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I tibia you like like yeah, it if you not to go to the top to Yeah, even even now. Thank you. No, you know, typically you can get it. Thank you. You able to do. You were just exhausted quickly. Thank you. Yeah. Yeah, I no it you thinking about oh shopping? What is I? Yeah, temporary depolarized state. Mhm. Yeah. Out thank you. Um Can everyone hear me? Ok. Yeah, so yeah. Ok, great cool. Uh We'll just wait for the speaker and then we can go going. Cool. Uh We can probably make a stop. Um and our other speaker is gonna join us in a couple of minutes. She's just at work. Um So just checking if someone can't hear me, let me know now. Um so today we're gonna be speaking to you about common scenarios. Um and as you may know, this is like it depends on obviously where you're sort of interviewing for, but sometimes it makes one of sort of three of the situations they can give you in an interview. Sometimes they choose two or sometimes they do all three. It depends. Um but so hopefully you joined last week where they, I believe they discussed with you how to sort of tackle these a to e scenarios techniques, you can use things you should include. Uh So we're just gonna go over some examples today. So take everything if you've got the slides downloaded from last time, all the sort of information from that and this is just a tack of real life examples they can give you. So. Right. So that's just a summary of where we are currently in the timeline. Uh So we've got um, say on the seventh to the 11th. So we've gone through quite a lot now. So quite a lot for you guys to sort of look over and review before your interviews. So common topics. So what I suggest you do or what I did anyway is kind of work through all of these topics and make sure, you know, the management of all of them and quite fluently as well. And this may seem like quite a lot of work. But because you're going to, you may have your, I had my exams in March. Um But whenever you have your exams, you're gonna need all this information anyway. And ultimately, when you start in August, which is not too far away from now, really, it is gonna help you quite a lot. And I feel like because I became quite prepared for this in sort of around November time. Well now is I felt like a lot more fluent in a lot of these situations coming towards my exam. Uh And what I'd suggest you do as well is just get up some guidelines. You can either use nice, they have some quite nice guidelines or on the Oxford handbook. If you go down to the kind of the red section, the emergency section for pretty much all of these, they have flow through charts, just explaining how to deal with the, the different kind of caveats as to whether you deal with something in a different way, maybe someone's BP or something or, or their weight and just try and be as fluent as you can with all of these. I know some are a bit tricky. So sort of asthma can be a bit confusing and CO PD as well, but at least definitely the common ones, um like seizures, pneumonia, sep, sepsis, six, that kind of stuff and, and yeah, I definitely try and get familiar with all of these. Uh So yeah, this is just a reminder all of the structure and all the sort of tips we have uh on our last talk. Uh but feel free to ask any questions as we're going through. Uh But this is more giving you examples, you kind of work for yourself. So scenario one, let me just see if Maya joined uh because she was initially gonna do this scenario, but if not, I'll just go through it. Um I did, OK, I don't think I don't believe she's joined at the moment. Uh, but if she joins, at any point, she can pop in. Let me just double check. She doesn't message me. Um Oh, ok. Yeah, I don't think she's managed to join yet. So I'll just read this with you then. Uh, so scenario one, you're an F one covering general surgery on call on Christmas Eve, you are bleed by one of the nurses and they're concerned about a patient who has started to vomit fresh red blood and they ask you to see the patient. What do you do next? And what would you like to do? So imagine they could give you the scenario and give you maybe a couple of minutes to read it and then you need sort of, you'll be taken to an interview room and answering questions on that. So, does anyone have any thoughts of the bat of things they're kind of thinking of when they see this, we have to attack it, any sort of differentials or anything you're worried about? Yeah. Yeah. Good. Good. Go to the patient and the patient immediately. Yeah. Good, good. It's always good to remember allergies because you don't want to start one of the most important things which they probably emphasized in the last talk is to be safe. And even if you're sort of, well, you don't want your medical knowledge to lap. But a key importance of this is the safety of the patient Uh Yeah. Yeah. Good, good. Yeah. So just remember just in a real life scenario, you don't just need to run into something you can see what kind of information you can gain before actually going towards the patient's bed. So when you go to do your assessment, you're acting more efficiently, you're acting with more knowledge and making sure that nothing is left out because you might be dealing with quite a lot of patients. So you're not always going to know every single detail about them, especially for example, on call Christmas Eve. So scenario one, so these are kind of sort of sort of add in just for you to, I think they're quite nice. I wouldn't say memorized, but just sort of have them in your head. Uh because what they also do is give you a bit of delay while you're trying to think of differential diagnosis and everything like that just gives you a bit of delay. And so I'd like to follow L and carry out for a assessment and then just as you guys said about the sbar, ask him to get all of those things information which you think you might need. So any so whatever the scenario is, it's often going to be blood, it's going to be things like allergies or maybe they information very specific to the situation like what was it? They were vomiting. If there's any information they can tell you about this before you get there. Another thing, it's nice to look at the new school as well. You could uh we use new school quite a lot in the hospital just to see how serious the situation is. Are you gonna need extra help? Are you gonna, are you thinking you're going to need a senior quite critically depending on how high they're going on the new school? And then when you go through your assessment, you're just acting a lot more fluently. Um and just as Cathy is written here, recognizing the importance of your MDT team. So it's just like in the hospital, you don't need to manage the situation by yourself. You could leave the situation if you're by yourself, but other people can do other things. So if you want an E CG for example, and it doesn't mean, I mean, I don't know if it seems a bit disjointed with the at E, but if you ask them to be prepared in advance, you can then refer back to them when you go through your at E situation. Hi, Maya. Hello. I was just discussing with them about um scenario one. I don't know if you want, you want me to keep going or you want to go through it up to you. Um So you can finish this slide and then I can take over from then from there. Yeah. So that's pretty much it, to be honest, just making sure you're using all your keywords like patient safety, your MDT team and making sure things are prepared in advance. So when you arrive at the bedside, you've got sort of all the information you need to make a really solid assessment based on all the information you currently have. Hello? Um, my name is Aya, by the way, I'm one of the SF PS in Norwich and I just my on call just ran a bit late. So apologies for the delay. Um But yeah, so um this is the scenario about the patient who has vomited fresh vomiting fresh blood. Um So as with any scenario, you have to have your a three assessment, very clear. Um So a in this case, especially if they're vomiting blood, you need to make sure that it's not obstructed. So if it is um you can suction um or consider an oropharyngeal or not nasopharyngeal airway, um Usually if they're conscious, then you need to use a nasopharyngeal one because um like it's hard to tolerate an oropharyngeal one. Um and then for b um you measure respiratory rate, oxygen saturations and uh depending on the oxygen saturations, if they're low, then consider giving oxygen through nasal cannula or if um saturations are very low, then you can give um my venturia mask um as well or by non 50 L by non rebreath. Um Then you also assess for any cyanosis and listen to the chest across the chest. Yeah. And you can also at this point, consider an ABG um or if you don't get an ABG, at least a VBG to check for um lactate. Um And also you will also get the hemoglobin from the V VG, which is very important in this case because the patient's vomiting blood. Um then for c you measure BP, heart rate, copy of refill. Um Do you then um check the fluid status? So do you think they are dehydrated? They need fluids. Um check, you can put a catheter in at this point, check urine output, do an ECG and then also take blood. So usually what happens in real life is um I usually put a butterfly needle in and then take a set of full bloods. You have to make sure that you also take a group and save. So full blood count needs group and save and cross match um clotting as well. And then from that butterfly needle, then you can remove the vacutainer and put a syringe in for a G. That's usually how I do it. Um And then the BP will probably be low if they're bleeding. So IV fluids um and if they have an NG in, then you can check the NG aspirate for any blood. Then if they've got a stoma check for any melena within the stoma and ask them if they have, if they've had any pr bleeding. Um then d you can do an abdominal examination, check the G CS and for any signs of encephalopathy. And he um said kind of check for Melina, you can do ad R um and other signs of chronic liver disease because this upper gi bleed may be because of esophageal varices. So they may have an enlarged liver. Uh they may be jaundiced. Um Yeah. So and after doing an A three assessment, um it's good to say what your impression is in terms of your diagnosis, your differentials. So for an upper gi bleed, you would be thinking about um peptic ulcer disease. So, stomach or duodenal ulcer, esophageal varices or mallory vice tear. Um It could also be a lower gi bleed but unlikely if it's vomiting, it's upper gi um and you've checked the hemoglobin and the lactate on the VBG, remember like the key number. So if the hemoglobin is less than 70 you can do a blood transfusion. Um And you've already got the, that's why you sent off the group and safe because that way they've got the that they can cross match to the patient's blood group, then always get seniors involved early. And if you suspected a major bleed, then activate the major hemorrhage protocol. Um then in the interview, they sometimes like asking questions about the specific scores. So it's the type of thing where unless you've checked it like a couple of nights before you probably will forget. But the, it's a good idea to check the Glasgow Blackford score, which is a score which um tells us the severity of the upper gi bleed and what what management this patient might need. So if it's zero, then the patient might need an outpatient endoscopy and that's it. But um if it's more than zero, usually they will need um an like inpatient urgent endoscopy. So it's good to have a to check like the parameters. But for the Blatchford Blatchford score, you need to know the serum urea and you need to know the hemoglobin, the gender. Um So just make sure you, you look through that, that list. Um Yeah, that's that, that's it really for this case. I so OK, our next one tomorrow too. So you are on a one on your acute medical unit rotation. You're passing a day after collecting a patient when a relative calls you in says her father, a patient has been seeing for the last five minutes. What do you do? So you still have time before you're at the bedside? Is there any sort of things you think might be on your mind? Anything you can sort of prepare in advance for this situation? So basically what I've written down is you don't, as I was saying earlier, you don't have to always just rush it. Obviously, this is a very serious situation, but there might be a nurse there who's who's also seen the situation. So as you're walking towards bed, is there, is there a nurse available who's been with the patient to, for a seizure, for example, it's quite critical to know how long they've been seizing for. And obviously, in this situation, we mentioned, I think with the patient's relative, I said they've been seen in five minutes. So obviously go by that if you that what you've got to go by, but if there is uh some kind of uh name of your MDT team there as well, that might be able to give you a bit more of a better idea about what's been happening. And when they have actually been seeing for that long, uh again, just depending on the time, if there is someone there, you could just get a quick history of pro seizures. Um and probably quite critically has anything already been given. So if you're just arriving on a situation by yourself, uh you don't know whether samples to be given in an ambulance. Uh They've all medicated in some kind of way anything on the ward, anything in the past hour. And has everything been taken, for example, with seizures, blood glucose. Um So I did have uh annotations, but I think when I go to the next slide, they're gone. Now, did anyone have any idea about how you go about treating seizures? And I, I'll just move on to the slide. Uh But another thing I'd say just before the management, uh it's important to remember. Yeah. Nice, nice. So if you have, if you have access, I'd be LORazepam. Uh But again, the seizures, you just need to remember what kind of situation are you in because you might not be in a hospital in the situation you might be in the community. Um Or they just might not have access. Nice, nice. Yeah. So just, just know sort of both ways and remember to just point out, I think it's quite nice to point out those things as you're working through your answer. So not only do you know how to treat it in the situation, but just say, oh, if the cannula had tissued, for example, there are, there are other options you could use. So a bit more tricky with seizures, but I'd probably still suggest going through your A to E assessment. So obviously you want to treat them as soon as possible. And one thing you can say, if you're working through, if you could ask maybe a nurse to prepare the medication to give them in advance as you're working through your assessment. And also with situations like this, I'd probably consider quite early escalation as you're working through your at assessment. Just consider asking one of your N DT members who are there to contact the senior or contact someone who can help you. Because I think it's quite a good thing to just always go out just because you are an fy one. You shouldn't be dealing with a lot of these things by yourself or critically. Even if you could deal with the situation by itself. Now you're preempting the further deterioration of the patient. So probably start with a making sure the airways open and secure. Um things like seizures, that stuff like false teeth or anything in the mouth. Uh This is slightly different if you're in the community, I don't think they suggest going to near the mouth, but I know if you're in the hospital, it's sort of one thing you should check as a guideline and always start with airway the uh oxygen. If, if they are low in fat, you can give them oxygen, but quite quickly moving on to giving them treatment. And I think for the interview, you can as well. It would be nice to learn some common doses. So I do loraze LORazepam 4 mg and then you give another dose after four minutes. And then from that point onwards, you're sort of considering other antiphylaxis drugs such as um I put the dose there. You could remember that one if you want, but probably better to just remember the four if you were going to choose something and then just other options if I access is not available such as rectal dipam or B midazolam and then things you want to get. So I put here just to mention things you want to give and things you want to get just to try and remember that similar to the sepsis six. So as pretty much all situations you need a full blood count using these glucose um potential calcium electrolytes. Since you think about seizures, you can consider toxicology, maybe this is alcohol induced or some other drug induced since you would quite like an ECG as well and also a BP. Um I just put there, just consider what might be causing this. Like I was saying alcoholism hyperglycemia just so then you're able to treat beyond the current situation. Once, for example, you've solved the, the first seizure, for example, D checking the glucose and E one, once it's all stop se you can examine properly just in case they've been injured at all, any rashes which might suggest some kind of infection and then if you have time or if you're quite as well, it's quite nice to just go back to your A to E assessment and start again. So sometimes what people do is every time it's a bit time consuming. But some people do this every time you sort of address something in a situation, you should go back up to a and keep working your way through. I'd probably say for the interview, try and just work your way through and then you can reassess and then they'll probably stop you at some point and just, and then ask you some kind of questions. But I think it's good to go back check that that's OK because for example, if you have given oxygen, you should be going back to check if your oxygen is even done anything, for example. Um Same with all and then important, just remember you need to be escalating situations like this. Um or at least for the sake of the interview. And another type of scenario that you can have in um your interview. Prioritization, um prioritization, I don't think, oh sorry, some background noise. Um I don't, I'm just trying to think, I don't think I've got that in my interview to be fair. I'm not sure. But in especially if you apply to other places like London, this is very common. And then the one that you choose to prioritize is the one that you, then you do your A two E for. So um if you have a read through this and write it down in the chart, which one you would prioritize like 12 or three. Um So one is a 62 year old male who has been admitted with cellulitis and started treatment and he is now complaining shortness of breath. A 68 year old female who was admitted for breathlessness and it has now deteriorated. She has just had a portable chest X ray. You're, you're told that there is some bilateral opacification of the lower zones. A nurse then approaches you, a patient on her ward needs an urgent cannula. She was used to have her antibiotics for infective endocarditis three hours ago. So, firstly, what would you prioritize to you, please? Uh put it in the chart and then is there anything that you can do? Maybe in the meantime, imagine you, you, you're wrong about these approximately like like immediately one after the other. Um Is there anything you can do on the phone to tell the nurses to do or any information that you need from the nurses before you decide where like which one to prioritize? Imagine you getting three calls like back to back. So um Stanny me is suggesting two first, then one, then three. Yeah. So um yeah, that's a really good point. The first one you're worried about anaphylaxis because if someone has cellulitis, then we like you going to give them some antibiotics and we usually give co amoxiclav which contains amoxicillin. So it might be that they are penicillin allergic. Yeah. Um Manu has suggested news ops pattern. Yeah, that's very good. Um So you can ask them that over the phone in the Norfolk and Norwich. We have a, we have ops online so you can log on to a computer and have a look at the ops be for these, for all these patients before seeing them or you can ask the nurses to give you the op S. Um Yeah. Ok. Um So in this case, um I mean, usually a lot, sometimes there is not like a right answer as long as you justify it, I would say I would prioritize one as well because um like one of you said it because you are suspecting anaphylaxis. Then two. Um, and then three, because for three, you could possibly ask the nurse. Like, if they can do it, can, usually, nurses can do Cannulas or if one of the nurses can't, then usually there's a senior nurse who can do them. Yeah. So we've gone to the next slide and we, we have it in a bit more detail. Yeah. Um, so you, yeah, exactly. You prioritize one because you couldn't say away compromise. So number two, you can alert your senior, see if anyone else can help you. But it seems like number two, I mean, we'd have to have their observations, but it seems like at least it's a breathing problem, not an airway problem. So, um that's why we prioritize it second and then um the cannula, usually somebody else can usually do it. And I mean, it's not really going to make a difference if someone has it three hours later already for antibiotics, another like 20 minutes while you see that first patient probably won't make a massive difference. Any questions regarding that, that one so far. So, yeah, ask for more information over the phone for. So you imagine you've, you've selected number the first case to then do an A two E four. So um again, a, you can hear a stridor, you can see some angioedema. So these are like specific for anaphylaxis on B you can probably hear a wheeze you need to check oxygen saturations. Um I would also do an ABG just to check whether they um or the po two is um in the blood um and check for cyanosis, check the BP. They need like they need fluids. The um the abdomen will probably be OK. G CS might be a bit impaired and then um you might find some rashes, you might find that there's a risk on saying that they're allergic to penicillin um triggers. So you ask, um yeah, so removing the cannula. So we're not giving any antibiotics anymore, you know, so there's no confusion. Um and then the raising the patient's feet. Um So by raising the, if the BP is low, that can help. So in, in anaphylaxis, um the fluid can leave the vasculature, go to the um extravascular spaces. So that means that the BP is likely going to be very low. Um You give some fluids and sometimes it helps to raise the feet so that the blood flow goes to the head. Um Yeah, OK. You're welcome. OK. And then the management for the anaphylaxis it. So apart from the A three, what's going to stop the um reaction will be adrenaline. So, um it's important that, you know, this dose, 0.5 mg, I am adrenaline one in 1000. That's the same as 0.0 0.5 mils because it's 1 mg per meal. So, um it's important to remember that. Um And usually you give I adrenaline at five minute intervals and then if you've given it three times, then call anesthetics or I and, and they're not responding, then call anesthetics or itu because like the airway might be compromised, they might need intubation. Um And you can also give salbutamol nebulizer because that might open the airway. Um Yeah, so that's, that's the main thing. OK. So, so scenario four and the last scenario, so you're ble at 4 p.m. on a general surgery ward. A 45 year old patient is complaining of shortness of breath, chest pain. And um, um, oh, just, oh, I see, sorry, just saying on breathing two weeks following ATU RT past medical history of bladder ca A drug history. No, no family history, no lymph nodes. So, anything, any sort of ideas, anything you'd like to prepare just before you get to the bedside, maybe. Yeah. Yeah. Any others as well. So, um, so, uh, before arriving just very similar as before, if they have a new school or if the nurse should typically have a new school on whatever hospital system you're using. Try and get the new school. Yeah. Am I pneumothorax? Nice? I mean, as I was saying with these things, it's always, even if you see a scenario and you think, yes, I completely know what that is. They've listed some other comorbidities they've listed, they've been in surgery, they've anything like that. It's always good to throw out other things because it's so you can then sort of demonstrate a wider array of knowledge because then when you're going to answer, you can say why you're wanting to get something and what's going to rule out. So, for M I, for example, even if you don't think it's m I it might be important to assess that chest pain later on. Um But yeah, so the new school, uh could, you could get an ECG before you arrive. It depends on the timing. You could say I'd like a member of the N DT. If there is someone there a HC A could do that or a nurse to just get an ECG before you arrive. So then you, it's just because those things take time, especially in critical situations and again, bloods if you need them BBD, SAB DS, et cetera. So, uh yeah, as I was saying, I did have um annotations, but so kind of just laid out the situation of how they could get it. Um Typically, well, depending on the interview, but sometimes as you work through your answer, they'll verbally give you pieces of information. So you say you check the airway and they'll say patent, you say I'm gonna check the rest rate and they'll give you 22 oxygen 92 and then you can say how you wanna act on those things at what more you want to check. Um So just sort of put here an example of probably of oxygen because it's uh 92%. Um and things you might want to get on the bee, for example, at this point, chest X ray, I've put it to normal just for an example, I've got a la slide. I kind of break down some of the things it could be in the situation and then oxygen in emergencies typically give an acute situation 15 m normal breather. Um If you wanted to, you could say that you're checking about COPD. But I think depending on the guidelines, you often just give this anyway regardless. But uh sometimes I do say if you do know for a fact that there are CO2 retainer, you can change this. But I think when I was looking into it before it's kind of leaning towards 15 L in really pretty much most cases. Uh then see once again, just checking heart rate, BP in case someone's going into shock, checking, um auscultating the heart murmurs. Um All of those kind of things are important then getting an ABG and an ECG. Um Is there any reason why you might choose an ABG as a VG here? Uh So typically, I think I was kind of told if OB GS are quite good for acute situations anyway. Um the problem with them is that they're quite painful. But so that's why we don't do them on a regular, too much. And unless you're on a rest board. So, if you're worried about the oxygen for any reason I'd probably say an ABG. But I might do an ABG anyway, just because it's gonna give you more information, um, to more reliant on oxygen and those things. Uh, I think I've broken up the scenario here. Oh, yeah, that's why I've broken it up. So I put an ECG up here. Does anyone have any thoughts on the E CG? Mhm. So, yeah, nice. It's cool. Um, so in the situation, uh, because they can sort of hand you things like ABG, S like ECG S. So I try and get quite familiar with those kind of things. I think A BGI wouldn't obsess too much over it. But, um, I mean, if you can sort of tell, like, face that those kind of things, if someone, yeah. Uh, if someone was going into, I don't have an ABG here but if someone was acidosis or it might be good to know those things, uh, I just pulled up an E CG because I think it can be quite the stress inducing. Um, if they do bring out an E CG and you are a bit stressed about it, just sort of work your way through. Similar to the A CE, these things are always gonna be there to back you up, especially when you're a bit nervous, for example. So have a look at the E CG, you check the rate, um, by whichever way you choose to do, do the count in the boxes or between the peaks. Um So then check the rate, you can do that then to check the standard um P RSP wave, those kind of things. Um And you can link it towards what you're looking for as well. So with this, um it is one Q three T three. Uh so I don't think you can see my cursor, but so in the lead one, you're gonna have a sort of increase um downwards in the S wave. So that sort of just following the sort of QR S situation. Uh then in lead three, you're gonna have open increase in the Q wave, which is sort of just before your um QR S takes off and you're gonna have an inverted T wave. I can't really see the numbers on mine at all, but um just good to kind of see the inverted T wave here, but um you can't see my cursor but if, if this isn't clear, I just have a look on Google and that I should have sort of highlighted this. But yeah, so other things in P as well because often in a pe your E CG will be normal um or it will be a sinus tachy. Uh I also read a few things like right on the blog, but um I don't really hear that being thrown about too much. Uh But it's good to be familiar, especially if you're going through a diagnosis but all the different ways it could prevent. So you're not sort of deflected when it's not, for example, S one Q three T three. So here I just kind of put the end of my uh ABCD. So, and because they can kind of break it up and give you an ECG or something like that halfway through. So, checking, see uh what's the G CS? Um and then e just so a quick examination, abdomen, cough uh question pee uh so her cough red and swollen, but um it's always good to check those things. I probably check them in most scenarios, to be honest. Um And then when would you like to escalate? Uh just getting back to the situation? I mean, once you finish your a pe assessment, unless something is really diverse you in the middle of the assessment, um some kind of recess situation. I again just definitely making sure you're escalating things and making sure you're acting safely. Uh So I just put some differentials here. Uh Yeah, I was kind of going for a pee but just other things, it was shortness of breath. So C APD exasperation could be a sty. So the CG would obviously help you quite a lot there. I try and get quite familiar with things like sties and then semi being able to recognize them on an EKG and being able to manage them and manage them, potentially pneumonia. The shortness of breath, that kind of stuff. Um And again, how would you manage that? Um So, uh yeah, this is more of your own benefit really. Uh But I just kind of put down some stuff you could see, for example, for P uh chest X ray could also have a small pleural effusion or potentially AEX. Um And pe you could have hypertension or an increased BP um could have also gallop, rhythm and p then I sort of written down sort of different G which you could get in a pea uh particular, the will be fairly um clear cut, I'd say, but I would still mention all the other differentials and just as you're ruling out as you work through your at. So now on to your management, um and again, just reflecting what you did on your at assessment. So if the oxygen is low, give them oxygen, uh analgesia is quite a nice one. I feel like it's quite often forgotten, but you have to remember you're dealing with the relocation in the situation. They're gonna be in pain and they're gonna need some analgesia. And often if you don't prescribe the analgesia, then they're not going to get that. So it's very important to consider. Um Nice has some quite, I didn't put them up here, but nice, has some quite good guidelines on how to manage um PS and DVTs. And they give you a nice flow chart on whether you sort of want to calculate the well score. Um whether you're sort of going down the C TPA route or more of ad dier route, um because it's not sort of straight to D dier and call it a days often start the well school. Um It's also good to mention about trust guidelines. Same thing with when you're treating sepsis or antibiotics, there's always a third guideline, um s similar as anticoagulation. Make sure you said I would refer to the hospital's trust guidelines before you suggest a treatment, for example, um that would also be low me Heparin or do uh I know in the nn uh we always use delta. Uh if you can get familiar with sort of prophylactic doses and treatment doses, great. Um I guess other things to look into, you could say future management from the situation. So once you've dealt with this situation, acutely, you need to look forward to whether this was a provoked event or an unprovoked event. Um because that will then determine how long you an anticoagulate the patient for and whether you need to sort of act on those things accordingly. But um again, you said what I here is like the nice guidelines for learning. Um But the tough guidelines for managing. So as you're getting familiar with these situations, because obviously you don't have a trust to a specific trust guidelines really. Um but always making sure you're mentioning that in your answer that you would refer to what they give, um, in that trial because it, it can vary. Um, oh, that's the end. Um, yeah, that's pretty much, um, it really, uh, we're just taking you through four kind of quite difficult situations. Uh, I'll take you back to the list at the start. Can I do that slide? One or two? Um, yes. So, just back to the common topics here. So I do a very similar situation with all of the, all of these just making sure you know how to assess them a wise what you're treating in each letter. But just prioritizing patient safety all the time escalating, using your entity, checking their drug allergies before you're acting on any kind of medication. Really? Um But yeah, does, does anyone have any questions at all or am I have to um the only thing I had is if you can practice with maybe like um a friend or a colleague from med school, it's really helpful to just practice going through these scenarios before your interview. That's why I did like I if you know someone else is doing the SF P in your med school and you can meet up to do, even if it's just through Zoom to do a three E scenarios practice interview. Um I know some of you are doing some um interview mo interview, practice with us, but um if not just practice with each other and it's, they're just like practice going through a two E and being really sli at it. So that's what I would recommend. Yeah, it will be nice as well for um when you come to your a, whenever they are to uh depending on your medical school, they can give you kind of a cute situations like this. Um especially like if they use some man, you can pretty much have or anything really. Um So if you're quite fluent in speaking about this for an interview, um particularly because that's quite different from writing a sort of paper exam. It's quite nice to have these really straightened out in your head. So if you are doing a man, this will flow very nicely. For example, any sort of questions or worries at all on any of it or? Ok. Um Yeah, that's pretty much it. I believe you'll be able to have access to the slides and you can just do your own work. Um Please fill out the feedback form uh because it really helps us a lot. Um So yeah, uh I hope you have a nice rest of your evening. Thank you very much everyone. Thank you for joining.