- 3 months ago
Ambulance Code Red S04E02
Category
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TVTranscript
00:00In the intense world of medical emergencies, there's nothing more extreme than an immediate threat to life, responding to the most severe 999 calls.
00:18This lady is reporting pain in her head and is becoming less talkative.
00:23The Thames Valley Air Ambulance Response Vehicles are at the front line delivering life-saving medical treatments.
00:36Working day and night reacting to emergencies, the critical care teams are equipped to provide hospital-level treatments.
00:53So we'll give you some ketamine, that will mean that you don't know what we're doing whilst you straighten your ankle out.
00:57Whenever, and wherever, it's needed.
01:06Filmed over three months.
01:08Let's have your arm, my dad, let's give you some of this morphine.
01:11Just be aware he might stop spontaneously ventilating.
01:14I have the cheek.
01:15We captured every vital second.
01:18That's okay, you're safe.
01:19As these highly trained critical care teams...
01:22Can you take a deep breath in for me?
01:24...fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29When every second counts.
01:32Let's go, go, go.
01:34Tonight, a motorcyclist is seriously injured after a high-speed crash.
01:39We're going to just lay you down, okay?
01:41Oh, oh, oh.
01:43Five days after giving birth...
01:46Sophia, my name's Matt, I'm one of the doctors.
01:48...a young mother hemorrhages blood.
01:50Sorry, is it painful?
01:51Yeah, I bet it is.
01:52...two suspected broken legs.
01:54Look at mummy, keep breathing.
01:56...for a young lad in a playground.
01:58Oh, that hurt!
01:59That hurt a little bit, okay.
02:01All right.
02:02And...
02:02...one of my rides.
02:04It's got a tight chest now.
02:06Yeah, I can tell you're struggling.
02:07...a birthday bicycle ride results in a cardiac arrest.
02:11How's that chest tightness?
02:12Has it gone down at all or not at all?
02:14Not at all.
02:15Not at all.
02:15Not at all.
02:15It's Saturday morning, and Dr. Jaspreet-Riot...
02:24Asset checklist completed.
02:26All done.
02:27...and critical care paramedic Matt Hale are starting their shift.
02:32Jas and I actually joined together.
02:34So we started in August 2018, so probably seven and a half years.
02:38Working ten hours together on a regular basis means the Thames Valley Air Ambulance teams often build strong working relationships.
02:47Jas knows what I'm thinking. I know what Jas is thinking.
02:50Yeah.
02:50Usually, they're on the same page.
02:52Yeah.
02:54Such bonds are vital.
02:55You never really know what you're going to get to, but it's a weekend, nice sunny weather, so I'd imagine the motorcyclists will be out.
03:00When dealing with whatever emergencies come their way.
03:04You never really know.
03:06Ambulance, emergency. Is the patient breathing?
03:26Yes.
03:27And are they awake?
03:28They are, but instead of a motorcycle crash.
03:31Okay.
03:32Is there any heavy bleeding from what you can see?
03:35There's bleeding on the foot, and he's wrangled his hand as well.
03:39Okay.
03:39How old are they?
03:41How old are you, buddy?
03:4461.
03:45Is he breathing faster or harder than normal at the moment?
03:49Farther than normal, yeah?
03:50Yeah.
03:52He's in shock, I think, yeah.
03:53All right.
03:53We are getting a high priority ambulance out to him.
03:55Is there someone who can stay with him until we get there?
03:58Yeah, he can get to you, yeah.
04:00Perfect.
04:03A serious motorbike accident on a busy A-road means Jespreet and Matt are dispatched.
04:10So this is a 61, so it's when you're a male.
04:13It's a motorcycle accident.
04:15Okay.
04:17Gentleman's definitely said to have lost a finger.
04:20He's got a mangled hand, heavy bleeding from the foot.
04:25Okay.
04:26Broken arm, very agitated.
04:30Motorcyclists are 45 times more likely to be killed in a road accident than car drivers.
04:35But in this case, fractures.
04:37A severely injured hand with potentially a lost finger is extremely serious.
04:42Well, he's got high-speed mechanisms, motorcyclists are relatively low protection.
04:48Don't know whether he's collided with anything.
04:51So essentially, it's going to be head-to-toe injuries, so we're going to do a full assessment.
04:54Might need blood.
04:56May need to give some drugs to help control any bleeding.
05:00It takes 13 minutes for Matt and Jespreet to arrive on the scene.
05:06It looks like he's sat up.
05:08Just seconds after an ambulance crew.
05:10Hey, everybody.
05:16Alex, can you get a stretcher and scoop out for me, please?
05:19Ash, is it?
05:19Hi, Ash, I'm Matt.
05:21This is jazz, all right?
05:23Just going to rock the clock.
05:25Okay.
05:26Okay, just get your head still for us.
05:28I'm going to set my back.
05:29Okay, sit as still as you can first, buddy.
05:3161-year-old courier Ashley was on his way to meet his brother and spend the day riding their bikes.
05:37But he lost control on a bend, sending him flying onto the tarmac and then into a hedge.
05:42This is broken.
05:44You've broken that one?
05:44Without a doubt.
05:45Okay, okay.
05:45Because I'm moving the shoulder and the arm's just...
05:48Okay, fine.
05:48Ah!
05:49Okay, so let's try and keep the arm nice and still.
05:52I'm going to cut this jacket off.
05:54How fast do you think you're travelling?
05:56Well, when I cut the bend, I was doing about 50 or 60.
06:01Ow.
06:03Ah.
06:04Sorry.
06:05So, what we'll do, we'll get a drip in.
06:07We'll get you some pain relief shortly, okay?
06:09Are you happy to start looking for an IV access in his left arm for me?
06:12Oh, yeah.
06:14So, I'm just going to have a quick feel down the neck, okay?
06:17Any pain?
06:18Dr. Jaspery needs to perform a full-body assessment to establish just where Ash is hurt
06:24and critically try and uncover any life-threatening internal injuries.
06:31Are you happy there's an emergency?
06:46Is the patient breathing?
06:47Yes, they are.
06:49Thank you. Is the patient on wait?
06:51They are, yes.
06:53Thank you. What's the main reason?
06:55There's an accident in the playgrounds and they've got bones sticking out their legs.
06:59Can I ask how old's Luke?
07:01Twelve. Twelve years old.
07:03What leg is it, Luke, sir?
07:05Left and right.
07:07Is there bones sticking out the left and the right leg?
07:09The skin's broken on both legs and you can see the bones are broken.
07:13Okay, sir, so we have got some help around here, but it's a high priority ambulance response.
07:23Okay, twelve year old male fallen from apparatus and playground.
07:27Both legs query broken. Reports of the seabones sticking through with blood loss.
07:33The possibility of a double leg open wound fracture means the specialist skills of Dr. Manjit Riyat
07:40and critical care paramedic Matt Jarman are called upon.
07:43We've been dispatched to what sounds like a twelve year old,
07:47who's got two, what we think are open fractures,
07:50so two broken legs with the bone sticking out.
07:53And that's a worry for a couple of reasons.
07:55One is that the skin's a natural barrier to infection, so the risk of infection is higher.
08:00Also, when bone ends are exposed, A, they're very painful and B, they can bleed.
08:05Every year in the UK, around 40,000 children are seriously injured in playgrounds
08:11and need hospital treatment.
08:13So, Manjit, what's your preference for sort of analgesia and kids?
08:17Well, I think we'll go in, we'll try and get some intranasal fentanyl in,
08:20and then we'll get IV access and we'll go in for catching it.
08:24Happy with it? Yeah, yeah, definitely.
08:26Open fractures are extremely serious injuries.
08:29Alright, that's seen.
08:31Because not only can they become dangerously infected, they can also lead to loss of limbs.
08:36Look at my monkey, my thing.
08:38Nooooooooooooooo!
08:41Nooooooo!
08:42Stop!
08:54...
09:08emergency is the patient breathing. Is she awake? No, no, no. And she's not responding to you at all? No, no, no. No, okay. No, no. And so if you have a look at her chest, can you see it rising and falling in a regular pattern? Yes, yes. Yes, yes, yes, yes. Right and falling, yes. No problem. And is she pregnant at all? She had the surgery five days ago. Has she lost any blood today then? Yes, yes.
09:37Would you say that she's bleeding very heavily there at the moment? You would, okay. We are currently on the way of the moment.
09:49With reports of an unresponsive woman hemorrhaging blood. It's a 34-year-old female. She gave birth five days ago by C-section. She's had a PV bleed throughout the day.
09:59The specialist skills of Dr. Matt McGurran and critical care paramedic Andy Ludlow are required, because only the critical care teams can give blood transfusions out on the road.
10:13She is conscious of which has a precious 18-year-old. Continuing to lose blood.
10:19Luckily, the team are just a mile away.
10:23Is this it?
10:25Is this it?
10:32Is that a bloody?
10:38Knock, knock.
10:42Hi, everyone. Matt. Andy.
10:46This is Sophia.
10:48Sophia.
10:48Hi, Sophia.
10:49She's 34.
10:5034 year old Sophia gave birth to her third child five days ago via c-section
10:57but she's never suffered heavy bleeding in the postnatal period before
11:01earlier on today she's had a big gush of blood into the toilet so she's not able to estimate
11:07how much she said another big gush about an hour ago so they've called for us
11:12yeah and she's passed out um last ops her I think it was at 89 systolic um tacky at 102 103
11:21and we're also we're trying to cannulate for TXA really terrible veins so please can you help
11:28with that of course yeah sure Sophia has low blood pressure this could be a sign of hypervolemic
11:35shock a life-threatening condition where the body ceases to function properly Sophia hello
11:42my name is Matt I'm one of the doctors we've got Andy here as well hello Sophia urgently needs
11:47intravenous fluids to raise her blood pressure but inserting a cannula is extremely difficult
11:53because her veins have collapsed we're just going to try and get a drip in your hand
11:57have you felt like you've had any more bleeding since earlier no not yet all right so I'm not
12:03still bleeding she can't feel herself bleeding right now it's coming out in gushes is everyone
12:10happy for me to give a centermetrin I am yeah if Sophia has over 40 percent blood loss she could
12:17die a centermetrin injection will help her uterus contract to reduce her bleeding I'm going to give
12:24you an injection Andy is also trying to insert a cannula the blood pressure is a little bit low
12:29keeping with some bleeding Matt wants to brief Sophia's husband Rick who called 999 when she started
12:36hemorrhaging and fainting we're giving some medication to help the uterus contract a little
12:40bit and and then we're just getting a cannula in we'll be able to then if we do you need to give
12:45us some blood we can give us some blood but hopefully she won't need a blood transfusion at the moon
12:48hopefully and and then we'll get her to hospital that's the plan okay we're just going to check see how
12:53we're going Sophia how are you doing you're still okay even a lot are you in any pain at all a bit
13:04down in your tummy yeah when was the second episode of bleeding yeah right now after three attempts it's
13:15still extremely difficult to insert a cannula Sophia hello what we're going to do is we're going to get
13:23you on to the back of the ambulance okay we'll have one last look at see if we can get a cannula in
13:27your arm then and others will just get moving towards hospital okay without intravenous access
13:33for essential fluids to raise her blood pressure or a blood transfusion should Sophia lose any more
13:38she's at risk of life-threatening hypovolemic shock all right my dear can you open your eyes for me
13:44keep them open all right hey how are you in a playground in Abingdon dr. Manjit and critical
14:03care paramedic Matt have just arrived on scene where a 12 year old boy has potentially fractured
14:08both his legs and has gaping wounds hello hello are you all right yeah manjit and Matt we're with
14:17the air ambulance all right yeah and the patient's Harrison 12 year old Harrison was playing on a
14:23seesaw he fell off smashing his shins against a metal bar his parents and an ambulance crew are
14:29already with him we've done a primary survey we haven't found any other injuries but good a good
14:35equal air entry on the lungs I've heard all that that's fine haven't seen any other injuries haven't
14:39felt any other injuries pedal pulses are intact sensation is intact on the feet as well right
14:44those are the only injuries we've found we've got IV access there but no other access so far we
14:48haven't given any drugs yet we've just been doing Entonox so far Entonox or gas and air is usually
14:55carried by ambulance crews so far it's working well for Harrison it feels like I'm in slow motion
15:01Matt takes photographs as a record to pass on to hospital you're doing really well I know someone's
15:14already done this can you feel me touching your left foot yeah and you're right not really can you can
15:19you feel this side now okay can you wiggle your toes for me yeah and you're right yeah fantastic
15:29well done well done that's okay before dr. magic can progress with any treatment he needs to assess
15:35Harrison's injuries first checking his blood supply hasn't been compromised by the potential fractures
15:41you're doing really well can you can you feel me doing this that hurt a little bit okay all right
15:53so he's a bit sore up there yeah but whether that's on pushing on his back this one doesn't yeah but
15:59these guys say they did see bone okay it's what sort of cat ears right come out and come back in
16:05or no it was just you could just you could just see it from the depth it wasn't okay it's poking out
16:11it's just so it might not be broken they might have just we we won't know without an x-ray really
16:15I think what we can do is we can probably get some white gold we can probably wrap yeah because
16:18actually we're not going to manipulate that no fortunately Harrison's legs are showing no
16:23obvious bone deformity so the critical care team decide they don't need realigning at this stage
16:29as soon as such apps done the Ondansetron I'll just get their bandage thing Ondansetron is an
16:35anti-sickness drug in case Harrison feels nauseous he's loving that end to us isn't he we were gonna
16:43we were gonna we were planning to give him all sorts of stuff and he doesn't need it obviously so
16:46yeah I'm here any other allergies I'm down this end yeah definitely so what we're gonna do is we've
16:56given some anti-sickness because he can feel a bit sick we're gonna give him a dose of antibiotics
17:00because if they're fractured yeah the risk of infection is higher obviously the skin's a natural
17:04barrier to infection that's been that's been breached so we get the antibiotics in okay we've
17:08taken some pictures we're gonna wrap this up and he's coping really well with the gas and air so I
17:13don't think we're gonna need to give him anything more heavy-duty because we're just gonna wrap this
17:17and then we can probably stop once the antibiotics are administered the team next need to protect his
17:26injuries it's critical Harrison's legs addressed and bandage to stop the wounds becoming infected
17:38Harrison's wounds are now covered by transparent dressings to allow the hospital to view his injuries
18:05while still protecting them we're gonna put you on the trolley and take you in all right critical
18:12care paramedic Matt can now bandage over the top okay so what we're gonna do is put it we're gonna
18:21put half the ball would decide and half about that side breathing all right now what we're gonna do
18:27there's a hard board it's gonna go underneath you all right just just a little brace all right go ready
18:32steady brace safely on the scoop stretcher Harrison can be lifted to the safety of the ambulance you're
18:52in the air I'm a plane now you're in a helicopter thank you so much yeah absolute pleasure I think
19:01that we're worried about his open fractures he's had the right treatment he would have he needs some
19:04x-rays to have a look at those and manage the wounds and if they're fractured obviously manage the
19:09fractures themselves the critical care team have done everything they can for Harrison cool we'll leave
19:14you guys and are happy for the ambulance crew to take him to John Radcliffe Hospital
19:20this is a ground assist we've just left the crew with the patients going to the local yes yeah Dr
19:31Manjit and critical care paramedic Matt I've just cleared you down thank you are ready for their next
19:38emergency on a road near Great Missenden Buckinghamshire critical care paramedic Matt and Dr Jaspreet are
20:02attending to 61 year old Ash who has crashed his motorbike he's potentially lost a finger on his left
20:08hand and fractured his right arm Dr Jaspreet is trying to establish where Ash is hurt and critically if he
20:16has any internal injuries how that's painful there just to do it again okay that's there there anything down
20:27here okay and if I just press here okay I'm gonna pop this off should we get some penthrox
20:37penthrox is often the critical care team's first port of call for pain relief similar to gas and air
20:44it's fast acting and can be quickly dispensed via inhalation so I think it's got a right humorous
20:54fracture actually this one's just going to set up your nose buddy all right assessment-wise it's
21:05basically a bit of chest pain upper upper chest left thigh right arm and left hand as well having
21:14assessed Ash fully the critical care team now need to deal with a suspected fracture and mangled left
21:19hand but first need to get his pain under control Ash the pain that you're in at the moment if you had to
21:27give it a score out of 10 how would you rate the pain at the moment so 0 is nothing and 10 is the worst
21:32you could imagine how would you rate it at the moment eight okay ah she's in agony should we get our
21:41plan together between us all yeah I was gonna get a triangular bandaid on here just to swap the arm
21:45we'll get some IV paracetamol morphine some ketamine yeah I've got some ketamine drawn up and we'll get a
21:52second point of access we'll get that glove off once he's had enough analgesic on board yep all right
21:57what we're gonna do is we're gonna give you some ketamine into your vein here nice slow deep breaths
22:03and that's going to help with the pain okay all right sometimes it makes people go a little bit
22:07woozy and just relax and go with it all right ketamine is a strong sedative only carried by the
22:13critical care team always administered in tightly controlled doses okay so just for everyone's awareness
22:19really starts managing the ketamine as Matt gives the ketamine intravenously a temporary sling is
22:26fitted to support ashy's arm you bring through there buddy it'll help yeah that's 20 so in terms of
22:41our pack we're not going to stand think on to scoop here you have it was split the head end and we'll
22:45get ash to lay down and then we can get scoop underneath before any other treatment can take
22:51place the critical care team want ash in the more stable environment of the ambulance in terms of
22:56pelvis are you happy I think we're probably okay in the position we are okay not going to pain on
23:02touching pelvis I get you sat up okay okay ash no buddy okay that's ketamine again
23:09ash open your eyes for me all right buddy we're going to move you onto the ambulance now
23:13okay ash we're going to just lay you down okay just relax back with us
23:18we come up with a scoop of it oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh oh
23:48and find out if he's lost a finger.
24:11Right, Ash, we're going to lift you now, buddy, okay?
24:13Just stay nice and still, you're nice and safe.
24:15On a busy road near Great Missenden...
24:17All right, ready, brace, slow it.
24:19Dr. Jaspreet and critical care paramedic Matt...
24:22Okay, fine.
24:23...are extracting 61-year-old Ash...
24:25Everybody happy?
24:26...to an ambulance so they can deal with his fractured arm,
24:30mangled left hand, and find out if he's lost a finger.
24:35Perfect.
24:37Safely on the trolley, the critical care team support Ash's head with blocks
24:41to protect his neck and spine from any movement...
24:44Okay, ready, mate?
24:44...that could cause him further damage.
24:46Well done.
24:47We'll look for a second IV access,
24:50and then the plan would be to probably give him a bit more ketamine,
24:53get his arm straight, get that glove off.
24:54Probably add some more ketamine to get the right arm straight and the left glove off, yeah.
25:01In terms of access, we're going to look on the right hand.
25:04Yeah.
25:05Oh...
25:06Okay, Ash, how are you doing?
25:08The critical care team need to insert a second cannula for further pain relief.
25:12It's been a bit woozy and...
25:13Well, just a little.
25:14We're going to do a couple more little things.
25:17We'll pop another little needle into your right arm, and then we're going to give you some
25:20more painkillers to get your left glove off and get your right arm straight. Is that okay?
25:26Well, whatever you have to do.
25:28But we'll just crack on with that, all right.
25:30This is just a little bit of oxygen, all right?
25:33Push it and have a go.
25:34We've got suction working?
25:35Yep.
25:36Oh!
25:37Okay, everybody, so we're going to do a quick sedation brief for the procedure.
25:43Ash needs to be sedated fully to minimise pain as the glove is removed.
25:49Once we've done that, we'll know a bit more about where we're going to be taking you.
25:52If your hand looks like it needs some specialist surgery, which I think it might do, will be
25:56oxalad, okay?
25:57Oh, my feet.
25:58Uh-oh.
25:59Okay, that's first.
26:00Oh, dear.
26:01Okay, let's give that a minute.
26:03Good, sir.
26:04Get my hand to squeeze, Ash.
26:06Open your eyes for me.
26:09Squeeze my hand.
26:10Ash, how are you feeling?
26:14Yeah, see if I can gently take this off.
26:19Once Ash is sedated, Dr Jaspreet can now remove the glove to see the extent of his injuries.
26:25Do you want to cut down here?
26:27Yeah.
26:28No, if you just cut all the way along.
26:31That should, hopefully.
26:32There you go.
26:34There you go.
26:36Okay.
26:37So it's tipper finger?
26:38Yeah.
26:39Fortunately, Ash hasn't lost his entire finger as initially reported, but he could still
26:44require plastic surgery.
26:45I could drop some kefetaxime.
26:46I could drop some kefetaxime.
26:47Kefetaxime, an antibiotic, is given to stop infection.
26:52Do you mind passing that splint?
26:53Dr Jaspreet also straightens Ash's broken arm to increase blood flow and align the bones.
26:59What we'll do is place this along the side of the arm and then we'll just come forming bandage.
27:04A splint is vital to keep the arm in position and support it in transit.
27:08Okay.
27:09Happy position wise?
27:10Yep.
27:11I think that's as good as we're going to get, really.
27:16You okay there, Ash?
27:17You're doing really well, buddy.
27:18Nice and relaxed again.
27:19You're doing great.
27:20So, shall we just strap his arm in?
27:27Maybe along his side?
27:30Sorry.
27:31Just trying to avoid the tangle.
27:36Injuries dressed and the critical care team prepare Ash for the journey to hospital.
27:42Right, shall we get a little bit of morphine on board as well?
27:44Yeah.
27:45A bit more painkiller coming up now, buddy, alright?
27:54Ketamine pain relief only lasts around 10 to 15 minutes.
27:58Matt administers longer lasting morphine for the onwards journey.
28:02And the plan now is these guys are going to take you up to Stoke Mandeville, okay?
28:06Stabilised, the critical care team hand Ash back to the ambulance crew
28:11for the 30 minute journey to Stoke Mandeville Hospital.
28:14All the best, buddy.
28:15All right.
28:16Cheers.
28:17You're very welcome.
28:18Take care.
28:19All right.
28:20He, frankly, doesn't need to go to the major trauma centre from what we've found so far.
28:25So he's going to go to the local hospital, which is Stoke Mandeville.
28:28He'll have some scans there and they'll have plastics look at his finger.
28:31And they'll have a look at his arm as well.
28:34The ambulance emergency is supposed to be going.
28:35Yeah.
28:36I'm on a bike ride and I've just come up a hill.
28:49It's got a tight chest now and I just come all sweaty.
28:50Okay.
28:51You're all right.
28:52You've got pain in your chest at the minute.
28:53It's just tight across the top.
28:54It feels tight.
28:55Did the pain come on like a camp of thunder or was it gradual?
28:56No, it sort of came on quick.
28:57All right.
28:58How old are you, please, sir?
28:59I'm 61 today.
29:0031 today.
29:01Oh, happy birthday.
29:03Have you been diagnosed with any heart problems?
29:04No.
29:05I'm just sort of feeling more lethargic as I speak.
29:06No, I'm just feeling more lethargic as I speak.
29:07I'm up a hill.
29:08It's got a tight chest now and I just come all sweaty.
29:09Okay.
29:10You're all right.
29:11You've got pain in your chest at the minute.
29:12It's just tight across the top.
29:13It feels tight.
29:14Did the pain come on like a camp of thunder or was it gradual?
29:15No, it sort of came on quick.
29:16All right.
29:17How old are you, please, sir?
29:18I'm 61 today.
29:1961 today.
29:20Oh, happy birthday.
29:22Have you been diagnosed with any heart problems?
29:24No.
29:25I'm just sort of feeling more lethargic as I speak.
29:28Yeah.
29:29I can tell you're struggling, okay?
29:31We have got the appropriate health range for you, okay?
29:33It's classed as a high priority, obviously, so we'll be with you as quickly as we can.
29:39Car park in Long Downhill, Cadden.
29:43Oh, Cadden.
29:44Oh, I know.
29:45Came in as chest pain and it's now saying cardiac arrest.
29:48Escalated to a cardiac arrest by the ambulance crew already on scene, the advanced life-saving
29:53skills of Dr. Ed Norris and critical care paramedic Neil Plant are required.
29:58This is Friday afternoon.
29:59I was just thinking that.
30:01But getting to the scene is proving tricky.
30:04Right.
30:05It's a bit early though.
30:06Usually it's three o'clock.
30:07Yeah, one o'clock.
30:08It is a bit.
30:09It's because it's sunny.
30:10It would have gone up the back road if I'd have known it was going to be like this.
30:15In the UK, around 30,000 cardiac arrests happen every year outside of hospital.
30:21Survival rates are extremely low, at around 8%, so time is of the essence.
30:28So, we're going to a 60-year-old male.
30:31I think the original call came in due to chest pain and it seems that this gentleman has
30:39gone into cardiac arrest in the presence of the paramedics on scene.
30:44Ah, so this is why the...
30:45This is the traffic.
30:46Makes more sense.
30:47Someone's broken down.
30:49VF arrest following chest pain whilst riding a push bike.
30:50One shock delivered and now shows ST elevation.
30:51Criaged to Wickham.
30:52We'll be there in time.
30:53I wouldn't delay on scene, but if we're there, we'll just say let's go.
31:05As soon as a cardiac arrest patient is stabilised at a scene, it's critical they're taken to
31:10hospital quickly so they can be given further emergency treatment.
31:14This is one where speed is going to be the key, right?
31:17We want to just say go, go, go, go, go.
31:19We're not going to procrastinate too much on scene.
31:20No.
31:21I'll put bags in the back and let's go.
31:24No, I'll go behind the TL car.
31:26I'll just go here for now.
31:28They can reverse.
31:30It takes the critical care team 22 minutes to arrive on scene.
31:35Their specialist skills and drugs could be vital in keeping the patient alive.
31:39Hello.
31:40Do you want us to just hop in the back and...
31:42Yeah.
31:43They might...
31:44It's a case of let's go.
31:45Everything else can happen on route.
31:46Perfect.
31:47We're in five minutes to go.
31:49Wickham and Peeler, so they're expecting...
31:50Perfect.
31:5115 to 20 minutes.
31:52We'll squeeze in.
31:5461-year-old Carpenter Graham was on a 12-mile birthday bike ride when he felt severe
31:59chest pains and called 999.
32:02When the crew by here was laying on the floor being supported by members of the public.
32:06When the ambulance arrived, he walked into it unaided, but then suffered a cardiac arrest.
32:11One shot, ROSC.
32:14Ambulance paramedic days used a combination of CPR and a defibrillator to shock Graham's heart until they got ROSC, meaning it started beating again.
32:23I'm Wickham away.
32:24I'm Wickham away.
32:25Brilliant.
32:26Okay.
32:27An ECG monitor has been attached and Graham's been given aspirin and intravenous paracetamol.
32:32Hi, Graham.
32:33I'm going to go a little bit quickly.
32:34What?
32:35To Wickham Hospital.
32:36Okay, lovely.
32:37Let's go, go, go.
32:38Even though Daze and her team have stabilised Graham for now, Ed and Neil will accompany them
32:46to hospital in case his heart stops again.
32:49We have IVP running.
32:51Yeah.
32:52We have aspirin.
32:53Perfect.
32:54We've just run it through and reassessing it before, but I have my morphine now.
32:58Should we do that?
32:59I think so.
33:00Carefully, is he having anti-emetic if you want to draw some off for you?
33:03No.
33:04Graham has chest pain, so the team are going to administer morphine, but first he needs anti-emetic
33:09drugs to reduce the risk of nausea and vomiting.
33:13Two mil.
33:14Two mil.
33:15I'll get you a cooling up.
33:17Amazing.
33:19Can you get the order?
33:21Yeah, two-five.
33:23Just an update.
33:24So, myself and Ed are in the private truck en route to Wickham and Scaddon,
33:29in the car.
33:30Right, I'm just going to give you an anti-sickness medication.
33:34Two cannulas have already been inserted, so intravenous drugs can be administered.
33:38Should I do it for you?
33:39Yeah.
33:40Yeah.
33:41This is morphine in here, yeah?
33:42Yeah.
33:43One mig per mil, yeah?
33:44Yeah.
33:45Even with stronger painkillers, every second counts.
33:49The team have no time to lose.
33:50If you just look to the side of you, there's a wheelchair that we can take you out on, okay?
33:51Just a while.
33:52Just a while.
33:53Just a while.
33:54Okay.
33:55In Aylesbury, 34-year-old Sophia has been hemorrhaging blood and passing out with low blood pressure.
34:00After giving birth five days ago.
34:01Sorry, is it painful?
34:02Yeah, I bet it is.
34:03Yeah, I bet it is.
34:04Critical care paramedic Andy and Dr. Matt have been trying to insert a cannula on her
34:11to the side of you.
34:12If you just look to the side of you, there's a wheelchair that we can take you out on, okay?
34:19In Aylesbury, 34-year-old Sophia has been hemorrhaging blood and passing out with low blood pressure
34:25after giving birth five days ago.
34:27Sorry, is it painful?
34:28Yeah, I bet it is.
34:29Critical care paramedic Andy and Dr. Matt have been trying to insert a cannula on her
34:33to administer vital fluids to raise her blood pressure, but as yet, haven't been successful.
34:38Probably the easiest thing to do is put your legs on the ground, okay?
34:42Now, they're moving her to the ambulance.
34:45Yeah, you take your time.
34:50Oh, here we go.
34:51All right.
34:52Well done.
34:53Perfect.
34:54There we go.
34:55Well done.
34:56Sit back in the chair for me.
34:57Are you following us up there?
34:58Yeah, I'm following you.
34:59Yeah.
35:00Maybe in your own car, if that's okay.
35:01Yeah.
35:02So, she was just snorting there as we got around.
35:07Yeah.
35:08Sophia has passed out again.
35:09Sophia, how are you doing?
35:11Ah, such a kisser.
35:14Okay.
35:15Yep, ready?
35:16Yeah.
35:17One, two, three.
35:19Coming up, guys.
35:24Sophia, can you open your eyes for me?
35:29Hello.
35:30Safely in the ambulance, the critical care team can once again try and insert the much needed
35:36cannula.
35:37All right.
35:38You just had another light-headed episode there when you fainted.
35:42We're just going to put this blood pressure cuff around your arm and then we're going to
35:47try again to get a cannula in your arm, okay?
35:50Sophia, how are you doing?
35:52I feel really weak.
35:53I feel really weak.
35:54You feel really weak?
35:55Yeah.
35:56So far, the team haven't been successful because Sophia's veins have collapsed.
36:01Stop scratching your arm again, my dear.
36:03Another attempt.
36:04How are we looking?
36:05No success.
36:06Zero.
36:07Zero.
36:08Zero.
36:09Zero.
36:10No success.
36:11How is your pain at the moment?
36:12It's your pain.
36:13What do you score it out of ten?
36:15Eight, maybe.
36:16About an eight.
36:17Have you taken any painkillers today?
36:19Yes.
36:20What time did you take them?
36:21I think since the bleeding, yeah.
36:24It was two hours.
36:26About two hours ago.
36:27Yeah.
36:28What did you take?
36:29You took paracetamol?
36:30One paracetamol and one ibuprofen.
36:32One paracetamol?
36:33Yes.
36:34Okay.
36:35You feel sleepy.
36:36I know you feel sleepy, my dear.
36:37I know you do.
36:38Should we start running?
36:39Yeah.
36:40We can start going now, guys.
36:42So your husband is going to bring your little one up to the hospital.
36:46He's going to drive in the car.
36:48He's following you, okay?
36:49Yes.
36:52You okay?
36:53Is that pain in your tummy or is that pain in your leg?
36:55Is that your tummy?
36:56Your tummy.
36:57Okay.
37:00You need an injection into your shoulder, okay?
37:02It's called tranexamic acid.
37:04That's it.
37:05Tranexamic acid is a drug that helps reduce heavy bleeding by stopping the breakdown of
37:10blood clots.
37:11Perfect.
37:12There you go.
37:13You're doing very well.
37:14Is it your third baby?
37:17Third.
37:18Third.
37:19Third.
37:20A bit more tourniquet then.
37:23Dr Matt is now trying to insert a cannula for the fifth time.
37:27Andy, can I ask you a favour?
37:28Of course.
37:29Do you mind just holding here and applying some extra pressure in terms of...
37:30Yeah.
37:31I don't know.
37:32All right.
37:33That's it.
37:34Just minutes away from Stoke Mandeville Hospital and Matt has managed to do it.
37:40Can we get a band of fluids?
37:41We've got a cannula in your hand now.
37:42We're going to give you some fluid to help with your blood pressure.
37:43Okay?
37:46So you've got some salty water going in now.
37:47Hopefully that'll make you feel a bit better.
37:48All right.
37:4935 minutes after the team were called, Sophia is handed over into the care of the emergency
37:52medical team.
37:53You're very welcome.
37:54You're welcome.
37:56You're welcome.
37:57You're welcome.
37:58You're welcome.
37:59You're welcome.
38:00I'm sorry for the patient.
38:01She was in quite a lot of pain from the C-section that she'd had and very weak from what was going
38:11on.
38:12She'll be looked after by the patient.
38:14She's in quite a lot of pain from the C-section that she'd had and very weak from what was going
38:21on.
38:22She'll be looked after by the Ops and Gynae specialists at Stoke Manover Hospital
38:27and they'll do any procedures that they need and wish her a speedy recovery.
38:45So Graham, at the moment, how bad's the pain on a scale of 0 to 10?
38:49In an ambulance...
38:51About five, about five.
38:53About five.
38:55There's a race against time to reach Wickham Hospital in Buckinghamshire.
38:59OK, no worries. 2.5 of morphine.
39:03Critical care paramedic Neil and Dr. Ed are accompanying Graham,
39:07who suffered a cardiac arrest after chest pains during a birthday cycle ride.
39:12He was resuscitated at the scene by ambulance paramedic Daze.
39:16I think it's really important that we don't steal your thunder here,
39:19so when we get there we'll let you...
39:21I appreciate that.
39:22So Graham, when we get to hospital there's going to be quite a lot of people there
39:26and Daze is going to explain what's happened
39:28and you'll probably find they'll start taking bloods and stuff off you whilst they're chatting.
39:32And I can feel your nice radial parts.
39:34What they'll probably do is then take you off to a different room, OK?
39:37Looking at your ECG, one of the arteries in your heart looks like it's probably blocked.
39:42Yeah, so what's probably caused you to have the chest pain and arrest is that blockage.
39:47If one of Graham's arteries is blocked, the cardiologist will most likely fit a stent,
39:53a small mesh-like tube that will improve blood flow to the heart.
39:57Don't worry, the cardiologist whizzes and they can usually, they can get a wire in.
40:02You've seen it on the telly, well there you go.
40:05So that's almost certainly what the plan's going to be.
40:08Alrighty.
40:09Have you had any chest, you know the tightness you've had today, have you had any of that before?
40:15First time.
40:16How's that, how's that chest tightness?
40:18Has it gone down at all or not at all?
40:20Not at all.
40:21And it's your birthday today.
40:24What?
40:25Happy birthday.
40:26Oh my goodness.
40:2761 today.
40:28So, very lucky today.
40:31OK, well.
40:32I'll tell you how you look at it.
40:33I feel reluctant to use the word happy, but happy birthday.
40:36Your birthday present is surviving a cardiac arrest.
40:40And your birthday present is days here who saved your life.
40:43How's that?
40:44It's a decent birthday present, isn't it?
40:46Yeah.
40:47You OK there, Graham?
40:49You're grimacing, you all right?
40:51It's got a heart to breathe.
40:52What's that?
40:53It just feels a bit hard to breathe.
40:55OK.
40:56Yeah.
40:57That's the heart, I'm afraid.
40:59Which is why they're going to hopefully progress quickly to unblocking it.
41:04Have you got any GTM?
41:06Fast acting GTN spray widens the blood vessels.
41:09It should increase blood flow to Graham's heart.
41:12He's got a decent radio.
41:14Have you still got the chest tightness and the shortness of breath?
41:19A little bit?
41:20Slightly.
41:21Let's try this spray under the tongue, see if that helps as well.
41:24Lift your tongue up towards me.
41:26Towards me, yeah.
41:27That's it.
41:28Up.
41:29Up.
41:30Up.
41:31Up.
41:32Up.
41:33Up.
41:34Up.
41:35Up.
41:36There you go.
41:37Try that.
41:42Any better, Graham?
41:43You said it was a five out of ten when I first got in.
41:45What do you reckon it is now?
41:46About the same?
41:47OK.
41:48Let me get you a bit more morphine, OK.
41:49It's really close to us.
41:50It's close to us.
41:517.5 of morphine now in total.
41:52close for us. 7.5 of morphine now in total. Just giving him another 2.5. Great, your chest is also
42:02going to feel quite rough as well because we did a bit of bouncing up and down on it. We gave him
42:07some chest compressions before we gave the shock, so that is also going to make it feel a bit rubbish.
42:13It takes the team 19 minutes to reach Wickham Hospital from the car park where Graeme suffered
42:29his cardiac arrest. I'm trying to decide whether having a cardiac arrest on your birthday but
42:42surviving, overall whether that's a positive, as in the birthday present was you survived
42:46it, or whether it's a negative that you had it. If you're going to have an arrest, have
42:50it in front of someone who's got a defib. Graeme will be handed over to the specialist
42:54cardiology unit for further assessment and emergency treatment. He had his heart attack and his
43:01cardiac arrest in an ambulance with a very competent team who managed to immediately get him back
43:08and he's managed to get to hospital super quickly and go straight into the cath lab from the
43:12block his coronary arteries, so everything's worked very, very well.
43:45Uh-huh.
43:46Hear my heart.
43:50I see that you a little sign.
43:51All right.
43:52All right.
43:52We are in much moreわかть obese.
43:53Do you have to make sense to have a test?
43:56It'll be done!
43:57Oh my God.
43:58We will eat it tonight.
43:59We will help you plenty too.
44:00Safe total 간 in meals for ép chances to have it every night while you're out.
44:04durable, but you have to make sense to have a supple!
44:05As an extreme result, there won't beplaathing Ну-key.
44:08and all 치즈 could feel good.
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