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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:11You never know what's going to come through the door.
00:16At night, you always have to be prepared for the unexpected.
00:19Multiple kicks to the face.
00:21They said if anyone approaches them, they're going to attack us all.
00:23Across the UK.
00:24We're trying to help you.
00:25With extraordinary access to three of the most challenged emergency departments in the country.
00:31Guys, I need help in here.
00:32He could have died.
00:33We follow the work of emergency medics who battle every night to save lives.
00:38Trucking now.
00:40It's a stab wound.
00:42With drugs and alcohol rife.
00:45I've had five, six pints.
00:46Step back.
00:47Big man.
00:48The department's just on fire.
00:52The risk of violence and abuse looms large every night.
00:56And you, you're messing your .
00:58Stop.
00:59Try me, boys.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched.
01:06I've been spat at.
01:06You've got nothing on me, bro.
01:08No.
01:08Goodbye.
01:09There have been days when there have been more police officers than patients.
01:13What punch your head in, mate?
01:14What's going on?
01:15All hell's broken loose.
01:17Patients running around.
01:18Security everywhere.
01:19Shut up.
01:19I don't care.
01:21This is the sort of thing that we have to put up with.
01:23Get security to remove it.
01:24This chaos.
01:26Glorious chaos.
01:39He's been attacked by the machete.
01:40In A&E on the night shift across the UK, anything can happen.
01:45The night shift is a matter of life and death.
01:48Lots of pressures.
01:49Patients constantly come in.
01:51A&E's got a lot busier over the last few years.
01:53Most patients are desperate for help, but not all of them play by the rules.
01:57Nothing surprises or shocks me.
02:00We're 200 beats per minute.
02:01You always have to be able to adapt to the ever-changing situation of the department.
02:06Move away from this area.
02:07It's not acceptable.
02:12It's not a couple.
02:20I'm terrible.
02:22No rules.
02:23In Birmingham, the fire alarm has been triggered.
02:26Up north, Dave.
02:27Where is it?
02:29If the source of the smoke isn't found, the hospital will need to be evacuated,
02:34including seriously ill and vulnerable patients on the wards and intensive care.
02:42The alarm is going off in a toilet in the waiting room.
02:51And this is why you don't smoke from a hospital toilet.
02:54A patient has been smoking in the toilet.
02:57Can we just remind all patients?
02:58Not to smoke inside, Amy.
03:01All they've been inside the toilet, strictly forbidden.
03:05Anyone that is caught waking will be removed from the premises,
03:08so I have to guarantee the safety of everybody, not just one person, all right?
03:13Yeah, definitely.
03:14It was a member of the public smoking in the toilets,
03:19and obviously it's a massive safety risk to everybody at once.
03:23We do have piped oxygen throughout the department.
03:26Oxygen is just one of the extremely flammable items in the hospital
03:30that could explode near an open flame.
03:32Because obviously it's a massive safety incident.
03:35Patient safety is paramount,
03:36and obviously flames and oxygen don't mix very well.
03:40And if we can't guarantee patient safety,
03:43then obviously as a person in charge, you do have to take oxygen.
03:52We've got to pop into a hot race, sir.
03:56Paramedics are on their way to hospital
03:58with a 19-year-old male who smashed into a car on his motorcycle.
04:10He went head-on into the side of the car, moving about 20, 25 miles an hour.
04:17The window on the drive-side door has shattered,
04:20and he went over the top of the car, onto the bonnet,
04:22and then he's landed in front of the car as the car has stopped,
04:25possible two feet fractures of the right leg.
04:27We have a look at it. There is a laceration above it.
04:33Dr. Tom is leading the trauma team.
04:35Significant head injuries are common
04:38with traumatic injuries from motorcycles and cars.
04:42If someone's come off at speed,
04:44and especially if they hit something quite solid,
04:46really for us, that does raise suspicion of significant injury.
04:50No.
04:52See no deformity to upper nerves.
04:54Helping in the droid, bruising the flanks.
04:58Did you say anything about the aftermath?
05:00Aftermath soft, not 10.
05:02Let's get some algae on board first, before we go to scan.
05:05We're just going to keep it there nice and steady
05:07until we get some scans and show us what's going on with it.
05:11Ronnie may have serious hidden injuries to his organs,
05:14spine and head from impacting the car,
05:17which can only be detected by a scan.
05:19But first, Dr. Tom needs to assess his open wound.
05:24I'm going to borrow some scissors, please.
05:25I'm not going to cause you any pain.
05:26Just having a look at it.
05:27No, just having a look at it.
05:29I'm going to get some fresh dressing to put on.
05:32There's a hematoma with a laceration on top,
05:34which is bleeding.
05:35There's no active arterial bleed or anything like that.
05:38And does it hurt here?
05:40Yeah.
05:41That's me.
05:42Yeah.
05:42I'll just cover this up.
05:45Sorry.
05:46Sorry.
05:46I'm just going to wrap it back up again.
05:48Well done.
05:50You're right, though, like,
05:51I think you might feel something to that.
05:52We'll find out.
05:53When there's a crash,
05:54I did fall in the bone.
05:55Yeah, I'm still going to wrap it back up again.
05:57I think it's not in a straight line,
05:59which is always because it won't do it.
06:01Ready for a scan?
06:02Oh, yeah.
06:03Yeah.
06:03Let's just pull the feet together a little bit,
06:05you know what?
06:06What is this thing?
06:08To wrap you up.
06:09It's basically just to keep you tight
06:11so you don't cause any further damage,
06:14if there is anything.
06:14As Dr. Tom and the team are concerned
06:17about potential unstable injuries from the collision,
06:20Ronnie is wrapped in a trauma mattress
06:22to keep him steady.
06:23The trauma mattress is a structure
06:25that vacuums itself around the casualty
06:27and gives stability,
06:28but allows them to be moved
06:30without causing further pain
06:31or further movement to those injuries
06:33that we don't know are there or not yet.
06:39Ronnie's girlfriend, Abby,
06:40who works for the ambulance service,
06:42was on shift at the time of the accident.
06:45I got a text message saying
06:48that they detected sudden motion on Ronnie's phone.
06:51Ronnie's phone detected a sharp sudden change in his speed,
06:55which it recognises as an accident
06:56and alerts his emergency contact.
06:58So I called him.
07:00He didn't answer.
07:00Keep your head still, please.
07:02What's your beautiful friend?
07:04I tracked his location.
07:05He weren't moving,
07:06so I went there.
07:12I seen the sirens, I seen the car,
07:14and then I found his bike.
07:17Breathe away, darling.
07:20Seeing him just on the floor,
07:23I was like,
07:23oh, different notes do.
07:26I'm really scared of that.
07:33I almost cried,
07:34but then I was like,
07:35I can't cry if I'm going to help.
07:37So then it was just a big adrenaline rush,
07:40and that was it.
07:41Then I was ready to do anything they needed me to.
07:46Abby assisted the paramedics on site
07:48and followed behind to the hospital.
07:50We have to think that potentially
07:52there are spinal injuries,
07:53neck injuries,
07:54other organ pathologies,
07:56that removing the casualty
07:57in a less coordinated manner
07:59could cause further injury.
08:01Ronnie could have multiple
08:03serious internal injuries and bleeding,
08:05as the force from the bike
08:06stopping so suddenly
08:07is like being hit with a sledgehammer.
08:26It was just an alleged assault
08:28where he was punched to the head.
08:30Violent crime in the UK
08:32has been on the rise
08:33over the last 10 years.
08:35Indy-wise, he's got multiple stabbings.
08:38Gabriel, fill off three seconds.
08:39We'll be till 10,
08:40because he's after the blinding,
08:42he will need to be searched.
08:44And at night,
08:45it spills into A&Es across the country.
08:47I had a call reference,
08:48a male who's cut out
08:49of possession of a knife.
08:51So I want to keep the male outside
08:52before he comes back in
08:53to keep everyone safe.
08:54Good morning.
08:55No.
09:08In Birmingham,
09:09Ronnie was rushed into A&E
09:11after his motorbike
09:12collided with a car at speed.
09:14Please breathe in.
09:15Hold your breath.
09:16Due to the force of the collision,
09:18doctors are scanning Ronnie
09:20to check for any
09:20life-threatening internal injuries.
09:22One, two, three, four.
09:24His girlfriend, Abby,
09:25who works for the ambulance service,
09:27was on shift at the time of the accident
09:28and arrived on scene
09:30to help the paramedics already there.
09:32Because I know quite a few people
09:33that have actually passed away
09:35from boat crashes.
09:38So, I thought it was going to be
09:40a whole, like,
09:42I don't want to say the word,
09:43but death.
09:47While Ronnie's CT scan
09:48is evaluated for serious injury,
09:50he's stable enough for visitors.
09:53How are you feeling?
09:54Sure.
09:55Hello.
09:55Thanks.
09:57Just don't die.
09:58I don't want you to do that.
10:08Dr. Warkas has Ronnie's CT scan
10:11and X-ray results.
10:12Because he was in a
10:13high-velocity accident,
10:15we did a CT scan
10:17to rule out head injuries,
10:18spine injuries,
10:19and abdominal,
10:20pelvic injury,
10:21stuff like that.
10:22The CT scan report is back.
10:24It's now an open fracture.
10:26It's an emergency.
10:27It requires an emergency.
10:29Because of this injury,
10:31we have to put you on place
10:32that was going to happen tomorrow.
10:35So, what we're going to do
10:35is we're going to
10:37wash the wound
10:38and do the cast.
10:40Once we have done the cast,
10:42then your fracture
10:43will be kind of stable.
10:44Yeah.
10:44Stable, it won't move.
10:46If it won't move,
10:47it won't hurt.
10:48Ronnie will need to have
10:49his legs stabilized
10:50until he can have surgery,
10:51but this can be
10:52extremely painful.
10:54So, are you happy
10:55to go ahead with the surgery?
10:56Never mind.
11:04I just said hello
11:05and he meant something
11:06and that was me to him.
11:09That was his dinner.
11:11Last year,
11:12there were over 30,000 dog attacks
11:14resulting in injuries.
11:16I didn't even move.
11:17I only had to look at him
11:18and he bit me.
11:19A 21% increase
11:21from the previous year.
11:23It was more the shock
11:24than anything.
11:26Dog attacks can lead
11:27to serious infection
11:28or even life-changing injuries.
11:31Oh, that is sore.
11:32Sorry.
11:33What?
11:42Thanks so much for coming.
11:48Once he wiped all the blood,
11:49you see my finger missing?
11:51Just try to find
11:52and it can't find it.
11:53A bit of panic,
11:54aren't you?
11:54When we were missing,
11:55it was missing.
11:58A bit of a shock.
12:0032-year-old Mohammed
12:01has come to A&E
12:02with his partner, Tanya.
12:05I was playing with my mate's dog
12:07and he's chopped up
12:08to bite the toy
12:09and I was biting my finger.
12:11I don't want to see the dog again
12:12to be honest.
12:13It's not my dog.
12:17Mohammed.
12:19Dr. Rashid will assess Mohammed's injury.
12:22Sir, Mohammed,
12:23what happened?
12:24My mate's dog bit it.
12:26I was playing with the toy,
12:27he's chopped up
12:27and he matched onto my finger.
12:29OK, let me have a look.
12:31He just puts you there.
12:35Have you taken any painkiller?
12:37Give me some dust.
12:38Just give me some more.
12:41Dog bites are quite common.
12:43The most common sort of complication
12:45is infection, basically.
12:47When was your last tetanus injection?
12:49A few months ago.
12:50I went to Thailand.
12:52OK.
12:54No pain?
12:56Not pain?
12:57That's a bit there.
12:58The dog bites
12:59could have caused
12:59hidden nerve damage,
13:00so Mohammed's sensation
13:02needs to be assessed.
13:03Can you bend your finger?
13:05Push me down?
13:07Up.
13:08You feel my finger there?
13:10Yeah.
13:11Very tender?
13:12Yeah.
13:12OK.
13:13Yeah, I think your bone is exposed.
13:15So what I'm going to do,
13:17I'll put some dressing.
13:18We need to do an X-ray
13:20just to check whether you're going to need
13:22any bony injury.
13:23And I will call the plastics, basically.
13:25They can come and have a look.
13:27OK.
13:28Yeah.
13:28Mohammed could need reconstructive surgery
13:31from the plastics department
13:32on his finger
13:33to heal his wound.
13:34It looks like it's a bone exposed.
13:36Might be there is a bony injury there also.
13:38So we're going to do an X-ray
13:39just to see
13:40if there are any fractures there.
13:43And then we'll give some antibiotics.
13:46If the bone is exposed,
13:47basically,
13:47we need to just call the hands team
13:49to trim the bone
13:50and just basically they close the bone.
13:52The longer the bone is exposed,
13:54the more bacteria it comes into contact with,
13:57which could lead to a serious infection.
13:59Keep your finger there.
14:00We request the X-ray,
14:01then I'll take you to X-ray.
14:16It's massive.
14:18It literally looks like another kneecap.
14:19So, yeah.
14:21Mess it right up.
14:24In Tunbridge Wells,
14:2631-year-old night worker Samuel
14:28has had an accident
14:29while working at his generator business.
14:31He's higher.
14:33Been sitting down here from reception.
14:36I jumped off to work around
14:38and rolled my ankle.
14:41Painful, really painful.
14:43It's just getting bigger and bigger.
14:46What are you doing here?
14:48I didn't know what you wanted,
14:48so I got you both.
14:51Why have you been a mate?
14:53Colleague Will has arrived
14:54to offer some support.
14:56Yeah, I'm great.
14:59It looks worse in person.
15:01It's massive, mate.
15:02He's carrying a lot of weight, though.
15:05Slimer than you.
15:06Actually, in all seriousness,
15:08it has a lot worse.
15:11Look at the size of it.
15:13Yeah, it's just getting bigger and bigger.
15:15I can't lift my toes up.
15:16I can't move it.
15:19Did you finish the job?
15:20Yeah, I can't do it.
15:21I can't do it.
15:22I can't do it.
15:22Come on.
15:24Salvo?
15:24Yes.
15:29All right.
15:30Shall we sound in your ankle?
15:31Yeah.
15:32It's quite sore there.
15:33It is very sore.
15:34Are you ready?
15:35Ah!
15:36Do you have a second
15:37of any pain relief at all?
15:38Yeah.
15:39Nurse Eric will assess the ankle
15:41to get an impression
15:42of how serious the injury is.
15:44Anything from here to here?
15:46No.
15:46Anything on this side
15:48of the ankle?
15:50Anything here?
15:51Yes.
15:52Yes, over here, yeah?
15:53Yes.
15:53Okay, push me on this side.
15:55All right.
15:56Okay, so your pain is mostly on this side.
15:59Yeah.
16:00Okay.
16:01Oh, fuck.
16:02She's okay.
16:03Good job.
16:04I'm concerned about the swollen ankle,
16:07the bruising on the ankle.
16:09He might sustain a fracture on his ankle.
16:12So once I have the x-ray back,
16:14the next part is the treatment.
16:16Only an x-ray will reveal
16:17the extent of the damage to his ankle.
16:24Take the single legs around.
16:27That's it.
16:28Pull, pull.
16:29Ah.
16:30Pull in the leg.
16:32And tilt the head to the.
16:37This seems to be getting bigger and bigger.
16:40If it's broken,
16:41Samuel could be off work
16:43at his generator business for months.
16:45I was going to be at work tonight
16:46and it's our busiest month
16:48and now I don't know what I'm going to do.
17:14Kenzie.
17:16What do you want?
17:17Just jump up on there for me.
17:18Although not a designated children's A&E,
17:2012-year-old Kenzie has come in
17:22with his nan, Barbara,
17:23after an accident whilst playing.
17:25When it happened,
17:26I was crying for ages.
17:28I don't, like, love myself,
17:29so I wouldn't look at it.
17:31My mum wouldn't look at it,
17:33so she had to get my neighbour
17:34to do it for me.
17:36He's being treated by Dr. Abdul.
17:38No.
17:39Okay.
17:39Tell me what's happened.
17:41When I was out riding my bike.
17:44Yeah.
17:44I tried doing a wheelie,
17:46but then I fell off my bike.
17:48Fine.
17:48And then there was glass on the floor.
17:51Okay.
17:51And I think I've got my hand on the glass.
17:52He thinks there's glass
17:53and I was whatever on the floor.
17:55So you put your hand down
17:56and then when you looked up your hand,
17:58your hand was cut?
17:59Yeah.
17:59Okay, fine.
17:59Can I have a little look here?
18:02It's all warm.
18:02Yeah, it's very sore.
18:04Okay.
18:07Can you just bend your fingers like that for me?
18:10As much as you can,
18:11try and keep going for me.
18:13It hurts when you do that.
18:14Okay.
18:15A serious glass cut to the hand
18:17could damage nerves and tendons.
18:19Can you feel me touching your finger here?
18:21No.
18:22Okay.
18:23The main thing we want to just check
18:24is make sure there's no glass in there
18:25or anything, all right?
18:26So I'm going to just give it a little wash
18:28and a little clean
18:28and then we'll see what it looks like.
18:35Sorry, this is a bit
18:36where it's going to be a bit uncomfortable.
18:42Do you feel like there's anything
18:43in your finger when I'm doing that?
18:45No?
18:45Just can't.
18:46Okay.
18:47I can't see anything in your finger.
18:49What we're going to do,
18:49just to be on the safe side,
18:50we're going to get an x-ray.
18:52All right, ready to go?
18:53Yeah.
18:54Lovely.
18:54Okay, follow me.
18:55If there are any glass pieces in the wound,
18:58it could prevent it from healing properly
19:00or cause a serious infection.
19:02Just take a seat on those chairs for me.
19:04I've got Kenzie for finger x-rays.
19:08Say hello to you, mate.
19:10Bye.
19:11He's tired and he's hungry.
19:21Hang on, you're going to go to your back, darling.
19:23Don't you know, Neil?
19:24Yeah?
19:25What's his arms?
19:27One half day.
19:32Sister Sarah has just taken a call from paramedics
19:35who are rushing in a patient with a rapid heart rate.
19:37His heart's racing at 50 beats a minute.
19:40He's vomiting.
19:41He's also a diabetic.
19:43And his blood sugars are low.
19:47How there?
19:49Dr. Karthik is preparing for his arrival.
19:55Oh.
19:57If he's been quite dehydrated,
20:00he will require a lot more fluids.
20:04This is Jamie, who's 39 years of age.
20:06He was discharged Wednesday
20:08from gastroenteritis,
20:11but complicated with type 2 diabetes,
20:13managed with insulin.
20:15He's been having multiple hypos,
20:17which has managed himself with oral glucose.
20:21Jamie's vomiting bug
20:22is stopping his body absorbing food,
20:24affecting his diabetes,
20:26causing his blood sugar levels
20:27to drop dangerously low.
20:29This has been going on quite well.
20:31He had an admission into City Hospital
20:33for 10 days,
20:34about three weeks ago.
20:36So basically,
20:36gentlemen has come with
20:38multiple episodes of vomiting.
20:39Yeah, yeah.
20:40Recting.
20:41Blood in the urine.
20:41And blood in his shield.
20:42Blood in the urine.
20:43Good evening, sir.
20:44My name's Karthik.
20:45I'm one of the doctors in A&E.
20:51How many times
20:52have you been vomiting, sir?
20:54About eight or nine times.
20:56Eight to nine times yesterday?
20:57Yeah.
20:58OK.
20:59Have you been able to keep down
21:00any liquid down?
21:02Very little.
21:03Very little.
21:04Fine.
21:05I'm very dry.
21:07How about you with needles?
21:08You OK?
21:10Due to his sickness,
21:12Jamie is severely dehydrated.
21:15Dr. Karthik needs urgent
21:16cannula access
21:17to get fluids into him
21:18as soon as possible.
21:21OK, let's have a look.
21:27Oh, sorry about that.
21:30Janice,
21:31could you pass me a green, please?
21:33Yeah.
21:34Veins are hard to find
21:35when the patient is dehydrated.
21:37And so Dr. Karthik
21:39will use an ultrasound
21:40to assist.
21:41One of the most common things
21:42that we find in our ED
21:44is we aren't able
21:46to do a quick IV access.
21:50The person is critically unwell,
21:53so time is of essence.
21:54It could be a source
21:54of stress for them,
21:55but it could be
21:56quite stressful for us.
22:03I'm sorry, it's a pair.
22:04OK, I'll have a look there.
22:08Oh.
22:13Jesus.
22:15Sorry, buddy.
22:16With Jamie dehydrated,
22:18his heart racing
22:19and his blood sugar low,
22:20the team need to move quickly
22:22to stabilize him
22:23before he becomes
22:24even more seriously ill.
22:26Oh, man.
22:27Better?
22:28No.
22:49He is very intoxicated.
22:51Yeah.
22:51Reduced GCS,
22:53found on the road
22:53with a head injury.
22:54There are nearly a million
22:55alcohol-related admissions
22:56to hospital every year.
22:58Fine.
22:5820 minutes.
22:59Patients under the influence
23:01in A&E regularly lead
23:02to violence
23:03and attacks on staff.
23:05Patients that come in
23:06violent, drunk, abusive
23:09can have a major effect
23:10on the entire department,
23:12whether it be our staff
23:13or other patients
23:14who are vulnerable.
23:16And it's our responsibility
23:17to make sure
23:18that everyone's safe.
23:27And I crashed my leg
23:29when it flopped me.
23:31Still is.
23:3219-year-old Ronnie
23:33could be in a serious condition
23:34after his motorbike
23:35crashed into a car.
23:37It was literally
23:38your normal shit
23:39with skin drys on it,
23:42but like a hard one.
23:43You can see the flesh
23:44under there.
23:45His girlfriend,
23:46Abby,
23:46who works for the ambulance service,
23:48found him at the scene
23:49and helped the paramedics.
23:51But it was bleeding
23:52quite a bit,
23:53quite a bit.
23:54And then you could just
23:55see the outline
23:56of like a golf ball.
23:58Dr. Wakas has just
23:59informed Ronnie
24:00his leg has an open fracture
24:02and needs surgery.
24:03It's a fracture
24:04of his tibia fibula.
24:05When there's a wound on that,
24:06making an open fracture,
24:07there's a huge risk
24:08of infection when it's open.
24:10So, and when it's
24:11an open fracture,
24:12we need to deal this urgently.
24:14So, what we're going to do
24:15is we're going to start
24:16the antibiotics
24:17and he needs surgery.
24:18So he's going to be...
24:19How long was that?
24:19Uh, open it to our morning again.
24:21You know your leg bones?
24:22I can tell you why it's rattling.
24:24Because yours is like...
24:26that.
24:30So it's not a strike?
24:32No, it's skewiff.
24:35So it's a strike?
24:37I just knew it's broken.
24:39It was literally like,
24:40my bones were rattling
24:41on the floor.
24:43Ronnie's surgery
24:44will need to happen
24:45in the day.
24:46so the medics
24:47need to ensure
24:47his leg is in a safe
24:49and stable position
24:50until then.
24:51This is called Penfrox.
24:52This is to relieve the pain
24:54because we're going to
24:55change the different things
24:56and give you tasks.
24:57Securing the leg
24:58in a safe position
24:59can be extremely painful.
25:00So he's being given
25:02a fast-acting,
25:03strong painkiller inhaler
25:04called Penfrox.
25:07Deep breaths in.
25:08Deep breaths in.
25:09We didn't even know
25:09what it was going to be like.
25:11Oh, God.
25:13There was a lot of blood.
25:15The bone in Ronnie's leg
25:17has snapped
25:18and come through the skin,
25:19creating a wound.
25:25Keep breathing to that.
25:26Keep breathing to that.
25:27Just fucking buffed on it.
25:28It's already good.
25:30Keep breathing it in.
25:31In and out.
25:33Madness trip.
25:34Is this like sending
25:35a blue pill?
25:37Yeah.
25:38Keep breathing it in.
25:39The team get the cast in place
25:41before getting the leg
25:42into position.
25:43Relax your leg.
25:45I'll be proximal.
25:50Now the plaster's setting,
25:52the team needs to hold
25:53Ronnie's leg steady
25:54until the cast can maintain
25:56the safe positioning.
25:57Try and keep still.
25:59It's fucking pushing on it, man.
26:00I'm sorry.
26:02Ah, man.
26:03Silky, silky, silky.
26:05I'm a lot of killers.
26:06It's basically going to make
26:07a little bit sick.
26:08I'm having my leg, man.
26:09I know.
26:10They've just got to align it.
26:11They're basically finished now.
26:14That is killing.
26:20What just happened?
26:23The Pentrox painkiller
26:25has made Ronnie temporarily confused.
26:28Look at it.
26:28Everyone's voice
26:29was like echoing
26:30over and over and over.
26:33Am I in a cast now?
26:36No, genuinely.
26:38That was a nice meal.
26:41It was like a bad
26:41mushroom trip.
26:44Yeah, you kept
26:44swearing at those
26:45motherfucking screen.
26:47There's a shower.
26:48Yeah.
26:50Extremely trippy.
26:51Now his leg is secured
26:53and in a safe position,
26:55Ronnie will have to wait
26:56until the daytime
26:56for his surgery.
26:58That would be
26:58a good Friday night
26:59when you've got no friends.
27:02That's the best
27:03kind of Friday.
27:04I'm going to try
27:05and buy one off of
27:06£10.
27:16So, yeah,
27:17that's the x-ray
27:18of his right little finger.
27:21In Birmingham A&E,
27:23Dr. Rashid is examining
27:24Mohammed's x-ray
27:25after the tip of his finger
27:27was torn off by a dog.
27:29Sir, I've seen your x-ray.
27:31The small tip of the bone
27:33is missing
27:34and it's exposed.
27:37The hands team,
27:38they're coming
27:39to have a look.
27:40It needs a proper washout.
27:42So, I'm going to put
27:43a cannula.
27:44We need to give you
27:45some antibiotics
27:45and it will be seen
27:46by the hands team.
27:47You're feeling
27:48a stain here?
27:49It depends.
27:50I mean, it will be seen
27:51by the hands
27:51and then they can decide
27:52whether they're going
27:53to do anything overnight
27:54or in the morning.
27:55Ah, okay.
27:56Okay.
27:57Fine.
27:58The tip of the bone
28:00is missing
28:00and the bone
28:01is exposed there.
28:02You can't leave
28:03the bone open
28:04while I'm in it
28:04otherwise you're
28:05going to get in.
28:06Perfection from there
28:06so it needs
28:07a proper washout
28:09and then repair.
28:11Be all right, though.
28:13Just try and see
28:14what the specialist's saying.
28:15If the one needs to stay,
28:16you're going to have to stay.
28:19Sharp scratch.
28:21Last year,
28:22nearly 3,500 people
28:24needed surgery
28:25after being attacked
28:26by a dog.
28:28Have a last one
28:29of the nurse
28:29to give you
28:29some antibiotics.
28:30If anything,
28:31okay, well done.
28:33Cheers.
28:34Thanks.
28:36So, I've still got the hands to you, sir.
28:39If they can just treat you
28:40with some antibiotics
28:40and then give you an appointment
28:41and you'll never come back.
28:43Hopefully, if that's the case.
28:45Feeling in the cup
28:46back the bone,
28:47we'll have to go from there.
28:48So, you've just got to wait now.
29:05Things I do to get out of work.
29:07In Tunbridge Wells,
29:09small business owner Samuel
29:10is in A&E
29:11with colleague Will.
29:12That's bad.
29:13That's real bad.
29:14After he injured his ankle
29:15at work
29:16jumping down
29:17from his van.
29:20I need learning things
29:21on this.
29:22L plates.
29:23If it's broken,
29:25it will have a big impact
29:26on his generator business
29:27during its busiest
29:29period of the year.
29:31So, we'll get your x-ray.
29:33Nurse Eric reviews
29:34the x-ray results
29:35of Samuel's ankle.
29:36So, with your ankle x-ray,
29:39when you first look at it,
29:40it looks okay,
29:41but you've got
29:41a really large tissue swelling
29:43on both medial
29:45and the lateral aspect
29:47reading both sides.
29:48Yeah, right, right.
29:49You have a little bit
29:50on the tailor-do,
29:52which is where you were
29:53tender on the side.
29:54Yeah.
29:55That's a very, very small fracture,
29:57that bit there.
29:58I can see that
29:59there's a small avulsion fracture
30:00on the medial
30:01modulose of the ankle.
30:03So, the treatment plan
30:03for this gentleman
30:04is walking boots
30:05and crutches,
30:06and the length of treatment
30:07could be six to eight weeks.
30:09You need to rest,
30:10elevate,
30:11and ice them
30:13at least a good 20 minutes
30:15for every four to six hours.
30:17Whoa.
30:19I will do the referral
30:20to Queen Victoria,
30:21which is the virtual
30:21fracture cleaning team
30:22with us.
30:23Yeah.
30:24and they will advise you
30:25what to do next.
30:27Okay.
30:27Fine.
30:30Look at the size of it.
30:35Okay.
30:35Now, walk your boots.
30:37Are you ready?
30:40A little bit more.
30:41Ah, fuck you.
30:43All right.
30:46There you go.
30:47As easy as that.
30:49Right.
30:50There you go.
30:50The boots will support
30:52the ankle
30:52and help Samuel walk
30:54while he heals
30:54for the next two months.
30:56Lovely.
30:57Thank you, Yelp.
30:57Okay.
30:58Cheers.
30:59The injury will have
31:01a massive impact for him.
31:03It's our busiest season
31:04and it's our busiest month
31:05this year, so...
31:06Not ideal.
31:07Terrible timing.
31:08Yeah, not ideal.
31:10But one of his workers,
31:11Will,
31:11has something to cheer him up.
31:14I got you a teddy bear.
31:15All right.
31:17It's going to match
31:18my pink crutches.
31:23Taxi driver.
31:41Okay.
31:43Sorry, sir.
31:44It's not your fault.
31:4539-year-old diabetic,
31:47Jamie,
31:47has been rushed into hospital.
31:51He has severe sickness,
31:53making him dehydrated.
31:54His heart rate
31:55is at 150 beats per minute
31:57and his type 2 diabetes
31:59is spiralling out of control.
32:01I'm really sorry
32:02about this, Jamie.
32:04But Dr Karthik
32:05can't access his veins
32:06to give him
32:07any fluid or medication.
32:09He didn't have
32:10any visible veins
32:11that we could say
32:11and that makes it
32:13a bit difficult
32:13for us to do it.
32:14If you're quite dehydrated,
32:16the veins don't open up
32:17as much.
32:19Registrar Dr Farouk
32:20comes to assist.
32:26Oh, yeah.
32:27That's a good vein there.
32:35Yes, you're in.
32:37So, let's hang
32:38a bag of Hartman's.
32:39The other one
32:40will hang
32:40with the needle
32:42finally inserted
32:43into a vein,
32:44the medical team
32:45give Jamie a drip
32:46to start to rehydrate
32:47and stabilise him.
32:49Yeah, OK.
32:51Your potassium
32:51is quite large.
32:53So, you're replacing
32:53your potassium
32:54from fluid, so, OK?
32:58Why would it be large?
33:00Because he's being sick.
33:01A potassium imbalance
33:03in the body
33:03can be dangerous,
33:05can affect the heart
33:06and could be responsible
33:07for Jamie's
33:08erratic heart rate.
33:10kidney pain.
33:12Kidney pain.
33:13You've got pain?
33:14Kidney pain?
33:14Yeah.
33:15OK.
33:16Any pain here?
33:17A little bit.
33:19Yeah?
33:19Yeah.
33:21Yeah?
33:21Yeah.
33:22Yeah.
33:26Could I kindly get
33:27CT up the pelvis
33:28wetted for the patient,
33:29please?
33:30It is up to minutes,
33:32tender,
33:33all over the place.
33:34So, I just need to make sure
33:35that there isn't anything else
33:37going on that we are missing.
33:38Just because we assume
33:39that this is all dehydration,
33:41I shouldn't be missing
33:42out on other pathology.
33:43So, hence, the scan.
33:45Hello, CT.
33:46How are you?
33:47A CT scan will reveal
33:49any other problems
33:50going on in Jamie's body
33:51caused by his sickness,
33:53dehydration and diabetes.
33:55You OK?
33:56Got a seat, Tom.
33:57Yeah.
34:11Please breathe in
34:12and hold your breath.
34:13Not long to go, darling.
34:19Breathe away normally.
34:21Thank you very much.
34:23The scan results
34:24have come through
34:24to Dr. Karthik in Rhesus.
34:27We were thinking
34:28that there could be
34:29abdomen pathology
34:30for the vomiting and things.
34:39I've had a look at the images.
34:41I couldn't find anything
34:42obvious on the images.
34:43Yeah, basically nothing
34:45on the scan.
34:47The scan's all clear
34:48and the fluids have helped
34:50bring Jamie's heart rate down.
34:51Come back.
34:52Let's come back
34:53all back as normal.
35:01Jamie's condition is stabilising,
35:04but he will remain monitored.
35:05He was in the hospital
35:07with similar complaints
35:08about three days ago.
35:10He will be admitted
35:11under the medical team
35:12to be assessed by then
35:13so that they can further
35:14adjust the insulin levels
35:16and so that he doesn't have
35:18a recurrence
35:19of the hypoglycemic
35:20facilities.
35:33Yeah, let's do it, guys.
35:38Oh.
35:41Hello.
35:41Ending your age
35:42for that phone.
35:43Go ahead.
35:43Yeah, we've got
35:45a 34-year-old female
35:48in SVT,
35:50a rate of 160.
35:54Paramedics are bringing
35:55in a woman
35:55with a dangerously
35:56fast heart rate.
35:58Come to recess.
35:59I'm going to have a little look at him.
36:00Thanks, mate.
36:03Clock into three.
36:05Oh, so she's heard.
36:07I'm the CEO.
36:08Hello, I'm Jack,
36:09one of the doctors.
36:10It's kind of a bit more
36:11on you and A&E.
36:11Overnight,
36:12you don't have the specialty teams
36:14to kind of get down
36:14straight away
36:15to help you out
36:15and people don't want
36:17to get out
36:17but it's 3 o'clock
36:17in the morning
36:18so if they come in
36:18they're generally
36:19very sick.
36:20My name's Jane.
36:21Jane.
36:22So it's a sudden onset.
36:24That is,
36:25at 6 o'clock,
36:26came out,
36:26feeling cold,
36:27trying to warm yourself up.
36:29It was sick three times.
36:31Have you got the ECG?
36:32So, ECG...
36:34She's got a very fast heart rate.
36:36It's about 160 beats
36:37per minute at the moment.
36:38Your heart eventually gets tired,
36:40it's not used to going
36:41that fast for that long.
36:42Oh, I can feel the heat
36:43coming off again.
36:44The average resting heart rate
36:46is between 60 and 100 beats per minute.
36:49Jane's is around
36:50double what it should be.
36:51May I have a little
36:51listen to your chest to start?
36:53Is that okay?
36:54Just breathing normally.
37:00All right.
37:01You are very hot, aren't you?
37:02The heart can't maintain
37:03a high rate for a prolonged period
37:05without a risk of failure.
37:06In the short term,
37:07you can tolerate it relatively well,
37:09but in the longer run,
37:09it can be dangerous,
37:11so we need to fix that
37:12sooner rather than later.
37:13You might end up
37:14just going straight
37:15into cardiac arrest.
37:16We're just going to give you
37:17a bit of fluid,
37:17wait for the paracetamol
37:18to kick in
37:19and see if it starts
37:20coming down on its own.
37:21Aside from its pain-killing effects,
37:24paracetamol will lower
37:25a temperature
37:25by a degree or two.
37:26It all seems to have
37:27started quite quickly, this.
37:29It's like the whole thing
37:30just went, like,
37:30freezing cold,
37:32but, like,
37:32freezing,
37:33like, teeth chattering,
37:34but really...
37:36Yeah, okay.
37:38That's probably
37:38your temperature
37:39starting to spike.
37:40Any recent bugs,
37:41coughs, colds,
37:42fevers?
37:43No, no vomiting?
37:45Well, I mean,
37:45I was a bit sickly,
37:46like, last weekend.
37:47Any rashes that you've noticed?
37:49No.
37:49No? Okay.
37:50All right, fine.
37:51Any pains in your chest
37:52at the moment?
37:53No.
37:53It doesn't hurt.
37:54You just can feel it.
37:55It's uncomfortable
37:56because it's so hot.
37:57And have you ever
37:57had anything like this before?
37:59While Dr Jack
38:00is treating Jane's symptoms,
38:02it's still unclear
38:03what's causing
38:04her dangerously fast
38:05heart rate and temperature.
38:07So, your heart rate's
38:08going very fast.
38:09We need to get a proper ECG
38:10and just see what that shows.
38:11We'll do some blood tests
38:12and we'll see what we find.
38:13The paramedic's ECG
38:15does look like an SVT,
38:16in fairness.
38:17If the team can't find
38:18and treat the cause
38:19of Jane's condition,
38:20it could become deadly
38:21at any moment.
38:4912-year-old Kenzie
38:50is in A&E
38:51with his nan, Barbara,
38:53after he fell off
38:53his bike and into glass.
38:55Come and take a seat.
38:56Let me have a look
38:57at the x-rays
38:57and I'll let you know.
38:58Dr Abdul sent him
39:00for an x-ray
39:00to check for any shards
39:01of glass still in his wound
39:03which could lead
39:04to a major infection.
39:06So, good news.
39:08Couldn't see any glass
39:09in your finger
39:10or anything like that.
39:11There's nothing in there.
39:12We'll just patch that
39:13back up for you,
39:14dress it up for you nicely
39:14and then that's it.
39:15Cool.
39:16Any questions so far?
39:18Can I go home after?
39:19Yeah, you can go home after.
39:21No worries.
39:23The wound may not
39:24have glass in it
39:24but it's still at risk
39:26of infection
39:27if not closed correctly.
39:31Is this going to hurt?
39:32No, it might be
39:33a little bit uncomfortable
39:35but it shouldn't hurt
39:36too much.
39:39About water?
39:40Yeah, it's just a bit of water.
39:44Don't want to feel okay?
39:46Yeah, good, well.
39:50Sorry.
39:50This is the only bit
39:51that's going to be
39:52a little bit uncomfortable.
39:53What I need to do
39:54is I just need to just
39:55make sure your skin
39:56goes back where it's
39:57supposed to go.
39:59Dr. Abdul needs
40:00to pull the torn skin
40:02back over the cut
40:03to help seal it.
40:04If he doesn't,
40:05it may heal incorrectly.
40:08Sorry.
40:10Leave, eh?
40:12Okay, just bring your hand
40:13over here again for me.
40:14Just turn it over
40:15like that.
40:15That's it.
40:17Doing really well, mate.
40:36One last little one
40:38across here.
40:43Yeah.
40:44One last little one
40:45across here.
40:46Yeah.
40:47One last little one
40:49That's it.
40:50The skin will be held
40:51in place with a
40:52steristrip
40:53until it can heal.
40:54But we'll still
40:55need a dressing.
40:57It's about Wednesday.
41:03There you go.
41:04It looks a bit better
41:04now, doesn't it?
41:05No.
41:05Sorry.
41:06How does that feel?
41:08Good.
41:10All right?
41:10No, it's fine.
41:11No worries.
41:12You just need to keep it
41:13nice and clean and dry
41:14for the next few days
41:14and it will just heal up
41:15nicely.
41:17And you can't help
41:17but push the limit
41:18a little bit,
41:18especially if it's
41:19something you enjoy.
41:20You know, we've all
41:20been there on a bike
41:22trying to do wheelies
41:22and trying to do stunts
41:23but, you know,
41:24sometimes it goes wrong
41:25but that's what we're
41:26here for.
41:26We're here to, you know,
41:27help people get back
41:28on their feet again,
41:29get back on the bike.
41:30All right?
41:30Thank you very much.
41:31You're very welcome.
41:32No worries.
41:32Cheers.
41:53I think it is just sinus.
41:55Like 33.2.
41:59The potassium's marginal.
42:01In Norwich A&E,
42:02Dr Jack is monitoring
42:0434-year-old Jane
42:05who has a very high heart rate.
42:09What do you reckon?
42:11Yeah, it doesn't look
42:14like an SVT to me.
42:15It's just a very quick onset.
42:18Jane has had an ECG
42:20to investigate her heart
42:21and paracetamol
42:22to lower her temperature.
42:24Any arrhythmia
42:25can be triggered
42:25by a multitude of things.
42:27An infection
42:27is just one of those things.
42:30But also,
42:31when you're unwell
42:31with an infection,
42:32your heart rate
42:33will go fast naturally.
42:34So I'm just going to
42:35put you up some fluids, okay?
42:37We'll start looking for
42:38if there's any
42:39bacterial components to it
42:40and we'll probably give you
42:41some antibiotics
42:42at that stage as well.
42:43All right.
42:44If Jane has an infection,
42:45that could be driving
42:47her temperature
42:47and heart rate up
42:48rather than a cardiac issue.
42:50It looks like your heart's
42:51probably going in
42:53not in an unusual rhythm,
42:54which is good.
42:55It's just fast in itself,
42:57probably because
42:57the temperature's so high.
42:58It's probably
42:59all infection-driven.
43:00So it is starting to settle,
43:02so it's getting down
43:03to the 130s now
43:03from 160.
43:04So we've just given
43:06this my profen,
43:06so hopefully that
43:07starts kicking as well.
43:08Dr Jack's treatment
43:09seems to be taking effect,
43:11indicating the cause
43:12is likely an infection.
43:14If the pain's getting
43:15more severe,
43:16we can give you
43:17something a bit stronger,
43:18but I'm hoping
43:18that'll kind of do the trick.
43:20I suspect when your
43:20temperature's a bit better,
43:21you'll feel a lot better
43:22because having a temperature
43:23of as high as 40
43:24is pretty grim.
43:25All right.
43:31I don't know what
43:32happened to me
43:32for the past three hours.
43:46What will she say?
43:47Start the bike.
43:48Start the bike.
43:50I reckon by Monday.
43:56Not ideal,
43:57but at least
43:58I'll be able to get out
44:00and mobile.
44:16She didn't do it intentionally,
44:17did she?
44:18Thank you for your health.
44:18No.
44:19No.
44:45If you're someone you know
44:47has been affected
44:48by any of the issues
44:49raised in tonight's programme,
44:51please go to
44:51channel5.com
44:52slash helplines
44:53for information
44:54and support.
44:56A gruesome discovery
44:57is a job for forensics
44:59as we follow investigators
45:00on the murder scene.
45:02True crime tomorrow at 10.
45:04Next tonight,
45:05Ambulance Code Red.
45:11Ambulance Code Red.
45:13Ambulance Code Red.
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