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Short filmTranscript
00:03after dark while the nation sleeps 16 year old male who was shot the A&E night shift begins
00:11can be very dangerous we deal with a lot of aggressive patients things can escalate
00:18can be quite scary when it's just you and one violent patient across the UK we join the staff
00:26of three of the most challenged emergency departments it's always busy it's always under
00:31pressure time is of the essence and the medics who face danger each shift most shifts I see more
00:38place than nurses with the amount of drugs and alcohol admissions rising have you been drinking
00:43today the risk of violence and abuse looms large every night please don't swear like that they try
00:50to attack and stuff calm yourself down people can become aggressive you've been punched
00:58okay you see the good bad and the ugly yeah we'll get security the emergency department
01:04is like a battlefield it's like organized chaos
01:19every night staff and patients in A&E waiting rooms across the UK are subjected to the abusive
01:26behavior of intoxicated patients
01:30it's estimated that up to 15% of A&E attendances are alcohol related so do you understand the
01:36reason why you're arrested we always have disruptive patients or aggression there's been times where I
01:42have felt frightened you don't know what to do in that exact moment there there's nothing you can
01:46do other than hope you don't get really hurt and at weekends after dark that percentage can rocket to a
01:54massive 70% gentlemen here assaulted outside a pub today high numbers coming through a lot of them
02:01obviously under the influence of drugs alcohol every single shift there will be somebody arrested
02:20in Belfast Royal Victoria A&E the security team are attending a disturbance in the waiting room
02:50with the woman clearly under the influence of alcohol deputy sister Rebecca and the security team
02:56are worried about her upsetting the rest of the patients
03:15she was shouting all around the place she made a few racist comments to many people in the waiting room
03:21and was very loud and aggressive about it
03:24this is absolutely
03:29you know what you're out of your family have a better respect
03:33you know what you're out of your family have a better respect for everybody everybody else
03:54why why why why why what are you pointing
03:56the fight nearly broke out but they've been separated and we've removed the alcohol and we have explained
04:04her that we'll give it back to her whenever she leaves any the woman can only stay and be seen
04:10by a doctor if she gives up her alcohol but she's already asking for it back explained like if you're
04:16willing to sit here and behave yourself you know we will see you and get you seen by a doctor
04:21but you
04:22know we can't tolerate that
04:22we have your hair
04:23wait what are you doing
04:26so um one more chance really and then she has to be removed okay
04:31what am I doing
04:32right
04:33you tell me
04:50also in Belfast 21 year old Roberta has been rushed in by her father and sister after a high-impact
04:57fall at home
04:59no slow slow deep breaths they said hey that's not a cigarette she's already been x-rayed and given a
05:06penthrox inhaler for the pain
05:10it's actually still not working what's not working
05:13ah could we get another one of those probably not in the waiting room let me check
05:26the penthrox inhaler needs to be used constantly if it runs out the pain-killing effects wear off quickly
05:32oh
05:36please
05:38please
05:46it won't be long it won't be too much longer
05:49okay
05:51are you running
05:53Dr. Dara has been alerted that Roberta's extreme pain has returned and needs immediate attention
05:57what we're going to do is give you some good pain relief okay
06:00okay we're going to get you nice and relaxed
06:01give a go putting this back in place okay
06:03please please
06:06right sweet kids let's go
06:09Dr. Mike will be working with Dr. Dara and has just received the images of Roberta's shoulder
06:14looking at the x-ray here this this big bone her humerus should be within the joint here it's quite
06:23clearly out of position and so we need to try and get that back in the joint sooner rather than
06:29later
06:31oh
06:32all right next step is we're going to get Mike and he's going to get the green whistle again okay
06:38and we're going to try and settle you down and relax you a bit okay
06:41have you checked the skull
06:42yeah
06:42is it okay
06:43so just showing your shoulders dislocated okay
06:47so the ball of the humerus bone has just popped out okay
06:52so what we're going to do is just try and put it back in place okay
06:54and you see the most important thing is see if you can keep really relaxed after you're in a lot
06:58of pain then we're going to try and relax you
06:59but the more relaxed you are the easier it is for us to do
07:02yeah
07:02okay
07:03just take some deep breaths okay
07:04I'm going to try and make it as easy as it can
07:06please
07:06all right
07:07oh
07:07there's a lot of ligaments in that joint that are being stretched and in the wrong position
07:13the longer the joint is out of socket the longer it is very very painful
07:18ah
07:19Roberta fell over four hours ago if the shoulder is not put back into position soon there's a risk of
07:25permanent nerve damage and ongoing severe pain
07:46no no no no
07:47I'm a straight up
07:49police are an almost permanent fixture in A&E's up and down the UK
07:55I do not have an issue ringing 999 to try and get police and escalating my concerns that I have
08:01staff to look out for
08:02I have myself to look out for and I have other vulnerable patients to look out for as well
08:06oh
08:07it's even calm down we can set a job
08:10officers spend an estimated 800,000 hours in the department every year
08:14just stay nice and calm thank you
08:16I think an ED often feels like a bit of a police station
08:20normally in resus it is quite chaotic anyway
08:23add police
08:24add nurses
08:25add radiologists
08:26add all of this into the mix and
08:28yeah it does get quite chocker
08:31from the bisschen
08:31What points you're aiming man
08:32LEDs
08:38come here
08:39up here
08:41so I can make up all your knees
08:43In Belfast
08:44Deputy Sister Rebecca has given a drunken disruptive patient one more chance to behave before she's removed
08:54I do love my job, but, like, there's easier ways to make money, I'm just like, what am
08:58I doing with my life? But, you know, it doesn't really kind of limit to just the weekends
09:04anymore, it's all of the time, really. Monday to Sunday, every night of the week is just
09:10the same. Alcohol, drugs, and then, oh, there's something happening out here. Sorry, excuse
09:22me. Right, we'll move you out. Sorry. Sweetheart, we can't have you getting involved. I want
09:32your name, I want your name. Sweetheart, we need to get you to leave. No, no, no, I want
09:44your name. You do? Do you know what he's doing to me? It's disgusting. Well, you're standing
09:49in the waiting room just harassing other people, there's a full waiting room here of people
09:52who are afraid. What about me? Right, come on, let's talk outside. No! Patients who are being
09:59fairly aggressive, we'll have to approach them in a calm manner, explaining to them why they
10:03can't behave like that, you know, it is obviously putting other patients at risk, scaring the
10:07staff. Listen, there's been times where I have felt a bit frightened. Recently, I was
10:13assaulted. You don't know what to do in that exact moment. It is quite frightening. You're
10:18being very, fairly aggressive to everybody in this waiting room, OK? You're frightening.
10:21Ah, you're lying? Right, we can't have that in this department.
10:25You're treating me like I'm a second bastard. No. And I don't like it. We're not, we're treating
10:30everybody here the same, OK? We're not going to be able to let you back in whenever you're behaving
10:34like this, OK? All right. That's fine. You don't want that? That's OK. Right? Yeah. That's
10:42OK. But do my thing. Right, we're going around in circles here. She's not really looking to
10:46listen to what I have to say. Right, he's happy enough to support art. Yeah. Thank you.
10:55The intoxicated woman will have to leave the hospital untreated due to her behaviour. I always
11:03like to give people a chance. However, there is a line and you can't cross it. We just
11:08can't allow that kind of behaviour, you know. Patients are leaving our department to go home
11:12because they can't bear to watch what's going on anymore. They feel threatened, they feel
11:16unsafe, so therefore they leave. These are normally the people who actually need to be there and
11:21treated for something really wrong and then they go home and deteriorate, which is not ideal
11:27at all.
11:44Hi. I'm streaming to Newham A&E. Can I get a CTF pelvis, please? In Newham A&E, a midwife
11:52has been taken seriously ill in the hospital at the end of her evening shift. So she had
11:56some right iliar fossa pain this morning with a bit of vomiting in the past hour. She's
12:01now 10 out of 10 pain in the right iliar fossa. We've done the bloods, but they're not back
12:05yet. Dr Karl is trying to help 33-year-old Agnes, who has had extreme stomach pain for over
12:1212 hours. I think there is a mentality of still coming to work even when you're feeling unwell
12:17within the NHS. Unfortunately, push yourself too hard and then you end up here.
12:23Obviously, you're in a lot of pain when you came in. The first things we did is we just
12:26got some blood tests from you, okay? And we're giving you some fluids and some painkillers
12:32as well. I've already spoken to the radiologist to give you a scan. So we're going to scan
12:36your tummy and down into a pelvis. I'm a bit worried that your appendix might either burst
12:43or be very, very angry with me.
12:46Intravenous morphine has reduced Agnes' pain, but her condition could be deadly if her appendix
12:52has burst.
12:56I thought I could manage my shift and then go home so that I could some painkillers, but
13:02I realised I couldn't. Then my colleagues put me here. I've not experienced this kind of
13:08pain before.
13:11My biggest concern for Agnes right now is that she might have a ruptured appendix, but
13:16we can't rule out other causes. And in young females, we always need to think about things
13:20like ectopic pregnancies or ovarian torsion or ruptured ovarian cysts. So the next step is
13:27to wait for the blood to come back and to get her into the CT scanner to see if we
13:30can find
13:31what's going on and see whether or not it's the appendix that's causing this problem.
13:35The longer it takes to diagnose the source of Agnes' pain, the higher the risk of life-threatening
13:40complications like peritonitis and sepsis.
13:45How bad is the pain? Out of ten, how will you grade it?
13:49It's nine or ten.
13:51So can I have it look at your tummy, please?
13:56Surgeon Mr. Shahzad has come to assess Agnes before her scan, as she may require surgery.
14:03Is it sore here?
14:05No.
14:07Is it sore here?
14:08No.
14:08Is it sore here?
14:08Sore here?
14:09No.
14:10Is it sore here?
14:11No.
14:12If you make a big cough for me, please?
14:15Cough.
14:17It hurts when you make a cough?
14:19Just slightly.
14:20Okay.
14:20That's fine.
14:24On examination, she's tender in righty leg fossa with a little bit of guarding.
14:28Let's see what CT shows.
14:30So if it's appendicitis, we'll apply it on her.
14:34With surgeon Mr. Shahzad unsure, a CT scan may be the only way to know if Agnes' appendix
14:41or an ovarian cyst has ruptured and her life is in jeopardy.
14:45I was in CPB pain before. I don't know what it was.
15:02It's six in recess at the moment and one is going to ITU.
15:06Four in intoxicated. I'll assess it when it arrives.
15:10In Newham recess, a man is arriving who fell while intoxicated, causing a head wound.
15:16You can come to this bed. Well done.
15:19He was found unresponsive. Members of the public tried to wake him.
15:23So he's got a laceration bump to his head there.
15:26Okay.
15:27Clearly happened with his hat on.
15:28Yeah.
15:28He's still got a bit of blood in there.
15:30Okay.
15:30Unknown to any members of the public.
15:32No one knows where he's come from.
15:34They've just literally found him lying on the floor.
15:37We don't know much about this gentleman.
15:39His last historic case was at the beginning of January, where he had a fall down stairs.
15:45Yeah.
15:46Sustaining a head injury and that was after being intoxicated again.
15:49Okay.
15:52Do you know where we are at the minute?
15:55No?
15:56We're in the hospital.
15:59Do you know what day it is today?
16:02No?
16:03Do you think you might have had a few drinks?
16:07Yeah?
16:08How much would you drink normally?
16:09What do you think you might have drank today?
16:11One.
16:11Just one?
16:13Yeah.
16:14One beer.
16:15Okay.
16:16All right.
16:16Nothing else?
16:18No, no.
16:19You got any pain anywhere?
16:21No.
16:22No pain?
16:23Normal.
16:25Normal.
16:25All right.
16:27Because what you've done is you've got a bang on your head there.
16:29You've been bleeding a bit on your head.
16:30Did you not notice that?
16:33So you don't remember falling over?
16:35No?
16:36Nothing like that?
16:37You don't remember?
16:40Okay.
16:40Housing.
16:42No pain.
16:43I'm here.
16:44So there's a problem with the housing?
16:46Yes.
16:47Okay.
16:49He's drunk quite a lot tonight.
16:51He's already explained that he's having some trouble paying his rent for next month.
16:55And now he's also telling my colleague that he's also been fired from work.
17:00So it starts to make sense why he's here in the middle of the night, very heavily intoxicated
17:05and having fallen over and injured himself.
17:08I'm going to get a CT of his head.
17:10Would you mind just to clean up the wound and see the right side of the head?
17:14Just a little bit, see if it needs a drop of glue.
17:16Okay.
17:16We're going to get a scan of your head to make sure everything is okay.
17:19All right?
17:20Yeah.
17:21No, you're all right.
17:22With the patient under the influence of alcohol, Dr Sarah requests a CT scan to make
17:27sure his behaviour isn't related to a brain injury.
17:30So we're going to clean up your head a bit.
17:31Yeah.
17:31All right?
17:33We're going to come back and see you after you've had your scan.
17:35Okay?
17:36Okay.
17:50She's screaming the place down here.
17:54Dr Mike and Dr Dara are about to attempt to get 21-year-old Roberta's painfully dislocated
17:59shoulder back into its socket.
18:02Please give me something.
18:05I think we can maybe get you onto this bed.
18:07No!
18:08I need something, please!
18:09Can she have any pain relief before?
18:11Is this just an absolute agony?
18:14The problem with it is once it kicks in you'll be very relaxed and it's safer to get you
18:19onto the bed first.
18:21Oh, I mean, I can't.
18:23It took me 20 minutes to get into the car.
18:25I can't.
18:27Does she need to be on the bed before she can have that?
18:29Ideally, yes, because the problem is we're going to do your reduction on the bed.
18:33I'm sorry.
18:35We'll go slow.
18:36We'll go at your pace.
18:37But the quicker you get on here, the quicker you can have that pain relief, okay?
18:40Listen to me.
18:41Listen to me.
18:41Listen to me.
18:42Hey, come on.
18:43Too much pain medication within 24 hours carries a risk of kidney and liver damage.
18:48So Roberta's last dose is being reserved for manipulating the bone back into its joint.
18:53Oh, oh, oh, oh, oh, oh.
18:54You've got to touch my hand.
18:58I'm going to go, okay?
18:59I'm going to go, I'm going to go.
19:00I'm going to go.
19:01I'm going to go, I'm going to go.
19:02I'm going to go.
19:02I'm going to go, I'm going to go.
19:02Take your feet off this.
19:03Take your feet down.
19:04Right, put your feet on the ground.
19:06And we'll do it.
19:07One, two, three, stand up.
19:08Stand up, stand up, that's it, that's it.
19:10You're up.
19:11Pull it away, pull it away.
19:13Stop, stop, stop.
19:14Nobody's still there.
19:17That's what she's right there you go back on it just like the car
19:36Now in position she can be prepped for the arm to be manipulated into its socket, but this will be
19:42even more painful
19:44Do you think you can release this on because it's best that you're in control of this?
19:48No, I could use my teeth before she did after a couple of breaths the first time she had it
19:54in her hand
19:54She was like she was smoking it after about two or three puffs. She was fine
19:59The Penthox inhaler is a fast-acting pain medication that can be self-administered
20:04Nice big deep breaths first
20:06I'll get you as comfortable as possible
20:09Robert, your job now is just to keep taking that green whistle for me
20:13Lovely slow big deep breaths
20:16We see a lot of patients with shoulder dislocations and it is very very painful
20:21The muscles that are used to usually keep it in the socket essentially are in high tension and high force
20:27And are keeping it now out of socket because the pain is causing the patient to be so tense
20:35We're going to sleep on you one, but I wouldn't do you like it
20:42I'm going to lay a little bit flatter and keep taking nice big deep breaths
20:46Keep taking it, Roberta
20:47Keep taking that
20:47Roberta, keep taking it, look
20:49Keep taking the muscle
20:50Roberta needs consistent pain relief to ensure her muscles are as relaxed as possible
20:55Keep puffing
20:56Keep sucking on the muscle, look
20:59Keep going, big deep breaths, Roberta
21:02Come on, big breath
21:03Even with the inhaler working, it will only dull the pain
21:07So the doctors need to work quickly to slip the arm back into position
21:10Big breath
21:13Stop
21:14You're okay, you're okay
21:15Ow, ow, ow
21:18Ow, ow
21:19Come on, it's going in that side, good girl
21:22Well done, keep going
21:25Roberta's arm has been out of its socket for four hours
21:28And the shoulder muscles have become incredibly tense
21:31Keep breathing, love
21:34Ahhhh
21:36Big deep breath
21:37Where the joint has been out for longer can be sometimes a bit trickier
21:40And often that's because the muscle has maybe gone into spasm
21:43And the patient's in a lot more pain
21:45We don't get it under control until we've got that joint back in place
21:49We're nearly there, okay
21:50Nearly there, just another wee bit, love
21:52You'll be okay, hold on to me
21:56Ow!
22:09He was collapsed and was in cardiac arrest
22:13Over two and a half million people attend A&E at night every year
22:18You can't make no permission
22:22Which is particularly challenging for the reduced night shift staff
22:26I don't give a fuck
22:27Yeah, we'll get security
22:28Fuck you
22:38How are you doing, Donnie? How are you feeling?
22:40An intoxicated patient has just returned from the CT scanner
22:44After being found unresponsive on the floor with a gash on his head
22:48We had, we did, we got the CT result, it was okay, alright
22:51We did a CT of your head
22:54Do you remember?
22:56No, you don't remember?
22:58We might have to wait until he's sober enough to go
23:01When he arrived, the man explained he's been having money trouble after losing his job
23:05Can you just turn over so I can see your head again, just to see if we've cleaned it up
23:10alright
23:11It's really unfortunate that it's a bit of a downward spiral, isn't it?
23:14That you're having problems, then you drink, then you hurt yourself and it goes round and round
23:18We can step him out and then I think we just keep him somewhere until he's awake enough to go
23:23home
23:34We need to keep him safe and so we're going to keep him in the department really until he's sober
23:38enough to go home safely
23:39Because at the minute he's not really remembering everything that's going on and things
23:43So we just want to keep him safe here for probably until the morning now
23:46You want to sit up a bit, yeah?
23:49Sit up, I need to clean this side, yeah?
23:51So I can clean your head, yeah?
23:53When you're working in the night, the problem is that no one else is working in the night
23:56And so we don't get much support from other services
23:58That's a real bit of a gap really, that we're just doing a bit of patching up
24:01And then sending people home without really giving any long-term solutions
24:06Anything and everything is what A&E stands for
24:25Doctors Mike and Dara are struggling to manipulate 21-year-old Roberta's arm back into its shoulder socket
24:31Sit back
24:32At you, good girl
24:33Despite being medicated with strong pain relief
24:38The muscles in her shoulder remain tight, making it incredibly hard to move the bones into the correct position
24:44Sometimes when reductions are particularly tricky then we have to apply counter traction
24:53This is essentially where we use a sheet to apply a force in the opposite direction
25:00And that just gives us greater force in order to try and get the shoulder in to join
25:05Stay still, stay still
25:07That's when you're getting into brute force territory
25:10You don't really want them relaxed
25:12Come on, I know, I know, I know
25:15The counter traction should allow the doctors to pull the ball at the end of the arm bone
25:20Around the edge of the joint and back into position
25:23Roberta
25:23Come on, breathe
25:24But they're fighting against extremely strong, tense muscles in the shoulder
25:29Oh, help, stop, stop, everyone, stop
25:31Stay still, stay still
25:33The key is you keep taking this medication
25:36For us, keep taking a big deep breath
25:38Big deep breath
25:39Come on
25:42Stop, stop your head moving
25:44Stop your head moving
25:45You're doing super
25:46Put your leg down, Roberta
25:47Put your leg down
25:48Roberta, put your leg down
25:50Come on, come on
25:52Breathe it in
25:55The longer it takes to get Roberta's shoulder joint back into position
25:58The more chance she has of permanent nerve damage and potential corrective surgery
26:04Come on, Roberta
26:05Breathe
26:06Breathe
26:07Breathe in, come on
26:09Roberta, breathe in
26:12Stop on this, come on
26:13Stop on this, come on
26:15Stop the air
26:16Oh, that was it
26:17Ow!
26:17That's it, that's it, that's it
26:21That's it, that's it, that's it
26:22Ow!
26:23Did you see what happened?
26:24I heard it
26:25So we'll just need to get it in a sling and get another x-ray
26:29Okay
26:29And then we'll take it from there
26:32No problems
26:33No problems
26:34No problems with me
26:34Absolutely no problems
26:36There, good you are, well done
26:37Super done
26:38Proud of you, yes
26:39Yeah
26:40It's incredibly satisfying when a joint just falls into joint and you get a nice satisfying clunk
26:46We'll probably have to take it off you now
26:48You've had your fun
26:50No!
26:51I'm sorry
26:51Don't upset her
26:52I'm so sorry
26:53Don't be upset now
26:54Okay, can I have one more?
26:56One last puff, because it's really sore, isn't it?
26:59That's why you're taking it
27:00One more puff, then that's it away
27:04While Roberta's shoulder appears to be now in the correct position, there's no way of knowing without a follow-up
27:10x-ray
27:10Should I have to go back for an reaction and then I can go home?
27:13Yeah, if you're, if you're past
27:16If the joint isn't in the correct position
27:18Can you take it easy, okay?
27:20Yes, mom
27:20It could be causing further damage to her shoulder or become dislocated again
27:25It's hard, it's hard to watch your child, you know, in pain
27:30And it's, you feel sorry for her and really, really your heart goes out to them
27:34Just gotta, just gotta take it off this move
27:36That is what it is
27:41This is where our humerus was
27:42This is where we are back in joint
27:45We had to use a little bit more force than we had hoped we would
27:48But thankfully it did work
27:52The joint is perfectly back where it should be
27:55And patients are good to go home
27:57How do you feel now?
27:58You feel a lot better
27:59It just feels a wee bit like me, so pain but I can, it's there
28:02Oh, okay
28:03You'll be followed up in the fracture clinic
28:04Obviously if it, you hear a pop or it seems to go back out of place
28:08Obviously come back to any, hopefully that won't happen
28:10Okay, all right
28:11Yeah, thank you very much
28:13No worries at all
28:14There we go, let's get you home
28:32In Newham Resus, a patient who is on a fancy dress night out has arrived after collapsing at a train
28:37station
28:38This is celeste, she's 27 years old, she was on her way out tonight dressed up
28:43Um, she had passion fruit, alcohol drink, 30 minutes later she started feeling a very dry throat
28:50But then progressively got more itchy and then she felt like it started swelling
28:55Passion fruit is an allergen and can trigger a serious allergic response
29:01My throat suddenly felt like very dry and like my tongue, like my mouth area felt very dry
29:07And then I started having trouble breathing and like that freaked me out
29:11My breathing was like
29:13Like that
29:15And I couldn't, it felt like I couldn't get enough like air in
29:19They gave me the injection when I was on like the floor
29:22And I was able to kind of like sit up a bit more after that and they were able to
29:25like move me
29:26You never have passion fruit?
29:28I don't think so
29:30With adrenaline administered at the scene to combat the immediate reaction
29:33Dr. Mohamed needs to make sure celeste's breathing and heart rate are back under control
29:38So your heart will get down this time
29:42Normally if you had an adrenaline you should have six hours of monitoring
29:50Either celeste's fast pulse is because of the adrenaline she was given or the allergic reaction
29:56So she still might be in serious danger
30:02Okay, let's have a look
30:04I've got her attached to our monitoring over here typically for an allergic reaction anaphylaxis you monitor them
30:11For a period of like six hours just to see if there's lack of reaction fingers crossed
30:17It's terrifying like to to not be able to like breathe properly or like
30:22Because you start getting lightheaded and you start feeling like you're gonna like pass out or like something's really wrong
30:28And it's just it's really scary
30:32I
30:33I was like am I gonna die here on the G platform
30:42Accident and emergency good evening how can I help
30:4564 year old male with a high high bm
30:51Also in newham midwife agnes is being taken for an emergency ct scan after having severe abdominal pain while on
30:58shift
30:59Don't worry, it's a quick scan won't take too long yeah
31:03Doctors need to establish if her appendix has burst which could be deadly
31:08Keep your both hands above your head
31:11Like that get same over here there you go hold like that
31:16Like mission is gonna say breathe in and hold your breath okay
31:24Okay
31:25David is still
31:30Hold on
31:32I'm gonna sit you up now yeah
31:34You're okay
31:36As part of her scan radiographer jan has given agnes an injection of contrast to help show her appendix
31:43When patient comes we tend to say is like they feel a hot flush going through their body
31:48A metallic taste in their mouth and you might feel like you're gonna warm it yourself
31:53Can you feel the hot flush yeah it's normal don't worry don't worry
31:56The vomiting could be due to the contrast but it's also a symptom of a burst appendix
32:01You have to explain to the patients why this is happening and these symptoms so that they are aware of
32:06it and pick more karma
32:10Surgeon mr suzad has been monitoring agnes's case and reviewing her scans
32:15So we had a ct scan it showed that your appendix is normal okay so it means you don't need
32:24surgery
32:26So there was a concern whether you have some infection of your kidneys on ct scan but it's not very
32:33clear
32:34So what we'll do will give you some antibiotics right
32:41Agnes is out of danger, but her suspected infection is still extremely painful
32:48We will keep her overnight and we'll reassess in the morning with our consultant on call team and we'll discuss
32:55how to scan with our own radiologist and
32:59So that we can have some more clarity about our kidneys
33:15Oh
33:15Sorry, I've lost nothing. Oh, hi. Yeah, sorry. Can I just confirm gcs?
33:20That's a lot. Yes, please
33:2566 year old terry has come into a and e after crashing his motorbike
33:29things happen so quickly and uh i'm not exactly sure what happened but a deer came from the left-hand
33:36side
33:37and crossed my path i then hit it and uh i was away you know i was flying
33:43his daughter jessica and her partner daniel rushed into a and e when they heard about the collision
33:49do you feel dizzy or nauseous at all anymore no not really but that feels the least of my problems
33:54my head
33:55this this wrist is painful
33:59Dr eniola is treating terry after his accident he was riding a bike
34:05and a deer popped up from the view he hits the deer he fell down off the bike
34:11the ideas around the area so and they pop up from time to time
34:16deer are more common at night and early morning and headlights cause a freeze reaction making them deadly obstacles
34:24any headaches now no headaches any hand pain any foot yeah yeah this is quite painful
34:31and that too is quite painful we're trying to look out for other injuries that may be marked by
34:38the more obvious one so it could be a broken bone but there could be an abdominal um injury it
34:45could be
34:46a fracture in the chest in the ribs any head pain anywhere no no can you open your mouth bring
34:55out your tongue
34:57okay so we try to make sure that we don't miss out on any other um injuries which may be
35:03potentially
35:04life threatening
35:12some abdominal injury but doesn't look worrying because his observations are also fine but
35:18he sustained some injuries on the right wrist and on the left toe as well
35:26being reassured by terry's vital signs his abdomen is likely okay
35:30dr eniola turns his attention to potential broken bones
35:50over half of the bones in the human body are in the hands and feet combined
35:54so you're just going to bend his left knee because he wants to slap like that making them incredibly
35:59vulnerable to breaks
36:02and one more for your toes the worst case scenario if it's untreated the patient could have crippling pain
36:09chronic pain throughout the years if that area isn't treated on time yeah i won't be sleeping on that
36:39so tonight though
36:39any north for norwich medical trauma
36:43dr eniola is treating 66 year old terry who crashed his motorbike into a deer
36:51he's been x-rayed as there are suspected breaks in his hands and feet
36:55big toe yeah you can see there's a fracture and it's fractured in two places oh bloody hell
37:03i don't understand that big big milk boat boots the wrist looks fine the wrist looks fine oh my goodness
37:13even though there seems to be no breaks in terry's hand he could still have a fracture of the scaphoid
37:18a collection of small bones in his wrist it can be easy to miss things on the x-ray there
37:24are some
37:24fractures that are a bit small and subtle so physical examinations are quite important
37:31the x-ray can only show so much of course really show everything so well because of the bruising
37:38yeah i'm just expecting there may be a little bone break
37:43if dr eniola doesn't find all the fractures there's a chance he could heal in the incorrect
37:48position which could lead to chronic pain for the rest of terry's life the pain as a touch
37:53yeah it's painful yeah that appears that there's a fracture here
38:01yeah there's a fracture yeah there's a fracture okay dr eniola has spotted a scaphoid fracture not
38:07clear on the x-ray but for this where i put a strap around here yeah sure the fracture heals
38:15yeah same
38:16thing with this okay in about two to three weeks time we'll do a repeat x-ray okay so that
38:22everything
38:22is okay yeah
38:28before terry can go home his breaks will need to be given temporary orthopedic support
38:32to help them heal oh i'm a little bit surprised that i've got a slight fracture of the toe
38:40and uh this section of the thumb it could have been a lot worse so yeah i'm pretty lucky really
38:46i think and been really good service tonight i've been really looked after i can tell people have
38:52been on a skiing holiday this is your fashionable shoes doing okay considering the mechanism of the
39:02injury okay i expected them something a bit more drastic the purpose sir is to immobilize your thumb
39:09keep it still keep it still so it will reduce the swelling which is the pain recovering time for
39:17him considering his age it may be between about six weeks to ten weeks thank you much appreciate
39:26terry will need to return to the fracture clinic in the day once the hospital is completely open
39:31for permanent treatment it really could have been a lot worse so i think that he's quite a lucky chap
39:40yeah not too bad
39:51hello this was in newham 27 year old celeste is being closely monitored to see if she'll have any
39:57further potentially lethal anaphylactic reactions with the hospital needing to free up space and her
40:13condition remaining stable she's moved to an observation area
40:16i don't know where they put my phone on that
40:26you're doing all right
40:30celeste is joined by a partner ori who is with her on the way to the fancy dress party when
40:35she had a
40:35reaction and her airway started to close isn't like anaphylactic shock like can it kill you i guess
40:42depends how much other it closes you can google it it's a severe potentially life-threatening
40:48allergic reaction that requires immediate emergency treatment
40:57adjustment
40:59dr mohammed has been monitoring celeste for signs of further allergic reaction
41:05her heart rate um last time i checked it was 19 which is which is good one of the most
41:10concerning
41:10thing about anaphylaxis is your airway is closed so you've been suffocated basically but she was quite
41:18lucky the ambulance found there early what you need to know is you need to go home with epi pen
41:25okay so epi pen have um adrenaline on it if you have um symptoms that you think your your throat
41:32is
41:32closing you can't talk in full sentences you're very wheezy you're unwell you're about to collapse
41:38yeah this is a red flag that you're looking for before you're injecting yourself okay what's that
41:44epi pens are essential as 2.4 million people have food allergies in the uk and could die of fatal
41:50reactions can you swing you that's not that's real you actually have to like you swing and push it
42:00i just thought that was like i've only ever seen that like um movies and stuff like that
42:07any questions did i almost die from this like you you have a reaction okay you yeah you're lucky
42:17and the ambulance found you in the good time
42:20they were very fast they were so fast yeah yeah they saved your life basically today
42:25with no further signs of anaphylaxis and equipped with an epi pen celeste can go home
42:32taxi taxi taxi we can take the train
42:45we're happy to get you seen by a doctor but we can't have that behavior here here so
43:06you would think desiccating a shoulder wouldn't be a sword oh it's sort of and putting it back in
43:11it's going to be even shorter
43:36Have you been built out?
43:38Have you only got to the hospital?
43:53Luckily I'm retired so I don't have to go to work.
43:56I'll just do a bit more reading I suppose.
44:27I'll just do a bit more reading I suppose.
44:34I'll just do a bit more reading I suppose.
44:35I'll just do a bit more reading I suppose.
44:35I'll just do a bit more reading I suppose.
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