Ambulance Code Red (2020) Season 4 Episode 11

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Transcript

00:00There's nothing more extreme

00:03than an immediate threat to life

00:07Responding to the most severe 999 calls

00:13The rapid response vehicles of the Thames Valley Air Ambulance

00:21are at the front line delivering life-saving medical treatment

00:27The big decision is for us whether we need to put a tube in to protect us that way or not

00:31Working day

00:32We're going to give you some strong medication

00:34And night

00:36It should not hurt, it's a very good painkiller

00:38Reacting to emergencies

00:40You've been super brave, darling

00:42The critical care teams

00:43You've had a pretty big blow to the head

00:45Are equipped to provide hospital-level treatment

00:48So we'll give you some ketamine

00:49That will mean that you don't know what we're doing

00:51Whilst we straighten your ankle out

00:52Whenever

00:53Do you think it's bad?

00:54Potentially, yeah

00:55And wherever

00:56It's needed

00:58You are doing a fantastic job

01:00Filmed over three months

01:02Let's have your arm, my dad

01:04Let's give you some of this morphine

01:05Just be aware

01:06You might stop spontaneously ventilating

01:08I have the tube

01:10We captured every vital second

01:12That's okay

01:13You're safe

01:14As these highly trained critical care teams

01:17Can you take a deep breath in for me?

01:19Fight to save lives

01:21Your birthday present is surviving a cardiac arrest

01:24When every second counts

01:26Let's go, go, go

01:28Tonight

01:29Ah, fuck, stop, stop

01:32A man is left with potentially life-changing injuries

01:35Ah, fuck

01:36After a road traffic accident

01:38Listen to me, alright?

01:40And you need to relax

01:41A woman fights for her life

01:43She's not taking regular breaths

01:45After a cardiac arrest while driving

01:47In the event of a sudden deterioration or cardiac arrest

01:50Are you happy to do CPR while we get the Lucas on?

01:52A punch to the face

01:54What's your name?

01:54Knocks a woman out and leads to a seizure

01:58Ready, brace and move

02:01And

02:02We're gonna have a look at you, okay?

02:04A ten-year-old boy is critically injured

02:07We're gonna sort your leg out

02:08When a motorbike jump goes badly wrong

02:11You're not gonna remember it

02:12And you're not gonna feel it

02:13Ambulance emergency

02:30Is the patient breathing?

02:32Yes

02:32Is the patient awake?

02:34No

02:34Is the patient currently unconscious?

02:36Yes

02:37She's in her car

02:38I was driving down

02:39And I saw her go across the verge

02:41And onto the path

02:43Breathing is shallow

02:44She's not breathing well now

02:45She's not breathing

02:47I need you to get her out of the car

02:49And on the floor

02:49Flat on her back

02:50Yep, we're just doing it now

02:51So I had another lady's photo to help me, hopefully

02:53I'm a lovely

02:54I'm just gonna bring you out

02:55You need advice on how to give basic life support

02:58We're probably gonna need some guidance

03:00So kneel by her side

03:01And put one hand flat in the centre of her chest

03:03Put the other hand on top

03:05And lock your fingers

03:07Keep your arms straight

03:08Push down hard and fast

03:09Don't be afraid to push too hard

03:11Push about two times a second

03:13And say push out loud

03:14With every push

03:15So I know how fast you are going

03:16Push, push, push, push, push, push

03:20Keep pushing hard and fast

03:22You will not hurt her

03:23Keep going

03:27Okay, we've got an NHS nurse here now

03:30We do have a unit

03:31That's just under three minutes away

03:32So keep going with the chest impressions

03:34A woman in cardiac arrest is a code red emergency

03:42So critical care paramedic Nick Cole

03:45And Dr. Susie Stokes are immediately dispatched

03:48Adult female witness to crash car into central reservation

03:52Bystanders are 999 callers

03:55Found patient apneic CPR commenced

03:57Less than one in ten people survive a cardiac arrest outside of hospital

04:03I think it's just there

04:04And the traffic is rubbish

04:05But fortunately

04:07The quick thinking of the woman who found the driver

04:10Means that CPR is underway

04:12This early intervention could prove life saving

04:16Blood pressure 170

04:19Tolerating eye gel

04:20Two times IV

04:21Approximately 60 for age

04:24GCS 3

04:24GCS 3 means the woman is still unresponsive

04:28I'll go here

04:30Police and an ambulance crew have arrived on scene

04:34And the critical care team aren't far behind

04:37Two, five, patient side

04:39The patient's life is hanging by a thread

04:42Our bystand's pulled back in the car

04:44Over in CPR when we arrived

04:46And is he awake?

05:12Yes, he's awake

05:13And how old is he?

05:15How old are you, bud?

05:16He's 19

05:17Can I just speak to him?

05:19Yeah

05:19Hello?

05:21Hello, it's the ambulance service

05:23Yeah, I understand that

05:25My leg doesn't feel normal

05:27Just please, come over

05:28We are getting you the help

05:29A young man has come off his motorbike on a country road

05:37He has a potentially timed critical injury

05:40Requiring the advanced medical expertise

05:43Of Dr. Laura Douglas Beveridge

05:45And critical care paramedic Andy College

05:48Okay, so we have a 19-year-old male

05:51Fallen from a motorbike

05:52Suspected femoral fracture

05:54Potential reduction and sedation requirement

05:57There are medical personnel on scene

06:00Isolated injury to left thigh

06:03With potential deformity

06:05Distal pulses

06:07Nill neurology

06:08Nill open wounds

06:09Last year on UK roads

06:12Around 5,500 motorcyclists

06:15Sustained serious injuries

06:16Including fractures

06:17Spinal and head injuries

06:19Even loss of limbs

06:21With 70% of fatalities on rural roads

06:25So we have been sent there to see if we can support

06:28With some pain relief

06:30Potentially some sedation

06:31And to try and move the limb back into a more

06:35And a safer position

06:37There we go

06:39It takes Andy and Laura 22 minutes to arrive on the scene

06:43Let's off-road

06:45An ambulance crew are already in attendance

06:49Grab the monitor as well

06:52Yeah

06:5227 at scene

06:57Hi guys, how we doing?

07:01We've had a crash at approximately 15 miles an hour

07:04Our main concern is our

07:07Femoral fracture

07:10Displays

07:11That's where our main pain is

07:13Yep

07:13Helmet was removed prior to us arriving

07:17We've been mobilising neck

07:19We haven't got any ceasefire

07:20And concern

07:21Lovely

07:21Okay

07:22Okay, fine

07:23Pain is our main concern

07:25And what have you given him so far for pain?

07:27We're just giving him morphine

07:28So we're just giving him morphine now

07:30We're coming to Entenox

07:31We've got the TXA ready to make up

07:33TXA is a drug that helps to clot the patient's blood

07:38Should he have internal bleeding

07:39What's your name?

07:41Gleb

07:42Gleb, nice to meet you

07:44My name's Laura

07:44I'm one of the doctors

07:45I'm just going to quickly check that there's not anything else

07:48Any other injuries anywhere

07:50Apart from your leg

07:51Does anywhere else hurt?

07:53Just a few girls

07:5419-year-old Ukrainian car mechanic Gleb

07:58Went out for an evening ride on his motorbike

08:00When he crashed on a dark country lane

08:02We'll get you feeling a bit better soon, mate

08:04All right?

08:05The couple Gleb's lodging with rushed to his aid when they heard of the accident

08:09So I just need to have a little listening to your breathing

08:11Any pain in your chest at all?

08:14Dr. Laura has to perform a primary assessment

08:16To check for other injuries he's possibly sustained before anything else

08:21Nice deep breaths for me

08:23Lovely

08:24And out

08:25And again

08:27Big deep breath in

08:29And out

08:30Okay

08:32And then I'm just going to have a gentle feel over the chest wall

08:35Any pain when I'm pressing at all?

08:38And come in over this side

08:39And round into the back there

08:42Any pain there?

08:43What about on this side?

08:45Fortunately

08:46It appears Gleb hasn't broken any ribs

08:48And he's breathing well

08:50Just having a gentle feel over your tummy

08:52When I'm pressing the tummy

08:53Any pain at all?

08:55Okay

08:55Fine

08:56Just going to have a quick little look

08:58Okay

08:59Let's just get that up

09:00Any pain round into the side there?

09:03Or on this side?

09:04Feeling over the pelvis

09:05Any pain when I press?

09:07A broken pelvis is extremely serious

09:09Because it means Gleb could have internal bleeding

09:12If he does

09:14His life is on the line

09:15I'm just going to have a little look

09:17Make sure there's no bleeding

09:18Oh

09:18So he's got no pain on the pelvis at all

09:40Okay

09:41On a dark country road near Wallingford, Oxfordshire

09:44Nineteen-year-old car mechanic Gleb crashed his motorbike

09:47Potentially fracturing his left femur and injuring his hand

09:51Fortunately, his pelvis appears intact

09:54So what we can do is maybe if we get the Pentrox on board

09:58And then let's see if we can bring the legs out

10:00And see if they're symmetrical in length

10:02Critical care paramedic Andy and Dr. Laura

10:05Must realign his left leg

10:06So blood flow isn't compromised

10:08He's already been given morphine by the ambulance crew

10:12To combat pain

10:13But he's in absolute agony

10:16You need to listen to what I'm going to explain to you

10:19How to use it, alright?

10:21So I want you to grip it

10:22But I need you to breathe in and out of it

10:25Like you're a deep sea diver

10:26Andy administers Pentrox

10:29It's a drug similar to gas and air

10:31But it offers immediate stronger pain relief

10:34Laura's just going to have a look on your legs

10:36I just want you to keep going on that whistle

10:37Like you have been

10:38Ah, fuck

10:39Is there pain in this leg?

10:42In your right leg?

10:42Laura's just hurt in the other leg

10:44Take, listen

10:44Don't move to the side

10:46Keep taking the pain for me

10:48Okay, okay

10:49Keep taking that whistle, okay?

10:53That's all I want you to do

10:54Alright?

10:55Alright

10:55Well

10:56Okay, well, wait

10:57Okay

10:58I'm not

10:59Stop

11:00Stop

11:01Stop

11:01Everyone, just stop a second

11:03I can say

11:04Just stop a second, sir

11:05Laura and Andy have to take control of the situation

11:08And quickly

11:09Listen to me

11:11He can do it, sir

11:12Keep that working, alright?

11:15And you need to relax

11:16Because the more you're getting agitated

11:19The more your muscles are going to tighten in that leg

11:22And the more it's going to hurt

11:23So I just need you

11:25To keep taking long, deep breaths

11:27We're here to help you, alright?

11:30So I need you to calm down

11:32With Gleb overwhelmed by the pain

11:35Ah, ah

11:36The team have to get his pain relief under control

11:39Before they can manipulate his leg

11:41I think probably, I think probably ketamine

11:44So I'd probably suggest rather than more morphine

11:46I think ketamine would be a good option for this

11:48Yeah, so I've got it here ready

11:49Just so that we get everything nice and calm there

11:52Alright

11:53You need to calm down

11:55I'm trying to

11:56I'm trying to

11:57I can't relax

11:58Too many people

11:59No, there isn't

12:00We need to help you

12:01Straight out

12:01Let's just hold on

12:03Stop, stop, stop

12:04Stop

12:05Stop

12:06Can everybody just give them space

12:08Stop, stop, stop

12:09Shall I tell you what we're going to do?

12:12We're going to give you some strong medicines

12:14That help everything feel more comfortable

12:16And more relaxed

12:18We've got to straighten your leg

12:19Ketamine is a strong sedative

12:22But can have unpredictable effects on patients

12:25And Laura needs Gleb calm before it's administered

12:28Your heart rate is good

12:30Your blood pressure is good

12:32Your oxygen level is great

12:34Lots of things are really good

12:36I'm going to throw up

12:38You're going to throw up

12:39Have we got some undanzatron, please?

12:41Yeah

12:41All right, and have we got a little sick bolus?

12:43We need it

12:44Undanzatron is a strong anti-sickness drug

12:47So we'll give you some anti-sickness

12:49All right, darling

12:50All right, all right

12:51Turn this way

12:52Turn your head to one side, buddy

12:53Turn this way

12:53All right, all right, all right

12:56So I think that's probably the morphine

12:57That's made you feel a bit sickly

12:59All right, we'll get that anti-sickness on board

13:01Let's see if you can get a line in the other side for us

13:03Yeah

13:04A cannula has been inserted

13:06But critical care teams prefer two lines of access to ensure a backup

13:11And to allow simultaneous delivery of life-saving drugs and fluids

13:15I'm just going to give him 10 of ketamine now

13:18Yeah, I think that's a good shout

13:19And add on, undanzatron's in?

13:20Yeah, it's in there

13:21Yeah, so that was at 2113

13:23Fast-acting ketamine is a drug only carried by the critical care teams out on the road

13:29All right, darling, how are you doing there?

13:33Okay, so just while he's got ketamine on board

13:35We'll just keep things as calm and quiet as possible

13:38Little bit of a sharp prick there

13:40Well done

13:41Sorry, darling

13:44And let's just switch over onto some oxygen via the nasal cannula

13:51Can I have the oxygen cylinder on this side?

13:53Oxygen is vital to keep Gleb's organs and brain functioning during the sedation

13:58As ketamine can slow breathing down

14:00Okay, so we're just on four litres via the nasal cannula there as well

14:04Okay

14:04And have we got that sat trace there?

14:07It's on

14:08Lovely

14:08So if you look, that's coming through

14:09Okay, saturation's 100%, heart rate's 80

14:13Lovely

14:13Okay

14:13Then let's try and bring the legs to length

14:15And just see how they compare one side to the other

14:19You're doing really well, Gleb

14:21I'm going to move your leg that's the right leg

14:24Okay

14:25You're doing very well

14:26Okay

14:28Well done

14:31Sorry

14:33Good lad, buddy

14:34Yeah, yeah, yeah

14:35No, this is

14:36It's gone

14:36Yeah, yeah, yeah

14:37Gleb has broken his left femur

14:39It's the longest bone in the body joining the hip to the knee

14:43So we'll need the KTT

14:45So can we get the groin strapped first?

14:47Then we'll put the pelvic binder on

14:49As well as realigning his leg

14:51Have we got a blanket or something that can go underneath just to support?

14:54The team decide to fit a pelvic binder to support Gleb's pelvis during extrication

15:00Well done

15:01All right, keep your legs still

15:04But first more ketamine is needed

15:06So now, shall we bring the pelvic binder underneath?

15:11Just relax that leg down, Gleb

15:13Well done

15:13Gleb, you're doing really well, mate

15:14Just relax that leg

15:15Great at your cantus

15:17Yeah?

15:18Yeah

15:18So that's going to go

15:19You're doing really well, mate

15:22You're doing really well

15:23Yeah

15:23Can we have another 10, please, Andy?

15:27Yeah, absolutely

15:28Thank you

15:30Another dose of ketamine is administered

15:32That's another 10

15:33So that's 30 now

15:3430 so far, yeah

15:35Okay

15:37If there's anyone spare

15:39We'll do a gram of paracetamol en route as well

15:41Right, it's going to be a bit uncomfortable for a minute

15:45Okay

15:45It's just going to feel like it's pulling tight

15:48Yep, that's it

15:49Well done, Gleb

15:51With the pelvic binder secure

15:53Lovely

15:53Just relax that leg down

15:55It's time to realign Gleb's left leg using a Kendrick traction device

15:59A splint designed to pull the leg straight and stabilise fractures

16:03Right, your leg's back in the same, the right direction

16:07And what they're going to do, they're just putting some traction in

16:11I feel like that's not pretty much

16:19That's looking good

16:20Do you want to check, Andy, that you're happy with that?

16:24Yeah, I'm happy

16:25That looks really good

16:27Gleb's legs are now equal in length

16:29He can now be prepared for the journey to hospital

16:32Just going to waist height

16:36Ready, steady

16:37Lift

16:37Lovely stuff, well done

16:41Side up on this side

16:44Just going to keep you warm there, buddy

16:46And we'll have a look at your hand as we travel, okay?

16:51Safely in the ambulance after an hour lying on the road

16:54Dr. Laura can check Gleb's injured hand

16:57There's no obvious deformity

16:59Let's have a little look inside

17:01Okay, so we can clean that and just pop a fresh dressing on

17:04Fortunately, Gleb's hand is relatively unscathed

17:08No broken fingers, just minor abrasions

17:11Lovely, okay, I think we are ready to go

17:14We get that paracetamol running

17:19As Gleb has been sedated, the critical care team choose to travel with him to ensure he remains stable

17:25Okay, IV paracetamol is just dripping through

17:29Hello there, this is the HEMS team calling to pre-alert with a trauma call, please

17:34So this is a gentleman who's had a motorcycle accident

17:38He has sustained a left femoral fracture

17:42And a finger injury on his left hand

17:45It takes the team 32 minutes to arrive at the Royal Berkshire Hospital

17:49All right, Gleb, we're just arriving into hospital

17:52Where Gleb is being handed into the care of the emergency department team

17:56Who are awaiting his arrival

17:58You're doing really well, buddy

18:02So it may well be that this injury might need an operation

18:08So the surgical team are assessing him at the moment

18:11And then they'll see if there's any further operation or procedure he needs

18:28Some central ambulance, who can help, can I help?

18:34Hello, this is 107 Police here

18:36Someone's having a seizure

18:38Okay, are they male or female?

18:40A female

18:41She was punched in the head

18:44We're attending because she was assaulted

18:47But the patient has got a pre-existing brain issue

18:51Which the punch has then led to this

18:54Okay, that's fine

18:56Far on the way

18:57Okay, perfect, thank you

18:58The report of a woman being punched in the head and having a seizure

19:05Means consultant paramedic Mark Hodkinson

19:08And chief operating officer and critical care paramedic Adam Panter

19:11Are instantly dispatched

19:13What are we going to?

19:15An assault

19:16Punched in the face

19:18We're 19 minutes away

19:22Around 26% of violent assaults in England and Wales

19:27Result in serious injury

19:28Including head trauma and life-threatening blood loss

19:31But just one punch can also kill a person

19:35Our notes are saying there's a potential pre-existing brain injury

19:38So the worry is that an assault punch to the face

19:41Even as like, you know, what would appear to be a relatively minor punch

19:46Can cause you to have a potential

19:48Or a traumatic brain injury

19:51Then you become unconscious

19:53Have a seizure

19:53You lose your airway

19:55You don't protect your own airway

19:56So you then not ventilate improperly

19:59So that's the worry

20:00Adam and Mark arrive on scene with an ambulance crew and police already in attendance

20:05Hello, are you alright?

20:09So we've got a very limited history

20:12What we understand, she's been assaulted

20:14Whilst walking to the shops

20:1720-year-old Mandy was hit in the face by a member of the public

20:20And knocked to the ground

20:22She's had one police officer who then had to leave

20:25Had a seizure with that police officer

20:27And then these ones she hasn't had a seizure with

20:29But she does have C-spine tenderness

20:31Mandy's seizure appears to have stopped

20:33But C-spine tenderness

20:36Or a pain in the neck

20:37Could mean she's critically injured

20:39Where's the pain at the moment?

20:43In your neck

20:45This lady's Catherine

21:08Yeah

21:09She was driving this car

21:10She's come across here

21:11At a medical event

21:12Dr. Susie and critical care paramedic Nick are in Wokingham

21:16Where 57-year-old graphic designer Catherine

21:19Went into cardiac arrest whilst driving

21:21Fortunately, the car rolled to a stop

21:25And bystanders delivered early CPR

21:27Really high-quality CPR

21:30Excellent

21:31Down in VF

21:32And one shock

21:33And then two minutes later

21:34At the rhythm check

21:35She had a pulse

21:36Oh, amazing

21:36The ambulance crew also gave Catherine a shock

21:40With a defibrillator

21:41That encouraged her heart to restart

21:43But Catherine's life is still in danger

21:47The husband phoned in

21:51Yeah

21:51And she's got no medical history

21:53She's got two IV access

21:55Amazing

21:55So we're literally about to load

21:57And go to all barks

21:58But you turned up

21:59Yeah, perfect

21:59So I assume you want to put a tube in her

22:02And then take her all barks

22:02Yeah, is that right?

22:03Yeah, that's why we left her outside

22:04Great

22:04The critical care team

22:06Need to take mechanical control

22:08Of Catherine's breathing

22:09So she's kept outside the ambulance

22:11To give them more room to work

22:13Can you grab some adrenaline out?

22:16Catherine will be put into an induced coma

22:18So they can insert a tube into her windpipe

22:20To maintain oxygen to her brain

22:22And other vital organs

22:23All right, I'll start drawing up some drugs

22:26Are you all right

22:27To just have a quick

22:27Top to toe?

22:29Yeah, yeah, yeah

22:29Okay

22:32That felt like

22:33Own respiratory effort

22:34She's not taking

22:36Breaking the breaths

22:36Catherine is barely breathing

22:38While Susie draws up the drugs

22:43For the pre-hospital emergency anesthetic

22:45So chest feels grossly intact

22:47I can't feel any surgical emphysema at all

22:49Okay

22:49Nick performs a primary survey

22:51To check for any other undiscovered injuries

22:54Possibly caused by the car crashing

22:56And no injuries to the head at all

22:57Much damage to the car?

22:59None

22:59None, okay

23:00Cut these off

23:03So primary survey

23:05Airways being maintained

23:08Got an appropriately sized eye gel

23:09So that's our 100%

23:10Chest feels grossly intact

23:12With good air entry

23:13Good

23:13Skin is warm and dry

23:14Abdomen soft and untender

23:16Brilliant

23:18Long bones look intact

23:20So no indication

23:22It looks like it's come to a slow rest

23:24So no indication for a pelvic binder

23:25It seems the car must have come to a gentle stop

23:28Fortunately Catherine appears to have no other injuries

23:32I just drew up ketamine

23:35Rocuronium

23:36Yeah

23:36We've got adrenaline

23:37Fine

23:37Want to omit fence?

23:41Yeah

23:41I'm going to swap this over if that's okay

23:46Lovely

23:48Right

23:51Ready for James

23:53Yep

23:54Okay

23:54So I've optimised patient position

23:56Acceptable IV access and fluid attached

23:59So there are two IVs

24:00They're both working

24:01I've used that one for meds

24:02And this one is attached to fluids

24:03So monitoring

24:05Can you see blood pressure cycling every three minutes?

24:08Yes

24:09Sats

24:09Yep

24:10After running through their pre-anesthesia safety checklist

24:13ECG

24:15I can see three lead

24:16It's time to put Catherine into the induced coma

24:19A hospital procedure

24:21Only the critical care teams are allowed to undertake

24:23Out on the road

24:24So in the event of sudden deterioration or cardiac arrest

24:29Are you happy to do CPR while we get the Lucas on?

24:31Have you got pain on your back?

24:44In Maidenhead

24:4520-year-old Mandy was punched in the face

24:48And knocked unconscious by a member of the public

24:50Resulting in a seizure

24:51Just keep nice and still

24:52She has pain in her neck

24:54Indicating there may be damage to her spinal cord

24:57Critical care team Adam and Mark are assessing her injuries

25:01So just here

25:03Damage to the spinal cord can lead to paralysis

25:06There

25:08Mark needs to know if Mandy has any sensation in her neck and spine

25:12Here

25:13Here

25:14Before proceeding with any medical intervention

25:17What about here?

25:19Down your back

25:20Is that sore?

25:22Yeah

25:22Can you take a deep breath in for me?

25:25Does that hurt your chest at all?

25:27Yeah

25:28Okay

25:28Alright

25:29Can you wiggle your toes for me?

25:34And move your hands?

25:36Any tingling or pins and needles or anything?

25:38No

25:38In your arms

25:39Okay

25:40Alright

25:41Although Mandy has pins and needles in her arm

25:43She doesn't have any obvious pain

25:45So Mark decides it's safe to lift her to the ambulance's stretcher

25:49If you carry on

25:51We'll get the scooping and stuff

25:52And then

25:52Because you're happy to keep hold of the head

25:55Yeah, of course

25:56And we're going to just roll hard

25:57And make a scoop

25:58And then obviously we'll mobilize the head

26:00Yep

26:00Get on to the stretcher

26:03Yeah

26:04I'm just going to hold your head, okay?

26:06All we're going to do is roll you backwards

26:08And you're going to slide them to a hard board, okay?

26:12If it's really sore, just let me know, alright?

26:16Everybody ready?

26:16So we're going to go all the way in one movement, yeah?

26:20Alright

26:20Ready

26:21Brace

26:22And move

26:23That's it

26:25Well done

26:26Well done, Mandy

26:27What we're going to do is roll you slightly to your left

26:30And then onto the other side of the board, okay?

26:33And you'll hear a loud click behind your head, okay?

26:36Everybody happy?

26:37Ready

26:37Brace

26:38Roll

26:38That's it

26:40Perfect

26:41How's that?

26:44Yeah?

26:45Just keep your head nice and still for me, okay?

26:47Safely on board

26:48As a precaution, Mandy's head needs supporting to prevent any further movements of her neck and spine

26:54I'm just going to hold your forehead while we pop these blocks in next

26:57Next to your head, okay?

26:58Oh

26:58Yeah, that's it

27:00Just going to get closer

27:03That's it

27:04That's it, perfect

27:05Keep nice and still, alright?

27:07With Mandy secure, she can be lifted onto the stretcher

27:11Alright, ready

27:13Brace

27:13Lift

27:14We're going to just wrap you up so you get nice and warm, okay?

27:24Is that too tight on your chest?

27:26Is that okay?

27:27Okay

27:28Mark and Adam are satisfied that Mandy doesn't need any further treatment on scene

27:35Are you happy?

27:36Sure

27:37Meaning the ambulance crew can take her to Wexham Park Hospital for x-rays

27:41You're all good, you're all good

27:43Leaving them ready for their next call-out

27:463-1, clear at sea, never

27:50And the emergency is the patient breathing?

28:10Yes

28:11Yes, he is, yeah

28:12Are they awake?

28:14Yes

28:15What's the reason for the ambulance today?

28:17Uh, we're at the motocross track

28:19He's come over the jump, nose dive, and then he's come off his bike

28:22How old is the patient?

28:23Yes

28:25Have you lost any blood at all?

28:27Are you bleeding anywhere?

28:28No bleeding

28:29And where have you hurt him at the moment?

28:31On his left leg

28:32Practice femur

28:34So don't move him from his current location unless he's in immediate danger

28:38We do have cruise on route already, okay?

28:41With the report of a seriously injured 10-year-old boy at a motocross event

28:48As well as an ambulance, the Code Red team have been requested

28:52Ah, motocross

28:55Hey

28:56Nose dive, post jump

28:58Critical care paramedic Charlie Shorthouse and Dr. James Rate are dispatched

29:03I've just had a quick chat with the on-site medics

29:07This is a 10-year-old at a motocross event

29:09And it looks like he's wearing all of his appropriate PPE

29:12Um, got over a jump, nose dived

29:15He's on some gas and air

29:17Cool

29:18No worries mate, thank you

29:20Motocross racing comes with significant risks

29:23Due to the rough terrain and nature of the competition

29:26Injuries can include broken bones, head trauma, even fatalities

29:32Right, let's go and do some work

29:34It takes the team 28 minutes to arrive on scene

29:38Hello

29:39I'm Charlie, this is James

29:40An ambulance crew is in attendance

29:42And they're already administering oxygen

29:45To keep the boy's vital organs and brain functioning normally

29:48So basically Harper's come through this jump

29:52Landed heavily on his left-hand side

29:54The only thing that we are concerned with is a wobbly left B mask

29:5710-year-old Harper was enjoying his favourite hobby, motocross

30:01But as he tackled a jump, his motorbike nosedived, throwing him hard onto the ground

30:07He was wearing a helmet and the correct protective clothing

30:10We're going to take really good care of him, okay?

30:13His dad is at his side

30:14Then we'll have a proper look at that leg

30:16It looks, just looking at it, like we probably need to sort it out now

30:19So we'll get it nice and straight and back in alignment, okay?

30:22We'll probably give him some nice drugs to make that happen, okay?

30:24But he's in good hands

30:25The force of the impact was enough to break the strongest bone in Harper's body

30:29The femur, or thigh bone

30:31And we're going to have a look at you, okay?

30:34If the team don't realign his leg and restore good blood flow

30:37Harper's at risk of nerve damage, reduced mobility and permanent disability

30:42I'll have a whole lot in the bed, please

30:44Hi, Harper, I'm Charlie, hello, mate

30:47Pop your mouth open for me and stick your tongue out

30:49It's not every day someone asks you that, is it?

30:51Cool, alright

30:53If I squeeze around your chest here, is this sore at all?

30:58No

30:59No

30:59James is trying to ascertain if Harper's fractured any ribs

31:03How's your pain, Harper?

31:06It hurts

31:07It hurts, okay

31:08Not sore around here, no?

31:10No

31:10Alright, lovely

31:11Okay

31:12So, airway's fine, breathing fine, circulation is fine

31:15We've got an obvious, deformed, rotated left femur

31:19Yeah

31:19Almost certainly a mid-shaft left femur fracture here

31:22Fortunately, Harper hasn't sustained any other injuries

31:25But now faces the painful procedure of having his thigh bone pulled back into line

31:30We're going to do a procedural sedation, KTD, scoop, pep blocks, John Radcliffe

31:36What we plan to do is give him some ketamine

31:38A powerful, fast-acting sedative, ketamine is ideal for procedures like this

31:44But must be given with care, as it can affect breathing and heart rate if not closely monitored

31:50So that's a drug that sedates him, makes him really sleepy, okay

31:53And that way we can sort that leg out, pull it nice to length, because we can't keep it like that

31:58Okay, it's important to sort that out as soon as we can, okay

32:01He shouldn't remember anything at all, okay

32:03So he'll just be really sedated

32:05Wears off relatively quickly, and then he should come back to normal, okay

32:09The sedative effects of ketamine only last around 15 minutes

32:14Harper, if I touch your foot here, can you feel me touching now?

32:20Yeah

32:21Yeah, goodbye

32:22Great

32:22A positive sign, Harper has sensation in his foot, meaning his nerves are intact

32:28So is motocross your favourite thing to do?

32:31Yeah

32:31It was until today

32:32Ah

32:33But we're going to give you some nice medication, okay

32:36And then we're going to sort your leg out, and you're not going to feel it, okay

32:39You're not going to remember it, and you're not going to feel it

32:41Administering ketamine to sedate 10-year-old Harper, then realigning the broken bone

32:46Is a procedure that has to be executed perfectly

32:50Right, blood pressure on a three-minute cycle

32:52Lovely

32:52So Dr James runs through a vital checklist before starting

32:56At the moment we've got heart rate 90, SATs 99

32:59Blood pressure's just cycling, but it was perfectly normal before

33:03128, so that's something good

33:05Lovely

33:05So, sedation checklist

33:07Two times vascular access

33:10Yes we do

33:10Monitoring attached and visible

33:12Yes it is

33:13Now the team face giving an extremely powerful drug that can cause breathing difficulties to a young boy

33:19So I'm going to manage any airway issues, any emergence

33:22Okay

33:23Before performing a vital medical procedure, all in a muddy field

33:28Oxygen administered

33:29Yes, he's on 100% currently

33:31Perfect

33:32So I'll go 15 milligrams ketamine

33:50Perfect

33:54Perfect

34:24Yeah, okay mate, well done

34:27As Harper is responding to Charlie, he isn't sedated enough for the realignment

34:31Can you open your eyes again?

34:35Well done

34:35So you give me another five?

34:37More ketamine is needed

34:39How are you feeling?

34:41Can you talk to me?

34:41Can you tell me your name?

34:57Can you talk to me?

34:59Can you talk to me?

35:00Can you talk to me?

35:01Okay, man

35:02Once all the straps are in place, I've lost verbal response

35:03I've lost verbal response

35:04I think just very tentatively, James

35:05We'll make a little stop

35:06So, first thing we're going to do is just really carefully weasel in this strap

35:09Open your eyes, Harper

35:10All right mate, you relax

35:12You're okay

35:13Sorry

35:14Good boy

35:15A Kendrick traction device is called upon for the realignment

35:19If you take this and feed it underneath my middle of his leg

35:22Good boy, mate

35:25Good boy

35:26Can you talk to me?

35:28Okay, man

35:29Once all the straps are in place, Harper's leg can be gently pulled back into line

35:35So, what we'll do now, we'll put the ankle strap on

35:37You can do the middle strap now

35:39I just slide it up

35:40So it's just above it

35:41Okay, mate

35:43It's all right

35:44All right, buddy

35:45Beautiful

35:48How are you doing up the top, Charlie?

35:49Yeah, we're happy

35:50We're happy

35:51Yeah

35:52All good

35:53So now his leg length is equal

35:55And his knees are in the same place

35:57The swift realignment is complete

36:00And Harper's leg is straight

36:02Great

36:03Let's get him on the scoop

36:04So we're going to roll towards me

36:05Okay, everyone got a bit?

36:06Yeah

36:07Okay, so on roll

36:08Very steady roll

36:09That's fine, thank you

36:11Harper is transferred onto a scoop stretcher

36:14Oh, everyone happy?

36:15Yeah

36:16Let's say on rolling

36:17Very steady roll

36:19Lovely

36:20In at the bottom

36:21Right, these are just some blocks for your head

36:23Okay

36:24Securely strapped onto the scoop

36:26With the head blocks to minimise any further injuries during transit

36:29How are you doing, Harper?

36:31Harper is carefully carried to a waiting ambulance

36:34Okay

36:35Can you open your eyes?

36:36Well done, mate

36:37Well done

36:38Well done

36:39A few little bumps, Harper

36:41Okay, mate

36:42He's waking up nicely, actually

36:47Okay

36:48As Harper begins to come round

36:50Can you say hello?

36:51Hello

36:52Good boy

36:53It's time to say goodbye

36:55We're going to go now, okay?

36:57I'm going to leave you with the ambulance crew

36:58All the best, mate

36:59Cheers, mate

37:00Thank you

37:01Thank you

37:02Thanks, guys

37:03The critical care team

37:04Are happy for the ambulance crew

37:05To proceed to the John Radcliffe hospital without them

37:11Harper was absolutely amazing

37:13I've seen grown adults complain far worse than him

37:17And rightly so

37:18It's an extremely painful injury

37:19So I was really, really impressed at how brave Harper was

37:22I'll stay with the airway if you're happy to do the physical bits with the Lucas

37:38Yep

37:39Roadside on a busy roundabout near Wokingham

37:42Dr. Susie Stokes and critical care paramedic Nick

37:45Are about to put 57-year-old graphic designer Catherine into an induced coma

37:50After she suffered a cardiac arrest at the wheel

37:53She's had, as you said, 30 minutes of sustained ROSC

37:56And no more ventric ectopics, really, since we've been here

37:58No

37:59So things seem to be more stable

38:00It works like by Gemini at one point, but then it's down again

38:02Yeah, perfect

38:03Fortunately, after early CPR and a shock with a defibrillator

38:07Her heart restarted

38:09But now the critical care team need to keep her alive

38:12Is it okay if I take over the airway, please?

38:14Thank you

38:15They have to mechanically take control of Catherine's breathing

38:17To keep her brain and other organs oxygenated

38:20In case she has another arrest

38:22Happy to proceed?

38:24Happy to proceed

38:25This means strong drugs are needed to anaesthetise her before the intubation

38:29So we're happy starting with one per kilo

38:32Yeah

38:33Go 17

38:3417

38:35Yeah

38:36So we're starting on 15

38:37Okay

38:38Yeah

38:39And we go down to eight

38:40Okay

38:41First, Nick administers a powerful sedative that only critical care crews can use outside of hospital

38:46Every now and then, we're getting a spontaneous breath

38:50Happy to rock

38:51That's followed by the muscle relaxant rocuronium

38:54This combination will temporarily paralyse her

38:57So a tube can be inserted deep into her airway

39:00Okay

39:01Yeah

39:02Definitely aware of that

39:03Yeah

39:04I'm going to continue ventilating through the apneic period

39:07Yep

39:08Sats are 100

39:09Lovely

39:10And tidals remained unchanged

39:13But pressure maintained

39:14Yep

39:15So we'll go back

39:17Any difficulties, we'll go back to the eye gel

39:18So we know it works

39:19Yeah, yeah

39:20Okay

39:21You happy?

39:22Yep

39:23A little bit of blood in the eye gel

39:27A laryngoscope gives Dr. Susie a clear picture of Catherine's airway as the breathing tube is inserted

39:34Can you see?

39:40Oh yes

39:41Yes

39:42Grade 1

39:43Bougie through the cords

39:44Amazing

39:45Loading tube

39:46I have the Bougie

39:50I have the tube

39:51Okay

39:52Yeah

39:53Tube scene through

39:54Black lines

39:5522 at teeth

39:56Bougie coming out

39:57Watch your eyes

39:58Right

39:59Bougie's away

40:00Cough going up

40:01No herniation

40:02Cough is up

40:03Lovely

40:04Amazing, thank you

40:05Okay

40:06Okay

40:07Fogging scene

40:11Chest is rising and falling

40:14Dr. Susie now has full control of Catherine's breathing

40:17Right, can you swap them over now? That'd be great

40:20That's perfect

40:21Okay

40:22Nothing

40:23She can now be switched onto a mechanical ventilator

40:27Fine

40:28Okay, mains O2, you're right connecting to mains oxygen?

40:30Yeah

40:31So propofol's in

40:32Catherine's given propofol, a general anaesthetic only carried by critical care teams, which combined with ketamine provides deep stable sedation with fewer side effects than either drug alone

40:45Fine, let's recycle under blood pressure now

40:46Fine, let's recycle under blood pressure now

40:47All the numbers are good, Susie

40:48Great

40:49Our end total has basically stayed the same from 4.8 to 4.9, we're on 450

40:51I'm happy with that, let's, yeah, we'll keep it below five

40:58Catherine is stable and successfully ventilated

41:01Temperature monitoring and O.G. and then we are good to go

41:04So 999 was 0809, but I'm happy with that

41:06Yeah, we'll keep it below five

41:08Catherine is stable and successfully ventilated

41:11Temperature monitoring and OG and then we are good to go

41:14temperature monitoring and og and then we're good to go so 999 was 0809 and

41:21Ross was 08 19 about 10 minutes that's great yeah it's an amazing job

41:32hello can I pass a medical pre-alert please

41:36at November alpha 431 but with a HEMS team traveling with medical cardiac

41:42arrest with Ross dr. Susie phones ahead to the Royal Berkshire Hospital so they are

41:48prepared for Catherine's arrival so this young lady was driving her car and it

41:56was seen to kind of veer off and come to a slow stop so no trauma pulled out by

42:01bystanders excellent CPR one shock from VF to Ross 10 minute downtime she's been

42:09intubated and it's being ventilated okay see you then thank you so quick top to

42:15toe and airway we're happy with yep breathing is controlled so people's

42:21equal and reactive the end was normal we've pre alerted yeah cool okay let's

42:26drop ourselves in on arrival at the Royal Berkshire Hospital Catherine is handed

42:33over to the emergency department for scans and possible heart surgery okay

42:43Catherine we're at hospital now just in case you can hear me we're gonna go in

42:47and we're gonna speak to the doctors about you and get you feeling better okay

42:50the people who saved a life whether the bystanders we know the things that make

42:55the big differences early good quality CPR which was definitely happening she may

43:00need an implanted defibrillator so a little sort of shop box that sits under

43:05the skin should she ever have a similar event the box would shock her out of it

43:08before do you feel really hopeful for her yeah

43:30you

43:36you

43:38you

43:40you

43:42you

43:44you

43:47you

43:49you

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