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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:10It can be very dangerous.
00:13We deal with a lot of aggressive patients.
00:17Things 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 them.
00:50They try to attack and stuff.
00:52Calm yourself down.
00:54People can become aggressive.
00:57You've been punched, kicked.
00:59You see the good, bad and the ugly?
01:01I am done.
01:02Yeah, we'll get security.
01:03The emergency department is like a battlefield.
01:05It's like organised chaos.
01:20Every night, staff and patients in A&E waiting rooms across the UK are subjected to the abusive behaviour of
01:26intoxicated patients.
01:30It's estimated that up to 15% of A&E attendances are alcohol related.
01:35Do you understand the reason why you're arrested?
01:37We always have disruptive patients or aggression.
01:40There's been times where I have felt frightened.
01:43You don't know what to do in that exact moment.
01:45There's nothing you can do other than hope you don't get really hurt.
01:49Can I already get out of this cubicle?
01:50And at weekends after dark, that percentage can rocket to a massive 70%.
01:55There's a gentleman who was assaulted outside of pub today.
01:59High numbers coming through.
02:01A lot of them obviously under the influence of drugs, alcohol.
02:03Every 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.
02:27I've been born and raised in this country and I can't get triggered.
02:33You're a lot drunker when you first came in to me, you are.
02:36Now you're allowed as well.
02:37We can give up.
02:39We can give up.
02:40This is crazy.
02:41No.
02:43You can have it back afterwards.
02:45I'm not drinking it anyway.
02:48That's mine.
02:50With the woman clearly under the influence of alcohol,
02:53Deputy Sister Rebecca and the security team are worried about her upsetting the rest of the patients.
02:59What can we get treated?
03:00What we're dealing with?
03:01Can we alcohol or anything?
03:02No.
03:03No.
03:03What the f***ing call?
03:05This is disgusting.
03:07This is disgusting.
03:09Could you use your...
03:10No.
03:13Yes.
03:13No.
03:14Yes.
03:15She was shouting all around the place.
03:17She made a few racist comments to many people in the waiting room
03:21and was very loud and aggressive about it.
03:25This is absolutely f***ing.
03:30No.
03:31Do you know what?
03:31Give me a favor.
03:32Have a better respect.
03:34You're the f***ing father.
03:35I mean, you get a better respect for everybody else.
03:40No.
03:40No.
03:42No.
03:44No.
03:44No.
03:45No.
03:45What did you say?
03:46I didn't let my hand.
03:47What did you say?
03:50I didn't let my hand, right?
03:53Oh, no, no, it's f***ing mother.
03:54Bye, bye, bye, what are you putting in?
03:57The fight nearly broke out, but they've been separated.
04:00We've removed the alcohol, and we have explained to her that we'll give it back to her whenever
04:06she leaves NA.
04:08the woman can only stay and be seen by a doctor if she gives up her alcohol but
04:13she's already asking for it back explained like if you're willing to sit
04:17here and behave yourself you know we will see you and be seen by a doctor but you
04:21know we can't tolerate that so um one more chance really and it's just to be removed okay
04:50also in Belfast 21 year old Roberta has been rushed in by her father and sister
04:55after a high-impact fall at home no slow slow deep breaths they said hey that's not a
05:04cigarette she's already been x-rayed and given a penthrox inhaler for the pain
05:10it's not working ah could we get another one of those probably not in the waiting room but let me
05:19check and it's annoying the penthrox inhaler needs to be used constantly if it runs out
05:30the pain-killing effects wear off quickly
05:52Dr. Dara has been alerted that Roberta's extreme pain has returned and needs immediate attention what we're gonna do is
05:59give you some good pain relief okay okay we're gonna get you nice and relaxed
06:01let's give a go putting this back in place okay please 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
06:15looking 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
06:32oh all right next step is we're gonna get Mike and he's gonna get the the green whistle again okay
06:37I'm gonna try and settle you down and relax you a bit okay
06:41have you checked the skull is it okay so just showing your shoulders dislocated okay so the the ball of
06:48the of the of the humerus bone has just popped out okay so what we're gonna do is
06:53just try and put it back in place okay and you see the most important thing is
06:56see if you can keep really relaxed after you're in a lot of pain then we're gonna
06:58try and relax you but the more relaxed you are the easier it is for us to do
07:02yeah okay just take some deep breaths okay I'm gonna try and make it easy to calm all right
07:07oh there's a lot of ligaments in that joint that are being stretched and in the
07:12wrong position the longer the joint is out of socket the longer and it is very very
07:17painful ah Roberta fell over four hours ago if the shoulder is not put back into
07:23position soon there's a risk of permanent nerve damage and ongoing severe pain
07:49police are an almost permanent fixture in A&E's up and down the UK I do not have an issue
07:56ringing 999 to try to get police
07:58and ask that in my concerns that I have staff to look out for I help myself to
08:03look out for and I have other vulnerable patients to look out for as well
08:10officers spend an estimated 800,000 hours in the department every year
08:14just stay nice and calm thank you I think an ED often feels like a bit of a police station
08:20normally in resus it is quite chaotic anyway add police add nurses add radiologists add all of
08:27this into this into the mix and yeah it does get quite chocker
08:43in Belfast deputy 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 was just like what am I
08:58doing with my life but no it doesn't really kind of limit to just the weekends anymore it's all of
09:06the time really Monday to Sunday every night of the week it's just
09:10the same alcohol drugs and then oh there's something happening out here
09:18sorry excuse me
09:23right
09:23we'll move you out
09:26no
09:26that's ok
09:28sorry
09:29sweetheart we can't have you getting involved with it
09:32I want your name I want your name
09:33right
09:34I want your British name
09:35I came here for treatment and you took me in the second class
09:40sweetheart we need to get you to leave
09:42no
09:42no
09:42no
09:43I want names
09:44you do
09:45do you know what you're saying to me
09:46it's disgusting
09:48well you're standing in the waiting room distressing other people there's a full waiting room here of people who are
09:52afraid
09:53what about me
09:54right come on let's talk outside
09:56no
09:57patients who are being fairly 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 staff
10:09there's been times where I have felt a bit frightened recently I was assaulted
10:14you don't know what to do in that exact moment that is quite frightening
10:18you're being very firmly aggressive to everybody in this waiting room okay you're frightened
10:21ah you're lying
10:23right we can't have that in this department
10:25he's treating me like I'm a second bastard
10:27no
10:28and I don't like it
10:29we're not we're treating everybody here the same okay
10:31we're not going to be able to let you back in whenever you're behaving like this
10:35ok
10:36will you give me your name
10:37that's fine
10:38I'm going to hold your name
10:39you don't want that's okay
10:40right
10:41yeah that's okay
10:42but do my thing
10:43right we're going around circles here
10:45she's not really looking to listen to what I have to say
10:47right he's happy enough to support art
10:50yeah
10:50thank you
10:55the intoxicated woman will have to leave the hospital untreated due to her behaviour
11:02I always like to give people a chance however there is a line and you can't cross it
11:07we just can't allow that kind of behaviour you know patients are leaving our department
11:11to go home because they can't bear to watch what's going on anymore they feel threatened
11:16they feel unsafe so therefore they leave these are normally the people who actually need to be there
11:21and treated for something really wrong and then they go home and deteriorate which is not ideal at all
11:27I'm sorry
11:28I'm sorry
11:28I'm sorry
11:40BESSING
11:48In Newham Anne
11:49A midwife has been taken seriously ill in the hospital at the end of her evening shift
11:55And since she had some right iliar fossa pain this morning with a bit of vomiting in the past hour,
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 hours.
12:13I think there is a mentality of still coming to work even when you're feeling unwell within the NHS.
12:19Unfortunately, push yourself too hard and then you end up here.
12:23Obviously, you're in a lot of pain when you came in.
12:25And the first things we did is we just got some blood tests from you, OK?
12:29And we're giving you some fluids and some painkillers 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 pelvis.
12:38I'm a bit worried that your appendix might either burst or be very, very angry at the moment.
12:47Intravenous morphine has reduced Agnes' pain, but her condition could be deadly.
12:51If her appendix has burst.
12:56I thought I could manage my shift and then go home so that I could get some pinkness, but I
13:02realised I couldn't.
13:04And then my colleagues put me here.
13:06I've not experienced this kind of thing before.
13:11My biggest concern for Agnes right now is that she might have a ruptured appendix, but we can't rule out
13:17other causes.
13:18And in young females, you always need to think about things like ectopic pregnancies or ovarian torsion or ruptured ovarian
13:25cysts.
13:25So the next step is to wait for the blood to come back and to get her into the CT
13:29scanner to see if we can find what's going on and to see whether or not it's the appendix that's
13:33causing this problem.
13:35The longer it takes to diagnose the source of Agnes' pain, the higher the risk of life-threatening complications like
13:42peritonitis and sepsis.
13:56Surgeon Mr. Shahzad has come to assess Agnes before her scan, as she may require surgery.
14:08Surgeon Mr. Shahzad has come to assess Agnes' pain, as she may require surgery.
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 or an
14:41ovarian cyst has ruptured and her life is in jeopardy.
14:45I was in CPAP 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 little laceration 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, sustaining a head
15:46injury, 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?
16:03Do you think you might have had a few drinks?
16:07Yeah?
16:07How much would you drink normally?
16:09What do you think you might have drank today?
16:11Just one?
16:14One beer.
16:15OK.
16:16All right.
16:16Nothing else?
16:18No.
16:18You got any pain anywhere?
16:22No pain?
16:23No.
16:25Normal.
16:25All 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?
16:37You speak to me?
16:38I may not remember.
16:39You don't remember?
16:40OK.
16:41Housing.
16:42No pain by me.
16:44I'm here.
16:44So there's a problem with the housing?
16:46Yes.
16:47OK.
16:49He's drunk quite a lot tonight.
16:50He's already explained that he's having some trouble paying his rent for next month and now
16:55he's also telling my colleague that he's also been fired from work so it starts to make sense
17:01why he's here in the middle of the night very heavily intoxicated and 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?
17:20Yeah.
17:21Yeah, all right.
17:22With the patient under the influence of alcohol, Dr Sarah requests a CT scan to make sure his behaviour isn't
17:28related to a brain injury.
17:29So we're going to clean up your head a bit, all right?
17:33We're going to come back and see you after you've had your scan, OK?
17:36OK.
17:36OK?
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 back into
18:00its socket.
18:02Please, give me something.
18:05I think we could maybe get you onto this bed.
18:07No, I need something, please.
18:09Did you have any pain relief before?
18:11Is this just an absolute agony?
18:13The 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.
18:21No, I mean, no, 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 it when she's on the bed.
18:35We'll go slow, we'll go at your pace, but the quicker you get on here, the quicker you can have
18:39that pain relief, OK?
18:40Listen to me, listen 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!
18:58I can't let go of it.
18:59I can't let go of it.
19:00Right, I'll hold you here.
19:01I can't let go of it.
19:02Take your feet off this.
19:03Take your feet down.
19:04Right, put your feet on the ground.
19:06Right, and we'll do it with another one.
19:07One, two, three, stand up.
19:08Stand up, stand up, that's it, that's it, that's it.
19:10You're up.
19:11You're up.
19:11Pull it away, pull it away.
19:12Stop, stop, stop, you're putting in a different place.
19:17That's what she's, great, there you go.
19:18There you go.
19:19Back on it, just like the car.
19:22All right.
19:23It's OK, you're OK.
19:25You're OK.
19:26Right?
19:27All right.
19:27See me and lie back.
19:28I'll take your legs, come on.
19:29I can't lie back.
19:30You'll be OK, you'll be fine.
19:32Come on, keep going.
19:36Now in position, she can be prepped for the arm to be manipulated into its socket,
19:40but 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, no, no, no.
19:49I can use my teeth, as I've done before.
19:51She did, after a couple of breaths the first time, she had it in her hand, but she was...
19:55It was like she was smoking it.
19:56After about two or three puffs, she was fine.
19:59The Penthox inhaler is a fast-acting pain medication that can be self-administered.
20:03Nice, 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
20:27and high force, and are keeping it now out of socket, because the pain is causing the patient to be
20:32so tense.
20:35We're just going to sleep on you one, but I wouldn't do you like it.
20:42I'm going to lie a little bit flatter, and keep taking nice, big deep breaths.
20:46Keep taking that, Roberta.
20:47Keep taking that.
20:47Keep taking that.
20:48Roberta, keep taking it, love.
20:49Keep taking the muscle.
20:51Roberta needs consistent pain relief to ensure her muscles are as relaxed as possible.
20:55Keep puffing.
20:56You.
20:57Keep sucking on the muscle, love.
20:59Keep going.
21:00Keep going.
21:00Big deep breaths, Roberta.
21:01Ah!
21:03Come on, big breath.
21:04Even with the inhaler working, it will only dull the pain, so the doctors need to work
21:08quickly to slip the arm back into position.
21:11Big breath.
21:11Ah!
21:13Stop!
21:14You're OK.
21:15You're OK.
21:15You're OK.
21:17Ow!
21:17Ow!
21:18Ow!
21:20Come on, it's going in.
21:21That's it, girl.
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.
21:33Ah!
21:34Keep going.
21:36Big deep breath.
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, OK?
21:50Nearly there.
21:51Just another wee bit, love.
21:53You'll be OK.
21:53Hold on to me.
21:56Ow!
21:58One, 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.
22:18Try not to go.
22:19Try not to go.
22:20Try not to go.
22:20Let me go.
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, Donning?
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.
22:47We got the CT result.
22:50It was OK.
22:51All right?
22:52We did a CT of your head.
22:54Do you remember?
22:56No?
22:57You 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.
23:05Yes.
23:06Can you just turn over so I can see your head again, just to see if we cleaned it up
23:10all
23:10right?
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
23:18and round.
23:18We can step him out, and then I think we just keep him somewhere until he's awake enough
23:23to go home.
23:24I'm going to take you to a room there and clean the wounds, OK?
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 until
23:45probably till 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 and then
24:02sending people home without really giving any long-term solutions.
24:06Anything and everything is what A&E stands for.
24:24Do it.
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.
24:33Come on.
24:34Despite being medicated with strong pain relief.
24:36Ah!
24:38Come on.
24:39The muscles in her shoulder remain tight, making it incredibly hard to move the bones
24:43into the 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 really want that.
25:11You want them relaxed.
25:12Ow!
25:13I'm dying!
25:14Come on.
25:14I know.
25:15I know.
25:15I 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.
25:24Breathe.
25:24But they're fighting against extremely strong, tense muscles in the shoulder.
25:29Ow!
25:29Help!
25:30Stop!
25:31Everyone stop!
25:32Stay still.
25:32Stay still.
25:33The key is you keep taking this medication.
25:36Keep taking a big deep breath.
25:38Big deep breath.
25:39I'm going to swap sides.
25:40Come on.
25:41Hey.
25:42Come 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.
25:50Some more big deep breaths.
25:51Come on.
25:51Come on.
25:52Breathe it in.
25:55The longer it takes to get Roberta's shoulder joint back into position, the more chance she has
26:00of permanent nerve damage and potential corrective surgery.
26:04Come on.
26:05Come on.
26:05Roberta.
26:06Oh!
26:06Breathe.
26:07Breathe in.
26:08Come on.
26:09Roberta, breathe in.
26:11Breathe.
26:12Stop on this.
26:13Come on.
26:15Look there.
26:16Oh, that was it.
26:17Ow!
26:17That's it.
26:18That's it.
26:20That's it.
26:21That's it.
26:21That's it.
26:22That 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.
26:29Okay.
26:30And then we'll take it from there.
26:32No problem.
26:33No problem for me.
26:35Absolutely no problem.
26:36There, good girl.
26:37Well done.
26:38Proud of you.
26:39Yes.
26:39Yeah.
26:41It's incredibly satisfying when a joint just falls into joint and you get a nice satisfying
26:46clunk.
26:47I'll probably have to take that off you now.
26:49I've had your fun.
26:50Sorry.
26:51I'm so sorry.
26:51Don't upset her.
26:53I'm so sorry.
26:53Don't be upset now.
26:55Okay.
26:55Can I have one more?
26:57One last puff.
26:58Because 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
27:08of knowing without a follow-up x-ray.
27:10Should I have to go back around the x-ray and then I can go home?
27:13Yeah.
27:13Yeah, if you're...
27:14If you're...
27:16If the joint isn't in the correct position...
27:19Can you take it easy, okay?
27:20Yes, ma'am.
27:20It could be causing further damage to her shoulder or become dislocated again.
27:25It's hard...
27:25It's hard to watch your child, you know, in pain.
27:29Um...
27:30And it's...
27:30You feel sorry for her and really, really, your heart goes out to them.
27:34Just gotta...
27:34Just gotta take it off this move.
27:36That is what it is.
27:40This 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, 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 muscle pain, but I can...
28:02It's terrible.
28:02Okay.
28:03You'll be followed up in the fracture clinic.
28:05Obviously, if it...
28:06You hear a pop or it seems to go back out of place, obviously come back to any.
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.
28:26Hello.
28:32In Newham Resus, a patient who is on a fancy dress night out has arrived after collapsing
28:37at a train station.
28:38This is Celeste.
28:39She's 27 years old.
28:41She was on her way out tonight dressed up.
28:43She had a passion fruit alcohol drink.
28:4713 minutes later she started feeling a very dry throat, but then progressively got more
28:51itchy 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, 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 sit up a bit more after that and they were able to
29:25like move me.
29:26I don't think so.
29:30With adrenaline administered at the scene to combat the immediate reaction, Dr. Mohamed 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, to not be able to like breathe properly or like, because you start getting lightheaded and
30:24you start 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?
30:42Accident 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.
30:59Normally 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.
31:12Same over here.
31:14There you go, more like that.
31:16The technician is going to say, breathe in and hold your breath, okay?
31:24Okay, ready still?
31:30Sit all down.
31:32I'm going to sit you up now, yeah?
31:35You 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, don't worry, don'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 a bit more calmer.
32:10Surgeon Mr Suzad has been monitoring Agnes' case and reviewing her scans.
32:15So, we had a CT scan.
32:19It showed that your appendix is normal, okay?
32:22So, 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 tonight.
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.
32:54And we'll discuss her scan with our own radiologist and so that we can have some more clarity about our
33:03kidneys.
33:15Yeah, sorry, 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 any after crashing his motorbike things happen so quickly and uh i'm
33:32not exactly sure what happened but a deer came from the left hand side and crossed my path
33:38i then hit it and uh i was away you know i was flying his daughter jessica and her partner
33:46daniel rushed into any when they heard about the collision do you feel dizzy or nauseous
33:51no not really but that feels the least of my problems my head this this wrist is painful
33:59dr eniola is treating terry after his accident he was riding a bike and a deer popped up from the
34:07view he hits the deer he fell down off the bike there are deers around the area so and they
34:14pop
34:14up from time to time deer are more common at night and early morning and headlights
34:20cause a freeze reaction making them deadly obstacles any headaches now no headaches any
34:27hand pain any foot yeah yeah this is quite painful okay and that too is quite painful
34:34we're trying to look out for other injuries that may be marked by the more obvious one so it could
34:40be a
34:41broken bone but there could be an abdominal um injury it could be a fracture in the chest in the
34:48ribs
34:49any head pain anywhere no not so no can you open your mouth bring out your tongue okay
34:57so we try to make sure that we don't miss out on any other um injuries which may be potentially
35:04life
35:05threatening
35:11some abdominal injury but doesn't look worrying because his observations are also fine but
35:18um he sustained some injuries on the right wrist and on the left toe as well being reassured by terry's
35:28vital signs his abdomen is likely okay dr 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
35:55so you're just going to bend his leg because you want to flat like that making them incredibly vulnerable
36:00to breaks so i'm one more for your toes the worst case scenario if it's untreated the patient could
36:08have crippling pain chronic pain throughout the years if that area isn't treated on time yeah i won't
36:18be sleeping on that side tonight though
36:34so
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
36:55the big 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 motorbike boots
37:07the wrist looks fine the wrist looks fine oh 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
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
37:38yeah 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 the
37:50rest of terry's life any pain as a touch yeah it's painful yeah that appears that there's a fracture
37:58yeah 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 we put a strap around here yeah sure the fracture heals yeah
38:15same
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 before 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 this section of the thumb it could have been a lot worse so yeah i'm pretty lucky really i
38:46think
38:46and been really good service tonight i've been really looked after i can tell people have been on
38:53a skiing holiday this is your fashionable shoes it's doing okay considering the mechanism of the injury
39:02okay okay i expected something a bit more drastic the purpose sir is to immobilize your thumb keep it
39:10still keep it still so it will reduce the swelling reduce the pain uh recovering time for him considering
39:18his age it may be between about six weeks to ten weeks thank you much appreciate it terry will need
39:27to return to the fracture clinic 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
39:51hello 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
40:12and her condition remaining stable she's moved to an observation area
40:16i don't know where they put my mother
40:18come on see you bro you'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 athletic shock like can't kill you i guess depends how much
40:43her throat closes you can google it it's a severe potentially life-threatening allergic reaction that
40:49requires immediate emergency treatment
40:56adjustment
40:59dr mohammed has been monitoring celeste for signs of further allergic reaction
41:04her 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 adrenaline on it if you have symptoms that you think your your throat is closing you can't
41:34talk
41:34in false sentences you're very wheezy you're unwell you're about to collapse yeah this is a
41:40red flag that you're looking for before you're injecting yourself okay with that epi pens are essential
41:46as 2.4 million people have food allergies in the uk and could die of fatal reactions and you swing
41:55you that's not that's real you actually have to like you swing and push it
42:00oh snap well that's 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
42:19um they 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
42:31taxi 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 you're
43:06you would think desiccating the shoulder wouldn't be a sore oh it's sore love and then putting it back in
43:11is going to be even sore
43:14as
43:35so have you been built out have you only got to the hospital
43:53Luckily I'm retired so I don't have to go to work, I'll just do a bit more reading I
44:26suppose
44:35I'll just do a bit more reading
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