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get in my back up. Sorry, guys. Get some people actually come up with really sensible problems. So probably actually what we've got for Tony's. You've got an infection driven f. We don't know what he's got previous a. F. A lot of people would jump to thinking about rate or rhythm control, but actually, we don't think Tony needs this the moment. What? I need this and fluids because he's probably a little bit septic. Is that pull real intake? We haven't matches. Insensible loss is actually even though, If I pressure's all right, maybe we can give you muscle bolus and reassess. So I think that's what I do is well. But like I said, we're gonna put two cannulas in. Both say CF mood takes and blood off. We might want to think about correcting his electrolytes, aiming for a magnesium over one, for example, because all of those will precipitate arrhythmias as well. And also we need to be really clear with our with our nursing staff. When we told him that if he develops any signs of shock, for example, of cardiogenic shock or of decompensation, if he's starts becoming drowsy, if he's got heart failure. If he's got chest pain of his BP drops, we need to think about. But for now, yep, fluids, then reassess. And that, as we do, we'll give a bolus. He's over 65 to maybe get 250 miles to start off with 500 minutes. Is that, um, actually fast? I mean, if you think he's, he's hypovolemia can. If he's a big enough champ and he's got no sounds very followed. I don't see why you couldn't do a 500 early bolus. It might also be useful to look at what he's had today as well. We need to think about the entire clinical picture. So we do our eight in May, Um, and we'll think about, you know, is this patient demonstrating signs of So the reception steps shock, in which case we do need to get quite a lot of fluid. But moment, blood pressure's all right. Although he's right. I got it, so I probably just give 2 50 mills normal, saving your heart mons again. I mean, it depends what you want, so hardened is probably posted physiological, but normal saline is also fine. He's probably just type of anemic, but I probably have a quick look. It's electrolytes first and have a look over. Those is completely fine, depending on most available as well. If they, for example, he's got, like potassium in right simvastatin the foot. But we wouldn't do that with the bolus. We'd get that for a longer period. Soberness. It's going to be normal. Saline or heartburns. Good. Okay, what else have we missed it, given that he has got probably quite severe pneumonia and he's very dry, although it's not very nice. Um, I probably would suggest that we put a catheter in and measures input output because he's probably need and criteria stage one a k i. Even without looking, is that yet? So we're probably gonna get good. Let me go on to our de section. Do we have any questions about Toni before we before we continue, right, Thanks. That's okay. Anyways, we'll give it a minute and obviously, no, that Tony has had a If we do need to think about long term management of that, but that's not the point of 88 to me that we need to think about weaponry, meets criteria, fancy calculations, cetera But again, we're not gonna focus that Exelon that no, no good. So let's move on to Lucy's Low, GCS and again another another real life out of ours. Medical F. One story. So very rescue on the dialysis unit for two patients. That's horrible, isn't it? So we just go straight. See, You see, this one's a bit more, a bit more of a stressful situation that we got to deal with this to patients and you're S h O goes off and sees one patient and you say, Okay, I'll go see Lucy For now. I'm going to need some open a bet We find Lucy and she drowned depo style assistant us that have been very stressed, and she said she's had one week. Need to take it off sheets completely fine for our diet dialysis. I don't know what's happened now you obviously you can. You can you be by the bedside and get some obs running things we've already spoke about. So it's running. Can you get me some some equipment for cannula in a BG? Maybe, and I'll start my eight away and his are ready to be finding so is completely normal financially maintaining around way we need to think about that with the low GCS Be is absolutely fine. Just maintaining a sex and spiritually rate on a ranch is not acceptable work of breathing. You have a quick listen to her chest. It's fine. See, maybe moderately high heart rate, but not really within normal limits. She's hypertensive, not hypertensive, which excludes one of the causes of low GCS. And we go on included. High pox here is well, I haven't looked at the B section. She's got a good volume. Peripheral pulse is regular. Okay, by this stage would like please cannot find something to correct because I'm really worried about Lucy that we don't have to put our kind of a rescue because that's why we're here. And we're waiting for the couple of weeks. Come. What are we going to do in our D sections? Lucy? No. Any ideas? I'm the ant. Any of our good idea? Let's do that. Let's ask for a blood sugar. And that's something that can happen while so we assess efficacy and again thinking about are subjective, objective actions. What we're going to do a sesame CS? Yep. So you can do it every GCSE and after whatever you're comfortable with, have a look in the people's. And that might give us an idea. Good thinking about intracranial causes of low GCS or thinking about drug course is whether that the doctors that have caused it a weapon, you she's caused it herself. Assess. Yeah, with the second toe get again. Successor. I'm against it. A shot and identify problems. Correct them, and I'd probably stick my temperature in this section as well. So I don't for a quick temp with the full set of labs probably going to need a few nursing staff with you. So hopefully more turned up what you can article if we take in a VBG in the C section, that might be quite useful that we'll have a blood glucose on that, but it's not. We can ask for a peripheral blood glucose. You guys are very good to hear a lot of things like that, and also we can have a look. A drug charts, of course, to see if there's any causes of low T z s like you mentioned about whether if there's anything that we need to reverse, potentially potentially, that's normally would hear our actions good. So we need to think about the airway. But the moment there's no Strider, she's maintaining a saturation, so we don't really need to do anything. But we aren't worried about it. We're gonna keep rechecking and reassessing as we spoke about earlier. If we've got a low blood glucose, we are certainly going to correct that. And hopefully that'll help. And then later we can think of she needs imaging. But that's really not further for the eight mg section at all. This is what, uh, okay. So I put down some of the causes that we need to think about for our patients with particularly low geez yet. So we've identified that she's not quite Boksic, you know, she's not hypotensive were already asking for probably close. We've got no reason to think that Lucy might be hypercapnic. But if we are thinking that we can do in a BG and see if we need to correct the hypocapnia and again that would be if she's in a deconsecrated talk to your respiratory failure, we might need to think about Bipap. Is she seizing is very important point. We've had a look at the people. So we've got any abnormal movements. We can look a history. You might be having an organ versus seizure. But the moment we've got nothing to suggest that she is seizing on again drugs and doctors. So have we prescribed anything? Has she taken anything? Is there anything we need to do about that? For Lucy, her blood glucose was 1.1. So it's certainly a very good explanation for why she's completely knocked off and his doctor GCS waters or several. I'm going to do about that blood glucose of 1.1. We don't need to do something about it that were. If you don't know where it might be, just be taking more off the Commons temp. Simply put in 500 mils. Okay, that's quite a lot, But yet we do need to get some glucose, probably so I'd probably give 200 mils a 10%. It's kind of guidance, but both correct, so we'll run it in a sock. PSAs we can. We've already put cannulas in in in the C section, which is one that comes in the right way, even for our patients that don't necessarily have a seat problem. So we've got access that administer glucose. That's right. We're gonna get a lady because of a GCS. We can't really give anything or really, And it's too late for Glucagon. But if we got if we've got some some time before the glucose is available because we are in an outpatient dialysis unit there, maybe we can get some glucose. Got an interim, every water. It should have a hypo box. So we should ask Ask the nurse is going to bring the Hypo box as soon as possible, and I have everything you need in it. In the meantime, we can think about carrying on Move are greatly. But we know we've identified the problem, so really, we just focus on getting getting excessively. First accident. Sorry if there's a delay in the in the channel, think it's just Maybe it's my Internet connection. I leave that on the screen for a minute because if we're if, if we're unsure about our guidelines for managing quite those that's quite good flow chart feel so low. GCS blood glucose is below three. She's certainly one herself. 210% on. Then we're going to recheck that any questions? At least see you guys got to that immediately on when I had a couple of cases like this. I can tell you it's very reassuring locally.