I don't remember what it's called I'm sorry I'm I'm if you're not you're gonna need to come home yeah yeah glad you got my job I'm here glad I'm glad you're I'm I'm here here but the central year of judgement you was admitted on the yeah in fourth around the head june 4 mhmm came in short of breath mhmm came in short of breath decreased exercise tolerance and a nonproductive cough in the background of a tabby 5 months ago mild cough is fine x maker but nothing else significant he had an echo on admission that showed a small pericardial effusion but good es but there's thin that looks like yeah evidence to give it he's both had it can you me that I don't can you hear me I've got the idea we have here yeah alright no I I've had his blood pressures 98 over 50 but that's vaguely what it's been throughout and a heart rate of 58 we're just waiting for an ecg yep we're focusing on getting a gas high he's had blood tests it is largely unremarkable presumably high he's not 80 okay he's full full escalation of the body so yeah tracking an 8 week so maybe he's got bilateral access today that's good you got the head of the bed off were you happy I got the bed off yeah you're happy does he need anything else from got mp airway I see a bit of a on a c yeah exactly so we've got no sounds no worries no do we recycle blood pressure no that's alright yeah okay this is eventually it's all a bit strange it's all a bit weird what's the recent deterioration it was a decreased episode it's still it's an episode of a cancer so we're concerned about a 100 yeah yeah and we're concerned about he sure recently passed he was he was still like he's not out range so you have no chest pain ian no chest pain so a 100% it's coming down now it's starting to slow down alright have you got any bloods on I did change I was just gonna say do you want any more access or are you happy with we're happy with access yeah some blood would be really helpful yeah that'd be great just the usual 3 tubes yeah yeah thank you alright thank sorry these are all materials that you inform me if I stay active at that time he does pericardial effusion this week for 18 minutes thank you we'll have a look at his heart he's the funny 1 you see out out out yes and you can have a listen yeah alright so you're gonna have you able to cough for me all the I'm I'm just like okay you would give that the the just little bit got my we're gonna ask about the nickel and see if the chloratexendin or no just then jess sure hi jeremy alright are you over the side so I'm just gonna try some light into your eyes can you open your eyes sir well I'm gonna see you with this alright sorry on here mean I've got a 5 p 8 guys so ctpa alright joe have you got anything you need no pe central oedema just open your eyes again left sided mono right sided effusion open your eyes it's torch coming there tammy oh yeah large peripheral effusion reflux of contrast thank you so a bit of a bright light there and right at 4.7 you can see 4.3 yeah vo 2 6. Bit bit new you're a bit weird 21 all a bit weird isn't it a bit of a weird gas not anywhere else you can go just it's bit difficult it might be a prolonged time on the on the tour we go it's gonna look like it's a bit messy it ultrasound is there and then if we take another 1 we get a venous cell I have to take another gas we'll get you up with your instructions thank you for voice ct was your focus still closed okay but not with a no the vascular probe no with a vascular probe not the phaser right like yeah yeah well I'll note that the audio here it actually shows up for the portable information that's fantastic and then you make fast speech yeah yeah yeah someone who's been left looking at it yeah don't know you're head back down with it chest please I'm sorry I felt like I was getting a short to right now I'm just barely breathing no chest incredibly sharp I'll calm down okay and it was I think I don't think any of the other organizing probably mbu would have would have come for whole intelligence oh absolutely oh you got yeah I've got catheter that is no it's not anything take it out beautiful you're bit sort of gargling in your throat in the moment rarelle I'm gonna take this mask off though for me for a alright just to see if you actually need that can you hear me fine I can hear you absolutely are you feeling a bit better yeah don't we don't know what happened yet but you had I think a bit of a moment of I'm not really feeling much all the rest of it water water okay k might sit you up in a minute if that's the best 1 but let's see the thoughts thank you is it bluffing it is I'm not loading is it touch is it not there larr it's definitely on but it's just I just can't change the your lip can't change the transducer I'll go to the other transducer alright jay yeah have you been out no it's been yeah there is 1 there somewhere sorry just been on your left hand in there so let's keep that off for a minute alright you okay yeah nice deep breath in nice syringe oh yeah so it's better than a few is it high yield back to you I can sit up a bit sit up a bit sorry I'm gonna sit you up a little bit alright yeah okay just a button yeah yeah how's that fine fine not late I'm interested no thanks geez you're connected I mean it's far worse than it was before yeah but it helped that it was like morning hot cats of gorps weather had 6 weeks off it was just gone back from the beach not too much the whole time what do you mean paddle boarding mother-in-law had the baby what's this zarian they're pro zarian no had the baby they had preeclampsia we had that we had look for half of the full jelly yeah so good there good so it's quite deep isn't it and that heart is bleeding around it is isn't it can we pass through the condyles again yeah they are they're on their way okay what do they call they call it like the rocking heart or a single heart as a no what is it but the atria and ventricles go separately that was that was a pretty good view that was the best view really wasn't it anyone running gas please it's a depth isn't it thank you alright that is that's that's it's a couple of centimeters I think at the apex no it's he's on moumea now it's a venous sample anyway 2 cm at the apex I think cardiology are on their way apparently that's good news we'd like them so they report back to me what you see yeah you're missing out on that I can see something moving mhmm I noticed that about 10 minutes ago hello hello good boy john budgeon how are doing I'm glad you brought something better than this today it's so funny I've got a story there this gentleman has had has had a hundredfold test still with me yesterday which is wonderful he's been investigated for pulmonary embolism and a ctpa yesterday yeah showed this morning showed large volume peripartial effusion with possible signs of a moderate compromise refluxing of contrast into to the ivc on sick an echocardiogram showed that he had a very high effusion there was only a 72 year old son's and he's now become slightly unresponsive meaning that he oa blood pressure's been maintained and sacrificed throughout ecg showed rate of a hundred and 70 in atrial fibrillation hello sir hello hi should I be 1 of the registrars hello registered registrars that hello I'm I'm going to just yeah on the phone yeah I'm be I'm on phone was his last dose of treatment of 7 yesterday as well yeah yeah you can give him friday evening yes yeah treatment dose clexane yesterday evening mhmm on the yeah yeah 3pm he doesn't have alright and you've heard that 1 yeah yeah I really cut this up I'm scared of needles can I have some of that number yeah think that's all it's all it's all yeah has your bleed gone off sorry you've lost blood on somebody's bleached but they've not put a number in oh okay so and I think that's what I'm saying I don't know don't yeah is what I'm saying you got a sticker isn't it you're gonna pass someone else I'm sorry jane no no you're sorry it's just well over there it's just because I wanna lean on it because I'm lazy enough to air just says large we can have a look at our inside count we'll we'll measure it can you bring up the ct yeah I'm on it yeah so he has got that to a greater degree of movement now yeah back at night it's let's see yeah I don't know right so we need to do a needle for this yeah sure need to if we can get very busy with that and apart from that anything else I need to know about him any other history no tavith yeah 5 or so months ago no since done that echo okay then okay mild moderate so why did he have the echo of his back so I think that was in lieu of his shortness of breath and irritability yeah okay yeah did they comment on heart strain on that they echoed they said reflux and contrast into the ivc oh no but then the echo yeah was 1 cm and no sign of hematoma compromise can we get you some kit what do you need no no we we will take him back to the cath lab or no it's everything yeah I'll go and get the bottle let's let's go and yeah yeah excellent yeah I'll take to thank you let's see yeah to the cherry and how far along is the case please and there's a next couple of infusion that would need to be drained yeah I think if understood that's that's what actually what you're doing yeah yep but I think blood pressure is fine cells are fine you're not taking stuffy nose yeah the heart looks like I do not see because it actually does look like he is much as can and then she can do some bowel stuff yeah no preference yeah but it looks quite complicated it is and it's very operator it's depending on what you're hearing so you need like a chair and you'll go back yeah that's great yeah yeah will you pee yeah what I'll do is I'll acquire a bit more pictures and just hold everything else yeah yeah yeah yeah yeah ian mcinnis ian mcinnis and number is f915234 so he's on marlboro ward 0.5 he's got pe so he's got pe he's not got pe not got pe we don't know what the effusion is about yeah no okay fine and we've a ward think you mind we we at this? We don't know and we don't have any no but we'll do with that later yeah okay bye okay cheers bye bye bye so we're gonna transfer him to see to the lab what do you need I even tried I'm gonna I wasn't even gonna try I had used some sort short term but I'm sure it's confirmed in the past I wonder if the vascular probe would be a bit right it's very not much depth though I was thinking she's quite deep yeah well was just gonna check for me was just gonna the middle so I've got a patient I think in the next 1 we're going to see her in the middle of the procedure yeah yeah so f9f91515233 is ahmed still there okay she's so just gonna pause the chat pause the chat a minute yeah that'll be good just just a minute fine fine yeah it's it's just that I've I've given a heads up to the kaplan but the gurus in the middle of the core strength work so we try and pull them but I don't think there was any other lag so we take a sharp pull across all the time again but just let them know do as well oh no the lab to run the machine obviously if you crash it then we just do it to the left side so that we don't have the lab here okay but otherwise we we you'll be teed up for this after you are working of course well he's shortness of breath but we don't think it causes this kind of rapid accumulation so he's got edema on the lung yeah he's got effusions bilateral there are effusions moderate on 1 side then it's going small on the other okay so but injection fraction 55 to 60% I'll be resected right in the middle you did as well yeah probably yeah yeah brilliant malt oh background central op in emphysema with biochemical scarring small left and moderate right we we need to make the best decision because that's sometimes as intense so we know what we're doing it's just working at the logistics yeah working at the logistics yeah but I don't think from a safety standpoint you are not safe here you're better off down with me in in the coronary care unit yes so you know he has got a chronic problem to him and looks like a past tense he maybe may not be there his son's there as well his son is there yeah okay so that's the only background we know about him he's got problems with his yep problems with him with how they could have otherwise been yeah what's the echo go ahead sorry I was can I talk about him yeah what what did the echo show I know it showed a question so diastolic wise in diastolic the the 1 of patient wheezing well the ventricles in the significant to get it there sorry where it is so we need to understand the inflow over stuff like that like the deviation the jump I think the bigger the downstairs yeah yeah was that heart popping did you yeah yeah so if we keep the disc actually filling and diastole so we can look at the lv and try and work out but this is not a gated scan okay so you usually need to gauge this area like deco so it let me know when it's diastole yeah with an ecg yeah right so can some some some thank you yeah we've we've chatted about him yeah no fair enough there's a bit of a glitchy fluid around his heart yep we're not sure exactly why mhmm but we do know that it's making his blood pressure a bit low and probably led to a lot of deterioration too yeah sounds like he's grown a bit from the other day certainly but he brings back up so I'm actually having a bad heart on top of that the heart's getting a bit of a funny rhythm as well so we need to fix both of those things yep and avoid the best way to do that is to turn it out without the sass surrounding the heart yep and that's what my bloody ology the judges come up to do the plan would be to move him to a safer area a coronary care unit and then from there take him to a specialized procedure room where they'll take that fluid from his heart yep and that will allow his heart to beat a bit better we can analyze that fluid find out about what it is mine is also a little bit of previous sort of blood sugar and chemicals yeah yeah probably quite a few at the moment as I'm sure you yeah yeah already watched it yeah yeah so we'll make sure everything gets sorted yeah yeah so he's been in emergency care for a couple of years right I know a little bit about what's going on but yeah it's different enough into clinic at 8 units or in the lounge depending on what you're able to do does that make sense yeah that's a shame actually because it's ejection fraction very very good I know yeah 5 6 I think think 5