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Sorry, I'm ready. Just give me a second. I'll just get my space. I'm home. So I want to face where the door if someone walks in. Ok. Yeah. And to be fair, no one's gonna see. Look at me anyway. So are you still in the hospital? No, I'm no, I've just come home but I didn't have time to because uh I was last minute.com with the presentation. Oh, ok. Other questions ready but I just in put them in. So e so um great. So um welcome everyone to our first lecture in the Med Ed specialty series. Can I just confirm if everyone can hear me? Ok, if someone could just pop something into the chat, but it's super helpful. Um ok, that's fine as well. So um so yeah, we're starting off with Peds in the month of Feb and then we'll have some more lectures on Ong and on psychiatry in the following month. So do keep an eye out for messages and on the Instagram. So we have Doctor Redone with us today to give us a lecture on pediatric respiratory emergencies. So I'll hand over. Hello, everyone. Uh Can I just double check that you guys can hear me as well and then we shall take it from there then. Ok. So what we're gonna do um is we're gonna go a bit through pediatric emergency medicine, um respiratory emergencies and, and we will take it from there. Ok. A bit about myself. Um Do let me know if you can see that the slides going forward or not. So I am II work as a registrar at um Chelsea and Westminster Hospitals. I've got a very interesting job. 70% of my work at Chelsea and 30% of my job is as a global Emergency medicine fellow. Uh Sorry, I did not include a picture. I've completely forgot that. Um um my Global Emergency Medicine fellow bit is working a bit around the world really. Um um currently involved in projects in Ethiopia and India and one in Bangladesh where I'm originally from. Um So it's an interesting job that includes a bit of work abroad. Little bit of work. My focus has been mostly on education and training because that's been my interest and that's what I've been doing mostly and this is something I want to continue into my career. So this was uh towards the end of my emergency medicine training. I, I'm I finish in November if everything goes good. Um I might use it by doing an extra year in pediatric emergency medicine. Um I graduated from Bristol in 2017 and then therefore left to up in the Midlands. My main training is actually in the east of England. Uh Cambridge, Watford, Luton, West Suffolk have mostly been involved in teaching with uh the University of Cambridge where we used to get to do an undergraduate clinical supervisor role. And then when I was at Watford and Lu got a bit of hands on with UCL. And then finally, whereas Chelsea now a bit of work with you guys, um I don't know if anyone was a care conference this weekend, that was there on Sunday doing a bit of chest teaching. We're gonna do a bit of etiology, a bit of history, a bit of presentation, investigations and management. Um, we're gonna mostly not, we're not, not gonna cover everything of pediatric respiratory. We're not even going to cover all of pediatric respiratory emergencies, but we're gonna cover some really hardcore uh, topics, uh, you know, the core stuff that come on and most important with practice questions. I've got 10 questions of practice today. So the focus will be on those and a lot of discussion around the questions. So the cases not as much do interact on the chat. Uh The one good thing about metal as compared to zoom or uh teams. I can actually look at the chat. So please do answer on the chat and I, we can interact that way you don't have to talk to me, but you can OK, we start off with what you see the commonest thing that comes in respiratory medicine, adult or Children, you know, medicine or A&E or pediatrics or actually even respiratory is the cough in patient. But you've got a case of an unusual cough. So you have 5 a.m. a 23 month old girl, not 23 years old, 23 month old comes up with an unusual cough. The parents are a bit worried because they've never heard them cough like this before. It's unusual patient was very upset when they woke up, breathing was making a bit of a whistling noise. However, currently the child looks well, has got a bit of a snotty nose, has had a snotty nose for the last two days and this is all, you know, so far, how do you assess the patient or do your differential diagnosis or what do you want to do? How do you want to treat them any takers? So, one quick thing about, yeah, I was just about to say, you know, you want to do a two assessment. Yes, good. That's good. Uh As you go to do that, airway is currently patent, there is no whistling noise that the mother mentioned that is present at the moment. Uh in terms of breathing, there's a bit of cough, there's uh when you listen to the chest, the chest is clear, uh you know, observational or within range temperature 37 8. So a bit of a low grade fever circulation wise there was good, good volume pulses. Uh cap was less than two seconds. Nothing really worrying. We didn't do a BP because it's a child. Uh dis the patient's alert. Um G CS would be treating from falling into one, but we didn't do any, um, no glucose was done because she's alert and es there is no actual rashes or anything that you see when you've completely stripped the child off. There's no signs of distress on just viewing even. And there wasn't any when you examined them for B So that's a two E assessment. That's your assessment of the patient. She is otherwise. Well, the only history is the unusual cough and when she coughs, she's still got that weird cough. You know, perhaps you've never heard this before. It's the first time you've heard it as well. Uh, but you've got a weird coffee patient and it's just woken up with it. What do you guys think? What are your differential diagnosis? What are your differential diagnoses of weird coughs? You know, uh, that's waking patients up. Had a bit of whistling noise with it. Let's, I'll add a bit more to it. Yeah. Good. Bronchiolitis. Good. Very good. You're going around down the right route. 23 month old is likely viral. Wheeze is possible as well as the, we'll, we'll talk about when bronchiolitis becomes viral. Wheeze and viral. Wheeze and bronchiolitis overlap with each other later in whooping cough. Very good. Right. You've talked about whooping cough. Um, what makes it slightly unlikely for this to be whooping cough, by the way, there's something in the story that doesn't really go with the story of whooping cough. It's possible but it's not for a reason. Um, I haven't actually told you about the vaccination. The vaccination history was positive but even if it was negative, this history doesn't really go with a whooping cough. The reason being mainly is that this is a cough that's been going on. N only tonight you'd expect with a whooping cough for it to have been going on for a while and to be there to be some few other systemic symptoms or constitutional symptoms, you know, they've been losing weight, not really getting better weeks and weeks and weeks and otherwise, you know, you wouldn't really expect to str or, I mean, you can, it's not impossible but it's unlikely. So that's why it's not whooping off, but you can think about it. So, if I changed the history and I said this is a 23 month old child who has been, um, fleeing war, has lived in multiple refugee camps and has come to come to the UK, uh, as a asylum seeker and they've been living in squalor conditions for the last, since the age of birth and have, you know, missed all vaccinations and there's nothing and has had this cough for the last six months. I think whooping cough is a very possib, big possibility there versus here where it's just overnight and it's not really there, but very good to think about it. So, you kind of got all the right differentials, improve bronchiolitis, viral wheeze whooping cough. Anything else you can think of? I'll have one for myself. You guys have added yours. Um, bacterial tracheitis is another one. So it's when the tonsils look fine, but there's a lot of, uh, um, um, you know, sore throat and difficulty in, uh, so in terms of, uh, re feeding and things like that and they've also got a cough, they're often though very sick. Uh, so their, uh, temperature would be high. They'd be tachycardic and I wouldn't get normally to a, ok. So this kid was a kid of croup. Croup is an upper airway DS barking cough and struggle. I did not give, give away the barking cough in the vignette because intentionally, I mean, why would I, you would know immediately what the answer is but that's not what patients tell you patients tell you. They've got unusual cough and a cough that I've not seen before or not heard before. And the whistling noise as they're breathing, that's a bit of stridor. It's worse when they're crying worse when they're usually a bit unwell and then often gets better on its own. The PK is six months for three years and is often preceded by viral respiratory symptoms. As in this patient had about uh you know, two days of coral symptoms, other differentials, you guys have all mentioned it. I've mentioned bacterial tracheitis myself, but you've mentioned bronchiolitis and viral wheeze and whooping cough, foreign body aspiration is another one, especially if it's still further up. Uh You would still expect though.