- 11 hours ago
A and E After Dark S06E09
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00:02No, man, no!
00:03After dark...
00:04You're described!
00:05...while the nation sleeps...
00:07He's been hit by a car.
00:08...the A&E night shift begins.
00:11You never know what's going to come through the door.
00:13An absolute storm has just come in.
00:15Look, yeah, whatever.
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...
00:24We're trying to help you.
00:26...with extraordinary access to three of the most challenged
00:29emergency departments in the country.
00:31Guys, I need help in here.
00:33He could have died.
00:33We follow the work of emergency medics
00:36who 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.
00:46Step back, big man.
00:48The department's just on fire.
00:50You've got to kill it!
00:51Yeah, yeah, yeah, yeah, yeah!
00:52The risk of violence and abuse looms large every night.
00:56And you, you're maximum.
00:59Stop trying to bite.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched.
01:06I've been 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
01:12than patients.
01:13I'll punch your head in, 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 the mover.
01:24This chaos.
01:26Glorious chaos.
01:39Get security to the mover patient.
01:41The security team is an essential part of any hospital staff.
01:45I need 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 comes out?
02:05Yeah.
02:06There, now.
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.
02:15I didn't think that a hospital would be in flux so badly.
02:18And when it's critical...
02:19Shut the f*** up, you stupid.
02:20If they have to, security will get physical to resolve a situation.
02:24The abuse they get.
02:26Being assaulted all the time.
02:28I wanna f*** the safety of you.
02:30You need 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, Wilu.
02:49Get the f*** off.
02:50The antisocial behaviour is related due to the intoxication.
02:54But, often times, it's just that people are just rude to us for no reason.
03:01Go back in there for me, please.
03:03No.
03:03Come on.
03:04Go back in here, please.
03:05No.
03:06In Birmingham A&E, security have been called in to restrain a patient who has become violent
03:12while being treated.
03:14We can't have you out, because you've been assaulting our staff.
03:18Can't we?
03:18Well, I know you don't remember.
03:20You've punched one of our members of staff as well.
03:23It's because the minute you guys go...
03:25It's exhausting.
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 sidewalk.
03:42Withdrawal from alcohol can alter your mental state, and, if not treated, be deadly.
03:47The doctor's gonna come in a minute.
03:49What are you gonna do?
03:50Take it off here.
03:51It's only because you've obviously hit a nurse tonight, ain't it?
03:55Yeah.
03:55Yeah.
03:56It's not a nice situation, and they've become confused, and they're trying to leave the hospital,
04:02but it's really not safe.
04:04We'll give them medication.
04:05Hopefully, that eases some of these agitations.
04:08The nurse has just got to go and sign off your medicine.
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,
04:20it's hurting us.
04:21Just stay in there for me.
04:22Okay.
04:24Luckily, it's not every shift, 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 gonna make you a little bit drowsy as well, so you might get a bit unsteady on your
04:44feet.
04:45That's all I'd like you to stay sat 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.
05:19Sister 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.
05:45The car has then driven off, so there's no bystanders in here, no driver.
05:49All right.
05:50Cameron has been the victim of a hit-and-run.
05:56He'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 dick, sir?
06:10Yeah.
06:12And again.
06:13Dr. 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.
06:25From severe laceration on the right knee.
06:28Oh!
06:29Oh!
06:29Yeah, same.
06:32It's okay, too.
06:32Can we have the answer?
06:33Oh, thank you.
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 for 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, we're going to take the CT and we'll have a look, okay, man.
06:54After his assessment, it's decided Cameron needs an urgent full-body CT scan.
06:59Just want a minute, I think the better.
07:01Yeah.
07:02Okay, let's go.
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
07:11and if there's any bleeding or any damage to any of his major organs.
07:16Slide.
07:19Okay.
07:20Slide you over.
07:21Oh, shit.
07:22Very steady slide.
07:23Oh, shit.
07:24Oh, one second.
07:25Oh, shit.
07:27With a hit and run, we're worried that there could be a brain injury.
07:31Am I going to do a scan?
07:32No, head.
07:33No, way down to your legs.
07:34All right.
07:34You're thinking, get them in and out to scan as quick as possible.
07:38The extreme forces when being hit by a car can smash fragile internal organs into bones,
07:44potentially causing catastrophic damage.
07:47Please breathe in and hold your breath.
08:09The 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.
08:20You 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.
08:50It's an isolated injury, pretty nasty, open fracture.
08:56In resus, an elderly woman has been rushed in with an open ankle fracture.
09:02Ready, steady, slide.
09:04Yeah.
09:06Thelma, age 6-year-old female.
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 we 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 has 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.
09:52Now, 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 quite a 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.
11:15We're 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 had my sister shout, there's a fire in the kitchen, and a boiling pan of oil set 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 a bit of pain of number eight.
12:53Because you are in a lot of pain.
12:54Yeah.
12:55It comes in waves, like it'll go 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.
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.
13:20But a lack of pain after a burn can 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 this is gonna, you're gonna be having these dressed for quite a long time,
13:52moving forward.
13:53What do you think about work then?
13:55Like how long do you, how long do you mean like long?
13:58Like a couple of weeks or?
13:59What I would probably give, ask that question tomorrow, when you see the specialists.
14:05Um, but the, your problem's gonna be, you're gonna have big bandages on,
14:11so your, the dexterity of your hands isn't gonna be very good for you to be a builder.
14:16We'll see once we've got all the dresses on how, um, how big they're gonna be.
14:23I'm just gonna basically make you look like you've got one massive boxing glove on here, I'm afraid.
14:27Sorry, I'm just gonna come take that finger out there.
14:34All right.
14:35The other thing you're gonna need to do as well is get it elevated.
14:37So sit with it up like that. All right.
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 wanna 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 in the, apparently, in the east entrance.
15:18Good luck.
15:19Thank you. Cheers. Bye.
15:20Take care.
15:23How bad is it?
15:24Bad.
15:31Six, five.
15:34Wait, 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, but 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
16:03and they're not able to understand.
16:07At the weekend it's estimated that seven out of ten patients
16:12have come in due to drinking.
16:13I'm probably good class as a binge drinker.
16:16Okay.
16:16Take a seat, lovely.
16:23Hello, QE A&E.
16:27Feels like we've come in.
16:29Put some fake blood on her head.
16:32You do look like a Halloween costume, to be fair.
16:35In Queen Elizabeth Hospital,
16:3626-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.
16:56Dr Ash is one of the senior medics on shift tonight.
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 around and hit the concrete pole of the fence.
17:19All right.
17:20Like, smacked my head on it,
17:21kind of went like stars
17:23and 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?
17:32No, I felt incredibly sick.
17:34What did you have?
17:34Head injuries can be very serious.
17:38So, you could have a fracture on the skull,
17:40or you could have bleed on the brain,
17:42which can be life-threatening.
17:43Any seizures or double vision?
17:46No.
17:47As Jay didn't lose consciousness and didn't vomit,
17:50it indicates he's unlikely to have a brain injury,
17:52but it doesn't rule out other serious issues.
17:55Any other injuries I need to know about?
17:57I hurt my shoulder, but I don't think it's relevant.
18:01Just in case.
18:02Okay.
18:04How did you hurt this shoulder?
18:06Did you fall on the ground?
18:07I think it's just part of the fall, yeah.
18:08Or did you get the concrete post?
18:10I have no clue, to be fair.
18:12No, I didn't see it.
18:14That's not tender there, is it?
18:16That's where it hurts, yeah.
18:20All right, then.
18:23Can I take this off?
18:24Yeah, of course.
18:29How bad is the cut?
18:31I am not too sure.
18:33It's going to bleed out.
18:34It's going to get this post.
18:37Look, accidents can happen any time.
18:40I think people do tend to get injured more
18:44than when you're not under the influence of alcohol.
18:47So people should be drinking responsibly
18:49so they can prevent these kinds of injuries,
18:53which are completely avoidable.
18:55How bad is it?
18:57It's hard to tell with all your hair.
19:01Yeah, so there is a lot of clotted blood there
19:05under your scalp.
19:06So it's collected there and swollen.
19:10So we'll have to find a room with a bed.
19:14We'll have to clean it properly.
19:15Sure.
19:16Before that, I'll send you for a shoulder x-ray
19:19because you are tender on the joint
19:24between your shoulder blade and your collar.
19:27Yeah.
19:27Okay.
19:28So we just need to make sure that because if you landed onto there,
19:31you could have had a break there.
19:33An injured shoulder or broken collarbone can be hard to treat
19:37and may even require surgery.
19:40Sometimes when you have injury in more than one place,
19:45the signals from the brain for pain are only coming from the worst one.
19:51It's called a distractible injury.
19:53So you could have a broken leg,
19:54but because you've got a serious head injury which 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.
20:18Hello, QA.
20:21Yeah, x-ray, x-four.
20:27Can you just pop this arm up for me?
20:2923-year-old Cameron has been the victim of a hidden run.
20:34We're just covering it up to be hard.
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 by the car.
20:51We don't know at what speed.
20:52We don't know how it's hit him
20:54because the driver will believe it's sped off.
20:56He has a large gash across his knee
20:59and suspected internal injuries.
21:01We have to keep him really in a tight map
21:06so he doesn't turn or doesn't move his head
21:08just in case he's got some injuries to his neck or his spine.
21:12We also need to give you an injection.
21:14It's a tetanus injection, okay?
21:16Just because you might have landed in metal, gravel, dirt.
21:19I see it in runs all the time.
21:22For a person to be hit at that speed,
21:24it is really, really, really damaging.
21:25Normally, it's the longer bones that we're really, really worried about
21:29because that's what tends to get what's fractured worse.
21:31I think this fragment from this level.
21:34Yeah.
21:34Yeah, yeah, yeah.
21:35Dr Mohamed 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.
21:47You don't need surgery.
21:49You don't need surgery.
21:50You don't need surgery.
21:51You don't need surgery.
21:51All right, Cameron, are you okay?
21:52The scan was done.
21:54It showed that you have a fracture in your right head.
21:56It's hip.
21:57Yeah.
21:58The hip is like a ball and socket.
22:00So the socket itself is broken.
22:03Most probably it might need surgery for the fixation of this one.
22:06And there is a big laceration in your knee.
22:09So we'll book you tomorrow for theatres.
22:11For washing out of your knee and skin closure.
22:14But the hip surgery will not be tomorrow.
22:16It 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
22:26to have his hip permanently fixed.
22:30Are you able to bend your knee?
22:31Oh, no.
22:32But he needs it temporarily manipulated into a safe position now
22:36or risk further injury.
22:39Can you ask him to bring the painkillers, yeah?
22:42Oh, fuck him.
22:43Oh, God.
22:46Just a morphine.
22:47We're happy with your pain, okay?
22:50Are you okay?
22:51No.
22:52So, Cameron, this is what...
22:53This one for your pain also.
22:54Put it around your hand, yeah?
22:56And then take your breath from in and out.
22:58You take a breath in and out.
23:00Yeah.
23:02Keep it going.
23:03Yeah, yeah.
23:03Keep it going.
23:05Keep it going.
23:06Manipulating the hip back into position
23:08can be extremely painful.
23:10Just show me all below.
23:11Oh.
23:12Keep blowing, keep blowing, keep blowing.
23:13Keep blowing.
23:15You're doing fantastic, son.
23:16Come on.
23:17But if they don't do it,
23:18he could cause permanent damage to his leg
23:21and even affect his walking.
23:23Oh!
23:24One minute, one minute.
23:25It's going to be too far.
23:27Sorry, Julian.
23:28Ah!
23:29Ah!
23:32Stop!
23:33Stop!
23:33Stop!
23:34Stop!
23:35Stop!
23:36Put my leg down!
23:36Stop!
23:52Stop!
23:54Stop!
23:55Stop!
23:56Stop!
23:56At night, A&E sees more patients
23:58under the influence of alcohol and drugs.
24:00very very pretty which leads to accidents and violence with almost a
24:10hundred and seventy-five thousand people attending with injuries sustained in
24:14violence each year
24:27how bad is your pain at the moment in Birmingham resus dr. Helen is looking
24:35after 86 year old Thelma you haven't got any pain okay that's good who has a
24:41serious open ankle fracture after suffering a fall at home I think the
24:47medicine the paramedics have given you've made you quite sleepy this is kind of
24:51becoming the bread and butter in some ways of A&E departments up and down the
24:56country we see a huge number of patients who have sustained falls it's kind of
25:04termed as one of the the geriatric Giants as they call them that the things that
25:08bring older people into hospital Thelma was sent for an x-ray and dr.
25:13Kasim is assessing the images nasty fracture that should all be one piece
25:17so that's fractured off there broken off and this is the bit that sort of
25:22sticking out that we can see on a leg and this is all the skins come off Thelma's
25:26wound will need to be undressed but first word has reached her family and friends
25:31of her fall her daughter Dawn has arrived with her friend Jenny so from what we know
25:51so far she's got a pretty bad fracture so see the bones poking through the skin
25:55the ankles fractured and dislocated the team only have one opportunity to look
26:01at the wound on Thelma's leg and redress it we're just gonna have a little look
26:05sweetheart I don't know if you want to have a seat in the rails room yeah I
26:09think I would given the option yeah so we're just gonna have a look and then we
26:14will make a plan we see these injuries frequently but this is you know a very
26:19traumatic event this is family re-exposing them over and over again to this nasty
26:24injury is is not really fair and it's not really necessary
26:28Thelma my darling we need to take the bandage off this ankle and have a little
26:33look because we've not really seen it properly yet yeah we won't be moving
26:37ankle yeah if it's uncomfortable for you please do let us know yeah okay I see 20
26:44year old men who come running in with a tea towel wrapped around their hand with
26:47what essentially is a paper cut screaming at the top of their lungs it never ceases to
26:53amaze me and it never will how some of our older population can be incredibly
26:59stoic with the most horrific injuries okay thank you dr. Arslan from trauma
27:05orthopaedics joins dr. Helen to help but the team need to be careful an exposed
27:11open fracture is prone to infection okay just keep still don't try and move it
27:25to be around 15 to a centimeter all the way it's at least 20 isn't it so that gauze is
27:3510 centimeters
27:36so 10 20 20 I guess 30 isn't it the tear is more substantial than they initially thought when you
27:47meet anybody with an open fracture you have thoughts about the recovery period when that's then applied to
27:57an older patient who has thin frail skin you can't help but start to think this is going to be
28:08much more
28:09significant than it may be in a much younger fitter well patient I won't be able to reduce this on
28:20the
28:20bedrock to treat it and the dislocation Thelma will need sedating but her age is a concern she's
28:27already got a new oxygen requirement she's a frail old lady she's becoming very very drowsy after the
28:34morphine I don't think she's safe for sedation 23 year old Cameron has a fractured hip socket and a
28:50massive tear in his knee after being the victim of a hit and run so the hip is mainly like
28:59ball and
29:00socket so the socket of the his hip is broken that's why I have got is this is his pain
29:04dr.
29:05Mohammed needs to apply skin traction to prevent further damage to the broken hip socket nerves and
29:10vessels around the area this also helps stop the broken bones moving out of place this is what I'm
29:16scared of love I got you done yeah his mom Jackie is supporting him through the painful procedure
29:27oh come on breathe yeah that's the way you pull that from yeah yeah give this on your mouth yeah
29:31come on breathe breathe breathe breathe oh come on come on son you can get me come on just show
29:42me
30:05all right let's go oh oh oh deep breath for me keep breathing keep breathing I've got you
30:12yeah I've got you soon I've got you I've got you oh yeah we can go down oh thank you
30:18yeah we
30:19have done it here we finished Cameron's hip is realigned but he's a long way from recovery we
30:29book for him theater for tomorrow for washout of the knee and skin closure for his hip it might go
30:35for
30:36operative treatment but we need to discuss it with the pelvic consultants and we'll take it from there
30:42yeah he will go now to to have another x-ray on his pelvis then after that he will go
30:47to one of the
30:59or to be records
31:01bang in the day
31:04what are they going to do with my shoulder is bothered like they need to put like a metal rod
31:08in
31:08it or something oh what is it like surgery you better hope you've not done any damage to that shoulder
31:13yeah 26 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 does it does it is it worse than before it's getting worse
31:26all right nice nothing broken on your shoulder good just ligament might be slightly boost okay okay
31:37how did I find yes we've had multiple traumas come in so I'm just stuck there sure in recess I'll
31:43ask
31:43one of my colleagues to sit this out okay okay thanks so much if you wait for me it probably
31:47might
31:47be I don't know one two three four hours depending on I'll be yeah yeah yeah so I'll get one
31:52of my
31:52colleagues all that thanks so much appreciate it that's right that's one thing ticked off the list
32:08hello sir hello my name is sergeant one of the doctors here okay let's do now quickly check okay yeah
32:14yeah with the other doctors dealing with incoming serious traumas dr sarget will now take over the
32:21treatment for his bloody head wound yeah do you have any pain in your neck not at the moment actually
32:26no no can you look up for me please look down look to your right and look to your left
32:31when you do
32:33that it doesn't hurt in your neck there you're not only the blood thinners no no okay that's fine
32:38we'll make a plan okay okay yeah if the cut is deep Jay may need to have stitches by the
32:44facial
32:44specialists I don't want to look it's making me feel a bit crazy yeah I honestly want to see it
32:51yeah all right when you'll know what it looks like now yes I'm fairly long yeah it's gory lovely so
33:03you won't go up to the ward to have the stitches done by the maxillofacial surgeons okay then you go
33:09home after that okay so it should have been done here but because like there are many patients where
33:13like children yeah that's fine you go upstairs okay and the next one will come and call you and take
33:17you
33:17upstairs okay perfect yeah after you with A&E being so busy Jay will have his head stitched up in
33:25the
33:26maxillofacial ward what a night I know what Saturday night what Saturday night if you could go into
33:48number three in Tunbridge Wells 82 year old Carol has been rushed into A&E with a dangerously high
33:58heart rate Carol's being examined by doctors Lucy and Ahmed last 40 45 minutes she's been SVT at a rate
34:16of 205 paramedic Dan rushed Carol to hospital she's just felt dizzy and she's had some palpitations as
34:24well okay the ambulance crew called it in as an SVT which means a very fast heart rate my concerns
34:32would be that she has had a heart attack if she goes back into an SVT a supraventricular tachycardia
34:39that can be dangerous that can cause cardiac arrest if not treated promptly on route to hospital
34:45Carol's heart has been monitored with an electrocardiogram or ECG which measures electrical
34:51activity in the heart and we had an attack when she got very diaphragmatic very pale so she had
34:56palpitations okay and this is probably had third or fourth attack this week when you say a third or
35:01fourth attack this week has it been attended to by any doctor no any no she's better for that no
35:06not
35:06at all she's just felt kind of dizzy had palpitations and then it's what resolved itself and in any of
35:11these episodes this week has she had any chest pain and she has had some chest pain on the left
35:15hand
35:16side and going down her arm Carol's heart is not the only concern this morning husband's had a funny
35:23episode she was kind of slurred to one side the left hand side the left facial droop yeah her other
35:30symptoms could be the sign of a stroke okay okay thank you very much so your heart rate's going a
35:39bit fast yes you're kind of going in and out of an arrhythmia okay funny heart rate right it's coming
35:45and going what we're gonna do is give you some fluid because that sometimes settles it down I'm
35:50gonna do some blood tests okay and then we've got all the results back we'll see where we're at yeah
35:58all right my love thank you can we yeah just run that bolus that fluid through what's left of it
36:06and
36:07then we'll give her another liter while the fluids go in dr. Lucy wants to check out the other symptoms
36:12reported by the paramedic this episode of her being confused and and collapsing could indicate
36:18some sort of intracranial event like a stroke an undiagnosed atrial fibrillation that can increase
36:24stroke risk is it all right if I examine you yeah airways patient speaking of all sentences we've
36:33got sats of 94 on there every time you've had these funny turns have you felt a bit muddled yeah
36:39oh just
36:41get the ECG first yes just hold on still for just a second until we get the ECG done okay
36:47it's just
36:48the heart racing any slight movements can affect it I know we were attacking you from different angles
36:52but because your heart rate was running really fast we're trying to get to the bottom of what was going
37:04on Carol's heart rate is behaving erratically she's alternating AF SVT AF stands for atrial fibrillation the
37:15atria of the two top chambers the heart they start off the electrical impulses in your heart and if that
37:22electrical impulse is is firing abnormally then instead of a nice strong pump they will vibrate
37:29or fibrillate the problem with that is the heart rate can become extremely fast the blood isn't getting
37:36pumped properly around the body and 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 yeah let's get a CT head as
37:51well so we're gonna get a CT scan of her head to check the stroke my concern if she's had
38:01a stroke
38:01would be that she might deteriorate neurologically if the scan shows she's had a stroke they'll need to
38:07move quickly to prevent permanent damage to her brain hold that position now nice and still
38:30well done sweet are you okay in Birmingham 86 year old Thelma has a severe open fractured
38:36dislocation to her ankle that has broken through the skin how's your pain there's not painful at the
38:43moment okay to treat Thelma's injuries dr. Helen and dr. Arslan would need to sedate her but her
38:49age makes this extremely dangerous yeah but we cannot exclude tendon injury on here for this we need
39:00to have examined properly so what we can do now then we can just cover the wound with lines or
39:06causes
39:06yeah apply a platter in the position I think that's the best yeah I think that's safer for her yeah
39:15you
39:16just relax we're gonna get you into a plaster cast to make it a little bit more comfortable for now
39:21the team agree the safest option is to protect Thelma's injury by wrapping it in a plaster cast
39:26you've really got to balance the risks and benefits of trying to move that fracture around to get it
39:32into a better position because she is at risk essentially she's not a young person who can very
39:38simply go off to sleep it needs a bit of planning and it's better that that happens in a in
39:43an organised
39:48fashion was more important to get her into a very simple plaster cast to make her comfortable and
39:54then the operation that needs to be done anyway you can happen in daylight hours give us a tiny toe
40:00wriggle sweetheart yeah that's it beautiful thank you we will be planning to take her to filter in
40:07morning morning to see to use ankle back to his place and also to take care of soft tissues as
40:14much
40:14as we can around six elderly people fall every minute in the UK equating to around eight and a
40:25half thousand falls a day with many of these going on to need home care and extra support just feel
40:31really sorry for her you know it's gonna be a bit of an uphill struggle for her and I just
40:37kind of
40:38question going forward what what limited mobility she's actually gonna have and how as a family we deal
40:48with that you want to do it back home no no we're gonna stay here just close your eyes don't
40:57worry that
40:58we're here yeah all right
41:14sinus tachy then AF then SBT then back to AF again and then back to sinus tachy and now she
41:19looks like
41:19she's back in AF again I wonder if she's had an acute cardiac event in Tunbridge Wells A&E doctors
41:26Lucy and Ahmed are investigating Carol's dangerously fluctuating heart rate and other conditions that
41:32may be linked it's very difficult to tell at this stage what might be going on there are several
41:36things that could be happening she could have had a stroke she could have had a heart attack or she
41:41could have had an undiagnosed disturbance in her heart rhythm dr. Lucy has received Carol's blood
41:52results and CT scan hello again Carol how are you feeling now I know it's very noisy in here so
42:05I've
42:05got all your test results back and they're all fine but your heart is still going fast despite
42:11treatment thankfully Carol hasn't had a stroke but her heart is still behaving dangerously all of
42:19Carol's blood results were fairly normal but her ECG is remaining abnormal so it's not in a normal regular
42:26rhythm that is probably coming from a problem in the top part of her heart in the atria so we
42:33need
42:33you to stay in hospital for some further tests on your heart and you'll go to the ward tonight now
42:39do
42:39some more investigations tomorrow okay there's nothing more they can do for Carol tonight but
42:48make her comfortable until the specialists see her in the morning all right would you like the light
42:54off oh yeah have a little sleep yeah no right they haven't had a sleep oh that's better yeah you
43:01have a
43:02rest while you wait for them yeah okay thank you all right yes I'm just quite involved
43:25I'll get you sorted out dear oh dear oh yeah thank you
43:39you all right hand still coming
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44:00oh my gosh grace so her in that was so slightly
44:21if you or someone you know has been affected by anything raised in tonight's program
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44:39murder scene tomorrow at 10. next tonight ambulance code red
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