- 2 days ago
Category
📺
TVTranscript
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.
00:26I wanted to have a seizure and a whale crashed into some people.
00:29Are at the front line delivering life-saving medical treatments.
00:32The big decision is for us whether we need to put a tube in again to protect us that way or not.
00:36Working day.
00:37We're going to give you some strong medication.
00:40And night.
00:41It should not hurt. It's a very good painkiller.
00:44Reacting to emergencies.
00:45You've been super brave, darling.
00:47The critical care teams.
00:48You've had a pretty big blow to the head.
00:50Are 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 you straighten your ankle out.
00:57Whenever.
00:58Do you think he's fast?
00:59Potentially, yeah.
01:01And wherever.
01:02Oh, my leg.
01:02It's needed.
01:03Oh.
01:04You are doing a fantastic job.
01:06Filmed over three months.
01:08Let's have your arm, I don't know. 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.
01:18You're safe.
01:20As these highly trained critical care teams.
01:22Will you take a deep breath in for me?
01:24Fight 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.
01:35All right.
01:35Well, we'll see what we've got.
01:37The critical care team raced to a man whose life hangs in the balance.
01:41Go to this cardiac arrest.
01:42Do you know anything more about it?
01:4367-year-old male.
01:45Eyes open, not breathing.
01:47Open your mouth for me.
01:48A man is severely burnt when lighting a bonfire with petrol.
01:52I would strongly recommend you have some pain relief.
01:54Because that burn is just going to keep burning.
01:57A gym workout ends in serious injury.
02:00Doing all right there, mate.
02:01A few deep breaths.
02:02And.
02:03He's fallen out of a moving car.
02:05He was tightening it.
02:06A pensioner is in a critical condition following a seizure.
02:09Eddie's getting up out of the car.
02:11He's just collapsed.
02:13Abbott's emergency.
02:30Is the patient breathing?
02:31no he's not he's eyes open she's not moving okay just have a look at his chest is he breathing
02:37no he's not but he's i don't know what's wrong slow down for me okay how old is he he's in 16
02:46okay right is he breathing at the moment if you have a look no he's not he's not breathing
02:51okay hello hello the next neighbor had a nurse come over she's just she's just come over
02:58sorry you have to go like that one and two and three is cpr's being given at the moment
03:06yeah yeah you're fine the nurse is doing it and i'm doing stay with us mister because can you hear us
03:13stay with us
03:16with a man in cardiac arrest it's now a race against time every second loss can be the difference
03:24between life and death so the specialist medical skills of dr james rate and critical care paramedic
03:31joe epton are urgently required hi we're going to this cardiac arrest do you know anything more about
03:36what's her 67 year old male eyes open not breathing the wind is the rest right
03:42as i'm not breathing um cpr straight away there's a nurse now one team doing cpr and we went out for a d5
03:50i'm not sure if the d5 got there but tl and dma have just arrived okay
03:55fortunately a nurse who was visiting next door was able to deliver cpr almost instantly
04:01the dispatch desk updates the critical care team hello um see if this was a compound cardiac arrest
04:08and we're going to ideal and get ready to execute they have just told me that as of the latest rhythm
04:14check they have a ross
04:15amazing good job cheers guys i'll speak in a bit cheers bye
04:21ross or return of spontaneous circulation means the patient's heart has restarted itself
04:27following a shock from a defibrillator carried by the ambulance crew
04:30all right well we'll see what we got outside of hospital
04:35hey right there stretches off the chances of surviving a cardiac arrest
04:40are fewer than one in ten right great good job
04:43but early cpr and defibrillation more than doubles those odds
04:48hello my name's joe and we've got james with us
04:52we've got sustained ross with sustained rest rate right so we've got sustained ross for about ten minutes
04:59yeah 67 year old hgv driver bicker was watching tv with his daughter working upstairs she found him slumped in a chair with bloodshot eyes she rang 999 and vitally called for help from the nurse next door
05:15is that all right well if i jump in i'm going to put them to a different mask thank you very much
05:20can you help to manage his airway yeah i could do a really quick primary survey and you've had ross now
05:25for about 20 minutes is that right brilliant great okay so airway joe's maintaining we're going to get an ecg
05:33okay okay so he's got airway on both sides
05:40well we don't we're obviously not doing ecma at the moment
05:43well he's self-insulating through through this do you want to come and take over
05:46then i can have a look at getting some other bits ready
05:48yeah we're not we're not delivering any events we're just it's just supporting
05:51and now he's on the mapes and sea you'll see him breathing
05:53currently bicker is managing to breathe unaided
05:57so he's 67 years old he's an hgv driver so he must be well enough to pass an hgv
06:02medical and he's quite active like he walks around the place and he does loads of stuff
06:06i think if he sustains this that what we should do is pop him on a trolley
06:10intubate him and take him to wexham and the time now is 1746
06:14do you reckon we can be out on wheels rolling in 20 minutes
06:18before traveling to hospital james wants to mechanically take over bicker's breathing
06:22in case his heart stops beating again
06:25we can do it in here if you like wheel the trolley in here
06:27yeah we'll set up our kit back here did you get that cannula in
06:30yes that's brilliant thank you right i'll get the bicker has two cannulas
06:34in his veins to administer drugs and fluids joe is now working on an arterial
06:39cannula which will enable them to continuously monitor his blood pressure
06:43so as soon as joe's finished there can we get scooped and then yeah
06:47let's get it half in joe talks to you ready
06:49uh no i'm really struggling to feel a radial pulse now
06:53due to low blood pressure caused by the cardiac arrest joe struggling to fit an arterial
06:58cannula and time is critical to bicker survival
07:02in that case abandoned at the moment we'll try and drive this forward as fast as we can
07:07right now
07:09телефон
07:09has a crevice
07:11bugged
07:11ambulance emergency is patient breathing
07:13yeah he just um he's using fire he just set fire himself he's got burned of his arm on his face and his hair
07:18ambulance emergency is patient breathing
07:24yeah he just um his am he just um he just fired himself he's got burned of his arm on his face he's hair
07:29He just set five himself. He's got burns on his arm and his face and his hair.
07:33Is he awake?
07:35He's awake, yeah.
07:37How old is the patient?
07:40Forty-four.
07:42Forty-forty-four. And his burns are out of the mouthful nose.
07:47Yeah, he's burnt lips, his nose, got spirit burns on his face and his arms.
07:53He supplied a cold cell to his face.
07:55He had a picture in his hand that caught light and blew back on him.
07:59He was really lagging for a few minutes there.
08:02Really, he was amazed.
08:04Alright, we're getting some help arranged.
08:07We call some casteride as a high priority. We're on our way.
08:15Extensive burns to the body and head are a code red emergency.
08:19So critical care paramedic Lisa Brown and Dr David Metcalf are immediately dispatched.
08:25All 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.
08:34Around 250,000 people endure burn injuries every year in the UK.
08:39Burns can continue to worsen with time as the skin blisters.
08:43Fast treatment is key to reducing pain and swelling of the airway that can potentially lead to death.
08:502-7 on scene.
08:54Right.
08:5544-year-old self-employed businessman John lit a bonfire using petrol, but flames whipped up, burning his head, arm and hand.
09:08Lisa is quick to take action, administering a Penthox inhaler, which offers immediate and strong pain relief.
09:14Okay, let me have a look at your face.
09:18There we go.
09:19They are.
09:20We'll get some water on your lips, I think.
09:23Right, John, put your hand in there.
09:25The 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.
09:32They've also already checked his airway.
09:35Fortunately, John's breathing is good for now.
09:37Right, are you happy to first give you some pain, Rachel?
09:39Because you're going to have to have something, my lovely, because this is a bit of a long journey.
09:43Are you okay with some morphine?
09:45I'll leave it for now.
09:47Leave it for now, okay.
09:48Burn pain develops over time, but John's reluctant to have stronger drugs for pain relief.
09:54Right, is your hand in that water?
09:55Yeah.
09:56Yeah?
09:57So far, he's only had Penthox inhaler, which is similar to gas and air.
10:02Good.
10:03Right, let's bring your hand to a comfortable position, but be careful because that water's going to go everywhere, okay?
10:07So you can use that arm there.
10:09Just hold that.
10:11I'm bossy, aren't I?
10:12Yeah, I'm bossy.
10:13Severe burns cause fluid loss and reduce blood volume.
10:17Without prompt treatment, John could go into shock, leading to a dangerous drop in blood pressure and a risk of organ failure.
10:24I would strongly recommend you have some pain relief because that burn is just going to keep burning and you don't want to get to the point that it's unbearable.
10:31Oh, yes, and I'm sorry.
10:33Okay.
10:34I'm sorry, let's go.
10:35I'm Lenz, emergency is the patient breathing?
11:00Yes, the patient is breathing.
11:02And are they awake?
11:03Yes, they are.
11:03Thank you. What's the main reason for the call?
11:06Member has fallen into the ground.
11:08If I look at his ankle, it obviously hits his head as he's fainted.
11:11Are you with him at the moment?
11:14Yes, I'm with him at the moment.
11:16So this is right ankle that turns the complete opposite way.
11:21Pressure is building up the three legs.
11:24Okay, so the call has now been upgraded to a high-priority ambulance.
11:28Please just don't move him from where he is.
11:30We're going to a young man, 32 years old, with what sounds like a dislocated ankle.
11:40Without fast treatment, badly broken and dislocated limbs can have life-changing complications.
11:46So in addition to an ambulance crew, Dr. Tim Waite and critical care paramedic Nick Cole are dispatched.
11:53We normally go to these because we can give some procedural sedation while we manipulate the ankle.
11:58It's a smoother and more humane way to put a dislocated ankle back in place.
12:06Go right.
12:09Is that the gym just there?
12:11Yeah, looks like it.
12:12The team need to make their way to the first floor of the gym.
12:19Hello.
12:20Hello, Bruce.
12:21Hi.
12:22Hello, Nick.
12:22Tim.
12:23And Tim.
12:24Hi.
12:24This is Brian.
12:25So basically he had been working out as he normally would and we fainted essentially.
12:31About 10 seconds unconscious on the floor.
12:34He does have a slight bump to the back of his head but no ceasefire and no other injuries.
12:3832-year-old admin assistant Brian was at the gym working on his legs but after feeling dizzy and going for some water, he fainted, injuring himself as he hit the ground.
12:48Very obvious dislocation.
12:50He's had 2.5 of IV morphine.
12:53What's that?
12:53About a bottle and a half of gas in there.
12:56The ambulance crew have already inserted a cannula so morphine has been administered for fast-acting pain relief.
13:02Pain was initially an 8 but now we've come down to about a 5 or a 6.
13:05However, when he doesn't think about it, it's actually not too bad.
13:10Good.
13:10Can I have a chat with him about sedation and put in a second line?
13:13I've done a little mention to him.
13:15Brilliant.
13:16Fine.
13:16Fine.
13:19It's vital Brian's ankle is realigned so his blood flow isn't compromised, risking further damage to his blood vessels and nerves.
13:27My name's Tim.
13:27I'm one of the doctors from the air.
13:28I'm in self-delive.
13:29I'll say if that's all right.
13:30What we're going to do, if this sounds reasonable to you, is give you some sleepy medicines and while you're asleep, Nick will give that a pull, pop it back in.
13:37We'll put a splint on it, get you off to hospital.
13:39That's the plan.
13:40An x-ray itself if it needs surgery.
13:41Yeah, exactly that.
13:43Looking at it, I'd expect it will need surgery.
13:46Looking at you though, you're a young, healthy man and you're likely to have a very good outcome after surgery.
13:51I'm hoping it doesn't need surgery.
13:52I'd be optimistic but it looks like that, I'll need operating.
13:57Can you feel when Nick's touching that foot with his fingers?
13:59It doesn't feel numb or anything like that.
14:01No.
14:02I can feel everything.
14:02Good stuff.
14:02You can do everything.
14:03Excellent.
14:04Fortunately, Brian has sensation in his foot, a good sign indicating nerves are functioning and blood is circulating.
14:11Brilliant.
14:12You've got any medical problems?
14:13However, while the bones are misaligned, the blood supply is at risk of becoming compromised, so Brian's ankle needs to be straightened.
14:23We'll get some medicines drawn up for you.
14:25The medicine we're going to give you, a medicine called ketamine, so we'll take really good care of you.
14:29And then when you sort of wake up, so to speak, we'll have that ankle back in and a splint for you.
14:34We'll get you in a wheelie chair.
14:36Are you all right with needles generally?
14:37I don't like them.
14:38Right, as well.
14:39I don't look good.
14:40Fine.
14:40Okay.
14:41Nick inserts a second cannula, so ketamine can be administered.
14:47Good.
14:48All right.
14:48Everyone happy.
14:49So, Brian, we're going to give you some of these lovely medicines now.
14:51I'm going to steal the internet away, if that's all right.
14:55Only carried by critical care teams, ketamine causes dissociative sedation, so Brian will have no memory of the procedure.
15:02You're a big guy.
15:03I'm usually very tolerable.
15:04Yeah.
15:05You might see me topping up the syringe part of the way.
15:07This is fine.
15:08You're allowed as much as you need.
15:09That's the beauty of it.
15:10I don't want to...
15:11So, this is the moment to sort of feel relaxed and happy.
15:17As Brian works out, and is a tall man at over six foot, Dr. Tim might have to increase the dose of ketamine for it to properly sedate him.
15:33Brian, how are you doing there, mate?
15:35Can you open your eyes, mate?
15:37Well done.
15:38You're very safe.
15:39We're going to start gently moving that ankle, all right.
15:46If his ankle isn't realigned soon, Brian's at risk of permanent disability.
15:51You're doing really good.
15:52John, I strongly recommend that you have something a little bit stronger.
16:15On a farm in Buckinghamshire, 44-year-old self-employed businessman, John, is suffering from severe burns to his head and arm after setting himself alight starting a bonfire with petrol.
16:27We can titrate it to see how you feel, and if you don't like the effect of it, we'll just slow down.
16:32But I would strongly recommend you have some pain relief.
16:34To combat his pain, John has only had Penthrox, but critical care paramedic Lisa and Dr. David want to administer morphine, because his pain will continue to develop.
16:45So far, he's refused.
16:47Right, how is your pain?
16:50A little bit more.
16:52We're trying to call it as best we can, but at some point you're going to need some pain relief, and you don't want to get to the point that it's unbearable.
17:01But you are within your own right to decline.
17:06Morphine's quite nice.
17:07It's not too strong, but it's enough to take away this type of pain.
17:11Are you happy, John?
17:12A little bit?
17:12Give you a tiny dose, see what you think of it.
17:14Tiny dose.
17:15Tiny dose.
17:16That's a two milligrams.
17:18John finally accepts the morphine.
17:20It's a good drug to combat burn pains, because it works by blocking pain signals in the central nervous system.
17:26Right, so the only thing is, we haven't obviously checked the lower body, but we're happy it's all upper, do we think?
17:32Yeah.
17:33Right, let's take some from your mouth, because then you've got some blisters.
17:36I just want to try and cool them down a little bit, okay?
17:38Open your mouth for me, and you're just going to hold that in your mouth, okay?
17:42Yeah.
17:43Some cool, wet gall should help cool down the blisters, starting to form around John's mouth.
17:48Should we, um...
17:50Try and ready whenever you are.
17:52Yeah.
17:52With him stabilised, the team want to get him to hospital as soon as possible.
18:02Still all right, John?
18:03Yeah.
18:03Excellent.
18:06So how's your pain out of ten, John?
18:08Ten being the worst pain, one being no pain?
18:11Seven.
18:12Okay, so if we put these on, we'll get you some more of that morphine.
18:15Lisa administers more morphine to combat John's growing pain.
18:19A 44-year-old man with a flash burn to his face and neck.
18:24While David calls Wexham Park Hospital, the nearest to the scene.
18:29Our reason for coming to you is we're only nine minutes away.
18:33And although he's not got any impending airway compromise, he has got a bit of lip swelling,
18:37and he's got some singeing of nasal hairs.
18:39So we didn't feel there was any justification for intubating him at scene.
18:45Right then, John, let's take your hand out this water, okay, because it's been in there for a long time now.
18:50There we go.
18:53You all right?
18:53Yeah.
18:54Sure?
18:55Yeah.
18:56So where's the worst pain?
18:57Is it your face or your arm?
18:58My arm.
18:59Your arm.
19:00You can breathe, okay, can't you, John?
19:02Yeah.
19:02Yeah.
19:02Let me see if I can take a little bit of this and put it on your hand, okay?
19:07Lisa dresses John's hand with pieces of cool, wet bandage to further soothe his skin.
19:12It's the best we can do.
19:14This is actually a face mask that we've just pulled apart.
19:17How's your lips?
19:19Yeah, okay.
19:20It's starting to go down, actually.
19:21It does look a bit better.
19:22Yeah, it was quite blistery just now, but I think putting that gauze has probably helped a little bit.
19:28It takes ten minutes for the ambulance to reach Wexham Park Hospital.
19:34All I can smell is burn here in the skin.
19:36Yeah, this is quite a smell, isn't it?
19:40Horrendous.
19:41Right, I think we're here.
19:44Keep your arms in.
19:45Is there any arm injuries, Timmy?
19:46John's handed over to the emergency department for further observation and possible surgery.
19:53The initial treatment had already been started by the ambulance crew, and that's cooling of the burns.
19:57With cool water.
19:59Our main concern when we arrived was to give him some good pain relief.
20:03I'm hoping that most of his burns will be superficial, and that he won't need any other particular treatment.
20:09But they'll likely observe him for a while to make sure there's no deterioration.
20:22We'll try and drive this forwards as fast as we can.
20:24Yeah.
20:25In Slough, 67-year-old HGV driver Bicker has had a cardiac arrest at home.
20:31We had spontaneous movements.
20:33Yeah, it's been around, hasn't it?
20:34By chance, Raluca, a nurse, was visiting next door and performed immediate CPR.
20:40Bicker's heart restarted after the ambulance crew shocked him with a defibrillator.
20:44Right, James, you're doing tips, so I do some drugs.
20:46Yes, please.
20:47Now, Dr. James and critical care paramedic Joe need to intubate Bicker, placing a tube down
20:53his airway so they can mechanically take control of his breathing in case he goes back into
20:58cardiac arrest.
20:59Are you just passing by or something, Lee?
21:01What?
21:01I am the nurse next door.
21:03Oh, this is the one for him.
21:04So they just run, say that he has collapsed, and I come and end.
21:07All right, well, good job.
21:08I think it just saved his life.
21:10So, what we'll do, we'll lift him up, drive the scoop under, drive the stretcher under.
21:15Are you happy we take the Lucas off?
21:17Yeah, fine.
21:17A Lucas machine has been fitted over Bicker's chest for mechanical chest compressions.
21:23Fortunately, it's not needed.
21:25All right, ready when you are?
21:26It's going to be on lift, and then the trolley's going to come in underneath.
21:29Ready?
21:30Steady.
21:30Lift.
21:32Right.
21:33Right.
21:34Just slide out.
21:34So, we're going to do our checklist now.
21:38Ready, Joe?
21:38I am ready.
21:40James and Joe run through a vital checklist before the emergency anesthetic, a procedure that's
21:45normally carried out in hospital.
21:47So, we're going to do a drug-assisted intubation.
21:50I will challenge you, and you will respond.
21:52Yeah.
21:52I have optimized patient position.
21:53Yes, I'm happy with this position.
21:55Except to have the access and fluids attached.
21:56So, I can see.
21:58Yeah, fluids are running beautifully.
22:00Monitor and attach invisible.
22:01NIBP?
22:02Yes.
22:02ECG?
22:03Yes.
22:03Probably 90 kilos, you reckon, so it would give nine...
22:06Probably 80, do you think?
22:0780.
22:0880 milligrams of ketamine and 100 a rock.
22:10Yeah.
22:10So, the time is 17.
22:12And I've noticed, that's 95.
22:14Perfect.
22:14Checklist complete, and the invasive procedure can begin.
22:19Perfect.
22:19So, 80 milligrams of ketamine coming now.
22:27And 100 of rock coming now.
22:32There we go.
22:34Okay, so we're going to time one minute.
22:36The ketamine will sedate Bicker, whilst the rocuronium will relax his muscles, allowing
22:40the breathing tube to be inserted down his airway.
22:43I think he's got a flailed sternum.
22:44Can you see how his sternum goes in when he takes a breath?
22:46It appears Bicker has some fractured ribs.
22:49This can happen during CPR when trying to save a life.
22:53And I think that makes him, that we should go to the hair field.
22:55Well, a cardiac arrest and flailed chest that could puncture Bicker's lungs will need specialist
23:00treatment at hospital.
23:02But first, he needs to be intubated.
23:05Let's get started.
23:10Slightly poor dentition.
23:12Grade one view.
23:14Bougie, please.
23:14Bougie.
23:17I have the Bougie.
23:18I have the tube.
23:19Carefully pass the teeth.
23:21Cuffs in.
23:22Black line at the teeth.
23:22Okay, Bougie out.
23:24Cuff up, please.
23:26So, right, so we've got end tidal.
23:28Good heart rate and blood pressure's fine.
23:30Bicker is intubated and can be placed on a mechanical ventilator.
23:34But he's in a fragile state and could suffer another arrest at any moment.
23:38The team now need to rush him to Hairfield Hospital.
23:42Are there tubes in place?
23:42Yes.
23:52In a gym in Milton Keynes, 32-year-old Brian was working out when he suddenly felt dizzy
24:09and fainted, dislocating and potentially breaking his ankle.
24:13Just topped up to 100.
24:15Dr. Tim and critical care paramedic Nick need to realign his ankle.
24:19Brian's been administered ketamine, but because he's a tall man at over six foot, the team
24:24are having to give a significant dose to sedate him.
24:30Back in.
24:31The team have successfully realigned Brian's ankle.
24:39Well done, mate.
24:40Now it needs to be supported with a splint before he can be moved to the ambulance.
24:46Brian, doing all right there, mate?
24:49Do your deep breaths.
24:50All right, Nick, just for your awareness, you've got a touch of apnea.
25:02Apnea means Brian has temporarily stopped breathing.
25:07The larger dose of ketamine has suppressed his brain's respiratory drive.
25:12And we're now desatting.
25:14Do you mind plugging him on that one?
25:16Oh, we've got some...
25:22There's a bit of the effort coming back.
25:27That's amazing.
25:28Is it, Brian? You're OK?
25:29Yep.
25:31Dr. Tim assists Brian's breathing by manually delivering oxygen.
25:38Tim, if you need us to come up that end, just shout.
25:40Yeah.
25:41We'll carry on for the moment.
25:42I think we're going to be all right.
25:43Lovely.
25:43So we're going to go up and down on the chair.
25:48I think we'll just come back up quite nicely.
25:50There we go.
25:51That'd be perfect, yeah.
25:58He's taking some good breaths on his own now.
26:01Brian is breathing for himself once more, and the team have the splint in place.
26:05Put me steady now.
26:06Oh, mate, I've just woken up from that sedation medicine.
26:10So if you're feeling a bit funny, that's totally normal.
26:14And you'll be feeling back to normal again in a few minutes, yeah?
26:18And you dislocated your ankle, and it's all back in now.
26:21I've got a splint on.
26:23It's really good.
26:24Ketamine is a dissociative anaesthetic, meaning Brian probably won't remember a thing.
26:30It takes sort of five minutes just to get your breath back, wake up fully, get the rest
26:34of that medicine out of your system.
26:36The stuff washes out of your system very quickly, so the fact that you're wide awake now sort
26:40of tells us most of it has gone.
26:43A ketamine sedation usually lasts for around 15 minutes.
26:46So, we need to get you in a, um, a wheelie turner.
26:49We'll just wait till the, till the paramedic's back.
26:51They're just having a look at the lift and working out these, just where to get you down.
26:55Do you remember the, um, the ankle being, being put back in?
26:58Do you remember when Nick moved your ankle?
27:00No, you put it back in, though.
27:01Yeah, yeah, it's back in, yeah.
27:04It's important.
27:06Uh, it's, it's, well, it's definitely dislocated.
27:08My, my guess is it's broken as well.
27:10You never, you never know a hundred, a hundred.
27:12A hundred percent until the x-ray's done, but my guess is it's broken as well.
27:16It's dislocated.
27:18The team now need to transfer Brian to hospital.
27:22So, yeah, I think what we'll do when you're ready, we'll support you, like, under your arms.
27:26You bend this leg all the way up to your bum so you can push off it.
27:29And then we'll aim to sort of push you up to, like, a standing position on your good leg.
27:32I mean, I just.
27:33And then as you, as you come up, we'll bring the chair underneath you, all right?
27:36We'll be going.
27:37Are you ready?
27:37Yeah.
27:38One, two, three, stance.
27:40Good man.
27:40Well done, boss.
27:41Good.
27:42Good.
27:42Wow.
27:43Perfect.
27:44Well done.
27:44Perfect.
27:45It's seamless.
27:46Successfully in the wheelchair, Brian can be taken down to the ambulance.
27:50There he is.
27:51Are you still smiling?
27:53It's always a good sign.
27:54Go.
27:55Well done.
27:56That's it.
27:57Good work.
27:58Awesome.
27:59We can give you a hand with these legs.
28:00Awesome.
28:01Perfect.
28:02Yeah.
28:03Excellent.
28:04Give you a hand with a bad leg.
28:05Excellent.
28:06How about that?
28:07Seamless.
28:08Hey, I can see them moving nicely.
28:09There you go.
28:10Yeah.
28:11Excellent.
28:12Good.
28:13Keep it all stuck in there.
28:14I will do.
28:15You're all good.
28:17Cheers.
28:18Here you go.
28:19Feels good.
28:20Fine.
28:21Come in.
28:22I can work it.
28:23Yeah.
28:24All of that's really good.
28:25We worry with these that the blood vessels can get kinked when it's off the funny angle
28:36and the nerves can get squashed and stuff like that.
28:38The fact that you can wiggle your toes, your foot's well perfused as we call it, you've
28:42got good pulses, it feels normal.
28:44All of that suggests you'll make a really good recovery from this.
28:47I started off with leg press, 140 kilos, 20 reps, 3 sets, and then I got up and gave me
28:56all of that once if I have a drink.
28:58So this is probably down to dehydration.
29:01With Brian stable and safely in the ambulance.
29:04Cheers, Brian.
29:05Take care.
29:06Get well soon.
29:07Tim and Nick have done all they can and are happy for the ambulance crew to take him to
29:12Milton Keynes Hospital for x-rays and surgery.
29:15Cheers.
29:16Thanks.
29:17Bye.
29:18Ankle went back in reasonably smoothly.
29:21He needed a top up of sedation and we needed to breathe for him for a few breaths just to
29:26keep his oxygen levels back up where we wanted them but very quickly picked up again on his
29:31own.
29:32He's doing very well afterwards.
29:33Hopefully we'll have a good outcome after surgery on that ankle.
29:46Hello,urence, what's going on?
29:47I'm sorry.
29:48I'm sorry, thank you.
29:49I'm sorry.
29:50I'm sorry.
29:51Can we hear it?
29:52Ambulance emergency, is the patient breathing?
29:54Um, yes.
29:55Was he hit by a car?
29:57No, he just hit by a car.
29:59Oh, he just fell out of the car.
30:02Is he bleeding?
30:03He is, yeah, from his head.
30:05How old is the patient?
30:07Um, I don't know him. I would estimate probably in his 80s.
30:12Can I speak to him?
30:14Um, he's not really in a state, so he's taken to.
30:17Can I try?
30:19No, he can't speak.
30:22Gone again.
30:24He's gone again. He's losing consciousness.
30:26He's feasuring. He's having a seizure.
30:29Okay, that's fine.
30:30I'll be strange. It's our highest priority, okay?
30:37So, this is a male. He's fallen out of a moving car.
30:40He was driving it.
30:42He had a head injury and started spitting.
30:44I'm feeling confusing from the head.
30:46Yeah, that's all received, many thanks.
30:48An elderly man who's collapsed, hit his head and may be having a seizure
30:52is a potentially life-threatening emergency
30:55that urgently requires the enhanced medical skills of Dr John Pike
31:00and critical care paramedic Neil Plant.
31:03What the dispatcher's thinking is,
31:05this is likely to need an anaesthetic free hospital.
31:08And that's effectively why we've been sent.
31:12If the patient has suffered a traumatic brain injury,
31:15the team may need to put him into an induced coma
31:18to protect his brain from further damage.
31:21If I thank you, just to let you know you're going to be first on the scene.
31:25Yes, yes, many thanks.
31:26We kind of anticipated that.
31:28And we are just about to pull up on the scene
31:30in about one minute, over.
31:32Fortunately, the critical care team were just a mile away.
31:36All right, thanks.
31:39Hi, guys.
31:40You're all right?
31:41Who have we got?
31:42Do you know this gentleman's name?
31:44This is my dad, Ron.
31:45This is your dad.
31:46How are you feeling?
31:48I think you've had a seizure, I think that's what happened.
31:50What we'd like to do is get some observations and things going.
31:5379-year-old Ron from Glasgow was visiting family in Maidenhead with his wife.
31:58But as he got out of his car, he fainted and seemed to have a seizure
32:02after hitting his head on the tarmac.
32:04Fortunately, he's now regained consciousness.
32:08I'm called John.
32:09I'm one of the doctors.
32:10We've got Neil here.
32:11He's one of our paramedics.
32:12Oh, are you?
32:13I wonder.
32:14I mean, having seizures is not that uncommon.
32:16It sometimes just comes out of the blue.
32:18Seizures are caused by abnormal electrical activity in the brain.
32:22Nerves misfire or send too many signals at once, causing muscle spasms.
32:26But also, you've banged your head.
32:28We need to make sure you haven't caused too much damage there.
32:30No other pain anywhere else.
32:32Ooh.
32:33Neck feels all right?
32:34No.
32:35OK, can I just have a quick look in your mouth?
32:37Uh-huh.
32:38Fantastic.
32:39That's lovely.
32:40You can close that up again.
32:41Good enough, thank you.
32:42So, GCS is good.
32:44He's talking.
32:45The pupils are equally reactive.
32:47The GCS, or Glasgow Coma Scale, is used to assess a person's level of consciousness by scoring their eye-opening, verbal and motor response between three the worst and 15 the best.
32:58Ron appears to be fully conscious, so at the higher end of the scale.
33:02148.52.
33:03Love it.
33:04So...
33:05Good stuff.
33:06OK.
33:07I think we'll take that off, Neil, and just...
33:08Yeah, yeah, yeah.
33:09Do you think you'll be able to fit up, Ron?
33:11No.
33:12Shall we get you sitting up?
33:13Do you want to try?
33:14No.
33:15And no trouble if you can't.
33:16Oh, OK.
33:17No, that's fine.
33:18Don't worry, Dad.
33:19What's stopping you?
33:20Do you feel kind of just generally weak?
33:21Oh.
33:22I don't know.
33:23I don't know.
33:24It's mine.
33:25Although Ron's seizure was brief, he could have another at any moment.
33:29The team want to understand what caused it before giving any medical intervention.
33:34He does it, Dad.
33:36Yeah.
33:42Right.
33:43OK.
33:44So, we're going to stick him on the ventilator.
33:59In Slough, critical care paramedic Joe and Dr James, attending to 67-year-old Bicker,
34:05who's had a cardiac arrest.
34:07Fortunately, his heart has restarted after CPR and a shock from a defibrillator.
34:12Airway, we're happy.
34:14Chest is moving equally.
34:15Sats are good.
34:16Just have a look.
34:17Listen in there.
34:18The team have performed a pre-hospital emergency anaesthetic to mechanically take control of
34:23his breathing.
34:24Air entry.
34:25Air entry.
34:26So, we've got air entry both sides.
34:29Numbers are all good.
34:30The critical care team will travel with Bicker to Harefield Hospital.
34:37His life still hangs in the balance.
34:39And they may need to intervene en route, should his condition deteriorate.
34:43No need to go crazy.
34:44Just like, steady blues is fine.
34:46If there's a problem, we'll let you know and ask you to pull out later.
34:49See you later, guys.
34:50Yeah.
34:51I've got propofol set up, ready to go.
34:53Lovely.
34:54OK.
34:55And that's leaving soon, 18-12.
34:57Propofol is a sedative drug that will help keep Bicker in the induced coma.
35:02Dr. Ray here from Thames Valley Air Ambulance.
35:05Can I place a PPCI call for an out-of-hospital cardiac arrest in ROSC, please?
35:11Dr. James telephones ahead to the hospital.
35:14Male.
35:1667.
35:1767 years old.
35:21Our ETA is 20-0 minutes.
35:24We're coming from Slough.
35:26No, they're intubated and ventilated.
35:29So now we've got pulse of 90.
35:33BP.
35:34BP-1, 3,382.
35:36The rest of the 12.
35:37The rest of the 14 now.
35:3814.
35:39Should we blow him a bit harder?
35:41Yeah.
35:42What's his volume?
35:43500.
35:44Because oxygen levels are low, so James and Joe need to up the volume of oxygen being pumped
35:49into his body to protect his brain and vital organs, ensuring they continue to function normally.
35:54We go up to...
35:55We could easily go to...
35:56600.
35:57600.
35:58That's where I've just come off, but they were reading at 94.
35:59100% now.
36:00Great.
36:01So we're just arriving.
36:02Amazing.
36:03We think that's a little bit ahead of schedule, aren't we?
36:05Bicker is delivered to Harefield Hospital, one of the largest and most experienced cardiac
36:20centres in the UK.
36:21Here we go.
36:22You good?
36:23Mm-hmm.
36:24Where he will undergo further treatment that could include fitting a stent or pacemaker.
36:30When someone's heart stops beating, the sooner you can get some kind of blood flow around
36:35the body, the better.
36:36In this case, there was a nurse visiting someone else, and when the patient collapsed, she was
36:41able to immediately start and bystand her CPR, and that undoubtedly helped the patient get
36:48their heart restarted.
36:50If anyone can learn CPR, I'd really urge you to go and see if you can get those skills.
37:05How long was he kind of seizing, like full body seizing?
37:08It was very brief.
37:10On a road in Maidenhead, 79-year-old Ron and his wife were visiting family when he fainted
37:15as he got out of his car, had a seizure and sustained a head injury.
37:19His family are with him.
37:21So it was more of a collapse out of the car.
37:23Eyes closed.
37:24Gotcha.
37:25And then we kind of got him into the position.
37:28Dr. John and critical care paramedic Neil are on scene and want to ascertain what caused
37:32the seizure so they can work out the best plan going forward.
37:36How quickly was he conscious?
37:37You speaking to him was the most conscious.
37:39Okay.
37:40To be honest, before that he wasn't, he was making that kind of noise.
37:47So it took a quite loud groan.
37:49He's had a lot, not a lot, quite a few falls.
37:52I see.
37:53Falls or blackout?
37:54I don't know.
37:55No.
37:56And it's often a bit difficult to tell.
37:58Yesterday, the place that they're staying, he fell in the bath.
38:02The other thing that you just wonder, has there been some sort of funny rhythm of the heart?
38:06Yeah.
38:07Yeah.
38:08And given his background, that's possible as well.
38:10If Ron has frequently been falling over, he could have a serious underlying medical issue.
38:15It sounds a bit like he's having maybe cardiac syncope to me.
38:19Cardiac syncope is a temporary loss of consciousness caused by the heart's inability to pump enough
38:24oxygenated blood to the brain, often due to an abnormal heart rhythm.
38:28It sounds like that as he's getting up out of the car, he's just collapsed.
38:32And it sounds like he's had multiple previous falls.
38:34Cardiac syncope could also have caused the seizure because of the drop in blood flow to Ron's brain.
38:39Whether it's a cardiac syncope, it's very short and self-terminating with not a long post-ictal period.
38:45So it feels a bit like it might be a cardiac syncope.
38:49An ambulance crew have now arrived on scene.
38:52So John's next priority is getting Ron inside the vehicle so he can be fully assessed.
38:56Right then.
38:57Ron, we're going to get you onto our stretcher if that's okay.
39:01We're going to be putting this hard stretcher down one side of you.
39:05Right.
39:06And we're going to roll you onto that in a minute.
39:08So do you think we can get you to roll onto your back now?
39:12Yeah.
39:13Right, Ron, you stay nice and still.
39:16Ready.
39:17Steady.
39:18Lift.
39:19There we go.
39:21You okay?
39:22Just going to roll you towards me.
39:23Once on the stretcher...
39:24Right, well done, Ron.
39:25...Ron's quickly transferred to the ambulance, whilst Dr John updates the dispatch desk.
39:302-5, just a quick update.
39:31So this patient looks like they have had probably a cardiac syncope, a collapse with a short self-terminating seizure and a small head injury.
39:43Right, Ron, do we have a quick look at the rest of you now?
39:46Yeah.
39:47Ron, do you mind if I cut your jumper?
39:48Oh, I couldn't see.
39:49We saved your jacket.
39:51It was a nice jumper, though.
39:52It was a nice jumper.
39:53Oh, it's just unusual.
39:54I know.
39:55How are you feeling now?
39:56Oh, terrible.
39:57Terrible in what way?
39:58Oh, dry.
39:59I don't know.
40:00I don't know.
40:01It's just unusual.
40:02I know.
40:03How are you feeling now?
40:04Oh, terrible.
40:05Terrible in what way?
40:06Oh, dry.
40:07Yeah, okay.
40:08Have you been feeling unwell recently?
40:09Not in the least.
40:10This is just sudden, out of the blue.
40:13No pain in your chest.
40:14No.
40:15Nice deep breath for me.
40:16Lovely.
40:17All right.
40:18No tummy pain, nothing like that.
40:19No.
40:20Okie dokie.
40:21That really is.
40:22And just an ECG is probably the one thing we really definitely do want.
40:25That's all right.
40:26An ECG will record Ron's heart's electrical activity, also checking its rhythm.
40:31But first, Dr. John performs a primary survey, looking for any hidden injuries or fractures.
40:47Can you give me a good squeeze of both arms?
40:50Squeeze my hands.
40:52Great.
40:53Can you lift your arms right up, Ron?
40:55Keep them up there.
40:56Just keep them there for me.
40:57Good man.
40:58That's nice.
40:59Good man.
41:00That's wonderful.
41:02And your legs, can you pull your toes back up, up towards there?
41:05Okay.
41:06No pain, no problems.
41:08I can't find any injuries.
41:11His neck's not painful.
41:12He's got normal power everywhere.
41:14Popping that very tight round your arm as well.
41:17Yeah.
41:18Gonna put up a little line in your arm as well.
41:20It might give you some anti-sickness too, I guess.
41:23Ron, I'm sorry this has happened to you today.
41:26It's random, isn't it?
41:28Totally, isn't it?
41:29A cannula is inserted, so the anti-sickness drug on Danzatron can be administered, in case
41:35Ron becomes nauseous on the way to hospital.
41:38Right, Ron.
41:39That's that.
41:40Done.
41:41Well done.
41:42I think he's had an episode of bradycardia, hasn't he?
41:45That's the way it feels like.
41:47Okey-dokey.
41:48Bradycardia is a slow heartbeat that can cause a cardiac syncope or fainting episodes.
41:53Shall we leave you to him?
41:55Thank you very much.
41:56Ron.
41:57Oh.
41:58Gonna get you warm now.
41:59Blanket, hospital, they'll look after you there.
42:01Oh my.
42:02So we're gonna leave you with these guys now.
42:04Right.
42:05You look after yourself.
42:07Thanks, guys.
42:08Take care.
42:09Cheers.
42:10I just wonder whether he's had an episode of his heart going really slow.
42:16Before departing, Dr. John briefs Ron's wife Sue.
42:19I think there's some evidence that that might be the case.
42:22And that might make him collapse.
42:24And his heart's a little bit irregular.
42:26It's a little bit slow.
42:27And he's got some things on his heart tracing.
42:29It just suggests that he might be having episodes where it suddenly goes really slow.
42:33They'll look after him really carefully in hospital.
42:35If they think that's the case, they'll consider something like a pacemaker.
42:38But he needs a bit more imaging first.
42:40And he's gonna need a scan of his head as well.
42:42Yeah.
42:43But I think that's all fine.
42:44It's actually just a big bruise and a lot of scuss, I think.
42:47All right.
42:48No worries.
42:49Not at all.
42:50We're gonna leave you to it and leave him in the care of the crew.
42:52Dr. John is satisfied Ron is stable enough.
42:55All right.
42:56For the ambulance crew to transfer him to Wexham Park Hospital.
43:00And the Thames Valley Air Ambulance critical care team are now free for their next emergency.
43:17We're going to punt to see you soon to ultimately get this one.
43:28Good morning.
43:29You may have recorded some presentation about this, but we do not know each other.
43:36So we can watch these previous technologyうん educational platforms as well for us.
Be the first to comment