribute anything in hospital. So we usually say that paint stripped should go in if the seizures more than five minutes long, or if it's more than five minutes of their normal over, it's more than their normal Sorry if they have more than two seats, two or more seizures in a row because normally ask you that that's not have had two seizures is that they've had a really, really long seizure on and the time in the middle of just one season for it. But the brain electricity is still going on if they're postictal. So this is what we call the phase where they're They just had that seizure and they're really drowsy and sleepy. If that's longer than normal, we could send them in. And if they got any other injuries, so if they want their arm on something or if they got a head injury, that probably to go to hospital is off. And as you mentioned that the main principles kind of protect from home, get some help on know when he's called the ambulance questions about that one pretty no massive. Yet if you want to start talking about the next one that people have questions, do you feel free to ask them more than once when you come up with? But so you start on the next one and see if anyone that's safe case to we have a three year old boy is presented to the treatments into this with his parents with leg pain. I was limping what we think might be going on here because they don't have any idea or can think of any kind of examples, and we'll give the country minute. We'll say this throat of a child with the lip Or is this just a photo of the regular child who happens to look a bit like a little. I mean a giggle child with a limp. It this came up. That's the best I could find. So let's go with a limp. The power of the incident always amazes me. Not saying anyone. Answer. End of the 10 seconds if it comes from sure. Yeah, that's fine on me. But they could be loads of things going on basically on. There's quite a few things that could cause it. The first one is trauma you can appreciate. This is an X ray off a leg. This is a kid's leg. This is the femur, so they're five bone. This is very broken. This kid will not be walking, but this is the best kind of a something like a get things. Kids will not be walking, but they might. If they have another kind of injury or two that leg, they might not be walking. It's very important when kids have injuries that you consider nonaccidental injury. So the kid comes in with an injury to that back, for example, that the parent goes, Oh, they fell over. Actually, that's not very common. That mechanism doesn't really fit the injury if they've got greatest on the hands and the knees and a parent goes, they found over sure, that makes sense. But if they've got an injury to their back or the inside of that FIEs or that kind of thing, I'm concerned that might be some kind of abuse. And then going on there, you got infection. So you're jumping step sick arthritis. This is a basically a big red hot swollen. Then there's an infection of this joint. This could be really sick. Don't have a fever. You have a big, red hot, swollen drink, but they could have another, like effective about, Um, I have a thing called transient songwriters, which is where the fluid in your joints can get inflamed after like coughing cold. That's really common in kids is what they might have a cancer. So hopefully you can appreciate this bone that's not normal, that I get not causing pain. They might have some problems with their hips. There's a couple different ones. So you think like a Sufi or slipped up her femoral purposes. No need, no need to kind of understand what that is, but actually, like the kid comes in with knee pain actually might be the hip that's referring the plane well, it could be kind of sickle cell, so getting kind of blood clots with him that blood vessels around the joints, that something loaded. If it causes that, it's about to note that like isn't just trauma could be other things if they have a tiny little bit. But otherwise you're not worried they don't really to go in, but otherwise they need to get checked out. If they're not too sick, they might not eat good hospital that they definitely to get the GED pretty quickly on day. One thing we always ask about is when. If I have a cane, do they get a night? Is that wake up a night? That's one classic thing with cancer is that normally your immune system fights cancer and your immune system really good fighting it And it will suppress it a little bit, however, and your immune system's kind of driven by cortisol Cortisol peaks is a hormone that's gonna make by the adrenals. It peaks in the morning, and it kind of goes down for us today, so your lowest course, your levels are at night, and with low cortisol levels, you get low immune system function, which is not from what if you got cough or cold. You feel dreadful at night. But it's also why can't with cancer you get in that night slats on also pain at night because this tumor is growing a little bit quicker at night than it is in the day. And obviously, um, actually do a full history and examine that kind of thing with the kids with pain. We need to kind of assess pain. This covered from ways of doing this. And obviously, if we ask, did uh, who has two years old? How would you rate the pain out from, what, 10. They're not pure. That means they're not respond to you. They're gonna carry on doing whatever they're doing or sitting in pain. So there's different schools we can use in a baby is the thing with the flax score, your sense of face, legs activity, crying controllability, just a little chart that basically gives you an idea of how the baby's acting on how sick they might be. The younger trucking use how they're acting so a little bit like the flat, but maybe just kind of sitting there happily playing or are they screaming holding that leg? If they're a 48 roughly, you think of the one Baker face is for So can you get me to a point to the one you think is you point to. What it has is nothing. I want, um, functional. So what is it stopping them from doing if they in pain? But this is from the TV all day. They're not in that much pain. So then case three. We've got a one after a girl is brought to the treatment center by her mom, who's quite worried about her. Breathing appears wheezy on this noticeable facial swelling, and her mom mentions that are older. Brother gave her some of his lunch, but short short was in it. What is most likely going on here? Do you reckon again? Get the obligatory minute again. Who took this photo? Least it looks vaguely like someone's doing something about it. But I think I understand people who take time to take photos. They're sick. Children or friends be much more worried. Doing other things. Uh huh. That's my parenting. If you think back to the parents looking at this kid's this kid looks sick, but look well, um, so you can immediately tell you what they're allergic Reaction? That's a little correct. Answer that. So this is a type of allergic reaction, but actually looking at the lips swelling stuff, this is a full access, which is a life threatening allergic reaction on Do usually comes about after being exposed to something. Um, usually, like nuts sings that kind of thing. Um, however, um, if you kind of look at the capsules of it could be loads of symptoms. So if they've had an explosion to something they know they're allergic to and they've got some symptoms or something going on this problem Fluxus or if they've probably been exposed and they've got some either respiratory problems or difficulty breathing or always they've got some care of rash or kind of that kind of thing. They got GIC upset. So diarrhea, vomiting or a low BP or other symptoms? Yeah, suggest it could be that on. But we'll treat this CT. Basically, I give them their on EpiPen. Call on a nine on getting ready to treat an unresponsive patient. Does this patient to be sick and you can repeat the EpiPen every five minutes or so. Hopefully they'll have to on them because there's no ambulance. It's going to you in five minutes, especially, um, that usually they don't carry both with them, but they should guilty case, for we've got questions and, um, after this. So we just ask this question. But your first aid, or more than a 50 year old ball go, comes to you with abdominal pain. This is your history. So she's got some right lower quadrant abdominal pain. It came on over the last day or so. It's sharp. Just got some pain. The tip for shoulder, she nor yes, you get. It's getting worse. Nothing makes it better or worse. It's going to be out of town. Otherwise, nothing else going on One really important thing here, which is actually highlighted by our heads assessment, is actually what pregnancy is. Only shelf there could be pregnant. Um, it's a thing a lot people avoid. Just it can be the awkward, and you definitely want to make sure that parents are around when you ask, because the parents might be quite mouth. But it's a really important differential to think about, like a topic pregnancy. There's loads of different things that cause abdominal pain. Kids get it all the time, and often it isn't anything specific causing at that. These are the things we need to worry about in this myself. Diagram, I found. So if you think about where the best way I like to think that abdominal pain is, where is the pain? So if it's a top of the stomach, you might be worried about the pancreas and pancreatitis or pneumonia, because that can kind of roughly set in that area. Or maybe like a reflux, that kind of thing. If it's in the middle, this could be some it from the middle. So something from the battle it could be. I think I'm using that at night. It's which is basically like some of the lymph nodes in your guts, getting a little bit inflamed because you got that cold. It's quite common course, and or it could be that that sort of just generic or you got something like diabetes going on. It's cause the abdominal pain you could have like hernia. You could have 10 deciders. You could have gynecological things, so they're very insist That's ruptured that would be a very classic kind of a sudden onset pain on day. One key thing to remember is that in boys especially. But you need to ask about that specifically testicular pain, because they might present to us through the abdominal pain. But actually, they got testicular torsion. And that's what you need to really ask about, which is where basically the testicle twists on itself on. Do the blood supply can get kind of cut off is a really important to ask about. So go home from we're just going to talk about resuscitation very quickly before we come to some questions. So in little kids, basically, kids compensate really quickly. They compensate really well, now, look, look sick, but they look okay. And in the crash, and they'll go off really quickly. And this is what you should do basically, in this situation. So if you didn't unresponsive kid gonna get some help, open the airway. Um, if they're not breathing normally, which is two breaths in 10 seconds you get five rescue breaths, check the signs, other signs of life and see if that works. If that didn't work, you want to start 15 to 2 just compressions to rescue breaths and then get some help. Get a lot of help. And here's a video of Explains that and talk to threat. Press you breath. Open the airway by kids in their head back with one hand on the forehead and two fingers under the chin. Because any obstructions from the mouth to clear the airway only if you can clearly see something, keep it a head in this position. Pain. Too soft part of the nose. A lot of the multi fall open. Take a deep breath and Syria mouth around. There's You're still into their mouth, given a rescue breath in about one second digested rise, you move your more from there's I watched that just fall. Give them five initial rescue breast. Other boat, one breath for a second like this to the chest. Compressions. Needle mother child beside the chest, place or in one hand on the center of the chest. We know the child with your arms straight and press down vertically. One third of its debt. We used to pressure of the chest to come back. Oh, we don't. We move in your hand from the chest. Repeat this to give 30 chest compressions at a rate off 100 to 120 BPM. This is quite far on to help you. You can sing nearly the elephant, which can help you to keep up with the pace after 30 chest compressions, open the airway. I'm getting further to rest your breath. I'm sure you're getting point that, um this is obviously for a can't say this is anyone before the end of one, up until 12. After 12, you start using 10 hunts for CPR. Um, baby, baby CPR is crucial to know there's a few simple steps. So here we go. Get you a food. Take a chart first. You miss school, wait for the ambulance to arrive, Paris and tips to have your baby survive your baby on a nice flat service until their head back. Don't be nervous. Nervous? Okay, you five months over the mouth nose. Not sure what we mean. Well, here's how it goes. 123432 fingers upon the chest pumps that time. No more. On a way. That was fun of information. Her work here is done. Oh, I need a vacation. Okay. What's in a very dark evening open to covered and found those puppets in my cupboard. And it's terrifying, just terrifying, especially the egg. He's a scary looking guy. Eyebrows are about. It's this off semi humanness of it. New has a flesh colored egg. No idea. Let's not think about flashcard eggs too much. Um, yeah, that was a little bit recess on drinking. For the sake of time, I won't play this video. Excuse me about post in the trap later to be half a look in the right time. So that's basically everything. I've got some questions which hopefully should be okay on. Pop your answers in the trap. So question one. You got four year old girl presents your treatment center with her mother. She's flopping. You got a swollen face. He's clearly struggling to breathe. You got a spool red mark on her leg on. My mother says that she's allergic to bee stings. What is the first thing here that you should do? Your options are fine. No, no, no. Administer oxygen. Assist the mother and giving the patients. People will take a full set of ops. He is good at marquee sections. I believe I just shared the choking video in the chance for those who are looking for it, actually, to double check that. Got the exact right one. It's the one you had about a minute. Your question. Uh, excuse me. Yeah, I think I got the right one. Good. 50 seconds will say Okay. What do you wonder with this choking video? How they manage to recruit both Johnny Vegas on David Mitchell into a video about choking jelly, baby? Yes, people quite about money. I love the do free for a charity, but you know. Okay, so we got some answers here for you. Uh, so the first one's one's put phone 999. Assuming Peritus capable of Minister Administry auto injector alone of was auto injector first, and then see, but our someone else to call 999 while doing space It we have the exact Yeah, we've got the exact opposite of each other here. One of them says you called 999 parent, you auto injector. And the other one says You do auto injector. Someone else. Do you know that night? Very much. Agree? I said give the effort on fast assuming only one thing could be now a time. That's probably the thing you do first, because actually finding know nine. That might take 2 to 3 minutes. Give them all the information, and that's a lot of time for somebody who's probably having anaphylaxis. But, yeah, definitely agree. If you get multiple people to do multiple things the EpiPen and your phony 99 your two things that you're focusing on, I'm happy with my face. Really good chances. So, question, too. Um, seven year old child presents The trick is that with which started yesterday. You do some obs, yet the Pew scores five, which is a little bit high. It's got temperature 39.6, which is really high. What do you think is likely to be going on here? You think leukemia? That's a blood cancer. Septic, arthritis and infected drink Irritable hip. That's, Ah, that transient center I was talking about. What do you think of sustains in trauma? Legatory 90 seconds. Just no stuff. Creepy. That choking video is at the end where it writes, Please share with other humans, though, like the reptile people don't need to learn how to do study. They're babies joking. No. Charge them. I feel like everyone should lead. That's not just humans feel that's very restrictive. Okay, so you got some answers here for you. I have a B. Just just the letter B. Which, essentially arthritis as on is written out. Septic arthritis infection. Seems most likely if no previous cancer history. Yeah, I got a fever. They've got a limp. You're thinking that I've got infection going on, but yeah, leaking it. It could be a thing. It can cause a fever. And it will make your apps go dot So could be the that I went for septic arthritis. Griffin three. Um, a 50 year old bowl go comes to your treatment center at normal, then with lower right abdominal pain started 20 minutes ago. What could be the cause? Actually, why do you think that? I don't know why this going bald, But why do you think you aren't serious? Well, I like the recent theme ing of the aura questioning today. Yeah, I think. Yeah. For our non nonsense John attendees. A TC is treatment center. That's where you get based. If you're doing first aid on events. Um, right. I'm amazed. One of your answer isn't got hit by bold does not It's not meant to you. But you see, every year I've never seen one. It's been hit, but I'm not seeing one little line judges because they get in trouble if they get out the way. Yeah, you cheap Such histories, now, full of, like, recommended videos is now just full of nursery rhymes. Uh huh. Oh, well, have a watch some of these. Um, so our first answer is appendicitis. It's the right area for the pain. You need to find out about some other symptoms as well. Yeah. Valid. I'm very happy. The answer is, actually, it could be any of them. There's not enough information here. Teo have a really good idea of what it is. Low right abdominal pain Could be loads of things, Especially things that aren't even in the abdomen is like hip arthritis. See a proper history, as I mentioned for, I think seven title You got a five year trial of broad spectrum isn't fitting. This seizure last for minutes. It terminate spontaneously 10 minutes on its own. His mother say's is epileptic, and this is normal time. You, Martha him is a little bit tachycardia and liberty drowsy, but actually seems okay. And he doesn't have another seizure while he's with you. Um, how are you gonna manage this patient? So you got discharged them to you The care of that month. You got admitted to hospital via a taxi. You can admit the hospital for your ambulance or you're gonna give him a dust around. She's a benzodiazepine. Look, two answers. So some of my best in relaxation of severity, the history of severity decisions on. But the person says describes the care of mom with safety net and going to see a GP or specialist team. Um, if you have any other seizures that are normal Good. Uh, 99 hospital? Yeah. Brilliant. This's a normal seizure, as he can. Both said Mom probably knows best here. Mom knows the kids go by what they say. If this is normal, this is normal. Realistically, the hospital probably won't have anything. But if there's any of those red flags from earlier, So if they have a next another seizure really quickly, they have a long one. If they're a bit too drowsy after, could be kind of a lot of things going on. And then he's going. Uh huh. Cushion five is a hard part when there we go. Very topical. What? Getting lunch at home park on since you hear some screening and you walk over to find it. A child unresponsive on the floor, his mother said. He's been choking, um, on some food, and it's now one. Responsive is blue around the lips and you notice that he's not. You don't think he's breathing? What is the order of things you do next, give you a hand with a with ease? Can you give me an order? George could explain what have what d is for those want. He is basically when we're ready, um, control on we as a 14, we would radio control and just say Whatever is going on, if there is an emergency going on, um, all if there is, if we think that airport all is more of an emergency than someone else called is going on, we would phone up. Really? Oh, in what's called a priority. So you say that priority, priority control. This is where my course and it's practical over on. That's basically telling control. I have something that You need to listen to you now and you cannot interrupt me. Listen to what I'm saying. Like this is an emergency. Um, so basically, basically, we're putting use that query. Cardiac arrests. Um, the ads are basically telling control. Listen to me now. Don't sort of carrying doing something else and come back to you later, because I've got ready situation. Okay, we've got compare this person's ancestor. Yeah, this is the problem now. Is he gonna figure out what the older every letter? It's, uh Why does it that way? Okay, sorry. This pleasant has set F which I agree, and then d sure he doesn't see? Yeah, this this see in there? But it's just a stick. See, in between seven and the other was it doesn't match your fairly well, uh, a d. He hates that stuff. Six. That's, um it's actually a refill before the chest compressions. Realistically, you have two different people doing this stuff at the same time that presuming the defense out of the way, you would put in the defense out the way you start CPR, and someone else would come in and put that on. But you probably end up starting CPR before the defense palm. We've got other history. Check the danger. It's once it just good airway breathing. Make sure someone call for help. Five Breaths. 15 compressions, 15 to until help comes. Reluctant to use a defect in there until necessary. If this gets not breathing, think you need a refill on the um, if the heart is going to funky rhythm, the only thing that's gonna stop fix this is the defense. You're kind of kind of right in saying, actually, when adults have a cardiac arrest, it's usually because of the heart, something going on with the heart. Where is when kids have a problem? It's usually that breathing. A lot of the time I got a five s You about some of the time five rats might actually be really helpful on it might help bring them back, but just because it it's probably a respiratory thing. So they were choking. Is that probably having a high pox interes? You still want to pop the deeper, But um anyway, that's basically because the defense attached to a patient doesn't mean it's going to do anything, so it it is an automatic one, which is the most common form that you'll find pre hospital and in hospitals. Well, it will only shock if it thinks there's a reason to. And obviously with the manual you can have arrived this and then you decide on the shock. So actually, if someone is is very sick on the floor or looks like they're getting sicker and you're worried that this might be saying that will happen in the future like the near future, it doesn't hurt. Just stick about, stick the pads on, have it ready, in case they sort of get to that point where it becomes necessary in the sort of short term future. Yeah, well, Onda, I think it's the last question in a newborn baby. Which of these is the most worrying observation on? You shouldn't need normal ranges for this. One of these is a lawyer things. It's not like the other one of these was recorded by very lazy person working. Yeah, basically, yeah, we got rest 16. Absolutely. So a lot of the time healthcare professionals that old guilty of this on. But the first day isn't anyone, really. They weren't bothered counter respiratory rate, and they'll just document it was 16 because it's a nice middle number. It's even so if they think the counter for 15 seconds or 30 seconds, then times that by whatever to get breast full minute, they'll be like, Oh, that's fine. They didn't look like they're breathing quickly, but in a newborn baby rests of kind of 30 to 40. A good rest of 16 are very, very, very, very, very bad. Um, so, yeah, just one thing to very. Let's be aware off. So that's all questions. Thank you all for listening. Just a couple of take away points. A key thing when talk about kids is big family and talk about them often they want to be involved in the consultation. They don't just want to kind of be there while you tracked them. Um, so take a history from them and talk to mom or Dad or whatever. Occasionally on escalate let their toys after they've got with them that kind of thing. They can help build a better report. Parents is key. Um, you could generally tell whether a second is sick based on what is what they look like and trust the parents because the parents know their kids best. They have to live with this kid's kind of 24 7 for the first time in many years of their life. They're gonna know when this gets sick. So you force him for the reading on, Obviously, check out the same time. It's website. It's got all of those videos and stuff. There's electrical doctor. Get the bubbles, which is a great pediatric vegetation website. It's just constant UK for, um, recessive. That's on. There's a podcast call to Pete's in a pot just to you, to to pediatric emergency medicine doctors chatting about pediatrics and pediatric emergencies. That's on that Spotify and after music, whatever, what podcast? And then this works. I could spot in a sec child. You'll need a neat test email to access that. But if you do have one, it's got a lot of good Resource is in terms of. I have two spots that kid, but I can put these links in the description in a second, So thank you for listening. If you've got questions, pop in the chapel hung around for a couple of minutes. Otherwise, if you could fill out the feedback through medal to get your certificates and such. Be much appreciated, Thank you very much. Thank you just and you beat me to. It's like I was going to say I tried the feedback form in the chat. There's one girl earlier on, and one later on. Please fill out a, well, your feedback, and it's really useful to us because it tells us how we're doing, and we'll do better on then. The other part is, please start making myself a bit because I just finished this light. So hatred of having things not on screen. It'll, uh, please do give feedback. It's really still for us. It's how it sort of improve our Siris. Make sure everything's going well on. Also, if you want the tendency difficult to prove that you showed up to this if you only use it for anything in the future, then please do so, Um, I get a couple of minutes just for anyone to ask any last minute questions off. So if you come up with anything after you left, feel free to that for free to email it to us, we we don't mind. We're happy to answer questions whenever they come. Then I'm going to quickly switch over to actually like Title Slight again. Because then it's just not a master picture of me. Fantastic. A couple linked to me que and anything. I hope I never see them. Oh, yes, I see them. You're not falling into the same trap everyone always seems to do here, which is that they keep sharing in the like admin checked than not in the general population shot by getting a nice, uh, give another sort of 60 seconds just to make sure that no one's got any questions coming. Books finish. But thank you. Everyone has come along. Thank you. Everyone has interacted. Do you love your interaction? No, I'm not seeing anything here. I think that's so thank you very much. Uh, let's give it a like a eight on the dog. I just want us to email. Yes, I could show my email again. Mine is email a music atria. And then, actually, I've got it on a slide. It's well, I could move along too. Uh, it's got a queries. You feel free to email any questions or anything you want to ask or any suggestions of sessions You really want to go to or anything like that. We're happy to put on things if people are interested in them. Ultimately, we want to do sessions that you want to show up to because there's no point doing these. If no one wants to come along otherwise, if there's nothing else, thank you, Ron, for coming along. And thank you so much for running this session for us and we'll see everyone in a couple weeks time for our next one coming. Nice evening around. Take care. But I