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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:10It can be very dangerous.
00:13We deal with a lot of aggressive patients.
00:16Things can escalate.
00:18It can be quite scary when it's just you and one violent patient.
00:24Across the UK, we join the staff of three of the most challenged emergency departments.
00:29It's always busy, it's always under pressure.
00:31Time is of the essence.
00:34And the medics who face danger each shift.
00:37Most shifts, I see more place than nurses.
00:40With the amount of drugs and alcohol admissions rising.
00:43Have you been drinking today?
00:44The risk of violence and abuse looms large every night.
00:48Please don't swear like that.
00:50They try to attack and stuff.
00:53Calm yourself down.
00:54People can become aggressive.
00:57They've been punched, kicked.
00:58I'll punch you right in my eye.
00:59You see the good, bad and the ugly.
01:00I don't give a ****.
01:02Yeah, we'll get security.
01:03The emergency department is like a battlefield.
01:05It's like organised chaos.
01:24After dark across the UK, NHS A&E departments face a gauntlet of difficult and extreme patients.
01:31Night shifts can be wildly different state shifts.
01:34We're not going to be able to let you back in whenever you're behaving like this.
01:37I think you were quite aggressive with the police when you came in.
01:40You're more likely to get people that are heavily intoxicated.
01:42You're more likely to get a lot more police presence.
01:45You can get a lot more interpersonal violence.
01:47No.
01:48No.
01:49You're a ****.
01:50You're a ****.
01:51You're a ****.
01:53It's hard to nurse someone who is calling you everything under the sun, and it's hard
01:56to be empathetic, but it is part of your job and there's no getting away from it.
02:01Don't tell me you can't, man.
02:09Do you know where you are at the minute?
02:12In Norwich, it's another challenging night for the A&E department.
02:16Can you feel me touching your thumb here?
02:18OK.
02:20I'll punch your head in, mate.
02:22****.
02:23The police have arrived to take a statement from the victim of a stabbing.
02:26He's being treated by Nurse Jess.
02:28****.
02:29I want you to leave me alone, please.
02:32Go away.
02:33I want to be in my home.
02:34I want you to ****.
02:36The police officer's gone in there to try and get him into a gown, but I'm just going
02:40to hold off going in for a second.
02:43He's had an altercation with another person in the community.
02:47He had a laceration to his chest.
02:49He was initially stable.
02:50The police then showed up, and he became quite agitated with the police.
02:53****.
02:54****.
02:57The man managed to fight off his attacker, but only after being seriously wounded.
03:02I ain't got nothing, bro.
03:04Leave me alone.
03:05****.
03:05This ****.
03:06You have to calm down.
03:09****.
03:09Sit down.
03:10Sit down on that.
03:11Sit down on that.
03:12Hold on.
03:14Leave me alone.
03:19While the victim is being aggressive in majors, his attacker is arriving into resource by ambulance.
03:27On three, ready?
03:29One, two, three.
03:33We believe that this gentleman has been punched, kicked, and assaulted in the head.
03:39There are some significant lacerations above the eyebrows.
03:42From top to toe, we've got a hematoma on the right-hand side of his head.
03:47I can only assess one pupil and can't open the other arm.
03:51I think he may have had fractures in the face.
03:53My significant concern is that the head, whether he's got a significant TBI.
04:00A TBI is a traumatic brain injury and will require an urgent CT scan.
04:05The attacker's injuries could be life-changing or life-ending.
04:09Do you know what today's date is?
04:13Best guess?
04:14Do you know what month?
04:15Closest to the next transition?
04:18No?
04:19Year?
04:21The patient's come in with quite a large swelling and some obvious facial injuries.
04:25We can see some superficial injuries, but we want to know a bit more about what's going on underneath.
04:30We're going to have to be real careful with cleaning his face because it's lots of confounding injuries.
04:39Can we try and give your face a little bit of a clean?
04:43Yeah, we'll be nice and gentle.
04:46While the scanner is prepared, the nurses need to see how serious the attacker's injuries are.
04:52We're going to try and get some of this dried blood off and then we can see what's happening a
04:57bit better.
04:57He's got lots of dried blood going on here.
05:01He's got quite large lacerations sort of around his eyes.
05:04He's also got possibly a dislocated jaw.
05:08He's not able to open or move it and it's very tender to touch.
05:11Same with his nose as well.
05:15I'm just going to give your eye a little wipe, okay?
05:18So just try and stay nice and still just for a sec.
05:21Just be careful for a minute.
05:29In Resos, the attacker is prepared for an urgent CT scan of his brain.
05:34While his victim has been acting aggressively towards police in majors.
05:39Lift this arm up for a second.
05:40Pass it.
05:41Nurse Jessica has managed to get back into the victim's room to check on his wounds.
05:46When the police got in there, we couldn't do much with him. He was too agitated.
05:50It's bleeding over the top of it.
05:51He's dislodged the clot and then he started to actively bleed and went a bit pale.
05:56Should we get him up the bed a little bit as well?
05:58Yeah.
06:01With the victim losing a lot of blood quickly, he needs to be moved to Resos where they see the
06:06most seriously ill patients.
06:07But it's the same area his attacker is being treated in.
06:11Initially, he wasn't taken through to Resos because he was stable.
06:15And they wanted to try and prevent another fight happening.
06:18He's lost quite a bit of blood. He might need a blood transfusion.
06:22There's nothing wrong, man. I just got f***ed up.
06:24Why am I being treated like a man?
06:25You know why you're here.
06:26I ain't that, man.
06:27Is he treating you like a good boy?
06:28Wait.
06:29No, let's...
06:30Are you warming up?
06:31Um, tell them I'll triage him now.
06:33I want these gloves. I ain't that, man.
06:45I'm sorry.
06:47I'm sorry.
06:48For the staff inside A&E, the night shift brings aggression and danger.
06:52He was just verbally abusing everyone who's brought here, he's drunk.
06:5698% of clinicians say they've felt unsafe at work. Security teams are now in every A&E up and
07:02down the country.
07:03I don't believe there's been a shift where we haven't had an incident of violence and aggression towards staff within
07:10the last couple of years.
07:11Right. You've put your hands on security. I need you to calm all the way down.
07:15I've had it with your pigs. I'm telling you, I've had it with every f***ing warrior.
07:20We're in hospital. F***ing you're safe. We're going to look after you, okay?
07:35Are these guys kicking off, though?
07:37Come on there.
07:39Security guards Bidi and Layak are on patrol near the A&E entrance.
07:43We like to go around and we know what's happening in the hospital.
07:46And try to figure out who's the trouble, who can cause trouble.
07:51We just want to identify the problem before they call us.
07:54It's a busy day on Monday.
07:57It's really busy. Always kicking off Monday.
07:59Security.
08:01Yeah, Oscar, do you call me?
08:09A nurse is calling for backup inside the hospital.
08:12We don't know what's going on there. We just got a call, so we're going to see what's going on
08:16between us together.
08:18I just received a patient from A&E. This patient we didn't know that she's recording us all live on
08:25TikTok.
08:27A woman has been caught broadcasting hospital staff and patients live over the internet, infringing medical confidentiality.
08:35If someone walks in and they're filming you without letting you know, you don't want them to see some of
08:41the things that is happening.
08:43Whenever the patient is by their bedside, it is very important to keep their privacy and dignity.
08:49She just came in, so she's already airing us.
08:53Can you come with us now?
08:55Yeah, we had a call that you're recording. So you can do whatever you want inside here, but not outside.
09:01I don't like your attitude, and I don't like your attitude, and you've got a jealousy problem.
09:05I don't know.
09:06Yes, you have.
09:06No.
09:07You have.
09:07We told her you can't do that. You can record inside, but you can't record outside her cubicle.
09:12She just didn't like the warning, and she just got angry.
09:16Yeah, the patients have been seen on TikTok live.
09:19Liz, do you not record? It's privacy.
09:22The woman refuses to comply with hospital privacy rules, and is disrupting a ward of vulnerable patients in the middle
09:29of the night.
09:29When patients are disruptive, they even start making other patients very emotional.
09:35Now, I can imagine if it's me lying on that bed. I'm vulnerable.
09:40Brace, let's go with you.
09:41I think I picked your brains to make my property.
09:43Get out of my way!
09:45Are you leaving?
09:46Yeah, I'm leaving, bloods.
09:48You're going to stick to us.
09:49I'm going to stick to us.
09:50I'm going to stick to us.
09:50We experience racism all the time. It does bring your moral down.
09:54It tastes very frustrating, because nurses are supposed to be, like, respected.
10:00I'm going.
10:00I'm going off.
10:01Why are you going?
10:03Why are you going off?
10:04Why are you going off?
10:06Why do you have enough?
10:07The aggressive TikToker has decided to leave the hospital without treatment or being discharged.
10:13If you're going, you have to speak to the doctors, yeah?
10:17We'll help you, though.
10:18****
10:19You want to talk to the nurse inside?
10:21I'm a nice person.
10:22I'm excited.
10:23No reason.
10:25Look, we can help you get one of the nurses.
10:27One of the nurses.
10:30She'll cause trouble.
10:32Every day is a new challenge, new stuff happening.
10:43Ready?
10:46Once more.
10:48Good job.
10:48Good job.
10:49Come on, come on, come on.
10:52In Norwich, after a violent altercation, two men are receiving treatment.
10:58The attacker has a potentially life-changing head injury after the man he was stabbing fought back,
11:04punching him repeatedly in the head.
11:07Doing really well.
11:08Really well.
11:09But the victim has been stabbed multiple times.
11:12Can we have some kind of cheese in?
11:15Initially separated in different departments, they're now both in resus,
11:19with police swarming the area to keep both men, staff and other patients safe.
11:25Right, there's a bowl on your lap that you can spit and vomit into if you need to.
11:30It does make it a little bit dicey at times, because we've got to keep them apart
11:33so that they don't start fighting again.
11:35But we've also got to treat them, so we've had quite a lot of police around the department,
11:40lots of extra nurses and lots of extra team members to try and help put the patients back together.
11:46Number one, we've got our trauma board.
11:48He's having a CT head, neck and facial bone.
11:51The attacker with significant head wounds is being prepared for a CT scan,
11:56to check if he has a TBI, a traumatic brain injury.
12:01Ready, steady, slide.
12:07We're just going to pop these blocks around your head.
12:10So you stay nice and still, Bella.
12:21Whilst the attacker with the head wound goes for a CT scan,
12:25Dr. Claire is taking over the treatment of his stabbed victim.
12:29We're just going to do the extra of your hand here,
12:31and then we're going to take you to have a CT scan of your chest,
12:34and arm probably will catch a bit of it, but doesn't need scanning.
12:39Have you had a CT scan before?
12:40He's been stabbed to the chest and to his arm.
12:43He came in originally looking fine,
12:45but has then had quite a lot of blood loss as he's got to the department.
12:49So anyone that comes with wounds like this,
12:51we would always assess them top to toe,
12:53make sure there's no signs of things like a punctured lung or blood in their lung
12:56or anything in their abdomen that's going to need immediate surgery.
13:00And then, most of the time, we would do a CT scan
13:02to see exactly where those wounds go, what's going on,
13:05and what we can do with them.
13:06He looks like he's probably got some fractures in his hand as well.
13:09The victim's hand could be fractured from defending himself
13:12by giving his attacker a serious head injury.
13:16We'll have a proper look at this one when we come back.
13:18What's he doing? Yeah.
13:20That one's, I mean, it's definitely gone into muscle,
13:22and that's why it's bleeding, that's why it's so sore.
13:24We'll have a proper look at this one when we get back.
13:40Before being taken to the CT scanner,
13:42the mobile X-ray unit is used to see if his hand was damaged
13:46when defending himself.
13:49Right, we have a monitor, we have suction, you've got VAG.
13:52Have we got oxygen on the trolley if we need it?
13:54Yes, we have. Lovely.
13:56Right, rock and roll.
13:58While the victim is being CT scanned,
14:00the assailant has returned from being imaged.
14:04The results have come back,
14:06and it looks like they've got multiple fractures to their facial bones,
14:09they've got a fracture to their nose,
14:12as well as their left orbital bone,
14:14and some damage to their sinuses as well,
14:16so there might be some loss of smell there.
14:19There's no fractures to the spinal column or any of that sort of thing.
14:24With significant damage to his face,
14:26the patient will need immediate treatment
14:28from a team of specialists in another department.
14:31He's been referred through to the Maxfax team,
14:34which are the facial trauma team,
14:36and they put people's faces back together,
14:38but they don't do a lot with eyes,
14:40so we're going to have to get a separate team involved there.
14:48The fellow that we're doing the chest trauma scan on
14:51is in the CT scanner now.
14:53Meanwhile, the patient with stab wounds
14:55is having a scan of his body
14:56to determine if the knife has penetrated any organs.
15:00So he's got quite a lot of muscle there,
15:03so I think it's all just gone into muscle.
15:06I think we should give him some antibiotics.
15:09We'll give it a good clean, get loads of local in it,
15:11just work out how deep they are
15:13and make sure, obviously, there's no risk of foreign bodies
15:14and that sort of stuff.
15:22It doesn't look like it's gone anywhere
15:24apart from the skin and the muscle of your chest.
15:26You all right? Yeah.
15:28In a minute, we'll get some stuff together
15:30and we'll just have a real good look at these wounds.
15:32We'll probably need to put some anaesthetic in there
15:34and then stitch it up, but we'll just have a good look first
15:37to make sure we can stitch it up here.
15:39We'll have a look at this one on your arm as well.
15:41But your lung looks all right
15:42and it doesn't look like it's anything else.
15:45If he's OK, he's not too drowsy from the painkillers.
15:48His pain's under control.
15:50I'll get him home with some painkillers, some antibiotics
15:52and advice about when to get the sutures out.
15:55So hopefully later tonight I'll be able to discharge him home.
15:58The patient's injuries aren't life-threatening,
16:00but the attacker who he fought off
16:02may have ended up needing more medical care than his victim.
16:05There probably has been an increase in assaults
16:09in some areas, an increase in drug use, in alcohol use.
16:13If it's somebody that's being aggressive towards us
16:15not for a medical reason
16:17and they're just being aggressive and violent,
16:19we've got a very low threshold for call insecurity.
16:23But really every person that comes in, whoever they are,
16:26whatever they may or may not have done,
16:28our job is to see them as a patient.
16:30The wound looks really superficial, but it looks fine.
16:44One in, one out.
16:45It was a very chaotic scene, so they haven't given me any offs.
16:48In Belfast, extreme weather warnings are issued across the city.
16:52The Royal Victoria A&E is preparing for road traffic accidents.
16:57RTC Bullside.
16:58Another one?
16:59Yeah.
17:00Despite only 25% of journeys occurring after dark,
17:04nearly half of all road fatalities occur at night.
17:07One of them was a front passenger and the other three were in the back.
17:11After a high impact car crash at 70 miles per hour,
17:15four young men have been rushed into the department.
17:18The guy has hit the side of his face,
17:20so he's done a quick moving of the neck,
17:23but he's complaining a right-sided headache.
17:25Right.
17:26And then the other guy, he was in the back seat in the middle,
17:30so the other two passengers have hit his head,
17:32he's lost consciousness.
17:33I've hit my head off my friend, Daniel.
17:36Oh, the other one?
17:37Yeah.
17:38And then I've hit it off the weight wheel.
17:40OK.
17:40And then my whole left side of my body is just tingling with it.
17:45Look, our back's killing it.
17:47And how are you all feeling?
17:49It's really hurting, it's not.
17:50While David and Daniel are taken to Majors
17:53to be assessed for serious injuries,
17:55Dr Rachel checks on the other passengers.
17:58Is it sort of right in?
18:00I don't know where I can feel it.
18:01It's not like hurt is bad, I feel like it.
18:02It's like under my ribs.
18:04Yeah.
18:05Oh, no.
18:05Basically, there was a taxi in front of us
18:07that just changed lane,
18:08and it just started slipping and slipping and slipping,
18:10and then it just, boom,
18:11started twisting and twisting and twisting,
18:13and then smashed against the side of the rail.
18:15Do you have a photo?
18:16I've got a video of the car.
18:18That's the car.
18:19Right.
18:20Whereabouts was this?
18:21On the motorway, I'm not too sure.
18:23I'm going off for a moment here.
18:24It's probably like a slip-off.
18:28Look straight up there.
18:30Dr Michael is working to find the extent of David's injuries.
18:34He was the front passenger.
18:36Aye, there.
18:37There?
18:37Aye.
18:38Is this where you hit?
18:39Aye.
18:39Off him, yeah.
18:41You open the mouth.
18:42Any difficulty doing that?
18:43Aye.
18:43Obviously, the faster the car is going,
18:46the more severe injuries you will get,
18:48especially in adverse weather as well.
18:50Faster equals a higher mechanism of injury,
18:53and also different patterns of injury.
18:55Take a nice deep breath for me.
18:57Good.
18:57Okay.
18:58Lift this leg off the bed for me.
18:59Push my hand up in the air.
19:01Ah.
19:02Let's have a look at it here, if that's okay.
19:04Ah.
19:09Sorry.
19:10Right.
19:10We need to get you an e-x-ray as well.
19:12Try and keep your head really still, okay.
19:14So, we need to get your face x-ray to make sure there's no fractures here.
19:18We'll x-ray your neck and we'll x-ray your lower back and left knee.
19:21We're always demonstrating a lot of significant neck pain,
19:24lower back pain and knee pain.
19:26So, really needed to rule out any, um, fractures.
19:32Okay, do you lift this up for me?
19:34Just need one exam on the chest and the abdomen first.
19:37Dr. Michael needs to see the impact of the crash on Daniel,
19:40who was knocked unconscious in the collision
19:42while in the middle seat of the back of the car.
19:45Okay.
19:45Any pain doing that?
19:46No.
19:46Another bit of pain?
19:47There's a bit there, like...
19:48Yeah.
19:48I think it's pushed onto your spine there.
19:51Are you feeling that in the back?
19:52Mm-hmm.
19:52Okay, fine.
19:53Because you've lost consciousness,
19:55and you've been going quite fast,
19:57we'll get a scan of your head,
19:58and we'll do your neck as well, okay?
20:00Yeah.
20:00And if both of those are okay,
20:01then we'll be able to get you off this collar
20:02and off this mattress.
20:05There's an added layer of complexity with car accidents,
20:08because you can have a collapsed lung,
20:10you can also have an intra-abdominal injury
20:12or a limb fracture,
20:13which can sometimes distract from the head injury.
20:16So, these are what's called distracting injuries.
20:18So, we would keep an open mind
20:20when treating trauma patients, really, for that reason.
20:25Okay, Daniel.
20:26My name is Andrea.
20:27I'm one of the radiographers.
20:28Daniel is taken to the CT scanner,
20:31as a loss of consciousness
20:32could indicate a life-threatening injury.
20:35I'm going to do one scan for your head
20:37and one for your neck.
20:39You're going to go in and out a couple of times.
20:41Okay.
20:42The CT shows up, really, two things.
20:45In the setting of trauma,
20:46it will show up if there is a bleed on the brain
20:49or if there's a skull fracture.
20:51A bleed on the brain is a time-sensitive injury,
20:54which could be deadly if untreated.
21:02Oh, this is cool.
21:06There's nothing for their trial to get in,
21:08and that's all we want.
21:10In Norwich, senior consultant Dr. Shum
21:12is halfway through his night shift in recess.
21:15The resuscitation room is where we bring our sickest patients.
21:18You're always going to be on high alert.
21:23When you hear the alarm go off in the department,
21:25you know it's going to be something that needs an urgent response.
21:27We're going into cardiac bed, please.
21:29We have a bag of harm and spiting ready.
21:31Spite ready?
21:32Yeah.
21:33You're going to assume it is the worst-case scenario.
21:36We come down the set.
21:36We're going to ask you to do a pulse check.
21:39A patient in Majors has gone into cardiac arrest.
21:42Can you give us adrenaline, please?
21:44Fingers on the femoral now,
21:45so we can tell if we can feel the pulse
21:47while chest compresses are going.
21:48Is the adrenaline given, Obi?
21:49Yeah, yeah, yeah.
21:50Okay.
21:50The team gives CPR to maintain blood flow
21:53and preserve brain activity,
21:54while waiting for medication to take effect
21:56in restarting the heart.
21:58Okay, so we have signs of life,
21:59so stop CPR for a second.
22:01Feel for a pulse, please.
22:03Okay, restart CPR.
22:05So once the heart stops beating,
22:07the oxygen supply to the brain stops.
22:10Even if we're doing good quality chest compressions,
22:13the longer they're in cardiac arrest,
22:14the more tissue death occurs,
22:16the less the chances of survival are.
22:19Do we have signs of life?
22:20Yeah.
22:21Okay, stop CPR, please.
22:22We have rhythm compatible with life.
22:24Do you have a pulse?
22:27I can't be the one.
22:28No, no.
22:29Start CPR, please.
22:31How's ventilating?
22:32Ventilating.
22:33Do we have space we can go into and recess here?
22:35Even if the CPR generates a rhythm
22:37compatible with life,
22:38the patient needs to be moved to resus,
22:41an area designed for this kind of emergency.
22:43This patient's going to need
22:44what we call a definitive airway.
22:46In the resuscitation room,
22:47we've got the ability to do all that.
22:48We've got more nursing staff,
22:50we've got better monitoring,
22:51and we have all the equipment,
22:52drugs that we could need.
22:54But the timing of any movement is critical.
22:57Can you feel a pulse while CPR is on?
22:58Yeah.
22:59Okay, good.
22:59Keep it there for me for now.
23:01Okay, we're going to do a rhythm check in three,
23:03two, one.
23:04Stop compressions, please.
23:05Do you have a pulse?
23:06No.
23:07Even if we're doing good compressions,
23:08there's still going to be reduced blood and oxygen
23:11going to the brain and other vital organs.
23:13That's irreversible.
23:15Let's move to resus now while we have it.
23:18Time is off the essence.
23:32There are sick people here.
23:34Oh, this is going to make it worse.
23:36Across the country,
23:37the one area of a hospital open 24-7 is A&E.
23:41The diversity of people you see,
23:43cases you see and learning is like no other place in the hospital.
23:47The one place anyone can attend,
23:49including seriously volatile patients.
23:52All right.
23:54Physical violence against NHS staff
23:56has been found to have almost doubled in the last five years.
24:01I think he's a bit of a risk to us, isn't he?
24:04Night is a place that everything kind of sometimes just goes completely wild.
24:09You can't walk fucking down.
24:19Hello, is Daniel in resus?
24:21In Norwich A&E,
24:22medics are racing a patient into resus,
24:25who's in cardiac arrest.
24:27So for ITU colleagues, we're about five,
24:30probably about seven minutes in now.
24:32So ITU are coming.
24:34OK, as soon as you're in the bay,
24:36we'll go back on the chest, please.
24:38Every minute that passes reduces a patient's chance of survival.
24:42Do you have any pulse at all?
24:44No pulse.
24:44Restart chest compressions, please.
24:46In 30 seconds, we're going to do another rhythm check.
24:49Another adrenaline, please.
24:54Although the monitors show electrical activity in the heart,
24:55No pulse.
24:58No pulse.
24:59Restart chest compressions, please.
25:01OK, we're going to do a check in.
25:02Three, two, one.
25:03Stop compressions, please.
25:04Can we get some adrenaline, please?
25:05We have a rhythm compatible with life at the back.
25:08It's about 60.
25:09Do you have a pulse?
25:11Any central pulse?
25:12No.
25:14Restart chest compressions, please.
25:16Although the monitors show electrical activity in the heart,
25:19it's not enough to generate a pulse.
25:21The team need to continue CPR
25:23to buy the patient's heart more time to restart.
25:25For about 15 minutes at the moment.
25:27We are all trained in the emergency department
25:29to stay calm under pressure.
25:31So you're in the zone and you're running through
25:33what you have practised time and time again.
25:35So our next check is going to be in 10 seconds.
25:39Restart chest compressions again for us, please.
25:42So we've had now almost 15 to 20 minutes.
25:45Have adrenaline ready for the next, please.
25:46Time is of the essence.
25:48The longer they're in cardiac arrest,
25:50the less chance there is
25:51of that good neurological survival.
25:53Pulse, please. Sorry.
25:54We have rhythm compatible with life again.
25:57Do you have any central pulse?
25:59Dr. Sean brings in the Lucas,
26:01a mechanical CPR device
26:03that delivers perfect and relentless compressions,
26:06freeing up medical staff.
26:07We've had 25 minutes.
26:09If we don't have a pulse on this next rhythm check,
26:12I suggest that we stop at that stage.
26:14Is anyone in disagreement?
26:15After an extended period in cardiac arrest,
26:19the chances of a full recovery without brain damage
26:21become extremely unlikely.
26:23Choosing to stop chest compressions
26:25and end the resuscitation attempts,
26:28you're always doing in the patient's best interest.
26:31As hard as it might sound to stop,
26:32you know you're doing the right thing
26:33for the right reasons.
26:35Can I ask you to have a finger ready
26:36on the central pulse for us?
26:38Stop the Lucas, please.
26:40Are we going to do a rhythm check?
26:41Can't see it.
26:42Can't see it.
26:43Can't see it.
26:44Can't see it.
26:45No, it's completely flat.
26:50I suggest we stop unless anyone disagrees with her.
26:55After 27 minutes of CPR,
26:57Dr Sean and the team have exhausted every life-saving option
27:01and the patient has died.
27:03As well trained as you can be,
27:05how you feel at the time will vary
27:07depending on what's going on in your own life.
27:12You can catch you by surprise.
27:14You can find yourself tearing up a bit later on
27:16when you don't expect it
27:17or about something unrelated
27:18and that does happen.
27:19Thank you very much, everybody.
27:32We're going to do a tracing of your heart now, all right?
27:35At night, when GP surgeries and walking clinics are closed,
27:38A&E becomes the only option for many sick people.
27:42It says here, waiting for troponin.
27:46This is when I'm in the waiting room earlier.
27:48Definitely when you're cleaning it.
27:50In Newham A&E waiting room...
27:52Holly? Hello.
27:53..theatre actress Holly has come in with stomach pain.
27:57So, if you lie down for me, please.
28:00She's already been triaged by the nurse and had her blood taken.
28:04It started yesterday.
28:05Yesterday.
28:06All over my tummy.
28:08Okay.
28:08In the middle of the night, it woke me up with the pain there.
28:12Okay.
28:12A stabbing pain that gets worse once I'm moving around.
28:17Earlier, when I went to sit down,
28:18it felt like someone was really stabbing.
28:21Yeah.
28:22So, what I'm going to do is examine your tummy.
28:25Sorry.
28:26Sore here?
28:27Mostly here?
28:29Yeah.
28:29Yeah.
28:30A physical assessment will indicate the location of the issue,
28:33pain level, and if the abdomen has become rigid.
28:36Sore here?
28:38There's really bad.
28:39Okay.
28:40Any other medical problem or any significance?
28:43I had a laparoscopy.
28:46Yeah.
28:47We thought it was endometriosis.
28:50Okay.
28:50But it wasn't.
28:51They removed a cyst from my fallopian tube.
28:54Okay.
28:54Which side was that?
29:01Do you remember?
29:02Right or left?
29:02My left side of my fallopian tube.
29:05Okay.
29:05As you know, our first diagnosis is appendicitis.
29:10Usually, if appendicitis happens, the inflammatory markers start going up.
29:16What we need is having an ultrasound scan of your tummy.
29:19Okay.
29:20Holly's blood tests could show if she has appendicitis or ovarian cysts,
29:24but either condition could be serious if not treated.
29:27They will review your scan on cull team and make a decision.
29:30Whether you have appendicitis or not.
29:33There is always a 50-50 chance.
29:35So, we are not rushing for surgery.
29:37First, we have to make a diagnosis.
29:49Oh, my fucking back.
29:51No, I mean, my back's fucking doing my head, man.
29:54It's killing us.
29:55After spinning at 70 miles per hour in a car and crashing into a wall,
29:59David and Daniel are at risk of long-lasting damage to their heads, necks and backs.
30:05I can't even do me trousers up.
30:07My head's starting me up.
30:10They're waiting on results from urgent CT scans and x-rays to see the extent of their injuries.
30:15Did you hit your head whenever?
30:18Yeah, I hit my head off here and knocked me so low.
30:20So, where are you from then?
30:22I'm from Newcastle, you know.
30:23So, he's over here for where?
30:24Yeah, I.
30:25My head is hit off here.
30:27He's the one that knocked us open.
30:29Yeah.
30:29Just going to shine away line.
30:30What's your phone number?
30:31Victims of traffic collisions who black out are three times more likely to be diagnosed with a serious brain injury.
30:37The nurses must monitor the patient for signs of deterioration, which could be life-threatening.
30:42I'm just going to check your blood pressure and things.
30:46Dr. Michael has been treating the men and has received their scan results.
30:50Good news.
30:51You have no fractures.
30:53Right.
30:53And your head CT's clear too.
30:55You see no bleeding or anything, which is good.
30:57So, I'm going to take this collar off you, okay?
30:59Yeah.
30:59You will be a bit stiff.
31:00Your C-spine's clear as well, so it is.
31:02So, I'm going to take this collar off, because your knee's okay, there's no fracture there, and the lower back's
31:06fine as well.
31:07Yeah.
31:08So, you're all good.
31:09So, there's always a risk that it could have been quite a serious accident.
31:12We had quite a high index of suspicion.
31:15You know, you're making sure that they're all nice and square, nice and even, and that there's not one that
31:19gets stepped off from the other,
31:21and that there's no fracture lines visible, which is, there's not.
31:27These guys have got off quite lucky, which is good.
31:32With no fractures and no brain bleeds, the men are free to join the other passengers in the waiting room.
31:38Yeah, I had an accident for my leg.
31:40What was it?
31:40My leg?
31:41My back?
31:43My face?
31:45I don't know.
31:45Fucking everything, man.
31:47Yeah, it could be worse.
31:47The car could have flipped.
31:49Yeah.
31:49It was just like that.
31:51Like frozen, frozen in time.
31:57It is so satisfying to work out what's wrong with them, be able to give them sort of clear diagnosis
32:03that they're fine.
32:06It's a good part of the job, yes.
32:08It is the good part of the job.
32:11Every moment could be the last moment.
32:13I don't take anything for granted, you know, just because it could end like that.
32:31Hi, how are you?
32:32I'm Poppy.
32:33I'm one of the nurses.
32:34How are you?
32:36Also in Belfast, nurse Poppy has received a pre-alert for 89-year-old Myrtle, who has fallen at home.
32:43Is this hip very sore, Myrtle?
32:45Butt lifting.
32:46Yes.
32:47She has got quite a deformity here.
32:49We can't keep the pain under control at all.
32:51Right.
32:52Will we get you in and get you good pain relief?
32:55Pain relief.
32:56Pain relief, okay.
33:00My concerns with someone who is elderly and has had a fall, I think your mind automatically goes to,
33:06well, what was the mechanism?
33:07How did they fall?
33:08Why did they fall?
33:09And then, what are the injuries from the fall?
33:12I brought one of the doctors out to have a wee look at your hip, is that okay?
33:16Yes.
33:17She, on when it's fall, 3pm, so she doesn't actually remember any of the fall.
33:23It's just an extreme pain, she doesn't really know what's going on.
33:26Right.
33:27On the way in, she was basically screaming the whole time since we left.
33:30Being very sore?
33:31Yeah.
33:32And just the leg?
33:34The hip.
33:34Just the hip?
33:35Yeah.
33:36Okay.
33:36We're going to get you around and get some quick picture and then we'll know what to do with it.
33:40Okay?
33:42With Myrtle unclear on the details of the fall, it's hard to get an indication of how bad the damage
33:47is.
33:48She'll need an immediate x-ray.
33:49So, plan will be rolled to use, we'll side the board under, one, two, three, we'll go across.
33:54I'll look at, across the one.
33:55Yeah.
33:56One, two, three, very slowly, very slowly.
33:58Well done, Myrtle.
34:00Perfect.
34:01Right.
34:02And a slight tilt just towards us.
34:05There we go.
34:06There we go, well done.
34:07I'm sorry, I'm sorry.
34:08Well done.
34:08Sorry.
34:09I'm so sorry.
34:11While Myrtle is being imaged, her daughter Paula has arrived.
34:15My mum will actually be 90 in two days' time.
34:19Unfortunately, she was in hospital for her last birthday last year as well.
34:23We'll have to see what's going to happen, but I can't believe to find ourselves down here again this year.
34:28But it's just tough.
34:29For an elderly patient, the fall could be extremely hard to recover from, causing a serious loss of mobility.
34:36I'm just going to look at your x-rays, all right?
34:41She is fiercely independent, and she really hates the fact that her body won't do what she wants it to
34:49do.
34:49And that's frustrating for me to see her, you know, getting frustrated with herself.
34:58X-rays are back, and this is a normal hip on the right, and this is an abnormal hip on
35:03the left.
35:04You can see it's broken here.
35:06Because of the angulation, it's very swollen.
35:09It's probably bleeding in and around it.
35:10So the problem, if we don't get it out to length sooner, then you get more bleeding around it, and
35:15we get more pain.
35:16So we'll pull it out to length here now.
35:18That should tide it over then to the morning, and we'll get an operation.
35:23Myrtle's hip break is in the longest bone in the body, the femur.
35:27It's surrounded by extremely strong muscles, which are causing the bones to be pulled in together and overlap.
35:33Myrtle, I understand you had a fall today. Is that correct?
35:36Did you have a fall today, Mama?
35:38You didn't?
35:41What do you think you're in hospital for?
35:44Orthopaedic Dr. Mohamed will be helping pull Myrtle's leg into a safe position.
35:49Unfortunately, this is the kind of fracture that needs to be fixed.
35:51It would need an operation.
35:54You broke your side bone, Mommy, and you need to have an operation to get it fixed.
35:58This lady here, what she has is essentially a femoral fracture, which needs fixation.
36:03So I'm trying to prepare her for a treat list in the morning.
36:06Because of her age, she's 89, she's quite frail, so she's at a high risk.
36:10I mean, to be honest with you, this is a big operation.
36:13The femur bone is the largest bone in the body, and the operation will also be a big one.
36:16There's a higher risk.
36:19Right, now I need to keep the bones in line and help with the pain.
36:22Temporarily setting the injury will stop the sharp broken ends of her bones causing more damage to her leg muscle.
36:28But it will be extremely painful.
36:30I'm trying to prescribe her for an anesthesia, which will be inhalation.
36:35It's a nasty one.
36:36It's a very nasty one.
36:59Not a fan of the needles.
37:00Are they going to give you a drip?
37:01Stage actress Holly has come into A&E with abdominal pain, which could be appendicitis or a burst cyst.
37:08I've got to wait for a scan. Hopefully they can pick up on whether it is appendicitis.
37:13I feel like you haven't had pain like this before then.
37:16Her friend, Ali, has come to keep her company in the waiting room.
37:19I thought it was trapped in, because I was farting a lot.
37:24Don't make me laugh. Sorry.
37:28Holly is waiting for blood results to see which diagnosis is correct, and if she is in immediate danger.
37:36Finally, our cocktails have arrived.
37:40Paracetamol.
37:45While Holly waits to be treated, she's given intravenous paracetamol to ease her pain.
37:50I'm guessing I can't go to work.
37:52Oh, God, yeah.
37:53If it's appendicitis, I'll be off for like two weeks.
37:57So hopefully, yeah, it's not that.
37:59I was so shaky earlier when they were doing this.
38:01Yeah.
38:02And then I was going in.
38:03You've had a few too many needles today.
38:05I don't want to see another one.
38:07While Holly's pain has been addressed, Dr Shahzad has received her blood results.
38:12Bloods were normal.
38:13Her inflammatory markers are normal.
38:15The risk of any perforation of appendix is extremely low.
38:19Hold on to this for me.
38:21If Holly's appendix had burst, her blood tests would have shown inflammation in her body.
38:26What we will do, we will bring her tomorrow for an ultrasound scan.
38:30If ultrasound shows appendicitis, obviously we will operate on her.
38:34I just rock up tomorrow.
38:36Overnight, the hospital has fewer staff available.
38:38So Holly will return in the morning for her ultrasound and to find out her diagnosis.
38:44Thank you so much.
38:46Bye-bye.
38:46See you tomorrow.
38:49Ew, look at the rain.
38:53Well, let's wait here and I'll load the upper back.
39:01Squeeze my hand, they're sore.
39:0489-year-old Myrtle has come into A&E with her daughter Paula after a fall at home snapped her
39:10femur.
39:12You've broken your femur, which is your thigh boom, okay?
39:16So it's sitting in a bit of an awkward way.
39:18And that means that we can put, we want to put like a splint or a traction device on to
39:23pull your leg out to link.
39:24Now it still might be a bit sore because it's quite a nasty break.
39:30Medics prepare Myrtle for the painful procedure.
39:33What they'll do is start eating the pain, so you'll feel the pain.
39:37If the bone shards aren't realigned, they'll continue to cause bleeding and damage to the muscle.
39:43So that's good, that means that's probably worked a bit, that injection.
39:46So it's numbed up your leg.
39:48The next step then is to get this traction device on you.
39:53Would it be okay if I applied this contraction on you?
39:56So that is just to keep your bones in line and help with the pain.
40:00Is that okay?
40:03Orthopedic specialist Dr. Mohamed will be managing the leg manipulation.
40:06So I'm going to move your leg a bit, it might be a bit painful.
40:10We are going to give you something for the pain, but still it would be a bit painful, okay?
40:19And this is here something for the pain.
40:20Here's an inhalational anesthetic.
40:24The procedure is extremely painful, but at Myrtle's age, many forms of strong sedation could affect her breathing.
40:32So this here is something for the pain.
40:34You just have to use it like a cigarette.
40:36You just have to inhale on it and then exhale.
40:38Is that okay?
40:39Okay.
40:39So a less invasive inhaler of Penthox is given.
40:43Just breathe it in and I just push.
40:45Just breathe it in and I just push.
40:45It will just help with the pain.
40:46And feel your lips around it and inhale.
40:49Take a deep breath.
40:51And breathe out into the whistle.
40:56Is it good?
40:57Is that the good stuff?
41:00With pain medication on board, Dr. Mohamed sets up his counter traction apparatus,
41:05which will use a weight to slowly pull the legs straight against a powerful thigh muscle.
41:10I have the x-ray.
41:11Yes, I've had the x-ray.
41:13That's where they're able to tell me that you've broken your femur.
41:15Is that serious?
41:17Serious enough, Molly.
41:23Especially at your age.
41:26You have to roll that in.
41:31I'm going to put her leg straight first.
41:34Then I'm going to put this around her ankle.
41:36And I'm going to wrap it around.
41:37Just have to lift it a bit in the air.
41:39So if you have that tape, you can keep the leg down now.
41:42Dr. Mohamed needs to be very careful not to extend the muscles in Myrtle's leg too quickly
41:47and cause further damage and pain.
41:55I guess it's okay.
41:59Let's use some weight on this.
42:01A heavy counterweight will be left on the end of the traction device
42:05to continue slowly extending Myrtle's muscle for the next few hours,
42:09pulling the broken bones back into position and ready for surgery.
42:14We've got your toes again for me. Good.
42:19She seems more comfortable now anyway, which is the main thing.
42:23You're more comfortable now.
42:25Yeah.
42:27Most probably she's going to theatres tomorrow.
42:29Yeah, so I'll prepare her for that.
42:31She's definitely a priority for us.
42:33So far so good.
42:34It's just how long we'll have to wait before she gets to theatre and gets it fixed.
42:39But the paramedics and everybody who has come have been excellent.
42:43They really have been excellent and so good with my mommy.
42:46We'll have to postpone your birthday party.
42:53I'm not getting out of a day, is it?
42:55My face is fucking green.
42:56Literally, when the airbag blew up, all I seen was stars.
43:09Cheer up, dearie. Show an happy face.
43:12Yeah, go on, cheer up.
43:13Why are you so sad?
43:28I'm still back here. I'm still here.
43:45I'm just going to borrow your arm for a minute, fella.
43:46You guys are doing my birthday, fella.
43:48I'm still there.
43:49You guys are done.
43:50You guys are doing my birthday.
43:50You guys are doing my birthday, fella.
43:50I'm just waiting for you guys to come back here.
43:50We meet.
44:06I'm just going to borrow your birthday, fella.
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