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00:00In the intense world of medical emergencies, there's nothing more extreme than an immediate threat to life, responding to the most severe 999 calls.
00:18This lady is reporting pain in her head and is becoming less talkative.
00:23The rapid response vehicles of the Thames Valley Air Ambulance are at the front line delivering life-saving medical treatments.
00:32The big decision is for us whether we need to get a tube in again to protect us that way or not.
00:36Working day, we're going to give you some strong medication, and night.
00:41It should not hurt, it's a very good painkiller.
00:44Reacting to emergencies, the critical care teams are equipped to provide hospital level treatment.
00:53So we'll give you some ketamine, that will mean that you don't know what we're doing whilst we straighten your ankle out.
00:57Whenever, and wherever, it's needed.
01:04You are doing a fantastic job.
01:06Filmed over three months.
01:08Let's have your arm, my darling, let's give you some of this morphine.
01:11Just be aware you might stop spontaneously ventilating.
01:14I have the tube.
01:15We captured every vital second.
01:18That's okay, you're safe.
01:19As these highly trained critical care teams...
01:22Can you take a deep breath in for me?
01:24...fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29When every second counts.
01:32Let's go, go, go.
01:34Tonight, a motorway pile-up...
01:37...leaves a badly injured woman trapped.
01:40She definitely is less conscious and alert than she was before.
01:44A man in agony after a serious fall.
01:47How bad is your pain at the moment if you score it out of ten?
01:49Ten being the worst pain you can imagine, there being no pain at all.
01:51Ah!
01:52An elderly woman with a suspected stroke.
01:55My feeling is this looks neuro, and I think she's quite frail.
02:00And the critical care team responds to a woman suffering multiple seizures.
02:05Okay, Claire, you're all right.
02:07Have we done that, AC Jones?
02:08No, John, for your time.
02:09Well done, just watch your head.
02:10Ambulance, emergency, suppression, freebay.
02:28There's a lot of cars.
02:29I don't know.
02:30It's completely a million miles.
02:32Okay, how many cars are there?
02:34Five, six, seven.
02:36What road are you on?
02:38We're involved in this.
02:39Were you involved in the accident?
02:41Yes, I am.
02:42Someone's hit me up the back.
02:43Has anyone trapped in a car?
02:45I think there is.
02:46Can you see if anybody is injured?
02:49Hello?
02:51Hello?
02:52Sorry, the line popped out.
02:54Can you repeat that?
02:57Hello, can anyone hear me?
02:58There's been a road traffic collision on the motorway.
03:07Multiple vehicles have crashed, and there's a high probability of serious and potentially fatal injuries
03:13that will need the specialist skills of the critical care team.
03:16So, Dr. Laura Douglas-Beverage and critical care paramedic Andy College are dispatched.
03:25So, it's a seven-car RTC.
03:27Yeah.
03:27But the information's a bit patchy.
03:29Some people are saying everyone's out.
03:30Some people are saying there's someone trapped.
03:32And then you take to report a person who's severely injured.
03:34So, if you get there, you're first on.
03:35Just a quick report back so that we all know up here what the state of play is.
03:38Do you have layers?
03:39Over 29,000 people are seriously injured or killed in car crashes in the UK every year.
03:56RTCs involving multiple vehicles carry a greater likelihood of death.
04:01Okay, we've got a hard shoulder action.
04:03Yeah.
04:03We're going to be breaking.
04:04Yeah, no problem.
04:05You're okay, love.
04:05I'm behind.
04:07So, we've been sent to a seven-car collision on the M40.
04:14We are going to be the first on scene.
04:15So, a lot of this initially will be about assessing how many significant patients there actually are.
04:21And then delegating to additional resources as and when they arrive on scene.
04:25So, my feeling would be if we're first on, that anybody who can walk, we direct to the side and to move back unless we need additional pairs of hands.
04:32Yeah.
04:33I'll report back to the desk.
04:34Lovely.
04:35Yeah.
04:35And then I can get eyes in for initial.
04:37Just seven minutes after receiving the call, Andy and Laura arrive at the scene.
04:42Hey, are you all all right?
04:49You all okay?
04:50Are you guys injured?
04:51No, I'm dead.
04:52Go to her.
04:52They immediately need to assess any injuries and prioritize who needs their help the most.
04:58Any of you injured?
04:59No, this is my vehicle.
05:00Lovely.
05:01Lovely.
05:02Lovely.
05:02Anybody still inside the vehicle?
05:04Anybody injured?
05:05No.
05:05No.
05:05Everybody.
05:06Fine.
05:06Okay.
05:07Please stay where you are.
05:08All right?
05:09Hello, mate.
05:10You all right?
05:10Yeah, yeah.
05:11So, this is Ellie.
05:12Yeah.
05:1229-year-old lady.
05:13And this is Harry.
05:14Hiya.
05:14They were stationary.
05:16Yeah.
05:17And then this van here.
05:18Yeah.
05:18Okay.
05:19I've had a quick feel around this no C-spinal central neck, mate.
05:23Okay.
05:23What's your skill set, mate?
05:24I'm a paramedic.
05:25Off-duty paramedic Paul was driving back from an event when he saw the pileup happen and
05:31rushed to help.
05:32So, um, she's complaining of chest pain.
05:34I'd better listen to the chest.
05:36She's complaining of the sternum.
05:38Yeah.
05:38But I'm trying to calm her breathing down, she's all right?
05:40She's got a little bit of face pain underneath the eyes.
05:42Okay.
05:44Ellie and her husband, Harry, were traveling home from Birmingham when they were hit side
05:48on by a transit van while stationary in queuing traffic on the motorway.
05:53Hello, sweetheart.
05:53My name's Laura.
05:55I'm one of the doctors.
05:56Where does it hurt, sweetheart?
06:00Round your face.
06:01Okay.
06:02Look at me, sweetheart.
06:03You're doing really well.
06:05Does it hurt anywhere else?
06:06Normally, like toes or...
06:08Round your toes.
06:09Okay.
06:10Ellie has injuries to her face, chest, and potentially her spine and legs.
06:15Dr. Laura urgently needs to examine her, but that can't be done until she's been extricated
06:21from the vehicle.
06:21I've got a sit-rep for you when you're ready, Ella.
06:26Yeah, this is a three to four car RTC.
06:30If you can make ambulances three at this stage, please, Ella.
06:32I've got a sit-rep for you when you're ready, Ella.
06:46I've got an emergency patient breathing.
06:50Yes.
06:51And is patient awake?
06:53That's correct, yes.
06:54Is it possible for me to speak to him?
06:56Hello?
06:56Can you hear me?
06:58Have you lost any blood?
06:59No.
07:00And did you fall today?
07:02Yeah, I was stood in the bath, in the shower.
07:05Okay.
07:05And I just slipped and fell backwards out of the bath.
07:13Ah, the first contact was on my left side, the rim of the toilet.
07:19Okay, so from the information you have given me, the appropriate help is still being arranged,
07:24and this is now a high priority ambulance.
07:25An ambulance has arrived and is with the patient.
07:33The crew are concerned the man's life is in immediate danger, so request support from the critical care team.
07:38The 69-year-old, who fell backwards in the bathroom, and he's striked his kind of posterior thorax on the toilet.
07:45When the crew have got there, they say he's got a rest weight of 40, with severe difficulty of breathing.
07:51Dr. Matt McGurran and critical care paramedic Andy Luglow are dispatched.
07:55They've had a look, and he's got an obvious posterior flail segment, which is said, and the bubbling sound, and it was like an ostentation.
08:05They sat him out, he went bradycardic, lost consciousness.
08:09Okay.
08:09The ambulance crew think the patient's has fractured ribs, causing air to leak into the tissues under the skin.
08:16It's a severe and potentially life-threatening chest trauma.
08:19What's in one day, do you?
08:22Okay.
08:22We're sort of six minutes away, so that's fine, isn't it?
08:26That's fine.
08:26Okay.
08:27The patient's condition is critical, so Andy and Matt arrange to meet the ambulance en route to the hospital.
08:35They look okay.
08:39I'm Matt.
08:43This is Andy.
08:44So, this is John.
08:45Yeah.
08:45Approximately at 5, uh, 5.50.
08:48He's had a fall, uh, in his shower, so he's slipped, hitting to the left side of his, uh, rib area.
08:54He has obvious bruising.
08:56Um, he's been in a lot of pain on the left side when we got him.
09:00Uh, query may be a headstroke, but he remembers all events.
09:03Nils, C-spine tenderness.
09:06Ex-serviceman John was away on a walking trip with a friend.
09:09When he slipped in the hotel shower.
09:11His shouts for help alerted other guests who called for an ambulance.
09:15In a lot of pain, I've given three milligrams of morphine.
09:19We're running IV.
09:20I see them all now.
09:21Okay, fine.
09:22So, John, my name's Matt.
09:23I'm one of the doctors with the air ambulance.
09:24Um, we'll just do sort of a quick, uh, assessment of your chest, if that's okay.
09:29If John has sustained multiple broken ribs, he's at risk of a punctured lung, damage to other vital organs, and respiratory failure.
09:37How bad is your pain at the moment if you score it out of 10, and 10 being the worst pain you can imagine, and there would be no pain at all.
09:40Doctors on attachment with the Thames Valley Air Ambulance Charity receive specialist training in pre-hospital emergency medicine.
10:02Today, senior critical care paramedic and veteran of the service, Matt Jarman, is on shift with trainee, Dr. Andy Darby-Smith.
10:12So, I'm one of the registrars.
10:13So, I have a background in anaesthetics and intensive care medicine.
10:16And I joined here probably one and a half years ago, as part of a two-year training program.
10:21So, I'm kind of getting towards the end now.
10:24Um, and I happen to live in Marley, which means that I'm only about 20 minutes away from base, which is really nice.
10:30Because I'm married with a two-year-old, and he's lovely.
10:34And he sees the car go down Marley High Street a lot, and shouts, Daddy Nino car, which I think is lovely.
10:39So, that's really nice.
10:41Prepped and ready for their first code red call, Andy and Matt hit the road on a late shift, which will take them into the early hours of the morning.
11:03Ambulance, emergency, patient breathing?
11:05Yes.
11:06Is the patient awake?
11:07Yes.
11:08Can you tell me what's happened?
11:09She's got another nice undiagnosed pueric condition, where she has seizures.
11:15I'm in the car with the now, but the right side of her face has started to drop in.
11:19She's complaining it's less strange.
11:21Is she responded normally?
11:23No, it's about Daisy.
11:26She can barely talk.
11:27Is she breathing normally?
11:29Breathing's very shallow.
11:31She's breathing now.
11:33Okay.
11:36Yes, she's doing it again.
11:38She's speaking again.
11:39I'll hang her up.
11:42To help her, she's been organised for her.
11:44Okay, just down the line for me.
11:45Prolonged or severe seizures can quickly develop into life-threatening situations that need critical care intervention.
11:59Andy and Matt are immediately dispatched.
12:01So we've been tasked to a 32-year-old woman, and the information is relatively kind of scanty at the moment, but it sounds like she's having recurrent seizures.
12:10The ambulance crew, already on scene, sends through an update via messaging.
12:17So they're filming a sit-rep now, which is that they're having seizures, and they're not known to be epileptic.
12:23So it might suggest that something more complicated is going on, but I always think it's so important not to become blinkered and assess the scene yourself before you make any decisions.
12:35And that's something that we're trained to do and do every shift.
12:37The patient had been out with her partner when she began to feel ill.
12:43As they were travelling home, she began seizing.
12:46Andy and Matt arrive at the address where the woman is still in the car.
12:49The ambulance crew brief Matt and Andy.
13:03This is a 32-year-old female.
13:05She's got some kind of neuro-neurological condition going on.
13:09But it's important to have seizures starting at 18.45.
13:13She's had 11 bilateral tonic clonics, all lasting sort of 10 to 20 seconds.
13:17A bilateral tonic clonic seizure causes a person to lose consciousness, followed by the body stiffening and shaking uncontrollably.
13:25Already had 10 milligrams of buccal midazolam.
13:27We've just got another 10 milligrams of IV diazepam.
13:30We've got three points of access.
13:33Oxygen on, but maintaining.
13:35Multiple seizures in quick succession are rare and very dangerous, because the brain doesn't have time to recover between them, which can result in permanent damage.
13:44Hello, sir.
13:45Lovely to meet you.
13:46My name's Andy.
13:47Nice to meet you, Aidan.
13:48Just here to make sure that you see your wife, partner?
13:51Yeah, my fiancée.
13:51Your fiancée.
13:52OK, that she's OK.
13:54Claire's been unresponsive since the seizures started.
13:57So I've heard a little bit from the paramedics about what's going on.
14:00It's been going on for about three months now.
14:01OK.
14:02I started with stroke-like symptoms initially, and then she was admitted for about a week.
14:06To the John McCliffe or to the Stoke Randeville?
14:08To Stokes that went short or was, whether it was a stroke or something.
14:11They expect potentially some mycocondia disease or something along those lines.
14:16And now she has had seizures almost weekly.
14:18Mitochondrial disease is a genetic condition where the body's cells can't produce enough energy.
14:24It can lead to problems with the heart and brain, causing seizures and stroke-like symptoms.
14:29And then today it's got worse again?
14:30Yeah, we were in Stoke last night.
14:32Because of the seizures?
14:33Yeah.
14:33OK, that sounds really difficult.
14:34I'm sorry.
14:35It sounds like a nightmare.
14:37As you probably know, we can't really leave her here if she's having multiple seizures.
14:41Yeah, don't worry.
14:42It's not my first idea.
14:44I bet.
14:44It sounds like you're very clued up.
14:46Yeah, this is probably going on our nine-fizzards.
14:49Sure.
14:50So what I'd suggest is that we move from here to Stoke Mountain of a hospital, which is where
14:56they know her.
14:57With Claire barely conscious, the crew need to move her out of the car and onto the ambulance.
15:02I think the brake's on there, mate.
15:04That's it.
15:07All right.
15:09I'm going to top and tail.
15:10She's got no strength in her legs.
15:11OK.
15:12Claire, are you happy?
15:13Relax for us.
15:14Yeah, it's all right.
15:14I'm holding it.
15:16Happy?
15:16There we go.
15:19Well done.
15:19Good.
15:20Just going to pop this blanket from behind your head.
15:22Sorry.
15:23Sorry.
15:24As Claire is unable to communicate, Andy needs as much information from Aidan as possible.
15:30You should normally wake up from her seizures?
15:32Yeah.
15:33Normally after around 10 seizures, she'll wake up.
15:37But yesterday, she didn't wake up for two hours.
15:39OK.
15:39Is there normally a long delay for her to wake up?
15:42Or is it normally something that happens quite quickly?
15:44It do still happen quickly.
15:45Claire's getting longer and longer each time.
15:47Sure.
15:48OK.
15:48Sometimes yesterday, she actually came to you and then she went back into another one.
15:54Yeah.
15:54OK.
15:55So we're going to later up into the ambulance now and hook up to the monitoring.
15:59And we'll just do another assessment and talk to the ambulance crew about our next steps.
16:04With no diagnosis for the cause of Claire's seizures, Andy and Matt need to carry out a series
16:09of tests to ensure she's stable enough to travel.
16:12Maybe.
16:13Yeah.
16:14If you want.
16:14Yeah.
16:14What was that?
16:15Thanks.
16:18That's pain.
16:19Three.
16:20Chest pain?
16:21Chest pain.
16:21Yeah.
16:21OK.
16:22Have we done an ECG?
16:23No.
16:23Do you want to be a time?
16:23Yeah.
16:24You might as well.
16:25Well, we'll just do a, take a little picture of your heart.
16:28OK.
16:29But suddenly, Claire takes a turn for the worse.
16:33Oh, watch your head.
16:34Just wait now.
16:35Watch your head.
16:36Every time she has a seizure, Claire's brain and her life is at risk.
16:52Just a couple of breaths.
16:53Not too deep.
16:54OK.
16:54Just enough.
16:55In Maidenhead, Dr. Matt and critical care paramedic Andy are with an ambulance crew
17:00who are concerned that 69-year-old John's life is in danger after breaking several ribs
17:05slipping out of the bath.
17:08Well done.
17:09Is it on your left side?
17:11It's got good air, isn't it?
17:12Yeah, we've had fairly good air.
17:14It's just a bit bubbly on the lower face of the back.
17:16Yeah, sure.
17:17Is this still here?
17:18No.
17:19No.
17:20Is it OK here?
17:21Yeah.
17:21And here?
17:23Oh, OK.
17:23I'm not going to examine the back of his chest because I don't know.
17:27No, he's just worried about that bit.
17:28Yeah, sorry?
17:29You might be sick.
17:30Not the whole thing.
17:31There's a bit of...
17:31Can we get a bowl, please?
17:32I think the top two ribs are...
17:34Sick bowl.
17:35Sorry.
17:35Up there.
17:37John's nausea is one of the side effects of morphine.
17:40However, vomiting with rib fractures is dangerous because the broken bones can damage the lungs
17:45and surrounding organs.
17:46I'm just going to give you an anti-sickness medication to help with that nausea feeling.
17:50Is that OK?
17:51Matt and Andy need to get John's pain under control and keep him as still as possible to
17:56prevent any further internal injuries.
17:59John, how are you feeling?
18:00Oh.
18:01We're going to give some stronger pain relief.
18:03OK.
18:05That's why we're coming.
18:06So we can give you ketamine, which is a stronger pain relief.
18:09Ketamine is a powerful sedative and painkiller that critical care teams are specially trained
18:15to administer.
18:17It will help John to breathe more comfortably.
18:21Two, seven.
18:23Andy updates the dispatch desk of their plans.
18:26We're not really going to be able to manage this patient's pain with the cruise morphine,
18:31so we're going to ground escort this chap with ketamine and maybe fentanyl analgesia.
18:39John, you said you were doing the Thames Path?
18:45You said you were walking the Thames Path?
18:47To assess the effects the ketamine is having, Matt talks to John.
18:51Are you doing it with other people?
18:54Yeah.
18:55My lifelong friend with her pinkies because...
19:01Des.
19:02Your lifelong friend, Des?
19:04Yeah.
19:04We're close.
19:05You don't need to carry on talking if it's uncomfortable.
19:13John?
19:14John?
19:16John?
19:17You all right, buddy?
19:23I've only given him ten.
19:24In less than a minute, the ketamine takes effect, and John relaxes into a dreamlike state,
19:30unaware of any pain.
19:32Too fast, scanner?
19:35On route to hospital, the team check for internal bleeding using a portable ultrasound scanner.
19:41John, I'm just going to move your arm out to the side with me.
19:44And then my colleague's just going to scan your tummy.
19:50Okay.
19:55You all right there, John?
19:56Can you open your eyes?
19:58He's sort of behaving in a ketamineised way in terms of...
20:02He's a bit sedated, so it's almost like he's had a procedural sedation where we've made him
20:06less responsive to external stimuli.
20:11You're getting leather, a kidney?
20:13Yeah.
20:14Particularly this side.
20:15You drop that side down, it might be easier.
20:1845 minutes after rendezvousing with the ambulance,
20:21and with the ultrasound not showing any other trauma,
20:23the team arrive at the John Radcliffe Hospital in Oxford.
20:26John?
20:28John?
20:31John?
20:33We've just arrived at the hospital.
20:35Okay?
20:37Is that oxygen still next to the river, right?
20:39Yes.
20:41Right, brace yourself.
20:42Okay, John, a couple of buns.
20:47Still sedated, John will undergo a CT scan and thorough examination by doctors at the hospital.
21:05Where does it hurt?
21:06Dr. Laura Douglas Beveridge and Critical Care Paramedic Andy College are at the scene of a multi-car pileup on the M40.
21:13and again 29 year old Ellie is trapped in her car dr. Laura needs to assess if she has injuries
21:25that could be made worse by being extricated a quick feel over the tummy if I have a little look
21:30any pain there no okay fine any pain when I'm pressing over the pelvis okay what about over
21:40this leg here what about this one okay I'm gonna press in here hi let me have a little
21:47look around your face at all any pain when I'm pressing it's sore in there what about on this
21:51side okay fine while Laura examines Ellie Andy continues to manage the scene and liaise with
22:00the other emergency services now arriving hi mate you're right I'm Andy so this lady once she's
22:07out I think he'll be able to scramble across yeah yeah okay perfect thank you having carried
22:15out her initial assessment dr. Laura prepares to move Ellie out of the car but as she does when
22:22you're ready let's come to three and just gently sit up one two three there you go well done well
22:29done so she's got a lovely radio pulse but it's immediately feeling quite lightheaded at the
22:34minute that we set her up I think ideally if we can get hands-on to just get it out of the stretcher
22:38would be really helpful yeah I don't think she's necessarily going to be able to stand to support her
22:42own way to herself lightheaded and unable to get out herself Ellie will need the help of the fire
22:48service to extricate her all right big noise that's just removing the door so it can help you out a
22:55little bit easier okay you're doing ever so well Ellie lovely stuff chaps so this lady's just feeling
23:02quite lightheaded if we bring the trolley in can we just get hands-on to sit her up legs round and
23:07then open onto the trolley so if we maybe can bring the trolley alongside I'll move our bags out the way
23:12until Ellie is released her husband Harry remains trapped in the car have you got any pain fella I
23:20know you're a bit shaken up okay we'll look after you we'll look after your other half it's all gonna
23:26be fine all right are you guys all right to do the listings you're probably a bit better at it than
23:29me bring your legs out for me sweetheart we need to get you out of the vehicle all right yeah it's
23:34going to hurt all right until we can get you out and get a better look at you then we can do
23:40something about that all right you're doing ever so well that's it well done well done yeah it's
23:49going to hurt sweetheart we need to get you out of the cars so we can sort your head out that's it
23:56well done brilliant well done that's it well done we're doing all right sweetheart all right well done
24:06there we go okay scoot your bum all the way along excellent let's get access and monitoring and so
24:14on here are you able to get yourself across fella come on out fella that's it excellent all right
24:23with Ellie now out dr. Laura can carry out a proper examination you've got any pain anywhere sweetheart your
24:32head hurts have a little look at your people sweetheart look on your eyes for me the lightheadedness and
24:39now headaches following the impacts from the crash are worrying signs so this lady has been alert and
24:45talking but it's reporting pain in her head and it's becoming less talkative all right so my concern
24:50would be this is an evolving picture with this lady
24:52critical care paramedic matt and dr. andy are with 32 year old claire for the past six months she's been
25:19suffering from an as yet undiagnosed condition that causes her to have multiple seizures okay well
25:27done you're all right the abnormal activity in claire's brain has subsided for now but without knowing
25:35the cause she is still in danger so i'm just gonna pop something in your nose my name's andy i'm one of the doctors hello hello
25:43no worries all right well done yeah i'm just gonna say i'll just go bm if you pass me a time out there it's
25:52right there okay i'm just gonna put something next to your head okay just so you don't need some notes cool
25:56pop your hand out clear i'm just gonna do a sugar reading okay and it just involves a little pinprick
26:05in your finger sharp scratch on your finger clear okay just a drop of blood i need or i burn
26:11uh blood pressure 120 on 60 respirator 22 sat 97 on there and end tidal 4.6 and a bm 4.4
26:23after a seizure the body's vital functions can be unstable causing irregular breathing
26:29fluctuating heart rate slowed brain function and disrupted body chemistry
26:34i'm just going to take your temperature in your ear okay
26:3737 to
26:42all right claire okay
26:46sorry hang on can't really hear you say again
26:52the pins and needles sensation claire is experiencing is due to her brain and nerves
27:21being fatigued from repeated seizures
27:23so all of your numbers look really good so your oxygen levels are very good your breathing is
27:30very good and your heart rate and blood pressure are very good and the electrical tracing of your
27:35heart your ecg also looks completely normal it's really positive
27:39the intense muscle contractions and physical strain from repeated seizures are taking their toll
27:54yeah it's quite normal so don't don't worry too much that you can't remember
27:58the intense muscle contractions and physical strain from repeated seizures
28:02are taking their toll
28:04i'm in a lot of pain right now though
28:07are you where's the most pain
28:08my full left arm
28:10yeah
28:10my full right side of my head
28:13i had 17 sleeper class
28:15yesterday
28:1617 yesterday
28:19my body's still recovering
28:21yeah definitely definitely
28:22i feel like
28:23let's say it's like running a marathon
28:24yeah
28:25yeah
28:26yeah
28:27yeah
28:28yeah
28:29yeah
28:31despite it being less than 24 hours since she was last here
28:35claire arrives at stoke mandeville hospital in good spirits
28:39take the monitor on the back of the stretcher
28:43yep
28:45so everything's still fine
28:47all your arms are fine okay
28:49it's amazing they always are
28:51yeah i'll push you this way
28:52yeah
28:54oh can we do that like that
28:55it should just vent
28:56does it
28:57just vent
28:58just vent
29:01claire will be handed over to neurology where hopefully
29:04they can get to the bottom of what's causing her to have these seizures
29:21and look emergency is the patient breathing
29:26yes
29:27and is the patient awake
29:28she is i think she's having a stroke
29:31and what makes you think she's having a stroke
29:33she just looks like she is
29:35she's right half on and half off the sofa
29:38is her face drooped to one side is her speech slurred
29:42she's not talking
29:43her face does look a bit distorted
29:46okay
29:47in the last 24 hours has she mentioned any crushing or severe aching and pains in her chest upper back or upper abdomen
29:54yes
29:55yes she's had all this and was in hospital three or four times a week
29:59so i have got the help range for her it is an ambulance and a high pregnancy response they will be with you as far as they possibly can
30:07an ambulance crew is on scene but the patient's condition has become critical
30:15so dr tom wait and critical care paramedic matt bailey are dispatched
30:21so we're going to an 80 year old female who's had chest and tummy pain for 24 hours or so
30:28and then a collapsing episode with some stroke-like symptoms
30:32and then a brief cardiac arrest with the ambulance crew has been resuscitated from that cardiac arrest but is deeply unconscious
30:40the chances of surviving an out-of-hospital cardiac arrest are fewer than one in ten
30:46but early cpr and defibrillation more than doubles those odds
30:50so it's a little bit unclear what's going on and whether whether this is primarily a heart problem
31:00a head problem or some other problem entirely
31:04i think we'll go with an open mind
31:07get a good feel if we can for what's going on and try to make the best decisions we can for her
31:13okay 25 minutes after being dispatched the critical care team arrives
31:19yeah
31:21the ambulance crew already with the patient brief tim and matt on their treatment so far
31:27hi guys you okay
31:29matt matt and tim with you
31:31this is pat eight year old female
31:33roughly 9 20 began kind of speaking nonsensically to her husband
31:37and then she proceeded to have chronic chronic seizure-like activity
31:40no neurological history no history of seizures at all
31:43um managed to get IV access full set of odds and get some diaz
31:48um approximately two to three minutes after administration of said diaz
31:54um we went into what looked like a VT and i couldn't feel a pulse so we pulled that onto the floor
32:00did two rounds um and then had a pulse back
32:07it's unclear whether it was a stroke or a problem with Pat's heart that caused her cardiac arrest
32:12but by giving her CPR and assisting her breathing the ambulance crew saved Pat's life
32:19we've had a week-long like prominent history of in and out of stoke mandible for abdo pain complications with no formal diagnosis
32:29and you're instruction on the point of extricating aren't you i'm just thinking logistics wise
32:34what we don't want to do is slow progress down
32:37i wonder if we should get her down the stairs and do a primary survey on the back of the ambulance
32:42okay so we're gonna we're gonna rotate first where we are and point Pat's head towards the door
32:47Pat's husband Derek and their friends were with her when she collapsed
32:51I'm pleased to meet you i'm tim i'm sorry to be meeting you in this situation i'm one of the doctors from the air ambulance
32:56all right just wondering perhaps just going down the stairs in a stretcher just wondering if i get a bit more information
33:02about how she is normally when she's well it'll help us to work out how best to look after her
33:08um well she's normal when she's normal
33:12the two of you live together in in this flat i take it
33:16we've been in this flat for since now since 2016
33:20okay we've been married for since 1995
33:25can she get up and down the stairs to the flat okay under her own steam
33:29yeah normally yes
33:30okay yeah
33:32and do you have any extra help at home do you have do you have carers or anyone helping out completely completely self caring
33:38yes good so let's walk past and then swing around
33:42you need to go this way guys
33:44yeah i got her
33:45you got her
33:46yeah
33:47she's still making respiratory efforts
33:48yeah
33:49yes
33:51i think what we need is a really thoughtful examination
33:54Pat's medical history hasn't revealed any obvious causes of her sudden collapse
33:59so tim needs to proceed with caution
34:02uh i'm gonna look in your eyes all right my name's tim
34:06you're very safe you're just on the back of an ambulance
34:09my feeling is this looks neuro
34:12and i think she's quite frail
34:15and i think we'd be doing her a disservice by doing aggressive and invasive things to her
34:21i'd like to i'd like tx a for this lady critical care paramedic andy and dr laura are with teaching assistant ellie who is a passenger in a car
34:50that got hit side on in a multi-car pilot
34:52she has got a radial pulse
34:54i can't see any obvious head injury but she's got facial injuries
34:57she's got good air entry bilaterally and no increased work of breathing
35:01with good bilateral chest and chest air entry
35:05ellie has become less responsive
35:07and there's a risk her head injury may have caused a bleed on the brain
35:11which could be fatal
35:13um who could get us some tx a
35:15this lady
35:16orange kit
35:17out the back of the truck
35:18lovely can i have two grams please
35:20tx a or tranexamic acid stabilizes blood clots
35:24if ellie does have internal bleeding
35:26this could be the difference between life and death
35:30yeah
35:31darling i'm just gonna cut through your clothing
35:33so i can make sure we're not missing something important okay
35:36yeah please i think we just need to do top to toe because for all we've started off we were so soon onto the scene
35:41and she definitely is less conscious and alert than she was before
35:45she was talking and now is complaining and feeling very tired
35:48but i just want to make sure that we've not missed anything else important
35:51one first round tx a time is seventeen thirty
35:54if we can do two rounds that'd be lovely
35:56thank you
35:59excellent thank you and saturations are a hundred fantastic
36:03in trauma cases tiredness can be an early warning that the patient has serious complications that need immediate treatment
36:10can i have a little look into your mouth darling
36:12open your mouth nice and wide stick out your tongue for me
36:15lovely stuff okay i'm just gonna have a little feel of those teeth open wide for me
36:19any wobbly teeth
36:20what about these top ones anything wiggling wobbling
36:23no okay fine
36:25what talk to tell you what are we thinking
36:27significant headache but otherwise pupils are responsive
36:30observations are all within nice normal range
36:32yeah
36:33good error entry bilaterally
36:35abdomen soft non-tender pelvis is okay femurs are okay
36:38no obvious limb injury
36:40although dr laura is happy ellie can be moved
36:44she will need to be reassessed once she's in the ambulance
36:47ready steady roll
36:49ready steady roll
36:51ready steady lower
36:55ready steady roll
36:59just a little brace there only need a few degrees that's it lovely
37:03ready steady lower
37:06one
37:08great job everyone
37:09it's possible that ellie has suffered a spinal injury
37:12so her head is immobilized to prevent any movement during the journey to hospital
37:17and he updates ellie's husband harry
37:19hi mate you alright
37:20so should we go to wexham park i think in slough
37:23okay
37:24am i going with her
37:25uh i suspect so
37:27one second my darling i'm just gonna have a little look at your tummy okay
37:31now i'm gonna undo a couple of straps
37:33can i bring this arm right the way down to your side
37:35bring that arm out a little bit sorry darling i'm sorry
37:38i'm gonna do the same thing on the other side okay
37:41dr laura is using a portable ultrasound scanner
37:46this specialist kit will reveal whether ellie has any excessive internal bleeding
37:51or damage to vital organs that needs emergency intervention
37:54okay so splenorhenal angle looks good on the left
37:58sorry darling it looks really good
38:02just need to have a good look there
38:04sorry sorry sweetheart that's sore in there
38:10i'm sorry my love okay so no obvious tamponade there
38:15all right should we just pop that one over
38:18thankfully dr laura can find no signs of internal bleeding or other serious injuries
38:25okay lucky so fast there's nothing particularly exciting there
38:28um and otherwise observations have remained nice and settled throughout
38:32we're nice and responsive i think nothing's particularly changed in terms of deterioration
38:37fine so you guys happy the only other thing would be analgesia
38:41she hasn't had anything specifically
38:43sounds good yes
38:45happy ellie's condition is stable
38:47the critical care team leave her in the care of the ambulance crew
38:50who will now transport her to wexham park hospital for further treatment
38:55so one thing that was really reassuring these patients
38:59the passenger and driver of the vehicle both have their seatbelts on
39:02which massively reduced the impact if they hadn't been wearing their seatbelts
39:08the injuries could have been so much worse
39:10and i wonder if what we should do is get her up to state manager feel
39:26he's moving that that left side beautifully
39:28i think so pat just have a listen to your chest all right
39:31nice air entry
39:34in chesham dr tim is treating 81 year old pat
39:38who collapsed and went into cardiac arrest after a suspected stroke
39:42let's try and transition her onto nasal catenoprongs and a reservoir mask
39:48and we'll see how we get to
39:50to maintain pat's airway the team have fitted a device called an oropharyngeal airway or op
39:57it's re-established monitoring properly
39:59so bp's on
40:01stats are reading at 98 which is encouraging
40:05is it all right if we get some ecg monitoring on as well
40:09critical care paramedic matt updates pat's husband derek and their close friends
40:14so she's still not responding very much but she's responding more than she was
40:19so the trajectory is improving
40:22but the ceiling of that improvement is very hard to prognosticate
40:27exactly
40:28you can't tell how much she's going to come back to normal
40:29exactly
40:30yeah
40:31is the reality
40:32sorry pat
40:33lots of life
40:34how are you doing my love
40:35but the numbers actually look pretty respectable without aggressive intervention
40:40we've got vascular access if we need to give her anything to settle her
40:43or make her peaceful en route
40:46i think we should be aiming to leave scene fairly promptly
40:49although her vital signs are improving pat remains critical
40:54tim and matt decide to travel with her in case she deteriorates
40:58and they need to urgently intervene
41:00she's not moving her right arm is she
41:02no she's only moving the left arm
41:04i'm going to keep using it so i get the details
41:05oh yes of course
41:06hold on pat i'm just going to get the temperature my love
41:11i'm just going to keep coming i'm going to get the temperature over period
41:13and it's not going to get there
41:14but it's going to get through the reporting
41:1536.3
41:16the team continued to monitor pat throughout the journey to stoke mandeville hospital
41:1836.3
41:23Do we get any additional medical history?
41:27What I managed to gauge, there was no neurological history, there was no cardiac history at all.
41:31The only prominent thing she's had in the past, she's had chronic abdo pain and has been in and out of stone twice in the past week for said abdo pain, no for the diagnosis.
41:43Yeah, interesting.
41:45That's all that we know.
41:47She was actively fitting when you arrived on scene.
41:49Arms, chronic, chronic, face was fairly chronic, chronic, eyes were flickering as well, PCS-3, bopping in the mouth, not responding to anything else.
42:00Shut up.
42:01Dr Tim puts in a call to the hospital so they can be fully prepared for Pat's ongoing treatment on arrival.
42:06I have a medical pre-alert for you if that's okay.
42:11I bring in 80, 80-year-old female who's had a fairly sudden onset of speech disturbance and then slumped unconscious and then a prolonged seizure this evening.
42:25Had a brief ventricular tachycardia, cardiac arrest with a crew with a couple of cycles of CPR and Ross not moving her right arm.
42:34Breathing okay, saturating okay, the normal ECG.
42:39Thank you ever so much and much appreciated.
42:41Cheers.
42:42Thanks.
42:43Bye.
42:44After a 20-minute drive, the ambulance arrives at Stoke Mandeville Hospital.
42:50Pat, we're going into the hospital all right?
42:52Are you happy to take?
42:54Yeah, do you want me to do stretcher if you do monitor?
42:58Pat will undergo a series of investigations including CT scans, blood tests and further ECGs to diagnose exactly what's happened and to ensure she gets the correct ongoing care.
43:22Pat has no idea that Braun-san, blood tests and Kanata is currently being used to do so.
43:23Pat will also be able to help with your students.
43:26Pat will also use the test of the car, traffic-loading process and physical practice, when you can even contact the car.
43:27You also have an eyewear training video and can be able to check out the GPS and it seems to be safe for you to connect without the car,
43:29At first of all, I'm going to take off of the vehicle, and I can see you before the first car.
43:33You can also take the car.
43:35Pat is not to understand and have a mask for your passengers, but you can have to check out what if that is not possible for you.
43:38Pat will be that 좋을 port of the vehicle at the vehicle, and that's the vehicle on your house.
43:39At first of the car, you can now see that your car is not supposed to be able to move in.
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