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00:00in the heart of Yorkshire a team like no other busy busy busy fight to save lives
00:11open your eyes for me do you know where you are you're in Barnsley A&E department
00:1524 hours a day Wow seven days a week whoa nearly feel like a wet dish club
00:27serving their community looks like you have broken it
00:33I don't think I'm going to love I'm dreaming of your gin and tonic helping those most in need
00:41love you I'm dry there's nothing to be frightened of these girls will sort her out they care for
00:50anyone I think I've lost your hair up haven't I and everyone looking more like himself thanks to
00:55Barnsley working together to make people's lives better you know I just love to look I love to make
01:05a difference this is Barnsley casualty 24-7 let's not be entering a beauty contest
01:13on shift tonight sister Jane there's the world's biggest crew in here for triage
01:23have you seen that there's 19 waiting have you seen all this advanced clinical practitioner
01:30Gemma yeah so get ready to share a shift it's a 24-hour service seven days a week we've been in
01:50a repeat offender then yeah so get ready to share a shift it's a 24-hour service seven days a week with
02:00the team at Barnsley casualty it's 7 a.m. and at Barnsley casualty sister Jane is running the hub Tracy it's only Jane I need a female surgical bed love
02:17I'm round down here she's taking over from a very busy night shift we just need to get them out so that we can get some space
02:30we're always taking patients in by ambulance or walking or the police bring them in and it's difficult because the
02:41the department becomes gridlocked and unfortunately we're reliant on other areas helping us out to clear the department
02:56A&E has quite a reputation of just speed and pace a lot of people can be frightened by it
03:03it's a daunting place to come and do a shift it's coming through two ambulances waiting to come in
03:10right have they said that they're keeping you in right I'm gonna send you down surgical estec just to
03:17get you out of here all right love I hope it's only Jane down in A&E this lady and Tracy's aware of
03:24us she needs to come down to you all right darling all right love thank you bye all right she can get to
03:30us today sister Jane moves one patient on but as one leaves another arrives
03:45a d bansley
03:48a 53-year-old man has collapsed at home following multiple seizures
04:03paramedics take him straight to resource
04:06this gentleman had a stroke at the end of September and since then he's been having non-ethlectic seizures
04:13advanced clinical practitioner Chantel will take charge of Sean's care
04:16can you see me Sean Sean open your eyes for me open your eyes hello Sean do you know where you are
04:28no you're in bansley A&E department have you got any pain anywhere yeah this one did you fall onto your arm
04:38you don't know have you had chest pain today whereabouts in your chest
04:45I need to get these answers from Sean quickly but it's quite difficult with his condition
04:53Sean was found on the floor by his wife Sam did you lose consciousness and when I would came down
05:09he was speaking to me I'm really glad his wife's here so we can get these answers and I can get to the
05:14bottom of what's going off and did you not hear a crash or anything or nothing just
05:18no I just flicked the fastest and said help help
05:21okay
05:23am I in a great
05:24I just ran downstairs
05:25he was on the floor
05:26yeah
05:27and then he was mourning his right arm were hurting him it was like it's really hurting it hurts
05:32and then all of a sudden he was like his fingers have gone numb
05:35on his right side
05:36yeah on his right side
05:37but since stroke it's his right side there
05:39it's been affected
05:41it's been affected yeah
05:42how many seizures did you often have
05:44like every day and he's ever about
05:48what's that
05:49eight to ten a day
05:51eight to ten a day
05:52yeah
05:53does he get like a warning sign or anything
05:54yeah normally his face twitches and it'll start going like this to his head
05:59his seizures are becoming more frequent and she's quite concerned so that's the reason she's brought him to us
06:04we'll take an ECG pop a cannula into some blood and then we'll see what we find
06:09is that okay
06:11does it hurt there
06:13no
06:15what about there
06:16it hurts there
06:17is that where the pain's been coming from
06:19what about over here
06:20yeah
06:21it's tender there
06:22Sean is flipping it in and out of consciousness but he is also complaining of chest pain
06:28so my job at that moment in time is to figure out if this chest pain is contributing to his conscious level as well
06:35so it's quite important for me to establish that pain and where it's coming from
06:41mouse twitching I think I might have a seizure
06:45hmm
06:46Sean
06:48Sean
06:49Sean
06:50Sean
06:51Sean open your eyes
06:53Sean open your eyes
06:55Sean
07:10Sean
07:11Sean
07:12Sean
07:15is having multiple seizures Sean open your eyes okay Sean advanced clinical
07:24practitioner Chantelle needs to determine the course Sean open your eyes for me
07:30Sean Sean open your eyes hello are you feeling not good how do you feel Sean
07:42tell me how do you feel oh you feel terrible does he normally talk after his seizures yeah
07:49normal come straight out of him and he's just normal okay wife Sam has been Sean's main carer
07:57since his seizures started following a recent stroke is it only he'll have one about five
08:08seconds I'll stop then I'll go back into one and then it does that for about six or eight times
08:14and then I'll come around and I'll get up yeah but it's just continuing this is continuous is
08:20he more prone to them when he's unwell when he gets hot when he gets hot just when he gets off
08:25here sexy more Sean Sean Sean Sean Sean open your eyes for me open your eyes open your eyes hello
08:37Sean Sean how are you feeling you're not not feeling good there's many forms of seizures Shawn these
08:48seizures can you just stop them normally like that you can stop the seizure and then it comes again
08:55epileptic seizures and then there's none epileptic and there's a whole host of other types of seizures
09:00So you can control these seizures?
09:02Not half that time.
09:04But do you think you can do it now?
09:06Try. You try and do it?
09:09Are you alert and aware when they're happening?
09:11So what's really important is establishing what's normal for Sean
09:15and what's abnormal.
09:16When you're, like, talking to him, it'd be all right.
09:19As soon as you walked out the room, it'd set off.
09:22And then a nurse came back in and he'd talk to her.
09:25And then she'd go off and he'd start again.
09:28It's like if somebody keeps him talking or whatever,
09:31it seems to be all right.
09:33Yeah, which is not classic.
09:34It's not a classical seizure.
09:36Yeah.
09:37Cos I won't be able to bring him out of it
09:40and he won't be able to talk to me straight away.
09:42The increase in Sean's seizures
09:44could be the result of an infection.
09:47So this lung sounds quite crackly and quiet,
09:50so I'm going to get an X-ray of his chest.
09:52You said he's had a cough. How long for?
09:55About four days.
09:57They're going to come and do you an X-ray on your chest soon.
10:00OK?
10:01You need to be a little bit alert and sat up for it, OK?
10:05So I can see if there's any infection.
10:06All right?
10:07You're going to have to sit here and stroke his arm
10:12so you can keep him calm and then he doesn't have a seizure.
10:15That's your job, Sam.
10:17You're doing it as well.
10:19You're a good sport.
10:20There you go.
10:21Nice and calm.
10:22Well, it's been in and out that many times.
10:24It's like it's the norm now.
10:26But this has been the worst.
10:28He had a stroke about eight weeks ago, two weeks in.
10:32He started with seizures.
10:33He's got to go for like load of electrodes on his head to see what's happening.
10:45So we are going through tests to find out exactly what kind of seizures they are.
10:51It just feels useless now because he was always on the go.
10:54He never stopped around doing some gardening, building.
10:58And now it can't.
11:01Sean?
11:02Hello, Mum.
11:03Hiya, are you all right?
11:04Hello.
11:05Hello, Sean.
11:06My name's Rachel.
11:07We've got Lewis here as well.
11:08We've come to do an x-ray on your chest, love.
11:09All right?
11:10Radiology have come to do x-rays.
11:11Right, Sean.
11:12We're going to sit you forward and pop the board behind your back.
11:13All right, love?
11:14If the x-ray revealed that the x-ray was going to do an x-ray on your chest, love, all right?
11:19Radiology have come to do x-rays.
11:21Right, Sean.
11:22We're going to sit you forward and pop the board behind your back.
11:25All right, love?
11:26If the x-ray reveals a chest infection, Sean will need urgent treatment.
11:42Over in the paediatric department...
11:46I've got these things to put up for the children.
11:49And they're going to be like little stick puppets.
11:51There's a little road out here so that they can use them to drive along the road.
11:55There's like a little activity to do while they're waiting to see the doctor.
11:58Play leader Olivia is creating an interactive display about road safety.
12:04So this is going to be like the crossroads for Barnsley Hospital.
12:07There's going to be like a little lollipop man that's going to stick here.
12:11And then when the cars kind of come across, they're going to let the kids go fast.
12:16I love my job.
12:17Every day is so fun.
12:18They're just amazing, the kids that come here.
12:20They're so lovely and so friendly.
12:22Right, so we're going with that lady.
12:28Come on, sweetheart.
12:31One girl in paediatrics today is eight-year-old Harriet, who has a suspected broken toe.
12:37Harriet, my name's Gemma. Are you all right walking down, yeah?
12:41Yeah. Come this way then.
12:44Treating casualties younger patients today is advanced clinical practitioner Gemma.
12:49You okay?
12:50Yeah.
12:51Yeah.
12:52Who have you brought with you? Mum and?
12:54Brother.
12:55Brother.
12:56Brother.
12:57If you'll pop up on the bed.
13:01There you go.
13:02Perfect. So my name's Gemma.
13:03What's your name, Mum?
13:04Emma.
13:05Emma.
13:06She's jumped off Seti and she's banged a foot on the footstool.
13:11It was sticking right out.
13:13It was all red and she was crying.
13:15If that was my toe, it just went boom and then it hit it like there.
13:20But it also hurt here and then it just went like that and it was like that the whole time.
13:26And when it was sticking out, did you do anything?
13:29I didn't. I didn't touch it, no.
13:30Have you tried to move it or anything?
13:32No.
13:33Did a little bit swollen that, isn't it, sweetheart?
13:35Can I have a little look at you? Is that okay?
13:37Does that hurt there?
13:38Yeah.
13:39Does that hurt there?
13:40Sorry.
13:41And does that hurt there?
13:42A bit.
13:43A bit.
13:44Okay.
13:45Let's have a little look. Compare it to the other side.
13:50So it is sticking out.
13:52So normally I would say we'll just strap it.
13:55The fact that you've said it was sticking out that way and it is a little bit what I call
14:01angulated.
14:02I think we might just need to make sure it's not like a fracture type dislocation.
14:07Mm-hmm.
14:08Okay.
14:09So I think we will get an x-ray.
14:10So give me two minutes.
14:11Okay.
14:12And then we'll get you round.
14:13Okay?
14:15Thanks.
14:16You all right?
14:17Yeah.
14:18You've never really had any injuries before, have you?
14:22I've never broken a bone.
14:24Do you want to follow me and I'll show you where to go?
14:28Yeah.
14:29You're walking around?
14:30Yeah.
14:31If Harriet's x-ray reveals that her toe is dislocated, it will need to be manipulated
14:36back into position.
14:39That's sitting x-ray.
14:4033 have got no beds at the moment and I've got this neck of femur who they do know about
14:55and there's potentially another neck of femur that's come in.
14:58In the hub, the pressure is not letting up for Sister Jane.
15:03Casualty is still jam-packed from a busy night shift.
15:06It's looking busy at the moment.
15:09There's 63 patients in the departments at the minute for 11 o'clock in the morning.
15:15It's not great.
15:16Some of these patients have been here 14, 15, 16 hours, so it's not really very good.
15:22We're not a ward and we need to move patients out to get more patients in.
15:26It's just a vicious circle, really.
15:28It's just never-ending.
15:31You still have a duty of care towards those patients to ensure that they're safe.
15:35They've come to a hospital to be treated for their illness and they need to be safe
15:40and sometimes it's just difficult.
15:43We've been in there all morning.
15:46Nobody wants them in here for 12 hours because they're on trolleys.
15:49But everybody's doing their best.
15:52Hi, it's Jane.
15:54Hiya, love.
15:59A patient with a history of heart attacks has arrived.
16:0479-year-old Tommy is taken straight to the ambulance bay.
16:09So, granddaughter's born today because he's got this normally chest pain.
16:14OK, fine.
16:16Granddaughter Lauren called the ambulance.
16:18You had a bit of a chest pain again, didn't you?
16:20Oh, chest pain, yeah, yeah.
16:22Had a bit of chest pain again.
16:25I've not been very good for a long time.
16:27Tommy is all too familiar with Barnsley Casualty.
16:30I've been here a few times.
16:32You had a gash on your back of your head, didn't you?
16:34Oh dear?
16:35You fell.
16:36Is that when I fell down the stairs?
16:37Yeah, and you cut your head up, didn't you?
16:39Yeah.
16:40So, you had to have it gloom.
16:41Right?
16:42Good job.
16:43That was a good job in there.
16:44That was good.
16:46Hey, Tommy.
16:47My name's Jess.
16:48Am I okay to have a look to see if I can get a cannula in to take a test?
16:51Yeah, yeah.
16:52And what are you allergic to?
16:53What am I allergic to?
16:55Yeah.
16:56I used to be allergic to the sun.
16:57To the sun?
16:58You're not going to get that much of that now, are you?
17:00I was only in here about a week and a half ago, I think.
17:05No, two weeks, I think.
17:06Yeah.
17:07I was just going to go and get you shopping for you before you decided to feel unwell again.
17:13I've been staying with him for a few days.
17:16We take it in turns because he's on his own now since he lost his wife, my mamma.
17:24Since then, he's gone downhill, so he's got a lot worser.
17:31So, he's got 21 grandchildren and 16 great-grandchildren.
17:37So, we all take it in turns, don't we, Grandad?
17:40I'll come around and stick with it.
17:46You got to a seat doctor now?
17:48All right.
17:49Okay.
17:50Thank you, Tommy.
17:51Thank you very much.
17:52You're welcome.
17:53Tommy must wait for the blood test results to find out if he's had a heart attack.
17:58If he has, he will need to stay in for observations.
18:08So, Ellie's coming in at two and then they've put a message on for any band threes.
18:11Yeah.
18:12They have sent me somebody down from the ward, but only this morning.
18:15In the hub, Sister Jane not only has a jam-packed casualty, she's now two nurses down.
18:22We've had some sick calls today.
18:26When staff are tired they become susceptible to catching illnesses.
18:30So, we all struggle really.
18:33Sorry, can you please?
18:35Pretty rubbish.
18:38Sorry, can you please?
18:39We're not going to close the department for no staff.
18:43It's a 24-hour service, seven days a week, so you just have to plough on.
18:49OK.
18:50OK.
18:51OK.
18:52In resus, Sean is still having seizures.
18:53Advance clinical practitioner Shantel has the results of his chest X-ray.
19:08His infection markers are up a little bit,
19:10but there's no pneumonia on his chest x-ray, which is good.
19:13So I'm going to give him some antibiotics
19:15to clear that chest infection.
19:17So I have told the docs upstairs about him,
19:21and they're happy for him to go upstairs when there's a bed.
19:23Yeah.
19:24Do you think the infection's caused?
19:26Sometimes, yeah, sometimes if he's been a bit unwell
19:29and a bit feverish, it can upset him a little bit.
19:32He's got antibiotics in a little bit.
19:34Yeah.
19:35Yeah, and if he's OK tomorrow, they might convert them
19:38to oral tablets, and then he can take them at home.
19:40Yeah.
19:41Right, I'll leave you with him.
19:42All right. OK.
19:43This is one.
19:45Hopefully good.
19:47Get the antibiotics in and hopefully get him back home
19:50and get back to, well, normal as possible.
19:56Sean spent the night on the ward and was released the next day.
20:01He's still undergoing investigation for his seizures.
20:08There is no let-up for advanced clinical practitioner Chantelle.
20:13As one patient leaves, another arrives.
20:18Paramedics are bringing to Rhesus a 94-year-old woman
20:23with a high heart rate and dangerously low oxygen levels.
20:27Hi, Margaret.
20:29Can you just keep your arms in, all right?
20:30Hi, Margaret.
20:31Hi.
20:32Can you just keep your arms in, all right?
20:33Hi, Margaret.
20:34Hi, guys.
20:35Hi.
20:36Hi, all right.
20:37Sorry.
20:38I don't know what you're thinking.
20:39You're just chatting about.
20:41Right, we're going over onto here, OK, so a little ride.
20:45I'll be all right.
20:46Are you ready?
20:47Yeah.
20:48Ready, steady, slide.
20:49Ooh, you're light as a feather.
20:50Hey!
20:51Paramedic Marcus hands over her care.
20:55All right, Margaret.
20:56What, any other medical history?
20:58So, Alzheimer's and osteoporosis as well.
21:03How are you feeling at the minute?
21:05It's a bit frightened.
21:06You feel a little bit frightened?
21:08Our priority in emergency medicine is to find out the emergency,
21:12but it's really important to try and make a patient,
21:14regardless of age, not be scared or frightened,
21:17especially when they're confused as well.
21:19So, Margaret, do you know where you are at the minute?
21:21Yeah, I think I've been before.
21:24But this is this area that sets me.
21:31I have been before.
21:34I do like to give comfort with touch.
21:36Do you want me to remind you?
21:39Yeah.
21:39So, you're in Barnsley Hospital at the minute.
21:41Yeah, that's right.
21:42Can you remember now?
21:43Yeah, I remember.
21:45Don't worry, you're fine.
21:46And you're in the A&E department.
21:48You don't feel frightened at the minute?
21:50Oh, I'm not frightened.
21:51Good.
21:52Were you still in Australia?
21:54Did you?
21:54And you had your two little boys over there?
21:56Yeah.
21:57Are they still over there, or did they come back?
22:00Do you know, I don't even know where they are.
22:02Oh!
22:03All the best.
22:05All right.
22:06So, your son's going to come up, OK?
22:07Oh!
22:08So, your son's coming up, and he's going to come and see you.
22:09All right.
22:10Take care.
22:11Bye-bye.
22:12See?
22:13Your son's around.
22:14Not in Australia.
22:15Can I have a listen to your heart and your lungs?
22:17Is that OK?
22:18And can I take some blood tests as well?
22:19Yeah.
22:20Patient reassured, the next job is to find out what's causing Margaret's dangerous and low oxygen levels.
22:36There's the world's biggest crew in here for triage, have you seen that?
22:58There's 19 waiting.
22:59Have you seen all this?
23:01In the hub, Sister Jane is running a casualty that's full of patience and short on staff.
23:08Kelly?
23:09Kelly, there is just nobody else that I can send down there.
23:12I don't know what to do.
23:13It's walk-ins.
23:16There's 19 waiting to be seen with an hour and 15 minute wait.
23:20And it just makes it bad for this afternoon because they're going to continue to come in.
23:24It makes me want to go home.
23:26We all rely on a certain number of names.
23:30We all rely on a certain number of nurses to get work and jobs done.
23:33And obviously, if you haven't got that nurse there, if you're one down, then it falls on another nurse or two nurses to share that responsibility.
23:41So it does make it difficult.
23:43Tom in Rapid or Lisa in Resource?
23:47Take your pick, but let me know.
23:49You can do Rapid with me.
23:51Have you seen how many there is to a set?
23:53Walk-ins.
23:54Oh, you are kidding me.
23:56Are you okay?
23:57Yeah.
23:58Right, sweetheart.
23:59Can I have this arm just to take some blood?
24:01In Resource, Advanced Clinical Practitioner Chantel needs to find the cause of Margaret's dangerously low oxygen levels.
24:16In Resource, Advanced Clinical Practitioner Chantel needs to find the cause of Margaret's dangerously low oxygen levels.
24:23They're not very good.
24:30They're not very good?
24:31Oh, we'll see what I can do.
24:34I'm quite good, you know.
24:36I'll not be good now.
24:37I've said that.
24:38I'll never imagine.
24:39You're a good girl.
24:40I can see you're a good girl.
24:42Aww.
24:44You can see I'm a good girl.
24:45I can't see you.
24:47I know a good girl than I see you.
24:52Right.
24:53Are we ready?
24:54Yeah.
24:55Oh, ow, ow, ow, ow, ow.
24:57Oh, it's in.
24:58Don't worry.
24:59Yeah.
25:00There we go.
25:02There's no needling now.
25:03Oh, it's all done.
25:05It's done.
25:06I'm getting the blood out.
25:07Not bad at all.
25:09Not bad?
25:10Are you sure?
25:12Are you sure?
25:13I thought I hurt you then.
25:14I feel alright.
25:16The one I feel alright for is a nice cup of tea.
25:20I promised you a nice cup of tea, didn't I, after this?
25:23Yeah.
25:24As your little treat.
25:25Yeah.
25:27In sensitive emotional situations,
25:30I still like to be a little bit light-hearted
25:33and make the patient feel more comfortable.
25:38Do you want anything to eat?
25:40I only have a biscuit.
25:42Do you want a biscuit?
25:43We've got some biscuits.
25:44I try and be as human and normal as possible,
25:47because that's what I would want as a patient.
25:49I'd want someone to be just really normal and nice
25:52and light-hearted with me.
25:54I'll see what I can find.
25:56I'll rummage around.
25:59I'm sure you'll find one.
26:02I will.
26:03Margaret's sons join her,
26:05as she heads for an x-ray.
26:07Have a seat.
26:08We'll go with you, Charlotte.
26:10Not yet.
26:11They're going to tell us when they're ready.
26:12Also in radiology,
26:13eight-year-old Harriet is waiting for an x-ray
26:14to find out if she has dislocated her little toe.
26:28I want to go.
26:29I don't.
26:30Well, I think you'll be going no matter what.
26:31I might not be.
26:32Yeah, that's why I wish I was you.
26:33Isaac, did you?
26:34Plus I get all the sympathy from you.
26:35Watch your toe.
26:37Wait, do we go back where we went?
26:38No, I don't.
26:39I don't.
26:40I don't.
26:41I don't.
26:42I don't.
26:43I don't.
26:44I don't.
26:45I don't.
26:46I don't.
26:47I don't.
26:48I don't.
26:49I don't.
26:50I don't.
26:51I don't.
26:52I don't.
26:53I don't.
26:54I don't.
26:55I don't.
26:56I don't.
26:57I don't know where we came from.
26:59Yeah.
27:00Advanced clinical practitioner Gemma looks at the x-ray.
27:06I think she's definitely fractured it.
27:09If you look at these ones, we look for nice, smooth, smooth lines.
27:13And on this one, she's got a little bit of a step there.
27:16But she's also got a bit of a bend here.
27:19So that's what we're looking for.
27:21It's not nice and smooth.
27:22So it looks like she's fractured it.
27:24Right.
27:25Have a chat with her.
27:31Hello.
27:32Hi.
27:33So just had a little look at your x-ray.
27:36Looks like you have broken it.
27:38Okay.
27:39But it's not out of line.
27:40So we don't.
27:41It's not what we call dislocated.
27:43So what we need to do is just strap it together.
27:45What about like PE and can she do all that?
27:48I don't want to do it.
27:49I don't want to do it.
27:50You don't want to do PE?
27:52No, because I think we do only running.
27:54I would avoid it for a few weeks while she's healing.
27:58And then there's one other question.
27:59What about boxing?
28:00Because I do that.
28:01Boxing?
28:02You don't box with your feet, do you?
28:03No.
28:04As long as you're not in pain, then you should be fine.
28:06Yeah.
28:07Happy?
28:08Yeah.
28:09Any more questions?
28:10No.
28:11Okay.
28:12Thank you very much.
28:14All right.
28:15Good day, guys.
28:16Told you it was broken.
28:17Also on shift is volunteer Jane, who's heard there's a familiar face in cubicle 10.
28:35You've been in before.
28:37Been in a lot of times.
28:39A repeat offender then?
28:41Yeah.
28:42Now, when we say a repeat offender, we don't necessarily mean it in a bad way.
28:46Actually, sometimes it's nice to keep seeing them.
28:51And Tommy was one of them.
28:52He were a nice repeat offender.
28:55Repeat offender Tommy is here with his granddaughter Lauren after suffering chest pains.
29:00Yeah, he always causes trouble.
29:01That's what it is.
29:02Does it?
29:03You always remember them that cause trouble.
29:05Yorkshire men.
29:06I'd say nice to see you, but it's never nice to see you back in here, is it?
29:11But then again...
29:12That's it, isn't it?
29:14It's like meet and greet, isn't it?
29:16It's like these airports about to start and charge now, isn't it?
29:19Every time you come through the door.
29:20See you later, love, anyway.
29:21See you later, love.
29:24Dr. Hong Tet has come to assess Tommy.
29:29Hello, Thomas.
29:31I just understand that you came in with the chest pain.
29:35Yeah.
29:36What was the character of the pain?
29:37Is that sharp or...?
29:39It was a sharp pain cause you bent already.
29:42Yeah.
29:43Are you in pain now?
29:44No, no.
29:45No, no.
29:46Any surgery to the heart or something like that?
29:48No.
29:49He's got about 16 stents in his heart.
29:50Cause he's had quite a few heart attacks.
29:52I'm sorry to hear that.
29:53I was only here a week ago.
29:55I'll review your blood test and then I'll let you know the plan.
29:58Okay.
29:59It is good to know that you're pain free now.
30:02The blood test will show if Tommy has had another heart attack.
30:10While he waits for the verdict,
30:1394-year-old Margaret is on her way back from radiology.
30:17Yeah, we'll sort it in.
30:19We'll let them know when we hear you want to come to the teeth.
30:22Yes, you're good.
30:24Advanced clinical practitioner Chantelle assesses Margaret's x-ray.
30:28She's got a lovely big pneumonia sat there.
30:32That's what's causing her to be quite unwell.
30:37Hello.
30:38Are you okay?
30:39I'm fine.
30:40How are you feeling?
30:41You look tired.
30:42I'm tired.
30:43You look tired.
30:48You've got a big infection down there.
30:51What's that mean?
30:53What's that mean?
30:54Yeah.
30:55It means we need to give you some antibiotics.
30:57Are you sure?
30:59Are you just feeling me?
31:01No.
31:02No.
31:03You've got a chest infection,
31:05but quite a big one,
31:06at the bottom of your right lung.
31:10Pardon?
31:11It's a good job I'm getting looked after.
31:13It's a good job you're getting looked after,
31:15and it's a good job you're here.
31:17Yes.
31:21There you go.
31:23Hey, that's better.
31:24Yeah.
31:25Yeah.
31:26Hey.
31:27Hot.
31:28Is it hot?
31:29Just take your time with it.
31:30All right.
31:31Any questions?
31:32I don't think so.
31:33I'm a good girl.
31:34You are a good girl.
31:35You are?
31:36Yeah.
31:37I'm all right.
31:38I'm a good.
31:39Okay.
31:41I know she's in good hands.
31:42I know she's in good hands.
31:43Excellent.
31:44Fantastic service.
31:45Fantastic.
31:49Are you happy for her to go up to a ward once she's had?
31:51Once she's had all the treatment,
31:52and Niamh's happy with her from a nursing point of view.
31:55Yeah?
31:56She can go up.
31:58Bye, Margaret.
31:59Margaret was transferred to a ward where she was treated for pneumonia.
32:06She returned to her care home with regular visits from her two sons.
32:18Have you had your dinners down there?
32:20Just do me a favor and just go and see CDU.
32:23Make sure they've had the dinner,
32:24because they were told to take each other off.
32:25I just want to make sure that they have.
32:28In the hub, Sister Jane has a casualty full of patients
32:32and needs to keep check on the welfare of her skeleton staff.
32:37Are you two going for your break?
32:39Where's your Amelia?
32:40She's gone for dinner.
32:41Lovely.
32:43Do you want to go for your lunch, sweetheart?
32:45Do you want to stand Stella for her dinner?
32:52Has she gone?
32:53Oh, look at you.
32:54You're on the ball, aren't you, love?
32:57You're a superstar.
33:08Come on in.
33:09In the minor injury unit,
33:10emergency nurse practitioner Becky's next patient
33:13is 17-year-old Caden, who's here with Mum Gemma.
33:19I'll start a curtain.
33:24What have you been doing?
33:25Where have you come to see us?
33:26Er, all racing yesterday at Farmer John's.
33:29Racing on a bike, a car?
33:31A mountain bike.
33:32A mountain bike, okey-doke.
33:33So, were you, like, off-road?
33:34Yeah.
33:35OK, and what happened?
33:36Er, I came out of track.
33:37Yeah.
33:38I went into the woods.
33:39Yeah.
33:40And I went straight into a tree at some speed.
33:41OK, what thinking speed-wise?
33:4315, 20 miles per hour straight into a tree.
33:45Straight into a tree, and then obviously stopped impact?
33:47Yeah.
33:48Fell off the bike?
33:49Yeah.
33:50OK.
33:51Did you get back on the bike or not?
33:52I, like, fell off, and then I started screaming,
33:54me leg, me leg.
33:55Okey-doke.
33:56And did you get pain straight away, then, when you fell off?
33:58Yeah, I got pain, and then...
33:59And pain all the way back?
34:00And pain all the way back.
34:01Did you have to take painkillers or anything when you got home, or...?
34:04No, I've just took some thingamajigs.
34:06You just took some ibuprofen.
34:07Thingamajigs?
34:08Yeah.
34:09Ieprofen today?
34:10Yeah.
34:11Yeah, has that helped or not?
34:12Er, it's just still frobbing.
34:14Right, let's have you on this couch, then.
34:17So, any pain in your hips?
34:24That, there.
34:25Where you were just pressing it, then.
34:26Yeah, there.
34:27In here?
34:28Yeah, I can feel it, there.
34:29Saw in there.
34:30Can you lift up and touch my arm straight as you can?
34:33That's as far as.
34:34OK, and back down.
34:35So you're definitely saw in here?
34:36Yeah.
34:37That's saw?
34:38Yeah.
34:39What about here?
34:40Saw there.
34:41Saw there.
34:42I think your hips are all right, it's your femur, isn't it?
34:43Yeah.
34:44We'll get a quick x-ray of your femur, and then it might be that we have to get a doctor
34:48to have a look at you, just to be sure.
34:49So you'll get yourself dressed, and then we'll take it from there.
34:50Is that OK?
34:51Follow these blue dots to x-ray.
34:52Yeah.
34:53All right, flowers.
34:55No problemo.
34:58No problemo.
34:59If you're looking at 15 mile an hour, and then it just comes to a sudden stop, that's
35:19quite a big impact on that area.
35:22He's weight-bearing, he's walking up and down.
35:24So I think it's unlikely that he has got anything fractured there.
35:28However, we have had people that have walked him before with broken femurs.
35:33If the x-ray shows his femur is broken, Caden won't be getting back on his bike any time
35:39soon.
35:40So your patient that's just come to you from High Dependency 2, they've pulled his bed
35:59so he can go up to the ward now, lovely.
36:01Thanks, Charlotte.
36:02Do you need a porter?
36:03I've booked it.
36:04You're on the ball.
36:06With casualty full and her staff working non-stop, Sister Jane brings out the emergency medication.
36:16Kimberley?
36:17They've brought your chocolates ready.
36:18Yeah?
36:19I'm putting them in the drawer for everyone.
36:33Penny's sugar here is good.
36:36We have our sweet drawer, which is generally always full, and if it's not, then there's
36:42words to be had.
36:44Specialities come down and take our sweets, and that's not fair, is it?
36:48We are renowned in the hospital for the sweet drawer.
37:06In cubicle 10, Tommy is hoping to go home, but Dr Tett has the results of his blood test.
37:13I would like you to keep in AMU, admission ward.
37:19Why?
37:20Because he's got a chest pain, and the first heart attack is...
37:28Rez.
37:29I'm just worried that the heart attack is back when you get back home, and then you need
37:34to come back in, okay?
37:36I think it is best recommended to keep you...
37:39We've got to stay in, Grandad.
37:40He's said this morning it was just a pain, but obviously it won't.
37:43They're thinking it might have been an heart attack.
37:45It might have been an heart attack.
37:47But I don't know.
37:48So his Grandad here weren't even going to come in.
37:52I didn't know what it was.
37:54I just had a bit of pain.
37:55I've had pain before.
37:56But we ulster it, because he's had that many heart attacks.
37:59He's got 16 cents in his heart, because he's had that many heart attacks.
38:05So...
38:06Don't let no help bother you, bless you.
38:08He doesn't look as though he's just had an heart attack, does he?
38:16I want to get back home.
38:19You're going to stay, aren't you, Grandad?
38:20Yeah, yeah.
38:21I'm just hoping it's not for long.
38:23Tommy spent the night in hospital and is now back at home being cared for by his family.
38:34In the minor injury unit, 17-year-old Caden is waiting for the results of his leg x-ray after a collision with a tree.
38:42Look at them.
38:44This is the race yesterday that we were racing.
38:50I came a lot faster.
38:53I was just going too down there, too fast.
38:56I was up to him yesterday, so he was trying to give me an eye to tap.
38:59And he fell off three times.
39:01Yeah, it's just...
39:03It's just part of the sport, really.
39:05Having fun.
39:06Consultant doctor Andrew Snell has Caden's results.
39:15We do see a lot of sports-related injuries.
39:18Ones that are the highest risk are certainly speed is related.
39:24I've had a look at the x-rays.
39:26No fracture on the x-rays.
39:28It's nice and clean all the way down, down to the knee.
39:31And this is from side on.
39:33And there's your knee itself.
39:34So that's good news.
39:35But, of course, it's not only the bones that are, you know, at risk.
39:38So, we need to have a quick look at the general function.
39:41Have you got to pop up on the bed?
39:46How long have you been racing for?
39:48I started this year.
39:49Oh, did you?
39:50Yeah.
39:52Are you serious stuff, or is it...?
39:53Serious.
39:54Is it?
39:55Yeah.
39:56Very good.
39:57Well, that's getting into it all now.
39:58He started with BMX, but he's starting to get into some of the more stunts
40:01and wants to do the downhill stuff.
40:02I think, historically, we haven't been necessarily as good as we should be at encouraging physical activity.
40:09So, when we do see cases of sports and exercise-related injury, I think it's really important that we congratulate them for being active.
40:18Lift this leg straight off the bed.
40:20That's as far as I can get.
40:21Where's the pain there?
40:23All in that.
40:24Using, bending the knee, lift it as high as you can.
40:27Right, so with the knee bent, it's all right.
40:29Yeah.
40:30Bit tight, but not as hard as with the knee straight.
40:32Mm.
40:33Okay, back down.
40:35And no numbness down the leg at all?
40:36No.
40:37Feels normal both sides.
40:39Pull those back on, and then you can get your shoes back on.
40:41When's your next race?
40:43October.
40:44Oh, okay.
40:45And what do you do for work?
40:47Build motor homes.
40:48Oh, good.
40:50Brilliant.
40:52That's great.
40:54Busy lads.
40:57I don't think there's anything we need to do.
40:59Maybe for the first 48 hours, a bit of frequent icing will help to bring the swelling down.
41:05So, all in order.
41:06Thank you very much.
41:07All right.
41:08Nice to meet you both.
41:09Some good luck with it all, including the motor homes.
41:12Yeah.
41:13Back to work tomorrow.
41:14Yeah, yeah.
41:15Ah, there you go.
41:16You've been told.
41:17Yeah.
41:18All right.
41:19Thank you all.
41:20Take care.
41:21Bye-bye.
41:23Caden was absolutely right to be concerned, and we were concerned, but thankfully it looks
41:26like this time it's going to be what we call kind of soft tissue injury that will time
41:30and his body will do all the healing.
41:32As things heal, and he feels ready and safe to ride, there's no reason.
41:36I'm very keen for him to get back to riding.
41:39Very good news.
41:40Big sigh of relief.
41:42Yeah.
41:43Can't go out back out on bike now.
41:45See you later.
41:47After a few weeks of taking it easy, Caden is back doing what he loves best, and he's
41:52trying hard to avoid the trees.
42:02Hello.
42:03Is it Harriet?
42:05In paediatrics, charge nurse Johnny is treating eight-year-old Harriet.
42:10Did it hurt?
42:11Yeah.
42:12Yeah, but it did.
42:13I cried, and then I told Mummy, and then she said that she'd come, and then she went
42:20into a meeting for half an hour.
42:22Oh, so she weren't even your first priority?
42:24Yeah.
42:26Oh, God.
42:27Mum are here.
42:29Right, there you go.
42:30All right.
42:31Any problems?
42:32Just come back.
42:33Bill, thank you so much.
42:35You're welcome.
42:36Bye-bye.
42:37Bye.
42:38Bye.
42:40I'm feeling a little bit guilty that it's actually broken and I left her for half an hour.
42:46But, yeah, everyone's been really nice.
42:48It's been really quick.
42:50So, yeah, happy that she's sorted.
42:57Come on, then.
42:59Yeah.
43:00Come on.
43:04Is Daddy going to pick us up?
43:05No, I don't think so.
43:06Wait, what are we going to do, then?
43:08Get the bus.
43:10Good job.
43:11Thank you, you too.
43:13Just go.
43:16Harriet was limping for a few days, but is now back boxing and even doing PE.
43:22I'm going to go this way.
43:23Yeah, that's it.
43:24Come on, cross over.
43:30Are you doing a 12-hour shift today?
43:31Yeah, I do 12-hour shift.
43:45In the hub, Sister Jane is handing over to Sister Kim.
43:50Let me bring my staff in up.
43:52Well, that one's gone to the ward.
43:53There's a patient in cubicle seven who's a neck of femur.
43:56She's not had a block because she's too restless and there is no bed for her.
44:00Tracy is aware of it and she's trying to sort it out.
44:04To be in charge of the department, you do have to have a certain flair about you.
44:08You do have quite a lot of responsibility and obviously not everybody does want that.
44:13Chad, can you do me a transfer?
44:15I'll never ask you for anything else again in my life.
44:18You are, yeah.
44:22But I think every person should be given the respect that they deserve.
44:27Every team member that I work with work hard and to the best of their ability for what's best and safe for the patient.
44:33That's it from me.
44:34All right, sweet.
44:35All right, love.
44:36Hello, Anikin speaking.
44:38Jane's shift may be over, but the work of the casualty team continues.
45:13Transcription by CastingWords
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