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00:00After dark, while the nation sleeps, the A&E night shift begins.
00:11You never know what's going to come through the door.
00:16At night, you always have to be prepared for the unexpected.
00:19Multiple kicks to the face.
00:21They said if anyone approaches them, they're going to attack us all.
00:24Across the UK, with extraordinary access to three of the most challenged emergency
00:30departments in the country...
00:32Guys, I need help in here.
00:33He could have died.
00:34...we follow the work of emergency medics who battle every night to save lives.
00:39Chuck in now.
00:41It's a stab wound.
00:43...with drugs and alcohol rife...
00:45I've had five or six pints.
00:47Step back, big man.
00:48The department's just on fire.
00:53The risk of violence and abuse looms large every night.
00:57You, you're maxing your f***.
00:59Stop.
01:00Try me.
01:01Bugs.
01:02They can be verbally aggressive, physically aggressive.
01:05I've been punched, I've been spat at.
01:07You've got nothing on me, bro.
01:08No.
01:09Why?
01:10There have been days when there have been more police officers than patients.
01:13I've got points you're reading, mate.
01:15What's going on?
01:16All hell's broken loose.
01:17Patients running around, security everywhere.
01:19Shut up.
01:20I don't care.
01:21This is the sort of thing that we have to put up with.
01:23Get security to remove it.
01:25It's chaos.
01:26Glorious chaos.
01:28Hey, I'm going to f*** this seat.
01:44Across the UK, there are over 50,000 gang members,
01:48with the West Midlands being host to an estimated 80 violent gangs.
01:52They sent multiple stragglers to them and said how many?
01:55This is potentially life threatening.
01:57Crime in Birmingham is 57% higher than the rest of England and Wales.
02:02Careful, the knife's still in situ.
02:04With assaults with weapons rapidly increasing.
02:06A 19-year-old male in T.I. 20 minutes.
02:09Might be worth asking plastics to have a look at it.
02:11And the number of under 18-year-olds arrested has increased by 9% in the last year.
02:16You didn't see the weapon?
02:17No, OK.
02:19Give me a look on.
02:22It's a challenging night for the staff in Birmingham's A&E.
02:26Four minutes.
02:27We're quite inundated tonight.
02:31There was a protest in Birmingham.
02:33It's having a massive implication for the Almond Service.
02:36So we're trying to redistribute patients to the most appropriate location.
02:41Give me a look on.
02:43Stabbed about 1,600 today.
02:48One male.
02:50Shot.
02:52Just go to three racist guys.
02:54I'm going to go and have a look.
02:56The ones in whole tree says none of them look like it can be stepped down.
02:58Doctor in charge, Eleanor, is expecting an incoming trauma case.
03:02A young male who's been shot.
03:06Heart rate of 1,600 with no recordable blood pressure.
03:20Right, we need to look at the back.
03:22OK.
03:23Well, keep that blood going for TXA infusion on board.
03:27While the gunshot victim is being treated...
03:29Ah!
03:31..sister Sarah is manning the entrance to A&E,
03:34and a group of his associates turn up.
03:36What's wrong with him?
03:37No one will be allowed in.
03:38I can't give you any information.
03:39You're not next to kin.
03:40I can't give you any information.
03:41You're not next to kin.
03:42Sorry.
03:43I can't give you any information.
03:44You're not next to kin.
03:45Sorry.
03:46Can I get you to move away from this area as well?
04:01You don't know who these people are.
04:02They're saying they're friends.
04:03This young gentleman was shot.
04:05We don't know if these are people that want to come and finish the job.
04:08We don't know what relation they are.
04:10Our priority is to keep the patient safe.
04:12I've asked the police to tell them to go.
04:19I think he's left.
04:22What was that?
04:24That group of young IC1 males and females,
04:27they're throwing objects now.
04:29With the situation escalating,
04:31the police attempt to move the group on.
04:35No, they need to go off-site.
04:36If they're going to throw stuff at staff, it's not acceptable.
04:39OK.
04:41Just saying. That's the police.
04:43There's just...
04:44There's just been a lady standing beside that group of lads,
04:47and if they said if anyone approaches them,
04:48they're going to attack us all.
04:51So it's now causing an incident outside.
04:54So they need to go off-site completely.
04:56We haven't got the security to deal with.
04:59She just told us if she couldn't go near them,
05:01they would start attacking staff as well.
05:03But if they kick off,
05:04Ashley's going to barricade us in here.
05:06What are you doing?
05:07What are you doing in the room?
05:14I'm going to set this lady down.
05:16I'm going to get her ready for that.
05:17In resus, Nurse Laura is in the middle of her already busy night shift.
05:20I'm readying this and I'm readying this side.
05:25So, to your side, some water to me,
05:27so we can have a look at the side of your fire as well.
05:29Yeah, yeah.
05:30So that's cranky and scared, going around.
05:3152-year-old carer, Masni, is being treated after burning her leg with boiling water.
05:37I'm just going to put some more dressing on.
05:39Can you bend your knee a little bit?
05:40That's perfect there.
05:41She's got a big leg.
05:42But Nurse Laura has spotted some worrying symptoms
05:46and needs to talk to a doctor.
05:48So, she's coming with a scald on her left thigh.
05:50Yeah.
05:51However, when I've looked at her, she's actually got a facial group right-sided
05:54and mild weakness to her left hand,
05:56and chest pain.
05:58So, I just thought, it's not just a scald.
06:03Looking at the actual patient, there's more going on.
06:06It's life-threatening.
06:07Nurse Laura is concerned, Masni, who was rushed to A&E by her husband, Antonio,
06:12is having a stroke.
06:13She came in with a scald, but then noticed when actually seeing her
06:17that she had a facial droop, high blood pressure,
06:21left-sided weakness, which obviously indicates a stroke.
06:24So, that could have been the reason as to why she's dropped the pan
06:27and had that, like, immediate weakness.
06:29During a stroke, two million brain cells can die every minute,
06:34which can lead to brain damage.
06:36My name is Sukrit, I'm one of the doctors.
06:39Dr. Sukrit needs to assess the situation quickly.
06:42A stroke needs to be treated within four and a half hours,
06:45or the changes in the brain can become irreversible.
06:49What do you think?
06:50Do you think her mouth is a little bit uneven?
06:54Earlier was a bit, but now it's okay, it's normal.
06:57Wow.
06:59Do you notice any weakness of your arms or anything?
07:03I feel weak, because the pain is something.
07:07I've seen many cases where, like, if you see the individual themselves,
07:12they will look fine to you, but the family members concerned their speech
07:16does not look crisp as before, and then you do a head scan
07:20and it turns out to be a stroke.
07:21So, it's very important to take this perspective of family members as well.
07:25And did you notice any problems with your speech?
07:29Like, it was slurring or anything like that?
07:31No.
07:32No.
07:33I feel dizzy.
07:35You didn't lose consciousness, you didn't collapse?
07:37Ah, no.
07:38No.
07:39Right, right.
07:40If you follow my fingers, somebody with my fingers, just follow it with your eyes, okay?
07:44Okay.
07:45Go get the CD and then completely come and examine you again.
07:49Okay.
07:50All right.
07:51See you in a bit.
07:52With the clock ticking, Dr. Sokrat isn't taking any risks.
07:56It's getting better now.
07:58Still a little bit.
08:00And sends Mazni for an immediate brain scan.
08:04It will show if the blood supply to her brain has been restricted, causing a stroke.
08:09Hello.
08:10Hello.
08:11Hello.
08:12My name's Alice.
08:13We're going to be an elephant.
08:14We'll be doing a scan.
08:15You look very nice to see, okay?
08:18Just watch the scan.
08:21In the UK, someone dies from a stroke every 15 minutes.
08:26And less than 20% of survivors make a full recovery.
08:30If we don't do a CT scan, we will never be able to find out the injuries.
08:34It's really important that the blood supply to the brain is restored very quick.
08:38Because the neurons die every second in millions.
08:42Stroke is one of the things that can lead to permanent disability if not picked up early.
08:47And obviously lead to permanent paralysis.
08:51There are over 4,000 criminal gangs in the UK.
09:06What actually happened?
09:07Someone came up with a knife, tried to stab him.
09:08Stay nice and still, fella.
09:09With 27,000 under-18s identifying as gang members.
09:22A gangled bullet in his spine around T-12s.
09:24I don't even actually remember the Muffet whatsoever.
09:29I don't know.
09:30I don't know.
09:31I don't know.
09:32I've asked you not to come in.
09:33No, you've been asked to remove.
09:34We've asked you to go.
09:35We've asked you to get in.
09:36At Birmingham's Queen Elizabeth Hospital, tensions are rising.
09:40I see one mails down by you.
09:41They are not to come in the building.
09:42Any issues, let us know.
09:43We'll come down and attend.
09:44I've asked the police to tell them to go.
09:45Because I can't guarantee that they won't try and get Theresa's.
09:46Associates of a gunshot victim who's receiving treatment inside have been denied access, but
09:50are refusing to leave.
09:51They're starting to throw things in that and it's a zero tolerance approach.
09:53If they kick off, Ashley's going to barricade us in here.
09:54He's got to start and want inside, these doors closed and we'll keep everybody in there.
09:57If we get a job on this nature, whether it will be a stabbing, whether it will be a road
10:03traffic accident, whether it will be a shooter, a shooting, and we'll be able to do it.
10:17We'll talk about 30 minutes.
10:19it be a road traffic accident whether it be a shooting and particularly maybe a younger demographic
10:24male demographic we will expect a lot of family friends and maybe other young males to arrive on
10:33site pretty quickly after the ambulance arrives themselves the group appear to move on but sister
10:41sarah warns colleagues in resus where their friends being treated just in case they return
10:46they've just told someone they're going to charge us if we try and stop them so yeah so police are with
10:52them they've thrown objects what they're coming up trying to get in with their hoods and everything
10:56up i've said absolutely not so just to make your way that is all kicking off at the front door
11:02there have been protests happening in the city the a and e is juggling beds to make room for
11:08incoming patients and if you have to hold that cycling you might have to at the moment we're
11:14running a full ed department in one single bed space there's no space for no one to go anywhere
11:21senior doctor elena is struggling to manage all the patients and is determined not to let the issues
11:27outside interfere with patient care there are some guys outside with masks police would have been here
11:33straight away but the real problem is there are the protests that are happening in town so police is very
11:38busy tonight and very stretched on the other side of the hospital security have been alerted to a problem
11:50we have multiple entrances to any because it's such a big any department so we try and cover all the
11:57entrances with security staff because we do have a situation occasionally that relatives will find
12:03another way into the department and that causes all sorts of issues one of the gang is trying to look
12:09for a way in on the other side of the hospital and this is not a drill where is this with security
12:19potentially being breached and staff and patients possibly in danger a and e is put into lockdown
12:26fundamentally hospital security it's the patient's protection but also the protection of all the
12:30stuff they're locking it down because apparently there's people with masks and stuff outside with
12:35the shooting around a million people in the uk each year are admitted to hospital with alcohol-related
12:50issues and head injuries are the eighth most common emergencies seen in a and e just trying to find
12:57the bleeding point this can range from cuts and bumps to brain damage
13:12hello my name is anna i'm one of the a and e doctors do you want to come with me
13:17in tunbridge wells dr anna needs to assess 77 year old rugby fan eric who had a fall after having a drink
13:27i think i think i think i'm still drinking all right come and have a seat thank you oh you okay yeah
13:39right so what happened today i got out of the car and fell over clunk okay yeah um did you trip on
13:49something what exactly probably something stupid okay how much have you had to drink this evening
13:56uh probably too much he's currently a little intoxicated so he probably won't realize the
14:04severity of his injuries and the pain probably won't hit him until much later so you've got a
14:11big cut to your forehead should be i believe injured yourself anywhere else no i don't believe so
14:16so you can move all your arms and legs okay okay yeah so i think we need to give your cut a bit of a
14:22clean out it'll probably need a few stitches okay and i think we need to do a scan of your head to
14:28make sure that there's no bleeding going on internally right okay yeah goodness me how bad does that
14:35patients who are over the age of 65 who have come in with severe head injuries to require a ct
14:41head to rule out any intracranial hemorrhage
14:45an intracranial hemorrhage is when blood vessels rupture in the brain causing pressure to build up which
14:51can lead to brain damage i'm just gonna give your face a little bit of a clean up okay
14:57now i must have bumped my head because that is quite moderately sore yeah before eric can be sent
15:04for a ct scan the gaping wound needs attention okay sorry all right we can give you some local
15:12anesthetic first to numb the skin and then pop some sutures in and try and get you around to the scanner
15:18okay okay yeah okay you'll thank me for it later okay you ready for this yeah happy for me to start
15:27yeah you go ahead okay i shall only scream open your eye for me
15:38so you have i mean there's quite a big one here but then you've also got a cut
15:42that's why your eye really once i started i noticed that he had a larger cut to his eye
15:49i could see the muscle beneath it sorry no you carry on one wrong move could damage the eye permanently
15:57limiting eric's vision it's a very delicate area and there's a lot of nerves and different muscles
16:03and blood vessels running through there i'm worried about potential nerve damage if i stitch too close to
16:09his eye to his eye a little bit of tugging around your eye
16:23we need some manpower despite the department facing challenges
16:27you need to relax now flexible come down a bit
16:31in birmingham a and e dr sutkrit sent 52 year old masney for a head scan after she developed stroke
16:39symptoms one of the nurses i think noticed some facial truth and some power weakness in the arms
16:45would have to be on the safer side if she has suffered a stroke she could have speech problems
16:51or even permanent paralysis so i've seen your head scan does not look anything abnormal to me uh what we'll do
16:58is we get a burn steam to have a look at this it looks very superficial drawing maybe just dressing
17:03and then you can go home okay thank you i know yeah all right take care all right thank you
17:12aside from minor treatment for her burn masney has the all clear
17:16the doctor says okay the only worry this would be the the button on the leg and the rest seems like all
17:24uh under control all stable all normal her stroke-like symptoms were caused by the shock of her burn
17:33i was uh cleaning my kitchen and and then i i i thought that i want to mop the kitchen with the
17:42hot water and when i pour in the bowl of water and it just gushing all over my leg the pain was
17:50unbearable so that is why i think um my blood pressure went went up
17:59masney will now be treated in the burns department
18:03although luckily she didn't have a stroke it's always good to be on the safer side so now we've
18:08given a loads of uh analgesia uh her pains come down considerably so she's going to be taken upstairs
18:13seen by one of the plastic registrar uh probably have a bit of more dressings and then very likely
18:18she's going to go home they're not going to keep her we just had our dinner actually and that was uh
18:26you know tidying up the kitchen and then he wanted to cook you like
18:41how tall are you when you work can you pull over outside the freezers and then let me know that you're
18:47here in norwich they're also fully stretched as a 46 year old motorcyclist is being rushed to hospital
18:55after being hit by a car from behind at high speed let's get you into recess two please
19:00so this is angela from six year old female she was riding her motorbike stationary waiting to pull out
19:16into the main road car behind her has driven into the back of her angela sort of skidded with the bike
19:23um she caught her left arm over the bike and under the wheel as it landed on the foot and immediately
19:29was complaining paid her left upper arm right lower leg and back sort of set spied no loss of consciousness
19:37she was wearing full protective gear and helmet she does have extra deep into these
19:41so she's on rivux band brilliant thank you very much the patient has a history of deep vein thrombosis
19:49and is taking blood thinning drugs which could stop her from clotting if she has an internal bleed
19:55my name's will and how are you feeling other than thanks yeah in your arm and your hip anywhere else
20:01my arm in my leg and my back in your head in my leg what we're doing is we're taking these restraints
20:08off so we can change them over to hours and it's all sort of precautionary stuff okay because uh your
20:13mechanism is quite significant are your car going back into the back of you whilst you're on your
20:19motorbike we just want to make sure that your your spine's nicely aligned ah my arm my arm
20:27up angela was uh on her bike and then was hit from behind um by a car sort of sent several meters
20:36forward and then got caught underneath the bike because of the the forces applied to her body
20:42um there's high risk for traumatic injuries as well with the head and the spine just i'm going to hear
20:48now any pain as you take a deep breath in okay yeah but what i'd like to do is just do a uh a
20:57head to toe survey just to make sure you're breathing your abdo and everything's all okay
21:02yeah all right and that kind of informs our uh investigation deep breath in because of the nature
21:08of the impact trainee advanced clinical practitioner will needs to perform a full physical examination
21:14to ensure no underlying injuries have been missed are you able to wiggle your toes able to wiggle
21:21these toes are you able to grip my hands just to grip my hands it's just you'll be able to grip them
21:31perfect and you can still in touch with them yeah okay where are you most saw on here though
21:38on the inside yep down here no yeah just there the pain could be due to a fracture in angela's leg
21:48which could increase the chance of compartment syndrome a dangerous build-up of pressure in her muscles
21:53the ultrasound shows no signs of compartment syndrome
22:23so with the initial checks complete they sent angela straight for a ct scan hello ct it's only
22:28christian here in recess just checking are we now ready for the ct trauma all right thank you
22:34due to her blood thinning medication she won't be able to clot and the consequences of any bleeding
22:40could be fatal
22:48violence against doctors nurses and other hospital workers
23:05is rising in parts of the uk
23:13with assault and battery making up 23 percent of the incidents
23:18and if they said if anyone approaches them they're going to attack us all
23:31in birmingham's queen elizabeth hospital friends of a patient have threatened staff after being
23:36refused admission there's about 12 of them and they've all got their hoods up faces covered
23:41they're now trying to force entry to the hospital so a and e has gone into lockdown the concern is if
23:47they do get in what they're going to try and do
23:53because our department has to be split in so many areas and we have so many doors the nursing
23:59charge has gone to close one area which is minor injury which is the furthest away from us
24:03because it's unsafe so until we know that they're gone and they're not on the grounds anymore the
24:08nursing judge has gone to um tell everybody to come over here with the patients and with the staff
24:13and as you can see security is only already all over the place so we're trying to make sure
24:18everybody's in here so we know where everyone is so we can keep everyone safe
24:25at reception sister sarah has a plan that could bring the standoff to a quick and peaceful end
24:32we've asked his brother who seems quite sensible and he's the actual patient's texting
24:36them and telling them to go as well and his brother said i'll come and have a bottle and
24:39ask them to leave as well so try to de-escalate it and get them gone
24:43the plan seems to have worked for now and security has lifted the lockdown
25:05with everything returning to normal barry's free to leave sister sarah to finish her night shift
25:10oh should i do what's day later barry no i don't know go on leaving me on my own don't know what i'll do
25:20see you tomorrow see you later
25:32have any problems for any of your patients no over two million people visit a and e every month
25:42with a large amount of them having undiagnosed illnesses
25:45okay relax your arm for me let's pop this on the opposite thing you can get for medics triage and
25:51taking a medical history are essential in understanding easily misunderstood conditions in a and e are you
25:57having any symptoms at all bruises here here and my hands any cardiac history breathing conditions
26:04diabetes or anything like that no diabetes no no let's do a book test first go from there
26:12roger we're gonna get you a bit more comfortable mate do you feel sick at all at the moment
26:18an 18 year old with diabetes jude was raced in by his dad stuart after being sick and woozy all day
26:25so he's a type one diabetic um and his sugar's been high at home um and his ketones will be high as
26:34well ketones are a chemical released by the liver to break down fat when you don't have enough insulin
26:40to turn blood sugar into energy ketones can cause the blood to become acidic and that can cause um
26:46significant problems for the rest of the organ system as well we just need to get him started on
26:50the treatment jude normally relies on his automatic insulin pump fitted to his body to keep him safe
26:58do you know what time we stopped working about two three in the morning two three in the morning okay
27:02fine so at least 12 hours 10 to 12 hours yeah of um no insulin yeah without his automated insulin
27:09injections jude is at risk of falling into dka or diabetic ketoacidosis which untreated could be fatal
27:18both things have failed his parents haven't gotten alert that his sugars have gone too high
27:22and the pump hasn't been able to correct sugars with the insulin i just want to check the ketones
27:28sorry for guessing it's okay jude's blood will be tested to see if his condition is worsening
27:39what was his ketones his ketones are 4.6 so he's just on the cusp he might have been in dka
27:44jude's ketone reading is seven times the level it should be so what we'll probably do now is give
27:50you some fluids flush out the rest of those ketones and probably just give you a little bit more
27:55insulin just to really bring your sugars under control no thank you you know what just keep a normal
27:59saline just a normal saline just a normal saline yeah we'll do that all right okay so just gonna run
28:06so do it it's just but this is that i am
28:12i was throwing off couldn't keep any water in and it got to the point where like i was just
28:16throwing up stomach acid which is not nice so please excuse my breath
28:22his body has been trying to flush out the acidic ketones resulting in him being dehydrated
28:28saline should help rehydrate him and start to balance his blood chemistry he's just turned 18
28:34yep so he's able to go out drinking okay and he's been a bit woozy and tired it must just be the hang
28:40yeah and of course it wasn't it was like 12 hours without insulin
28:48regular blood monitoring is essential to see which way jude's condition is going
28:533.4 3.4 yeah okay the saline solution is having the desired effect we've got this bag of fluids going
29:03as soon as that one's gone we'll put another bag up we just uh continue it yeah we just continue it
29:08basically on every quarter hour we'll just check it and just see what it's doing all right great
29:14jude's condition is improving but for now he'll remain under observation
29:18the last question for me was a good good night out last night oh she's not linked to this in
29:24any way that's what it's just a general question not really no okay and all of this has happened at
29:33the same time they decide to go uh on a night out and then be drinking and this the symptoms of
29:39raised blood sugars and a possible dka are very very similar to just being hung over basically so
29:45it's yeah it's just been very very unfortunate for him i'm feeling all right now a lot better
29:52a lot better than when i come in here yeah you're in good fancy right i ain't gonna stop you partying
30:06how many stitches you're doing then i'm gonna have to do quite a few in kent 77 year old eric's
30:17being treated by dr anna it's looking a lot better now how many have you done uh
30:25the 10 total just for this one and then we need to have a look at your eye
30:29mm-hmm he suffered a nasty fall after having a drink which has left him with two serious wounds to
30:37his face once i started i noticed that he had a larger cut to his eye i could see the muscle beneath
30:46it the dangerous proximity to eric's eye makes the stitching a very delicate process oh dear oh dear
30:54i'm sorry it's okay
30:56the skin on the forehead and the head tends to be a lot thicker and the skin around the eyes very
31:16delicate and easily torn stay still for me
31:19mm-hmm so you have to be very careful about how much tension you're putting on that
31:27and make sure you're not pulling it too tight or leaving it too loose
31:31dr anna must draw on all her years of experience as eric's eye could easily be further damaged that's
31:38the last one now
31:42okay the cut at the outer corner of his eye was right at the edge of his eyelid
31:49if it had come any closer he could run the risk of causing damage to his eye muscles
31:55or maybe the nerve supplying the eye as well um if it had involved the eye itself he could have
32:00potentially lost his vision open your eyes over here yeah yeah indeed good good i can see you brilliant
32:12dr anna needed to give eric 23 stitches to close his eye wound but now he needs to have a ct scan
32:19to ensure he doesn't have damage to his brain oh you're all right yeah it's bad work sad yeah
32:24yeah okay thank you very much all right yeah
32:29so i can have one of these for a while you haven't so it's coming to the seat here okay
32:34yep your heart is going to end up here with your feet that way yeah yeah go ahead if eric has a
32:42brain hemorrhage his situation could be critical as only around a quarter of people who are diagnosed
32:47with one live more than five years after the incident i need to take your glasses off okay yeah indeed
32:54so the scan will take about two minutes yeah i need you to keep really still okay it's very important for
33:00the scan we're looking for fractures for this gentleman and keen to see if there is any injuries to his brain
33:14he's all done you okay yeah indeed lovely yeah so we're going to take you back to where you were
33:21and then the doctors will see you there okay yeah indeed right do you want to take my hand you sure
33:27you don't want to take my hand the results will be sent to specialist dr shuran who will be able to
33:35tell eric if he needs further treatment hello hello one of the doctors yeah so we had done a ct scan for
33:43you on the head and the spine so fortunately everything is all right there is no bleeding or
33:50anything as such okay there is no intracranial bleeding so he has to just take care of his wound
33:56that it doesn't get infected to cover any infection try to give him some antibiotics for some seven days
34:03i think already the previous doctor she has had some stitches done for you or over here on that
34:08i think she lost scout after about 23 i think okay yes okay yeah i haven't actually looked at
34:16myself in the mirror yet yeah i assume it's bloody awful eric can return home and have his stitches
34:21removed at his local gp once he's healed oh that's close
34:25head up jack okay okay well done ames across the country see nearly 800 000 minor injuries a month
34:41so what's bringing you here today i was bitten by an armadillo he just decided that it was my finger
34:47was tasty these range from animal bites to serious head injuries so did any blood came out
34:55yes uh quite a lot actually you will need to get a tetanus jab and then antibiotics to take home so
35:04if you could relax your arm that will make the pain less that's what we all say
35:13shall scratch
35:13well done now yeah thank you thank you another big challenge for a and e departments is broken bones
35:27and dislocations bring your elbow across is that right one of the main causes being sports and exercise
35:35we're nearly done now i'm just putting the plaster on in tunbridge wells the waiting room is full of
35:41cuts springs and breaks i'd love to stay but i'd love to stay with pockets like that
35:47yeah yeah you guys can head then to your left i'll have fun
35:5519 year old builder jasper has become injured after being tackled from behind playing football
36:00playing football hi hi hi my name is ziggy thank you what has happened to bringing you into
36:12uh playing football towards the end of the game i just got pushed over and i fell forwards onto my
36:19my left shoulder and rolled over it and i just yeah i never done something can you move it i can move it
36:27out i can't move it like up this way though okay until it hurts a lot just under half of all sports
36:34related admissions are by people 19 years of age and younger with football injuries making up the most
36:40of these can i have a look yeah so it's hurting the head yeah yeah right there about here no not there
36:52no no so it's really this region here yeah right there very painful yeah very painful okay what about
37:02outwards that was not too bad yeah that's fine okay all right if i tried to rotate yeah that hurts
37:12and inwards that hurts as well um it's okay it hurts a little bit but jessna's coming in having
37:19had an accident playing football he's fallen onto his left shoulder and he looks like he's fractured
37:26his collarbone i also work in construction so i'm self-employed so so that's quite a physical lifting
37:36and stuff yeah you can't work with one arm jasper will have an x-ray if he's broken his collarbone
37:44it could have devastating consequences can you put your arm down and turn it like this yeah that's good
37:51it just and then look that way
38:0921 female dark dc he's been hit by a car that's unknown speed
38:14ah there are over 130 000 casualties from road traffic collisions every year in the uk
38:2355 year old male lost control of the bike and he's been ejected off with almost 2 000 of these
38:28being fatalities you can have a bleed in the brain broken spine and motorbikes are the second
38:34most common vehicle to have an accident in just impacted a wall gone straight over
38:44so
38:48hi andrea i'm tom put you down please
38:5346 year old motorcyclist angela is about to have a ct scan after being hit by a car from behind
39:00so and we're going to do some x-ray dives today we have that before
39:04so that gives you a warm feeling a bit of a mess and takes the head makes you feel like you're going
39:09wet yourself all right but you're ready everyone ready ready to see
39:22medics are checking for any life threatening internal injuries
39:26due to blood thinning medication angela takes for deep vein thrombosis there's a greater risk of complications
39:32you may breathe normally
39:41she had a ct from her head to her pelvis and luckily she had no injuries which is good given her risk
39:49factors she's very lucky to not sustain more injuries than what she's got but on the ct we don't
39:55cover the bits that we want to x-ray we've ordered a leg x-ray just in case and we're suspecting
40:00an arm fracture angela is out of immediate danger with no internal injuries but will still spend
40:07the night in hospital to treat her minor wounds and be observed i've handed over a care to dr amy
40:13that will take care of her from there recess is quite a dynamic part of the department we keep
40:20people when we deem them high risk and they need sort of immediate management as soon as they turn
40:25out to be lower risk we generally tend to move them out so that other people that are high risk
40:30gain our attention and we can divert our attention to those people
40:45that's fine i'll come around i'll show you what the x-ray
40:49okay so this is your left shoulder bill the jasper has had an x-ray of his collarbone as dr ziggy suspects
41:00he's broken it playing football as you can probably see for yourself it broke not only is it broken but
41:08it's displaced nice but as you can see this is really quite displaced and you might need enough
41:17he's got a fracture mid shaft uh in the right in the middle of his collarbone but most fractures
41:23of the collarbone are not largely displaced and what we can do is treat them conservatively
41:29and they usually heal up pretty well but this one is very heavily displaced the bad news is sinking in
41:35that it's a lot more serious than jasper thought and he may be out of action for months you're quite
41:42painful for a while and it would take in an adult between six and ten weeks to heal i'm self-employed
41:50so obviously it's so yeah a lot of time off work yeah gutted to be honest yeah i'm quite into my uh
41:58my cycling and running right now so yeah um it's probably well it's probably a bit of time off that
42:05isn't it yeah if you are going to operate would you send me home first yeah that's what will happen
42:12because it's displaced the two ends are not likely to meet each other and actually heal so that the
42:20bone won't be complete so that's the reason why he needs an operation to bring the two ends together
42:25and allow the bone to heal back to its original state so in the meantime we'll put you in a broad arm
42:32sling okay you okay yeah i can give you some painkillers yeah please yeah okay young man
42:46all the best yeah thank you let me get up don't have any more accidents bye bye bye
42:53well they're working their way down through the triage as fast as they can okay
43:15do you want to go just there yeah
43:23you can open your eyes okay yeah yeah indeed
43:37where's what day is the team where's where's what day where's what day yeah
44:07we won today so okay it was worth it so it was worth it definitely
44:19if you or someone you know has been affected by any of the issues raised in this program please
44:23go to channel5.com helplines for information and support an ex's version of events quickly
44:29unravels when a killer makes a call tomorrow night at 10. next surgeons a matter of life or death
44:37here's one of the two judges of the world
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