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00:03after dark while the nation sleeps 16-year-old male who was shot the A&E
00:09night shift begins it can be very dangerous we deal with a lot of
00:15aggressive patients things can escalate it can be quite scary when it's just you
00:22and one violent patient across the UK we join the staff of three of the most
00:27challenged emergency departments it's always busy it's always under pressure
00:31time is of the essence and the medics who face danger each shift most shifts I
00:38see more place the nurses with the amount of drugs and alcohol admissions
00:42rising have you been drinking today the risk of violence and abuse looms large
00:47every night please don't swear like that they try to attack and stuff people can
00:55become aggressive they've been punched okay they see the good bad and the ugly
01:01yeah we'll get security the emergency department is like a battlefield it's
01:05like organized chaos
01:20every night staff and patients in A&E waiting rooms across the UK are subjected to the abusive
01:26behavior of intoxicated patients it's estimated that up to 15 percent of A&E attendances are alcohol
01:34related so do you understand the reason why you're arrested we always have
01:38disruptive patients or aggression there's been times where I have felt
01:42frightened you don't know what to do in that exact moment there's nothing you
01:46can do other than hope you don't get really hurt and at weekends after dark
01:52that percentage can rocket to a massive 70 percent
01:55a gentleman who was assaulted outside of pub today high numbers coming through a lot of
02:01them obviously 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
02:55and the security team are worried about her upsetting the rest of the patients
03:14yeah she was shouting all around the place she made a few racist comments to many people in the
03:31right now
03:31and I know
03:32but I don't care about it
03:33no
03:35I mean you're gonna get a very much back to everybody.
03:38everybody else
03:40no
03:40no
03:40you don't
03:41No
03:41You're listening to me
03:42no
03:42no
03:43I know
03:44I know
03:45no
03:45I know
03:46I can live my home
03:49I can live my home
03:51I can live my home
03:51right
03:52no
03:52my
03:57The fight nearly broke out, but they've been separated and we've removed the alcohol and
04:02we have explained to her that we'll give it back to her whenever she leaves NA.
04:08The woman can only stay and be seen by a doctor if she gives up her alcohol, but she's already
04:13asking for it back.
04:15I explained, look, if you're willing to sit here and behave yourself, you know, we will
04:19see you and get seen by a doctor, but, you know, we can't tolerate that kind of behavior.
04:27So, one more chance really and then she has to be removed, okay?
04:30Are you going to get to the seen by doctor?
04:31What do I do?
04:33Right.
04:33You tell me.
04:44I'm sitting here with a shoulder hanging right here.
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.
05:03Hey, that's not a cigarette.
05:05She's already been x-rayed and given a Penthox inhaler for the pain.
05:10It's actually still not working.
05:12It's not working.
05:13It's not working.
05:14Ah!
05:15Should we get another one of those?
05:17Probably not.
05:18In the waiting room.
05:19Let me check.
05:22I need some now.
05:24I know them.
05:26The Penthox inhaler needs to be used constantly.
05:29If it runs out, the pain-killing effects wear off quickly.
05:35Please.
05:37I know them.
05:38Please.
05:39I know them.
05:40There's nothing to do.
05:41Absolutely nothing I can do.
05:42I'm sorry.
05:47It won't be long.
05:48It won't be too much longer.
05:51Are you running?
05:53Dr. Dara has been alerted that Roberta's extreme pain has returned and needs immediate attention.
05:58What we're going to do is give you some good pain relief, okay?
06:00We're going to get you nice and relaxed.
06:01Give a go putting this back in place, okay?
06:03Please.
06:04Please.
06:06Right, sweet kids.
06:07Let's go.
06:09Dr. Mike will be working with Dr. Dara and has just received the images of Roberta's shoulder.
06:15Looking at the x-ray here, this big bone, her humerus, should be within the joint here.
06:22It's quite clearly out of position, so we need to try and get that back in the joint sooner rather
06:29than later.
06:32Alright, so the next step is we're going to get Mike and he's going to get the green whistle again,
06:37okay?
06:38And we're going to try and settle you down and relax you a bit, okay?
06:41Have you checked the skull?
06:43Is it okay?
06:43So just showing your shoulder's 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?
06:55And you see the most important thing is to see if you can keep really relaxed.
06:57After you're in a lot of 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.
07:03Okay, just take some deep breaths, okay?
07:05I'm going to try and make it easier to calm, alright?
07:08There'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.
07:19Roberta fell over four hours ago.
07:21If the shoulder is not put back into position soon,
07:24there's a risk of permanent nerve damage and ongoing severe pain.
07:49Police are an almost permanent fixture in A&Es up and down the UK.
07:55I do not have an issue ringing 999 to try and get police.
07:59And I estimate my concerns that I have staff to look out for,
08:02I have myself to look out for,
08:03and I have other vulnerable patients to look out for as well.
08:10Officers spend an estimated 800,000 hours in the department every year.
08:15Just stay nice and calm. Thank you.
08:17I think an ED often feels like a bit of a police station.
08:21Normally in resus, it is quite chaotic anyway.
08:23Add police, add nurses, add radiologists, add all of this into the mix,
08:28and, yeah, it does get quite chocker.
08:30What points are you reading, mate?
08:37What points are you reading, mate?
08:39Come here, ****.
08:40I'm here, so I can make out all your needs.
08:43In Belfast, Deputy Sister Rebecca
08:46has given a drunken, disruptive patient
08:48one more chance to behave before she's removed.
08:52Please, what can you do, that brain?
08:54I do love my job, but, like, there's easier ways to make money.
08:58I'm just like, what am I doing with my life?
08:59But, you know, it doesn't really kind of limit to just the weekends anymore.
09:05It's all of the time, really.
09:07Monday to Sunday.
09:08Every night of the week is just the same.
09:10Alcohol, drugs, and then...
09:12Oh, there's something happening out here.
09:18Sorry, excuse me.
09:23Right.
09:24We'll move you out.
09:26No, that's okay.
09:27It's not roomy, no.
09:28Sorry.
09:29Sweetheart, we can't have you getting involved, please.
09:32I want your name.
09:33I want your name.
09:33I want your name.
09:34I want everybody's name.
09:36I came here with a gentleman, and you took me in a sack of glass.
09:40Gee, sweetheart, we need to get you to leave.
09:42No, no, no.
09:43I want names.
09:45You do?
09:45See what you're saying to me?
09:47It's disgusting.
09:48Well, you're standing in the waiting room
09:49with a thrift and other people.
09:50There's a full waiting room here of people who are afraid.
09:53Don't bring me!
09:54Right, come on.
09:55Let's talk outside.
09:57Patients who are being fairly aggressive, we'll have to approach them in a calm manner,
10:02explaining to them why they can't behave like that.
10:04You know, it is obviously putting other patients at risk, scaring the staff.
10:08Listen, there's been times where I have felt a bit frightened.
10:12Recently, I was assaulted.
10:14You don't know what to do in that exact moment.
10:16It is quite frightening.
10:18You're being very, firmly aggressive to everybody in this waiting room, okay?
10:21You're frightened of their patients.
10:22You're lying.
10:23Right, we can't have that in this department.
10:25Do you treat me like I'm a sack of glass citizen?
10:28No.
10:28And I don't like it.
10:29We're not.
10:30We treat everybody here the same, okay?
10:32We're not going to be able to let you back in whenever you're behaving like this, okay?
10:35I don't give a .
10:37That's fine.
10:39You don't want that?
10:40That's okay.
10:40Right?
10:41Yeah, that's okay.
10:42But do my thing.
10:44Right, we're going around in circles here.
10:45She's not really looking to listen to what I have to say.
10:48Right, he's happy enough to support art.
10:50Yeah.
10:55The intoxicated woman will have to leave the hospital untreated due to her behaviour.
11:02I always like to give people a chance.
11:04However, there is a line and you can't cross it.
11:07We just can't allow that kind of behaviour.
11:09You know, patients are leaving our department to go home because they can't bear to watch
11:14what's going on anymore.
11:15They feel threatened.
11:16They feel unsafe.
11:17So therefore they leave.
11:19These are normally the people who actually need to be there and treated for something
11:23really wrong and then they go home and deteriorate, which is not ideal at all.
11:47I want to be wrong.
11:51A midwife has been taken seriously ill in the hospital at the end of her evening shift.
11:56So she had some right iliar fossa pain this morning with a bit of vomiting in the past
12:00hour.
12:00She's now 10 out of 10 pain in the right iliar fossa.
12:04We've done the bloods but they're not back yet.
12:07Dr Karl is trying to help 33 year old Agnes who has had extreme stomach pain for over 12
12:12hours.
12:13I think there is a mentality of still coming to work even when you're feeling unwell within
12:17the NHS.
12:19Unfortunately, you push yourself too hard and then you end up here.
12:23Obviously, you're in a lot of pain when you came in and the first things we did is we
12:26just got some blood tests from you, okay, and we're giving you some fluids and some
12:31painkillers as well.
12:32I've already spoken to the radiologist to get you a scan.
12:35So we're going to scan your tummy and down into a pelvis.
12:39I'm a bit worried that your appendix might either burst or be very, very angry at the moment.
12:46Introvenous 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 can get some pain.
13:02I realised I couldn't.
13:04Then my colleagues put me here.
13:06I've not experienced this kind of pain before.
13:11My biggest concern for Agnes right now is that she might have a ruptured appendix.
13:15But we can't rule out other causes.
13:18And in young females, you always need to think about things like ectopic pregnancies
13:22or ovarian torsion or ruptured ovarian cysts.
13:26So the next step is to wait for the blood to come back and to get her into the CT
13:29scanner
13:30to see if we can find what's going on and to see whether or not it's the appendix
13:33that's causing this problem.
13:35The longer it takes to diagnose the source of Agnes' pain,
13:38the higher the risk of life-threatening complications like peritonitis and sepsis.
13:45How bad is the pain out of 10, however you grade it?
13:49It's 9 or 10.
13:51Okay.
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?
14:11Yeah.
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.
14:23On 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 operate on her.
14:34With surgeon Mr. Shahzad unsure, a CT scan may be the only way to know if Agnes' appendix or an
14:41ovarian cyst has ruptured and her life is in jeopardy.
14:44How was this if you were in 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 and intoxicated.
15:07I'll assess it when it arrives.
15:11In Newham recess, a man is arriving who fell while intoxicated, causing a head wound.
15:16You can come to this bed.
15:18Well done.
15:19He was found unresponsive.
15:21Members of the public tried to wake him.
15:23So he's got a laceration, bumped to his head there.
15:27Clearly happened with his hat on.
15:28He's still got a bit of blood in there.
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,
15:45sustaining a head injury, and that was after being intoxicated again.
15:49OK.
15:51Do 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?
16:02Do you think you might have had a few drinks?
16:07Yeah.
16:07Yeah?
16:08How much would you drink normally?
16:09What do you think you might have drunk today?
16:11One.
16:11Just one?
16:13Yeah.
16:14One beer.
16:15OK.
16:16All right.
16:16Nothing else?
16:18No.
16:18You got any pain anywhere?
16:21No.
16:22No pain?
16:23No.
16:24Normal.
16:26All right.
16:26Because 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?
16:39You don't remember?
16:40OK.
16:44So there's a problem with the housing?
16:46Yes.
16:47OK.
16:49So he'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.
17:16We're going to get a scan of your head to make sure everything is OK.
17:19All right?
17:22With the patient under the influence of alcohol,
17:24Dr Sarah requests a CT scan to make sure his behaviour isn't related to a brain injury.
17:29So we're going to clean up your head a bit.
17:31All right?
17:32We're going to come back and see you after you've had your scan.
17:35OK?
17:36OK.
17:36OK?
17:49All right.
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 shoulder
17:59back into its socket.
18:02Please, give me something.
18:05Come on, Mom.
18:05I think we could 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 onto
18:19the 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.
18:34Sorry.
18:35We'll go slow.
18:36We'll go at your pace.
18:37But the quicker you get on the gear, the quicker you can have that pain relief.
18:40OK?
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.
18:53Ow, ow, ow, ow, ow, ow, ow.
18:54The fingers don't touch her head.
18:56Give me sure of that.
18:57Give me sure of that.
18:58I can't, I can't let go of it.
18:59I can't let go of it.
19:00Right, I'll hold you here.
19:02Take your feet off this.
19:03Take your feet down.
19:04Right?
19:04Put your feet in the ground.
19:06Right?
19:06And we're going to do it.
19:07One, two, three, stand up.
19:08Stand up.
19:09Stand up.
19:09That's it.
19:10That's it.
19:10That's it.
19:10You're up.
19:11Pull it away.
19:12Pull it away.
19:13Stop, stop, stop.
19:14Nobody's.
19:14You're putting it in your face.
19:17That's what she's.
19:18Great.
19:18There you go.
19:19Back on it.
19:20Just like the car.
19:22All right.
19:23It's okay.
19:24It's okay.
19:25It's okay.
19:25You're okay.
19:26Right?
19:27Nice.
19:27You can lie back.
19:28I'll take your legs.
19:29Come on.
19:29I can't lie.
19:30You'll be okay.
19:31You'll be fine.
19:32Come on.
19:33Keep going.
19:36Now in position, she can be prepped for the arm to be manipulated into its socket.
19:41But this will be even more painful.
19:44Do you think you can release this hand because it's best that you're in control of this?
19:48No.
19:48I could use my teeth.
19:50That's what I've done before.
19:51She did.
19:51After a couple of breaths the first time, she had it in her hand.
19:54She was.
19:55It was like she was smoking it.
19:56After about two or three puffs, she was fine.
19:58The Penthox inhaler is a fast-acting pain medication that can be self-administered.
20:04Nice big deep breaths first.
20:06And we'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
20:27in high force and are keeping it now out of socket because the pain is causing the patient
20:32to be so tense.
20:35Where's the sleep on your one?
20:38Better when do you lick it.
20:42I'm going to lie a little bit flatter and keep taking a nice bit deep breaths.
20:46Keep taking that, Robert.
20:47Keep taking that.
20:48Robert, keep taking that.
20:49Keep taking the muscle.
20:50Robert needs consistent pain relief to ensure her muscles are as relaxed as possible.
20:55Keep puffing.
20:56Keep going.
20:57Keep sucking the muscle.
20:58Keep going.
21:00Big deep breaths.
21:02Come on.
21:03Big breath.
21:04Even 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.
21:11Big breath.
21:13Stop.
21:14You're okay.
21:15You're okay.
21:15You should relax right there.
21:17Ow.
21:19Ow.
21:20Come on.
21:20It's going in.
21:21That's it.
21:21Good girl.
21:22Well done.
21:23Keep going.
21:25Roberta's arm has been out of its socket for four hours, and the shoulder muscles have
21:29become incredibly tense.
21:31Keep breathing, love.
21:34Keep breathing.
21:35All right.
21:36Big deep breaths.
21:37Where the joint has been out for longer can be sometimes a bit trickier, and often that's
21:41because the muscle has maybe gone into spasm, and 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?
21:51We're nearly there.
21:51We're nearly there.
21:51Just another wee bit, love.
21:53You'll be okay.
21:53Hold on to me.
21:56Ow!
21:57We're still up, baby.
21:58I've got one.
22:10He was collapsed and was in cardiac arrest.
22:14Over two and a half million people attend A&E at night every year, which is particularly
22:23challenging for the reduced night shift staff.
22:26Yeah, we'll get security.
22:38How are you doing, Donny?
22:39How are you feeling?
22:40An intoxicated patient has just returned from the CT scanner after being found unresponsive
22:46on the floor with a gash on his head.
22:48We got the CT result.
22:50It was okay, all right?
22:52We did a CT of your head.
22:54Do you remember?
22:56No, you don't remember?
22:57We 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
23:10all right?
23:11It's really unfortunate that it's a bit of a downward spiral, isn't it, that you're
23:14having 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.
23:24Yeah.
23:24I'm going to take you to a room there and clean the wounds, okay?
23:28Is that all right?
23:34We need to keep him safe, and so we're going to keep him in the department really until
23:38he's sober enough to go home safely, because at the minute he's not really remembering
23:41everything that's going on and things, so we just want to keep him safe here for,
23:45probably 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.
23:59That's a real bit of a gap, really, that we're just doing a bit of patching up,
24:02and 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
24:30socket.
24:31Sit back.
24:32At you.
24:33Good girl.
24:34Despite being medicated with strong pain relief,
24:38the muscles in her shoulder remain tight, making it incredibly hard to move the bones into
24:43the correct position.
24:44Sometimes, when reductions are particularly tricky, then we have to apply counter traction.
24:49If you just apply traction horizontally.
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 into joint.
25:05Ow!
25:06Stay still, stay still.
25:07That's when you're getting into brute force territory.
25:09Ow!
25:10You don't usually want that.
25:11You want them relaxed.
25:12Ow!
25:13I'm dying!
25:14Come 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.
25:24Come on, breathe.
25:24But they're fighting against extremely strong, tense muscles in the shoulder.
25:29Ow!
25:29Help!
25:30Stop!
25:30Everyone stop!
25:32Stay still, stay still.
25:33The key is you keep taking this medication for us.
25:37Keep taking all the big deep breaths.
25:38Big deep breaths.
25:39I'm going to swap sides.
25:40Come on.
25:41Hey, come on.
25:43Stop.
25:43Stop your head moving.
25:44Stop your head moving.
25:45You're doing super.
25:46Put your leg down, Roberta.
25:47Put your leg down.
25:49Roberta, put your leg down.
25:50Come on.
25:51Come on.
25:52Try and get us relaxed.
25:53Breathe it in.
25:55The longer it takes to get Roberta's shoulder joint back into position, the more chance she
26:00has of permanent nerve damage and potential corrective surgery.
26:04Come on.
26:05Roberta.
26:06Oh!
26:07Breathe in.
26:08Come on.
26:09Roberta, breathe in.
26:11Breathe.
26:12Stop on this.
26:13Come on.
26:16Oh!
26:17That's it.
26:18That's it.
26:20That's it.
26:21That's it.
26:21That's it.
26:22That's it.
26:22That's it.
26:23That popped.
26:24You see the problem?
26:24I heard it.
26:25So we'll just need to get it in a sling and get another x-ray.
26:29Yeah.
26:29Okay.
26:30And then we'll take it from there.
26:32No problem.
26:33No problem.
26:34No problem for me.
26:35Absolutely no problem.
26:36There.
26:36Good you are.
26:37Well done.
26:38Proud of you.
26:39Yes.
26:40It's incredibly satisfying when a joint just falls into a joint and you get a nice satisfying
26:46clunk.
26:47We'll probably have to take that off, you know.
26:48You've had your fun.
26:50Sorry.
26:51Don't upset her.
26:52I'm so sorry.
26:54Don't be upset now.
26:55Okay.
26:55Can I have one more?
26:57One last puff, because it's really sore, isn't it?
26:59One more puff, then that's it away.
27:04Yeah.
27:05While Roberta's shoulder appears to be now in the correct position, there's no way of knowing
27:09without a follow-up x-ray.
27:10Should I have to go back for an reaction and then I can go home?
27:13Yeah.
27:13Yeah, if you're, if you're past.
27:16If the joint isn't in the correct position.
27:19Can 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.
27:28Um, and it's, you feel sorry for her and really, really, your heart goes out to them.
27:34Just gotta, you 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.
27:44We had to use a little bit more force than we had hoped we would, but thankfully it did work.
27:51The joint is perfectly back where it should be and patients are good to go home.
27:57How do you feel now?
27:58Do you feel a lot better?
27:59It just feels a wee bit like my sole pain, but I can, it's there now.
28:02Okay.
28:03You'll be followed up in the fracture clinic.
28:05Obviously if it, you hear a pop or it seems to go back out of place, obviously come back to
28:09any.
28:09Hopefully that won't happen.
28:10Okay.
28:11Alright.
28:11Yeah, thank you very much.
28:13No worries at all.
28:14There we go.
28:14Let's get you home.
28:27Good evening.
28:28Hello.
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.
28:39She's 27 years old.
28:41She was on her way out tonight dressed up.
28:44She had a passion fruit alcoholic drink.
28:4713 minutes later she started feeling a very dry throat, but then progressively got more itchy and then she felt
28:52like 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, like 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 set up a bit more after that and they were able to
29:25like move me.
29:26Do you never have questions?
29:28I don't think so.
29:30With adrenaline administered at the scene to combat the immediate reaction, Dr. Muhammad needs to make sure Celeste's breathing and
29:36heart 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.
29:55So she still might be in serious danger.
30:02Okay, let's have a look.
30:04Got her attached to our monitoring over here.
30:07Typically for an allergic reaction, anaphylaxis, you monitor them for a period of like six hours just to see if
30:13there's lack of reaction.
30:14Fingers crossed.
30:17It's terrifying like to not be able to like breathe properly or like, because you start getting lightheaded and you
30:24start feeling like you're going to like pass out or like something's really wrong.
30:28And it's just, it's really scary.
30:32I was like, am I going to die here on the G platform?
30:43Accident and emergency.
30:44Good evening.
30:44How can I help?
30:4564 year old male with a high, high VM.
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.
31:00It's a quick scan.
31:01Won't take too long.
31:02Yeah?
31:04Doctors need to establish if her appendix has burst, which could be deadly.
31:08Keep your both hands above your head.
31:11Like that.
31:12Get the same over here.
31:14There you go.
31:14Hold like that.
31:16Like the mission is going to say, breathe in and hold your breath.
31:19Okay?
31:24Okay, ready still?
31:30Hold on.
31:32I'm going to sit you up now, yeah?
31:35You'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 it's like, they feel a hot flush going through their body, a metallic
31:49taste in their mouth, and you might feel like you're going to vomit yourself.
31:53Can you feel the hot flush?
31:55Yeah, it's normal.
31:56Don't worry.
31:56Don't worry.
31:57The 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.
32:09Surgeon Mr. Shuzad has been monitoring Agnes' case and reviewing her scans.
32:15So, we had a CT scan.
32:19It showed that your appendix is normal.
32:22Okay?
32:23So, it means you don't need surgery.
32:26So, there was a concern whether you have some infection of your kidneys on CT scan.
32:32But it's not very clear.
32:34So, what we'll do, we'll give you some antibiotics at night.
32:41Agnes is out of danger, but her suspected infection is still extremely painful.
32:48We will keep her overnight and we'll reassess us in the morning with our consultant on call team.
32:54And we'll discuss her scan with our own radiologist and so that we can have some more clarity about our
33:03kidneys.
33:15Sorry, I've lost you, I think.
33:17Oh, hiya, sorry. Can I just confirm GCS?
33:20That's all right.
33:21Yes, please.
33:2566-year-old Terry has come into A&E after crashing his motorbike.
33:29Things happen so quickly and I'm not exactly sure what happened.
33:34But a deer came from the left-hand side and crossed my path.
33:38I then hit it and I was away, you know, I was flying.
33:44His daughter Jessica and her partner Daniel rushed into A&E when they heard about the collision.
33:49Do you feel dizzy or nauseous at all anymore?
33:51No, not really, but that feels the least of my problems, my head.
33:55This, this wrist is painful.
33:59Dr. Eniola is treating Terry after his accident.
34:03He was riding a bike and a deer popped up from the view.
34:08He hits the deer, he fell down off the bike.
34:11There are deers around the area, so, and they pop up from time to time.
34:16Deer are more common at night and early morning
34:19and headlights cause a freeze reaction, making them deadly obstacles.
34:24Any headaches now?
34:26No.
34:26No headaches.
34:27Any hand pain, any foot pain?
34:29Yeah, yeah, this is quite painful.
34:31Okay.
34:31And that too is quite painful.
34:34We're trying to look out for other injuries that may be marked by the more obvious one.
34:40So it could be a broken bone, but there could be an abdominal injury.
34:45It could be a fracture in the chest, in the ribs.
34:49Any head pain, anywhere?
34:51No.
34:52Not the tongue?
34:52No.
34:53Can you open your mouth?
34:55Bring out your tongue.
34:57Okay.
34:58So we try to make sure that we don't miss out on any other M injuries,
35:03which may be potentially life-threatening.
35:08In.
35:10Okay, relax.
35:12Some abdominal injury, but it doesn't look worrying because his observations are also fine.
35:18But he 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.
35:34So if I can just get you to face that wall there, and then you rub up your back seat.
35:40Like that?
35:40You're fine.
35:41That's it, perfect.
35:46Okay, are your bones still there?
35:50Over half of the bones in the human body are in the hands and feet combined.
35:55So you're just going to bend his leg, because you want them to sort of slap like that.
35:58Making them incredibly vulnerable to breaks.
36:02And one more for your toes.
36:05The worst case scenario, if it's untreated, the patient could have crippling pain, chronic pain,
36:11throughout the years, if that area isn't treated on time.
36:17Yeah, I won't be sleeping on that side tonight, though.
36:20Oof.
36:39Any, North, Norwich, medical trauma.
36:43Dr. Eniola is treating 66 year old Terry
36:46who crashed his motorbike into a deer.
36:51he's been x-rayed as there are suspected breaks in his hands and feet big toe yeah
36:57can see there's a fracture and it's fractured in two places oh bloody hell
37:03i understand that big milk with both boots looks fine the wrist looks fine oh my goodness even
37:13though there seems to be no breaks in terry's hand he could still have a fracture of the scaphoid a
37:18collection of small bones in his wrist it can be easy to miss things on the x-ray there are
37:24some
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
37:38here i'm suspecting there may be a little bone break if dr eniola doesn't find all the fractures
37:46there's a chance he could heal in the incorrect position which could lead to chronic pain for
37:50the rest of terry's life the pain has a touch 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
38:07not clear on the x-ray but for this where i put a strap around here yeah sure the fracture
38:14heals yeah
38:15same thing with this okay in about two to three weeks time we'll do a repeat x-ray okay that
38:22everything is okay yeah
38:27before 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 a slight fracture of the two
38:40and uh this section of the thumb it could have been a lot worse so yeah i'm pretty lucky really
38:46i
38:46think and been really good service tonight i've been really looked after i can tell people i've been on
38:53a skiing holiday this is your fashionable shoes
38:59it's doing okay considering the mechanism of the injury okay i expected something a bit more
39:05drastic the purpose sir is to immobilize your thumb keep it still keep it still so it will reduce the
39:13swelling reduce the pain uh recovering time for him considering his age it may be between about six
39:21weeks to ten weeks thank you thank you much pretty jacket terry will need to return to the fracture
39:28clinic in the day once the hospital is completely open for permanent treatment
39:34it's really could have been a lot worse so i think that he's quite a lucky chap yeah not too
39:41bad
39:50hello this was in newham 27 year old celeste is being closely monitored
39:56to see if she'll have any further potentially lethal anaphylactic reactions
40:10with the hospital needing to free up space and her condition remaining stable she's moved to an
40:23observation area celeste is joined by a partner ori who is with her on the way to the fancy dress
40:34party when she had a reaction and her airway started to close isn't like anaphylactic shock
40:40like can't kill you i guess depends how much her throat closes you can google it it's a severe
40:46potentially life-threatening allergic reaction that requires immediate emergency treatment
40:59dr mohammed has been monitoring celeste for signs of further allergic reaction
41:05her heart rate last time i checked it was 19 which is which is good one of the most concerning
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
41:24okay so
41:25epi pen have um adrenaline on it if you have symptoms that you think your your throat is closing
41:33you can't talk in false sentences you're very wheezy you're unwell you're about to collapse yeah this
41:39is the red flag that you're looking for before you're injecting yourself okay with that epi pens are
41:45essential as 2.4 million people have food allergies in the uk and could die of fatal reactions can you
41:52swing
41:56that's not that's real you actually have to like you swing and push it well that was like i've only
42:03ever seen that like um movies and stuff like that any questions did i almost die from this like
42:11you you have reaction okay you yeah you're lucky um and the ambulance found you in a 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
42:30taxi taxi 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
42:54you
42:55you would think desiccating a shoulder wouldn't be a sore oh it's sore love
43:10and they're putting it back again it's going to be even shorter
43:36have you been built out have you only got to the hospital
43:42have you been able to go to work i'll just do a bit more reading i suppose
44:16so
44:22so
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