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00:00Bounce any department.
00:02Just a busy day.
00:04Everybody's decided to come today.
00:06An unbeatable team.
00:08Have you given it a clean or did you just put that on?
00:10No, I wouldn't let my wife anywhere near it.
00:12Slide.
00:14Hard at work, 24 hours a day.
00:16Sorry.
00:18You've got the booby fries, you've got me.
00:20Seven days a week.
00:26Saving lives.
00:28No, no.
00:30Helping loved ones.
00:32Well, this is shocking. They're actually broken bones.
00:34Making the community they serve better.
00:37As well as everybody's safe, that's all that matters.
00:40A health service treating anyone.
00:42Restrain your temperature, Jane.
00:44And everyone.
00:46In and out, keep going.
00:48A team doing anything and everything for each other.
00:52The staff have been amazing.
00:54They've not been able to know enough for us.
00:56No worries.
00:58This is Barnsley Casualty 24-7.
01:00It brings me faith in the staff and NHS, definitely.
01:04On shift tonight.
01:14Dr John Shepard.
01:16Relax your head back for me.
01:18Dr Nicholas Allcroft.
01:20With this one last injection, then hopefully everything will be nice and young, okay?
01:24Could you not just put me to sleep?
01:26And...
01:28Sister Vicky and Sister Jane.
01:30You've worked hard today, Vicky.
01:32I am.
01:33How's your love?
01:34I am.
01:35So...
01:36Sorry, I'm catching your hair, I'm sorry.
01:38Get ready to share a shift...
01:40Is that hurt when I'm a bit like that?
01:42Yep.
01:43With the team at Barnsley Casualty.
01:46Well done there.
01:47You were awesome.
01:53How long's that gonna take?
01:55You always say two minutes, but it never ever is.
01:587am and Sister Jane has just clocked on at Barnsley Casualty.
02:02You know your patient in seven.
02:04Have you all done your SBAR a bit?
02:06No, not yet.
02:07She's sharing the shift with Sister Vicky.
02:10Oh, my sidekick, wherever she is.
02:12You can hear her before you see her sometimes.
02:14Can you take him round to CDU for me?
02:16He's got a bed on CDU while he awaits that report.
02:19The waiting rooms are full.
02:21Has the patient gone there?
02:22I don't know.
02:23Louise has just come to me and says, has he gone?
02:24I said, I don't think so.
02:26And more patients are arriving.
02:29Hiya, it's Jane.
02:31The floor within the apartment obviously can be extremely difficult.
02:34We're getting ambulances in and we're also getting his walk-ins in.
02:37We can't shut his doors.
02:39So we've just got to manage it and try and keep safe.
02:42But there's no let-up.
02:47Another critical patient is on the way.
02:49Perfect.
02:50Thanks very much.
03:01Seventy-year-old retired painter and decorator, Thomas, is struggling to breathe.
03:09Take this one from your waist.
03:11He's had pains in his chest and stomach since returning from holiday in Tunisia two weeks ago.
03:18There you go.
03:21He'll be treated by Dr John Shepard.
03:26So, my name's John.
03:27I'm one of the doctors.
03:28Nice to meet you.
03:29Nice to meet you.
03:30So, you and Tina's here for how long?
03:31Two weeks.
03:32When did you start feeling unwell?
03:33On the flight or as you landed?
03:34When we landed in Manchester.
03:35Okay, fine.
03:36And what was the first problem?
03:37Well, sneezing and coughing.
03:39Like a phlegm.
03:40Yeah.
03:41Did you get pain in your tummy and the sort of coughing and stuff at the same time?
03:45Yeah.
03:46So, with Thomas or anyone that's been abroad on holiday, we have to be quite worried as
03:49whether or not they've picked up an infection wherever they've been staying.
03:52That's a fairly common problem that people can suffer from when they come back.
03:55Why have you called the ambulance today as opposed to any time in the last couple of weeks?
03:59What's new?
04:00You had worse today.
04:01Okay.
04:02What was worse?
04:03Pain in your tummy.
04:04Pain.
04:05Okay.
04:06Pain in your tummy.
04:07Yeah.
04:08Can't breathe.
04:09Can't breathe.
04:10Okay.
04:11So, you've got COPD?
04:12Yeah.
04:13Do you use inhalers for that?
04:14Yes.
04:15COPD is a chronic condition of the lungs which affects your breathing and it affects the
04:19way that you can transfer oxygen between the air and your lungs.
04:23So, it gives you the opportunity to pick up more severe chest infections than if you
04:28didn't have the condition.
04:29Have you ever had a heart attack?
04:30No.
04:31No?
04:32Fine.
04:33Do you smoke?
04:34Yeah.
04:35Cool.
04:36How many do you smoke?
04:37Okay.
04:38Cool.
04:39Stop smoking.
04:40It's bad for you.
04:41I am.
04:42Do you drink alcohol?
04:43I'm one of eight.
04:44Okay.
04:45Do you drink alcohol?
04:46Well, yeah.
04:47What's your tipple?
04:48Tipple is about 20 pints a day.
04:5020 pints of beer a day?
04:51Yeah.
04:52Good lord.
04:53For patients who come in with illnesses related to smoking and drinking, it's tricky because
05:00they're very addictive substances.
05:03Okay.
05:04Relax your head back for me.
05:06smoking and alcohol intake will make his immune system less able to fight off infection.
05:13Ah.
05:14Okay.
05:15Have you had any surgery on your tummy at any point?
05:17Not really, mate.
05:18What do you call it?
05:19What do you call it?
05:20Appendix?
05:21Yeah.
05:22It's a shame isn't it?
05:23When I was young.
05:24Fine.
05:25Any other problems surgery wise?
05:26No.
05:27No.
05:28So, it's all a bit all over the place.
05:31It's got a temperature so he's probably got an infection and he's coughing up green stuff
05:34so it's probably a chest infection.
05:35That's all fairly expected.
05:37It's just how sore his tummy is.
05:39It's sort of throwing us off a little bit at the moment.
05:42Further tests are needed to work out if Thomas' pain is a sign of a more serious undiagnosed
05:48condition.
05:57Marjorie.
05:58She's been called for her bloods but it's not been done so can you get somebody to do her
06:02bloods now, love?
06:04In the hub, Sister Jane and Sister Vicky are juggling patients.
06:08Oh, hello Marjorie.
06:10John, will you just code that CTKUB patients?
06:14I've sent them to CDU.
06:15Okay.
06:16You can come onto a shift on a morning and all of a sudden it's like the bus has been dropped
06:21off outside and we could get 15, 20 patients in booking within an hour.
06:27One of those patients being blue lighted in is 71-year-old Christine.
06:39Oh, shit.
06:40Oh, shit.
06:41Her head is bleeding badly after a fall.
06:45What have you seen?
06:46What have you seen?
06:47Sister Vicky assesses her injuries.
06:48Hi, Christine, I'm Vicky.
06:49Nice to meet you.
06:50So what's been happening with you?
06:51What have you been doing?
06:52I fell out of my sisters.
06:53Oh.
06:54So you've come out of your sisters and you've stepped down and you've blocked your foot in
06:57and then you've gone face first like that.
06:58Yeah.
06:59Yeah.
07:00Did you block out?
07:01No.
07:02I remember everything.
07:03Yeah?
07:04Right.
07:05Just look straight forward at my nose.
07:06I'm just going to shine his torch in.
07:07Oh, yeah.
07:08Okay.
07:09Perfect.
07:10I'm just going to have a chat with the ambulance crew.
07:11Okay.
07:12Then I'll come back and see you.
07:13Yeah.
07:14She's come home from dropping her sister after half past the till.
07:16Been going up the step.
07:17Lost her foot in.
07:18I'm just going to have a chat with the ambulance crew.
07:20Okay.
07:21Then I'll come back and see you.
07:22Yeah.
07:23She's come home from dropping her sister after half past the till.
07:25Been going up the step.
07:26Lost her foot in.
07:28Slipped down one step.
07:29Landed onto her knees and then onto the left side of her face.
07:32Yeah.
07:33She's been bleeding quite a few so I've managed to stop it just.
07:36Yeah.
07:37No other injuries that I can see.
07:40Left eye.
07:41Very bloodshot.
07:42My name's John.
07:43Hello.
07:44Hello.
07:45Any pain in your neck when I squeeze?
07:47I have pain in my neck and down my spine because I've got osteoporosis.
07:50Is it worse than normal?
07:52Not really, no.
07:53Can you look over there with that paramedic for me?
07:55Yeah.
07:56Cool.
07:57Can you look over there at that door for me?
07:58Can you look up at the ceiling for me and look down the floor?
08:00Good.
08:01Well done.
08:02Do some tests I think.
08:03Alright.
08:04Oh, you're dripping.
08:05My consultant went in and had a little look.
08:08She's on blood thinners so obviously she needs a CT scan.
08:12So we're going to get your CT head scan done.
08:17Alright.
08:18And then every so often, every half an hour somebody will have to come in.
08:23You'll probably get fed up on her but they're going to have to do your blood pressure and
08:26stuff okay.
08:27You just need to make sure that there's no pressure that's building up in your head.
08:31Alright.
08:32Yeah.
08:33Yeah.
08:34Because she's on blood thinners, a scan is needed to check if Christine has had a bleed
08:39on the brain.
08:40Untreated, it can be life threatening.
08:42It's just rammed at the minute, I've got three nurses in there.
08:57Three hours into the shift and pressure is mounting in the hub.
09:01Oh, we've got 91 patients in the department.
09:06Just looks like waiting room, just getting hammered at the minute.
09:09The patients keep arriving.
09:12Are you going to cheer me up Antonia?
09:15No.
09:16I'm not.
09:17But there are not enough spare beds on the wards to move them on.
09:2237 is practically full.
09:24And that's our winter ward.
09:27And it's full.
09:29Yeah.
09:30If there's no beds within the trust or in the areas that we need them, then that's when
09:36we become stuck.
09:37One of those still being treated in recess is Thomas.
09:50Dr. Shepard is trying to work out what's causing his chest and stomach pain.
09:54I'm about to look him up on the GP records to see if he's got anything else going on.
09:59Because he told me he hadn't had a heart attack in his head.
10:04I'm going to give you some antiges for your chest.
10:11The question is, why is your tummy bad?
10:14How often do you wee?
10:17About three times a day.
10:18Fine.
10:19Is that more than you would normally wee at the moment?
10:21No.
10:22No?
10:23Same time?
10:24Same amount of time?
10:25Fine.
10:26And again, your bowels are all right at the moment?
10:27Yeah.
10:28Yeah, so these are to try and have a look for any fluid in the bottom of his lungs or fluid
10:39in his tummy that shouldn't be there.
10:41Sorry, Tom, I know I'm going to stop fiddling with you in a second, all right?
10:46I am attempting to have a look and see if there's any fluid where there shouldn't be fluid.
10:54Do you want to spit something out?
11:00You could be surprised by how much you can tell from someone's phlegm or from what they've
11:09coughed up.
11:17Delicious.
11:18Is that what's been coming up?
11:20Yeah.
11:21That's mine.
11:22Sometimes it's green, isn't it?
11:24Mmm.
11:25Cool.
11:26Still thinking it's a chest infection, I'm afraid, with that.
11:28That's gorgeous.
11:29You can tell, you know, if there's blood in there, if there's green-looking stuff, if
11:32it's bacterial, or importantly, if something more serious is going on.
11:36Dr Shepherd needs to get a second opinion from a consultant.
11:41So you said some comoxin clarithromycin.
11:43Would you just give him the STAT TAS as well, or next day's TAS?
11:48Thomas is prescribed antibiotics, but if they can't find the cause of his pain, he will
11:54need to be admitted for further tests.
11:57If a bed can be found.
12:04Surgery have got no beds, orthopedic have got two, gynae have got none.
12:10Sister Jane briefs the team on the state of play.
12:13So it's just going to be slow, medicine-wise.
12:17Ward 37 is full.
12:19Yeah, our winter ward is full.
12:22It's all about keeping the staff and patients safe, and the department running safely as
12:29well.
12:30And just keeping them informed of the flow of the department.
12:33So, yeah, fingers crossed it shouldn't be too much longer now, and we'll get you sorted.
12:36All right, thank you.
12:37All right, love, thank you.
12:43Just arrived in Majors.
12:45Is it Dean?
12:46Yeah.
12:47Hiya, Dean, I'm Chantel.
12:48Are you dozing off?
12:49I am, yeah.
12:50Sorry.
12:51Once clinical practitioner Chantel's next patient, Dean, is back in hospital after
12:55a holiday nightmare eight months ago.
12:58I've just been reading all about your eventful Benidone trip.
13:02I've got a bit on foot with a mozzie.
13:04No mosquito.
13:05I had a little spot on me foot.
13:06You know, like a proper yellow-headed spot.
13:08I knew I didn't feel no more about it.
13:10Yeah.
13:11When I got off at the plane, my leg had just...
13:12Ballooned.
13:13Ballooned.
13:14The doctors had picked us up.
13:15She said, I'm taking you straight to hospital.
13:17We're straight in resource.
13:18Straight into resource.
13:19Yeah.
13:20Then we did our, our operating table.
13:22Yeah.
13:23She said, you're the latest person.
13:24You're going to lose your leg.
13:25Yeah, it does.
13:26Well, there's no guarantees you're going to survive off of it.
13:28Yeah, it's really severe and dangerous.
13:31Working in A&E, it's often that we come across patients that just have really bad luck.
13:37Dean, for example, was on holiday minding his own business, enjoying himself
13:41and a mosquito bite, created this really bad bacterial infection.
13:46And if prompt surgical interventions not acted upon immediately, the patient can die.
13:53Dean had necrotising fasciitis, a flesh-eating infection that required skin grafts.
14:00For about three weeks, I'd be wetting up at the middle of the night, at three, four o'clock.
14:04My leg's bent 90.
14:06Mm-hm.
14:07I can't move my leg.
14:08You can't get your leg straight again.
14:09But then this morning, it was my ankle.
14:12And my foot was solid.
14:14Let's have a look.
14:17Right.
14:18So, where was the little spot on your leg? Just round here initially?
14:22No, smack it middle up to my foot.
14:24On there?
14:25Yeah.
14:26And then it spread up here?
14:27Yeah.
14:28And tell me what's different and new and concerning with your leg.
14:31Is it this leaking, weeping area?
14:33No, that's been like that. I believe it's weak now in general.
14:36And is this from healing still?
14:38Yeah, it's still healing.
14:39Good.
14:40Where did they take the graft from?
14:41There.
14:42It's really clever, isn't it, how they do it?
14:45Yeah, they took it from there.
14:46Top of this thigh and back of this thigh.
14:48My main concern when I looked at Dean's leg was, has he got necrotising fasciitis again?
14:54Some patients can just develop it.
14:56It can live on the skin.
14:57And when it breaks into the skin, that's when it becomes a problem.
15:01Tell me about your ankle again.
15:02Well, this morning, it took me an hour to go to bed.
15:04It's a lot solid.
15:05When I put a new weight on it, it's really painful.
15:06And is this new?
15:07Yeah.
15:08From yesterday?
15:09From yesterday, yeah.
15:10OK.
15:11Does it feel normal?
15:12Or does it feel hot and throbby?
15:13No, it feels normal.
15:14But like that, when you move it, that's a bit then that.
15:16OK.
15:17But your skin's not painful?
15:18No.
15:19And that's...
15:20I've got a lot of ostentation down there.
15:21That's fine.
15:22OK.
15:23Right.
15:24Can you point your foot for me?
15:25Point your foot.
15:26You can't do it, can you?
15:27No.
15:28Right, and we'll try and do it for you.
15:29No, it's not going, is it?
15:30So, Dean's proven to be quite a tricky patient to treat in A&E, because he's got multiple things
15:45going off.
15:46He's got a couple of open areas to his legs, which are still oozing, so he could have cellulitis,
15:52so a bacterial skin infection, which I need to cover and treat.
15:56Is that painful?
15:57I feel a bone.
15:58That will crack it.
15:59Yeah.
16:00But he's also got a very painful, hot ankle that's not moving quite well.
16:05I could feel that as well.
16:07So I need an orthopaedic review.
16:09Is that hurt when I move it like that?
16:11Yeah.
16:12That's tender.
16:13Mary.
16:14Not this, no.
16:15Let's get an X-ray of this.
16:16Have you got a cannula in?
16:17Yeah.
16:18I'll have a look at your blood tests as well.
16:19OK.
16:20It's Dean's 61st birthday today.
16:22He hadn't planned to celebrate it in casualty.
16:26My daughters are coming over from Leeds.
16:27I know we're taking them out for a meal somewhere.
16:28So I didn't know where we were going.
16:29We never know.
16:30We might still be able to be there.
16:31Well, it's if I can get anywhere, innit?
16:32Yeah.
16:33Right, let me get you sorted, Dean.
16:34What time's your birthday meal?
16:35I don't know.
16:36How long have I got?
16:37I don't know.
16:38How long have I got?
16:39They were aiming to be back at Dalton for 24.
16:40Right, OK.
16:41If the X-ray reveals a new infection, Dean will have to spend the rest of his birthday
16:56on a ward.
17:02One patient's sister Vicky is keeping a watchful eye on is Christine.
17:07Just try to shuffle a bit more.
17:11Just keep your head nice and still for the scan.
17:14You can keep your eyes closed so you can feel all the pain.
17:17Yeah.
17:18She's on blood thinners and has a nasty head wound.
17:21It's nice and still for me, all right.
17:27The worst case scenario would probably be her leave on the brain because I've
17:30rescheduled to her blood thinners and things like that, hence why she's having a scan.
17:34Christine's sister Susan is waiting with her for the results of the scan.
17:53The staff's been lovely, the hospital staff's been lovely, but they've not been able to
18:00do enough for us.
18:02Dr Orcroft checks the scan.
18:04If Christine has a bleed on the brain, she'll need emergency surgery.
18:09Five hours into the shift.
18:14There's no cubicles.
18:16And that's what I need.
18:18And sister Jane has to make space for emergencies.
18:22Asim, Salim, have you done with your patients in cubicle 15?
18:26She can go to surgical aspect, yeah.
18:28To keep the department open for new patients.
18:31Shall we move her out and then I can move some ambulances across?
18:34Yeah.
18:35I think when you are the sister in charge, it does fall on your shoulders because you're
18:39responsible for the running of the department, so it is your responsibility to get those patients
18:44out.
18:45Right, William, we're just moving your sweetheart into another cubicle, all right, my love?
18:50A cubicle is freed up just in time.
18:57The patient's being rushed in by ambulance after collapsing on the street.
19:03I'm just going to give you a bit of a clean.
19:07They got there within about three minutes and it stopped season and they were just confused.
19:1362-year-old Christopher has epilepsy.
19:16It's complained of pain and throbbing in both legs.
19:21And then he has a numerous, maybe three or four slight lacerations to the top of the
19:28back of his head.
19:29You should be resting on it, mate, all right?
19:31Yeah.
19:32So I had a seizure today, coming back from town.
19:36I know I know when I'm going to have one, but this time I didn't.
19:39He'll be examined by Dr Charlotte Foster.
19:46Hello, my name's Charlotte, I'm one of the doctors.
19:50So what's happened today to bring you in?
19:51I had an epileptic, so I had a seizure without coming back from town going home.
19:57Yeah, okay.
19:58Did anybody see you, the seizure?
20:00Yeah, the passerby saw me on the floor.
20:02Did you get any symptoms before you went, any dizziness?
20:05No, no.
20:06Have you always had symptoms before you had these seizures?
20:09Yeah.
20:10Yeah, and this is the first one you've not had any?
20:11Yeah, yeah.
20:12Yeah, okay.
20:13I'm just going to keep an eye out for your bloods.
20:15I'll come back shortly and just let you know whether we need to do anything else if that's
20:19okay.
20:20Yeah.
20:21He normally gets symptoms before a seizure and this time he hasn't.
20:25So, kind of just a bit, slightly more worried about things because of that.
20:33Because Christopher's seizure didn't follow its normal pattern, Dr Foster decides to get
20:38a second opinion from a consultant.
20:40He had no preceding symptoms at all, which normally he does when he has seizures, that's
20:45the only thing that's worried me.
20:46Normally he gets kind of dizziness.
20:47He's known to have epilepsy.
20:48He's known to have epilepsy.
20:49He's known to have epilepsy.
20:50He's known to have epilepsy.
20:51He hasn't had a seizure in the last two years.
20:52He came round within about five minutes or so.
20:54So, I was just a bit worried that it doesn't sound like his normal seizures.
20:57He's applying the standard of pressure.
20:59I've done that.
21:00Needs one of them and an ECG.
21:02I think you're right to make sure it's not anything like a cardiac therapy or anything
21:05like that.
21:06So, there'll be some further investigations that we do just to rule out other causes.
21:10We'll also add on some blood tests just looking at his heart to make sure that's
21:13not kind of a cause of his kind of collapse.
21:18So, this blood test will just be to look at your heart to see whether it's stable or
21:21if it's getting kind of more strain on it.
21:23No.
21:24And also to have a look at your blood clotting as well, just to make sure that's all all
21:29right.
21:30Given that you've kind of had this episode of collapsing, we just want to make sure that
21:37it's not because of your heart really and not a seizure.
21:40All right.
21:41What are they expecting?
21:42All these tests.
21:43You don't know if it's my heart or what now.
21:56With Christopher's symptoms appearing unusual, Dr Foster needs to rule out of the causes of
22:01his collapse.
22:02An X-ray will look for infection, whilst blood tests check for signs of a heart attack.
22:08Paul, can you do me a favour? I've got loads to get out to AMU now, because they've pulled
22:24them all.
22:25Hospital beds are starting to free up for patients waiting in casualty.
22:30Louise, Paul's getting some patients ready for the ward. Can you just help him out,
22:35love, please?
22:36But it's given Sister Jane a new problem.
22:39And then can you get her up to EPA you for me, Paul, or get her porter to take her up?
22:44You don't particularly need to go up yourself.
22:46Finding staff to help that are not tied up with patients.
22:51A lot in waiting room, and I know I've just heard Jane say that there's five members of
22:55staff now down there, trying to get through it and triage as fast as they can. All hands
23:00on deck, yeah.
23:01My name's Sheila, this is Beth, and we'll be taking your X-ray.
23:09One of those needing close monitoring is Christopher.
23:12Hold, breathe out.
23:18He has epilepsy, but his last seizure didn't follow the usual pattern.
23:27Dr Foster is concerned that he might have had a heart attack, so she's carrying out further tests.
23:33The chest X-ray is cleared, so no signs of infection on the chest X-ray there.
23:37One of the blood tests that we added on was looking at damage to the heart, and that has
23:45actually come back quite raised, so it's come back at 134.
23:49Well, it didn't sound like his normal seizures, and his first drop was 134, second drop 194.
23:55Did you, and you said you treated them for ACF?
23:59Yeah.
24:00I've done a D-dimer as well.
24:03Like I said, drop 194, so his drop's gone up.
24:09Rising levels of troponin in Christopher's blood are another indicator of a possible heart attack.
24:16He now needs further tests by the cardiac team.
24:21So I've just come to give you a little update.
24:23The marker for your heart has come back raised from what it was before, so it looks like there's some damage going on.
24:29So it looks like you might be having what we call an end STEMI, so it's a heart attack.
24:35For that, you'll just be kind of admitted to the medical ward just for some more monitoring.
24:40But at the moment, are you still pain-free?
24:43Yeah.
24:44Still not got any pain in your chest?
24:45No, no.
24:46Perfect.
24:47So it's not super common to have a heart attack without any chest pain.
24:51It's more common in women than it is in men, so it is a bit unusual.
24:56He'll carry his treatment here, and then we'll head up to the wards as of when there's a bed, up to the medical unit for more treatment and monitoring.
25:05Thankfully, further tests ruled out a heart attack and confirmed Christopher's seizure was caused by his epilepsy.
25:13He's now back home and recovering well.
25:17That's all she's just done to have her intake, yeah.
25:22It's almost lunchtime in the hub, but Sister Vicky...
25:26Is it cubical?
25:27Yeah.
25:28Yeah.
25:29And then one down in the lamp.
25:31..and Sister Jane are struggling to clear the backlog.
25:34I've said you literally help them, cos there's two qualified nurses round there, and you come back.
25:40Talisa, we just got a scan with HDC1.
25:43Right, I'll get Louise to go.
25:46We've all got his own way of coordinating the department.
25:49Myself, I just like to go with the floor, make sure everybody's happy, make sure I help and assist where I can.
25:56Did you take that one from LAM up to AMU?
25:59So that one's gone.
26:01I think it takes a kind of person to be able to do the job.
26:07You have to have a certain flair for it.
26:10I have respect for everybody that I work with, and I like them to have respect for me.
26:16So there's no point shouting and moaning.
26:20I think you just have to have an element of assertiveness.
26:23In radiology, Dean is having an urgent x-ray.
26:35You have to just roll your ankle this way for me.
26:40Can you roll that way anymore?
26:42He needed life-saving surgery after a mosquito bite led to a dangerous skin infection.
26:49How comfortable do you feel about rolling once you're on the left hand side?
26:52Not at all.
26:53No, not at all.
26:55Now his ankle is painful, which could be a sign of a new infection.
26:59Orthopaedic doctor Nida Ahmed reviews his x-ray.
27:09Can you just go through what's happening?
27:12When I got up this morning, I couldn't move it to tell me.
27:15I managed to get it going, but it's...
27:17It's obviously going to get worse, isn't it?
27:19OK.
27:20I can't bear to put any weight on it at all.
27:22OK, fine.
27:23Is that a push against my hand?
27:25No, I can't much.
27:27And is that because of the pain?
27:29Oh, yeah.
27:30So, this bit?
27:32It's all right, I don't know.
27:36OK, that's fine.
27:37It seems to be more in your joint than the lower bit itself.
27:41So, not around your heat.
27:42Yeah.
27:43You need two minutes.
27:48I knew it wasn't right when I woke up this morning.
27:50I feel more confident, and I know there is something wrong with me.
27:54She always worried that you're just being petty, aren't you?
27:56Dr. Ahmed suspects cellulitis, an infection in the deep tissue of Dean's ankle.
28:03Cellulitis, then?
28:04Yeah.
28:05It's just an infection of the skin.
28:06Just because there's nothing that's seen on the x-ray, your bone looks OK.
28:11Yeah.
28:12That should be OK.
28:13We'll bring you in and start you on some antibiotics.
28:14All right.
28:15Any questions?
28:16No.
28:17No.
28:18Keeping me overnight on antibiotics.
28:19It took five weeks for that.
28:20I hope it's not as long this time.
28:21Proper birthday present, innit?
28:22Dean had to spend eight days in hospital.
28:25He's now back home and looking forward to a belated birthday bash.
28:32In recess, Thomas is responding well to his antibiotics.
28:33Sister Rachel checks up on him.
28:35So, how are you feeling, first and foremost?
28:36I'm not getting away much.
28:37OK.
28:38Have you got any pain anywhere, Thomas?
28:39No.
28:40No.
28:41I did have this morning, though.
28:42Is it gone now?
28:43Yeah.
28:44Good.
28:45Thomas has discovered he's not the only family member in the hospital today.
28:47Yeah.
28:48And looking forward to a belated birthday bash.
28:49In recess, Thomas is responding well to his antibiotics.
28:51Sister Rachel checks up on him.
28:53So, how are you feeling, first and foremost?
28:56I'm not getting away much.
28:57OK.
28:58Have you got any pain anywhere, Thomas?
28:59No.
29:00I did have this morning, though.
29:02Is it gone now?
29:03Yeah.
29:04Good.
29:05Thomas has discovered he's not the only family member in the hospital today.
29:09Yeah.
29:10I've had a son come in.
29:11Your son's in hospital?
29:12Yeah, his wife.
29:13She's had another grandson.
29:14Oh, congrats.
29:15Has he been born already?
29:16Yeah.
29:17Oh, congratulations.
29:18She's already got to hopefully do it.
29:19Is everyone up there?
29:20Yeah.
29:21How many grandchildren have you got?
29:22All together?
29:23Yeah, all together.
29:2417.
29:2517?
29:2617 and 18.
29:2718?
29:28Oh, my God.
29:29Yeah.
29:30Yeah.
29:31All together?
29:32Yeah.
29:33All together.
29:3417.
29:3517?
29:3617 and 18.
29:3718 over there.
29:3818?
29:39Oh, my giddy aunt.
29:40I bet your house is busy at Christmas.
29:41Why?
29:42Blood tests have confirmed that Thomas has a chest infection, which needs further investigation.
29:49Dr Shepherd suspects it also caused his stomach pains.
29:54It's actually soft now, isn't it?
29:55Yeah.
29:56Cool.
29:57Your blood tests that look at stuff in your tummy are largely fine.
30:00You're a bit dehydrated, but nothing else particularly.
30:03So, I think it's all just your chest, because your inflammatory infection markers are quite
30:07high.
30:08So, we'll continue to target treating your chest and get you up to the medical team, all
30:11right?
30:12Yeah.
30:13Cool.
30:14His heart rate, blood pressure and oxygen levels are all essentially normal now.
30:19His tummy's no longer painful, and all of his blood tests just point to a bad chest infection.
30:24If there was other problems, then potentially the medical registrar would have come down,
30:27but didn't need to.
30:28So, he's now well enough to go out to the ward, which is what I'm missing.
30:31Yeah.
30:32Tom, I'm going to leave you two out.
30:33Your bed's ready upstairs.
30:34All right.
30:36Keep having a look at your chest.
30:37Yes.
30:38Hopefully, you get better, and I hope you get to see your new grandson.
30:40I hope so.
30:41Son, daughter?
30:42Grandson or granddaughter?
30:43Grandson.
30:44Grandson.
30:45I hope you get to see your new grandson soon, all right?
30:46Yeah.
30:47All the best.
30:48All the best, man.
30:49Do you take all these wires off me?
30:51Yeah, I'm going to come take them on for a sec.
30:54I'll just make sure the porter's coming.
30:56Yeah, I look like a metal Mickey.
30:58Yeah.
30:59That's enough, then.
31:00That's enough.
31:01Let's go.
31:02Further tests revealed Thomas had pneumonia, and he had to spend a week in hospital.
31:15But he's now back home and has met up with his 18th grandchild.
31:23In the hub...
31:24Great, my love.
31:25Thank you very much, sir.
31:26See you later.
31:27See you later, love.
31:29Sister Vicky and Sister Jane...
31:31Louise!
31:32Would you mind doing a CT head run?
31:35Actually, what time?
31:36No, I'm going to send her for a break, because it's 22.
31:39...are clearing the backlog of patients.
31:42I've asked Paul to go for his break.
31:44Louise has, but they wanted some help with the washing.
31:47But lunchtime is almost over, and staff still need their breaks.
31:51Just do the one you're doing, and then I'll get Paul to take you off for your dinner.
31:56We're the dynamic duo.
31:59We are.
32:00I'm the dynamic, she's the duo.
32:03And new patients are still arriving.
32:12In paediatrics, 12-year-old Nevaeh has hurt her hand at a majorette dance troupe practice.
32:17She's coming with mum, Amy.
32:19She'd done the walk-over, and then she started crying, like, through her next dance.
32:25And I was saying, oh, you'll be fine, but then she carried on complaining.
32:30Nevaeh?
32:31Yeah.
32:32She'll be seen by emergency nurse practitioner, Tony.
32:43So what's happened?
32:44I did, like, a walk-over, and I landed on my hand and went over it.
32:48And so when you landed, have you, like, put your hands down like that, or onto the side of it, or...?
32:53You've got to, like, put your hands flat.
32:55Okay, so what's the thing you like when you go down like that?
32:57She rolls when she does it, and she kind of goes sideways, right?
33:02She hasn't quite mastered the whole thing yet.
33:04Oh, that's fine. Let's have a look, then.
33:06Any wiggly fingers for me?
33:07Okay.
33:08Can you make a fist?
33:09I'll find a fist finger.
33:10Oh, that's okay.
33:12Soar around your knuckle a bit.
33:14It hurts her.
33:15Hurts there.
33:16Then it's coming down here.
33:17It hurts.
33:18So she chipped her bone off her foot, and then she's broke her nose with her baton as well a few weeks ago.
33:24So she's prone to...
33:27Accidents.
33:28It's very rewarding working with children.
33:31You can very quickly fix things in children and make them better.
33:36Sometimes you can get a little crack on a bone and you can't always see, but we'll get an X-ray of it first, and we'll go from there.
33:42Some patients don't need anything doing.
33:44Sometimes it's just a bit of reassurance for parents that everything that they're doing is fine.
33:48You don't need to do anything else.
33:49You want to come this way?
33:50Sometimes you examine them, they've got a bit of pain in the wrist.
33:53You send them for the X-ray, and they've got a really nasty fracture, and they're just quite happy with it.
33:58They're not bothered.
33:59Turn right, and as you head long, you'll see X-rays.
34:01It's just on your left-hand side.
34:02When you come back, just press that doorbell.
34:04We'll come and get you back in.
34:06We'll see you back shortly.
34:08If the X-ray shows Nevaeh's injury is severe, her baton-twirling days could be over.
34:20In majors, Christine is waiting for the results of her head scan.
34:26Just looking at the damage.
34:28It's lovely, isn't it?
34:30And the jumper's good enough to be thrown away by it, look, innit?
34:35Sister Susan is there for moral support.
34:38Me and her, we've sent to stick together.
34:41We've had this moment.
34:43We're with you for each other and all.
34:48Dr Orcroft reviews the scan.
34:51Thankfully, it doesn't show any bleeding inside the head, which is really good news.
34:55So we can be reassured from that big thing we were worried about at the start,
34:59we can sort of tick that off as a worry.
35:02So that's good news.
35:03Ow.
35:04So what do you want some more cleaning?
35:07Aye.
35:08I just wish it would stop bleeding.
35:13But Christine's open wound still needs closing.
35:18My name's Nick.
35:19I'm one of the emergency doctors.
35:21The good news is, is that there's not any bleeding inside the head, which is great.
35:25Can I have a little look under here?
35:29Sorry, I'm catching your hair.
35:31I'm sorry.
35:32Oh, bless you.
35:34Okay.
35:35I suspect looking at that, that might need some stitches, if I'm honest.
35:41There's a clot in it at the moment that we'd need to remove to help it heal, basically.
35:46Yeah.
35:47Now, I think what we need to do to start with is probably get a bed in here so I can sort
35:53of have you laying down so I can have a really good look at it and give it a good clean is sort
35:59of the first and most important thing.
36:01Make it hurt.
36:02You've got to laugh at it all, otherwise you just sit there and cry.
36:14She's laughing now, but Christine will need stitches to close her head wound.
36:20Beep.
36:21Beep.
36:22Beep.
36:23Beep.
36:24Beep.
36:25Beep.
36:26Beep.
36:27Beep.
36:28Beep.
36:29Beep.
36:30Oh.
36:31It's nearing the end of the shift for Sister Vicky and Sister Jane.
36:36You've worked hard today, Vicky.
36:38I am.
36:39How's your love?
36:40I am.
36:41On your little team.
36:42I've hurt my crust.
36:43Where are you?
36:44Where's she?
36:45Right, well, you can tell her.
36:46She said no.
36:47I want her to come back and do some work.
36:48I've been a nurse for a long, long time and I've said numerous times, you cannot buy experience.
36:59You just, you can't.
37:00Let me go get you a pillow, eh?
37:03Or another blanket for this leg so it don't fall down.
37:06How's that sound?
37:07We are all problem fixers.
37:10Some are very good at working on a team and delivering, you know, a good standard of nursing
37:15care.
37:16She can go in a chair, clergy, and then I can get this patient in.
37:19And then others are very good at being in charge, steering the ship if you like.
37:23And I think, you know, we all have different flares for different things and I think once
37:28you put all that together, it is a well engineered team.
37:35In radiology, majorette Nevaeh is hoping she's not broken any bones.
37:42Come on in.
37:44Yeah.
37:45After a tricky move at dance practice went wrong.
37:49Do you want me in?
37:50Yeah.
37:51What have you done?
37:55It was like a walk over and I went over with my hand.
38:00Nevaeh came to casualty with mum, Amy.
38:04She plays football as well, so you'd think she'd get more injuries from football than dance.
38:09She's got her first goal last week, but she'd put it in her own head.
38:22I'll send those x-rays across to Amy.
38:24If you just want to make a bit back round there.
38:27No, you've had your x-rays.
38:28Emergency nurse practitioner Tony assesses the injury.
38:34She was more painful down this side of her hand and into her little finger.
38:41No obvious cracks or breaks or anything there.
38:45So I think that's going to be bruised rather than anything else.
38:50Bones in children tend to bend more than they'll break.
38:53Whereas in the same injury for an older person, they would likely get a more significant break to the wrist.
38:59I needed potting and sometimes even surgery.
39:02Can't see anything broken.
39:03I think you might have just rolled it a little bit and you just caused a bit of bruising.
39:07Keep it moving.
39:08Paracetamoliboprofen, absolutely fine.
39:10Brilliant.
39:11Yeah, you'll be fine.
39:13I'll let you go then.
39:14It's the best outcome for Nevaeh.
39:18At least you can dance on Saturday now.
39:21But she'll be watching how she lands those tricky moves a bit more carefully from now on.
39:28In majors, Dr Allcroft is preparing to stitch the open wound on Christine's forehead.
39:41Right, you want me to keep it?
39:43No, no, just lay down now.
39:45What I want you to do is just be basically relaxing as much as possible.
39:49Best case scenario would have been the fall had done no injury.
39:53There'd be no injury to the head and everything was absolutely perfectly fine.
39:56I'm going to get this up a little bit just to save my back so I'm not a hunchback.
40:00I think luckily, looking at the injuries that have happened, most of it is going to be able to be managed without sort of hopefully any need for surgical invention or causing sort of longer term, more serious damage.
40:13It's stinging.
40:14Sorry.
40:15It's just to make sure when we put it in it's okay.
40:16Oh, bless you.
40:17I'm sorry.
40:18It's really sore around that then.
40:19I know.
40:20I think where it's grazed and unfortunately this isn't.
40:21I'll do it quick.
40:22Oh, I will be glad when I get home.
40:23Just going to do a little injection above your eyebrow.
40:24Ouch.
40:25Unfortunately, the local anesthetic can sting a little bit in itself.
40:26Give me that little massage.
40:27Okay.
40:28I'm used to injections.
40:29I'm used to inject myself four times a day.
40:30Oh, did you?
40:31Yeah, I went first for now.
40:32I've got diabetes.
40:33Oh, bless you.
40:34Oh, bless you.
40:35Oh.
40:36Okay.
40:37Exactly.
40:38I'm going to do a little injection.
40:39I'll do it quick.
40:40Oh, I will be glad when I get home.
40:41I'm just going to do a little injection above your eyebrow.
40:42Unfortunately, the local anesthetic can sting a little bit in itself.
40:46Mm-hm.
40:47Give me that little massage.
40:49Okay?
40:50Oh, I'm used to injections.
40:51I used to inject myself four times a day.
40:54Oh, did you?
40:55You know, when I first found out, I've got diabetes.
40:58Lord bless you.
41:01Let's do a little one this way as well.
41:04I had my nose pierced and all.
41:06I was 71 and I thought,
41:08I've always wanted to have my eyebrow done in my nose.
41:12So I had my nose done at Skeggy
41:14and my eyebrow done in Barnsley.
41:17Yeah.
41:18Full works, basically.
41:20Yep.
41:21Well, just one last injection
41:23and hopefully everything will be nice and nice, okay?
41:25Could you not just put me to sleep?
41:28No.
41:32You can see we've got a fairly big clot in there
41:34that we need to take out...
41:37You've got a big clot outside and all.
41:49There we go. That's what we wanted.
41:51Is it too big for butterfly stitches?
41:56Yeah.
41:57I think, unfortunately...
41:59You've got longlipops for after.
42:01I'm sure we can fix you some up.
42:02I'll raid our special sweet treats.
42:04Oh, you are kind.
42:06So I need you to keep your head really still
42:07because if the head moves as I go along,
42:10it's going to be tricky to get.
42:24So, I think we're all done.
42:27Yep.
42:27Give me a little, sort of, wiggle of your face.
42:32Raise your eyebrows for me.
42:34I love you.
42:35Well done there. You were awesome.
42:37So that's, I suppose, always the best-case scenario
42:43that we've not had anything serious and long-term going on.
42:47That being said, I think the worst-case scenario
42:49would be if we'd found a big bleed on the head
42:51and that could have been very serious.
42:54So, thankfully, we've not had that happen.
42:56Very, certainly, fingers hurt.
43:02Christine's face is healing well.
43:05She's watching out for the steps outside her sister's house
43:07whenever she visits.
43:12I love these.
43:14It's the end of the shift for Sister Vicky and Sister Jane.
43:19Look at you all.
43:20Like, bees round the little honeypot.
43:23Vultures, as a nurse in charge of the department,
43:28the more experience you get at doing it,
43:30then the better you become at it.
43:33Bye, Carol.
43:34And I think to work here in this department
43:36where we are so gelled as a team.
43:40All right, A's.
43:41See you later.
43:42It's incredibly important.
43:44Good night.
43:45At the end of the day, we're one big family here,
43:48so we're all here for each other.
43:50Done it.
43:51It's so easy when you quick chart.
43:53Some shifts can be really gruelling
43:55and you can walk off absolutely exhausted.
44:00But I like to leave the shift happy and positive
44:02and know that everybody's done a good job.
44:05Oh, I love you.
44:07I love you.
44:09And as the new shift arrives,
44:11another team is ready to serve the people of Barnsley 24-7.
44:16It's so easy whenlvester does stuff to get on.
44:22It's so easy when there's a good job.
44:24It's so easy when you say,
44:26but why aren't you talkingè·Ÿ Vil foot ayudarê°™ a little bit aside.
44:28It's so easy when we find a way that makes you alive.
44:31You can pop might be easier when you're a baby.
44:33Face up sometimes the test.
44:34It's so easy.
44:35It's like the worst thing.
44:35It's a tough one.
44:36You can pick us on.
44:40It's so easy when you're a kid.
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