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00:00Bansley, 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 prize, you've got me.
00:20Seven days a week.
00:26Saving lives.
00:28No, no.
00:30Helping loved ones.
00:32Well, this is shocking. They're actually broken bones.
00:34Making the community they serve better.
00:38Well, everybody's safe, that's all that matters.
00:40A health service treating anyone.
00:42Restrain 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.
01:04On ship tonight.
01:14Dr John Shepard.
01:16Relax your head back for me.
01:18Dr Nicholas Allcroft.
01:20With this one last injection, then hopefully everything will be nice and young, okay?
01:24Could you not have just put me to sleep?
01:26And...
01:28Sister Vicky and Sister Jane.
01:30You've worked hard today, Vicky. How's your love?
01:32I am.
01:34So...
01:36So, catching your hair, I'm sorry.
01:38Get ready to share a shift...
01:40Does that hurt when I'm all a bit like that?
01:44With the team at Barnsley Casualty.
01:46Well done there, you were awesome.
01:53How long's that gonna 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, you're a 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?
02:22I don't know.
02:23Louise has just come to me and said, has he gone?
02:24I 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 let-up.
02:44Another critical patient is on the way in.
02:49Perfect.
02:50Perfect, Homer.
03:0170-year-old retired painter and decorator, Thomas, is struggling to breathe.
03:09Take this one from your waist.
03:11He's had pains in his chest and stomach since returning from holiday in Tunisia two weeks ago.
03:21He'll be treated by Dr John Shepard.
03:26My name's John.
03:27I'm one of the doctors.
03:28Nice to meet you.
03:29Nice to meet you, Homer.
03:30So you and Tunisia for how long?
03:31Two weeks.
03:32When did you start feeling unwell?
03:33On the flight or as you landed?
03:34When we landed in Manchester.
03:36Okay, fine.
03:37And what was the first problem?
03:38No, sneezing and coughing.
03:40Like a phlegm.
03:41Yeah.
03:42Did 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 whether
03:50or 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 on you?
04:00You had worse today.
04:01Okay.
04:02What was worse?
04:03Pain in your tummy.
04:04The pain.
04:05Okay.
04:06Pain in your tummy?
04:07Yeah.
04:08Fine.
04:09So right now...
04:10Okay.
04:11So you've got COPD?
04:12Yeah.
04:13Do you use inhalers for that?
04:14COPD 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 didn't
04:28have the condition.
04:29Have you ever had a heart attack?
04:30No.
04:31No.
04:32Fine.
04:33Do you smoke?
04:34Yeah.
04:35Cool.
04:36How many do you smoke?
04:37I go to a pouch about a week.
04:38Okay.
04:39Cool.
04:40Stop smoking.
04:41It's bad for you.
04:42I am.
04:43Do you drink alcohol?
04:44Okay.
04:45Do 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,
04:58it's tricky because they're very addictive substances.
05:02Okay.
05:03Relax your head back for me.
05:05His smoking and alcohol intake will make his immune system less able to fight off infection.
05:13Ah.
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.
05:22When I was young.
05:23Fine.
05:24Any other problems surgery wise?
05:26No.
05:27No.
05:28No.
05:29So, 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.
05:36That'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 condition.
05:48Marjorie.
05:49She's been called for her bloods but it's not being done so can you get somebody to do her bloods now love?
06:04In the hub, Sister Jane and Sister Vicky are juggling patients.
06:09Oh, hello Marjorie.
06:11John, will you just code that CTKUB patient? I've sent them to CDU.
06:16Okay.
06:17Once we shift on a morning and all of a sudden it's like the bus has been dropped off outside.
06:23We could get 15, 20 patients in booking within an hour.
06:28One of those patients being blue lighted in is 71-year-old Christine.
06:43Her head is bleeding badly after a fall.
06:50Sister Vicky assesses her injuries.
06:52Hi, Christine. I'm Vicky. Nice to meet you.
06:54So what's been happening with you? What have you been doing?
06:57I fell out of my sister's door.
07:00So you've come out of your sister's and you've stepped down and you've lost your foot in
07:05and then you've gone face-face like that.
07:08Yeah.
07:09Did you black out?
07:10No.
07:11I remember everything.
07:12Yeah?
07:13Right, just look straight forward at my husband's going to shine his torch.
07:16Oh, we're all right.
07:17Perfect.
07:18I'm just going to have a chat with the ambulance crew.
07:20Okay, then I'll come back and see you.
07:22She's come home from dropping her sister off at her pants until she's been going up the step.
07:26Lost her footing, slipped down one step, landed onto her knees and then onto the left side of her face.
07:32Yeah?
07:33He's been bleeding quite because I've managed to stop it just.
07:37Yeah.
07:38No other injuries that I can see. Left eye, very bloodshot.
07:42My name's John. Hello.
07:43Hello.
07:44Any pain in your neck when I squeeze?
07:46I have pain in my neck and down my spine because I've got osteoporosis.
07:51Is it worse than normal?
07:52Not really, no.
07:53Can 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.
08:06Our consultant went in and had a little look.
08:09She's on blood thinners, so obviously she needs a CT scan.
08:13So 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, but they're going to have to do your blood pressure and stuff okay.
08:27You just need to make sure that there's no pressure that's building up in your head.
08:31All right.
08:32Yeah?
08:34Because she's on blood thinners, a scan is needed to check if Christine has had a bleed on the brain.
08:40Untreated, it can be life-threatening.
08:55It'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.
09:06Just looks like waiting room, just getting hammered at the minute.
09:09The patients keep arriving.
09:13Are you going to cheer me up, Antonia, no?
09:16I'm not.
09:18But 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.
09:29Yeah.
09:30If there's no beds within the trust or in areas that we need them, then that's when we become stuck.
09:39One of those still being treated in recess is Thomas.
09:50Dr. Shepherd 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 you hadn't had a heart attack in here.
10:04Yeah.
10:05I'm going to give you some anti-gressions for your chest.
10:13The 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.
10:28No.
10:29Yeah, so these are to try and have a look for any fluid in the bottom of his lungs or fluid
10:40in his tummy that shouldn't be there.
10:41Sorry, Thomas.
10:42I'm 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.
10:55Do you want to spit something out?
11:04You could be surprised by how much you can tell from someone's phlegm or from what they've coughed up.
11:17Delicious.
11:18Is that what's been coming up?
11:20Yeah.
11:21That's mine.
11:22And sometimes it's green, isn't it?
11:23Mmm.
11:24Cool.
11:25I'm still thinking it's a chest infection, I'm afraid, with that.
11:28That's gorgeous.
11:29You can tell, you know, if there's blood in there, if there's green-looking stuff, if it's
11:32bacterial, or importantly, if something more serious is going on.
11:37Dr Shepherd needs to get a second opinion from a consultant.
11:41So, you said some comox and clarithromycin.
11:44Would you just give him the stat taz as well, or next day's taz?
11:48Thomas is prescribed antibiotics.
11:51But if they can't find the cause of his pain, he will need to be admitted for further tests.
11:56If a bed can be found.
12:03Surgery have got no beds, orthopedic have got two, gynae have got none.
12:09Sister Jane briefs the team on the state of play.
12:13So, it's just going to be slow, medicine-wise.
12:18Ward 37 is full.
12:20Our, yeah, 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 flow of the department.
12:34So, yeah, fingers crossed, it shouldn't be too much longer now, and we'll get you sorted.
12:37All right, love, thank you.
12:38Just arrived in Majors.
12:44Is it Dean? Yeah.
12:46Hiya, Dean, I'm Chantel. Are you dozing off?
12:48I am, yeah.
12:49Sorry.
12:50Advanced clinical practitioner Chantel's next patient, Dean, is 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 of fault with your mozzie.
13:04A mosquito, and I had a little spot on me foot.
13:07You know, a proper yellow-redded spot.
13:09And I didn't feel no more about it.
13:10Yeah.
13:11And I got off at play, and my leg had just...
13:12Ballooned.
13:13Ballooned.
13:14Yeah.
13:15The taxi driver picked us up.
13:16I was taking him 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.
13:26Well, there's no guarantees you're going to survive.
13:28Yeah, it's really, 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 minding his own business
13:40enjoying 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 the middle of the 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 throat 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?
14:22No, smack it middle up to my foot.
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 been like that.
14:34I'm going to eat snow in general.
14:36And is this from healing still?
14:37Yeah, it's still healing.
14:39Good.
14:40Where did they take the graft from?
14:41There.
14:42There.
14:43It's really clever, isn't it, how they do it?
14:45Yeah, 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, has he got necrotising fasciitis again?
14:55Some patients can just develop it.
14:57It can live on the skin.
14:58And when it breaks into the skin, that's when it becomes a problem.
15:02Tell me about your ankle again.
15:03Well, this morning, he took me now into go to bed.
15:06It's a lot of solid.
15:08When 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.
15:18It feels normal, but like that when you move me back a bit, then that...
15:20Okay.
15:21But your skin's not painful?
15:22No.
15:23And that's...
15:24I've got a lot of 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.
15:36So, Dean's proven to be quite a tricky patient to treat in A&E because he's got multiple things
15:45going 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.
16:06Mm.
16:07So I need an orthopaedic review.
16:08Is that hurt when I'm over 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 along from Leeds, I know we're taking them out for a meal somewhere.
16:22Aww.
16:23So I didn't know we had to do it quite well.
16:24I could feel that as well.
16:25I could feel that as well.
16:26So I need an orthopaedic review.
16:27Does that hurt when I'm over it like that?
16:28Yeah.
16:29That's tender?
16:35We never know.
16:36We might still be able to be there.
16:37Well, it's if I can get anywhere, innit?
16:39Yeah.
16:40Right, let me get you sorted, Dean.
16:42All right, please.
16:43What time's your birthday meal?
16:44I don't know.
16:45How long have I got?
16:46They were aiming to be back at Dalton for twenty 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
16:57a ward.
16:58One patient's sister Vicky is keeping a watchful eye on is Christine.
17:09Let's try to shuffle a bit more.
17:11Just keep your head nice and still for the skull.
17:14If your eyes closed all the time, you feel a little pain.
17:18Yeah.
17:19She's on blood thinners and has a nasty head wound.
17:22It's nice and still for me.
17:24All right.
17:27The worst case scenario would probably be a bleed on the brain because I've rescheduled
17:30to her blood thinners and things like that.
17:33Hence why she's having the scum.
17:37Hey.
17:38Hold on, Dean.
17:40Don't get you on.
17:41Come on, Dean.
17:50Christine's sister Susan is waiting with her for the results of the scum.
17:54The staff's been lovely.
17:56The hospital itself's been lovely.
17:58They've not been able to do enough for us.
18:02Dr. Orcroft checks the scan.
18:04If Christine has a bleed on the brain, she'll need emergency surgery.
18:09Five hours into the shift.
18:14There's no cubicles.
18:16And that's what I need.
18:18And sister Jane has to make space for emergencies.
18:22Asin, Salim, have you done with your patients in cubicle 15?
18:26She can go to surgical anesthetic, yeah.
18:28To keep the department open for new patients.
18:32Shall 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.
18:46Right, William, we're just moving your sweetheart into another cubicle, alright, my love?
18:51A cubicle is freed up just in time.
18:58The 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.
19:07They got there within about three minutes, within his stop season, and he was 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 and back of his head.
19:29You're asking about it, mate, alright?
19:31Yeah.
19:32So I had a seizure today, coming back from town.
19:36I normally know when I'm going to have one, but this time I didn't.
19:45He'll be examined by Dr Charlotte Foster.
19:48Hello, my name's Charlotte, I'm one of the doctors.
19:50So what's happened today to bring you in?
19:52I had an epileptic, so I had a seizure when I was coming back from town and going home.
19:57Yeah, okay.
19:59Did anybody see you, the seizure?
20:01Passing by, 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 had these seizures?
20:09Yeah.
20:10Yeah, and this is the first one you've not had any?
20:12Yeah.
20:13Yeah, okay.
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
20:19okay.
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.
20:29Yeah.
20:30Because Christopher's seizure didn't follow its normal pattern, Dr. Foster decides to get
20:38a 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.
20:46Normally he gets kind of dizziness.
20:47He's known to have epileptic seizures.
20:48He's known to have epileptic seizures.
20:49He hasn't had a seizure in the last two years.
20:52He came round within about five minutes or so, so I was just a bit worried that it doesn't
20:55sound like his normal seizures.
20:57Implying the standard for pressure needs 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
21:05like that.
21:06So, there'll be some further investigations that we do just to rule out other causes.
21:10We'll also add on some blood tests, just looking at his heart, to make sure that's
21:13not 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
21:21it's getting kind of more strain on it.
21:24And also to have a look at your blood clotting as well, just to make sure that's all all
21:29right.
21:30Yeah, I think given that you've kind of had this episode of kind of collapsing.
21:35Yeah.
21:36We just want to make sure that it's not because of your heart really and not a seizure.
21:41All right.
21:50What are they expecting?
21:51All these tests.
21:52Not that fits me after I woke up.
21:56With Christopher's symptoms appearing unusual, Dr. Foster needs to rule out of the causes
22:01of his collapse.
22:03An X-ray will look for infection, whilst blood tests check for signs of a heart attack.
22:08Paul, can you do me a favour? I've got loads to get out to AMU now, because they've pulled them all.
22:25Hospital beds are starting to free up for patients waiting in casualty.
22:31Louise, Paul's getting some patients ready for the ward. Can you just help him out, love, please?
22:36But it's given Sister Jane a new problem.
22:40And then can you get her up to EPA you for me, Paul, or get a porter to take her up? You don't particularly need to go up yourself.
22:46Finding staff to help that are not tied up with patients.
22:50A lot in waiting room, and I know I've just heard Jane say that there's five members of staff now down there, trying to get through it and triage as fast as they can.
22:59All hands on deck, yeah.
23:07My name's Shel and this is Beth. We'll be taking your X-ray.
23:10One of those needing close monitoring is Christopher.
23:15Hold. Breathe out.
23:19He has epilepsy, but his last seizure didn't follow the usual pattern.
23:24Dr Foster is concerned that he might have had a heart attack, so she's carrying out further tests.
23:34The chest X-ray is clear, so no signs of infection on the chest X-ray there.
23:40One of the blood tests that we added on was looking at damage to the heart.
23:45And that has actually come back quite raised, so it's come back at 134.
23:50Well, it didn't sound like his normal seizures.
23:52And his first drop was 134, second drop 194.
23:56And you said you treated them for ACF?
23:59Yeah.
24:02I've done a D-dimer as well.
24:06Third drop 194, so his drop's gone up.
24:10Rising levels of troponin in Christopher's blood are another indicator of a possible heart attack.
24:17He 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.
24:28So it looks like there's some damage going on.
24:30So it looks like you might be having what we call an endstemi.
24:35So it's a heart attack.
24:37For that you'll just be kind of admitted to the medical ward just 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.
24:46Perfect.
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.
24:55So it is a bit unusual.
24:56You'll carry this treatment here and then we'll head up to the wards as and when there's a bed.
25:02Up to the medical unit for more treatment and monitoring.
25:05Thankfully, further tests ruled out a heart attack and confirmed Christopher's seizure was caused by his epilepsy.
25:12He's now back home and recovering well.
25:19That's what she just ended over into, yeah.
25:22It's almost lunchtime in the hub, but Sister Vicky.
25:26Is it cubicle?
25:28Yeah.
25:30And then one down in lamb.
25:32And Sister Jane are struggling to clear the backlog.
25:35I've said you literally help them because there's two qualified nurses round there and you come back.
25:40Talisa, we just got a scan with HDC1.
25:44Right, I'll get Louise to go.
25:46We've all got his own way of coordinating the department.
25:50Myself, I just like to go with the flow, make sure everybody's happy, make sure I help and assist where I can.
25:57Did you take that one from lamb up to AMU?
26:01So that one's gone?
26:03I think it takes a kind of person to be able to do the job.
26:08You have to have a certain flair for it.
26:11I have respect for everybody that I work with and 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, Dean is having an urgent x-ray.
26:34Are you able to just roll your ankle this way for me?
26:39Can you roll that way anymore?
26:42He needed life-saving surgery after a mosquito bite led to a dangerous skin infection.
26:48How 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, which 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, I couldn't move it to tell me.
27:15I managed to get it going, but it's...
27:18It's always going to get worse, isn't it?
27:20Okay.
27:21I can't bear to put any light on it at all.
27:23Okay, fine.
27:24Is that a push against my hand?
27:26No, I can't push.
27:28And is that because of the pain?
27:30Yeah.
27:31It's the best bit.
27:33Sorry, Dr. I'm a devil.
27:36Okay, that's fine.
27:37It seems to be more in your joint than the lower bit itself.
27:41So it's not around your heat.
27:43Yeah.
27:44Give me two minutes.
27:48I knew it wasn't right when I woke up this morning.
27:51I feel more confident.
27:52And I know there is something wrong with me.
27:54Because you're always worried that you're just being petty, aren't you?
27:57Okay.
27:59Dr. Ahmed suspects cellulitis, an infection in the deep tissue of Dean's ankle.
28:05What's cellulitis, then?
28:07Yeah.
28:08It's just an infection of the skin.
28:09Just because there's nothing that's seen on the x-ray, the bone looks okay.
28:14Yeah.
28:15That should be okay.
28:17We'll bring you in and start doing some antibiotics.
28:19Alright.
28:21Any questions?
28:22No.
28:24Keeping me overnight on antibiotics.
28:27Very neat, but obviously it took five weeks for that.
28:29I hope it's not as long this time.
28:32Proper birthday present, innit?
28:35Dean had to spend eight days in hospital.
28:39He's now back home and looking forward to a belated birthday bash.
28:47In 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 feeling very much.
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.
29:10Yeah.
29:11I have something.
29:12Your son's in hospital?
29:13Yeah, it's my...
29:15She's had another grandson.
29:17Oh, congrats!
29:19Has he been born already?
29:20Yeah.
29:21Oh, congratulations.
29:22Yes, I did.
29:23I had to offer you to...
29:25Is everyone up there?
29:26Yeah.
29:28How many grandchildren have you got?
29:30All together?
29:31Yeah.
29:32All together.
29:33Shhh.
29:3517.
29:3617?
29:3717 and 18 over there.
29:3818?
29:39Oh my...
29:40Gideon, I bet your house is busy at Christmas.
29:41Why?
29:43Blood tests have confirmed that Thomas has a chest infection,
29:47which needs further investigation.
29:50Dr Shepherd 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,
30:05because your inflammatory infection markers are quite high.
30:08So we'll continue to target treating your chest
30:10and get you up to the medical team, all right?
30:11Yeah.
30:12Cool.
30:15His heart rate, blood pressure and oxygen levels
30:17are all essentially normal now.
30:19His tummy's no longer painful,
30:21and all of his blood tests just point to a bad chest infection.
30:23If there was other problems,
30:25then potentially the medical registrar would have come down,
30:27but didn't need to.
30:28So he's now well enough to go to the ward,
30:30which is what I'm missing.
30:32Tom, I'm going to leave you to it.
30:33Your bed's ready upstairs.
30:34All right.
30:35Thank you very much.
30:36Keep having a look at your chest.
30:37Yes.
30:38Hopefully you get better,
30:39and I hope you get to see your new grandson.
30:40I hope so.
30:41Son, daughter?
30:42Grandson or granddaughter?
30:43Grandson.
30:44Grandson.
30:45I hope you get to see your new grandson soon, all right?
30:46All the best.
30:47Yeah, all the best, man.
30:48Do you take all these wires off?
30:51Yeah, I'm going to come take him on.
30:52I'm going to come take him on for a sec.
30:54I'll just make sure the porter's coming.
30:56Yeah, I look like it.
30:57I'm making a miki motor.
30:59A miki motor.
31:01Yeah, that's enough then, doesn't it?
31:07No.
31:08Let's go.
31:09Let's go.
31:10Further 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.
31:23In the hub.
31:24Great, my love.
31:25Thank you very much, sir.
31:26See 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.
31:39Are clearing the backlog of patients.
31:42I've asked Paul to go for his break, Louise has, but they wanted some help with the washes.
31:47But 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.
31:57We are.
31:58I'm the dynamic.
31:59She's the duo.
32:00And new patients are still arriving.
32:11In paediatrics, 12-year-old Nevaeh has 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 was saying,
32:27oh, you'll be fine, but then she carried on complaining.
32:31Nevaeh?
32:32Yeah.
32:34She'll be seen by emergency nurse practitioner, Tony.
32:43So what's happened?
32:44I did, like, a walkover, and I landed on my hand and went over it.
32:48OK.
32:49And so when you've landed, have you, like, put your hands down like that, or onto the side
32:52of it, or...?
32:53You remember?
32:54You've got to, like, put your hands flat.
32:55OK.
32:56She's the thing you like when you go down like that.
32:57She rolls when she does it, and she kind of goes sideways.
33:02She hasn't quite mastered the whole thing yet.
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?
33:10I'll find a fist you can get.
33:11That's OK.
33:12Can you saw around your knuckle a bit?
33:14It hurts her.
33:15It hurts 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.
33:36Sometimes you can get a little crack on a bone, and you can't always see, but we'll get an X-ray of it 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 is fine.
33:48You don't need to do anything else.
33:49You want to come this way?
33:50Sometimes you examine them, they've got a bit of pain in the wrist.
33:53You send them for the X-ray, and they've got a really nasty fracture, and they're just quite happy with it.
33:58They're not bothered.
33:59Turn right, and it's headlong, you'll see X-rays.
34:01It's just on your left-hand side.
34:02When you come back, just press that doorbell.
34:04We'll come and get you back in.
34:06We'll see you back shortly.
34:09If 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.
34:29It's lovely, isn't it?
34:31And 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, but we're there for each other and all.
34:49Dr Orcroft reviews the scan.
34:52Thankfully, it doesn't show any bleeding inside the head, which is really good news.
34:56So we can be reassured from that big thing we were worried about at the start,
35:00we can sort of tick that off as a worry.
35:02So that's good news.
35:03Ow.
35:04So what do you want some more cleaning?
35:07Aye.
35:08I just wish you could stop bleeding.
35:13But Christine's open wound still needs closing.
35:18My name's Nick.
35:19I'm one of the emergency doctors.
35:21The good news is, is that there's not any bleeding inside the head, which is great.
35:25Um, 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.
35:34Okay.
35:35I 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
35:53of have you laying down so I can have a really good look at it and give it a good clean is
35:59sort of the first and most important thing.
36:01Make it hurt.
36:02You've got to laugh at it all, otherwise you just sit there and cry.
36:14She's laughing now, but Christine will need stitches to close her head wound.
36:20Beep.
36:21Beep.
36:22Beep.
36:23Beep.
36:24Beep.
36:25Beep.
36:26Beep.
36:27Beep.
36:28Beep.
36:29Beep.
36:30Oh.
36:31It's nearing the end of the shift for Sister Vicky and Sister Jane.
36:36You've worked hard today, Vic.
36:38I am.
36:39How's your love?
36:40I am.
36:41On your little team.
36:42Pervert me crossed.
36:43Where are you?
36:46Where's she?
36:48Right, well you can tell her.
36:50She said no.
36:51I want her to come back and do some work.
36:53I'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.
37:01Let me just get you a pillow, eh?
37:03Or another blanket for this leg so it don't fall down.
37:06How's that sound?
37:08We are all problem fixers.
37:10Some 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, can't she?
37:17And then I can get this patient in.
37:19And then others are very good at being 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.
37:35In radiology, majorette Nevaeh is hoping she's not broken any bones.
37:42Nevaeh, do you want to come on in?
37:44Yeah.
37:45After a tricky move at dance practice went wrong.
37:49Do you want me in?
37:50Yeah.
37:51What have you done?
37:52It was like a walk over and I went over with my hand.
37:56Nevaeh came to casualty with mum, Amy.
38:02She plays football as well so you think she'd get more injuries from football than dance
38:09but...
38:10Can I do x-rays of your hand and finger?
38:11Sorry.
38:12Just pop it down nice and flatten to there.
38:14She scored her first goal last week but she put it in her own head.
38:19So I'll send those x-rays across to Amy if you just want to make a way back round there,
38:26like 90-factor x-rays.
38:28Emergency nurse practitioner Tony assesses the injury.
38:35She 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.
38:51Bones 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 to the wrist.
39:00That needed potting and sometimes even surgery.
39:03Can't see anything broken.
39:04So I think you might have just rolled it a little bit and you just caused a bit of bruising.
39:07Keep it moving.
39:08Paracetumal ibuprofen, absolutely things like that, absolutely fine.
39:11Brilliant.
39:12Yeah?
39:13Yeah?
39:14Yeah?
39:15It'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.
39:28In majors, Dr Orcroft 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.
39:45What 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, there'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 to be managed without sort of hopefully any need for surgical invention or causing sort of longer term, more serious damage.
40:13It's stinging.
40:14I'm sorry.
40:15It's just to make sure when we put it in it's okay.
40:16Oh, bless you.
40:17I'm sorry.
40:18It's really sore around that then.
40:19I know.
40:20I think where it's grazed and unfortunately this isn't.
40:21I'll do it quick.
40:22Oh, I will be glad when I get home.
40:23Just going to do a little injection above your eyebrow.
40:24Oh, no.
40:25Unfortunately the local anaesthetic can sting a little bit in itself.
40:26Give me that little massage.
40:27Okay.
40:28I'm used to injecting.
40:29Oh, no.
40:30Oh, no.
40:31Oh, no.
40:32Oh, no.
40:33Oh, no.
40:34Oh, no.
40:35Oh, no.
40:36Oh, no.
40:37Oh, no.
40:38Oh, no.
40:39Oh, no.
40:40Oh, no.
40:41Oh, no.
40:42Oh, no.
40:43Oh, no.
40:44Oh, no.
40:45Oh, no.
40:46Oh, no.
40:47Oh, no.
40:48Oh, no.
40:49Oh, no.
40:50Oh, no.
40:51Oh, no.
40:52I'm used to injections.
40:53I used to inject myself four times a day.
40:54Oh, did you?
40:55Yeah.
40:56When I first found out, I got diabetes.
40:58Oh, bless you.
41:01Let's do a little one this way as well.
41:04I had my nose pierced and all.
41:06I was 71 and I thought, I've always wanted to have my eyebrow done in my nose.
41:12So I had my nose done at Skeggy and my eyebrow done in Barnsley.
41:17Okay.
41:18Full works, basically.
41:20Yep.
41:21Well, just one last injection and hopefully everything will be nice and then, okay?
41:25Could you not just put me to sleep?
41:27No.
41:28You can see we've got a fairly big clot in there that we need to take out.
41:33You've got a big clot outside and all.
41:34Yeah.
41:35Yeah.
41:36There we go.
41:37That's what we wanted.
41:38Is it too big for butterfly stitches?
41:39Yeah.
41:40I think unfortunately.
41:41You've got longlipops for after.
41:42I'm sure we can fix you some up.
41:43I'll raid our special sweet treats.
41:44Oh, you are kind.
41:45So I need you to keep your head really still because if the head moves as I go along, it's
41:46going to be tricky to get.
41:47Yeah.
41:48tricky to get.
41:49Yeah.
41:50Yeah.
41:51tricky to get.
41:52Hmm.
41:53Hmm.
41:54Hmm.
41:55Hmm.
41:56Hmm.
41:57Hmm.
41:58Hmm.
41:59Hmm.
42:00So, I think we're all done.
42:01Yep.
42:02Give me a little bit of a bit of a bit of a bit.
42:03You've got longlipops for after.
42:04You've got longlipops for after.
42:05I'm sure we can fix you some up.
42:06I'll raid our special sweet treats.
42:07Oh, you are kind.
42:08So I need you to keep your head really still.
42:09Because if the head moves as I go along, it's going to be tricky to get.
42:13Hmm.
42:14Hmm.
42:15Hmm.
42:16Hmm.
42:17Hmm.
42:18Hmm.
42:19Hmm.
42:20Hmm.
42:21Hmm.
42:22Hmm.
42:23Hmm.
42:24Hmm.
42:25Hmm.
42:26Hmm.
42:27Hmm.
42:28Hmm.
42:29give me a little sort of wiggle of your face raise your eyebrows for me well
42:35done there you are saying
42:40so that's I suppose always the best case scenario that not had anything serious
42:45and long-term going on that being said I think the worst case scenario be if we
42:50found a big bleed on the head and that could have been very serious so
42:55thankfully they've not had that happen very certainly in the look Christine's
43:03face is healing well she's watching out for the steps outside her sister's house
43:07whenever she visits
43:12I love things it's the end of the shift for sister Vicki and sister Jane look at
43:20you all right these round the little honeypot vultures as a nurse in charge of
43:27the department the more experience you get at doing it then the better you become
43:32at it I think to work here in this department where we are so gelled as a
43:38team it's incredibly important the end of day we're one big family here so we're
43:49all here for each other so easy when you quick chart some shifts can be really
43:55grueling and you can walk off absolutely exhausted but I like to leave the shift
44:02happy and positive and know that everybody's done a good job and as the new
44:10shift arrives another team is ready to serve the people of Barnsley 24 7
44:32you
44:46you
44:50you
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