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A and E After Dark S06E08
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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, we're trying to help you.
00:25With extraordinary access to three of the most challenged emergency departments in 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.
00:38Trucking now.
00:40It's a stab wound.
00:42With drugs and alcohol rife.
00:45I've added five or six pints.
00:46Step back.
00:47Big man.
00:48The department's just on fire.
00:52The risk of violence and abuse looms large every night.
00:56And you?
00:57You're maxing your ****.
00:59Stop.
00:59Try me, boys.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched up and spat at.
01:07You've got nothing on me, bro.
01:08Right.
01:09Fire.
01:09There have been days when there have been more police officers than patients.
01:13I'll punch your head in, mate.
01:14What's going on?
01:15All hell's broken loose.
01:17Patients running around.
01:18Security everywhere.
01:19Shut up.
01:20I don't care.
01:21This is the sort of thing that we have to put off this.
01:23Get security to remove it.
01:24This chaos.
01:26Glorious chaos.
01:39Over two million people visit A&E every month.
01:42And there's another alert coming in as well.
01:44And the number is continually rising.
01:46Ready, steady.
01:46With more patients comes more people under the influence of drugs and alcohol.
01:51The actual people that come through your doors out of ours.
01:55There are other people that end up having too much fun.
01:58Smell quite a lot of alcohol.
01:59Well, they're up to no good and ending up in A&E for whatever reason.
02:02So that's when we see our most challenging cases.
02:05We're not going to stand from the abuse that you're giving people.
02:08With more people arriving having been involved with alcohol and drugs comes an increase in violence against staff.
02:14Oh, yeah!
02:15Yeah, yeah, yeah.
02:22Yeah.
02:26Yeah.
02:35In Birmingham's A&E waiting room, a man trying to book his mother in
02:39has started hurling abuse at patients around him.
02:48Security have been called as he's beginning to disrupt the sick patients in the waiting room.
03:15With the man not calming down, more security have been requested to contain the situation.
03:35The waiting room is normally just wild. You have to have a personality about you where you can control difficult
03:41situations.
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 yet.
04:11It's been times where, like, staff out here have been assaulted, punched, kicked, threatened with weapons.
04:18With the man becoming even more aggressive, security backup is requested again.
04:48The man is out of control, and Sister Lauren can see no other
04:52option but to call the police.
05:00Police have arrived on scene to assist security.
05:04You go and mind your business and you, like, go back inside there,
05:08and you go and take the people that you came for, because of me, did you cross 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 cure. That's the annoying thing. He was literally a cure.
05:24And he just didn't like that. He was so close. That was nasty.
05:28With the presence of police and security combined, the man is deterred enough to leave the hospital grounds,
05:34taking his mother with him before she could be treated.
05:38We'll stay in the area for now. That's why I couldn't get in the taxi. As soon as they leave
05:41the hospital, we should be there.
05:43Are you trapped wrong, man?
05:44Yeah, that's fine.
06:01Yeah, that's fine.
06:02There's a three-year-old male who's been the victim of a serious attack.
06:05Assault in the city, GCS 5, and lots of blunt force trauma to the face.
06:11GCS stands for Glasgow Coma Scale, which measures a patient's consciousness.
06:17So what is the plan? If the GCS is really 5, then do we have additional support?
06:22Do you have anybody here who can help?
06:25Any reading under 8 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?
06:37So this is Connor. He was assaulted. One punch to the head and then a kick to the head while
06:42it was on the floor.
06:43When we arrived, he was unresponsive. He was a little bit agitated and restless, pulling things away.
06:49So he's got clear blunt trauma force to his face with multiple injuries to his face.
06:54His airway is manageable. Chest is clear and equal. Belly soft. Pelvis symmetrical. No long bone injuries.
07:01So we don't think there is any drug or alcohol on board at this moment.
07:06We don't. We don't know. Okay.
07:07Okay. Everybody ready? On move. Ready. Set. Move.
07:10We want to start the primary survey whilst we are doing this.
07:14Connor.
07:18Just try and relax, Connor. We 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. Abdomen is soft and non-tender.
07:34So straighten these out, Connor. Come on.
07:36Good man. That's it.
07:38He's not responded to voice and eyes. Has he opened at all with any kind of stimulus? No.
07:43He is painful stimulus. He is actually localising. So 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 is 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. He is unconscious is what we would say,
08:07but we will go through all the necessary tests in bloods as well as imaging and then we'll come
08:11back and talk to you. Connor? Connor, my man, wake up. Can you open your eyes for me?
08:20Are you able to do a FAR scan? When a trauma patient comes to A&E,
08:23we know that a priority is getting a CT scan as that allows us to identify nearly all injuries
08:28in a very short period of time. We have a patient with a GCS of six.
08:32He will need airway support, has a lot of facial injuries,
08:35to be transported to CT immediately. Without a CT scan, it's unknown how serious
08:41his brain could be damaged. There's no science to fighting,
08:44there's no science to being punched in the head. It can be a simply wrong punch in the wrong place
08:49at the wrong time, can kill someone. Connor, open your eyes for me.
08:55Uh, I think it's CT.
09:15NHS staff in the UK experience more than 150 incidents of violence and aggression every day.
09:23There's been an increase in sort of drugs and alcohol. We see increase in violence.
09:28The problem is particularly prevalent in high pressure departments like A&E's
09:32and even more so at night. I've seen a lot more abuse towards staff. These are things that I don't
09:38think we come to work to deal with. The estimated cost of violence and aggression to the NHS is in
09:44excess of 69 million pounds a year.
09:54Connor, open your eyes for me.
09:57I think he's seeing him.
09:59His people are unreactive.
10:01Yeah. That one wrecked him.
10:03What should he do?
10:0423-year-old Connor is being assessed after a serious assault has left him with multiple head injuries.
10:10I think he's seizing. He 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. But before he can go,
10:21the team decide they need to intubate him, which means taking control of his airway.
10:26We're going to use ketamine. We're going to use rocuronium. We're going to give a little smidge of
10:29metaminoid induction. We're going to maintain the fentanyl and propofol.
10:34I'm team leader. Your first intubator. I'm second.
10:36Connor's partner and mum are waiting for news.
10:39Unfortunately, he has been unconscious for a long time. And it is not... We have to do a CT scan
10:44for him. And it won't be safe to take him just like that. We will have to protect his airway
10:48because
10:49he may lose his air. So we will be giving him some medicines, protecting his airway, taking him to
10:54a CT scan. Okay? These are my anaesthetic colleagues who will facilitate that.
10:57We're going to do video laryngoscopy. But if the blood... If the airway is contaminated,
11:00we've got a direct available. Basically, if the solid goes below 100 or you see anything else
11:05critical, give us a shout if that's okay. Intubating a patient in layman's terms means
11:09popping them on life support. Give me a shout when you want the timer.
11:12Yeah, let's start it now. Bit of metaminoid.
11:16Do you want to have a look in now? So you're about 40 seconds now, so...
11:20What we do is pop a tube down into their windpipe, and then we connect them up to a ventilator,
11:25which breathes for them. Blood pressure, 98.
11:33When you drop your consciousness level, you lose that ability to keep your tongue forward and out
11:39of the way of your windpipe. That then impacts on breathing, and that can affect the amount of
11:44gases in your blood, which we know can have a knock-on effect for the brain.
11:49I'm happy. Happy? Happy. Check in tidal.
11:56We have in tidal, come in tidal. His airway has been secured now. He's put on the ventilator,
12:02so the ventilator will be breathing for him, which is a good thing, because we can monitor him more
12:06closely. We'll be taking him for the CT scan, and depending on what it shows, we will plan the next
12:11step.
12:12With Connor's airway protected, he can now have the crucial CT scan to find the impact the attack
12:18has had on his brain. Mainly with these kind of injuries, from our experience, it is fractures
12:23involving the skull and the head, as well as accumulation of blood around the brain that can
12:28induce fits, seizures. Everyone happy? Yeah. Ready, steady.
12:34He was assaulted mostly with punches and kicks, and then probably weapons involved. Most of the injuries
12:39that we can see externally are facial. Okay.
12:45If he has a bleed on the brain, he could need emergency surgery.
12:53So he has a, um, some blood in the fissure here.
13:02It looks like a subarach. It's going into the, yeah, it looks like it's going into the fissure,
13:10but it's very focal. There's no subneural hemorrhage. He has some blood in his, we'll see if it's blood,
13:19but it could be blood in his right maxillary sinus. He's got a very small bleed in his brain.
13:25We're going to discuss it with our neurosurgeons down at Cambridge, but I don't think that, um,
13:29they're going to want to operate on it. He's also fractured at the bottom of his eye socket,
13:34and his muscles have kind of just kind of penetrated through there. And he's also got a bit of blood
13:39in his sinus, which is just behind the cheekbone, which is all consistent with being punched and
13:43kicked in the head. Thank you, Robert.
13:47Connor's injuries will need careful monitoring until he can be transferred to the ward to recover.
13:51We'll go to recess now and the intensive care, uh, clinicians are going to do other lines and more
13:57invasive monitoring so that we can keep a close eye on him. And we will wait for the neurosurgeons to
14:02get back to us if they have any other suggestions.
14:24We'll get some blood tests done and we'll give it a good go and try and get you better.
14:30In Birmingham, senior consultant Elena is in charge of recess.
14:36We can hold, hold on. Some stuff going on.
14:39Where the most critical patients come for treatment.
14:43We have ten bedded recess, and at the moment there's eight patients, all of them extremely unwell.
14:50A&E is a lifestyle, it's not a career. We need to learn to do it alongside everything else in
14:55your
14:55life, really. You know, whatever it is, family, kids, passions, hobbies, then you have to learn early
15:01whether it's for you or not. The majority of us that stick with it is because we love it. You
15:04okay?
15:04Yes. That looks bad. Yes, we do. Who's that? Hello, Kiwi.
15:14You're looking for a recess for me. Have we got any space for this asthma?
15:17Yeah, I've got, that's the last recess, babe, so I'll give them one. 17.
15:20A 36-year-old woman is having a severe asthma attack and is on her way to A&E.
15:27Her stats are 87 on air, so that makes me a little bit worried.
15:32She may be suffering a life-threatening asthma attack, meaning that she can just about gasp in
15:37between breaths. The ambulance have reported an oxygen saturation at 87, so anything below 95,
15:44you know, young adult is definitely bad. We have your piece.
15:48This is Jenny. She's a 36-year-old. She has the onset of an asthma attack today.
15:53She's used her inhaler 12 times to nil effect.
15:56While the paramedics hand over, the medical team will take blood to be analysed for oxygen and CO2 levels.
16:04Asthma attacks are an absolute medical emergency. You never know what walks through that door,
16:10so you always prepare for the worst when it comes to asthma.
16:15We have given three salbucemols, an hypotropium and 100 hydroquartz.
16:21She has got a one-week history of a chest infection. Her triggers are dust, perfume and cold air,
16:27so we think she's been triggered by the dust in the house along with the chest infection today.
16:33OK. OK. Jenny, I'm Helen. I'm one of the A&E consultants.
16:37Does your chest feel very tight?
16:42I'm going to do that.
16:45I think we should put a salbutamol while we do all of that.
16:49The team administer salbutamol, a drug that relaxes the muscles in the airway.
16:55The calmer she is, the deeper breath she takes, the more medication gets into the lungs and where
16:59exactly needs to be for it to work. When you can't breathe, your brain gets the message that
17:05something really bad is happening, so 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. Is this OK?
17:22So we've given you magnesium that usually helps the chest settle a bit more. We're going to get
17:27the chest x-ray done over here just to make sure that there isn't anything else that we need to
17:30deal with in the lung, and 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.
17:42I was really fighting for a breath, isn't it? Look at the lactate.
17:45It's hyperventilating as well.
17:49There's a reason why we keep them in places like resuscitation area or
17:52monitored cubicles because we know for a fact they can go off or decompensate in a second.
17:59She's not retaining her CO2. I'm thinking, well, she's just had the magnesium.
18:04She's just having another mixed neb. Really, what's the next step, isn't it?
18:11It would be aminophilin. Either that or salbutamol IV. But if we're moving to that line,
18:18we're going to have to go like you. Jenny may need stronger medication to help her control her
18:24breathing. But if that fails, intensive care will need to be ready to step in.
18:47Do you have a specific space? In Tunbridge Wells Hospital Majors,
18:51Dr. Ahmed is working the night shift. Fine. Wonderful. Thank you so much.
18:57The emergency alarm has been raised.
19:06Did you listen to me? Yeah, yeah. No, I like you.
19:09You're having a large issue. And do you know where you are at the moment?
19:12What? OK, where is that?
19:14That's fine. 42-year-old David walked into A&E with back pain and dizziness
19:20before collapsing in triage.
19:24OK, look at the site.
19:29We've brought in a patient into resus. He looks very ill with a very, very low blood pressure,
19:34looking pale, very drowsy, very dizzy, almost collapsed.
19:39I have a bad back. And when you say bad back, what do you mean?
19:42I came home, uh, Monday, not Monday. Just got on the window before.
19:46I had an agony getting home, breathed back.
19:49That was two weeks ago.
19:50That was two weeks ago.
19:51Like between your shoulder blades?
19:52Yeah.
19:53OK, so yeah.
19:54I couldn't take a full breath because of the pain. And at midnight, I had to call 111.
19:59They sent to the paramedics. They gave me gas and air, which then relieved the pain.
20:05You took the pain away?
20:06Well, then I took some, uh, COVID.
20:08Did that help manage your pain?
20:10Yeah.
20:11OK.
20:20And you have the back pain today as well?
20:22Yeah, yeah, yeah.
20:23You have the back pain.
20:24How would you describe it?
20:25Is it dull or...
20:26It's more dull pain today.
20:27It's not like the first day.
20:29The first day was like, I was...
20:30Severe?
20:31Really severe.
20:32And someone who has collapsed, someone who's had his blood pressure go down as far as 60,
20:37systolic, someone who looks that pale. My main concerns would be, uh, first aortic dissection,
20:43meaning that his aortic walls might be thinning. It becomes very weak and might burst, causing the
20:49blood to drain into his chest cavity in a few minutes. And it's a very, um, fatal condition,
20:55if not treated or not caught, uh, in time.
20:58Because it's between your shoulder blades and because your blood pressure collapsed all of a sudden,
21:03we're thinking the main blood pressure on your body that takes the blood from the heart,
21:07distributes it throughout the body. You might have something wrong with it, uh, probably an aneurysm.
21:14OK. So we need to do a scan for that. We'll also examine and test for other causes like heart
21:20problems and infection. But we have to work our way from the most critical to the least critical.
21:27Hi, I have a patient who crashed in the triage room. We are querying an aortic dissection.
21:32Are you guys ready for him? Thank you. Bye-bye.
21:35An aortic aneurysm can rupture at any moment. And if it does, it can kill you within minutes.
21:41It's critical they get him into the scanner as soon as possible.
21:45Three, two, one.
21:49He's got interscapular pain. And that's why we were thinking about aneurysm.
21:54So we'll go ahead for a CT scan, uh, of the aorta. And if it's one of the things that
21:59we're
21:59concerned about, it will show. Take a breath in.
22:03Please be okay.
22:14You may breathe normally.
22:18So basically, this is the heart. And this is the pericardium. Usually, this space should not be
22:25there. But there's some sort of inflammatory process going on.
22:30It's not the aneurysm Dr. Ahmed suspected, but it is serious.
22:35When you've got the heart with fluid in between the membrane surrounding it and the heart muscle
22:40itself, that fluid can build up to a limit, creating a pressure. If not treated properly,
22:48and early on, it can prevent the heart from refilling and pumping blood to the rest of the
22:53body. And that can be life-ending. It can end one's life.
23:08The night shift in A&E sees a large amount of visitors under the influence of alcohol,
23:14with one in five young adults having 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.
23:24To breaking bones and falling over in high heels.
23:27On a wet down, on a wet down, in a pub.
23:30You know, people go out and people have drinks and fights and, you know, this and that. So,
23:34yeah, you see more people coming with 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.
23:5736-year-old Jenny has come into A&E with a serious asthma attack.
24:02And then we're given a salbutamol.
24:04Dr. Elena is hoping the medication they've given Jenny will help her breathing.
24:10If the medication doesn't take effect soon, they may need to involve the intensive care unit.
24:19How does it feel now compared to how you were at home?
24:23I think maybe slightly worse this time.
24:27It's slightly worse this time.
24:28Okay. It lasts longer.
24:33It's a condition in which the inner structure of your lungs, they 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 a special type of medication in order for the lungs to relax.
24:44The muscles that are keeping your lungs tight, they need to relax.
24:47So, let's give five of salbutamol and 500 vatroven.
24:50So, this will be five of salbutamol?
24:51Yeah. I prescribed you 2.5. I'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, but I think this is the bit that
25:07we haven't tried.
25:09Wait a little bit and see what happens.
25:11If it doesn't work, then the next plan would be to call our colleague 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, any concerns?
25:25You may be pregnant.
25:31While they wait to see if the medication works, the team x-rayed Jenny's lungs to look for any other
25:37medical conditions that 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. So, 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.
25:58The x-ray hasn't revealed anything new, but 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. It wasn't really a gamble. Sometimes, in certain conditions,
26:16like including in asthma, you 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, you're trying to fix it. You see somebody struggling with their breath,
26:31you're trying to give medication, more medication, more medication, fix it.
26:34But there comes a point where you actually need to allow for those medication to start working.
26:38So, another skill that we need to learn as we become seniors is to learn to stop, breathe,
26:43and, like, allow a bit of a time to, you know, to pass.
27:03It's a busy night in Norwich A&E.
27:10Ashley. Hello.
27:1231-year-old Ashley has come into A&E after 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, so 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.
27:35Okay.
27:36So it seemed like a great idea at the time.
27:38And I just remember sort of tumbling over.
27:42Okay.
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.
27:50After that, I'm a little bit hazy.
27:51Did you have any bleeding from your nose, your mouth, your ears?
27:56Did you bleed?
27:57I mean, I don't think so.
27:59Okay.
28:00Since he can't remember, the reason why I ask him all those questions is to know
28:03if he lost consciousness and if his conscious level dropped at any point during the time
28:10he had the fall or after he had the 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 because I hadn't quite a lot to drink.
28:28So, like, how much did you have to drink?
28:30About seven or eight pints.
28:33Okay.
28:34Any headaches, chest pains?
28:38I'm a little bit of a headache now.
28:40Let's now check you.
28:42If they find signs of a head injury, Ashley may need serious attention.
28:48I'm going to flash this into your eyes.
29:02It's going into recess four.
29:05At Queen Elizabeth Hospital, Birmingham, an ambulance crew has arrived with a critically ill patient.
29:10Our BP was 52 out of 64.
29:13And its ECG said there was a first degree block.
29:17First time we're just Punjabi.
29:19You can speak to England.
29:20The paramedics suspect 85-year-old Churangi has had a stroke.
29:26Hello, sir.
29:26Hello, sir.
29:27I'm Ashley.
29:28I look after you today.
29:31We were told that the patient is at stroke alert.
29:34He's tested positive for the fast test that we complete, which is face, arms, speech and time.
29:41And then, therefore, he was brought here on the alert.
29:50Churangi's son, Ash, rushed home to help his dad when he heard the news.
29:54I had the call from my mum.
29:56Um, he does his daily routine.
29:58This is yoga.
29:59Um, so he did sit on the floor, doing his stretches.
30:03And apparently, he just tried to get up.
30:07He's lost his sensation in his left leg.
30:09And he's collapsed.
30:11There's no sensation in his left hand.
30:13You always start thinking, you know, he's the agent.
30:16And you say, please, not yet.
30:21Is that OK?
30:29Consultant Dr Farooq is running recess.
30:35Happy?
30:36All right.
30:37That's fine.
30:37Somebody even who presents with a stroke,
30:40obviously, they are having a weakness on some side of the body.
30:44It's the timing, because to prolong the injury,
30:47the more the damage will be.
30:49The nerves in the brain, they start to get damaged.
30:54There's a...
30:55Probably a proper stroke on left side of the business.
30:59We're going to get a head scan, OK?
31:01Mm?
31:01Head scan.
31:02Scan the head.
31:03All right.
31:05We'll take them for a full head CT scan,
31:07just to confirm that there is a bleed on the brain
31:10or something causing pressure to give this patient these symptoms.
31:13We have to lay you flat, OK?
31:16During a stroke, two million brain cells can die every minute.
31:21Ready, steady, slide.
31:24OK?
31:25It's critical they get him scanned as soon as possible.
31:32But there's a problem.
31:34That's all the patients.
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,
31:50the medical team won't be able to start the correct life-saving treatment.
31:55The longer it's delayed, the more chances of the brain damage,
32:00it can eventually lead to permanent weakness,
32:03permanent loss of sensation as well,
32:06depending on where the stroke is in the brain.
32:09So time is the key, basically.
32:11Sooner, the better.
32:24He's tired, you know?
32:25He's got pleural effusion as well on both sides.
32:27I think his blood pressure is OK.
32:29So his blood pressure collapsed initially.
32:34Hi, David.
32:35I'm back.
32:36In Tunbridge Wells, 42-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, it compresses the heart,
33:00so your heart is not able to expand well enough to refill with blood so it can pump it back
33:06out 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, compressing it.
33:15For someone who is 42 years old, that's quite rare to develop this amount of fluid around his heart.
33:21That could be as a result of an infection, tumours, could be an autoimmune disease.
33:27It's a very life-threatening condition if not treated appropriately in time.
33:32We think there's an inflammatory process going on, causing you your symptoms.
33:37Are you okay?
33:38Yeah, it's a bit.
33:39Where is it?
33:40It's a sharp pain.
33:41In the chest?
33:42Yeah.
33:43Does the pain go away if you lean forwards?
33:46I'm going to try and do that now, and you tell me if there's any difference, okay?
33:49Yeah.
33:50Three, two, one.
33:52There you are.
33:56You dizzy again now?
33:57A little bit.
33:58Any pain?
34:01Where is it?
34:04In the chest?
34:05Yeah, but I feel, I feel a bit sweaty.
34:09Okay, I'm going to give you some oxygen.
34:13Ah, guys, need some assistance.
34:18Okay, 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, anesthetics and medics?
34:29Yeah.
34:31Guys, I need help in here.
34:49Now, fast sleep, anesthetics and medics.
34:54Medics and anesthetics, please.
34:56Dr. Ahmed has called for emergency assistance after David had sudden chest pain and his blood pressure.
35:02crashed.
35:03Yes, okay.
35:04This is David.
35:05He's 42 years old.
35:06He started feeling hot.
35:08Yeah.
35:0820, measured the blood pressure again.
35:10It was 62 systolic, pretty 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 gram of paracetamol, 4.5 grams of tazacin.
35:23This is the second unit of fluid going in right now.
35:26Can we have someone to do the AVP, please?
35:28Just before David's situation deteriorated, he'd been diagnosed with fluid surrounding his heart,
35:34putting 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, my name is Asad, one of the doctors.
35:43Oh.
35:44We need 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?
35:57Groggy?
35:58No.
35:59Yeah.
35:59Okay.
36:00Okay, blood pressure is 94 systolic now.
36:04Heart rate is 61.
36:06Do you have any chest pain?
36:08Uh, not now.
36:15At the moment, we think that you've got quite a bad infection,
36:19which is causing the sepsis.
36:21Okay.
36:21We've given antibiotics.
36:23Yeah, that's...
36:24So we've already given you antibiotics,
36:25so we are filling you up with some fluids.
36:35Yeah, that's good.
36:39Yeah, that's good.
36:56Okay?
36:57I think he dodged a bullet there.
37:00We've given him antibiotics, we'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,
37:12there was no one to treat him there, and he could have died.
37:33I'm going to just ask you to make some funny faces now, okay?
37:37I'm always up for funny faces.
37:38In Norwich, Ash is being examined for any neurological damage,
37:42after falling on a drunken night out and banging his head.
37:45Good, very good. Close your eyes real tight, very tight.
37:49Could you open them up, please?
37:50Yeah.
37:50There's no cognitive decline in any way.
37:53He's able to talk, he 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.
38:06So, 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.
38:20I have a bit of a tingly feeling in my hand.
38:24Okay.
38:26So, I'm going to check the sensation in your fingers.
38:32Okay.
38:34Obviously skin scrapes.
38:36How far can this go?
38:37There.
38:38Do we take it off?
38:39Yeah, I think so.
38:44Very.
38:45Skin scrapes are actually very painful.
38:48Ah, yeah.
38:50Obviously a Chelsea fan.
38:52Yeah, very much so.
38:54Can you move your wrist, please?
38:56Okay.
38:57Any pain?
38:58Not 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, feels fine.
39:06The sensation is intact.
39:08You can move your fingers.
39:09Not likely to have a fracture.
39:12Ashley's only suffered minor injuries.
39:14Needs to be cleaned again.
39:15Yeah, it looks a bit main.
39:17No, it'll be fine.
39:18Give it time to heal.
39:20Okay.
39:22Although he's not done any serious damage.
39:27Yeah.
39:27We're stinging like mad.
39:30Ashley will still need his wound cleaning up.
39:33A terrible idea.
39:35Well, you're like a lot of pints deep.
39:37It was like my legs are moving faster than my brain was.
39:40After a tetanus jab to prevent infection.
39:44Okay, shot scratch.
39:46Ashley's left with a sore hand and a bruised ego.
39:50Like I said, I feel a bit embarrassed by all of it,
39:52to be honest, yeah.
39:53So, not my proudest moment, but, you know.
39:56Wow.
39:56You know.
39:59Oh, dear.
40:10Oh, dear.
40:13Hey.
40:13Where now?
40:14Where?
40:14Hey.
40:15How are you?
40:16Are you hanging for sport?
40:18No.
40:18Get back.
40:20In Birmingham A&E, 85-year-old Churangi is having a CT scan for a suspected stroke.
40:30He's leaving it.
40:31Yeah, it's me.
40:32He's raising his leg.
40:34Yeah, but he's having these.
40:35He'll be close.
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.
40:58They reposition Churangi's leg and hope he can stay still long enough.
41:03Help someone.
41:04Hi, stay really still forward.
41:07Stay really still now.
41:09It's moving, but as long as he keeps his head still, it should be all right.
41:14That guy's going in now.
41:20Okay.
41:22Hold it.
41:27Can I just do some, an assessment?
41:30Is that okay?
41:31Yeah.
41:33While they wait for the scan results, nurse Ashley is monitoring his condition in case it suddenly worsens.
41:41Just look up there for me.
41:45Can you lift both arms up?
41:48That's it.
41:48And 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 through.
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 arm, make sure
42:17he 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 damage.
42:27He'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.
42:42Praise the Lord.
42:42It's a lot better.
42:46And I'm a lot happier.
42:48Chirangi 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 it's sort of a minute.
43:03We'll take him upstairs to ITU, keep him asleep probably for 24, 48 hours, and go from there.
43:20I've been hearing all about you.
43:22It's part of this bit of a rubbish time.
43:49Okay?
43:53Give me a big smile.
43:55No, no.
44:08When he came back, he said,
44:10I just want to look at the yogurt.
44:12Is that got anything to do with yogurt?
44:13Do I, like, exert myself, or...?
44:24Well, I 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, find information and support
44:41at 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.
44:57Stay with us.
44:58I'm dead.
45:00Stay with us.
45:02on
45:02on
45:03You
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