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Ambulance Code Red Season 4 Episode 12
#Ambulance Code Red
#RealityInsightHub
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#Ambulance Code Red
#RealityInsightHub
🎞 Please subscribe to our official channel to watch the full movie for free, as soon as possible. ❤️Reality Insight Hub❤️
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FunTranscript
00:00There's nothing more extreme
00:03than an immediate threat to life.
00:10Responding to the most severe 999 calls.
00:14This lady is reporting pain in her head and is becoming less talkative.
00:18The 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 again to protect us that way or not.
00:31Working day.
00:32We're going to give you some strong medication.
00:35And night.
00:36It should not hurt. It's a very good painkiller.
00:39Reacting 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 whilst you straighten your ankle out.
00:53Whenever.
00:53Do you think it's bad?
00:55Potentially, yeah.
00:55And wherever.
00:56Oh, my leg.
00:58It's needed.
00:58Oh.
00:59You are doing a fantastic job.
01:01Filmed over three months.
01:03Let's have your arm, my darling.
01:04Let's give you some of this morphine.
01:06Just be aware you might stop spontaneously ventilating.
01:09I have the tube.
01:10We captured every vital second.
01:13That's okay.
01:13You're safe.
01:15As 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.
01:27Let's go, go, go.
01:29Tonight.
01:30All right.
01:30Well, we'll see what we've got.
01:32The critical care team race to a man whose life hangs in the balance.
01:36Go to his cardiac arrest.
01:37Do you know anything more about it?
01:3867-year-old male.
01:40Eyes open, not breathing.
01:42Open your mouth for me.
01:43A man is severely burnt when lighting a bonfire with petrol.
01:47I would strongly recommend you have some pain relief.
01:49Because that burn is just going to keep burning.
01:51A gym workout ends in serious injury.
01:55Doing all right there, mate.
01:56A few deep breaths.
01:57And.
01:58He's fallen out of a moving car.
02:00He was driving it.
02:01A pensioner is in a critical condition following a seizure.
02:04As he's getting up out of the car, he's just collapsed.
02:07No, he's not.
02:28No, he's not.
02:28He's eyes open, but he's not moving.
02:30Okay, just have a look at his chest.
02:31Is he breathing?
02:33No, he's not.
02:35But he's...
02:35I don't know what's wrong.
02:37Slow down for me, okay?
02:39How old is he?
02:40He's in 16.
02:41Okay.
02:42Right, is he breathing at the moment if you have a look at his chest?
02:44No, he's not.
02:45He's not breathing.
02:47Okay.
02:47Hello?
02:49Hello?
02:49The next neighbor had a nurse come over.
02:52She's just come over.
02:54Sorry.
02:54You have to go like that.
02:57One and two and three.
02:59Is CPR being given at the moment?
03:02Yeah.
03:02Okay.
03:03The nurse is doing it.
03:04And I'm done.
03:05Stay with us, mister.
03:06Vicar?
03:07Vicar?
03:08Can you hear us, Vicar?
03:10Stay with us.
03:13With a man in cardiac arrest, it's now a race against time.
03:18Every second loss can be the difference between life and death.
03:21So the specialist medical skills of Dr. James Raitt and critical care paramedic Joe Epton are urgently required.
03:28Hi, we're going to this cardiac arrest.
03:30Do you know anything more about it?
03:3167-year-old male.
03:34Eyes open, not breathing.
03:36The wind is the rest.
03:37Right.
03:38As I'm not breathing, CPR straight away.
03:41There's a nurse now on the team doing CPR.
03:43And we went out for a D-5.
03:45I'm not sure if the D-5 got there.
03:47But T-L and D-MA have just arrived.
03:49Okay.
03:51Fortunately, a nurse who was visiting next door was able to deliver CPR almost instantly.
03:57The dispatch desk updates the critical care team.
04:00Hello.
04:00So, see, this was a confirmed cardiac arrest and we're going to IGL and get ready to extricate.
04:07They have just told me that as of the latest rhythm check, they have a ROSC.
04:13Amazing.
04:14Good job.
04:14Cheers, guys.
04:15Have a good day.
04:15Cheers, bye.
04:17ROSC, or return of spontaneous circulation, means the patient's heart has restarted itself,
04:22following a shock from a defibrillator carried by the ambulance crew.
04:26All right.
04:27Well, we'll see what we've got.
04:28Outside of hospital, the chances of surviving a cardiac arrest are fewer than one in ten.
04:37Right, great.
04:38Good job.
04:39But early CPR and defibrillation more than doubles those odds.
04:45Hello, my name's Joe and we've got James with us.
04:48We've got sustained ROSC with sustained breast rate.
04:51Right.
04:52So, we've had sustained ROSC.
04:53I don't know about ten minutes.
04:55Yeah.
04:5567-year-old HGV driver Bicker was watching TV with his daughter working upstairs.
05:02She found him slumped in a chair with bloodshot eyes.
05:05She rang 999 and vitally called for help from the nurse next door.
05:10Is that all right?
05:11Well, if I jump in, I'm going to put them to a different mass.
05:13Thank you very much.
05:15Joe, you have to manage his airways.
05:16Yeah.
05:16I could do a really quick primary survey and you've had ROSC now for about 20 minutes.
05:21Is that right?
05:22Brilliant.
05:23Right.
05:23Okay.
05:24So, airway.
05:25Joe's maintaining.
05:26We're going to get an ECG.
05:28I'd like to do percussion.
05:33Okay.
05:33So, he's got air entry on both sides.
05:36Well, we don't.
05:37We're obviously not doing ECMO at the moment.
05:38He's self-ensilating through this.
05:40Do you want to come and take over?
05:41Then I can have a look at getting some other bits ready.
05:44Yeah.
05:45We're not delivering any events.
05:46We're just supporting.
05:47And now he's on the Mapes and C, you'll see him breathing.
05:49Currently, Bicker is managing to breathe unaided.
05:52So, he's 67 years old.
05:54He's an HGV driver, so he must be well enough to pass an HGV medical.
05:58And he's quite active, like he walks around the place and he does loads of stuff.
06:01I think if he sustains this, that what we should do is put him on a trolley,
06:05intubate him and take him to Wexham.
06:07And the time now is 17.46.
06:10Do you reckon we can be out on wheels rolling in 20 minutes?
06:13Before travelling to hospital, James wants to mechanically take over Bicker's breathing
06:18in case his heart stops beating again.
06:20We can do it in here if you like.
06:21Wheel the trolley in here.
06:22Yeah, we'll set up our kit back here.
06:24Did you get that cannula in?
06:25Yes, I did.
06:25That's brilliant.
06:27Right, I'll get the...
06:28Bicker has two cannulas in his veins to administer drugs and fluids.
06:32Joe is now working on an arterial cannula,
06:35which will enable them to continuously monitor his blood pressure.
06:38So, as soon as Joe's finished there, can we get scoop?
06:41Yeah.
06:42Scoop's half in.
06:43Joe, are you ready?
06:44No, I'm really struggling to feel a radial pulse now.
06:48Due to low blood pressure caused by the cardiac arrest,
06:51Joe's struggling to fit an arterial cannula,
06:54and time is critical to Bicker's survival.
06:57In that case, abandoned at the moment.
06:59We'll try and drive this forward as fast as we can.
07:02Yeah.
07:14Ambulance emergency, patient breathing.
07:20He is, yeah. He's just fired himself. He's got burns on his arm and his face and his hair.
07:28Is he awake?
07:30He's awake, yeah.
07:32How old is the patient?
07:34He's 44.
07:36He's 44.
07:38Is there any burns around the mouth or nose?
07:41Yeah, he's burned his lips, his nose. He's got weird burns on his face and his arms.
07:47He supplied a cold cell to his face. He had text on his hand, it caught light and blew track on him.
07:53He was extremely mad at him for a few minutes there. Really, he's just amazed.
07:59Alright, we're getting some help arranged. We called some casteride as a high priority. We're on our way.
08:05Okay.
08:10Extensive burns to the body and head are a code red emergency.
08:14So critical care paramedic Lisa Brown and Dr. David Metcalf are immediately dispatched.
08:20All we've been told is we're going to a 44-year-old man who's on a farm and has sustained burns from a petrol can that's become a light.
08:29Around 250,000 people endure burn injuries every year in the UK.
08:34Burns can continue to worsen with time as the skin blisters.
08:38Fast treatment is key to reducing pain and swelling of the airway that can potentially lead to death.
08:4444-year-old self-employed businessman John lit a bonfire using petrol, but flames whipped up burning his head, arm and hand.
09:02Lisa is quick to take action, administering a penthox inhaler, which offers immediate and strong pain relief.
09:09Okay, let me have a look at your face.
09:11There we go.
09:13They are. We'll get some water on your lips, I think.
09:17Right, John, put your hand in there.
09:19The ambulance crew have already wrapped John's head and arm in cling film to protect his skin and damaged nerves from bacteria and the air.
09:28They've also already checked his airway.
09:30Fortunately, John's breathing is good for now.
09:32Right, are you happy to first give you some pain relief because you're going to have to have something, my lovely,
09:36because this is a bit of a long journey.
09:38Are you okay with some morphine?
09:40I'll live for now.
09:42Live for now, okay.
09:43Burn pain develops over time, but John's reluctant to have stronger drugs for pain relief.
09:48Right, is your hand in that water?
09:50Yeah.
09:51Yeah.
09:52So far, he's only had penthox inhaler, which is similar to gas and air.
09:57Good.
09:58Right, let's bring your hand to a comfortable position, but be careful because that water's going to go everywhere, okay?
10:02So you can use that arm there.
10:04Just hold that.
10:05I'm bossy, aren't I?
10:07Yeah, bossy.
10:08Severe burns cause fluid loss and reduced blood volume.
10:12Without prompt treatment, John could go into shock, leading to a dangerous drop in blood pressure
10:17and a risk of organ failure.
10:19I would strongly recommend you have some pain relief because that burn is just going to keep burning,
10:23and you don't want to get to the point that it's unbearable.
10:26No problem, no problem.
10:27That's the reason we should leave so hard, but you don't want to get to the point that it's
10:54Yes, the patient is breathing.
10:56And are they awake?
10:57Yes, they are.
10:58Thank you. What's the main reason for the call?
11:00The member has fallen into the ground, dislocated his ankle.
11:03It obviously hit his head as he's fainted.
11:06Are you with him at the moment?
11:08Yes, I'm with him at the moment.
11:10So this is why his ankle has turned the complete opposite way.
11:16Pressure is building up through his leg.
11:18Okay, so the call has now been upgraded to a high-priority ambulance.
11:22Please just don't move him from where he is.
11:28We're going to a young man, 32 years old,
11:31with what sounds like a dislocated ankle.
11:34Without fast treatment, badly broken and dislocated limbs
11:38can have life-changing complications.
11:40So in addition to an ambulance crew,
11:43Dr Tim Waite and critical care paramedic Nick Cole are dispatched.
11:47We normally go to these because we can give some procedural sedation
11:51while women manipulate the ankle.
11:53It's a smoother and more humane way
11:55to put a dislocated ankle back in place.
12:01Go Bryant.
12:04Is that the gym just there?
12:05Yeah, looks like it.
12:07The team need to make their way...
12:09Got it. Cool.
12:10...to the first floor of the gym.
12:12Hello.
12:13Hello, Bruce.
12:15Hi.
12:16Nick.
12:17Tim.
12:18Hi.
12:19This is Brian.
12:20So basically he had been working out as he normally would
12:23and we fainted essentially.
12:25About ten seconds unconscious on the floor.
12:28He does have a slight bump to the back of his head,
12:30but no ceasefire and no other injuries.
12:3232-year-old admin assistant Brian was at the gym working on his legs,
12:37but after feeling dizzy and going for some water,
12:39he fainted, injuring himself as he hit the ground.
12:42Very obvious dislocation.
12:44He's had 2.5 of IV morphine.
12:47What's he?
12:48About a bottle and a half of gas in air.
12:50The ambulance crew have already inserted a cannula,
12:53so morphine has been administered for fast-acting pain relief.
12:56The pain was initially an eight,
12:58but now we've come down to about a five or a six.
13:00However, when he doesn't think about it,
13:02we're actually not too bad.
13:04Good.
13:05Have a chat with him about sedation and put in a second line.
13:07I've done a little mention to him about...
13:09Brilliant.
13:10Yeah, fine.
13:13It's vital Brian's ankle is realigned
13:15so his blood flow isn't compromised,
13:17risking further damage to his blood vessels and nerves.
13:21My name's Tim.
13:22I'm one of the doctors from the area.
13:23I'm so feeling your posture, if that's all right.
13:25What we're going to do, if this sounds reasonable to you,
13:27is give you some sleepy medicines,
13:28and while you're asleep,
13:29Nicole, give that a pull, pop it back in,
13:31we'll put a splint on it,
13:32get you off to hospital.
13:33So that's the plan.
13:34So an x-ray itself needs surgery?
13:36Yeah, exactly that.
13:37Looking at it, I'd expect it will need surgery.
13:40Looking at you though, you're a young, healthy man,
13:42and you're likely to have a very good outcome after surgery,
13:45so I'd be optimistic,
13:47but it looks like that will need operating.
13:51Can you feel when Nick's touching that foot with his fingers?
13:53Yeah.
13:55It doesn't feel numb or anything like that?
13:56No.
13:57Good stuff.
13:58Excellent.
13:59Fortunately, Brian has sensation in his foot,
14:01a good sign indicating nerves are functioning and blood is circulating.
14:05Brilliant.
14:06You've got any medical problems?
14:08Ah, yeah.
14:10However, while the bones are misaligned,
14:12the blood supply is at risk of becoming compromised,
14:15so Brian's ankle needs to be straightened.
14:17We'll get some medicines drawn up for you.
14:19The medicine we're going to give you,
14:20a medicine called ketamine,
14:21so we'll take really good care of you,
14:23and then when you sort of wake up, so to speak,
14:25we'll have that ankle back in in a splint for you,
14:27and we'll get you in a wheelie chair.
14:29Are you all right with needles generally?
14:31I don't like them as well.
14:33Yeah.
14:34I don't look good.
14:35Fine.
14:36Okay.
14:37Nick inserts a second cannula,
14:39so ketamine can be administered.
14:41Good.
14:42All right.
14:43Everyone happy.
14:44So, Brian, we're going to give you some of these lovely medicines now.
14:46I'm going to steal the internet away, if that's all right.
14:49Only carried by critical care teams,
14:51ketamine causes dissociative sedation,
14:53so Brian will have no memory of the procedure.
14:56You're a big guy.
14:57I'm usually very tolerable.
14:58Yeah.
14:59You might see me topping up the syringe part ways.
15:01That's fine.
15:02You're allowed as much as you need.
15:03That's the beauty of it.
15:04Well, don't worry.
15:05So, this is the moment to sort of feel relapsed and happy.
15:14As Brian works out, and is a tall man at over six foot,
15:18Dr. Tim might have to increase the dose of ketamine
15:21for it to properly sedate him.
15:27Brian, how are you doing there, mate?
15:29Can you open your eyes, mate?
15:31Well done.
15:32You're very safe.
15:34We're going to start gently moving that ankle, all right.
15:41If his ankle isn't realigned soon,
15:43Brian's at risk of permanent disability.
15:45You're doing really good.
15:47But the critical care team can't safely move him
15:50until his pain is under control.
15:52John, I strongly recommend that you have something a little bit stronger.
16:10On a farm in Buckinghamshire, 44-year-old self-employed businessman, John,
16:15is suffering from severe burns to his head and arm after setting himself alight,
16:19starting a bonfire with petrol.
16:21We can titrate it to see how you feel.
16:24And if you don't like the effect of it, we'll just slow down.
16:26But I would strongly recommend you have some pain relief.
16:29To combat his pain, John has only had Penthrox.
16:32But critical care paramedic Lisa and Dr. David want to administer morphine,
16:36because his pain will continue to develop.
16:39So far, he's refused.
16:41Right, how was your pain?
16:42A little bit more.
16:43We're trying to call it as best we can.
16:48But at some point, you're going to need some pain relief.
16:53And you don't want to get to the point that it's unbearable.
16:56But you are within your own right to decline.
17:00Morphine is quite nice.
17:01It's not too strong, but it's enough to take away this type of pain.
17:05Are you happy, John?
17:06A little bit?
17:07Give you a tiny, tiny dose.
17:08See what you think of it.
17:09Tiny dose.
17:10Tiny dose.
17:11Two milligrams.
17:12John finally accepts the morphine.
17:14It's a good drug to combat burn pains,
17:17because it works by blocking pain signals in the central nervous system.
17:21Right, so the only thing is, we haven't obviously checked lower body,
17:24but we're happy it's all upper, do we think?
17:26Yeah.
17:27Right, let's take this from your mouth,
17:28because then you've got some blisters.
17:30I just want to try and cool them down a little bit, okay?
17:32Open your mouth for me,
17:34and you're just going to hold that in your mouth, okay?
17:36Yeah.
17:37Some cool, wet gall should help cool down the blisters,
17:40starting to form around John's mouth.
17:42Should we, um...
17:45I'm ready whenever you are.
17:47With him stabilised,
17:50the team want to get him to hospital as soon as possible.
17:55Still all right, John?
17:57Yeah.
17:58Excellent.
17:59So, how's your pain out of ten, John?
18:03Ten being the worst pain, one being no pain.
18:05No pain.
18:06Okay, so we'll put these on,
18:07and we'll get you some more of that morphine.
18:09That's okay.
18:10Lisa administers more morphine to combat John's growing pain.
18:13A 44-year-old man with a flash burn to his face and neck.
18:18While David calls Wexham Park Hospital, the nearest to the scene.
18:22Our reason for coming to you is we're only nine minutes away.
18:26And although he's not got any impending airway compromise,
18:30he has got a bit of lip swelling and he's got some singeing of nasal hairs.
18:34So, we didn't feel there was any justification for intubating him at scene.
18:38Right then, John, let's take your hand out this water.
18:41Okay, because it's been in there for a long time now.
18:43There we go.
18:45You all right?
18:47Yeah.
18:48Yeah.
18:49Sure?
18:50Yeah.
18:51So, where's the worst pain?
18:52Is it your face or your arm?
18:53My arm.
18:54Your arm.
18:55You can breathe, okay, can't you, John?
18:56Yeah.
18:57Yeah.
18:58Let me see if I can take a little bit of this and put it on your hand, okay?
19:02Lisa dresses John's hand with pieces of cool, wet bandage to further soothe his skin.
19:07It's the best we can do.
19:08This is actually a face mask that we've just pulled apart.
19:11How's your lips?
19:13Yeah, okay.
19:14It's starting to go down, actually.
19:15It does look a bit better.
19:17Yeah, it was quite blistery just now, but I think putting that gauze has probably helped
19:22a little bit.
19:24It takes ten minutes for the ambulance to reach Wexham Park Hospital.
19:28All I can smell is bare neck and skin.
19:31Yeah.
19:32This is quite smell, isn't it?
19:34Horrendous.
19:35Right, I think we're here.
19:38Keep your arms in.
19:39Is there any arm injuries, Timmy?
19:41John's handed over to the emergency department for further observation and possible surgery.
19:47The initial treatment had already been started by the ambulance crew, and that's cooling
19:51of the burns with cool water.
19:53Our main concern when we arrived was to give him some good pain relief.
19:57I'm hoping that most of his burns will be superficial, and that he won't need any other particular
20:02treatment, but they'll likely observe him for a while to make sure there's no deterioration.
20:06We'll try and drive this forwards as fast as we can.
20:19In Slough, 67-year-old HGV driver Bicker has had a cardiac arrest at home.
20:25We have spontaneous movement.
20:27Yeah, he's moving there, hasn't he?
20:28By chance, Raluca, a nurse, was visiting next door and performed immediate CPR.
20:34Bicker's heart restarted after the ambulance crew shocked him with a defibrillator.
20:38Right, James, you're doing kitsch, so I do some drugs.
20:40Yes, please.
20:41Now, Dr. James and critical care paramedic Joe need to intubate Bicker, placing a tube
20:46down his airway so they can mechanically take control of his breathing in case he goes
20:51back into cardiac arrest.
20:53Are you just passing by or something, Lee?
20:55I am the nurse next door.
20:57Oh, next door.
20:58So they just run and say that he has the last, can I come in?
21:01Oh, great.
21:02Well, good job.
21:03I think it just saved his life.
21:04So, what we'll do, we'll lift him up, drive the scoop under, drive the stretcher under.
21:09Are you happy we take the Lucas off?
21:11Yeah, fine.
21:12A Lucas machine has been fitted over Bicker's chest for mechanical chest compressions.
21:17Fortunately, it's not needed.
21:19All right, ready when you are?
21:20We're just going to be on lift and then the trolley's going to come in underneath.
21:23Ready.
21:24Stay.
21:25Lift.
21:27Great.
21:28Right.
21:29So, we're going to do our checklist now.
21:32Ready, Joe?
21:33I am ready.
21:34James and Joe run through a vital checklist before the emergency anaesthetic, a procedure
21:39that's normally carried out in hospital.
21:41So, we're going to do a drug-assisted intubation.
21:44I will challenge you and you will respond.
21:46Okay, yeah.
21:47I've optimized patient position.
21:48Yes, I'm happy with this position.
21:49Except to have the access from fluids attached.
21:51So, I can see.
21:52Yeah, fluids are running beautifully.
21:54Monitor and attached invisible.
21:55NIBP?
21:56Yes.
21:57ECG?
21:58Yes.
21:59Probably 90 kilos, you reckon, so it will give nine...
22:00Probably 80, do you think?
22:0280.
22:0380 milligrams of ketamine and 100 of rock.
22:04Yeah.
22:05So, time is 17.
22:06And I'm noticed.
22:07Satch 95.
22:08Perfect.
22:09Checklist complete and the invasive procedure can begin.
22:13Perfect.
22:14So, 80 milligrams of ketamine coming now.
22:17There we go.
22:18Okay, so we're going to time one minute.
22:30The ketamine will sedate Bicker, whilst the rocuronium will relax his muscles, allowing the breathing tube to be inserted down his airway.
22:37I think he's got a flailed sternum.
22:38Can you see how his sternum goes in when he takes a breath?
22:41It appears Bicker has some fractured ribs.
22:44This can happen during CPR when trying to save a life.
22:47And I think that makes him, that we should go to the hair field.
22:50A cardiac arrest and flailed chest that could puncture Bicker's lungs will need specialist treatment at hospital.
22:57But first, he needs to be intubated.
22:59Let's get started.
23:00Slightly poor dentition.
23:01Grade one view.
23:02Bougie, please.
23:03Bougie.
23:04I have the Bougie.
23:05I have the tube.
23:06Carefully pass the teeth.
23:07Cuffs in.
23:08Black line at the teeth.
23:09Okay.
23:10Bougie out.
23:11Cuff up, please.
23:12So, right.
23:13So, we've got end tidal.
23:14Good heart rate.
23:15And blood pressure's fine.
23:16Bicker is intubated and can be placed on a mechanical ventilator.
23:28But he's in a fragile state and could suffer another arrest at any moment.
23:33The team now need to rush him to Hairfield Hospital.
23:36Are the tubes in place?
23:37In a gym in Milton Keynes, 32-year-old Brian was working out when he suddenly felt dizzy and fainted, dislocating and potentially breaking his ankle.
23:54Just topped up to a hundred.
23:55Dr. Tim and critical care paramedic Nick need to realign his ankle.
23:59Brian's been administered ketamine, but because he's a tall man at over six foot, the team are having to give a significant dose to sedate him.
24:07Here we go.
24:08Back move?
24:09Yeah.
24:10Back move?
24:11Yeah.
24:12Back in?
24:13Good.
24:14The team have successfully realigned Brian's ankle.
24:16It does look like that.
24:17Good.
24:18Well done, mate.
24:19Now it needs to be supported with a splint before he can be moved to the ambulance.
24:22Brian, doing all right there, mate?
24:23A few deep breaths.
24:24Good.
24:25Good.
24:26Good.
24:27Good.
24:28Good.
24:29Good.
24:30Good.
24:31Good.
24:32Good.
24:33Good.
24:34Good.
24:35Good.
24:36Good.
24:37Good.
24:38Good.
24:39Good.
24:40Good.
24:41Good.
24:42Good.
24:43Good.
24:44Good.
24:45Good.
24:46Good.
24:47Good.
24:48Good.
24:49Good.
24:50Good.
24:51Good, Nick.
24:52Just for your awareness, I've got a touch of apnea.
24:57Apnea means Brian has temporarily stopped breathing.
25:02The larger dose of ketamine has suppressed his brain's respiratory drive.
25:06I'm going to add these stuff then.
25:08Do you mind plugging him on that one?
25:11Oh, we've got some respect for coming back.
25:18That's amazing, Brian, you're okay?
25:23Yep.
25:24Dr. Tim assists Brian's breathing by manually delivering oxygen.
25:30Tim, if you need us to come up that end, just shout.
25:34Yeah.
25:35We'll carry on for the moment.
25:36We're going to be all right.
25:37Lovely.
25:38So we're going to go up and down on the chair.
25:42I think we'll just come back up quite nicely.
25:45There we go.
25:46Perfect, yep.
25:53He's taking some good breaths on his own now.
25:55Brian is breathing for himself once more, and the team have the splint in place.
26:00Getting steady now.
26:02Oh, mate, I've just waking up from that sedation medicine,
26:05so if you're feeling a bit funny, that's totally normal.
26:08And you'll be feeling back to normal again in a few minutes, yeah?
26:12And you dislocated your ankle, and it's all back in now.
26:16Got a splint on.
26:17Looks really good.
26:19Ketamine is a dissociative anaesthetic, meaning Brian probably won't remember a thing.
26:24It takes sort of five minutes just to get your breath back, wake up fully, get the rest of that medicine out of your system.
26:30The stuff washes out of your system very quickly, so the fact that you're wide awake now sort of, you know, tells us most of it has gone.
26:37A ketamine sedation usually lasts for around 15 minutes.
26:40So, we need to get you in a, um, a wheelie turner.
26:43We'll just wait till the, till the paramedic's back.
26:45They're just having a look at the lift and working out these, just where to get you down.
26:49Do you remember the, um, the ankle being, being put back in?
26:52Do you remember when Nick moved your ankle?
26:54No, you put it back in, right?
26:55Yeah, yeah, it's back in, yeah.
26:57Well, it's, it's, well, it's definitely dislocated.
27:02My, my guess is it's broken as well.
27:04You never, you never know a hundred, a hundred percent until the x-ray's done, but my guess is it's broken as well as dislocated.
27:13The team now need to transfer Brian to hospital.
27:16So, yeah, I think what we'll do when you're ready, we'll support you, like, under your arms.
27:20You bend this leg all the way up to your bum so you can push off it.
27:23And then we'll aim to sort of push you up to, like, a standing position on your good leg.
27:27I mean, I just...
27:28And then as you, as you come up, we'll bring the chair underneath you, all right?
27:31We'll be going.
27:32Are you ready?
27:33Yeah.
27:34One, two, three, stance.
27:35Good man.
27:36Well done, boss.
27:37Good.
27:38Wow.
27:39Perfect, well done.
27:40Perfect.
27:41He's seamless.
27:42Successfully in the wheelchair, Brian can be taken down to the ambulance.
27:45There he is.
27:47He's still smiling.
27:48It's always a good sign.
27:50Well done.
27:51That's it.
27:52Good work.
27:53Awesome.
27:54We can give you a hand with his legs.
27:55Awesome.
27:56Perfect.
27:57Yeah.
27:58Excellent.
27:59How about that?
28:00Seamless.
28:01Oh.
28:02I can feel my toes.
28:03Hey, I can see them moving nicely.
28:05Yeah.
28:06Excellent.
28:07Good.
28:08Keep your arm stuck in, right?
28:10I will do.
28:12You're all good.
28:15Cheers.
28:16Here we go.
28:17Feels good.
28:18Fine.
28:19Come in.
28:20I can work with you.
28:21Yeah.
28:22All of that's really good to be honest.
28:26We worry with these that the blood vessels can get kinked when it's off the funny angle
28:31and the nerves can get squashed and stuff like that.
28:33The fact that you can wiggle your toes, your foot's well perfused as we call it, you've
28:37got pulses, it feels normal.
28:39All of that suggests you'll make a really good recovery from this.
28:42I started off with leg press, 140 kilos, 20 reps, 3 sets, and then I got up and can be
28:51seeing all of that once if I have a drink.
28:53So this is probably down to dehydration.
28:56With Brian stable and safely in the ambulance.
28:59Cheers, Brian.
29:00Take care.
29:01Get well soon.
29:02Tim and Nick have done all they can and are happy for the ambulance crew to take him to
29:07Milton Keynes Hospital for x-rays and surgery.
29:10Cheers.
29:11Bye.
29:12Ankle went back in reasonably smoothly.
29:16He needed a top up of sedation and we needed to breathe for him for a few breaths just to
29:21keep his oxygen levels back up where we wanted them.
29:24But very quickly picked up again on his own.
29:26He was doing very well afterwards.
29:27Hopefully we'll have a good outcome after surgery on that ankle.
29:30Ambulance emergency, is the patient breathing?
29:49Yeah.
29:50Was he hit by a car?
29:53No, he just hit by a car.
29:55Oh, he just fell out of the car.
29:56Is he bleeding?
29:57He is, yeah, from his head.
29:59How old is the patient?
30:01I don't know him.
30:03I would estimate probably in his 80s.
30:06Can I speak to him?
30:08He's not really in the States.
30:10He's taken to.
30:11Can I try?
30:12He's gone.
30:13No.
30:14No.
30:15He can't.
30:16He can't speak.
30:17He's gone again.
30:18He's gone again.
30:19He's losing consciousness.
30:20What are you doing?
30:21He's seizureing.
30:22He's having a seizure.
30:23Okay.
30:24That's fine.
30:25How strange.
30:26Is the highest priority okay?
30:28Yeah, that's all received.
30:29Many thanks.
30:30An elderly man who's collapsed, hit his head and may be having a seizure is a potentially
30:35life-threatening emergency that urgently requires the enhanced medical skills of Dr.
30:41John Pike and critical care paramedic Neil Plant.
30:44What the dispatcher's thinking is this is likely to need an anaesthetic for a hospital.
31:03And that's effectively why we've been sent.
31:06If the patient has suffered a traumatic brain injury, the team may need to put him into
31:11an induced coma to protect his brain from further damage.
31:15If I thank you just to let you know you're going to be first obviously.
31:19Yes, yes.
31:20Many thanks.
31:21We kind of anticipated that and we are just about to pull up on scene in about one minute
31:26over.
31:27Fortunately, the critical care team were just a mile away.
31:31All right.
31:33Thanks.
31:34Hi guys.
31:35You're all right.
31:36Who have we got?
31:37Do you know this gentleman's name?
31:38This is my dad, Ron.
31:39This is your dad.
31:40Sorry.
31:41How are you feeling?
31:42Hi.
31:43I think you've had a seizure.
31:44I think that's what happened.
31:45What we'd like to do is get some observations and things going.
31:4879-year-old Ron from Glasgow was visiting family in Maidenhead with his wife.
31:53But as he got out of his car, he fainted and seemed to have a seizure after hitting his
31:58head on the tarmac.
31:59Fortunately, he's now regained consciousness.
32:02I'm called John.
32:03I'm one of the doctors.
32:04How are you?
32:05We've got Neil here.
32:06He's one of our paramedics.
32:07Really?
32:08I wonder.
32:09I mean, having seizures is not that uncommon.
32:11It sometimes just comes out of the blue.
32:13Seizures are caused by abnormal electrical activity in the brain.
32:17Nerves misfire or send too many signals at once causing muscle spasms.
32:21But also, you've banged your head.
32:22We need to make sure you haven't caused too much damage there.
32:25No other pain anywhere else.
32:27Ooh.
32:28Neck feels all right?
32:29No.
32:30Okay.
32:31Can I just have a quick look in your mouth?
32:32Uh-huh.
32:33Fantastic.
32:34That's lovely.
32:35You can close that up again.
32:37GCS is good.
32:38He's talking.
32:39The pupils are equally reactive.
32:41GCS, or Glasgow Coma Scale, is used to assess a person's level of consciousness by scoring
32:47their eye-opening, verbal and motor response between three the worst and 15 the best.
32:53Ron appears to be fully conscious, so at the higher end of the scale.
32:57148.52.
32:58I think so.
32:59Good stuff.
33:00Okay.
33:01I think we'll take that off, Neil.
33:02Yeah, yeah, yeah.
33:03Do you think you'll be able to sit up, Ron?
33:06No.
33:07Shall we get you sitting up?
33:08Do you want to try?
33:09No.
33:10And no trouble if you can't.
33:11Oh, okay.
33:12No, that's fine.
33:13Don't worry, Dad.
33:14What's stopping you?
33:15Do you just feeling kind of just generally weak?
33:16Oh.
33:17I don't know.
33:18I've never felt this in my life.
33:20Although Ron's seizure was brief, he could have another at any moment.
33:24The team want to understand what caused it before giving any medical intervention.
33:29He does it, Dad.
33:31Yeah.
33:50Right.
33:51Okay.
33:52So, we're going to stick him on the ventilator.
33:54In Slough, critical care paramedic Joe and Dr. James, attending to 67-year-old Bicker,
34:00who's had a cardiac arrest.
34:02Fortunately, his heart has restarted after CPR and a shock from a defibrillator.
34:07Airway, we're happy.
34:09Chest is moving equally.
34:10Sats are good.
34:11Just have a look.
34:12Listen in there.
34:13The team have performed a pre-hospital emergency anaesthetic to mechanically take control of his breathing.
34:19Air entry.
34:21Air entry.
34:22So, we've got air entry both sides.
34:24Numbers are all good.
34:29The critical care team will travel with Bicker to Harefield Hospital.
34:32His life still hangs in the balance, and they may need to intervene en route should his condition deteriorate.
34:39No need to go crazy.
34:40Just, like, steady blues is fine.
34:42If there's a problem, we'll let you know and ask you to pull over.
34:44See you later tonight.
34:45Yeah.
34:46I've got propofol set up, ready to go.
34:48Lovely.
34:49Okay.
34:50And that's leaving scene at 18-12.
34:52Propofol is a sedative drug that will help keep Bicker in the induced coma.
34:57Dr. Raitt here from Thames Valley Air Ambulance.
35:00Can I place a PPCI call for an out-of-hospital cardiac arrest in ROSC, please?
35:06Dr. James telephones ahead to the hospital.
35:09Male.
35:1167, 6-7 years old.
35:16Our ETA is 20 to 0 minutes.
35:20We're coming from Slough.
35:22No, they're intubated and ventilated.
35:25So now we've got pulse.
35:27Of 90.
35:28BP.
35:29BP1.
35:303,382.
35:31The rest are 12.
35:32The rest are 14 now.
35:3314.
35:34Should we blow him a bit harder?
35:35Yeah.
35:36What's his volume?
35:37500.
35:38Because oxygen levels are low, so James and Joe need to up the volume of oxygen being pumped
35:48into his body to protect his brain and vital organs, ensuring they continue to function normally.
35:53Should we go up to...
35:55We could easily go to...
35:56600.
35:57600.
35:58600.
35:59That's where I've just come off where they were reading at 94.
36:02100% now.
36:04Great.
36:05So we're just arriving.
36:07Amazing.
36:08I think that's a little bit ahead of schedule, aren't we?
36:10Bicker is delivered to Harefield Hospital, one of the largest and most experienced cardiac
36:15centres in the UK.
36:16Here we go.
36:17Good.
36:18Where he will undergo further treatment that could include fitting a stent or pacemaker.
36:23When someone's heart stops beating, the sooner you can get some kind of blood flow around
36:30the body, the better.
36:31In this case, there was a nurse visiting someone else and when the patient collapsed, she was
36:36able to immediately start bystander CPR and that undoubtedly helped the patient get
36:43their heart restarted.
36:44Anyone can learn CPR.
36:45I really urge you to go and go and see if you can get those skills.
37:00How long was he kind of seizing, like full body seizing?
37:03It was very brief.
37:05On a road in Maidenhead, 79-year-old Ron and his wife were visiting family when he fainted
37:10as he got out of his car, had a seizure and sustained a head injury.
37:15His family are with him.
37:17So it was more of a collapse out of the car.
37:19Eyes closed.
37:20Gotcha.
37:21And then we kind of got him into the position.
37:23Dr John and critical care paramedic Neil are on scene and want to ascertain what caused
37:28the seizure so they can work out the best plan going forward.
37:31How quickly was he conscious?
37:33You speaking to him was the most conscious.
37:35Okay.
37:36To be honest, before that he wasn't.
37:38He was making that kind of noise.
37:41So it took a quite loud groan.
37:44He's had a lot.
37:45He went out a lot.
37:46He's had quite a few falls.
37:47I see.
37:48Falls or blackouts?
37:50I don't know.
37:51No.
37:52And it's often a bit difficult to tell.
37:54Yesterday, the place that they're staying, he fell in the bath.
37:57The other thing that you just wonder, has there been some sort of funny rhythm of the
38:01heart?
38:02Yeah.
38:03Yeah.
38:04And given his background, that's possible as well.
38:05If Ron has frequently been falling over, he could have a serious underlying medical
38:09issue.
38:10It sounds a bit like he's had maybe a cardiac syncope to me.
38:14Cardiac syncope is a temporary loss of consciousness caused by the heart's inability to pump enough
38:19oxygenated blood to the brain, often due to an abnormal heart rhythm.
38:23It sounds like that as he's getting up out of the car, he's just collapsed.
38:27And it sounds like he's had multiple previous falls.
38:29Cardiac syncope could also have caused the seizure because of the drop in blood flow to
38:34Ron's brain.
38:35Whether it's a cardiac syncope, very short and self-terminating with not a long post-dictal
38:40period.
38:41So it feels a bit like it might be a cardiac syncope.
38:45The ambulance crew have now arrived on scene.
38:47So John's next priority is getting Ron inside the vehicle so he can be fully assessed.
38:52Right then.
38:53Ron, we're going to get you onto our stretcher if that's okay.
38:58We're going to be putting this hard stretcher down one side of you.
39:01Right.
39:02And we're going to roll you onto that in a minute.
39:03Right.
39:04So do you think we can get you to roll onto your back now?
39:07Right.
39:08Right, Ron, you stay nice and still.
39:11Ah.
39:12Ready.
39:13Steady.
39:14Lift.
39:15Ah.
39:16There you go.
39:17You okay?
39:18I'm just going to roll you towards me.
39:19Once on the stretcher.
39:20Right, well done, Ron.
39:21Ron's quickly transferred to the ambulance, whilst Dr John updates the dispatch desk.
39:262-5, just a quick update.
39:28So this patient looks like they have had a, probably a cardiac syncope, a collapse with a
39:34short self-terminating seizure and a small head injury.
39:38Right, Ron, should we have a quick look at the rest of you now?
39:41Yeah.
39:42Ron, do you mind if I cut your jumper?
39:44Oh, I didn't see.
39:46We saved your jacket.
39:48No.
39:51It was a nice jumper, though.
39:54It was a nice jumper.
39:55Oh, this is unusual.
39:57I know.
39:58How are you feeling now?
40:00Oh, it's terrible.
40:02Terrible in what way?
40:03I'm all dry.
40:06I've been all...
40:08I'm just alive.
40:10Yeah, okay.
40:11Have you been feeling unwell recently?
40:13Not in the least.
40:14This is just sudden, out of the blue.
40:17No pain in your chest.
40:19No.
40:20No.
40:21Nice deep breaths for me.
40:22Lovely.
40:23All right.
40:24No tummy pain, nothing like that.
40:26No.
40:27Okie dokie.
40:28All right.
40:29And just an ECG is probably the one thing we would really definitely do one.
40:32That's all right.
40:33An ECG will record Ron's heart's electrical activity, also checking its rhythm.
40:38But first, Dr John performs a primary survey looking for any hidden injuries or fractures.
40:43Can you give me a good squeeze of both arms?
40:46Squeeze my hands.
40:47Squeeze my hands.
40:48Great.
40:49Can you lift your arms right up, Ron?
40:51Keep them up there.
40:52Just keep them there for me.
40:53Good man.
40:54That's wonderful.
40:56And your legs.
40:57Can you pull your toes back up?
40:58Up towards there.
40:59Okay.
41:00No pain.
41:01No problems.
41:02I can't find any injuries.
41:03His neck's not painful.
41:04He's got normal power everywhere.
41:05Popping that very tight round your arm as well.
41:06Yeah.
41:07Gonna put up a little line in your arm as well.
41:08It might give you some anti-sickness too, I guess.
41:09Ron, I'm sorry this has happened to you today.
41:10Random, isn't it?
41:11Totally, isn't it?
41:12A cannula is inserted so the anti-sickness drug on Danzatron can be administered in case
41:30Ron becomes nauseous on the way to hospital.
41:33Right, Ron.
41:34That's that.
41:35Done.
41:36Well done.
41:37I think he's had an episode of Predacardi, hasn't he?
41:40That's what it feels like.
41:41Okie dokie.
41:43Radicardia is a slow heartbeat that can cause a cardiac syncope or fainting episodes.
41:49Shall we leave you tonight?
41:50Yes.
41:51Thank you very much.
41:52Ron, gonna get you warm now.
41:54Blanket, hospital, they'll look after you there.
41:57So we're gonna leave you with these guys now.
41:59Right.
42:00You look after yourself.
42:05Thanks guys.
42:06Take care.
42:07Cheers.
42:08I just wonder whether he's had an episode of his heart going really slow.
42:11Before departing, Dr. John briefs Ron's wife Sue.
42:14I think there's some evidence that that might be the case and that might make him collapse.
42:19And his heart's a little bit irregular.
42:21It's a little bit slow.
42:22And he's got some things on his heart tracing that just suggests that he might be having episodes
42:26where it suddenly goes really slow.
42:28They'll look after him really carefully in hospital.
42:30If they think that's the case, they'll consider something like a pacemaker.
42:33But he needs a bit more imaging first.
42:35And he's gonna need a scan of his head as well.
42:37Yeah.
42:38But I think that's all fine.
42:39It's actually just a big bruise and a lot of scuss, I think.
42:42All right.
42:43No worries.
42:44Not at all.
42:45He's gonna leave you to it and leave him in the care of the crew.
42:47Dr. John is satisfied Ron is stable enough.
42:50You're all right.
42:51For the ambulance crew to transfer him to Wexham Park Hospital.
42:55And the Thames Valley Air Ambulance Critical Care Team are now free for their next emergency.
43:00The Thames Valley Air Ambulance
43:13The Thames Valley Air Ambulance
43:18The Thames Valley Air Ambulance
43:37The Thames Valley Air Ambulance
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