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00:00On go, ready, set, go.
00:02You're at the Royal Melbourne.
00:04How are you feeling at the moment?
00:05Not good.
00:06The fact that her conscious state is not normal,
00:08we can't rule out an injury or a bleed to her brain.
00:11Grace, I'm really worried that you've
00:13got a blood clot in your lungs, and that
00:15can be something that's very dangerous to you
00:17and to your baby.
00:18Even a brief period of low blood pressure or low oxygen
00:21can be catastrophic for the baby.
00:23Can you feel your baby moving?
00:26Grace?
00:27Grace?
00:27Grace.
00:29You, by my side, came to my aid.
00:34Look inside my eyes and help me try to ease the pain.
00:37Do my life right, it's gonna be right.
00:45Do my life right, reach out your head, take my mind.
00:52Oh!
00:54Very worried to you, my friend.
00:55Ah!
00:56The Boeing's dream smashed abuse.
00:58Whoa!
00:59He was actually stopped breathing.
01:00Oh!
01:01See ya!
01:03Without intervention, he's likely to die.
01:05That's better.
01:06I need you to save me now.
01:23After 30 years as an emergency doctor at the Royal Melbourne Hospital...
01:27My son is always making me something to eat.
01:31Dr Jonathan's wife knows there's often little time to grab a bite.
01:35It helps having a homemade lunch.
01:37I reckon this is a kebab.
01:39This looks beautiful.
01:40I've worked here so long, we always get challenges every day.
01:43There's, you know, every day I'll see something I haven't actually seen before,
01:46which is pretty amazing.
01:49And today, Dr Jonathan's the EPIC, which stands for Emergency Physician in Charge.
01:55What the EPIC does is they keep an eye on what's going on in the department.
01:59It's a bit like a conductor in an orchestra, although there's probably no one gives you a clap at the
02:05end.
02:06Morning.
02:07Let's just see what today brings.
02:10Arrested.
02:11Yeah?
02:12Yeah.
02:14Someone's arrested, maybe.
02:16What's happened?
02:19Emergency doctor Martin and paramedics are trying to save a man's life.
02:26Arrested patient just needs to be cured and work out what rhythm he is.
02:30I'll do the airway jank bag.
02:32Can you break?
02:32Yeah.
02:33Everything on our trolley.
02:36Just come on in.
02:38Just come on in.
02:39Okay, let's just get him across.
02:41Don't cut anything.
02:42Just get him across.
02:43Get him across.
02:44Get him across.
02:44Get him across.
02:45Keep going with CPR.
02:47Spot rating.
02:50Has he got a pulse, Jess?
02:51Pulse there.
02:52No pulse?
02:54No.
02:55Okay.
02:55He's away.
02:56He's away.
02:57He's away.
02:57Alright, good.
02:58Alright, sir.
02:59The quick actions of our team have literally brought this gentleman back from the brink.
03:03This is what we do in emergency medicine.
03:05That's why we do it.
03:06So I'll leave you to it, Martin.
03:08Yeah, thanks.
03:09With the man's life saved...
03:11Receiving, go ahead.
03:12The next trauma is rolling in.
03:14We have a 21-year-old male.
03:17He's been attacked by a machete.
03:18The police have applied a tourniquet to his arm.
03:22I understand the injury is on his left forearm.
03:24It's a deep wound.
03:26Heart rate is 120.
03:28Everything happens all at once, so I'll get some sand scant.
03:32Emergency doctor Luke quickly gets up to speed.
03:36How you doing?
03:37We're expecting a 21-year-old guy who's been attacked with a machete.
03:41If the police have deployed a tourniquet, then that to me says that they've seen significant bleeding.
03:46If the tourniquet is on for an excessive amount of time, the lack of blood supply to that limb means
03:52that the arm will die.
03:5421-year-old Ilya was enjoying a day at the park when he was attacked.
03:59Wait, let's steal your boy?
04:00Yes, okay.
04:01The engineering student, originally from Russia, was hit with a machete after stepping in to protect a teenage boy who
04:09was being bullied.
04:11All right, thank you, guys.
04:13Anastasia, guys.
04:14We'll get you some paper, don't worry.
04:16We'll get you some snaps.
04:17It's for me.
04:18And that's my spirit.
04:19Yeah, I know.
04:20But that's just life.
04:23All right, are you ready?
04:25That's close.
04:26Good job.
04:27Good job.
04:29Sweet.
04:32Good job, mate.
04:33I'm Luke, I'm one of the emergency doctors.
04:34Luke, can I see you?
04:36What's happened today?
04:38I can't tell you.
04:39I'm sorry, I need an anesthesia.
04:40Wait, that's a good one.
04:41All right, just hang tight.
04:42I really need it.
04:44Ilya can't actually tell me what's happened today because he's in such extreme amounts of pain.
04:50Him not being able to tell me whether he has any associated injuries is of concern to me.
04:55But it means that I need to work faster, exclude other potential life-threatening injuries.
05:00Pain through here, no wounds through here?
05:02Doesn't hurt.
05:03Can you sit forward for a sec?
05:04I just want to look at your back.
05:07Just need to go to sleep.
05:08Good.
05:09Okay, I'll lay back.
05:11Now that Dr. Luke is confident he has no other major injuries.
05:15I can 50?
05:15Yeah, I can 50.
05:17Ilya can get the pain relief he so desperately needs.
05:21Yeah.
05:21He is fentanyl.
05:22He is fentanyl.
05:23He is fentanyl.
05:24He is fentanyl.
05:26Ilya's best mate, Francois, witnessed the attack.
05:29I see Ilya about 10, 20 meters ahead of us, and the machete is being swung at him.
05:36At first, all I see is that there's blood everywhere.
05:39And I thought, oh my god, my best mate's dead.
05:43As soon as I got Ilya's arm wrapped up with a towel, I knew we had to call an ambulance.
05:49Ilya always tries to help people whenever he can.
05:51He's a lovely bloke.
05:52I love him to pieces.
05:54All right, is everyone ready for handover?
05:57Ilya was struck by a machete to the left forearm.
06:00It's quite a deep laceration.
06:02All right, when's the last time I had something to eat?
06:04In case we need to sedate.
06:05Yesterday.
06:06The cops have applied the first tourniquet, and that did stop the bleeding.
06:11And in the ambulance, it started bleeding through the bandage, so I applied that second
06:15tourniquet.
06:16We need to assess your arm, okay?
06:18And then we'll go from there, all right?
06:20The second tourniquet has been applied.
06:22That raises my level of concern about, is this an arterial injury?
06:26You can lose a lot of blood very quickly, and it can be catastrophic.
06:31With two tourniquets being deployed, his entire arm is on fire and not getting enough blood.
06:37Have you been touching at all?
06:38No.
06:38No, not at all.
06:39Not at all.
06:40Okay.
06:41Ilya has no feeling in his arm.
06:43We've got a good number of things, I think we're taking down and have a look.
06:46Ilya has an engorged, swollen arm.
06:49It's not getting blood flow to the nerves and to the other tissues.
06:52But if we take the tourniquet down and there's further bleeding, then that increases the risk
06:57of arterial bleeding.
06:59But with two tourniquets being deployed, we've got a really finite amount of time to save the
07:04arm.
07:04Bleased blood.
07:05Bleased.
07:06They really just need to go to sleep.
07:15How are the kids going?
07:17They're doing well.
07:18They're doing really well.
07:19Emergency doctors Scott and Manny are taking advantage of a quiet moment.
07:25Any plans for the holidays?
07:27Nothing in particular.
07:28We're just gearing up for the arrival of another one, the early Feb.
07:32That's exciting news.
07:34Yeah.
07:35My wife and I are expecting a second child.
07:37She's currently 29 weeks pregnant.
07:39We've got a 15-month-old running around the house at the moment.
07:43Being a dad is the greatest feeling in the world.
07:45You're going to have your hands full when the second one arrives.
07:47Yeah.
07:50And Dr Scott could well have his hands full right now.
07:54Breaches are preventing her suspected of pulmonary embolism.
07:58She's currently 29 weeks gestation.
08:00She's had an onset of shortness of breath and fatigue.
08:03She'll probably be there in about five minutes.
08:07We'll move up and receive.
08:10Yeah, we'll take a pregnant lady.
08:12Sounds good.
08:12We've just taken a call about a lady, 29 weeks pregnant, who's presented with some breathlessness.
08:17Low blood pressure and a high heart rate.
08:20One of the things that we worry about is something called a pulmonary embolism or a blood clot in the
08:25lungs.
08:25And that's something that can be life-threatening.
08:27That's fine.
08:28OK.
08:28All right, no worries.
08:29I'll let some people know.
08:31Her name's Grace.
08:32My wife's also named Grace and currently 29 weeks pregnant.
08:35So that's a pretty eerie feeling.
08:38Is she stable and we're still convincingly thinking it's a few?
08:41I'd probably push for CTPA.
08:43Working alongside Dr. Scott is new emergency registrar, Dr. Millie.
08:49Maybe her SATs were bad because her blood pressure was bad.
08:52See what she gets here, huh?
08:5527-year-old Grace is a teacher at a childcare centre.
08:58She had a sudden onset of really severe headache.
09:02Dropped her GCS, blood pressure of 50, I'm 30.
09:04So they've called us for a suspected PE.
09:06But then she's had this neuro stuff happen whilst we were there.
09:11Grace has developed a severe headache.
09:13Now I'm wondering, does she have something concerning going on in her head?
09:16In particular, bleeding on the brain.
09:18We know that during pregnancy the blood vessel in his head can become weak
09:22due to the hormone changes in the body.
09:24That goes right to the top of the list because that's something that can be life-threatening.
09:28I've got his number now.
09:30I've got his number.
09:30Fearing the worst, the team urgently contact Grace's husband.
09:35Alright, everyone ready?
09:36Yes.
09:36I should go.
09:37Ready, set, go.
09:39Alright.
09:41So did you want me to do primary and ultrasound?
09:44Yeah.
09:45Hello.
09:46Hello, I'm Scott.
09:47I'm one of the doctors.
09:48You're at the Royal Melbourne.
09:49How are you feeling at the moment?
09:52Not good?
09:54What's...
09:55What's the matter?
09:56Is it pain?
09:57Is it your breathing?
09:58Is it something else?
10:01Breathing is awful.
10:03Breathing and headache?
10:04Okay.
10:05Okay.
10:05What came first?
10:07Was it the headache or the breathing?
10:11The breathing.
10:13Okay.
10:13Where's the headache?
10:14Which part of your head?
10:16It's that.
10:17Okay.
10:17Worried Grace has severe pain in her head,
10:20Dr Scott immediately checks her brain function.
10:24Alright, can you open your eyes for me?
10:26Open your eyes for me.
10:28Yeah, that's it.
10:28Can you look to your left?
10:31Look to your right.
10:33Okay, look up for me.
10:37Yep.
10:37Can you puff your cheeks out for me?
10:39Like you're blowing up a balloon?
10:43Alright.
10:44Okay, do your thing.
10:46Millie?
10:46Yeah.
10:47Neurologically, she's a bit odd.
10:49Hmm.
10:49So eyes closed, very slow to respond.
10:52There's no focal neurology, just kind of generally weak.
10:57The fact that her conscious state is not normal,
10:59we can't rule out an injury or a bleed to her brain.
11:02Can you squeeze my hands?
11:04Squeeze, squeeze, squeeze, squeeze.
11:05The next step is a trip to the CT scanner.
11:08But first, it's important that we perform an assessment of the baby's health.
11:13Even a brief period of low blood pressure or low oxygen can be catastrophic for the baby.
11:18Can you feel your baby moving?
11:22Grace, I'm just going to do a scan.
11:24I'm going to do an ultrasound of your tummy.
11:26Dr Scott is worried the childcare worker's life and the life of her unborn baby are in danger.
11:33So I'm going to have a look at your baby.
11:36There's just one baby in there.
11:45Baby's very active.
11:48All right, so baby looks okay.
11:52With the baby stable, Dr Scott urgently scans for a blood clot.
11:57I'm going to have a look at your lungs.
11:59The ultrasound machines we've got in our department are a real game changer.
12:02You can have a look at the lung on the left.
12:04But sometimes it doesn't give us the information that we need.
12:07It's not a great view, is it?
12:09I'm not entirely sure that I've ruled out a blood clot.
12:12The next step's going to be a CT scan.
12:14It sounds like a pit.
12:16The team's still no closer to working out what's wrong with Grace.
12:21Yeah, I just can't fit the...
12:22But it's just the drowsiness and the headache.
12:25So we have to scan her head as well.
12:27Okay.
12:29We're worried about her having blood clots in her lungs.
12:32That's something that can be catastrophic for her and her baby.
12:35Can't really quite figure out why she's drowsy.
12:37It doesn't quite fit with that.
12:39It's all a bit of a mystery, but yeah,
12:41some signs that things are not so good at the moment.
12:46Grace?
12:47Grace?
12:48Hello.
12:49I'm really worried that you've got a blood clot in your lungs
12:52and that can be something that's very dangerous to you and to your baby.
12:56And I think we need to do a CT scan.
12:58We try not to do scans unless we really need to,
13:03because of the doses of radiation that come with that.
13:06And that can have consequences for you and for your baby.
13:10Would you be happy for us to do that?
13:12Okay.
13:13I'll just give him a quick call now and just let him know what we're doing.
13:17Grace's husband Dean is on his way,
13:20but Dr Scott needs to speak to him immediately.
13:24Dean, my name's Scott.
13:25I'm one of the emergency doctors at Royal Melbourne.
13:28I'm worried that she could have a blood clot in her lungs.
13:32All right.
13:32So what I think we need to do from here is take her for an urgent scan.
13:37The risk of the radiation can increase your risk of cancer
13:41and that risk is a little bit higher for the baby.
13:43All right. We'll see you soon. Bye.
13:45Risk versus benefit is something that we've always got to weigh up as emergency physicians.
13:49In this circumstance, I think the benefit from doing a CT scan
13:52far outweighs any negatives.
13:54Just going to get you a couple of warm blankets.
13:56She warmed up a little bit.
13:58If I was in Dean's position, I think I'd be really scared.
14:00It must be terrifying and something that you can certainly empathise with.
14:04Are you happy that I go round with anything?
14:07Raise your arms.
14:09We're looking for the things that are going to be catastrophic
14:12to both Grace and her baby or blood clot in the lungs or a bleed in the brain.
14:16All right, my lovely.
14:17We're just going to go around for a CT scan, okay?
14:26She didn't look her finger?
14:28No.
14:2921-year-old uni student Ilya is in excruciating pain
14:33and has lost feeling in his left arm
14:36after being attacked with a machete
14:38while coming to the aid of a boy being bullied.
14:42He's really distressed with this, so I think we'll just take it down and have a look.
14:45To stem the bleeding, emergency tourniquets were tightly applied,
14:50stopping blood flowing through his arm.
14:53So, what we're going to do, you've got two tourniquets on,
14:55which is why you have so much pain, yeah?
14:56Yeah.
14:58Sorry, but we need to do it in a safe way in case it bleeds again, okay?
15:01We'll take it down, have a look into the damage,
15:03and hopefully we shouldn't have to put this back on,
15:05unless it's bleeding severely, in which case we might have to.
15:08But before they can take the tourniquets down,
15:11the team need to see how deep the machete is sliced into his arm.
15:16I was going to cut off the dressing so we can have a better look.
15:19It's really important to see the wound,
15:21to see if we can identify what's actually bleeding.
15:24Yeah.
15:27Being attacked with something like a machete, you know, it's dirty,
15:30are there foreign bodies in there?
15:32There's always that secondary risk of infection,
15:34which can result in multi-organ failure and even death.
15:50It's a pretty significant injury.
15:52It's a really deep wound, and it makes me worry,
15:55has he actually damaged the bone underneath in the forearm?
15:58It's not actively bleeding, it's the long wound.
16:01I think we just...
16:04Yeah.
16:06And then we can pack and dress.
16:08We want to wash the wound to reduce the chances of infection,
16:11and then we apply a really firm pressure bandage to the bleeding point.
16:16That allows us to take the tourniquet down.
16:19You can lift your arm up a little bit, okay, mate?
16:21I can't feel it.
16:22As the team clean Ilya's wound,
16:24in preparation for taking off the tourniquets...
16:27What is leaking there?
16:29...Ilya's arm starts to bleed.
16:31You've got something you can put directly across,
16:33so you've got direct pressure, localised pressure.
16:36When we wash the wound, there's some leak of blood.
16:39If there's an arterial injury,
16:41that's a really high-pressure blood vessel.
16:43If we don't apply pressure appropriately in the right position,
16:47there's that risk that you can bleed to death.
16:49Okay, you ready? You got pressure?
16:52You ready?
16:52Yep.
16:53Dr. Luke is about to unwind the first tourniquet at the top of Ilya's arm.
16:59Yep, I'm ready.
17:01Alright, practice moving on.
17:11Okay, you ready? You got pressure?
17:14You ready?
17:15Yep, I'm ready.
17:17Dr. Luke is about to undo the first of two tourniquets
17:21that have been put on 21-year-old student Ilya's left arm
17:25after he was attacked with a machete.
17:28Back pressure is moving on.
17:29The team don't know if an artery has been severed.
17:33That's horrible, I say.
17:33If it has, removing the tourniquet could cause the artery to hemorrhage
17:38and Ilya could bleed out.
17:41Just relax, okay?
17:42I'm just going to leave them undone, but on.
17:45Is it undone?
17:46Yeah.
17:50Oh, that feels a lot better.
17:51Yeah.
17:52All right.
17:52Good.
17:54Much history?
17:57All right.
17:58Careful.
17:58All right.
17:59As we've taken down the first tourniquet, there's been no increase in bleeding.
18:03Ilya has had some instant relief because that pressure has suddenly gone away.
18:08As we're prepared to take down the second tourniquet,
18:10I'm really worried that he might start to re-bleed
18:13and he'll have to go to theatre urgently.
18:16Just leave it out there and I'll take the orange off.
18:18Because the orange is over the...
18:19It's right over the joint.
18:21As Dr. Luke prepares to remove the second tourniquet,
18:24the teams stand by in case Ilya's wound gushes blood.
18:30That's the second tourniquet coming off, yeah?
18:32Does it feel a bit better?
18:33Yeah.
18:34As we've taken down both tourniquets,
18:36there's been no significant bleeding.
18:38That allows the rest of the arm and the hand to receive blood flow freely.
18:43Most importantly, Ilya's much, much more comfortable
18:46and a lot less distressed than when he was when he first arrived.
18:49Yeah.
18:50Can you feel it's touching your finger now?
18:52Yeah.
18:52Yeah.
18:53Just relax, okay?
18:54We're gonna do some pictures.
18:55It feels much better, yeah?
18:56Yeah, yeah.
18:57Even though Ilya's no longer in pain from the tourniquets,
19:01Dr. Luke needs an x-ray to show if the blow from the machete...
19:05X-ray.
19:07...has smashed the bone in his arm.
19:09Okay, cool.
19:10Cheers, man.
19:12All right, I'm just gonna give you some medication, all right?
19:16All good, no worries.
19:17What's this?
19:17All good.
19:18Just some antibiotics.
19:19While they wait for results, emergency nurse Liz checks how Ilya's coping.
19:26Pleasure to meet you.
19:27Nice to meet you, too.
19:28I'm sorry what happened to you.
19:30Yeah.
19:30I've never, like, been attacked with a machete before, right?
19:34No.
19:34I'm just gonna be, like, remembering this, and I'm gonna be like,
19:37well, this was pretty sick, you know?
19:40This was pretty sick.
19:40Yeah.
19:41So you're not as scared of this as other people would be?
19:45I mean...
19:46Because I'd be pretty scared.
19:47I got super lucky.
19:49You're not left-handed, are you?
19:51No.
19:51Oh, that's lucky, too.
19:53Ilya's putting on a very brave face.
19:56He's making me laugh.
19:57But I am concerned that, in the future,
19:59he could develop some sort of PTSD or anxiety.
20:04There you go.
20:06Especially with younger men, laughing it off might be a bit of a coping mechanism.
20:14The results are in.
20:18This is his radius and ulna, so the bones in his forearm.
20:22It looks as if the cortex of the bone is completely intact,
20:25so there's no bony injury.
20:27I can't see anything that's remained in the wound,
20:30like, you know, soil, debris, or a broken-off piece of knife.
20:33So that's good.
20:35The next steps for Ilya are that the plastic surgeons will take him to theatre
20:39and they'll explore the wound, wash it out,
20:42and then repair any damage that may have been done.
20:45Ilya's recovery may be a long one.
20:47We're talking four to six weeks
20:49before he can probably even start rehabilitation of that hand.
20:53It's going to be a really long road of recovery.
20:57Despite his terrible injury, Ilya has no regrets.
21:02I just think that it was, you know, the right thing to do.
21:14I'm going to drink caffeine. Does anybody else need caffeine? Always?
21:18Emergency doctor Maya has an ever-evolving relationship with coffee.
21:23I'm going to drink coffee.
21:26I'm going to drink coffee.
21:27I no longer need coffee to keep me awake.
21:30I'm a 46-year-old menopausal woman.
21:32I don't sleep very much anymore anyway.
21:35When I was younger, absolutely I needed the coffee.
21:40But the coffee does serve a different purpose for me.
21:43It's about giving me a break
21:45and building a bit of community with your colleagues
21:47because most of the time you can be on a shift sometimes
21:50and not see them.
21:51If you're really busy, you can end up feeling a bit lonely
21:53despite the number of people that are around.
21:56That seems a bit odd, but that's sometimes how it feels.
22:03It's all happening.
22:05Maya?
22:05Yes.
22:06Could you do a trauma for us?
22:08Mountain bike rider who's crashed into something.
22:11Yeah.
22:13Pelvic injury, they think.
22:15Blood pressure's a little bit soft, like 105 or something,
22:18and the heart rate's 50.
22:20Yeah, okay.
22:22Jonathan has let me know about a gentleman
22:25who's had a mountain bike accident.
22:27He's been thrown a distance,
22:28and we've got a suspected pelvic injury.
22:31I guess a mountain bike injury could be pretty much anything,
22:34from isolated limb injuries to head injuries
22:37to something more serious in the torso.
22:39These injuries are potentially life-threatening.
22:43I'm receiving, go ahead.
22:45Wonderful, you are cleared to land Hammers 2.
22:49With the chopper carrying the badly injured mountain bike rider
22:52just moments away...
22:54The pelvis, I think you're worried about the pelvis.
22:56Dr Maya gathers her team...
22:58Alison is one of the ED registries.
22:59She's going to do the fast scan.
23:00..and preps the trauma bay.
23:02Have you guys got enough people to do lines and stuff?
23:04I don't need anybody else, do I?
23:06Let me just go find out how far away it is.
23:1345-year-old John was out on a country bike trail
23:16when the accident happened.
23:18Just let me know if you think there actually is something
23:20that you're worried about.
23:24Is that a binder, right?
23:25Is that a binder?
23:27Are you worried about anything down?
23:28No, my blood pressure is sitting at 90.
23:2990, okay.
23:30That's been the whole time.
23:32Pelvic injury can be concerning,
23:33because if bleeding starts, we don't have as much control.
23:36That's on three, one, two, three.
23:38But the pelvic binder helps any bleeding that's happening.
23:44He's riding a bike at speed, maybe 30 kilometres an hour,
23:47and he's hit a jump, a ramp.
23:49He's been vandalised,
23:50so he's ejected off the top of the bike.
23:53Point of impact to where he was found was eight metres.
23:56John was taking a jump he'd been on many times before.
24:00How far do you think he flew on?
24:01Vertically-wise, probably two and a half metres to the ground.
24:07All right, I need to get around.
24:0912.
24:10Yeah, the jump was a ramp, and someone had vandalised it.
24:14Humans sometimes do stupid things
24:16and don't think ahead to the consequences.
24:18I guess that's what's happened in this case,
24:21and that's what makes it a little bit extra sad.
24:23Everything hurts.
24:24Yeah.
24:25Oh, I'm sorry.
24:26Immediate pain to the right hip,
24:28and when he tried to move initially,
24:30he could feel the bones grinding.
24:32Are you tender here?
24:34Yeah.
24:36He received a lot of analgesia to be able to move him.
24:38Yes.
24:40I need a blood tray.
24:42John, does your family know you're here?
24:44Uh, yeah.
24:45Um, do you know who's coming?
24:46Do you know?
24:47Uh, Jenny.
24:47Jenny, wife?
24:48Uh, partner, yeah.
24:49I don't know.
24:49John's partner of 12 years, Jenny,
24:53is currently making the 300km drive from their home
24:56to be by his side.
24:58Oh, Garfin, you can hit your goals.
25:02Yeah.
25:02Excuse me.
25:04Chest and pelvis?
25:05Yeah, fab.
25:06Worried John's bleeding in his pelvis,
25:08Dr. Meyer urgently needs answers.
25:11Alison?
25:12There's a little bit of trace fluid in the pelvic area
25:15on the trans long view.
25:16Okay.
25:17When we do an ultrasound,
25:19we're looking to see if there's any evidence
25:21of blood pooling in an area,
25:23and there is blood there for John,
25:26which suggests to us that there's bleeding
25:28related to the pelvic injury,
25:30which is concerning.
25:36Exhale.
25:40Oh, no.
25:41There it is.
25:43It's really broken.
25:45Maybe it's just a wing,
25:47but, um,
25:49you always wonder what's going on the other side,
25:51don't you?
25:51It's clearly a fracture here.
25:53The wings of the pelvis have been smashed in
25:56on the right-hand side.
25:57We're mostly worried about what else is injured on the inside.
25:59Any pelvic injury is potentially life-threatening.
26:03I want to get an urgent CT scan.
26:06I'm going to say at the moment
26:08there's an isolated pelvic slash hip,
26:10and we'll aim to get to the CT scanner.
26:17Alright, we're just going to roll you a little bit.
26:2029-week pregnant Grace is about to have a CT scan.
26:24Back on three, one, two, three.
26:26Doctors are looking for a suspected blood clot on her lungs,
26:29and a bleed on the brain.
26:31I'm going to slide you across to the CT scanner, okay?
26:33One, two, three.
26:35Dr Scott...
26:35Alright, I might go around and have a look at a scan.
26:37...is also trying to work out
26:39why she has a severe headache
26:41and is short of breath.
26:43Low SATs could be related to the hypotension,
26:46but what's caused all that?
26:50Who knows?
26:51At this point, I'm not really sure what's going on.
26:54The headache's a mystery.
26:55I don't know how that relates to the shortness of breath
26:57or whether this is an entirely different problem on its own,
27:00but the CT scan is the definitive test here.
27:04For Dr Scott,
27:06Grace's precarious situation hits close to home.
27:10Have you met my wife?
27:12Yeah.
27:12Her name's Grace.
27:13She's 29 weeks pregnant.
27:15Is she?
27:15Yeah.
27:15It's given me a pretty big genius here.
27:21I don't like any of this.
27:28Nothing obvious on the brain, Millie?
27:30I'm sweet.
27:32We're looking at the scans of the brain as they're coming through
27:34and reassuringly, they look pretty normal.
27:37I can't see any signs of any bleeding,
27:39but although we don't have a clear explanation for the headache,
27:43at the moment I'm a little bit confused about what's going on
27:45and how this all ties together.
27:47Well done.
27:48Cool.
27:49While he's relieved that Grace doesn't have a life-threatening brain bleed...
27:53Let's get her back.
27:55Dr Scott now has an anxious wait to see the scans of her lungs.
28:01So, the doctors have just done a scan of her brain
28:04and her chest just to rule out any blood clots or anything in the brain.
28:09Grace's husband, Dean, is finally by her side.
28:13Once we have those results, we'll have perhaps a few more answers for you.
28:19When I first look at her laying down,
28:22just really worried, waiting for the confirmed results.
28:26So, yeah.
28:28The deal in chat will happen or something like that.
28:30There's maybe a boy too.
28:33We're going to be a heal loss if something happens.
28:36So, yeah.
28:37I'm not daring to think about it.
28:41Moment of truth.
28:43Dr Scott and Millie are hoping the scans reveal what's wrong with Grace.
28:49Lungs don't look normal.
28:51No.
28:53It's a little effusion almost.
28:58The CT scan of the chest doesn't show any signs of a blood clot, fortunately.
29:02What I think I'm seeing is maybe a tiny amount of fluid around one of her lungs,
29:06called an effusion.
29:07If there is an effusion there, it would make a heart problem,
29:10something we call a cardiomyopathy, much more likely.
29:14And that would certainly be something we'd be very concerned about,
29:17especially in a patient who's growing a baby inside of them.
29:21We should get radiology to have a look at this ASAP.
29:35We should get radiology to have a look at this ASAP.
29:39Dr Scott's seen something alarming on Grace's CT scan.
29:44Oh, hi there. It's Amelia.
29:45I'm all about Grace.
29:47We're seeing Grace's life.
29:48If there's a blood clot on Grace's lung,
29:51her life and her baby's life are at risk.
29:55It's just a very strange presentation.
29:57We can't see any in the back of the knee,
29:59but it doesn't look completely normal.
30:01At the moment, we've got Dr Millie and one of our radiology doctors
30:04both looking at the scans of Grace's head and chest,
30:07making sure that we're not missing any serious diagnoses
30:11and making sure that we're ruling out the things of concern.
30:15Yeah, it's fine, it's very much.
30:18What we've done is that
30:21it's not a security thing.
30:23We can break the spine on the scene without no pain.
30:25Okay.
30:26They haven't been able to find any abnormalities in the brain or the chest,
30:30which is reassuring, but just means that the mystery is far from solved
30:34and sometimes all we can do is throw up our hands and say,
30:36what on earth could this be?
30:39So what do we do?
30:41Bloods.
30:42Obstetrics.
30:42No.
30:44All right.
30:45So obstetrics, medical, CCG monitoring.
30:48Yeah.
30:49While Dr Scott and Dr Millie try and solve the mystery...
30:54So you said you felt baby kick about here?
30:58About there, okay.
30:59Emergency nurse Chris keeps track of Grace and her baby's heartbeat
31:04in case her condition deteriorates.
31:07Just gonna try and find the heart rate, okay?
31:10Yeah.
31:12There we go.
31:13Looking after pregnant patients can be quite nerve-wracking
31:17considering you have two patients in the room.
31:20Grace's husband's definitely concerned.
31:21You feel for him because not only is he worried about baby,
31:25but he's also worried about his wife.
31:27He's looking so unwell.
31:29Yeah.
31:30I think that's all I can think of.
31:33I think we've done as much as we do.
31:35Yeah, and I think we've considered the big killers of, you know,
31:38PEs, cardiomyopathy, et cetera, and her baby looks fine, so...
31:42Dr Scott has one more thought.
31:44Iron.
31:46Yeah.
31:47Could add on an iron.
31:47We've done a really comprehensive job of looking into all of the things
31:52that could be harmful to Grace and her baby.
31:54The next step for Grace is gonna be a consideration of an iron infusion
31:59and a review by the obstetric team.
32:09Oh, no. There it is.
32:11It's definitely got a cardiac wing fracture on the right.
32:14An X-ray has confirmed that 45-year-old John has fractured pelvis
32:20after he flew over the handlebars of his mountain bike.
32:24We'll aim to get to the CT scanner.
32:26Dr Maya is worried John is bleeding into his pelvis.
32:30Sam, are you happy ordering a scan?
32:32Yeah.
32:32Which can be life-threatening.
32:34Hello, I'm Maya.
32:36Hi.
32:36I'm one of the doctors.
32:37So you know that crunchy feeling you felt?
32:39There's lots of broken bones on the wing of your pelvis.
32:43Right.
32:43Which is what you felt.
32:45What we're gonna do is a CT scan
32:47to make sure that there's no fractures that we can't see on the plane X-ray.
32:50To make sure there's no bleeding associated with it.
32:53Okay, thank you.
32:56Keep the mat pack for now?
32:58Yeah, I would keep it for now.
33:00Cool.
33:00Worry John's condition could change in an instant,
33:03Dr Maya has blood on standby.
33:07Do you guys want some pain relief for CT?
33:10What do you want?
33:10Uh, fentanyl.
33:12Okay.
33:12We're gonna take you to CT now.
33:14Alright, let's go.
33:17Oh, the door's shut.
33:18It's a bad sign.
33:21How are you feeling?
33:22Yeah, I'm okay.
33:24How often do you normally do that jump?
33:27Um, I hadn't done it for a while in any way,
33:31so I hadn't seen it for a month or so.
33:34It's alright.
33:37She's 25.
33:38Finish.
33:39We're gonna go really slowly all the way.
33:42On three.
33:43One, two, three.
33:45There you go.
33:46Well done.
33:48I think anyone who's flown eight metres in the air and landed hard
33:51has potential for lots of other injuries,
33:53but also we know that he has a significant pelvic fracture at a minimum,
33:58so we want to make sure that we know what we're dealing with.
34:01Is there a radiology reg around?
34:03Yeah, they are in the back room.
34:06We have radiologists who are right there to give us immediate kind of read on what we're dealing with.
34:11So I just want to make sure there's nothing in the pelvis that needs embolising.
34:15Smash his eye.
34:16Yeah.
34:16The team know he's badly broken the wing of his pelvis, but if he's bleeding internally, it could be deadly.
34:28It looks awful.
34:29It's here.
34:30It's here.
34:30It's here.
34:31It's here.
34:31It's here.
34:32Amazable.
34:35Nothing that's facing you.
34:36Amazing.
34:38The CT's confirmed it.
34:40There isn't any active bleeding, and he doesn't need an urgent operation or any intervention at the moment.
34:45So it's a pretty reassuring looking scan.
34:48Doesn't look like there's anything too concerning.
34:50We need to have some time for a better look.
34:52All right.
34:53Just a nice little gentle lift.
34:55On three.
34:55One, two, three.
34:57There we go.
34:59As John heads back to the trauma bay, Dr. Meyer gets the full report.
35:04So these are the wings of your pelvis.
35:07This is what the normal d'Aliac wing looks like.
35:10You can see there's a bit here.
35:12This is where the break starts, and it comes all the way down, and then it's in a few bits,
35:16with one bit that's pushed in.
35:19And blood is white.
35:20All this white stuff, that's blood.
35:23It's a little bit in here.
35:24And so what we look for is whether there's any active bleeding.
35:30He seems to have got away with it.
35:32Dr. Meyer can give John some good news.
35:36The pelvis looks like that.
35:37Yeah.
35:37In this wing side.
35:39Just in lots of bits.
35:41It'll be a few weeks of rehab.
35:44When I say weeks, I mean like five or six weeks.
35:48So we haven't found anything that's more damaging than that.
35:50Right.
35:51Yeah, I think it could have been much worse.
35:53It could have been.
35:53You are right.
35:55John has a really long road ahead.
35:57These bones are pretty smashed up.
35:59It will be a long recovery of potentially some surgery and some bone healing that will take weeks.
36:05And when he's back walking, let alone riding, is a little bit unknown.
36:08I hope he gets back on the bike.
36:10I know for his sake, because that's what he loves to do.
36:14As Dr. Meyer predicted, all John's thinking about is getting back in the saddle.
36:20I just love riding.
36:23So I've just got to rehab as quickly as possible.
36:26And I'm the world's worst injured person.
36:31Hopefully this won't be too long.
36:42Do you have a character you impersonate?
36:47God, no.
36:47Go to character.
36:48After three years in ED, emergency registrar Dr. Matt is showing off hidden talents.
36:55Kermit?
36:56Kermit the Frog.
36:57It's Moon River, wasn't it?
36:59Is Kermit saying Moon River?
37:01I don't know.
37:01I don't know.
37:02Oh, you are good.
37:03I am impressed.
37:05I'll take it.
37:06Don't film this.
37:09But as a new patient arrives, it's time for Dr. Matt to return to his real-life role in ED.
37:1849-year-old Paul has been rushed into emergency by wife Claire.
37:23He's developed facial paralysis and slurred speech following brain surgery 12 days ago.
37:30Paul's had major cranial surgery to relieve space-occupying cysts that was putting pressure on his brain.
37:36And he's got a new headache and new left-sided facial droop.
37:41Pretty concerned about complications of the surgery.
37:43The supermarket manager is anxious history is repeating itself.
37:48Seven years ago I had a stroke, yeah, at this hospital.
37:52So I couldn't walk and talk, couldn't eat.
37:55I didn't know anything, pretty nice.
37:57Hi, Paul.
37:58Hey, how are you?
37:59Good.
37:59I'm Max from one of the doctors.
38:01Since the surgery you've been recovering really well.
38:03Yeah.
38:03So I think it's good.
38:04Yep.
38:05So pretty much, say, the night onwards.
38:07Mm-hmm.
38:08Sort of got worse, worse, worse.
38:10Headache?
38:11Headache.
38:12Headache.
38:13Yeah.
38:13What side is the headache?
38:15Oh, sort of.
38:16Yeah, down the road, I don't think.
38:18Walking in, I'm quite alarmed that this could represent something really serious.
38:22When someone like Paul's had a stroke in the past, these kind of symptoms might represent
38:27reoccurrence of this sort of problem.
38:29Any changes to your hearing, you reckon?
38:31Paul's recent brain surgery, the part of the brain that they've had to assess is deep.
38:36It's very high on my radar that these symptoms are a complication of the surgery.
38:42I'll just pop your specs off for a sec.
38:45I'll give them to you.
38:47Looking over at me...
38:48Dr. Matt checks Paul's brain responses.
38:51Follow my finger with your eyes, don't move your head.
38:54Do you feel a bit spinny in the head or a bit of vertigo when you look in the peripheries?
38:57A little bit.
38:58A little bit?
38:58Yeah.
38:58Rest your head back.
39:00Do your best to close this eye as much as possible.
39:02Close your eyes.
39:03Close your eyes.
39:04Yeah.
39:05Okay.
39:07Somewhere between your brain and the muscles that control the side of the face, there's
39:12a disruption in the communication.
39:14It could be a suggestion of a complication of the surgery, like a blood clot.
39:21The biggest thing I worry about is that blood clot occupying part of the brain around where
39:26he's had this operation.
39:27It's critical that we get Paul to the scanner right away.
39:31One hour it's open.
39:32Yeah.
39:32One more than one.
39:34One more than one.
39:43One more than one.
40:02Seven years ago, wife Claire knows all too well how this could change their lives.
40:07He had to learn to do everything again, walk, talk, feed himself.
40:12Your job is just to keep very still.
40:14I met him later in my life after the breakup of marriage.
40:19I reckon we fell in love straight away.
40:21Well, I know I did.
40:23See you in a minute.
40:24And he means the world to me.
40:27He's a great husband, a fantastic father and stepfather.
40:32I love him so much.
40:34He's my world.
40:36As Paul heads back to the trauma bay to wait with Claire, his results are in.
40:47The thing I'm looking at is acute bleeding.
40:49And thankfully I don't see any of that.
40:51What is probably happening is this seventh cranial nerve that supplies this left side of his face.
40:57It's probably being stretched by some swollen parts of the operative site.
41:01This is not an uncommon facial nerve palsy that we call Bell's palsy.
41:05I'm pretty happy with that, so I think I'll go and discharge him now.
41:11The updates that we think that all of the changes that you've got are progression from the swelling around the
41:19operative site.
41:19Yeah.
41:20So not a new stroke, not a new bleed.
41:22So it's like a Bell's palsy.
41:24It is.
41:24Yeah.
41:25This is about a grade three Bell's palsy, and that goes up to five.
41:30So it's likely to get better with time.
41:32No, it's good.
41:33It's all good.
41:33I thought I had enough stroke.
41:35Our expectation is that the benefit of time will relieve the swelling.
41:40He'll have pretty satisfactory return of his normal nerve function to the face.
41:45So let's get you out of here, get you home, huh?
41:50It absolutely feels good to give good news.
41:53It's my favourite part of this job.
41:55I feel relieved.
41:56Now we have a diagnosis of what's going on.
42:00And he can go home and recover and just chill out.
42:0845-year-old tradie John was choppered into emergency.
42:11One, two, three.
42:13After flying over the handlebars of his mountain bike when he hit a vandalised ram.
42:19Oh, no.
42:20There it is.
42:21It's really broken.
42:23An x-ray showed Dr. Meyer he'd shattered the wing of his pelvis.
42:27But a CT scan.
42:28No, no, nothing inside you.
42:30Amazing.
42:31Confirmed he wasn't bleeding internally.
42:34John needed surgery to pin his broken pelvis back together.
42:39And after only four weeks, he's back on his bike and doing what he loves most.
42:4521-year-old engineering student Ilya was rushed to ED after being attacked with a machete
42:51while helping a teenage boy who was being bullied.
42:54Anesthesia, guys.
42:55Please.
42:56That's like...
42:57Dr. Luke feared the blade had severed an artery.
43:00We need to assess your arm.
43:01And that the tourniquets had stopped blood flow to his hand.
43:04We've got a really finite amount of time to save the arm.
43:09Ilya spent one night in hospital after he had surgery to fix his arm.
43:14The treatment consisted of stitching together a few tendons, a few muscle groups and gluing
43:19together the skin.
43:20It's not as badass of a scar as a stitched one would have been, but it's quite good.
43:25Cheers, mate.
43:26Recovery has been driving me crazy.
43:28Just having this pseudo-claw because obviously I can't work.
43:33I'm just glad you didn't get hurt anymore.
43:36Yeah.
43:36I can't do university tasks and all I've been able to do is just hang out with my friends.
43:42But will Ilya be stepping in to help another person in trouble anytime soon?
43:47If I see someone getting bullied again, I'm definitely figuring out if they have a sharp object on them first.
43:53I don't want to lose my arm.
43:54Here's to sticking up to the little guy, mate.
43:56Absolutely, mate.
43:56Good on you, mate.
43:5929-week pregnant Grace was rushed into ED with breathing problems and a severe headache.
44:06What came first?
44:07Was it the headache or the breathing?
44:09Descott feared she could have a blood clot on her lungs and a possible brain injury.
44:14The next step is going to be a CT scan.
44:16He also worried Grace's baby was at risk.
44:20Can you feel your baby moving?
44:24Grace?
44:25Grace?
44:27Honey, you want some tea?
44:29Me.
44:30Two back, one back?
44:31Just one.
44:32Just one, yep.
44:33I've never been to the hospital like with that serious illness before.
44:37It was really scary at that time.
44:39And with the baby, it's just making things even harder.
44:42Blood tests revealed Grace had extremely low iron levels, and she was given an infusion
44:49later that night.
44:50After two or three weeks, the iron infusion slowly, slowly bring me back.
44:55Yeah, yummy, yummy.
44:57And two months later, little Samuel was welcomed into the world.
45:02Sleep the whole night off, which is good for us.
45:05Samuel was very healthy when he was born, and that is the luckiest thing ever for me.
45:11Dr. Scott and Dr. Millie, I just couldn't thank you guys enough for helping me and Samuel.
45:17You guys just saved me.
45:19You guys just gave me like literally like a second life.
45:43Transcription by CastingWords
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