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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.
07:02Ambulance emergency is patient breathing.
07:16Ambulance emergency, is patient breathing?
07:21He is, yeah, he's just, um, he's just fired himself, he's got burns on his arm on his face, his hair.
07:28Is he awake?
07:30He's awake, yeah.
07:32How old is the patient?
07:35Forty-four.
07:37Forty-four, and is there any burns around the mouth or nose?
07:42Yeah, he's burnt lips, his nose, got a strip burn on his face and his arm.
07:47He supplied a cold cell to his face.
07:50He 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.
07:57Really, he's just amazed.
07:59Alright, we're getting some help arranged.
08:01We call some casteride as a high priority.
08:04We're on our way.
08:06Extensive burns to the body and head are a code-red emergency.
08:13So critical care paramedic Lisa Brown and Dr David Metcalf are immediately dispatched.
08:19All 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.
08:28Around 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.
09:13There we go.
09:14They are.
09:15We'll get some water on your lips, I think.
09:18Right, John, put your hand in there.
09:20The 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.
09:27They'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, Rachel?
09:34Because you're going to have to have something, my lovely, because this is a bit of a long journey.
09:38Are you okay with some morphine?
09:41I'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?
10:06Yeah, bossy.
10:07Severe 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 and a risk of organ failure.
10:19I 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.
10:26I will.
10:27Transcription by CastingWords
10:57Transcription by CastingWords
11:28We're going to a young man, 32 years old, with what sounds like a dislocated ankle.
11:35Without fast treatment, badly broken and dislocated limbs can have life-changing complications.
11:41So in addition to an ambulance crew, Dr. Tim Waite and critical care paramedic Nick Cole are dispatched.
11:48We're normally called to these because we can give some procedural sedation while we manipulate the ankle.
11:54It's a smoother and more humane way to put a dislocated ankle back in place.
11:59Go Brines.
12:04Is that the gym just there?
12:06Yeah, looks like it.
12:08The team need to make their way...
12:10Got it.
12:11...to the first floor of the gym.
12:13Hello.
12:14Hello, Bruce.
12:15Hi.
12:16Hello.
12:17Nick Tiamanton.
12:18Hi.
12:19This is Brian.
12:20So basically he had been working out as he normally would and we fainted essentially.
12:26About 10 seconds unconscious on the floor.
12:28He does have a slight bump to the back of his head but no ceasefire and no other injuries.
12:3432-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.
12:43Very obvious dislocation.
12:45He's had 2.5 of IV morphine.
12:47What's that?
12:48About a bottle and a half of gas and air.
12:50The ambulance crew have already inserted a cannula so morphine has been administered for fast acting pain relief.
12:56Pain was initially an 8 but now we've come down to about a 5 or a 6.
13:00However, when he doesn't think about it, it's actually not too bad.
13:04Good.
13:05Have a chat with him about sedation and put in a second line.
13:08I've done a little mention to him about testing.
13:10Brilliant.
13:11Yeah, fine.
13:12It's vital Brian's ankle is realigned so his blood flow isn't compromised.
13:18Risking further damage to his blood vessels and nerves.
13:21My name's Tim.
13:22I'm one of the doctors from the air.
13:24I'm in the cell phone.
13:25That's all right.
13:26What we're going to do if this sounds reasonable to you is give you some sleepy medicines.
13:29And while you're asleep, Nick will give that a pull, pop it back in.
13:32We'll put a splint on it.
13:33Get you off to hospital.
13:34So that's the plan.
13:35It needs surgery.
13:36Yeah, exactly that.
13:38Looking at it, I'd expect it will need surgery.
13:41Looking at you though, you're a young, healthy man and you're likely to have a very good outcome after surgery.
13:45So I'd be optimistic, but it looks like that I'll need operating.
13:51Can you feel when Nick's touching that foot with his fingers?
13:54Yeah.
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, a good sign indicating nerves are functioning and blood is circulating.
14:06Brilliant.
14:07You've got any medical problems normally?
14:08Yeah.
14:09Yeah.
14:10Good stuff.
14:11However, while the bones are misaligned, the blood supply is at risk of becoming compromised.
14:16So Brian's ankle needs to be straightened.
14:18We'll get some medicines drawn up for you.
14:20The medicine we're going to give you, a medicine called ketamine, so we'll take really good care of you.
14:24And then when you, when you sort of wake up, so to speak, we'll have that ankle back in and a spimp for you.
14:29We'll get you in a wheelie chair.
14:30Are you all right with needles generally?
14:32I don't like them.
14:33As long as I don't look at them.
14:35Fine.
14:36Okay.
14:37Nick inserts a second cannula, so ketamine can be administered.
14:42Good.
14:43All right.
14:44Everyone happy.
14:45So 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.
14:50Only carried by critical care teams, ketamine causes dissociative sedation, so Brian will have no memory of the procedure.
14:57You're a big guy.
14:58I'm usually very topical.
14:59Yeah.
15:00You might see me topping up the syringe part ways.
15:02That's fine.
15:03You're allowed as much as you need.
15:04That's the beauty of it.
15:05I don't worry.
15:06So this is the moment to sort of feel relapsed and happy.
15:12As 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.
15:27Brian, how are you doing there, mate?
15:30Can you open your eyes, mate?
15:32Well done.
15:33You're very safe.
15:35We're going to start gently moving that ankle, all right?
15:40If his ankle isn't realigned soon, Brian's at risk of permanent disability.
15:46You're doing really good.
15:47But the critical care team can't safely move him until his pain is under control.
15:53John, I strongly recommend that you have something a little bit stronger.
16:12On 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.
16:22But we can titrate it to see how you feel.
16:25And if you don't like the effect of it, we'll just slow down.
16:27But I would strongly recommend you have some pain relief.
16:30To combat his pain, John has only had Penthrox.
16:33But critical care paramedic Lisa and Dr. David want to administer morphine because his pain will continue to develop.
16:40So far, he's refused.
16:42Right, how's your pain?
16:43A little bit more.
16:44We'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.
16:57But you are within your own right to decline.
17:01Morphine is quite nice.
17:02It's not too strong, but it's enough to take away this type of pain.
17:06Are you happy, John?
17:07A little bit?
17:08Give you a tiny dose, see what you think of it.
17:10Tiny dose.
17:11Tiny dose.
17:12Two milligrams.
17:13John finally accepts the morphine.
17:15It's a good drug to combat burn pains because it works by blocking pain signals in the central nervous system.
17:22Right, so the only thing is we haven't obviously checked the lower body, but we're happy it's all upper, do we think?
17:27Yeah.
17:28Right, let's take this from your mouth because then you've got some blisters.
17:31I just want to try and cool them down a little bit, okay?
17:33Open your mouth for me.
17:35And you're just going to hold that in your mouth, okay?
17:37Yeah.
17:38Some cool wet gaule should help cool down the blisters starting to form around John's mouth.
17:43Should we, um...
17:45I'm ready whenever you are.
17:48With him stabilised, the team want to get him to hospital as soon as possible.
17:56Still alright, John?
17:58Yeah.
17:59Excellent.
18:00So how's your pain out of ten, John?
18:03Ten being the worst pain, one being no pain.
18:06No pain.
18:07Okay, so we'll put these on and we'll get you some more of that morphine.
18:10Lisa administers more morphine to combat John's growing pain.
18:14A 44-year-old man with a flash burn to his face and neck.
18:19While David calls Wexham Park Hospital, the nearest to the scene.
18:23Our reason for coming to you is we're only nine minutes away.
18:28And although he's not got any impending airway compromise, he has got a bit of lip swelling and he's got some singeing of nasal hairs.
18:35So we didn't feel there was any justification for intubating him at scene.
18:39Right then John, let's take your hand out this water, okay, because it's been in there for a long time now.
18:44There we go.
18:46You alright?
18:48Yeah.
18:49Sure?
18:50Yeah.
18:51So where's the worst pain, is it your face or your arm?
18:53I don't know.
18:54Your arm.
18:55You can breathe, okay, can't you, John?
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.
19:09This is actually a face mask that we've just pulled apart.
19:12How's your lips?
19:14Yeah, okay, it's starting to go down actually.
19:16It does look a bit better.
19:18Yeah, it was quite, it was quite blistery just now, but I think putting that gauze has probably helped a little bit.
19:25It takes ten minutes for the ambulance to reach Wexham Park Hospital.
19:29All I can smell is burn here in the skin.
19:32Yeah, this is quite smell, isn't it?
19:34Oh.
19:35Horrendous.
19:37Right, I think we're here.
19:39Keep your arms in.
19:40Is there any arm injuries, Timmy?
19:42John's handed over to the emergency department for further observation and possible surgery.
19:48The initial treatment had already been started by the ambulance crew and that's cooling of the burns with cool water.
19:54Our main concern when we arrived was to give him some good pain relief.
19:59I'm hoping that most of his burns will be superficial and that he won't need any other particular treatment,
20:04but they'll likely observe him for a while to make sure there's no deterioration.
20:07We'll try and drive this forwards as fast as we can.
20:20In Slough, 67-year-old HGV driver Bicker has had a cardiac arrest at home.
20:26We have spontaneous movement.
20:28Yeah, he's moving out, hasn't he?
20:29By chance, Raluca, a nurse, was visiting next door and performed immediate CPR.
20:35Bicker's heart restarted after the ambulance crew shocked him with a defibrillator.
20:39Right, James, you're doing kitsch, so I do some drugs.
20:41Yes, please.
20:42Now, Dr James and critical care paramedic Joe need to intubate Bicker,
20:46placing a tube down his airway so they can mechanically take control of his breathing
20:51in case he goes back into cardiac arrest.
20:54You're just passing by or something, Luke?
20:56I am the nurse next door.
20:58Oh, next door.
20:59Don't put him.
21:00I see.
21:01Well, good job.
21:03I think you've just saved your life.
21:05So, what we'll do, we'll lift him up, drive the scoop under, drive the stretcher under.
21:10You're happy we take the Lucas off?
21:12Yeah, fine.
21:13A Lucas machine has been fitted over Bicker's chest for mechanical chest compressions.
21:18Fortunately, it's not needed.
21:20All right, ready when you are?
21:21It's going to be on lift, and then the trolley's going to come in underneath.
21:24Ready.
21:25Stay.
21:26Lift.
21:27Okay.
21:28Great.
21:29Right.
21:30So, we're going to do our checklist now.
21:33Ready, Joe?
21:34I am ready.
21:35James and Joe run through a vital checklist before the emergency anaesthetic,
21:39a procedure that's normally carried out in hospital.
21:42So, we're going to do a drug-assisted intubation.
21:45I will challenge you and you will respond.
21:46Okay.
21:47Yeah.
21:48I've optimized patient position.
21:49Yes, I'm happy with this position.
21:50Except to have the access from fluids attached.
21:51So, I can see.
21:53Yeah, fluids are running beautifully.
21:55Monitor and attached invisible.
21:56NIBP?
21:57Yes.
21:58ECG?
21:59Yes.
22:00Probably 90 kilos, you reckon?
22:01So, it will give nine...
22:02Probably 80, do you think?
22:0380.
22:0480 milligrams of ketamine and 100 a rock.
22:05Yeah.
22:06So, the time is 17.
22:07And I've noticed.
22:08Satch 95.
22:09Perfect.
22:10Checklist complete and the invasive procedure can begin.
22:14Perfect.
22:15So, 80 milligrams of ketamine coming now.
22:23And 100 of rock coming now.
22:25There we go.
22:28Okay.
22:29So, we're going to time one minute.
22:31The ketamine will sedate Bicker, whilst the rocuronium will relax his muscles, allowing
22:36the breathing tube to be inserted down his airway.
22:38I think he's got a flailed sternum.
22:39Can you see how his sternum goes in when he takes a breath?
22:42It appears Bicker has some fractured ribs.
22:44This can happen during CPR when trying to save a life.
22:48And I think that makes him, that we should go to the hair field.
22:51A cardiac arrest and flailed chest that could puncture Bicker's lungs will need specialist
22:56treatment at hospital.
22:57Yeah, we are strong.
22:58But first, he needs to be intubated.
23:00That's all right.
23:01Let's get started.
23:05Okay.
23:06Slightly poor dentition.
23:07Grade one view.
23:09Bougie, please.
23:10Bougie.
23:11I have the Bougie.
23:14I have the tube.
23:15Carefully past the teeth.
23:16Cuffs in.
23:17Black line at the teeth.
23:18Okay.
23:19Bougie out.
23:20Cuff up, please.
23:21It's all right.
23:22So we've got end tidal.
23:23Good heart rate.
23:24And blood pressure's fine.
23:25Bicker is intubated and can be placed on a mechanical ventilator.
23:29But he's in a fragile state and could suffer another arrest at any moment.
23:34The team now need to rush him to Hairfield Hospital.
23:37Let's get the tubes in place.
23:38In a gym in Milton Keynes, 32-year-old Brian was working out when he suddenly felt dizzy and fainted.
23:55Dislocating and potentially breaking his ankle.
24:08Just topped up to 100.
24:10Dr.
24:11Dr. Tim and critical care paramedic Nick need to realign his ankle.
24:14Brian'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.
24:25Back in.
24:26Back in.
24:27Good.
24:28The team have successfully realigned Brian's ankle.
24:32Well done, mate.
24:35Now it needs to be supported with a splint before he can be moved to the ambulance.
24:40Brian, doing all right there, mate?
24:44Do your deep breaths.
24:51All right, Nick.
24:52Just for your awareness, we've got a touch of apnea.
24:57Apnea means Brian has temporarily stopped breathing.
25:03The larger dose of ketamine has suppressed his brain's respiratory drive.
25:07I'm going to add these suffering.
25:10Do you mind bugging him, that one?
25:14Oh, we've got some...
25:18Respect, yeah, for coming back.
25:23Is it Brian, you're okay?
25:24Yep.
25:26Dr. Tim assists Brian's breathing by manually delivering oxygen.
25:33Tim, if you need us to come up that end, just shout.
25:35Yeah.
25:36We'll carry on for the moment.
25:37We're going to be all right.
25:38Lovely.
25:41So we're going to go up and down on the chair.
25:43I think we'll just come back up quite nicely.
25:45There we go.
25:46Perfect, yep.
25:54He's taking some good breaths on his own now.
25:56Brian is breathing for himself once more, and the team have the splint in place.
26:00Getting steady now.
26:01Oh, mate, I've just woken up from that sedation medicine, so if you're feeling a bit funny, that's totally normal.
26:09And you'll be feeling back to normal again in a few minutes, yeah?
26:13And you dislocated your ankle, and it's all back in now.
26:16Got a splint on.
26:17Looks really good.
26:18Ketamine is a dissociative anaesthetic, meaning Brian probably won't remember a thing.
26:25It takes sort of five minutes just to get your breath back, wake up fully, get the rest of that medicine out of your system.
26:31The 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.
26:38A ketamine sedation usually lasts for around 15 minutes.
26:41So, we need to get you in a, um, a wheelie turnip.
26:44We'll just wait till the, till the paramedic's back.
26:46They'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?
26:53Do you remember when Nick moved your ankle?
26:54No, you put it back in, right?
26:56Yeah, yeah, it's back in, yeah.
26:58Wow.
26:59Is it broken?
27:00Uh, it's, it's, well, it's definitely dislocated.
27:03My, my guess is it's broken as well.
27:05You never, you never know a hundred, a hundred percent until the x-ray's done, but my guess is it's broken.
27:10My guess is it's broken as well as it's 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.
27:21You bend this leg all the way up to your bum so you can push off it,
27:24and 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.
27:40Well done.
27:41Perfect.
27:42He's seamless.
27:43Successfully in the wheelchair, Brian can be taken down to the ambulance.
27:46There 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 these legs.
27:55Awesome.
27:56Perfect.
27:57Yeah.
27:58Excellent.
27:59Give you a hand with a bad leg.
28:00Excellent.
28:01How about that?
28:02Seamless.
28:03I can feel my toes.
28:04Hey, I can see them moving nicely.
28:05Is that okay?
28:06Yeah.
28:07Excellent.
28:08That's so good.
28:09Keep your arms tucked in, right?
28:11I will do.
28:12You look good.
28:14Cheers.
28:15There you go.
28:16Feels good.
28:17Fine.
28:18Come in.
28:19I can work with you.
28:20Yeah.
28:21All of that's really good to be honest.
28:22We worry with these that, you know, if the blood vessels can get kinked when it's off the
28:31funny angle and the nerves can get squashed and stuff like that.
28:33So the fact that you can wiggle your toes, your foot's well-perfused, as we call it, you've
28:37got good pulses, it feels normal, all of that suggests you'll make a really good recovery
28:42from this.
28:43Started off with leg press, 140 kilos, 20 reps, 3 sets.
28:49And then I got up and gave me seeing all of that, not once if I have a drink.
28:54So this is probably down to dehydration.
28:57With Brian stable and safely in the ambulance.
29:00Cheers, Brian.
29:01Take care.
29:02Get well soon.
29:03Tim 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, but very quickly picked up again on his
29:26own.
29:27He's doing very well afterwards.
29:28Hopefully we'll have a good outcome after surgery on that ankle.
29:31radio, airing and talking.
29:32I'm just going to go ahead and check it out.
29:33What is the matter of the ambulance number?
29:34Any questions on that ankle?
29:35We need to know this.
29:36The ambulance number, our emergency.
29:37The ambulance number is a patient breathing.
29:38Yeah.
29:39We've been hit by a car.
29:40No, he just fell out of the car.
29:42Oh, he just fell out of the car.
29:44Is he delivering?
29:45He is, yeah.
29:47With his head.
29:49um yeah was he hit by a car no he just fell out of the car is he bleeding he is yeah on his head
30:00how old is the patient um i don't know him i would estimate probably in his 80s can i speak to him
30:09um he's not really in the states he's taken to can i try no no no he can't he can't speak
30:17go on again he's gone again he's losing consciousness he's feasuring he's having a
30:23seizure okay that's fine how's the strange is the highest priority okay
30:33so this is a male he's fallen out of a moving car he was driving it he had a head injury
30:38and started fitting and feeling confusing yeah that's all received many things an elderly man
30:45who's collapsed hit his head and maybe having a seizure is a potentially life-threatening emergency
30:51that urgently requires the enhanced medical skills of dr john pike and critical care paramedic neil plant
30:58what the dispatcher's thinking is this is likely to need an anesthetic pre-hospital
31:03and that's that's effectively why we've been sent if the patient has suffered a traumatic brain injury
31:10the team may need to put him into an induced coma to protect his brain from further damage
31:20yes yes many thanks we uh kind of uh anticipated that and we are just about to pull up on scene in
31:25about one minute over fortunately the critical care team were just a mile away
31:33right thanks hi guys you're all right who have we got do you know this gentleman's name my dad
31:39this is your dad how are you feeling oh i think you've had a seizure i think that's what happened
31:45what we'd like to do is get some observations and things going 79 year old ron from glasgow was
31:51visiting family in maidenhead with his wife but as he got out of his car he fainted and seemed to have
31:57a seizure after hitting his head on the tarmac fortunately he's now regained consciousness
32:03i'm called john i'm one of the doctors we've got neil here who's one of our paramedics i wonder i
32:08mean something you're having seizures is not that uncommon it sometimes just comes out of the blue
32:13seizures are caused by abnormal electrical activity in the brain nerves misfire or send
32:19too many signals at once causing muscle spasms but also you've banged your head we need to make
32:24sure you haven't caused too much damage there no other pain anywhere else neck feels all right
32:29no okay can i have a quick look in your mouth fantastic that's lovely you can close that up
32:35again so gcs is good he's talking pupils are equally reactive gcs or glasgow coma scale is used to assess
32:45a person's level of consciousness by scoring their eye-opening verbal and motor response between three
32:51the worst and 15 the best ron appears to be fully conscious so at the higher end of the scale 148 52
32:59i think so good stuff okay i think we'll take that off neil and yeah yeah do you think you'll be able
33:05to sit up ron no should we get you sitting up do you want to try and no trouble if you can't no that's
33:13fine don't worry what's stopping you do you're feeling kind of just generally weak oh i don't know
33:21although ron seizure was brief he could have another at any moment the team want to understand
33:26what caused it before giving any medical intervention he does it dad yeah
33:43right okay so we're going to stick him on the ventilator in slough critical care paramedic joe
33:57and dr james attending to 67 year old bicker who's had a cardiac arrest fortunately his heart has
34:04restarted after cpr and a shock from a defibrillator airway we're happy chest is moving equally sats are
34:11good i'll just have a look listen in there the team have performed a pre-hospital emergency
34:16anaesthetic to mechanically take control of his breathing air entry air entry so we've got air
34:23entry both sides numbers are all good the critical care team will travel with bicker to hairfield hospital
34:33his life still hangs in the balance and they may need to intervene on route should his condition
34:38deteriorate no need to go crazy just like steady blues is fine if there's a problem we'll let you
34:43know and ask you to pull out later yeah i've got propofol set up ready to go lovely okay and that's
34:51leaving scene 18 12. propofol is a sedative drug that will help keep bicker in the induced coma
34:57dr rate here from thames valley air ambulance uh can i place a ppci call for um out of hospital
35:05cardiac arrest rosk please dr james telephones ahead to the hospital male 67 67 years old
35:17our eta is 20 20 minutes we're coming from slough no they're intubated and ventilated so now we've got
35:26pulse of 90 bp bp 1 3 3 82 the rest of the 12 rest of 14 14. should we learn a bit harder yeah
35:42what's his volume 500 because oxygen levels are low so james and joe need to up the volume of oxygen
35:48being pumped into his body to protect his brain and vital organs ensuring they continue to function
35:54normally we go up to we can easily go to 600 600 that's where i've just come off but they were
36:01reading at 94 100 now great so we're just arriving amazing i think that's a little bit ahead of schedule
36:10aren't we bicker is delivered to hairfield hospital one of the largest and most experienced cardiac
36:16centers in the uk here we go good where he will undergo further treatment that could include fitting a
36:23stent or pacemaker when someone's heart stops beating the sooner you can get some kind of blood
36:30flow around the body the better in this case there was a nurse visiting someone else and when the
36:36patient collapsed she was able to immediately start and bystander cpr and that undoubtedly uh helped
36:43the patient get their heart restarted anyone can learn cpr i really urge you to go and go and see if
36:49you can get those skills how long was he kind of seizing like full body seizing yeah it was very
37:04breathing on a road in maidenhead 79 year old ron and his wife were visiting family when he fainted as
37:11he got out of his car had a seizure and sustained a head injury his family are with him so it was more
37:18of a collapse out of the car eyes closed gotcha and then we can have gone into the position dr john and
37:25critical care paramedic neil are on scene and want to ascertain what caused the seizure so they can work
37:30out the best plan going forward how quickly was he conscious you speaking to him was the most conscious
37:36okay honest before that he wasn't he was making that kind of you know he was so it took a quite
37:43loud groan he's had a lot it wouldn't have a lot to you there quite a few falls has he um falls or blackout
37:51i don't know no and it's often a bit difficult to tell yesterday the place that they're staying he fell
37:57in the bath the other thing that you just wonder has there been some sort of funny rhythm of the heart
38:02yeah yeah and given his background that's possible if ron has frequently been falling over he could
38:08have a serious underlying medical issue it sounds a bit like he's having like maybe cardiac syncope to
38:14me cardiac 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 it sounds like that he's getting up out
38:26of the car he's just collapsed and it sounds like he's had multiple previous falls cardiac syncope could
38:31also have caused the seizure because of the drop in blood flow to ron's brain whether it's a cardiac
38:36syncope very short and self-terminating with not a long post-ictal period so it feels a bit like it
38:43might be a cardiac syncope an ambulance crew have now arrived on scene so john's next priority is getting
38:49ron inside the vehicle so he can be fully assessed right then ron gonna get you onto our stretcher if that's
38:56okay we're going to be putting this hard stretcher down one side of you right and we're going to roll
39:02you onto that in a minute so do you think we can get you to roll onto your back now right right ron
39:10you stay nice and still ready steady lift okay okay just gonna roll you towards me once on the stretcher
39:20right well i'm ron ron's quickly transferred to the ambulance whilst dr john updates the dispatch desk
39:2725 just a quick update so this patient looks like they have had a probably a cardiac syncope a collapse
39:34with a short self-terminating seizure and a small head injury right ron should we have a quick look at
39:41the rest of you now ron do you mind if i cut your jumper we saved your jacket thank you
39:53it's a nice jumper though it was a nice jumper oh it's just unusual i know how are you feeling now
40:00oh terrible terrible in what way and all dry
40:11yeah okay have you been feeling unwell recently not in the least this is just sudden out of the blue
40:18no pain in your chest no nice deep breaths me lovely all right no tummy pain nothing like that
40:27okay okay all right and just an ecg is probably the one thing we really definitely do one that's
40:33all right an ecg will record ron's heart's electrical activity also checking its rhythm but first dr john
40:40performs a primary survey looking for any hidden injuries or fractures can you give me a good squeeze
40:45of both arms squeeze my squeeze squeeze squeeze my hands great can you lift your arms right up ron
40:52keep them up there just keep them there for me good man that's wonderful thank you and your legs can
40:58you pull your toes back up up towards there okay no pain no problems i can't find any injuries like his
41:07neck's not painful he's got normal power everywhere popping that very tight around your arm as well okay
41:14gonna put up a little line in your arm as well we might give you some anti-sickness too i guess
41:18well i'm sorry this has happened to you today it's random isn't it totally isn't it
41:25a cannula is inserted so the anti-sickness drug on danzotron can be administered in case ron becomes
41:31nauseous on the way to hospital all right ron that's that done well done i think he's had an episode of
41:39bradycardia hasn't he that's what it feels like okey dokey bradycardia is a slow heartbeat that can cause a
41:47cardiac syncope or fainting episodes should we leave you to them thank you very much ron
41:53gonna get you warm now blanket hospital they'll look after you there so we're gonna leave you with
41:59these guys now okay you look after yourself thank you thank you
42:05thanks guys take care cheers i just wonder whether he's had an episode of his heart going really slow
42:12before departing dr john briefs ron's wife sue i think there's some evidence that that might be
42:17the case and that might make him collapse and his heart's a little bit irregular it's a little bit
42:22slow and he's got some things on his heart tracing that just suggests that he might be having episodes
42:27where it suddenly goes really slow they'll look after him really carefully in hospital if they think
42:31that's the case they'll consider something like a pacemaker but he needs a bit more imaging first and
42:36he's going to need a scanner of his head as well yeah but i think that's all fine it's actually just
42:40a big bruise and a lot of scuffs i think all right no worries not at all we're going to leave you to it
42:46and leave people leave him in the care of the crew dr john is satisfied ron is stable enough all right
42:52for the ambulance crew to transfer him to wexham park hospital and the thames valley air ambulance
42:57critical care team are now free for their next emergency
43:11so
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