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00:00:00He was diagnosed with Kabuki syndrome when he was one.
00:00:04It's a rare condition that affects one in 32,000 births, so it's very rare.
00:00:09We've basically lived in hospitals since he was born.
00:00:13Dr Fish suspects Lewis has a badly broken arm,
00:00:16which could mean an operation, an anaesthetic and needles.
00:00:23Alathea has arrived in Teresa's
00:00:25and straight away I can tell that she's not behaving
00:00:29how we would normally expect a child to behave of her age
00:00:33and straight away I can see that she's in distress.
00:00:38In paediatric casualty is four-year-old Pippa.
00:00:42She's been brought in by mum Jodie.
00:00:44Hello, is it Pippa?
00:00:46Hi, Pippa. My name's Chris. I'm one of the doctors.
00:00:49So you've been a bit poorly, Pippa, is that right?
00:00:52What's been going on then, mum?
00:00:53Well, about 10 past 6 this morning, she decided that she was going to be sick.
00:00:56And then since then, she's just carried on being sick.
00:00:59We've had really high temperatures of, like, 40, about 89.
00:01:02But she's been sick a couple of times since we got here as well.
00:01:05Oh, OK.
00:01:06So we're just trying to get fluid down an hour, but she's still...
00:01:09So we're bringing some stuff away.
00:01:10And the stuff coming up, is it just the fluid that she's been drinking?
00:01:13Yeah.
00:01:14OK.
00:01:14And has she been feeling of any pain in her throat or any pain in her ears?
00:01:18No, she did say her stomach was hurting this morning, but nothing since.
00:01:22Fine. Any diarrhoea?
00:01:23No.
00:01:24OK. Who's this?
00:01:26Who's Monty?
00:01:27Monty.
00:01:27Monty.
00:01:28Does Monty make you feel better?
00:01:30Yeah.
00:01:30Good.
00:01:31Right. Let's have a little look at you then.
00:01:34Working with children can be a bit complex because you do have to work out how to communicate
00:01:38with them.
00:01:39You know, most children will say, ow, if you, you know, kind of poke them or, you know,
00:01:43ask them if this hurts, they'll say, yeah.
00:01:44Let's have a feel behind your ears.
00:01:46This is usually a good place for tickles.
00:01:48Yeah.
00:01:48So working out what they actually mean, and there is a skill to that, to actually examining
00:01:55them and getting a lot of stuff from mom and dad.
00:01:57Can you do a big, deep breath like a big, ah, good, well done.
00:02:04Let's have a listen to this gummy as well.
00:02:06Let's see if I can hear your breakfast.
00:02:09What breakfast?
00:02:09No breakfast in there.
00:02:11Say, ah, I'm going to pop the lollipop stick in for a second.
00:02:15Oh, that's fine.
00:02:17So, yeah, tonsils are a little bit big.
00:02:19So I suspect if she's had a little bit of a cough, a bit of a red throat, you know, it
00:02:23all sounds very virally.
00:02:24So I think we'll keep an eye on her for a little bit longer.
00:02:26We'll keep going with this kind of fluid trial, see how we get torn.
00:02:30Ideally, we'll just get a wee sample as well.
00:02:32All right.
00:02:33So, yeah, so we'll pop back in a bit.
00:02:34Yes.
00:02:34You're welcome.
00:02:35Thank you.
00:02:36You're very good.
00:02:37Very brave.
00:02:37All right.
00:02:38Good girl.
00:02:39Thank you.
00:02:39No problem.
00:02:40Pippa will be closely monitored over the next hour to see if her temperature decreases
00:02:45and if she manages to keep down any liquids.
00:02:50How are we doing?
00:02:52I've been sick quite a good time.
00:02:54Oh, okay.
00:02:56Oh, yeah, you are, haven't you?
00:02:57Oh, dear.
00:02:59We want weed, but we've tried weed.
00:03:01Just not happening.
00:03:03Fine.
00:03:04How are you feeling?
00:03:05Good.
00:03:05You're feeling good?
00:03:06Because there's a light set in your eyes.
00:03:08Oh, is it okay?
00:03:09That's fine.
00:03:10So the reason that we keep pushing for a wee is, number one, make sure there's no infection,
00:03:14but also it's good to see the wee because it means that they're getting enough fluid
00:03:17to make wee, basically.
00:03:19Because if you're not doing that, then you're definitely dehydrated and need topping up with
00:03:23a drip.
00:03:24So I think for now, I'll give the paediatric team a ring.
00:03:27We'll get her up to CAU, the assessment unit, and they'll just keep an eye on her for a bit
00:03:30longer.
00:03:31It'll just be more of the same for a while, and then they'll make a decision.
00:03:34All right.
00:03:34Thank you so much.
00:03:35No problem.
00:03:36Thank you.
00:03:38With no improvement in her condition, Pippa is transferred to the hospital's paediatric
00:03:42ward.
00:03:44Hiya, Pippa.
00:03:45Shall we go upstairs, chicken?
00:03:46I know you're having a sleep.
00:03:49After staying on the ward for another four hours, Pippa was diagnosed with a viral infection
00:03:54and sent home with medication.
00:03:56Just one minute to the lifts.
00:03:58An ambulance is rushing in a three-year-old toddler who's struggling to breathe.
00:04:03Here we go.
00:04:04In recess, sister Gemma Malpass and Dr Louise Nugent are on standby.
00:04:09We've got a nebulised mask out.
00:04:13Hiya.
00:04:14Hiya.
00:04:14Hiya.
00:04:14We're going to pop in this way.
00:04:16Pippa on here for us.
00:04:20Hello, sweetheart.
00:04:21What's she called, Mum?
00:04:22Alethea.
00:04:23Alethea.
00:04:24Oh, that's a posh name.
00:04:25Alethea has arrived in to recess, and straight away I can tell that she's not behaving how
00:04:32we would normally expect a child to behave of her age.
00:04:36So she's not happy, she's not playful, and straight away I can see that she's in distress.
00:04:44Can I pop this on your half of your toes, Pippa?
00:04:49Good girl.
00:04:50Well done.
00:04:50She woke up about 4 o'clock this morning, trying her eyes out when my dad put on the
00:04:55sand will have.
00:04:56She's gone back to sleep as normal, but when she's got up this morning, she's had it.
00:05:02We've got her at 6.0, really wheezy all across.
00:05:07She looks a bit tired to me, and every mum says she's very tired.
00:05:10Three-year-old Alethea's resting heart rate and oxygen levels are low.
00:05:15There's a risk she could have a serious infection.
00:05:17The team need to get her breathing under control, and fast.
00:05:27At Barnsley Casualty, three-year-old Alethea has been rushed into recess, struggling to breathe.
00:05:36With her is mum, Amy.
00:05:38At risk of a dangerous infection, paediatric registrar Dr. Ella De Zora checks her over.
00:05:56You are being super brave.
00:06:08We're going to give you some more steamy medicine.
00:06:10The likelihood is that she's got wheeze because she's got a virus in her upper airways.
00:06:15Do you want to see how she goes, Ella?
00:06:17Are we out of oxygen?
00:06:18Yeah, please, yeah.
00:06:20You've got a smile.
00:06:21Oh, yay.
00:06:23Yay, that's better.
00:06:25Alethea is also under the care of Sister Gemma.
00:06:28Hi.
00:06:29Hi.
00:06:31Something I've always wanted to do from being a little girl, really, I always wanted to be a nurse,
00:06:35and being a children's nurse has just been a natural thing for me.
00:06:39Are you feeling better?
00:06:40I find with children, it's a bit more rewarding experience, because you don't just work with the children,
00:06:45you work with the family as well.
00:06:47You're going to have a bit more of your juice?
00:06:50Good girl, well done.
00:06:52She's maintaining her sex all right, isn't she?
00:06:54Yeah, she is, yeah.
00:06:56Packy, but obviously she's got all in there, doesn't she?
00:06:57Yeah.
00:06:58Some of these kids initially do quite well, but then get tired again, and we do kind of have to escalate therapy.
00:07:04We just kind of keep a really close eye and see how she goes.
00:07:08For now, Alethea's oxygen levels are stable.
00:07:11She's moved out of recess, but still needs to be heavily monitored.
00:07:18Oh, mummy's right there, no pickle.
00:07:21I know it's rubbish feeling like you can't breathe properly.
00:07:25Their breathing probably is a wee bit harder, isn't it?
00:07:27It's getting probably a little bit worse, isn't it?
00:07:29So I think probably we are going to end up with IVs for her, all right?
00:07:35We kind of try and make the experience as least traumatic as possible,
00:07:39so sometimes that decision between putting a cannula in is really hard.
00:07:43You don't want to jump in too early and really traumatise them for kind of next time they have to come in.
00:07:48But with Alethea's condition deteriorating again,
00:07:52Dr. De Zoran needs to give her antibiotics through an IV drip.
00:07:57You are being so good and brave.
00:08:01Staying so nice and still.
00:08:03Last little bit.
00:08:04I'm just putting up sticky on, OK?
00:08:06Last little bit of being brave and still.
00:08:08Good girl.
00:08:10Nearly, nearly there.
00:08:12The team will now monitor her closely to see if it takes effect.
00:08:21After being given an IV drip, her oxygen levels have improved and breathing stabilised.
00:08:27I'm going to go for a little ride, sweetheart.
00:08:29Now the team can move her to a special care unit on the children's ward to be observed further.
00:08:39After two days of being monitored, Alethea was released, fully recovered.
00:08:46Nurse Ellie is attending to 11-year-old Alana, who's injured herself while playing at school.
00:08:51Alana might have badly broken her arm, so she's taken for immediate assessment.
00:09:16Here to help comfort her is Mum, Lisa.
00:09:35Ow!
00:09:36It's OK, I promise.
00:09:38I don't like it.
00:09:39There you go.
00:09:40It's just so it can rest a little bit.
00:09:43And then we're going to get you some medicine, OK?
00:09:45I'll be back in two minutes.
00:09:46OK.
00:09:49I was on, like, a log thing and then I was talking to these people and I fell off of it and I broke my arm.
00:09:59It scared me to death.
00:10:01Alana is struggling with the pain, so Nurse Ellie brings some strong medication to help.
00:10:07Are you ready?
00:10:08Yeah.
00:10:08Get set.
00:10:09Somebody's going to do a big breath.
00:10:11Breathe in for me.
00:10:12Are you ready to breathe out?
00:10:13Good girl.
00:10:15I've got that in a second.
00:10:18There we go.
00:10:19Awesome stuff.
00:10:20Because the slightest movement causes Alana agony, her arm needs to be put into a plaster before she can have an X-ray.
00:10:27They can't do it once I move out of bed.
00:10:29We need to get you onto the bed, all right?
00:10:31So I'm going to hold it.
00:10:33I'm going to hold it.
00:10:34Be careful.
00:10:35We're going to do it super careful.
00:10:37I've got it.
00:10:38OK.
00:10:39I've got it, I've got it, I've got it.
00:10:41Don't move it, Lana.
00:10:42I'm going to pull your bum forward really slowly.
00:10:45Slow as you like.
00:10:46There's no much to you.
00:10:47Really slowly.
00:10:48There you go.
00:10:49Yeah.
00:10:50Right.
00:10:51On to the bed for me.
00:10:53Nice and slow.
00:10:53Right, sit back a bit.
00:10:54Hang back.
00:10:55Hang back.
00:10:55Please don't let go.
00:10:56I'm not going to let go.
00:10:57Come here.
00:10:59Do it carefully, please.
00:11:00We're going to, we're going to.
00:11:01Yeah, we're going to speak out.
00:11:02There we go.
00:11:02We're going to let up with it.
00:11:03We don't want to pull it off, do we?
00:11:05It hurts when you let go.
00:11:06I know it does, I know.
00:11:08It won't hurt once we've got this on.
00:11:09It's going to feel loads better because it's just going to support your arm a bit while you're OK.
00:11:14How does that feel?
00:11:17Better?
00:11:18Well done.
00:11:19Well done.
00:11:22Finally, she's taken to x-ray to find out the extent of the damage and if she'll need surgery to repair it.
00:11:31I was on like a log and I slipped off of it and I landed on my arm.
00:11:36and I broke it.
00:11:39Were you with your friends then?
00:11:42No.
00:11:42Your great kind.
00:11:43Yeah, I wasn't with my friends then though.
00:11:55They'll have to wait for the x-ray results, but Alana's confident she'll be going home.
00:12:02Yeah, I want my tea cooking and I want some chocolate and I'll get home.
00:12:05and a cup of tea.
00:12:10They're told that they looked at the x-ray and they said that my arm's looking good, but
00:12:15what's it called again?
00:12:18The doctor's going to come down and have a look at it.
00:12:21It needs to be decided whether it needs surgery or not, but it does look in a good position.
00:12:25Yeah.
00:12:26I mean it did well putting it back into place, didn't it?
00:12:30Have you got to come back on Friday and have you to finish your pot off?
00:12:33Yeah.
00:12:34Yeah.
00:12:35Just to check, it's not swelling or anything like that and then she can have the full pot
00:12:38done because that's just temporary one.
00:12:39They say I can pick a colour, I'm going to pick pink, so I'm going to have a pink one.
00:12:43Nurse Ellie brings good news from orthopaedics.
00:12:48The orthopaedic doctors, the bone doctors have been down to see her already, they've seen
00:12:53her x-ray, they're happy for you to go home.
00:12:55I popped her sling on, the idea of the sling is just to keep her arm in that nice position
00:13:00and when you're at home, pop your hands on some pillows, okay.
00:13:04Alana returned for her pink plaster cast and her arm is on the mend.
00:13:11On duty today in paediatric casualty is registrar doctor Sarah Foster.
00:13:16Hi, have we got Reggie?
00:13:18Yeah.
00:13:19Hello.
00:13:20I'm Sarah.
00:13:21What have you got on your top?
00:13:22Oh, it's a Justice League one.
00:13:23I knew I'd like you.
00:13:24Come on through.
00:13:26Nicola has brought in her four-year-old Reggie with a nasty bumper.
00:13:30on his head.
00:13:31Reggie, do you want to sit on the chair with your mummy?
00:13:33Do you think you can tell me what happened?
00:13:36Shall we get mummy to tell?
00:13:39He's been on the Segway board and he's banged his head on metal bench, so I thought I'd better
00:13:43come and get him checked out.
00:13:45I think he's banged his nose as well, because that will bleed him, won't it?
00:13:49Okay.
00:13:50And he didn't lose consciousness, did he, when he hit his head?
00:13:52No.
00:13:53All right.
00:13:54Has he been sick since you've not attacked him?
00:13:55No.
00:13:56Have you found any injuries anywhere else?
00:13:58Just his head, that's all he did.
00:13:59Just his head.
00:14:00And he's got a few bruises from...
00:14:01Yeah.
00:14:02..calling that.
00:14:03From being poor.
00:14:04Yeah.
00:14:05So, Reggie, what I need to do is I need to have a look at you.
00:14:07Is that okay?
00:14:11Can you show me your teeth?
00:14:12Open your mouth really wide like a lion.
00:14:13Very wide.
00:14:14Well done.
00:14:15He's not had any bleeding from his mouth.
00:14:16No.
00:14:17Lovely.
00:14:18Well done.
00:14:19Can I have a look in your ears?
00:14:20See if we've got any treasure in there.
00:14:21Might tickle a bit.
00:14:22Good boy.
00:14:23That looks brilliant.
00:14:24Can you turn that way with your head?
00:14:26Good boy.
00:14:27And can you turn the other way?
00:14:28Well done.
00:14:29That's really good.
00:14:30Just seems to be that poor forehead, doesn't it?
00:14:33And it has gone down a little bit, hasn't it?
00:14:35Yeah.
00:14:36Things I worry about is, for example, you struggle to wake him up in the morning, whereas normally you wouldn't.
00:14:41That's unusual for Reggie.
00:14:42Yeah.
00:14:43So there are reasons to come back.
00:14:44If he started vomiting, that's a reason to come back.
00:14:46But the gist is, if he's his normal self, he's eating and drinking okay, that's fine for him.
00:14:51I worry about kids that are drowsy.
00:14:54Yeah.
00:14:56You want your blanket?
00:14:57That's a good idea.
00:14:58You can have your blanket.
00:14:59But it's a good bump on the outside, but I can't see anything more serious.
00:15:02We'll just get you some advice about his poor head.
00:15:04It'll take out a while to go down on that.
00:15:06It probably will take a while, yeah.
00:15:07It's a good-going bruise, isn't it?
00:15:08Yeah.
00:15:09I'll just go get Mummy some advice.
00:15:10You stay with your blanket there, as you were super brave.
00:15:13Yeah.
00:15:16All right, buddy.
00:15:17So we've got the head injury advice sheet.
00:15:18It is quite long.
00:15:19Yeah, thank you.
00:15:20Is there anything else you're worried about or just want to ask before you go?
00:15:23No.
00:15:24I mean, you could always climb on my chairs.
00:15:26Everything's a climbing frame, isn't it?
00:15:27No.
00:15:28I'd always have us come and go and check them out.
00:15:29Oh, I'd always rather get them checked out so you don't have to worry, do you?
00:15:31You can then get some sleep tonight, can't you?
00:15:33Rather than keeping him awake and worrying.
00:15:34Yeah.
00:15:35Hi, Reggie.
00:15:36Bye.
00:15:37See you later.
00:15:38Bye, Reggie.
00:15:39Great for Q.
00:15:40See you later.
00:15:41Bye.
00:15:42Super cute.
00:15:43I bet he's not normally that quiet.
00:15:45Reggie has made a full recovery and he's back out on the Segway.
00:15:49Four-year-old Max is taken straight through to the paediatric emergency department.
00:15:59Nurse Molly will be in charge of his care.
00:16:05When Max first came in, he was, bless him, covered head to toe in blood, which immediately
00:16:10just sort of put a bit of panic in you because you're worried about how much blood they've
00:16:13lost.
00:16:17He was literally head to toe covered.
00:16:21There's always the risk with a head injury that they might deteriorate.
00:16:25Children in particular tend to go downhill very, very quickly.
00:16:29Nurse Molly takes a quick handover from the paramedics who brought him in.
00:16:33What's the screaming straight away?
00:16:36He's got a laceration under his hairline.
00:16:42He's described the blood as spurting out.
00:16:45It's quite sensitive to touch.
00:16:47OK.
00:16:48We'll have a little meeting.
00:16:50All right.
00:16:51Here with Max is Mumtani.
00:16:54He's tripped up, went to put his hands out, but he landed his head straight onto the corner
00:17:01of a very, very hard flower pot, cracked the flower pot and smashed his head.
00:17:09So, yeah, there was a lot of blood and he was very distressed for a long time.
00:17:14Nurse Molly does an initial assessment.
00:17:18Oh, good boy.
00:17:20Could this go on your thumb or your toe?
00:17:23You did it last time.
00:17:24What did we do?
00:17:25Would you like your toe or your thumb?
00:17:28Your finger.
00:17:30Yeah.
00:17:31With head wounds, you've always got in the back of your mind that this might be more serious
00:17:34than you think.
00:17:35You just need to be looking out for the signs of neurological damage, you know, consistent
00:17:39vomiting with confusion or loss of consciousness, things like that.
00:17:43It's just regular monitoring to make sure you're not missing anything.
00:17:46Good boy.
00:17:47That's it.
00:17:48Keep going.
00:17:49So Max is now is four.
00:17:53He was diagnosed with Kabuki syndrome when he was one.
00:17:58It's a rare condition that affects one in 32,000 births, so it's very rare.
00:18:04He had hypoglycemia, respiratory trauma, suspected sepsis.
00:18:12We've basically lived in hospital since he was born.
00:18:17I'm going to get a magic pen that pipes up.
00:18:19A symptom of Max's condition is that he doesn't like to be touched.
00:18:23So, well, can you see these?
00:18:25Look, these have got circles on here.
00:18:27And when I press this button here, it shines a light.
00:18:30Are you ready?
00:18:31Yeah.
00:18:32Distraction is key, I think, in children's nursing.
00:18:34It can be quite a scary environment, a new environment,
00:18:36and finding a common ground like play can really help put children at ease,
00:18:40especially when you've got additional needs.
00:18:42Can you press it?
00:18:43Can you press it to make the light?
00:18:44Whilst you do that, I'm going to move your hair.
00:18:47Oh, Max.
00:18:49Wow.
00:18:50Finding something that you can relate to them to can help distract them
00:18:52so you can get your normal observations and things.
00:18:55Would you be better in a cubicle or in the waiting room?
00:18:58Where is there a clock?
00:19:00There's a clock in all my rooms.
00:19:02Max, should we count the clocks on the way out?
00:19:05Yeah.
00:19:06Thank you.
00:19:07Right, can you see one?
00:19:10I think there's one round here.
00:19:11That's number two.
00:19:12The good thing is about clocks, the obsession he's got with clocks,
00:19:15thank goodness, really, because generally there's a clock everywhere you go.
00:19:20And all the doctors and nurses, Max, know, don't they,
00:19:22that when they see you, they always get the clock off the wall, don't they,
00:19:25and they give it to you to play with.
00:19:29Max needs his wound to be glued,
00:19:31but if the procedure becomes too stressful for him,
00:19:34he'll have to be transferred to Sheffield for surgery.
00:19:37That's a lovely box.
00:19:38They knew you were coming.
00:19:41They knew you were coming.
00:19:44Yep.
00:19:45We can't go home until we fix it.
00:19:48My eye.
00:19:49Huh?
00:19:50My eye.
00:19:51And how many clocks have you seen in the hospital so far, Max?
00:19:57Three!
00:19:58You have seen three!
00:19:59You saw three clocks!
00:20:00Max has a rare sensory condition and doesn't like to be touched,
00:20:06which could make his treatment difficult for Nurse Molly.
00:20:11Although it's a deep laceration, it looks like it will come together quite nicely.
00:20:14so they're happy that we can glue and steristrip it.
00:20:18But hopefully it will be nice and smooth and he'll be able to go home with Mum shortly afterwards.
00:20:25He's not very good when he has to have treatment, so you're going to struggle, aren't you,
00:20:31when you have to have this, when you have to have your wound treated, Max?
00:20:36She's clearly a very loving and caring parent.
00:20:39She's really good at explaining everything at his level.
00:20:42So he's not really been too distressed while she's here.
00:20:44She's just fantastic.
00:20:46Oh, yeah.
00:20:48What's that? Can I hold it?
00:20:50Wow, that's a nice ball.
00:20:53Hi, Max.
00:20:55Did Mummy and you have a little bit of a chat?
00:20:57We did.
00:20:58He said we're not allowed to go home until we've sorted out his cut.
00:21:03And then I think we might have to find some stickers and a certificate.
00:21:07Oh, that got a look.
00:21:09And I've got one with robots on, I've got one with ambulance on.
00:21:12You can have a sticker and a certificate.
00:21:15If you pick him up, I'll grab the toy.
00:21:17Matt, it's all right, darling.
00:21:19It's all right.
00:21:21OK, sweetheart.
00:21:23But as the team tries to prepare Max, it seems the situation is all too much for him.
00:21:28Well done.
00:21:29And then head that end.
00:21:31It's always really difficult when a child starts to cry because even though you know you're doing your job, it's still quite distressing for you as well as them.
00:21:39OK, sweetie. OK, I've got his legs done.
00:21:42It wasn't that we were hurting him.
00:21:44He was starting to cry, but unfortunately, before we'd even touched him because he didn't like us being that close to him.
00:21:49Oh, Charlotte!
00:21:51Oh, sweetheart.
00:21:53The additional problem is if we can't close them with SteriStrips and glue, then a child will have to go under sedation and there's additional risks with putting children to sleep.
00:22:00So, therefore, we try and minimise those by treating quite quickly and in our department.
00:22:06So, Mum, the next option will be, unfortunately, we'll have to see if we'll have to have a chat with the consultant about some sedation.
00:22:11All right. I'm really sorry.
00:22:13OK, but the problem we've got is the more upset it gets, the more it bleeds.
00:22:16I can't close it whilst it's bleeding.
00:22:18With Max distressed, the team's focus now is to try and stop the bleeding.
00:22:24It does happen. The more children cry and get upset, the blood pumps quicker around their body and it can cause that clotting to be unclotted.
00:22:32It was so sweet, bless him, but we decided very quickly we then weren't going to do it, but because we'd then opened the wound, it was just pouring and pouring and pouring and pouring.
00:22:41We're going to leave off for a minute, leave you with some gauze just to mop him up as he goes along, try and calm him down a bit.
00:22:47He's difficult.
00:22:48If they hit their point, that's it, you might as well just be talking to a brick wall.
00:22:51Well, this is it and you just can't bring him back down.
00:22:54As Max is still needing treatment, it's now looking likely he'll have to be transferred to Sheffield Children's Hospital for a general anaesthetic.
00:23:01Just trying to help him, trying to help him sort of understand that if he could just cooperate and we could go home, he just won't.
00:23:20To save him any further distress, Nurse Molly has arranged a transfer to Sheffield, where Max can be sedated before his head wound is stitched.
00:23:29Look what I found, because I did promise you one.
00:23:34So look, it's got your name.
00:23:36It's definitely really rewarding at the end of the day when you know you've helped a child or you've helped that family,
00:23:41even if it's only something very small like reassuring a parent that's very anxious, it makes the job worthwhile.
00:23:47That's it. And look, it says, I bumped my head today, because I thought that was quite accurate.
00:23:52Going home, we're going to get a bit of sleep and then leave early tomorrow morning to go to Sheffield Children's.
00:24:01Max's head wound was treated under sedation the next day.
00:24:06He's back home now and happily playing with his collection of clocks.
00:24:09And next, rushed into casualty, is 15-year-old Vinnie.
00:24:19Oh, I like you, Doc Martens, Vinnie.
00:24:22Vinnie's had a seizure at school and blacked out. His school called 999.
00:24:27So I'll do a set of options and you'll get an ECG on you as well, all right?
00:24:30Staff nurse Greg is on hand to help Vinnie and his mum, Kerry.
00:24:34All right, buddy, I need you to undo your shirt for me, please, if that's OK.
00:24:37All right. Get that hairy chest out.
00:24:39Have you got an hairy chest? No.
00:24:42If you're medical and you see a child come in and, to you, that's just a standard, ordinary day for you.
00:24:48But to that parent, it could be, and to that child, it could be one of the worst days you've ever, ever had.
00:24:54A promising young footballer, tomorrow Vinnie has a life-changing opportunity
00:24:58with his beloved Barnsley Football Club.
00:25:02What are you doing this weekend?
00:25:03Ah, I've got a trial of Barnsley.
00:25:06Oh, lovely. You're big into your football, then.
00:25:09Just bought Barnsley, then.
00:25:10Vinnie's never had a seizure before, and there are other telltale signs that not all is well.
00:25:16Can you remember all the planes tomorrow, Vinnie?
00:25:18Er...
00:25:20Who are the planes tomorrow?
00:25:21Darby.
00:25:23Is it home or away?
00:25:24Er...
00:25:26Home, I think.
00:25:27No, it's not.
00:25:28Oh, you see, he's still a little bit confused there, because he's only on the ball with that.
00:25:32Vinnie's blood pressure and oxygen levels seem normal, but Nurse Greg needs to check the readings from his heart with Dr. Sofia Yazdani.
00:25:41We're back in two seconds, buddy.
00:25:43All right.
00:25:45How is he doing that?
00:25:46Sat up, talking, chatting.
00:25:48That's fine. We can keep him in and see how he is.
00:25:50Lovely. Thank you very much.
00:25:51Vinnie's ECG hasn't raised any concerns.
00:25:54I'm just going to keep him in for a while, for a period of observation, really.
00:25:57But while Nurse Greg is with another patient, Mum shouts for emergency help.
00:26:05Have you seen him?
00:26:06No, no, no, we haven't seen you.
00:26:08Does she like? Does she like to me?
00:26:09Help him!
00:26:18Help him!
00:26:19If we can get some...
00:26:20After being rushed into casualty, 15-year-old Vinnie is having another seizure.
00:26:28It's OK. You're all right.
00:26:30Sorry.
00:26:31Vinnie?
00:26:32Vinnie?
00:26:33You know he's here, look.
00:26:35Vinnie?
00:26:36Vinnie?
00:26:38Are you all good, Vinnie?
00:26:39Are you all right? Just come in and have a chat with us about what's happened.
00:26:43Just to see a seizure, it's a horrible thing to witness.
00:26:55There's a lot of jerking, a lot of eye rolling and everyone running in and rushing in to help him.
00:27:00I can't imagine what the parent's feeling.
00:27:04What's he been like whilst he's been here? Has he been his normal sap?
00:27:07In what way?
00:27:08Just very vacant.
00:27:10Is he all right, Vin?
00:27:11Having made sure Vinnie can breathe, Dr Ellison now needs to work out why he's having seizures.
00:27:18She'll have to send him for a CT scan to find out if there's a problem in his brain.
00:27:24It's important that Vinnie has a brain scan, because we don't know what's going on.
00:27:27Parents could be thinking the worst case scenario, like he's got a brain tumour or something like that.
00:27:32When he had his second seizure in the department, it was clear that there was something going on.
00:27:37and I was hoping that it was new epileptic rather than something sinister growing inside his head.
00:27:44Just a few hours ago, Vinnie was looking forward to a trial with Barnsley Football Club.
00:27:49Listen, you're just going for a scan, and then you're coming back.
00:27:54All right, so I'll see you in a bit.
00:27:56Now, all thoughts of a career in football are on hold.
00:28:03So you just rest yourself back?
00:28:05You should go back and put it, and you can have it all the way down, okay, can't you?
00:28:09Radiologist Sian Charlesworth needs Vinnie to stay still.
00:28:13Any slight movements, and the images of his brain won't be clear enough to read.
00:28:19Okay, you're going to move now nice and still.
00:28:22Just comfortable and move his head to the side.
00:28:24Vinnie, it's very important you keep nice and still now.
00:28:26This is your big scan.
00:28:28Close your eyes and keep still.
00:28:30Keep your head up.
00:28:31Vinnie, turn your head up.
00:28:34Yeah, where is it?
00:28:35Keep your head still.
00:28:37Yeah?
00:28:38Keep your head still for me.
00:28:40Yeah.
00:28:41Last bit now.
00:28:42Keep nice and still.
00:28:44Don't move.
00:28:45You're doing really well.
00:28:46Keep going.
00:28:47Well done.
00:28:50You did it.
00:28:51It's your calming voice.
00:28:52I'm all in the back.
00:28:53That's good.
00:28:54Well done.
00:28:55That was strong.
00:28:57Dr Sim hopes the CT scan will reveal why Vinnie is having seizures.
00:29:06You all right?
00:29:07Don't pull that off.
00:29:09Leave it.
00:29:11That's giving you some medicine, that.
00:29:14Yeah.
00:29:15So we need to find out what's wrong with you, so...
00:29:18Dr Sim has the results of his brain scan.
00:29:22So the CT scan was normal, so no sign of anything worrying on that,
00:29:26which is good.
00:29:27And his blood tests will come back as pretty normal.
00:29:30It's a slightly raised right cell count,
00:29:32which could suggest a possible infection.
00:29:34but we would have thought if it was something like meningitis or encephalitis,
00:29:38that it would actually be quite a bit higher.
00:29:40What may have caused it then?
00:29:42So we're not sure it's possible that he has had what's called an epileptic seizure,
00:29:47but it's odd to have two in quite quick succession.
00:29:51So, at the moment, we don't really know what's caused it,
00:29:54which is why we want to get him around to the Children's of Sesame Unit
00:29:58once we're happy that he's stable enough to go around.
00:30:01Thank you.
00:30:02OK, thank you.
00:30:03Vinny's trial with his favourite team will have to be put on hold.
00:30:12He'll not get his McDonald's today then, will he?
00:30:19In paediatrics, it's been a traumatic day for Vinny's mum Kerry.
00:30:23I'm hoping it's just a one-off episode.
00:30:25It has no lasting consequences.
00:30:27We just have to wait and see.
00:30:29I'll be staying with Vinny if they'll allow me to stay with him tonight.
00:30:33With no diagnosis for his seizures,
00:30:35Vinny is being admitted for further observation.
00:30:38He spent three nights in hospital
00:30:40and will return for another scan to determine if he has epilepsy.
00:30:44Barnsley Football Club has invited him for a trial next year.
00:30:48A teenager is in extreme pain following a sports injury.
00:30:55He can't move his arm.
00:31:00Paediatric nurse Greg is waiting to receive the patient
00:31:03and get the handover from the paramedics.
00:31:12This is Jude.
00:31:13He's a 16-year-old male.
00:31:15He's been at school playing football.
00:31:17He's gone in for a tackle and fallen, landing on his left side.
00:31:21Mum has arrived at school to try and get him to go in the car.
00:31:25Due to the positioning of his arm, he can't bend it down.
00:31:28He can't move it.
00:31:29It literally stays in that L-shaped position.
00:31:31She couldn't get him in the car, so called for us.
00:31:34How do you feel?
00:31:36All right.
00:31:37All right?
00:31:38You don't feel sick or anything, or...?
00:31:40It's just, what, pain?
00:31:42Yeah.
00:31:44Registrar doctor Gemma Hartshorn is assigned to Jude's case.
00:31:50I think I decided in senior school that I wanted to become a doctor.
00:31:54Jude, hello. I'm Gemma. I'm one of the doctors.
00:31:57If my parents had had their way, I'd probably be an engineer now,
00:32:01but not to be, and here I am.
00:32:05I'm going to try and sort your shoulder out for you.
00:32:08Where does it hurt?
00:32:10Just there.
00:32:11Just in there?
00:32:12Okey-dokey.
00:32:13And what did you do?
00:32:15Fell over on my shoulder and hit football.
00:32:17Straight onto it?
00:32:18Yeah.
00:32:19OK, I'm just going to feel your shoulder.
00:32:20Is that all right?
00:32:21So I'm going to touch you like this on the other side.
00:32:23Can you feel it here?
00:32:24Yeah.
00:32:25Can you feel it here?
00:32:26Slightly.
00:32:27Slightly.
00:32:28Can you make an O sign for me like this?
00:32:30Well, keep supporting your arm.
00:32:32Keep your fingers like that.
00:32:33So keep them really tight together the best you can.
00:32:36Lovely.
00:32:37And the most pains all around here.
00:32:38Yeah.
00:32:40Looking at the way he's holding his shoulder,
00:32:42I think he's dislocated it in a way that we don't typically see.
00:32:47I'm going to get you around for an x-ray.
00:32:48Yeah.
00:32:49I think it's dislocated, but I need to make sure it's not broken as well.
00:32:52Right.
00:32:53And then we need to put it back for you.
00:32:54Once it's back and if it's not broken,
00:32:56it will, I promise you, feel an awful lot better.
00:32:59If the x-ray shows that Jude's shoulder is broken,
00:33:02he'll need emergency surgery to fix it.
00:33:09Hey, mate, how was that?
00:33:10All right.
00:33:11Be nice to you.
00:33:12Yeah.
00:33:13That's what we like.
00:33:14Dr Hartshorn is in the hub looking over his scans.
00:33:19This is the head of the humerus and it should be up here.
00:33:23And it's kind of below the joint.
00:33:25So it's definitely dislocation.
00:33:27And it looks like it's probably an inferior type of dislocation,
00:33:31which isn't the most typical we normally see.
00:33:34Jude's shoulder isn't broken,
00:33:37but a dislocation of this nature needs a clear plan to get it back into joint.
00:33:42Julia, can't decide where it is other than not in the right place.
00:33:47Jude's injury is reasonably unusual.
00:33:50It's certainly the first time I'd seen this injury,
00:33:53which is one of the reasons I spoke to Dr Julian.
00:33:56So he's holding his arm like this and won't put it down by his side,
00:34:00which made us think it was inferior.
00:34:02Because normally it's here if it's anterior, isn't it?
00:34:05Yeah, it's inferiorly.
00:34:06So you just need to pull it out.
00:34:09So just pull it, keep it going the trajectory that he's already in?
00:34:12Yeah.
00:34:13OK.
00:34:14Pull it out, actually, flop back in.
00:34:15OK.
00:34:16Just relax him and pull it.
00:34:19Plan agreed.
00:34:21Jude and his mum can be updated on the course of treatment.
00:34:24So, your shoulder is dislocated, but there's no breaking bones,
00:34:28which is good, OK?
00:34:30Because that means we can do something about it
00:34:32and once we've fixed it for you,
00:34:34it might be a bit achy, but the pain that you're in now will go away.
00:34:37Yeah.
00:34:38OK?
00:34:39The procedure isn't straightforward.
00:34:41It's also the first time Dr Hartshorn has attempted
00:34:44to treat this rare dislocation.
00:34:47If she can't get the shoulder back into joint,
00:34:50he'll need emergency surgery.
00:34:53OK?
00:34:54Yeah.
00:34:55Any questions at all from either of you?
00:34:58Lovely.
00:34:59Are you ready?
00:35:00Don't worry.
00:35:01You'll not feel anything.
00:35:02So they just put it back in place and that's it?
00:35:04Yeah.
00:35:05Yeah, yeah.
00:35:06No.
00:35:07Right then, put this bit in your mouth
00:35:11and I want you to keep your lips around it
00:35:13and breathe in and out through your mouth, OK?
00:35:16So it's a bit funny.
00:35:18It smells and tastes a bit funny to start, right?
00:35:20It will get better, I promise you.
00:35:21Let it work.
00:35:22So you need to keep it in your mouth the whole time,
00:35:24take a deep breath in, fill your lungs bigger than that.
00:35:27Really deep breath.
00:35:29That's better.
00:35:30That's it.
00:35:31You're doing really well.
00:35:33You're doing really well.
00:35:35Jude needs to be completely relaxed
00:35:37before the doctors can attempt to put his shoulder back in place.
00:35:40Some nice deep breaths for me, Jude.
00:35:42Well done.
00:35:43If he stiffens up or fights,
00:35:46he could cause further damage.
00:35:51Deep breaths.
00:35:52Well done.
00:36:09How are you feeling?
00:36:10Whoa.
00:36:15Turn that arm for me.
00:36:17Is that feeling better?
00:36:18Yeah.
00:36:19Good.
00:36:20What?
00:36:21This is so weird.
00:36:23Do you feel a bit spaced out?
00:36:25Yeah.
00:36:26You can have a good giggle now.
00:36:27So maybe I should have mentioned
00:36:30it's like you've given him a couple of fights.
00:36:32Yeah.
00:36:33We're going to put a sling on
00:36:34and then we're going to give you a moment with your mum
00:36:36just to kind of come round.
00:36:37Shall I keep going on?
00:36:38No, you're all done.
00:36:39You're all done.
00:36:40Sure, sure.
00:36:41That's fun though, isn't it?
00:36:42Yeah.
00:36:43Good stuff, eh?
00:36:44So his shoulder looks like the other one again now.
00:36:47Yeah.
00:36:48and there's a nice little walk as it went back.
00:36:50That was easy, wasn't it?
00:36:51Yeah.
00:36:52It's about traction as much as anything else
00:36:54rather than strength, luckily,
00:36:55because I've got none of that.
00:36:57So I'll get you round for another x-ray.
00:36:58Yeah.
00:36:59Make sure we have put it back to where it should be.
00:37:01But given that it doesn't hurt anymore
00:37:02and you've not got any medication going,
00:37:04hopefully it's in the right place.
00:37:06Okay.
00:37:07Lovely.
00:37:08I actually really quite enjoy treating dislocations.
00:37:11It's quite a satisfying thing to do
00:37:13because you really can see an immediate end result.
00:37:17How do you feel now?
00:37:18Weird.
00:37:19All right, mate.
00:37:21Go round here, pal.
00:37:25It went in pretty easy, didn't it?
00:37:27Thank goodness.
00:37:28Oh.
00:37:29Oh, thank God.
00:37:30It's over.
00:37:31It all went well.
00:37:32Yeah.
00:37:33I'm very pleased.
00:37:34It makes me very happy when you do something useful.
00:37:38Thank you.
00:37:39A follow-up x-ray revealed his arm was back in position.
00:37:45Jude and his mum Charlie can go home, freeing up another bed.
00:37:50But another patient is being brought into recess.
00:37:57Right, mate.
00:37:58You come and jump up there.
00:37:59And we'll sort you out.
00:38:0215-year-old Danny has been brought in by his mum
00:38:05after falling from a tree and crushing his wrist.
00:38:12Paediatric charge nurse Johnny is treating him.
00:38:16Being a male nurse, that works well, especially with teenage boys.
00:38:19Talked a little bit more relevant stuff about them,
00:38:21like going to the gym or football.
00:38:23I feel like they can get that trust and that bond with me sometimes.
00:38:27A team of doctors are going to attempt
00:38:29to manipulate Danny's bone back into position.
00:38:33What's this to do?
00:38:34It's just some oxygen.
00:38:36And it can be a painful process.
00:38:40Are we ready?
00:38:41Yeah.
00:38:42Shall we ferment?
00:38:43He'll need to be anaesthetised.
00:38:45When I wake up, yeah, we must be all right.
00:38:50When I wake up.
00:38:51The aim of this is to get it in a better position
00:38:53and when you wake up you should have a plaster on it.
00:38:57Okay.
00:38:58Yeah, yeah.
00:38:59Right, so medication is going in.
00:39:03How do you feel?
00:39:04Tired.
00:39:06Do you have any pain?
00:39:07No.
00:39:08You're going to lean your head back.
00:39:10That's it.
00:39:12Daniel.
00:39:14Younger patients may need up to twice as much anaesthetic
00:39:17as older people of the same weight.
00:39:21Danny is now safely under.
00:39:23Let us know when you're ready.
00:39:24Are you talking?
00:39:25Yeah, I think we're ready.
00:39:27His mum is being kept informed and the medical team get to work.
00:39:31If they can't manage to manipulate it successfully, Danny will need major surgery.
00:39:46Consultant Dr. Dave Walker and his team are trying to manipulate the bones into position.
00:39:54To do that, they'll have to wrench the broken bones apart.
00:39:58It can look really scary.
00:40:01I can assure you that the patient doesn't feel anything.
00:40:05They're away with the fairies.
00:40:07Can they be ready?
00:40:08Ahhhh.
00:40:10Sorry.
00:40:11Ahhhh.
00:40:12Charge nurse Johnny puts a cast on Danny's wrist to hold the bones in place.
00:40:17But the team continue to make adjustments.
00:40:20Now the wrist is supported by plaster.
00:40:23Just going to do a bit more bending.
00:40:25Alright.
00:40:26Just going to do a bit more.
00:40:27Moulding.
00:40:28Yeah.
00:40:29Yeah.
00:40:31Yeah.
00:40:32So fine.
00:40:33Yeah, fine.
00:40:34Yeah, fine.
00:40:35Nice.
00:40:36I'm putting that hand.
00:40:37Yeah.
00:40:51Just waiting for the set.
00:40:52and then screw it with us again.
00:40:53Thank you.
00:41:03Just six minutes after going under.
00:41:05Hi, are you feeling?
00:41:06Hi.
00:41:07All right.
00:41:08All good?
00:41:09Yeah.
00:41:11It's all done now.
00:41:12Yeah?
00:41:13Yeah.
00:41:14Danny wakes up with his bones set and a cast on his arm.
00:41:17No.
00:41:18No.
00:41:19Did you feel anything?
00:41:20No.
00:41:21No, that's good.
00:41:22You all right, mate?
00:41:23Yeah.
00:41:24How's your arm feel?
00:41:25Feels all right.
00:41:26Feels all right?
00:41:27Yeah.
00:41:28I'm just going to unplug you from all this.
00:41:29He's all right then behind him, yeah?
00:41:30We're going to get an x-ray.
00:41:31Yeah.
00:41:32We're going to get an x-ray.
00:41:33We're going to see what position it's in.
00:41:34Wow.
00:41:35We want to manipulate it as best we can, and then we take it around for an x-ray.
00:41:39Fingers crossed it's in a lot better position than it was before.
00:41:42However, unfortunately, sometimes it cannot be manipulated correctly.
00:41:47He might have to have some pins and plates in his wrist, which can be scary for a young
00:42:06teenager.
00:42:07The x-ray will show if the team have saved Danny from an overnight stay and a serious
00:42:12operation.
00:42:13We've just had it manipulated, have you?
00:42:18Yeah.
00:42:19What we need is your hand just over here, sweetheart.
00:42:22Because there's a shortage of porters, charge nurse Johnny heads over to the x-ray department
00:42:27himself to collect a patient.
00:42:29Right, just stay nice and still there for me.
00:42:31Danny had a procedure on his broken wrist bone in recess to pull it back into position.
00:42:37The x-ray will tell if the bone is now in place.
00:42:40If not, he'll need a major operation.
00:42:46That's great.
00:42:48Thank you.
00:42:50You all right, mate? Yeah.
00:42:51Orthopedic team.
00:42:52They'll have a look at your x-ray now.
00:42:54The crushed wrist bone has been stretched back to its original shape.
00:42:58It does look loads better, that.
00:43:01Compared to that, that's before.
00:43:03And that's after.
00:43:04It looks loads better.
00:43:05I do have you do.
00:43:07With that, can you hold it again?
00:43:09Of course.
00:43:10Of course he is.
00:43:11Come on.
00:43:12Damn question, wouldn't it, to be fair?
00:43:14Charge nurse Johnny gives Danny the good news.
00:43:17So the doctors have had a look at your x-ray, mate.
00:43:19They're happy for you to go home.
00:43:20Yeah.
00:43:21You don't have to have an operation or anything like that at this moment in time.
00:43:23Yeah.
00:43:24Just make sure you keep wiggling your fingers.
00:43:25Yeah.
00:43:26Make sure they don't turn purple or blue or anything.
00:43:28Yeah.
00:43:29Just like that for some swelling.
00:43:30Make sure you get a little bell to ring so you can get your mum to make you plenty of
00:43:33cups of tea.
00:43:34He's still quite a young teenager, so his bones will be growing still.
00:43:40And at that age they heal really good as well, which is always nice.
00:43:44You're not going to go climb new trees any time soon?
00:43:46No.
00:43:47No.
00:43:48I regret it.
00:43:49Stay at home.
00:43:50Yeah.
00:43:51Alright mate, that's it.
00:43:52You get yourself off.
00:43:53Alright mate, nice to meet you.
00:43:54See you later.
00:43:55See you.
00:43:56Danny's wrist is fully functional again and he's back out enjoying the South Yorkshire woodlands.
00:44:04Hello, Alex.
00:44:05Hi.
00:44:06Alex.
00:44:0717-year-old Alex had a suspected seizure after falling off his bike.
00:44:21Mum Emma came with him in the ambulance.
00:44:23He was flying up partway his girlfriend and his brother and his cousin and he's going
00:44:28to go a wheelie on his bike and he's gone flying behind his head off the floor and he
00:44:33and he started when unconscious, then started to hurt-fitting.
00:44:36So you've got some pain in your neck?
00:44:38Yeah.
00:44:39It's just started.
00:44:40Oh okay, it's just started now?
00:44:41Yeah.
00:44:42Yeah.
00:44:43Consultant Dr Liz Docherty takes charge of Alex's care and immediately starts to check
00:44:48for signs of spinal trauma.
00:44:50So whereabouts is it here?
00:44:51The lower.
00:44:52The lower.
00:44:53The lower.
00:44:54So where hurt initially?
00:44:57The back.
00:44:58Whereabouts when you're back?
00:44:59Yeah.
00:45:00The upper is it?
00:45:01That's where it hurt to start?
00:45:02Yeah.
00:45:03The upper is it?
00:45:04Yeah.
00:45:05Is that where it's sore now?
00:45:06Yeah.
00:45:07Yeah.
00:45:08Yeah.
00:45:09Sore all the way up, is it?
00:45:10Yep.
00:45:11Right.
00:45:12And how's the numbness that's down your arms?
00:45:14I can feel a little bit of pain but not a lot.
00:45:15Can you feel me touching your arms though?
00:45:16No.
00:45:17What, both of them?
00:45:18Nowhere?
00:45:19Can't feel it?
00:45:20No.
00:45:21Dr Docherty needs to keep Alex's movement to a minimum as he's showing signs of nerve
00:45:37damage.
00:45:38Three, one, two, three.
00:45:41If it is broken, any movement could cause further serious damage.
00:45:46Just gonna keep your neck just with the blocks on either side just to keep it nice and steady
00:45:50until we've had some x-ray.
00:45:51Is that okay?
00:45:52Yeah.
00:45:53Yeah?
00:45:54Did you hit your hand?
00:45:55Yeah.
00:45:56Sorry, but it's showing the box.
00:45:58It's fine.
00:45:59Mm-hmm.
00:46:00Nurse Ainsley checks for signs of concussion.
00:46:05Yeah, Alex.
00:46:07You've got an x-ray.
00:46:09You're okay, Alex?
00:46:10Yeah.
00:46:11Okay.
00:46:12See you in there, pal.
00:46:13Cheers.
00:46:14I'm gonna do a couple of x-rays of your neck.
00:46:15All right.
00:46:16Let's press .
00:46:17If Alex has broken his neck, it could cause damage to his spinal column, an injury that
00:46:30has the potential to leave him seriously debilitated.
00:46:34Despite his own predicament, Alex is more worried about his girlfriend.
00:46:38How's Alicia?
00:46:39She's scared, obviously.
00:46:42It's fine.
00:46:43Don't worry.
00:46:44Yeah, it's fine.
00:46:46I'm scared of her.
00:46:49Do you have scared everybody?
00:46:52You're just that way.
00:46:55You're fine.
00:46:56And accidents happen, don't they?
00:47:00Yeah?
00:47:01Hmm.
00:47:02Don't worry about it.
00:47:04You'll be fine, all right?
00:47:07Right, if that results come by, yeah?
00:47:10Mm-hmm.
00:47:11You mean?
00:47:12Just don't panic too much, but she'll start again, okay?
00:47:15Hey, I've already been told.
00:47:17Oh.
00:47:18Go, Chad.
00:47:20All right.
00:47:21It's now a waiting game for Alex.
00:47:32His x-rays will reveal if he's suffered any serious neck or spinal damage.
00:47:37Yeah.
00:47:38Well, you have to wait for a wee, soz.
00:47:40Can't wait.
00:47:41Can't wait to have a pee-pee.
00:47:42Mm-hmm.
00:47:43What?
00:47:44Evening to put a doll in it, yeah?
00:47:45Yeah.
00:47:46Finally, Dr Doherty has some news.
00:47:47Hi.
00:47:48Hey, are you okay?
00:47:49I've had a look over your x-rays, and everything looks fine on your x-rays.
00:47:51Mm-hmm.
00:47:52Okay, so no broken bones.
00:47:53So I can take this off, because I understand you're desperate for a wee.
00:47:54Yeah, it really is a wee.
00:47:55Yeah, so we can get you wet.
00:47:56With his x-rays showing no broken bones, Alex can finally have the neck brace removed.
00:48:11Just move your neck from side to side.
00:48:12Give him a hand.
00:48:13That feel all right?
00:48:14Yeah.
00:48:15Yeah.
00:48:16And that's not the only relief.
00:48:19This isn't the first time Mum Emma has brought Alex to Barnsley Casualty.
00:48:28Falls, injuries.
00:48:29We're unconscious.
00:48:30It's just right.
00:48:31Accident brought up everything.
00:48:32It's annoying.
00:48:33It's high for a lot of time, but that's because he's got ADHD.
00:48:38He's actually a young, caring lad, actually.
00:48:41I won't ask for a better kit, really, sometimes, because he'll help anybody.
00:48:46He's always caring for his family.
00:48:49This is the best one.
00:48:51Oh, thank you.
00:48:53See how it's there for me.
00:48:56I am.
00:48:57While Stalix's x-rays haven't revealed any areas of concern,
00:49:01he can't leave until the doctors have found out the reason for his fit.
00:49:06All right?
00:49:07Yeah.
00:49:08How are you feeling, Alex?
00:49:09All right.
00:49:10You're all right?
00:49:11Yeah.
00:49:12I'm happy.
00:49:13Nothing too serious.
00:49:14Nothing too worrying.
00:49:15And likely your neck will feel a bit stiff and sore tomorrow after it.
00:49:19So take some regular painkillers, paracetone or brufa and that type of thing.
00:49:22Yeah?
00:49:23Yeah.
00:49:24And it's really important to keep it moving.
00:49:25Yeah.
00:49:26All right.
00:49:27Anything you're worried about or you want to ask me?
00:49:28No.
00:49:29Good.
00:49:30But Mum Emma is still concerned about Alex's fit.
00:49:33Yeah.
00:49:34Can I ask you a question about a kind of fit seizure kind of thing?
00:49:36What would have caused that?
00:49:38From what the doctor that came to assess you first on scene,
00:49:42their assessment was that it was likely due to hyperventilation.
00:49:46So do you know what that is?
00:49:47That's when you breathe too fast.
00:49:48So when something stressful happens, you can feel stressed and you breathe faster.
00:49:52And then that makes you feel unwell and so then you feel unwell and you breathe even faster.
00:49:58But definitely your lungs are working perfectly fine when we've checked them.
00:50:02I'm going to say it's oxygen 100% for...
00:50:04Yeah, exactly.
00:50:05So normally, normal is between 94 and 98.
00:50:07So it just shows you've been breathing too much more than what your body needs.
00:50:11And it's just from having the bad accident or something other stressful can cause it as well.
00:50:16Thank you.
00:50:17Alex was discharged from casualty, but has follow-up appointments with cardiology and neurology
00:50:25to confirm that he has no underlying conditions.
00:50:28Hello, I'm Richard. I'm one of the doctors. Come this way.
00:50:3213-year-old Bobby was rushed to casualty in pain after falling and landing awkwardly on his arm.
00:50:38Let's put this on the lights on.
00:50:40Have a seat on the orange chairs for me.
00:50:43And looking after him today is Registrar Richard Gentles.
00:50:48Have a seat.
00:50:49Thank you.
00:50:50With Bobby is Mum Leanne.
00:50:52So, what's been going on?
00:50:54I was walking.
00:50:55There was this little lad walking in front of me.
00:50:57And it was either I went on him or on the floor.
00:51:00My foot kind of went and then I put my arm out.
00:51:03This one.
00:51:04Yeah.
00:51:05Did you land like this?
00:51:07This one?
00:51:08Yeah.
00:51:09Yeah.
00:51:10Yeah.
00:51:11If Bobby's arm is badly broken, it could affect the blood flow to his hand.
00:51:14Can I have a look at your arm?
00:51:16Yeah.
00:51:17So, can you wiggle them fingers for me?
00:51:18I can do it, but it depends a bit.
00:51:21Can you feel me touching that finger?
00:51:22Yep.
00:51:23Can you feel me touching this one?
00:51:24Yep.
00:51:25And that one?
00:51:26Yep.
00:51:27And that one?
00:51:28Yep.
00:51:29If I just squeeze in your hand, does anything hurt in your hand?
00:51:30It feels a bit weird, but no.
00:51:31It feels a bit weird.
00:51:32What if I feel on this side of your wrist?
00:51:36Yeah.
00:51:37That is.
00:51:38What if I feel on this side?
00:51:40Yeah, yeah.
00:51:41OK.
00:51:42Sorry.
00:51:43Sorry.
00:51:44Feel your pulse under there.
00:51:45Lovely stuff.
00:51:46So, let's get you round for an x-ray and see what it all looks like.
00:51:49You're at a funny age where some of your bones are still quite soft,
00:51:52so they can bend rather than break, but some of them are getting more adult bones,
00:51:56so they can break rather than bend.
00:51:58So, let's see where it's done.
00:51:59Bobby has made a habit of visiting Barnsley Casualty.
00:52:02It's one his mum is keen to end.
00:52:04Are we going to say this is the last one now?
00:52:07I can't promise that one.
00:52:08No, this is the third time I have to have surgery.
00:52:12You don't have to remind me.
00:52:14Then you've broken your foot.
00:52:15Yeah.
00:52:16And then this one, you fell off with fresh air.
00:52:19Yeah.
00:52:20I think my arms have had enough.
00:52:22Yeah.
00:52:23Dr Gentles needs to know the extent of any damage to Bobby's arm.
00:52:27Follow me, I'll show you where to go.
00:52:29So he's shown straight through to x-ray.
00:52:31That sort of jaggedy appearance across it, so that's a break.
00:52:44When you look on the other side, it's very lovely and straight.
00:52:46It's bent.
00:52:47It's got a big step on it.
00:52:48Here's where he's broken it.
00:52:50He's broken two bones.
00:52:52You know, I was saying your bones are still relatively soft.
00:52:56You have essentially sort of bent and slightly broken both the bones in your forearm.
00:53:00Because you've done both the bones, we need to put you in a pot.
00:53:03That'll be on for about a month, maybe six weeks.
00:53:06You've done it properly.
00:53:07Thank you.
00:53:08All right.
00:53:09Now it's confirmed that Bobby has broken his arm for the second time, staff nurse Molly
00:53:18arrives to put a plaster cast on.
00:53:20All right then.
00:53:21So first things first, I'm just going to put a little tuby sock on your arm.
00:53:24Okay.
00:53:25Right, they've got some fluffy stuff.
00:53:27Technical turn.
00:53:28Okay.
00:53:29Does it feel nice and warm?
00:53:30Yeah.
00:53:31I thought it might.
00:53:32Bit weird.
00:53:33Bit weird.
00:53:34Bit weird.
00:53:35I haven't done it in a while.
00:53:36Not done it.
00:53:37You're becoming a professional, are you?
00:53:38Yeah.
00:53:39Right, but you need to keep your arm straight for me, sweetheart.
00:53:40Just put your arm up like that to put your fingers up.
00:53:42Yeah.
00:53:43Is it going harder?
00:53:44Getting on all right?
00:53:45Oh, look at you with your hands still up.
00:53:46You're doing well.
00:53:47An hour and a half after first being seen, Bobby, complete with cast, is allowed to
00:53:50go home.
00:53:51Oh, look at you with your hands still up.
00:53:52You're doing well.
00:53:53An hour and a half after first being seen, Bobby, complete with cast, is allowed to go
00:54:08home.
00:54:09Right.
00:54:10Home at last.
00:54:11Excellent.
00:54:12Thank you.
00:54:13No showering.
00:54:14Sorry.
00:54:15That'll not be hard.
00:54:16Well done.
00:54:17He returned to the fracture clinic four weeks later for further treatment and physiotherapy.
00:54:32The latest ambulance arrival is 18-year-old Lewis, who came off his moped at high speed.
00:54:38This main concern, Lewis, is his right arm with control of the medium with the dressing,
00:54:43but it doesn't wait to irrigate the weeds because they're very, very painful.
00:54:46Nurse Millie wants to take his ops.
00:54:48Well, we've got this on your arm.
00:54:49Where's the majority of you paying, then?
00:54:50This arm.
00:54:51Nice to tell you.
00:54:52Oh, that's annoying because I put an needle in there.
00:54:53Can I have some gas in there?
00:54:54I don't like needles.
00:54:55I don't like needles.
00:54:56All right.
00:54:57Go after that, then.
00:54:58I have to go, Mum.
00:54:59I have to go.
00:55:00Right, right.
00:55:01I don't like needles.
00:55:02I have to go, Mum.
00:55:03I have to go.
00:55:04Right, right.
00:55:05I don't like needles.
00:55:06Oh, man.
00:55:07Can I have some gas in there?
00:55:08I don't like needles.
00:55:09All right.
00:55:10Go after that, then.
00:55:11I have to go, Mum.
00:55:12I have to go.
00:55:13Right, right.
00:55:14I don't like needles.
00:55:15I can't just go the other way.
00:55:16Oh, man.
00:55:17I can't give me a needle.
00:55:19I don't like her.
00:55:20I need some gas in there, or something.
00:55:22Lewis?
00:55:23No chance, man.
00:55:24It hurts.
00:55:25It hurts.
00:55:26I'm not going to hurt.
00:55:27No.
00:55:28No.
00:55:29We're putting no needle in me, no.
00:55:30I'm taking it off.
00:55:31I'm taking it off.
00:55:32It hurts like a coat, man.
00:55:34It's not a needle arm to put in, Lewis.
00:55:36It's a little plastic tube.
00:55:38No.
00:55:39I don't want...
00:55:40No.
00:55:41But we need to get you started out.
00:55:43I'm not probably by myself.
00:55:45Lewis's needle phobia is going to test the bedside charm
00:55:48of junior doctor Tom Fish.
00:55:50Hi, Lewis.
00:55:51I'm Tom.
00:55:52I'm one of the doctors.
00:55:53We're putting no needle in me, no.
00:55:54You can try good cop, you can try bad cop, and...
00:56:00often, neither work.
00:56:03Ah!
00:56:04Ah!
00:56:05Ah!
00:56:06Yeah, so I wouldn't be surprised if there's a bit of you breaking that.
00:56:09All right.
00:56:10Do you want to rest it down where it's comfortable for you?
00:56:12Because the support is going to be painful at the moment.
00:56:15So we're going to need to get an x-ray of that.
00:56:18Yeah.
00:56:19In terms of temporary bandage,
00:56:21and just get something really tight.
00:56:23I hope we can give them a sling as well to get to x-ray.
00:56:29People can make their own decisions.
00:56:30I can't force people to accept anything if they're of sound mind.
00:56:35And I wouldn't want to.
00:56:37The nurse has returned to clean up the wound.
00:56:40That's why I'm just going to put some work on a few bandages.
00:56:43Oh, he's going to f***ing hurt, isn't he?
00:56:45He's going to sting a little bit, yeah.
00:56:46Oh, man.
00:56:47A bit of salt, isn't it?
00:56:49Hey.
00:56:50Oh!
00:56:51Oh!
00:56:52Oh!
00:56:53Oh!
00:56:54Oh!
00:56:55Oh!
00:56:56When we were coming at you with needles, as you put it,
00:57:00the reason that we do that is because when people have big injuries,
00:57:04sometimes they can get injuries internally which bleed.
00:57:08We can't always see it.
00:57:09I don't know.
00:57:10I want more.
00:57:11No.
00:57:12Sorry.
00:57:13I don't think it's going to come.
00:57:14I think if anything changes, we're going to need to re-discuss this.
00:57:18All right.
00:57:19No.
00:57:20I want more.
00:57:22Cut some tape.
00:57:23You feel this banger healing in?
00:57:24How am I supposed to take that?
00:57:25Pretty mad.
00:57:26Oh.
00:57:27It's a dreaded syringe, but thankfully, no needle.
00:57:31It's a dreaded syringe.
00:57:32Yeah?
00:57:33Oh!
00:57:34And then this is like a nail.
00:57:35Just breathe it.
00:57:36Breathe it in.
00:57:37It's a good thing, as well.
00:57:38It's good.
00:57:39Have you ever tried this?
00:57:40No.
00:57:41Oh.
00:57:42Definitely.
00:57:43I would recommend you.
00:57:46Oh!
00:57:47Oh!
00:57:48Can you do it in your vanilla?
00:57:50I can't.
00:57:51I don't like it.
00:57:52You can't have some of that white, can't I?
00:57:54Well, we can.
00:57:55I know, but I'm probably going to be sick of it.
00:57:58You know?
00:57:59Oh!
00:58:00Oh!
00:58:01Oh!
00:58:02Oh!
00:58:03Oh!
00:58:04Oh!
00:58:05Oh!
00:58:06Oh!
00:58:07Oh!
00:58:08Oh!
00:58:09Oh!
00:58:10Is it working yet?
00:58:11Yeah.
00:58:12Probably it's weird, did you?
00:58:13It sounds as if Lewis may now allow them to use needles.
00:58:16Nurse Kim goes to the hub to give Dr Fish the good news.
00:58:20I think you might like to stitch it.
00:58:21If you need to stitch it, I'd put a needle in there.
00:58:23Okay.
00:58:24That's fine.
00:58:25Has he had his activity?
00:58:26No, it hasn't gone yet.
00:58:27I'll come to ask for me.
00:58:28I'll come to ask for me.
00:58:33Kim was just saying that you think you'd be happy for us to take bloods if he wanted
00:58:36us to take bloods?
00:58:37Yeah, I think when you stitch it, I don't think you've never done it.
00:58:39No, so we need to get the x-ray first.
00:58:41Oh, yeah.
00:58:42All right.
00:58:43Yeah.
00:58:44Because if the x-ray is really bad, we will need to take bloods.
00:58:45Yeah, yeah, yeah.
00:58:46Okay.
00:58:47We'll get the x-ray first.
00:58:48All right, you're looking a bit cleaner, aren't we?
00:58:49Yeah.
00:58:50Yeah.
00:58:51Thanks, ladies.
00:58:52Yeah.
00:58:53Lewis is wheeled off for his x-ray.
00:58:59Looks like there's some sort of avulsion fracture.
00:59:01It looks unusual.
00:59:02It does look unusual, doesn't it?
00:59:05The other complicated thing, as I was saying, is he's got a laceration over that area.
00:59:08I haven't fully explored it.
00:59:09No, you don't want to.
00:59:10Somebody needs to wash it out.
00:59:11Yeah.
00:59:12You can go to people and they're going to have a conversation with you where you feel supported
00:59:17and they can help you get the right answer.
00:59:19It is a way of teaching, isn't it, really?
00:59:21It looks like you've chipped a bone right at the end there.
00:59:25The complication is that you've got a nasty wound over that area.
00:59:29That can be an entry point for an infection into the bone.
00:59:32What they will need to do is they'll need to wash out your elbow joint, so you'll have to
00:59:35have an operation.
00:59:36Oh, you're lying.
00:59:38I'm not lying, no.
00:59:39And if you're going to have an operation, they're going to probably want some blood tests as
00:59:41well.
00:59:46All right.
00:59:47Be back soon, OK.
00:59:48Dr Fish briefs Nurse Christy.
00:59:50He's going to be admitted, but we're going to have to have some conversations about going
00:59:53a cannula in and bleeding him.
00:59:55Oh, he hates needles is the problem.
00:59:57My next job is supposed to try and persuade him.
01:00:00Hello again.
01:00:01What's that?
01:00:02They want you to have some IV antibiotics, so antibiotic steroid drip.
01:00:05I don't like needles.
01:00:06I know.
01:00:07I know you don't like them.
01:00:08So whatever happens, you need to come into hospital overnight.
01:00:10No, I'm not.
01:00:11No.
01:00:12Not a chance, mate.
01:00:13I need to go home.
01:00:14OK.
01:00:15So the risks of you going home, firstly, the pain.
01:00:16Yeah.
01:00:17Secondly, we were talking about how we wanted to do bloods because sometimes people are bleeding
01:00:32inside and we can't see.
01:00:34if we have potentially missed it and then you go home, you could get a lot worse.
01:00:38Oh, I want to see my grandad, man.
01:00:40What?
01:00:41I don't think it's very safe.
01:00:42You've been in the hospital.
01:00:43It's not very safe to go see your grandad, is it?
01:00:45I'll come back 100%.
01:00:46I'm not going to run out.
01:00:47I have to run it past my consultant.
01:00:48It's not normally how we do things.
01:00:52Hello.
01:00:53Can we borrow you to make a decision about our young chap?
01:00:55If we go somewhere a bit more private.
01:00:57He would like to leave for half an hour to an hour to have McDonald's get his charger
01:01:02and then come back and then he will do everything and he'll stay.
01:01:05I hope he comes back.
01:01:06Yeah.
01:01:07OK.
01:01:08Having someone who's been through countless numbers of these cases is really helpful.
01:01:14Just having his backing and ensuring that he doesn't think that I've overlooked something
01:01:20is really reassuring.
01:01:21For me, it means I can go home and sleep at night.
01:01:23Lewis.
01:01:24What, man?
01:01:25Yeah, so you can go.
01:01:26Yeah?
01:01:27You can't take that with you.
01:01:28You need to leave that here.
01:01:29No.
01:01:30Yeah.
01:01:31And did you get the other one back as well?
01:01:32You should check by the bin.
01:01:33No.
01:01:34Did you tell me so now?
01:01:35Oh, do I just come straight back?
01:01:36No, so you can come straight back to reception, yeah?
01:01:39Yeah.
01:01:40All right.
01:01:41All right.
01:01:42You're coming straight back.
01:01:43I'm going to get my charger, get something to eat, and I'll be back.
01:01:45And now it's mine.
01:01:46All right.
01:01:47Do you know what's your back?
01:01:48Can I do your cannula in there?
01:01:49Yeah, yeah.
01:01:50And you're going to say, what?
01:01:51Yeah.
01:01:52Which way?
01:01:53Through there, into the waiting room, turn left, and then you'll see the daughter.
01:01:55All right.
01:01:56And we'll see you in a bit.
01:01:57OK?
01:01:58Where am I?
01:02:02That way?
01:02:03Dr. Farahar heads back to the hub for a catch-up about the junior doctor's first shift.
01:02:08Move it that way.
01:02:12Should we do your handover?
01:02:13The sheets are there.
01:02:14All fun and games, isn't he, do you?
01:02:17Try and spread out as much as possible.
01:02:21Have we got all the team here?
01:02:22He's got an open fracture of his humerus.
01:02:25Despite his injuries, he insisted on leaving the hospital for a burger, but promised to return.
01:02:31He's taken a leave of absence.
01:02:34I think a lot of my more experienced colleagues had a more cynical view.
01:02:38They were like, no, he's not coming back.
01:02:41You just have to hope something, isn't he?
01:02:43Fantastic.
01:02:44Suddenly, Lewis is back.
01:02:45But did he leave his fear of needles at his favourite fast food place?
01:02:55Do you want to take a seat in that bay for us?
01:02:58One of the nurses is going to come in.
01:03:00Can you just eat these?
01:03:01Yeah, of course you can.
01:03:02It's good that you've had some food and drink now, because at some point they're going to want you to be not eating.
01:03:07Not eating, OK?
01:03:08Not eating?
01:03:09Yeah.
01:03:10Because you can't...
01:03:11What?
01:03:12I'm not going to eat!
01:03:13It would only be for like...
01:03:14It would only be...
01:03:15Something like that.
01:03:16All right.
01:03:17I'll leave you in capable hands.
01:03:19All right, mate.
01:03:20I wish you all the best.
01:03:21Dr Fish asks nurse Christy to get a cannula in Lewis before the needle-phobic teenager changes his mind.
01:03:28I'm just surprised he's got this one.
01:03:30He's got his Mackies, though, so...
01:03:32Yeah, but no, he's got one.
01:03:33I've got one.
01:03:34They are.
01:03:35You feel better now, you've had your McDonalds.
01:03:36You've got some numbing cream on.
01:03:37Mm.
01:03:38It's what they all want kiddies.
01:03:39Well, they're kids.
01:03:40It's not like they're numbing.
01:03:41Well, kiddies manage all right.
01:03:43Leave, don't they?
01:03:44It was a lot of work, wasn't it?
01:03:49I thought he'd come back, and he did.
01:03:51That's massive.
01:03:52It's small.
01:03:53Got any more of that stuff?
01:03:54No.
01:03:55I can't go any smaller for you.
01:03:57Tiny.
01:03:58He'll be fine.
01:03:59It's about being persuasive without forcing people to do things against their will.
01:04:04We want to do these things and need to do these things if we're going to help him not get a nasty infection.
01:04:08Look, Ben.
01:04:09Ah!
01:04:10Ah!
01:04:11All right.
01:04:12Don't look at it.
01:04:13Right.
01:04:14It's done.
01:04:15We trust each other at the end of the day.
01:04:17Um, and it works.
01:04:19You know, it doesn't always work.
01:04:20But it always ends well at the end of the day.
01:04:22I got my blonde.
01:04:23Come on, love, in here.
01:04:25All right.
01:04:26We're going all right.
01:04:27Have a nice meeting you.
01:04:28I hope you're doing okay.
01:04:29All right.
01:04:30After a night in hospital, Lewis had his arm cleaned and set.
01:04:35He can't wait to get back on his moped.
01:04:37He can't wait to get back on his moped.
01:04:38He can't wait to get back on his moped.
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