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00:00After dark...
00:01You described!
00:03...while the nation sleeps...
00:04He's been hit by a car.
00:06...the A&E night shift begins.
00:08You never know what's going to come through the door.
00:11And after 12 is just coming.
00:12At night, you always have to be prepared for the unexpected.
00:17Multiple kicks to the face.
00:18They said if anyone approaches them, they're going to attack us all.
00:21Across the UK...
00:22We're trying to help you.
00:23...with extraordinary access
00:25to three of the most challenged emergency departments in the country.
00:28Guys, I need help in here.
00:30He could have died.
00:31We follow the work of emergency medics
00:33who battle every night to save lives.
00:36Chucking now.
00:38It's a stab wound.
00:39With drugs and alcohol rife...
00:42I've had five or six pints.
00:44Step back.
00:44Big man.
00:45The department's just on fire.
00:50The risk of violence and abuse looms large every night.
00:54And you, you're maximum.
00:56Stop.
00:57Try me, boys.
00:59They can be verbally aggressive, physically aggressive.
01:02I've been punched.
01:03I've been spat at.
01:04You've got nothing on me, brother.
01:06No.
01:06Come on.
01:07There have been days when there have been more police officers than patients.
01:10What punch you're eating, mate?
01:12What's going on?
01:13All hell's broken loose.
01:14Patients running around.
01:15Security everywhere.
01:16Shut up.
01:17I don't care.
01:18This is the sort of thing that we have to put up with.
01:20Get security to the mover.
01:22It's chaos.
01:23Glorious chaos.
01:37Hello.
01:39Hello.
01:40So this is an unknown male.
01:42Struck by a vehicle.
01:43He was crossing the road.
01:43Let's get his scanner across the table.
01:45We'll go in as soon as the other guy's out.
01:46A&Es across the country are the busiest they've ever been.
01:50Pushing the staff to the limit.
01:51We need to handle a complete system.
01:53Oh, Sarah.
01:53Ah, my arm.
01:55Working in A&E is pretty crazy all the time.
01:58Obviously, people drink can make them quite aggressive, quite hard to treat.
02:02At night, A&E can be chaos, with people out drinking and increased traffic on the roads.
02:08I've gone into the back of a car without wearing a helmet.
02:10Bringing in serious accidents and emergencies.
02:14He's been hit by a car that's unknown speed.
02:17When that phone goes off, you just have to guess what's going to come,
02:19and you can prepare for any kind of situation.
02:28In Birmingham, a motorist is on their way to A&E after a serious car crash.
02:35Hello.
02:35Could I put out a trauma call for a male into cold research?
02:41No idea where it's coming from.
02:43We'll find out when we get here.
02:44Dr Abdul and the research team are preparing for the trauma.
02:48So, this is a gentleman who's come in following a road traffic collision.
02:53His car's rolled over, but he's come in with suspected loss of consciousness,
02:57and we're unsure about what the injuries are.
03:00Obviously, any time a car rolls over, it can cause quite significant injuries.
03:04There's a suspicion of drink driving as well, so police are involved.
03:07I actually do a look at your primary survey, and then we'll take it from there.
03:10I'm not ready to study on your side.
03:13I've got one of his head. He's going fast.
03:15I've got one of his head. He's going fast.
03:15I've got one of his feet.
03:16I've got one of his feet.
03:16He is currently on the rest of the road.
03:18He's driving.
03:19We're querying a head injury isolated.
03:22It's splitting between GCS 13 and 14.
03:24He's just been playing to the side of his rib, but I can't see anyone spruising,
03:28a bit like that.
03:3037.4.
03:3137.4.
03:32Is your heart rate going a little bit quick?
03:35Are you in pain?
03:36No?
03:37Try not to move your head.
03:38Just yes, no answers.
03:40It's vital the team keep the patient still to prevent making any injuries worse.
03:46When you extricate him, was he on the roof of the car then, or was he...?
03:50No, so he was in this bit by the seats.
03:53OK.
03:53He was kind of lay across his feet almost.
03:55So he wasn't buckled in or anything like that?
03:57OK.
03:58The danger in high-speed collisions is that you can get injuries to the organs that we can't see,
04:04so things like the liver, the spleen, and sometimes kidneys as well,
04:08and that can cause bleeding internally that we don't see until we get them into a scan.
04:12Chest extension is normal, so most likely just a hidden C-spine.
04:18Perfect.
04:18OK.
04:20Just keep your legs nice and straight in the former, please.
04:23The team prepare the patient for a CT scan.
04:27Try not to move your head, because we need to scan your head,
04:29make sure you haven't done any damage to your spine.
04:31So don't move your head.
04:33We're just going to take you around for a scan.
04:34We're going to scan you from your head down to your toes,
04:36and if there is any damage, we'll find out what it is.
04:39OK?
04:40Any questions for us before we take you around?
04:41No?
04:42OK, lovely.
04:44The police need a blood sample from the driver as soon as possible
04:47to prove if he was drink-driving.
04:49Because his heart rate is quite high.
04:51Yeah.
04:52And he's not in pain.
04:54It's normally an indication that he was stressed or worried.
04:58I think the reality and the realisation is hitting him now.
05:01Yeah.
05:01The high heart rate could also indicate internal bleeding,
05:05so until the patient is stable, the police have to wait.
05:09If we think someone might have quite a significant head injury
05:12and they're drowsy, we're not sure if it's because they're intoxicated
05:15or whether they've got a significant head injury as well.
05:18Is it pain or are you just a little bit worried about what's happening?
05:33So we're giving 100 of hydrocortisone.
05:36Working in A&E in this hospital, I find it very challenging.
05:40At one point, you might be treating something from very simple cold or flu
05:45to something as complex as somebody comes in following an accident,
05:48stab injury, things like that.
05:53QE alert phone.
05:55What have you got?
05:56Caused by what?
05:59A machete.
06:04An ambulance is rushing a 40-year-old man to hospital
06:07who's been attacked with a machete.
06:10Unfortunately, some things happen after dark
06:13that you wouldn't expect in the daytime,
06:14some dangerous, violent things that happen.
06:17So when you receive the call, everybody becomes heightened and ready.
06:23Dr Victory will be running the trauma team when the patient arrives.
06:28So from what I've heard so far, it's somebody that was assaulted with a machete
06:33and has a laceration on his face.
06:36So we're just getting things ready.
06:38One of the colleagues have already called for the maxillofacial.
06:41So they're the ones that deal with facial injuries.
06:49He's got a laceration to the left side of his face around 10 to 15 centimetres.
06:55He's also got a laceration to his left hand.
06:58So the laceration is on the extensor surface of the left hand, yeah?
07:03Can you lift that leg up in the air for me?
07:06And pop it down again?
07:07You have to want to get the morphine through that?
07:09Yes, please. Yes, yes, yes.
07:12Thank you very much for that.
07:13We're going to get the CT head to pelvis.
07:15Yeah.
07:15We're going to give him some tetanus because he's had this machete attack.
07:19Yeah.
07:19It's an open wound.
07:21I think we're going to give him some antibiotics.
07:23Open wounds are prone to serious and potentially life-threatening infection.
07:28Antibiotics and tetanus will prevent these from taking hold.
07:31He had a bit of pain in the left side of his chest.
07:33So we have to be sure, is it bleeding?
07:35Is the air going into the wrong place there?
07:38So that's why we're going to do a CT scan.
07:40Also have a look at that.
07:41What's the vascular supply?
07:43What's going on?
07:44How much has he lost?
07:45Any fractures there?
07:46And then we're going to also try and get the hand in it
07:49because he also has a hand injury.
07:51Jasvir needs an urgent CT scan
07:53to show if the brutal gashes across his face and hand
07:56could be life or limb-threatening.
07:58This time.
08:23The night shift brings aggression to the staff of A&Es across the country.
08:32I think violence, we're seeing an increasing amount, especially when it's alcohol-fuelled.
08:37It's particularly difficult to kind of come to terms with.
08:41Six.
08:42Five.
08:43Five.
08:44Five.
08:45Five.
08:46It's upsetting to de-escalate patients which become aggressive.
08:50There will be patients which are genuinely very poorly, but that gets taken away.
08:56Nothing works.
08:56I'll just give it myself.
08:57Demonstrate us some calm behaviour.
09:07Nice shoes.
09:12Across the slide.
09:13Ready, steady slide.
09:15Dr. Abdul is treating a suspected drink driver who crashed his car.
09:20All right.
09:20Well, we'll find out soon enough how much damage he's done to himself.
09:22Yes.
09:24The high-speed impact could have caused serious internal injuries, so the patient has had
09:28a CT scan.
09:31Often the things we look at for patients who come in like this is, one, do we think there's
09:35some sort of bleeding going on and they're compensating their heart rate's going up to
09:38try and keep their blood pressure up.
09:40Other reasons can be pain.
09:41Pain can cause people's heart rate and blood pressure to go up as well.
09:44The scans have been assessed by a radiologist and sent to Dr. Abdul.
09:49I think he's been very lucky.
09:50I think he's definitely been wearing a seatbelt because there's no way he would have gotten
09:53away without those injuries.
09:56He's just very drunk and he's going to be in a lot of trouble.
09:58And basically, just discharged basically.
10:00It just depends on what the police want to do with him at that point.
10:03The police are on hand to try and get an evidential blood sample to record the patient's
10:07alcohol level.
10:08Have you got someone coming up now to do his bloods and stuff?
10:11I think we're just trying to organize it now.
10:12Now the patient has been given the all clear, they need to act quickly to get an accurate
10:17reading before his alcohol level drops.
10:19Do you understand what's going on now?
10:21We're going to need to speak to you about the incident when you're sober for a little bit
10:25OK?
10:25In the UK, up to 320 people are killed in vehicle collisions where the driver is drunk every
10:32year, with many more seriously injured.
10:35We work quite closely with the police to make sure that, you know, not only is the patient
10:40receiving the best healthcare, but also if there's any sort of criminal matter that
10:43is dealt with appropriately as well.
10:58What happened, Callum?
10:59Er, leg to leg contact playing football.
11:01In Tunbridge Wells A&E, 27-year-old special needs teaching assistant Callum has a suspected
11:08broken leg.
11:15It won't be clear if it's broken or how badly until he's had an x-ray.
11:20OK, if I want to send to leave children, I'll test.
11:23Oh!
11:24Oh!
11:25Oh!
11:26Oh, no, that's...
11:27Oh!
11:29Oh!
11:30Oh, fucking hell, I had it cracking as well.
11:32Oh!
11:34Fuck!
11:36Oh!
11:37Oh, sorry.
11:38I just need you to turn it this way.
11:41Oh!
11:43Oh!
11:46Oh!
11:49Oh!
11:51Oh!
11:51Definitely the worst pain I've ever been in.
11:53Oh!
11:54Oh!
11:56Oh!
11:57Oh!
12:01Oh!
12:02Oh!
12:02Oh!
12:03Oh!
12:07Oh!
12:07Oh!
12:07You're a dad now.
12:09You look good to look after.
12:10Waiting for Callum are his partner Casey and sister Chloe.
12:14I'm not going to be a climbing friend for a little while.
12:16She can still jump on you, just not your legs.
12:19Callum is a family man.
12:22We've got a three-year-old who loves to jump up and down on Daddy, so I think that it's
12:27going to be quite tough for her, that Daddy's going to be out of action for a little while.
12:33Oh, I never broke a bone before.
12:36It's a really tricky one, isn't it?
12:39Dr. Pete is going to be managing Callum's treatment and has his x-ray results.
12:44Hi, Callum. How you doing, mate?
12:46Yeah.
12:46All right.
12:46How you feeling?
12:48Impacting.
12:48Yeah.
12:49You've got quite a nasty fracture, unfortunately.
12:51Yeah, I thought it might be.
12:52So you've broken the middle of your two bones there at the lower...
12:55Both of them?
12:55Yeah, both of them.
12:57The pain from this sort of injury is excruciatingly bad.
13:00I've had it happen to myself before, and it's one of the worst pains I've ever had.
13:04So I can really sympathise with what he's going through, to be honest.
13:07So we're going to move around somewhere else.
13:10I'm going to pop your leg back into a better position.
13:12It's going to work.
13:13Yeah.
13:13It won't be comfortable.
13:15But I'll give some good painkillers, and then we'll pop a cast on it.
13:18And then, unfortunately, you're going to have to have surgery on this.
13:21So I'll speak to the bone doctors.
13:22Do I stay here, or...?
13:23So you'll stay in.
13:24I'll speak to the bone doctors and organise for you to have surgery at some point.
13:28Manipulating the leg back into position can be extremely painful,
13:31but if not done, could cause serious complications.
13:35Looking at the initial x-ray, part of the bone is pushing up against the skin,
13:40so we call that tenting of the skin.
13:41You actually see on the x-ray where it's pushing up,
13:44at risk of that bone actually poking through the skin.
13:48That's when we get concerned,
13:50because you have some real complications from that,
13:53getting nasty infections into the bone.
13:55So we need to really get that quite quickly into alignment
13:59and reduce that risk.
14:01I'm going to use your good leg just to measure up, OK?
14:11In Norwich...
14:12Peckford, they'll clean that up soon.
14:1523-year-old Ryan has come into A&E with his partner, Megan,
14:19after falling off his motorcycle at 50 miles an hour.
14:23I understand there was a crash today.
14:26Yeah.
14:26Sorry to hear about that.
14:28So how did it happen?
14:29Did you lose control or collided with anyone?
14:32No.
14:33How about helmet?
14:34The helmet was on.
14:36There was no damage to it at all.
14:37No damage at all to the helmet?
14:39Yeah.
14:39And the visor was intact as well?
14:40Yeah.
14:41OK.
14:42Did you pass out?
14:43OK.
14:44Any headache, neck pain?
14:47No.
14:47Yeah.
14:47I would want to know how he was traced,
14:50and then also the level of damage,
14:52because that would give you an idea how bad the impact was
14:58and the level of damage he may have sustained.
15:02Protective gear is essential when motorcycling.
15:05As on a bike, you're 50 times more likely to die in a crash
15:09than in a car.
15:09Please play a little slowly.
15:11All right.
15:14That's very deep.
15:15Oh.
15:16Have you had morphine before?
15:18Yep.
15:19And you're OK with that?
15:20Yeah.
15:20OK.
15:21I'll prescribe some for you.
15:23OK.
15:23It doesn't look deep, so it might not require suturing.
15:27We'll just apply dressing over it.
15:30And extend around here.
15:31Mm-hm.
15:33How about this side?
15:34I think it's fine.
15:35Well, you can feel the sensation, the touch.
15:37That's fine by me.
15:38And your ankle?
15:39OK.
15:39That's all fine.
15:40OK.
15:41There could be chances of internal injury
15:43because of the speed of impact.
15:45So you could break your skull, break your spine,
15:49enjoy your chest, stomach, hips, you know.
15:51A lot of things could happen.
15:55Ryan will need an x-ray to see if he's broken any bones
15:58in his arm or leg.
16:00So if you sit up nice and straight for us,
16:03just keep your shoulder relaxed.
16:06OK.
16:06Just stay nice and still there.
16:10So can you bring your foot up onto here?
16:14If he's broken his foot,
16:16he may need a plastic cast or even surgery.
16:19The x-rays of your elbow and forearm were OK.
16:24There were no fractures.
16:25However, for the foot, the x-ray showed a fracture
16:29on one of the bones of the little toe.
16:44Mm-hm.
16:45And then get an appointment for you to be seen in a fracture clinic.
16:48So I'll get someone to attend to these wounds
16:50and get you a boot for your legs.
16:53I'll prescribe some painkillers for you as well.
16:55Ryan's cracked bone will require some follow-up treatment.
16:58But right now, his arm needs to be looked at.
17:02OK, I know this is going to be a hard bit
17:04because you're going to feel pain, but that should...
17:07It's going to be quite miserable, isn't it?
17:09Nurse Brenda will clean the wound on Ryan's elbow.
17:13OK.
17:14So the reason we really want to clean it,
17:16to make it really clean,
17:18is all to do with the infections.
17:19I'm sorry.
17:20Mm-hm.
17:29I'm almost done.
17:30I'm just going to try and pull this together.
17:36You won't feel it.
17:37Mm-hm.
17:38See?
17:38You didn't feel that, did you?
17:41No.
17:42No?
17:42No, not at all.
17:47I tried to get your size.
17:50Yeah.
17:51Ryan is given a protective boot for his foot
17:53and will return to the fracture clinic in a few days.
17:57Don't run.
18:00Look after yourself.
18:01Take care, lovely.
18:12So, your left hand, keep it there for me.
18:1440-year-old Jasvia has been rushed into hospital
18:17after being viciously attacked with a machete.
18:20This scan, you can stay very still for me.
18:22Dr Vitry is trying to find the extent of Jasvia's
18:25potentially life-threatening wounds with a CT scan.
18:29Do your favour all done, guys.
18:31Everybody happy?
18:32Ready?
18:32Yep.
18:33Ready, steady, slide.
18:35Yeah, it's fine.
18:38Looking at the scan, there's nothing going on with the head.
18:40Can't see any obvious bleed.
18:42Can't see any air in the chest or any fluid in the chest.
18:45So, I think he's relatively lucky.
18:49Jasvia's deep machete wounds to his face and hand
18:52are still incredibly serious and potentially life-changing.
18:57Bend your wrists towards me.
19:00Can you lift...
19:05Can you lift your little finger?
19:08Can you kind of...
19:10No, no, not with the hand.
19:12Can you lift it up?
19:14No.
19:15No.
19:16Can you try again?
19:16I'll hold these fingers.
19:17Can you lift this one up?
19:18Plastic surgeon Dr. Matthew is testing Jasvia's hand
19:22to see if the deep wound has permanently damaged his ability to move it.
19:26Usually, this is the movement you expect in the hand,
19:30but the patient is unable to move his little finger.
19:32The laceration that he has is right there.
19:35So, that's a big problem.
19:37If you keep still...
19:46I think there's two.
19:47I don't know if they're related or not, but we shall see.
19:49We'll find out when we get here.
19:51It's a busy night shift in A&E for Dr. Abdul.
19:55Top to the bottom of the stairs, 87-year-old male.
19:58Queery, shoulder deformity.
20:00Queery scar fracture.
20:02Oh, yeah.
20:02Hello.
20:03Hi, guys.
20:03He's awake, yeah?
20:04Yes, he is.
20:05He says 14.
20:06Paramedics have brought in 87-year-old Brian,
20:09who has serious trauma injuries.
20:12Brian, we're going to get you onto this bed, OK?
20:18So, this 87-year-old male,
20:20he was found by his family this evening.
20:22He had an unwitnessed fall from top to bottom of the stairs.
20:26They were 13 steps down.
20:28Haematoma on the right side.
20:30Blood from his left ear.
20:32Right shoulder deformity.
20:34He's had a gram of IV paracetamol,
20:3610 milligrams of morphine,
20:37and a gram of TX8.
20:39Brian?
20:40Brian?
20:41How's your pain at the moment?
20:44If you were to score it out of 10,
20:4610 being the worst pain imaginable,
20:47how bad is the pain at the moment?
20:49Not too bad.
20:50Not too bad.
20:52OK.
20:52If that changes, if you need more pain relief,
20:54just let us know.
20:57Air entry is slightly reduced on the left side.
21:01Abdomen soft, non-tender.
21:03I'm going to throw some light in your eyes.
21:06Is that OK?
21:07Yeah.
21:07We've seen some bleeding from the left ear.
21:09There's some abnormalities in the chest as well.
21:11So we're suspecting possible fractures of the brain,
21:14or at least a ruptured eardrum.
21:16And then we're not 100% sure what's going on in the abdomen as well.
21:19I'm just going to have a little feel of your chest.
21:21Can you just take a nice deep breath in for me?
21:24And again.
21:27Is it tender on this left side?
21:29A little bit tender.
21:32A little bit tender.
21:32A little bit tender.
21:33We're going to get you through a scanner,
21:35so you're going to go into a CT scanner.
21:37Once we've got the scan done and everything,
21:39and we get the results of it,
21:40we can let you know what damage has been done.
21:47You're going to feel a bit snug in this, Brian.
21:50Happy to go right now?
21:51Yes.
21:52Right now, yeah?
21:54Across the slide.
21:55Right.
21:57Well done.
21:59As people age, they lose bone density,
22:02making their bones easier to break.
22:04So the effects of a fall can be devastating.
22:07We always get a little bit worried, a little bit concerned
22:09when there's blood coming from the ear.
22:11So it's of the utmost importance to get the patient
22:13into the scanner and see what's going on.
22:15A bleed from the ear could indicate a serious skull fracture
22:18and damage to his brain.
22:20Please breathe in and hold your breath.
22:44Knife crime in the UK is on the rise,
22:47and A&E staff across the country deal with it every night.
22:50It's a stab now.
22:53We definitely don't go more than a couple of days
22:55without having a fairly sick patient who's been stabbed.
22:58The difference between them and the patients who die
23:01is a matter of a couple of centimetres.
23:03It's been stabbed multiple times to the chest.
23:06Working in the trauma centre and seeing so many stabbings
23:09and some of them innocent people getting stabbed.
23:12Night crime isn't just on the rise, but getting more extreme,
23:16with the number of incidents involving large blades and swords
23:19doubling in the last five years.
23:34Can you feel me touching your thumb here?
23:36Yeah.
23:37Medical staff are treating 40-year-old Jasvir,
23:40who's been violently attacked with a machete
23:42while walking home from work.
23:45Bend your wrists towards me.
23:48He has deep wounds to his left hand and face.
23:52Can you lift your little finger?
23:54Yeah.
23:55Can you kind of...
23:56No, no, not with a hand.
23:58Can you lift it up?
24:00No.
24:01No.
24:02There are tendons on the back of the hand
24:05which straighten the fingers.
24:06These have been severed in the attack.
24:09All these will get an x-ray of your hand, sir.
24:12Okay?
24:13See if there's any bony damage.
24:15I think we'll probably need to take you into theatre
24:19to have a look at the wound
24:20and try and repair anything that's damaged.
24:23Okay?
24:24Yeah?
24:24Yeah.
24:25Okay.
24:25Hello, I'm Jay.
24:27I'm one of the facial doctors.
24:29Jasvir was also struck in the face with the machete.
24:32When I was examining the patient,
24:33I did notice that the patient was not able to smile as normal.
24:36So, on a normal day, people smile like that.
24:39But the patient is smiling like that.
24:41So, that points to an injury there.
24:43So, most likely,
24:44you might have had a facial nerve injury.
24:47So, that's a problem.
24:48Okay, I'm just going to take this off, okay?
24:52Okay.
24:55So, you were attacked by a machete, was it?
24:57There are five branches of the facial nerve
25:00which could have been damaged in the attack.
25:02Just checking if your nerve is still working,
25:05which it looks like it is.
25:06Jasvir's facial nerve and its branches
25:08appear to be intact,
25:10so the wound can be closed.
25:11Okay, that looks okay to me.
25:13So, I'm going to put some local anaesthetic in
25:15to make it nice and numb.
25:19Okay.
25:21So, you're doing really well.
25:25You're doing really, really well.
25:29Well done.
25:30Well done.
25:31So, I'm just going to clean you up a bit, okay?
25:37Yeah.
25:38But, yeah, it doesn't look like there's any grit in here
25:40or it looks fairly clean, actually.
25:43The nature of that injury there, he will have a scar.
25:46It's not going to end his life,
25:48but it's going to affect him socially and mentally
25:50from that point of view.
25:51That feels okay?
25:52Yeah.
25:53All right.
25:54Let me know if he gets really painful, okay?
25:56It's going to feel like a weird sensation, okay?
25:59I just want you to take deep breaths.
26:01Maxfax specialist, Jay,
26:03needs to ensure the stitches are carefully positioned
26:05to reduce scarring
26:07and any psychological effects Jasvia could feel.
26:10And you've got my hand, okay?
26:14Sorry, a bit of pulling, okay?
26:17I'd say you're doing well.
26:18You're going to have to get these top stitches removed, okay?
26:21The black ones.
26:24In about ten days' time.
26:27Okay.
26:29This should be the last one.
26:36Your team's plan is potentially discharge from there
26:39to come back to a clinic, yeah?
26:40Yeah, come back to a clinic, yeah.
26:41Cool.
26:42No problem.
26:43We're going to send him home.
26:44We'll give him oral tablets, then.
26:45Okay.
26:46I'll leave you with the rest of the team.
26:49Okay.
26:49Any pain in your neck?
26:52No?
26:52That's fine.
26:53Now you go up and down.
26:55Down and up.
26:56Yeah, that's fine.
26:57Follow with your eyes.
26:58Don't move your head.
26:59Just follow, follow, follow.
27:00Yep, that's fine.
27:02Jasvia will be sent home,
27:03but will need to return for further treatment on his hand.
27:06They have repaired the laceration that he had on his face.
27:11So what the Max Facts have done is good.
27:13It's just very unfortunate with the hand injury,
27:15it might make things a bit more complicated.
27:17But we will try and get to the bottom of that
27:19and try and get in better.
27:21Yeah.
27:24Yeah.
27:25Yeah.
27:26Yeah.
27:30Yeah.
27:34Yeah.
27:35Yeah.
27:36Yeah.
27:36Yeah.
27:36Ah, family members.
27:37Can I pop you outside for a few minutes there?
27:39Okay.
27:40Just whilst we get this done and I'll bring you back in.
27:44In Tunbridge Wells Hospital,
27:46Dr Pete needs to urgently realign Callum's broken leg.
27:50This bone here should really be aligned with this bone here.
27:54So the main concerns with these sort of injuries
27:57is a risk of him having damage to the blood vessels
28:00and the nerves that go down the leg
28:02and compromising the actual blood flow to his foot.
28:06He seems quite anxious to me at the moment.
28:08The unknown, never been in hospital, he's quite a young guy.
28:11So we'll try and get him as comfortable as possible,
28:14try and reassure him as much as we can.
28:16Trying to realign the two sharp ends of a broken bone within a leg
28:19is extremely painful for the patient.
28:22I'm going to give you this drug.
28:23Yeah.
28:24It's called ketamine.
28:25So it can make you quite spaced out
28:27and you won't remember what's happened, okay?
28:29Why?
28:30Yeah?
28:30We'll get you feeling a little bit better
28:32and then we'll pop it into a cast, yeah?
28:34Yeah.
28:37Ketamine, it's got a bad rap
28:38because it's sometimes used as a street drug.
28:41But it's a really good drug in the emergency setting
28:43for basically taking the sensation
28:46away from the procedures that we're doing.
28:51You might hallucinate.
28:53Some people see fairies.
28:54Yeah.
28:55Don't need to do it too much.
28:56I see myself finishing this football game.
28:58And scoring.
28:59Yeah.
29:00Okay.
29:01Okay.
29:01Where's your candela?
29:02The ketamine will assist with the pain,
29:05but more importantly means that Callum won't remember it afterwards.
29:09How are you doing there, my friend?
29:11Yeah, all right at the moment.
29:12You feeling a bit weird?
29:14I'm starting to get a little tingly in my fingers.
29:15Yeah.
29:17Yeah, it's getting dizzy, yeah.
29:18Yeah, you will get a bit dizzy.
29:20Tibia, fibia fractures can be quite complex to treat.
29:23So in the emergency setting, we need to make sure that that limb is safe
29:27and it's not compromised.
29:29There's a risk of losing a limb, there's a risk of infection
29:32and it can actually become life-threatening.
29:35So we've plastered quite quickly and then I'll do the manipulation.
29:39Realigning the leg just before the plaster sets
29:42will give it a good chance of staying in the right position.
29:48So he will make noises, but he won't remember what's going on.
29:56So if you pull that back, please.
30:00You're doing a very good job there, mate.
30:02Well done, Callum.
30:06Well done.
30:08I'm going to put some nice warm plaster on you, Callum.
30:12OK, let's get that plaster on, please.
30:14Well done, my love.
30:16OK, so warm plaster going on.
30:19I'm just going to give him some more ketamine.
30:29OK, let's get that round and then I can mip a leg.
30:36With Callum sedated, Dr Pete begins the procedure
30:40with only x-rays from earlier as a guide.
30:42Manipulations are challenging.
30:44You are having to align broken bones
30:47without being able to see what you're doing.
30:49We've put on plaster cast and what I'm going to do
30:51is physically move the bones back into position.
30:55It's all touch and feel and experience
30:57on doing those procedures.
30:59Oh!
31:02Well done.
31:03Nice and relaxed, Callum.
31:05You're doing really well.
31:07Oh!
31:10I'm physically pushing the bones back into place.
31:17Well done.
31:18It's a squeeze. Give me a squeeze if you can.
31:20That's it. Well done.
31:23It's the worst part over, Callum.
31:25So you'll just be waking up a little bit now.
31:27All right.
31:28I'm just tying the bandage up and then we're all done, OK?
31:31Callum.
31:33Wakey-wakey.
31:36It's all done.
31:37We'll just wait for him to wake up
31:39and then we'll get him round for another x-ray
31:41and just make sure that we've got a good position on that.
31:43There's a chance the bones could be in the wrong position,
31:46meaning Callum's leg is still in danger
31:48and he may need the procedure again.
31:50If a manipulation isn't properly aligned,
31:53the limb is at risk.
31:54You've got blood vessels, you've got nerve supply
31:56and they're at risk of something called a compartment syndrome
31:59which could risk that limb.
32:01Being able to blindly align two bones,
32:05it's a difficult skill
32:06and unfortunately sometimes we have to repeat that
32:09just so we have a better result.
32:12We're just going to get you an x-ray, Callum.
32:20All right, we're going across on slide.
32:22Ready, steady, slide.
32:26In Birmingham, 87-year-old Brian has had a scan
32:29after falling down a full flight of 13 steps.
32:33Thanks so much.
32:35Thanks, Ngeeta.
32:40I lost this, yeah.
32:45Dr. Abdul is looking for serious internal injuries
32:48from the impact of the fall.
32:50I can't see any skull fractures.
32:52He had the bleeding from the ear as well.
32:55Yeah.
32:55So I think it's probably just his eardrum.
32:57He's got a small bleed on the front right side of his brain.
33:00We're given the size of it and where it is
33:01and which layer and everything.
33:02He won't be able for any surgical management for that.
33:05In his chest, he's got one rib fracture on the left-hand side
33:07and that's allowed air to get in
33:09so he's got what's called a pneumothorax.
33:11There's also some blood in there at the bottom as well.
33:14A pneumothorax is a collapsed lung.
33:17Air has got into the chest cavity
33:19which stops the diaphragm being able to inflate the lung when it contracts.
33:23OK, Brian.
33:25So, your scans come back.
33:28It shows you've got a very small bleed on your right side.
33:32Which the neurosurgeons aren't concerned about.
33:36It's very, very small.
33:37It's almost like a little bruise, basically.
33:39The main thing that's come back is that you've broken a rib on the left-hand side.
33:43Yeah.
33:44And it's basically punctured your lung.
33:46So, your lung can't expand properly.
33:49So, to sort that out, what we need to do is we need to put a drain in.
33:52We'll pop a tube in there.
33:54That gets all the air out and then helps your lungs to expand and get back to normal.
33:58Yeah.
33:59All right?
34:00Yeah.
34:01In terms of your chest, we need to put a small tube through your chest.
34:05Dr. Sudkrit will carry out the urgent thoracostomy to drain the trapped air and blood in Brian's chest cavity.
34:12Basically, it's making a small cut on the side of your chest and putting a tube inside.
34:17We do this every day, but obviously it's got a few risks.
34:21There's a very, very small chance that the drain might hit your heart.
34:26I just want to make sure that you're happy with it.
34:29Yeah.
34:30Yeah.
34:33Hi, let's have your hand up.
34:36Yeah.
34:37Relax it for me.
34:39The doctors need to cut a hole between Brian's ribs and then push the tube into the chest cavity.
34:44It has serious risks, which carry severe consequences.
34:49The air that's trapped between his rib cage and his lung will keep building up and then squash his lung.
34:55If too much air builds up, it can start pushing across onto the heart and that can cause the heart
35:00to stop as well.
35:02It's one of the causes of a cardiac arrest.
35:05If it gets too painful, just let us know.
35:07I don't know.
35:07I don't know.
35:12I don't know.
35:37Oh.
35:38In Tunbridge Wells, 27-year-old Callum is having his second x-ray of the night after breaking his leg
35:45playing football.
35:49So I'm just comparing both the images now.
35:52Dr Pete is checking if he's managed to realign Callum's broken leg correctly.
35:56He'll need surgery later to fix it permanently.
35:59Callum is quite a complex case.
36:02His fracture is quite difficult, fracture to manage.
36:04Our job in A&E is to basically make that fracture a bit more stable in a better position to
36:09reduce the immediate risk to that leg.
36:12The angle there is completely off.
36:15Dr Pete has spotted a problem.
36:17So this is before we did any procedures.
36:20We've had a pull.
36:22Slightly better position, but it needs probably another pull, unfortunately, to just make the bones in a slightly even better
36:30position than this, just to make sure that the leg is safe over the course of the evening.
36:37Okay, so it's not the greatest news, unfortunately.
36:41It's better than it was.
36:43I think we're going to have to give it another pull, unfortunately.
36:46Get it into a slightly better position.
36:48Is it painful?
36:50Yeah, every sort of thing is just like a pressure feeling, yeah.
36:56Manipulation is one of the key skills as an A&E doctor.
36:59It's a difficult skill to learn, but one I really enjoy.
37:01It involves broken bones that you can't see through the skin, so you're doing this procedure blindly.
37:07And unfortunately, sometimes we have to repeat that procedure just so we have a better result.
37:12If they don't get it into a better position, Callum is at risk of permanent nerve damage, or even the
37:18bone tearing a hole in the skin.
37:20All right, Callum, we're just taking off the old one.
37:26It's a painful procedure, so Callum is sedated again.
37:32Two of us, Callum.
37:33Yeah?
37:34You feeling woozy?
37:37He's starting to fall asleep.
37:40Yeah, it's very unstable.
37:41You can feel the bones moving around, unfortunately.
37:45There are risks with manipulations.
37:47We're blindly aligning the bones of the leg and making sure that the blood supply and the nerve supply to
37:53the leg remain intact,
37:55because these are at risk in these sort of injuries and in these procedures.
38:00So we'll just pop some plaster on and then once that's on, we'll start to get into a better position
38:04and give it a bit more of a pull.
38:07That's fine, that's fine.
38:09That's fine.
38:10That's it, perfect.
38:11That's where.
38:16Yes, nice.
38:17That's better.
38:18Let's lift up a little bit more.
38:22Do you want lift for this?
38:23Yeah, please, just traction.
38:26Yeah.
38:28Perfect.
38:34Callum?
38:35How are you doing?
38:36It's all done.
38:38Yeah, it felt better.
38:40Did a bit more traction on it.
38:42So, yeah, we'll do another post-reduction x-ray.
38:44If it's in a position that we're happy with, we'll leave it for tonight.
38:48I think he's been through quite a lot tonight.
38:50Hopefully get a better result this time.
38:52If the bones are still not in the correct position, Callum could need his leg manipulated for a third time,
38:59which will be extremely painful for Callum and risk damaging the inside of his leg further.
39:04How's it look?
39:06That's a lot better.
39:09You can see where we've actually managed to get those in a much better alignment, straighter.
39:13It's the best we're going to get, really, without any surgery.
39:17So, yeah, just go to the theatre.
39:20How are you doing, Callum?
39:21Yeah.
39:22Okay.
39:23So, yeah.
39:24So, it's a much nicer alignment of your leg.
39:27The bone doctors will come and have a chat with you, and then they'll plan for having surgery hopefully in
39:31the next 24 hours.
39:32So, okay?
39:32Okay.
39:33All the best, mate.
39:34Hope he gets all sorted out.
39:35Take care.
39:35Yeah.
39:36Apologies.
39:37I can't really see you, but...
39:38Yeah, I know.
39:39It's the drugs.
39:40He will take six to eight weeks to heal, and then he's going to have a time of rehab, but
39:44he should be back to playing football again within the next year.
39:47Yeah.
39:47I'll leave you to your family, mate.
39:49Oh, do you have to?
39:50No, darling.
39:51Okay.
39:51Oh.
39:53You all right?
39:55How are you doing, then?
39:56Well, I'm spinning.
39:59Really, really spinning.
40:02Do you feel like you're out of pain now?
40:06A little.
40:08I'm tired.
40:22He's at the front now, and his blood pressure's holding.
40:25So that's okay.
40:26In A&E, 87-year-old Brian has a punctured lung from falling down a full flight of stairs.
40:33Brian?
40:35You okay?
40:37Yeah?
40:38You feeling a bit drowsy?
40:40If doctors Abdul and Sukrit can't drain the air and blood from his chest, his lung can't fully inflate,
40:46and could lead to a cardiac arrest.
40:49How are you doing, Brian?
40:51You with us?
40:53Are you okay, Brian?
40:54Brian?
40:55Just relax, Brian. Are you okay?
40:57I'm really mad.
40:58Are you wondering what we're doing?
41:00No.
41:01Yeah.
41:02Just putting a drain in.
41:05It'll help you feel better.
41:06The doctors are making a hole between his ribs into his chest cavity,
41:10which would be extremely painful without medication.
41:13The pain relief that we're giving, fentanyl, can drop the blood pressure.
41:17It's quite important that he's, one, not in a great deal of pain,
41:20and secondly, that his blood pressure's still enough to keep the blood flowing around the rest of his body
41:24and, yeah, keep him stable.
41:27Are you comfortably in?
41:29Yeah.
41:30Now they have access, they need to insert a tube to drain the air and blood.
41:38Brian?
41:39What?
41:40Is it hurting what we're doing?
41:43A little bit.
41:45A little bit?
41:46Okay.
41:47A bit sore?
41:50Yeah.
41:50Okay.
41:55Almost done, my love.
41:56You're doing very well.
41:57The tube can now be connected to a pump, which will drain the air and blood and allow Brian to
42:03breathe properly again.
42:04Brian, can you take a deep breath for us?
42:07Take a deep breath.
42:07It's bubbling.
42:08Yeah, bubbling?
42:09Yeah.
42:09And swinging as well.
42:12Are you okay, Brian?
42:14Brian?
42:16Just take some nice deep breaths for me now, please.
42:19Good.
42:19And breathe out.
42:21Yeah.
42:24Just waiting for as much of the air to get out of his chest,
42:27let his lung expand and refill completely,
42:29and then it's just going to be about pain management for his fractured rib
42:32and just trying to get him on his feet.
42:34He lives alone and we want to make sure that he's safe to go back home.
42:37So often the medicine side of it is dealt with fairly quickly.
42:41He's had all the treatment that he needs at the moment.
42:43It's now more just making sure that we rehabilitate him,
42:45get him back on his feet and do so safely.
42:49Brian, breathe it.
42:51Hold your breath.
42:54Breathe normally.
42:56Brian is having a chest x-ray to check the positioning of the tube.
43:01Looks very good.
43:03Yeah.
43:04So you can see the drain going in from here along here
43:07and the lungs expanded really nicely across here now,
43:10so it's a very, very good result.
43:12Yeah.
43:14That's perfect.
43:14That's actually perfect.
43:15Very good.
43:16Good job.
43:17Bye-bye.
43:28Yeah, I can let you know.
43:29Yeah.
43:29As soon as the hot report goes back, I'll let you know.
43:30Brilliant.
43:31And then we'll know then if it's life-threatening or serious or not.
43:34Yeah, lovely.
43:46and then we'll call the plastics team Hanson to go and have a look at you okay
44:02okay
44:02let's prescribe you some pen relief as well yeah
44:23if you need painkillers just let us know yeah you can have something to eat and drink as well
44:43and if you or someone you know has been affected by anything in tonight's program
44:48please go to channel5.com slash helplines for information and support
44:53with their families fearing the worst the disappearance of two schoolgirls sparks a
44:58huge search in brand new true crime snatched tomorrow at 10. next tonight cause of death
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