- 6 settimane fa
Categoria
📚
ApprendimentoTrascrizione
00:00A man is in agony after a motorbike crash
00:02Mate, this is the worst thing I've ever done
00:04A cardiac arrest in a supermarket
00:06If she has another arrest, you're going to do three stack shocks if needs be, okay?
00:13A race against time to save a man's foot
00:15What we could do is to pull it to a better alignment
00:1890 degrees isn't good
00:20And a car crashed into a lamppost, trapping a child inside
00:24I know it's going to be a bit painful, just bear with it, be strong, okay?
00:30The critical care team in the West Midlands was set up in 2012
00:34Police are now on scene, saying it's a significant wound
00:37Thank you, speech soon
00:3870% of the doctors on the team are consultant anaesthetists
00:43Who also work in hospitals all over the region
00:46We're basically a specialist team, effectively
00:50West Midlands Ambulance Service will respond to between 3,000 and 4,000 calls a day
00:54And the trauma service is commissioned really only 10 patients a day
00:57There are 34 full-time critical care paramedics
01:01Who have each undergone a rigorous selection process
01:05Before a further 18 months' training
01:07This is our mechanical CPR device
01:10Which can take over chest compressions
01:13Which is especially handy if we're transporting a patient on an ambulance
01:17Right
01:18Ready for another thrilling instalment
01:20See what the world has got in store for us today
01:2440-year-old critical care paramedic Stephen Mitchell, known as Mitch, has been with the team from the beginning
01:31When you've just enhanced a team or become a team on a job
01:37You know, it does make you proud to be part of the system
01:40And it's a good feeling, I suppose
01:53Ambulance Service is a patient breathing
01:55Well, I think she's trying
01:57She's talking to the blue
01:58Is she awake?
01:59Is she awake?
02:00Hello? No, she's not actually
02:03Is her breathing noisy?
02:05Yes
02:06I need you to look at her chest for me
02:08To see if it's rising and falling back in the bay
02:11She's breathing but she's grunting breathing in the fire
02:14She's breathing
02:15We are coming up to the crew
02:17She's breathing
02:18She's breathing
02:19She's breathing
02:24An ambulance has been called to a local supermarket where the woman works
02:28And Mitch has also been scrambled
02:32Chris has just given us an update about a job that's in Oldbury
02:35Somebody who's collapsed in a supermarket
02:38I believe it's cardiac arrest
02:43Crew's five minutes away
02:44Or five minutes away
02:45They should be there by now
02:47But really these patients need quick management
02:53Without a heartbeat
02:54The human body can store between three to five minutes worth of oxygen
02:58But after that
02:59The brain and major organs begin to shut down
03:04Hi, Nate
03:05Night, Nate
03:18Do you know an approximate age?
03:21There's no age
03:22There's no details at all
03:26With no information to go on
03:27Mitch and the ambulance crew must act fast
03:29If the patient's life is going to be saved
03:30If the patient's life is going to be saved
03:35I'm on this here
03:39You alright?
03:41Five minutes after he received the call
03:43Mitch arrives at the scene
03:44Okay
03:47You alright guys?
03:49How you doing?
03:50Keep her on her side
03:51Yeah, yeah, yeah
03:52She's had three shots
03:53What about you?
03:54No drugs, do you?
03:55No drugs, do you?
03:56No, me
03:57You've got just a normal two mask
03:59That's it
04:00We'll just get a free flow
04:0245-year-old employee Jo
04:04Was at work stacking shelves
04:06When she collapsed
04:08Luckily for her
04:09The ambulance crew arrived within two minutes
04:11And managed to restart her heart
04:13Well done guys
04:14Yeah
04:15Okay
04:16She's got a candy to me?
04:17Yes
04:18Let's see
04:19Keep her on her side
04:20You've got a family behind her
04:21Yeah
04:22Yeah, yeah
04:23Got you
04:24The paramedics have hooked Jo up to an electrocardiogram
04:27Which shows a very agitated heart rhythm
04:29Thank you
04:30Did you see anything on it?
04:32I put it in
04:34Mitch knows there's a real chance
04:36She may re-arrest again at any moment
04:38You okay?
04:39Do you know?
04:40Are you a do you know?
04:41Yeah
04:42What's her name?
04:43Jade
04:44Jade
04:45She's obviously had a cardiac event
04:47Where they've had to defibrillate her
04:48Okay
04:49So she's quite poorly
04:50But we're looking after her
04:51It's good that she's away
04:52Yeah
04:53Jo's brain was deprived of oxygen for several minutes
04:56Which has left her confused
04:58Mitch needs to calm her down
04:59To minimise the stress on her heart
05:02I need you to sort of be around and talk to her
05:04Yeah
05:05So if you go behind my colleague there
05:06You just talk to her
05:07Thank you this morning
05:10Jo we've got Jade here for you
05:11The team now need to get Jo to hospital as quickly as possible
05:16It's her best chance of survival
05:18If she does have another cardiac arrest
05:20It's the ambulance okay
05:22Nottingham connecting a multiple request for ambulance and fire brigade
05:31Yeah
05:32Copyright the hello caller is the patient breathing?
05:46I'm not sure it's a car crash but they're stuck in the car
05:49Are they?
05:50How many vehicles involved?
05:51Just one
05:52And what have they actually gone into?
05:53Come off the road and gone into the curb and hit a landfill
05:56One person stuck inside
05:58He's in a lot of pain
06:00Is that him screaming?
06:02Yeah
06:03Is that him screaming?
06:04Yeah
06:05Yeah
06:10A major road traffic collision requires all the emergency services working together to save lives
06:16Are next?
06:17The critical care team on duty tonight are Dr. Ben Taylor and critical care paramedic Aidan Brown
06:27The passenger trapped in the back of the smashed vehicle is a young boy
06:41A child's life is in danger and Dr. Ben knows there's a lot that can go wrong
06:46It's a very cold night tonight, it's four degrees Celsius
06:50Physiologically children are different from adults, they get colder quicker
06:54They tend to compensate very well physiologically in terms of blood pressure and so on until they don't
06:59So they've got the potential to become sicker very suddenly
07:05The police have arrived on scene along with the fire brigade and ambulance crew
07:09It's a big impact smash and the boys' condition is deteriorating fast
07:14It's all received, many thanks, we're just approaching scene now
07:23The critical care team in the West Midlands
07:25Was set up to improve the chances of survival to hospital for seriously ill and injured patients
07:31Air monitor on there, suck oxygen down there, isn't it?
07:34Yeah, perfect
07:35Together with the Midlands Air Ambulance
07:37The highly qualified doctors and paramedics fly around six missions a day
07:42Zero three, we are lifted from Cosford
07:45Covering an almost 6,000 square mile region
07:48ETA, ten minutes
07:50On the ground, they rely on a fleet of high powered vehicles to get to each emergency in the fastest time possible
07:57Turn right here
07:59Will Meadows has recently completed his 18 months advanced training to become a critical care paramedic
08:05As this is one of his first shifts, he's being accompanied by Colin Apps
08:10I've been working for West Mid for about 19 years
08:17But Midlands Air Ambulance for about, I think nearly 11 years now
08:21Today I'm just doing the support shift for Will Sue
08:24I'm a mentor, my role model and mentor
08:26I'm not getting involved, I'm happy to sort of stay quiet in the background
08:31Keep calm mate
08:38Ambulance services for patient breathing
08:41Fuck, yes, this is, this is a, uh, this is cut to his right wrist
08:45Okay, is he conscious?
08:47Yes
08:48Will we be able to speak to him?
08:50No, no, he's in, alright
08:51Are you asking him how he's done with this?
08:53How have you done, mate?
08:54Cancelled
08:55You're not going to call mate?
08:56Come in as quickly as possible
08:58Is he a deathly color?
09:01Oh Jesus, yes.
09:04Relax, relax, no, no, no.
09:06Keep supplying that pressure until we get there.
09:08They're coming on a blue light.
09:13An ambulance has been called, but the man's condition is so serious,
09:17critical care backup is needed, so Will and Colin are also en route.
09:21So, it's a 26-year-old male who's sliced his arm with a tool of some sort.
09:30He's bleeding quite heavily and apparently he's now unconscious.
09:34If the man's unconscious because he's losing too much blood,
09:37he could be about to go into cardiac arrest.
09:41He's had to be put on the floor, legs raised.
09:43There's a crew only a couple of minutes away, so we should get an early update.
09:48It's not going to be gone.
09:51So, 6-2, get home.
09:536-2, I've just spoken to the crew.
09:55They say the patient was in the street.
09:57They've got him onto the back of the ambulance.
09:59He's GCF 15, but looks very grey.
10:0513 minutes after they were called,
10:07Will and Colin arrive on scene to be briefed by the ambulance crew.
10:11Hi, how are you?
10:11Hi, how are you?
10:12My name's Will.
10:13He's been working on a building site,
10:16ground floor just across the road from here.
10:18He's been using a plunge saw.
10:20I thought he'd had it all stable and reached underneath it,
10:23but it's still been going.
10:24It's dropped and gone through his arm.
10:27Okay.
10:27We've just got quite a deep laceration to the right forearm there.
10:30Quite a bit.
10:31The blade has sliced open a deep three-inch-wide wound.
10:35Clean cut.
10:39Went quite grey.
10:40Was quite shocked from everything that happened originally.
10:43Had his legs raised on our arrival.
10:45Rich was working alone when the mechanical saw caught in his coat and sliced through his arm.
10:50He ran outside to get help before collapsing unconscious in the street.
10:56We've got the first set of rocks done now.
10:57We've just got him inside.
10:58It was so cold, really.
10:59Lovely.
11:00Quite deep.
11:00I think we have gone through some tendons or ligaments there, haven't we?
11:04But not much in the way of blood loss.
11:06We're unsure.
11:06The towel that we've wrapped around him disappeared once we were getting there.
11:10There was some blood in his left glove, so we're not sure exactly...
11:13No hand of loss.
11:14True.
11:16If the blade has cut through muscles and tendons,
11:19there's a chance Rich could lose the use of his arm.
11:23Do you think there is tendon damage?
11:25It looks like it.
11:30Joe, we're just going to slide you back, my darling, all right?
11:32In Oldbury, Mitch is working with the ambulance crew
11:36to get 45-year-old supermarket worker Joe to hospital.
11:43You're happy, mate.
11:44What we'll do is we'll just pick her up
11:46and then just someone just feed the stretcher straight in
11:48so we're not all like...
11:50Right.
11:51Well done, guys.
11:52She has suffered a cardiac arrest and is fighting for her life.
11:56You OK, Joe?
11:58Her daughter-in-law, Jade, is also on scene.
12:00Can you just carry on talking to her, Jade?
12:03That's it.
12:04She wants her up to the best, she'll tighten her arm.
12:07Tighten her arm.
12:09But she couldn't get any of her for her.
12:11You OK, Joe?
12:13So everybody on the side, pull apart slightly as well.
12:16So, and then just watch everybody's toes.
12:18Yeah.
12:19OK.
12:20One, two, three.
12:22OK.
12:23Advance.
12:24On your toes.
12:25Go on, go on your toes.
12:25OK, lovely.
12:26Lovely.
12:27OK, so, guys, can we go a little bit further over that way
12:30and then put her on her side?
12:33OK, cos if she vomits...
12:34If she vomits...
12:36Fair take that.
12:36It's 26 minutes since Joe had a cardiac arrest,
12:40but Mitch knows the window for her rearresting is still wide open.
12:44Have we got a little cushion for her?
12:46Can I just insist that we keep her on the defib?
12:50Sorry.
12:51We need to know what's happening, don't we?
12:52The cardiac monitor contains a defibrillator,
12:57which can be used to deliver an electrical shock
13:00if her heart rearrests.
13:03You ready for a quick update?
13:05No, mate.
13:06Yes, go ahead.
13:06I've got lost at 11.30.
13:08That was correct.
13:11Yeah, female.
13:13Appears to be in her 50s.
13:14I can confirm some details,
13:16but looking to go to PCI centre.
13:17Would you mind just seeing which is the closest?
13:22We're thinking City.
13:26Six minutes after he arrived on scene,
13:28Mitch has his patient packaged and ready to leave.
13:32He radios control to report on her condition.
13:34Yeah, currently GCS14, heart rate 120, BP, 11886.
13:40You are in Old Blight,
13:44so yes, I'd agree that probably City is your closest.
13:49Nice one.
13:50Cheers, Mooka.
13:51Yeah, we'll alert direct and appreciate that.
13:57There is a real chance of Joe rearresting,
14:00so Mitch will travel with her
14:01to continue giving emergency care
14:03throughout the four-mile journey.
14:05So, guys, what we're going to do is
14:10if she has another arrest,
14:13we're going to do three stack shocks if needs be, okay?
14:16Happy with that?
14:16Yeah, sorry, mate.
14:17Okay.
14:19Sorry, Joe.
14:25Joe, how are you feeling?
14:27Okay.
14:30Liam, just nice and smooth, mate.
14:32What we're going to do is
14:32we're going to do a cannulation in a bit,
14:34but I'll tell you when it is
14:35and we'll just pull it over slightly, okay?
14:39Okay, we're just going to put a little needle in your arm.
14:42Okay, lovely.
14:44The cannula will allow Mitch
14:46to administer painkillers directly into her bloodstream
14:48as well as prepping her
14:50for immediate treatment at hospital.
14:53Yeah, that's probably from the compressions on your chest.
14:57Going to get you sorted, lovely.
14:59You're doing really well, okay.
15:04Just four minutes later, they arrive at hospital.
15:09Good skills, top marks.
15:11Where Mitch delivers his still critically ill,
15:14but now stable patient,
15:15to the waiting emergency doctors.
15:17From when we got there, we looked by the crew,
15:22and they'd reported that they'd just got a rosk on us,
15:25so that sort of really changes the game plan for us.
15:28The crew were, like, literally two minutes away,
15:31delivered the shock straight away.
15:32Her heart was in such a rhythm
15:35that it gives the potential to go back into cardiac arrest,
15:38and there is, like, a window
15:40of where the heart is, like, sort of agitated
15:44and actually it's quite likely they may go into arrest again.
15:49But on the same note, it was, like, a really good outcome.
15:52Ambulance, sir, this is the patient breathing.
16:03Are they awake? Are they conscious?
16:05Yeah.
16:06What's happened, sorry?
16:07We're on a rumble, Jack, but, uh, it's a dislocated ankle.
16:11It's a dislocated ankle?
16:13With a possible ride, yeah.
16:15Is he able to talk to me, or...?
16:16Yeah, we're alive, we're all right.
16:18So what happened? Did someone just talk to you, or did you...?
16:21Someone's in touch, I just...
16:22Does your foot look cold pale or blue?
16:24It's covered in a sock in a boot.
16:25Would you say you're in severe pain?
16:28Yeah.
16:34If the man's ankle is fractured,
16:36the broken bones could cut off the blood supply to his foot.
16:40A time-critical injury that must be treated on scene.
16:44So critical care paramedic Pete Edwards is en route.
16:48So we're going to a male in his 40s
16:50who apparently has a fractured dislocation of his ankle.
16:54Um, there is a crew in attendance who are requesting us,
16:57so I suspect it's for advanced analgesia.
17:01The critical care team is trained in the use of high-strength drugs
17:05and painkillers, normally only used by doctors,
17:07so they can carry out procedures in the field.
17:11The ambulance crews carry, er...
17:14Gas and air or Entinox.
17:16Er, they carry IV paracetamol and IV morphine.
17:21and then we carry ketamine,
17:26which is a much stronger pain relief
17:29that gives, um, sort of, sedation as well.
17:34This is it.
17:37Nine minutes after he was called,
17:39Pete arrives at the rugby ground.
17:40Hello.
17:48Hello, how are you, mate?
17:49Hello, all right.
17:51The ambulance paramedic updates him on the man's condition.
17:54So far, Entinox on the field,
17:57onto the stretcher,
17:58give me a score, about five or six at the moment,
18:01but that's because it's not moving.
18:02OK.
18:03It can feel sensation all around it.
18:05It says it just feels like pressure.
18:07Hello, sir.
18:08I can see the problem.
18:1040-year-old Dave was playing a friendly match
18:13when a nasty tackle floored him.
18:15He was carried from the field by the paramedics
18:17and given gas and air for the pain.
18:19Yeah.
18:20And we've got a little bit, like,
18:22looks like some critical skin there, haven't we?
18:24The fracture is so bad
18:25that the skin around the ankle bone is dying
18:28because of the lack of circulation.
18:30If it continues,
18:32he could cause lasting nerve damage
18:34and he could lose his foot.
18:36Dave, you've obviously got a fracture,
18:38or a dislocated ankle.
18:40Looks like there's a little bit of compromise
18:41to the skin because of the bone.
18:43What we don't want it to do
18:44is the skin over the joint
18:46to sort of die or become necrosed, really.
18:50What we could do with him, really,
18:52is to pull it to a better alignment.
18:5490 degrees isn't good.
18:55No, I've seen better.
18:57I've seen better.
18:58I'm going to just uncover you a little bit, all right,
19:00so we can get to you.
19:01We've got a couple of options, haven't we?
19:03We run with it like that
19:04and blow lights into the manor.
19:06Or we could give him a little bit of ketamine
19:08and just pull it, you know,
19:10to get rid of that critical skin
19:11because obviously that's time critical,
19:13isn't it, really?
19:13Administered correctly,
19:17ketamine will allow Pete to perform this procedure,
19:20putting the broken bones back into position
19:22and restoring the vital blood supply to Dave's foot.
19:27Big deep breaths, that's it, all right?
19:31I've got an 11-year-old male in the back of here.
19:35He can't get out.
19:36He's mechanically trapped on the left leg down.
19:39We don't know how to see anything below there.
19:41In West Bromwich, Dr. Ben Taylor
19:43and critical care paramedic Aidan Brown
19:45are at the scene of a serious car accident.
19:49I'm going to have a quick assessment, Ben.
19:51A child is trapped in the wreckage
19:52with potentially critical injuries.
19:55With the temperature near freezing,
19:57they need to get him out as quickly as possible.
19:59My initial plan at the moment is,
20:01once the that's all released and clear,
20:03how he's actually mechanically trapped.
20:05If work is worse,
20:07it goes a bit downhill a bit quickly,
20:08what we'll do,
20:09we'll get the telescopic ramp down to the middle, rapid.
20:13That's a fan base, smashing.
20:14No worries.
20:17I'm just going to have a go around
20:18and have a quick look at that leg, all right?
20:21The police, ambulance service and fire brigade
20:24are working together to free him.
20:28Hi, bud.
20:29How you doing?
20:30My name's Aidan.
20:31I'm just going to have a quick look at your leg, okay?
20:33When the car smashed into the lamppost,
20:39the front passenger seat was forced backwards
20:41and he's now pinning the boy's leg to the floor.
20:46Mate, if you just cut that, you'll see his mouth.
20:48Before they move him,
20:50Aidan investigates his trapped leg.
20:54It might be broken, okay?
20:57So bear with me, okay?
20:58I'm going to have to move it.
21:00I know it's going to be a bit painful.
21:01Just bear with it, be strong,
21:03because as soon as we get you out,
21:04we're going to give you some strong painkillers.
21:06Getting him out without making his existing injuries worse
21:09is going to be a delicate operation.
21:11I think we've got enough room to manoeuvre your leg now.
21:15Right, what we're going to have to do, mate,
21:16I'm going to lift your leg, okay?
21:17We're going to have to get you to shuffle to the back there, okay?
21:20So if you want to start shuffling your bum across,
21:22I'm going to support your foot.
21:23We'll look after you.
21:24It'll hurt a wee bit, but we'll get you...
21:26All right, mate, I've got it.
21:26I've got it.
21:27Well done.
21:27You're doing very well now.
21:28Well done.
21:32Frightened and in pain,
21:33the boy isn't able to move.
21:35Let's just relax it there, a second.
21:37Just relax it there.
21:38But Aidan can't wait any longer.
21:40This is time critical.
21:42The boy has now been trapped for over 42 minutes
21:45in the freezing cold
21:46and is in extreme danger of becoming hypothermic.
21:50We'll just get the longboard, like it.
21:51Can we get you the longboard out of your truck, please?
21:53Yeah, yeah.
21:53Thank you.
21:54Ben?
21:55Yeah?
21:55And a Vax splint.
21:57And a Vax splint.
21:58Stand by.
21:59Can I have you, mate?
22:00I'm going to have you out in the warm in just a second.
22:03Aidan oversees the fire brigade
22:04as they prepare to get him out.
22:07Yeah, yeah, don't worry.
22:08We'll help you with that.
22:10I want you to lie your head down there for me.
22:12I've got your foot.
22:14Lie your head down.
22:17Well done, mate.
22:18Longboard in position.
22:19The crew can now manoeuvre the boy out of the wreckage.
22:23You guys happy there?
22:24OK.
22:24Once the feet are clean, pendulum them in.
22:27OK.
22:28And we want him off the longboard,
22:29so we'll need to easily hold him to the side
22:31and slide him across every happy.
22:33OK.
22:35Here we go, mate.
22:36Ready, steady, slide.
22:37It's well done.
22:38It's up and OK.
22:39Get you nice and warmed up.
22:39It's all right.
22:40Finally out of the car,
22:41the crew lay the boy on top of the stretcher.
22:44It's up in.
22:45Any pain up here?
22:46No.
22:47No?
22:48OK.
22:48Any pain down there?
22:49Yeah.
22:49Yeah.
22:50Aidan assesses him
22:51and confirms his left ankle and foot are badly damaged
22:54with potential multiple fracture and dislocation.
22:59We'll get him in the north first and we'll do some air traffic.
23:02The blood and nerve supply could also be compromised.
23:05Let's go in there.
23:06I bet you're cold now, aren't you?
23:07You've been brave, lad, haven't you?
23:08Yeah.
23:09Very brave.
23:10I'm just going to go into the ambulance now.
23:11You see your thumb.
23:12All right?
23:13Good man.
23:13With a temporary splint on the injured ankle
23:16and wrapped in a foil blanket
23:18to try and warm him up as quickly as possible,
23:20the boy can now be moved into the back of the ambulance.
23:25Any pain in your chest?
23:27No?
23:28Aidan carries out a thorough examination of his chest and vital organs
23:32to be sure he hasn't suffered any undetected internal injuries.
23:37Ben, I'm happy that it's isolated.
23:41I feel like tibs-tibs.
23:43Ben's happy for us to clear truth in transport.
23:46I don't know what I've thought.
23:50The boy is now in a stable enough condition
23:52for Aidan and Dr Ben to leave him in the sole care of the ambulance crew
23:56for the eight-mile journey to Birmingham Children's Hospital.
24:03Took a little bit of time to get him extirpated from the vehicle.
24:07He's got quite severe lower leg fractures,
24:09which we need treatment at a specialist trauma centre.
24:12It's difficult when you go to a child at the same age
24:15as one that you have at home
24:16and it brings home a little bit closer
24:18and breaks through the veil a little bit.
24:20It's bad enough for an adult to be in that position
24:22where they're trapped inside a crash car,
24:24probably very scared,
24:26probably getting cold,
24:28probably in a lot of pain.
24:29But as a child,
24:30it must be significantly worse
24:32and significantly harder.
24:51Yeah, it's quite deep.
24:53I think we have gone through some tendons or ligaments there, haven't we?
24:57In Birmingham,
24:58critical care paramedics Will Meadows and Colin Apps
25:01have been called to an accident on a building site.
25:07How old are you, sir, mate?
25:08So it's a tool that sort of dropped onto his arm?
25:13Yeah, a punch saw.
25:14It's like a type of saw.
25:17Rich was operating a mechanical saw,
25:19which got caught in his clothing.
25:21The wound is so serious,
25:22he's in danger of losing some of the use of his arm.
25:29Have you got a good sensation in all your fingers?
25:31Yeah, completely normal.
25:32Do you feel like your grip is weak?
25:35Last year,
25:38there were 54,000 injuries on building sites.
25:42Do you feel sick at all?
25:44Yeah, a little bit.
25:45A little bit.
25:46This is a 26-year-old chap
25:48who is working on a construction site
25:51with what he calls a clone saw.
25:54Will phones control
25:55to update them on Rich's condition
25:57and discuss which hospital he should be sent to.
26:00This saw has come down onto his...
26:02the inside of his right forearm
26:04and he sustains an isolated, open laceration.
26:11It's quite deep.
26:12There's lots of adipose tissue
26:13and it looks like there's possible tendon
26:16and big of a damage there as well.
26:18As he was sort of moving,
26:19you could see stuff moving in the forearm,
26:22if you know what I mean.
26:23We'll go with QE as his destination.
26:27Rich's arm urgently needs to be assessed
26:29by a plastic surgeon,
26:31which means he will be blue-lighted
26:32to the Queen Elizabeth Hospital
26:34Major Trauma Centre in Birmingham.
26:37There's no sort of fine bodies debris
26:39or anything, it wasn't dirty, was it?
26:41It did look clean, didn't it?
26:42Yeah.
26:44Rich's blood pressure and heart rate
26:45are returning to normal,
26:47so the ambulance crew can give him some pain relief
26:49with less risk of him passing out.
26:52What we might do then
26:53is pop a little cannula in your arm,
26:55give you some paracetamol that way.
26:59How much pain are you in?
27:01Well, it's getting worse
27:03as it's got...
27:04Look, as I'm calm and dying a bit.
27:06Yeah.
27:07If you had to give the pain you're in a score,
27:09a mark out of ten,
27:10ten being the worst pain...
27:11I'd say it might be about a six or seven.
27:1422 minutes after they arrived on scene,
27:18Rich is ready to start
27:19the five-mile journey to hospital.
27:21Get our arms sorted, right?
27:22Yes, guys, thank you for your help.
27:25Thank you.
27:26Take care.
27:27Very well, see you.
27:29Satisfied with his progress,
27:30Will and Colin are happy to leave him
27:32in the care of the ambulance crew.
27:39Is it OK to pop in on
27:40or just a little bit of oxygen?
27:42Is that all right?
27:42Eight miles away in Walsall,
27:45following a bad tackle on the rugby pitch,
27:47critical care paramedic Pete Edwards
27:49is about to try and realign
27:51the broken bones in Dave's ankle.
27:55Have you ever had ketamine before?
27:57I've had morphine before.
28:00Yeah?
28:01It's been over 40 minutes since the accident.
28:04Deprived of blood and oxygen,
28:06healthy tissue can suffer irreparable damage,
28:09so Pete needs to act fast
28:10to restore blood supply to his foot.
28:14He's got dislocated or fractured ankle or both,
28:17but what we've got is what we call critical skin
28:19over the joint,
28:20so that means that the skin is that tight,
28:22it's restricting the circulation to it,
28:24and it is quite important
28:25that we restore circulation.
28:27It's going to get a little bit of sedation,
28:29try and pull it straight,
28:29get him to the hospital as quick as we can.
28:31Have you given it some anzatron?
28:35Before Pete injects the ketamine,
28:37it's vital it gives Dave a dose of anti-sickness medication
28:40to help him tolerate it.
28:42All right, give him a bit of that.
28:43Is that all right?
28:47His observations are all all right, aren't they?
28:49Yeah.
28:49So that's ketamine.
28:5410 milligrams per mil,
28:55so in here is 200 milligrams, all right.
28:57Have you seen it given before, Stu?
29:00Ketamine?
29:00Yeah, okay, all right,
29:01so it's just,
29:02it just has to be
29:03no sudden noises.
29:05All right, I'm just going to go
29:06some very small amounts to start with,
29:08all right?
29:11It's Paul, isn't it?
29:13I might just feel a bit woozy,
29:14that's all, all right?
29:15All nervous.
29:15Yeah, don't worry, all right,
29:16okay, we're going in very small increments here
29:19just to gauge a response, all right,
29:22giving you a really small dosage.
29:26The skilled and effective use of drugs like ketamine
29:28is a vital part of the critical care team's training.
29:32In the wrong setting,
29:33it can cause unpleasant psychoactive disturbances,
29:37so keeping a calm, controlled environment
29:39is very important.
29:41I'll just give that a minute or so just to work in.
29:43As the drugs start to take effect,
29:47Pete closely monitors Dave's reactions.
29:54You doing me, Dave?
29:57You doing me?
29:58Yeah, okay.
30:04Lift your arm.
30:06Fine?
30:07Lift your arm.
30:08That's it.
30:09Yeah.
30:09Okay, all right.
30:10It's a difficult judgment.
30:12Not enough,
30:14and Dave won't be able to tolerate the pain
30:16of manipulating his ankle.
30:19Just give him a little bit more.
30:21Too much,
30:22and he could suffer the adverse side effects.
30:27All right, Dave.
30:29Okay.
30:29Okay.
30:32With the ketamine now in Dave's system,
30:36he is hopefully oblivious to what's going to happen.
30:38Okay.
30:42I'm going to give it a little go at that,
30:43or he might shout.
30:47Pete needs to proceed very carefully.
30:49There are three main bones in the ankle.
30:52They could all be broken.
30:55And they all need to be correctly aligned
30:57if he's going to reverse the damage done
31:00by the lack of circulation.
31:02All right, Dave?
31:04Oh, good.
31:05Okay.
31:06That's a bit better.
31:07Okay.
31:10That looks a bit better alignment.
31:12Skin colour's going back, has it?
31:16Let's just check for a pedal pulse.
31:22So I just checked.
31:24Yeah, the critical skin has gone.
31:26I've got a good pedal pulse.
31:29Cap refill on his foot, although it is cold.
31:31Okay.
31:32Shall we just pop a vacuum splint on that, then,
31:34and I think that's all good?
31:36It's worked.
31:37With the bones now realigned,
31:39blood is circulating properly to the foot.
31:44Dave, all done.
31:47Yeah, it's all good.
31:48Looking better.
31:49So, he probably doesn't...
31:52He's answering us, but I don't think he knows...
31:54Is that normal for the catch of the arm?
31:56Yeah, that's a good indicator that it's kicked in, yeah.
31:59You can pop that oxygen mask back on him just for a sec.
32:01I mean, his sats are fine, but...
32:02Pete encases the ankle in a splint
32:06to create a rigid support for the journey to hospital.
32:11Now he's relaxed.
32:11Lucky to come back.
32:12There we go.
32:12Okay, yeah.
32:13I'll put a bit of traction on it, and you put that vacuum splint on.
32:17If we just keep our eye on it.
32:19Super.
32:20So I can see it.
32:22Skin's good.
32:22Okay, that's lovely.
32:24So, Warsaw Manor, innit?
32:25I think quite happy now.
32:26We've got rid of that critical skin,
32:28so we could just have a nice, steady ride in.
32:30Pete will travel in the back of the ambulance with Dave
32:34to keep him under close observation
32:36while he's still under the effects of the ketamine.
32:40Are you warm enough?
32:42I think so, yeah.
32:43Yeah? Do you know where you are now?
32:45No.
32:46No?
32:48It's good stuff, isn't it, that?
32:50I kind of feel floating.
32:52Yeah, yeah.
32:52It's the way it feels.
32:55It can take several hours for ketamine to wear off,
33:01but Dave shouldn't have any memory of his ankle realignment.
33:07Do you feel like you need anything else for pain, or is it okay?
33:10No, it's okay.
33:11It's nice to be able to see that my toe is now actually...
33:15Pointing the right way?
33:16Yeah, up right either than pointing...
33:18Yeah, it didn't look very good, did it?
33:21No, no, no.
33:22We're here now, Dave. You'll be glad to know, all right?
33:29Yeah, that's all right.
33:31A bit of fresh air might just make you feel a bit better as well.
33:34Have a seat, Dave.
33:36Maybe you like your head, you.
33:40He had a little bit of a moment where he was as high as a kite,
33:43for want of a better description.
33:45He seemed a bit bewildered, you know,
33:46what's just happened and where am I?
33:48But after a bit, slowly, he was back to as he was, as normally,
33:52so it was a good result.
33:56We joined together, didn't we?
33:58On this team, yeah, we did.
33:59It's just a chart of two years, isn't it?
34:01Yeah.
34:03In the critical care car, paramedics Sarah Foley and Becky Chappell
34:07are on their day shift.
34:08I think it's nice to have the option to do something slightly more, isn't it?
34:13Yeah, definitely.
34:15I think once you've had a few years as a paramedic
34:18dealing with general travel nine calls,
34:22it's nice to specialise your skills
34:24and increase your knowledge in one specific area
34:28and be able to target it.
34:30Variety's the spice of life.
34:31Ambulance service, just a bit of breathing.
34:49Just had an accident.
34:50Er, I can't see the spot.
34:51Okay.
34:52Are they breathing at the moment?
34:53Er, he's breathing at the moment when he's rode in the middle of the road.
34:57So what's happened?
34:58My driver's pulled down, he's just been flying
35:00and he's with the old skin of his foot.
35:03Was he on a motorbike or a pushbike?
35:05More to one.
35:07Is he bleeding very heavily?
35:08Yeah.
35:09Toddler's load around.
35:11Pursor stuff around it.
35:12Angle's literally gone.
35:14He's caught open and, you know, showing to move.
35:17Is there any complete or partial amputation?
35:19I'm not quite sure, sir.
35:20I can't see.
35:21Is the ambulance on the way, yeah?
35:23Yeah, yeah, yeah.
35:26Mike Delta 9-8.
35:27That's lovely.
35:36Thanks, Steve.
35:37We'll go and have a look.
35:40When a car hits a motorbike,
35:42injuries can be complex and life-changing.
35:46An ambulance has been dispatched
35:47and Becky and Sarah's enhanced clinical skills are also needed.
35:51All we know at the moment is that there's a leg injury.
35:55Somebody's come off a motorcycle.
35:56Only two minutes away.
36:04At the scene, they are briefed by the ambulance crew.
36:07Hi there, are you all right?
36:10He was on his buoy.
36:11Yeah.
36:11And a car turned right in front of him
36:13and he's got to come off the buoy.
36:14and I think he might have fractured his ankle.
36:16No KO'd.
36:18No.
36:1820-year-old Jake, a restaurant assistant,
36:21was riding home from the motorbike test centre
36:24when he crashed into a car.
36:27The impact dislodged his boot,
36:29throwing him off his bike onto the road in a hard landing
36:32that caused several gashes to his foot
36:34and injured his ankle.
36:35You've felt down all his back and neck
36:38and he's got no pain, yeah?
36:40No, as long as you're happy.
36:41Can I just have a quick look at it?
36:42Would that be all right?
36:43You've got no pain anywhere else?
36:45No.
36:45No, OK.
36:47Were you thrown at all?
36:48Yes.
36:48Yeah?
36:49You've got no pain higher up in your legs?
36:51No.
36:51It is just here.
36:51That's my most concern.
36:53Yeah.
36:53All right.
36:54We'll be able to wash that once you're on the ambulance.
36:57Motorbike versus car.
36:59No loss of consciousness.
37:00Appears to be an isolated ankle fracture.
37:02No further resources required.
37:04I'm going to grab him on the back of the ambulance
37:06and fully assess him.
37:10You're all right?
37:13Ruling out further serious injury,
37:16Sarah needs to get Jake onto the ambulance
37:18to carefully assess the damage to his ankle
37:20and lacerated foot.
37:23I'm going to just let go of that for a moment.
37:26All right.
37:27Out of 10, mate.
37:29How bad is this hurting you?
37:30Oh, 11.
37:3210 is the worst pain you've ever had in your life.
37:33It tends to be cutting your arm off.
37:34Mate, this is right up there.
37:36This is the worst thing I've ever done.
37:38Can I cut these before the cannula goes in?
37:41Is that all right?
37:42It just makes life much easier.
37:43I'm terrible with needles.
37:46All right.
37:47We need to get some pain relief into you, don't we?
37:50There we go.
37:50That's the only way we're going to manage her at the minute.
37:52Okey-dokey.
37:53All right.
37:53Before Sarah and Becky treat his injuries,
37:58Jake needs a cannula inserted into the back of his hand
38:01for intravenous pain relief.
38:03I'll make you miss it, please.
38:06But Jake has a fear of needles.
38:09I'm shit with needles.
38:11It's like absolutely terrifying.
38:12Just talk to me about what happened.
38:14I've just come back from Sutton Coldfield
38:16because my theory test is tomorrow from a motorbike.
38:19How fast were you going?
38:22I was going about 30.
38:24About 30?
38:24OK.
38:26Just looked out towards me?
38:27So you were going about 30.
38:28Were you wearing a helmet?
38:30Yeah.
38:31And your jacket, is that the only jacket you had on?
38:33Oh, that jacket, I'm on my boy jacket.
38:36Yeah.
38:37He's just come straight in front of me.
38:40You've gone into the side of him then
38:42because he's gone in front of you?
38:45I think, yeah, morphine and paracetamol.
38:47You're OK with paracetamol?
38:49You haven't had any in the last four hours?
38:51I've had any in four hours.
38:52OK, this is just normal paracetamol,
38:54but we give it IV and it's actually far more effective
38:56giving it IV as a painkiller.
38:58OK, so that's 2021 paracetamol running through.
39:02The intravenous drugs have been administered
39:04but are going to take a short while to kick in.
39:14My lovely, I'm going to just lift this up from here, OK?
39:18In West Bromwich, critical care paramedics Becky Chappell
39:22and Sarah Foley are at the scene of a motorcycle RTC.
39:26Just trying to work out what these greys
39:28and took the skin layers off.
39:31As well as an ankle injury,
39:3220-year-old Jake has a badly lacerated foot.
39:35The critical care paramedics are concerned the cuts are so deep
39:42they may have exposed bone that could become infected.
39:45OK.
39:46Just that one really.
39:47A bone infection can be difficult to treat
39:54and, in extreme cases, life-threatening.
39:58That's the one.
39:59That's a little bit deeper down here.
40:01She was trying to work out what these greys
40:06and took the skin layers off
40:08and what is what could potentially be bone.
40:11He's got good circulation,
40:13so he's got good pulses.
40:15The capillaries...
40:16Yeah, just put a bit more on.
40:19Are you all right to hold that back?
40:22Yeah.
40:23Put the ibuparacetamide.
40:26Oh, I'll leave that up to you.
40:27Yeah, I'll leave this out to you.
40:28Oh!
40:30Satisfied that his wounds haven't revealed the bone,
40:33Sarah decides Jake needs an X-ray to check for any breaks.
40:38I think, because we've covered the wounds,
40:40he's got such a large haematoma here.
40:43Yeah.
40:43Well, we can try it and we'll leave it open over the haematoma.
40:47And if it eases the pain, great.
40:50A haematoma is a pooling of blood
40:52that is leaked from a damaged blood vessel
40:54into the surrounding tissue.
41:00To ensure the injury is stabilised and the bone supported,
41:03Sarah puts the ankle into a vacu-splint
41:06for the journey to hospital.
41:07You didn't have one of these before?
41:09I've never broken a bone before.
41:10Do you want anything like this?
41:12We're going to suck the air out of this,
41:13so it's going to get real hard to go out of drag.
41:15It's going to come out of it, OK?
41:16Oh!
41:22Confident Jake's injuries are not life-threatening,
41:26Becky and Sarah are happy to leave him
41:28in the care of the ambulance crew.
41:30Jake, all the best.
41:32OK, we'll leave you with these guys.
41:34Obviously, just tell them if you need anything further
41:36for the pain.
41:37All right.
41:38Thank you.
41:38Thank you.
41:39OK.
41:39No, no, thank you.
41:40Yeah, and you guys.
41:42He's very lucky, really.
41:43He's come off a motorcycle,
41:44and at the moment,
41:46it looks like he's just got an injury to his foot,
41:49so it could have been far worse.
41:51He knows what happens to somebody.
41:52He's coming off a motorcycle,
41:56and he's were my hip in the air,
41:56and he's still there.
41:58He's my favorite car,
41:59and she's going to obey at all.
41:59And she's the protector.
42:00All right.
42:02Are you才verенный cookboy?
42:02No.
42:03It's 167.
42:03It's 168.
42:04$10.
42:07...
42:08Still not.
42:10...
42:15...
42:18I find my luck...
42:20Grazie a tutti.
Consigliato
1:48:49
|
Prossimi video
1:34:24
1:27:59
10:16
15:46
1:10
1:55
4:08
4:17
5:39
7:09
8:42
3:47
9:55
Commenta prima di tutti