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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.
21:55With Christopher's symptoms appearing unusual, Dr Foster needs to rule out of the causes of
22:01his 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 don't
22:44particularly need to go up yourself.
22:46Finding staff to help that are not tied up with patients.
22:51A lot in waiting room, and I know I've just heard Jane say that there's five members of
22:55staff now down there, trying to get through it and triage as fast as they can. All hands
23:00on deck, yeah.
23:01My name's Shel and this is Beth, we'll be taking your X-ray.
23:10One of those needing close monitoring is Christopher.
23:13Hold, 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
23:33tests.
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, and that's
23:45actually come back quite raised, so it's come back at 134.
23:50Well, 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.
24:05Like I said, drop 194, so his drop's gone up.
24:11Rising levels of troponin in Christopher's blood are another indicator of a possible heart
24:17attack.
24:18He now needs further tests by the cardiac team.
24:21So I've just come to give you a little update.
24:24The marker for your heart has come back raised from what it was before, so it looks like there's
24:28some damage going on.
24:30So it looks like you might be having what we call an endstemi, so it's a heart attack.
24:36For 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.
24:46No.
24:47Perfect.
24:48So it's not super common to have a heart attack without any chest pain.
24:52It's more common in women than it is in men, so it is a bit unusual.
24:57You'll carry on his treatment here and then we'll head up to the wards as and when there's
25:01a bed, up to the medical unit for more treatment and monitoring.
25:06Thankfully, further tests ruled out a heart attack and confirmed Christopher's seizure
25:11was caused by his epilepsy.
25:14He's now back home and recovering well.
25:18That'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.
25:35I've said you literally help them because there's two qualified nurses round there and
25:39you come back.
25:40At least we just got a scan with HDC1.
25:43Right, I'll get Louise to go.
25:46We've all got our own way of coordinating the department.
25:50Myself, I just like to go with the flow, make sure everybody's happy, make sure I help
25:54and assist where I can.
25:57Did you take that one from lamb up to AMU?
26:00So that one's gone.
26:02I 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
26:15me.
26:16So there's no point shouting and moaning.
26:20I think you just have to have an element of assertiveness.
26:24How comfortable do you feel about rolling once you're on the left hand side?
26:25Not at all.
26:26No, not at all.
26:27No, not at all.
26:28Okay.
26:29No, not at all.
26:30No, not at all.
26:32Okay.
26:33Dean is having an urgent x-ray.
26:36Are you able to just roll your ankle this way for me?
26:40Can you roll that way anymore?
26:43Yeah.
26:44He needed life-saving surgery after a mosquito bite led to a dangerous skin infection.
26:49How comfortable do you feel about rolling once you're on the left hand side?
26:52Not at all.
26:53No, not at all.
26:54Okay.
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 the toe, but like, I managed to get it going,
27:17but it's, as soon as it's going to get worse, isn't it?
27:20Okay.
27:21I 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?
27:29Uh, yeah.
27:30So this bit?
27:32It's all I do, I'm dead, though.
27:36Okay, that's fine.
27:37It seems to be more in your joint than the lower width itself.
27:41So it's not around your heat.
27:43Yeah.
27:44Give me two minutes.
27:48I knew it wasn't right when I woke up this morning.
27:50I feel more confident, and I know there is something wrong with me.
27:54Because you're always worried that you're just being petty, aren't you?
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.
28:13The bone looks okay.
28:14Yeah.
28:15That should be okay.
28:16We'll bring you in and start doing some antibiotics.
28:19All right.
28:20Any questions?
28:21No.
28:22No.
28:23I'm keeping me overnight on antibiotics.
28:26It hit me knee, but obviously it took five weeks for that.
28:29I hope it's not as long this time.
28:31Proper birthday present, isn't it?
28:35Dean had to spend eight days in hospital.
28:38He'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.
29:14She has another grandson.
29:16Oh, congrats.
29:18Has he been born already?
29:20Yeah.
29:21Oh, congratulations.
29:22She said he had to hopefully do it.
29:24Is everyone up there?
29:26Yeah.
29:27How many grandchildren have you got?
29:30All together?
29:31Yeah.
29:32All together.
29:3317.
29:3417?
29:3518.
29:3618.
29:37Oh, my.
29:38Gideon, I bet your house is busy at Christmas.
29:41Why?
29:42Blood tests have confirmed that Thomas has a chest infection, which needs further investigation.
29:49Dr. 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, because your inflammatory infection markers are quite
30:07high.
30:08So, we'll continue to target treating your chest and get you up to the medical team.
30:11All right?
30:13No worries.
30:14His heart rate, blood pressure and oxygen levels are all essentially normal now.
30:19His tummy's no longer painful, and all of his blood tests just point to a bad chest infection.
30:24If there was other problems, then potentially the medical registrar would have come down,
30:27but didn't need to.
30:28So, he's now well enough to go to the ward, which is what I'm saying.
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, and 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.
30:49Do you take all these wires off?
30:51Yeah.
30:52I'm going to come and take him on for a sec.
30:54I'll just make sure the porter's coming.
30:56Yeah, look like a...
30:57...a metal Mickey, of course.
30:59Thank you, Walter.
31:06Yeah, 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, and has met up with his 18th grandchild.
31:23In the hub...
31:24Great, my love. Thank you very much, sir.
31:26See you later, though.
31:28Sister Vicky and Sister Jane...
31:31Louise!
31:32Would 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.
31:39...are clearing the backlog of patients.
31:42I've asked Paul to go for his break, Louise has,
31:45but they wanted some help with the washing.
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.
31:54We're the dynamic duo.
31:55We are.
31:56I'm the dynamic, she's the duo.
31:57We're the dynamic duo.
31:58We are.
31:59I'm the dynamic, she's the duo.
32:04And new patients are still arriving.
32:10In paediatrics, 12-year-old Nevaeh's hurt her hand at a majorette dance troupe practice.
32:17She's come in with mum, Amy.
32:19She'd done the walkover, and then she started crying, like, through her next dance,
32:25and I was saying, oh, you'll be fine, but then she carried on complaining.
32:30Nevaeh?
32:31Yeah.
32:32She'll be seen by emergency nurse practitioner, Tony.
32:43So what's happened?
32:44I did, like, a walkover, and I landed on my hand and went over it.
32:48And so when you landed, have you, like, put your hands down like that,
32:51or onto the side of it, or...?
32:53And then you'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.
33:22A 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 and make them better.
33:36Sometimes you can get a little crack on a bone and you can't always see,
33:39but we'll get an extra bit first, and we'll go from there.
33:42Some patients don't need anything doing.
33:43Sometimes it's just a bit of reassurance for parents that everything that they're doing is fine.
33:47You don't need to do anything else.
33:49You want to come this way?
33:50Sometimes you examine them.
33:51They'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,
33:56and they're just quite happy with it.
33:58They're not bothered.
33:59Turn right and head along.
34:00You'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.
34:06See you back shortly.
34:07If 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.
34:26Just looking at the damage.
34:28It's lovely, isn't it?
34:30And the jumper's going to have to be thrown away by it, look, innit?
34:34Sister Susan is there for moral support.
34:37Me and her, we've sent to stick together.
34:41We've had this moment, but 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.
35:02So 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,
35:24which is great.
35:25Can I have a little look under here?
35:28Sorry, I'm catching your hair.
35:29I'm sorry.
35:30Oh, bless you.
35:31Okay.
35:32I suspect looking at that, that might need some stitches, if I'm honest.
35:33There'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,
35:53so I can sort of have you laying down so I can have a really good look at it,
35:57and give it a good clean is sort 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.
36:20It'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.
36:46Where are you?
36:47Where'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,
36:57you cannot buy experience, you 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.
37:11Some are very good at working on a team and delivering, you know,
37:14a good standard of nursing care.
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.
37:27And I think once you 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?
37:55It was like a walk over and I went over with my hand.
38:00Nevaeh came to casualty with mum, Amy.
38:03She plays football as well, so you'd think she'd get more injuries from football than dance,
38:09but...
38:10Do you want to do x-rays of your hand and finger, sorry?
38:12Just probably down nice and flat into there.
38:14She scored her first goal last week, but she'd put it in her own head.
38:18What happened?
38:19So, I'll send those x-rays across to Amy.
38:25If you just want to make a way back round there, like 95 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,
38:56they would likely get a more significant break to the wrist.
39:00That needed potting and sometimes even surgery.
39:03Can't see anything broken, so I think you might have just rolled it a little bit
39:05and you'd just caused a bit of bruising.
39:07Keep it moving.
39:08Paracetumal ibuprofen, absolutely things like that, absolutely fine.
39:11Brilliant.
39:12Yeah? Yeah?
39:13You'll be fine.
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, no, 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.
40:13You're grazed.
40:14You're grazed, aren't you?
40:15It's stinging.
40:16I'm sorry.
40:17It'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?
40:24I know.
40:25I think where it's grazed and unfortunately this isn't.
40:26We'll do it quick.
40:27Oh, I will be glad when I get home.
40:28Just going to do a little injection above your eyebrow.
40:29Oh.
40:30Unfortunately, the local anaesthetic can sting a little bit in itself.
40:33Give me that little, little massage.
40:34I'm used to injections.
40:35I used to injections.
40:36I used to injections.
40:37I used to inject myself four times a day.
40:38Oh, did you?
40:39Yeah, when I first spun out, I've got diabetes.
40:40Oh, bless you.
40:41Just do a little one this way as well.
40:42I have my nose pierced and all.
40:43I see.
40:44I see.
40:45I see.
40:46I see.
40:47I see.
40:48I see.
40:49I see.
40:50I see.
40:51I see.
40:52I see.
40:53I see.
40:54I see.
40:55I see.
40:56I see.
40:57I see.
40:58I see.
40:59I see.
41:00I see.
41:01I see.
41:02I see.
41:03I see.
41:04I see.
41:05My nose pierced and all.
41:06I was seventy one and I thought, I've always wanted to have me eyebrow done in my nose.
41:12So I had me nose done at Skaggy and me eyebrow done in Barnsley.
41:16Full works, basically.
41:17Yep.
41:18Just one last injection, then hopefully everything will be nice enough.
41:26Could you not just put me to sleep?
41:29No.
41:30You can see we've got a fairly big clot in there that we'll need to take out.
41:37You've got a big clot outside and all.
41:41There we go, that's what we wanted.
41:54Is it too big for butterfly stitches?
41:56Yeah, I think unfortunately.
42:00You'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.
42:12So, I think we're all done.
42:27Yep.
42:28Give me a little sort of wiggle of your face.
42:32Raise your eyebrows for me.
42:34I love you.
42:35Well done there.
42:36You were awesome.
42:38So that's, I suppose, always the best case scenario that we've not had anything serious and long-term going on.
42:46That being said, I think the worst case scenario would be if we'd found a big bleed on the head and that could have been very serious.
42:54So thankfully we've not had that happen.
42:56My wrists certainly fingers hurt.
43:01Christine's face is healing well.
43:04She's watching out for the steps outside her sister's house whenever she visits.
43:09I love these.
43:13It's the end of the shift for Sister Vicky and Sister Jane.
43:18Look at you all.
43:20Like these round the little honeypot.
43:23Like vultures.
43:25As a nurse in charge of the department, the more experience you get at doing it, then the better you become at it.
43:32Bye, Carol.
43:34And I think to work here in this department where we are so gelled as a team.
43:39All right, Ais.
43:41See you later.
43:42It's incredibly important.
43:44Goodbye.
43:45At the end of the day, we're one big family here, so we're all here for each other.
43:50It's so easy when you quick chalk.
43:53Some shifts can be really gruelling and you can walk off absolutely exhausted.
44:00But I like to leave the shift happy and positive and know that everybody's done a good job.
44:05Oh, I love you.
44:07I love you.
44:09And as the new shift arrives, another team is ready to serve the people of Barnsley 24-7.
44:19I love you.
44:21It's so easy.
44:25I love you.
44:26You're the one.
44:28I love you.
44:29Bye.
44:31Bye.
44:32Bye.
44:33Bye.
44:34Bye.
44:35Bye.
44:36Bye.
44:37Bye.
44:49You
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