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so hopefully we're back up. Sorry, guys, having a few medical issues here. I'll tell my camera offense if it's a streaming thing, and that makes it a bit easier. But hopefully you can all hear me again Now. Good, Fantastic. We might do that couple times, So we only just heard about Birthday looking at the comments. So let's start against the doctor. Can you please assess a pretty decent rate is rated percent. He's now maintaining his saturations on 60 liters effort to know 0.6 or 60% of high flow nasal oxygen. Obviously not what birth he's wearing that because he's an eight year old male, He's got Type two diabetes, hypertension, osteoarthritis. The day seven cove it He's had a friend desert here and dexamethasone and has been given Talk Elizabeth today because he's escalate. It's a high flow nasal oxygen, a zipper. Local guidelines. He's an unvaccinated man, and fortunately he's still escalation. So we've already done our end of the bed a gram. We've had to look at his airway, and that's Peyton, and he's maintaining it. Good start birthday. How are we gonna assess his B section again? Thinking about it's subjective objective and actionable points. What are we going to do for birth to, you know, to to 100% so potentially. But even before that, let's think about assessing Burti and seeing if he needs anything good. So we've got some some inspection points there. So is he using an accessory muscles? Is he cyanotic? Look at his work of breathing very good. And then we leave on to our palpations and percussion. Another look. It's tricky. A see if his chest is expanding, I'll actually have a listen to his chest good and then moving from the subjective. So the object is what results in saturations. Water is respiratory rate. And then we can think about more insulation that we can get from our actionable points, whoever he needs, anything like an ABG or any any imaging. Good, Very good. So here's some information about birthday or rather, this is what we're going to do. And we've spoken about all of this. And what else can you do? It? The actual points. Obviously we can think about any medications we want to give whether that be nebulized intravenous arrival wise on. Think about his oxygen. What we're going to do with that. And as with all of our patients again thinking about whether this patient needs a senior of you if we're if we're looking for some information on different kind of option to re devices that have a quick scan of that code, um, of anyway, so this is our our subjective birthday and a bit of objective stuff there. So these respiratory rate is 30 and he's got quite quite dramatic. Increase work of breathing. So you season intercostal recession is working really hard on is struggling t get out full sentence with you when you have a listen to his chest. He's just got cramps all over. It's just salivation if we percussed and it was normal residence for out. So there's no delay areas. It'll importantly is carbs. It's soft, and it might be interesting for you guys to think about what we've looked at. His carbs at this stage is well, And like I said, he's on high. So 60 of 60 and once he's maintaining saturations, he's working really on TV. That respect you're rated 30 and for those that don't know, actually, in the hospital, 60 60 is pretty much as high as we go of our copay patients on high flow. So we probably need to think about what we're going to do about that oxygen. So what are we going to do? What options are we going to undertake for 30? So we've looked at some subjects of an objective things. What actions that we want to do is never one right now. Give me some suggestions and have a look at your recess council guidelines, which you lost. Tell you what with the entities. Cool, a senior good and Sara's that's had an idea about some CPAP. Very good. Any other signs so very good for all of you? So, yes, I think CPAP would be appropriate for this patient because he's 60 sixties. It's a far as we go. But if he's going for CPAP, really, this is a patient that needs to be seen by some more senior than you, and actually, depending on are very good for Antonia's. Well, there depending away you want. Certainly in my hospital, the guidelines are bility should be seen by seacocks. So our critical care out which team and if he's four intensive care should also be reviewed by an intensive care doctor. They might deny him fit to be managed on the ward, but really, he needs that. Reviewed needs to be on the radar. Um, interesting point that I am a list that's up there about buying up. And actually, that raises some other things that we find a forgotten about in our assessment of birth. Because if we're thinking about bringing, I see you, they might have a little bit of a, um, only if you haven't done a lot of the investigations before. So what might I see you you asked for now and that might help. Aren't on 10 years question about fluid. Well, which is again will come in the C section. Know So actually, you've got a We've got a clear chest and no documented history for a reason for him to have bronchospasm should be very talented to give someone like 30 nebulizers. But actually, I don't think there's an indication at the moment. And there are some known side effect of nebulizer's that might not help Burti. So to start off with, you need to put it on t poor if he's on a cpap what you can do but might know that you might need CPAP off. If we don't have a teapot available, it can make him go. Tachacardic can affect it. Taxi balance And there are side effects of nebulizer. I don't think it's perfectly reasonable moment. Probably no lumps. Samantha's Reagan important point. Absolutely. We should do an ABG. And if he is, for example, in Decompensated, try to stretch that we might think about bypass. Or we might think about just lowering his oxygen because the saturating 96% No. 88 to 90 which we'd be talking for our retainers. But for argument's sake, birthday isn't a retainer. So we'd be going for CPAP and not buy for our for our patients, the Indian Type two Prosperity senior. Good. Say I was thinking about chest X ray blood to use knees so good blood will come in. The C section will speak about and chest X rays and important point I want to raise for F one out about is because when we go through, all right, so we approach, we think about these things and we just real them off and say what we're going to do. How are we going to get birds in chest X ray. And are we doing, sir? Leave Burti now to try and arrange that. Anyone got any ideas? We're gonna leave birthday. We're gonna wheel and down to the X ray department. Um, what do we get a day? Does he need it right now? Possible Good. So I'm not a good idea. Good. So Burti certainly isn't going anywhere, so we'd get portable for him, and then we need to think about whether we complete all right away or whether we leave him or if we get a portable phone. My personal preference here was yes, he definitely needed to separate. A lot of things will cause it, which we could go off course. The saturated apart from progression of covert and a chest X ray is going to be really important. Call for help is a very good one. So, yes, we can ask for help from the rest of our team and maybe they can arrange a chest X ray. Can we ask a nurse tickle radiology yet? Someone has to request it on the system, which from website bit also annoyingly probably really good ideas. So my preference would be I'm going to stay with birth. Er completely ate away. Probably quickly. Texts? Um, I have a team that working overnight and see if they can come help me anyway, because you need to see, in your view, I'll be giving them arenas. Well, but first off, I'm going to complete my eight away. Then we can think about that after very good. Very good. Um, well, if I put next to these and that, these are the things good. So we've spoken about one of this and coags an important point and something to think about for our favorite patients. My hospital. Anyway, if you're patient, that dose anoxic, which because of the risk of peas and that might be a cause of the situation and birdies birth his case. But once you got a high flow or CPAP, you go down to the intermediate dose. And that's because the high flow via your prescription can course, of course, and bleeding, actually, so we slightly know the dose. So that needs to be a decision, Really, about whether we think this is birthday spot up here where he needs to stay on treatment. So every goes to intermediate dose and the point I'm trying to get out here is actually getting interesting. New once is that I don't really want to be dealing with the next one with a sick patient. So we need you need the med rec review. Really? Indian Sea. Got to have a look at it in the nineties looking well, and we can make a lot of those decisions after Very good. And if we're thinking about it, whether he has a PPI, for example of one of one differential some stage, we're gonna have to think about putting him through the scanner when he's just we can't put it for extended at the moment. If he's going to see so all important questions for his management, What Rocky differential. So what do we think happening to birthday? Why is he decide? Waiting any ideas and only don't know is a perfectly acceptable idea, given that we we got for our Mezrich and I'll seeing used to coming up. And look why missus incomes. Yeah, so it comes in the section idea. Unless because you're thinking about a query, pa, I'm having a DVT already. Um