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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.
21:52All these tests.
21:53Not if it's me after all, what ab.
21:57With Christopher's symptoms appearing unusual, Dr. Foster needs to rule out of the causes
22:02of 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
22:24them 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?
22:37But 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
22:44don't particularly need to go up yourself.
22:47Finding staff to help that are not tied up with patients.
22:51A lot in the waiting room, and I know I've just heard Jane say that there's five members
22:55of staff now down there, trying 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.
23:10One 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.
23:33The 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, and that's actually
23:46come back quite raised, so it's come back at 134.
23:49Well, it didn't sound like his normal seizures, and his first drop was 134, second drop 194.
23:56Did you, and you said you treated them for ACF?
23:59Yeah.
24:02I've done a D-dimer as well.
24:05Third drop 194, so his drop's gone up.
24:11Rising 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, so it looks like there's some damage going on.
24:30So it looks like you might be having what we call an endstemi, so it's a heart attack.
24:35For that, you'll just be kind of admitted to the medical ward just for some more monitoring.
24:41But at the moment, are you still pain-free?
24:43Yes, fine.
24:44Still not got any pain in your chest?
24:45No, no.
24:46Perfect.
24:47So 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'll carry on his treatment here, and then we'll head up to the wards as and when there's a bed, up to the medical unit for more treatment and monitoring.
25:04Thankfully, further tests ruled out a heart attack and confirmed Christopher's seizure was caused by his epilepsy.
25:14He's now back home and recovering well.
25:20That's what she just ended over into, yeah.
25:23It's almost lunchtime in the hub, but Sister Vicky...
25:26Is it cubicle?
25:28Yeah.
25:29And then one down in lamb.
25:31And Sister Jane are struggling to clear the backlog.
25:36I've said you literally help them, because there's two qualified nurses round there, and you come back.
25:40At least we just got a scan with HDC1.
25:44Right, I'll get Louise to go.
25:46We've all got our 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?
26:00So 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, so 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? Can you roll that way any more?
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.
26:59Orthopaedic doctor Nida Ahmed reviews his x-ray.
27:10Can you just go through what's happening?
27:12What's happening?
27:13When I got up this morning, I couldn't move with the toe, but like, I managed to get it going, but it's...
27:18It's always going to get worse, isn't it?
27:19Okay.
27:20I can't bear to put any weight on it at all.
27:23Okay, fine.
27:24Try to push against my hand?
27:26No, I can't push.
27:28And is that because of the pain?
27:29Oh, yeah.
27:30So this bit?
27:33It's all right at all.
27:35Okay, that's fine.
27:37It seems to be more in your joint than the lower width 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?
27:58Dr. Ahmed suspects cellulitis, an infection in the deep tissue of Dean's ankle.
28:05What's cellulitis then?
28:07Yeah, it'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.
28:19All right.
28:21Any questions?
28:22No.
28:24Keeping me overnight on antibiotics.
28:27It 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.
28:50Sister Rachel checks up on him.
28:53So, how are you feeling, first and foremost?
28:56I'm not making it very much.
28:57Okay.
28:58Have you got any pain anywhere, Thomas?
28:59No.
29:00I did have this morning, but...
29:02Is it gone now?
29:04Yeah.
29:05Good.
29:06Thomas has discovered he's not the only family member in the hospital today.
29:11Your son's in hospital?
29:13Yeah.
29:14It's my children.
29:15She's having another grandson.
29:17Oh, congrats.
29:18That's nice and nice.
29:19Has he been born already?
29:20Yeah.
29:21Oh, congratulations.
29:22Yes, I did.
29:23You have to hopefully do it.
29:25Is everyone up there?
29:26Yeah.
29:28How many grandchildren have you got?
29:30All together?
29:31Yeah.
29:32All together.
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.
29:41Right.
29:44Blood tests have confirmed that Thomas has a chest infection,
29:47which needs further investigation.
29:50Dr Shepherd suspects it also causes his stomach pains.
29:54It's nice 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.
30:07So 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.
30:24If 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 miss you.
30:31Yeah.
30:32Tom, I'm going to leave you two out.
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?
30:46Yeah.
30:47All the best.
30:48All the best, man.
30:49Can I take all these wires off?
30:51Yeah.
30:52I'm going to come take him on for a sec.
30:54I'll have to make sure the porter's coming.
30:56I look like a...
30:57a metal Mickey.
30:58What?
30:59A Mickey porter.
31:06Yep, that's enough then, doesn't it?
31:08Let's go.
31:09Further tests revealed Thomas had pneumonia,
31:12and he had to spend a week in hospital.
31:15But he's now back home,
31:17and has met up with his 18th grandchild.
31:23In the hub...
31:24Great, my love.
31:25Thank you very much, sir.
31:27See 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,
31:38because it's 22.
31:39..are clearing the backlog of patients.
31:42I've asked Paul to go for his break.
31:44Louise has,
31:45but they wanted some help with the washes.
31:46But lunchtime is almost over,
31:49and staff still need their breaks.
31:51Just do the one you're doing,
31:52and then I'll get Paul to take you off for your dinner.
31:55We're the dynamic duo.
31:58We are.
31:59I'm the dynamic.
32:00She's the duo.
32:01I'm the dynamic.
32:02She's the duo.
32:03And new patients are still arriving.
32:10In paediatrics, 12-year-old Nevaeh has hurt her hand
32:14at a majorette dance troupe practice.
32:17She's coming with Mum, Amy.
32:19She'd done the walk-over,
32:21and then she started crying, like, through her next dance,
32:25and I was saying,
32:27oh, you'll be fine,
32:28but then she carried on complaining.
32:30Nevaeh?
32:31Yeah.
32:32She'll be seen by emergency nurse practitioner Tony.
32:37So what's happened?
32:44I did, like, a walk-over,
32:46and I landed on my hand and went over it.
32:48Okay.
32:49And so when you landed,
32:50have you, like, put your hands down like that,
32:52or onto the side of it,
32:53or...
32:54You remember?
32:55She's the thing you like when you go down like that.
32:57She rolls when she does it,
32:59and she kind of goes sideways.
33:02She hasn't quite mastered the whole thing yet.
33:04Okay.
33:05That's fine.
33:06Let's have a look, then.
33:07Any wiggly fingers for me?
33:08Okay.
33:09Can you make a fist?
33:10I'll find a fist you can get.
33:11That's okay.
33:12You 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,
33:20and then she's broke her nose with her baton as well
33:23a few weeks ago.
33:24So she's prone to accidents.
33:28It's very rewarding working with children.
33:31You can very quickly fix things in children
33:35and make them better.
33:36Sometimes you can get a little crack on a bone
33:38and you can't always see,
33:39but we'll get an extra bit first,
33:41and we'll go from there.
33:42Some patients don't need anything doing.
33:44Sometimes it's just a bit of reassurance for parents
33:46that 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.
33:52You've got a bit of pain in the wrist.
33:53You send them for the x-ray,
33:55and they've got a really nasty fracture,
33:57and they're just quite happy with it.
33:59They're not bothered.
34:00Turn right and it's headlong,
34:01you'll see x-rays.
34:02It's just on your left-hand side.
34:03When you come back,
34:04just press that doorbell.
34:05We'll come and get you back in.
34:07If the x-ray shows Nevaeh's injury is severe,
34:11her baton-twirling days could be over.
34:20In majors, Christine is waiting for the results of her head scan.
34:26Just looking at the damage.
34:28It's lovely, isn't it?
34:29And the jumper's going to have to be thrown away by it, look, innit?
34:34Sister Susan is there for moral support.
34:38Me and her, we've sent to stick together.
34:41We've had this moment,
34:43but we're there for each other and all.
34:48Dr. Orcroft reviews the scan.
34:51Thankfully, there doesn't show any bleeding inside the head,
34:54which is really good news.
34:55So we can be reassured from that big thing we were worried about at the start,
34:59we can sort of tick that off as a worry.
35:01So that's good news.
35:03Ow.
35:04So what do you want some more cleaning?
35:09Aye.
35:10I just wish you could stop bleeding.
35:14But Christine's open wound still needs closing.
35:19My name's Nick.
35:20I'm one of the emergency doctors.
35:21The good news is,
35:22is that there's not any bleeding inside the head,
35:24which is great.
35:26Can I have a little look under here?
35:29Sorry, I'm catching your hair.
35:31I'm sorry.
35:33Oh, bless you.
35:35Okay.
35:37I suspect, looking at that,
35:40that might need some stitches, if I'm honest.
35:42There's a clot in it at the moment that we'd need to remove
35:45to help it heal, basically.
35:47Yeah.
35:48Now, I think what we need to do to start with,
35:51is probably get a bed in here,
35:53so I can sort of have you laying down,
35:55so I can have a really good look at it.
35:57Yeah.
35:58And give it a good clean,
35:59is sort of the first and most important thing.
36:01Make it hurt.
36:02You've got to laugh at it all,
36:11otherwise you just sit there and cry.
36:14She's laughing now,
36:15but 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, Vicky.
36:37I am.
36:38How are you, love?
36:39I am.
36:40On your little team.
36:41Pervert me crossed.
36:46Where are you?
36:47Where's she?
36:48Right, well, you can tell her.
36:49She said no.
36:50I want her to come back and do some work.
36:53I've been a nurse for a long, long time,
36:55and I've said numerous times,
36:57you cannot buy experience.
36:59You just, you can't.
37:00Let me just get you a pillow, eh?
37:03Or get another blanket for this leg so it don't fall down.
37:06How's that sound?
37:07We are all problem fixers.
37:10Some are very good at working on a team
37:12and delivering, you know, a good standard of nursing care.
37:15She 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,
37:21steering the ship, if you like.
37:23And I think, you know,
37:24we all have different flares for different things,
37:26and I think once you put all that together,
37:29it is a well-engineered team.
37:32In radiology, majorette Nevaeh
37:39is hoping she's not broken any bones.
37:42Nevaeh, come on in.
37:44Yeah.
37:45After a tricky move at dance practice went wrong.
37:49You want me in?
37:50Yeah.
37:54What have you done?
37:55It was like a walk over,
37:57and I went over with my hand.
37:59Nevaeh came to casualty,
38:01with mum, Amy.
38:03She plays football as well,
38:05so you'd think she'd get more injuries
38:07from football than dance, but...
38:09I'm going to do x-rays of your hand and fingers,
38:11so it's just probably down nice and flattened to there.
38:14She scored her first goal last week,
38:16but she put it in her own head.
38:22So I'll send those x-rays across to Amy.
38:25If you just want to make your 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
38:40and 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,
38:56they would likely get a more significant break to the wrist.
39:00Like needed potting and sometimes even surgery.
39:02You can't see anything broken.
39:04I think you might have just rolled it a little bit
39:05and you've just caused a bit of bruising.
39:07Keep it moving.
39:08Paracetumal ibuprofen, absolutely things like that,
39:10absolutely fine.
39:11Brilliant.
39:12Yeah, you'll be fine.
39:14All right, we'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
39:25a bit more carefully from now on.
39:35In majors, Dr Allcroft is preparing to stitch the open wound
39:39on Christine's forehead.
39:42Right, you want me to keep it...
39:44No, no, just lay down now.
39:46What I want you to do is just be basically relaxing
39:48as much as possible.
39:50The best case scenario would have been
39:52the fall had done no injury,
39:53there'd be no injury to the head
39:54and everything was absolutely perfectly fine.
39:56I'm going to get this up a little bit
39:58just to save my back so I'm not a hunchback.
40:00I think, luckily, looking at the injuries that have happened,
40:03most of it is going to be able to be managed
40:05without, sort of, hopefully any need for surgical invention
40:09or causing, sort of, longer-term, more serious damage.
40:16You're crazy.
40:17It'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, isn't it?
40:26I know.
40:27I think where it's grazed, unfortunately, this isn't.
40:29We'll do it quick.
40:30Oh, I will be glad when I get home.
40:33Yeah.
40:34Just going to do a little injection above your eyebrow.
40:40Oh.
40:41Unfortunately, the local anaesthetic can sting a little bit in itself.
40:46Mm-hm.
40:47Give me that a little, a little massage, okay?
40:50No, I'm used to injections.
40:52I used to inject myself four times a day.
40:54Oh, did you?
40:55Yeah, when I first spun out, I've got diabetes.
40:58Oh, bless you.
41:01Let's do a little one this way as well.
41:03I 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 Skaggy and my eyebrow done in Barnsley.
41:17Yeah.
41:18Full works, basically.
41:20Yep.
41:21Well, just one last injection, then hopefully everything will be nice enough, okay?
41:25Could you not just put me to sleep?
41:28No.
41:29You can see we've got a fairly big clot in there that we need to take out.
41:37You've got a big clot outside and all.
41:40There we go, that's what we wanted.
41:53Is it too big for butterfly stitches?
41:56Yeah.
41:57I think, unfortunately.
41:59You've got longlipops 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,
42:08because if the head moves as I go along, it's going to be tricky to get.
42:24So, 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, you were awesome.
42:38So that's, I suppose, always the best-case scenario,
42:43that we've not had anything serious and long-term going on.
42:46That being said, I think the worst-case scenario would be
42:49if we'd found a big bleed on the head,
42:51and that could have been very serious.
42:54So, thankfully, we've not had that happen.
42:57My wrists certainly fingers hurt.
43:02Christine's face is healing well.
43:05She's watching out for the steps outside her sister's house whenever she visits.
43:10I love these.
43:11It's the end of the shift for Sister Vicky and Sister Jane.
43:20Look at you all.
43:21Like these round the little honeypot.
43:23Sorry.
43:24Vultures.
43:25As a nurse in charge of the department, the more experience you get at doing it, then the 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.
43:39It's incredibly important.
43:44At 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.
43:59But I like to leave the shift happy and positive and know that everybody's done a good job.
44:05Oh, I love you.
44:10And as the new shift arrives, another team is ready to serve the people of Barnsley 24-7.
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