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okay patrick you want to walk us through a couple of case studies here and cena and ill uh jump in and chime in on our management yeah we got about 15 minutes left so i think we need to get to some of the you know the why is great and the experience you guys have shared and really talking about being a little bit more targeted and being a little more precise with smaller volumes and being purposeful about how we approach it within a common framework is good but lets perhaps go through some examples of how you guys do that at your institution so uh our first case is a patient who is uh undergoing a three vessel off pump uh bypass shes got underlying good cardiac function with an ef of 55 percent uh and shes received a couple hundred milliliters of cell saver and about a liter of fluid uh and were gonna pick up with her as shes arriving uh in that transition into the icu bed so as we attach her to the bedside monitor and we get all of our monitor up and running our baseline assessm