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00:00Today, Dr Rob is called to a young man who's been s***ed in the back.
00:04He's got two wounds, one to the lower left back and one to the left buttock.
00:11Tracey and Dan treat a woman writhing in agony.
00:14What's the matter?
00:18Short, sharp breaths, like we said.
00:20And John looks after a cardiac patient whose heart rate is off the scale.
00:25So your heart rate's gone up to 158.
00:27So you're getting really irregular as well.
00:30We're going to a 33-year-old female who has rang 111 this evening because she's got stomach pain.
00:38She's got a bit of flank pain as well.
00:40She's got a headache.
00:42And that's all we know at the minute.
00:56Evening.
00:57How's it going, bud? You all right?
01:00So, where is she?
01:03Upstairs.
01:06You all right, darling?
01:07She said it's OK.
01:09Do you want to sit up for me, darling?
01:10Oh, please don't let me. I'll sit up.
01:12It hurts.
01:12OK, that's all right.
01:13If you don't want to sit up, don't worry.
01:15Right, let's have a talk about what's going on this evening, then.
01:18What's the matter?
01:19So it started Sunday evening, just severe pain in my left side of my stomach and my rib.
01:28And that just gradually got worse.
01:30Yeah.
01:31I was still able to function as normal yesterday, just every now and then doubling up in pain.
01:35And then last night, I developed a severe headache and back pain.
01:39And I couldn't sleep at all with it all night.
01:41OK.
01:42It's just got worse and worse.
01:44I'd been feeling unwell for a number of days, but then suddenly that day it became so intense
01:51and it was hurting to breathe and hurting if I tried to walk.
01:55And I just knew I needed to get medical attention.
02:00Have you had anything else for the pain? Paracetamol?
02:02No, just paracetamol, regular paracetamol every four hours, like, drunk work.
02:05OK.
02:06The last one was half past seven.
02:08Half past seven tonight?
02:09Yeah.
02:10OK, so you've had some recently, haven't you?
02:12So what prompted the call because the pain just got too much, you couldn't...
02:15It just got so bad.
02:15OK.
02:16My headache in my back and she just couldn't even move.
02:19OK.
02:21Is it all right if I do a few ups on you?
02:23Is that OK?
02:24Are you all right to sit up or are you more...
02:25I know you'd rather lie down there.
02:28Right, I'll see if I can get to you.
02:38Have you done your temperature or anything like that or is it?
02:40No.
02:41OK.
02:41That's all right.
02:48There you go.
02:49You got an infection somewhere.
02:51Do you get kidney infections a lot or urinary?
02:54I used it years ago.
02:55I haven't had a kidney infection in years.
02:57No problems with waterworks passing the urine or anything like that?
03:00I'm struggling to pass urine.
03:01You are.
03:02I've only managed to pass urine twice, but I've drunk about 12 pints of water.
03:06Do you mind if I have a look at your tummy?
03:07Is that OK?
03:08It's all good.
03:08Don't worry about them.
03:09Let's have a look at your tummy.
03:10I'll come round this side.
03:12Right, show me where this pain is.
03:14In this area here.
03:16OK.
03:16All right.
03:18It has been pain in the back pain.
03:20There, on your flank.
03:24Just under there.
03:25I'm just a trap.
03:26OK.
03:27All right.
03:27Ow!
03:28I was developing intense pain in the sort of mid, lower back, either side of my spine,
03:36just sort of underneath where your ribs end.
03:38It was very, very tense.
03:40And when I tried to take a breath in, it felt like someone was squeezing something inside
03:45of me really, really tight, which was very, very painful.
03:49In terms of what's going on, the way you're describing the pain, you've got a bit of a
03:53temperature, you've got a headache, you don't feel like eating.
03:56It seems like maybe possibly a bit of a kidney infection you've got.
03:58Yeah, I mean, you're showing some signs of infection, and kidney infections aren't very
04:02nice, and we don't know how long you've had it.
04:04When people get kidney infections, they can be quite painful.
04:08Sometimes they've had a water infection that's not being treated, and it's just got worse.
04:13We can go to patients that have just got a bit of irritation, and they're in a bit
04:17of pain, they've got a bit of back pain, and then we can go to people that are totally
04:22off their legs, they can't walk, they're confused, and it can really knock them about
04:26for a long time.
04:28I think you could probably do with some, you know, some more tests, something that we
04:32can't do here.
04:33So, you know, you need to see a doctor and probably get some antibiotics sorted out for
04:39you before it gets any worse.
04:43Are you happy to pop up to A&E?
04:47OK.
04:47But before they can move her, the ambulance crew need to get Melissa's pain under control.
04:53Have you ever had gas and air before?
04:54Yeah.
04:55Yeah, yeah?
04:56You want to try some gas and air?
04:57I think we'll try some gas and air, don't we?
04:59Obviously, it's not going to take the pain away, but it's going to take this edge off,
05:02so we can sort of have a proper look at you without causing you too much pain, OK?
05:06It's a pretty common affair, and at the major trauma centre here, we get a decent number
05:29through the doors each day, if not double figures.
05:31They vary from very minor things through to more serious ones and through to photo ones,
05:36and it's part of being a decent-sized city that it's just part of the way of life, unfortunately.
05:42All right, so it's to us, young male who's been stabbed twice.
05:55It doesn't appear to be unwell at the moment, but apparently the blade was of a reasonable size.
06:02And we'll find out what he's like when we get there in about 10 seconds, hopefully.
06:05That's not my close thing.
06:07So when we arrived on scene, there was quite a big crowd still on the housing estate.
06:31The police had been there 30 seconds, 90 seconds before we got there,
06:34and there was an ambulance crew already on scene,
06:37and there was a few shouting matches going on, that sort of thing,
06:41and it just gave us the impression that it was probably still quite a volatile environment.
06:49Knock, knock. How are you doing, mate?
06:50You all right?
06:51Yeah, two seconds.
06:55Howdy, Chief.
06:57Hello, Tony.
06:57It's Rob. One more other doctors with the ambulance service.
07:00Hi, Rob.
07:00How are you feeling?
07:03We have got a large knife this big.
07:06Let me show you.
07:06Two penetrating wounds.
07:10The gentleman had been stabbed twice, once at his back, and I think once on his backside.
07:16It's not unusual to get stabbed in all sorts of strange places,
07:19and for me, it's a question of trying to identify where all of the injuries are
07:24and working out what might be damaged underneath them.
07:28I'm Oliver, and that's Dr Rob.
07:30All right, we're going to look after your son for you.
07:32Okay.
07:32We're going to pop him down to the hospital.
07:34The hospital we're going to go to is one in Birmingham, the Queen of Elizabeth.
07:37All right.
07:38So if there's a seatbelt just on your left shoulder,
07:39if you want to put that on, if you're going to come with us.
07:42We'll have a look with that, and that'll tell us what's going on.
07:44All right.
07:44With victims, there's no time to lose.
07:47Rob calls ahead to the hospital so they can prepare for the patient's arrival.
07:51He's got two wounds, one to the lower left back and one to the left buttock.
07:58He's GCS 15, heart rate of 90, 100%.
08:04BP doesn't want to record at the moment, but that's probably positional
08:07because he's lying face down, and he's got a good radial.
08:11So we've just candidated him.
08:14We should be at the QE in about eight minutes.
08:16It didn't appear that he'd lost a lot of blood or too much blood externally.
08:21It was just down to the nature of what sort of implement he'd be disturbed with
08:24and how far inside his body that it's got.
08:27And that wasn't something that we're going to be able to find out
08:30in the back of an ambulance.
08:32That was going to need to be found out in hospital.
08:34Just going to make sure you've got a few straps on, Chief, for a little ride in.
08:38I'm just getting cold.
08:40You're all right, don't worry.
08:41Yeah, very similar.
08:42One of the reasons why you're shaking is because of all the adrenaline that's in your body at the moment.
08:45That's perfectly natural.
08:47We're keeping you nice and warm as well, my friend, all right?
08:49I suspect when you're in a fight, the adrenaline is reasonably high.
08:54And as you start the come-down process of that, it's not unusual to get the shakes.
08:58The fear, the realisation of what's been going on, and that's probably when you start thinking
09:02about how you're actually feeling and how cold you are.
09:07The police believe the weapon used in the attack was a large hunting knife.
09:12The size of the knife does matter.
09:14We go to machete attacks every so often, and for those sort of injuries,
09:18you get quite impressive tissue loss.
09:20But it's normally then reasonably quite easy to see what's been injured,
09:23and you can see how deep the injury is.
09:25The ones that concern me more are the small screwdriver-like injuries
09:29where you just have no idea in which direction the wound went,
09:33how far it's gone in, and what it's damaged on the way through.
09:37So, don't take any medicines at home normally?
09:40Not allergic to anything at all?
09:42Not at all.
09:43We'll be there in a minute.
09:47Heads are playing now. Is it easing off a bit?
09:48Feeling a bit more relaxed?
09:49I don't know.
09:50Yeah, that's a good one.
09:51You didn't really well.
10:02We get called to quite a few things over a week,
10:05but at least every other night.
10:07And those are, obviously, when you get called to the more serious ones.
10:10So, there's quite a few that happen across the region most days, I would have thought.
10:15We'll take you into the little resource room,
10:17and you'll be met by about six or seven people, probably.
10:20That's special, isn't it?
10:21Yeah, you're that special.
10:22There'll be one big boss who'll be shouting out all the instructions
10:26and a few people will attack you.
10:28They might sneak another one of these little drips in, I'm afraid,
10:30and take a little bit more blood.
10:31Right, we're just going to take a few bits and pieces off you now,
10:33because we're nearly there.
10:35Well done.
10:38We'll take your feet first, mate, all right?
10:39There's the man.
10:47Given the nature of his injuries and given the nature and size of the blade,
10:50which is allegedly being used,
10:52then he's at quite a decent risk of having an internal injury
10:55associated with the location of those winds on his body.
10:57and so he's put him through the CT scanner
11:00to see if there's any internal injuries
11:01and take it from there.
11:03Substance abuse is probably a big percentage of the calls
11:26that we attend, particularly on a weekend.
11:29You can guess that during a Friday, Saturday night,
11:32you're going to be going out to somebody
11:33who's had too much of some substance,
11:35and it's just something you become sort of used to,
11:38and it's commonplace now.
11:50We're on the way to a queer, unconscious male patient.
11:54He's in an alleyway, back of a street, just round the corner.
11:59I'm guessing a member of the public has called for us.
12:01First impressions, a bit cynical, maybe,
12:05but it could be alcohol-related.
12:10Oh, he says he's got a bottle of wine next to him,
12:12so there's a chance of some alcohol involvement.
12:16Hello there.
12:37I've found probably five minutes ago, I think,
12:42and I've found this chap here.
12:46I've had a quick look through his bag.
12:47Yeah.
12:47There's some medication there.
12:49I've just got the bag, tried to raise it.
12:51Oh, I'll have a look in a moment.
12:52So you were just passing by, were you?
12:54Yeah, we were just over the bag, so...
12:56OK, lovely. Thank you very much.
12:57OK.
12:58Thank you.
13:03Can you talk to me?
13:08Looks well out of it, doesn't he?
13:09Yeah.
13:10When I'm telling somebody unconsciously clearly out of it,
13:12I need to decide quickly as to what's caused that.
13:17Is it a medical condition?
13:18Is it down to sort of intoxication from alcohol or drugs?
13:21So we need to ascertain through a history from bystanders
13:24or looking at the area around that patient
13:26as to how it could have happened,
13:28and then we can treat as we see
13:31and make an improvement for that patient.
13:33All right, is there any other bottles anywhere?
13:35No, I don't need to.
13:40Have you ever seen him around before?
13:42I haven't, no.
13:43OK.
13:44I haven't.
13:45But there's a...
13:46I have to put the back up here.
13:48Yeah, I'm aware of the one with the flats, yeah.
13:50Yeah.
13:51A lot of drugs?
13:52Yeah, yeah, yeah.
13:53OK.
13:54Yeah, thank you.
13:55Thank you.
13:56We live locally in this area,
13:58and we've just parked up,
14:00and we sometimes walk down this gullyway,
14:03turned around the corner
14:05and saw a guy just kind of slumped on the floor.
14:08It's kind of common knowledge, really,
14:10that there's a lot of drug problems in the area,
14:12so I think we immediately thought
14:16this guy might have taken an overdose.
14:18Would somebody do me a favour?
14:20Yeah.
14:21If you've got a spare minute,
14:22there should be an ambulance.
14:23Well, there is an ambulance coming.
14:24Would somebody just point in the right direction
14:25of where we are?
14:26Yeah, yeah.
14:27Thank you.
14:30Let's set you up a bit, mate.
14:32Oh.
14:33Hello there, mate.
14:34Oh.
14:35Hello.
14:36You had a drink?
14:37Yeah.
14:38Yeah.
14:39How much you had?
14:40A little.
14:41A little.
14:42All right, mate.
14:43OK.
14:44How are you feeling?
14:45Horrible.
14:46Horrible.
14:47OK.
14:48Take any tablets,
14:49or is it just the drink?
14:50Yeah.
14:51Tablet.
14:52Tablet.
14:53What are you taking?
14:54All right, mate.
14:57All right, mate.
14:58OK.
14:59Just lift your head up for me.
15:00Let's have a look in your eyes, OK?
15:02Open your eyes for me.
15:07OK, keep your eyes open wide.
15:09He smells of alcohol, and there was an empty bottle of wine next to him.
15:12So that is telling me straight away that there's certainly a chance of him being sort of under
15:17the influence of alcohol.
15:18Also, looking at his pupils, they were constricted.
15:20But having pinpoint pupils, that didn't tie in with alcohol use.
15:23So I was guessing that he may be under the influence of heroin or heroin substitute.
15:28Just going to check you over.
15:29I'm all right.
15:30Do you know who I am?
15:31Yes.
15:32Who am I, mate?
15:33Ambulance.
15:34All right.
15:35Somebody's call for the ambulance.
15:36Bravo.
15:37Let's have your finger, mate.
15:38There's going to be a little scratch on your finger.
15:39Is that OK?
15:40A little scratch on your finger.
15:41Is that OK?
15:42A little scratch on your finger.
15:44Yes.
15:45Have you got any pains anywhere?
15:47In your chest.
15:49All right.
15:50What we're going to do, we're going to get you on the back of the ambulance in a moment
15:56when it arrives, and we'll get your chest.
16:01OK.
16:02Let's have your finger, mate.
16:04There's going to be a little scratch on your finger.
16:07Is that OK?
16:08Of course.
16:09A little scratch on your finger.
16:10quando si arriva e vi'll get you checked over, all right.
16:15Altho he suspects the man has taken a mixture of heroin and alcohol,
16:19Stee doesn't believe he's taken an overdose.
16:23My assessments are that his observations appear okay at the moment,
16:27but it may be a chance that he's taken something,
16:31whether it be prescription medication or some sort of narcotic.
16:34So what I'm doing is, because he's got a bag with him,
16:36I'm going to go through his medication
16:37and just see if there's anything that could suggest that he's taken too many of something,
16:41or something that could give him the symptoms he's got at the moment.
16:54Are you here? Lovely, thank you.
17:00Hello, chaps, all right? Yes, you? Very well, thank you.
17:03Member of the public called for us, found him slumped on the floor.
17:06He's responsive initially to pain, but he's had a chat to us since.
17:10Okay. Quite sort of like, um, confused conversation, smells of alcohol.
17:14Obs are fine. I've had a look at the medication.
17:16I can't really make Edna Taylor what half of it is.
17:18There's certainly nothing in there like opiate-based or, um,
17:22you know, anything that could sort of make him like this.
17:24Okay. All right. So we're going to get the bed?
17:25Yeah, yeah, we'll get the bed.
17:26Yeah, we'll get the bed and get him on, all right.
17:28I think the public's perception of, um, of what we do dealing with alcohol and drug-related jobs
17:33is the fact that these people are wasting our time.
17:35I don't see that as, uh, as the case.
17:38I think that everybody needs to be dealt with, uh, in the same manner, with respect and dignity.
17:43Come on, bud. That's it. Come and stand up with us, mate.
17:46Sit down. Sit down. There we go. Good lad.
17:48Let's just swing your legs up. Yep.
17:51How's that, mate? Is that better?
17:53Let's get you in the warm, because you're out in the cold at the moment.
17:56Thank you.
18:06It's okay. What's occurring today? What's going on?
18:08What are you doing down in an alley?
18:14What are you doing sleeping in an alleyway?
18:17No, no, no.
18:18You were?
18:19We're going to do a bit more of a thorough investigation now.
18:21Chances are he's some sort of IV drug user, so in light of that,
18:24there's potential that he could have had something, um, maybe heroin-related this evening.
18:28So we're going to have a good look at that, and then we'll see what he can come up with.
18:32Once in the ambulance, the man admits that he has taken heroin.
18:35A bit too much heroin, I think, today.
18:40Yeah.
18:41Yeah.
18:41Do you...
18:42I've got big enough.
18:42Yeah.
18:43Every day?
18:45Yes.
18:46Yeah.
18:47Are you getting any help?
18:49No.
18:49No.
18:50Do you want help with your use?
18:56Answer honestly.
18:58Yeah.
18:59Good.
18:59Good.
19:01The first step is actually wanting the help.
19:04Yeah.
19:04He's a bit more with it now to what he was, and he's, er, he's stated that he has took
19:10heroin today, erm, it's not causing him too much of a problem, I think this is more
19:13alcohol-related, he's not showing any signs of an opiate overdose, but the fact he's had
19:17heroin and he was in a public place, he's definitely going to have to go to the hospital,
19:20so the crew are here now, and they're going to be off shortly with him.
19:22Take care.
19:23Yeah, obviously it's difficult to see people in pain, obviously.
19:48that's something we can do something about, which is nice, but I think there's only so
19:53many clinical skills we can be taught to treat people and stuff with pain, and there's only
19:59so many drugs we can give, and if they're sort of contraindicated or we can't give them
20:03for whatever reason, that's when you draw on sort of your talking skills and your interpersonal
20:08skills, and it definitely does help.
20:10In Willenhall, Tracey and Dan are treating Melissa, who's got severe abdominal pains and
20:16a suspected kidney infection.
20:18Try some Entenox, hopefully it'll take the edge off.
20:21All right, you've had it before, so just grip it with your teeth, and then, erm, might make
20:27you a bit dry, it might make you a bit rude, there.
20:29Breathe in, that's it, breathe in. Hold it, and then nice, slowly breathe out. All in one
20:42breath. Then breathe in. Try and regulate your breathing, because I think you're anxious with
20:52the pain, aren't you? Is that making any difference at all? Is that helping with the pain?
20:57It's hurting when you're breathing. Melissa had already taken some of her own pain relief,
21:05so it meant that we couldn't give her paracetamol, so we had to look at a bit of gas and air for
21:10her, the next best thing. Yeah, she had some gas and air, and it wasn't, erm...
21:15It wasn't helping her at all, was it really? No, it wasn't quite at all. She was in quite
21:18bit of pain. Sometimes we can only manage so much and then further tests are need doing
21:31at the hospital, urinalysis, erm, scans maybe, but something that we can't do, so we'll take
21:37her to hospital. But Dan and Tracy are loath to move Melissa when she's in so much pain.
21:43I think you need some more help to manage this pain, don't you? I'm OK. Why don't you try
21:50your arm off? I normally take it if, like, my jaw dislocates or something like that, or
21:58my ankle. But it's not that bad. Melissa is no stranger to pain as she suffers from a rare
22:04genetic disorder that causes her joints to dislocate. When they do, she takes oral morphine,
22:11or Oromorph. The condition I suffer with is Ehlers-Danlos Syndrome. Erm, it's a connective tissue disorder,
22:17so I dislocate my joints very easily. Erm, whereas normally you would need quite a lot of trauma
22:23to dislocate a joint. It's quite easy for someone with Ehlers-Danlos Syndrome to dislocate one of their joints.
22:30And it also causes things like easy bleeding and easy bruising. Erm, and we just have to get regular check-ups, really.
22:38Right. You seem like you're in a lot of pain, and that Internox, it's only taking the edge off, isn't it?
22:45Do you know what I mean? So, do you want to try some of your Oromorph?
22:49Well, I normally only take it when it's something really severe, like...
22:53Well, obviously that's where we'd go, is Oromorph. OK.
22:57And there's plenty in the cupboard, if that's what you think it is, but I would think it's not at the stage
23:04I wouldn't need the Oromorph just yet. OK. OK, that's fine, that's fine, yeah.
23:09For me, yes, I was in a lot of pain.
23:12Nevertheless, it still wasn't as bad as some of the dislocations I've been through.
23:16I was explaining to him that I'd rather not take the Oromorph unless I absolutely had to,
23:22like with a really bad dislocation,
23:24and just because of the side effects I get from it
23:27and because it's something I don't like taking very frequently.
23:30With morphine not an option,
23:33Melissa will have to rely on gas and air for the trip to hospital.
23:36Which way are you going? That way, this way?
23:39Your slippers are down here. Oh, are they? All right.
23:45Do you want to grab the gas and air, Dan? Yeah.
23:48Do you need any, darling? Do you want any gas and air? Yeah?
23:51Thank you. Let's take it slow.
23:53I'll go first.
24:06All right, darling. Sick bag's there.
24:09As I said, I know it's not the best,
24:11but obviously it's the best we got for the minute, innit? All right, OK?
24:14We'll go to Newcross. Yeah? Happy tries? All right.
24:19As my colleague said, looking like a kidney infection,
24:22obviously with the kidneys you have to be careful.
24:24We don't know how long she's had it, we don't know what's going on underneath.
24:26She's clearly in a lot of pain. She's clearly got quite a high pain threshold.
24:29Obviously she's had the paracetamol, so we can't do anything stronger there.
24:34She needs a few further tests, basically, that we can't do.
24:36So we'll see what happens there.
24:38What's the matter? What's the matter? What's the matter, darling? What's the matter? Hmm? What's the matter?
24:48Short, sharp breaths, like we said.
24:50Short breaths.
24:52Short breaths.
24:54Come on, don't get upset.
24:56How old are your son?
24:58Six.
24:59When have you got him back?
25:00It's all right.
25:02My mum and dad picked him up for his football club and wrote him out and said,
25:06he didn't feel well all day tonight, and I wasn't thinking...
25:08Ah, so they said they'd look after him.
25:10When we got onto the truck, he was still in a bit of pain,
25:13so we reverted to sort of the talking tactics and trying to calm her down a bit.
25:18It's one of the best tools that we have, I think,
25:21without even bothering to give any drugs or medicines.
25:26Tracy and Dan, the paramedics, were really good.
25:29Lovely people, very patient, very calm, and I think you need that.
25:36When you're in a lot of pain, it can make you a bit panicked or flustered,
25:40and, you know, you need someone who's staying calm.
25:44It's reassuring, and I think it's always good as well
25:47when they talk to you and try and distract you a little from your pain.
25:50All right. Here we are.
25:56Do you want to take the Internox in with you, or...?
25:58It's making you feel sick. Do you want to give it a break, then?
26:02We'll give it a break.
26:05Let's have these off, yeah. Now you're charged up.
26:08OK. Yeah. OK.
26:15OK.
26:17All right.
26:19OK.
26:22She seemed to have calmed down by the time we got to hospital.
26:25So she's feeling cold and trying to snuggle up,
26:28so I think there's definitely some sort of infection there.
26:30So hopefully they might...
26:32I don't know whether they'll scan her
26:33or just treat her with antibiotics and send her home.
26:36but, er...
26:37Yeah.
26:38Job done.
26:39Our most common call-outs tend to be chest pains or falls.
27:02Falls in the elderly, chest pains in a wide-aged group, really.
27:06If someone's got a pain in their chest, it's highlighted to call an ambulance.
27:09And whether or not then that's for a chest infection or a heart attack,
27:12there's such a wide range of issues,
27:15and that's why we're commonly called out to them, really.
27:26We are on the way to a 55-year-old gentleman.
27:28He sounds like he's got some chest pain.
27:30There is actually a technician crew in attendance,
27:32and they've requested a paramedic to go,
27:35and check his ECG.
27:37There's some ECG abnormalities on there.
27:39Canceling?
27:40Hello.
27:41All right?
27:42How are you doing?
27:43Is she upstairs?
27:44Let's try and squeeze in.
27:45That's all right.
27:46It's me.
27:47It's me.
27:48It's me.
27:49Hello, mate.
27:50How are you doing?
27:51It's Tim.
27:52Hello, Tim.
27:53How are you doing?
27:54How are you doing?
27:55In April, he had a triple bypass.
27:56Since then, he's had runs of AF.
27:57He was on digoxin for a bit.
27:58About three weeks ago, he'd come off the digoxin.
27:59He's got up this morning to jump in the shower,
28:00and he's had a sudden onset of feeling dizzy, palpitations.
28:01Right.
28:02He's gone very pale and clammy.
28:03He's dried himself off.
28:04When we came in here, he was still clammy.
28:05He's ready.
28:06Done a 12 lead.
28:07There was a couple of days in the morning,
28:09and he's had a big day.
28:10It's him.
28:11It's me.
28:12It's me.
28:13It's me.
28:14It's me.
28:15It's me.
28:16It's me.
28:17It's me.
28:18It's me.
28:19Hello, mate.
28:20How are you doing?
28:21It's Tim.
28:22Hello, Tim.
28:23How are you doing?
28:24He's gone very pale, very clammy.
28:27He's dried himself off.
28:28When we came in here, he was still clammy.
28:30He's ready.
28:31Done a 12 lead.
28:32There was slight...
28:33I mean...
28:34And I mean slight.
28:35Probably one box on two, three and ABF.
28:38I don't know.
28:40He's got no pain as such,
28:43but he did have an ache across the back of his shoulder,
28:45initially, which has since passed.
28:47Right.
28:48But it looks as though he's back in AF now, to be fair.
28:51I think it was...
28:52Tim had a heart attack four months ago
28:54and underwent a triple heart bypass operation.
28:57After the surgery, he developed atrial fibrillation.
29:01Tim had what we call AF, or atrial fibrillation.
29:04It's in a regular heartbeat,
29:05so the two portions of the heart, the top and the bottom,
29:08they don't quite work in sync.
29:10A few issues that cause it by there,
29:11it can cause some turbulent blood flow in the heart,
29:13which can cause clots,
29:15hence why the patients normally go on a blood thinning tablet
29:18post-diagnosis.
29:20Tim's blood pressure is also lower than normal.
29:23But it's hypertensive as well, 97, 65,
29:26quite a weak radial.
29:28Right.
29:29Although it is low, it's not as low as I would expect you to.
29:32Yeah.
29:33For you to be feeling that bad and this clammy.
29:35Worse comes to worse,
29:36if you are feeling lightheaded when we get you up,
29:37we'll just pop a little needle and give you some fluid.
29:39Yeah.
29:40just to make sure we get you out,
29:41and then we can poke the torsles on and get you sorted anyway.
29:43Do you feel lightheaded if we sit up?
29:45Just try and sit up for me now, even just in this position.
29:47Don't drop your legs or anything.
29:48I know it's a bit awkward like that.
29:50Does that make you feel dizzy or...?
29:52Not at the moment.
29:55Just relax yourself back then, Tim.
29:57All right, OK?
29:58It is what we thought.
29:59It should be pressure.
30:00Down to 82 and your heart rate's gone up to 158.
30:03Yeah.
30:04So really irregular as well.
30:05So we'll just pop the needle in.
30:06We'll get you some fluid.
30:07Mm-hm.
30:08Just to bring your pressure up.
30:09We'll get you out of the vehicle, mate.
30:12Did a full range of tests from blood sugars to temperature,
30:15ECGs, blood pressures and a 12-lead ECG.
30:1812-lead ECG allows you to look at 12 different angles of the heart
30:21to see the electrical activity of it,
30:23and obviously that was the diagnosis that we came up with AF.
30:26There wasn't anything else significantly concerning
30:28in terms of heart attacks,
30:29but it showed us the AF that it was going quick,
30:31so we needed to treat that.
30:32I'm going to jump over there if I can
30:35until every day you get a bloke on your bed.
30:46That's better.
30:48Is it just cold water going up your arm?
30:50Yeah.
30:51You're probably used to.
30:52There you go, mate.
30:58Right.
30:59I'm ready to go.
31:00Thank you, mate.
31:01Just base it the same as what I've just put into my eyes.
31:04I hope I just put your blood pressure up a bit
31:06and we can get you out.
31:07A, a bit safer and B, making you feel better.
31:10Are they planning on actually looking into it any further to do the...
31:21No.
31:22Anything with it or...?
31:23Yeah.
31:24They gave me the Dioxin to bring it under control.
31:28And then, as I said, I wanted to see the consultant on last Thursday
31:33and they kind of said they didn't want to see me for another six months.
31:36And then, as soon as he said that, everything's gone.
31:38It's good in one way, at least, if you know what I mean, at least if it is something,
31:44at least we can get you back in and quick and get it sorted.
31:48Tim's got a history of AF or atrial fibrillation.
31:50Initially, he was going to have some treatment done by the hospital,
31:53but because he kind of reverted himself back to a normal rhythm,
31:56the hospital have actually stopped planning the planned treatment for him.
32:01Unfortunately, he's come back today, from what we gather.
32:03His blood pressure's dropped quite significantly,
32:04so it's making him feel very light-headed and dizzy when he gets up.
32:07So we'll just pop the calendar in, give him some fluids,
32:10pick his blood pressure up, and then we'll take him up to the local A&E
32:13to see the cardiologist again, and see if we'll take it from there.
32:17The team take Tim's blood pressure again.
32:20Do you want to sit up again or...?
32:22Er, you can do, actually.
32:23If we just sit, you'll start it.
32:25That's what the last one we did went.
32:27Hopefully we'll make some improvement on it.
32:34That's much better, isn't it?
32:36Super.
32:37Right.
32:38What we'll do, we'll drop your legs as well,
32:40before we start to do anything.
32:42If there's any change, we'll learn.
32:44We can take it from there, aren't we?
32:46With his blood pressure back at a safe level,
32:49the team can now take Tim to hospital.
32:51Do you feel OK, yeah?
32:52Yeah.
32:53His wife, Sarah, will travel with him.
32:58I'll lay on the bed for her.
33:01We'll, er, check your blood pressure again.
33:09You comfy like that, or...?
33:10Yeah, it's fine, to be honest, I feel...
33:12Much better, isn't it?
33:13No different to when you lay down?
33:15No, not really.
33:17It's clean caution.
33:19Rear door open.
33:21Right.
33:23Pop that up.
33:26One wire here.
33:31And we've now brought him into the local alien,
33:32which is Mrs Hall.
33:33Then I'm doing further checks, ECGs,
33:35and they're going to refer him down onto the cardiologist
33:37to see exactly what's going on with this rhythm,
33:39if it's going to stay or is it just going to be a transit
33:41where it just comes and goes again.
33:43And obviously the cardiologist will treat it from then on after.
33:51As a paramedic, you see all sorts of jobs from something so minor
34:12that isn't an emergency, but that person that you're dealing with,
34:16it's their emergency to life-threatening conditions.
34:21And you just work to your full ability to each job.
34:25I'll come and have a look at it for you. Don't worry.
34:27I'll come and have a look at it for you. Don't worry.
34:28I'll come and have a look at it for you. Don't worry.
34:30I'll come and have a look at it for you. Don't worry.
34:32I'll come and have a look at it for you. Don't worry.
34:37Ok, get there?
34:38I'm starting to walk in here.
34:51I'll come and have a look at it for you. Don't worry.
34:54No, no, no, no, no.
35:24A skin tear is something that an advanced paramedic can actually do whilst in the home and it's hospital avoidance which we try and do as much as we can.
35:36Sì, sì.
36:06Sì, sì.
36:36Do you want to just hold that on?
36:43So we can have a proper look.
36:46Senior paramedics like Kath are trained in wound care,
36:50so they can treat patients at home rather than taking them to hospital.
36:53As an advanced paramedic, this is one of the injuries that we can deal with.
36:59Skin tears are ideal to be dealt with by using Steri-Strips to lock long pieces of thin plaster.
37:06What we have to do is clean all the wound up and place the skin back how it should be
37:11and apply Steri-Strips over it.
37:15You haven't dropped that on the bits we've got?
37:16Yeah, it might be a bit easier or anything.
37:18OK.
37:22Okey-doke.
37:23Let's have another little look, my darling.
37:25It's cold.
37:29It's only water.
37:32It certainly is.
37:35So everything else is cleaned around it.
37:38Move your fingers OK?
37:40Good.
37:41I'm glad you had that.
37:45Can you?
37:47That's good, that is, because you couldn't before you fell over.
37:51Right.
37:52You put this on your lap.
37:54You put your hand down on your lap.
37:57That's it.
37:58You feeling OK?
37:59Yeah.
38:00Yeah.
38:01Yeah, it's more little skin tear on Brenda's hand
38:04that we can Steri-Strips and she'll be able to stay at home,
38:08which I'm sure she'll be very happy about.
38:14Hold that on a little bit longer.
38:18Right, what we need once we've done this,
38:20in a couple of days' time,
38:22we need to go and see the district nurse
38:25so she can check on your wound
38:27and how it's healing.
38:29Are there some carers coming, babe?
38:31Yeah, they're not medical now.
38:33No, I'm just saying, so where will the district nurse be?
38:37Who's your doctor?
38:38Who's your doctor?
38:40Waterfront service.
38:41Waterfront service, do you think?
38:42They've got district nurses there.
38:44Right.
38:44All you've got to do is ring them up.
38:46Yes.
38:46And they'll come out.
38:48OK, we need it checked in two to three days.
38:51OK.
38:52That's held it together quite well.
38:55OK.
38:56I'll have a little dressing on it in a minute.
38:59These stars and stripes.
39:01You want a stars and stripes dressing?
39:04Do you?
39:04If it is a skin tear, which we're dealing with,
39:09stitches really wouldn't be appropriate
39:11because it's not a cut.
39:13It's more that the top layer of the skin
39:16has tore and rolled back
39:18so then you can get that skin
39:20and roll it back down again,
39:22almost sealing the wound
39:23and put in these Steri-Strips over.
39:27It shouldn't start bleeding again,
39:29but if it does,
39:30you just put another dressing on top of it.
39:32Don't take the original one off.
39:33OK.
39:35Brenda?
39:36That?
39:37Fantastic.
39:38Mended?
39:39I'll play the piano.
39:40You'll play the piano.
39:42That's lovely.
39:43That's lovely.
39:45Okey-doke.
39:46All right.
39:47Everything's fine now.
39:48Yes.
39:48As long as you keep up to this two to three days.
39:51Well, it's a bit more than what we...
39:52I'll go tomorrow and tell them
39:54and then ask them to call in one day and say...
39:56Make an appointment.
39:57OK.
39:57Check it and see if they're happy with it
39:59and how it's healing.
40:01Yes, OK.
40:01Yeah, no problem.
40:02OK, Brenda?
40:04I call you.
40:05Are you happy?
40:08Fine.
40:09Are you feeling happy?
40:11Like me.
40:12I know.
40:13Not acne.
40:14Are you happy?
40:16Yes.
40:17Thumbs up?
40:18No, ma'am.
40:19That's it.
40:20OK, then.
40:21Thank you for what you've done.
40:22You're very welcome.
40:23OK?
40:24Thank you.
40:24Be careful.
40:26Thank you very old.
40:27OK.
40:28Hospital avoidance is very important.
40:31There are so many people that go to hospital that don't need to go.
40:36But if it's something we can go to and deal with them in the home surroundings,
40:40it's much better for the patient.
40:44Thank you, ladies.
40:45Beaver silence.
40:46Yes, I will, yes.
40:49OK.
40:49Thank you.
40:49Thank you.
40:51Brenda seems very happy in herself and extremely happy to be staying at home and not having to
40:56go into hospital.
40:57So it's a job well done and although it's not an emergency, it's something that gives us
41:02fulfilment and we've left a happy.
41:05Thank you very much so much for being here today.
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