- 5 hours ago
A And E After Dark S07E01
Category
📺
TVTranscript
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...
00:59You see the good, bad and the ugly.
01:01I don't do 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.
01:49You ****.
01:49You ****.
01:51You ****.
01:53It's hard to nurse someone who is calling you everything under the sun and it's hard to
01:57be empathetic, but it is part of your job and there's no getting away from it.
02:01Don't tell me to call, man.
02:03****.
02:10Do you know where you are at the minute?
02:12In Norwich, it's another challenging night for the A&E department.
02:17Can you feel me touching your thumb here?
02:20I'll punch you right in there.
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.
02:40But I'm just going to 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****.
02:54Leave me alone.
02:58The 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**** this ****.
03:06You have to calm down.
03:09Sit down.
03:10Sit down on that.
03:11Sit down on that.
03:12Hold on.
03:14Leave me alone.
03:15Hold on.
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 eyebrow.
03:43From top to toe, we've got a haematoma 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 fractures in the face.
03:53My significant concern is that the head, whether he's got a significant TBI or...
04:00A TBI is a traumatic brain injury and will require an urgent CT scan.
04:06The 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?
04:18No?
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.
04:31We're going to have to be real careful with cleaning his face because it's...
04:35Lots 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.
04:52I'm going to try and get some of this dried blood off and then we can see what's happening a
04:57bit better.
04:58He'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.
05:22Just be careful for a minute.
05:23Oh!
05:24Oh!
05:26Oh!
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?
06:00Yeah.
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.
06:08But it's the same area his attacker is being treated in.
06:11Initially, he wasn't taken through to Resos because he was stable and they wanted to try and prevent another fight
06:18happening.
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 an animal?
06:25You know what you're here.
06:26I ain't gonna hurt, man.
06:27Is he treating you like a good dog?
06:29No, let's go.
06:30Um, tell them I'll triage him now.
06:33I want these scalps up. I ain't gonna hurt, man.
06:46I'm sorry.
06:47For the staff inside A&E, the night shift brings aggression and danger.
06:52We're just verbally abusing everyone who's brought here. He's drunk.
06:5598% 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. If you put your hands on security, I need you to calm all the way down.
07:15I've had it with you in peace. 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 gonna 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.
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
08:17between us together.
08:18I just received a patient from A&E.
08:21This patient we didn't know that she's recording us all live on Tiktok.
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 though?
08:55Yeah, we had a call that you're recording.
08:58So you can do whatever you want inside here, but not ourselves.
09:01I don't like your attitude, and I don't like your attitude, and you've got a jealousy problem.
09:05I told her.
09:06Yes you have.
09:06You have.
09:07You have.
09:07We told her you can't do that.
09:09You can record inside, but you can't record outside her cabicle.
09:12She just didn't like the warning, and she just got angry.
09:16The patients have been seen on Tiktok live.
09:19Please do not record.
09:21It'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.
09:30When patients are disruptive, they even start making other patients very emotional.
09:36I can imagine if it's me, lying on that bed, I'm vulnerable.
09:40Brace, let's go with you.
09:41I think I took your brace because they bump on you.
09:43Get out of my way!
09:45Are you leaving?
09:46Yeah, I'm leaving blood.
09:48You're going to stick up.
09:49I'm going to stick up.
09:51I'm going to stick up.
09:52I'm going to stick up all the time.
09:53It does bring your moral down.
09:55It is very frustrating, because nurses are supposed to be, like, respected.
10:00I'm going.
10:01What?
10:01Where are you going?
10:02Why are you going?
10:04I'm going to stick up.
10:06What 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?
10:17It will help you, though.
10:18****
10:19Do you want to talk to the nursing child?
10:21I'm a nice person.
10:22It's fighting for no reason.
10:25Look, we can help you get one of the nurses, one 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.
10:49Good job.
10:49Good job.
10:50I can't, I can't, I can't, I can't.
10:56I can't, I can't, I can't.
11:15I can't.
11:19us, with 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 so that
11:34they don't start fighting again, but we've also got to treat them so we've had quite
11:37a lot of police around the department and lots of extra nurses and lots of extra team
11:43members trying to help put the patients back together.
11:45Number one, with our trauma board, he's having a CT, head, neck and facial bone.
11:52The attacker with significant head wounds is being prepared for a CT scan to check if he
11:57has a TBI, a traumatic brain injury.
12:01Legs, ready, steady, slide.
12:07We're just going to pop these blocks around your head.
12:10So you stay nice and still, Bella.
12:12Take a deep breath first.
12:14Woah.
12:17Woah.
12:20Woah.
12:22Whilst the attacker with the head wound goes for a CT scan, Dr Clare is taking over the
12:27treatment of his stabbed victim.
12:29You're just going to do the extra of your hand here and then we're going to take you to
12:32have a CT scan of your chest and 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 but has then had quite a lot of blood loss as he's
12:47got to the department.
12:49So anyone that comes with wounds like this, we would always assess them top to toe, make
12:54sure there's no signs of things like a punctured lung or blood in their lung or anything in
12:57their abdomen that's going to need immediate surgery.
12:59And then most of the time we would do a CT scan to see exactly where those wounds go,
13:04what's going on and 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 by giving his attacker a serious
13:14head injury.
13:14We'll have a proper look at this one when we come back.
13:20That one's, I mean, it's definitely gone into muscle and that's why it's bleeding,
13:24that's why it's so sore.
13:25We'll have a proper look at this one when we get back.
13:40Before being taken to the CT scanner, the mobile x-ray unit is
13:44used to see if his hand was damaged when defending himself.
13:49Right, we have a monitor, we have suction, you've got the bag, have we got oxygen on
13:53the trolley if we need it?
13:54Yes, we have.
13:54Lovely.
13:56Right, rock and roll.
13:58While the victim is being CT scanned, the assailant has returned from being imaged.
14:04The results have come back and it looks like they've got multiple fractures to their facial
14:09bones, they've got a fracture to their nose as well as their left orbital bone.
14:14And some damage to their sinuses as well, so 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, the patient will need immediate treatment from a team of
14:29specialists in another department.
14:31He's been referred through to the Maxfax team, which are the facial trauma team and they
14:36put people's faces back together.
14:38But they don't do a lot with eyes, so we're going to have to get a separate team involved
14:42there.
14:48The cellar that we're doing the chest trauma scan on is in the CT scanner now.
14:53Meanwhile, the patient with stab wounds is having a scan of his body to determine if
14:58the knife has penetrated any organs.
15:01He's got quite a lot of muscle there, so 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, just work out how deep they are and
15:13make sure obviously there's no risk of foreign bodies and that sort of stuff.
15:22It doesn't look like it's gone anywhere apart from the skin and the muscle of your chest.
15:27You alright?
15:28Yeah.
15:28In a minute we'll get some stuff together and we'll just have a real good look at
15:31these wounds.
15:32We'll probably need to put some anaesthetic in there and then stitch it up, but we'll
15:36just have a good look first to make sure we can stitch it up here.
15:39And we'll have a look at this one on your arm as well.
15:41But your lung looks alright and it doesn't look like it's anything else.
15:45If he's okay, he's not too drowsy from the painkillers, his pain's under control, I'll
15:50get him home with some painkillers, some antibiotics and 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, but the attacker who he fought off may have
16:03ended up needing more medical care than his victim.
16:06There probably has been an increase in assaults in some areas, an increase in drug use, in
16:12alcohol use.
16:13If it's somebody that's being aggressive towards us, not for a medical reason, and they're just
16:18being aggressive and violent, we've got a very low threshold for call insecurity.
16:23But really every person that comes in, whoever they are, whatever they may or may not have
16:27done, our 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, nearly half of all road fatalities occur
17:06at night.
17:07One of them was front passenger and the other three were in the back.
17:11After a high impact car crash at 70 miles per hour, four young men have been rushed into
17:17the department.
17:17The guy has hit the side of his face, so he's done a quick moving of the neck, but
17:23he's complaining a right-sided headache.
17:25Right.
17:26And then the other guy, he was in the back seat in the middle, so the other two passengers
17:31have 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 great wheel.
17:40Okay.
17:40And then my whole left side of my body is just tingling with this.
17:45Look, our back's killing it.
17:47And how are you solving them?
17:49It's really hurting us now.
17:50While David and Daniel are taken to Majors to be assessed for serious injuries, Dr.
17:55Rachel checks on the other passengers.
17:58It's sort of right in.
18:00I can feel it.
18:01It's not hurting us badly.
18:03It's like under my ribs.
18:04Yeah.
18:05Basically, there was a taxi in front of us that just changed lane, and it just started
18:09slipping and slipping and slipping, and then it just, boom, started twisting and twisting
18:12and twisting, and then smashed against the side of the rail.
18:15Yeah.
18:16Yeah.
18:16I've got a video of the car.
18:18That's the car.
18:19Right.
18:20Whereabouts was this?
18:21On a motorway.
18:22I'm not too sure.
18:23I'm going off for a round 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.
18:35Aye.
18:36There.
18:37Aye.
18:38Is this where you hit?
18:39Aye.
18:39Off him?
18:40Yeah.
18:40Can you open the mouth?
18:42Any difficulty doing that?
18:43Aye.
18:44Obviously, the faster the car is going, the more severe injuries you will get, especially
18:48in adverse weather as well.
18:50Faster equals higher mechanism of injury, and 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.
19:00Push my hand up in the air.
19:01Ah.
19:02Let's have a look at it here, if that's okay.
19:05Ah.
19:09Sorry.
19:10Right.
19:10I need to get you an e-x-ray as well.
19:12Try and keep your head really still, okay.
19:14So, I'll get your...
19:15You need to get your face x-ray to make sure there's no fractures here.
19:18I'll x-ray your neck, and I'll x-ray your lower back and left knee.
19:21You know, he's demonstrating a lot of significant neck pain, lower back pain, and knee pain.
19:26So, really needed to rule out any, um, fractures.
19:33Okay.
19:33Can 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, who was knocked unconscious in the collision,
19:42while in the middle seat of the back of the car.
19:45Any pain doing that?
19:46No.
19:46No.
19:47There's a bit there, like...
19:48Yeah.
19:48I think it's pushed under my spine there.
19:51Are you feeling that in the back?
19:52Mm-hmm.
19:52Okay, fine.
19:53Because you've lost consciousness, and you've been going quite fast, um, we'll get a scan of your head,
19:58and we'll do your neck as well, okay?
20:00And if both of those are okay, then we'll be able to get you off this collar and off this
20:03mattress.
20:05There's an added layer of complexity with car accidents, because you can have a collapsed lung,
20:10you can also have an intra-abdominal injury, or a limb fracture, which can sometimes distract from the head injury.
20:16So, these are what's called distracting injuries.
20:18So, we would keep an open mind when treating trauma patients, really, for that reason.
20:25Okay, Daniel. My name is Andrea. I'm one of the radiographers.
20:29Daniel is taken to the CT scanner, as a loss of consciousness could indicate a life-threatening injury.
20:34I'm gonna do one scan for your head, and one for your neck.
20:39You're gonna go in and out a couple of times.
20:42Okay.
20:42The CT shows up, really, two things.
20:45In the setting of trauma, it 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, which could be deadly if untreated.
21:05Oh, this is cool. There's nothing for their trial to get in, and that's all we want.
21:10In Norwich, senior consultant Dr Shum is halfway through his night shift in recess.
21:15The resuscitation room is where we bring our sickest patients.
21:18You're always gonna be on high alert.
21:22When you hear the alarm go off in the department,
21:25you know it's gonna be something that needs an urgent response.
21:27We're going into cardiac base, please.
21:29Can we have a bag of harm and spites in ready?
21:31Spites ready?
21:32Yeah.
21:33You're gonna assume it is the worst-case scenario.
21:36If we come down this end, we're gonna 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, so we can tell if we can feel the pulse while 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 and preserve brain activity,
21:54while waiting for medication to take effect in restarting the heart.
21:58Okay, so we have signs of life, so stop CPR for a second.
22:01Feel for a pulse pulse.
22:02I've lost the pulse pulse.
22:03Okay, we start CPR.
22:05So once the heart stops beating, the oxygen supply to the brain stops.
22:10Even if we're doing good quality chest compressions,
22:13the longer they're in cardiac arrest, the more tissue death occurs,
22:16the less the chances of survival are.
22:19Do we have sign of life?
22:20Yeah.
22:21Okay.
22:21Stop CPR, please.
22:22We have rhythm compatible with life.
22:24Do you have a pulse?
22:27I can't be the guy.
22:28No.
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 compatible with life,
22:38the patient needs to be moved to resus,
22:41an area designed for this kind of emergency.
22:44This patient's going to need what we call a definitive airway.
22:46In the resuscitation room, we've got the ability to do all that.
22:48We've got more nursing staff, we've got better monitoring,
22:51and we've all the equipment, drugs 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, two, 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 into the brain and other vital organs.
23:13That's irreversible.
23:16Let'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, the one area of a hospital open 24-7 is A&E.
23:41The diversity of people you see, cases you see, and learning
23:44is like no other place in the hospital.
23:47The one place anyone can attend,
23:49including seriously volatile patients.
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.
24:08You people are fucking dead!
24:19Hello, is Daniel in resus?
24:21In Norwich A&E, medics are racing a patient into resus, who's in cardiac arrest.
24:27So for ITU colleagues, we're about five minutes, probably about seven minutes in now.
24:32So ITU are coming.
24:34Okay, as soon as you're in the bay, we'll go back on the chest, please.
24:38Every minute that passes reduces a patient's chance of survival.
24:42No.
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.
24:51Can I have a finger on a central pulse?
24:52Stop the CPF.
24:53Can I see the monitor, please, behind you?
24:55We have a rhythm compatible with life.
24:56Do you have a pulse?
24:57No pulse.
24:58No pulse.
24:59Restart chest compressions, please.
25:01Okay, I'm going to do a check in three, two, one.
25:03Stop compressions, please.
25:04Can I get some adrenaline, please?
25:05We have a rhythm compatible with life at the back.
25:08It's about 60.
25:09Here we go.
25:09Do you have a pulse?
25:11Any central pulse?
25:12Can I have a flush pulse?
25:13No.
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 to buy the patient's heart more time to restart.
25:26For about 15 minutes at the moment.
25:28We are all trained in the emergency department to stay calm under pressure.
25:31So you're in the zone and you're running through what you have practised time and time again.
25:36So our next check is going to be in 10 seconds.
25:39Restart chest compressions again first, please.
25:42So we've had now almost 15 to 20 minutes.
25:45Have adrenaline ready for the next, please.
25:47Time is of the essence.
25:48The longer there in cardiac arrest, the less chance there is of that good neurological survival.
25:53Pulse, please.
25:54Sorry.
25:54We have rhythm compatible with life again.
25:57Do you have any central pulse?
25:59Dr. Sean brings in the Lucas, a mechanical CPR device that 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, I suggest that we stop at that stage.
26:14Is anyone in disagreement?
26:15After an extended period in cardiac arrest, the chances of a full recovery without brain damage become extremely unlikely.
26:23Choosing to stop chest compressions and end the resuscitation attempts, you're always doing in the patient's best interest.
26:30As hard as it might sound to stop, you know you're doing the right thing for the right reasons.
26:35Can I ask you to have a finger ready on the central pulse for us?
26:38Stop the Lucas, please.
26:40Are we going to do a rhythm check?
26:45No, it's completely flat.
26:50I suggest we stop unless anyone disagrees with her.
26:55After 27 minutes of CPR, Dr. Sean and the team have exhausted every life-saving option and the patient has
27:02died.
27:03As well trained as you can be, how you feel at the time will vary depending on what's going on
27:09in your own life.
27:12It can catch you by surprise.
27:14You find yourself tearing up a bit later on when you don't expect it or about something unrelated and that
27:18does happen.
27:19Thank you very much everybody.
27:32We're going to do a tracing of your heart now, alright?
27:35At night, when GP surgeries and walking clinics are closed, A&E becomes the only option for many sick people.
27:42It says here, waiting for troponin.
27:46This as well. I'm in the waiting room earlier.
27:48Definitely won't need 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. Yesterday.
28:06All over my tummy. Okay.
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, it felt like someone was...
28:19Stabbing.
28:20...really stabbing. Yeah.
28:22So what I'm going to do is examine your tummy.
28:25Sorry.
28:26Sore here?
28:27Mostly here?
28:29Yeah.
28:30A physical assessment will indicate the location of the issue, pain level and if the abdomen has become rigid.
28:36Sore here?
28:38There's really bad.
28:39Okay.
28:40Any other medical problem of any significance?
28:43I had a laparoscopy.
28:46Yeah.
28:47We thought it was endometriosis but it wasn't.
28:51Okay.
28:51They removed a cyst from my fallopian tube.
28:54Okay.
28:55Which is also what I was...
28:56I thought either appendicitis or maybe like a cyst.
29:00Which side was that? Do you remember? Right 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 happen, the inflammatory markers start going up.
29:15What 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.
29:31Whether 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.
29:38Yeah.
29:42Yeah.
29:43What the fuck is back?
29:52No, I mean, my back is fucking doing my head and run.
29:54It's killing us.
29:55After spinning at 70 miles per hour in a car and crashing into a wall, David and Daniel
30:01are at risk of long-lasting damage to their heads, necks and backs.
30:04I 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.
30:16Did you hit your head whenever?
30:18Yeah, I hit me head off his and knocked me so low.
30:21So where are you from then?
30:22I'm from Newcastle, you know.
30:23He's over here for where?
30:24Yeah, I...
30:25My head is hit off him.
30:27He's the one that knocked us open.
30:29Just going to try to know where you're lying.
30:30What's your fault, Andy?
30:31Victims of traffic collisions who black out are three times more likely to be diagnosed
30:36with a serious brain injury.
30:38The nurses must monitor the patient for signs of deterioration, which could be life-threatening.
30:43I'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.
30:55So you have no bleeding or anything, which is good.
30:57So I'm going to take his collar off you, okay?
30:59Yeah.
30:59You will be a bit stiff.
31:00Your C-spine's clear as well, so it is.
31:03So I'm going to take this collar off.
31:04Because your knee's okay, there's no fracture there, and the lower back's fine 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,
31:18and that there's not one that gets stepped off from the other,
31:21and that there's no fracture lines visible, which is...
31:24There's not.
31:27These guys have gone 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.
31:37Yeah, I had an accident for my leg.
31:40I was hit my leg.
31:41My back.
31:43My face.
31:45It was fucking everything, man.
31:47It could be worse.
31:47The car could have flipped.
31:49Yeah.
31:49He was just like that.
31:52Like frozen...
31:54Frozen in time.
31:57It is so satisfying to work out what's wrong with them,
32:00be able to give them sort of clear diagnosis that 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.
32:14Don't take anything for granted, you know, just...
32:16Because it could end like that.
32:31Hi, how are you?
32:32I'm Poppy.
32:33I'm one of the nurses.
32:34Hi, how are you?
32:36Also in Belfast, Nurse Poppy has received a pre-alert for 89-year-old Myrtle, who has fallen
32:41at 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.
32:56OK.
33:00My concerns with someone who is elderly and has had a fall,
33:04I think your mind automatically goes to, well, 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.
33:15Is that OK?
33:16Yes.
33:17She's on with this fall, 3pm.
33:20So she doesn't actually remember any of the fall.
33:23It's just an extreme game.
33:25She 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.
33:30You're very sore?
33:31Yeah.
33:32And just the leg?
33:34The hip.
33:34Just the hip?
33:35Yeah.
33:36OK.
33:36We're going to get you around and get some quick picture,
33:38and then we'll know what to do with it.
33:40OK?
33:42With Myrtle unclear on the details of the fall,
33:44it's hard to get an indication of how bad the damage is.
33:48She'll need an immediate x-ray.
33:49So a plan will be rolled to use.
33:52We'll side the board under.
33:53One, two, three.
33:54We'll go across.
33:54We'll cross the one.
33:55Yeah.
33:56One, two, three.
33:57Very slowly, very slowly.
33:58Well done, Myrtle.
34:00Perfect.
34:01Right.
34:02And a slight tilt just towards us.
34:05Slight, sight, sight.
34:06There we go.
34:06Well done.
34:07I'm sorry.
34:07Well 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,
34:25but I can't believe she found herself standing here again this year.
34:28But it's just tough.
34:30For an elderly patient, the fall could be extremely hard to recover from,
34:34causing a serious loss of mobility.
34:36I'm just going to look at your x-rays, all right?
34:41She is fiercely independent,
34:44and she really hates the fact that her body won't do what she wants it to do.
34:50And that's frustrating for me to see her, you know, getting frustrated with herself.
34:58X-rays are back.
34:59This is a normal hip on the right,
35:01and this is an abnormal hip on the 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,
35:12then you get more bleeding around it, and we get more pain.
35:16So we'll pull it out to length here now.
35:18That should tide it over then to the morning,
35:21and we'll get an operation.
35:24Myrtle'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?
35:38I did not.
35:38You didn't?
35:40No.
35:40What do you think you're in the hospital for?
35:44Orthopaedic Dr. Muhammad will be helping pull Myrtle's leg into a safe position.
35:49Unfortunately, this is the kind of fracture that needs to be fixed.
35:52It would need an operation.
35:54You broke your thigh 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 always be a big one.
36:16There's a high risk.
36:19All right, 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.
36:31I'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.
37:09I'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.
37:15Her friend, Ali, has come to keep her company in the waiting room.
37:19I thought it was trapped wind, 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,
37:32and if she is in immediate danger.
37:36Finally, our cocktails have arrived.
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.
38:02Yeah.
38:02And I was going in.
38:03You've had a few too many needles today.
38:05I don't want to see another one.
38:06While 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.
38:20If 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 woke 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.
38:46See you tomorrow.
38:49Ew.
38:50Look at the rain.
38:53Well, let's wait here and I'll load the over back.
39:01Just squeeze 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.
39:13You've broken your femur, which is your thigh boom, okay?
39:16So it's sitting in a bit of an awkward way and that means that we can put,
39:20we want to put like a splint or a traction device on to pull your leg out to like.
39:24Now it still might be a bit sore because it's quite a nasty break.
39:31Medics 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.
39:44That means that's probably worked a bit, that injection.
39:47So it's numbed up your leg.
39:48The next step then is to get this traction device on you.
39:54Would it be okay if I apply this contraction on you?
39:56So that is just to keep your bones in line and help with the pain.
40:01Is that okay?
40:03Orthopedic specialist Dr. Mohamed will be managing the leg manipulation.
40:07So 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?
40:18And this is here something for the pain.
40:21Here's an inhalation 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?
40:39So a less invasive inhaler of Penthox is given.
40:43Just breathe it in and I...
40:44It really just helps with the pain.
40:46And feel your lips around it and inhale.
40:49Take a deep breath.
40:51And breathe out.
40:52Into the whistle.
40:56Is that good?
40:57Is that the good stuff?
41:00With pain medication on board,
41:02Dr. Mohammed sets up his counter traction apparatus,
41:05which will use a weight to slowly pull the leg straight against a powerful thigh muscle.
41:10I had the x-ray.
41:11Yes, you'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.
41:38Okay.
41:39So if you have the tape, you can keep the leg down now.
41:42Dr. Mohammed 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.
42:14You've got your toes again for me.
42:15Good.
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.
42:29So I'll prepare 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
42:37and gets it fixed.
42:38But the paramedics and everybody who has come have been excellent.
42:43They really have been excellent and so good with my mum and my wife.
42:46We'll have to postpone your birthday party.
42:53I'm not getting out of it that easy.
42:55My face is fucking green.
42:56Literally, when the airbag blew up, all I'd seen was stars.
43:09I'm so glad.
43:10Cheer up, dearie.
43:11Show a nappy face.
43:12Yeah, go on, cheer up.
43:14I'm so sad.
43:28I'm still back here.
43:30I'm still here.
43:45I'm just going to borrow your arm for a minute, fella.
44:07I'm still here.
44:29I'm still here.
Comments