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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.
00:45I've had five or six pints.
00:46Big man.
00:48The department's just on fire.
00:52The risk of violence and abuse looms large every night.
00:56And you, you're masking your ****.
00:58Stop.
00:59Try me.
01:00Bugs.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched.
01:06I've been spat at.
01:07You've got nothing to move on.
01:08No.
01:09Quiet.
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.
01:20This is the sort of thing that we have to corrupt.
01:23Get security to remove it.
01:24This chaos.
01:26Glorious chaos.
01:39Get security to remove a patient.
01:41A security team is an essential part of any hospital staff.
01:46Leave my **** can over there.
01:48Particularly in A&E at night.
01:54Every day this hospital surprises me.
01:56I first came to the hospital and I didn't think I'd see half the things that I see now.
02:01Security deflect abuse away from the medical staff.
02:04You swear on the order for yourself?
02:05Yeah.
02:06F***ing up.
02:07And try to maintain calm in the department.
02:10Has he gone now?
02:11Yeah, he's gone now.
02:12The impacts of just people going out for a drink.
02:15Didn't think that a hospital would be influxed so badly.
02:17And when it's critical...
02:19Shut the **** up, you stupid.
02:20If they have to, security will get physical to resolve a situation.
02:24F***ing you.
02:25The abuse they get.
02:26Being assaulted all the time.
02:28I wanna f*** this thing.
02:30You trying to calm down.
02:41One of the privileges of working in A&E is you never know what's gonna come through those doors.
02:47Get the f*** off me, little f***.
02:49Get the f*** off.
02:50The antisocial behaviour is related due to the intoxication.
02:53But, often times, it's just that people are just rude to us for no reason.
03:01Go back in there for me, please.
03:03Go back in there for me, please.
03:03Go back in there for me, please.
03:06In Birmingham A&E, security have been called in to restrain a patient who has become violent while being treated.
03:14I can't have you out because you've been assaulting our staff.
03:18Can't we?
03:18Well, I know you don't remember, but you've punched one of our members of staff as well.
03:23It's the minute you guys got...
03:25It was exhausted.
03:27Just wait in there for me, mate.
03:28The patient has become aggressive.
03:30They're going through some alcohol withdrawals.
03:33He did three punches at myself and my other colleague, and pushed me into the side hall.
03:42Withdrawal from alcohol can alter your mental state and, if not treated, be deadly.
03:47The doctor's going to come in a minute.
03:49Take it off, yeah.
03:50It's only because you've obviously hit a nurse tonight, ain't it?
03:55Yeah.
03:57It's not a nice situation, and you become confused, and they're trying to leave the hospital, but it's really not
04:03safe.
04:04We'll give them medication, hopefully, that eases some of these agitations.
04:08The nurse has just got to go and sign off for your members.
04:10You just stay in there for me, all right?
04:14It's very frustrating, especially when, like, he calls, like, he's grabbing onto us, like, it's hurting us.
04:21Just stay in there for me.
04:24Luckily, it's not overpatient, but it happens, especially in A&E.
04:30You've just got a little bit of a tablet for you.
04:33It won't be giving him enough to, like, put him to sleep or anything like that, just to calm his
04:37agitation.
04:39It's for his benefit.
04:41That medication's going to make you a little bit drowsy as well, so you might get a bit unsteady on
04:44your feet.
04:45That's all I'd like you to stay slack down, all right?
04:48Take a seat there for me.
04:52Yeah.
04:53Yeah.
04:54Yeah.
05:03Paramedics are blue-lighting a cyclist with serious injuries into Birmingham resus.
05:09Can I have a trauma alert, please?
05:11Yeah, 23-year-old male coming by land into resus.
05:15Staff will clear.
05:19Sister Katie calls the trauma team.
05:22So it's a 23-year-old male who's come off a pushbike, hit by a car, possible pelvic fracture, possible
05:28hip fracture.
05:29He's got a large laceration to his knee.
05:37We'll do it later.
05:41He's been hit by a car at unknown speed.
05:44The car is then driven off, so there's no bystanders in here, no driver.
05:48All right.
05:50Cameron has been the victim of a hit-and-run.
05:57He's also complaining of some pelvic pain and right femur pain.
06:02He has got a laceration across, like, just the bottom part of his right knee there.
06:06It's quite deep down to bone.
06:07Yeah.
06:08Can you take a picture?
06:11And again.
06:12Dr. Mohamed is leading the trauma team, inspecting Cameron's injuries, while nurse Sharnice is gaining IV access.
06:20Oh!
06:21Oh!
06:23Oh!
06:24Right hip pain.
06:32Have you heard the answer?
06:35Sorry, look.
06:36I'm just going to give you some antibiotics, okay?
06:39We're just treating him with some antibiotics, because he's got quite a significant wound from his leg.
06:44And we've also had to give him a lot of pain relief, because he's in a lot of pain.
06:48Yeah.
06:50We're going to take the CT and we'll have a look, okay, mate?
06:54After his assessment, it's decided Cameron needs an urgent full-body CT scan.
07:04The CT scan is very important.
07:07With a trauma scan like he has had, we need to know if there's any injuries that we can't obviously
07:11see, and if there's any bleeding or any damage to any of his major organs.
07:16Slide.
07:17Ah!
07:19Okay.
07:20Just slide it over.
07:21Oh, shit.
07:22Ready, steady slide.
07:23Oh, shit.
07:24One second.
07:25Oh, shit.
07:27With a hit and run, we're worried that there could be a brain injury.
07:31All right, am I going to do a scan with your head?
07:33No, way down to your legs, all right?
07:34You're thinking, get them in and out of scan as quick as possible.
07:39The extreme forces when being hit by a car can smash fragile internal organs into bones, potentially causing
07:45catastrophic damage.
07:47Please breathe in and hold your breath.
08:03Please breathe in and hold your breath.
08:07Ah!
08:08I'll punch your head in there.
08:10The night shift brings challenges to hospitals around the country.
08:13A&E sometimes feels like a war zone.
08:15Over the years, I've seen the nights get much busier.
08:19Call IT, you don't know.
08:20We might have to tube this guy.
08:22I do find patients can be a bit more aggressive and a bit more rude.
08:25So that bit's particularly unpleasant.
08:29This is a 38-year-old male that's been stabbed.
08:32There are some things you see on a night shift that you don't usually see during the day shift.
08:36I guess 83 is 121.
08:38The light taste is 10.
08:39And that's a dot at 7.2.
08:49Cheers.
08:50It's an isolated injury.
08:52Pretty nasty open fracture.
08:56In resus, an elderly woman has been rushed in with an open ankle fracture.
09:02Ready?
09:03Steady.
09:03Slide.
09:04Yeah.
09:06Thelma had a 6-year-old fever.
09:08I believe she's rolled her ankle and then gone to the floor.
09:11Open fracture to right ankle.
09:13Quite a lot of tissue damage.
09:14She had rump paracetamol.
09:167.5 morphine.
09:18She's been really stoic.
09:22Thelma, I'm just going to put a needle in your arm so he can give you some more medication, okay?
09:26Dr. Kasim is gaining IV access to help manage Thelma's pain while the team look at images of the injury
09:32from the scene.
09:35Oh, okay.
09:38Thelma's dislocated bone is punctured through her skin.
09:42Let's get our blood done.
09:43Let's do a quick primary.
09:45Let's make sure we're definitely happy with the rust of her.
09:47It's very evident that she's a frail lady and it's important to take that into consideration.
09:51Now, often these patients are really stoic.
09:54Often they'll pretend or they're reluctant to have pain relief, but she is at risk.
10:01Have we got a Doppler?
10:02Yes.
10:03Dr. Helen needs to use a device called a Doppler to check Thelma still has a blood supply to her
10:09foot.
10:10There's lots of blood vessels that go alongside the bones.
10:12So if one of the bones cut one of the blood vessels, then her foot would be dead in about
10:16four hours.
10:24Yeah, it's reasonable.
10:25Yeah, it's a core pulse, but there is one.
10:30You've got quite a nasty ankle injury.
10:33Yeah.
10:34I think it's probably going to need an operation.
10:37Thelma's foot has a blood supply, but the pulse is weak.
10:41And if the blood supply becomes worse, the flesh in her foot will start to die.
10:45As people get older and frailer, you can't help but look at these significant injuries and be aware.
10:55This may be a life-changing event that has happened in literally a matter of seconds.
11:01Try to relax as best you can, okay? We'll take care of you.
11:15I'm just going to put some more dressing on. Can you bend your knee a little bit?
11:19That's perfect there.
11:21Every single year, 175,000 people attend A&E with burn injuries.
11:28I heard my sister shout, there's a fire in the kitchen, and a boiling pan of oil sat on fire.
11:34Tried getting it out of the house and spilled it all over myself.
11:3723-year-old builder Arthur is being treated by healthcare assistant Louise and nurse Annabelle
11:43after suffering severe burns to his hand and leg after a chip pan blaze.
11:49So on his right index finger and middle finger, he's got like thick, hardened burns.
11:56They look white and waxy.
11:57And then on his right calf to the sort of lateral aspect, he's got about 20 centimetres.
12:04All blistered and the skin beneath is white, reduced sensation.
12:09He called it himself 20 minutes and then we've called it again in the department for another 20 minutes.
12:14Under running water more his hands and then we've had a burn shield on his leg.
12:18Burns are cooled for 20 minutes immediately to reduce pain, swelling and the risk of scarring.
12:24We always take all of the top skin off the burns when we see them.
12:29So what we can see is the base of the wound, so we know how deep it is.
12:32Here's a quite deep, the colour of the burn has changed and it's quite white,
12:36which is suggestive a deeper burn.
12:38It won't be clear how bad the burn is until they've been inspected and dressed.
12:43Deep burns can damage underlying bones, muscles and tendons and need major skin grafts.
12:49You said you're in pain of number of waves, because obviously you are in a lot of pain.
12:54Yeah, yeah.
12:55It comes in waves, like it goes for a minute and then all of a sudden it comes back like
13:00ten times worse.
13:02What I'll do is I'll get you some liquid morphine.
13:04All right, darling?
13:04Yeah, yeah.
13:05So just pop that underneath your tongue.
13:08There we are.
13:09All right.
13:10That's just a bit of morphine.
13:12Hopefully that will take the pain away a bit better.
13:14In the world of burns, it's a good thing that you've got pain.
13:16Air interaction with burns can be excruciatingly painful, but a lack of pain after a burn
13:22can mean the nerves in the surrounding area are damaged or dead.
13:26He is in a lot of pain.
13:27Where he's sore is where the burns are less thick and deep.
13:33So what normally happens is they get dressed, the air comes away from them for a little bit,
13:37the pain relief will kick in and he'll be a little bit more comfortable.
13:39The more serious a burn, the more likely it is to become infected.
13:43So nurse Annabelle will dress his wounds to reduce the risk.
13:47I would expect that you're going to be having these dressed for quite a long time moving forward.
13:53What do you think about work then?
13:55Like how long do you mean like long, like a couple of weeks or?
13:59Well, I would probably ask that question tomorrow when you see the specialists.
14:07But your problem's going to be you're going to have big bandages on,
14:10so the dexterity of your hands isn't going to be very good for you to be a builder.
14:16We'll see once we've got all the dresses on how big they're going to be.
14:23I'm just going to basically make you look like you've got one massive boxing glove on here, I'm afraid.
14:27So I'm just going to come take that finger out there.
14:34The other thing you're going to need to do as well is get it elevated.
14:37So sit with it up like that.
14:40Having looked closely, it's becoming clear that Arthur will need a skin graft.
14:45The blisters have been taken off the calf so I can see the base of the burn.
14:49It's white and waxy so it's burnt into more layers of tissue
14:53and potentially gone through some nerves.
14:55But it's not gone anywhere near his muscular system or his bones.
14:59It's not gone right down that deep.
15:01So I don't think that they will want to graft him at this point.
15:05With the night shift limiting the amount of specialists available,
15:08Arthur will need to return in the daytime for his treatment to be continued.
15:13So where you need to go when you get to the hospital is the burns outpatients
15:16is apparently in the east entrance.
15:18Good luck.
15:18Thank you, cheers.
15:20Bye.
15:20Take care.
15:23How bad is it?
15:24Bad.
15:25Is it?
15:31Six, five.
15:33Wait, wait, wait, don't go.
15:35Busy A&Es across the UK are in large parts fueled by intoxicated patients.
15:40Crazy.
15:41I know, my love.
15:41But you're very injured and we're trying to help you.
15:45I'm trying.
15:45When someone's intoxicated it can be quite challenging to treat them.
15:49No, don't slag them.
15:50Don't slag them.
15:51How much have you had to drink?
15:53Probably too much.
15:53Three billion pounds of taxpayers' money is spent on alcohol-related A&E visits
15:58and hospital admissions a year.
16:00The memory is fuzzy and they're not able to cooperate and they're not able to understand.
16:05In the nablu.
16:06Come on, dear.
16:07Yes!
16:07Fucking .
16:08At the weekend, it's estimated that seven out of ten patients have come in due to drinking.
16:14I'm probably good class as a binge drinker.
16:16Okay.
16:16Take a seat, lovely.
16:23Hello at QE A&E.
16:27Feels like we've come in, put some fake blood on her head.
16:32You do look like a Halloween costume, to be fair.
16:35In Queen Elizabeth Hospital, 26-year-old Jay has come into A&E with his girlfriend Ellie
16:40after running into a concrete post at a party.
16:43You did hit it at some speed, though.
16:45Yeah, I did.
16:46You were running quite fast.
16:49Yes, that's me.
16:52Dr. Ash is one of the senior medics on shift tonight.
17:01All right, you've brought her to the hospital.
17:06So, I had a few drinks, playing a game in the garden.
17:09I'm almost certain everyone knows the game.
17:11It was a game of duck, duck, goose.
17:13Okay.
17:15Ran round and hit up the concrete pole of the fence.
17:19All right.
17:20Like, smacked my head on it, kind of went like stars and then just gushing blood out of my head.
17:26And when this happened, did you lose consciousness at all?
17:29No.
17:30Have you been sick at all?
17:31No.
17:32I felt incredibly sick, but I didn't process it.
17:35What happened?
17:35Head injuries can be very serious.
17:37So, you could have a fracture on the skull, or you could have bleed on the brain, which can be
17:42life-threatening.
17:43Any seizures or double visions?
17:46No.
17:46As Jay didn't lose consciousness and didn't vomit, it indicates he's unlikely to have a brain injury, but it doesn't
17:53rule out other serious issues.
17:55Any other injury on it to no man?
17:57I hurt my shoulder, but I don't think it's relevant.
18:14It was.
18:14It's not tender there, is it?
18:16That's, that's where it hurts, yeah.
18:18Take it.
18:19Ah.
18:20Ah.
18:21All right.
18:21All right, can I take this off?
18:24Yeah, of course.
18:29How bad is the cut?
18:31I'm not too sure.
18:37Look, accidents can happen any time.
18:40I think people do tend to get injured more than when you're not under the influence of alcohol.
18:47So, people should be drinking responsibly, so they can prevent these kinds of injuries, which are completely avoidable.
18:55How bad is it?
18:57Hard to tell with all your hair.
19:01Yeah, so, there is a lot of clotted blood there under your scalp, so it's collected there and swollen.
19:10So, we'll have to find a room with a bed, we'll have to clean it properly.
19:15Sure.
19:16Then I'll go look.
19:17Before that, I'll send you for a shoulder x-ray, because you are tender on the joint between your shoulder
19:25blade and your collar.
19:27Yeah.
19:27Okay.
19:28So, we just need to make sure that, because if you landed onto there, you could have had a break
19:32there.
19:33An injured shoulder or broken collarbone can be hard to treat and may even require surgery.
19:40Sometimes, when you have injury in more than one place, the signals from the brain for pain are only coming
19:49from the worst one.
19:51It's called a distractible injury, so you could have a broken leg, but because you've got a serious head injury,
19:58which is hurting more,
19:59your brain's not going to tell you that your leg's also injured.
20:03So, sometimes that can be a red herring.
20:06It does hurt on that point.
20:18Yeah.
20:18Hello, Q-A.
20:21Yeah, head three, head four.
20:26Can I just pop this arm up for me?
20:28Okay.
20:2923-year-old Cameron has been the victim of a hit-and-run.
20:34We're just putting it up for you.
20:36Just putting a blast on top of that, all right?
20:39Oh, God.
20:40Nurse Sharnice is caring for him after his CT scan.
20:44He's going to keep you very still, okay?
20:47He was running a pushbite.
20:49He has been hit with the car.
20:51We don't know at what speed.
20:52We don't know how it's hit him, because the driver will believe it's sped off.
20:56He has a large gash across his knee and suspected internal injuries.
21:02We have to keep him really in a tight mat, so he doesn't turn or doesn't move his head, just
21:09in case he's got some injuries to his neck or his spine.
21:11And we also need to give you an injection.
21:13It's a tetanus injection, okay?
21:16Just because you might have landed in metal, gravel or dirt.
21:19I see hit-and-runs all the time.
21:22For a person to be hit at that speed, it is really, really, really damaging.
21:26Normally, it's the longer bones that we're really, really worried about,
21:29because that's what tends to get what's fractured worse.
21:32I think this fragment from this level.
21:35Dr. Muhammad and the team are examining the CT scans.
21:39We need to make sure that the spine is okay.
21:41While Cameron waits for the results with his mum.
21:45You don't need surgery. You don't need surgery. You don't need surgery.
21:50You need surgery.
21:51All right, Cameron, are you okay?
21:52The scan was done. It showed that you have a fracture in your right hip.
21:56It's hip. It's broke.
21:58Yeah. The hip is like a ball and socket.
22:00So the socket itself is broken.
22:02Most probably it might need surgery for the fixation of this one.
22:06And there is a big laceration in your knee, so we'll book you for tomorrow for theatres.
22:11For washing out of your knee and skin closure.
22:14But the hip surgery will not be tomorrow. It will be on another day.
22:17But the most urgent one is your knee because it's an open wound.
22:20This is fucked.
22:22Yes.
22:24Cameron will have to wait until the daytime to have his hip permanently fixed.
22:30Are you able to bend your knee?
22:31Oh, no.
22:32No.
22:32But he needs it temporarily manipulated into a safe position now or risk further injury.
22:38Oh, no.
22:39Can you ask him to bring the painkillers, yeah?
22:41Oh, fuck him.
22:43Oh, God.
22:46Just a morphine. We're happy with your pain, okay?
22:49Are you okay?
22:51No.
22:52So, Cameron, this one is for your pain also.
22:54Put it around your hand, yeah?
22:56And then take your breath in and out.
22:58Take a breath in and out.
23:00Yeah.
23:02Yeah, yeah.
23:03Keep it going.
23:05Keep it going.
23:06Manipulating the hip back into position can be extremely painful.
23:16But if they don't do it, he could cause permanent damage to his leg and even affect his walking.
23:24One minute.
23:25One minute.
23:26One minute too far.
23:27Sorry, Julian.
23:28Ah!
23:29Ah!
23:32Stop!
23:33Stop!
23:34Stop!
23:35Stop!
23:35Put my leg down!
23:49C- That's it.
23:52No, stop.
23:54Stop!
23:55Stop!
23:55Stop!
23:55At night, A&E sees more patients under the influence of alcohol and drugs.
24:00We're very, very pretty.
24:02Have some hair away.
24:03That's the way.
24:04Which leads to accidents and violence.
24:06He is coming in and he has to do a drug fucking.
24:09With almost 175,000 people attending
24:13with injuries sustained in violence each year.
24:20Thanks so much for that.
24:23GCS 15, moving all limbs.
24:27How bad is your pain at the moment?
24:30It's down, really.
24:32In Birmingham resus, Dr Helen is looking after 86-year-old Thelma.
24:37You haven't got any pain?
24:39OK, that's good.
24:40Who has a serious open ankle fracture
24:43after suffering a fall at home.
24:46I think the medicine the paramedics have given you
24:48have made you quite sleepy.
24:50This is kind of becoming the bread and butter, in some ways,
24:54of A&E departments up and down the country.
24:57We see a huge number of patients who have sustained falls.
25:03It's kind of termed as one of the geriatric giants,
25:06as they call them,
25:07the things that bring older people into hospital.
25:10Thelma was sent for an X-ray,
25:12and Dr Kasim is assessing the images.
25:15A nasty fracture.
25:16That should all be one piece.
25:18So that's fractured off there, broken off,
25:20and this is the bit that's sort of sticking out
25:23that we can see on her leg,
25:24and this is where all her skin's come off.
25:26Thelma's wound will need to be undressed,
25:28but first, word has reached her family and friends of her form.
25:32Hello.
25:33Hi.
25:33Hello.
25:39Her daughter Dawn has arrived with her friend Jenny.
25:50So, from what we know so far, she's got a pretty bad fracture.
25:53So, she's the bones poking through the skin,
25:55and the ankle's fractured and dislocated.
25:58Yeah.
25:58The team only have one opportunity
26:00to look at the wound on Thelma's leg and redress it.
26:04We're just going to have a little look, sweetheart.
26:06I don't know if you want to have a seat in the Raoul's room.
26:08Yeah.
26:09I think I would, given the option.
26:11Yeah, yeah.
26:11So, we're just going to have a look,
26:14and then we will make a plan.
26:15We see these injuries frequently,
26:17but this is, you know, a very traumatic event for this family.
26:21Re-exposing them over and over again to this nasty injury
26:24is not really fair, and it's not really necessary.
26:28Thelma, my darling,
26:30we need to take the bandage off this ankle
26:32and have a little look,
26:34because we've not really seen it properly yet.
26:36Yeah.
26:36We won't be moving ankle.
26:38Yeah.
26:39If it's uncomfortable for you,
26:41please do let us know.
26:42Yeah.
26:42Okay?
26:43I see 20-year-old men who come running in
26:45with a tea towel wrapped around their hand
26:47with what essentially is a paper cut,
26:49screaming at the top of their lungs.
26:51It never ceases to amaze me,
26:53and it never will how some of our older population
26:57can be incredibly stoic
26:59with the most horrific injuries.
27:02Okay, okay.
27:04Dr. Arslan from Trauma Orthopaedics
27:06joins Dr. Helen to help,
27:08but the team need to be careful.
27:10An exposed open fracture is prone to infection.
27:15Okay, just keep still.
27:17Don't try and move it, okay?
27:25It's going to be around 15 to a centimetre all the way.
27:31It's at least 20, isn't it?
27:33Just a minute.
27:33So that gauze is 10 centimetres.
27:36So 10, 20, I guess, 30, isn't it?
27:42The tear is more substantial than they initially thought.
27:46When you meet anybody with an open fracture,
27:49you have thoughts about the recovery period.
27:53When that's then applied to an older patient who has thin, frail skin,
28:02you can't help but start to think this is going to be much more significant
28:10than it may be in a much younger, fitter, well patient.
28:16I won't be able to reduce this on the pain blocks.
28:20To treat it and the dislocation, Thelma will need sedating, but her age is a concern.
28:26She's already got a new oxygen requirement.
28:29She's a frail old lady.
28:32She's become very, very drowsy after the morphine.
28:35I don't think she's safe for a sedation.
28:44Oh, my God.
28:4723-year-old Cameron has a fractured hip socket and a massive tear in his knee
28:52after being the victim of a hit and run.
28:54Oh, come on.
28:55Oh, calm.
28:56He'll heal my leg like that.
28:58So the hip is mainly like a ball and socket.
29:00So the socket of his hip is broken.
29:03That's why he's got this pain.
29:05Dr. Muhammad needs to apply skin traction to prevent further damage
29:08to the broken hip socket, nerves and vessels around the area.
29:12This also helps stop the broken bones moving out of place.
29:15This is what I'm scared of.
29:17I've got your hand.
29:19Yeah?
29:20His mum, Jackie, is supporting him through the painful procedure.
29:25Oh, no, are you OK?
29:27Oh!
29:27Come on, breathe.
29:28Careful where you pull that from.
29:29Yeah, yeah.
29:30Just give this on your mouth.
29:32Come on, breathe, son.
29:33Oh!
29:35Son, breathe.
29:35Come on, breathe.
29:36Breathe.
29:37Oh!
29:38Come on, come on, son.
29:38Oh!
29:39Come on, come on, son.
29:40You can give me.
29:41Come on.
29:42Just show me all the law.
29:43Oh!
29:43Keep loving.
29:44Keep loving.
29:45Keep loving.
29:45Keep loving.
29:47You're doing fantastic, son.
29:48Come on, come on, come on.
29:49Keep it in your mouth.
29:51Keep it in your mouth.
29:52Keep it in your mouth.
29:52Keep that, yeah.
29:53Come on, come on, come on, come on.
29:54My goal is left.
29:55I will lift the foot and you will put the bandage, this one.
29:58Oh!
29:59I've got you, son.
30:00I've got you, son.
30:01I've got you.
30:04Oh!
30:04Come on, son, you've got to do it for me.
30:06All right, let's go.
30:07Oi!
30:08Oi!
30:09Oi!
30:09Deep breath for me.
30:10Keep breathing, keep breathing.
30:12I've got you.
30:12I've got you soon.
30:13I've got you.
30:13I've got you, I've got you, I've got you.
30:15Oh!
30:16Yeah, we can put it down.
30:18Oh, thank you, yeah.
30:19We have done it here.
30:20We're finished.
30:21Well done, you've got something.
30:23Yes, well done, you've got this.
30:24Cameron's hip is realigned, but he's a long way from recovery.
30:29We booked for him setter for tomorrow for washout of the knee and skin closure.
30:34For his hip, it might go for operative treatment, but we need to discuss it with the pelvic consultants
30:39and we'll take it from there.
30:42Yeah, he will go now to have another x-ray on his pelvis.
30:46Then after that, he will go to one of the orthopedic cords.
31:01Banging the dick.
31:04What are they going to do if my shoulder's bothered?
31:06Do they need to put, like, a metal rod in it or something?
31:09Oh, what?
31:09Is it like surgery?
31:10You better hope you've not done any damage to that shoulder.
31:1426-year-old Jay is waiting with his girlfriend, Ellie, for x-ray results on his shoulder after
31:19running into a concrete post at a party.
31:22Does it hurt?
31:23Does it?
31:23Does it?
31:24Is it worse than before?
31:25It's getting worse.
31:26And then...
31:30You all right?
31:31You all right?
31:32Nice.
31:32Nothing broken on his shoulder.
31:34Good.
31:34This ligament might be slightly bruised.
31:36Okay.
31:37I think that's fine.
31:38We've had multiple traumas coming, so I'm just stuck there in recess.
31:42I'll ask one of my colleagues to sort this out, please.
31:44Okay.
31:45Okay.
31:45Thanks so much.
31:46If you wait for me, it probably might be, I don't know, one, two, three, four hours,
31:49depending on how we need to share.
31:51Yeah.
31:51Yeah.
31:51So I'll get one of my colleagues to sort that out.
31:53Thanks so much.
31:53I appreciate it.
31:54That's all right.
31:55That's good.
31:56Let me show him about a broken shoulder.
31:58That's one thing ticked off the list.
32:09Hello, sir.
32:09Hello.
32:10My name is Sarge.
32:11I'm one of the doctors here.
32:12Okay.
32:12Let's do now quickly check, okay?
32:14Yeah.
32:15Yeah.
32:15With the other doctors dealing with incoming serious traumas, Dr Sarget will now take over
32:20the treatment for his bloody head wound.
32:23Do you have any pain in your neck?
32:25Not at the moment, actually, no.
32:26No.
32:27Can you look up for me, please?
32:28Look down.
32:29Look to your right.
32:30Look to your left.
32:32Okay.
32:33When you do that, it doesn't hurt in your neck, then?
32:35No.
32:36You're not on any blood thinners?
32:37No.
32:37Okay, that's fine.
32:39Okay.
32:40Okay?
32:40Yeah.
32:41If the cut is deep, Jay may need to have stitches by the facial specialists.
32:45What's it look like?
32:46I don't want to look.
32:47It's making me feel a bit pleasy.
32:48Is it bleeding or not?
32:49Yeah.
32:50I want to see it.
32:51You want to see it?
32:51Yeah.
32:52All right.
32:54I mean, you'll know what it looks like, Val.
32:57Oh, yeah.
32:57It's fairly long, isn't it?
32:59Yeah, it is.
33:00Gory.
33:01Lovely.
33:02Okay.
33:03So, you will go up to the ward to have the stitches done by the maxillofacial surgeons.
33:08Okay.
33:08Then you go home after that, okay?
33:09Super.
33:10It should have been done here, but because, like, there are many patients that have, like,
33:13shoulders.
33:13Yeah.
33:13That's fine.
33:15Okay.
33:15The next one will come and call you and take you upstairs, okay?
33:18Okay.
33:19Perfect.
33:20After you.
33:21With A&E being so busy, Jay will have his head stitched up in the maxillofacial ward.
33:28What a night.
33:29I know.
33:30What a Saturday night.
33:31What a Saturday night.
33:31What a Saturday night.
33:47If you could go into number three.
33:49Hello.
33:50Hello.
33:50Hi there.
33:52In Tunbridge Wells, 82-year-old Carol has been rushed into A&E with a dangerously high heart
33:58rate.
33:59On slide, ready, set, slide.
34:03Oh!
34:04Carol, do you want something behind your head?
34:06Yeah.
34:06Yeah?
34:07There we go.
34:07Is that a little bit better?
34:08Fine.
34:09Okay.
34:10Carol's being examined by doctors Lucy and Ahmed.
34:14The last 40, 45 minutes she's been SVT at a rate of a 205.
34:18Paramedic Dan rushed Carol to hospital.
34:20She's just felt dizzy, and she's had some palpitations as well.
34:25Okay.
34:26The ambulance crew called her in as an SVT, which means a very fast heart rate.
34:31My concerns would be that she has had a heart attack.
34:34If she goes back into an SVT, a supraventricular tachycardia, that can be dangerous.
34:40That can cause cardiac arrest if not treated promptly.
34:44En route to hospital, Carol's heart has been monitored with an electrocardiogram, or ECG, which measures electrical activity in the
34:51heart.
34:52Then we had an attack when she got very diaphoretic, very pale, so she had palpitations.
34:56Okay.
34:57This is probably her third or fourth attack this week.
35:00When you say a third or fourth attack this week, has it been attended to by any doctor or any
35:04medical crew?
35:04No, she's felt...
35:05No, not at all.
35:06She's just felt kind of dizzy, had palpitations, and then it sort of dissolved itself.
35:10And in any of these episodes this week, has she had any chest pain?
35:14And she has had some chest pain on the left-hand side, and going down her arm.
35:18Carol's heart is not the only concern.
35:21This morning, her husband actually had a funny episode.
35:24She was kind of slurred to one side.
35:26Okay.
35:26The left-hand side facial droop.
35:28The left facial droop.
35:29Yeah.
35:29Her other symptoms could be the sign of a stroke.
35:32Okay.
35:33Lovely.
35:33Thank you very much.
35:37So your heart rate's going a bit fast.
35:39Yes.
35:40You're kind of going in and out of an arrhythmia, okay?
35:43Funny heart rate, right?
35:44It's coming and going.
35:46Oh.
35:46What we're going to do is give you some fluid, because that sometimes settles it down.
35:50I'm going to do some blood tests, okay?
35:53And then we've got all the results back.
35:56We'll see where we're at.
35:58Yeah.
35:58All right, my love?
35:59Okay, thank you.
36:02Can we, yeah, just run that, bowl us that fluid through, what's left of it, and then
36:07we'll give her another litre.
36:08While the fluids go in, Dr. Lucy wants to check out the other symptoms reported by the
36:13paramedic.
36:15This episode of her being confused and collapsing could indicate some sort of intracranial event
36:20like a stroke.
36:21An undiagnosed atrial fibrillation, that can increase stroke risk.
36:25Is it all right if I examine you?
36:27Yeah.
36:28Okay.
36:29Airways patient.
36:30Yeah.
36:30Speaking of all sentences.
36:32We've got sats of 94 on air.
36:35Every time you've had these funny turns, have you felt a bit muddled?
36:39Yeah.
36:40Well...
36:41Just get the ECG first.
36:44Just hold on still for just a second until we get the ECG done, okay?
36:47It's just the heart tracing.
36:49Yeah.
36:49Any slight movements can affect it.
36:51Yeah.
36:51I know we were attacking you from different angles, but because your heart rate was running
36:54really fast, we're trying to get to the bottom of what was going on.
36:59I think this is more SVT.
37:01It is.
37:01More AF.
37:03It does.
37:04Carol's heart rate is behaving erratically.
37:07She's alternating to AF, SVT.
37:10Hmm.
37:11AF stands for atrial fibrillation.
37:15The atri at the two top chambers, the heart, they start off the electrical impulses in your
37:20heart.
37:21And if that electrical impulse is firing abnormally, then instead of a nice strong pump, they will
37:28vibrate or fibrillate.
37:31The problem with that is the heart rate can become extremely fast.
37:35The blood isn't getting pumped properly around the body.
37:38And blood can pool inside the heart and clot, and that can lead to stroke.
37:44So we're thinking maybe multiple arrhythmias, AF, and maybe a blood clot.
37:48Could be.
37:49Yeah.
37:50Let's get a CT head as well.
37:52Yeah.
37:52Ready to slide.
37:56So we're going to get a CT scan of her head to check for stroke.
37:59My concern if she's had a stroke would be that she might deteriorate neurologically.
38:04If the scan shows she's had a stroke, they'll need to move quickly to prevent permanent damage
38:09to her brain.
38:10Hold that position there.
38:12Nice and still.
38:30Well done, sweetheart.
38:31Are you okay?
38:32In Birmingham, 86-year-old Thelma has a severe open fractured dislocation to her ankle
38:38that has broken through the skin.
38:40How's your pain?
38:42It's not painful at the moment.
38:43Okay.
38:44To treat Thelma's injuries, Dr. Helen and Dr. Arslan would need to sedate her.
38:49But her age makes this extremely dangerous.
38:51Do you want a D bus?
38:52Do you want a D bus?
38:53Now she's able to wriggle those.
38:55Yeah.
38:55But we cannot exclude tendon injury on here.
38:59For this we need to have examined properly.
39:01So what we can do now then, we can just cover the wound with lines or gauzes.
39:07Yeah.
39:07Apply a clatter in the position we are.
39:09I think that's the best option.
39:11Yeah.
39:12I think that's safer for her.
39:15Yeah.
39:15You just relax.
39:16We're going to get you into a plaster cast to make it a little bit more comfortable.
39:20For now, the team agree the safest option is to protect Thelma's injury by wrapping it in a plaster cast.
39:27You've really got to balance the risks and benefits of trying to move that fracture around to get it into
39:32a better position.
39:33Because she is at risk, essentially.
39:35She's not a young person who can very simply go off to sleep.
39:39It needs a bit of planning and it's better that that happens in an organized fashion.
39:48It was more important to get her into a very simple plaster cast to make her comfortable.
39:54And then the operation that needs to be done anyway can happen in daylight hours.
39:58Give us a tiny toe wriggle sweetheart.
40:01Yeah.
40:03That's beautiful.
40:05We will be planning to take her to the theatre in the morning.
40:08In the morning.
40:09To reduce ankle back to its place.
40:12And also to take care of soft tissues as much as we can.
40:15Happy?
40:16Yeah.
40:17See you in the evening.
40:19Bye.
40:19Around six elderly people fall every minute in the UK, equating to around eight and a half thousand falls a
40:26day.
40:26With many of these going on to need home care and extra support.
40:30I just feel really sorry for her.
40:32You know, it's going to be a bit of an uphill struggle for her.
40:36And I just kind of question going forward what limited mobility she's actually going to have
40:45and how, as a family, we deal with that.
40:49You want to do it back home?
40:51No.
40:52No.
40:52We're going home.
40:54We're going to stay here.
40:56Just close your eyes.
40:57Don't worry that we're here.
40:59Alright.
41:14Sinus tacky, then AF, then SBT, then back to AF.
41:16Then AF again.
41:17And then back to sinus tacky.
41:18Back to sinus tacky.
41:19And now she looks like she's back in AF again.
41:21Hmm.
41:21I wonder if she's had an acute cardiac event.
41:23In Tunbridge Wells A&E, doctors Lucy and Ahmed are investigating Carol's dangerously fluctuating heart rate
41:30and other conditions that may be linked.
41:33It's very difficult to tell at this stage what might be going on.
41:36There are several things that could be happening.
41:38She could have had a stroke.
41:39She could have had a heart attack.
41:40Or she could have had an undiagnosed disturbance in her heart rhythm.
41:49Dr Lucy has received Carol's blood results and CT scan.
41:55Hello again, Carol.
41:57Hiya.
41:57How are you feeling now?
41:59I'm okay.
42:00It's very noisy around here.
42:02I know.
42:03It is very noisy in here.
42:05So I've got all your test results back.
42:07And they're all fine.
42:09But your heart is still going fast despite treatment.
42:13Thankfully, Carol hasn't had a stroke.
42:15But her heart is still behaving dangerously.
42:18All of Carol's blood results were fairly normal.
42:21But her ECG is remaining abnormal.
42:24So it's not in a normal regular rhythm.
42:27That is probably coming from a problem in the top part of her heart in the atria.
42:32So we need you to stay in hospital for some further tests on your heart.
42:37And you'll go to the ward tonight.
42:39And they'll do some more investigations tomorrow.
42:41Yeah, it's all right.
42:42Is that okay?
42:43Yeah.
42:45There's nothing more they can do for Carol tonight, but make her comfortable until the specialists
42:50see her in the morning.
42:53All right.
42:53Would you light the lights off?
42:54I will.
42:55Yeah, have a little sleep.
42:56Yeah.
42:57All right.
42:57I haven't done a sleep.
42:59Oh, that's better.
43:00Yeah.
43:01You have a rest while you wait for them.
43:03Yeah.
43:03Okay.
43:04All right.
43:05Yeah, thanks very much.
43:11I'm a seal, mate.
43:13Come.
43:25I'll get you sorted out.
43:27See you, Ruby.
43:39You all right?
43:41My hand's still coming.
43:50If you need anything, you press this button.
44:00Oh, my days.
44:02Is that hurting?
44:04No, it's so slightly.
44:06Mm-hmm.
44:22If you or someone you know has been affected by anything raised in tonight's program, please
44:27go to channel5.com slash helplines for information and support.
44:32A domestic turned violent or something even more sinister investigating a brutal stabbing and true crime forensics murder scene tomorrow
44:40at 10.
44:40Next tonight, Ambulance Code Red.
44:43Next tonight, Ambulance Code Red.
44:44is not really far from the end of this program.
44:45But I'm sure they're going to get rid of this one and are going to be at home.
44:47It's very expensive.
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