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Ambulance: Code Red - Season 4 Episode 6
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04:25Yeah, looks like it's so...
04:26Clear left, clear left.
04:30This is a bit of a mess, isn't it? There's cars going everywhere.
04:34Right.
04:36As soon as the critical care team arrive on scene,
04:40an ambulance paramedic briefs Dr James.
04:44He was about 35 miles an hour down this road.
04:47Cars come out, impacted. He's gone over.
04:50No loss of consciousness, no 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?
04:58His bike is that side of the car.
05:0541-year-old builder Travis was riding along Stoke and Church High Street
05:10when he crashed into a car.
05:11The impact sent him flying over the bonnet onto tarmac,
05:15landing around 10 feet away.
05:17So, yeah, he's gone inside and then over.
05:21Oh, I see.
05:22Rolled over.
05:23So, so his bike's there and he's gone over there.
05:26Yeah, this car's come out here, so...
05:27All right.
05:28So, you think isolated arm then, really?
05:30I 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,
05:34of course, generally kept him there.
05:36Initially, Travis felt okay and wanted to walk away,
05:39something the ambulance crew put a stop to.
05:41And his observations?
05:43Oh, yeah, heart rate was about 90.
05:45Love pressure was 1-1-10.
05:47Fortunately, Travis has both good blood pressure
05:50and 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?
06:00No, I'm not a T-shirt.
06:01Well, the thing is, we've done a lot of damage here.
06:06Okay.
06:06Yeah, and I'm quite worried that there might be something,
06:10quite a lot going on here, and you've already broken your arm.
06:13A dangerous motorbike crash, a fractured arm,
06:16and the possibility of further undiscovered internal injuries
06:19means 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.
06:46When the driving engine, he's falling down on the range.
06:48He's falling down, okay.
06:49Did you witness this?
06:51Yeah, I didn't, but I released someone on the range yet.
06:54Yeah, I didn't, but I didn't.
06:55Okay.
06:58Is the person doing CPR trained?
07:00I believe he didn't know what he's doing.
07:02Okay.
07:03So he needs to keep giving compressions,
07:05and they are coming to you as fast as they can.
07:11The report of a man unresponsive and having CPR
07:14means there's not a second to lose.
07:16So the specialist's life-saving skills of Dr. John Bailey
07:20and critical care paramedic Joe 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,
07:31but they can't get much more information from scene,
07:33so we've been sent on that basis.
07:36The caller said the patient fell and was bleeding from his nose.
07:40I don't know if that was before or after he fell,
07:41but he's only fallen from his own height,
07:43so he's just fallen from standing.
07:44Every year, around 400 people suffer cardiac arrests
07:51or have heart attacks on the golf course.
07:54Outside of hospital, cardiac arrest victims
07:56have a less than one in ten chance of survival.
08:00That was my golf bag, man, go to the left.
08:02Yeah.
08:03Right.
08:04Many people.
08:05Police.
08:05An ambulance crew is already on scene.
08:13You've got a Lucas?
08:14He's not in cardiac arrest at the moment.
08:16Oh, yeah.
08:17But they're with the Lucas inside.
08:18Amazing.
08:19A bystander has performed CPR,
08:21and the patient is currently breathing,
08:23but non-responsive.
08:24So, we were going to drive in range and just collapse down.
08:28Yeah.
08:28A few to S3 of our pupils are one unreactive.
08:31Yeah.
08:31All observations are in range.
08:33You're OK.
08:34You're all right.
08:35Yes, relax.
08:3664-year-old ex-serviceman Dusty
08:38was at a golf driving range for a practice session
08:41when he suddenly fell to the floor
08:43and has been unresponsive since.
08:46It'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 assess Dusty's airway
08:55is compromised.
08:56To keep his body oxygenated
08:58and prevent any further damage to his vital organs,
09:01they need to anaesthetise him
09:02and take control of his breathing.
09:04Let's create the space around, guys.
09:06We're turning around to the heads there
09:08so that we can have a look again
09:10and pin his airway in.
09:14He's got a lot of left-sided tone.
09:18This side is...
09:20Flaccid.
09:20This side's quite stiff, isn't he?
09:23Yeah, is he?
09:24Alarmingly, one side of Dusty's body appears stiff
09:27whilst the other isn't.
09:29Right, so he's probably had a stroke.
09:30Yeah.
09:31Suddenly, it's apparent Dusty isn't in cardiac arrest
09:35but has had a stroke.
09:37Blood flow and oxygen to his brain has been cut off.
09:40This can be fatal
09:41as it affects vital functions
09:43like breathing or heartbeat.
09:45Yeah.
09:45He's had a massive stroke.
09:47Yeah, she's breathing.
10:01Yes, she's breathing.
10:15Is she awake?
10:17Er, sort of.
10:17She's not responding to anything.
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?
10:27Fine.
10:29Okay, there's a 75.
10:30Are you able to lay her flat?
10:32Lay her flat on the floor.
10:34Flat on the floor on her side?
10:37Flat on her floor on her side.
10:38She's just puked on me.
10:45Move any vomit away from her mouth
10:46if she doesn't choke, okay?
10:48Is she still not responding to anything?
10:51Fine.
10:52Okay.
10:52We're just going to keep checking her breathing
10:54until we get there.
10:58An unresponsive, vomiting five-year-old
11:01is of serious concern.
11:02So the specialist skills of Dr Jaspreet Riott
11:05and critical care paramedic Dudley Mops are requested.
11:08I think they're going along the sepsis line.
11:11They said it's quite pronounced negligent
11:13in heritaphobia.
11:14They report no obvious seizure,
11:16but whether there may have been some
11:18without them present, they're not sure.
11:19An ambulance crew on scene
11:21are worried the child has sepsis,
11:23caused by the body in overdrive,
11:25fighting off infection.
11:26If it's not treated quickly,
11:28the body can attack its own organs.
11:30It can cause a seizure,
11:32but in the worst cases,
11:34catastrophic organ failure.
11:36At the moment,
11:37we've been tasked to a five-year-old
11:38skill that has come through as unconscious.
11:42The ambulance crew is carrying some antibiotics,
11:44like intravenous access
11:45and some fluids at the moment.
11:47Anyone with an infection can get sepsis,
11:50but antibiotics,
11:51if administered quickly,
11:52can control the underlying infection,
11:55stopping the body's
11:55life-threatening overreaction.
11:57So when we arrive,
11:59our priorities are going to be
12:00a quick but thorough assessment,
12:03trying to determine what the cause
12:05of the lay-conscious state is
12:06and whether or not this child needs
12:08possibly intubation and ventilation
12:11and seizure control.
12:13It takes just 13 minutes for Jaspreet and Dudley
12:24to arrive on scene.
12:31Hello, how are you doing?
12:32Yeah, just up the stairs.
12:33Cheers, buddy.
12:34Morning.
12:34Morning.
12:36Do you find the patient?
12:37How are you there?
12:38Dudley.
12:39Jazz.
12:39Five-year-old Amelia was in bed
12:41when she fell ill.
12:42Her mum, May, couldn't wake her.
12:44Fortunately, she's regained consciousness
12:46and the ambulance crew have quickly
12:48administered the vital antibiotics.
12:50Yeah.
12:50and a very, very stiff neck.
12:53We've not seen any rash.
12:54I can't see anything immediately.
12:56Signs of sepsis in children
12:57can include a stiff neck,
12:59rash, vomiting,
13:01bluish or pale skin
13:02and being lethargic
13:03or difficult to wake up.
13:05OK.
13:05Shall we...
13:06Go down?
13:07Go down.
13:07Yeah, as we are now.
13:08Go down.
13:08Go down.
13:09Take all the kit.
13:10Get on to the stretcher.
13:11Have a wee assessment there.
13:13The team decide Amelia
13:14is stable enough for now
13:15to be taken to the ambulance
13:17carried in her mum's arms.
13:19I don't like to stay.
13:20Do you want to bring her up here, man?
13:27Amelia.
13:28We're going to pop these seatbelts
13:30just round you.
13:31All right.
13:31Good job.
13:33Well done.
13:34Put that.
13:34And then this one's just going to come here.
13:37Good job, Amelia.
13:38Mummy's here.
13:39Mummy's here.
13:40And team, you had a BM
13:41and temp and stuff as well, didn't you?
13:44So...
13:44Yeah, temp was fine.
13:458 pyreptic.
13:46BM, 5.5.
13:47This has 100%.
13:49That's actually 100%.
13:50Oh, well done, guys.
13:52All over it.
13:52Pupils.
13:53Oh, 7s.
13:547s, pupils.
13:56I'll say 118.
13:57I'll say 119.
13:59A high heart rate
14:00combined with dilated pupils
14:02indicates Amelia might have had a seizure,
14:05possibly caused by sepsis.
14:07But because she's 5,
14:08Dr. Jaspreet needs all the facts
14:10before any further medical intervention.
14:13I'm quite worried that there might be
14:23quite a lot going on here.
14:24On the high street in Stoke and Church,
14:26Buckinghamshire,
14:27critical care paramedic Charlie and Dr. James
14:30are attending to 41-year-old motorcyclist Travis,
14:33who's been in a collision with a car,
14:35sending him flying 10 feet through the air
14:37onto the road.
14:38Heart rate, 74.
14:40Blood pressure, 117, 78.
14:43Have we got a pelvic binder handy?
14:45Just coming up.
14:46Brilliant.
14:47The team think he's fractured his arm
14:48and are extremely concerned
14:50he could have other undiscovered
14:52life-threatening injuries,
14:53including internal bleeding.
14:55Has he had any analgesia?
14:58I've not yet, no.
14:59He's not taken any 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.
15:07Yeah.
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?
15:13All right, we won't give you any cats.
15:14Put your right arm out for me.
15:16Are you putting an easy?
15:17Yeah, we are.
15:18Yeah, yeah.
15:19Squeeze as hard as you can.
15:20Your right hand.
15:22Squeeze my fingers and let go.
15:24All right.
15:25Cannular inserted.
15:27The critical care team
15:28can now take care of Travis's pain.
15:30Just keep nice and still for us.
15:33Right, this is just some salty water
15:34just 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.
15:40OK, 10's the worst pain you could possibly imagine
15:42and zero is no pain at all.
15:45Whereabouts would it be?
15:46Well, this is the most pain I've been in.
15:47OK.
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.
15:55But I might be being tough.
15:57I've got no doubt.
16:00I've got no doubt.
16:02While builder Travis puts on a brave face,
16:05Charlie prepares to administer
16:06the strong painkiller morphine.
16:08Do you feel sick at all?
16:10Um, yeah.
16:12OK.
16:12We'll get you something for that as well.
16:15You're going to have the full work?
16:16Yeah.
16:17Right.
16:18I'll just grab someone down.
16:19He's feeling a bit nauseous, James.
16:20Perfect.
16:20Before moving Travis onto the scoop,
16:23Dr. James performs a secondary assessment,
16:26checking for other potentially life-threatening injuries.
16:29Any pain around here at all?
16:30No, no.
16:31Oh, no.
16:32No.
16:32Any pain in here at all?
16:33Bad.
16:35No, carry.
16:35OK.
16:36There we go.
16:36OK.
16:36Any pain down here?
16:37Yeah, for my hamstrings.
16:39You're in your hamstrings.
16:40All right.
16:40And there's a few grazes there,
16:43but no long bone fractures.
16:45All right.
16:46OK.
16:47Excellent.
16:47Cool.
16:48So if we get one more person.
16:50James, you're happy that side of us three on 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.
17:04I'm just going to move your leg.
17:05James, you're going to put the scoop
17:06and the pelvic binder at the same time.
17:08Lovely.
17:09OK.
17:09When you're ready.
17:10OK.
17:11Travis, you need to stay nice and still
17:13and relax while we do this.
17:14OK.
17:15Ready?
17:16Yeah.
17:16Steady.
17:17Roll.
17:18Hold her.
17:18You're OK.
17:19Relax.
17:19One half of the scoop is placed underneath Travis
17:23with a binder also in position to support his pelvis
17:26should it be broken.
17:28OK.
17:28OK.
17:29I'm ready.
17:29Steady.
17:30Roll.
17:32OK, lovely.
17:33We're going to do the same thing the other way this time.
17:36Everyone ready again?
17:37Yeah.
17:38Ready?
17:39Steady.
17:39Roll.
17:40Roll.
17:41Well done.
17:42Well done.
17:43Point.
17:43Point.
17:44Just grab this binder, James.
17:45See you back.
17:47Yeah, they just bind out.
17:50Here we go.
17:52It's on.
17:53Ready?
17:53One, two, three, one.
17:54Lovely.
17:55Cool.
17:56I'm going to put some blocks on round your head
17:58so that I don't have to hold your head for the whole way to hospital.
18:02Further supportive blocks are positioned to support Travis's head
18:05as it's vital to stop him moving, preventing damage to his neck and spine.
18:09It's nice and tight.
18:10Pull it that way.
18:11Well 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 feel like I'm on the truck.
18:23Travis, is that OK now?
18:24Yeah, why are you doing this to me?
18:25Sorry.
18:25It's just to protect your pelvis.
18:27Yeah, but I'm all right.
18:28Sorry, Travis.
18:29That's all sorted now, mate.
18:30Well, I don't know, yeah?
18:31You need to have a scan to...
18:33Yeah.
18:33...to bring this to me.
18:35Potentially, yeah.
18:36The only thing we can be concerned of at the moment is there's something going on with your 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 be packing you up like this, OK?
18:49Travis is securely strapped onto the scoop to ensure he can't move,
18:53minimising the risk of further injury to his body.
18:56What we're going to do, we're going to lift you up and put you on a stretcher to move you onto the ambulance.
19:01Ready?
19:02Study.
19:02Lift.
19:03Oh.
19:04Are these painkillers going to cut in or what?
19:07Safely on the stretcher.
19:09Have they not done so?
19:10No.
19:11One fucking hand is killing.
19:12We'll give you some more.
19:14Travis can now be moved to the ambulance.
19:17Oh, my legs.
19:20Sorry for my throat.
19:22There we go.
19:23All in.
19:25Right, I'll give you some more painkiller, OK?
19:29Charlie, what do you want to do now?
19:31We're just going to have some on Danzatron.
19:32Is that TXA?
19:33TXA.
19:34Two grams.
19:35Danzatron.
19:36I'm done.
19:36Super.
19:37It's blood.
19:37On Danzatron is an anti-sickness drug to counteract any nausea that can sometimes affect patients after 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.
19:58Oh, my legs.
20:01Feels like I've run a marathon.
20:03Is it broken?
20:04I don't think...
20:04You're just having a little look now.
20:06Down here.
20:07Is there a sore down here at all?
20:08Yeah.
20:09Yeah.
20:09It's been broken at the moment for.
20:12Does that feel nice on your arm?
20:14Does it feel supported?
20:15Well, not really.
20:16Right, 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?
20:30Can I come?
20:31You are definitely coming.
20:32Stay there, Thomas.
20:34There's a lot of damage to the bike and a lot of damage to the car.
20:37But actually, as far as we can determine, his primary cellway, his airway, breathing, circulation and disability are all fine.
20:44And he may or may not have a fracture of that arm, but it's hard to tell.
20:49And he's got normal observations.
20:52Are you guys happy to convey him for the John Redcliffe?
20:54Yeah.
20:55It appears Travis has had a lucky escape and is stable enough to be taken to hospital.
21:00Lovely.
21:01We'll leave you.
21:02Travis, we're going to disappear.
21:03Thank you very much.
21:04Leaving the very, very capable hands of the Assembling's crew.
21:06No problem at all.
21:07Thank you.
21:08No worries.
21:08Thanks, Charlotte.
21:09No worries.
21:10Take care.
21:10Have a good day.
21:10You too.
21:11The critical care team have done all they can for Travis, so scans in hospital are the next priority.
21:19Charlie, do we need anything else here or can we let these guys get on their way?
21:21Absolutely.
21:26We go to quite a lot of motorcycle accidents and you never really know what you're going to expect.
21:31So we were reassured that he'd not got any immediately life-threatening injuries and our colleagues in 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, can we just move him into a position where you can choose a golf?
22:03Dr. John and critical care paramedic Joe attending to 64-year-old Dusty, who's had a massive stroke, 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.
22:19Yes.
22:20Has he got an eye job?
22:25A stroke could compromise Dusty's ability to breathe, because the brain fails to tell the body it needs to.
22:32The team needs to take control.
22:34First, a temporary eye gel tube is inserted to open his airway.
22:41I've done all the kit, it's just drugs now.
22:44Yes, it'll be fentanyl, ketamine, rocuronium.
22:47The strong drugs fentanyl, ketamine and rocuronium will be administered to anaesthetised Dusty before 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 dealing with.
23:00Stable blood pressure is key when a patient is sedated to ensure adequate oxygen is delivered to 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.
23:16Just because it means we can position him a bit more effectively.
23:19Maybe if we could start getting the scoop ready.
23:23I feel like that for a second, but once we get there, if you could just hold it 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 intubation known as FEE, or pre-hospital emergency anaesthetic.
23:44All right, we'll 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.
23:59Thank you.
24:00Now in V2.
24:01All right, Dusty.
24:02We've got his arm there.
24:03So he's now, I 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.
24:13Dusty's body isn't receiving enough oxygenated blood.
24:17Often a side effect of a stroke.
24:18It'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?
25:21Right.
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 spatial position?
25:31I have.
25:32Acceptable IV access, so 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, prime laryngoscope.
25:45Four and tested and working.
25:46OK, so I'm going to give him some fentanyl now, OK?
25:58Thank you.
26:00Can't just be aware he might stop spontaneously ventilating.
26:03OK, the remainder will be two per kilo of ketamine.
26:08Yep.
26:09And then the whole of the rock you're in.
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 is BT.
26:21Now, that is BT.
26:21It's full BT.
26:22It's full BT.
26:23Just as they are about to start, Dusty's heart speeds up again.
26:27You won't do induction while he's in BT.
26:28No, no, no, no.
26:30All right, so we're now self-reverted.
26:32Self-reverted.
26:33Fortunately, moments later, his heart self-reverts back to a more regular rhythm,
26:38meaning the team can proceed with intubation.
26:40But that was, that probably was an episode of BT when we thought it was.
26:44OK.
26:45That makes sense.
26:46OK.
26:47Dr. John administers ketamine, an anaesthetic drug.
26:51Full recipe mix.
26:52Still got spontaneous respiratory effort.
26:56Right, rock going in now.
26:58Rocuronium 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
27:08and avoid damaging the vocal cords.
27:12Grade two of you.
27:14Make that a grade one of you.
27:16Foogee, please.
27:17Foogee.
27:20Just leave us through the cords.
27:22A little bit of coughing and gagging.
27:23OK.
27:24I have the Foogee.
27:25I have the tube.
27:28Foogee, please.
27:31Foogee.
27:32We have misting.
27:35We 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.
27:49We, er, start loading.
27:52Yes.
27:52Let's get loading and get him secured in there.
27:54And quickly transfer to the ambulance.
27:58How are we doing?
27:59Doing good.
28:00Have a couple of hours loaded with E2.
28:02Although in critical condition, Dusty is stable for now.
28:06That's wrong.
28:07On the journey to the John Ratcliffe Hospital, the critical care team closely monitor him and keep him safely anaesthetised.
28:16When 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.
28:46But 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?
29:25Yes, he is.
29:25And is the patient awake?
29:27He is, yes.
29:28Can you hear what's the main music for the call, please?
29:29He's fallen off a ladder and he's lying on the ground.
29:33He's had a bad bash to his 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.
29:51Shut up.
29:51I'm in pain.
29:53Ah!
29:53Did someone...
29:53Ah!
29:55Ah!
29:55And sometimes breathe.
29:57So, there's got the appropriate help arranged, okay?
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.
30:28Okay.
30:29He's also got an internal defibrillator from a previous cardiac arrest.
30:33Crew 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've 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.
31:03And this 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.
31:18The crew have just booked leaving scene.
31:21Okay.
31:22Okay.
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
31:31critical care team on the way to hospital, rather than delay.
31:35Come on, baby, man.
31:37Let's go on, baby.
31:45Hi, team.
31:47Hi, guys.
31:4865-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 axilla.
32:02Okay.
32:02Sad, so even 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 had very conscious levels throughout.
32:13Okay.
32:13He's had a gram of IVP.
32:14He's had two grams of TSA.
32:16He's had four of undanodontrol.
32:18Okay.
32:19You guys are actually smashing it.
32:20Two points of access.
32:20The ambulance crew have administered intravenous paracetamol, as well as drugs to help prevent
32:26excessive internal bleeding.
32:28Okay.
32:28If it's all right with you, I'm going to repeat a primary survey quick.
32:30Yeah.
32:31So we can see it right now.
32:32Yeah.
32:32Okay.
32:33Hello, Dave.
32:34Hello, sir.
32:36My name is Tom.
32:37I'm one of the doctors.
32:38How are we doing?
32:40Oh.
32:40Yeah, I'm sorry this is happening.
32:43All a bit scary.
32:45Yeah.
32:45Do you know where we are?
32:47No.
32:47Okay.
32:48You're an ambulance at the moment.
32:50Okay.
32:51Dr. Tom needs to assess David for any other injuries and ascertain if he does have a potentially
32:57life-threatening flail chest.
32:59Have you got pain anywhere?
33:01Yeah.
33:01Where's your pain?
33:03Yeah.
33:04No.
33:05Yeah.
33:06Can you squeeze my hand?
33:07Yeah.
33:08Squeeze this hand for me.
33:10Squeeze this hand.
33:11Okay.
33:12All right.
33:12Thank you.
33:13Well done.
33:14So 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 segment?
33:25It is just kind of part C. It's almost on his back down here.
33:29He's got this breathing.
33:31Posterior.
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.
33:36Okay.
33:37All right.
33:39Have a listen to your breathing.
33:40Okay.
33:41Take a deep breath for me.
33:42Deep as you're able to.
33:44Sorry.
33:45Okay.
33:45Don't push it anymore.
33:46I'm sorry.
33:47Have you guys got morphine?
33:49Yeah.
33:49Can we draw up this?
33:50With David in serious pain.
33:52Where's that sore?
33:54Here.
33:55Okay.
33:55Okay.
33:55It's critical Dr. Tom establishes if David's lungs are functioning normally, because if they're
34:00not, his life is in serious danger.
34:03She's cold as well.
34:22You're a bit shivering as well.
34:24In Maidenhead, five-year-old Amelia has potentially had a seizure, possibly caused by sepsis.
34:30Critical care paramedic Dudley and Dr. Jaspreet are on scene.
34:34We're going to get you a nice blanket.
34:36The ambulance crew have already administered vital antibiotics to combat the sepsis and
34:42any underlying infection.
34:44Has 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 before any further
34:51treatment can be given.
34:53Has she been difficult to wake up?
34:54Today, yes.
34:55Any vomiting?
34:57Yes.
34:57A little bit, yeah.
34:58What happened exactly this morning?
35:00What did you notice?
35:01Well, I may have waited 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.
35:13I'm Jas.
35:13I'm one of the doctors.
35:15Can I have a look at you?
35:16With all the facts, Jaspreet now needs to assess Amelia.
35:19She's going to have a look at your feet, have a look at your legs.
35:23It's all right.
35:24Mommy's here.
35:24Mommy's here.
35:26I'm looking after you.
35:28Let's have a look at this bit as well, Amelia.
35:37Let's have a look at this arm.
35:39Jaspreet is looking for a rash or blotchy skin, one of the signs of sepsis.
35:44Let's just have a quick look at your tummy.
35:45And I'll pop this down.
35:47Sorry.
35:48They work.
35:49You 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.
36:03Amelia.
36:04Amelia, can I get you to just open your eyes for me?
36:08Amelia.
36:09No, nothing else to find.
36:14They'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, another sign of sepsis, but that has
36:28fortunately eased.
36:29However, her pupils are still dilated, suggesting 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.
36:46Pupils are large, but other than that, there's nothing else to sort of find.
36:50She doesn't seem to be, you know, having any sort of neck stiffness, no fever or anything
36:56like that.
36:58So, I think, essentially, it'll be another assessment in hospital.
37:02Dr Jaspreet is satisfied Amelia is stable enough for the journey to hospital, with no
37:06further action needed on scene.
37:09Wexham, how far is that?
37:1120 minutes.
37:1120 minutes.
37:12Okay.
37:12I think Wexham's appropriate.
37:14Yeah, yeah.
37:14Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:15Wexham, really.
37:16You not wanting to travel?
37:18I don't think we need to.
37:19These guys have a house.
37:20She's stable.
37:21She looks relatively well.
37:24People to large, but nothing else to go in.
37:26They'll assess her in hospital, take 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 and probably do some blood tests and likely keep her in
37:39for the day, at least.
37:40All right.
37:42We're going to let these guys get going, then.
37:44Absolutely.
37:45Thank you so much.
37:46No worries.
37:46Take care.
37:47While Amelia is driven to A&E, Dudley and Jaspreet are ready for their next emergency.
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41:33Nói bằng tôi có hai lẽ của nơi tông.
41:37Pydd tập phòng xảy ra khu.
41:40Nói bây giờ thì ông ấy phụ các rzet thêm khu.
41:40Nói bây giờ thì là người có một trái tim phối xảy ra.
41:43Nói bên đây thì là người sợ hỗ trợ.
41:45Chỉ này là người sợ hỗ trợ.
41:47Nói bây giờ thì hỗ trợ.
41:48Nói bây giờ thì được tượng nát.
41:49Điều đó là một cách rất vấn đặc nữ.
41:52Nhưng mà không tiếng của công việc này.
41:53Cảm ơn cũng đã là một người sợ hỗ trợ.
41:56Nói bây giờ thì là người sợ hỗ trợ.
41:58Có một điều này hỗ trợ.
42:00Thông tin được, hãy đăng ký kênh của mình để tìm kiếm.
42:02Để tìm kiếm tồn, anh có thể tìm được.
42:04Cảm ơn.
42:05Cảm ơn.
42:07Để tìm kiếm một bước bước, nếu mà có thể.
42:10Cảm ơn.
42:11Mình sẽ làm cái giữa bên đằng sau.
42:14Để tìm kiếm đằng sau.
42:17Để tôi biết, nếu tôi có thể tìm được lòng, đằng sau đây.
42:21Chúng tôi sẽ hạnh phúc đó.
42:22Chúng tôi sẽ hạnh phúc đó.
42:24Bước đi.
42:25Bước đi.
42:26Thưa bước đi.
42:27Ừ.
42:27Well, Barry was making sure when we're scanning on the chest that your lungs aren't collapsed.
42:33That they're properly inflated and that was a reassuring scam.
42:37Fortunately, the ultrasound confirms David's lungs are functioning normally
42:41and there doesn't appear to be any other internal injuries.
42:45I didn't see anything around the kidney on this side.
42:47I didn't see anything around the bladder, which is all reassuring.
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