- 4 months ago
Casualty 24/7 - Season 10 Episode 4
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Short filmTranscript
00:00Bouncy, 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 fries, 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.
00:42Strain 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 and hopefully everything will be nice and young, okay?
01:25Could you not just put me to sleep?
01:28And, Sister Vicky and Sister Jane.
01:31You've worked hard today, Vic.
01:33I am.
01:34How's your love?
01:35So.
01:36Sorry, I'm catching your hair.
01:38I'm sorry.
01:39Get ready to share a shift.
01:41Does 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 going to 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?
02:23I don't know.
02:24Louise has just come to me and said, has he gone?
02:25I said, I don't think so.
02:26And more patients are arriving.
02:29Hi, 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 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 in.
02:49Thanks very much.
03:01Seventy-year-old retired painter and decorator, Thomas, is struggling to breathe.
03:08Take this one from your waist.
03:11He's had pains in his chest and stomach since returning from holiday in Tunisia two weeks ago.
03:18You know?
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?
03:34Well, we landed in Manchester.
03:35Okay, fine.
03:36And 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, 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.
03:56Why 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, what was worse?
04:02Pain in your tummy.
04:03Pain, okay.
04:04Pain in your tummy?
04:05Yeah.
04:06Fine.
04:07Can't breathe.
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.
04:35I go to a pouch of vodka a week.
04:37Okay.
04:38Cool.
04:39Stop smoking.
04:40It's bad for you.
04:41I am.
04:42Do you drink alcohol?
04:43Okay.
04:44Do you drink alcohol?
04:46Yeah.
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.
04:53Patients 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.
05:06His smoking and alcohol intake will make his immune system less able to fight off infection.
05:13Yeah.
05:14Okay.
05:15Have you had any surgery on your tummy at any point?
05:18Not really mate.
05:19What do you call it?
05:20Appendix?
05:21Yeah.
05:22I can't tell you to appendix.
05:23Fine.
05:24Any 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.
06:09Oh, 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.
06:28One of those patients being blue lighted in is 71-year-old Christine.
06:40Her head is bleeding badly after a fall.
06:45Sister Vicky assesses her injuries.
06:46Hi Christine, I'm Vicky.
06:47Nice to meet you.
06:48So what's been happening with you?
06:49What have you been doing?
06:50I fell out of my sisters.
06:51Oh.
06:52So you've come out of your sisters and you've stepped down and you've lost your foot in and
06:57then you've gone face-face like that.
06:58Yeah.
06:59Yeah.
07:00Did you black out?
07:01No.
07:02I remember everything.
07:03Yeah?
07:04Right, just look straight forward at my nose.
07:05I'm just going to shine this torch.
07:06Oh, all right.
07:07All right.
07:08Perfect.
07:09I'm just going to have a chat with Angela's crew.
07:10Okay.
07:11And then I'll come back and see you.
07:12Yeah.
07:13She's come home from dropping her sister after half past the tilt.
07:14Been going up the step.
07:15Lost her footing.
07:16Slipped down one step.
07:17Landed onto her knees and then onto the left side of her face.
07:19Yeah.
07:20She's been bleeding quite quickly so I've managed to stop it just.
07:22Yeah.
07:23No other injuries that I can see.
07:24Left eye and very bloodshot.
07:25My name's John.
07:26Hello.
07:27Hello.
07:28Any pain in your neck when I squeeze?
07:29I have pain in my neck and down my spine because I've got osteoporosis.
07:32Is it worse than normal?
07:33Not really.
07:34Not really.
07:35No, no.
07:36No.
07:37No.
07:38No.
07:39No.
07:40No.
07:41No.
07:42No.
07:43No.
07:44No.
07:45No.
07:46No.
07:47No.
07:48No.
07:49No.
07:50No.
07:51No.
07:52No.
07:53No.
07:54Can you look over there at that paramedic for me?
07:55Cool.
07:56Can you look over there at that door for me?
07:57Can 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.
08:05Our consultant went in and had a little look.
08:09She's on blood thinners so obviously she needs a CT scan.
08:14So we're going to get your CT head scan done.
08:18Alright.
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 okay.
08:26Yeah.
08:27Because you 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 on the brain.
08:40It's just rammed at the minute. I've got three nurses in there.
08:55Three hours into the shift and pressure is mounting in the hub.
08:58Oh, we've got 91 patients in the department.
09:02Just looks like waiting room, just getting hammered at the minute.
09:06The patients keep arriving.
09:07Are you going to cheer me up, Antonia? No?
09:08I'm not.
09:09But there are not enough spare beds on the wards to move them on.
09:2137 is practically full.
09:25And that's our winter ward.
09:27And it's full.
09:28Yeah.
09:29If there's no beds within the trust or in the areas that we need them, then that's when we become stuck.
09:36One 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 you told me you hadn't had a heart sack, can you have?
10:05Yes.
10:10I'm going to give you some anti-wescents 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.
10:32Yeah, 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.
10:54Do you want to spit something out?
11:04You could be surprised by how much you can tell from someone's phlegm or from what they've coughed up.
11:09Delicious.
11:10Is that what's been coming up?
11:11Yeah.
11:12What's mine?
11:13Sometimes it's green, isn't it?
11:14Mmm.
11:15Cool.
11:16Still thinking it's a cestine infection, I'm afraid, with that.
11:17That's gorgeous.
11:18You 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.
11:33Dr Shepard 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?
11:48Thomas is prescribed antibiotics, but if they can't find the cause of his pain, he will need to be admitted for further tests.
11:56If a bed can be found.
12:03Surgery have got no beds, orthopedic have got two, gynae have got none.
12:09Sister Jane briefs the team on the state of play.
12:13So it's just going to be slow, medicine-wise.
12:17137 is full.
12:19Our, yeah, our winter ward is full.
12:24It's all about keeping the staff and patients safe, and the department running safely, as well.
12:30And just keeping them informed of the flow of the department.
12:34So, yeah, fingers crossed, it shouldn't be too much longer now, and we'll get you sorted.
12:37Oh, thank you.
12:38All 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've got a bit on foot with a mozzie, a mosquito.
13:05I had a little spot on me foot.
13:07You know, a proper yellow-headed spot.
13:09I knew I didn't feel no more about it.
13:10Yeah.
13:11When I got off at play, me and my leg had just...
13:12Ballooned.
13:13Ballooned.
13:14Yeah.
13:15The taxi driver picked us up, she said I would take you straight to the hospital.
13:17We were straight underneath us?
13:18Straight underneath us.
13:19Yeah.
13:20And then we had an hour, our operating table.
13:22Yeah.
13:23She said, you've been 80% chance you're going to lose your leg.
13:25Yeah, it does.
13:26You can't, well, there's no guarantees you're going to 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
13:42bite, 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.
14:03At 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?
14:09No.
14:10But then this morning, it was my ankle.
14:12And my foot was solid.
14:15Let's have a look.
14:17Right.
14:18So, where was the little spot on your leg?
14:21Just 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 being like that.
14:34I'm going to eat snow in general.
14:36And is this from healing still?
14:37Yeah.
14:38Yeah, it's still healing.
14:39Good.
14:40Where did they take the graft from?
14:41There.
14:42There.
14:43It'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?
14:55Some patients can just develop it.
14:57It can live on the skin.
14:58And when it breaks into the skin, that's when it becomes a problem.
15:02Tell me about your ankle again.
15:03Well, this morning, he took me an hour to go out to bed.
15:06It's a lot of solid.
15:08When 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.
15:14Okay.
15:15Does it feel normal?
15:16Or does it feel hot and throbby?
15:17No.
15:18It feels normal, but like that, when you move me that a bit, then that hurts.
15:20Okay.
15:21But your skin's not painful?
15:22No.
15:23And that's...
15:24I've got lots of ostentation down there.
15:25That's fine.
15:26Okay.
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, and we'll try and do it for you.
15:37No.
15:38It's not going, is it?
15:40So, Dean's proven to be quite a tricky patient to treat in A&E, because he's got multiple
15:45things going 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.
16:09Does 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 test as well.
16:19Okay.
16:20It's Dean's 61st birthday today.
16:23He hadn't planned to celebrate it in casualty.
16:26My daughters are coming over from Leeds.
16:27I know we're taking me 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.
16:34All right, please.
16:35What time's your birthday meal?
16:36I don't know.
16:37How long have I got?
16:38They were aiming to be back at Dalton for 20 past four.
16:39Right, okay.
16:40If the x-ray reveals a new infection, Dean will have to spend the rest of his
16:55birthday on a ward.
17:02One patient's sister Vicky is keeping a watchful eye on is Christine.
17:08Just try to shuffle a bit more.
17:11Just keep your head nice and still for the skull.
17:14Keep your eyes closed so you can feel a little 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.
17:24The worst case scenario would probably be a bleed on the brain because obviously due to her
17:31blood thinners and things like that.
17:33Hence why she's having the scan.
17:35The hospital staff has been lovely.
17:36They've not been able to do enough for us.
17:37Dr Orcroft checks the scan.
17:42If Christine has a bleed on the brain, she'll need emergency surgery.
17:49Five hours into the shift.
17:50There's no cubicles.
17:51And that's what I need.
17:56And that's what I need.
17:57And sister Jane has to make space for emergencies.
18:03Asin, Salim, have you done with your patients in cubicle 15?
18:04Yes, you can go to surgical plastic.
18:05Yeah.
18:06To keep the department open for new patients.
18:08Should we move her out and then I can move some ambulances across?
18:09Yeah.
18:10I think when you are the sister in charge, it doesn't work.
18:11It doesn't work.
18:12It doesn't work.
18:13It doesn't work.
18:14It doesn't work.
18:15It doesn't work.
18:16It doesn't work.
18:17It doesn't work.
18:18It doesn't work.
18:19It doesn't work.
18:20It doesn't work.
18:21It doesn't work.
18:22It doesn't work.
18:23And sister Jane has to make space for emergencies.
18:24Asin, Salim, have you done with your patients in cubicle 15?
18:27She can go to surgical plastic, yeah.
18:29To keep the department open for new patients.
18:32Should we move her out and then I can move some ambulances across?
18:35Yeah.
18:36I think when you are the sister in charge, it does fall on your shoulders
18:39because you're responsible for the running of the department.
18:42So it is your responsibility to get those patients out.
18:46Right, William, we're just moving your sweetheart into another cubicle,
18:50all right, my love?
18:51A cubicle is freed up just in time.
18:58A patient's being rushed in by ambulance after collapsing on the street.
19:05I'm just going to heal your head a bit of a clean.
19:08They got there within about three minutes.
19:10We've been in stop season and they were just confused and stiff.
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
19:27to the top of the back of his head.
19:29It's interesting about it, mate, all right?
19:31Yeah.
19:32So I had a seizure today, coming back from town.
19:36Yeah, okay.
19:37Did anybody see you, the seizure?
19:38Yeah, the passerby saw me up floor.
19:39Did you get any symptoms before you went?
19:40Any dizziness?
19:41No, no.
19:42Have you always had symptoms before you have these seizures?
19:43Yeah.
19:44Yeah.
19:45Yeah.
19:46Yeah.
19:47Yeah, okay.
19:48And this is the first one you've not had any?
19:49Yeah.
19:50Yeah, okay.
19:51I'm just going to keep an eye out for your bloods.
19:52I'll come back shortly and just let you know whether we need to do anything else, if that's
19:55okay.
19:56Yeah.
19:57Yeah.
19:58And then he normally got symptoms before a seizure, and this time he hasn't.
20:02So, kind of just a bit slow to know you were talking about the pain that I had to take
20:04you to go and you'd like to go with a bit of pain, a bit of pain.
20:05So, you know, this is the first patient to get a bit of pain.
20:06Yeah.
20:07No, no.
20:08Yeah, no.
20:09So, did anybody see you, the seizure?
20:10I'm sitting there, the passerby saw me on floor.
20:11Did you get any symptoms before you went?
20:12No, no.
20:13Have you always had symptoms before you have these seizures?
20:14Yeah.
20:15Yeah.
20:16And this is the first one you've not had any?
20:17Yeah, yeah.
20:18Yeah, okay.
20:19I'm just going to keep an eye out for your bloods.
20:20He 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.
20:32Because Christopher's seizure didn't follow its normal pattern,
20:36Dr Foster decides to get a second opinion from a consultant.
20:41He had no preceding symptoms at all, which normally he does when he has seizures.
20:44That's the only thing that's worried me.
20:46He normally gets kind of dizziness, known to have epilepsia seizures.
20:49He hasn't had seizures 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.
20:57Applying the standard blood pressure.
20:59I've done that.
21:00Knees one of them and knee CG.
21:02I 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
21:12to make sure that's not kind of a cause of his kind of collapse.
21:16So this blood test will just be to look at your heart
21:20to see whether it's stable or if it's getting kind of more strain on it.
21:23And also to have a look at your blood clotting as well,
21:27just to make sure that's all all right.
21:29Yeah, I think given that you've kind of had this episode of kind of collapsing,
21:35we just want to make sure that it's not because of your heart really
21:38and not a seizure.
21:40Oh, no.
21:41What are you expecting?
21:50All these tests.
21:53Not that it's me after I walk out.
21:56With Christopher's symptoms appearing unusual,
21:59Dr. Foster needs to rule out of the causes of his 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?
22:22I've got loads to get out to AMU now because we've pulled them all.
22:26Hospital beds are starting to free up for patients waiting in casualty.
22:31Louise, Paul's getting some patients ready for the ward.
22:34Can you just help him out, love, please?
22:36But it's given sister Jane a new problem.
22:40And then can you get her up to EPAU for me, Paul,
22:43or get her ported to take her up?
22:44You don't particularly need to go up yourself.
22:47Finding 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
22:54that there's five members of staff now down there,
22:56trying to get through it and triage as fast as they can.
23:00All hands on deck, yeah.
23:01MUSIC PLAYS
23:03My name's Sheila, this is Beth.
23:08We'll be taking your X-ray.
23:09One of those needing close monitoring is Christopher.
23:15Hold.
23:17Breathe out.
23:19He has epilepsy,
23:20but his last seizure didn't follow the usual pattern.
23:23MUSIC PLAYS
23:25Dr. Foster is concerned that he might have had a heart attack,
23:30so she's carrying out further tests.
23:33The chest X-ray is cleared,
23:34so no signs of infection on the chest X-ray there.
23:39One of the blood tests that we added on
23:41was looking at damage to the heart,
23:44and that's actually come back quite raised,
23:47so it's come back at 134.
23:50Well, it didn't sound like his normal seizures,
23:52and his first drop was 134,
23:54second drop, 194.
23:55Did you...
23:56And you said you treated them for ACS?
23:59Yeah.
24:01I've done a D-dimer as well.
24:05It's sad.
24:06Drop, 194.
24:07So his drop's gone up.
24:09Rising levels of troponin in Christopher's blood
24:14are 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.
24:24The marker for your heart has come back raised
24:26from what it was before,
24:27so it looks like there's some damage going on.
24:31So it looks like you might be having what we call an endstemi,
24:35so it's a heart attack.
24:36For that, you'll just be kind of admitted to the medical ward
24:39just for some more monitoring.
24:41But 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
24:49without any chest pain.
24:51It's more common in women than it is in men,
24:54so it is a bit unusual.
24:58You'll carry on his treatment here,
24:59and then we'll head up to the wards
25:00as well as there's a bed up to the medical unit
25:03for more treatment and monitoring.
25:06Thankfully, further tests ruled out a heart attack.
25:09And confirmed Christopher's seizure
25:10was caused by his epilepsy.
25:14He's now back home and recovering well.
25:19That's what she just ended up over, isn't it? Yeah.
25:22It's almost lunchtime in the hub,
25:24but Sister Vicky...
25:26Is it cubicle?
25:27Yeah.
25:29And then one down in lamb.
25:31And Sister Jane are struggling to clear the backlog.
25:34Oh, God.
25:36I've said you literally help them
25:37because there's two qualified nurses round there
25:39and you come back.
25:40Talisa, we've got a scan with HDC1.
25:44Right, 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 flow,
25:51make sure everybody's happy,
25:53make sure I help and assist where I can.
25:57Did you take that one from Lamb up to AMU?
26:00So that one's gone.
26:02I think it takes a kind of person
26:05to be able to do the job.
26:08You 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.
26:20I think you just have to have an element of assertiveness.
26:27In radiology...
26:29I'm going to stop your x-ray.
26:32Dean is having an urgent x-ray.
26:34Are you able to just roll your ankle this way for me?
26:38Can you roll that way any more?
26:43He needed life-saving surgery
26:45after a mosquito bite led to a dangerous skin infection.
26:49How comfortable do you feel about rolling once you're left?
26:52Not a look.
26:52No, not a look.
26:54Now his ankle is painful,
26:56which could be a sign of a new infection.
27:06Orthopaedic Dr Nida Ahmed
27:07reviews his x-ray.
27:10Can you just go through what's happening?
27:12When I got up this morning,
27:13I couldn't hold you to tell me, like,
27:15I managed to get it going,
27:16but it's...
27:17It's always going to get worse, isn't it?
27:19OK.
27:20I can't bear to put any light on it at all.
27:22OK, fine.
27:24Is that a push against my hand?
27:26No, I can't push.
27:27And is that because of the pain?
27:29Oh, yeah.
27:30So, this bit?
27:31It's all I do, like, I'm dead, like.
27:34OK, that's fine.
27:37It seems to be more in your joint
27:39than the lower width it's up.
27:41So, it's not around your heat.
27:43Yeah.
27:43Give me two minutes.
27:44I knew it weren't right when I woke up this morning.
27:50I feel more confident.
27:51I know there is something wrong with me.
27:54You're always worried that you're just being petty, aren't you?
27:56Dr. Ahmed suspects cellulitis,
28:01an infection in the deep tissue of Dean's ankle.
28:05What's cellulitis, then?
28:07Yeah.
28:07It's just an infection of the skin.
28:09Just because there's nothing that's seen on the X-ray,
28:13the bone looks OK.
28:14Yeah.
28:14That should be OK.
28:16I'll bring you in and start you on some antibiotics.
28:18All right.
28:20Any questions?
28:21No.
28:22No.
28:23Keeping me overnight on antibiotics.
28:26It took five weeks for that.
28:29I hope it's not as long this time.
28:32Proper birthday present, innit?
28:35Dean had to spend eight days in hospital.
28:38He's now back home
28:39and looking forward to a belated birthday bash.
28:42In Rhesus,
28:48Thomas is responding well to his antibiotics.
28:51Sister Rachel checks up on him.
28:53So, how are you feeling, first and foremost?
28:55I'm not better than I was.
28:57OK.
28:57Have you got any pain anywhere, Thomas?
28:59No.
28:59Did I be small enough?
29:02Is it gone now?
29:03Yeah.
29:04Good.
29:05Thomas has discovered
29:06he's not the only family member in the hospital today.
29:10Ah, something new.
29:11Your son's in hospital?
29:12Yeah, his wife.
29:14She's had another grandson.
29:16Oh, congrats.
29:17That's nice.
29:18Has he been born already?
29:20Yeah.
29:20Oh, congratulations.
29:22She said he had to hopefully do it.
29:24Is everyone up there?
29:26Yeah.
29:27How many grandchildren have you got?
29:30All together?
29:31Yeah, all together.
29:3517.
29:3517?
29:3617 and 18, what are you doing?
29:3718?
29:38Oh, my giddy aunt.
29:39I bet your house is busy at Christmas.
29:41Why?
29:43Blood tests have confirmed
29:44that Thomas has a chest infection,
29:47which needs further investigation.
29:49Dr. Shepard suspects
29:51it also caused his stomach pains.
29:54It's nice and soft now, isn't it?
29:55Yeah.
29:55Cool.
29:55Your 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 high.
30:07So we'll continue to target treating your chest and get you up to the medical team, all right?
30:11Yeah.
30:11Cool.
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.
30:23If 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 to the ward, which is what I'm missing in.
30:31Tom, I'm going to leave you two.
30:33Your bed's ready upstairs.
30:34All right.
30:35Keep having a look at your chest.
30:36Yes.
30:37Hopefully you get better, and I hope you get to see your new grandson.
30:40I hope so.
30:40Son, daughter.
30:42Grandson or granddaughter?
30:43Grandson.
30:43Or grandson.
30:44I hope you get to see your new grandson soon, all right?
30:46All the best.
30:46All the best, man.
30:48Do you take all the wires off me?
30:51Yeah, I'm going to come and take them on for a sec.
30:54I'll just make sure the porter's coming.
30:55Yeah, I look like a metal Mickey.
30:58I'm going to make you watch it.
30:59Yeah, that's enough, then, doesn't it?
31:07No.
31:08Let's go.
31:09Further tests revealed Thomas had pneumonia,
31:12and 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, then.
31:27See you later.
31:28Sister 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,
31:53and then I'll get Paul to take you off for your dinner.
31:55We're the dynamic duo.
31:58We are.
32:01I'm the dynamic.
32:02She's the duo.
32:06And new patients are still arriving.
32:08In paediatrics, 12-year-old Nevaeh's hurt her hand
32:14at a majorette dance troupe practice.
32:17She's come in with mum, Amy.
32:19She'd done the walk-over,
32:21and then she started crying, like, through her next dance,
32:25and I was saying, oh, you'll be fine,
32:27but then she carried on complaining.
32:31Nevaeh?
32:32Yeah.
32:32She'll be seen by emergency nurse practitioner, Tony.
32:43So what's happened?
32:44I did, like, a walk-over,
32:46and I landed on my hand and went over it.
32:48OK.
32:48And so when you landed,
32:50have you, like, put your hands down like that,
32:51or onto the side of it, or...?
32:53You remember?
32:54You've got to, like, put your hands flat.
32:55OK.
32:56So what's the thing you like when you've gone down like that?
32:57She rolls when she does it,
32:59and she kind of goes sideways.
33:01Right, she hadn't quite mastered the whole thing, yeah.
33:04That's fine.
33:05Let's have a look, then.
33:06Can you wiggle your fingers for me?
33:07OK.
33:08Can you make a fist?
33:09How far into a fist can you get?
33:10That's OK.
33:12Saw around your knuckily bit.
33:14It hurts, huh?
33:15It hurts there.
33:16Then it's coming down here.
33:17It hurts.
33:18So she chipped her bone off her foot,
33:20and then she's broke her nose with her baton as well
33:23a few weeks ago.
33:24So she's prone to...
33:26..accident.
33:28It's very rewarding, working with children.
33:31You can very quickly fix things in children
33:35and make them better.
33:36Sometimes you can get a little crack on a bone
33:38and you can't always see,
33:39but we'll get an X-ray of it first,
33:41and we'll go from there.
33:42Some patients don't need anything doing.
33:44Sometimes it's just a bit of reassurance for parents
33:46that everything that they're doing is fine.
33:48They don't need to do anything else.
33:49You want to come this way?
33:50Sometimes you examine them,
33:52they've got a bit of pain in the wrist,
33:53you send them for the X-ray,
33:54and they've got a really nasty fracture,
33:56and they're just quite happy with it.
33:58They're not bothered.
34:00Turn right and it's headlong,
34:01you'll see X-rays,
34:01so it's only left-hand side.
34:03When you come back,
34:03just press that doorbell,
34:04we'll come and get you back in.
34:06See you back shortly.
34:06If the X-ray shows Nevaeh's injury is severe,
34:12her baton-twirling days could be over.
34:20In majors,
34:22Christine is waiting for the results of her head scan.
34:24Just 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?
34:35Sister Susan is there for moral support.
34:39Me and her, we've sent to stick together.
34:42We've had this moment.
34:43We're with you for each other and all.
34:45Dr. Allcroft reviews the scan.
34:52Thankfully, it doesn't show any bleeding inside the head,
34:54which is really good news.
34:56So if you're 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.
35:04Ow.
35:05So why do you want some more cleaning?
35:09Aye.
35:11I just wish it had stopped bleeding.
35:12But Christine's open wound still needs closing.
35:19My name's Nick.
35:20I'm one of the emergency doctors.
35:22The good news is,
35:23is that there's not any bleeding inside the head,
35:24which is great.
35:26Can I have a little look under here?
35:29Sorry, I'm catching your hair.
35:31I'm sorry.
35:32Oh, bless you.
35:34Okay.
35:36I suspect looking at that,
35:39that might need some stitches, if I'm honest.
35:41There's a clot in it at the moment,
35:43that we'd need to remove to help it heal, basically.
35:47Yeah.
35:47Now, I think what we need to do to start with,
35:50is probably get a bed in here,
35:53so I can sort of have you laying down,
35:55so I can have a really good look at it,
35:57and give it a good clean,
35:59is sort of the first and most important thing.
36:01Make it hurt.
36:02You've got to laugh at it all,
36:11otherwise you'd just sit there and cry.
36:14She's laughing now,
36:15but Christine will need stitches to close her head wound.
36:18It's nearing the end of the shift for Sister Vicky and Sister Jane.
36:35You've worked hard today.
36:38I am.
36:38How are you, love?
36:39Where are you?
36:40On your little team.
36:41Pervert me crossed.
36:46Where are you?
36:47Where's she?
36:48Right, well, you can tell her.
36:49She said no.
36:50I want her to come back and do some work.
36:53I've been a nurse for a long, long time,
36:55and I've said numerous times,
36:57you cannot buy experience,
36:59you just, you can't.
37:01Let me go get you a pillow, eh?
37:03Or get another blanket for this leg
37:05so it don't fall down.
37:06How's that sound?
37:08We are all problem fixers.
37:11Some are very good at working on a team
37:12and delivering, you know,
37:14a good standard of nursing care.
37:16She can go in a chair, can't she,
37:17and then I can get this patient in.
37:19And then others are very good at being in charge,
37:21steering the ship, if you like.
37:23And I think, you know,
37:24we all have different flares for different things,
37:27and I think once you put all that together,
37:29it is a well-engineered team.
37:35In radiology,
37:38majorette Nevaeh is hoping she's not broken any bones.
37:43Come on in.
37:44Yeah.
37:46After a tricky move at dance practice went wrong.
37:49You want me in?
37:50Yeah.
37:53What have you done?
37:55It was like a walkover,
37:57and I went over with my hand.
38:00Nevaeh came to casualty with mum, Amy.
38:03She plays football as well,
38:05so you'd think she'd get more injuries
38:07from football than dance, but...
38:09Can I do, Max, raise your hand and fingers,
38:11sort of just rub it down nice and flattened to there?
38:14She scored her first goal last week,
38:16but she'd put it in her own head.
38:22So I'll send those x-rays across to Amy.
38:24If you just want to make a way back round there,
38:26like 90-factor x-rays, we'll see.
38:31Emergency nurse practitioner Tony assesses the injury.
38:35She was more painful down this side of her hand
38:41and into her little finger.
38:42No obvious cracks or breaks or anything there.
38:46So I think that's...
38:47I'm going to be bruised rather than anything else.
38:51Bones in children tend to bend more than they'll break,
38:54whereas if it's the same injury for an older person,
38:56they would likely get a more significant break to the wrist.
39:00I need a pot in and sometimes even surgery.
39:02Can't see anything broken.
39:03I think you might have just rolled it a little bit
39:05and you just caused a bit of bruising.
39:07Keep it moving.
39:08Paracetumolibopropin, absolutely things like that.
39:10I'll sort of find.
39:11Brilliant.
39:11Yeah, you'll be fine.
39:13All right, we'll let you go then.
39:16It's the best outcome for Nevaeh.
39:18At least you can dance on Saturday now.
39:22But she'll be watching how she lands those tricky moves
39:25a bit more carefully from now on.
39:35In majors, Dr Allcroft is preparing to stitch the open wound
39:39on Christine's forehead.
39:42Right, you want me to keep it...
39:43No, no, just lay down now.
39:46What I want you to do is just be basically relaxing as much as possible.
39:50Best case scenario would have been the fall had done no injury,
39:53there'd be no injury to the head
39:54and everything was absolutely perfectly fine.
39:56I'm going to get this up a little bit
39:58just to save my back so I'm not a hunchback.
40:00I think luckily, looking at the injuries that have happened,
40:04most of it is going to be able to be managed
40:05without, sort of, hopefully any need for surgical invention
40:09or causing sort of longer-term, more serious damage.
40:15You're all grazed, aren't you?
40:17It's stinging.
40:18I'm sorry.
40:19It's just to make sure when we put it in, it's OK.
40:21Oh, bless you.
40:22I'm sorry.
40:24It's really sore around that, isn't it?
40:26Oh, no, I think where it's grazed and unfortunate,
40:28this isn't.
40:29I'll do it quick.
40:30Oh, I will be glad when I get home.
40:37Just going to do a little injection above your eyebrow.
40:41Oh, no.
40:43Unfortunately, the local anesthetic can sting a little bit in itself.
40:46Oh.
40:47Just give that a little massage, OK?
40:50I'm used to injections.
40:52I used to inject myself four times a day.
40:54Oh, did you?
40:55Yeah, when I first spun out, I've got diabetes.
40:58Oh, 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 Skaggy
41:14and my eyebrow done in Barnsley.
41:18Full works, basically.
41:20Yeah.
41:21Well, just one last injection
41:23and hopefully everything will be nice and nice, OK?
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.
41:39No.
41:45Outside.
41:46There we go.
41:50That's what we wanted.
41:53Is it too big for butterfly stitches?
41:56Yeah.
41:57I think, unfortunately.
41:59You've got lollipops for after.
42:01I'm sure we can fix you some up.
42:02I'll raid our special sweet treats.
42:05Oh, you are kind.
42:06So I need you to keep your head really still
42:08because if the head moves as I go along,
42:10it's going to be tricky to get.
42:12So, 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.
42:36You 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.
42:48That 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.
42:57Very certainly fingers hurt.
43:00Christine'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.
43:21Like these round the little honeypot.
43:24Vultures.
43:25As a nurse in charge of the department,
43:27the 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.
43:50Damn 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.
44:51Bye.
44:52Bye.
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