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00:00After dark, while the nation sleeps, the A&E night shift begins.
00:11You never know what's going to come through the door.
00:15At night, you always have to be prepared for the unexpected.
00:19Multiple kicks to the face.
00:21They said if anyone approaches them, they're going to attack us all.
00:23Across the UK...
00:25We're trying to help you.
00:26...with extraordinary access to three of the most challenged emergency departments in the country...
00:31Guys, I need help in here.
00:33He could have died.
00:34...we follow the work of emergency medics who battle every night to save lives.
00:38Shocking now.
00:40It's a stab wound.
00:42...with drugs and alcohol rife...
00:44I've had five or six pints.
00:46Step back, big man.
00:48The department's just on fire.
00:50I've got a kick!
00:52There you go!
00:53The risk of violence and abuse looms large every night.
00:56And you?
00:57You're maxing your arm.
00:58Stop.
00:59Try, you egg bite.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched, I've been smacked at.
01:07You've got nothing on me, bro.
01:08Come on.
01:09There have been days when there have been more police officers than patients.
01:13I'll punch your head in there.
01:15What's going on?
01:16All hell's broken loose.
01:17Patients running around, security everywhere.
01:19Shut up!
01:20I don't care.
01:21This is the sort of thing that we have to put up with.
01:23Get security to remove it.
01:25This chaos.
01:26Glorious chaos.
01:39Hospitals have seen a 47% increase in physical assaults on staff over the last four years.
01:45And most of those incidents occur on the night shift.
01:50In Tunbridge Wells A&E, security have been called to assist police officers with a violent suspect, who injured his ankle during his arrest.
02:11officers with a violent suspect, who injured his ankle
02:14during his arrest.
02:22As security arrive on scene, the man
02:24is still refusing to calm down, and things
02:26are beginning to escalate.
02:29Every situation is different from every other situation.
02:33Sometimes patients are very agitated, very aggressive.
02:37Sometimes a situation which is not under control, which
02:41can be dangerous for us.
02:45Release the pressure off my head.
02:46You've just switched it to me.
02:48If you don't release the power off my head, yeah,
02:51then the next time I'm up, then that's that.
02:54Bro!
02:55Release the power off my head.
02:57It's all too bad.
02:57Someone's going to get a bit you over there.
02:59We need to get your own food with that.
03:00Not really.
03:01My room wants to get ourselves to.
03:02My room wants to get us back, sir.
03:03We're going to want to get them.
03:04Bro, if you want me to chill, let go.
03:07Bro, don't.
03:08Bro.
03:09Bro.
03:10Bro.
03:10Bro.
03:11No.
03:11Don't take my arm.
03:14Stop resisting.
03:15I'm not moving then.
03:16I'm out.
03:17I'm not moving then.
03:18Listen.
03:19Ah!
03:20Three, two, one.
03:21Hit you up.
03:23Up, up, up, up.
03:25The only way to get the cuffed man safely in for treatment
03:29is on a stretcher.
03:30I'm on my arm.
03:32I'm going to go train, Dad.
03:34This takes two security guards, four police officers,
03:37and five medical staff.
03:40We receive a lot of mental health and aggressive patients,
03:44usually during nights, and especially on weekends.
03:48And if any staff member or any hospital staff needs our assistance,
03:54we go there.
03:54We assist them.
03:55What?
03:56Release my arm.
03:57We are.
03:57You actually like pretty good, aren't you?
03:59I can't move my arm.
04:03No desk block.
04:05There is no room.
04:07It's unsafe for the medical team to treat him
04:09until he's stopped being aggressive.
04:11I strategize and I analyze the situation.
04:14And I, if sometimes, if I need a call, if I need a backup,
04:18I call a backup and, you know, control the situation.
04:21No desk block.
04:23No desk block.
04:25I can't film my arm, man.
04:29Until he calms down, the furniture will need
04:31to be removed for his safety.
04:34And the police and security will stay to ensure he can't
04:37cause any harm to the staff.
04:39Ah, ah, ah.
04:45Ah, my arm.
04:47My arm.
04:48In the UK, there are 900 road traffic collisions every day.
04:54Lost control of the bike, and he's been ejected off.
04:56Motorcyclists are four times more likely to be injured
04:59in an accident than any other road users.
05:03Significant gravel abrasions all over him.
05:05It's like, what?
05:06The urella's there.
05:16My spike rider, wearing gear, struck a wall.
05:19Headscreen fracture.
05:21Collapse after standing.
05:23A biker is on his way to Birmingham A&E for urgent medical treatment
05:28after hitting a wall at speed.
05:29So, I'm going to go.
05:32Thanks, do you mind hooking him up on that, this one?
05:34Dr. Karthik will be managing the incoming trauma.
05:37No, is it freezing?
05:40No, it's cold.
05:41Tom, I'm just going to move you across.
05:43Ready, he's going to start.
05:44Ah, my arm then.
05:46This is Tom.
05:47He is 27 years old, travelling on a motorbike.
05:50He's impacted a wall.
05:52He stood up and then collapsed to the floor.
05:55Injuries, he's got bilateral wrist fractures
05:59and a possibility of a leg injury as well.
06:03Now, treatment was a bit tricky.
06:05He's not allowing us to do any IV access.
06:07Ah!
06:09I'm going to stop everything in my arm.
06:11So, just enter not to him?
06:12Just enter not to him.
06:13The patient is refusing pain medication through a needle,
06:17so we'll be given gas and air for his painful, broken wrists.
06:21Tom, you might put a cannula in your arm so he can give you something.
06:24Ah!
06:26We get quite a few people who are quite extremely needle-phobic.
06:30I wouldn't include myself in it, because when I go to get my bloods done at the GP,
06:35I take my wife along with me, because I just need to hold somebody's hand,
06:40so I know what they're going through.
06:41Tom could have life-threatening injuries,
06:44but it's hard to treat him without any IV access.
06:47Bear with me. Airways, patients, self-maintain.
06:50Just open your mouth for a minute.
06:53Nothing inside the airway.
06:54I'm sorry, my breath stinks.
06:56That's okay, don't worry.
06:57The medical team need to find a way to help Tom overcome his fear of needles, quickly.
07:02There, we put it on his arms.
07:03We need to put it on his arms.
07:05No, no, no, don't let the needle from me!
07:08Ah!
07:10The night shift can be a dangerous place for hospital workers.
07:27Just being verbally abusive towards staff.
07:29Over 25% of NHS staff have experienced at least one incident of harassment or abuse
07:35from patients or their relatives.
07:37You need to calm down!
07:38I know that's all, Tom, I apologise.
07:58Tom was raced into recess after crashing his bike into a wall at speed
08:02and could have serious injuries.
08:04You're going to need some really good pain relief.
08:08And that, the synopsis that you had isn't going to solution.
08:10You need stronger...
08:11Well, it is.
08:12You're going to put the cannula and let me have the gas.
08:14Okay, we'll go and get something to give you that while you're doing it.
08:17You're going?
08:18Yeah.
08:19Ben Throx, please.
08:20Dr Karthik and the team are trying to find a way to treat Tom's pain,
08:23but he's refusing strong medication as he's a needle phobic.
08:27Ah!
08:28They hope inhalable painkillers will distract Tom while they put in the cannula.
08:33Okay.
08:34So, we're going to have a look now to see where we can get the cannula in.
08:36Don't let me see it! Don't let me see it!
08:37Don't let me see it!
08:38Let me see it!
08:39What is it?
08:40So, just hold on, like...
08:41Tom, just read through this.
08:44The cannula will be placed into his foot, so it's out of his view.
08:47Okay, yeah, how are you doing?
08:49Ah!
08:50You're okay, lad?
08:52You're okay?
08:53They've been easy for blood spenches.
08:55Keep going.
08:56You're okay?
08:57You're okay?
08:58You're okay?
08:59Oh, my God.
09:02Done?
09:03No, my God.
09:05So, the needle's out now.
09:07Well done.
09:08Let's give one parasite more, one gram.
09:10Yeah.
09:11Let's take your eyes upon.
09:14It's okay.
09:17It's okay.
09:22After some pain relief, assessing Tom's injuries should be much less excruciating.
09:29Abdomen soft, non-tender.
09:31Peribus looks symmetrical.
09:33And lift that leg, left leg up in the air.
09:35Good.
09:36And can you do the same with the right leg?
09:38No.
09:39Give it a go.
09:40I'm not flexing.
09:41Okay.
09:42I'm going for a scan to work out what injuries you've got.
09:45Motorcycles are quite dangerous.
09:47Face and neck are the most common injuries that we see.
09:51And those are the most feared injuries.
09:53I wish a lot more people would wear a lot more sturdy helmets while they're riding a motorcycle.
10:01But I usually wear bodies and jeans.
10:02On average, 104 motorcyclists are seriously injured every week, with six of the incidents fatal.
10:17You should consider wearing armour.
10:18I can't serve wearing armour.
10:19Green review.
10:20You are wrong.
10:21I'll call it law.
10:22Even at 20 miles per hour to bike, you could get rid of any of that.
10:25I understand your deal.
10:30Ah, no.
10:31Just being adventurous.
10:35Hello, geezer.
10:37If Tom has any potentially life-altering injuries,
10:43the CT scan should detect them.
10:49The neck looks a bit wonky there, do you think?
11:02We've got a chest pain coming in worth 200 beats per minute.
11:05In the UK, 7.6 million people live with heart-related conditions.
11:12Heart attack, it's one of the conditions we see the most in A&E
11:15and still one of the ones that we have to think about the hardest.
11:19We're going to be starting at 150 goals.
11:22It can go from being very, very benign to life-threatening.
11:27So you've got to get it right.
11:28Looks like it's about to be inferior.
11:30Increase to 200.
11:31I had a cardiac murmur.
11:3330,000 of these heart conditions
11:36lead to cardiac arrest out of a hospital each year.
11:39Sometimes patients come in
11:41and we don't initially know the severity of the condition,
11:43so a heart attack could be quite minor, mild chest pain,
11:47but actually when we get an ECG, they're having a stonking heart attack.
11:52You're going to do a quick scan on your heart.
11:54The overall survival rate for a cardiac arrest
11:56out of the hospital in the UK is less than 1 in 10.
12:00ECG is quite erratic.
12:02You've got to take a very thorough history,
12:06do your specialist investigations.
12:09The risks of getting that wrong are huge.
12:11Hello, Norfolk and Norwich and Erisa,
12:25how can I help you?
12:27How long will you be?
12:29OK, all right.
12:30Paramedics have blue-lighted in 68-year-old Geraldine,
12:44who has a dangerously fast heart rate.
12:47What was the story such here today?
12:49Geraldine's heart is beating more than double the speed it should be.
13:07Hello, Geraldine. I'm Tarek. We will be looking after you.
13:13This patient has got a very fast heart rate,
13:16which we call as supraventricular tachycardia.
13:20It can become dangerous.
13:21It is important to be fast because, as you see, the pulse rate is 195,
13:26so obviously things can be abnormal any moment.
13:29A prolonged, rapid heartbeat can lead to cardiac arrest.
13:35There is a limit to it when the patient will get fatigued
13:39because of the tachycardia and ongoing,
13:42in which case you as a clinician need to do something for that heart
13:46to get that heart rate back in place.
13:49Have you, um, that will trust me?
13:50That will trust me.
13:51I'm just...
13:52I'm just going to try what we call as a valsalva maneuver.
13:58Hopefully, that should dominate the attack.
14:01The valsalva maneuver increases pressure in the chest cavity,
14:06forcing blood out of the heart and affecting blood pressure
14:09and should bring the heart rate back to normal.
14:12Geraldine, what I want you to do is,
14:14if I could put this here in that finger,
14:17I want to sit upright, OK, if you can.
14:20We'll just try with one valsalva nut first.
14:22Let's sit up.
14:24Geraldine, if I could sit you up a bit.
14:26If the maneuver fails,
14:28they may have to give Geraldine an electric shock
14:31directly to the heart to reset its rhythm.
14:34It is time critical because if there are features
14:36that the patient is unstable because of the tachycardia,
14:40you have to act quickly and sort the problem out.
14:44The patient can go into cardiac arrest.
14:46OK.
14:47Big one.
14:48Slow these breaths.
15:05In England last year,
15:07more than 850,000 people were treated in A&E
15:10for sprains, torn ligaments and fractures.
15:13No, fuck off!
15:30There's so many people here.
15:32It's mad, isn't it?
15:33Yeah.
15:33In Tunbridge Wells...
15:35It's so painful.
15:37I don't need nightmares.
15:39...50-year-old Paul, with partner Barry,
15:41has checked himself in
15:43after suffering a suspected broken ankle
15:45after falling in his garden.
15:47It was only a thun to me.
15:48The minute it cracked and went on,
15:50I can't understand what happened.
15:53It was just so sudden.
15:55Paul?
15:55Hello.
15:56Hi.
15:56If you park, Paul, between the chair and the trolley.
15:59OK.
15:59So is there pain in your foot?
16:00Yeah.
16:01Yeah.
16:01Can we take the shoe and sock off?
16:03The triage nurse needs to find out
16:05how bad the injury is
16:06before a doctor can help.
16:08Ah!
16:10And then let's just...
16:11Ah!
16:12Ready?
16:13Can you lift it up?
16:14Can you bend any higher?
16:15Perfect.
16:15Right.
16:16So let's leave your shoe off.
16:17Oh.
16:17And so now we need to take the sock off.
16:19Ah!
16:20If you lift your foot off the paddle...
16:22Oh, I'm sorry.
16:24Can you lift your leg?
16:24Yeah, good job.
16:25So point to me where the pain is.
16:26All right.
16:27So it radiates from starting there.
16:30Yeah.
16:30But the main bulk pain is right through the actual ankle bone itself
16:34and through here.
16:36The swelling isn't conclusive,
16:38but an x-ray will show if it's broken or a sprain.
16:42Ah!
16:47Ah!
16:48Oh!
16:50Almost there.
16:51Almost there.
16:52Ah!
16:53There.
16:54Oh!
16:58Although I'm fighting for anything else, it's going to be that pain.
17:01Turn around.
17:02Right.
17:02Can I help you?
17:03I can help you.
17:04Oh, yeah, please.
17:05Hold on.
17:06So let's do it gently.
17:07Oh, jeez!
17:07If Paul's suffered a serious fracture,
17:12he could need surgery and a long period off his feet.
17:22They're still forming.
17:25Each year, more than 300,000 people are treated in A&E for head injuries.
17:30Are you OK?
17:32The head wounds, they always bleed a lot.
17:34No!
17:35Sorry, sorry, sorry.
17:38Something exploded, definitely.
17:40And being two foot away, like...
17:44Close.
17:45Bang.
17:46Also in Tunbridge Wells' A&E...
17:48Nathan?
17:49..42-year-old Nathan with his son Johnny
17:51have rushed in after the side of his head and ear
17:54were hit by an exploding object.
17:56I'm just going to ask you a couple of questions.
17:58Is that all right?
17:58Yeah, yeah.
17:59So tell me, what's happened to bring you to A&E then the scene?
18:02Well, I've had a bag of rubbish.
18:04Obviously, something's in the bag.
18:06I don't know what it is.
18:07It could have even been maybe a vape.
18:09But obviously, it's exploded.
18:11I was quite close to the fire.
18:13OK.
18:13Hit my arm first, obviously.
18:15Did you go in the shower to put that under water for 20 minutes?
18:19No, I've just literally, um...
18:21Just come straight here.
18:22I had to, because obviously the earlobe's missing, so I had to...
18:25Right, OK.
18:27OK.
18:28I'm just going to take down your dressing.
18:30Please, I feel silly with all this around my head.
18:33What am I going to look like now with half an earlobe missing?
18:35Well, let's have a look first.
18:36Do you think...
18:36See what's missing.
18:37Yeah.
18:40OK.
18:41It's not, you're not missing the whole lobe.
18:45Is it bad, is it bad?
18:47Uh, depends on what you define as that.
18:49Well, oh, please.
18:50OK.
18:51May I just look at your arm again?
18:53You should really have that under water for 20 minutes.
18:56While a doctor is consulted, it's important Nathan cools his burns
18:59to reduce pain, swelling and risk of scarring.
19:02Normally, we have, like, a shower.
19:04Just basically, all you have to do is put cold water on
19:07and then we'll get someone to have a look at your ear and go from there.
19:09Now Nathan's burns are cooled,
19:22nurse Eric will clean and dress the ear
19:24until a doctor can see him.
19:27Look like you've done that before.
19:30You're very busy.
19:33It is, yeah.
19:36OK.
19:38I trust you.
19:40I've got to, don't I?
19:45Yeah, you're missing some skin there.
19:47Yeah.
19:48There's definitely a bit missing, isn't there?
19:49Yes, there is.
19:50Yeah.
19:51There's a partial amputation on the lower tip of the ear,
19:56which is the lobe itself.
19:58So the plan for this one is actually take a picture of that
20:01and send it to the ear specialist.
20:04They have to look at the ear,
20:05making sure there's no other cartilage involvement,
20:07but obviously they want to see it themselves.
20:09The injury could be superficial
20:11or the sign of something more serious.
20:14The ear, nose and throat department will use the photos
20:17to decide if Nathan will require surgery.
20:19So now we're just going to put some dressing.
20:24Ah, a cloth.
20:27Stingy now.
20:28It is challenging to treat the wound laceration
20:32or part of the body missing
20:34because it's really painful to, on the patient's side.
20:40The ear also bleed quite a lot,
20:42so you have to manage it accurately and quickly
20:45by applying pressure on the ear
20:47and getting the appropriate people as well.
20:50Oh, dear.
20:53Can I get a bit of a drink?
20:54Yeah, sure.
20:57Okay.
20:58Here, let's open it for you.
21:06So?
21:07Are you okay?
21:12Yeah, I feel a little bit sick for a minute.
21:14I'll do your blood pressure in a minute.
21:19Oh.
21:23Didn't like it on a minute, yeah.
21:26That's it.
21:27A bit hot.
21:28A bit hot.
21:29Okay.
21:33Do you want it like that, huh?
21:34Nathan suddenly loses consciousness.
21:39Can you lie down for me?
21:41Are you okay?
21:42All right.
21:43Down.
21:48And nurse Eric raises the alarm.
21:53Okay.
21:56Take it.
21:58If they can't bring him round,
22:00he could be in serious danger.
22:02Oh, shit.
22:22We've got one space.
22:24Wait times in A&E are longest after midnight.
22:26No, no, you're just waiting to be triaged.
22:28With resources stretched overnight
22:30and patients even more volatile.
22:32Don't melt you fucking beasties.
22:44Well done.
22:46Very brave.
22:47At Birmingham A&E,
22:5627-year-old Tom suffered serious injuries
22:58when he crashed his motorbike into a wall.
23:02Don't mind you well.
23:04He has a suspected broken leg and wrists,
23:07but they're unsure about any internal damage.
23:09Tom's waiting for the scan results
23:20and he's got a visitor.
23:22I knew a rich one of those in my saloon fans.
23:25Oh, Tom.
23:26His grandad, Ray.
23:27When I heard, I just left me bingo card
23:31and got in the car
23:33and I went up to where the crash had happened
23:36and he was in the back of the ambulance.
23:40They thought he might have broke his leg,
23:41but his two wrists are the main problem.
23:45Fingers crossed he's going to be okay.
23:47Dr. Karthik gave Tom a full body scan
23:54to check for any life-threatening injuries.
23:57We couldn't find any bleed in the brain
23:59or any injuries in his chest or an abdomen.
24:04This is one of the wrists.
24:06As you can see, it's not in line.
24:07It's quite displaced and fractured there.
24:11Tom's broken both wrists
24:12and they'll need to be reset in the correct position.
24:15To deform your bone,
24:18that's quite a lot of energy that's required to do.
24:20So you need to expend the same amount of energy
24:22to pull them back into the place.
24:24We are going to have to give some medications
24:28so that we can put these two hands properly back in.
24:32I'm going to give you a very short, mild sedative.
24:36Okay.
24:37I need to be like I was before,
24:38absolutely mungo, do you know what I mean?
24:40You would be exactly the same,
24:43but just not with the gas on air.
24:45Do you understand?
24:46I'll give you something strong.
24:47You will inject something into this.
24:49For me, Mosh.
24:50Yeah, I brought that in there, then.
24:52Okay.
24:53Can I get the sedation, guys?
24:55Grandad.
24:56What?
24:56Come here and distract me.
24:58No, your grandad needs to stay there.
25:01Oh, is he?
25:04I'll be in the way, child.
25:06Green and barely.
25:07Right, guys.
25:09Autogies.
25:09B to D.
25:10The sedation allows them to manipulate his painful breaks,
25:14safe in the knowledge that Tom won't remember it.
25:17Ah!
25:20Ah!
25:21Happy birthday.
25:23Popping some oxygen on.
25:25Ah!
25:27Deep breath.
25:27Deep breath.
25:28Ah!
25:29Deep breath.
25:30Deep breath.
25:30Deep breath.
25:31Doing really well.
25:31Ah!
25:32All right.
25:33Tom, Tom, Tom, Tom.
25:36Relax, we're nearly done.
25:37Ah!
25:39Tom, Tom, Tom.
25:41Sorry.
25:41You're all right, Tom.
25:42You're doing really well.
25:44I got it.
25:45Put your weight back.
25:46Oh, no, my weight's back.
25:47My weight's back.
25:50All right, Tom.
25:51All right.
25:51Well done.
25:52Well done.
25:52With both wrists and casts,
25:55his grandad can return to his bedside.
26:00You're in the London odd, Thomas.
26:02Just anaesthetics wearing off now.
26:06I'm back.
26:08I love you.
26:10I love you.
26:11I love you.
26:12Yeah, yeah.
26:14No more motorbikes.
26:16Tom will stay in hospital for a few more hours
26:19until the sedation has worn off
26:21and it's safe for him to go home.
26:23He's had about 30 minutes of observation for sedation,
26:27so he's OK.
26:32He's dead.
26:32He's dead.
26:32He's dead.
26:33He's dead.
26:33You
26:49Big one
26:5168 year old Geraldine's heart is racing at 200 beats a minute double its normal speed putting
27:06her heart at risk of cardiac arrest nothing has happened you want adenosine I think yes yeah
27:13dr. Tarik has tried to treat Geraldine without medication with no luck if you leave untreated
27:23what will happen is the patient can lose the pulse or because of heart failure you need to make sure
27:29you put the heart rhythm back in place and there are medications in place that we can give them
27:36through the intravenous route to slow down the heart Geraldine will be given a drug called adenosine
27:42to try and slow down her heart rate it's an uncomfortable medication but it's only for a
27:47few seconds is that okay if the drug fails the last option is to electric shock the heart to reset it
27:56to a normal rate it is frightening because they are having to deal with a heart rate of 200 per minute
28:03it is can be exhausting for the patient so the sooner we get the heart rate back in place the better it
28:09it is for them
28:23oh there you go all right okay
28:27slows down now you can feel it yeah so your heart rate has come back 220 from 200 okay so hopefully
28:45the six milligram has done the job okay she looks okay now her observations are stable her heart rate
28:56has come down she looks well right we're gonna do a heart racing now darling okay the medical team will
29:03continue to monitor Geraldine's heart until she's ready to go home so I think we'll just wait for your
29:10heart to behave nicely now it's already back to 100 so we'll keep you here okay
29:15the moment of truth have you haven't you have you haven't you yes you smashed it
29:39hello in Tunbridge Wells Paul's about to find out if he's broken his ankle after falling in the
29:46garden well take a seat there for me sir nurse practitioner Vanessa has the results of his x-ray
29:52so tell me a little bit about what's brought you here tonight and what happened
29:57didn't look good work for a friend yes um and I took a step to the right and as I did so my whole
30:03foot kind of twisted sort of under itself and went inwards so went inwards yeah and I heard it crack
30:08you felt a crack okay so if I show you the x-ray to start with so this is your ankle here can you see
30:17that break there oh yeah what you've done is you've broken the bottom of that off and that's called your
30:23malleolas I've sheared that off completely yeah so that's broken off at the bottom there wow yeah the
30:30lateral malleolas which is the outside of the ankle with the knobbly bit that sticks out and it looks like
30:36that where he's twisted his ankle that maybe the bottom of the ankle has been pulled off sometimes
30:41ligaments pulled it or it snapped and he's just broken the very tip of the bottom of the ankle
30:46it's not a particularly weight-bearing bone so it does heal quite well quite quickly it's not a pretty
30:52one breaks breaks they're all bad but it's it's the nice thing is that we can put you in a walking
30:57boot okay so you won't need a plaster they will take about four to six weeks to heal normally any
31:03breaks yeah that's one maximum eight usually thank you okay it won't be a moment that's a bit of a relief
31:10isn't it that's a hefty old break though yeah yeah I didn't expect that I was just expecting to
31:15kind of crack through the bone tabs but to actually lose it completely if it's not very weak ankles
31:22we're very delicate ankles Paul's break doesn't appear serious but after leaving A&E it's crucially
31:31avoids making the break any worse so needs training on crutches I wish we had to chop sticks with them
31:38I'd love to see that Chinese takeaway in go crutches bad leg good leg it's quite dangerous to
31:50not use them properly people use them to push themselves up off chairs and they can slip fall
31:54backwards or if they walk too far in front of the crutch they could topple backwards and we certainly
32:00don't recommend ever use them going up and down stairs either because it's completely unsafe yeah yeah
32:05that's what I say be very careful because they're not stable crutches lean bad foot good foot so as
32:11you go forward the weight is on your hands more than the ankle does that feel a bit better it does
32:17yeah although an orthopedic boot is better than a cast using one does come with its own set of risks
32:24please don't go to bed with these boots on all right because we need you not to get any DVTs or
32:30or blood clot you know in your leg thank you for everything that's all right it's what we're here
32:34for especially the long way okay mind there you go no long distance running or hurdling yeah I think
32:48I'm going to give that one a miss I think don't blame you all right take care now be safe drive safely bye bye
32:53it's fine you eat us as little moving as possible please because you're on a spine board at the
33:07moment it's for your own protection okay there are nearly four and a half thousand spinal cord
33:12injuries each year in the UK okay ready that's one person every two hours at risk of paralysis
33:19this way in Norwich A&E a farmer has been brought in by the air ambulance medics ready set slide I've
33:49the falling 30 feet the height of two double-decker buses onto hard concrete so this is Tim that's a 61
33:57year old male he's fallen backwards onto a concrete floor he's been a bit just come on the back of his head
34:04and spinal pose Tim's injuries could be catastrophically life-changing 10 milligrams of morphine
34:13medication has dulled his pain but the team need to assess Tim quickly to understand what the fall has
34:26done to his body what the air ambulance critical care paramedics told me I'm guessing you work on a farm
34:35yeah I'm just gonna shine a little torch in your eye all right just check your pupils so just look
34:50straight ahead for me yeah staff need to identify if Tim has any life-threatening injuries with nurse
34:56Abby keeping a close eye on him a trauma is basically anything that has like a major impact and could
35:01affect multiple parts of his body and could have like internal bleeding or and like spinal injuries
35:07where's your main problem at the moment the biggest concern for the medics is a damaged spine
35:16which could leave him paralyzed right love I'm gonna have to take some bloods is that all right yeah
35:28fine I was in the pigs all morning you could tell you've been in with the pigs give you a quick
35:36bath oh you know what I can't smell you to be fair but um look at the state of that
35:41it's so important to build a rapport with a patient it's just another day for someone working in A&E
35:49but for them it's quite possibly the worst day of their life it could easily be a life altering day
35:56their life could never be the same from then on you've got to be kind you've got to be calm and
36:02just be there to listen sharp scratch down beautiful you've gone a long way you've walloped your head so
36:12we're gonna scan there I want you to stay flat yeah to avoid further damage Tim will have to be kept as
36:20still as possible until he has a full body scan I'm just gonna plunk this next year here we're
36:26gonna have a CT trauma which basically is a CT of head to toe he's having everything because of the
36:31extent of his fall it's just checking for whether there's any internal bleeding any breaks and it's
36:36similar to an MRI keep your arms and legs in the vehicle yes at all times thank you
36:41yes lovely thanks guys oh you've got my favorite little crew on tonight oh yeah well to be fair
36:57it's always busy yeah all right so we're gonna slide it towards that okay yeah nice and still
37:02everyone ready yeah ready steady sorry spinal injuries can be quite problematic if they are
37:08unstable fractures and there is a really high chance of them suffering the spinal cord which
37:14can then cause you to become paralyzed right so we are all done you take care thanks very much
37:22the higher a spinal cord is severed the greater the level of paralysis if Tim's spinal cord becomes
37:30severed near the top of his back he may never be able to move his limbs again just getting ready
37:35so bless you so let me get trying to get injured
37:39I'll show you TA please in Tunbridge Wells Hospital the A&E department is feeling the pressure
38:06okay okay yeah 42 year old Nathan has lost a chunk of his earlobe in an accident with a fire
38:20and lost consciousness whilst being treated
38:22okay nurse Eric has hit the emergency button and needs immediate assistance
38:30right now let's get you into that trolley first we'll do your blood pressure yeah okay
38:47now lift up your arm pop cigarette yeah perfect good job you're well done 132 over 71 you all right
39:07yeah is that okay yes all right I'll leave you to show me if you need me
39:11so they can just pass out as I was cleaning the ear or or packing the ear it's very common in some
39:21patient they just pass out do you know where you are yeah I'll go okay good I know where you are
39:26but they could give me comfort which is good thing his blood pressure observation was pretty normal
39:32if part of the ear is missing people who had speciality like plastic will be the best help for
39:42that patient they can manage it but they can suture it back they can repair it back with less this
39:48disfigurement on the patient's side my name is Brooke and this is the mission we're the ENT I'm just gonna
39:54have a look a specialist from the ear nose and throat department has come down to assess
39:59the extent of the damage if the cartilage has been affected he may need surgery
40:05happy death oh sorry let's move yeah
40:13how the bleeding has stopped stop yeah there's no cartilage involved I can't see any cut there so
40:35it's just the lobe the tip of the lobe has very basically has been cut off so it's the
40:42ear lobe there's no cartilage involvement so it's not an urgent suturing normally the patient comes
40:49back tomorrow morning to be sutured by our senior team Nathan's injuries appear to be superficial and
40:55he's managed to avoid any damage to the ear structure I think it needs a proper suturing because it has
41:02basically the lobe has been removed really yeah what an old hell yeah you know I mean lucky with my face
41:12for me really amazing it may never come up the wreck my eyesight can it count myself lucky
41:20all done thank you boss
41:26what was it 25 to 30 feet
41:38in A&E 61 year old farmer Tim has been brought in by the air ambulance team after falling off a 30
41:49foot silo onto concrete it's still a bit higher up than I'd like to be he's been looked after by
41:55emergency department nurse Abby it might have banged your head as well falls from height can result in
42:01anything from skull fractures to paralysis so Tim was given a full body scan so you've got some quite
42:09serious injuries you've fractured your breastbone you've also broken your pelvis you have broken your
42:17heel the biggest problem you've got is in your lumbar spine the vertebrae the building blocks of your
42:23spine you've really badly broken at least two of them yeah we're worried that a part of that has
42:31pushed backwards into where the nerves that come out of your spinal cord are he has broken two bones in
42:38his back which could be placing his spinal cord under pressure this is a very unstable injury yeah
42:45he's got loads of breaks in his spine and unfortunately they are impingent on his spinal cord
42:52he's going to need surgery there is always that chance of paralysis unfortunately because he's got
42:57such an unstable fracture it could if we were to move in cause that that fracture to them become so
43:02unstable and cut through his spinal cord Tim's condition is precarious and he won't know until
43:08after surgery if he suffered life-changing injuries but nurse Abby is here to comfort him
43:14we'll feel a bit battered I think you're allowed to feel battered nursing is not just you know giving
43:19medication doing observations stuff like that nursing is so much more than that and caring for
43:24the patient as a whole and not just the injury that they've presented with that day
43:28it's never done anything like that before then oh that's how he fell off on you then you go ahead
43:35all right if you need to just give us a shout okay all right love
43:40I got the car in the big car park I'm gonna go back and get my voice
43:52a couple of wet flannels put them in like a sandwich bag put them in the fridge so you're ruining your peas
44:14if you or someone you know has been affected by any of the issues raised in this program please go to
44:44channel5.com slash helplines for information and support it's the case of Raoul Mote and the seven
44:49day manhunt that gripped the nation when a killer makes a call brand new tomorrow at 10. Surgeons a
44:55matter of life or death is next
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