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also about your here, beside me as well. So we are just going around three section on track of study. I'm large, actively emergencies. We're gonna bit more on the track close to me bit and explain that we that leash her. And essentially, we're doing this because it's really scary. And when someone comes in with the track, your tumor, ginseng tea and it's one of those things, it no matter how much airway stuff you've done in the past, always make sure we get anxious and especially in the versus for mealtime. Don't know. Actually, what patient has their video on whales and on over want to do with us is trying to leave it the mystery out of it's just try and show you how simple it is really clear path place and that you actually don't need to be scared of muscle mass. You follow these really simple pathways. You can't be criticized it all. And even if it's the worse case married for the patient, my everything would be in today. It's problem the national travel. So we saved the project. They've got fantastic website that traffic feels to me the order dot UK and but lots of the learning. I'm not sufficient things, and especially about section on and Children as well. So in that really encourage you to go and read through that a website and look at more. See deep ones from there is well, if you want. And essentially, I've put the lengths to the guidelines on to the chapters well, so if you want to well, listening to the videos we're going to show you you can follow along. This way I'll just stick Teo sort of and tracking room and what's happening the's to little posters of any patient in the hospital with the track, your spirit or injected me. They should have one of these posters on the beds ps an anti pillow off the wall in the back of it to the emergency management past. We should be there. It's different in our emergency department because our patients usually just come in with the problems. But if you go to resource one in the and Stacker nearest sink, there's a truck yields to me drawer on. The guidelines are printed and vomiting. In there on the way I was talking and any emergency dealing with the track of where our ject me literally get the guidelines. Which of these ones here on get someone to read? It's really, um, do a colon recall and go through the steps. So you keep Cam on your able thio and follow it a sort of systematically, it's possible. So and we're just gonna play a couple of it. He was lying. And on that at the end can answer any questions you have. So these are the guidelines. Bring one. Struck. Feels to make the penguins laryngectomy well, but mostly looks on the green one because it's not about for mostly and why I stretch. So here you go. Okay. Hello. You're right, sir. Day. I don't think he's breathing that well. Making good lean towards that track. You might be blocked. I Can you give me a hand here, please? I think my blocked office from the ostomy cheese bit worried about you. Can you run a pin emergency call? Like get some help, bring back the track. Your emergency guidelines from resource. Hi, guys. And I were just going to run three. Sorry. Hello? Hello. You're right, sir. Dad. And he's breathing that well, making good noise. That track, you might be blocked. Em. Uh, I am a Can you give me a hand here, please? I think this this chat my blocked off his track Your stomach to a little bit worried about you. You're on a pin emergency call. Like get us some help. Bring back track your emergency. One cover, please. Sir, can you hear me? Okay, so he's not talking to me. He seems to be stopping. It is tracking, So I think it's a track is we're gonna put some auction over his mice on tracking. And how did you get some sense from under home? Yeah, that's that's pretty. So this answer about 70% in the moment. Has that made any difference? Applying oxygen? Does it look any better at all? No, that's I'm coming up on. He's still looks like he's starting with. The track is gurgling and making some signs of, you know, use accessory muscles. Things like that. So you called frax Where expert help. You look, It's in the field on, but you could apply maples and see, or you could just fly oxygen. Is the patient breathing? Yes, but we difficult to you. Quite high for oxygen you may want to assess to track your sleep aids and see. So remove the speaking valuable cat is present. Patient doesn't have a cat. Okay, so remove the tube. Just remember not to throw that away. Keep it one side. We talk about that later. Just gonna play some oxygen mask on with CNN. Entitled There a swell way. Not getting decent entitled Trace on the SATs are still 60 70. So not great. Except is kind of part of suction catheter that seems to be getting stuck to you. Okay, so you can't do that. So the next age is to deflate the cuff president, then the assess that list and failed the mouth on the truck, your stomach, and still appear to be getting to see you today aside. Turns out to see. And he doesn't missing his mask. Still really struggling, Making bad noises. Okay, Uh, so the next stage is to remove the track. Your stomach tube. Okay. So just get rid of the straps. That Okay? So you really look like feeling looks a lot better job and they're missing of the neck and his are even quite a lot. I think we've got intro situation. Great. So we've stabilize the situation for now, but obviously, we're gonna keep doing monitoring Onda cess mint as required. Okay. Hi, guys. And I were just going to run three. Hi, guys. And I were just going to run three emergency tracheostomy monitoring pathway just bit by basically my age, That's important. And so we're just gonna be a bit better next day. Might be a bit Okay, so the first stage is on call for help there. Right on the scene. I'm a little concerned cool for Emma, and she comes and calls for help. And then look, listen, feel at the mouth on the truck. Yours to me. So it seems every emergency you get so many people as you can there, especially with on airway issue with the minutes, that's gonna be catastrophic for this patient. So call everyone become, you know, would be of help, especially in this situation. But I airway of our conceivable and you want that anything is to be coming in pretty soon. And but this is definitely already met. This is an 80 s e. And any we should be able to manage this. In the meantime, ourselves. So get the guideline. Get someone to go through it with you. Don't panic. Stay calm. That's the most important thing in all of these situations, and truck else makes it seem as managing an upper airway. If it's gonna be the same signs of you, hear it gurgling. If you can see of his little instruction of its half honey night, he clearly religion Is she an anti will see you to do is gonna be your friends to try and get that quite early long that can help See if you've got hidden and track. Those were not very quickly. So that's the first step. Pretty So we should say that this this green guideline that were running off here is when you think there is a painting Upper Airway on, we're going to do the next one way. They probably isn't the patient up for a race. It's just just that's what That's a really pretty guidance. So the next step is Is the patient breathing going to say yes or no? If not, you would go for CPR and a less protocols going to say there are breathing, but with some difficulty, then you apply high flops, a high flow oxygen to both the face on the truck yesterday. So it doesn't matter how you buy oxygen to Booth and I flew. Simple only breathe is fine. The face of the truck E often works really well for truck ease and stomach sites as a pediatric mask, so generally fits on really well. If they're some of it, just a stomach, and sometimes you can apply on l amaze over. But whenever there's something there, it's quite hard today. And so generally I would just stick with the basics, just whatever you have to hand and just get something on their function as a senator. This is something we think has a payment. Upper Airway I. Sometimes it's very hard to know the difference. Just looking at patients and patients and any generally are sick with these sort of emergencies to tell us. And so you find the night and treat it as a lot of, uh, tractor supply oxygen to both. You're not going to leave everything if they don't have a very bad reaction to the right, and so that one. So then the next step is to assess the track. Your stomach Patency first thing is to remove the speaking valuable cup if it's present. Yep, so this patient doesn't have a speaking about. It didn't help him to show you. So essentially, they they cannot look differently. But generally on the ones that are common in this area, it's just a little green capsule. It's very obvious that it's something sitting on top. Essentially, it's a one way valve. People can speak because, obviously areas not going past their vocal cords to create signed. The biggest error is that people have speaking up all on Don't take during the balloon. So there's one my vowels. The air is getting in but can't escape. I'd fire mites, which is why the speaking bowels work the simple solution, usually in the situation. Just take the speaking valuable, and everything was resolved very quickly. This patient doesn't have one, so that's fine. Generally, they're scary. There's so many track is that we can possibly teach you, but everyone just take home. Look at what you have to see what you think it is. If there's something that it doesn't look like it's permanent, take it off. That might be speaking up. That's the first step. So then the next step is to remove the inner tube. Okay, so each one is different as well. So this is a trick of twist. Try the ostomy. So you, as it says in any twist, to get the energy. And it's really important not to let that piece of equipment goes away from doing any situations to say gold. In that case, I need it. We actually have lots of stock of this in resource, so we should have spares. And often patient comes in with lots of spare kit with them in a box. Generally tracking awesome patients are very good at doing that. Some are just pills, so you just have to live and see what you have at the times. Take, um, it's really important to know that that's some track. You'll still don't have an energy, so you'll not be able to fill anything. I just just be aware if you're having difficulty finding the nature of removing the nature of, it might be because er isn't one, and you just move on to the next step. Pretty girl. Generally do not suction line tracking on that, she removes the energy because usually That's biggest problem because more damage if we if we do that. So remove the internship first. Before you were one of the suction. But the reason you don't want to check this away is so it's really important to sometimes if you get your results situation, you've restarted. Get you fixed it. If we go 12 needing to mentally patient or bag them and we come to play, I see circular nearly every T A trickle twist Especially sure. Most common one in this hospital. You need to energy to be able to do that, so don't throw this away because you might need it later on your next adjustment. You don't teacher and eventually a patient if we fix the problem or they need it for another reason. So do not throw away the inner tube. If you're asked to clean it and our special cleanings, that's all you need, is a start of water. That's all you need and patients themselves to drop them under top. So don't be, too, where they give him a different one leader. They don't like what we've done with it, but generally just start The water is a living, so you've removed the speak about you remove the inner tube, and the next step is to try and pass the suction catheter. Yes, so just simple. If there's something off the serum instruction, or see if there's a passage into the trachea and it's just what we used Teo Suction don't eat chips or bronchial. It'd be buddies. Keep them in recess just to touch it instead of your younger and pick yourself over the top and transection. That's really simple. Like I'm sold the situation and that might not do. You got a very large were kicked in obstruction. So if that hasn't removed the obstruction in the next stages to deflate the cuff soon, another really simple step. And the idea behind this is if you've got the building up sometimes what happens? Is it kinks, the end of the tracking against the wall of your trachea. So, Eric, and so, by just deflating the clinic and something, lift your yeah, tracking away from the wall of the Tricky S you can get on. So you're deflated the calf and you re assess, um, again, Look, listen and feel. Look at your brand title. Look at your SATs. see if that's made any difference. If it hasn't, then you. The next step is to remove the whole truck, your stomach you. So this is a really scary stuff that's really important. And I always feel like the room thing to do. You don't leave someone's airway that we have in, but this is not working, and we've been shooting time and time again and confidential qualities of my desk. People attracted me. Step wasn't followed. If you take the sock on, something bad happens. Patient. You can say you followed critical to the T if you didn't in the patient days of that. But that is obviously we didn't follow the protocol. So it's even though it's scary feeling wrong. It is the right thing to do, and you just need to get it lifted, are okay and reapply oxygen to two. Are you taking a night? And some are situated in. Some are calculations on are tied in till the matter. What's the air about Citrus? Cut them. If it's Velcro Kata Evans. Typical. Just get it all. Forget tracking. That might be the life saving thing for this patient that's really important and then just reapply auction overrated. Taken it like that. So in our snow, really, that was successful on Do we're now able to oxygenate through the stoma? However, if you look, if you follow the protocol down, that may not be successful or any point during the during this scenario, you might lose on Despont any circulation. At that point, you'll be going into your LS protocols if you need to really have a finger on the pulse there on def. If if you can't feel the pulse or signs of life and the patients stop breathing, you then need to go down and start doing CPR whilst you're continuing to try and clear the airway. So CPR and patient track helps me is essentially, it's exactly the same. You just need to put some thought into how you manage up like CPR. Two cm shocks and see if insurance and see him. And generally, if you've got a patient with a track, your stomach. They have a pizza and upper airway. Sometimes the safest thing is just get someone to put their hand or gold or something to create tracking side on the manage your upper airway as normal as they have pizza. Upper airway. So your normal Joel thruster bagging your eye gel. And, um, usually, when I said it come If we know it's got pitting overweight, it would be the upper airway that will contribute way. Usually stay away from this last week. We can't really go for front of neck access again. That is obviously different in a laryngectomy. Patient has no upper airway, at which point this is our only and get a feel free card in that circumstance, it's very seasick. And if you've not been on a statically, probably shouldn't be instrumenting a laryngectomy stoma. So all you do is get a pediatric face mask, get a good seal. I'm trying bags through that where, as we discussed earlier old fashioned elementary I jail. You could smash that over and try and bag through that. And but generally, that's all you would be expected today. We don't expect you to be instrumenting a stomach. A laryngectomy occasion. Yeah. Okay, so, um, really the main difference between the two guys distance. This is the main one that we've been using here. The green one. The main difference is is the red one. You You know this patient doesn't have a painting upper airway because they've had radical surgery on the larynx. So if you know that, then there really is a census is no, there's no there's nothing you can do with the upper airway. In reality, you may not know that. So your default default stages is this one where you think that maybe, is a patient type where where, in which case, you apply the oxygen until you know otherwise, Really, Sometimes they're very hard to know which sometimes can exactly see you, and it's very hard to know. So always default. Teo picking up room it. It's a cm steps essentially. And until you get to the stuff that I'm sad, it'll be doing so just go with that information that you have at the time If I die of my auction. Um, the only other points to mention are if you go up to someone and they got a tracking teacher, that setting half do not force that back in you cause more harm than good, and it's better to just remove it. And if you haven't gotten anti CO2 trees, don't be bagging a tracking. You might just call surgical embassy make a difference. So that actually puts you tell you if you've got no trees, it's in their own place. And do not use that you're better full of algorithm, which which point for you to take. I know. And I'm just a time on the protocol is crystal clear. If you feel without you, company is ice. Okay, so that's that's really him. It him on just once a day could give you a time of anyone wants to. And it was. Any questions are if you want to go over, but not that's much Emma on Joe. That was a great I think. As you said, the very started just We wanted to get the message if I were better. And if you really seen at once that somewhere in your memory that you have seen it on haven't idea what what sort of principles to follow in terms of managing. I think as you said, we're stroking that we put like these guidance. Um, don't lying yourself remembering it when it happens and he's had it done sometimes. And any questions come in there into the No, I don't think so far, and they can see anyway. Okay, thanks so much