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00:00Bansley, I need a panel.
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 prize, you've got me.
00:20Seven days a week.
00:26Saving lives.
00:28Oh no.
00:30Helping loved ones.
00:32Well this is shocking, they've 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 do enough for us.
00:56This is Barnsley Casualty 24-7.
01:00It brings me faith in the staff and NHS, definitely.
01:04I love you.
01:14On shift tonight.
01:16Dr John Shepard.
01:18Relax your head back for me.
01:20Dr Nicholas Allcroft.
01:22With this one last injection, then hopefully everything will be nice and young.
01:24Okay?
01:25But you know that'll just put me to sleep.
01:28And...
01:29Sister Vicky and Sister Jane.
01:31You've worked hard today, Vicky.
01:33I am.
01:34How's your love?
01:35So...
01:36Sorry.
01:37I'm catching your hair.
01:38I'm sorry.
01:39Get ready to share a shift.
01:41Is that hurt when I'm all a bit like that?
01:43Yeah.
01:44With 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, when Sister Jane has just clocked on at Barnsley Casualty.
02:02You know your patient in Severn.
02:04Have you all done your SBAR a bit?
02:05No, not yet.
02:06She's sharing the shift with Sister Vicky.
02:09Oh, my sidekick, wherever she is.
02:11You can hear her before you see her sometimes.
02:13Can you take him round to CDU for me?
02:15He's got a bed on CDU while he awaits that report.
02:18The waiting rooms are full.
02:20Has the patient gone there?
02:22I don't know.
02:23Louise has just come to me and said, has he gone?
02:24I said, I don't think so.
02:25And more patients are arriving.
02:27Hiya, it's Jane.
02:29Floor within the apartment.
02:31Obviously can be extremely difficult.
02:33We're getting ambulances in and we're also getting us walk-ins in.
02:37We can't shut us doors.
02:39So we've just got to manage it and try and keep safe.
02:42But there's no letter.
02:47Another critical patient is on the way.
02:49Perfect. Thanks very much.
03:01Seventy-year-old retired painter and decorator Thomas is struggling to breathe.
03:07Take this one from your waist.
03:11He's had pains in his chest and stomach since returning from holiday in Tunisia two weeks ago.
03:17He'll be treated by Dr John Sheppard.
03:23So my name's John. I'm one of the doctors. Nice to meet you.
03:27Nice to meet you.
03:28So you and Tina's here for how long?
03:30Two weeks.
03:31When did you start feeling unwell? On the flight or as you landed?
03:34When we landed in Manchester.
03:35OK, fine. And what was the first problem?
03:37No, 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,
03:48we have to be quite worried as whether 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're having worse today.
04:01OK, what was worse?
04:02Pain in your tummy.
04:03Pain, OK. Pain in your tummy?
04:05Yeah.
04:06Fine. So right now?
04:07Couldn't breathe.
04:08Couldn't breathe.
04:09OK. So you've got COPD?
04:10Yeah.
04:11Do you use inhalers for that?
04:12Yeah.
04:13COPD is a chronic condition of the lungs which affects your breathing
04:18and it affects the way 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 didn't have the condition.
04:28Have you ever had a heart attack?
04:30No.
04:31No. Fine. Do you smoke?
04:32Yeah.
04:33Cool. How many do you smoke?
04:34I go to a pouch about a week.
04:36OK. Cool. Stop smoking. It's bad for you.
04:39I am. I'm one on a drink.
04:40Do you drink alcohol?
04:41I'm one on a drink.
04:43OK. Do you drink alcohol?
04:45Well, yeah.
04:46What's your tipple?
04:47Tipple is about 20 pints a day.
04:4920 pints of beer a day?
04:50Yeah.
04:51Good Lord.
04:52Patients who come in with illnesses related to smoking and drinking,
04:57it's tricky because they're very addictive substances.
05:03OK. Relax your head back for me.
05:05His smoking and alcohol intake will make his immune system less able to fight off infection.
05:12Ah!
05:13OK.
05:14Have you had any surgery on your tummy at any point?
05:17Not really, mate.
05:18What do you call it?
05:19Appendix?
05:20Yeah.
05:21It's a shame isn't it?
05:22I can't tell you to appendix.
05:23Fine.
05:24Any other problems surgery-wise?
05:26No.
05:27No.
05:28No.
05:29So, it's all a bit all over the place.
05:31It's got a temperature so it'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.
05:38It'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 condition.
05:57Marjorie.
05:58She's been called for her bloods but it's not being done so can you get somebody to do her bloods 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.
06:15OK.
06:16You can come onto a shift on a morning and all of a sudden it's like the bus has been dropped off outside.
06:22We could get 15, 20 patients in booking within an hour.
06:31One of those patients being blue lighted in is 71-year-old Christine.
06:40Oh, shit.
06:41Her head is bleeding badly after a fall.
06:46You sit.
06:50Sister Vicky assesses her injuries.
06:52Hi, Christine.
06:53I'm Vicky.
06:54Nice to meet you.
06:55So what's been happening with you?
06:56What have you been doing?
06:57I fell out of my sister's door.
07:00So you've come out of your sister's and you've stepped down and you've lost your foot in and then you've gone face-face like that.
07:07Yeah.
07:08Yeah.
07:09Did you black out?
07:10No.
07:11I remember everything.
07:12Yeah?
07:13Right.
07:14Just look straight forward at my nose.
07:15I'm just going to try on this torch.
07:16Oh, yeah, yeah.
07:17Nice to meet you.
07:18Perfect.
07:19I'm just going to have a chat with the ambulance crew.
07:20OK.
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.
07:27Lost her footing.
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 confused and managed to stop it just.
07:36Yeah.
07:37Yeah.
07:38No other injuries that I can see.
07:40The left eye, very bloodshot.
07:42My name's John.
07:43Hello.
07:44Hello.
07:45Any pain in your neck when I squeeze?
07:46I 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 at that paramedic for me?
07:55Cool.
07:56Can 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.
08:03All right.
08:04Oh, you're dripping.
08:06Our consultant went in and had a little look.
08:09She's on blood thinners, so obviously she needs a CT scan.
08:15So we're going to get your CT scan done.
08:18All right.
08:19And then every so often, every half an hour, somebody will have to come in.
08:22You'll probably get fed up on her, but they're going to have to do your blood pressure and stuff.
08:26OK.
08:27You just need to make sure that there's no pressure that's building up in your head.
08:31All right.
08:32Yeah?
08:33Yeah.
08:34Because she's on blood thinners, a scan is needed to check if Christine has had a bleed on the brain.
08:39Untreated, it can be life-threatening.
08:42It's just rammed at the minute.
08:55I'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.
09:07I'm just getting hammered at the minute.
09:10The patients keep arriving.
09:13Are you going to cheer me up, Antonia?
09:15No?
09:16I'm not.
09:17I'm not.
09:18But there are not enough spare beds on the wards to move them on.
09:22Thirty-seven is practically full.
09:25And that's our winter ward.
09:27And it's full.
09:29Yeah.
09:30If there's no beds within the trust or in areas that we need them, then that's when we
09:36become stuck.
09:38One 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.
09:55I'm about to look him up on the GP records to see if he's got anything else going on.
10:02Because he told me you hadn't had a heart attack any of us.
10:09I'm going to give you some antibiotics for your chest.
10:12The question is why is your tummy bad?
10:15How 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? Same time? Same amount of time?
10:23Fine.
10:24And again, your bowels are all right at the moment?
10:25Yeah.
10:26Not suddenly loose?
10:27No.
10:28Not suddenly constipated?
10:29No.
10:30Yeah, 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.
10:42I'm not going to stop fiddling with you in a second, all right?
10:45I am attempting to have a look and see if there's any fluid where there shouldn't be fluid.
10:55Do you want to spit something out?
10:59You could be surprised by how much you can tell from someone's phlegm or from what they've coughed up.
11:10Yeah.
11:11Delicious.
11:12Is that what's been coming up?
11:13Yeah.
11:14I don't like it.
11:15And sometimes it's green, isn't it?
11:16Mmm.
11:17Cool.
11:18Still thinking it's a chest infection, I'm afraid, with that.
11:19That's gorgeous.
11:20You can tell, you know, if there's blood in there, if there's green-looking stuff, if it's bacterial, or importantly, if something more serious is going on.
11:35Dr. Shepherd needs to get a second opinion from a consultant.
11:40So you said some comoxin clarithromycin.
11:43Would you just give him the STAT-TAS as well, or next day's TAS?
11:46Thomas is prescribed antibiotics, but if they can't find the cause of his pain, he will need to be admitted for further tests.
11:59If a bed can be found.
12:02Surgery have got no beds, orthopedic have got two, gynae have got none.
12:09Sister Jane briefs the team on the state of play.
12:12So 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 well.
12:29And just keeping them informed of the floor of the department.
12:33So, yeah, fingers crossed it shouldn't be too much longer now, and we'll get you sorted.
12:36Oh, thank you.
12:37All right, love, thank you.
12:43Just arrived in majors.
12:45Is it Dean? Yeah.
12:46Hiya, Dean, I'm Chantel. Are you dozing off?
12:48I am, yeah. Sorry.
12:50Advanced Clinical Practitioner Chantel's next patient, Dean, is back in hospital after a holiday nightmare eight months ago.
12:58I've just been reading all about your eventful Benidone trip.
13:02I got a bit on foot with him, was he?
13:04The mosquito.
13:05I had a little spot on me foot.
13:06You know, a proper yellow-headed spot.
13:08I knew I didn't feel no more about it.
13:10Yeah.
13:11When I got off at play, my leg had just...
13:12Ballooned.
13:13Ballooned.
13:14Yeah.
13:15The doctor's dad picked us up, he said I would take him straight to hospital.
13:17We straight in resus?
13:18Straight in resus.
13:19Then we had an hour, our operating table.
13:21Yeah.
13:22She said, you have an 8% chance you can hold your leg.
13:24Yeah, it does.
13:25You can't...
13:26Well, there's no guarantees you can survive off of this.
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 in a mosquito bite,
13:42created this really bad bacterial infection.
13:45And if prompt surgical interventions not acted upon immediately, the patient can die.
13:51Dean had necrotising fasciitis, a flesh-eating infection that required skin grafts.
13:59For about three weeks, I'd be wetting up at middle at night, at three, four o'clock.
14:04My leg's bent 90.
14:05Mm-hm.
14:06I can't move my leg.
14:07You can't get your leg straight again?
14:08No.
14:09But then this morning, it was my ankle.
14:12And my foot was solid.
14:14Let's have a look.
14:16Right.
14:17So, where was the little spot on your leg?
14:20Just round here initially?
14:22No, smack it middle up.
14:23On there?
14:24Yeah.
14:25And then it spread up here?
14:26Yeah.
14:27And 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.
14:34I go in the weeds now in general.
14:36And is this from healing still?
14:37Yeah, 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?
14:44Yeah, they took it from the top of this thigh and back of this thigh.
14:48My main concern when I looked at Dean's leg was,
14:51has 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,
14:59that's when it becomes a problem.
15:01Tell me about your ankle again.
15:03Well, this morning, it took me an hour to go to bed.
15:05It was a lot of solid.
15:07When I put a new weight on it, it's really painful.
15:10And is this new?
15:11Yeah.
15:12From yesterday?
15:13From yesterday, yeah.
15:14Does it feel normal?
15:15Or does it feel hot and throbby?
15:16No.
15:17It feels normal.
15:18But when you're moving that bit, then that...
15:20OK.
15:21But your skin's not painful?
15:22No.
15:23And that's...
15:24I've got a lot of sensation down there.
15:25That's fine.
15:26OK.
15:27Right.
15:28Can you point your foot for me?
15:30Point your foot.
15:31You can't do it, can you?
15:33No.
15:34Right, I'm going to try and do it for you.
15:36OK.
15:37So, 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.
15:50So, he could have cellulitis, so a bacterial skin infection, which I need to cover and treat.
15:56Is that painful?
15:57I feel a bone.
15:58That would crack it.
15:59Yeah.
16:00But he's also got a very painful, hot ankle.
16:03That's not moving quite well.
16:05I could feel that as well.
16:06Mm.
16:07So, I need an orthopaedic review.
16:09Does that hurt when I move it like that?
16:11Yeah.
16:12That's tender.
16:13Really?
16:14Not...
16:16Let's get an X-ray of this.
16:19Have you got a cannula in?
16:20Yeah.
16:21I'll have a look at your blood test as well.
16:23OK.
16:24It's Dean's 61st birthday today.
16:27He hadn't planned to celebrate it in casualty.
16:30My daughters are coming home from Leeds.
16:32I know we're taking them out for a meal somewhere.
16:33Oh!
16:34So, I didn't know where we were going, but...
16:35We never know.
16:36We might still be able to be there.
16:37Well, it's if I can get anywhere, innit?
16:39Yeah.
16:40Right, let me get you sorted, Dean.
16:42All right, please.
16:43What time's your birthday, Emil?
16:44I don't know.
16:45How long have I got?
16:46They were aiming to be back at Dayton for 20 past four.
16:49Right, OK.
16:50If the X-ray reveals a new infection, Dean will have to spend the rest of his birthday on a
16:56ward.
16:57One patient's sister, Vicky, is keeping a watchful eye on, is Christine.
17:09Just try to shuffle a bit more.
17:11Just keep your head nice and still for the skin.
17:14If your eyes close all the time, you 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 you.
17:22All right.
17:23The worst case scenario would probably be a bleed on the brain, because obviously
17:28due to her blood thinners and things like that, hence why she's having the scum.
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.
18:05If Christine has a bleed on the brain, she'll need emergency surgery.
18:10Five hours into the shift.
18:15There's no cubicles, and that's what I need.
18:19And sister Jane has to make space for emergencies.
18:22Ask him, Salim, have you done with your patients in cubicle 15?
18:26She can go to surgical aspect, yeah.
18:29To keep the department open for new patients.
18:32Should we move her out and then I can move some ambulances across?
18:35I think when you are the sister in charge, it does fall on your shoulders because you're
18:40responsible for the running of the department, so it is your responsibility to get those patients
18:45out.
18:46Right, William, we're just moving your sweetheart into another cubicle, all right, my love?
18:51A cubicle is freed up just in time.
18:58The patient's being rushed in by ambulance after collapsing on the street.
19:02I'm just going to heal your head a bit of a clean.
19:07They got there within about three minutes.
19:10He was in his stop-season and he was just confused.
19:1362-year-old Christopher has epilepsy.
19:16He'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 his head.
19:28So I had a seizure today, coming back from town.
19:35I normally know when I'm going to have one, but this time I didn't.
19:44He'll be examined by Dr Charlotte Foster.
19:47Hello, 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.
19:59Did anybody see you, the seizure?
20:00Yeah, the passerby saw me on the floor.
20:03Did you get any symptoms before you went?
20:05Any dizziness?
20:06No, no.
20:07Have 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 okay.
20:19Yeah.
20:22He 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.
20:29Because Christopher's seizure didn't follow its normal pattern, Dr. Foster decides to get a second opinion from a consultant.
20:41He had no receiving symptoms at all, which normally he does when he has seizures.
20:44That's the 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 seizures.
20:49He hasn't had seizures in the last two years.
20:51He came round for about five minutes or so, so I was just a bit worried that it doesn't sound like his normal seizures.
20:57Implying the standard for pressure needs one of them and an ECG.
21:01I think you're right to make sure it's not anything like a cardiac therapy or anything like 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 not 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 if 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 right.
21:28Oh, right.
21:29Yeah, I think given that you've kind of had this episode of kind of collapsing.
21:34Yeah.
21:35We just want to make sure that it's not because of your heart really and not a seizure.
21:40Oh, no.
21:41We're not expecting all these tests.
21:53Not 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 his collapse.
22:03An X-ray will look for infection, whilst blood tests check for signs of a heart attack.
22:08PHONE RINGS
22:20Paul, can you do me a favour? I've got loads to get out to AMU now because they've pulled them all.
22:25Hospital beds are starting to free up for patients waiting in casualty.
22:29Louise, Paul's getting some patients ready for the ward. Can you just help him out, love, please?
22:36But it's given Sister Jane a new problem.
22:39And then can you get her up to EPAU for me, Paul, or get a porter to take her up?
22:43You don't particularly need to go up yourself.
22:46Finding staff to help that are not tied up with patients.
22:50A lot in waiting room, and I know I've just heard Jane say that there's five members of staff now down there,
22:56trying to get through it and triage as fast as they can.
22:59All hands on deck, yeah.
23:06My name's Shella, this is Beth, and we'll be taking your X-ray.
23:09One of those needing close monitoring is Christopher.
23:15Hold. 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.
23:39One of the blood tests that we added on was looking at damage to the heart,
23:44and that has actually 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,
23:53second drop, 194.
23:55Did you... and you said you treated them for these, yeah?
23:58Yeah.
23:59I don't know. I've done a D-dimer as well.
24:03Third 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.
24:18He 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,
24:27so it looks like there's some damage going on.
24:30So it looks like you might be having what we call an endstemi, so it's a heart attack.
24:36For 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?
24:43Yes.
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.
24:57You'll carry on his treatment here, and then we'll head up to the wards as of when there's a bed,
25:01up to the medical unit for more treatment and monitoring.
25:05Thankfully, further tests ruled out a heart attack
25:08and confirmed Christopher's seizure was caused by his epilepsy.
25:13He's now back home and recovering well.
25:19That's what she just ended over into, yeah.
25:22It's almost lunchtime in the hub, but Sister Vicky...
25:25Is it cubical?
25:27Yeah.
25:28And then one down in Lamp.
25:30..and Sister Jane are struggling to clear the backlog.
25:34I've said you literally help them, because there's two qualified nurses round there,
25:39and you come back.
25:40She needs to be able to scan with HDC1.
25:43Right, I'll get Louise to go.
25:45We've all got his own way of coordinating the department.
25:49Myself, I just like to go with the flow, make sure everybody's happy,
25:52make sure I help and assist where I can.
25:55Did you take that one from Lamp 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,
26:13and I like them to have respect for me,
26:16so there's no point shouting and moaning.
26:19I think you just have to have an element of assertiveness.
26:22In radiology, Dean is having an urgent X-ray.
26:35Are you able to just roll your ankle this way for me?
26:39Can you roll that way any more?
26:41He needed life-saving surgery after a mosquito bite led to a dangerous skin infection.
26:48How comfortable do you feel about rolling once you're on the left hand side?
26:51Not a lot.
26:52No, not a lot.
26:53Now his ankle is painful, which could be a sign of a new infection.
26:58Orthopaedic doctor Nida Ahmed reviews his X-ray.
27:10Can you just go through what's happening?
27:12When I got up this morning, I couldn't hold you to tell me.
27:15I managed to get it going, but it's something that's 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.
27:23Try to push against my hand?
27:25No, I can't push.
27:27And is that because of the pain?
27:29Oh, yeah, yeah.
27:30So, this bit?
27:32It's all I do, though.
27:33I'm dead, though.
27:36OK, that's fine.
27:37It seems to be more in your joint than the lower bit itself.
27:41So it's not around your heat.
27:42Yeah.
27:43Give me two minutes.
27:48I knew it wasn't right when I woke up this morning.
27:50I feel more confident.
27:51And I know there is something wrong with me.
27:53Because you're always worried that you're just being petty, aren't you?
27:58Dr. Ahmed suspects cellulitis, an infection in the deep tissue of Dean's ankle.
28:05Cellulitis, then?
28:06Yeah.
28:07It's just an infection of the skin.
28:09Just because there's nothing that's seen on the X-ray, your bone looks OK.
28:14Yeah.
28:15That should be OK.
28:16We'll bring you in and start you on some antibiotics.
28:18All right.
28:19Any questions?
28:20No.
28:21No.
28:22I'm keeping me overnight on bad antibiotics.
28:25It took five weeks for that.
28:28I hope it's not as long this time.
28:31Proper birthday present, innit?
28:34Dean had to spend eight days in hospital.
28:37He's now back home and looking forward to a belated birthday bash.
28:42In recess, Thomas is responding well to his antibiotics.
28:49Sister Rachel checks up on him.
28:52So, how are you feeling, first and foremost?
28:55Not better than I was.
28:56OK.
28:57Have you got any pain anywhere, Thomas?
28:58No.
28:59I did that this morning, but...
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 have some time now.
29:11Your son's in hospital?
29:12Yeah.
29:13It's my...
29:14She's had another grandson.
29:15Oh, congrats!
29:16That's nice, isn't it?
29:17Has he been born already?
29:18Yeah.
29:19Oh, congratulations.
29:20She said he had to operate over.
29:21Is everyone up there?
29:22Yeah.
29:23How many grandchildren have you got?
29:24All together?
29:25Yeah.
29:26All together?
29:27Yeah.
29:28All together?
29:29Yeah.
29:30All together.
29:3117.
29:3217?
29:3317 and 18.
29:34All together.
29:3518?
29:36Oh, my...
29:37Giddy-an.
29:38I bet your house is busy at Christmas.
29:39Why?
29:40Blood tests have confirmed that Thomas has a chest infection, which needs further investigation.
29:49Dr. Shepherd suspects it also causes his stomach pains.
29:53It's nice and soft now, isn't it?
29:54Yeah.
29:55Cool.
29:56Your blood tests that look at stuff in your tummy...
29:58Yeah.
29:59...are largely fine.
30:00You're a bit dehydrated, but nothing else particularly.
30:02So, I think it's all just your chest, because your inflammatory infection markers are quite high.
30:07So, we'll continue to target treating your chest and get you up to the medical team, all right?
30:11Yeah.
30:12Cool.
30:14No worries.
30:15His 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, but didn't need to.
30:28So, he's now well enough to go to the ward, which is what I'm listening to.
30:31Tom, I'm going to leave you to it. Your bed's ready upstairs.
30:34All right.
30:35Thank you, Lord.
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.
30:44I hope you get to see your new grandson soon, all right?
30:45Yeah.
30:46All the best.
30:47All the best, man.
30:48Do you take all these wires off me?
30:51Yeah.
30:52I'm going to come and take him on for the sec.
30:54I'll just make sure the porter's coming.
30:56That'll look like a...
30:57a metal Mickey or something.
30:58A metal Mickey or something.
30:59Yeah.
31:00That's enough, then.
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.
31:19In the hub...
31:20Great, my love.
31:21Thank you very much, sir.
31:22See you later, love.
31:25Great, my love.
31:26Thank you very much, sir.
31:27See you later, love.
31:29Sister Vicky and Sister Jane...
31:31Louise, would 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 washes.
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.
32:02She's the duo.
32:04And new patients are still arriving.
32:08In paediatrics, 12-year-old Nevaeh's hurt her hand at a majorette dance troupe practice.
32:16She's come in 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.
32:37So what's happened?
32:43I did, like, a walk-over, and I landed on my hand and went over it.
32:48Oh.
32:49And so when you landed, have you, like, put your hands down like that, or on to the side of it, or...?
32:53You remember?
32:54And then you've got to, like, put your hands flat.
32:55OK.
32:56What's the thing you like when you've gone down like that?
32:57She rolls when she does it, and she kind of goes sideways, right?
33:02She hadn't quite mastered the whole thing yet.
33:04OK.
33:05That's fine.
33:06Let's have a look, then.
33:07Any wiggly fingers for me?
33:08OK.
33:09Can you make a fist?
33:10I'll find a fist you can get.
33:11That's OK.
33:12You saw around your knuckle a bit?
33:13It hurts her.
33:14It hurts there.
33:15And then it's coming down here?
33:16It hurts.
33:17So she chipped her bone off her foot, and then she's broke her nose with her baton as well
33:22a few weeks ago, so she's prone to accidents.
33:27It'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, you send them for the X-ray, and they've got a really nasty fracture.
33:56And they're just quite happy with it.
33:58They're not bothered.
33:59Turn right and there's your head longer, you'll see X-ray, so it's on your left-hand side.
34:02When you come back, just press that doorbell, we'll come and get you back in.
34:06We'll see you back shortly.
34:07If 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.
34:25Just looking at the damage.
34:28It's lovely, isn't it?
34:30And the jumper's going to have to be thrown away by it, look, isn't it?
34:34Sister Susan is there for moral support.
34:38Me and her, we've sent to stick together.
34:41We've had this moment, but we're there for each other and all.
34:46Dr 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, we can sort
34:59of tick that off as a worry.
35:01So that's good news.
35:02You want some more cleaning?
35:03Aye.
35:04I just wish it had stopped bleeding.
35:05But Christine's open wound still needs closing.
35:06My name's Nick.
35:07I'm one of the emergency doctors.
35:08The good news is, is that there's not any bleeding inside the head, which is great.
35:09Can I have a little look under here?
35:10Sorry, I'm catching your hair.
35:11Sorry.
35:12I'm sorry.
35:13I'm sorry.
35:14Oh, bless you.
35:15Okay.
35:16I suspect looking at that, I'm not going to be a little bit more so-
35:38that might need some stitches if I'm honest there's a clot in it at the moment that we'd need to
35:43remove to help it heal basically now I think what we need to do to start with
35:50is probably get a bed in here so I can sort of have you laying down so I can have a really
35:55good look at it and give it a good clean is sort of the first and most important thing
36:08you've got to laugh at it all otherwise you just sit there and cry she's laughing now
36:15but Christine will need stitches to close her head wound it's nearing the end of the
36:32shift for sister Vicky and sister Jane you've worked hard today I love on your little team
36:40pervert me crossed where are you where's she right well you can tell us I said no I wanted to come
36:51back and do some work I've been a nurse for a long long time and I've said numerous times you cannot
36:58buy experience you just you can't let me go get you a pillow or another blanket for this leg so
37:05it don't fall down how's that sound we are all problem fixers some are very good at working on
37:12a team and delivering you know a good standard of nursing care she can go in a chair car she and
37:17then I can get this patient in and then others are very good at being in charge steering the ship if
37:22you like and I think you know we all have different flares for different things and I think once
37:27you put all that together it is a well-engineered team in radiology majorette Nevaeh is hoping she's
37:40not broken any bones after a tricky move at dance practice went wrong yeah
37:50what have you done it will like a walk over and on I went over with my hand Nevaeh came to casualty with
38:01mum Amy she plays football as well so you think she'd get more injuries from football than dance but
38:09we're going to do x-rays of your hand and finger so if just pop it down nice and flattened to there
38:13she scored her first goal last week but she'll put it in her own head
38:17so I'll send those x-rays across to Amy if you just want to make a way back round there no you've had your x-rays
38:27emergency nurse practitioner Tony assesses the injury she was more painful down this side of her
38:39of her hand and into her little finger no obvious cracks or breaks or anything there
38:45so I think that's we bruised rather than anything else bones in children tend to bend more than they'll
38:53break whereas in the same injury for an older person they would likely get a more significant
38:58break to the wrist I needed potting and sometimes even surgery can't see anything broke so I think
39:04you might just rolled it a little bit and you just just caused a bit of bruise keep it moving
39:07paracetamolibopropin absolutely things like that's absolutely fine brilliant yeah yeah be fine thank
39:13you it's the best outcome for Nevaeh at least you can dance on Saturday now but
39:23she'll be watching how she lands those tricky moves a bit more carefully from now on
39:34in majors dr. allcroft is preparing to stitch the open wound on Christine's forehead you want me to
39:43keep it lay down what I want you to do is just be basically relaxing as much as possible best case
39:50scenario would have been the fall had done no injury there'd be no injury to the head and everything was
39:55absolutely perfectly fine I'm gonna 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 gonna be able to be managed
40:05without sort of hopefully any need for surgical invention or causing sort of longer-term more
40:11serious damage it's stinging sorry it's just to make sure when we put it in it's okay oh bless you
40:22I'm sorry it's really so around that I know it's I think where it's grazed and unfortunate isn't I'll do it quick oh I will be glad when I get home
40:31just gonna do a little injection above your eyebrow
40:39unfortunately the local anesthetic can sting a little bit in itself a little massage
40:48I'm used to injections I used to inject myself four times oh did you know and first for now I've got
40:56diabetes bless you let's do a little one this way as well I have my nose pierced and all 71 and I
41:07thought I've always wanted to have my eyebrow done in my nose so I had my nose done at Skeggy and my
41:15eyebrow done in Barnsley okay full works basically yep well just one last injection and hopefully everything
41:23will be nice and then okay could you not just put me to sleep no you can see we've got a fairly big
41:33clot in there that will need to take out you've got a big clot outside and all
41:38yeah that's what we wanted is it too big for butterfly stitches yeah I think unfortunately you've got
41:59longlipops for after I'm sure we can fix you some up I'll raid our special sweet treats oh you are
42:05kind so I need you to keep your head really still because if the head moves as I go along it's going
42:10tricky to be tricky to get
42:23so I think we're all done yeah give me a little sort of wiggle up your face raise your eyebrows for me
42:34well done there you were awesome thank you
42:37so that's I suppose always the best case scenario that we've not had anything serious and long term
42:45going on um that being said I think the worst case scenario would be if we'd found a big bleed on the
42:50head and that could have been very serious so thankfully we've not had that happen very certainly
42:58fingers hurt Christine's face is healing well she's watching out for the steps outside her sister's
43:07house whenever she visits I love things it's the end of the shift for sister Vicki and sister Jane look at
43:20you all right these round the little honeypot vultures as a nurse in charge of the department the more
43:28experience you get at doing it then the better you become at it bye Carol and I think to work here in
43:36this department where we are so gelled as a team it's incredibly important the end of day we're one big
43:47family here so we're all here for each other so easy when you quit job some shifts can be really grueling and
43:55you can walk off absolutely exhausted but I like to leave the shift happy and positive and know that
44:03everybody's done a good job and as the new shift arrives another team is ready to serve the people of
44:14barnesley 24 7
44:44you
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