- 7 hours ago
A And E After Dark S07E01
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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.
00:51Calm yourself down.
00:54People can become aggressive.
00:57You've been punched, Kate.
00:58I'll punch you right in my...
00:59Do you 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.
01:38I 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.
01:49No.
01:52It's hard to nurse someone who is calling you everything under the sun.
01:56And it's hard.
01:57There's no getting away from it.
01:58Don't tell me you can't, man.
02:00No, shut up, man.
02:07Do you know where you are at the minute?
02:09In Norwich, it's another challenging night for the A&E department.
02:14Can you feel me touching your thumb here?
02:15OK.
02:17I'll punch you really, mate.
02:19****.
02:20The police have arrived to take a statement from the victim of a stabbing.
02:23He's being treated by Nurse Jess.
02:26**** me.
02:27I want you to leave me alone, please.
02:29Go away.
02:30I want to be at my home.
02:32I want you to a **** phone box.
02:34The police officer's gone in there to try and get him into a gown.
02:36But I'm just going to hold off going in for a second.
02:40He's had an altercation with another person in the community.
02:44He had a laceration to his chest.
02:46He was initially stable.
02:47The police then showed up.
02:49And he became quite agitated with the police.
02:51**** me.
02:51He's in the mouth.
02:53Ah!
02:55The man managed to fight off his attacker,
02:57but only after being seriously wounded.
02:59I ain't got nothing, bro.
03:01Leave me alone.
03:02Now, **** me, ****.
03:03You have to calm down.
03:04You have to calm down.
03:07You have to calm down.
03:09You have to calm down.
03:09You have to calm down.
03:10I've got a force.
03:11You have to calm down.
03:14You have to calm down.
03:16You have to calm down.
03:16While the victim is being aggressive in majors,
03:19his attacker is arriving into resource by ambulance.
03:24On three, ready?
03:26One, two, three.
03:30We believe this gentleman has been punched, kicked.
03:33and consulted in the head,
03:36there are some significant lacerations above the eyebrow.
03:40From top to toe, we've got a haematoma on the right-hand side of his head.
03:44I can only assess one pupil and can't open the other arm.
03:48I think he may have had fractures in the face.
03:50My significant concern is that the head,
03:52whether he's got a significant TBI.
03:57A TBI is a traumatic brain injury
04:00and will require an urgent CT scan.
04:03The attacker's injuries could be life-changing or life-ending.
04:06Do you know what today's date is?
04:10Best guess? Do you know what month?
04:15No? Year?
04:18The patient's come in with quite a large swelling
04:20and some obvious facial injuries.
04:22We can see some superficial injuries,
04:24but we want to know a bit more about what's going on underneath.
04:28We're going to have to be real careful with cleaning his face
04:30because it's...
04:30Oh!
04:32Lots of confounding injuries.
04:36Can we try and give your face a little bit of a clean?
04:40Yeah, we'll be nice and gentle.
04:43While the scanner is prepared,
04:44the nurses need to see how serious the attacker's injuries are.
04:49We're going to try and get some of this dried blood off
04:51and then we can see what's happening a bit better.
04:55He's got lots of dried blood going on here.
04:58He's got quite large lacerations sort of around his eyes.
05:01He's also got possibly a dislocated jaw.
05:05He's not able to open or move it and it's very tender to touch.
05:08Same with his nose as well.
05:12I'm just going to give your eye a little wipe, OK?
05:15So just try and stay nice and still just for a sec.
05:19Just be careful for a minute.
05:20Oh!
05:21Oh!
05:22Oh!
05:26In Rhesus, the attacker is prepared for an urgent CT scan of his brain.
05:31While his victim has been acting aggressively towards police in Majors.
05:36Lift this arm up for a second.
05:37Fast it.
05:38Nurse Jessica has managed to get back into the victim's room to check on his wounds.
05:43When the police got in there, we couldn't do much with him.
05:45He was too agitated.
05:47It's bleeding over the top of it.
05:48He's dislodged the clot and then he started to actively bleed and went a bit pale.
05:53Should we get him up the bed a little bit as well?
05:55Yeah.
05:58With the victim losing a lot of blood quickly,
06:00he needs to be moved to Rhesus where they see the most seriously ill patients.
06:04But it's the same area his attacker is being treated in.
06:08Initially, he wasn't taken through to Rhesus because he was stable
06:12and they wanted to try and prevent another fight happening.
06:15He's lost quite a bit of blood.
06:17He might need a blood transfusion.
06:19There's nothing wrong.
06:19I know he's got f***ed up.
06:21Why am I being treated like an animal?
06:23I ain't that.
06:24Is he treating you like a good boy?
06:26No, let's...
06:28Tell them I'll triage him now.
06:30I want these cops off.
06:31I ain't that.
06:48I don't believe there has been a shift where we haven't had an incident of violence
07:04and aggression towards staff within the last couple of years.
07:08Right, you've got your hands on security.
07:10I need you to calm all the way down.
07:12I've heard it with you pigs.
07:14I'm telling you, I've heard it with every f***ing warrior.
07:17We're in hospital.
07:18F***ing you're safe.
07:19We're going to look after you, okay?
07:32Are these guys kicking off, though?
07:34Come on, there.
07:35Security guards Bidi and Layak are on patrol near the A&E entrance.
07:40We like to go around and we know what's happening in the hospital.
07:43And try to figure out who's the trouble, who can cause trouble.
07:48We just want to identify the problem before they call us.
07:51It's a busy day on Monday.
07:54It's really busy.
07:55Always kicking off Monday.
07:58Yeah, Oscar, do you call me?
08:06A nurse is calling for backup inside the hospital.
08:09We don't know what's going on there.
08:11We just got a call, so we're going to see what's going on between us together.
08:15I just received a patient from A&E.
08:18There's a patient within now that she's recording us.
08:21We're all live on TikTok.
08:24A woman has been caught broadcasting hospital staff and patients live over the internet,
08:30infringing medical confidentiality.
08:32If someone walks in and they're filming you, without letting you know,
08:37you don't want them to see some of the things that is happening.
08:40Whenever the patient is by their bedside,
08:43it is very important to keep their privacy and dignity.
08:47She just came in, so she's already airing us.
08:50Can you come with us, though?
08:52Yeah, we had a call that you're recording.
08:55So you can do whatever you want inside here, but not outside.
08:58I don't like your attitude, and I don't like your attitude,
09:01and you've got a jealousy problem.
09:02I don't know.
09:03Yes, you have.
09:04No.
09:04You have.
09:04We told her you can't do that.
09:06You can record inside, but you can't record outside her cubicle.
09:09She just didn't like the warning, and she just got angry.
09:13Yeah, the patients have been seen on TikTok, right?
09:16Liz, do you not record?
09:18It's privacy.
09:19The woman refuses to comply with hospital privacy rules
09:22and is disrupting a ward of vulnerable patients
09:25in the middle of the night.
09:27When patients are disruptive,
09:29they even start making other patients very emotional.
09:33I can imagine if it's me lying on that bed.
09:35I'm vulnerable.
09:37Brace, let's go with you.
09:38I think I'll take your brace to make fun, please.
09:40Get out of my way!
09:42Are you leaving?
09:43Yeah, I'm leaving, blokes.
09:45You're going to stick off?
09:46I think I'll stick to that.
09:47We experience racism all the time.
09:50It does bring your morale down.
09:52It is very frustrating,
09:53because nurses are supposed to be, like, respected.
09:57I'm going.
09:58Where are you going?
09:59I'm going to make sure I'm going.
10:00Where are you going?
10:01Because I'm going to do that.
10:03What do you have with that?
10:04The aggressive TikToker has decided
10:07to leave the hospital without treatment
10:08or being discharged.
10:10If you're going,
10:11you'll have to speak to the doctors, yeah?
10:14It will help you, though.
10:15F***.
10:16You want to talk to the nurse inside?
10:18I'm a nice person.
10:19I'm excited.
10:21No reason.
10:21We can help you get one of the nurse,
10:24one of the s***.
10:27She'll cause trouble.
10:29Every day is a new challenge,
10:31new stuff.
10:33I'm happy to be.
10:40Ready?
10:43Once more.
10:45Good job, good job.
10:49In Norwich,
10:50after a violent altercation
10:51two men are receiving treatment.
10:55The attacker has a potentially
10:57life-changing head injury
10:58after the man he was stabbing
11:00fought back,
11:01punching him repeatedly in the head.
11:04Doing really well.
11:05Really well.
11:06But the victim has been stabbed
11:08multiple times.
11:12Initially separated
11:13in different departments,
11:15they're now both in resus,
11:16with police swarming the area
11:18to keep both men, staff,
11:20and other patients safe.
11:22Right, there's a bowl
11:23on your lap
11:24that you can spit
11:25and vomit into if you need to.
11:27It does make it a little bit
11:28dicey at times
11:29because we've got to keep them apart
11:30so that they don't start fighting again.
11:32But we've also got to treat them
11:33so we've had quite a lot of
11:35police around the department.
11:37Lots of extra nurses
11:38and lots of extra team members
11:40trying to help
11:41put the patients back together.
11:42number one
11:43with our trauma board
11:45because he's having a CT
11:46head, neck, and facial bone.
11:49The attacker with significant head wounds
11:51is being prepared for a CT scan
11:53to check if he has a TBI,
11:55a traumatic brain injury.
11:58Legs ready, steady, slide.
12:04We're just going to
12:05pop these blocks
12:06around your head.
12:07So you stay nice and still, Bella.
12:09I know, take a deep breath first.
12:11Whoa.
12:14Oh.
12:19Whilst the attacker
12:19with the head wound
12:20goes for a CT scan,
12:22Dr. Clare is taking over
12:24the treatment of his stabbed victim.
12:26You're just going to do
12:27the X-ray of your hand here
12:28and then we're going to take
12:29to have a CT scan
12:30of your chest
12:31and arm probably
12:33will catch a bit of it
12:34but doesn't need scanning.
12:36Have you had a CT scan before?
12:38He's been stabbed
12:38to the chest and to his arm.
12:40He came in originally looking fine
12:42but has then had
12:43quite a lot of blood loss
12:44as he's got to the department.
12:46So anyone that comes
12:47with wounds like this
12:48we would always
12:49assess them top to toe,
12:50make sure there's no signs
12:51of things like a punctured lung
12:53or blood in their lung
12:53or anything in their abdomen
12:55that's going to need
12:55immediate surgery
12:56and then most of the time
12:58we would do a CT scan
12:59to see exactly
13:00where those wounds go,
13:01what's going on
13:02and what we can do with them.
13:03He looks like he's probably
13:04got some fractures
13:04in his hand as well.
13:06The victim's hand
13:07could be fractured
13:08from defending himself
13:09by giving his attacker
13:10a serious head injury.
13:13We'll have a proper look
13:14at this one
13:15when we come back
13:15because he's doing the cold.
13:16Yeah.
13:17That one's, I mean
13:18it's definitely gone into muscle
13:19and that's why it's bleeding
13:20and that's why it's so sore.
13:22We'll have a proper look
13:23at this one
13:23when we get back.
13:37before being taken
13:38to the CT scanner
13:39the mobile x-ray unit
13:41is used to see
13:42if his hand was damaged
13:43when defending himself.
13:46Right, we have a monitor
13:47we have suction
13:48you've got the bag
13:49have we got oxygen
13:50on the trolley
13:50if we need it?
13:51Lovely.
13:53Right, rock and roll.
13:55While the victim
13:56is being CT scanned
13:57the assailant
13:58has returned
13:58from being imaged.
14:01The results have come back
14:03and it looks like
14:04they've got multiple fractures
14:05to their facial bones
14:06they've got a fracture
14:08to their nose
14:09as well as their
14:10left orbital bone
14:11and some damage
14:12to their sinuses as well
14:14so there might be
14:14some loss of smell there.
14:16There's no fractures
14:17to the spinal column
14:19or any of that sort of thing.
14:21With significant damage
14:22to his face
14:23the patient will need
14:24immediate treatment
14:25from a team of specialists
14:27in another department.
14:28He's been referred through
14:29to the Maxfax team
14:31which are the facial trauma team
14:33and they put people's faces
14:34back together
14:35but they don't do a lot
14:36with eyes
14:37so we're going to have to get
14:38a separate team involved there.
14:45The cellar that we're doing
14:46the chest trauma scan on
14:48is in the CT scanner now.
14:50Meanwhile, the patient
14:51with stab wounds
14:52is having a scan of his body
14:53to determine if the knife
14:55has penetrated any organs.
14:57So he's got quite a lot
14:59of muscle there
15:00so I think it's all
15:01just gone into muscle.
15:03I think we should give him
15:04some antibiotics.
15:05We'll give it a good clean
15:07get loads of local in it
15:08and just work out how deep
15:09they are and make sure
15:10obviously there's no risk
15:11of foreign bodies
15:11and that sort of stuff.
15:19It doesn't look like
15:20it's gone anywhere
15:21apart from the skin
15:22and the muscle of your chest.
15:24You alright?
15:25Yeah.
15:25In a minute we'll get
15:26some stuff together
15:27and we'll just have
15:28a real good look at these wounds.
15:29We'll probably need to put
15:30some anaesthetic in there
15:31and then stitch it up
15:32but we'll just have
15:33a good look first
15:34to make sure we can
15:34stitch it up here
15:35and we'll have a look
15:36at this one on your arm as well.
15:37But your lung looks alright
15:39and it doesn't look like
15:40it's at anything else.
15:42If he's okay
15:43he's not too drowsy
15:44from the painkillers
15:45his pain's under control
15:46I'll get him home
15:48with some painkillers
15:49some antibiotics
15:49and advice about
15:50when to get the sutures out
15:51so hopefully later tonight
15:53I'll be able to discharge him home.
15:55The patient's injuries
15:56aren't life-threatening
15:57but the attacker
15:58who he fought off
15:59may have ended up
16:01needing more medical care
16:02than his victim.
16:03There probably has been
16:04an increase in assaults
16:06in some areas
16:08an increase in drug use
16:09in alcohol use
16:10if it's somebody
16:10that's being aggressive
16:11towards us
16:12not for a medical reason
16:14and they're just being
16:15aggressive and violent
16:16we've got a very low threshold
16:18for call insecurity
16:19but really every person
16:21that comes in
16:22whoever they are
16:23whatever they may or may not
16:24have done
16:24our job is to see them
16:26as a patient.
16:27The wound looks
16:28really superficial
16:29but it looks fine.
16:41One in, one out
16:42It was a very chaotic scene
16:44so they haven't given me
16:44any offs
16:45In Belfast
16:46extreme weather warnings
16:47are issued across the city
16:48The Royal Victoria A&E
16:51is preparing
16:51for road traffic accidents
16:53RTC
16:54Bullside
16:55Another one?
16:56Yeah
16:56Despite only 25%
16:59of journeys occurring
17:00after dark
17:00nearly half of all
17:02road fatalities
17:03occur at night
17:04One of them
17:05was front passenger
17:06and the other three
17:07were in the back
17:08After a high impact
17:10car crash
17:10at 70 miles per hour
17:12four young men
17:13have been rushed
17:14into the department
17:14The guy has hit
17:16the side of his face
17:17so he's done
17:19a quick moving
17:20of the neck
17:20but is complaining
17:21a right-sided headache
17:22Right
17:23And then the other guy
17:25he was in the backseat
17:26in the middle
17:26so the other two
17:27passengers have hit
17:28his head
17:29he's lost consciousness
17:30I've hit me head
17:31off my friend
17:32Daniel
17:33Oh, the other one
17:34Yeah
17:35And then I've hit it
17:36off the weight wheel
17:37And then my whole
17:38left side of my body
17:40just continue to live
17:41and it's
17:41you know our back's
17:43killing this
17:44And how are you
17:45solving him?
17:46It's really hurting
17:47it's not
17:47While David and Daniel
17:49are taken to Majors
17:50to be assessed
17:50for serious injuries
17:51Dr. Rachel checks
17:53on the other passengers
17:55It's sort of right in
17:57I can feel it
17:58It's not like hurt
17:58it's bad
17:59but I feel it
17:59It's like under
18:00my ribs
18:01Yeah
18:02Basically there was
18:03a taxi in front of us
18:04that just changed lane
18:05and it just started
18:06slipping and slipping
18:07and slipping
18:07and then it just
18:07boom
18:08started twisting
18:09and twisting
18:09and then
18:11smashed against
18:11the side of the rail
18:12Do you have a photo?
18:13No
18:13I've got a video
18:14of the car
18:15That's the car
18:16Right
18:16Where are bikes all this?
18:18On the motorway
18:18I'm not too sure
18:19I'm going to
18:20for a round here
18:20It's a slip off
18:25Look straight up there
18:27Dr. Michael is working
18:28to find the extent
18:29of David's injuries
18:30He was the front passenger
18:32Aye, there
18:33There?
18:34Aye
18:34Is this where you hit
18:36off him?
18:37Yeah
18:37You open the mouth
18:38Any difficulty doing that?
18:40Aye
18:40Obviously the faster
18:42the car is going
18:42the more severe
18:43injuries you will get
18:45especially in adverse weather
18:46as well
18:47faster equals
18:48higher mechanism
18:49of injury
18:50and also
18:51different patterns
18:52of injury
18:52Take a nice deep breath
18:53for me
18:54Good
18:54Okay
18:55Lift this leg
18:55off the bed
18:56for me
18:56Push my hand
18:57up in the air
18:59Let's have a look
18:59at it here
19:00if that's okay
19:06Sorry
19:07Right
19:07I need to get you
19:08an e-xray
19:08as well
19:09Try and keep
19:09your head
19:10really still
19:10okay
19:11So I'll get
19:12your face
19:13x-ray
19:13to make sure
19:13there's no
19:14fractures here
19:14I'll x-ray
19:15your neck
19:16and I'll x-ray
19:16your lower back
19:17and left knee
19:17You know
19:18he's demonstrating
19:19a lot of
19:19significant neck pain
19:21lower back pain
19:22and knee pain
19:23so really needed
19:24to rule out
19:25any
19:26fractures
19:29Okay
19:30Can you lift this up
19:31for me?
19:31Just need one
19:31examine the chest
19:32and the abdomen
19:33first
19:34Dr. Michael
19:34needs to see
19:35the impact
19:35of the crash
19:36on Daniel
19:37who was knocked
19:37unconscious
19:38in the collision
19:39while in the middle
19:40seat of the back
19:41of the car
19:41Any pain doing that?
19:43No
19:43There's a bit there
19:44like
19:45Yeah
19:45I think it's pushed
19:46under my spine
19:47then
19:48Are you feeling
19:48that in the back?
19:49Okay
19:50fine
19:50Because you've
19:51lost consciousness
19:51and you've been
19:52going quite fast
19:54we'll get a scan
19:54of your head
19:55and we'll do
19:56your neck as well
19:56okay
19:57and if both of those
19:58are okay
19:58then we'll be able
19:59to get you off
19:59this collar
19:59and off this mattress
20:02There's an added
20:03layer of complexity
20:04with car accidents
20:05because you can
20:06have a collapsed
20:07lung
20:07you can also have
20:08an intra-abdominal injury
20:09or a limb fracture
20:10which can sometimes
20:11distract from
20:12the head injury
20:13so these are
20:13what's called
20:14distracting injuries
20:15so we would
20:16keep an open mind
20:17when treating trauma
20:18patients really
20:19for that reason
20:22Okay Daniel
20:23my name is Andrea
20:24I'm one of the radiographers
20:25Daniel is taken
20:27to the CT scanner
20:28as a loss of consciousness
20:29could indicate
20:30a life-threatening injury
20:32I'm going to do one scan
20:33for your head
20:34and one for your neck
20:35you're going to go
20:37in and out
20:37a couple of times
20:38Okay
20:39The CT shows up
20:41really two things
20:42in the setting of trauma
20:43it will show up
20:44if there is a bleed
20:45on the brain
20:46or if there's a skull fracture
20:48A bleed on the brain
20:50is a time-sensitive injury
20:51which could be deadly
20:52if untreated
21:02Oh this is cool
21:03there's nothing
21:04for their try
21:05to get in
21:05and that's all we want
21:07In Norwich
21:07senior consultant
21:09Dr Shum
21:09is halfway through
21:10his night shift
21:11in recess
21:12The resuscitation room
21:13is where we bring
21:14our sickest patients
21:15you're always going
21:16to be on high alert
21:20When you hear the alarm
21:21go off in the department
21:22you know it's going to be
21:23something that needs
21:23an urgent response
21:24We're going into cardiac
21:25base please
21:26Can we have a bag of
21:27harm and spiked and ready?
21:28Spiked ready?
21:29Yeah
21:30You're going to assume
21:31it is the worst case scenario
21:32We come down this set
21:33we're going to ask you
21:34to do a pulse check
21:36A patient in Majors
21:37has gone into cardiac arrest
21:39Can you give us adrenaline
21:40please?
21:41Fingers on the femoral now
21:42so we can tell
21:43if we can feel the pulse
21:44while chest compresses are going
21:45Is the adrenaline given, Obi?
21:46Yep
21:47Okay
21:47The team gives CPR
21:48to maintain blood flow
21:50and preserve brain activity
21:51while waiting for medication
21:53to take effect
21:54in restarting the heart
21:55Okay
21:55So we have signs of life
21:56So stop CPR for a second
21:58Feel for a pulse bruise
21:59I've lost the pulse again
22:00Okay
22:01Restart CPR
22:02So once the heart stops beating
22:04the oxygen supply
22:06to the brain stops
22:07Even if we're doing
22:08good quality chest compressions
22:10the longer the cardiac arrest
22:11the more tissue death occurs
22:13the less the chances
22:15of survival are
22:16Do we have signs of life?
22:17Yeah
22:17Okay
22:18Stop CPR please
22:19We have rhythm compatible in life
22:20Do you have a pulse?
22:21Do you have a pulse?
22:23Do you have a pulse?
22:24Do you have a pulse?
22:25Do you have a pulse?
22:25Do you have a pulse?
22:25No
22:25Start CPR please
22:27How's ventilating?
22:29Ventilating
22:29Do we have space we can go into
22:31and recess here?
22:32Even if the CPR generates a rhythm
22:34compatible with life
22:35the patient needs to be moved to resus
22:38an area designed for this kind of emergency
22:40This patient's going to need
22:41what we call a definitive airway
22:43In the resuscitation room
22:44we've got the ability to do all that
22:45we've got more nursing staff
22:46we've got better monitoring
22:48and we've all the equipment drugs
22:49that we could need
22:51But the timing of any movement is critical
22:54Can you feel a pulse while CPR is on?
22:55Yeah
22:55Okay good
22:56Keep it there for me for now
22:58Okay we're going to do a rhythm check in
22:593, 2, 1
23:01Stop compressions please
23:02Do you have a pulse?
23:03No
23:04Even if we're doing good compressions
23:05there's still going to be reduced blood and oxygen
23:08going to the brain and other vital organs
23:11that's irreversible
23:13Let's move to resus now while we have it
23:15Time is off the essence
23:29There are sick people here
23:31Oh this is going to make it worse
23:33Across the country
23:34the one area of a hospital open 24-7 is A&E
23:38The diversity of people you see
23:40cases you see
23:41and learning is like no other place in the hospital
23:44The one place anyone can attend
23:46including seriously volatile patients
23:51Physical violence against NHS staff
23:53has been found to have almost doubled in the last five years
23:56I think he's a bit of a risk to us isn't he?
24:01Night is a place that everything kind of
24:03sometimes just goes completely wild
24:05You need more fucking Daniel!
24:16Hello, is Daniel in resus?
24:18In Norwich A&E
24:19medics are racing a patient into resus
24:22who's in cardiac arrest
24:24So for ITU colleagues we're about five
24:26probably about seven minutes in now
24:29So ITU are coming
24:31Okay, as soon as you're in the bay
24:32we'll go back on the chest please
24:34Every minute that passes reduces a patient's chance of survival
24:39Do you have any pulse at all?
24:40No pulse
24:41Restart chest compressions please
24:42In 30 seconds we're going to do another rhythm check
24:46Another adrenaline please
24:48You have a finger on a central pulse
24:49Stop the CPF
24:50Can I see the monitor please behind you?
24:52We have a rhythm compatible with life
24:53Do you have a pulse?
24:54No pulse
24:55No pulse?
24:56Restart chest compressions please
24:57Okay, we're going to do a check in
24:59Three, two, one
25:00Stop compressions please
25:01Can we get some adrenaline please?
25:02We have a rhythm compatible with life in the back
25:05It's about 60
25:06Do you have a pulse?
25:08Any central pulse?
25:09Can I have a pulse?
25:10No
25:11Restart chest compressions
25:12Although the monitors show electrical activity in the heart
25:16It's not enough to generate a pulse
25:18The team need to continue CPR
25:20To buy the patient's heart more time to restart
25:22For about 15 minutes at the moment
25:24We are all trained in the emergency department to stay calm under pressure
25:28So you're in the zone and you're running through what you have practised
25:31Time and time again
25:32So our next check is going to be in 10 seconds
25:36Restart chest compressions again first please
25:39So we've had now almost 15 to 20 minutes
25:42Have adrenaline ready for the next please
25:44Time is of the essence
25:45The longer they're in cardiac arrest
25:47The less chance there is of that good neurological survival
25:50Pulse please
25:50Sorry
25:51We have rhythm compatible with life again
25:54Do you have any central pulse?
25:56Dr. Sean brings in the Lucas
25:58A mechanical CPR device that delivers perfect and relentless compressions
26:03Freeing up medical staff
26:04We've had 25 minutes
26:06If we don't have a pulse on this next rhythm check
26:09I suggest that we stop at that stage
26:11Is anyone in disagreement?
26:13After an extended period in cardiac arrest
26:15The chances of a full recovery without brain damage
26:18Become extremely unlikely
26:20Choosing to stop chest compressions and end the resuscitation attempts
26:25You're always doing in the patient's best interest
26:27As hard as it might sound to stop
26:29You know you're doing the right thing for the right reasons
26:32Can I ask you to have a finger ready on the central pulse for us?
26:35Need the frequency
26:36Stop the Lucas
26:36Please
26:37Can we do a rhythm check?
26:38Can't see it
26:39Can't see it
26:39Can't see it
26:40Can't see it
26:40Can't see it
26:41Can't see it
27:01Can't see it
27:05Can't see it
27:05Can't see it
27:06Can't see it
27:10Can't see it
27:10Can't see it
27:11Can't see it
27:12Can't see it
27:12Tearing up a bit later on when you don't expect it or about something unrelated and that does happen. Thank
27:16you very much everybody
27:29We're gonna do a tracing of your heart now all right at night when GP surgeries and walking clinics are
27:35closed
27:35A&E becomes the only option for many sick people. It says here waiting for troponin
27:43This is when I'm in the waiting room earlier. Definitely will need cleaning it. In Newham A&E waiting room
27:50Theatre actress Holly has come in with stomach pain
27:54So if you lie down for me, please
27:57She's already been triaged by the nurse and had her blood taken. It started yesterday
28:02Yesterday all over my tummy. Okay in the middle of the night. It woke me up with a pain there
28:09Okay, a stabbing pain that it gets worse once I'm moving around earlier when I went to sit down it
28:15felt like someone was
28:17Really stabbing. Yeah, so what I'm going to do is examine your tummy
28:23Sore here mostly here
28:25Yeah, a physical assessment will indicate the location of the issue pain level and if the abdomen has become rigid
28:33Sore here?
28:35There's really bad
28:36Any other medical problem of any significance?
28:40I am I had a laparoscopy
28:44We thought it was endometriosis, but it wasn't they they removed a cyst from my fallopian tube
28:51Which is also what I was I thought either
28:55Appendicitis or maybe an like a cyst side was that you remember right or left my left side of my
29:01fallopian tube as you know
29:02Our first diagnosis is appendicitis
29:07Usually if appendicitis happen the
29:10Inflammative markers start going up
29:12What we need is having an ultrasound scan of your tummy
29:16All these blood tests could show if she has appendicitis or ovarian cysts, but either condition could be serious if
29:23not treated
29:24They will review your scan on cull team and make a decision whether you have appendicitis or not
29:29There's always a 50 50 chance, so we are not rushing for surgery first. We have to make a diagnosis
29:48No, maybe backs fucking do me a man killed us
29:52After spinning at 70 miles per hour in a car and crashing into a wall
29:56David and Daniel are a risk of long-lasting damage to their heads necks and backs
30:01I can't even do me a trousers up
30:04My my head's starting me up
30:07They're waiting on results from urgent CT scans and x-rays to see the extent of their injuries
30:13You hit your head whenever
30:14Yeah, I hit me head off his and knocked me so low
30:17So where are you from then?
30:19I'm from Newcastle, me, you know
30:20So he's over here for work?
30:22Yeah, I
30:22My head is hit off him
30:24He's the one that knocked his open
30:25Yeah
30:26He's going to show you where you're lying
30:27Yeah, he's it
30:28Victims of traffic collisions who black out are three times more likely to be diagnosed with a serious brain injury
30:34The nurses must monitor the patient for signs of deterioration which could be life-threatening
30:39I'm just going to check your blood pressure and things
30:43Dr. Michael has been treating the men and has received their scan results
30:47Good news
30:48You have no fractures
30:50Right
30:50And your head CT is clear too
30:52So you have no bleeding or anything which is good
30:53So I'm going to take this collar off you, okay
30:55Yeah
30:56You will be a bit stiff
30:57Your C-spine is clear as well
30:59So it is
30:59So I'm going to take this collar off
31:01Because your knee's okay, there's no fracture there and the lower back's fine as well
31:04Yeah
31:05So you're all good
31:06So there's always a risk that it could have been quite a serious accident
31:09We had quite a high index of suspicion
31:12You know, you're making sure that they're all nice and square
31:14Nice and even
31:15And that there's not one that gets stepped off from the other
31:18And that there's no fracture lines visible
31:20Which is, there's not
31:24These guys have got off quite lucky
31:25Which is good
31:29With no fractures and no brain bleeds
31:31The men are free to join the other passengers in the waiting room
31:34I had an accident for my leg
31:36I was hit my leg
31:38My back
31:39My face
31:43It could be worse
31:44The car could have flipped
31:48Like frozen
31:51Frozen in time
31:54It is so satisfying to work out what's wrong with them
31:57Be able to give them sort of clear diagnosis that they're fine
32:03It's a good part of the job
32:04Yes
32:05It is the good part of the job
32:08Every moment could be the last moment
32:10I don't take anything for granted
32:12You know, just
32:13Because it could end like that
32:28Hi, how are you?
32:29I'm Poppy, I'm one of the nurses
32:31Hi, how are you?
32:33Also in Belfast
32:34Nurse Poppy has received a pre-alert for 89-year-old Myrtle
32:38Who has fallen at home
32:40Is this hip very sore, Myrtle?
32:42Butt lifted
32:43Yes
32:43She has got quite a deformity here
32:46We can't keep the pain under control at all
32:48Right
32:48Will we get you in and get you good pain relief?
32:52Pain relief
32:53Pain relief, okay
32:57My concerns with someone who is elderly and has had a fall
33:01I think your mind automatically goes to
33:03What was the mechanism?
33:04How did they fall?
33:05Why did they fall?
33:07And then what are the injuries from the fall?
33:09I brought one of the doctors out to have a wee look at your hip
33:12Is that okay?
33:13Yes
33:13She, on with this fall, 3pm
33:16And so she doesn't actually remember any of the fall
33:20And it's just an extreme pain
33:21She doesn't really know what's going on
33:23Right
33:23On the way in, she was basically screaming the whole time since we left
33:27You're very sore?
33:28Yeah
33:29And just the leg?
33:31Just the head?
33:32Yeah
33:33Okay
33:33We're going to get you around and get some quick picture
33:35And then we'll know what to do with it
33:37Okay?
33:38With Myrtle unclear on the details of the fall
33:41It's hard to get an indication of how bad the damage is
33:44She'll need an immediate x-ray
33:46So plan will be rolled to use
33:48We'll side the board under
33:501, 2, 3
33:50We'll go across
33:51Across the 1
33:52Yeah
33:521, 2, 3
33:54Very slowly, very slowly
33:55Well done, Myrtle
33:56Perfect
33:57Right
33:58Sorry
33:59Bring your rear arm across
34:00Slight tilt just towards us
34:02Slight, sight, sight
34:03There we go
34:03Well done
34:04I'm sorry
34:04Well done
34:05Sorry
34:06I'm so sorry
34:08While Myrtle is being imaged
34:10Her daughter Paula has arrived
34:12My mum will actually be 90 in two days' time
34:15Unfortunately, she was in hospital for her last birthday last year as well
34:20We'll have to see what's going to happen
34:21But I can't believe she found herself standing here again this year
34:24But she's tough
34:26For an elderly patient
34:28The fall could be extremely hard to recover from
34:31Causing a serious loss of mobility
34:38She's fiercely independent
34:40And she really hates the fact that her body won't do what she wants it to do
34:46And that's frustrating for me to see her, you know, getting frustrated with herself
35:24X-rays are back
35:24Surrounded by extremely strong muscles which are causing the bones to be pulled in together
35:29And overlap
35:30Myrtle, I understand you had a fall today, is that correct?
35:33Did you have a fall today, Mum?
35:36I didn't
35:36You didn't?
35:37I said
35:37What do you think you're in hospital for?
35:40I said
35:41Orthopedic Dr. Mohammed will be helping pull Myrtle's leg into a safe position
35:45Unfortunately, this is the kind of fracture that needs to be fixed
35:48It would need an operation
35:51You broke your thigh bone, Mummy, and you need to have an operation to get it fixed
35:55This lady here, what she has is essentially a femoral fracture which needs fixation
36:00So I'm trying to prepare her for a treat list in the morning
36:03Because of her age, she's 89, she's quite frail, so she's at a high risk
36:07I mean, to be honest with you, this is a big operation
36:09The femur bone is the largest bone in the body and the operation will also be a big one
36:13There's a high risk
36:16Right, now I need to keep the bones in line and help with the pain
36:19Temporarily setting the injury will stop the sharp broken ends of her bones
36:23Causing more damage to her leg muscle
36:25But it will be extremely painful
36:27I'm trying to prescribe her anesthesia which will be inhalation
36:32It's a nasty one, it's a very nasty one
36:56Not a fan of the needles
36:57Well, they're going to give you a drip
36:58Stage actress Holly has come into A&E with abdominal pain
37:02Which could be appendicitis or a burst cyst
37:05I've got to wait for a scan
37:07Hopefully they can pick up on whether it is appendicitis
37:10I feel like you haven't had pain like this before then
37:12Her friend Ali has come to keep her company in the waiting room
37:16I thought it was trapped in, because I was farting a lot
37:21Don't make me laugh
37:23Sorry
37:25Holly is waiting for blood results to see which diagnosis is correct
37:29And if she is in immediate danger
37:33Finally, our cocktails have arrived
37:38Thank you
37:42While Holly waits to be treated
37:44She's given intravenous paracetamol to ease her pain
37:47I'm guessing I can't go to work
37:49Oh God, yeah
37:50If it's appendicitis, I'll be off for like two weeks
37:54So hopefully, yeah, it's not that
37:55I was so shaky earlier when they were doing this
37:58Yeah
37:59And I was going in
38:00You've had a few too many needles today
38:02I don't want to see another one
38:04While Holly's pain has been addressed
38:06Dr Shazad has received her blood results
38:08Bloods were normal
38:10Her inflammatory markers are normal
38:12The risk of any perforation of appendix is extremely low
38:15Hold on to this for me
38:17If Holly's appendix had burst
38:19Her blood tests would have shown inflammation in her body
38:23What we will do
38:24We will bring her tomorrow for an ultrasound scan
38:27If ultrasound shows appendicitis
38:29Obviously, we will operate on her
38:31I just rock up tomorrow
38:32Overnight, the hospital has fewer staff available
38:35So Holly will return in the morning for her ultrasound
38:38And to find out her diagnosis
38:41Thank you so much
38:42Thank you
38:42Goodbye, see you tomorrow
38:46Ew, look at the rain
38:50Well, let's wait here
38:51I'll load the Uber back
38:58Squeeze my hand
38:59They're sore
39:0189-year-old Myrtle has come into A&E with her daughter Paula
39:05After a fall at home snapped her femur
39:10You've broken your femur
39:11Which is your thigh boom
39:12Okay
39:13So it's sitting in a bit of an awkward way
39:15And that means that we can put
39:17We want to put like a splint or a traction device on
39:20You want to pull your leg out to leg
39:21Now it still might be a bit sore
39:23Because it's quite a nasty break
39:27Medics prepare Myrtle for the painful procedure
39:30What they'll do is start eating the pain
39:33So you'll feel the pain
39:34If the bone shards aren't realigned
39:37They'll continue to cause bleeding and damage to the muscle
39:40So that's good
39:41That means that's probably worked a bit, that injection
39:43So it's numbed up your leg
39:45Okay
39:46The next step then is to get this traction device on you
39:51Would it be okay if I apply this contraction on you?
39:54So that is just to keep your bones in line
39:56And help with the pain
39:57Is that okay?
40:00Orthopaedic specialist Dr Mohamed
40:01Will be managing the leg manipulation
40:04So I'm going to move your leg a bit
40:05It might be a bit painful
40:07We are going to give you something for the pain
40:08But still it would be a bit painful
40:12Okay?
40:16And this is here something for the pain
40:17It's an inhalational anesthetic
40:21The procedure is extremely painful
40:23But at Myrtle's age
40:25Many forms of strong sedation could affect her breathing
40:29So this here is something for the pain
40:31You just have to use it like a cigarette
40:33You just have to inhale it and then exhale
40:35Is that okay?
40:36Okay
40:36So a less invasive inhaler of Penthox is given
40:40Just breathe it in and I just
40:41It will just help with the pain
40:43And feel your lips around it and inhale
40:46Take a deep breath
40:48And breathe out into the whistle
40:53Is that good?
40:54Is that the good stuff?
40:57With pain medication on board
40:59Dr Mohamed sets up his counter traction apparatus
41:02Which will use a weight to slowly pull the legs straight
41:05Against the powerful thigh muscle
41:07I had the x-ray
41:08Yes, I had the x-ray
41:10That's where they were able to tell me
41:11That you've broken your femur
41:12Is that serious?
41:14Serious enough, Molly
41:20Especially at your age
41:23Yeah, you have to roll that in
41:28I'm going to put her leg straight first
41:31Then I'm going to put this around her ankle
41:32And I'm going to wrap it around
41:34Just have to lift it a bit in the air
41:35Okay
41:36So if you have that tape
41:37You can keep the leg down now
41:39Dr Mohamed needs to be very careful
41:41Not to extend the muscles in Myrtle's leg too quickly
41:44And cause further damage and pain
41:52I guess it's okay
41:56That's nice and weird on this
41:58A heavy counterweight will be left on the end of the traction device
42:02To continue slowly extending Myrtle's muscle for the next few hours
42:06Pulling the broken bones back into position and ready for surgery
42:11You've got your toes again for me
42:12Good
42:16She seems more comfortable now anyway
42:18Which is the main thing
42:20You're more comfortable now
42:21Yeah
42:24Most probably she's going to theatres tomorrow
42:26Yeah, so I'll prepare for that
42:28She's definitely a priority for us
42:30So far so good
42:31It's just how long
42:32We'll have to wait before she gets to theatre
42:34And gets it fixed
42:35But the paramedics and everybody who has come
42:39Have been excellent
42:40They really have been excellent and so good with my mum all out
42:43We'll have to postpone your birthday party
42:49I'm not getting out of it that easy
42:51My face is full of gold
42:53Literally when the airbag blew up
42:55All I seen was stars
43:06Cheer up, dearie, show an happy face
43:09Yeah, go on, cheer up
43:10I'll try
43:11Why are you so sad?
43:25I'm still back here
43:27I'm still here
43:41I'm still here
43:42I'm just going to borrow your arm for a minute, fella
44:11I'm just going to borrow your arm for a minute, fella
44:11I'm just going to borrow my phone
44:25You've got to borrow your own
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