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00:00In the intense world of medical emergencies...
00:03Is the patient breathing?
00:05No! She's lost!
00:07..there's nothing more extreme...
00:09These lips are blue.
00:11..than an immediate threat to life.
00:13Massive, massive burn.
00:15Responding to the most severe 999 calls.
00:19This lady is reporting pain in her head
00:21and is becoming less talkative.
00:23The Thames Valley Air Ambulance Fast Response Vehicles...
00:26The woman's had a seizure, the whale crashed into some people.
00:29..are at the front line delivering life-saving medical treatments.
00:32The big decision is for us whether we need to put a tube in there
00:35to protect us that way or not.
00:36..working day...
00:37We're going to give you some strong medication.
00:40..and night.
00:41It should not hurt. It's a very good painkiller.
00:43..reacting to emergencies.
00:45You've been super brave, darling.
00:47..the critical care teams...
00:48You've had a pretty big blow to the head.
00:50..are equipped to provide hospital-level treatment.
00:53So we'll give you some ketamine.
00:54That will mean that you don't know what we're doing
00:56whilst we straighten your ankle out.
00:57..whenever...
00:58Do you think it's bad?
01:00Potentially, yeah.
01:01..and wherever...
01:02Oh, my leg!
01:03..it's needed.
01:04You are doing a fantastic job.
01:06Filmed over three months...
01:08Let's have your arm, my dad.
01:09Let's give you some of this morphine.
01:11Just be aware you might stop spontaneously ventilating.
01:14I have the tube.
01:15..we captured every vital second...
01:18That's OK.
01:19You're safe.
01:20..as these highly trained critical care teams...
01:22Can you take a deep breath in for me?
01:24..fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29..when every second counts.
01:31Let's go, go, go.
01:33..tonight, a five-year-old...
01:36She's leaving again! She's leaving again!
01:38..suffers multiple seizures with life-threatening implications.
01:41All are staining, the patient's unresponsive...
01:44..and chest is not rising and falling.
01:46..a farm worker is injured after plummeting ten feet from a trailer.
01:51A young man who's had quite a significant fall.
01:54..the left arm is the vapour, sir.
01:57We're going to get a full heart-tracing, Luke.
01:59There should be loads of stickies on your chest.
02:01The critical care team respond to a potentially life-threatening heart condition.
02:05We zap you with a defibrillator and zap you back into a normal rhythm, essentially.
02:09And...
02:10Adam, look at me, darling.
02:12..a postman is treated after a serious fall in the sorting office.
02:17He's all right. He's all right. He's all right. He's all right.
02:20He's all right. He's all right. He's all right.
02:21He's all right.
02:26Thames Valley Air Ambulance Charity rely on a fleet of fast response cars
02:30to get them and their specialised equipment
02:33to the scenes of emergencies as quickly as possible.
02:36You've got...?
02:37Asthma.
02:38COPD.
02:39A heart murmur.
02:40Thanks to the enhanced medical expertise of 34 doctors
02:44and 25 critical care paramedics.
02:46Where's all your pain?
02:48Your arm. Which one?
02:49This one?
02:50This one?
02:51Countless lives have been saved across the Thames Valley region.
02:54He's now got repetitive eye ticks.
02:56I think he's still seizing.
02:57Yeah.
02:58And today, Dr. Jaz Rayatt and critical care paramedic Lisa Brown
03:02are preparing for another potentially life-saving shift.
03:05I've got to find a 100% mask.
03:07PHONE RINGS
03:19PHONE RINGS
03:21PHONE RINGS
03:22PHONE RINGS
03:23PHONE RINGS
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03:28PHONE RINGS
03:29he be able to speak to me directly and answer any of my questions at all yeah i can pass the
03:33phone over hello are you the patient yeah i understand that you've injured your leg
03:41yeah and are you able to get up from the floor right now or are you stuck on the floor
03:46stuck on the floor the phone's showing oh okay so bone's sticking out through the skin
03:52yeah the phone's popping out okay so based on the information you've given me you'll call
03:56have to categorize as a high priority just to confirm you've got somebody remaining with you
04:01until the ambulance arrives yeah a broken bone that's pierced the skin is a code red emergency
04:13so in addition to an ambulance the enhanced skills of the critical care team are also required
04:26there's a crew that's just arriving on teams that should update shortly but supposedly the leg is
04:32pointing at the right angle this sounds like this man's got an open fracture of his leg that's when
04:41the bone is protruding from the skin so things that we're thinking about is most likely he'll need
04:48good pain relief probably sedation to manage his injury so we can reduce the fracture with a high
04:55risk of infection if they're not treated quickly open fractures can lead to complications including
05:02internal bleeding nerve damage and even loss of limbs down here yes it is
05:08the accident has taken place at a royal mail sorting office where an ambulance crew is already with
05:19the patient hello hi hi uh uh hi i'm jas dr rep one of the uh for the ambulance service what's your name
05:29posty adam was sorting his round when he fell colleagues came to his aid calling 999 and tending
05:36to him until the ambulance arrived he's got good pedal pulse um no other injuries he's not in his
05:41head not gone unconscious um we're just running some paracetamol we haven't given anything else
05:48in addition to paracetamol the ambulance crew are giving adam entonox gas a form of pain relief that's
05:54frequently used in childbirth and trauma care the benefit of entonox it works really really well if you
06:00take it for a really long time okay because what you're doing is you're sucking it in blowing it out
06:04and having a break keep on taking it and load that pain relief for you and enable yourself look at your
06:09leg a little bit better as well although adam's in extreme pain fortunately the bone hasn't pierced
06:15the skin as he first thought adam can you wiggle your toes that's good and he can feel me touching
06:22however the bone is misaligned and the blood supply to his foot could be compromised just relax you've got
06:28to try and relax with it's best you can adam because when you tense it makes the pain worse
06:33it's important the team straighten adam's leg to prevent any complications
06:38you like the entonox do you know what they call it anybody know laughing gas
06:58the entonox gas might be masking adam's pain now but it won't be enough when dr rayett starts pulling
07:03the bones back into line
07:1025 miles away in oxford critical care paramedic matt jarman and dr liesel blom are on one of many
07:17late shifts they've done together you sometimes don't see one of the paramedics for a very long time
07:22but back to my day do every few months get a shift together probably more regular than that
07:27right yeah probably at least once a month with over 25 years of critical care medicine between them
07:32liesel and matt are one of the service's most experienced teams we're both really chill don't
07:37we like yeah you know there's no i don't really feel that much pressure no i'm pretty we're not a
07:43flexible team no no exactly and we're both on the same wavelength i think that means
07:47two and a half hours into their shift the 999 call center takes its 1838th call of the day
08:08so
08:13ambulance emergency is the patient breathing she wasn't but she is now is that her up in here
08:19yeah she's just had a seizure she's got an icd she has cardiac issues she's had cardiac arrest before
08:25how old is she it is she's five years old she's never had a seizure before she was fully
08:31sneezing eyes rolling in the back of her head okay she has two heart conditions she has long qt
08:37syndrome and she has stp is she breathing in and out in a regular pattern no what we would advise is
08:44that if she's not breathing in and out in a regular pattern at least one breath every 10 seconds then
08:49we do need to start the hospital she's breathing again she's breathing again she's okay and i've
08:54got to do it i can't deal with you if she's having a seizure don't move her okay is the ambulance on
09:03its way as i said the ambulance is on its way coming as quick as if possibly can she's not going to be
09:10the child has a known heart condition and is fitted with an icd an internal defibrillator it's
09:20designed to activate only when the heart is about to stop the child's life is in danger so as well as
09:27an ambulance the critical care team are urgently needed five-year-old fatigue following chest pain
09:34Liesel and matt are updated through phone messaging en route to the emergency
09:40yeah multiple seizures extensive cardiac history built-in icd five-year-old with an icd
09:49mostly we see them in adults not in children but it's basically if your heart um shorts out then it's
09:56got a built-in defibrillator that's like what we carry around and it will give the heart a little shock
10:01internally that's a little box bolt in under the skin now well this child is obviously known to
10:07cardiology the icd or implantable cardioverter defibrillator corrects dangerous heart rhythms
10:15by delivering electric shocks icd activated in 1836 activated well amina went off yeah rarely used in
10:26infants the icd was fitted as the child had previously suffered a cardiac arrest
10:32waller stating the patient's unresponsive chest is not rising and falling it's gone floppy mother trying
10:39to keep him awake the fact that he's um devices firing means his heart's gone into a funny rhythm
10:45uh which also means you know there's a risk that it's gonna stop
11:04in oxfordshire never mouth off or two on scene they're a paraeca crew so literally seven minutes ago
11:14dr leisel and critical care paramedic matt are en route to a five-year-old who suffered multiple
11:19seizures and stopped breathing there's that ambulance let's leave it here for a moment we'll
11:25see what's going on a local ambulance crew were quickly on scene and have managed to stabilize the
11:33child let me just step on hi you guys leisel and matt from the air ambulance hello how are we doing
11:39hello hi this is rummy rummy that's gorgeous i bought that i know they brief leisel and matt on
11:47their findings so far so rummy five-year-old who has an icd fitted due to long qt type 3 and svt
11:56okay um has had two seizures and then after each seizure her icd has gone off as rummy has two
12:04serious heart conditions and an implanted defibrillator they need to be sure she remains
12:08stable and doesn't deteriorate she's got a fever of 38.5 okay a febrile seizure is a convulsion
12:17triggered by a high temperature to help in their treatment of rummy dr leisel needs more information
12:23from mom kelly how long were the seizures each they were less than a minute okay and then stopped by
12:29themselves the first one i can't actually say whether it was it's all right she was actually
12:32sat behind me oh um and i heard her like chasing on her tongue okay but the second one was definitely
12:39less than a minute okay the fact that rummy's internal defibrillator shocked her twice
12:44suggests that her heart had stopped beating they were quite close together she was stretched right out
12:50back arched her eyes were wide open bulging with a tear falling down she has had history of um so
12:57she's had cardiac arrest she is what age was she then she was one and a half so um arrhythmia that's
13:04when we found out that she's okay okay um so she has her icd she has had a few episodes of like
13:10sudden collapse that they thought was low blood sugars okay she has had uh like sickness and diarrhea
13:16for 24 hours but even with the temperature she's never never never and how much has she been
13:21drinking um she's been sipping water and i have put dirolite in it fabulous well done how many kids
13:28have you got i've got nine she's well prepared six of my own and then i'm looking after an extra three
13:34yes with rummy in a potentially life-threatening condition they want to get her to hospital as soon as
13:40they can have you got all her meds yeah she's doing her medicine here which one is what's that it looks
13:48probably like we're gonna need it yeah so what we're gonna do if you guys are happy we'll jump on
13:53board and we'll get to the john rathcliffe perfect and we'll get all our kids on board as well just in
13:59case why don't you get on board and get her flaconite yeah and then have you got her drugs in the bag ready
14:05to go as well you are so well prepared i love it uh let me just gonna help matt get the kit
14:13peace bag if rummy suffers another arrest the critical care team's unrivaled life-saving
14:19skills will be crucial medical please it's the air ambulance coming by road on november alpha 442
14:26due to the seriousness of rummy's condition dr liesel calls the dispatch desk to alert the hospital in
14:32advance i've got a five-year-old girl with a known cardiac history who's had two seizures today
14:41she's got an icd that fired at the same time latest obs at the moment i've got pulse is quite irregular
14:49ranging from 90 to 150 sets of 98 gcs is 15
14:57she had chest pain at six o'clock when just prior to the first seizure currently she's calm and stable
15:07we'll see you there cheers bye-bye
15:15pop a little reading thingy in your ear okay
15:18after close monitoring throughout the journey the team safely deliver rummy to oxford's john
15:25radcliffe hospital i'm going to let you drive because i'm a terrible bed driver
15:32although she's stable now rummy will undergo a thorough investigation
15:37to find out exactly why her heart stopped beating
15:50for 26 years thames valley air ambulance charity has been responding to code red emergencies
15:56delivering advanced medical care to a population of around 2 million people all right swin's drivers
16:02all left thoracotomy thoracotomy it's early morning and dr laura douglas beverage and critical care
16:11paramedic neil plant who's been with the service since its inception are starting a 10-hour shift
16:23i love working with neil he's very good fun he's very experienced and he keeps me laughing a lot
16:29humor is integral to us coping you know and if you don't do this job then you might not understand
16:36it but it is just a coping mechanism the reality of what we're dealing with is it's often very intense
16:42very emotionally challenging very psychologically heavy um so having humor is a bit of a way to to offset that
16:58the
17:09ambulance margin 2 patient breathing yeah the patient's breathing at the moment he's just
17:13the pain okay okay
17:17mom how old is the patient so we do have an ambulance on their way reports of the farm worker falling from
17:40a trailer means neil and laura's advanced medical skills could be needed and quickly 16 year old
17:48on a farm was approximately five meter full uh has landed apparently in a ditch has got head and arm
17:55injuries uh there's a crew on scene doing an initially primary assessment 50 of all fatalities in the
18:05workplace are due to falls from height and life-threatening injuries can include damage to vital organs
18:11including the brain so this patient's a a young man who's had quite a significant fall is what we've
18:18been given so far we have to make sure we're being cautious of any uh injury to the to the spine
18:24potentially we're thinking about any injury to the brain and what measures we might need to take to
18:29protect his brain then we have to just make sure that we're not being falsely reassured by an injury
18:35that they're just less aware of because of the pain elsewhere so we still would have a fairly low
18:40threshold for being cautious about protecting someone's neck
18:47it takes the critical care team 11 minutes to arrive at the scene
18:51where an ambulance crew are already in attendance hello there hello you all right thank you guys
18:59robin he is 16 yeah he was on a trailer it was moving in that direction the connection between the
19:06forklift and the trailer has gone loose that it's gone into the ground 16 year old robin works on his
19:12family's farm and was on the trailer when the hitch broke plunging him over 10 feet to the ground
19:18the left arm is the main concern obviously it brought me to the top pain at the elbow the pressure
19:24was a 90 to 97 systolic and that's why we wanted some better pain relief okay weren't getting on too
19:29well with the entonox the ambulance crew have administered an intravenous infusion of paracetamol
19:35and given robin entonox gas a 50 50 mix of nitrous oxide and oxygen often used as an initial pain
19:42reliever at a scene i understand you've got this injury to your arm but with robin not responding well to the
19:47gas and air the ambulance crew asked for the critical care team to help with their advanced
19:52medical skills and stronger pain relief any pain anywhere else at all my my mouth hurts but it's
19:58fine okay and when you fell so you when did you kind of injure around your face you're not sure
20:08do you do you remember falling the first time you hurt your arm down my arm was broken like i felt it
20:13it's moving in my in my skin sure okay okay i know it's not a very nice feeling the ambulance crew
20:20have already checked there's no spinal damage so laura ensures no other serious injuries are being
20:26masked by the pain in robin's arm any pain when you're moving your neck at all lovely let me just
20:31have a gentle feel any pain over the top there no it does feel like fat though okay it's a little bit
20:37swollen perhaps any pain when i'm pressing down under the jaw there no okay what about over the side
20:45and across that front section
20:48anything going down over the top no can you open your jaw nice and wide for me
20:53look i'm just gonna have a quick look inside and you mentioned that your teeth felt a bit strange
20:57i just thought fortunately robin seems to have avoided serious injury to his head and face
21:04but his arm needs attention do you mind let us have a little look at this arm you can look babe
21:09i'm not going to prod up there where it's sewn feel me touch on this side lovely stuff on on this side
21:16laura has to check for tingling sensations or numbness that could indicate potential nerve damage
21:21alongside the fracture can you give my hands a good squeeze before any further treatment can be done
21:31at the royal mail sorting office in aylesbury your blood pressure moment's a little bit sky high
21:36is that normal for you dr jazz rayett and critical care paramedic lisa brown
21:41are treating posty adam whose leg is badly broken after a fall
21:45can you just flick my leg a little bit more with a risk of internal bleeding and nerve damage adam's
21:50bone needs straightening before they can move him is that a little bit more support or is that worse
21:56that's better it's an agonizing procedure so the first stage is to control his pain adam you keep
22:03doing what you're doing but what i'm going to give you is i'm going to hold it in front of your face i'm
22:06going to give you this okay it's our green whistle it's an anesthetic type drug it works a lot more
22:12effectively than the entonox okay and i just confirm you've got no allergies and no problems
22:17with your kidneys that you're aware of brilliant now what you need to do is hold this okay you take
22:24exactly the same to the entonox but what i want you to do keep this in your mouth breathe it in and
22:29breathe it back out through the chamber okay penthrox omethoxyflurane is an extremely potent and
22:37fast-acting form of pain relief it will make you feel very light-headed a little bit sleepy and it's
22:41going to work a lot better than the entonox it has got a horrible taste so give it a go adam adam
22:47so what you need to do six really big breaths in and out so fill up your lungs fully and then
22:52breathe out and then breathe normally after that okay i know the taste isn't nice adam but
22:59it's the effect of the drug that's going to help you okay good man yeah yeah keep going well done
23:07they're going to do your leg yeah you're going to need this yeah you're going to want this
23:11is it the taste office first aider tracy is among colleagues rallying around adam to offer their
23:17support keep going keep using it keep going to really breathe it in yeah yeah keep going keep going
23:28don't worry about what everyone else is doing just listen to us and let them do what they're going to
23:32do i don't carry on using it because every time you come off it's going to wear off very quickly
23:40the critical care team is concerned that adam isn't inhaling enough of the gas to control his pain
23:45um have you got any morphine yeah give him some more yeah give him a little bit okay how much do you
23:52want him to have um just give him five start with adam adam look at me darling did you prefer the other
23:57one yeah let me give you the other one right put your head there we're just going to give you some
24:03medication into your arm yeah you're fine they just need to get the drugs in your system to stop the pain
24:08okay right yes have some laughing gas suck away on that if it isn't straight and soon adam's leg is at
24:17risk of permanent damage but until his pain is under control the critical care team can't safely move him
24:32in aylesbury so if you take four really big breaths in and out critical care paramedic
24:38lisa brown and dr jaz rayett are trying to get posty adam's pain relief under control with a
24:44cocktail of morphine and enternox gas so they can straighten his badly broken ankle what are you
24:52worried about adam nothing and more what exactly are we waiting for at the moment so we're just waiting
24:59to get you to a good place before we can strap your leg into a splint okay so that's all we're waiting
25:03for we need you to relax because it's going to hurt yeah adam i need you to keep using the pain relief
25:10and then i can yeah reduce your ankle head down if you keep coming up i can't right so tracy's going
25:16to tell you to keep on breathing okay and a good five minutes of deep breaths of that keep that in your
25:24mouth breathe in and out just in and out all the time yeah just keep breathing in and out that is
25:31brilliant yeah right adam keep going we're going to we're going to make your leg straight now so keep
25:37taking the gas big deep breath well done the increased pain relief has taken effect and dr rayett can
25:44attempt to realign the bones in adam's leg and just try and relax yourself down well done that's it
25:51that's it that's it all right fantastic brilliant that's it don't breathe breathe breathe it's all right
26:01all right it's okay it's okay we've got you yeah we've got you okay okay that's it just relax relax
26:08okay okay well done yeah yeah that's the worst of it adam your leg's nice and straight okay
26:16before he can be moved adam's leg will need to be immobilized right adam open your eyes well done
26:22how are you doing well done good all right talk to me you all right adam hang on there's about four
26:31people no one seven people talking to me now 25 people talking to me now oh just me and just tracy
26:39yeah adam just pop your leg down for me relax let's go let go i don't think i've seen anybody
26:45experience sentinox as greatly as you absolutely brilliant okay my legs adam if you need to take it
26:54take it okay but don't take it if you don't need to it's like a comfort like yeah yeah okay i'll give
27:01me that with his leg secured in a vacuum splint adam can be loaded onto a stretcher so adam what we
27:09need you to do we're going to help you to stand put all your weight into this good leg here we're going
27:13to hold that leg we're going to go on three might be a little bit uncomfortable luckily the combination
27:18of morphine and entonox has adam in high spirits okay we'll do one of those tres if you want to
27:24go ahead what would you like one time try okay right on just today brilliant well done okay good leg up
27:39as adam's condition is stable he can be left in the hands of the ambulance crew uh so we're going
27:49to pop you up to state mandeville hospital and they'll see you over there okay freeing up the
27:55critical care team to respond to the next emergency call he was certainly interacting with his colleagues
28:02and with us and i think that his demeanor made it a little bit easier for us to communicate with him
28:08explain what we're going to do and it also helped with his pain and management of his injury at the
28:11same time as well so job well done and he's no longer required any pain relief and the plan is to
28:17go to state management hospital for x-ray
28:25every year the thames valley air ambulance responds to over 1200 cardiac arrest calls and the food
28:32right here was lay on the floor okay they account for more than a third of its emergencies
28:38brain have you got any chest pain at the moment out of hospital the chances of surviving a cardiac
28:43arrest are just one in ten i can't feel a pulse all right let's get back to here but with early access
28:48to a defibrillator those odds are greatly increased
29:05good morning and it's just 111 what's the reason for your call today i uh found myself at work with an
29:11an irregular heartbeat shortness of breath and pain from my chest and my neck
29:17um i have one of my colleagues nearby have you lost any blood no i haven't you mentioned chest pain
29:25shortness of breath irregular heartbeat which one is giving you the most concern probably the shortness of
29:32breath and do you have any pain in the chest or upper back i have a very slight pain in sort of the
29:38center of my chest and have you got palpitations right now yes i mean it's going fairly quickly
29:43and the left side is going sort of a beat or two just before the right side okay the information
29:51will be passed on to the ambulance service who will attempt to dispatch an ambulance to your location
29:55all right
30:00heart palpitations can occur when the heart's electrical signals malfunction
30:05thames valley air ambulance crews carry medications and cutting edge kit to treat these problems
30:10so dr tim wait and critical care paramedic emma gray are dispatched
30:15it's a 22-year-old male pulse vt pulse rate 200 odd um he's very shut down the crew are quite worried
30:22um they're just trying to get a line in there they're coming okay cool uh so we're going to a 22 year old
30:29man uh who's reported to be in an abnormal fast heart rhythm and there's there's been some concerns
30:37passed from the ambulance crew that he looks quite unwell um potentially with a with a low blood
30:42pressure and what we call a kind of shocked state a very fast and irregular heartbeat is a potentially
30:49life-threatening combination if left untreated it can lead to catastrophic consequences the kind of
30:56obvious consideration is whether he whether he needs electrical cardioversion whether he needs
31:00some sedation and an electrical shock from a defibrillator to get him back into a normal heart
31:06rhythm and it sounds like he's shut down and they're worried about him so i feel like our default should
31:12be sedate and cardiovert sedation is going to be moderately high risk the patient was on his way to work
31:21at a garden center when he began to feel unwell presumably the dma's there somewhere after calling
31:27111 a local ambulance crew was dispatched and he's already on scene
31:36oh have they brilliant hello hello
31:38this is luke um howdy hey how are you doing around kind of 10 to 9 he was cycling into work
31:47had started to have palpitations on the left side of his chest with tightness um shortness of
31:52breath that's persisted for the last kind of three hours okay wow we're going to get a full heart
31:58tracing luke which will be loads of stickies on your chest yeah that's fine 22 year old luke works
32:03as a sales assistant at the garden center to assess his heart the team are carrying out a tracing to
32:09record the electrical activity do you have any medical problems normally excellent any medicines
32:15you take regularly um i take loratide for my hay fever that's it okay nothing else and you're just
32:19cycling into work and yeah literally woke up fine showered everything like that started cycling got to
32:25the roundabout just down the road from here and chest felt weird and you've never experienced that
32:29before nothing first time uncommon in someone of luke's age chest pain and unusual sensations can
32:37indicate a serious heart problem which without urgent treatment could lead to cardiac arrest
32:43i think there's broadly speaking two directions that we might go with this and it will depend a
32:47bit on the heart tracing um the first is we give you some medicines to see if they make your heart go
32:52back into a normal rhythm um the second which we might need to do is we give you some sleepy medicine
32:57so you're sleepy and sedated and then we zap you with a defibrillator and zap you back into a normal
33:02rhythm essentially who's your next of kin by the way my mom and dad are just outside yeah thank you
33:07cheers i think we have to presume that's a vt don't we like i don't i think you'd be you'd be brave to
33:17call that anything else the heart trace shows ventricular tachycardia or vt meaning a problem with
33:23the electrical signals in luke's heart are causing it to beat in an abnormal rhythm okay shall we get
33:30the ultrasound put a big line into a big vein hopefully and then load with amiodra in over 20
33:36minutes no problem instead of using a defibrillator to shock and reset the rhythm and rate of luke's heart
33:43tim is opting for a less invasive approach a powerful intravenous medication do you mind would
33:49you be able to hold the screen about that that's really helpful thanks just saves me sort of piling
33:54get more stuff on top of um on top of luke and just kind of look around for a good vein luke and then
33:59when we find one we'll um hopefully put a cannula in it for you well these guys have got a bit more
34:07gadgets than we do yeah we use our toys speed is of the essence so tim is using a portable ultrasound
34:15scanner to find a vein in luke's arm bring that arm a little straight there if that's all right thanks
34:20man that's perfect yeah well done so he can quickly insert a cannula and administer the medication luke
34:27needs it's broken around there coming i'm going to press really hard to try and stop it bleeding we've got the end of it
34:40in a matter of seconds the cannula is successfully in good um that should be dressing in there
34:47outside emma updates luke's mum his heart's still gone way too fast but his blood pressure's good and
34:54all that kind of stuff so we are just going to give him a medication to help hopefully to bring
34:59his heart back to a normal rate yeah we've got several different things we can do to help him
35:04here so we're starting at the least invasive yeah and see if we can do it but there's many other options
35:10all right so you're starting the things that you would maybe would have been done in in hospital
35:14we're doing it now so yeah that's why we're not rushing off all right but if you've got any questions
35:17in the meantime just shout okay if luke doesn't respond to the medication then the critical
35:23care team will have no option other than to shock his heart with a defibrillator
35:46we'll do one more blood pressure and then we'll give you something a bit stronger for the pain if
35:49you're not getting on with that gas and air in a farmer's field near windsor critical care paramedic
35:55neil and dr laura are assessing 16 year old farm worker robin who's fallen 10 feet from a trailer
36:02he's in pain with a fractured arm and facial cuts from the fall if you're not joking on the entonox we
36:08can lose that one laura has checked for nerve damage and fortunately robin appears to have normal
36:14sensation so now she can treat his arm is it humorous the fracture yeah a humorous fracture is a break
36:22to the bone in the upper arm okay i wonder if a sling might be a bit more comfortable for him than that
36:26the fact that when we got here we were like this yeah normally the way a humoral fracture the weight
36:32of the arm's quite good so just a yeah yeah trying to bandage yeah it's just doing his blood pressure so
36:38just wait two seconds just because you won't go in time although it's well supported now robin's
36:44arm will need to be properly immobilized in a sling for the trip to hospital what we'll do is we'll
36:49do your blood pressure we'll get you on the trolley and then we can look to get your arm in a bit of a
36:53better sort of position something a bit more comfortable where are we going we'll just budge this
37:01out the way and i can take the weight of that arm it will feel a little bit strange as we're starting
37:05to get you moving okay but i'll support your arm as much as possible and we'll very much take our
37:10time no rush okay grand you're doing really well i'll just take that on there now you know when you're
37:16ready do you mind just moving that bag out there laura and neil are satisfied that robin can be safely
37:22moved shall we just stand up first that's it there we go then you'll be here if you just turn yourself
37:30around and come out this way you got that on i've got you so don't worry about like and then uh yeah
37:36just sit your bottom on there that's it put your bum right back into the back of the trolley okay
37:42whenever you're comfortable just pop your other leg up whilst neil moves robin to the ambulance laura
37:48talks to his mum who's arrived at the scene injuries but he has got what looks like a break to the top
37:53part of his arm from our side of things otherwise in terms of his heart rate his blood pressure
37:58everything else is looking lovely and settled yeah absolutely obviously he has still had a
38:03significant bump to the head so he'll need to be observed for a period of time yeah and the wound
38:08you'll need to have x-rays of his arm on the stretcher neil can get a better look at robin's arm
38:14so we've got the sling ready we're just going to remove that there you go that's you've just got some
38:21abrasions on there and so is it broken so we think you might break this bone your humerus
38:27humerus bone this top bone here which which is fine because they heal quite easily really
38:33all right darling
38:36you all right there buddy yeah confident that robin is stable
38:44rob we are going to leave you in the team's very capable hands like mum's going to come with you as
38:48well but wish you all the best all right darling all right thank you very much laura's happy that no
38:55further critical care is needed so the ambulance crew are taking robin to wexham park hospital for x-rays
39:02and further treatment
39:07at a garden center in wokingham is that right save me dropping dr tim wait and critical care paramedic
39:14emma gray are treating 22 year old sales assistant luke who has a potentially life-threatening fast and
39:21irregular heartbeat i think you're sort of well enough if i could put it that way that that we shouldn't be
39:26zapping you with a defibrillator um let's try with the medicines we'll spend the time while the
39:32medicines are trickling in transporting you up to the royal barks hospital if the medicines don't agree
39:38with you or if things get worse on the way we can give you some sleepy medicines pull over and um and
39:44go back to sort of plan a so to speak and use the defibrillator but once we've got amiodarone running
39:49there's probably little reason to stay on scene a powerful and potentially life-saving drug the
39:55amiodarone should slow down the overactive electrical signals in luke's heart yeah so
40:01ladies in i think we give 300 of amio and we run it in in a mini bag of saline and we're about what
40:0920 minutes from the royal barks and we want our amio going in over about 20 30 minutes if successful
40:15the drug will restore a stable rhythm to luke's heart without shocking him with a defibrillator
40:20why don't we start amiodarone pack up gentle slow time steady blues up to the royal barks
40:27and then that will will sort of use the interval of time while that's running to move him to hospital
40:31okay and then he can always have a sedation and cardioversion if he doesn't respond to
40:35pharmacological management lovely we could always pull over can't we yeah exactly let me just go and
40:41speak to mum i'm going to tell her yeah that would be that would be brilliant so we are um going to
40:47give him the medication whilst moving on the way to hospital he's not got any worse or anything it's
40:51just that we can do it on rate so that's what we're going to do if given too quickly the amiodarone could
40:57dangerously lower luke's blood pressure so tim's administering it slowly with saline this one it
41:04sometimes can cause a bit of irritation in the vein but it doesn't normally instead of when it's diluted and
41:08it's in the initial oh it's initial sort of dosing wonderful you're a very calm cool customer luke
41:15yeah there's no point about something when there's nothing i can do about it i like you
41:21i like your style i'm just going to put your seat belts on
41:27there we go so the intent is for this to trickle in over about 20 to 30 minutes just keep an eye on it
41:34look appears stable but with a possibility that his heart may still need to be shocked tim and emma
41:42travel with him we are on november alpha 410 uh with an eta of approximately 10 minutes one zero minutes
41:52tim puts in a call to the dispatch desk to alert the hospital to their imminent arrival
41:57Bring in a 22-year-old male with onset of haemodynamically stable pulsed VT at approximately 9 a.m. this morning.
42:08He's got a heart rate currently of 167, so we've given him 300 amiodarone, which is just finishing now.
42:16But I think the outcome of that strategy is going to be we're likely to arrive with a man who will need a procedural sedation and a cardioversion.
42:22As serious as the situation is, Luke's maintaining his cool and looking to the future.
42:29I'm meant to be going on a trip to Boston. Would anything like this cause any sort of issues?
42:35I would say take this one thing at a time, work out what's going on first.
42:38Yeah, absolutely.
42:39Yeah, it's probably just worth double-checking the temperature and making sure you've got it as well in America.
42:44Absolutely.
42:45On arrival at hospital, with his heart rate still dangerously high, Luke's handed over to the cardiac team.
42:52Leaving Dr. Tim and critical care paramedic Emma free for the next emergency call.
42:59Yes, sir.
43:01Yes, sir.
43:02Yes.
43:03Good morning.
43:04Yes, sir.
43:05Yes.
43:05That's right.
43:08Good morning.
43:08Good morning, everyone.
43:22ersch ahead把 thisalamus袋 Elle played him and together with the起來 of August zombies.
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