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00:00En el mundo de emergencias de medicinas
00:03No, no es nada más extrema
00:08Los ojos son blusos
00:10Que un gran peligro de vida
00:12Massive, massive burn
00:14Respondiendo a la más grave 999
00:18La señora está reportando pain en la cabeza
00:21y se está menos hablando
00:23La vehículos de la Tames Valley Air Ambulance
00:26Las personas han tenido un cajillo
00:27La persona está en el centro de la cabeza
00:29...delivering life-saving medical treatments.
00:32The big decision is for us whether we need to put a tube in there 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, Dallin.
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 it's fast?
00:59Potentially, yeah.
01:01And wherever.
01:02Oh, my leg.
01:03It's needed.
01:04You are doing a fantastic job.
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 tube.
01:15We captured every vital second.
01:18That's okay. You're safe.
01:20As these highly trained critical care teams.
01:22Can 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.
01:32Let's go, go, go.
01:33Tonight, a broken and dislocated ankle.
01:37The biggest risk here is I won't be able to get his ankle back in.
01:39Leaves an elderly man facing life-changing consequences.
01:42It's very unstable and spontaneously re-dislocated.
01:48A seizure puts a young boy in serious danger.
01:51The decision is whether we need to put a tube in to protect it that way or not.
01:55Multiple injuries and amnesia.
01:57I literally, like, woke up thinking I'm not aware of this.
01:59Yeah.
01:59For a motocross rider after a crash at speed.
02:02I can't tell you, like, right now, everything is going to be fine.
02:05And...
02:05I feel I'm going to conk out.
02:07A climber's arm is crushed after a fall.
02:10You see yourself...
02:11Ow, s***!
02:12That hurts!
02:27Hamlet's emergency.
02:29Patient breathing?
02:30Yes, I'm breathing.
02:32To your patient?
02:34Yes.
02:34Thank you.
02:35Can I ask no reason for the call?
02:36I think I've broken my ankle.
02:38My foot is sticking out at 90 degrees to my leg.
02:41But you've fallen.
02:42What's happened?
02:44I don't know.
02:45I just woke up on the floor by the bottom.
02:48My foot is sticking out at 90 degrees.
02:50And I take it you're still on the floor?
02:53I'm on the floor.
02:54Okay.
02:55Do you know how long we've been on the floor, sir?
02:57Do you know how long?
02:58No idea.
02:58No idea.
03:00Yeah?
03:00Okay.
03:01Okay.
03:01Any other multiple major injuries that you've got in mind, then?
03:06Okay, what was it that had to pay?
03:11Hello, can you hear me?
03:15Hello, can you hear me?
03:19A loss of consciousness and a badly broken ankle is an emergency that requires the advanced skills of the critical care team.
03:26So, in addition to an ambulance, Dr. John Bailey and critical care paramedic Andy Ludlow are dispatched.
03:34So, we're on our way to a court that's for a man who's woken up on the floor, not sure how long he's been there, with his ankle facing in the wrong direction.
03:46Fractions can be serious injuries.
03:48However, the loss of consciousness could be a bigger concern.
03:51Clearly, breaking your ankle is reasonably stimulating, as experiences go, so it's unusual to do that whilst unconscious and not realise.
03:58So, he must have been genuinely unconscious, which probably means he's had some kind of dysrhythmia or maybe a seizure.
04:07There's a bit more to consider in terms of what's happened to him medically around what's caused him to get the fracture.
04:12An ambulance crew is already on scene and updates John and Andy.
04:19The last thing he remembers is getting up, going to the bathroom, and then he woke up on the floor, has bumped his head, doesn't know what on, can't remember the fall at all.
04:29Semi-retired CEO Dave was looked after by his wife Sally and their housekeeper Helen until help arrived.
04:36BP is high.
04:37Okay. I'm not surprised your BP is high. Hello.
04:42I am. My name's John Bailey. Hi.
04:45John.
04:45How you doing?
04:47Pretty uncomfortable.
04:49You don't remember anything about what happened?
04:51No, I passed out.
04:53Is it dislocated?
04:54Probably fractured and dislocated.
04:56But we need to straighten that out.
04:59First, John needs to consider Dave's loss of consciousness.
05:02And you've been having a few episodes where you've been passing out.
05:05One at the beginning of May.
05:07Yeah.
05:07And one on Monday.
05:09Yeah.
05:10Have you seen anybody about that yet?
05:12I would expect you to have an ECG at my doctor's next Friday.
05:16Well, you're definitely going to get one today.
05:19If the ECG reveals a problem with Dave's heart, it could have serious complications for how they treat his ankle.
05:25Get an ECG to make sure he's not got some drastic abnormality.
05:28The Thames Valley Air Ambulance Charity has a team of 34 doctors, all trained in pre-hospital emergency medicine.
05:40When Dr. Manjit Riyat isn't with the critical care team, he works in intensive care at Oxford University Hospital.
05:47So I do two weeks, basically two weeks in the hospital, and then two weeks here.
05:52The jobs that we have here probably are more challenging, like managing a cardiac arrest sort of on the floor, propped up against a radiator in a narrow corridor where you've barely got access to some of the patient's torso and airway.
06:04It is much more difficult.
06:06There's things that you just take right after the hospital.
06:08Today, Manjit is on shift with critical care paramedic Hannah Hurst, responding to code red calls over a patch of more than 2,000 square miles.
06:30Ambulance emergency, is the patient breathing?
06:34Yes, in the middle of having a spirit.
06:36Right, okay. How old is the patient?
06:38Twelve.
06:39Okay, how long has he been sitting for?
06:41I don't know, because I've just come in, because I've heard some funny noises. He's been asleep.
06:45I just want to track his rate of breathing together to make sure it's all right.
06:49When I say go, you can watch him closely and say now, every time you take the breath in, until I tell you to stop.
06:55Yep.
06:56Go.
06:58One.
06:59Going for me?
07:00Two.
07:01Keep going for me?
07:03Three.
07:04Thank you. You can stop now.
07:05That helps in a range of the beginning of the call.
07:09Caused by sudden and abnormal changes to electrical activity in the brain, seizures can be life-threatening.
07:16Manjit and Hannah are dispatched.
07:18Just two minutes away, they arrive ahead of the ambulance.
07:23Hello.
07:23I'm Hannah. This is Manjit. Who's this?
07:28This is Louis.
07:29Hello, Louis.
07:31Twelve-year-old Louis was found unresponsive in his bed by his younger sister, who alerted their mum, Georgie.
07:37Okay. Tell us the story, then, Mum.
07:40So, he had a TBI in September 23.
07:42Yeah.
07:43He was run over by a car.
07:45Um, was on, in a coma for eight days.
07:48Yep.
07:48Then he was fine.
07:49And then, October last year, he had the first ever seizure that he's had at school.
07:54Yep.
07:55Was fitting for, well, they think it was over 30 minutes.
07:58They put him to sleep at school.
07:59Yep.
07:59Took him back to hospital.
08:00Yep.
08:00And this is the first time it's happened since October.
08:03The TBI, or traumatic brain injury, left Louis with the most extreme form of epilepsy.
08:09This causes prolonged non-convulsive seizures and fitting, which can be life-threatening.
08:15I don't know how long he's been fitting for.
08:17Okay.
08:17Me and my daughter just up, and she said she could hear some funny noises.
08:20Yeah.
08:20So, I came in and found him.
08:21Okay.
08:21Found him fitting.
08:22I don't know when it started.
08:24It's over 11 minutes since Louis' mum realised something was seriously wrong and raised the alarm.
08:29First, Manjit and Hannah need to carry out a quick assessment.
08:34So, I think he's still fitting.
08:36Yeah, shall we get...
08:37Yeah.
08:38Sats are reading at 57.
08:40Louis, I'm just going to pop a little bit of oxygen on for you, my darling.
08:45It's just going to be a little mask over your nose and mouth, okay?
08:50Oh, you can probably hear my colleagues arriving as well.
08:54It's moving a little bit.
08:57How's the chest sound?
08:57It's clear on the left-hand side.
09:00It's got a little bit wheezy on the right-hand side.
09:02I would say his refs are quite irregular, though.
09:04Okay.
09:04Quite slow.
09:06Yeah.
09:06I'll get you some of the dabs.
09:08Louis' brain functions, including those that control his breathing, are being disrupted,
09:13resulting in his low oxygen levels.
09:16Muscle spasms in his chest and throat are making it hard for him to breathe.
09:20It was one of those things where my daughter goes,
09:22can you just check with him, Mum?
09:23He's not standing, Mum.
09:24Oh, bless him.
09:26You might be in a bit of a sharp scratch, all right, mate?
09:28Just try and hold nice and still.
09:30You're doing really well.
09:31Well done.
09:31The team needs to act fast.
09:35A portable ultrasound scanner allows Manjit to quickly find and insert a cannula into
09:40Louis' tiny veins.
09:41There's five.
09:44Thank you.
09:457.9 BM.
09:47So that's a 9.98.
09:48Excellent.
09:49Manjit is giving Louis midazolam, a powerful, fast-acting anticonvulsant, to help bring his
09:55seizures under control.
09:56Just going to get you feeling a bit better, all right.
10:00Going to make you quite sleepy.
10:02Stop these seizures.
10:04Okay, that's five in and flushed.
10:06With his breathing already compromised and his brain at risk of damage, as long as he's
10:11seizing, Louis' life is in danger.
10:15Just going to have a look at your eyes.
10:26It's 7 a.m. on Sunday morning, and Dr. Martin Weller and critical care paramedic Joe Jeffries
10:42are preparing for their shift.
10:44Nice.
10:45Yeah.
10:46All been.
10:46On duty for the next 10 hours, Joe is predicting a busy day ahead.
10:53We've had two weeks of warm weather, so we tend to think that that brings people out doing
10:58sort of leisure activities and out and about walking, cycling, doing what they do.
11:05So sometimes I think these Sundays are a little bit busier, but I might add that today is the
11:11sort of end of the hot forecast, so maybe people are more inclined to get out today ahead of
11:17the rain.
11:32Ambulance emergency, is the patient breathing?
11:35Yeah, the patient's breathing.
11:37I just had a crash, I'm all about a crash out of here.
11:38It's a trap.
11:40She's got quite serious bumps to the head, though, the front of the head.
11:43All right, thank you.
11:44I think there was a short spout of where he went unconscious.
11:47And he told me he's cracked, or he told me that he was cracked up.
11:51Yeah, thank you.
11:51Okay, so your call has been categorized as a high priority.
11:54We are on our way on Dulac and Siren.
11:58A motocross rider has crashed at speed and knocked unconscious.
12:02Martin and Joe are dispatched and updated via messaging.
12:06Motocross, sir, I went over to jump, about 40 miles per hour, knocked out, and I'm complaining
12:11of chest and leg injuries.
12:12Uh-huh.
12:13He has what is described as a large deformity on his head.
12:16Oh.
12:17All right, he's stopping.
12:19Yeah, you're good.
12:20Thank you.
12:21With speeds up to 60 miles an hour on off-road terrain, motocross is a high-risk sport.
12:28Injuries are common and often serious, varying from broken bones to life-threatening trauma
12:33to the head and spine.
12:34Six-five, hello.
12:36Hello.
12:36Hi.
12:36You all right?
12:37Death from this was initially unconscious, quite a large mechanism.
12:42Do have a cruise side, but they're coming from quite a distance.
12:45They're 30 minutes away at the moment, 3-0.
12:47Yeah, cool.
12:48That's all right.
12:48Cheers, mate.
12:49Thank you, guys.
12:49Thanks.
12:49Bye-bye.
12:50In the UK, there is a hospital admission for a head injury every four minutes.
12:55Unconsciousness after a blow to the head is dangerous, as it can signal swelling or trauma
13:00to the brain.
13:01It looks like somebody's expecting us, which is good.
13:04First to arrive at the scene, Martin and Joe are greeted by one of the other riders.
13:10He's down on the bottom.
13:11I'll see you guys on that far left.
13:13Okay, thank you.
13:14I assume you'd be somewhere in there.
13:16I'll probably in the van.
13:20Let's take these two and then we'll decide everything else once we've seen him.
13:25With the help of his friends, the injured rider has made it back to his van.
13:29Hello there.
13:30Martin and Joe.
13:31You're the one who's done the jumping and the falling.
13:34What's your name, buddy?
13:34Hello.
13:35Charlie.
13:36Hello, Charlie.
13:37Where are you most sore?
13:39My head.
13:40My hips.
13:41Yeah.
13:43My arm.
13:44That's a little bit.
13:44Yeah.
13:45Okay, fine.
13:46Obviously, where did you fall at?
13:47Just right on the track?
13:48Did you jump at the back?
13:49At the back.
13:50And you walked all the way back here?
13:52Yeah.
13:53Or did you walk in back?
13:55Did you?
13:55Okay, gotcha.
13:56Do you remember doing the jump?
13:57No.
13:58Or not?
13:58I remember hitting there.
13:59Yeah.
13:59I couldn't get anything.
14:03And then I must just like nose by crack.
14:06Do you mind if I check you over?
14:07Is that all right?
14:07And we'll take some observations.
14:09Short-term memory loss after an impact to the head is a sign of a concussion, but could
14:14indicate a more serious brain injury.
14:16Any pain in the middle of your neck yet?
14:18No, that's fine.
14:19And then can you pull this up for me?
14:20Is that okay?
14:21I want to have a good look at your chest.
14:25Just a little bit feel around that.
14:26Is that sore when I'm pressing anywhere?
14:28It's a little bit sore, yeah.
14:29Both sides?
14:30Not really, like, really.
14:31Yeah, that hurts.
14:31Which side?
14:32The front.
14:33The front?
14:34Okay.
14:34Charlie's body has hit the ground at high speed with little protection, so Martin must carry
14:41out a head-to-toe assessment.
14:43Any pain in the middle of your spine?
14:46Nah.
14:47Nah, that's okay?
14:47How about your tummy?
14:48Is that okay?
14:49Okay, so that's sore when I press on there, but you were able to walk on it, were you?
14:52Yeah.
14:53Okay.
14:54And when I just squeeze your arms, that's whereabouts?
14:58Down there.
14:59The crash has left Charlie with injuries to his head, chest, leg, and arm, but it's the
15:04risk of brain trauma that is the biggest concern.
15:08It's more just like, I'm just in a different way.
15:11Well, to be honest.
15:21We're getting to move your position slightly in a minute.
15:24In Reading, critical care paramedic Andy Ludlow and Dr. John Bailey are with Dave, who
15:29has a badly broken ankle after a fall.
15:33There we are.
15:34So, have we got some fentanyl?
15:36The last thing Dave remembers is going to the bathroom and then waking up on the floor
15:40with his ankle facing the wrong way.
15:44I'll start feeling a bit better in a couple of minutes' time.
15:47That's fentanyl, which is sort of a faster axial version of morphine.
15:52Do you mind grabbing some hands on?
15:54We're just coming a little further away from the top here.
15:56There we go.
15:57There we go.
15:58Okay.
15:59You're shuffling.
16:00Oh, well done.
16:01That's it.
16:02I think this is how he got here, isn't it?
16:03Yeah, he shuffled on his bum up to the bed.
16:05There we go.
16:06Okay.
16:07Lie yourself down again.
16:08The pillows are behind you.
16:09It could be several hours since the injury happened.
16:12If the blood flow in Dave's foot is compromised, then it's at risk of permanent damage or amputation.
16:19He has actually got a pulse on that.
16:20And it is quite warm.
16:21But it clearly can't stay that way because of the skin.
16:24Yep.
16:25So we'll sedate him and pull it straight.
16:28The blood supply appears to be healthy, but it's a particularly bad break.
16:32This will be quite difficult to reduce because I think his entire tailer joints there.
16:36John suspects that Dave's ankle is broken and dislocated, making realignment difficult and painful.
16:42To complicate matters further, there's an additional concern.
16:46Of course, there's a lot of pressure on the skin.
16:48We need to be able to reduce the ankle to take the pressure away from the skin,
16:52otherwise the skin itself will start to break down, and that then can cause a problem with an open fracture later on.
16:57So we'll sedate him here, reduce it, and then once that's done, package him up,
17:02let him recover from the sedation and go to the local hospital.
17:05Right.
17:06The team must act quickly.
17:08But Dave can't be sedated until they're confident his collapse wasn't caused by a problem with his heart.
17:14We're just looking at your heart rhythm.
17:16ECG's coming, that's it.
17:17Right.
17:18QRS is fine.
17:19That'll do.
17:20An ECG of Dave's heart is all clear.
17:23Right, Dave, I've got to put this mask on you, OK?
17:26So the team can proceed with the sedation.
17:29You won't feel strained straight away.
17:32Give it a minute or two, and it'll start feeling a bit weird.
17:35When you wake up, your pain will have gone away, OK?
17:39Your ankle will be straight, right?
17:41Yeah, well, as long as we've been able to reduce it, which I'm reasonably sure we will be able to,
17:46you, then your ankle will be straight.
17:48Is it protein or is it just this?
17:50It's both of those things.
17:52Andy's administered ketamine.
17:54A strong sedative that will allow John to try and straighten Dave's ankle without causing him distress.
18:00Dave, you're still with us?
18:02Open your eyes, Dave.
18:03A bit in the stagmus now, but still aware.
18:07You're very safe.
18:09Can you squeeze my hand?
18:11You're still with us, sir?
18:13Can we pull it in here?
18:14I think.
18:15You can hear it.
18:16No.
18:17OK.
18:18So the biggest risk here, realistically, is that I won't be able to get this ankle back in,
18:21which means I'm going to have to pull it really, really hard.
18:23So when we do that, if I have to, I'm going to stand up, and then I'm going to pull him with me standing,
18:29and him still on the floor.
18:30If we get to that point, you need to hold his pelvis.
18:33So basically, whoever's going to support him, just keep his pelvis on the floor, and I'll pull against that.
18:37The harder John has to pull Dave's ankle, the greater the risk of the skin rupturing,
18:41which could lead to infection and even loss of his foot.
18:52Well done.
18:53You're very safe.
18:57No, I don't think I can reduce it.
19:07I'm just going to pop this on your arm.
19:10It's going to go a bit tight.
19:13In Stoke and Church, Dr. Manjit and critical care paramedic Hannah are treating 12-year-old Lewis,
19:19who has had a seizure and is struggling to breathe.
19:22The numbers are heart rate is 111.
19:25Sats are 99 on the 15 litres.
19:28We've got a respirator of 8, end tidal 4, BP 12664.
19:33Two years ago, Lewis suffered a traumatic brain injury
19:36that left him with a rare and severe form of epilepsy.
19:39OK, so I've got 3 grams of Keppra in 100ml. Happy?
19:43Happy.
19:44An ambulance crew is now on scene.
19:46The intravenous infusion of Keppra, an anti-epileptic drug,
19:50will also help to stop Lewis's seizure while they transport him to hospital.
19:58OK, nice and easy.
19:59Just keep coming.
20:00OK, one, roll.
20:01Ready, steady.
20:02Roll.
20:07OK, OK, OK, OK, OK.
20:09Coughing and gagging.
20:11OK.
20:12Shall we get suction?
20:13Yeah.
20:14One of the biggest dangers of the seizure
20:16is that Lewis can't control his body's gagging cough reflexes.
20:20So, just because he's had this vomit,
20:22the main thing we need to think about is his airway
20:24and making sure things aren't going down the wrong way.
20:26And the big decision is for us whether we need to put a tube in
20:29again to protect his airway or not.
20:30OK.
20:31With his vomiting posing a threat to his breathing,
20:34maintaining Lewis's airway is the critical care team's first priority.
20:38All right, mate.
20:39So, we're going to move.
20:40What I'm going to do is I'm just going to support the airway.
20:41Yeah, great.
20:42OK.
20:43And that's what we'll do all the way down.
20:44We'll do the rest, OK?
20:45Now Lewis has stopped being sick, the team can begin moving him to the ambulance.
20:58Ready, steady, slide.
21:00Great job.
21:01But that involves navigating a narrow, steep staircase,
21:05whilst Manjit holds open Lewis's airway.
21:07Right.
21:08If you rest up there, I'll go down there and get the feet.
21:10Everyone help me for that?
21:11Yeah, I'll go in.
21:12OK.
21:13Ready, steady, slide.
21:15OK.
21:16Tell me if you need me to stop.
21:17No, you're OK.
21:18All Lewis's mum, Georgie, can do is watch on.
21:22Well done, Lewis.
21:24We're downstairs now, OK.
21:26Safely down, Lewis's breathing needs to be reassessed
21:30before they can move him any further.
21:32OK.
21:33Sats are good.
21:34It's respiration.
21:35Good.
21:36You're still needing to support the airway, yeah?
21:39Yeah, periodically, yes.
21:40OK.
21:41I think the main concern is airway en route.
21:45Yeah.
21:46Oh, hello.
21:47Can you put me through to soccer, please?
21:49Concern that Lewis can't breathe properly without his airway being supported,
21:53Manjit puts in a call for advice.
21:56So, 12-year-old, he was found by sister this morning and mum to be not right,
22:02not breathing properly.
22:03So he has some respiratory depression, but we're correcting that with a jaw thrust
22:06and we're supporting him.
22:07The concern is just airway protection.
22:10Just looking at him now, so he's having some intermittent twitching of his arms,
22:14which, again, is a bit concerning, yeah.
22:17We're just going to give him another two milligrams of midaz now.
22:20His wrists are quite irregular as well.
22:22Yeah, because now he's fitted again.
22:24As Lewis is still showing signs of fitting,
22:27another dose of the anticonvulsant midazolam is administered.
22:30Yeah, so if it's airway protection, we might be able to support the airway en route,
22:34but if we think there is some residual ongoing seizure activity,
22:37just for airway protection, we're just going to intubate, so...
22:41Yeah, yeah.
22:42Intubating would mean anaesthetising Lewis to take control of his breathing.
22:46It's a high-risk procedure, but without it, his condition is critical.
22:51In Reading, Dave has been sedated, while critical care paramedic Andy and Dr. John attempt to realize that he has been sedated.
23:08In Reading, Dave has been sedated, while critical care paramedic Andy and Dr. John attempt to realign his badly fractured and dislocated ankle.
23:23No, I don't think I can reduce it, because his bone's in his joint.
23:29It's a brutal yet delicate procedure, as the protruding bone could rupture the skin, turning it into an open fracture and compromising the blood supply to Dave's foot.
23:40He's a bit happier.
23:50OK, so he is closed all round.
23:56OK.
23:57The skin on this side is probably ulcerating.
24:00It's probably been out a long time.
24:02It's very unstable and spontaneously re-dislocated.
24:07OK.
24:08Are you able to maintain circulation?
24:11Yeah, circulation's fine.
24:16That's probably as good as it's going to get.
24:18Right.
24:19To prevent any movement that could tether skin, Dave's ankle must be immobilised.
24:23So this needs to be really, really tight.
24:24OK.
24:25So...
24:26It's going to hold fire on it.
24:27It's going to stay out, because it's so unstable.
24:28In your house.
24:29And we're the ambulance people.
24:30You're very safe.
24:31Yeah.
24:32The team are using a vacuum splint to try and hold the bones in place.
24:48I just can't keep him in the joint.
24:50He basically just keeps slipping back out again.
24:52And when he slips, he slips into the skin throat position, so...
24:55Do you want to use Sam's bit?
24:57You can see how unstable it is.
25:00It's just...
25:04His lateral component's completely gone.
25:07So there's nothing to hold it in.
25:09Yeah.
25:10I think, to be honest, I think if we pack this well enough, this will be just as good.
25:13It's just holding it in place while...
25:15While we do it.
25:16Yeah.
25:17So...
25:18All right, let's try that.
25:21After several attempts, Dave's ankle is splinted, and the skin is still intact.
25:26How you doing, buddy?
25:28You're in...
25:29You're in your bed...
25:31You're in your bedroom.
25:33OK?
25:34We're the ambulance people.
25:35You're going to feel a bit strange for a little while.
25:38And that's perfectly normal.
25:40But you're safe.
25:41OK?
25:42Dave's feeling a bit wappy.
25:43Yeah.
25:44We're going to scoop him.
25:45All right?
25:46Ready, steady, roll.
25:47That's it.
25:48That's it.
25:49That was it.
25:50Thank you.
25:51All right.
25:52Perfect.
25:53He can now be moved downstairs and into the ambulance.
25:56I'm just on ketamine facial.
25:57Ready?
25:58Are you OK?
25:59Ready.
26:00Ready, steady, end.
26:01Ready, end.
26:02OK.
26:03Ready, steady, move.
26:04That's it.
26:05Well done, folks.
26:06That's it.
26:07Right, everybody ready?
26:08Ready, steady, lift.
26:09John updates Dave's wife, Sally.
26:10So, he'll go to Royal Barkshire.
26:11Now that he's awake, so if he was still not quite conscious from the ketamine, we'd come
26:16with him.
26:17Yep.
26:18But he's one of the best.
26:19That's it.
26:20That's it.
26:21That's it.
26:22That's it.
26:23That's it.
26:24That's it.
26:25That's it.
26:26That's it.
26:27Well done, folks.
26:28That's it.
26:29I've seen we come with him.
26:30Yep.
26:31But he's waking up.
26:32He's appropriately orientated.
26:34He knows where he is.
26:35Happy that Dave's condition is now stable, John and Andy leave him in the care of the
26:39ambulance crew for the journey to hospital.
26:41We're going to get clear if you're all right?
26:43Yeah, thank you.
26:44All right.
26:45We had to pull the fracture quite hard to get it back into alignment, because it was
26:49quite significantly displaced.
26:50And when we'd done that, the fracture's in lots of pieces, so it's very unstable.
26:56And it keeps slipping in and out of joints, so he will need surgery on his ankle.
27:00It's quite a nasty fracture.
27:01Yeah.
27:02Yeah.
27:03At a motocross track in Buckinghamshire, critical care paramedic Joe and Dr. Martin are treating
27:21Charlie, who has suffered multiple injuries after hitting a jump at 40 miles an hour.
27:26Okay, so that looks like you've got a bit of bruise.
27:28His friends were first to the scene.
27:30Were you there immediately?
27:31I was trying to wake him up.
27:32Yeah.
27:33Well, I just tried to get some responses out of him and there was nothing.
27:35And it took two minutes to...
27:36Yeah.
27:37Okay.
27:38And when he did respond, how was he?
27:40Err, non-verbal.
27:41And how have you got it back here?
27:43He walked himself.
27:44He walked.
27:45And how far from where we are was...
27:46It's about 100 yards, 150 yards.
27:48A loss of consciousness for two minutes is a sign of brain trauma.
27:53And we'll need investigating to rule out bleeding or swelling of the brain.
27:57You're obviously a little bit sore, but that's hopefully all just bruising.
28:00Okay.
28:01But I think from a head perspective.
28:03And sometimes it just takes a little bit of time for that to develop.
28:05You definitely have to go to hospital and then...
28:07To be honest, I think I'm awful, right?
28:09I think you should go to hospital.
28:10I think I might.
28:11Do you know what it is?
28:12If anything, I'm a bit worried just because I've knocked out.
28:15Yeah, exactly.
28:16And I think that's where you should go.
28:18I literally woke up thinking, like, where the fuck is this?
28:21Yeah.
28:22So we may well end up scanning your head when you come to a hospital to make sure you haven't
28:25done any damage.
28:26And that's the main reason to go at the moment.
28:28We need to observe you for a bit.
28:29So I think you should go to hospital, okay?
28:31An ambulance is on its way to take Charlie to hospital.
28:34Right.
28:35This is some pain relief.
28:36It's called Penthox.
28:37Everyone, it's starting to be new.
28:38And just...
28:39Well, you were quite sore when I was patting you down, probably.
28:41Try it.
28:42Pop your hand through this.
28:43And then you breathe through this.
28:45In and out through it.
28:46Yeah.
28:47In and out through it.
28:48Keep your mouth nice and closed.
28:49Your lips doesn't close.
28:50No?
28:51Okay, that's fine.
28:52Not like when you take a bit of medication, you know, it's just...
28:54That's okay.
28:55That's okay.
28:56You don't have to have it.
28:57Pain relief isn't the only thing Charlie isn't keen on.
29:00We'll have to.
29:01I think you should.
29:02Because you were knocked out and we often end up scanning your head if you've done something
29:05like that, okay?
29:06And it takes us a little bit of time to make sure that nothing has happened in your head.
29:10I can't tell you, like, right now, everything is going to be fine.
29:12It was clearly at a significant impact if you were knocked out, right?
29:15And I think our colleagues are saying you were going, what, sort of, 40 miles an hour?
29:18I've never been knocked out.
29:19Yeah.
29:20Exactly.
29:21It's 45 minutes since Charlie's accident.
29:22And more injuries are coming to light.
29:23Yeah.
29:24Why is that like that?
29:25Well, you've got...
29:26It's like a big bruise, but underneath.
29:27Yeah.
29:28Yes, it will be.
29:29The lump is a hematoma.
29:30A pocket of blood that carries a risk of infection, nerve and tissue damage.
29:34So, I ain't internal bleeding, is that?
29:35Well, it's...
29:36I mean, any bruise is technically internal bleeding, but not...
29:37Probably not what you mean.
29:38Oh, don't point that.
29:39So, well, again, that might get... that might swell up again in a bit more than the next
29:40few hours.
29:41So, that's another reason why we need to just keep an eye on you.
29:42An ambulance crew has now arrived, and will take Charlie to Wexham Park Hospital.
30:01Hello, Martin Joe. Charlie here.
30:05He was going up on a jump over there, about 40 miles an hour.
30:06He remembers coming down, and then, basically, the guys picked him up, he knocked himself
30:07out.
30:08But then he's walked from there to here.
30:09His ups are all right at the moment.
30:10And, yeah, just the abrasions.
30:11It's like, on the side here, on the side here.
30:12No C-spine or any spinal tenderness, really.
30:13And no obvious immediate neurology.
30:14You guys are happy, I'm assuming?
30:15Yeah?
30:16Yeah, yeah, yeah.
30:17Sweet.
30:18I'll let these guys look after you.
30:19Okay, we'll get you properly checked over.
30:20Satisfied that Charlie doesn't need any specialist treatment from the critical care team.
30:37He's left in the hands of the paramedics, who will take him to hospital, where he'll
30:49undergo x-rays, a CT scan, and further examination.
31:09Ambulance emergency, is the patient breathing?
31:12Yeah, they are.
31:13The reason for your call, stay tuned.
31:15So, we are at a climbing centre, and we've just had someone come off the wall and land
31:19badly, and their elbow is basically dislocated.
31:22How old is the patient?
31:23Uh, mid-30s.
31:24Male.
31:25Yes.
31:26We're wondering if it's also maybe fractured, but definitely dislocated.
31:29Okay.
31:30What are you getting from the health range?
31:34UK hospitals treat over 2 million sports-related injuries each year.
31:38Climbing carries a particularly high risk of serious trauma.
31:42So, the specialist skills of Dr Jasperit Rayat and critical care paramedic Tracy Olden are required.
31:48This is a 28-year-old by the name of Matthew, who is at a rock climbing wall.
31:54He's fallen off 2 to 3 metres.
31:56I think he's landed on his left hand, and it looks like a supracondular fracture dislocation.
32:03He's in a lot of pain, and it looks like something which needs to be pulled sooner rather than later.
32:09But, uh, you can obviously be the judge of that.
32:12Okay.
32:13Super.
32:14A supracondular fracture dislocation means the upper arm has broken and the elbow joint is dislocated.
32:19Without urgent treatment, it can lead to loss of mobility, nerve damage, and deformity.
32:25So, you haven't got an ambulance at the moment?
32:27Okay.
32:28No problem.
32:29Okay?
32:30Yeah, cool. Thank you.
32:33The accident happened at a climbing centre in Oxford.
32:36Just 30 minutes after receiving the call, the critical care team arrive on scene.
32:42Hello.
32:43What have you been doing?
32:44I fell off there, but if anyone asks, I actually did it.
32:47You did do it.
32:48Okay.
32:49It was just, you came down badly.
32:50Yeah.
32:51Any other injuries?
32:52No.
32:53What's your name, sorry?
32:54Matthew.
32:55Matthew, I'm Dr Jasperit.
32:56Hello Matthew.
32:57Nice to meet you guys.
32:58Nice to meet you too.
32:5928-year-old robotics engineer Matthew fell over 3 metres onto his left arm.
33:04Centre staff put an ice pack on the injury.
33:07Are you left or right handed?
33:08I'm left handed.
33:09Left handed.
33:10Are you able to make a fist?
33:11I can.
33:12Good.
33:13Can you squeeze my hand?
33:14Yeah.
33:15Good.
33:16Yeah.
33:17And just open your hand for me.
33:18Yeah.
33:19Feel me touching?
33:20I can feel you, yeah.
33:21There?
33:22Yeah.
33:23There?
33:24Yeah.
33:25There's a risk that the nerves in Matthew's arm have been crushed from the fall.
33:27Dr Jasperit must assess whether he has any loss of sensation or movement.
33:31Feels normal?
33:32It feels like it has, but it is normal.
33:34Okay.
33:35No numbness, tingling?
33:36I mean, it's a bit numb because I've had the ice.
33:39It's tingling.
33:40I think it's all just within the normalities of it looking messed up.
33:43But no numbness, tingling in the hand?
33:45No.
33:46Okay.
33:47I feel everything in the hand.
33:48Okay.
33:49And you've got a nice strong pulse.
33:50Fine.
33:51Good.
33:52Normally, Dr Jasperit turns his attention to the injury itself.
33:55I'm just going to pop these on your finger, okay?
33:57Yeah, thanks.
33:58And do your blood pressure in bits.
33:59Is that okay?
34:00Yeah, that's true.
34:01Yeah.
34:02I'm just going to have a look at your elbow.
34:03Yeah, yeah, have a look.
34:04Once we're doing your observations.
34:05And how high do you think you were when you fell?
34:06I was on that hole there.
34:07The green one?
34:08And I was joking.
34:09I was actually at the top.
34:10Okay, so reasonably.
34:11Should we be surprised?
34:12Do you not normally climb?
34:13It's the first time I've climbed in a while.
34:14Oh, no.
34:15The team need to check if Matthew's high spirits are masking potentially serious internal injuries.
34:21It looks a bit messed up, doesn't it?
34:23Yeah.
34:24Any pain here?
34:25No, not anymore.
34:26Is that good?
34:27It's not hit the nerve there?
34:28Stuff got to say at the moment.
34:29Okay.
34:30And here?
34:31A tiny bit.
34:33Okay.
34:34Unsure if it's safe to straighten Matthew's arm, the critical care team will have to proceed
34:39with caution.
34:40What you need is an x-ray to determine whether that's just a dislocation, whether that's fractured.
34:45All right.
34:46Or it could be both.
34:47Yeah, you've got lots of important nerves and vessels that run through there.
34:50Yeah.
34:51And I think pulling it here is probably not the best thing to do.
34:56So we're going to put the tube in.
35:14Just a bit.
35:15A little bit.
35:16In Stoke and Church, Dr. Manjit and critical care paramedic Hannah are treating 12-year-old
35:21Louis who has had a seizure.
35:22We're going to get a second line in.
35:24Okay.
35:25It's all nice.
35:26More.
35:27He is also struggling to breathe, so the team are preparing to insert a tube into his
35:32windpipe.
35:33Okay.
35:34Just going to get another line in.
35:35You're doing really, really well, mate.
35:36To do this, they need to perform a pre-hospital emergency anaesthesia, which will allow them
35:41to secure Louis' airway and take control of his breathing.
35:45All right.
35:46All right.
35:47All right.
35:48All right.
35:49All right.
35:50All right.
35:51Sorry.
35:52Just hold my hands still.
35:53Just relax.
35:54Just relax.
35:55Okay.
35:56Okay.
35:57Okay.
35:58Okay.
35:59Okay.
36:00Okay.
36:01Nice and easy.
36:02You're doing really well.
36:03So Manjit inserts a second cannula to administer the drugs for the procedure.
36:05That's okay.
36:06All right.
36:07Okay.
36:08Okay.
36:09I don't use that.
36:10Okay.
36:11It's waking up a bit.
36:12I think it might be stronger.
36:13Just close to the amount.
36:14Luis's increased movement and awareness as the team insert a second cannula is a positive sign.
36:24Well done, sorry.
36:32I know, it's not comfortable, I'm sorry.
36:34Just having a look at him, he had some much more purposeful movements, was trying to sit up a little bit ago.
36:40So he actually looks like he's, I think, much better from a transfer point of view and not seizing anymore.
36:47Yeah, I would agree. I think our risk-benefit has possibly flipped.
36:50Has possibly just shifted.
36:51Yeah.
36:52Yeah.
36:53An hour after he was found by his sister, Luis's seizing has stopped and his level of consciousness is improving.
37:00I think actually at the moment we don't need to intubate.
37:03I think you're absolutely right in terms of risk-benefit.
37:06I think it's safer not to at the moment and observe.
37:09And I think it'll probably, hopefully make his journey a bit smoother as well.
37:12I'd agree with that.
37:13Cool.
37:14Okay, great.
37:15Everyone happy?
37:15Yeah, yeah.
37:15I'm happy.
37:16Good, okay.
37:17Having decided it's more suitable to get Luis straight to hospital without intubating,
37:22Manchit updates Luis's mum, Georgie.
37:24You heard what we were talking about, so I think we're...
37:28I'll go into the yard.
37:29Yeah, I think so.
37:30We've got all our things ready.
37:31So if anything changes when we're going out, or if anything changes en route, then we can do whatever interventions we need to do.
37:39Okay.
37:41Yeah, as you know, we're going to take really good care of him, and they're fantastic.
37:45I've had you experience twice, and I trust all of you.
37:47Okay, we're going to lift on lift, hands on, ready, steady, lift.
37:55Happy?
37:55Due to the seriousness of Luis's condition, Manchit and Hannah will travel with him in case he deteriorates on the journey.
38:03All right, Luis, we're just going to get you in the ambulance.
38:07Mum's right here.
38:08Hey, buddy.
38:09See, there she is.
38:10Hey, baby.
38:11No.
38:12Just going to get you in the ambulance, mate.
38:14Okay.
38:17How are we doing?
38:19Yeah, we're good.
38:19Oh, I know.
38:20It's a bit tickly in your nose, isn't it?
38:22Luis has been taken to the John Radcliffe Hospital in Oxford, as it has a dedicated paediatric critical care unit.
38:30The latest blood pressure reading is 76 over 47.
38:34He's got a good tempo pulse, yeah.
38:35Blood pressure, heart rate, and other vital signs can be unstable after a seizure, so Luis is closely observed.
38:43See you again with an apology.
38:46Just need a little talk to the blood.
38:48Thanks to the rapid response of the critical care team, Luis is no longer seizing, and handed over to the emergency paediatric team for urgent assessment.
38:57It was a real team effort between everyone, wasn't it? The ambulance service came in, they kind of picked up exactly, immediately, where we were headed, that we needed to get extrication sorted.
39:06They managed all of that.
39:07He's actually sitting up now in A&E with his mum, doing really well, yep.
39:13And most importantly in that scene, I think, is his little sister.
39:17Big kudos to her, because she absolutely saved his life by raising the alarm this morning and highlighting to mum that something was wrong.
39:24So, yeah, well done, huh?
39:27At a climbing centre in Oxfordshire...
39:40Okay, I think probably the best thing we can do for you is some gas to breathe in and out.
39:44Critical care paramedic Tracy Olden and Dr. Jaspreet Rehatt are treating 28-year-old Matthew, who has had a badly broken arm and dislocated elbow after falling three metres.
39:55So what you need to do is you can use your good hand, if you hold on to that for me, just pop your mouth around it and take some nice deep breaths in, but keep your mouth around it when you breathe out as well.
40:07With important nerves and blood vessels around the injury, it's too risky to straighten Matthew's arm here, so he's been giving a potent form of pain relief before they can move him.
40:16So breathing in and out through the mouthpiece.
40:18In and out through it.
40:19It might make you feel a little bit funny, but that's normal.
40:21Okay?
40:22And then what we'll do is we'll dose you up on that and then we'll try and get a splint round it, just to get you a bit more mobile.
40:27Okay?
40:28Is it taking the edge off a bit?
40:29Maybe.
40:30Maybe.
40:31I'm not feeling any high or anything.
40:32It's okay.
40:33Keep going.
40:34Take some nice deep breaths.
40:35Keep going.
40:36Keep going.
40:37Deep breaths.
40:38Deep breaths.
40:39Keep your mouth around it all the time.
40:40That's it.
40:41Good lad.
40:42Keep going.
40:43Dr. Rehatt is preparing a foam-covered aluminium splint that can be moulded to support Matthew's arm.
40:48Well, I'm feeling a bit light-headed now, yeah.
40:49Yeah, that's perfectly normal.
40:50Oh, fuck.
40:51All right.
40:52Listen.
40:53Oh, fuck.
40:54That hurts.
40:55You're not going to go anywhere.
40:56You keep going on the gas.
40:58Keep going.
40:59You're not going anywhere.
41:00Deep breaths.
41:01Deep breaths.
41:02The splint is in place, but it needs to be secured.
41:06Fine.
41:07We're going to sit you up in just a moment.
41:09All right.
41:10I'm going to pop this.
41:11Do you want to hold that and keep using that if you need it?
41:13I feel I'm going to conk out this.
41:15No, you're not conking anywhere.
41:16You're on the floor.
41:17Okay?
41:18I've got you.
41:19Okay.
41:20On through.
41:21One, two, three.
41:22Can you sit yourself up?
41:23Oh, sugar muffin!
41:24Oh!
41:25That's the politest thing I've ever heard anyone say.
41:28How's that?
41:29I don't know.
41:30Those drugs are probably quite good.
41:31Yeah.
41:32Wait, are those drugs actually affecting...
41:33Oh!
41:34Yeah.
41:35I think those drugs have affected me.
41:38Are they actually supposed to do that?
41:39They can make you go funny.
41:41Now Matthew is upright.
41:43So if I'll pass this round to you...
41:46And enjoying the pain relief...
41:48Under the arm.
41:49Under the arm.
41:50Under the arm.
41:51They can finish immobilising his arm.
41:53We come round the...
41:54Just under the...
41:55You're funny.
41:56Underneath.
41:57Yeah.
41:58Can you go in?
41:59Amazing.
42:00Right?
42:01Good lad.
42:02With the splint now secure and holding Matthew's arm in place.
42:05He's ready for the trip to hospital.
42:08What the plan is, is we're going to see if somebody would be able to give you a ride down to the hospital.
42:13Take your time.
42:14So if you have to take it here for us.
42:16He's doing really well.
42:17He doesn't really need an ambulance to take him to the hospital.
42:20So do you have a car here?
42:21We have his car here.
42:23Okay.
42:24He's driving.
42:25Amazing.
42:26What we'll do is we write some notes and we'll send it to the hospital.
42:29So they'll be able to see that we've been out.
42:31Alright?
42:32No problem.
42:33Okay.
42:34They're happy to drive him down.
42:35Okay.
42:36Cool.
42:37Once he's settled a little bit.
42:39Matthew's lifter hospital may be organised.
42:42But he's still enjoying the benefits of penthrops.
42:45You've been so good.
42:46I'm good.
42:47Thank you.
42:48I'm sorry I'm acting like an accident dude.
42:50No, you're fine.
42:52I'm sorry.
42:53Can we get into the car?
42:54Come on then.
42:55I'm just being in here.
42:56Just take your time.
42:57Take it nice and steady.
42:58Watch where you're going.
42:59Because we don't want you to hurt anything else.
43:01Oh yes sir.
43:03Matthew is going to the John Radcliffe Hospital in Oxford.
43:06Where he'll undergo further treatment.
43:09Alright.
43:10Pleasure.
43:11Nice to meet you.
43:12Thank you so much.
43:13Take care guys.
43:14Drive safe.
43:18He'll need x-rays in hospital to determine what the injury is really.
43:22Possibly an elbow fracture or a dislocation elbow.
43:26Slightly swollen, quite tender.
43:28I should imagine he'll make a full recovery once he's had his fracture or dislocation treated.
43:33And he should be able to use his left arm again.
43:41Get spread safe.
43:42I think those all players are going to get in front of him.
43:43It doesn't matter in такой 고�
44:11Gracias por ver el video.
44:41Gracias por ver el video.
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