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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:11You never know what's going to come through the door.
00:16At night, you always have to be prepared for the unexpected.
00:19Multiple kicks to the face.
00:21They said if anyone approaches them, they're going to attack us all.
00:23Across the UK, with extraordinary access to three of the most challenged emergency departments.
00:29in the country.
00:31Guys, I need help in here.
00:32He could have died.
00:33We follow the work of emergency medics who battle every night to save lives.
00:38Chuck in now.
00:40It's a stab wound.
00:42With drugs and alcohol rife.
00:44I've had five or six pints.
00:46Step back.
00:47The department's just on fire.
00:50Get it.
00:51Yeah, yeah, yeah, yeah, yeah.
00:52The risk of violence and abuse looms large every night.
00:56And you, you're maxing your .
00:58Stop trying me, boys.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched, I've been spat at.
01:06You've got nothing on me, bro.
01:08Right?
01:08Fire.
01:09There have been days when there have been more police officers than patients.
01:13What punch you're reading, mate?
01:14What's going on?
01:15All hell's broken loose.
01:17Patients running around, security everywhere.
01:19Shut up.
01:20I don't care.
01:21This is the sort of thing that we have to put up with.
01:22Get security to remove it.
01:24It's chaos.
01:26Glorious chaos.
01:39Over two million people visit A&E every month.
01:42And there's another alert coming in as well.
01:43And the number is continually rising.
01:45Ready, steady.
01:47With more patients comes more people under the influence of drugs and alcohol.
01:51The actual people that come through your doors out of ours, there are other people that
01:56end up having too much fun.
01:58They smell quite a lot of alcohol.
01:59Well, they're up to no good and ending up in A&E for whatever reason.
02:03So that's when we see our most challenging cases.
02:05We're not going to stand for the abuse that you're giving people.
02:08With more people arriving, having been involved with alcohol and drugs, comes an increase
02:13in violence against staff.
02:14Yeah, yeah.
02:35In Birmingham's A&E waiting room, a man trying to book his mother in has started hurling
02:40abuse at patients around him.
02:48Security have been called as he's beginning to disrupt the sick patients in the waiting
02:52room.
03:15With the man not calming down, more security have been requested to contain the situation.
03:35The waiting room is normally just wild.
03:38You have to have a personality about you where you can control difficult situations.
03:42You've got to be quite a strong personality and be able to say, like, no, you need to leave.
03:47Otherwise, I don't think he would be able to work it, to be honest.
03:54Security have managed to get the man away from the patients, but he's not ready to leave
03:58yet.
03:58Don't get that ****.
03:59Don't get that ****.
04:01Don't get that ****.
04:01Don't get that ****.
04:02You ****.
04:04Hold up.
04:05And you, you're messing your ****.
04:07No one was here **** looking after you.
04:09Good man ****.
04:10Don't.
04:11There's been times where staff out here have been assaulted, punched, kicked, threatened
04:15with weapons.
04:16Can you leave the penalty?
04:18With the man becoming even more aggressive, security backup is requested again.
04:23No, no, no.
04:24Don't get aggressive.
04:25It's okay that someone's magic down, Molly, but you're all right to stand there and tell
04:29me.
04:30You're all right to tell me to move and let him carry on and bring this stuff in.
04:35I don't care.
04:36She's not landing.
04:38I'm fucking in for her.
04:39Why is it magic down, Molly?
04:41Why is it magic down here?
04:42Why is it magic down here?
04:44Why is it magic down here?
04:46Why is it magic down here?
04:46Why is it magic down here?
04:47Why is it magic down here?
04:48Why is it magic down here?
04:49The man is out of control and Sister Lauren can see no other option but to call the police.
04:54So there's a gentleman behind him waiting to lock in.
04:58They're just being verbally abusive towards staff.
05:01Police have arrived on scene to assist security.
05:04You've got my **** to use the door.
05:06Go back inside there.
05:08Then you go and take the people that you came for.
05:11You took me.
05:12You took me.
05:13So don't mind your business.
05:17The thing is, that gentleman then, though, he literally just wanted to book in.
05:21There was a queue.
05:22That's the annoying thing.
05:23He was literally a queue.
05:24And he just didn't like that.
05:25He was so close.
05:26That's nasty.
05:28With the presence of police and security combined, the man is deterred enough to leave the hospital
05:33grounds, taking his mother with him before she could be treated.
05:38We'll stay in the area for now.
05:39That's why I couldn't get a taxi as soon as they leave.
05:43I'm trapped from there.
05:45Yeah, that's fine.
05:46Cool.
05:51Cool.
05:53Cool.
05:54Cool.
05:59Paramedics are on their way to hospital with a 23-year-old male who's been the victim of
06:03a serious attack.
06:05Assault in the city, GCS 5, and lots of blunt force trauma to the face.
06:10GCS stands for Glasgow Coma Scale, which measures a patient's consciousness.
06:17So, what is the plan?
06:18If the GCS is really five, then do we have additional support?
06:22Do you have anybody here who can help?
06:25Any reading under eight after a blow to the head can indicate severe traumatic brain injury.
06:32Shall we do a hands-off handover and then we'll move if you're happy?
06:36All right, guys.
06:37So, this is Connor.
06:38He was assaulted.
06:39One punch to the head and then a kick to the head while I was on the floor.
06:43When we arrived, he was unresponsive.
06:46He was a little bit agitated and restless, pulling things away.
06:49So, he's got clear blood trauma forced to his face with multiple injuries to his face.
06:54His airway is manageable.
06:57Chest is clear and equal.
06:58Belly soft.
06:59Pelvis symmetrical.
07:00No long bone injuries.
07:01So, we don't think there is any drug or alcohol on board at this moment?
07:05We don't.
07:06We don't know.
07:06Okay.
07:07Okay.
07:07Everybody ready?
07:08On move.
07:09Ready.
07:09Set.
07:09Move.
07:10We want to start the primary survey whilst we're doing this.
07:13Connor.
07:15Maybe it's not pretty.
07:18Just try and relax, Connor.
07:20We are just trying to help you.
07:21The team need to perform a primary survey to assess and treat any immediate life-threatening injuries.
07:27No chest wall deformity.
07:30Abdomenus soft and non-tendered.
07:34Sit straight in and he's out, Connor.
07:35Come on.
07:36Good, man.
07:37That's it.
07:38He's not responded to voice and eyes.
07:41Has he opened at all with any kind of stimulus?
07:42No.
07:43He is painful stimulus.
07:45He is actually localising.
07:46So, five, six, seven.
07:47Maybe it is a bit abnormal, but I would say it is six because of the lower limb.
07:52As long as he's being looked after, that's what we care about.
07:55Connor's mother and partner arrived at the hospital shortly after hearing Connor was attacked.
08:00He's not very well because he's not responding as well.
08:05He is unconscious is what we would say, but we will go through all the necessary tests in bloods as
08:10well as imaging and then we'll come back and talk to you.
08:14Connor?
08:16Connor, my man.
08:17Wake up.
08:18Open your eyes for me.
08:19Are you able to do a fast scan?
08:21When a trauma patient comes through A&E, we know that a priority is getting a CT scan as that
08:26allows us to identify nearly all injuries in a very short period of time.
08:30We have a patient with a GCS of six. He will need airway support, has a lot of facial injuries,
08:34to be transported to CT immediately.
08:37Without a CT scan, it's unknown how serious his brain could be damaged.
08:42There's no science to fighting. There's no science to being punched in the head.
08:47It can be a simply wrong punch in the wrong place at the wrong time, can kill someone.
08:52Connor, open your eyes for me.
08:56I think it's CT.
09:14We have to calm down.
09:16NHS staff in the UK experienced more than 150 incidents of violence and aggression every day.
09:23There's been an increase in sort of drugs and alcohol. We see an increase in violence.
09:28The problem is particularly prevalent in high-pressure departments like A&E's and even more so at night.
09:34I've seen a lot more abuse towards staff. These are things that I don't think we come to work to
09:40deal with.
09:40The estimated cost of violence and aggression to the NHS is in excess of £69 million a year.
09:53Connor, open your eyes for me.
09:57I think he's seeing it.
09:59His people's run react to it.
10:01That one reacted.
10:0423-year-old Connor is being assessed after a serious assault has left him with multiple head injuries.
10:10I think he sees it.
10:12I think he sees it.
10:12He will need intubation before we can take him to scan.
10:16He needs a CT scan of his brain to see if it's damaged.
10:20But before he can go, the team decide they need to intubate him, which means taking control of his airway.
10:26We're going to use ketamine.
10:27We're going to use rocuronium.
10:28We're going to give a little smidge of metamil and induction.
10:30We're going to maintain the fentanyl and propofol.
10:33I'm team leader, your first intubator.
10:36Connor's partner and mum are waiting for news.
10:39Unfortunately, he has been unconscious for a long time.
10:41And it is not...
10:43We have to do a CT scan for him.
10:45And it won't be safe to take him just like that.
10:47We will have to protect his airway because he may lose his airway.
10:50So we will be giving him some medicines, protecting his airway, taking him to a CT scan.
10:54Okay?
10:55These are my anaesthetic colleagues who will facilitate that.
10:57We're going to do video laryngoscopy.
10:59But if the blood...
10:59If the airway is contaminated, we've got a direct available.
11:02Basically, if the solid goes below 100 or you see anything else critical, give us a shout if that's okay.
11:07Intubating a patient in layman's terms means popping them on life support.
11:11Give me a shout when you want the timer.
11:12Yeah, let's start it now.
11:14Bit of metamil.
11:15Do you want to have a look in now?
11:17So you're about 40 seconds now, so...
11:20What we do is pop a tube down into their windpipe,
11:23and then we connect them up to a ventilator which breathes for them.
11:27Blood pressure 98.
11:33When you drop your consciousness level,
11:36you lose that ability to keep your tongue forwards and out of the way of your windpipe.
11:40That then impacts on breathing,
11:42and that can affect the amount of gases in your blood,
11:45which we know can have a knock-on effect for the brain.
11:49Happy?
11:49Happy.
11:51Check in tidal.
11:54Check in tidal.
11:55Check in tidal.
11:58His airway has been secured now.
12:01He's put on the ventilator, so the ventilator will be breathing for him,
12:03which is a good thing because we can monitor him more closely.
12:07We'll be taking him for the CT scan,
12:08and depending on what it shows, we will plan the next step.
12:12With Connor's airway protected,
12:14he can now have the crucial CT scan to find the impact the attack has had on his brain.
12:20Mainly with these kind of injuries, from our experience,
12:22it is fractures involving the skull and the head,
12:24as well as accumulation of blood around the brain,
12:27that can induce fits, seizures.
12:30Everyone happy?
12:31Yeah.
12:32Okay, ready, steady.
12:33He was assaulted mostly with punches and kicks,
12:37and then probably weapons involved.
12:39Most of the injuries that we can see externally are facial.
12:45If he has a bleed on the brain, he could need emergency surgery.
12:53So, he has some blood in the fissure here.
13:02It looks like it's going into the fissure, but it's very focal.
13:12There's no subdural hemorrhage.
13:15He has some blood in his, we'll see if it's blood,
13:19but it could be blood in his right maxillary sinus.
13:23He's got a very small bleed in his brain.
13:25We're going to discuss it with our neurosurgeons down at Cambridge,
13:28but I don't think that they're going to want to operate on it.
13:31He's also fractured at the bottom of his eye socket,
13:34and his muscles have kind of just penetrated through there.
13:37And he's also got a bit of blood in his sinus,
13:40which is just behind the cheekbone,
13:41which is all consistent with being punched and kicked in the head.
13:46Connor's injuries will need careful monitoring
13:49until he can be transferred to the ward to recover.
13:52We'll go to recess now,
13:53and the intensive care clinicians are going to do other lines
13:56and more invasive monitoring
13:58so that we can keep a close eye on him.
14:00And we will wait for the neurosurgeons to get back to us
14:02if they have any other suggestions.
14:25We'll get some blood tests done,
14:26and we'll give it a good go and try and get you better.
14:30In Birmingham, senior consultant Elena is in charge of recess.
14:36Hold on, some stuff going on.
14:39Where the most critical patients come for treatment.
14:43We have ten bedded recess,
14:46and at the moment there's eight patients,
14:48all of them extremely unwell.
14:50A&E is a lifestyle, it's not a career.
14:53We need to learn to do it alongside everything else in your life, really.
14:56You know, whatever it is, family, kids, passions, hobbies,
14:59you have to learn early whether it's for you or not.
15:02The majority of us that stick with it is because we love it.
15:04You okay? Yes.
15:05That looks bad.
15:06Yes, it will be.
15:07Who's that?
15:10Hello, QA.
15:15Have we got any space for this asthma?
15:17We have got, that's the last race I've spared, so I'll give them one.
15:20A 36-year-old woman is having a severe asthma attack
15:24and is on her way to A&E.
15:27Her stats are 87 on air,
15:29so that makes me a little bit worried.
15:32She may be suffering a life-threatening asthma attack,
15:35meaning that she can just about gasp in between breaths.
15:39The ambulance have reported an oxygen saturation at 87,
15:42so anything below 95, you know, young adult, is definitely bad.
15:47We have your piece.
15:48This is Jenny.
15:49She's a 36-year-old.
15:51She has the onset of an asthma attack today.
15:53She's used her inhaler 12 times to nil effect.
15:57While the paramedics hand over,
15:58the medical team will take blood to be analysed for oxygen and CO2 levels.
16:04Asthma attacks are an absolute medical emergency.
16:08You never know what walks through that door,
16:10so you always prepare for the worst when it comes to asthma.
16:14We have given three salbucemols, an hypotropium, and 100 hydroquartz.
16:21She has got a one-week history of a chest infection.
16:25Her triggers are dust, perfume, and cold air.
16:27So we think she's been triggered by the dust in the house
16:31along with the chest infection today.
16:33OK.
16:34Jenny, I'm Helen. I'm one of the A&E consultants.
16:37Does your chest feel very tight?
16:46I think we should put a salbutamol while we do all of that.
16:49The team administers salbutamol,
16:52a drug that relaxes the muscles in the airway.
16:54The calmer she is, the deeper breath she takes,
16:57the more medication gets into the lungs
16:58and what exactly needs to be for it to work.
17:02When you can't breathe, your brain gets the message
17:04that something really bad is happening.
17:06So anxiety will play a big role in her not being able to breathe.
17:11And let me see if I can put the bed a bit more high up for you.
17:17I'm going to tilt it a little bit so you don't fall down.
17:20Is this OK?
17:22So we've given you magnesium
17:24that usually helps the chest settle a bit more.
17:26We're going to get the chest X-ray done over here
17:28just to make sure that there isn't anything else
17:30that we need to deal with in the lung.
17:31And we're going to take it from there, OK?
17:35While Jenny waits to see if the medication takes effect,
17:39Dr. Elena and Dr. Victory look at her blood results.
17:43I was really fighting for her birthday.
17:44Look at the lactate.
17:45She's hyperventilated as well.
17:48There's a reason why we keep them in places
17:50like a resuscitation area or monitored cubicles
17:53because we know for a fact they can go off
17:56or decompensate in a second.
17:59She's not retaining her CO2.
18:01I'm thinking, well, she's just had the magnesium.
18:04She's just having another mixed neb.
18:07Really, what's the next step, isn't it?
18:11Um...
18:11It would be aminophilin.
18:13Either that or salbutamol IV.
18:15But if we're moving to that line,
18:17we're going to have to call ITU.
18:20Jenny may need stronger medication
18:22to help her control her breathing.
18:25But if that fails,
18:27intensive care will need to be ready to step in.
18:47Do you have a specific space?
18:49In Tunbridge Wells Hospital Majors,
18:51Dr. Ahmed is working the night shift.
18:53Fine. Wonderful. Thank you so much.
18:57The emergency alarm has been raised.
19:06Did you listen to me?
19:08Yeah, yeah.
19:08No, I like this.
19:09Do you have any lung issues?
19:10No.
19:11And do you know where you are at the moment?
19:12What?
19:13OK, where is that?
19:15That's fine.
19:1642-year-old David walked into A&E
19:19with back pain and dizziness
19:20before collapsing in triage.
19:24OK, look at the side.
19:29We've brought in a patient into resus.
19:31He looks very ill
19:32with a very, very low blood pressure,
19:34looking pale,
19:35very drowsy,
19:36very dizzy,
19:37almost collapsed.
19:39I have a bad back.
19:40And when you say bad back,
19:41what do you mean?
19:42I came home
19:43Monday night,
19:44Monday night,
19:45just on the winter before.
19:46I had an agonist at home.
19:48That was two weeks ago?
19:50That was two weeks ago.
19:51Like between your shoulder blades?
19:52Yeah.
19:53OK, see ya.
19:54I couldn't take a full breath
19:55because of the pain
19:56and the midnight
19:57to have to call 911.
19:58They sent to,
19:59since the paramedics.
20:01They gave me gas and air
20:02which then relieved the pain.
20:05You took the pain away?
20:06Well then I took some,
20:07uh, COVID.
20:08Did that help manage your pain?
20:10Yeah.
20:10OK.
20:11This evening,
20:12I just sat and feel like I did this
20:14and then fell on the floor.
20:16Uh,
20:16I was feeling quite,
20:18like dizzy,
20:19like blurry when I was looking.
20:20Mm-hmm.
20:21And you have the back pain today as well?
20:22Yeah, yeah, yeah.
20:23I have my back pain.
20:23How would you describe it?
20:25Is it dull or...
20:26It's more a dull pain today.
20:27It's not like the first day.
20:29The first day was like,
20:29I was...
20:30Severe?
20:31Really severe.
20:32Someone who has collapsed,
20:33someone who's had his blood pressure
20:35go down as far as 60 systolic,
20:37someone who looks that pale.
20:39My main concerns would be,
20:40uh,
20:41first aortic dissection,
20:43meaning that his aortic walls might be thinning.
20:45It becomes very weak and might burst,
20:48causing the blood to drain into his chest cavity
20:51in a few minutes.
20:52And it's a very,
20:53um,
20:54fatal condition if not treated or not caught,
20:57uh, in time.
20:58Because it's between your shoulder blades
21:00and because your blood pressure collapse
21:02all of a sudden,
21:03we're thinking the main blood pressure on your body
21:05that takes the blood from the heart,
21:07distributes it throughout the body.
21:09You might have something wrong with it.
21:11Uh,
21:12probably an aneurysm.
21:13Yes.
21:14OK.
21:14So we need to do a scan for that.
21:17We'll also examine and test for other causes
21:19like heart problems and infection.
21:21But we have to work our way from the most critical
21:24to the least critical.
21:25Yeah.
21:27Hi.
21:27I have a patient who crashed in the triage room.
21:30We are querying an aortic dissection.
21:32Are you guys ready for him?
21:34Bye-bye.
21:35Yeah.
21:35An aortic aneurysm can rupture at any moment.
21:38And if it does,
21:39it can kill you within minutes.
21:41It's critical they get him into the scanner
21:43as soon as possible.
21:45Three,
21:46two,
21:46one.
21:49He's got interscapular pain.
21:51And that's why we were thinking about aneurysm.
21:54So we'll go ahead for a CT scan,
21:56uh,
21:56of the aorta.
21:57And if it's one of the things that we're concerned about,
22:00it will show.
22:01Take a breath in.
22:03Please be OK.
22:13You may breathe normally.
22:18So basically, this is the heart, and this is the pericardium.
22:23Usually, this space should not be there.
22:26But there's some sort of inflammatory process going on.
22:30It's not the aneurysm Dr. Amit suspected, but it is serious.
22:35When you've got the heart with fluid in between the membrane surrounding it
22:39and the heart muscle itself,
22:42that fluid can build up to a limit, creating a pressure.
22:46If not treated properly and early on,
22:49it can prevent the heart from refilling
22:51and pumping blood to the rest of the body.
22:53And that can be life-ending.
22:55It can end one's life.
23:07Ready, steady.
23:08The night shift in A&E sees a large amount of visitors
23:11under the influence of alcohol,
23:14with one in five young adults
23:15having attended for a drink-related injury.
23:18You weren't very with it when you came to us.
23:20Types of injury range from violent attacks...
23:22Well, basically, that was an assault.
23:24..to breaking bones and falling over in high heels.
23:27On a wet, on a wet path.
23:29In a path.
23:30You know, people go out and people have drinks and fights
23:32and, you know, this and that.
23:33So, yeah, you see more people coming
23:36with drug and alcohol-related issues,
23:38more in the night than you would see in the day.
23:41But not all night-time patients come in after a drink.
23:45Time to see you, lovely.
23:5736-year-old Jenny has come into A&E
24:00with a serious asthma attack.
24:02And then we've given her salbutamol.
24:04Dr. Elena is hoping the medication they've given Jenny
24:07will help her breathing.
24:10If the medication doesn't take effect soon,
24:12they may need to involve the intensive care unit.
24:20How does it feel now compared to how you were at home?
24:23I think they look slightly worse this time.
24:27Sorry.
24:27It's slightly worse this time.
24:28It's longer.
24:29It lasts longer.
24:31Okay.
24:32It's a condition in which the inner structure of your lungs,
24:37they go really, really tight,
24:38and it doesn't allow for the air to go in.
24:40And that's where we need to give them special type of medication
24:42in order for the lungs to relax.
24:44The muscles that are keeping your lungs tight,
24:46they need to relax.
24:47So, let's give five of salbutamol and 500 of Artoven.
24:50So, this will be five of the salbutamol?
24:51Yeah.
24:52I prescribed you 2.5.
24:53I'm going to go and prescribe this once now.
24:56The last chance they have is to use stronger medication.
25:00Let's see how we go after this.
25:02I guess we're not very good at being patient in A&E,
25:06but I think this is the bit that we haven't tried.
25:09Wait a little bit and see what happens.
25:11If it doesn't work, then the next plan would be
25:13to call our colleagues from intensive care.
25:15But hopefully, we don't need to go to extreme measures like that.
25:22I'm sorry about this, but because we're going to do a chest x-ray,
25:24any concerns you may be pregnant?
25:31While they wait to see if the medication works,
25:34the team x-rayed Jenny's lungs to look for any other medical conditions
25:38that could have triggered her asthma attack.
25:43I'm going to check to see if the x-ray has been uploaded.
25:46The x-ray?
25:48Yeah.
25:48So, she does have, like, the rib space is quite widened, isn't it?
25:52So, that's a sign that she's struggling to breathe and trapping some air in there.
25:57The x-ray hasn't revealed anything new,
26:01but after 30 minutes, there's good news.
26:04She's looking better.
26:06Her heart rate has actually calmed down a little bit.
26:08I'm happy that she responded very well to the treatment.
26:11So, my gamble worked.
26:13It wasn't really a gamble.
26:14Sometimes, in certain conditions, like, including in asthma,
26:18you have to allow a little bit of time for the medication to work.
26:22Dr. Elena can move Jenny out of recess to a less critical ward.
26:27The tendency is to...
26:28You're trying to fix it.
26:29You see somebody struggling with their breath,
26:31you're trying to give medication, more medication, more medication,
26:33fix it.
26:34But there comes a point where you actually need to allow
26:36those medication to start working.
26:38So, another skill that we need to learn as we become seniors
26:40is to learn to stop breathe and, like, allow a bit of a time to,
26:46you know, to pass.
27:03It's a busy night in Norwich A&E.
27:10Ashley.
27:10Hello.
27:1231-year-old Ashley has come into A&E
27:14after taking a fall on a night out with Mace.
27:18Could you just have a seat?
27:20He's being looked after by Dr. Lee.
27:23All right.
27:24So, why don't you tell me what happened?
27:26I was at the pub watching the footy.
27:29I got talking to a bunch of lads.
27:31One of them said, do you want to have a race?
27:33And I was like, yeah, let's have a race, all right.
27:35OK.
27:36So, it seemed like a great idea at the time.
27:37And I just remember sort of tumbling over.
27:42OK.
27:43Did you hit your head when you fell?
27:45I think so.
27:47I think I did.
27:48I can't actually really recall very well.
27:49After that, I'm a little bit hazy.
27:51Did you have any bleeding from your nose, your mouth, your ears?
27:56Uh...
27:56Did you bleed?
27:57I mean, I don't think so.
27:59OK.
28:00Since he can't remember, the reason why I ask him all these questions
28:03is to know if he lost consciousness
28:06and if his conscious level dropped at any point
28:09during the time he had a fall or after he had a fall.
28:14Dr Lee is worried his memory loss could be a symptom of concussion.
28:19The floor you fell on, was it hard?
28:21It was like...
28:22Was it concrete?
28:23Gritty concrete.
28:24I think I just went a bit hazy afterwards.
28:26Because I hadn't quite a lot to drink.
28:27Um...
28:28So, like, how much did you have to drink?
28:30I don't know.
28:31About...
28:32Seven or eight pints.
28:33OK.
28:34Any headaches, chest pains?
28:38Uh...
28:38A little bit of a headache now.
28:40Let's now check you.
28:42If they find signs of a head injury,
28:45Ashley may need serious attention.
28:48I'm going to flash this into your eyes.
29:02He's going into recess four.
29:05At Queen Elizabeth Hospital Birmingham,
29:07an ambulance crew has arrived with a critically ill patient.
29:10My BP was 52 under 64.
29:13And his ECG said there was a first degree block.
29:16First time we're just Punjabi.
29:19You can speak to England.
29:21The paramedics suspect 85-year-old Churangi has had a stroke.
29:25Hello.
29:26Hello, sir.
29:27I'm Ashley.
29:28Look after you today.
29:30Yeah.
29:31We were told that the patient is at stroke alert.
29:34He's tested positive for the FAST test that we complete,
29:37which is face, arms, speech and time.
29:41And then, therefore, he was brought here on the alert.
29:44I'm hungry.
29:45No.
29:46You can't.
29:47You can't.
29:47You can't.
29:47You can't.
29:50Churangi's son, Ash, rushed home to help his dad
29:52when he heard the news.
29:54I heard the call from my mum.
29:56He does his daily routine.
29:58This is yoga.
30:00So he did, he's on the floor, doing his stretches.
30:03And apparently, he just tried to get up.
30:07He's lost his sensation, his left leg.
30:08And he's collapsed.
30:11It's no sensation.
30:12Left hand.
30:13You always start thinking, you know, he's the agent.
30:16And you say, please, not yet.
30:21Is that OK?
30:28Consultant Dr Farooq is running recess.
30:31Are you happy?
30:36All right.
30:37That's fine.
30:37Somebody even who presents with a stroke, obviously,
30:40they are having a weakness on some side of the body.
30:44It's the timing, because the longer the injury,
30:47the more the damage will be.
30:49The nerves in the brain, they start to get damaged.
30:55It's probably a proper stroke on the left side of the brain, isn't it?
30:59We're going to get a head scan, OK?
31:01Head scan, scan the head.
31:03All right.
31:04I'll have a look.
31:05We'll take them for a full head CT scan,
31:07just to confirm that there is a bleed on the brain
31:09or something causing pressure to give this patient these symptoms.
31:13We have to lay you flat, OK?
31:16During a stroke,
31:18two million brain cells can die every minute.
31:20Ready, steady, slide.
31:24Are you OK?
31:25It's critical they get him scanned as soon as possible.
31:32But there's a problem.
31:34That's all the patient still.
31:37They're just trying to reposition him so that he's more comfortable,
31:40so he stays still for the CT scan.
31:43Because if he doesn't stay still,
31:44we won't get a real reading of what's going on.
31:48Without a full diagnosis,
31:51the medical team won't be able to start the correct life-saving treatment.
31:55The longer it's delayed,
31:58the more chances of the brain damage.
32:01It can eventually lead to permanent weakness,
32:03permanent loss of sensation as well,
32:06depending on where the stroke is in the brain.
32:08So time is the key, basically.
32:11Sooner the better.
32:13Where now?
32:14Where?
32:14Hey!
32:15How are they?
32:17Oh!
32:24He's got pleural effusion as well on both sides.
32:27I think it's so...
32:28Your pressure is OK.
32:29So his blood pressure collapsed initially.
32:33Hi, David.
32:35I'm back.
32:36In Tunbridge Wells,
32:3842-year-old David arrived at A&E with back pain and dizziness,
32:42before collapsing in triage.
32:45So I've just had a look at your CT images.
32:49Dr. Ahmed rushed David to the CT scanner to find the cause.
32:53Your heart was quite enlarged on the CT.
32:56When the pericardium membrane gets filled with fluid,
32:59it compresses the heart.
33:00So your heart is not able to expand well enough to refill with blood
33:04so it can pump it back out again.
33:06Maybe that was why you collapsed and had a low blood pressure.
33:10He found the sac surrounding David's heart is full of fluid,
33:14compressing it.
33:14For someone who is 42 years old,
33:17that's quite rare to develop this amount of fluid around his heart.
33:21That could be as a result of an infection,
33:24tumours, could be an autoimmune disease.
33:27It's a very life-threatening condition
33:29if not treated appropriately in time.
33:32You think there's an inflammatory process going on
33:36causing your symptoms.
33:37Are you OK?
33:38Yeah, it's a bit...
33:39Where is it?
33:40It's just a sharp pain.
33:41In the chest?
33:42Yeah.
33:42Yeah.
33:42Does the pain go away if you lean forwards?
33:45Uh...
33:46I'm going to try and do that now
33:47and you tell me if there's any difference, OK?
33:49Yeah.
33:50Three, two...
33:51One.
33:52There you are.
33:56You dizzy again now?
33:57A little bit.
33:58Any pain?
33:59A little bit.
34:01Where is it?
34:02It's there.
34:03Just here.
34:04In the chest?
34:05Yeah, well...
34:05I feel...
34:06I feel sweaty.
34:09OK, I'm going to give you some oxygen.
34:13Uh...
34:14Guys...
34:15Need some assistance?
34:18OK, I'm going to lay you back.
34:21I need help in here.
34:22Blood pressure is collapsing.
34:24Dr. Ahmed hits the emergency buzzer for help.
34:27Can you pass, please, anaesthetics and medics?
34:29Yeah.
34:31Guys, I need help in here.
34:49Yeah, fast sleep.
34:54Medics, anaesthetics, please.
34:56Dr. Ahmed has called for emergency assistance after David had sudden chest pain and his blood pressure.
35:02Crashed.
35:02Yes, OK.
35:04This is David.
35:05He's 42 years old.
35:06He started feeling hot.
35:08Yeah.
35:08Painty.
35:09Measured the blood pressure again.
35:10It was 62 systolic.
35:11Pretty much similar to what happened in triage.
35:13He had a cardiac murmur.
35:16It's a mitral polycystolic murmur propagating to the axilla.
35:19So far, we've given a gramoparacetamol, 4.5 grams of tazacin.
35:23This is the second unit of fluid going in right now.
35:25Yeah.
35:26Can we have someone to do the AVP, please?
35:28Just before David's situation deteriorated, he'd been diagnosed with fluid surrounding
35:33his heart putting pressure on it.
35:35Was there any oxygen requirement initially?
35:37Initially, yes.
35:38And now when he collapsed?
35:39Now, yes.
35:40David?
35:41Yeah.
35:41Hi.
35:41My name is Asad, one of the doctors.
35:43I'm going to do a quick scan on your heart.
35:46Dr. Asad, who runs the department, examines his heart with an ultrasound.
35:54How are you feeling, David?
35:56Still feeling dizzy, groggy?
35:58No.
35:59Okay.
36:00Okay, blood pressure is 94 systolic now.
36:04Heart rate is 61.
36:06Do you have any chest pain?
36:08Not now.
36:15At that moment, we think that you've got quite a bad infection, which is causing this
36:20sepsis.
36:21Okay.
36:21We've given antibiotics.
36:23Yeah.
36:23So we've already given you antibiotics.
36:25We are filling you up with some fluids.
36:28He thinks an infection might be the cause of the fluid around David's heart.
36:33You need to do quite as well as monitoring and get your blood pressure on the lower side.
36:40David's stable for now.
36:42But until his infection's treated, he's going to intensive care, where he'll be closely monitored.
36:48So your blood pressure's better than before.
36:50It was initially 75 over 60.
36:52Now it's 103 over 65.
36:54It's not the best, but it's gone up.
36:56Okay?
36:57I think he dodged a bullet there.
37:00We've given him antibiotics.
37:01We've given him medicines to support his blood pressure.
37:04I wish you the best, okay?
37:06Hang on in there.
37:08Should his condition have occurred on the way to the hospital, there was no one to treat
37:15him there, and he could have died.
37:18Coming out.
37:19Here we go.
37:20Okay.
37:33I'm going to just ask you to make some funny faces now, okay?
37:37I'm always like funny faces.
37:38In Norwich, Ash is being examined for any neurological damage after falling on a drunken
37:43night out and banging his head.
37:45Good.
37:46Very good.
37:46Close your eyes real tight.
37:48Very tight.
37:48Could you open them up, please?
37:50Yeah.
37:50There's no cognitive decline in any way.
37:53He's able to talk.
37:54He seems like he's not confused in any way.
37:56So he doesn't fall within the criteria of having something like a CT scan.
38:01It seems any memory loss and pain in his head is down to the alcohol.
38:05So the other injury sustained apart from the one in your head is your wrist.
38:10Yeah.
38:10So we're going to see if we can undress that.
38:13Ash could still have further injuries.
38:16Dr. Lee wants to check his hand for nerve damage.
38:19So I need you to sit down, please.
38:21I have a bit of a tingly feeling in my hand.
38:24Okay.
38:25Okay.
38:25So I'm going to check the sensation in your fingers.
38:32Okay.
38:34Obviously skin scrapes.
38:36How far can this go?
38:37That...
38:38Do we take it off?
38:39Yeah, I think so.
38:42Oh.
38:44Very.
38:45Skin scrapes are actually very painful.
38:48Oh, yeah.
38:50Obviously a Chelsea fan.
38:52Yeah, very much so.
38:54Can you move your wrist, please?
38:56Okay.
38:56Any pain?
38:57Not in the wrist itself.
38:59It's just where the cuts are and everything.
39:01All right.
39:02There's a bit of swelling, obviously.
39:03Yeah.
39:04Yeah.
39:04So it feels fine.
39:06The sensation is intact.
39:07You can move your fingers.
39:09Not likely to have a fracture.
39:11Ashley's only suffered minor injuries.
39:14It needs to be cleaned again.
39:15Yeah, it looks a bit main.
39:17No, it will be fine.
39:18Give it time to heal.
39:20Okay?
39:22Although he's not done any serious damage...
39:26Yeah.
39:27We're stinging like mad.
39:30Ashley will still need his wound cleaning up.
39:33A terrible idea.
39:35I hear like a lot of pints deep.
39:37It was like my legs were moving faster than my brain was.
39:40After a tetanus jab to prevent infection...
39:44Okay.
39:44Shot scratch.
39:46Ashley's left with a sore hand and a bruised ego.
39:50Thanks, sir.
39:50Like I said, I feel a bit embarrassed by all of this, honestly, so...
39:54Not my proudest moment, but, you know...
39:56Wow.
39:56You know?
39:59Oh, dear.
40:12Hey!
40:14Hey!
40:15How are you?
40:20In Birmingham A&E, 85-year-old Churangi is having a CT scan for a suspected stroke.
40:30He's leaving it.
40:31He's leaving it.
40:32He's leaving it.
40:33He's raising his leg.
40:34Yeah.
40:34He keeps coming next to us.
40:37The scan needs him to be completely still to get an accurate reading.
40:41Can I go in?
40:42Yeah.
40:44Without the scan, the team won't be able to diagnose and treat his potentially life-changing condition.
40:49So, where's the pain in your leg?
40:52Keep around and lying on the bottom.
40:55We need to try and stay as soon as possible.
40:57Okay?
40:58They repositioned Churangi's leg and hope he can stay still long enough.
41:04Try and stay really still forward.
41:07Stay really still now.
41:09It's moving, but it just needs to keep his head still.
41:12It should be all right.
41:14That guy's going in now.
41:20Okay.
41:22Well done.
41:27Can I just do an assessment?
41:29Is that okay?
41:31Yeah.
41:32While they wait for the scan results, Nurse Ashley is monitoring his condition in case it suddenly
41:38worsens.
41:40Can you just look up there for me?
41:45Can you lift both arms up?
41:47That's it.
41:49And down.
41:51And squeeze.
41:54Squeeze my hands.
41:56Okay?
41:59There seems to be some improvement in his muscle strength, and his scan results have come
42:04through.
42:05They think he's had a TIA, which is classed as a mild stroke.
42:10He's now on hourly observations and neuro observations, where we test the power, his strength in each
42:16arm, make sure he can raise his legs.
42:18A TIA is a transient ischemic attack.
42:21Unlike a stroke, the blockage of blood to the brain clears itself before causing any significant
42:27damage.
42:28He's improved a lot.
42:29He's got the sensation back in his left leg now, and his hand.
42:34And he's talking okay, and he's remembering things.
42:37He's a lot better at himself.
42:39It's a massive relief in a bad situation.
42:41Praise the Lord.
42:42It's a lot better.
42:46And I'm a lot happier.
42:47Chirangi will be moved to the stroke ward overnight, where they'll continue to monitor him.
43:00So he's bled into his brain, a very small amount, but at the minute we'll take him upstairs to ITU,
43:04keeping him asleep probably for 24, 48 hours, and going from there.
43:20I've been hearing all about you.
43:22He's back over there.
43:23Part of this bit of a rubbish time.
43:49All right, she's all right, she wants to give him a bit.
43:52Okay, give me a big smile.
43:55No, no.
44:08When he came back, he said,
44:11Is that what I've got to do with you?
44:13Did I exert myself or...?
44:24I will remember not to take part in the foot races after I've had a few pints.
44:36And if you've been affected by the subjects discussed tonight,
44:40find information and support at channel5.com slash helplines.
44:44Could DNA finally explain the brutal killing of an Aberdeen taxi driver 40 years on?
44:50The Wire, forensics murder, a double bill tomorrow from 10.
44:54Next tonight, Ambulance Code Red. Stay with us.
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