- 8 hours ago
Ambulance Code Red S04E01
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Short filmTranscript
00:00In the intense world of medical emergencies...
00:03It's a patient breathing.
00:05Come on! She's lost!
00:07There's nothing more extreme...
00:09His lips are blue.
00:11...than an immediate threat to life.
00:13Massive, massive burn.
00:15Spins appealing.
00:16Responding 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 and the whale crashed into some people.
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 again
00:35to 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.
00:50..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.
00:58..whenever...
00:59Do you think it's fast?
01:00Potentially, yeah.
01:01..and wherever...
01:02Oh, my leg!
01:03..it's needed.
01:04Oh...
01:05You are doing a fantastic job.
01:06..filmed over three months...
01:08Let's have your arm, my dad.
01:09Let's give you some of this morphine.
01:11Just be aware he 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...
01:23Can you take a deep breath in for me?
01:25..fight to save lives.
01:27Your birthday present is surviving a cardiac arrest.
01:30..when every second counts.
01:32Let's go, go, go.
01:34Tonight, a five-year-old...
01:36She's leaving again! She's leaving again!
01:38..suffers multiple seizures with life-threatening implications.
01:42All are stainting. The patient's unresponsive...
01:44..and chest is not rising and falling.
01:47A farm worker is injured after 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.
01:57We're gonna 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...
02:07..and zap you back into a normal rhythm, essentially.
02:10And...
02:11Adam, look at me, darling.
02:13A 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? He'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, COPD, a heart murmur.
02:40Thanks to the enhanced medical expertise of 34 doctors
02:44and 25 critical care paramedics...
02:46Oh!
02:47Where's all your pain?
02:48Oh!
02:49Which one?
02:50This one?
02:51..countless lives have been saved across the Thames Valley region.
02:54He's now got repetitive itics.
02:56I think he still sees it.
02:57Yeah.
02:58And today, Dr Jazz Rayet and critical care paramedic Lisa Brown
03:02are preparing for another potentially life-saving shift.
03:05I've got to find a 100% mask.
03:08...
03:19...
03:22...
03:23ambulance emergency is patient breathing yeah uh we've got a broken leg would he be able to speak
03:29to me directly and answer any of my questions cool yeah i can pass the phone over hello are you the
03:36patient yeah i understand that you've injured your leg yeah and are you able to get up from
03:43the floor right now or are you stuck on the floor stuck on the floor the phone's showing
03:49oh okay so bone's sticking out through the skin yeah the brain's popping out okay so based on the
03:55information you've given me you'll call her categorized as a high priority this will confirm
04:00you've got somebody remaining with you until the ambulance arrives yeah
04:07a 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
04:19you mentioned a 42 year old snail and he's got a broken leg and that bone you keep kind of
04:24see outside and in a lot of pain there's a crew that's just arriving on teams that should update
04:29shortly but apparently the leg is at a right angle this sounds like this man's got uh an open fracture
04:39of his leg that's when the bone is protruding from the skin uh so things that we're thinking about is
04:46most likely he'll need good pain relief probably sedation to manage his injury so he can reduce
04:53the fracture with a high risk of infection if they're not treated quickly open fractures can
05:00lead to complications including internal bleeding nerve damage and even loss of limbs
05:05down here yes the accident has taken place at a royal mail sorting office where an ambulance crew
05:18is already with the patient hello hi hi uh uh hi i'm jas dr one of the uh for the ambulance service
05:27what's your name what's your name posty adam was sorting his round when he fell colleagues came to
05:33his aid calling 999 and tending to him until the ambulance arrived he's got good pedal pulse um no
05:40other injuries he's not in his head he's not gone unconscious um we're just running some paracetamol we
05:45haven't given him anything else in addition to paracetamol the ambulance crew are giving adam
05:51entonox gas a form of pain relief that's frequently used in childbirth and trauma care the benefit of
05:58entonox it works really really well if you take it for a really long time okay because what you're
06:02doing is you're sucking it in blowing out and having a break keep on taking it and load that pain relief
06:07for you and enable us 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 okay 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 this is brilliant you like the entonox do you know what they call it anybody know
06:47the entonox gas might be masking adam's pain now but it won't be enough when dr reyatt starts
07:03pulling the bones back into line 25 miles away in oxford critical care paramedic matt jarman and dr
07:15liesel blom are on one of many late shifts they've done together you sometimes don't see one of the
07:20the paramedics for a very long time but that's when i tend to every few months get a shift together
07:26probably more regular than that probably at least once a month with over 25 years of critical care
07:31medicine between them bliesel and matt are one of the services most experienced teams we're both
07:37really chill don't we like yeah you know there's no i don't really feel that much pressure no i'm
07:42pretty relaxed we're not a special team no no exactly and we're both on the same wavelength i think that
07:53two and a half hours into their shift the 999 call center takes its 1838th call of the day
08:07i don't think that's what i think that's what i think that's what i think that's what i think
08:13is the patient breathing she wasn't but she is now is that her up in here yeah she's just had a
08:20seizure she's got an icd she has cardiac issues she's had cardiac arrest before how old is she
08:26she's five years old she's never had a seizure before she was fully sneezing rolling in the back
08:33of her head okay she has two heart conditions she has long qt syndrome and she has stp is she breathing
08:40in and out in a regular pattern no what we would advise is that if she's not breathing in and out in a
08:46regular pattern at least one breath every 10 seconds then we do need to start the concentration
08:52she's breathing again she's breathing again she's breathing again and i've got
08:55it i can't deal with you if she's having a fever don't move her okay
09:02is the ambulance on its way as i said the ambulance is on its way
09:06the child has a known heart condition and is fitted with an icd an internal defibrillator
09:20it's designed to activate only when the heart is about to stop the child's life is in danger
09:27so as well as an ambulance the critical care team are urgently needed five-year-old fitting following
09:32chest pain lizel and matt are updated through phone messaging en route to the emergency
09:40yeah multiple seizures extensive cardiac history oh seriously 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 them up then
09:56it's got a built-in defibrillator that's like what we carry around and it will give the heart a little
10:00shock internally that's a little box built in under the skin now well this child is obviously known
10:07to cardiology the icd or implantable cardioverter defibrillator corrects dangerous heart rhythms by
10:15delivering electric shocks icd activated in 1836 activated well i mean i went off young rarely used in
10:26infants the icd was fitted as the child had previously suffered a cardiac arrest
10:32waller stating the nation'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 he's gonna stop
10:59in oxfordshire never mouth or four foot two on scene they're a paraeca group so literally seven
11:13minutes ago dr liesel and critical care paramedic matt are en route to a five-year-old who suffered
11:19multiple seizures and stopped breathing there's that ambulance let's leave it here for a moment see what's
11:26going on i'll move it a local ambulance crew were quickly on scene and have managed to stabilize the
11:33child let me just step on hi you guys lizel and matt from the air ambulance how are we doing hi this is
11:41rummy rummy that's gorgeous i bought that i know they brief lizel and matt on their findings so far
11:48so rummy five-year-old who has an icd fitted due to long qt type 3 and svt okay um has had two seizures
11:59and then after each seizure her icd has gone off as rummy has two serious heart conditions and an
12:05implanted defibrillator they need to be sure she remains stable and doesn't deteriorate she's got a
12:11fever of 38.5 so we wonder whether a febrile seizure is a convulsion triggered by a high
12:18temperature to help in their treatment of rummy dr liesel 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
12:29first one i can't actually say whether it was that's all right she was actually sat behind me
12:33oh um and i heard her like chasing on her tongue okay but the second one was definitely less than
12:39a minute okay the fact that rummy's internal defibrillator shocked her twice suggests that her
12:45heart had stopped beating they were quite close together she was stretched right out back arched her
12:51eyes were widened and bulging with a tear falling down she has had history of um so she's had
12:58cardiac arrest she is what age was she then she was one and a half so um arrhythmia that's when we
13:05found out that she's okay um so she has her icd she has had a few episodes of like sudden collapse
13:11that they thought was low blood sugars okay she has had uh like sickness and diarrhea for 24 hours
13:17but even with the temperature she's never never and how much has she been drinking um she's been
13:23sipping water and i have to put dye roll out in it fabulous well done not really well done how many
13:28kids have you got i've got nine she's well prepared six of my own and then i'm looking after an extra
13:33three yes with rummy in a potentially life-threatening condition they want to get her to hospital as
13:40soon as they can have you got all her meds yeah she's due her medicine here which one is what's that
13:45nine oh yeah it looks probably like we're gonna need it yeah so what we're gonna do if you guys are happy
13:52we'll jump on board and we'll get to the john rathcliffe perfect uh we'll get all our kits on board
13:58as well just in case why don't you get on board and get her flick a night yeah and then have you
14:03got her drugs in the bag ready to go as well you are so well prepared i love it uh let me just gonna
14:10help matt get the kit peace back if rummy suffers another arrest the critical care team's unrivaled
14:18life-saving skills will be crucial medical please it's the air ambulance coming by road on november
14:25alpha 442 due to the seriousness of rummy's condition dr liesel calls the dispatch desk to alert the
14:32hospital in advance i've got a five-year-old girl with a known cardiac history who's had two seizures
14:40today she's got an icd that fired at the same time latest obs at the moment i've got pulse is quite
14:49irregular ranging from 90 to 150 sets of 98 gcs is 15 she had chest pain at six o'clock when just prior to
15:02the first seizure currently she's calm and stable we'll see you there cheers bye-bye
15:20after close monitoring throughout the journey the team safely deliver rummy to oxford's john
15:25radcliffe hospital i'm gonna 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
15:40for 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 thoracostomy thoracostomy other patches it's early morning
16:08and dr laura douglas beverage and critical care paramedic neil plant who's been with the service
16:14since its inception are starting a 10-hour shift
16:24i 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
16:58that's what we're going to do
17:09ambulance margin 2 is the patient breathing yeah the patient's breathing at the moment
17:13so we do have an ambulance on their way reports of the farm worker falling from a trailer means neil
17:42and laura's advanced medical skills could be needed and quickly 16 year old on a farm was approximately
17:50five meter full uh has landed apparently in a ditch has got head and arm injuries
17:57there's a crew on scene doing an initially primary assessment 50 of all fatalities in the workplace are due to
18:06falls from heights and life-threatening injuries can include damage to vital organs including the brain
18:12so this patient's a a young man who's had quite a significant fall is what we've been given so far
18:20we have to make sure we're being cautious of any uh injury to the to the spine potentially we're thinking
18:26about any injury to the brain and what measures we might need to take to protect his brain then we have to
18:32just make sure that we're not um being falsely reassured by an injury that they're just less
18:37aware of because of the pain elsewhere so we still would have a fairly low threshold for being cautious
18:42about protecting someone's neck
18:48it takes the critical care team 11 minutes to arrive at the scene where an ambulance crew are already in
18:53in attendance hello there hello you all right thank you guys robin he is 16 yeah he was on a trailer
19:03it was moving in that direction the connection between the forklift and the trailer has got loose
19:08that it's gone into the ground 16 year old robin works on his family's farm and was on the trailer
19:14when the hitch broke plunging him over 10 feet to the ground the left arm is the main concern obviously
19:22step over to the top pain in the elbow the pressure was a 90 to 97 systolic and that's why we wanted
19:27some better pain relief okay we weren't getting on too well with the entrance the ambulance crew have
19:32administered an intravenous infusion of paracetamol and given robin entonox gas a 50 50 mix of nitrous
19:38oxide and oxygen often used as an initial pain reliever at a scene i understand you've got this injury to
19:44your arm but with robin not responding well to the gas and air the ambulance crew asked for the critical care
19:50team to help with their advanced medical skills and stronger pain relief any pain anywhere else at
19:56all my mouth hurts but it's fine okay and when you fell so you when did you kind of injure around your
20:06face you're not sure do you do you remember falling the first time you hurt your arm down my arm was
20:12broken like okay it's moving in my in my skin sure okay okay i know it's not a very nice feeling
20:19the ambulance crew have already checked there's no spinal damage so laura ensures no other serious
20:25injuries are being masked by the pain in robin's arm any pain when you're moving your neck at all
20:30lovely let me just have a gentle feel any pain over the top there no it does feel like fat though okay it's
20:37a little bit swollen perhaps any pain when i'm pressing down under the jaw there no okay what about
20:42over the side and across that front section down over the top can you open your jaw nice and wide for
20:52me look i'm just kind of 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 want to 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 sore feel me touch on this side lovely stuff around on this
21:14side yeah 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
21:27treatment can be done at the royal mail sorting office in aylesbury so your blood pressure moment
21:35is a 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
21:46flick my leg a little bit more with a risk of internal bleeding and nerve damage adam's bone needs
21:51straightening before they can move him is that a little bit more support or is that worse that's
21:56better it's an agonizing procedure so the first stage is to control his pain adam you keep doing
22:03what 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 going
22:06to give you this okay it's our green whistle it's an anesthetic type drug it works a lot more effectively
22:12than the entonox okay and i just confirm you've got no allergies and the problem with your kidneys
22:19that you're aware of brilliant now what you need to do is hold this okay you take it exactly the
22:25same structure of the entonox but what i want you to do keep this in your mouth breathe it in and
22:30breathe it back out through the chamber okay penthrox on methoxyflurane is an extremely potent and
22:37fast-acting form of pain relief it will make you feel very light-headed and 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
22:47but they need to do it so what you need to do six really big breaths in and out so fill up your
22:51lungs fully and then breathe out and then breathe normally after that okay i know the taste isn't
22:58nice adam but it's the effect of the jug that's going to help you okay good man yeah yeah keep going
23:06well done well done do your leg yeah you're going to need this yeah you're going to want this office first
23:13aid of tracy is among colleagues rallying around adam to offer their support keep going keep using it
23:20down there keep going to really breathe it in yeah yeah keep going keep going don't worry about what
23:29everyone else is doing just listen to us and let them do what they're going to do yeah i didn't carry on using it
23:36because every time you come off it's going to wear off very quickly yeah the critical care team is
23:42concerned that adam isn't inhaling enough of the gas to control his pain um have you got any morphine
23:48you want to get yeah give them some more free yeah give them a little bit how much do you want
23:52into cards um just give them five start with adam adam look at me darling did you prefer the other one
23:58yeah let me give you everyone right pick your head they're just going to give you some medication
24:03into your arm yeah you're fine they just need to get the drugs in your system to stop the pain
24:11have some laughing gas suck away on that if it isn't straight and soon adam's leg is at risk of
24:17permanent damage but until his pain is under control the critical care team can't safely move him
24:28in aylesbury so if you take four really big breaths in and out critical care paramedic lisa brown
24:39and dr jazz reyatt are trying to get posty adam's pain relief under control with a cocktail of morphine
24:45and entonox gas so they can straighten his badly broken ankle what you worried about adam nothing and
24:55more what 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
25:05to relax because it's gonna hurt yeah adam i need you to keep using the pain relief and then i can
25:11yeah reduce your ankle if you keep coming up i can't right so tracy's gonna tell you to keep on
25:17breathing okay and a good five minutes of deep breaths of that keep that in your mouth
25:25breathe in and out just in and out all the time yeah just keep breathing in and out that is brilliant
25:33right adam keep going we're gonna we're gonna make your leg straight now so keep taking the gas
25:38big deep breath well done the increased pain relief has taken effect and dr reyatt can attempt to realign the
25:45bones in adam's leg and just try and relax yourself down well done that's it that's it
25:51that's it adam fantastic brilliant that's it that's it that's it that's it that's it that's it
26:05okay we've got you yeah we've got you okay that's it just relax relax okay okay well done yeah yeah
26:12that's the work about adam your legs nice and straight okay
26:15okay okay well done before he can be moved adam's leg will need to be immobilized right adam open your
26:21eyes well done how are you doing well done good all right talk to me you all right adam hang on
26:31there's about four people no one seven people talking to me now 25 people talking to me now oh just me
26:38and just tracy yeah adam just pop your leg down for me relax let's go let's go i don't think i've
26:45seen anybody experience enternox as great as you absolutely brilliant it's okay my leg
26:52adam if you need to take it take it okay but don't take it if you don't need to it's a bit like a
26:58comfort like yeah yeah okay i'll give you that i'll give you that with his leg secured in a vacuum
27:05splint adam can be loaded onto a stretcher so adam what we need you to do we're going to help you to
27:11stand put all your weight into this good leg here we're going to hold that leg we're going to go on
27:14three might be a little bit uncomfortable luckily the combination of morphine and entonox has adam in
27:20high spirits okay we'll do one dos tres if you want to go ahead what would you like
27:26one one two three three one one two three okay right one dos three up 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 to
27:49pop you up to state manderville hospital and they'll see you over there okay freeing up the critical care
27:56team to respond to the next emergency call he was certainly interacting with his colleagues and with us
28:03and i think that his demeanor made it a little bit easier for us to communicate with him explain what
28:08we're going to do and it also helped with his pain and management of his injury at the same time as well
28:13so job's well done and he's no longer required any pain relief and the plan is to go to state
28:18manderville hospital for next time
28:19every year the thames valley air ambulance responds to over 1200 cardiac arrest calls
28:32and the food right 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 arrest
28:43are just one in ten i can't feel a pulse all right let's go back to here but with early access to a
28:48defibrillator those odds are greatly increased
29:06good morning and it's just 111 and what's the reason for your call today i uh found myself at work with
29:11an irregular heartbeat shortness of breath and pain from my chest and my neck
29:19um i have one of my colleagues nearby have you lost any blood no i haven't you mentioned chest pain
29:26shortness of breath irregular heartbeat which one is giving you the most concern probably the
29:32shortness 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
29:42fairly quickly and the left side is going sort of a beat or two just before the right side okay the
29:50information will be passed on to the ambulance service who will attempt to dispatch an ambulance to your
29:54location all right heart 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 it's a 22 year old male pulse vt
30:17pulse rate from 200 odd um he's very shut down the crew are quite worried um they're just trying to get a
30:23line of the day coming okay cool uh so we're going to a 22 year old man uh who's reported to be in an
30:32abnormal fast heart rhythm and there's there's been some concerns passed from the ambulance crew that he
30:39looks quite unwell um potentially with a with a low blood pressure and what we'd call a kind of shocked
30:45state a very fast and irregular heartbeat is a potentially life-threatening combination
30:51if left untreated it can lead to catastrophic consequences the kind of obvious consideration
30:57is whether he whether he needs electrical cardioversion whether he needs some sedation and an electrical
31:03shock from a defibrillator to get him back into a normal heart rhythm and it sounds like
31:08he's shut down and they're worried about him so i feel like our default should be
31:13sedate and cardiovert sedation is going to be moderately high risk the patient was on his way to work at a
31:22garden center when he began to feel unwell presumably the dma's here somewhere after calling 111 a local
31:29ambulance crew was dispatched and he's already on scene
31:36oh have they brilliant hello hello
31:40this is luke um howdy hey how are you doing around kind of 10 to 9 he was cycling into work had started
31:48to have 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 going to get a full heart tracing luke which
31:59will be loads of stickies on your chest 22 year old luke works as a sales assistant at the garden
32:05center to assess his heart the team are carrying out a tracing to record the electrical activity
32:11do you have any medical problems normally excellent any medicines you take regularly
32:16um i take loratide for my hay fever that's it okay nothing else and you're just cycling into work and
32:21yeah literally woke up fine showered everything like that started cycling got to the roundabout just
32:26down the road from here and chest felt weird and you've never experienced that before nothing
32:30was before first time uncommon in someone of luke's age chest pain and unusual sensations can indicate a
32:38serious heart problem which without urgent treatment could lead to cardiac arrest i think there's
32:44there's broadly speaking two directions that we might go with this and it will depend a bit on
32:48the heart tracing um the first is we give you some medicines to see if they make your heart go back
32:52into a normal rhythm um the second which we might need to do is we give you some sleepy medicine so
32:57you're sleepy and sedated and then we zap you with a defibrillator and zap you back into a normal
33:02rhythm essentially who's here next to kim by the way mom and dad are just outside thank you cheers
33:08i 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 ultrasounds put a big line into a big vein hopefully and then load with amiodra in over 20
33:37minutes no problem instead of using a defibrillator to shock and reset the rhythm and rate of luke's
33:43heart tim 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
33:59then when we find one we'll um hopefully put a cannula in it for you well these guys have got a bit
34:07more gadgets 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
34:20so that's perfect yeah well done so he can quickly insert a cannula and administer the medication luke
34:27needs very near arm there come in i'm going to press really hard to try and stop it bleeding
34:34i've got the end of it
34:40in a matter of seconds the cannula is successfully in good um now should be dressing in there
34:46yeah outside emma updates luke's mum his heart's still gone way too fast but his blood pressure's
34:54good and all that kind of stuff so we are just going to give him a medication to help hopefully
34:59to bring his 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
35:09options all right so you're starting the things that you would maybe would have been done 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
35:17questions in the meantime just out 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
35:44we'll do one more blood pressure and then we'll give you something a bit stronger for the pain if
35:50you're not getting on with that gas in there 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 too keen on the
36:08end to knock so we can lose that one laura has checked for nerve damage and fortunately robin
36:13appears to have normal sensation so now she can treat his arm is it humorous the fracture yeah
36:20a humorous fracture is a break to the bone in the upper arm okay i wonder if a sling might be a bit
36:25more comfortable for him yeah the fact that when we got here we were like this yeah yeah normally
36:31the way a humoral fracture the weight of the arm's quite good so just a yeah yeah trying to a bandage
36:36yeah it's just doing his blood pressure so just wait two seconds just because you won't go in time
36:41although it's well supported now robin's arm will need to be properly immobilized in a sling for the
36:47trip to hospital what we'll do is we'll do your blood pressure we'll get you on the trolley and then we can
36:52look to get your arm in a bit of a better sort of position something a bit more comfortable where
36:56are we going we'll just budge this out the way and i can take the weight of that arm it will feel a
37:04little bit strange as we're starting to get you moving okay but i'll support your arm as much as
37:08possible and we'll very much take our time no rush okay grand you're doing really well i'll just take
37:14that on there now you know when you're ready do you mind just moving that bag out there laura and neil
37:20are satisfied that robin can be safely moved shall we just stand up first that's it there we go then
37:28you'll be here if you just turn yourself around and come out this way you got that arm i've got you so
37:34don't worry about like and then uh yeah just sit your bottom on there that's it put your bum right back
37:40into the back of the trolley okay whenever you're comfortable just pop your other leg up
37:45whilst neil moves robin to the ambulance laura talks to his mum who's arrived at the scene
37:51injuries but he has got what looks like a break to the top part of his arm
37:55from our side of things otherwise in terms of his heart rate his blood pressure everything else is
37:59looking lovely and unsettled yeah absolutely obviously he has still had a significant bump to
38:04the head so you'll need to be observed for a period of time yeah and the wound you'll need to have
38:09an x-rays of his arm on the stretcher neil can get a better look at robin's arm so we've got the
38:15sling ready we're just going to remove that there you go that's you've just got some abrasions on there
38:23and so is it broken so we think you might have broke this bone your humorous humorous bone this
38:28top bone here which which is fine could they heal quite easily really all right darling
38:36you all right there buddy yeah 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
38:55no further critical care is needed so the ambulance crew are taking robin to wexham park hospital for
39:01x-rays and further treatment
39:07at a garden center in wokingham is that right just saved me dropping dr tim wait and critical care
39:14paramedic emma gray a treating 22 year old sales assistant luke who has a potentially life-threatening
39:20fast and irregular heartbeat i think you're sort of well enough if i could put it that way that
39:25that we shouldn't be zapping you with a defibrillator um let's try with the medicines we'll spend the
39:32time while the medicines are trickling in transporting you up to robark's hospital if the medicines don't
39:38agree with you or if things get worse on the way we can give you some sleepy medicines pull over
39:44and um and go back to sort of plan a so to speak and use the defibrillator but
39:47once we've got amiodarone running there's probably little reason to stay on scene
39:52a powerful and potentially life-saving drug the amiodarone should slow down the overactive
39:58electrical signals in luke's heart yeah so ladies in i think we give 300 of amio and we run it in
40:06in a mini bag of saline and we're about what 20 minutes from the royal barks and we want our amio
40:11going in over about 20 30 minutes if successful the drug will restore a stable rhythm to luke's
40:17heart without shocking him with a defibrillator why don't we start amiodarone pack up gentle slow
40:24time steady blues up to the royal barks and then that will sort of use the interval of time while
40:30that's running to move him to hospital and then he can always have a sedation and cardioversion if he
40:34doesn't respond to pharmacological management we could always pull over can't we yeah exactly
40:40let me just go and speak to mum and tell her yeah that would be that would be brilliant so we are um
40:46going to give him the medication whilst moving on the way to hospital he's not got any worse of
40:51anything it's just that we can do it on so that's what we're going to do if given too quickly the
40:57amiodarone could dangerously lower luke's blood pressure so tim's administering it slowly with
41:02saline this one it sometimes can cause a bit of irritation in the vein but it doesn't normally
41:07and sort of when it's diluted and it's in the initial initial sort of dosing wonderful you're a very
41:14calm cool customer lake there's no point in having to talk about something when there's nothing i can
41:19do about it i like you i like your style i'm just gonna put your seat belts on there there we go
41:29so the intent is for this to trickle in over about 20 to 30 minutes just keep an eye on it
41:37luke appears stable but with a possibility that his heart may still need to be shocked tim and emma travel
41:43with him we are on november alpha 410 with an eta of approximately 10 minutes 10 minutes tim puts in
41:53a call to the dispatch desk to alert the hospital to their imminent arrival bring in a 22 year old male
42:01with onset of hemodynamically stable pulsed vt at approximately 9am this morning he's got a heart rate
42:09currently of 167 so we've given him 300 of amiodrome which is just finishing now but i i think the i
42:17think the outcome of that strategy is going to be we're likely to arrive with a man who's
42:20will need a procedural sedation and a cardioversion as serious as the situation is luke's maintaining his
42:27cool and looking to the future i'm meant to be going on a trip to boston would anything like this
42:34cause any sort of issues i would say take this one thing at a time work out what's going on first
42:38absolutely yeah it's probably just worth double checking the temperature making sure you've got
42:43it as well in america absolutely on arrival at hospital with his heart rate still dangerously high
42:50luke's handed over to the cardiac team leaving dr tim and critical care paramedic emma free for the next
42:58emergency call
43:28so
43:32so
43:40so
43:42so
43:48so
43:52Transcription by CastingWords
44:22Transcription by CastingWords
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