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Ambulance Code Red Season 4 Episode 6
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FunTranscript
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.
00:18So this lady is reporting pain in her head and is becoming less talkative.
00:23The rapid response vehicles of the Thames Valley Air Ambulance are at the front line.
00:30Delivering life-saving medical treatment.
00:32The big decision is for us whether we need to put a tube in again to protect us that way or not.
00:36Working day.
00:37We're going to give you some strong medication.
00:40And night.
00:41It should not hurt. It's a very good painkiller.
00:44Reacting to emergencies.
00:45You've been super brave, darling.
00:47The critical care teams.
00:48You've had a pretty big blow to the head.
00:50Are equipped to provide hospital-level treatment.
00:53So we'll give you some ketamine.
00:54That will mean that you don't know what we're doing whilst we straighten your ankle out.
00:57Whenever.
00:58Do you think he's fast?
01:00Intentionally, yeah.
01:01And wherever.
01:02Oh, my leg.
01:02It's needed.
01:03Oh.
01:04You are doing a fantastic job.
01:06Filmed over three months.
01:08Put this up your arm, my dad.
01:09Let's give you some of this morphine.
01:11Just be aware he might stop spontaneously ventilating.
01:14I have the tube.
01:14We captured every vital second.
01:17That's okay.
01:18You're safe.
01:19As these highly trained critical care teams.
01:22Will you take a deep breath in for me?
01:24Fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29When every second counts.
01:31Let's go, go, go, go.
01:33Tonight.
01:34I feel like I'm on the truck.
01:37A car versus motorbike RTC leaves the rider seriously injured.
01:42You've done a lot of damage here.
01:44We were on a driving range.
01:45We just collapsed down.
01:46A 64-year-old man fights for his life after a suspected cardiac arrest.
01:51And roll.
01:51Is she being difficult to wake up?
01:54Yes.
01:55But she wasn't responding.
01:56A young girl could have potentially life-threatening sepsis.
01:59Can I get you to open your eyes for me?
02:02Amelia.
02:03And a six-foot fall from a ladder leaves a man with multiple fractures.
02:07We're worried about his chest.
02:09He's definitely got some broken rib, hasn't he?
02:21I'm not right near him.
02:32It's just 100 metres away from me.
02:35A motorbike just ran into a car.
02:37He's gone over and it's all smashed up.
02:40Have they been ejected?
02:41Yes.
02:43Are you able to be with the patient?
02:46Yeah, I'm with them now.
02:47They're still breathing.
02:48They're screaming out in pain.
02:50Please, in the end of pain.
02:53Okay, fine.
02:53I've got the appropriate help arranged for you, okay?
02:58With the report of a potentially serious road traffic collision involving a motorcyclist
03:03and a car, the specialist life-saving skills of the Code Red team are urgently required
03:07in case of critical injuries, where only they can medically intervene.
03:12Motorbike versus car.
03:13Thrown from bike.
03:13Several calls.
03:14Honey trauma.
03:16Midway through their shift, Dr. James Rate and critical care paramedic
03:20Charlie Shorthouse, are sent straight to the scene.
03:24You are going to a, I believe, motorcyclist versus a car described as being thrown and
03:30gone over the car.
03:32I think there's about seven or eight calls on this one, so quite a lot.
03:35Is it on the motorway or is it somewhere else?
03:38Not on the motorway.
03:40Just near Stoke and George HQ.
03:42In the UK, motorcyclists are 50 times more likely to die in an RTC than car drivers.
03:52Those that survive can face life-changing injuries, including brain trauma, spinal injuries and
03:58broken bones.
03:59The only info we have is this chap has been launched off his motorbike and travelled through
04:04the air some distance.
04:05So anticipating him to have multiple injuries, hopefully he's got full protective gear on
04:11and a helmet, which very often makes a difference between life and death, frankly.
04:15I think the likelihood of life-threatening injuries is very high.
04:24Yeah, it looks like it's safe.
04:27Clear left.
04:27Clear left.
04:30This is a bit of a mess, isn't it?
04:32There's cars going everywhere.
04:34Right.
04:35As soon as the critical care team arrive on scene, an ambulance paramedic briefs Dr. James.
04:44He was going about 35 miles an hour down this road.
04:46Cars come out, impacted.
04:49He's gone over.
04:50No loss of consciousness.
04:52No C-spine pain at all.
04:54And he's freely moving his head.
04:56He's got a fractured left arm.
04:58Where's his bike?
04:59Okay.
04:59His bike is that side of the car.
05:0541-year-old builder Travis was riding along Stoke and Church High Street when he crashed
05:10into a car.
05:11The impact sent him flying over the bonnet onto tarmac, landing around 10 feet away.
05:17So, yeah, he's gone, yeah.
05:19Impact side and then over.
05:21Oh, I see.
05:22Rolled over.
05:23So his bike's there and he's gone over there.
05:25Yeah, this car's come out here, so.
05:27All right.
05:28So you think isolated arm then, really?
05:29I think so, yeah.
05:30What you've discovered so far?
05:31Yeah.
05:31Okay, great.
05:32He's happy to get himself up, but we've, you know, of course we've really kept him there.
05:36Initially, Travis felt okay and wanted to walk away, something the ambulance crew put
05:40a stop to.
05:41And his observations?
05:43Oh, yeah, heart rate was about 90.
05:45Love pressure was 110.
05:47Fortunately, Travis has both good blood pressure and a regular heartbeat.
05:52Hello, sir.
05:52All right.
05:53Hi, my name's James.
05:54I'm one of the doctors.
05:55Okay, we're just going to pop you on this board, all right?
05:57We're going to get these clothes off you, okay?
05:59No, I'm not the T-shirt.
06:02Well, the thing is, you've done a lot of damage here.
06:06Have you?
06:06Yeah, and I'm quite worried that there might be something, quite a lot going on here, and
06:12you've already broken your arm.
06:13A dangerous motorbike crash, a fractured arm, and the possibility of further undiscovered
06:18internal injuries means Travis could be in serious trouble.
06:23Keep nice and still for us.
06:24Ambulance emergency, is the patient breathing?
06:42CPR's going on right now.
06:44CPR's going on, okay.
06:46I'm on the driving range, but he's falling down on the range.
06:48He's falling down, okay.
06:49Did you witness this?
06:50Yeah, I didn't, but I will use someone on the range yet.
06:55Okay.
06:58Is the person doing CPR trains?
07:00I believe he knows what he's doing.
07:02Okay.
07:03So he needs to keep giving compressions, and they are coming to you as fast as they can.
07:06The report of a man unresponsive and having CPR means there's not a second to lose.
07:17So the specialist's life-saving skills of Dr. John Bailey and critical care paramedic
07:22Joe Epton are required on scene.
07:24We're going to a witness cardiac arrest on a golf course.
07:28The CPR's in progress with the defib on scene, but they can't get much more information from
07:33scene, so we've been sent on that basis.
07:35The caller said the patient fell and was bleeding from his nose.
07:39I don't know if that was before or after he fell, but he's only fallen from his own height,
07:43so he's just fallen from standing.
07:47Every year, around 400 people suffer cardiac arrests or have heart attacks on the golf course.
07:53Outside of hospital, cardiac arrest victims have a less than one in ten chance of survival.
07:59Have a fine golf ride, man, go to the left.
08:01An ambulance crew is already on scene.
08:13You've got a Lucas?
08:14He's not in cardiac arrest at the moment.
08:16Right, fine.
08:17But they're with the Lucas inside.
08:18Amazing.
08:19A bystander has performed CPR, and the patient is currently breathing, but non-responsive.
08:25So, we were going to drive in range and just collapse down.
08:28Yeah.
08:28QTS3 of our pupils are one unreactive.
08:31Yeah.
08:31All observations are in range.
08:33You're okay?
08:34You're all right?
08:35Yes, relax.
08:3564-year-old ex-serviceman Dusty was at a golf driving range for a practice session when he suddenly fell to the floor and has been unresponsive since.
08:45It's probably going to be a tube.
08:47Do you want me to get some airway bits ready?
08:50Yeah.
08:51I think so.
08:52Immediately, the critical care team assessed Dusty's airway is compromised.
08:56To keep his body oxygenated and prevent any further damage to his vital organs, they need to anaesthetise him and take control of his breathing.
09:04There's crazy space around, guys.
09:06We're spinning around to the heads there, so that we can have a look again and pin it in airway.
09:11He's got a lot of left-sided tone.
09:18This side is flaccid.
09:20This side's quite stiff.
09:23Yeah, is it?
09:24Alarmingly, one side of Dusty's body appears stiff, whilst the other isn't.
09:29So he's probably had a stroke.
09:31Suddenly, it's apparent Dusty isn't in cardiac arrest, but has had a stroke.
09:37Blood flow and oxygen to his brain has been cut off.
09:39This can be fatal, as it affects vital functions, like breathing or heartbeat.
09:45Yeah, he's had a massive stroke.
10:09Something in emergency, is the patient breathing?
10:14Yes, she's breathing.
10:15Is she awake?
10:17Uh, sort of, she's not responding to anything, really.
10:19Okay.
10:20Can you feel, hear, breath coming from her nose and mouth?
10:23She's breathing very slightly.
10:25May I take her age, please?
10:27Five.
10:29Okay, that's a subject, are you able to lay her flat?
10:32Lay her flat on the floor.
10:34Flat on the floor on her side?
10:36Clutch on the floor on her side.
10:40Dad?
10:42She doesn't...
10:42She's just cute, Tommy.
10:45Move any vomit away from her mouth if she doesn't choke, okay?
10:48Is she still not responding to anything?
10:51No.
10:51Okay, we're just going to keep checking our breathing until we get there.
10:58An unresponsive, vomiting five-year-old is of serious concern, so the specialist skills
11:04of Dr. Jaspreet Riott and critical care paramedic Dudley Mobs are requested.
11:08An ambulance crew on scene are worried the child has sepsis, caused by the body in overdrive,
11:25fighting off infection.
11:26If it's not treated quickly, the body can attack its own organs.
11:30It can cause a seizure, but in the worst cases, catastrophic organ failure.
11:35At the moment, we've been tasked with a five-year-old girl that has come through as unconscious.
11:42The ambulance crew are preparing some antibiotics, like intravenous access and some fluids at the
11:46moment.
11:47Anyone with an infection can get sepsis, but antibiotics, if administered quickly, can
11:52control the underlying infection, stopping the body's life-threatening overreaction.
11:57So when we arrive, our priorities are going to be a quick but thorough assessment, trying to
12:04determine what the cause of the lay conscious state is, and whether or not this child needs
12:08possibly intubation and ventilation and seizure controlled.
12:14We'll find out very shortly.
12:15It takes just 13 minutes for Jaspreet and Dudley to arrive on scene.
12:31Hello, how are you doing?
12:32Yeah, just up the stairs.
12:33Cheers, buddy.
12:34Morning.
12:34Good morning.
12:35Do you find the patient?
12:37Hello there.
12:38Dudley, Jas.
12:39Five-year-old Amelia was in bed when she fell ill.
12:42Her mum, May, couldn't wake her.
12:43Fortunately, she's regained consciousness, and the ambulance crew have quickly administered
12:48the vital antibiotics.
12:50Yeah.
12:51And a very, very stiff neck.
12:53And we've not seen any rash.
12:54I can't see anything immediately.
12:56Signs of sepsis in children can include a stiff neck, rash, vomiting, bluish or pale skin,
13:02and being lethargic or difficult to wake up.
13:05Okay.
13:05Shall we go down?
13:07Go down.
13:07Yeah, I'll be on now.
13:08Go down.
13:08Go down.
13:09Take all the kit.
13:10Go on to the stretcher.
13:11Have a reassessment there?
13:12Yeah.
13:12The team decide Amelia is stable enough for now to be taken to the ambulance, carried
13:17in her mum's arms.
13:18I don't like it, sir.
13:20Oh, thank you.
13:22Do you want to bring her up here, man?
13:25Just up here.
13:27Amelia.
13:28We're going to put these seatbelts just around you.
13:31All right.
13:31Good job.
13:33Well done.
13:33Put that.
13:34And then this one's just going to come here.
13:37Good job, Amelia.
13:38Mummy's here.
13:39Mummy's here.
13:39And team, you had a BM and temp and stuff as well, didn't you?
13:44So...
13:44Yeah.
13:44Temp was fine.
13:45Eight pyreptic.
13:46BM, five, five.
13:47It says 100%.
13:49Well done, guys.
13:52All over it.
13:52Pupils.
13:53Sevens.
13:54Sevens.
13:55Pupils.
13:56Top 718.
13:57Top 719.
13:58A high heart rate, combined with dilated pupils, indicates Amelia might have had a seizure,
14:05possibly caused by sepsis.
14:07But because she's five, Dr. Jaspreet needs all the facts before any further medical intervention.
14:13I'm quite worried that there might be quite a lot going on here.
14:24On the high street in Stoke and Church, Buckinghamshire, critical care paramedic Charlie and Dr. James
14:29are attending to 41-year-old motorcyclist Travis, who's been in a collision with a car,
14:35sending him flying 10 feet through the air onto the road.
14:38Heart rate 74, blood pressure 11778.
14:43Have we got a pelvic binder handy?
14:45Just coming.
14:46Brilliant.
14:47The team think he's fractured his arm and are extremely concerned he could have other undiscovered
14:52life-threatening injuries, including internal bleeding.
14:56Has he had any analgesia or wanted...
14:59Not yet, no.
14:59Not taking any...
15:00Super.
15:00...today at all.
15:01Do you want any painkillers at the moment?
15:03Yes, I do.
15:04Yeah?
15:04Shall we do that before we move?
15:06I think so.
15:06Yeah.
15:07Because we're not...
15:07Yeah.
15:08Right.
15:08So, um...
15:09We sort that out.
15:09Are you allergic to anything, mate?
15:11No.
15:11Nothing to us?
15:12Any cats, all right?
15:13We won't give you any cats.
15:14Put your right arm out for me.
15:16Are you putting any of this?
15:17Yeah, we are.
15:18Yeah, yeah.
15:19Squeeze as hard as you can.
15:20Your right hand.
15:22Squeeze my fingers.
15:23And let go.
15:25All right.
15:25Cannular inserted.
15:27The critical care team can now take care of Travis's pain.
15:30Just keep nice and still for us.
15:33Right, this is just some salty water just to wash this drip through, all right?
15:36Then we're going to give you some painkillers.
15:38Your pain at the moment?
15:39Yeah, yeah.
15:40Okay, 10 is the worst pain you could possibly imagine, and zero is no pain at all.
15:45Whereabouts would it be?
15:46Well, this is the most pain I've been in.
15:47Okay.
15:48I don't think it's the worst I could have.
15:50Try and give me a number if you can.
15:52About four or five.
15:53About four or five.
15:54Lovely.
15:54But I might be being tough.
15:57I've got no doubt.
16:00I've got no doubt.
16:01While builder Travis puts on a brave face, Charlie prepares to administer the strong painkiller morphine.
16:07Do you feel sick at all?
16:10Um, yeah.
16:12Okay.
16:12We'll get you something for that as well.
16:14You're going to have the full work.
16:16Yeah.
16:17Right.
16:18I'll just grab someone down to try and he's feeling a bit nauseous, James.
16:20Perfect.
16:20Before moving Travis onto the scoop, Dr. James performs a secondary assessment, checking for other potentially life-threatening injuries.
16:29Any pain around here at all?
16:30No, no.
16:30Oh, no.
16:32No.
16:32Any pain in here at all?
16:33No.
16:34Okay.
16:35Okay.
16:36There we go.
16:36Okay.
16:36Any pain down here?
16:38Oh, yeah.
16:38My hamstrings.
16:39In your hamstrings.
16:40All right.
16:40And there's a few grazers there, but no long bone fractures.
16:45All right.
16:46Okay.
16:47Do you want another?
16:48Cool.
16:48So if we get one more person.
16:50James, you're happy that side of us, or you're this side?
16:53Yeah.
16:53What we're going to do is we're going to roll you.
16:55You need to just lie completely relaxed.
16:57Don't try to help us let us move you.
17:00It's going to be a bit uncomfortable.
17:02I'm going to roll this way first.
17:03I'm just going to move your leg.
17:05James, you're going to put the scoop and the pelvic binder at the same time.
17:08Lovely.
17:09When you're ready.
17:10Okay.
17:11Travis, you need to stay nice and still and relax while we do this.
17:14Okay.
17:15Ready?
17:16Yeah.
17:16Steady.
17:17Roll.
17:18Awesome.
17:18No, you're okay.
17:19Relax.
17:19One half of the scoop is placed underneath Travis, with a binder also in position to support
17:25his pelvis, should it be broken.
17:28Okay.
17:28Okay.
17:29I'm ready.
17:29Steady.
17:30Roll.
17:32Okay, lovely.
17:33We're going to do the same thing the other way this time.
17:36Everyone ready again?
17:37Yeah.
17:38Yeah.
17:38Ready?
17:39Steady.
17:39Roll.
17:41Well done.
17:42Well done.
17:43Point.
17:44Just grab this binder, James.
17:46Super.
17:47Yeah, they're just going down.
17:51There we go.
17:51It's on.
17:52Ready?
17:53One, two, three.
17:53One, two, three.
17:54Lovely.
17:55Cool.
17:56I'm going to put some blocks on around your head so that I don't have to hold your head
18:00for the whole way to hospital.
18:01Further supportive blocks are positioned to support Travis's head as it's vital to stop
18:06him moving, preventing damage to his neck and spine.
18:09It's nice and tight.
18:10Pull it that way.
18:12Well done.
18:13Relax, relax.
18:14All right, Travis.
18:14Sorry, mate.
18:15Sorry.
18:16But the necessary tightening of the pelvic binder is causing him further pain.
18:20Ah, I've hurt.
18:23Travis, is that okay now?
18:24Yeah, what are you doing this tonight?
18:25Sorry.
18:25It's just to protect your pelvis.
18:27Yeah, what?
18:27I'm all right.
18:28Sorry, Travis.
18:29That's all sorted now, mate.
18:30Well, I don't know, yeah?
18:31What?
18:31Do you need to have a scan to bring it inside?
18:33It's fast.
18:35Potentially, yeah.
18:36The only thing we can be certain of at the moment is there's something going on with
18:39your arm slash wrist.
18:41All right?
18:41Yeah, all the other stuff we can't see because it might be looking inside.
18:46Right.
18:46Which is why we need to package you up like this, okay?
18:49Travis is securely strapped onto the scoop to ensure he can't move, minimising the risk
18:54of further injury to his body.
18:56What we're going to do, we're going to lift you up and put you on the stretcher to move
18:59you onto the ambulance.
19:01Ready, steady, lift.
19:04Oh.
19:05Are these painkillers going to cut in or what?
19:07Safely on the stretcher.
19:09Have they not done so?
19:10No.
19:11We'll give you some more.
19:14Travis can now be moved to the ambulance.
19:17Oh, my legs.
19:20Sorry for my phone.
19:22There we go.
19:23All in.
19:25Right, I'll give you some more painkiller, okay?
19:29Charlie, what do you want to do now?
19:30All right, we're just going to have some ondanzatron.
19:32Is that TXA?
19:33TXA, two grams.
19:36Ondanzatron, super.
19:38Ondanzatron is an anti-sickness drug to counteract any nausea that can sometimes affect patients
19:43after morphine is administered.
19:44Just going to have a little look at this arm, Travis.
19:46Yeah, go ahead.
19:47See if we can...
19:47Do you think you could straighten that arm out for us?
19:49Yeah, of course, yeah.
19:51This is two grams of TXA, is that right?
19:54TXA is a vital drug to stem any potential internal bleeding.
19:59Oh, my legs.
20:01Feels like I've run a marathon.
20:02Is it broken?
20:03You're just having a little look now.
20:06Is there a saw down here at all?
20:08Yeah, yeah.
20:09It's been broken in the moment for.
20:12Does that feel nice on your arm?
20:14Does it feel supported?
20:15Well, not really.
20:17Right, so you've had some nice painkillers now, okay?
20:20You've had something to stop you being sick.
20:23You let me know if those painkillers start kicking in, and we can always give you some more, okay?
20:27Shall we just have a quick team meeting?
20:29Sure.
20:30Can I come?
20:31You are definitely coming.
20:32Stay there, Travis.
20:34There's a lot of damage to the bike and a lot of damage to the car, but actually, as far as we can determine,
20:39his primary cellway, his airway, breathing, circulation and disability are all fine.
20:45He may or may not have a fracture of that arm, but it's hard to tell, and he's got normal observations.
20:52Are you guys happy to convey him for the John Radcliffe?
20:54Yeah.
20:54It appears Travis has had a lucky escape, and he's stable enough to be taken to hospital.
21:00Lovely.
21:01We'll leave you.
21:02Travis, we're going to disappear, leaving the very, very capable hands of the assemblies
21:06crew.
21:06No problem at all.
21:08No worries.
21:08Thanks, Charlotte.
21:09No worries.
21:10See you later.
21:10Have a good day.
21:10You too.
21:12The critical care team have done all they can for Travis, so scans in hospital are the next
21:18priority.
21:19Charlie, do we need anything else here, or can we let these guys get on their way?
21:21Absolutely.
21:24We go to quite a lot of motorcycle accidents, and you never really know what you're going
21:31to expect.
21:32So we were reassured that he'd not got any immediately life-threatening injuries, and our colleagues
21:37in the ambulance service were happy to convey him to hospital for some further investigations.
21:42But it also means that we're free to attend anyone else who needs us.
21:57On a golf driving range in Berkshire.
21:59So before we do anything, do we just move him into a position where you can choose?
22:03Yeah.
22:03Dr. John and critical care paramedic Joe are tending to 64-year-old Dusty, who's had a massive
22:09stroke, meaning his brain has been starved of blood.
22:13Let me have a little look at his airway, if you don't mind.
22:16I want to get a feel for it.
22:17Yes.
22:24You've got an eye job.
22:25A stroke could compromise Dusty's ability to breathe, because the brain fails to tell
22:30the body it needs to.
22:32The team need to take control.
22:34First, a temporary eye gel tube is inserted to open his airway.
22:37I've done all the kit.
22:42It's just drugs now.
22:44Yes, it'll be fentanyl, ketamine, rocuronium.
22:47The strong drugs fentanyl, ketamine and rocuronium will be administered to anaesthetise Dusty
22:52before they insert the breathing tube for mechanical ventilation.
22:56We'll get his blood pressures before we give him the fentanyl, just to be sure what we're
23:00dealing with.
23:00Stable blood pressure is key when a patient is sedated to ensure adequate oxygen is delivered
23:05to vital organs.
23:07First, a cannula needs inserting.
23:10Right, just to bend back a little bit once I can come in.
23:13Yeah, we'll put him on the stretcher before we are assigned, just because it means we can
23:17position him a bit more effectively.
23:19Maybe if we could start getting the scoop ready.
23:23Like that for a second, once we get there.
23:25If you could just hold it just there for a second.
23:27You happy with that, Jeff?
23:29Yes, mate.
23:30I think we're ready.
23:30Yeah.
23:31Are you done with drugs?
23:32All the drugs are ready.
23:33Right, let's get scooping.
23:34The team needs to place Dusty onto the ambulance trolley before proceeding with the invasive
23:40intubation known as FEE, or pre-hospital emergency anaesthetic.
23:44Right, so we go on roll, ready, brace and roll.
23:48Whoa!
23:49And then down.
23:50Ready, brace and down.
23:52Ready, brace and roll.
23:54Well done, Dusty.
23:54And ready, brace and down.
23:56All right, Dusty, mate.
23:58You're doing well.
23:59Well done, buddy.
24:00Now in V2.
24:01All right, Dusty.
24:02I can get the monitor back on.
24:05He's now gone into VT.
24:07VT, or ventricular tachycardia, is a fast and abnormal heart rhythm.
24:12Dusty's body isn't receiving enough oxygenated blood.
24:17Often a side effect of a stroke.
24:19It's dangerous if prolonged because the patient is at high risk of also going into cardiac arrest.
24:24Let's hop him on here and get him some drugs.
24:26Dusty is in critical condition.
24:28The team must secure his airway before any other emergency treatment can be done.
24:54Have we got a second suction unit?
24:56On a Berkshire golf course, 64-year-old Dusty has had a life-threatening stroke.
25:01His heart is in VT, meaning it's sporadically speeding up to dangerous levels.
25:07OK, hands out a minute.
25:09Dr. John and critical care paramedic Joe need to mechanically take control of Dusty's airway.
25:15This is to protect his brain and other vital organs from further damage.
25:20OK, ready?
25:21All right.
25:22John will challenge me and then I will respond.
25:24As in a hospital setting, the team run through a vital checklist.
25:29So, have you optimised facial precision?
25:31I have.
25:32Acceptable IV access.
25:33So both of these cannulas are flushed.
25:35They are flushed.
25:36So, fluids.
25:38Can we have some running fluids, please, on this line?
25:43OK, primary laryngoscope.
25:45Four and tested and working.
25:46OK, so I'm going to give him some fentanyl now, OK?
26:00Can't just be aware he might stop spontaneously ventilating.
26:02OK, the remainder will be two per kilo of ketamine.
26:08Yep.
26:09And then the whole of the rock uranium.
26:11Yep.
26:11So we give him 160.
26:13Mm-hmm.
26:15So he's got quite a substantial blood pressure response.
26:20Now, that's his B2.
26:22It's pulse with it.
26:22It's pulse with it.
26:22It's pulse with it.
26:23Just as they are about to start, Dusty's heart speeds up again.
26:27You won't do induction while he's in B2.
26:28No, no, no.
26:29All right, so we're now self-reverted.
26:33Fortunately, moments later, his heart self-reverts back to a more regular rhythm,
26:38meaning the team can proceed with intubation.
26:40That was, that probably was an episode of B2 when we thought it was.
26:44OK.
26:45That makes sense.
26:46OK.
26:47Dr. John administers ketamine, an anaesthetic drug.
26:50Full recipe mix.
26:52Still got spontaneous respiratory effort.
26:56Right, rock going in there.
26:57Rock-uronium will temporarily paralyze him, so the tube can be inserted.
27:03So suction on, please.
27:05A laryngoscope allows Joe to see down Dusty's airways and avoid damaging the vocal cords.
27:12Grade 2 of you.
27:14Make that grade 1 of you.
27:16Bougie, please.
27:17Bougie.
27:21She was through the cord.
27:22A little bit of coughing and gagging.
27:23OK.
27:24I have the Bougie.
27:25I have the tube.
27:25Bougie, please.
27:31Bougie.
27:32We have misting.
27:34We see chest rise.
27:37I've entitled.
27:38The team now have full control of his breathing.
27:40Suction can go off now, thank you.
27:43He's very unstable.
27:46Dusty's then attached to the mechanical ventilator.
27:48We, uh, start loading.
27:52Yes.
27:52Let's get loading, getting secure, don't we?
27:54And quickly transfer to the ambulance.
27:58How are we doing?
27:59Doing good.
28:00Had a couple of loads of the V2.
28:02Although in critical condition, Dusty is stable for now.
28:06What's wrong?
28:07On the journey to the John Ratcliffe hospital, the critical care team closely monitor him and keep him safely anaesthetised.
28:14When we arrive, we'll go for a CT scan of his head.
28:19Our suspects will probably show that he's had a fairly substantial injury or bleed.
28:25Unfortunately, at his age, the prognosis at this point is quite poor, potentially.
28:30Right, there we are.
28:36On arrival, Dusty's taken to the emergency department for further urgent treatment before heading to intensive care.
28:44It's too early to make a clear prognosis, but if he has had a large intracerebral hemorrhage, that's quite a difficult thing to survive and get over.
28:53There's a high likelihood, prospectively, that he will have some level of persistent disability after an event like that.
29:00It's going to be a case of waiting and seeing.
29:22Ambulance emergency. Is the patient breathing?
29:24Yes, he is.
29:25And is the patient awake?
29:27He is, yes.
29:28Can you hear what's the main reason for the call, please?
29:29He's fallen off a ladder, and he's lying on the ground.
29:33He's had a bad bastard's back, but he can't actually sit up.
29:38Hello, sir.
29:40So, I'd just like to ask you some questions.
29:42It's my back.
29:43So, have you lost any blood at all?
29:46I don't know.
29:47Godspeed.
29:48I'm in pain.
29:50Shut up.
29:51I'm in pain.
29:53Ah!
29:53Did someone...
29:54Ah!
29:55Ah!
29:55Sometimes I breathe.
29:57So, there's got the appropriate help arranged, OK?
29:59It's a high-priority ambulance.
30:00The report of a man falling off a ladder in serious pain with what could be back or chest
30:09injuries means the medical expertise of Dr. Tom Porter and critical care paramedic Barry
30:14Walsh are called upon.
30:15So, we're going to a 65-year-old man who has fallen from a ladder five to six feet.
30:23So, possible reported injuries are reduced air injury on his right side, maybe a flail
30:28chest.
30:28OK.
30:29He's also got an internal defibrillator from a previous cardiac arrest.
30:33The crew are asking for advice and has opted to dispatch us.
30:38An ambulance crew are already with the patient, but because of the potential problems associated
30:45with chest fractures, they want the critical care team to examine him.
30:48So, they said possible something called a flail chest.
30:51So, this is when you break multiple ribs in multiple places within a sort of segment.
30:57And what that can cause is essentially a loose segment of your rib cage.
31:03This can really make somebody's ability to breathe properly deteriorate.
31:09They can get very sick from this.
31:10As well as extremely painful, flail chest can be life-threatening, causing respiratory
31:15failure because the broken ribs can puncture the lungs.
31:19The crew have just booked leaving scene.
31:21OK.
31:22OK.
31:23They are coming up now.
31:25You should see each other, I'm hoping.
31:27Having managed to move the patient to the ambulance, the crew wants a rendezvous with the critical
31:32care team on the way to hospital, rather than delay.
31:35I love you, man.
31:37Let's go on, man.
31:46Hi, team.
31:47Hi, guys.
31:48Hi, David.
31:4965-year-old aircraft engineer David was stringing up fairy lights around his hot tub when his
31:54ladder fell, plunging him around six feet onto it.
31:58We've got what I believe might be a flail segment to the left.
32:02OK.
32:03Even on air, we're fine.
32:04We do have a bit of a reduced air entry in the base, but we are getting equal air entry
32:09at the top.
32:10He's at varying conscious levels throughout.
32:12OK.
32:13He's had a gram of IVP.
32:14He's had two grams of TXA.
32:15He's had four of ondansetron.
32:16OK.
32:17You guys are actually smashing it.
32:18Two points of access.
32:19TXA in.
32:20The ambulance crew have administered intravenous paracetamol, as well as drugs to help prevent
32:25excessive internal bleeding.
32:27OK.
32:28If it's all right with you, I'm going to repeat a primary survey quick.
32:30Yeah.
32:31So we can see what we're at now.
32:32Yeah.
32:33OK.
32:34Hello, Dave.
32:35Hello, sir.
32:36My name is Tom.
32:37I'm one of the doctors.
32:38How are we doing?
32:40Oh, oh.
32:41Yeah.
32:42I'm sorry this is happening.
32:43All a bit scary.
32:44Yeah.
32:45Yeah.
32:46Do you know where we are?
32:47No.
32:48OK.
32:49You're an ambulance at the moment.
32:50OK.
32:51Dr. Tom needs to assess David for any other injuries and ascertain if he does have a potentially
32:58life-threatening flail chest.
32:59Have you got pain anywhere?
33:01Yeah.
33:02Where's your pain?
33:03Yeah.
33:04No.
33:05Yeah.
33:06Don't.
33:07Can you squeeze my hand?
33:08Yeah.
33:09Come on for me.
33:10Squeeze this hand.
33:11OK.
33:12All right.
33:14Well done.
33:15So he's a bit confused, but he's at the moment obeying commands and communicative.
33:19Can you take a deep breath in for me?
33:22Can you show me where you think you saw the flail segments?
33:25It is just kind of can't see.
33:27It's almost on his back down here.
33:29He's got this breathing.
33:30Posterior.
33:31Yeah.
33:32Up the top was moving with the rest of the chest, but it was quite a small segment down
33:35here that wasn't.
33:36OK.
33:37All right.
33:38All right.
33:39Have a listen to your breathing.
33:40OK.
33:41Take a deep breath for me as deep as you're able to.
33:44Sorry.
33:45OK.
33:46Don't push it anymore.
33:47I'm sorry.
33:48Oh.
33:49Have you guys got morphine?
33:50Yeah.
33:51With David in serious pain.
33:53Where's that sore?
33:54Oh.
33:55Here.
33:56OK.
33:57It's critical Dr. Tom establishes if David's lungs are functioning normally.
34:00Because if they're not, his life is in serious danger.
34:03Oh.
34:04Oh.
34:05Oh.
34:06It's cold as well.
34:08A bit of sugar in the little bit as well.
34:21She's cold as well.
34:22A bit of shivering in the way as well.
34:24In Maidenhead, five-year-old Amelia has potentially had a seizure,
34:28possibly caused by sepsis.
34:30Critical care paramedic Dudley and Dr Jaspreet are on scene.
34:34We're going to get you a nice blanket.
34:36Yeah.
34:37The ambulance crew have already administered vital antibiotics
34:40to combat the sepsis and any underlying infection.
34:43Has she had a fever at all this weekend?
34:45No.
34:46Dr Jaspreet has to gather as much information as possible from Amelia's dad
34:50before any further treatment can be given.
34:53Has she been difficult to wake up?
34:54Today, yes.
34:55Any vomiting?
34:57Yes, a little bit, yeah.
34:58What happened exactly this morning?
35:00What did you notice?
35:01Well, I went to her.
35:03No, she wasn't responding.
35:04So she was already awake at this point?
35:06No, she wasn't awake then.
35:07Okay.
35:07She was just not responding.
35:10Amelia, hello.
35:12Hi.
35:12I'm Jas.
35:13I'm one of the doctors.
35:15Can I have a look at you?
35:16With all the facts,
35:17Jaspreet now needs to assess Amelia.
35:19She's going to have a look at your feet,
35:21and have a look at your legs.
35:23It's all right.
35:24Mummy's here.
35:24Mummy's here.
35:25I'm here.
35:26I'm looking after you.
35:27Let's have a look at this bit as well, Amelia.
35:33They're checking you, Amelia,
35:34so you can look at the skin.
35:36Let's have a look at this arm.
35:39Jaspreet is looking for a rash or blotchy skin,
35:41one of the signs of sepsis.
35:44Let's just have a quick look at your tummy,
35:46and I'll pop this down.
35:47Sorry.
35:47They work.
35:48You did a really good job, Amelia.
35:51Really good job.
35:53Should we pop this back down?
35:56All right.
35:56Can I have a look at your back quickly, Amelia?
35:59Amelia, look.
35:59The car is going to move now.
36:04Amelia, can I get you to just open your eyes for me?
36:08Amelia.
36:12Fine.
36:12No, nothing else to find.
36:14You can't breathe.
36:16They're large.
36:17Sorry.
36:18Amelia, can I get you to look at me?
36:20Can you turn your head towards me?
36:21That's it.
36:21Well done.
36:22Initially, it was reported Amelia had a stiff neck,
36:25another sign of sepsis,
36:27but that has fortunately eased.
36:29However, her pupils are still dilated,
36:32suggesting she has had a seizure.
36:33So, she looks okay at the moment.
36:39Sounds like she's had a seizure.
36:40Her observations are stable at the moment.
36:43I can't find anything obvious examining her.
36:46Peeples are large, but other than that,
36:48there's nothing else to sort of find.
36:51She doesn't seem to be, you know,
36:54having any sort of neck stiffness,
36:55no fever or anything like that.
36:56So, I think, essentially,
36:59it'll be another assessment in hospital.
37:02Dr. Jaspreet is satisfied Amelia is stable enough
37:04for the journey to hospital,
37:06with no further action needed on scene.
37:09Wexham, how far is that?
37:1120 minutes.
37:1120 minutes, okay.
37:13I think Wexham's appropriate.
37:14Yeah, yeah.
37:14Wexham reassess, travel with.
37:16You not want to travel?
37:18I don't think we need to.
37:19These guys are stable.
37:21She looks relatively well.
37:24Peeples are large, but nothing else to go in.
37:25They'll assess her in hospital,
37:27take some blood tests.
37:28She's stable.
37:29She looks stable to me at the moment.
37:31So, it's 20 minutes to the hospital.
37:34They'll see her in A&E there
37:35and probably do some blood tests
37:37and likely keep her in for the day at least.
37:41All right.
37:42Shall we let these guys get going then?
37:44Absolutely.
37:45Thank you so much.
37:46No worries. Take care.
37:48Whilst Amelia is driven to A&E,
37:51Dudley and Jaspreet are ready
37:52for their next emergency.
37:55In an ambulance in Bracknell.
38:08So, he does actually have quite good air entry that side.
38:11He's clearly not inflating the base of his lungs properly.
38:14Critical care paramedic Barry and Dr. Tom
38:16are attending to 65-year-old David
38:18who fell around six feet from a ladder
38:21while stringing up fairy lights around his hot tub.
38:23He now has multiple broken ribs
38:26with a possible punctured lung.
38:28Going up morphine, yeah? Fantastic.
38:30Let us know when you've got that ready.
38:32Just so everyone knows,
38:33he's been off oxygen now for a while
38:35and as you said,
38:36he's maintaining a saturation as well.
38:37So, I don't think we need to rush in
38:39to do any kind of chest procedures right now, do we?
38:41OK?
38:41Fortunately, no immediate intervention from the team is needed
38:45because David's breathing is satisfactory for now.
38:48He's got a nice, strong radial.
38:51That blood pressure is from...
38:53That's theirs, but it's been the same as we've been
38:56since we jumped on before.
38:56You've already got a monitoring on all over it?
38:58Our monitoring is coming back on.
38:59Any pain again?
39:00Oh!
39:00Is your tummy painful too?
39:03No, it's that side.
39:04It's that side.
39:05All right.
39:05Oh!
39:06OK, so to summarise,
39:08our primary survey,
39:09our concerns are of head injury.
39:12Currently alert or confused.
39:15We're worried about his chest
39:17and we think he could have a flail segment.
39:18He's definitely got some broken ribs posteriorly, hasn't he?
39:21Yeah.
39:21But right now,
39:22it's not compromising his ventilation very much
39:24and hemodynamically,
39:25he's actually OK at the moment as well.
39:28And this is more than an hour post-injury,
39:30so I think if he's bleeding really severely,
39:31we'd probably see signs of that by now, wouldn't we?
39:33Although Dr. Tom isn't ruling out internal bleeding,
39:36he's confident it's not a dangerous amount
39:38because the signs, including low blood pressure,
39:41would be clear by now.
39:42Priority is going to be to manage his pain better.
39:45So give some morphine.
39:46If we need to give other drugs, we can do.
39:48I'm going to give him five milligrams right now.
39:52Let's see how he goes.
39:53Yeah, I mean, his blood pressure's been nice and stable.
39:55He's an hour post-injuries.
39:56So I think once these medications are in,
40:00let's make our way, I think...
40:03This is morphine, one milligram.
40:04He's had five milligrams of morphine.
40:06Four, I've gone down to Trump.
40:08Where am I there?
40:09You're in an ambulance on the side of a roundabout in Bracknell.
40:12That's pain.
40:13Say again, sir.
40:14Pain.
40:15Pain, still there?
40:16No, it's bad.
40:17No, it's bad.
40:18Good.
40:19That's what we like, OK?
40:20So I'm just giving you some morphine,
40:22so that will continue to work as time goes on.
40:25And we've got more, we can give you more, OK?
40:30Morphine works by blocking pain receptors
40:32in the central nervous system and its fast acting.
40:35With David stabilised,
40:37he can be transferred to the trauma unit
40:39at Frimley Park Hospital around 15 minutes away.
40:43Just very gently, sir,
40:44I'm just going to slide you down the bed a small bit, OK?
40:46Yeah.
40:47Keep it pretty slow.
40:48Oh!
40:48What's your pain like now compared to before the morphine?
40:53A lot better.
40:55A lot better or not better?
40:56A lot better.
40:57Good.
40:58That's what you want to hear.
40:59David has to be securely strapped in
41:01to minimise any movement to his injured ribcage.
41:09Dave?
41:11Dave?
41:12A 65-year-old, mate.
41:13It's OK with you, sir.
41:14I'd like to get a little ultrasound probe
41:16and I want to have a look at your tummy and your chest.
41:18Is that OK?
41:19Just to see if you have any underlying injuries.
41:21Ready?
41:22About six feet.
41:24Using the ultrasound,
41:25Barry can see internal images
41:27and double-check David's broken ribs
41:29haven't damaged his lungs,
41:31as well as identify any other injuries.
41:34We bring you 65-year-old David
41:36who's fallen from a ladder.
41:37Meanwhile, Tom phones ahead to the hospital.
41:40Our main injury concerns
41:42are that he has got left-sided rib fractures
41:44and his main issue has been controlling his pain.
41:49His respiratory function
41:50has actually been surprisingly good
41:52despite his pain on inspiration
41:55and we have no other significant injury concerns.
41:58I'll see you in 10 minutes.
42:00I'm going to have a quick scan of your tummy.
42:01Is that OK?
42:02You have to rest your hands on your chest there for me.
42:04Good man.
42:07You're able to take a deep breath in if you can.
42:10Good man.
42:12Just going to do your other side now, sir, OK?
42:15Again, trying to get in between some ribs.
42:17Let me know now if I'm causing any pain
42:19on this side here, Dave, OK?
42:21We're happy with that, mate.
42:22I'll stop poking around the chest, Jim.
42:24Good scanning.
42:25Is there all right?
42:27Yeah.
42:27Well, Barry was making sure
42:29when we were scanning on the chest
42:31that your lungs aren't collapsed,
42:33that they're properly inflated,
42:35and that was a reassuring scan.
42:37Fortunately, the ultrasound confirms
42:39David's lungs are functioning normally
42:41and there doesn't appear to be
42:43any other internal injuries.
42:44I didn't see anything around the kidney on this side.
42:47I didn't see anything around the bladder,
42:48which is all reassuring.
42:49At Frimley Park Hospital,
42:56David is handed over to the emergency department
42:58for x-rays, further pain relief and observation.
43:01Thank you all.
43:03You are very, very welcome.
43:05So I think he probably has broken some ribs,
43:07and I think that's why he's in a lot of pain.
43:10We gave him some stronger pain relief,
43:13gave him some morphine,
43:13and that really seemed to make him more comfortable.
43:15He's now in hospital being assessed
43:19by the emergency medicine team
43:21and the trauma team.
43:45He's now in hospital being assessed
44:15in hospital being�
44:39Transcription by CastingWords
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