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00:00Bouncy, I need a panel.
00:02Just a busy day.
00:04Everybody's decided to come today.
00:06An unbeatable team.
00:08Have you given it a clean, or did you just put that on?
00:10No, I wouldn't let my wife anywhere near it.
00:12Slide.
00:14Hard at work, 24 hours a day.
00:16Sorry.
00:18You've got the booby fries, you've got me.
00:20Seven days a week.
00:26Saving lives.
00:28Oh no.
00:30Helping loved ones.
00:32Well this is shocking, they've actually broken bones.
00:34Making the community they serve better.
00:37As well as everybody's safe, that's all that matters.
00:40A health service treating anyone.
00:42Strain your temperature, Jane.
00:44And everyone.
00:46In and out, keep going.
00:48A team doing anything and everything for each other.
00:52The staff have been amazing.
00:54They've not been able to do enough for us.
00:56This is Barnsley Casualty 24-7.
01:00It brings me faith in the staff and NHS, definitely.
01:04I love you.
01:14On shift tonight.
01:16Dr John Shepard.
01:18Relax your head back for me.
01:20Dr Nicholas Allcroft.
01:22With this one last injection and hopefully everything will be nice and young, okay?
01:25Could you not just put me to sleep?
01:28And, Sister Vicky and Sister Jane.
01:31You've worked hard today, Vic.
01:33I am.
01:34How's your love?
01:35So.
01:36Sorry, I'm catching your hair.
01:38I'm sorry.
01:39Get ready to share a shift.
01:41Does that hurt when I'm all a bit like that?
01:43Yeah.
01:44With the team at Barnsley Casualty.
01:46Well done there.
01:47You were awesome.
01:53How long's that going to take?
01:55You always say two minutes, but it never ever is.
01:587am and Sister Jane has just clocked on at Barnsley Casualty.
02:02You know your patient in seven.
02:04Have you all done your SBAR a bit?
02:06No, not yet.
02:07She's sharing the shift with Sister Vicky.
02:10Oh, my sidekick wherever she is.
02:12You can hear her before you see her sometimes.
02:14Can you take him round to CDU for me?
02:16He's got a bed on CDU while he awaits that report.
02:19The waiting rooms are full.
02:21Has the patient gone there?
02:23I don't know.
02:24Louise has just come to me and said, has he gone?
02:25I said, I don't think so.
02:26And more patients are arriving.
02:29Hi, it's Jane.
02:31The floor within the apartment obviously can be extremely difficult.
02:34We're getting ambulances in and we're also getting us walk-ins in.
02:37We can't shut us doors.
02:39So we've just got to manage it and try and keep safe.
02:42But there's no letter.
02:47Another critical patient is on the way in.
02:49Thanks very much.
03:01Seventy-year-old retired painter and decorator, Thomas, is struggling to breathe.
03:08Take this one from your waist.
03:11He's had pains in his chest and stomach since returning from holiday in Tunisia two weeks ago.
03:18You know?
03:21He'll be treated by Dr John Shepard.
03:26So my name's John.
03:27I'm one of the doctors.
03:28Nice to meet you.
03:29Nice to meet you.
03:30So you and Tina's here for how long?
03:31Two weeks.
03:32When did you start feeling unwell?
03:33On the flight or as you landed?
03:34Well, we landed in Manchester.
03:35Okay, fine.
03:36And what was the first problem?
03:37No, sneezing and coughing.
03:39Like a phlegm?
03:40Yeah.
03:41Did you get pain in your tummy and the sort of coughing and stuff at the same time?
03:45Yeah.
03:46So with Thomas or anyone that's been abroad on holiday, we have to be quite worried as
03:49whether or not they've picked up an infection wherever they've been staying.
03:52That's a fairly common problem that people can suffer from when they come back.
03:56Why have you called the ambulance today as opposed to any time in the last couple of weeks?
03:59What's new?
04:00You had worse today.
04:01Okay, what was worse?
04:02Pain in your tummy.
04:03Pain, okay.
04:04Pain in your tummy?
04:05Yeah.
04:06Fine.
04:07Can't breathe.
04:08Can't breathe.
04:09Can't breathe.
04:10Okay.
04:11So you've got COPD?
04:12Yeah.
04:13Do you use inhalers for that?
04:14Yes.
04:15COPD is a chronic condition of the lungs which affects your breathing and it affects the
04:19way that you can transfer oxygen between the air and your lungs.
04:23So it gives you the opportunity to pick up more severe chest infections than if you
04:28didn't have the condition.
04:29Have you ever had a heart attack?
04:30No.
04:31No.
04:32Fine.
04:33Do you smoke?
04:34Yeah.
04:35I go to a pouch of vodka a week.
04:37Okay.
04:38Cool.
04:39Stop smoking.
04:40It's bad for you.
04:41I am.
04:42Do you drink alcohol?
04:43Okay.
04:44Do you drink alcohol?
04:46Yeah.
04:47What's your tipple?
04:48Tipple is about 20 pints a day.
04:5020 pints of beer a day?
04:51Yeah.
04:52Good lord.
04:53Patients who come in with illnesses related to smoking and drinking, it's tricky because
05:00they're very addictive substances.
05:03Okay.
05:04Relax your head back for me.
05:06His smoking and alcohol intake will make his immune system less able to fight off infection.
05:13Yeah.
05:14Okay.
05:15Have you had any surgery on your tummy at any point?
05:18Not really mate.
05:19What do you call it?
05:20Appendix?
05:21Yeah.
05:22I can't tell you to appendix.
05:23Fine.
05:24Any other problems surgery wise?
05:26No.
05:27No.
05:28So it's all a bit all over the place.
05:31It's got a temperature so he's probably got an infection and he's coughing up green stuff
05:34so it's probably a chest infection.
05:35That's all fairly expected.
05:37It's just how sore his tummy is.
05:39It's sort of throwing us off a little bit at the moment.
05:42Further tests are needed to work out if Thomas' pain is a sign of a more serious undiagnosed
05:48condition.
05:57Marjorie.
05:58She's been called for her bloods but it's not been done so can you get somebody to do her
06:02bloods now love?
06:04In the hub, Sister Jane and Sister Vicky are juggling patients.
06:09Oh, hello Marjorie.
06:10John, will you just code that CTKUB patients?
06:14I've sent them to CDU.
06:15Okay.
06:16You can come onto a shift on a morning and all of a sudden it's like the bus has been dropped
06:21off outside and we could get 15, 20 patients in booking within an hour.
06:28One of those patients being blue lighted in is 71-year-old Christine.
06:40Her head is bleeding badly after a fall.
06:45Sister Vicky assesses her injuries.
06:46Hi Christine, I'm Vicky.
06:47Nice to meet you.
06:48So what's been happening with you?
06:49What have you been doing?
06:50I fell out of my sisters.
06:51Oh.
06:52So you've come out of your sisters and you've stepped down and you've lost your foot in and
06:57then you've gone face-face like that.
06:58Yeah.
06:59Yeah.
07:00Did you black out?
07:01No.
07:02I remember everything.
07:03Yeah?
07:04Right, just look straight forward at my nose.
07:05I'm just going to shine this torch.
07:06Oh, all right.
07:07All right.
07:08Perfect.
07:09I'm just going to have a chat with Angela's crew.
07:10Okay.
07:11And then I'll come back and see you.
07:12Yeah.
07:13She's come home from dropping her sister after half past the tilt.
07:14Been going up the step.
07:15Lost her footing.
07:16Slipped down one step.
07:17Landed onto her knees and then onto the left side of her face.
07:19Yeah.
07:20She's been bleeding quite quickly so I've managed to stop it just.
07:22Yeah.
07:23No other injuries that I can see.
07:24Left eye.
07:25Very bloodshot.
07:26My name's John.
07:27Hello.
07:28Hello.
07:29Any pain in your neck when I squeeze?
07:30I have pain in my neck and down my spine because I've got osteoporosis.
07:32Is it worse than normal?
07:33Not really.
07:34Not really.
07:35Not really.
07:36No.
07:37No.
07:38No.
07:39No.
07:40No.
07:41No.
07:42No.
07:43No.
07:44No.
07:45No.
07:46No.
07:47No.
07:48No.
07:49No.
07:50No.
07:51No.
07:52No.
07:53No.
07:54Can you look over there at that paramedic for me?
07:55Cool.
07:56Can you look over there at that door for me?
07:58Can you look up at the ceiling for me and look down the floor?
08:00Good.
08:01Well done.
08:02Do some tests I think.
08:03All right.
08:04Oh, you're dripping.
08:05Our consultant went in and had a little look.
08:09She's on blood thinners so obviously she needs a CT scan.
08:14So we're going to get your CT head scan done.
08:18All right.
08:19And then every so often, every half an hour somebody will have to come in.
08:23You'll probably get fed up on her.
08:24But they're going to have to do your blood pressure and stuff okay.
08:26Yeah.
08:27You just need to make sure that there's no pressure that's building up in your head.
08:31All right.
08:32Yeah?
08:33Yeah.
08:34All right.
08:35All right.
08:36A scan is needed to check if Christine has had a bleed on the brain.
08:40Untreated, it can be life-threatening.
08:43It's just rammed at the minute.
08:56I've got three nurses in there.
08:58Three hours into the shift and pressure is mounting in the hub.
09:02Oh, we've got 91 patients in the department.
09:05It just looks like waiting room, just getting hammered at the minute.
09:09The patients keep arriving.
09:11Are you going to cheer me up, Antonia?
09:15No?
09:16I'm not.
09:17But there are not enough spare beds on the wards to move them on.
09:2237 is practically full.
09:25And that's our winter ward.
09:28And it's full.
09:30Yeah.
09:31If there's no beds within the trust or in the areas that we need them, then that's when we
09:37become stuck.
09:42One of those still being treated in recess is Thomas.
09:47Dr. Shepard is trying to work out what's causing his chest and stomach pain.
09:55I'm about to look him up on the GP records to see if he's got anything else going on.
10:02Because he told me he hadn't had a heart sack, had he?
10:05I'm going to give you some anti-wessants for your chest.
10:12The question is why is your tummy bad?
10:15How often do you wee?
10:17About three times a day.
10:19Fine.
10:20Is that more than you would normally wee at the moment?
10:21No.
10:22No?
10:23Same time?
10:24Same amount of time?
10:25Fine.
10:26And again, your bowels are all right at the moment?
10:27Yeah.
10:28Not suddenly loose?
10:29No.
10:30Not suddenly constipated?
10:31No.
10:32Yeah, so these are to try and have a look for any fluid in the bottom of his lungs or fluid
10:39in his tummy that shouldn't be there.
10:41Sorry, Tom.
10:42I'm not going to stop fiddling with you in a second, all right?
10:46I am attempting to have a look and see if there's any fluid where there shouldn't be fluid.
10:55Yeah.
10:56Do you want to spit something out?
11:02You could be surprised by how much you can tell from someone's phlegm or from what they've
11:09coughed up.
11:10Cough, cough, cough, cough, cough, cough, cough, cough, cough, cough.
11:17Delicious.
11:18Is that what's been coming up?
11:19Yeah.
11:21That's my...
11:22And sometimes it's green, isn't it?
11:24Mmm.
11:25Cool.
11:26Still thinking it's a Cessna infection.
11:28I'm afraid with that.
11:29That's gorgeous.
11:30You can tell, you know, if there's blood in there, if there's green looking stuff, if it's
11:33bacterial, or importantly, if something more serious is going on.
11:36Dr Shepard needs to get a second opinion from a consultant.
11:41So you said some comox and clarithromycin, would you just give him the STAT TAS as well
11:46or next day's TAS?
11:49Thomas is prescribed antibiotics, but if they can't find the cause of his pain,
11:54he will need to be admitted for further tests.
12:01If a bed can be found.
12:04Surgery have got no beds, orthopaedic have got two, gynae have got none.
12:10Sister Jane briefs the team on the state of play.
12:14So it's just going to be slow, medicine-wise.
12:18137 is full. Our winter ward is full.
12:25It's all about keeping the staff and patients safe and the department running safely as well.
12:30And just keeping them informed of the floor of the department.
12:34So, yeah, fingers crossed it shouldn't be too much longer now and we'll get you sorted.
12:36Oh, thank you.
12:38All right, love. Thank you.
12:40Just arrived in Majors.
12:44Is it Dean? Yeah.
12:46Hiya, Dean. I'm Chantel. Are you dozing off?
12:48I am, yeah. Sorry.
12:50Advanced clinical practitioner Chantel's next patient, Dean,
12:54is back in hospital after a holiday nightmare eight months ago.
12:58I've just been reading all about your eventful Benidone trip.
13:02I've got a bit on foot with a mozzie, a mosquito.
13:05I had a little spot on me foot.
13:07You know, a proper yellow-headed spot.
13:09I knew I didn't feel no more about it.
13:10Yeah.
13:11When I got off at play, me and my leg had just...
13:12Ballooned.
13:13Ballooned.
13:14Yeah.
13:15The taxi driver picked us up and said,
13:16I would take you straight to the hospital.
13:17We were straight underneath us?
13:18Straight underneath us.
13:19Yeah.
13:20And then we had an hour, our operating table.
13:22Yeah.
13:23She said, you've been 80% chance you're going to lose your leg.
13:25Yeah, it does.
13:26You can't, well, there's no guarantees you're going to survive off of this.
13:28Yeah, it's really severe and dangerous.
13:31Working in A&E, it's often that we come across patients
13:34that just have really bad luck.
13:37Dean, for example, was on holiday,
13:39minding his own business, enjoying himself in a mosquito bite,
13:42created this really bad bacterial infection.
13:45And if prompt surgical interventions not acted upon immediately,
13:50the patient can die.
13:52Dean had necrotising fasciitis,
13:55a flesh-eating infection that required skin grafts.
13:59For about three weeks, I'd be wetting up at middle at night,
14:02at three, four o'clock.
14:04My leg's bent 90.
14:05Mm-hm.
14:06I can't move my leg.
14:07You can't get your leg straight again?
14:08No.
14:09But then this morning, it was my ankle.
14:12And my foot was solid.
14:14Let's have a look.
14:16Right.
14:17So, where was the little spot on your leg?
14:20Just round here initially?
14:21No, smack it middle up.
14:23On there?
14:24Yeah.
14:25And then it spread up here?
14:26Yeah.
14:27And tell me what's different and new and concerning with your leg.
14:31Is it this leaking, weeping area?
14:33No, that's being like that.
14:34I'm going to eat now in general.
14:36And is this from healing still?
14:37Yeah, it's still healing.
14:38Good.
14:39Where did they take the graft from?
14:41There.
14:42It's really clever, isn't it, how they do it?
14:44Yeah, they took it from the top of this thigh and back of this thigh.
14:48My main concern when I looked at Dean's leg was,
14:51has he got necrotising fasciitis again?
14:54Some patients can just develop it.
14:56It can live on the skin.
14:57And when it breaks into the skin, that's when it becomes a problem.
15:01Tell me about your ankle again.
15:03Well, this morning, he took me an hour to go out to bed.
15:06It's a lot solid.
15:07When I put on his weight on it, it's really painful.
15:10And is this new?
15:11Yeah.
15:12From yesterday?
15:13From yesterday, yeah.
15:14Okay.
15:15Does it feel normal?
15:16Or does it feel hot and throbby?
15:17No, it feels normal.
15:18But like that, when you're moving that a bit, then that...
15:20Okay.
15:21But your skin's not painful?
15:22No.
15:23And that's...
15:24I've got the whole sensation down there.
15:25That's fine.
15:26Okay.
15:27Right.
15:28Can you point your foot for me?
15:30Point your foot.
15:31You can't do it, can you?
15:33No.
15:34Right, I'm going to try and do it for you.
15:36I'm going to try and do it for you.
15:38No.
15:39I'm struggling, is it?
15:40So, Dean's proven to be quite a tricky patient to treat in A&E, because he's got multiple
15:45things going off.
15:46He's got a couple of open areas to his legs, which are still oozing, so he could have cellulitis,
15:52so a bacterial skin infection which I need to cover and treat.
15:56Is that painful?
15:57I feel a bone.
15:58That would crack it.
15:59Yeah.
16:00But he's also got a very painful, hot ankle that's not moving quite well.
16:05I could feel that as well.
16:07So I need an orthopaedic review.
16:08Is that hurt when I'm all of it like that?
16:09Yeah.
16:10That's tender.
16:11Mary.
16:12Not hurts, no.
16:13Let's get an x-ray of this.
16:14Have you got a cannula in?
16:15Yeah.
16:16I'll have a look at your blood test as well.
16:17Okay.
16:18It's Dean's 61st birthday today.
16:19He hadn't planned to celebrate it in casualty.
16:20My daughters are coming over from Leeds.
16:21I know we're taking me out for a meal somewhere.
16:22So I didn't know where we were going.
16:23We never know.
16:24We might be still be able to be there.
16:25Well, it's if I can get anywhere, innit?
16:26Yeah.
16:27Right, let me get you sorted, Dean.
16:28All right, please.
16:29What time's your birthday meal?
16:30I don't know.
16:31How long have I got?
16:32I don't know.
16:33How long have I got?
16:34I don't know.
16:35I don't know.
16:36I don't know.
16:37I don't know.
16:38I don't know.
16:39I don't know.
16:40I don't know.
16:41I don't know.
16:42I don't know.
16:43I don't know.
16:44What time's your birthday meal?
16:45I don't know.
16:46How long have I got?
16:47They were aiming to be back at Dalton for 20 past four.
16:50Right, okay.
16:51If the x-ray reveals a new infection, Dean will have to spend the rest of his birthday on a ward.
17:03One patient's sister Vicky is keeping a watchful eye on is Christine.
17:08Just try to shuffle a bit more.
17:11Just keep your head nice and still for the scan.
17:14Would you keep your eyes closed all the time if you want to pair?
17:17Yeah.
17:18She's on blood thinners and has a nasty head wound.
17:21It's nice and still for me.
17:23All right.
17:24The worst case scenario would probably be a bleed on the brain because obviously due to her blood thinners and things like that.
17:32Hence why she's having the scan.
17:34We're scanning.
17:38Come on.
17:39Hold on, Dean.
17:40Don't we get you on?
17:44Sorry.
17:45Christine's sister Susan is waiting with her for the results of the scan.
17:54The staff's been lovely.
17:56The hospital staff's been lovely.
17:58They've not been able to do enough for us.
18:02Dr. Orcroft checks the scan.
18:05If Christine has a bleed on the brain, she'll need emergency surgery.
18:14Five hours into the shift.
18:15There's no cubicles.
18:17And that's what I need.
18:18And sister Jane has to make space for emergencies.
18:22Asim, Salim, have you done with your patients in cubicle 15?
18:26Yes, you can go to surgical aspect, yeah.
18:28To keep the department open for new patients.
18:32Should we move her out and then I can move some ambulances across?
18:35Yeah.
18:36I think when you are the sister in charge, it does fall on your shoulders because you're responsible for the running of the department.
18:42So it is your responsibility to get those patients out.
18:45Right, William, we're just moving you, sweetheart, into another cubicle, all right, my love?
18:51A cubicle is freed up just in time.
18:58A patient's being rushed in by ambulance after collapsing on the street.
19:04I'm just going to heal your head a bit of a clean.
19:08They got there within about three minutes.
19:10We've been in stop-season and they were just confused and stiff.
19:1362-year-old Christopher has epilepsy.
19:16He's complained of pain and throbbing in both legs.
19:21And then he has a numerous, maybe three or four slight lacerations to the top of the back of his head.
19:29So I had a seizure today, coming back from town.
19:35I normally know when I'm going to have fun, but this time I didn't.
19:39He'll be examined by Dr. Charlotte Foster.
19:47Hello, my name's Charlotte. I'm one of the doctors.
19:49So what's happened today to bring you in?
19:51I had an epileptic, so I had a seizure.
19:54Okay.
19:55Without coming back from town going home.
19:57Yeah.
19:58Okay.
19:59Did anybody see you, the seizure?
20:00Yeah, the passerby saw me on the floor.
20:03Did you get any symptoms before you went?
20:05Any dizziness?
20:06No, no.
20:07Have you always had symptoms before you have these seizures?
20:09Yeah.
20:10Yeah, and this is the first one you've not had any?
20:11Yeah, yeah.
20:12Yeah, okay.
20:13Okay.
20:14I'm just going to keep an eye out for your bloods.
20:15I'll come back shortly and just let you know whether we need to do anything else, if that's okay.
20:20Yeah.
20:22He normally gets symptoms before a seizure, and this time he hasn't.
20:25So, kind of just a bit slightly more worried about things because of that.
20:33Because Christopher's seizure didn't follow its normal pattern,
20:36Dr. Foster decides to get a second opinion from a consultant.
20:40He had no preceding symptoms at all, which normally he does when he has seizures.
20:45That's the only thing that's worried me.
20:46He normally gets kind of dizziness.
20:47He's known to have epilepsy.
20:48He's known to have epilepsy.
20:49He hasn't had a seizure in the last two years.
20:52He came round within about five minutes or so.
20:54So, I was just a bit worried that it doesn't sound like his normal seizures.
20:57I'm applying the standard for Prussia.
20:59I've done that.
21:00Needs one of them and an ECG.
21:02I think you're right to make sure it's not anything like a cardiac therapy or anything like that.
21:05Yeah.
21:06So, there'll be some further investigations that we do just to rule out other causes.
21:09We'll also add on some blood tests just looking at his heart to make sure that's not kind of a cause of his kind of collapse.
21:16So, this blood test will just be to look at your heart to see whether it's stable or if it's getting kind of more strain on it.
21:23No.
21:24And also to have a look at your blood clotting as well.
21:27Oh, right.
21:28Just to make sure that's all all right.
21:29Yeah.
21:30I think given that you've kind of had this episode of kind of collapsing.
21:34Yeah.
21:35We just want to make sure that it's not because of your heart really and not a seizure.
21:40Oh, right.
21:41All right.
21:42What are they expecting?
21:43All these tests.
21:44Not that fits me after I walk out.
21:45With Christopher's symptoms appearing unusual, Dr. Foster needs to rule out of the causes of his collapse.
22:03An x-ray will look for infection, whilst blood tests check for signs of a heart attack.
22:12.
22:13.
22:14.
22:15.
22:19.
22:20Paul!
22:21Can you do me a favour?
22:22I've got loads to get out to AMU now because we've pulled them off.
22:25Hospital beds are starting to free up for patients waiting in casualty.
22:30Louise, Paul's getting some patients ready for the ward.
22:34Can you just help him out, love, please?
22:36But it's given sister Jane a new problem.
22:39And then can you get her up to EPA you for me, Paul, or get a porter to take her up?
22:44You don't particularly need to go up yourself.
22:47Finding staff to help that are not tied up with patients.
22:51A lot in waiting room and I know I've just heard Jane say that there's five members of staff now down there
22:56trying to get through it and triage as fast as they can.
23:00All hands on deck, yeah.
23:02My name's Shel and this is Beth. We'll be taking your x-ray.
23:09One of those needing close monitoring is Christopher.
23:14Hold. Breathe out.
23:18He has epilepsy, but his last seizure didn't follow the usual pattern.
23:25Dr Foster is concerned that he might have had a heart attack,
23:30so she's carrying out further tests.
23:33The chest x-ray is cleared, so no signs of infection on the chest x-ray there.
23:39One of the blood tests that we added on was looking at damage to the heart
23:44and that's actually come back quite raised, so it's come back at 134.
23:49Well, it didn't sound like his normal seizures.
23:52And his first drop was 134, second drop 194.
23:55And you said you treated them for ACF?
23:59Yeah.
24:00Yeah.
24:02I've done a D-dimer as well.
24:05It's sad.
24:06Trop 194, so his drop's gone up.
24:11Rising levels of troponin in Christopher's blood
24:14are another indicator of a possible heart attack.
24:18He now needs further tests by the cardiac team.
24:21So I've just come to give you a little update.
24:24The marker for your heart has come back raised from what it was before,
24:27so it looks like there's some damage going on.
24:30So it looks like you might be having what we call an endstemi,
24:34so it's a heart attack.
24:36For that, you'll just be kind of admitted to the medical ward,
24:38just for some more monitoring.
24:40But at the moment, are you still pain-free?
24:43Yes.
24:44Still not got any pain in your chest?
24:45No.
24:46No.
24:47Perfect.
24:48So it's not super common to have a heart attack without any chest pain.
24:52It's more common in women than it is in men, so it is a bit unusual.
24:57You're carrying his treatment here, and then we'll head up to the wards
25:01as and when there's a bed, up to the medical unit for more treatment
25:04and monitoring.
25:06Thankfully, further tests ruled out a heart attack
25:09and confirmed Christopher's seizure was caused by his epilepsy.
25:14He's now back home and recovering well.
25:19That's all she just ended up into, yeah.
25:22It's almost lunchtime in the hub, but Sister Vicky...
25:26Is it cubical?
25:28Yeah.
25:29And then one down in lamb.
25:31And Sister Jane are struggling to clear the backlog.
25:35I've said you literally help them,
25:37cos there's two qualified nurses round there, and you come back.
25:40Talisa, we've got a scan with HDC1.
25:43Right, I'll get Louise to go.
25:46We've all got our own way of coordinating the department.
25:49Myself, I just like to go with the flow,
25:51make sure everybody's happy,
25:53make sure I help and assist where I can.
25:55Did you take that one from lamb up to AMU?
25:59So that one's gone.
26:01I think it takes a kind of person to be able to do the job.
26:07You have to have a certain flair for it.
26:10I have respect for everybody that I work with,
26:13and I like them to have respect for me,
26:16so there's no point shouting and moaning.
26:20I think you just have to have an element of assertiveness.
26:23In radiology,
26:29Dean is having an urgent x-ray.
26:35Are you able to just roll your ankle this way for me?
26:40Can you roll that way anymore?
26:43He needed life-saving surgery after a mosquito bite led to a dangerous skin infection.
26:49How comfortable do you feel about rolling once you're on the left hand side?
26:52Not at all.
26:53No, not at all.
26:55Now his ankle is painful,
26:57which could be a sign of a new infection.
27:06Orthopaedic Dr Nida Ahmed reviews his x-ray.
27:10Can you just go through what's happening?
27:13When I got up this morning,
27:14I couldn't hold you to tell me,
27:15like, well, I managed to get it going,
27:16but it's,
27:17some of it's going to get worse, isn't it?
27:19Okay.
27:20Now I can't bear to put any light on it at all.
27:22Okay, fine.
27:23Try to push against my hand?
27:25No, I can't push.
27:27And is that because of the pain?
27:29Oh, yeah, yeah.
27:30So, this bit?
27:32It's all I get that.
27:33I'm getting that.
27:36Okay, that's fine.
27:37It seems to be more in your joint than the lower width itself,
27:41so it's not around your head.
27:42Yeah.
27:43Give me two minutes.
27:48I knew it wasn't right when I woke up this morning.
27:50I feel more confident,
27:51and I know there is something wrong with me.
27:54You're always worried that you're just being petty, aren't you?
27:59Dr Ahmed suspects cellulitis,
28:01an infection in the deep tissue of Dean's ankle.
28:05What's cellulitis, then?
28:06Yeah.
28:07It's just an infection of the skin.
28:09Just because there's nothing that's seen on the x-ray,
28:13your bone looks okay.
28:14Yeah.
28:15That should be okay.
28:16I'll bring you in and start you on some antibiotics.
28:18All right.
28:20Any questions?
28:21No.
28:22No.
28:23I'm keeping me overnight on antibiotics.
28:26I hit my knee, but I can say it took five weeks for that.
28:29I hope it's not as long this time.
28:32Proper birthday present, isn't it?
28:35Dean had to spend eight days in hospital.
28:39He's now back home and looking forward to a belated birthday bash.
28:43In recess, Thomas is responding well to his antibiotics.
28:51Sister Rachel checks up on him.
28:53So, how are you feeling, first and foremost?
28:56I'm not better than I was.
28:57Okay.
28:58Have you got any pain anywhere, Thomas?
28:59No.
29:00I did have this morning, but...
29:02Is he gone now?
29:03Yeah.
29:04Good.
29:05Thomas has discovered he's not the only family member in the hospital today.
29:09Yeah.
29:10Ah, something.
29:11Your son's in hospital?
29:12Yeah, it's my...
29:13She's had another grandson.
29:14Oh, congrats!
29:15Has he been born already?
29:16Yeah.
29:17Oh, congratulations.
29:18Is everyone up there?
29:19Yeah.
29:20How many grandchildren have you got?
29:21All together?
29:22Yeah, all together.
29:2317.
29:2417.
29:2517?
29:2617 and 18.
29:2718?
29:28Oh, my giddy aunt.
29:29I bet your house is busy at Christmas.
29:30Why?
29:31Blood tests have confirmed that Thomas has a chest infection, which needs further investigation.
29:49Dr. Shepard suspects it also causes his stomach pains.
29:54Nice and soft now, isn't it?
29:55Yeah.
29:56Cool.
29:57Your blood tests that look at stuff in your tummy...
29:58Yeah.
29:59...are largely fine.
30:00You're a bit dehydrated, but nothing else particularly.
30:03So, I think it's all just your chest, because your inflammatory infection markers are quite high.
30:07So, we'll continue to target treating your chest and get you up to the medical team, all right?
30:11Yeah.
30:12Cool.
30:14His heart rate, blood pressure, and oxygen levels are all essentially normal now.
30:19His tummy's no longer painful, and all of his blood tests just point to a bad chest infection.
30:24If there was other problems, then, potentially, the medical registrar would have come down, but didn't need to.
30:28So, he's now well enough to go up to the ward, which is what I'm missing in.
30:31Tom, I'm going to leave you two, aren't you?
30:33Your bed's ready upstairs.
30:34All right.
30:36Keep having a look at your chest.
30:37Yes.
30:38Hopefully, you get better, and I hope you get to see your new grandson.
30:40I hope so.
30:41Son, daughter?
30:42Grandson or granddaughter?
30:43Yeah.
30:44Grandson.
30:45I hope you get to see your new grandson soon, all right?
30:46Yeah.
30:47All the best.
30:48All the best, man.
30:49Do you take all these wires off me?
30:51Yeah, I'm going to come and take him on for a sec.
30:54I'll have to make sure the porter's coming.
30:56Yeah, I'll look like it.
30:57A metal mickey.
30:58It's all.
30:59Shhh.
31:00Shhh.
31:01Yeah.
31:02That's enough, then.
31:03Just not.
31:04Let's go.
31:05Further tests revealed Thomas had pneumonia, and he had to spend a week in hospital.
31:15But he's now back home, and has met up with his 18th grandchild.
31:22In the hub.
31:23Great, my love.
31:24Thank you very much, sir.
31:25See you later, love.
31:29Sister Vicky and Sister Jane.
31:31Louise, would you mind doing a CT head run?
31:35Actually, what time?
31:36No, I'm going to send her for a break, because it's 22.
31:39I've asked Paul to go for his break, Louise had, but they wanted some help with the washes.
31:46But lunchtime is almost over, and staff still need their breaks.
31:51Just do the one you're doing, and then I'll get Paul to take you off for your dinner.
31:56We're the dynamic duo.
31:59We are.
32:00I'm the dynamic, she's the duo.
32:04And new patients are still arriving.
32:08In paediatrics, 12-year-old Nevaeh's hurt her hand at a majorette dance troupe practice.
32:17She's come in with mum, Amy.
32:19She'd done the walkover, and then she started crying, like, through her next dance, and I
32:26was saying, oh, you'll be fine, but then she carried on complaining.
32:30Nevaeh?
32:31Yeah.
32:32She'll be seen by emergency nurse practitioner, Tony.
32:37So what's happened?
32:38I did, like, a walkover, and I landed on my hand and went over it.
32:48OK.
32:49And so when you landed, have you, like, put your hands down like that, or onto the side
32:52of it, or do you remember?
32:53And then you've got to, like, put your hands flat.
32:55OK.
32:56So what's the thing you like when you've gone down like that?
32:57She rolls when she does it, and she kind of goes sideways, right?
33:02She hadn't quite mastered the whole thing, yeah.
33:04OK.
33:05That's fine.
33:06Let's have a look, then.
33:07Any wiggly fingers for me?
33:08OK.
33:09Can you make a fist?
33:10Can you get it?
33:11That's OK.
33:12You saw around your knuckle a bit?
33:14It hurts her.
33:15Hurts there.
33:16Then it's coming down here.
33:17It hurts.
33:18So she chipped her bone off her foot, and then she's broke her nose with her baton as well
33:23a few weeks ago, so she's prone to accidents.
33:28It's very rewarding working with children.
33:32You can very quickly fix things in children and make them better.
33:37Sometimes you can get a little crack on a bone and you can't always see, but we'll
33:40get an extra bit first, and we'll go from there.
33:42Some patients don't need anything doing.
33:44Sometimes it's just a bit of reassurance for parents that everything that they're doing
33:47is fine.
33:48You don't need to do anything else.
33:49You want to come this way?
33:51Sometimes you examine them, they've got a bit of pain in the wrist, you send them
33:54for the x-ray, and they've got a really nasty fracture, and they're just quite happy with
33:59it.
34:00They're not bothered.
34:01Turn right and it's headlong and you'll see x-rays, so it's on your left hand side.
34:03Can you come back?
34:04Just press that doorbell.
34:05We'll come and get you back in.
34:07See you back shortly.
34:08If the x-ray shows Nevaeh's injury is severe, her baton-twirling days could be over.
34:20In majors, Christine is waiting for the results of her head scan.
34:27Just looking at the damage.
34:28It's lovely, innit?
34:29And the jumper's going to have to be thrown away by it, look, innit?
34:35Sister Susan is there for moral support.
34:38Me and her, we've sent to stick together.
34:42We've had this moment where we're there for each other and all.
34:48Dr. Allcroft reviews the scan.
34:51Thankfully, it doesn't show any bleeding inside the head, which is really good news.
34:56So, if you're reassured from that big thing we were worried about at the start, we can
35:00sort of tick that off as a worry.
35:02So, that's good news.
35:03Ow.
35:04So you want some more cleaning?
35:07Aye.
35:08I just wish it would stop bleeding.
35:13But Christine's open wound still needs closing.
35:18Hello?
35:19My name's Nick.
35:20I'm one of the emergency doctors.
35:21The good news is, is that there's not any bleeding inside the head, which is great.
35:26Um, can I have a little look under here?
35:29Sorry, I'm catching your hair.
35:31I'm sorry.
35:32Oh, bless you.
35:33Okay.
35:34I suspect, looking at that, that might need some stitches, if I'm honest.
35:42There's a clot in it at the moment that we'd need to remove to help it heal, basically.
35:47Yeah.
35:48Now, I think what we need to do to start with is probably get a bed in here so I can sort
35:54of have you laying down so I can have a really good look at it and give it a good clean is sort
35:59of the first and most important thing.
36:01Make it hurt.
36:02You've got to laugh at it all, otherwise you'd just sit there and cry.
36:14She's laughing now, but Christine will need stitches to close her head wound.
36:19It's nearing the end of the shift for Sister Vicky and Sister Jane.
36:36You've worked hard today.
36:37I am.
36:38How are you, love?
36:39I am.
36:40On your little team.
36:41Pervert me crossed.
36:42Where are you?
36:43Where's she?
36:44Right, well, you can tell her.
36:45She said no.
36:46I want her to come back and do some work.
36:47I've been a nurse for a long, long time and I've said numerous times, you cannot buy experience.
36:59You just, you can't.
37:00Let me go get you a pillow or another blanket for this leg so it don't fall down.
37:06How's that sound?
37:08We are all problem fixers.
37:09Some are very good at working on a team and delivering, you know, a good standard of nursing
37:15care.
37:16She can go in a chair and then I can get this patient in and then others are very good at
37:21being in charge, steering the ship if you like.
37:23And I think, you know, we all have different flares for different things and I think once
37:28you put all that together, it is a well engineered team.
37:36In radiology, majorette Nevaeh is hoping she's not broken any bones.
37:46After a tricky move at dance practice went wrong.
37:49You want me in?
37:50Yeah.
37:51What have you done?
37:55It was like a walk over and I went over with my hand.
38:00Nevaeh came to casualty with mum, Amy.
38:03She plays football as well so you'd think she'd get more injuries from football than dance
38:09but...
38:10Will you do, make sure you see your hand and fingers, sort of, just pop it down nice and
38:13flat into there.
38:14She scored her first goal last week but she put it in her own head.
38:18What happened?
38:19I'll send those x-rays across to Amy if you just want to make a way back round there, like
38:2890-factor x-rays.
38:29Emergency nurse practitioner Tony assesses the injury.
38:38She was more painful down this side of her hand and into her little finger.
38:42No obvious cracks or breaks or anything there.
38:46So I think that's going to be bruised rather than anything else.
38:50Bones in children tend to bend more than they'll break.
38:54Whereas in the same injury for an older person they would likely get a more significant break
38:59to the wrist.
39:00I need a pot in and sometimes even surgery.
39:02Can't see anything broken.
39:03I think you might have just rolled it a little bit and you've just caused a bit of bruising.
39:07Keep it moving.
39:08Paracetamolibiprofen, absolutely things like that's absolutely fine.
39:11Brilliant.
39:12Yeah.
39:13You'll be fine.
39:15I'll let you go then.
39:16It's the best outcome for Nevaeh.
39:19At least you can dance on Saturday now.
39:22But she'll be watching how she lands those tricky moves a bit more carefully from now on.
39:35In majors, Dr Allcroft is preparing to stitch the open wound on Christine's forehead.
39:41Right, you want me to keep it?
39:43No, just lay down now.
39:46What I want you to do is just be basically relaxing as much as possible.
39:50Best case scenario would have been the fall had done no injury.
39:53There'd be no injury to the head and everything was absolutely perfectly fine.
39:56I'm going to get this up a little bit just to save my back so I'm not a hunchback.
40:00I think luckily looking at the injuries that have happened most of it is going to be able
40:05to be managed without sort of hopefully any need for surgical invention or causing sort
40:10of longer term more serious damage.
40:13You're all crazy.
40:16It's stinging.
40:18I'm sorry.
40:19It's just to make sure when we put it in it's okay.
40:21Oh, bless you.
40:22I'm sorry.
40:23It's really sore around that then.
40:26I know.
40:27I think where it's grazed and unfortunately this isn't.
40:29I'll do it quick.
40:30Oh, I will be glad when I get home.
40:33Just going to do a little injection above your eyebrow.
40:43Unfortunately the local anesthetic can sting a little bit in itself.
40:46Give me that little massage.
40:47I'm used to injections.
40:48I used to inject myself four times a day.
40:49Oh, did you?
40:50Yeah, when I first went out I got diabetes.
40:51Lord bless you.
40:52Just do a little one this way as well.
40:53I had my nose pierced and all.
40:54I was 71 and I thought I've always wanted to have my eyebrow done in my nose.
40:59So I had my nose done at Skaggy and my eyebrow done in Barnsley.
41:05Full works basically.
41:06Yep.
41:07Well just one last injection and hopefully everything will be nice and no, okay?
41:12Could you not just put me to sleep?
41:13No.
41:14You can see we've got a fairly big clot in there.
41:15And I'm going to get my nose pierced and all.
41:17I'm 71 and I thought I've always wanted to have my eyebrow done in my nose.
41:18So I had my nose done at Skaggy and my eyebrow done in Barnsley.
41:19Full works basically.
41:20Yep.
41:21Well just one last injection and hopefully everything will be nice and no, okay?
41:24Could you not just put me to sleep?
41:25No.
41:26You can see we've got a fairly big clot in there.
41:31that we need to take out.
41:32You've got a big clot outside and all.
41:38There we go, that's what we wanted.
41:54Is it too big for butterfly stitches?
41:56Yeah, I think unfortunately.
41:58You've got lonely pops for after.
42:01I'm sure we can fix you some up.
42:03I'll raid our special sweet treats.
42:05Oh, you are kind.
42:06So I need you to keep your head really still because if the head moves as I go along,
42:10it's going to be tricky to get.
42:13So I think we're all done.
42:27Yep.
42:28Give me a little sort of wiggle of your face.
42:32Raise your eyebrows for me.
42:34I love you.
42:35Well done there.
42:36You were awesome.
42:40So that's, I suppose, always the best case scenario that we've not had anything serious and long-term
42:45going on.
42:46That being said, I think the worst case scenario would be if we'd found a big bleed on the head
42:51and that could have been very serious, so thankfully we've not had that happen.
42:57Very certainly fingers hurt.
43:01Christine's face is healing well.
43:04She's watching out for the steps outside her sister's house whenever she visits.
43:09I love these.
43:14It's the end of the shift for Sister Vicky and Sister Jane.
43:18Look at you all.
43:19Like bees round the little honeypot.
43:20Sorry.
43:21Vultures.
43:22As a nurse in charge of the department, the more experience you get at doing it, then
43:31the better you become at it.
43:33Bye, Carol.
43:34And I think to work here in this department where we are so gelled as a team.
43:39All right, A's.
43:40See you later.
43:41It's incredibly important.
43:44Good night.
43:45At the end of the day, we're one big family here, so we're all here for each other.
43:50It's so easy when you quick chalk.
43:53Some shifts can be really gruelling and you can walk off absolutely exhausted.
43:59I like to leave the shift happy and positive and know that everybody's done a good job.
44:05Oh, I love this bit.
44:08I love it.
44:09And as the new shift arrives, another team is ready to serve the people of Barnsley 24-7.
44:16.
44:25.
44:31.
44:35.
44:39.
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