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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:10It can be very dangerous.
00:13We deal with a lot of aggressive patients.
00:16Things can escalate.
00:18This gentleman has been punched, kicked.
00:20It can be quite scary when it's just you and one violent patient.
00:24Across the UK, we join the staff of three of the most challenged emergency departments.
00:29It's always busy, it's always under pressure.
00:31Stop CPR.
00:32Time is of the essence.
00:34And the medics who face danger each shift.
00:37Most shifts, I see more police than nurses.
00:40With the amount of drugs and alcohol admissions rising.
00:43Have you been drinking today?
00:44The risk of violence and abuse looms large every night.
00:48Please don't swear like that.
00:50They try to attack and stuff.
00:51Calm yourself down.
00:54People can become aggressive.
00:56We've been punched, kicked.
00:59You see the good, bad and the ugly.
01:00I don't do a ****.
01:02Yeah, we'll get security.
01:03The emergency department is like a battlefield.
01:05It's like organised chaos.
01:24The night shift can be a dangerous place for hospital workers.
01:28People are out of ****.
01:29Do we think he has a knife or no?
01:31Oh **** this ****, you have to calm down.
01:34You have that constant awareness of you don't really know what's coming in through the door.
01:39With incidents of violence against nurses in A&E increasing by 91% in the last five years.
01:47We're regularly getting physically assaulted, verbally assaulted.
01:50Patients impacting our personal safety is a really big problem at the moment.
01:55I've had it with every **** you want me at.
01:56But often I can have to take a moment.
02:01Right?
02:07Come on.
02:09Honestly it's like a war zone out there.
02:15I was a 39 year old police station跟 that, yeah.
02:19Look at the dummy and that, ain't it.
02:29Police have arrived in Newham emergency department with an aggressive suspect who's been placed
02:34in a spit hood.
02:36He was found drunk in the street, apparently he'd been assaulted but he was extremely abusive
02:42to all officers on scene and racially abusive to officers so he ended up being arrested
02:49a racially unfated public order.
02:58It continuously spitting so the spit hood went on to him and he carried on spitting even
03:04once the hood was on.
03:11The abusive man has claimed to have swallowed heroin when being taken into police custody.
03:16Good.
03:17Can I send someone your way?
03:19We should be able to do it under protocol.
03:22Awesome, cheers mate.
03:24Bye, bye, bye.
03:25Dr Ella will be managing the patient.
03:40The man is a threat to the public in the waiting room and needs to be isolated.
03:45What's the situation?
03:47So, he got arrested for racially abusing one of our police, and then in the van...
03:54Oh, good.
03:55Okay.
03:55I'm going to hospital.
03:56Go on.
03:57Okay.
03:59All right, so he was arrested for a racially abusing police officer and then he swallowed
04:03some heroin.
04:04All right.
04:05If the swallowed drugs pack ruptures, the man could overdose and die within minutes.
04:10Sir, my name's Ella.
04:12I'm one of the doctors.
04:13Don't talk to me.
04:16Nice.
04:17What's your name?
04:19I'm a doctor.
04:20I'm a doctor.
04:20I'm a doctor.
04:21Okay.
04:21You can get seen by whoever's available.
04:23And right now I'm available.
04:25I'm a doctor.
04:26I'm a doctor.
04:27I'm a doctor.
04:29I'm a doctor.
04:30So, if you want to come to hospital, we have to take a little bit.
04:34What we worry about is if the vessel that they've swallowed it in has it burst in their abdomen
04:39and it's incredibly high toxicity level, but has it actually eroded through their intestinal
04:44system.
04:44I'm going to shine a little light in your eyes, okay?
04:46I took the cream of Africa.
04:49It's not ideal when someone like you're trying to help is hurling abuse at you.
04:53With the patient refusing treatment, Dr Ella can do nothing to prevent a potentially lethal
04:59dose of heroin entering the man's system.
05:01No, .
05:03That, .
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05:15Also in Newham, the resus team are experiencing a busy shift.
05:19One is going to ITU.
05:21It's a challenging environment to work in, particularly at night.
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07:29emergency department, a seriously ill 17-year-old Aoife has been rushed in by her parents after
07:37she started vomiting blood. Aoife had a tonsillectomy earlier this week and was only discharged
07:58a few hours ago. Dr Alice will be treating Aoife. A post tonsillectomy bleed is extremely serious
08:14because you can bleed a lot. So if someone's heart rate is up and they're bleeding we're
08:24worried about how much blood they've lost. Especially in the paediatric or young adult population they
08:30don't have as big a circulating blood volume and so if they start bleeding you're really concerned.
08:35Nothing to eat or drink? No, I'm okay. No water? No, nothing. So what we're going to do is the
08:42ear and throat doctors are going to come and see you again. ENT surgeons who are the ones that perform
08:48the procedure initially and they want to see them straight away and if necessary take them to theatre.
08:55If it won't clot the site of Aoife's tonsillectomy may need to be reclosed.
09:01There's a couple of things that we can do to slow the bleeding. One of them is a gargle of
09:06hydrogen peroxide
09:07and adrenaline soaked swabs can be used to sound the bleeding. So this has adrenaline on it okay.
09:14It helps the blood vessels like all tighten up. If Dr Alice can't stop the bleeding Aoife's blood pressure
09:19could continue to drop putting strain on her heart requiring further surgery to help close her
09:25operation wound. I'm going to pop this against your tonsil okay. Post tonsillectomy bleeds are extremely
09:32serious and children have died of them before.
09:49Resource nurses, could you please bring the care to me, thank you.
09:53I'm going to get dirty, dirty, dirty.
09:55In the UK, Nightsynt A&E are incredibly busy.
09:59Can I have the paediatric team to resource?
10:00With fewer staff members available to manage the influx of people.
10:04Okay, as soon as you're in the bay, we'll go back on the chest please.
10:08Have a seat please for me.
10:11I'm telling you to shut up!
10:26Sir, my name's Ella. I'm one of the doctors.
10:32Dr Ella is dealing with an abusive spitting patient who claims to have swallowed a heroin packet.
10:39If it leaks, it could cause a fatal overdose.
10:42So if you want to come to hospital, we have to take a little bit.
10:46I'm going to shine a little light in your eyes okay.
10:49Hey listen, I don't have to get a mother****** off till I hear it.
10:52The man is being racist and misogynistic, while refusing to be treated.
10:57So he's removed to the waiting room.
11:09It's very common that you'll find police in hospital.
11:12Sometimes people say they swallow drugs because they think they'll spend less time in police custody.
11:16But the time that they're at hospital doesn't count for their custody time.
11:20I'm a rich ass! Rich ass!
11:23With the man causing chaos in the waiting room...
11:28It's unclear if he's reacting to the drugs or lying to avoid a police cell.
11:33It's quite hard to work out what happened often.
11:36It's really helpful if someone has a thorough history that we can go into and find out what's happened before.
11:48He's come in with multiple attendances for the same story. I've got no real concerns.
11:53Are you going to hold Mark up? Can I hold yourself?
11:56Are you capable of doing that?
11:57I'll do a quick letter and you can go.
11:59Sound. Give me five minutes.
12:01The man's medical records have revealed a pattern of behaviour.
12:04He's got multiple reports of coming to hospital saying exactly the same thing.
12:08And none of those times that he swallowed drugs.
12:10So they're confident in their diagnosis that he's not swallowed heroin.
12:15He has been discharged as well from hospital.
12:17So he will be taken to custody now.
12:23When I went to the toilet, I swallowed a nose.
12:26So he's found all over him.
12:29Just as the patient was being discharged, he raises another issue.
12:33And he's claiming that while he went to the toilet that he swallowed heroin again.
12:39This time, the man says he swallowed nearly 30 grams of heroin.
12:43But even a trace can be deadly.
12:46You were watched fast the whole time.
12:48No, you didn't.
12:49You know?
12:51You know?
12:51Because we were watching it.
12:53He's just admitted that he's saying that because he wants the time to start over again
12:56because he wants us to be staying here.
12:58If you don't know, if you're not 100% sure, you have to report it.
13:03We're 100% sure.
13:04You're 100% sure.
13:07If a person says that they're doing something to waste any resources, it's disappointing and it's frustrating.
13:14The suspect will be taken to police custody despite his attempts to avoid it.
13:23I think there's a lot of misuse of NHS resources.
13:26This is a tip of an iceberg which is really, really big.
13:29And yeah, the problem is much wider than one person wanting to get away from a police station for a
13:35couple of hours.
13:47On the other side of the hospital, Dr. Samid is managing the entrance of A&E on the night shift.
13:54All right, ma'am, we're just going to have you slowly come out, OK?
13:59Working at the front door in A&E tends to be exciting but scary at the same time
14:04because you never know what's walking in.
14:08Hi, ma'am. My name is Sam, I'm a lady doctor.
14:10So what's going on? Where's the pain?
14:12In the hospital car park, a woman has been driven in by her daughter.
14:17She was discovered at home after falling from a ladder.
14:20Any head injuries at all? Did you pass out or anything?
14:23No.
14:23OK, fine.
14:27All right, let's bring a trolley just so we can keep you stable, OK?
14:30Don't try to move too much right now, OK?
14:32Oh, no.
14:33The top main concern, someone who's coming with any kind of trauma, is the head injury.
14:38The second thing is if they're complaining of any pain in the neck, we have to stabilize it right away.
14:43If they're moving their neck on a neck fracture, that can leave them paralyzed for life.
14:49Let's go closer.
14:51We're just going to have you come out, OK?
14:56Keep your back as still as possible, OK?
15:00I know it's very difficult. I'm so sorry you have to go through this.
15:03Almost there. You're doing great.
15:12There you go.
15:16All right.
15:23Whenever someone's coming in, the first thing you want to do is manage their pain.
15:26Once you have settled the pain, you can get like a full history of what exactly happened.
15:32Oh!
15:34Just open your mouth.
15:36Medics give patient Lynn liquid morphine to help her pain.
15:42I know you're in a lockdown right now.
15:44Yeah.
15:44Her care is taken over by Dr Sid.
15:47Try your best to tell me where exactly the pain is.
15:50The bottom of my spine.
15:51The bottom of your spine.
15:52On the right.
15:53OK.
15:54Did you land on anything?
15:56No, the floor.
15:57The floor?
15:58Was it a concrete floor?
15:59I don't know.
16:02I have your chest.
16:02I don't know.
16:03OK.
16:04Falling onto your back could involve spinal fractures with lifelong chronic pain issues.
16:10You could have damage to the spinal cord.
16:13OK.
16:13We're going to try and get the pain under control first.
16:15And then we're going to get you to a scanner, OK?
16:17Yeah.
16:18It usually takes about 15, 20 minutes to get working.
16:21That ain't doing shit, mate.
16:28We just need to have the patience to let the pain medication work so we could kind of assess
16:33her and start getting her treated.
16:35They said it takes 15, 20 minutes.
16:37Jess, I don't care what the doctor says.
16:39It ain't working.
16:40Lynn's daughter, Jess, helped her at the scene of the accident.
16:45My mom was doing the curtains and she's fallen down the ladder.
16:49And she's got a spine condition.
16:52She couldn't get to her phone so she was home alone for about an hour.
16:56Lynn's spinal condition is called spondylosis.
17:02Spondylosis essentially is a degenerative condition of the spine.
17:06We then subject the spine to any sort of trauma.
17:09In the worst case scenario, you've got a complete transection of the cord,
17:12which could result in paralysis.
17:14Oh!
17:15Oh!
17:16Oh!
17:17Fuck you, darling!
17:19Oh!
17:20Oh!
17:25Oh!
17:25Oh!
17:29Oh!
17:30Oh!
17:31Oh!
17:34Oh!
17:36Oh!
17:37Oh!
17:40Oh,
17:40no! This'll
17:41be nice. Oh!
17:43yeah! Oh,
17:44yeah. Oh,
17:47The läib
17:47sao do they see that? Oh. And
18:01now we've
18:01got two teeth. They've already done
18:02that.
18:03You've had a big boke there?
18:04Yes.
18:05OK, that's fine.
18:07Your blood pressure and your heart rate are a bit unhappily.
18:11This is a gargle of hydrogen peroxide which will help with the bleeding at the back of the throat.
18:16I don't know if you had this before.
18:18You can't swallow this, you must spit it out, OK?
18:21Ideally you want to stop bleeding.
18:23Slowing bleeding is preferential to buy you time, but slowing bleeding will not fix your problem.
18:30This is a gargle, OK?
18:31Gurgle and spit.
18:33I'll hold it, I'll guide it to your mouth, OK?
18:35Because you're a wee cheeky.
18:38No drink it, just spit it out.
18:40It's OK.
18:42I'm going to hold with you.
18:56You think it's easy enough to leave it?
18:59No?
19:02No.
19:03I'm not arguing with you, you know that?
19:04I know.
19:11Unfortunately these blades can be life threatening.
19:13You have quite a lot of vessels that run through the back of your tonsils and your mouth itself is
19:19very vascular.
19:19And unfortunately we have seen deaths for tonsillectomies.
19:24It is a risk.
19:26Do you understand what they're saying?
19:28Do you understand what they're saying?
19:28Just keep you fastened.
19:29Can't let things settle down.
19:30Maybe put up some fluids again.
19:33OK?
19:36I'm going to give you a medication.
19:38I think you've had it before.
19:40Transemic acid basically to try to stop the bleeding.
19:43Is that OK?
19:44I'll go through this wee line here.
19:46And this is the medication going through now.
19:53How are we feeling?
19:59Yeah, I'm Johnny.
20:01Hello.
20:01Hello.
20:02Hello.
20:03How are you?
20:04So you only got home this morning, didn't you?
20:05Yes.
20:06We only got home this afternoon.
20:08ENT Dr Danielle has brought her colleague Dr Johnny to make the final decision on whether
20:13or not Aoife's continued blood loss needs immediate surgery.
20:16Can I wait again if you step back for me slightly, all right?
20:20Good job.
20:23All right.
20:23Lift your head up.
20:25That's it.
20:25Open as wide as you can.
20:29Good job.
20:30Sorry about that.
20:31All right.
20:31Well done.
20:32Adrenaline.
20:33Right.
20:34How much more was there at home, do you think?
20:36A lot.
20:37It's just content.
20:37It's been content since it started.
20:39Yeah.
20:39Yeah.
20:40Fresh with clots.
20:43Dr Johnny needs to share with Aoife the plan to stop her blood loss.
20:46So, I think we need to go to the theatre.
20:49No.
20:50It's OK.
20:51It's OK.
20:52It's all right.
20:53It's OK.
20:54It's OK.
20:54Listen.
20:55Listen.
20:56It's going to be OK.
20:57We don't want anything else to happen, sweetheart.
21:00You've had too much bleeding here now, OK?
21:02Yes.
21:03Yes.
21:03All right.
21:05This is your second admission, so we can't be bored, OK?
21:08Mummy, Dad, are we there?
21:09We're not going to leave you.
21:10All right.
21:11You've had too much bleeding here.
21:13It's not going to stop by itself this time, OK?
21:16I imagine it's incredibly scary.
21:18Bleeding from anywhere can be very traumatic.
21:20But if it's severe enough for you to be worried about a patient,
21:22then it is important that you take the patient back to theatre
21:24and explore their mouth, find the source of the bleeding
21:27and deal with it.
21:28We can do that whenever we come back,
21:30because she needs to go right now.
21:37She was so upset.
21:38Yeah.
21:39She just didn't want to come down here again, you know,
21:41after being discharged this afternoon,
21:44to come back down again.
21:45I know.
21:46Understandable.
21:47Yeah.
21:47She's been through a lot.
21:49Hopefully this is the end.
21:50Yeah.
21:50Just get it sorted and that's it.
21:51Please God.
21:54Aoife will spend the next few hours under the knife,
21:56while surgeons try to repair where blood is gushing
21:59from inside her throat.
22:00All right, my love.
22:01Love you.
22:02Love you.
22:03You're going to be grand, OK?
22:05OK, bud.
22:06See you later.
22:07Yeah.
22:08Good care.
22:08OK, love.
22:11OK, thanks.
22:12Thanks.
22:15Be fine.
22:18Be fine.
22:19Bye.
22:21Where's Danielle waiting for you?
22:30Bye.
22:44325 miles away in Norfolk and Norwich University Hospital,
22:48consultant Dr Sean is managing a busy night in resus.
22:51And chest pain.
22:54What's your route here?
22:563-0.
22:58Corp outside the resus in resus.
23:01Is it the thyroid storm?
23:03No.
23:03No, this is the 185 SVT.
23:06Stuck in SVT.
23:07Fine.
23:08We've had three pre-alerts,
23:10so alerts from the ambulance about patients
23:12who need to come into resus to have urgent treatment.
23:17SAF, rapid ventricular rate.
23:19Any chest pain in palpitations?
23:21You.
23:21Fine.
23:23The patient, Maya, has atrial fibrillation,
23:26an irregular and rapid heart rate.
23:28You want to tell them to come into feet?
23:30You don't have to.
23:31With that heart rate.
23:32Fine.
23:37Maya's in atrial fibrillation at a fast rate.
23:41Her blood pressure's a little low and she's got some chest pain.
23:43Those signs do mean that she is undergoing damage as a result of it.
23:47The longer the heart goes this fast,
23:48just sustain too much damage and go into cardiac arrest.
23:54At half past three I started feeling the heart of the pulpitator.
24:00I left it a little while to see if it was down,
24:03then it went up to 190.
24:04This has been the fourth time I've been in in as many weeks.
24:10And I have had previous surgery on my heart.
24:14But obviously that hasn't been.
24:16It's really difficult to see patients coming back in
24:19with the same life-threatening complaints.
24:21You can imagine how they must be feeling,
24:23both scared but also frustrated.
24:25So I do really feel for them.
24:28What?
24:31190?
24:32No, 253.
24:34And it's not that high yet.
24:36Maya's heart's been beating at over double the normal speed
24:39for eight hours.
24:41Dr Shaw must act quickly.
24:44So if a patient's heart's beating too fast for too long,
24:47that can lead to cardiac arrest and death.
25:02The End
25:03Pop these blocks around your head so you stay nice and still.
25:06It's gone through one of these big juicy veins.
25:08Nighttime in A&E is full of bloody injuries caused by violence.
25:12It has hit the side of his face.
25:16In the night you don't want to respect the rules.
25:20What's going on?
25:21They use knives.
25:23Guns.
25:2516 year old male who was shot.
25:26The peak time for assault related injuries is between
25:299pm and 3am, when people are out at pubs and clubs.
25:35A large number of the violent incidents are due to alcohol
25:39and drug issues.
25:46When a patient is with lots of police,
25:48especially when they're aggressive or intoxicated.
25:52Stop it!
25:53You know what I am!
25:54It can make the assessment really difficult.
25:57Where are you from, Rosie?
25:59That all increases during the night.
26:01Come on, give us one.
26:02I knew that!
26:19I'm telling you that the pain is killing.
26:22I'm not joking, Sid.
26:23Dr Sid is treating 58 year old Lynn, who has a pre-existing spinal condition and has fallen from a
26:30ladder.
26:31So what we need to do is obviously get her pain under control, but also rapidly assess for any sort
26:36of fatal injuries.
26:37So in the case of the back, we're obviously worried about the spine, spinal cord and all sorts of kind
26:41of vital organs that could be damaged in any sort of trauma.
26:47There is no way of knowing the extent of Lynn's injuries until she has a CT scan.
26:52But without her pain under control, she'll be unable to remain still for the imaging.
26:57Fuck you in a labour, breathe through it.
26:59This is worse than labour, Jessica.
27:01Just fuck you in a labour, breathe through it.
27:03This is worse.
27:04There ain't no breathing out, no pain.
27:10I feel like I'm going to get a pass out.
27:14You're all kicking in, Jess.
27:15Fuck you kicking in, Jess.
27:17They're giving them nothing, though, Mum.
27:18Well, they ain't doing shit.
27:27I want pain killers.
27:28I want the pain to go.
27:29Let's have a look.
27:32Make a face for me.
27:33Sharp scratch coming in, yeah?
27:36Come on around.
27:42We're bringing your medication now, yeah?
27:43Oh, yeah.
27:44I've waited long enough.
27:47All right.
27:47I've got your morphine in here.
27:49I've got your morphine in here.
27:49Does it work quicker?
27:51Ah!
27:51Ah!
27:52Lynn is given more morphine, but this time intravenously to speed up the pain-killing effects.
27:59Ah!
28:00Oh, yeah.
28:01That's it.
28:02That's it.
28:02No, that's fine.
28:03It's OK.
28:04You're OK.
28:06Mum, you're OK.
28:07The morphine's going to work now.
28:09It's in your veins, OK?
28:11Take some deep breaths through your nose and up through your mouth.
28:14Here.
28:15Slowly.
28:16OK.
28:17That morphine's going to work.
28:18OK.
28:19Shall we put this up so she doesn't fall?
28:21OK.
28:22Yeah.
28:23OK.
28:24All right.
28:24Just hang in there.
28:27Now the effects of the medication are taking hold...
28:30Are you OK?
28:31Lynn's rushed to the CT scanner.
28:33So what we need to do is take the CT head all the way down to pelvis.
28:36That kind of gives us a good scan of everything so we can rule out anything serious, life-threatening
28:41or life-changing as far as injury goes.
28:44Especially when there's some sort of height added to a fall.
28:47We're on the table now.
28:48Up to about three minutes.
28:50Oh, God.
29:04We'll see you in recess in ten minutes.
29:07In Norwich...
29:08I'm coming back that way.
29:09Let me come find you.
29:10Dr. Sean is treating 47-year-old Maya, whose heart is racing dangerously fast after recent
29:16surgery.
29:17And if not reset, is at risk of cardiac arrest.
29:22So our next steps now, we're giving her some sedation and use electricity to bring the heart
29:26back into a normal rhythm.
29:27A shock delivered to the heart restarts it, turns it off and on again.
29:34How are you feeling at the moment?
29:36All right.
29:36Yeah?
29:37Not too much discomfort?
29:39No.
29:40Good.
29:40Start going gently.
29:42So do little bit by little bit and you let us know how you're feeling.
29:46To sedate Maya, Dr. Sean administers propofol, which will stop her remembering the painful electrical
29:52shock she's about to receive.
30:02In a good position.
30:05The defibrillator is prepared and the pads on Maya's chest are ready to deliver an electrical
30:11surge to pass through her heart.
30:14When we're delivering a shock to the patient's heart, it's a higher level of energy.
30:18It is going to feel like a painful electric bolt.
30:22Number one.
30:25Number one.
30:27So let's take the challenge.
30:51We're back in normal rhythm now, okay?
30:53So we're going to get a heart tracing for you and just make sure everything's okay.
30:58When you deliver that electrical shock, the cardioversion is successful and the patient's
31:02back in a size rhythm, it is incredibly satisfying.
31:05You know you've solved the problem.
31:09Use a nice low energy as well, so hopefully that should just do it.
31:13It can be a lot of pressure to have to deal with lots of patients and life and death decisions.
31:18But with experience and just knowing you're doing the best for each of those patients is
31:21what's going to enable you to keep going day after day.
31:47What's your name, Pat?
31:48Matthew.
31:49Matthew who?
31:50So we're Gwenda Redd?
31:51Yes.
31:51Yeah, don't do that.
31:53Emergency medicine consultant Dr Catherine is leading in resource tonight.
31:58So what's your last memory of the accident?
32:01I just remember seeing the car.
32:03Me waking up and like just on the road.
32:06And have you got any pain anywhere?
32:08In the back of my neck and the back of my head.
32:11I am automatically concerned.
32:13You can imagine the forces that are involved when there's a vulnerable pedestrian being hit by a large metal object
32:20with momentum.
32:21You can imagine the injuries could be very serious.
32:25Ready, steady, lift.
32:28Okay.
32:29Lovely.
32:30I want you to move your neck as little as possible.
32:33Your mission is to try and stay nice and still for us.
32:35Okay?
32:36We're going to do a log roll for everybody in position.
32:39Three hands over, three hands under.
32:40So ready, steady, roll.
32:42Matthew, I'm going to feel down your back.
32:44Spin.
32:48Okay.
32:48I'll get the scoop off.
32:52Perfect.
32:55Are you okay if I hold your head here?
32:57You've obviously got a wound there, but it's okay if I just put my hands here.
33:01He has what we call a boggy haematoma of his scalp.
33:05So that basically means that he's got head injury with bleeding around the scalp area, possibly a skull fracture underneath.
33:11We're not sure at this stage.
33:13Dr Lauren is working with Dr Catherine to assess Matthew as quickly as possible.
33:18Yeah.
33:19But there was a period where you blacked out?
33:21Yes.
33:22Yeah.
33:23Any pain to the abdomen or two?
33:25Oh.
33:25Just need to see if there's any bruising or anything.
33:27That all feel okay?
33:28Yeah.
33:29So what we're going to do is a scan of your brain and a scan of your neck.
33:34So we'll try and get you around for the scan as quickly as possible.
33:39Becoming unconscious after a head injury can indicate a life-threatening bleed on the brain.
33:44As soon as the patient arrives, the clock is really starting for us.
33:47We try to get our patients to the CT scanner within 30 minutes.
33:51That way we are able to see the nature of their injuries, the extent of their injuries, and make a
33:55definitive plan for their care.
33:58Until Matthew has his urgent CT scan, his neck brace and head blocks remain in place, as his spine and
34:04skull could be vulnerable to further damage.
34:08CT is approved.
34:09Excellent.
34:09Are they ready?
34:10Yeah, they're ready.
34:11Okay.
34:11Well, keep them nice and warm.
34:16Just going to have a look at your head, all right?
34:18Yeah.
34:18Because there's a bit of ooze coming in from...
34:20Matthew's head suddenly starts to bleed again.
34:23Is that where it hurts?
34:24Yeah.
34:25So we're going to do your head scan.
34:27Okay.
34:28But you can lose quite a bit of blood from your head.
34:31So we're going to put a dressing on it and a bandage, okay?
34:35I don't want you to move your head or anything because of your injury.
34:38So I'm just going to gently pad it here, okay?
34:41Yeah.
34:42So I'm just going to apply this all around it and then we can put a bandage over the top
34:46and that will apply a bit of pressure.
34:48And then it means we can get you up to the scanner.
34:53Matthew needs his CT scan as soon as possible, as he may have time-sensitive injuries.
34:58But with his head bleeding, he's not stable enough to be transported.
35:02Yeah, just to...
35:04So I'm very gently just going to...
35:08Lift your head very, very, very gently, the tiniest amount.
35:10Just let me get this bandage in okay, darling?
35:14Just make sure the gauze is all around the wound there, okay?
35:17Just one would be lovely, just to tidy up here.
35:20Is that it okay?
35:21Do you feel like it's covering your wound adequately, Matthew?
35:23Yeah.
35:24Yeah, okay.
35:26Okay.
35:29With the bleed under control, Matthew can now head for the CT scan.
35:34The results will be crucial.
35:37Worst case scenario, unfortunately, we do see it a lot in the Royal, is that we have a patient who
35:42has a severe traumatic brain injury that may or may not be suitable for surgery and may die as a
35:49result.
36:09Hello.
36:11Hello.
36:11Can you help me?
36:12Night-time conditions mean a higher risk of falls, particularly for people alone.
36:18Which one is it?
36:20This one.
36:21This one.
36:22Yeah.
36:23With over 6,000 people being admitted to A&E from falls from ladders every year.
36:37Do you suffer from chronic pain?
36:40I've got spondylosis.
36:42Spondylosis.
36:43Yeah.
36:43After the fall, it triggers the pain.
36:46Yeah.
36:47Yeah.
36:47Lin suffers from a degenerative spine condition.
36:50She's in excruciating pain after falling from a ladder.
36:55Essentially, any sort of spinal condition, whether it's chronic, it's structural, it's acute, just puts you at a higher risk
37:02of any sort of damage to the spine and making your case a little bit more challenging.
37:08It's okay. You can squeeze my hand as hard as you need, don't worry. As hard as you need. We're
37:12just trying to figure out what's going on, okay?
37:14Dr. Sid is waiting for CT scan results. They'll reveal if Lin's unbearable pain is stemming from any permanent damage.
37:24Hiya guys.
37:28So, you've fallen from a bit of height and you've hit yourself quite hard. Good news. CT is all good.
37:34So what's the problem?
37:35Soft tissue injury, which is basically horrible bruising.
37:40And I think because you've got spondylosis as well, having an injury of that kind of impact on that area
37:47is going to cause you to have a bit more pain and it's going to kind of shake everything up
37:50for you.
37:51Anything wrong in my head?
37:53No. Not that the scan could find at least.
37:56But yeah, maybe stay off ladders for a little bit.
37:58I'm not going to.
38:00This was a shock.
38:01I'm locking the ladders all in my room, so you're not allowed them anymore.
38:06Yeah, but this is a wake up call to say, you can't do it. You can't do it. No heights,
38:12no ladders.
38:12I'm not doing no DIY.
38:14And nothing near stairs.
38:18Happy to go home?
38:20Yes. Thank you.
38:21Happy days?
38:22Yeah. Cool.
38:23Link can now be discharged and sent home to recover with painkillers.
38:28Oh, at least that's good news.
38:29Do you want to take my spiders?
38:31Keep them on. They're quite the fashion statement.
38:33Yeah.
38:34Matching with your T-shirt as well.
38:36Love to see the sense of humour still intact.
38:38Yeah.
38:39But it wasn't earlier.
38:41Drugs are working.
38:44Morfie tends to make people funnier in my opinion.
38:46Don't worry, you're just in a bit of pain.
39:00Yeah, well, that's fine. I can triage her and then I'll discuss it with one of the doctors.
39:06There will probably be a scan of your head and your C-spine.
39:10Yeah.
39:10Have you had one of these scans before?
39:12No.
39:12No?
39:13In Belfast, 16-year-old Matthew is having an emergency CT scan after being hit by a car.
39:20We're concerned that he could have a bleed in the brain or that he could have a fracture in his
39:25neck.
39:27If there is a bleed there, it's something that can be very severe and can be life-threatening and need
39:32surgical management.
39:35We just have to be very careful with how we move the patients,
39:37because if there is a fracture there, it can be quite dangerous if anything moves where it shouldn't.
39:44Okay, Matthew, that's the scan all finished.
39:47Until the results of the scan come back, Matthew must keep his neck brace on in case of permanent spinal
39:53injury.
39:56Right?
39:57Yeah.
39:59Whilst he waits, Matthew's dad, Richard, and brother, Nathan, are at his bedside.
40:06Yeah.
40:07Good morning.
40:09I remember getting off a bus and walking down a bit, and then crossing the road, and then to see
40:16a car fly around the bus.
40:17And it's not the type of thing you want to arrive through to see your son land in the middle
40:22of a road.
40:23And expect the worst and hope for the best type scenario.
40:29Dr. Catherine receives the scan results.
40:32We're imagining that we're looking up from the feet up.
40:35So he has a big soft tissue swelling on the left side of his scalp there, which is consistent with
40:41where he has bleeding and where he has the swelling.
40:44So you can see it's really quite dramatic.
40:46This is all his skull.
40:48And then this sort of grey black matter here is his brain tissue.
40:54Right.
40:57Now.
40:58So, Matthew, your brain looks fine.
41:01There's no blood around it.
41:01There's no fracture.
41:02There's no break of your skull bone.
41:04Your scan results are normal.
41:09So I would like to start by loosening your collar.
41:12So I'm just going to undo the velcro.
41:15Are you able to turn your head towards me?
41:20Okay.
41:21And good, you've lifted off the pillow as well.
41:22And do the same on the other side.
41:26And are you able to pull your chin up as if you're looking behind you?
41:31Is that all okay?
41:32Yeah.
41:33I mean, it's normal to feel a bit stiff, but have you got any severe pain when you do that
41:37or any tingling?
41:37No, it's really sick.
41:39Okay.
41:39So one of our docs will have a look at your wound.
41:42The injury to the back of Matthew's head is still a concern.
41:47Head wounds bleed quite profusely.
41:49The scalp is a very vascular structure.
41:51It's got lots and lots of blood vessels in there.
41:53And so it's not unusual for us to see a scalp that's bleeding a lot.
41:58Matthew will need immediate treatment as an open head wound is vulnerable to serious infection.
42:03It's probably going to be at least two staples, potentially three.
42:07All right.
42:07But I'll let you know once I've put the two in.
42:10All right.
42:11Okay.
42:12Just breathe.
42:14The first one.
42:15Okay.
42:16Doing fine.
42:17Doing okay?
42:18Yeah.
42:19Now just tilt the head forward for me again.
42:21Keep squeezing.
42:22Now second one coming up.
42:24Keep squeezing.
42:25Just keep squeezing.
42:26Keep it.
42:27That's it.
42:27That's it.
42:28That's it.
42:28That's it.
42:29That's it.
42:29That's it.
42:30Gonna need a third one.
42:32Okay.
42:36Okay.
42:37That's us done.
42:38Quite a deep and irregular wound.
42:40He'll get the staples taken out in a week.
42:42He gets to go home tonight, back to his family and he's done okay.
42:47Yeah.
42:47Definitely used up one of the nine labs.
42:50Yeah.
42:52That's all he did.
42:56Get him out.
42:57No one's hoping he'll start.
42:59Tool will stay there.
43:09The last thing he would hope worked so he didn't have to do the pacemaking until I was older.
43:23You have to be the DIY person now.
43:52Yeah we brought the bucket from home.
43:55Yeah.
43:55Used for washing the car.
44:14Yeah we bought the bucket from home.
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