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How can you? Him And if you can, can you posting a chance? If that's okay, just let me know. You can hear me. Perfect. We'll give it a few minutes that I have one joint and I'll get my slides up. Uh huh. Minutes. They'll get the chance for my phones. We can see what you're saying. Once we do it, then if you haven't already, please just put your medical school year in the chat. And then we can kind of tailor content a little bit for everyone. And we can explain a few things a bit more. We can make it for a bit faster. Lovely. Thank you very much. Fact. I'll just keep darting backwards and forwards. I think so. That's good. So 58 4 year, second year get so fairly Seen you with some exceptions so far, um and can you will see my slides. When I do this, I'm gonna have to keep darting backwards and forwards. I'm afraid, and you'll see my screen. Me wiggling. My mouth's around some post. Yes, this concern. No, I can't see my screen. And how about when I move here? Can you see my slides? Night Okay, that's fine. Me one second, the one does it technology. And how about you see million different things in your own name is coming up. Excellent. So what I'll do, I will speak for a light amount of it, and then I'll keep darting back. To see the comments I think is the best is the best way to do so. Welcome, everyone. This is a presentation on the 80 approach for announce of Hours F one. So look at your old now quite senior medical students, and I imagine congratulations. The most you'll be you'll be starting. A zit is a gene you doctor. Very soon. Thean tension of this session is not really to teach you about the 80 we approach because most of you would have done that many times for our for our medical school, it's actually more about application of the eight we approach in Ah, in kind of really world scenarios. Thinking about the practicalities of doing so as an F one out of ours, often with limited access to a resource, is maybe a small team may be in a area unfamiliar. Um, and the idea is that used these things here and get up even the recess counsel or the occipital education going to need to the approach and rather than me just didactic Lee boring in water and not really encouraging anyone to retain a reply. Information. I'll give you some scenarios for each section the ate away and hopefully everyone actually just tell me what they're going to do at each stage. Foresee, that means under the flaking backwards and forwards. But I think it's the best way to do it on. Then I'll do some teaching round things that maybe we get wrong. Or are you some questions about why we apply different different components of the of the approach each stage? Hopefully, everyone's on board with that. If no, I'm terribly sorry and and and if it doesn't work, then you can leave with the back and we'll do another session a bit more. Me, just any stuff. But I think that's that's way more boring on deviously a small disclaimer that I am and if one this is affiliated with minor bleed. But it's my opinion. I've taken from guidelines that there may be errors essay. Feel free to call me out on some of the areas. And if you don't agree with me, then that's great that you've got a justification for why you don't agree with me on different stations. Get learning, injected. So after he said so learning about the eight to approach, thinking about how we're going to apply it on thinking about how we might today during your first one called Shift. The idea is that hopefully at the end of this session feel a bit more up a bit more. He's about the medical medical calls out of ours for your first shift, particularly for those of you that going in first week and and unfortunately, will draw the short straw more will have some nice just to start off with. Okay, good. So here again on before I did this session with some of my colleagues for even seeing a patient that they're going to do an eight of, you know, we're not questions for you to think about Well, because most of the time when you're going to be asked to see a patient out of hours, you're not going to be on the ward of them at the time, you're going to bleed. You're gonna be at the end of end of the hospital. It's important to think about how we utilize that time, whether it be on the phone or traveling to the patient, to make your life easier to make it safer experience around There is, um, the answers that people came up with. Start off if you were 100 over 60 patient. It's very important. Think about the recent resuscitation status of the patient. So how far among going to go with the expectation already, you might be called about really sick patient that might already be be meeting criteria for a crash school or might be might be thinking about, you know, is a wart the safest face, this patient. And if you don't reset status of that patient, you're really gonna going to going in blind, ideally, or the nursing staff having over the patient to note to you. But if not, it should be easily accessible from the notes on the second one. And this comes from from learned experience that actually, sometimes surprisingly, you get a get a bleed for a call on the patient. What, what you're told will already meet criteria for a crash cool, and it won't be one for a nephew. One out of hours to go see it two AM and and try and save the day. So I've had calls before of a doctor. Can you come see this patient? They're not responding to me and then saturating at 60% on that for for exploration. I'm not gonna check across that. Still see that patient? I'm going to be asking the nurse that out. Crash full immediately. Third one kind of relates to that. So, um, Ali, the best person to deal with this patient at this time you're gonna get know rewards for being a hero If it's a really sick patient And you are by far the most junior junior doctor on the team, this is your first week in hospital. Do you really want to be seeing a patient? That's, you know, on my phone is a cannula and the saturated it's really, um I was going to medical issues. No, you probably know, actually, that needs to be one of your seniors. By all means, if they're happy for you to go see the patient, then that's great. But we need to think about patient's safe deeper before anything So So no points for bravado here, for one, actually is more about making your life easy out of hours. So there's a lot of things that we can ask for that you're not tall in medical school. Really? About how you make your life easy when you're really busy and you've got sick patients and got track across, you have read at the hospital. So the way we're talking, a three approach usually is that we we do a subject of assessment. So we we have, for example, from the B section we have a listen to the chest within takes, um, objective information. So we're not. We respect aerating saturations, for example. And then we are. Then we're going to do things that we might example, taken a BG or initiate some oxygen therapy, a huge amount of what I've already said. It can be done before you even get to the patient so we can ask the nursing staff to give you another today sort of observations that have the office machine running when you get there. If you think you're going to need to do an ABG, there's no reason why you can't ask for the equipment to be by the bedside. So all things to make, you know, it's really easy. So I'd encourage you to think about that as we're going through the case in shortly. And then the fifth one we spoke about earlier. So if we're seeing a sick patient, medicine is very much a team sport. So for all of these patients, the expectation is you will let me know that you're going to see them, what your plan is. And you certainly be communicating the actions you've undertaken with your team. Okay, Get on the bottom one will just get for now. But basically, obviously, I think the approach is a very effective approach. But some of these patients you need to screen in some way you won't even need to see some. You can take your time. We ever review the notes before you developed those filters for out for our one and your your uncle shifts about about which pro cheat a for each patient. But again, that's probably no for this session. Good. Here's some of the principles. So some of these you would have been introduced to you in the palace before on some, like be quite new. So apologize is that if if they're slightly something boring for you, so to start off with the NATO we approach is a very simple, effective approach. And the reason it's designed as such is that you identify and deal with life threatening problems first. So there are absolutely no prices for deep deviating from this structure. If you've been after, see, it's a cardiac patients, whilst it might be tempting to immediately look at the CD and go straight to see section, actually, in a two approaches there for a reason, really, we should start for million work down. Um, we've spoken about Bravada. The third one, I actually think, is really important. And it's a complete lifesaver and something that I really appreciate within a three approach in that you are not looking for a single overarching diagnosis in a situation at 2 a.m. Nobody's going to give you any medals for diagnosing poor for Iraq two AM or anything like that. The point is that you stick to a structure, you implement thie actions that are indicated from investigations and the observations you you've looked at already, and you make sure that they say so that maybe you are You and your team can think about what's driving the problem, but ultimately is just about making sure someone safe out of hours. That's why the atrial pressure is really good, because it's really simple and easy to follow on something that you could just rely on a Z F one when you're nervous and its worst ever on full shift on day. Everything else you you will have read on the recess guidelines a minute or so. The idea is that you identify a problem and you don't move on from that problem until you fixed it. So if you are on the B section in, you've identified hypoc CIA. You shouldn't continue to assess be done something about the high boxier, probably by getting some oxygen or something similar to that. Next one talks about reassessing the effect of your interventions, and we talked to do this really well in some aspects of medical school. So the fluid bolus for always taught Teo assess the effects of this intervention. But really, we should be doing that for everything, for out the way to approach it. If you have a hypoglycemic patient and you give a bolus of glucose. Really, In 10 15 minutes, you should be checking other that's affected. Affected the problem in the first instance. And if you need to do anything else, we spoken about using your team on. This guy's not just a local team, but also so the 80 approach encompasses and see as you're looking at your guidelines in a minute, you'll see a huge amount of different things, and for one person to do this, it can be really quite challenging. Imagine having to take all of the observations yourself. Get all of the equipment for your cannulas and your ABG s. You know, they may need to give some fluids in your right toe. Line them up. All of this could be done by different people at different times to think about how you can utilize your team around you to make your life easy as possible and ultimately for out your entry approach. You should really just be assessing the pain, a few inventions by the bedside. But that shouldn't be a need for you to leave the bedside. You can always ask for more help. Call for help very early, so that includes you know, utilizing your team around you, but also about escalating early. If you ever scared about a patient out of hours, no one's going to criticize you for putting out a crash cool or even just calling your estate. Show your registrar just saying I'm really worried about this patient one out of death because ultimately, that's that's safest for the patient. And again, don't back to provider that you wouldn't you were no awards by by being the overconfident F one that's trying to trying to save the day. Uh, one is something that you see a lot to start off of. I think Junior's and I've been guilty of it, that if you get out of your depth and you're really scared about the picture that you don't quite know what to do, maybe have implemented a few interventions you will get out of jail. Free card is a crash course often, and it's asking for help. The temptation is that once the cavalry arrived and you've got your initiative stare and your senior registrars that you just want to leave and Hyde or maybe write a few notes. But actually, if you're the person that seeing this patient at two AM you assess that you've read their nose every out of everyone in the hospital. At the moment. You know, more than anyone about that patient, it's really important we stayed by the bedside. You given appropriate SP hand over and you describe what's going on because that's going to lead to what's the best care before you into some some cases. Does anyone have any questions? I'll just have a quick look at the chance. Really, What I've said, some kind of sense I saw. If there's no question in someone, just write know, so I'm no, I'm not talking to the abyss.