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A and E After Dark S06E11
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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, with extraordinary access to three of the most challenged emergency departments.
00:29in 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.
00:38Chucking now.
00:40It's a stab wound.
00:42With drugs and alcohol rife.
00:45I've had five or six pints.
00:46Big man.
00:48The department's just on fire.
00:50I've got a kick in there, yeah, yeah, yeah!
00:52The risk of violence and abuse looms large every night.
00:56And you, you're messing your .
00:58Stop trying me, boys.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched.
01:06I've been spat at.
01:07You've got nothing on me, bro.
01:08Right.
01:09Quiet!
01:09There have been days when there have been more police officers than patients.
01:13I'll 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!
01:20I don't care!
01:21This is the sort of thing that we have to put up with.
01:22Get security to the mover.
01:24It's 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 or 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.
01:56Nothing surprises or shocked me.
02:00We're 200 beats per minute.
02:02You 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.
02:23In Birmingham, the fire alarm has been triggered.
02:29If the source of the smoke isn't found, the hospital will need to be evacuated, including
02:34seriously 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 at a hospital toilet.
02:54A patient has been smoking in the toilet.
02:57Can we just remind all patients not to smoke inside, Amy?
03:01Yes.
03:01All day inside the toilet. Strictly forbidden.
03:05Anyone that is caught making will be removed from the premises.
03:08So I have to guarantee the safety of everybody, not just one person, alright?
03:13Yeah.
03:14It was a member of the public smoking in the toilets.
03:19Obviously, 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.
03:32Obviously, it's a massive safety incident.
03:35Patient safety is paramount.
03:37And obviously, flames and oxygen don't mix very well.
03:41And if we can't guarantee patient safety, then obviously, as a person in charge,
03:44you do have to take action.
03:52You've got to pop into a hot race, sir.
03:56Paramedics are on their way to hospital with a 19-year-old male who smashed into a car on his
04:01motorcycle.
04:05OK, it's great.
04:07Let's see what it is.
04:08So, this is Ron. He's 19 years old.
04:11He went head-on into the side of the car, moving about 20 to 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 or three fractures of the right leg.
04:27We have had a look at it.
04:29There is a laceration above it.
04:33Dr. Tom is leading the trauma team.
04:35Significant head injuries are common with traumatic injuries from motorcycles and cars.
04:42If someone's come off at speed, and especially if they've hit something quite solid,
04:46really, for us, that does raise suspicion of significant injury.
04:50I'm going to get access to the left side of the car.
04:52You can see no deformity to upper limbs.
04:54Having in the glide.
04:56No bruising in the flags.
04:58Did you say anything about the abdomen?
05:00The abdomen was soft and I'll tell you.
05:02Let's get some algae on board first, before we go to scan.
05:05I'm just going to keep the neck nice and steady until we get some scans
05:09and show us what's going on with it.
05:11Ronny may have serious hidden injuries to his organs, spine and head,
05:15from impacting the car, which 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, which is bleeding.
05:35There's no active arterial bleed or anything like that.
05:38And does it hurt here?
05:40Yeah.
05:41That's great.
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, Len.
05:51I think you might feel something to happen.
05:52We'll find out.
05:53When there's a crash.
05:54I did fall the bone.
05:55Yeah.
05:56We'll get it out.
05:57I think it's not a straight line, which is always a good way to do.
06:00I'll come to bed.
06:01Ready for scan?
06:02Oh, yeah.
06:03Yeah.
06:03Let's 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, so don't cause any further damage, if there is anything.
06:15As Dr. Tom and the team are concerned about potential unstable injuries from the collision, Ronnie is wrapped in a
06:21trauma mattress to keep him steady.
06:23The trauma mattress is a structure that vacuums itself around the casualty and gives stability but allows them to be
06:29moved without causing further pain or further movement to those injuries that we don't know are there or not yet.
06:39Ronnie's girlfriend, Abby, who works for the ambulance service, was on shift at the time of the accident.
06:45I got a text message saying that they detected sudden motion on Ronnie's phone.
06:52Ronnie's phone detected a sharp sudden change in his speed, which it recognises as an accident, and alerts his emergency
06:58contact.
06:59So I called him.
07:00He didn't answer.
07:01Keep your head still, please.
07:02What's your beautiful friend?
07:04I tracked his location, he weren't moving, so I went there.
07:12I seen the sirens, I seen the car, and then I found his bike.
07:20Seeing him just on the floor, I was like, different notes do.
07:26I'm really scared of that.
07:33I almost cried, but then I was like, I can't cry if I'm gonna help.
07:37So then it was just a big adrenaline rush, and that was it.
07:41Then I was ready to do anything they needed me to.
07:46Abby assisted the paramedics on site and followed behind to the hospital.
07:50We have to think that potentially there are spinal injuries, neck injuries, other organ pathologies.
07:56That removing the casualty in a less coordinated manner could cause further injury.
08:01Ronnie could have multiple serious internal injuries and bleeding, as the force from the bike stopping so suddenly is like
08:08being hit with a sledgehammer.
08:26He sustained an alleged assault where he was punched to the head.
08:30At night, violent crime in the UK has been on the rise over the last ten years.
08:35In the rise, he's got multiple stabbings.
08:38Gabriel, fill off three seconds.
08:39Probably a bit of ten, because after the blinding, he will need to be searched.
08:44And at night, it spills into A&Es across the country.
08:47I have a call reference of a male who's cut out of possession of a knife.
08:51So I'm gonna keep the male outside before he comes back in, to keep everyone safe.
09:08In Birmingham, Ronnie was rushed into A&E after his motorbike collided with a car at speed.
09:16Due to the force of the collision, doctors are scanning Ronnie to check for any life-threatening internal injuries.
09:24His girlfriend, Abby, who works for the ambulance service, was on shift at the time of the accident,
09:29and arrived on scene to help the paramedics already there.
09:32Because I know quite a few people that have actually passed away from bike crashes.
09:38So, I thought it was gonna be a whole lot, I don't want to say the word, but death.
09:47While Ronnie's CT scan is evaluated for serious injury, he's stable enough for visitors.
09:53How'd it be, then?
09:54Sure.
09:55Hello.
09:55Thanks.
09:57Just don't die, I don't want you to do that.
10:08Dr. Warkas has Ronnie's CT scan and X-ray results.
10:12Because he was in a high-velocity accident, we did a CT scan to rule out head injuries, spine injuries,
10:18and abdominal risk for pelvic injuries, stuff like that.
10:22The CT scan report is back.
10:24Now it's an open fracture.
10:26It's an emergency.
10:27Yeah.
10:27It requires an emergency surgery.
10:30Because of this injury, we have to put you on the list.
10:33That was happening tomorrow.
10:34So, what we're going to do is we're gonna wash the wound and do the cast.
10:40Once we have done the cast, then your fracture would be kind of stable.
10:44Yeah.
10:44Stable, it won't move.
10:46If it won't move, it won't hurt.
10:48Ronnie will need to have his legs stabilised until he can have surgery.
10:51But this can be extremely painful.
10:54So, are you happy to go ahead with the surgery?
10:55No more.
11:04I just sat around and went and something happened.
11:07And that was me to him.
11:09That was his dinner.
11:11Last year, there were over 30,000 dog attacks resulting in injuries.
11:16I didn't even move.
11:17I only had to look at him and he bit me.
11:19A 21% increase from the previous year.
11:23It was more the shock than anything.
11:26Dog attacks can lead to serious infection or even life-changing injuries.
11:31Oh, that is sore.
11:32Sorry.
11:33Awesome.
11:42Thanks so much. Come on.
11:48Once we worked on the blood, you see my finger missing?
11:50It's trying to find and it can't find it.
11:53Bit in a panic, aren't you?
11:54What?
11:54When we said it was...
11:56More angry.
11:56Yeah, when we said it was missing.
11:58It was a bit of a shock.
12:0032-year-old Mohammed has come to A&E with his partner, Tanya.
12:05I was playing with my mate's dog.
12:07He's chopped up to bite the toy.
12:09I ended up biting my finger.
12:11I don't want to see the dog again, to be honest.
12:13It's not my dog.
12:17Mohammed.
12:19Dr. Rashid will assess Mohammed's injury.
12:22So, Mohammed, what happened?
12:24I missed that.
12:25I missed it.
12:26I was playing with the toys chopped up.
12:27He matched onto my finger.
12:29OK, let me have a look.
12:31You just put your hand there.
12:35Have you taken any painkiller?
12:37I am.
12:37Give me some dust.
12:39Just a minute.
12:40That's horrible.
12:42Dog bites are quite common.
12:43The most common sort of complication is the infection, basically.
12:47When was your last tetanus injection?
12:49A few months ago.
12:50I went to Thailand.
12:52OK.
12:54No pain.
12:56No pain.
12:57That's a bit there.
12:58The dog bites could have caused hidden nerve damage, so Mohammed's sensation needs to
13:02be assessed.
13:04You 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 is put some dressing.
13:18We need to do an x-ray.
13:20Just to check whether you're going to need 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 from the plastics department on 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 just to see if there's any fracture there.
13:43And then we'll give some antibiotics.
13:45If the bone is exposed, basically, we need to just call the hands team to trim the bone
13:50and just basically they close the bone.
13:52The longer the bone is exposed, the more bacteria it comes into contact with, which could lead
13:57to a serious infection.
13:59Keep your finger there.
14:00We request the x-ray, then I'll take you to x-ray.
14:16That is massive.
14:18Literally looks like another kneecap.
14:20So, yeah.
14:21Mess it right up.
14:24In Tunbridge Wells, 31-year-old night worker Samuel has had an accident while working
14:30at his generator business.
14:32Hiya.
14:33Hello.
14:33Been sitting down here from reception.
14:36I jumped off to work van and rolled my ankle.
14:41Painful.
14:41Really painful.
14:43It's just getting bigger and bigger.
14:46What are you doing here?
14:47I didn't know what you wanted, so I got you both.
14:51Why have you been a mate?
14:53Colleague Will has arrived to 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, that's a lot worse.
15:11Look at the size of it.
15:13Yeah, she's getting bigger and bigger.
15:15Yeah.
15:15I can't lift my toes up.
15:16I can't move it.
15:18Did you finish the job?
15:20Yeah, I can't do it in.
15:22Go home.
15:24Yes.
15:29All right, it's a job.
15:30You're sounding your ankle.
15:31Yeah.
15:32It's quite sore, though.
15:33It is really sore.
15:34But you're ready.
15:35Ah!
15:36Do you have a thing in any pain?
15:37You'll be fat sore.
15:38Yeah.
15:39Nurse Eric will assess the ankle to get an impression of how serious the injury is.
15:44Anything from here to here?
15:46No.
15:46Anything on this side of 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.
15:57Your pain is mostly on this side.
15:59Yeah.
16:00Okay.
16:01Oh, fuck.
16:02You don't have to die.
16:04I'm concerned about the swollen ankle, the bruising on the ankle.
16:09He might sustain a fracture on his ankle.
16:12So once I have the x-ray back, the next part is the treatment.
16:16Only an x-ray will reveal the extent of the damage to his ankle.
16:37It seems to be getting bigger and bigger.
16:40If it's broken, Samuel could be off work at his generator business for months.
16:45I was going to be at work tonight and it's our busiest month and now I don't know what we're
16:51going to do.
16:52Here we go.
16:54Here we go.
16:55We're going to look at the little texas.
16:57It comes on the side a bit.
17:14Kenzie.
17:16Just jump up on there for me.
17:18Although not a designated children's A&E,
17:2012-year-old Kenzie has come in with his nan, Barbara,
17:23after an accident whilst playing.
17:25When it happened, I was crying for ages.
17:28I don't, like, love myself, so I wouldn't look at it.
17:31My mum wouldn't look at it,
17:33so she had to get my neighbour to do it for me.
17:36He's being treated by Dr Abdul.
17:38No, OK. Tell me what's happened.
17:41When I was out riding my bike...
17:44Yeah?
17:45I tried doing a wheelie, but then I fell off my bike.
17:48Fine.
17:48And then there was glass on the floor.
17:51OK.
17:51And I think I've got my hand in the glass.
17:52He thinks there's glass and I was whatever on the floor.
17:55So you put your hand down and then when you looked up your hand,
17:58your hand was cut?
17:59Yeah.
17:59OK, fine. Can I have a little look at it?
18:02It will wash.
18:02Yeah, it's very sore.
18:04OK.
18:07Can you just bend your fingers like that for me?
18:10As much as you can, try and keep going for me?
18:13Hurts when you do that? OK.
18:15A serious glass cut to the hand could damage nerves and tendons.
18:19Can you feel me touching your finger here?
18:21No.
18:22OK.
18:23The main thing I want to just check is make sure there's no glass in there or anything,
18:26all right?
18:26So I'm going to just give it a little wash and a little clean and then we'll see what it
18:29looks like.
18:35It's all right. This is a bit where it's going to be a bit uncomfortable.
18:42Do you feel like there's anything in your finger when I'm doing that? No?
18:45Just cut.
18:46OK. I can't see anything in your finger. What we're going to do, just to be on the safe side,
18:51we're going to get an x-ray. All right, ready to go?
18:53Yeah.
18:54Lovely. OK, follow me.
18:55If there are any glass pieces in the wound, it could prevent it from healing properly
19:00or cause a serious infection.
19:02Just take a seat on those chairs for me. I've got Kenzie for finger x-rays.
19:08Say hello to you, ma'am.
19:10Fine.
19:11He's tired and he's hungry, but...
19:21Don't you want to go to a prick, darling? Don't you want me out here?
19:25What's his obs?
19:32Sister Sarah has just taken a call
19:34from paramedics who are rushing in a patient with a rapid heart rate.
19:37His heart's racing at only 50 beats a minute.
19:40He's vomiting. He's also a diabetic and his blood sugars are low.
19:49Dr Karthik is preparing for his arrival.
19:55Oh.
19:58If he's been quite dehydrated, he will require a lot more fluids.
20:04This is Jamie, who's 39 years of age.
20:07She was discharged Wednesday from gastroenteritis,
20:11but complicated with type 2 diabetes, managed with insulin.
20:15He's been having multiple hypos, which has managed himself with oral glucose.
20:21Jamie's vomiting bug is stopping his body absorbing food,
20:24affecting his diabetes, causing his blood sugar levels to drop dangerously low.
20:29This has been going on quite well.
20:31He had an admission into City Hospital for 10 days, in fact, three weeks ago.
20:36So, basically, gentlemen has come with multiple episodes of vomiting.
20:39Yeah, yeah.
20:40Recting.
20:41Blood in the urine.
20:41And blood in his children.
20:42Blood in the urine.
20:43Good evening, sir.
20:45My name's Karthik.
20:45I'm one of the doctors in A&E.
20:51How many times have you been vomiting, sir?
20:54I don't know, about eight or nine times.
20:56Eight or nine times yesterday?
20:57Yeah.
20:58OK.
20:59Have you been able to keep down any liquid down?
21:02Very little.
21:03Very little.
21:04Fine.
21:05I'm very dry.
21:07How about you with needles?
21:09Are you OK?
21:10OK.
21:11Due to his sickness, Jamie is severely dehydrated.
21:15Dr Karthik needs urgent cannula access to get fluids into him as soon as possible.
21:21OK, let's have a look.
21:26Oh, sorry about that.
21:30Can you pass me a green, please?
21:33Yeah.
21:34Veins are hard to find when the patient is dehydrated.
21:37And so Dr Karthik will use an ultrasound to assist.
21:41One of the most common things that we find in our ED is we aren't able to do a quick
21:48IV access.
21:50The person is critically unwell, so time is of essence.
21:54It could be a source of stress for them, but it could be quite stressful for us.
22:03I'm sorry it is up here.
22:04OK, I'll have a look then.
22:09Jesus.
22:15Sorry, buddy.
22:16With Jamie dehydrated, his heart racing, and his blood sugar low,
22:20the team need to move quickly to stabilise him before he becomes even more seriously ill.
22:26Oh, man.
22:27No.
22:49He was very intoxicated.
22:51Yeah, he was.
22:52Reduced GCS, found on the road with a head injury.
22:54There are nearly a million alcohol-related admissions to hospital every year.
22:58Fine, 20 minutes.
22:59Patients under the influence in A&E regularly lead to violence and attacks on staff.
23:05Patients that come in violent, drunk, abusive, can have a major effect on the entire department,
23:12whether it be our staff or other patients who are vulnerable.
23:16And it's our responsibility to make sure that everyone's safe.
23:27I'm going to crash my leg when I flopped me.
23:31Still is.
23:3119-year-old Ronnie could be in a serious condition after his motorbike crashed into a car.
23:37It was literally your normal shit with skin drys on it, but like a bad one.
23:43You know where you can see the flesh under there.
23:45His girlfriend, Abby, who works for the ambulance service, found him at the scene and helped the paramedics.
23:51But it was bleeding quite a bit, quite a bit. And then you could just see the outline of like
23:57a golf ball.
23:58Dr. Wakas has just informed Ronnie his leg has an open fracture and needs surgery.
24:03It's a fracture of his tibia fibula. When there's a wound on that, making an open fracture,
24:07there's a huge risk of infection when it's open. So, and when it's an open fracture,
24:12we need to deal this urgently. So, what we're going to do is we're going to start the antibiotics
24:17and he needs surgery. So, he's going to be operated tomorrow morning.
24:21You know your leg bones? I can tell you why it's rattling. Because yours is like that.
24:30So, it's not a strike? No, it's skewiff.
24:35So, it is a strike? I just know it's broken. It was literally like my bones were rattling on the
24:41floor.
24:43Ronnie's surgery will need to happen in the day. So, the medics need to ensure his leg is in a
24:48safe
24:49and stable position until then. This is called Penfrox. This is to relieve the pain because we're going to
24:55change the things and give you tasks. Securing the leg in a safe position can be extremely painful.
25:00So, he's being given a fast-acting strong painkiller inhaler called Penfrox.
25:15The bone in Ronnie's leg has snapped and come through the skin, creating a wound.
25:25Keep breathing to that. Keep breathing to that.
25:28It's all you can do. Keep breathing it in. In and out.
25:33It might just trip. Is this like sending flu pills?
25:37Yeah. Keep breathing it in.
25:39The team get the cast in place before getting the leg into position.
25:43Relax your leg.
25:50Now the plaster's setting, the team needs to hold Ronnie's leg steady until the cast can maintain the safe
25:56positioning. Try and keep still.
25:58Just relax. Just fucking pushing on it, man.
26:01Sorry.
26:02Oh, man. Keep still. Keep still.
26:05Try and relax your leg.
26:09I know. They've just got to align it. They're basically finished now.
26:14That is killing.
26:20What just happened?
26:23The Penfrox painkiller has made Ronnie temporarily confused.
26:27I could hear everyone's voice was like echoing over and over and over.
26:33Am I in a cast now?
26:35No.
26:37No. Genuinely, that was a nice meal.
26:41It was like a bad mushroom trip.
26:43Yeah.
26:44Yeah, you kept swearing at them.
26:45It was just a fucking screamer.
26:48There's a shower?
26:48Yeah.
26:50Extremely tricky.
26:52Now his leg is secured and in a safe position, Ronnie will have to wait until the daytime for his
26:57surgery.
26:58That would be a good Friday night when you've got no friends.
27:02That's the best kind of Friday. I'm going to try and buy one off of £10.
27:16So, yeah, that's the X-ray of his right little finger.
27:21In Birmingham A&E, Dr. Rashid is examining Muhammad's X-ray after the tip of his finger was torn off
27:27by a dog.
27:29So, I've seen your X-ray. The small tip of the bone is missing. And it's exposed.
27:37The hands team, they're coming to have a look. It needs a proper washout.
27:42So, I'm going to put a cannula. We need to give you some antibiotics.
27:46And it will be seen by the hands team.
27:47Are you feeling any stain here?
27:49Well, it depends. I mean, it will be seen by the hands and then they can decide,
27:52well, they're going to do anything overnight or in the morning.
27:55Ah, okay.
27:57Okay.
27:57Fine.
27:58The tip of the bone is missing. The bone is exposed there.
28:03You can't leave the bone open while I'm in it. Otherwise, you're going to get infection from there.
28:06So, it needs a proper washout and then repair.
28:11Be all right, babe.
28:13Just trying to see what the specialist is saying.
28:15If they want you to stay, you're going to have to stay.
28:19Sharp scratch.
28:21Last year, nearly three and a half thousand people needed surgery after being attacked by a dog.
28:28Have a last one of the nurse to give you some antibiotics.
28:31Okay, well done.
28:36So, I've still got the hands to him, sir.
28:39If they can just treat him with some antibiotics and then give him an appointment,
28:42and he'll never come back.
28:43Hopefully, if that's the case.
28:45I think I'm going to cut back the bone.
28:47I'm going to have to go from there.
28:48So, he's got to wait now.
29:05Things I do to get out of work.
29:07In Tunbridge Wells, small business owner Samuel is in A&E with colleague Will.
29:12That's bad. That's real bad.
29:14After he injured his ankle at work jumping down from his van.
29:20I need learning things on this.
29:22L plates.
29:24If it's broken, it will have a big impact on his generator business during its busiest period of
29:30the year.
29:31Let's have a look at your x-ray.
29:33Nurse Eric reviews the x-ray results of Samuel's ankle.
29:37So, with your ankle x-ray, when you first look at it, it looks okay, but you've got a really
29:42large
29:42tissue swelling on both medial and the lateral aspect, reading both sides.
29:48Yeah, yeah, yeah.
29:49You have a little bit on the tailer though, which where you were tender on the side.
29:54Yeah.
29:55That's a very, very small fracture, that bit there.
29:58I can see that there's a small avulsion fracture on the medial mollulus of the ankle.
30:02So, the treatment plan for this gentleman is walking boots and crutches, and the length of
30:07treatment could be six to eight weeks.
30:09You need to rest, elevate, and ice them at least a good 20 minutes for every four to six hours.
30:16What?
30:19I will do the referral to Queen Victoria, which is the British Old Practical Clinic team
30:22with us.
30:23Yeah.
30:24And they will advise you what to do next.
30:27Okay.
30:27Fine.
30:30Look at the size of it.
30:50The boots will support the ankle and help Samuel walk while he heals for the next two months.
30:56Lovely. Thank you, Harold.
30:57Okay.
30:58Cheers.
31:00The injury will have a massive impact for him.
31:03It's our busiest season, and it's our busiest month of this year.
31:06So, not ideal. Terrible timing.
31:08Yeah, not ideal.
31:10But one of his workers, Will, has something to cheer him up.
31:14Oh, I got you a teddy bear.
31:15Oh, mate.
31:17It's going to match my pink crutches.
31:23Tax driver.
31:41Okay.
31:43Sorry, sir.
31:43It's not your fault.
31:4539-year-old diabetic, Jamie, has been rushed into hospital.
31:51He has severe sickness, making him dehydrated.
31:54His heart rate is at 150 beats per minute, and his type 2 diabetes is spiraling out of control.
32:01I'm really sorry about this, Jamie.
32:04But Dr. Karthik can't access his veins to give him any fluid or medication.
32:09He didn't have any visible veins that he could say, and that makes it a bit difficult for us to
32:14do it.
32:14If you're quite dehydrated, the veins don't open up as much.
32:19Registrar Dr. Farooq comes to assist.
32:26Oh, yeah. That's a good vein there.
32:35Yes, you're in.
32:37So, let's hang a bag of Hartmann's.
32:39The other one will hang potassium.
32:41With the needle finally inserted into a vein, the medical team give Jamie a drip
32:46to start to rehydrate and stabilise him.
32:50Your potassium is quite large, so we'll be replacing your potassium.
32:54It's almost a little, it's okay.
32:58Why would you feel large?
32:59Because he's being sick.
33:01A potassium imbalance in the body can be dangerous, can affect the heart,
33:06and could be responsible for Jamie's erratic heart rate.
33:10What? Kidney pain.
33:12Hmm? Kidney pain.
33:13You got pain? Kidney pain?
33:14Yeah.
33:15Okay.
33:16Any pain here?
33:17A little bit.
33:19Yeah.
33:19Yeah?
33:20Yeah.
33:21Yeah?
33:21Yeah.
33:25Radiology?
33:25Hello. Could I kindly get a CT up the pelvis wetted for a patient, please?
33:31It is up to minutes tender all over the place, so I just need to make sure that there isn't
33:36anything
33:36else going on that we are missing. Just because we assume that this is all dehydration, I shouldn't
33:41be missing, not another pathology, so hence the scan.
33:47A CT scan will reveal any other problems going on in Jamie's body caused by his sickness, dehydration,
33:53and diabetes.
34:11Please breathe in and hold your breath.
34:13Not long to go, darling.
34:19Breathe away normally.
34:20Well done.
34:21Thank you very much.
34:22The scan results have come through to Dr Karthik in Rhesus.
34:27We were thinking if there could be abdomen pathology for the vomiting and things.
34:39I've had to look at the images. I couldn't find anything obvious on the images.
34:43Yeah, basically nothing on the scan.
34:47The scan's all clear, and the fluids have helped bring Jamie's heart rate down.
34:51Come back, and let's come back all back as normal.
34:55So you're going to keep you overnight.
34:56You get to see by the medical team.
34:59All right.
34:59Cheers to me.
35:00Sleep.
35:00All right.
35:02Jamie's condition is stabilising, but he will remain monitored.
35:05He was in the hospital with similar complaints about three days ago.
35:10He will be out on the medical team to be assessed by then, so that they can further adjust the
35:15insulin levels,
35:16and so that he doesn't have a recurrence of the hypoglycemic episodes.
35:33Yeah, look, he goes.
35:38Oh.
35:41Hello.
35:41Ending your HP or that phone.
35:43Go ahead.
35:44Yep.
35:44We've got a 34-year-old female in SVT, a rate of 160.
35:54Paramedics are bringing in a woman with a dangerously fast heart rate.
35:58Come to recess.
35:59I want to have a little look at her.
36:03Welcome to three.
36:10It's kind of a bit more on you and A&E.
36:12Overnight, you don't have the specialty teams to kind of get down straightaway to help you out,
36:16and people don't want to get out, but it's 3 o'clock in the morning,
36:18so if they come in, they're generally very sick.
36:20My name's Jane.
36:21Jane.
36:22So it's a sudden onset.
36:256 o'clock came out, feeling cold, trying to warm myself 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 per minute at the moment.
36:39Your heart eventually gets tired.
36:40It's not used to going that fast for that long.
36:42Oh, I can feel the heat coming up again.
36:44The average resting heart rate is between 60 and 100 beats per minute.
36:49Jane's is around double what it should be.
36:51May I have a little listen to your chest to start?
36:53Is that okay?
36:54Just breathe normally.
37:00All right.
37:01You are very hot, aren't you?
37:02The heart can't maintain a high rate for a prolonged period without a risk of failure.
37:06In the short term, you can tolerate it relatively well, but in the longer run, it can be dangerous.
37:11So we need to fix that sooner rather than later.
37:13You might end up just going straight into cardiac arrest.
37:16We're just going to give you a bit of fluid.
37:18Wait for the paracetamol to kick in and see if it starts coming down on its own.
37:21Aside from its pain-killing effects, paracetamol will lower a temperature by a degree or two.
37:26It all seems to have started quite quickly, this.
37:29It's like the whole thing just went like freezing cold, but like freezing, like teeth chattering,
37:34like really.
37:34Yeah, it's a physical challenge.
37:36Yeah, okay.
37:38That's probably your temperature starting to spike.
37:39Any recent bugs, coughs, colds, fevers?
37:43No, no vomiting?
37:45Well, I mean, I was a bit sickly like last weekend.
37:47Any rashes that you've noticed?
37:49No.
37:49No? Okay.
37:50All right, fine.
37:51Any pains in your chest at the moment?
37:53No.
37:53It doesn't hurt.
37:54It's...
37:55You just can feel it, pal.
37:56It's uncomfortable because it's so hot.
37:57Have you ever heard anything like this before?
37:59While Dr. Jack is treating Jane's symptoms, it's still unclear what's causing her dangerously
38:05fast heart rate and temperature.
38:07So your heart rate's going very fast.
38:09We need to get a proper ECG and just see what that shows.
38:11We'll do some blood tests.
38:12We'll see what we find.
38:13The paramedic's ECG does look like an SVT in fairness.
38:17If the team can't find and treat the cause of Jane's condition,
38:20it could become deadly at any moment.
38:47Do you want to come back, Spru?
38:4912-year-old Kenzie is in A&E with his nan, Barbara,
38:53after he fell off his bike and into glass.
38:56Come and take a seat.
38:56Let me have a look at the x-rays and I'll let you know.
38:58Dr. Abdul sent him for an x-ray to check for any shards of glass still in his wound,
39:03which could lead to a major infection.
39:06So, good news.
39:08Couldn't see any glass in your finger or anything like that.
39:11There's nothing in there.
39:12We'll just patch that back up for you, dress it up for you nicely and then that's it.
39:15Cool. Any questions so far?
39:19Yeah, you can go home after, yeah.
39:21No worries.
39:23The wound may not have glass in it, but it's still at risk of infection,
39:27if not closed correctly.
39:30Is this going to hurt?
39:32No, it might be a little bit uncomfortable,
39:35but it shouldn't hurt too much.
39:39But what?
39:40Yeah, it's just a bit of water.
39:44Come on, feel okay?
39:46Yeah, goodbye.
39:50Sorry.
39:50This is the only bit that's going to be a little bit uncomfortable.
39:53What I need to do is I just need to just make sure your skin goes back where it's supposed
39:57to go.
39:59Dr. Abdul needs to pull the torn skin back over the cut to help seal it.
40:04If he doesn't, it may heal incorrectly.
40:08Sorry.
40:10Leave, eh?
40:12Okay, just bring your hand over here again for me.
40:14Just turn it over like that.
40:15That's it.
40:17Doing really well, mate.
40:36Yeah, one last little one across here.
40:43Oh, just the high glass over here.
40:49That's it.
40:50The skin will be held in place with a stereostrip until it can heal,
40:54but we'll still need a dressing.
41:00There you go. It looks a bit better now, doesn't it?
41:05Yeah.
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 nice and clean and dry for the next few days,
41:14and it'll just heal like nasty.
41:17And you can't help but push the limit a little bit,
41:19especially if it's something you enjoy.
41:20You know, we've all been there on a bike trying to do wheelies
41:22and trying to do stunts, but, you know, sometimes it goes wrong,
41:25but that's what we're here for.
41:26We're here to, you know, help people get back on 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.
41:50Thank you all.
41:51No problem.
42:01In Norwich A&E, Dr Jack is monitoring 34-year-old Jane,
42:05who has a very high heart rate.
42:09What do you reckon?
42:13Yeah, it doesn't look like an SVT to me.
42:15It's just very quick onset.
42:18Jane has had an ECG to investigate her heart
42:21and paracetamol to lower her temperature.
42:24Any arrhythmia can be triggered by a multitude of things,
42:27and infection is just one of those things.
42:30But also, when you're unwell with an infection,
42:32your heart rate will go fast naturally.
42:34So I'm just going to put you up some fluids, OK?
42:37We'll start looking for if there's any bacterial components to it,
42:40and we'll probably give you some antibiotics at that stage as well.
42:43All right.
42:44If Jane has an infection,
42:45that could be driving her temperature and heart rate up,
42:49rather than a cardiac issue.
42:50It looks like your heart's probably going in not in an unusual rhythm,
42:55which is good.
42:55It's just fast in itself, probably because the temperature is so high.
42:58It's probably all infection-driven.
43:00So it is starting to settle.
43:02So it's getting down to the 130s now from 160.
43:04So we've just given this my profen,
43:06so hopefully that'll start to kick in as well.
43:08Dr Jack's treatment seems to be taking effect,
43:11indicating the cause is likely an infection.
43:14If the pain's getting more severe,
43:16we can give you something a bit stronger,
43:18but I'm hoping that'll kind of do the trick.
43:20I suspect when your temperature's a bit better,
43:22you'll feel a lot better,
43:22because having a temperature of as high as 40 is pretty grim.
43:25All right.
43:31I don't know what happened to me for the past three hours.
43:38I don't know what happened to me for the past three hours.
43:46What will she say?
43:47Surf the bike.
43:48Surf the bike.
43:50I reckon by Monday.
43:56Not ideal, but at least,
43:59at least I'll be able to get out and mobile.
44:03I'll be able to get out and go to the next two hours.
44:12I'll be able to get out and get out of here.
44:12Do you have to tell me nothing wrong?
44:13Did you have to tell me nothing wrong?
44:13Did you throw a bite in the toe?
44:14I actually bit me, took my finger off.
44:16I didn't do it intentionally, did you?
44:18Thank you for your health.
44:18No, no.
44:19No.
44:19No.
44:19No.
44:48Transcription by CastingWords
45:13Transcription by CastingWords
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