- 2 weeks ago
Ambulance Code Red S04E01
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Short filmTranscript
00:00In the intense world of medical emergencies...
00:03Is the patient breathing?
00:05No! She's wrong!
00:07There's nothing more extreme...
00:09These lips are blue.
00:11...than an immediate threat to life.
00:13Massive, massive burns. Skin peeling.
00:15Responding to the most severe 999 calls.
00:19So this 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 vehicle.
00:29..are at the front line delivering life-saving medical treatments.
00:33The big decision is for us whether we need to put a tube in,
00:35again, to protect us that way or not.
00:37Working day...
00:38We're going to give you some strong medication.
00:40..and night.
00:41It should not hurt. It's a very good painkiller.
00:44Reacting to emergencies.
00:46You've been super brave, darling.
00:47The critical care teams...
00:49You've had a pretty big blow to the head.
00:51..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.
00:58..whenever...
00:59Do you think it's fast?
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...
01:08Put this up 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. You'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.
01:33Tonight, a five-year-old...
01:36..she's leaving again!
01:37..she's leaving again!
01:38..suffers multiple seizures with life-threatening implications.
01:42All are staining.
01:43The patient's unresponsive,
01:44and the chest is not rising and falling.
01:46..a farm worker is injured
01:48after plummeting ten feet from a trailer.
01:51A young man who's had quite a significant fall.
01:54The left arm is the main concern.
01:56We'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
02:03a potentially life-threatening heart condition.
02:05We zap you with a defibrillator
02:07and zap you back into a normal rhythm, essentially.
02:09And...
02:10Adam, look at me, darling.
02:12..a postman is treated
02:14after a serious fall in the sorting office.
02:16He's all right. He's all right. He's all right.
02:18He's all right. He's all right. He's all right.
02:20He's all right. He's all right.
02:26Thames Valley Air Ambulance Charity
02:28rely 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 asthma, COPD, a heart murmur.
02:40Thanks to the enhanced medical expertise
02:42of 34 doctors and 25 critical care paramedics.
02:46Where's all your pain?
02:48Oh!
02:49Which 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 seeing them.
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.
03:07I've got to find a 100% mask.
03:09signs of addiction.
03:20NO DECISION
03:23An ambulance emergency is the patient's breathing.
03:26Yeah. We've got a broken leg.
03:28Would he be able to speak to me directly and answer any of my questions at all?
03:31at all yeah i can pass the phone over hello are you the patient yeah i understand that you've
03:39injured your leg yeah and are you able to get up from the floor right now or are you stuck on the
03:45floor stuck 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 they'll call
03:56have categorized as a high priority just to confirm you've got somebody remaining with you until the
04:02ambulance 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
04:32looking 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 he can reduce the fracture
04:54with a high risk of infection if they're not treated quickly open fractures can lead to
05:00complications including internal bleeding nerve damage and even loss of limbs down here yes
05:13the accident has taken place at a royal mail sorting office where an ambulance crew is already with the
05:19the patient hello hello hi hi uh uh hello i'm drowse dr one of the uh doctors of the ambulance service
05:27what's your name no posty adam was sorting his round when he fell colleagues came to his aid
05:34calling 999 and tending to him until the ambulance arrived he's got good pedal pulse um no other
05:41injuries he's not in his head not gone unconscious um we're just running some paracetamol we haven't
05:45given everything else in addition to paracetamol the ambulance crew are giving adam entonox gas
05:52a form of pain relief that's frequently used in childbirth and trauma care the benefit of entonox
05:58it works really really well if you take it for a really long time okay because what you're doing
06:02is you're sucking it in blowing out and having a break keep on taking it and it'll load that pain
06:07relief for you and enable to have a look at your leg a little bit better as well although adam's in extreme
06:12pain fortunately the bone hasn't pierced the skin as he first thought adam can you wiggle your toes
06:19that's good and he can feel me touching thank you however the bone is misaligned and the blood supply
06:25to his foot could be compromised just relax you've got to try and relax with it's best you can adam
06:31because when you tense it makes pain worse it's important the team straighten adam's leg to prevent
06:37any complications you like the entonox do you know what they call it anybody know laughing gas
06:49the entonox gas might be masking adam's pain now but it won't be enough when dr reyett starts
07:03pulling the bones back into line
07:1025 miles away in oxford critical care paramedic matt jarman and dr liesel blom are on one of many late
07:17shifts they've done together you sometimes don't see one of the paramedics for a very long time but
07:22back to my time to every few months get a shift together probably more regular than that probably
07:27least once a month with over 25 years of critical care medicine between them bliesel and matt are one
07:34of the service's most experienced teams we're both really chill don't we yeah you know there's no i don't
07:40really feel that much pressure no i'm pretty we're not a special team no no exactly and we're both on
07:46the same wavelength i think that was two and a half hours into their shift the 999 call center takes its
07:57one thousand eight hundred and thirty-eight call of the day
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 seizing
08:32eyes rolling in the back of her head okay she has two heart conditions she has long qt syndrome and she
08:38has fct is she breathing in and out in a regular pattern no what we would advise is that if she's not
08:45breathing in and out in a regular pattern at least one breath every 10 seconds then we do need to
08:50start the patient she's breathing again she's breathing again okay i can't deal with you
08:59if she's having a fever don't move her okay is the ambulance on its way as i said the ambulance is
09:05on its way coming as quick as it possibly can she's not breathing
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 fitting following chest pain
09:34lizel and matt are updated through phone messaging en route to the emergency
09:40yeah multiple seizures extensive cardiac history
09:45built-in icd five-year-old with an icd mostly we see them in adults not in children
09:51but it's basically if your heart um shorts are not thin it's got a built-in defibrillator
09:58that like when we carry around and it will give the heart a little shock internally that's a little
10:03box built in under the skin now well this child is obviously known to cardiology
10:09the icd or implantable cardioverter defibrillator corrects dangerous heart rhythms by delivering
10:15electric shocks icd activated in 1836 it's activated
10:21um well i mean i went off yeah rarely used in infants the icd was fitted as the child had previously
10:30suffered a cardiac arrest all the stating the patient's unresponsive chest is not rising and falling
10:36it's gone floppy mother trying to keep him awake the fact that he's um devices firing means his heart's
10:44gone into a funny rhythm uh which also means you know there's a rest that is going to stop
11:05in oxfordshire never mouthful to on scene they're a para-eca 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
11:20seizures 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 hi there folks let me just step on hi you guys leisel and matt from the air ambulance hello
11:38how are we doing hello hi this is rummy rummy that's gorgeous i bought that i know they brief
11:46leisel and matt on their findings so far so rummy five-year-old who has an icd
11:53fitted due to long qt type 3 and svt okay um has had two seizures and then after each seizure
12:01her icd has gone off as rummy has two serious heart conditions and an implanted defibrillator
12:07they need to be sure she remains stable and doesn't deteriorate she's got a fever of 38.5
12:15a febrile seizure is a convulsion triggered by a high temperature
12:19to help in their treatment of rummy dr leisel needs more information from mum kelly
12:25how long were the seizures each they were less than a minute okay and then stopped by themselves
12:29that's when i can't actually say whether it was it's all right because she was actually sat behind
12:33me oh um and i heard her like chasing on her tongue okay but the second one was definitely less
12:39than 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
12:50out back arched her eyes were widened and bulging with a tear falling down she has had history of um
12:57so she's had cardiac arrest she is what age was she then she was one and a half so um arrhythmia
13:04that's when we found out that she okay okay um so she has her icd she has had a few episodes of
13:10like sudden collapse that they thought was low blood sugars okay she has had uh like sickness and
13:15diarrhea for 24 hours but even with the temperature she's never never no and how much has she been
13:21drinking um she's been sipping water and i have put diarrhea in it fabulous well done not really
13:27well done how many kids have you got i've got nine she's well prepared six of my own and then i'm
13:33looking after an extra three yes with rummy in a potentially life-threatening condition they want
13:38to get her to hospital as soon as they can have you got all her meds yeah she's due her medicine here
13:44which one is what's that it looks probably like we're gonna need it yeah so what we're gonna do
13:51if you guys are happy we'll jump on board and we'll get to the john rathcliffe and we'll get all
13:57our kids on board as well just in case why don't you get on board and get her flicker night yeah and
14:03then have you got her drugs in the bag ready to go as well they're all in that you are so well prepared
14:08we're all sorted i love it uh let me just gonna help matt get the kit peace bag if rummy suffers
14:15another arrest the critical care team's unrivaled life-saving skills will be crucial medical please
14:22it's the air ambulance coming by road on november alpha 442 due to the seriousness of rummy's condition
14:29dr liesel calls the dispatch desk to alert the hospital in advance i've got a five-year-old
14:35girl with a known cardiac history who's had two seizures today she's got an icd that fired at the
14:43same time latest obs at the moment i've got pulse is quite irregular ranging from 90 to 150 sets of 98
14:55gcs is 15. she had chest pain at six o'clock when just prior to the first seizure currently
15:04she's calm and stable we'll see you there cheers bye-bye
15:15i'm gonna pop a little reading thingy in your ear okay
15:20after close monitoring throughout the journey the team safely deliver rummy to oxford's john radcliffe
15:26hospital i'm gonna let you drive because i'm a terrible bed driver
15:30although she's stable now rummy will undergo a thorough investigation
15:37to find out exactly why her heart stopped beating
15:40for 26 years thames valley air ambulance charity has been responding to code red emergencies
15:56delivering advanced medical care to a population of around two million people
16:01all right syringe drivers all there thoracotomy thoracotomy other patches it's early morning
16:08and dr laura douglas beverage and critical care paramedic neil plant who's been with the
16:13service since its inception are starting a 10-hour shift
16:17i 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 it
16:36but 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
17:02the
17:09ambulance margin two patient breathing yeah the patient's breathing at the moment
17:13he's just been in the arm pain okay okay where's the pain
17:16where's the pain my arm help all in his arm has he injured his arm yeah he just kept the top of the trailer
17:25top of the trailer and he is there any heavy bleeding uh he's bleeding a bit from his mouth
17:29how old is the patient so we do have an ambulance on their way reports of the farm worker falling
17:40from a trailer means neil and laura's advanced medical skills could be needed and quickly 16 year
17:47old on a farm was approximately five meter full uh has landed apparently in a ditch has got head and arm
17:56injuries uh there's a crew on scene doing an initially primary assessment 50 of all fatalities
18:04in the workplace are due to falls from height and life-threatening injuries can include damage to vital
18:10organs including the brain so this patient's a a young man who's had quite a significant fall is what
18:17we've been 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 um 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
18:44it takes the critical care team 11 minutes to arrive at the scene where an ambulance crew are
18:53already in attendance hello there hello you all right thank you guys robin he is 16 yeah he was on
19:02a trailer it was moving in that direction the connection between the forklift and the trailer
19:07has got loose that it's gone into the ground 16 year old robin works on his family's farm and was
19:13on the trailer when the hitch broke plunging him over 10 feet to the ground the left arm is the main
19:21concern obviously it brought me to the top pain in the elbow the pressure was a 90 to 97 systolic and
19:26that's why we wanted some better pain relief okay weren't getting on too well with the end thoughts
19:30the ambulance crew have administered an intravenous infusion of paracetamol and given robin
19:35entonox gas a 50 50 mix of nitrous oxide and oxygen often used as an initial pain reliever at a scene
19:43i understand you've got this injury to your arm but with robin not responding well to the gas and
19:47air the ambulance crew asked for the critical care team to help with their advanced medical skills and
19:53stronger pain relief any pain anywhere else at all my mouth hurts but it's fine okay and when you fell
20:03so we when did you kind of injure around your face you're not sure do you do you remember falling the
20:09first time you hurt your arm down my arm was broken like i felt it it's moving in my in my skin sure okay
20:15it's not leaving all about okay i know it's not a very nice feeling the ambulance crew have already
20:21checked there's no spinal damage so laura ensures no other serious injuries are being masked by the
20:27pain in robin's arm any pain when you're moving your neck at all lovely let me just have a gentle
20:32feel any pain over the top there no it does feel like fat though okay it's a little bit swollen perhaps
20:38any pain when i'm pressing down under the jaw there no okay what about over the side
20:45and across that front section anything down over the top can you open your door nice and wide for
20:52me look i'm just gonna have a quick look inside and you mentioned that your teeth felt a bit strange
20:58i 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 there
21:09i'm not going to prod up there where it's sore feel me touch on this side lovely stuff around on
21:14this side good stuff laura has to check for tingling sensations or numbness that could indicate
21:20potential nerve damage alongside the fracture can you give my hands a good squeeze before any further
21:26treatment can be done at the royal mail sorting office in aylesbury your blood pressure moment's
21:35a little bit sky high is 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 you need to flick my leg a little bit more
21:47with a risk of internal bleeding and nerve damage adam's bone needs straightening before they can move him
21:53is that a little bit more support or is that worse that's better it's an agonizing procedure
21:59so the first stage is to control his pain adam you keep doing what you're doing but what i'm going
22:04to give you is i'm going to hold it in front of your face i'm going to give you this okay it's our green
22:08whistle it's an anesthetic type drug it works a lot more effectively than the enternox okay and i just
22:14confirmed you've got no allergies and no problems with your kidneys that you're aware of brilliant
22:21now what you need to do is hold this okay you take it exactly the same to do the enternox but
22:26what i want you to do keep this in your mouth breathe it in and breathe it back out through the
22:31chamber okay penthox on methoxy fluorine is an extremely potent and fast-acting form of pain
22:38relief it will make you feel very light-headed and a little bit sleepy and it's going to work a lot
22:42better than the enternox it has got a horrible taste but give it a go adam adam so what you need
22:48to do six really big breaths in and out so fill up your lungs fully and then breathe out and then
22:53breathe normally after that okay i know the taste isn't nice adam but it's the effect of the drug that's
23:00going to help you okay good man yeah yeah keep going well done do your leg yeah you're going to
23:10need this yeah you're going to want this office first aider tracy is among colleagues rallying
23:15around adam to offer their support keep going keep using it keep going to really breathe it in
23:24yeah yeah keep going keep going don't worry about what everyone else is doing just listen to us
23:31and let them do what they're going to do yeah adam carry on using it because every time you come off
23:37it's going to wear off very quickly all right yeah the critical care team is concerned that adam
23:43isn't inhaling enough of the gas to control his pain um have you got any morphine you want to get
23:48yeah give him some coffee yeah give him a little bit how much do you want him to have um just give
23:54him five to start with adam adam look at me darling did you prefer the other one yeah let me give you
23:59the other one right put your head there we're just going to give you some medication into your arm yeah
24:04you're fine they just need to get the drugs in your system to stop the pain
24:08yeah have some laughing gas and 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
24:24in alesbury so if you take four really big breaths in and out critical care paramedic lisa brown
24:39and dr jazz rayett are trying to get posty adam's pain relief under control with a cocktail of morphine
24:45and enter nox gas so they can straighten his badly broken ankle what you worried about adam nothing
24:55and more what exactly are we waiting for at the moment so we're just waiting to get into a good
25:00place before we can strap your leg into a splint okay so that's all we're waiting for we need you
25:04to relax because it's gonna hurt yeah adam i need you to keep using the pain relief and then i can
25:10yeah reduce your ankle head down if you keep coming up i can't right so tracy's going to tell
25:17you 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
25:32brilliant yeah right adam keep going we're going to we're going to make your leg straight now to keep
25:37taking the gas big deep breath wow 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 adam fantastic brilliant big breath that's it don't squeeze breathe breathe
26:00all right it's all right it's all right it's all right it's all right it's all right okay we've got you
26:04yeah we've got you okay it's all right okay that's it just relax okay okay relax relax okay wow
26:10damn yeah yeah that's the work of it adam your leg's nice and straight okay okay well done before he can be
26:17moved Adam's leg will need to be immobilized Adam up your eyes well done
26:22how are you doing I'm done good all right talk to me
26:29I think on there's about four people know one seven people talking about 25
26:35people talking to me now just pop your leg down for me relax I don't think I've
26:45seen anybody experience center Knox is great news you if you need to take it
26:54take it okay but don't take it if you don't need it yeah yeah with his legs
27:04secured in a vacuum splint Adam can be loaded onto a stretcher so Adam what we
27:09need you to do we're gonna have you to stand for all your weight into this good
27:12leg here we're going to hold that leg we're going to go on three might be a
27:15little bit uncomfortable luckily the combination of morphine and Entenox has
27:19Adam in high spirits okay we do honor those friends if you want to go
27:25one two three what would you like one two three three one two three okay right
27:31one two three three brilliant well done well done okay good leg up
27:39as Adam's condition is stable he can be left in the hands of the ambulance crew
27:49so we're gonna pop you up to State Mandeville Hospital they'll see you over there AK freeing up
27:55the critical care team to respond to the next emergency call he was certainly interacting with
28:01his colleagues and with us and I think that his demeanor made it a little bit easier for us to
28:06communicate with him explain what we're going to do and it also helped with his pain and management of
28:11his injury at the same time as well so job well done and he's no longer quite any pain relief and
28:17the plan is to go to State Mandeville Hospital for excellent every year the Thames Valley air
28:27ambulance responds to over 1,200 cardiac arrest calls and if we've got here was lay on the floor
28:33okay they account for more than a third of its emergencies brain have you got any chest pain at
28:39the moment out of hospital the chances of surviving a cardiac arrest are just one in ten I can't feel a
28:45pulse all right let's get back to here but with early access to a defibrillator those odds are greatly
28:51increased I found myself at work with an irregular heartbeat shortness of breath and pain from my chest
29:16and my neck I have one of my colleagues nearby have you lost any blood no I haven't you mentioned
29:25chest pain shortness of breath irregular heartbeat which one is giving you the most concern probably
29:31the shortness of breath and do you have any pain in the chest or upper back I have a very slight pain
29:37in sort of the center of my chest and have you got palpitations right now yes I mean it's going fairly
29:43quickly and the left side is going so 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
29:54all right heart palpitations can occur when the heart's electrical signals malfunction Thames Valley air
30:05ambulance crews carry medications and cutting-edge kit to treat these problems so dr. Tim wait and critical
30:12care paramedic Emma gray are dispatched okay cool so we're going to 22 year olds man he's reported to
30:32be in an abnormal fast heart rhythm and there's been some concerns passed from the ambulance crew that he
30:39looks quite unwell and potentially with a with a low blood pressure and what we call a kind of shocked
30:44state a very fast and irregular heartbeat is a potentially life-threatening combination if left
30:51untreated it can lead to catastrophic consequences the kind of obvious consideration is whether he whether
30:58he needs electrical cardioversion whether he needs a some sedation and an electrical shock from a defibrillates to
31:04get him back into a normal heart rhythm and it sounds like he's shut down and they're worried about
31:09him so I feel like our default should be sedate and cardiovert sedation is going to be moderately high risk
31:18the patient was on his way to work at a garden center when he began to feel unwell
31:24presumably the dma system after calling 111 a local ambulance crew was dispatched and he's already on
31:32scene I have a brilliant hey how are you doing around kind of 10 to 9 he was cycling into work had
31:48started palpitations on the left side of his chest with tightness um shortness of breath that's
31:53persisted for the last kind of three hours okay wow we're gonna get a full heart tracing Luke which
31:59be loads of stickies on your chest 22 year old Luke works as a sales assistant at the garden center to
32:07assess his heart the team are carrying out a tracing to record the electrical activity do you have any
32:12medical problems normally excellent any medicines you take regularly okay nothing else and you're
32:19just cycling into work can't actually woke up fine showered everything like that started cycling got
32:25to the roundabout just down the road from here and chest felt weird and you've never experienced that
32:29before uncommon in someone of Luke's age chest pain and unusual sensations can indicate a serious heart
32:38problem which without urgent treatment could lead to cardiac arrest I think there's this broadly
32:44speaking two directions that we might go with this and it will depend a bit on the heart tracing the
32:49first is we give you some medicines to see if they make your heart go back into a normal rhythm
32:53the second which we might need to do is we give you some sleepy medicine so you're sleepy and sedated and
32:59then we zap you with a defibrillator and zap you back into a normal rhythm essentially who's here next
33:04to Kim by the way mom and dad are just outside thank you cheers I think we have to presume that's a VT
33:12don't we like I don't I think you'd be brave to call that anything else the heart trace shows ventricular
33:20tachycardia or VT meaning a problem with the electrical signals in Luke's heart are causing it to beat in an
33:27abnormal rhythm okay shall we get the ultrasound put a big line into a big vein hopefully and then
33:35load with amiodarone over 20 minutes no problem instead of using a defibrillator to shock and reset
33:41the rhythm and rate of Luke's heart Tim is opting for a less invasive approach a powerful intravenous
33:48medication do you mind would you be able to hold the screen about that that's really helpful thanks
33:52just saves me sort of piling get more stuff on top of um on top of Luke and you can look around for a
33:58good vein Luke and then when we find one we'll um hopefully put a cannula in it for you
34:06well these guys have got a bit more gadgets than we do yeah we use our toys speed is of the essence so
34:14Tim is using a portable ultrasound scanner to find a vein in Luke's arm bring that arm a little straight
34:19there if that's all right thanks man that's perfect yeah well done so he can quickly insert a cannula and
34:26administer the medication Luke needs broken your arm there come in I'm gonna press really hard to try
34:32and stop it bleeding I've got the end of it in a matter of seconds the cannula is successfully in
34:43good um I should go dressing in there outside Emma updates Luke's mum heart's still gone way too
34:52glass but his blood pressure is good and all that kind of stuff so we are just going to give him a
34:57medication to help to hopefully to bring his heart back to a normal rate yeah we've got several
35:02different things we can do to help him here so we're starting at the least invasive yeah and see
35:08if we can do it but there's many other options all right so you're starting the things that you would
35:12maybe would have been done in hospital we're doing it now so yeah that's why we're not rushing off all
35:16right but if you've got any questions in the meantime just out okay if Luke doesn't respond to the
35:21medication then the critical care team will have no option other than to shock his heart with a
35:27defibrillator we'll do one more blood pressure and then we'll give you something a bit stronger for
35:49pain if you're not getting on with that gas in there in a farmer's field near Windsor critical
35:55care paramedic Neil and dr. Laura are assessing 16 year old farm worker Robin who's fallen 10 feet from
36:01a trailer he's in pain with a fractured arm and facial cuts from the fall if you're not joking on
36:07the internet so we can lose that one Laura has checked for nerve damage unfortunately Robin appears to have
36:13normal sensation so now she can treat his arm is it humorous the fracture yeah a humorous fracture is
36:21a break to the bone in the upper arm okay wonder if a sling might be a bit more comfortable for him
36:26the fact that when we got here we were like normally the way a humoral fracture the weight of the arms quite
36:33good so just a yeah yeah triangle bandage yeah it's just doing his blood pressure so just wait
36:38it's just because you won't go in time although it's well supported now Robin's arm will need to
36:44be properly immobilized in a sling for the trip to hospital what we'll do is we'll do your blood
36:49pressure we'll get you on the trolley and then we can look to get your arm in a bit of a better sort of
36:54position it's not a bit more comfortable where are we going we'll just budge this out the way and I
37:02can take the weight of that arm it will feel a little bit strange as we're starting to get you
37:06moving okay but I'll support your arm as much as possible and we'll very much take our time no rush
37:11okay grand you're doing really well I'll just take that on there now you know when you're ready to
37:16mind just moving that bag out there Laura and Neil are satisfied that Robin can be safely moved
37:22shall we just stand up first that's it then you'll be here if you just turn yourself around and come
37:30out this way I've got you so don't worry about like and then yeah just sit your bottom on there that's
37:39it put your bum right back into the back of the trolley okay whenever you're comfortable just pop
37:43your other leg up whilst Neil moves Robin to the ambulance Laura talks to his mum who's arrived at
37:50the scene injuries but he has got what looks like a break to the top part of his arm from our side
37:55of things otherwise in terms of his heart rate his blood pressure everything else is looking lovely
38:00and settled yeah absolutely obviously has still had a significant bump to the head so you'll need
38:05to be observed for a period of time yeah and the wound you'll need to have an x-rays of his arm on the
38:11stretcher Neil can get a better look at Robin's arm so we've got the sling ready we're just going to
38:17remove that that's you've just got some abrasions on there and so is it broken so we think you
38:25might break this bone your humorous bone this top bone here which which is fine could they heal
38:31quite easily really all right darling you know right there buddy yeah confident that Robin is stable
38:40Rob we are gonna leave you in the team's very capable hands like mom's gonna come with you as
38:48well but wish you all the best all right darling all right thank you very much Laura is 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 at a garden center in Wokingham dr. Tim wait and critical care paramedic Emma Gray a
39:15treating 22 year old sales assistant Luke who has a potentially life-threatening fast and irregular
39:21heartbeat 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 yeah 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 and go
39:45back to sort of plan A so to speak and use a defibrillator but once we've got amiodarone running there's
39:50probably a 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 I think we give 300 of
40:05amio and we run it in a mini bag of saline and we're about what 20 minutes from the Royal Barks and we
40:11want our amio going in over about 20 30 minutes if successful the drug will restore a stable rhythm
40:17to Luke's heart without shocking him with a defibrillator why don't we start amiodarone
40:22back up gentle slow time steady blues up to the Royal Barks and then that will will sort of use the
40:29interval of time while that's running to move him to hospital and then he can always have a sedation
40:33and cardioversion if he doesn't respond to pharmacological management we can always pull over
40:37can't we yeah exactly let me just go and speak to mum again tell her yeah that would be that would be
40:44brilliant so we are going to give him the medication whilst moving on the way to hospital he's not got
40:50any worse of anything it's just that we can do it on yet saying that's what we're going to do if given
40:55too quickly the amiodarone could dangerously lower Luke's blood pressure so Tim's administering it slowly
41:02with saline this one it sometimes can cause a bit of irritation in the vein but it doesn't normally
41:07instead of when it's diluted and it's in the initial initial sort of dosing wonderful you're
41:14a very calm cool customer like there's nothing I can do about it I like you I like your style I'm just
41:23gonna put your seat belts on there we go so the intent is for this to trickle in over about 20 to
41:3230 minutes just keep an eye on it Luke appears stable but with a possibility that his heart may
41:40still need to be shocked Tim and Emma travel with him we are on November alpha 410 with an ETA of
41:49approximately 10 minutes 1 0 minutes Tim puts in a call to the dispatch desk to alert the hospital to
41:56their imminent arrival bring in a 22 year old male with onset of hemodynamically stable pulsed BT at
42:05approximately 9 a.m. this morning he's got a heart rate currently of 167 so we've given him 300 amiodarone
42:14which is just finishing now but I think the I think the outcome of that strategy is going to be we're
42:19likely to arrive with a man who's will need a procedure of sedation and a cardioversion as serious
42:24as the situation is Luke's maintaining his cool and looking to the future I'm meant to be going on a trip
42:31to Boston would anything like this cause any sort of issues I would say take this one thing at a
42:36time work out what's going on first absolutely yeah it's probably just make it worth double
42:41checking the health insurance and making sure you've got it as well in America on arrival at
42:46hospital with his heart rate still dangerously high Luke's handed over to the cardiac team
42:51leaving dr. Tim and critical care paramedic Emma free for the next emergency call
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