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Casualty 24 7 Every Second Counts S10E05 MY5 H 264
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00:02In the heart of Yorkshire...
00:06Bouncy, I need a panel.
00:08Just a busy day. Everybody's decided to come today.
00:11An unbeatable team.
00:13Have you given it a clean or did you just put that on?
00:16No, I wouldn't let my wife anywhere near it.
00:18Slide.
00:19Hard at work, 24 hours a day...
00:22Sorry.
00:23You've got the booby fries, you've got me.
00:26Seven days a week.
00:31Saving lives.
00:33No, no.
00:34Helping loved ones.
00:36Well, this is shocking. They're actually broken bones.
00:39Making the community they serve better.
00:42As long as everybody's safe, that's all that matters.
00:45A health service treating anyone...
00:48Strain your temperature, Jane.
00:50...and everyone.
00:51In and out, keep going.
00:53A team doing anything and everything for each other.
00:57The staff have been amazing.
00:59They've not been able to do enough for us.
01:02This is Barnsley Casualty 24-7.
01:06It brings me faith in the staff and NHS, definitely.
01:12I love you.
01:13I love you.
01:14I love you.
01:18I love you.
01:19On shift tonight.
01:20Dr Emma Farragul.
01:22We're a bit worried you might have an infection in your head.
01:27Sister Georgia.
01:28We should see them really within a 15 minute window when they're booking in.
01:35And Dr Kitty Price.
01:37I think we need a little bit more than a plaster for that one.
01:41So get ready to share a shift.
01:44I'm lucky to be alive really.
01:46With the team at Barnsley Casualty.
02:00It's a hectic start to the afternoon shift.
02:06Sister Georgia is in charge.
02:08Just a busy day.
02:10Everybody's decided to come today.
02:14So we've got patients that have been here 14 hours and 15 minutes and we're still waiting on beds.
02:19So, not good.
02:21We're trying our best though.
02:24But getting to grips with running the department is an exciting new challenge.
02:30I've only actually been doing my sister role a couple of months.
02:33I do enjoy being a sister.
02:36Hello you dear sister.
02:37You need to make sure that all your patients are safe.
02:40It is really challenging, especially being a sister and like managing the department.
02:47And Casualty's doors are open 24-7.
02:51Patients are sat in waiting room that have been here an hour and 20 minutes and not been triaged yet.
02:56So obviously it's patient safety that we need to maintain.
03:00Sometimes like your walking patients are actually the sickest patients in the department.
03:04So if there's a long triage wait down there, you've got to prioritise getting them seen.
03:11So we've got 92 patients in the department.
03:14We've got a two hour, three minute doctor wait.
03:17It is a bit like a puzzle.
03:18We've got to move staff about to help in the areas that are more demanding.
03:25But yeah, we're just very busy, as always.
03:30And it's only an hour into her shift.
03:35To add to the pressure, paramedics are rushing in a patient who's had a serious accident.
03:44Dr Kitty Price is already in resus.
03:47So we've got an 85-year-old male, trauma pre-alert, who's coming in having fallen six foot forwards off
03:55a ladder and hit his head on the ground.
03:57The team prepare for his arrival.
04:1585-year-old John has a severe head injury and pain in his back.
04:28So, about 10.45 this morning, John has been approximately two metres up some ladders in his garage.
04:39The paramedics hand over to Dr John Shepherd and the team.
04:43The ladders have slid away from him.
04:46He's gone forward, he's hit his chest and his head on the ladders as they've collapsed on the floor.
04:55Colleagues were quite keen to demonstrate how worried they were as well, which always piques your interest.
05:00And it's important to try and bear their concern in mind and compare that with the patient that you've got
05:06in front of you.
05:08Notable injuries, about one inch laceration to the right side of his head and left clavicle about here.
05:19Tender.
05:21He's got, potentially, two different places that are causing him trouble.
05:24And it's trying to unpick how much is one, how much is the other, and how much we need to
05:29be worried about both of those together.
05:31Dr Price takes charge.
05:33She needs to assess which injuries need to be prioritised first.
05:38Hi Sean, my name's Kitty, I'm one of the doctors.
05:41We're going to have to cut your top off just so we can have a good look at you and
05:43a good listen to your chest.
05:44Can we get left arm or right?
05:46Can we get left arm or right?
05:47Can we get left arm or right?
05:48Can we get to do a prior research?
05:50John, I'm just going to borrow your finger, buddy.
05:52Keep your arm there to lift your finger up.
05:56John's wife, Muriel, has been with him since she called the ambulance.
06:00It's the old dentist.
06:02I'm sorry.
06:03I'm sorry.
06:03I'm sorry.
06:04I'm sorry.
06:05I'm sorry.
06:05There was this high up on the ceiling.
06:08Yeah.
06:08I stood halfway up.
06:09What were you doing?
06:13Trying to put a staircase in, but I ain't got that far.
06:16Oh.
06:19After such a high fall, John's showing signs he may have broken his back.
06:25There's a left back to the wall and it worked.
06:28A little bit of this side.
06:30A little bit of that right there.
06:32Saw here.
06:33Both sides.
06:34I thought saw her back.
06:37Can I have a squeeze of your hips, okay?
06:39I want you to tell me if there's any pain in anywhere.
06:42Where's that pain?
06:43The shoulder.
06:47I'm just going to check your temperature, my lovely.
06:50I'm going to go this side because I know you've got the cut on the other side, haven't you?
06:5436.
06:55John, have you got pain?
06:57Yeah.
06:58Yeah?
06:58There?
06:59Yeah.
06:59Just directly under there?
07:00Oh, yeah.
07:01Okay.
07:03How have you been with moving this hand?
07:05Alright.
07:07Any pain in your shoulder joint here?
07:11Or is it only where I was pressing it here?
07:13There you come up.
07:15It's not cold.
07:17Enough.
07:17Perfect.
07:18I'm sorry.
07:19I have to have a good look so I know what's going on me.
07:21Okay.
07:23Sorry, that arm on that side, just to get some blood's alright.
07:25I know we're coming at you from all angles.
07:27I can see that.
07:29I'm just going to pinch this arm to take some blood.
07:32Is that alright?
07:33It's beautiful.
07:34John has multiple injuries, so Dr Price puts together a thorough treatment plan.
07:43What we're going to do is we're going to order you some scans and get you some pain relief.
07:46We're going to send these bloods off.
07:48We're going to scan this area, scan your head because you've got a bump to your head as well.
07:52It looks like you've got a bit of a gash here that we need to have a look at.
07:57But what we're worried about is whether there's any bleeding in your head as well.
08:00Okay.
08:04We're going to have a look on this side as well.
08:10I'm not straightening your arm.
08:12I'm not straightening your arm.
08:13I'm not straightening your arm.
08:14I'm not straightening your arm.
08:15Try again there.
08:16Is that better?
08:18Is that better?
08:18See you next week.
08:23With the wrist John has internal bleeding or a brain injury, he gets taken down for his CT scan.
08:32If he has a bleed on the brain, he will need emergency surgery.
08:45In casualty, Sister Georgia is only a couple of hours into running the department.
08:50Lisa, would you be able to go down to walk-ins?
08:53Because I think there's like nine to us.
08:54That's for you about an hour.
08:56Wait, is that okay?
08:58Walk-in patients haven't stopped coming through the doors.
09:01And the triage team can't keep up.
09:04We've sent more staff down though to try and get up with work
09:08because we've got an hour and 20 minute triage wait.
09:12It just seems busy on triage this afternoon on walk-ins.
09:16When we're overflowing with walk-in patients, it's really, really stressful.
09:20You've got a long wait.
09:22You don't know what they've come in with really until you triage them.
09:27We should see them really within a 15 minute window when they're looking in.
09:31It's just in flux.
09:33We've had a lot in over a period, short period of time.
09:37Hopefully we get back on top.
09:40While sister Georgia tries to keep the department on track,
09:4985-year-old John is having an urgent CT scan on his head and spine,
09:54after he fell off a ladder in his garage.
10:04Now back in Reesos, daughter Beverly comes to visit her dad.
10:08That's one day.
10:09Right.
10:10I was laid in garage here for an hour before I couldn't move.
10:17Couldn't move.
10:18When I turned round, there was a lot of blood up right side.
10:21Yeah.
10:22So you knew then you'd done something.
10:24I knew I had to get up, you know, because I was drunk with it.
10:27Yeah, yeah.
10:28But I felt somewhere go, you know, a click.
10:31Ah.
10:31I just couldn't move at the time.
10:34I just couldn't move.
10:36Have you had any morphine or out?
10:38No, I didn't.
10:39I'm not in pain.
10:40Oh, that's good.
10:41I was at first, but it seized off this pain.
10:44Oh, that's good then.
10:45It seized off a lot.
10:47After assessing John's results, Dr Price heads to see him.
10:51John, how are you doing?
10:53All right.
10:53Yeah, how's your pain?
10:54It's gone a bit.
10:55Okay, so we're going to give you some pain relief.
10:58Some more pain relief.
10:59Send me on.
10:59So we've got a bit more to do before that.
11:02All right.
11:03So, first things first from your scan that you've had done.
11:07You've fractured your clavicle here.
11:09I've spoken to the bone doctors who want to have an x-ray of that specific area
11:14so that they can see how bad it is and what they're going to have to do about it.
11:18The scan of your head didn't show any bleeding inside your brain.
11:22No.
11:23It just shows that we know about this.
11:25Okay.
11:26Okay.
11:26We're waiting for the rest of the scan to be reported from your clavicle downwards.
11:31Okay.
11:32This has started seeping through a bit, this cut, so I need to have a look at it.
11:35All right.
11:36I'm moving out of the way.
11:36All right.
11:38I'm just going to have a good look at it.
11:39All right.
11:40I'm going to have a look at it.
11:41Cowards.
11:42Just.
11:44Cowards.
11:45That's going all right, darling.
11:47Yeah.
11:48Well, it can't be going all right.
11:49Just put a plaster on it.
11:51I think we need a little bit more than a plaster for that one.
11:54Sure.
11:55I know.
11:56We need some pain relief, don't we?
11:57Is it broke?
11:58Yeah, it's broke, that.
11:59Yeah.
11:59I think likelihood is, is we can close it with a bit of glue.
12:05At the minute, it doesn't look like you've caused much damage other than that clavicle.
12:09Here.
12:11It's not going down.
12:12Right.
12:13All right.
12:14Keep that head still for me, just whilst we wait that glue.
12:20Any questions for me?
12:21No.
12:23John's now got to wait for the final scan results before he can be moved out of recess.
12:28But there's still a chance he could have badly broken his back.
12:42Paramedics are bringing in another patient who will be going straight into recess.
12:5358-year-old Jane has come in with a severe headache, high temperature, confusion and vomiting.
13:02Dr. Emma Farragher is in charge of her care.
13:06Jane?
13:08We need to steal a little bit more blood just to see if there's any bugs in it.
13:12Is that OK?
13:15People coming in with textbook things is very rare.
13:18If everyone did that, we wouldn't have a job, because the computer would do it.
13:24Jane has a rare condition called Addison's disease.
13:28If an Addison's patient's coming in, they'd be concerned that they're going to be quite sick.
13:32They can get quite sick quite quickly, so they need to have steroids,
13:36because their bodies won't produce their own steroids to counteract them being sick.
13:42Jane is prone to serious infections.
13:47If we give you some morphine, will you be OK?
13:50Shall we try that?
13:53I love problem solving. I always loved learning.
13:56It's one of those industries where you always learn, it's always advancing.
14:01There's always something new.
14:05With recess filling up, Nurse Olivia has been drafted in to help Dr Farragher.
14:12My first day in recess, I've only just qualified, but I've been in A&E two years now.
14:20Every shift is different, you don't always work in the same place.
14:24Recess is one of the ones that everybody fights to go in, because it's adrenaline packed.
14:32I'm just going to take some blood, darling, OK?
14:37It's a big learning curve in recess, there's lots of things to learn,
14:41new cases that we find that I've never come across.
14:49I'm just going to pop your blood pressure cuff on as well, OK?
14:55Jane's daughter Melanie has arrived.
14:59Hello, Trouble.
15:01You causing chaos, are we, hey?
15:05You tired?
15:07You tired?
15:09I am, but I'm stressed.
15:13I'm not surprised.
15:15Still not with her, are you?
15:17Still not with her, are you?
15:19She is looking very hot and clammy, very pale, very lethargic.
15:24She seems to be a little bit confused as well, very weak, just not herself at all.
15:30We think she's got some sort of infection somewhere.
15:33You're warm enough? You're shaking a little?
15:42Dr Farragher and the team need to monitor Jane closely, in case her vital organs start to shut down.
15:59Back in the hub, patients are piling through the doors.
16:03Are you all right down there? Because I know it's really busy, isn't it?
16:06Faster than sister Georgia and the team can treat them.
16:09Is there any spare cubicles for somebody to assess or not?
16:13We've only got two triage rooms, we've got doctor's rooms as well,
16:16but then obviously doctors need to go in there and see patients in there as well, so it's hard.
16:21Otherwise, there'd be no patients getting seen by doctors if we used our rooms.
16:32In paediatrics, they have eight dedicated rooms for poorly children.
16:37And when it's as busy as today, the staff know the importance of pulling together.
16:43Teamwork here at Barnsley is incredible, especially in our emergency department.
16:50It becomes like a little family that you have around you, and that's important.
16:55I wouldn't change that for the world.
16:59And advanced clinical practitioner Liam might need to call on his colleagues for help
17:06with his next patient.
17:10Energetic three-year-old Leo has been brought in by his mum Jess and Dad Craig.
17:16I don't know if he just constantly lives off adrenaline, but it's nothing phases him at all.
17:25But yes, very active.
17:29He might not look poorly, but this morning Leo burnt his hand while his mum was ironing.
17:40Hello there.
17:41Hiya.
17:41Is this Leo?
17:42Yes, it is.
17:43I've seen you running up and down.
17:46And who are you guys?
17:47Mum and Dad.
17:48Fantastic.
17:49So, tell me what brings you into A&E today.
17:52So, I wore ironing uniform this morning, and then just as I've gone to put the iron down onto the
17:57T-shirt,
17:57his arm slid up, and the iron's touched the corner of his hand here.
18:01Okie dokie.
18:02I ran it underwater, and it just kind of looked red, so it didn't look bad.
18:07So, I've gone to school, and in that time it's, like, blistered up.
18:11Okie dokie.
18:12And how long did you run it underneath the water for?
18:15About 10, 15 minutes.
18:16About 10, 15 minutes.
18:18Fab.
18:19Leo, do you want to just sit on Mummy's knee over there for me, so that I can take a
18:22look?
18:22Hello.
18:23Oh!
18:24Nice juice bottle.
18:27So...
18:29And you say he didn't have any medical conditions, so no eczema or anything like that.
18:33Oh, it's ok.
18:34Just taking a quick look at it.
18:37It's ok, I'm not going to touch it.
18:39So, it's just a bit of eryphema around this bit here.
18:43It's not gone round.
18:44Can I just see the bottom of his hand, if that's alright?
18:48The position of a burn is really important.
18:52The burn itself can cause constriction of the skin.
18:55Which then could potentially cause issues for circulation,
18:59erm, nerve sensation and stuff like that.
19:02So, it's quite important to check exactly where that burn is.
19:06No, it's just that one.
19:08Okay.
19:09I'm literally just going to press on it a second.
19:12So, it might not like me, unfortunately.
19:13It's alright.
19:14It's ok.
19:15It's ok, buddy.
19:17It's ok.
19:20One, two, three, four, five.
19:22Good stuff.
19:23Ok.
19:25Good boy.
19:26Good boy.
19:26Fantastic.
19:30So, a couple of really positive points inside that.
19:32One, you've done exactly what you should have done,
19:34in terms of running it underneath the water.
19:37Yeah.
19:38He's just wanting to run up and down, bless it.
19:41The other good thing is that it's not around any of his fingers
19:45and it's not on what we call flexor bits.
19:47Right.
19:47So, the bits that bend down and get less.
19:51Ok.
19:52So, it's not going to constrict that muscle there.
19:54The fact that it's on the top is actually better.
20:01He's very active, innit?
20:04Bye-bye, mister.
20:06Bye.
20:08Bye.
20:08Bye.
20:09That's it.
20:12Leo's had a lucky escape.
20:14His blister could be much worse.
20:17But he would still have to endure the painful procedure
20:20of having it burst.
20:30In Rhesus, Nurse Olivia is caring for Jane,
20:33who came in with Addison's disease.
20:37Addison's disease is where the body doesn't produce
20:40enough of hormones such as steroids and adrenaline,
20:45which makes it hard for the patient to fight off any illness.
20:50Rhesus.
20:51Jane's now been stabilised and is being moved out of Rhesus.
20:58So, she wasn't as poorly as we feared,
21:00so she was suitable to be in HTC rather than Rhesus,
21:04which is just a slightly lower level of monitoring.
21:07She's taken round to a high-dependency cubicle.
21:11You've had a very bad headache, haven't you?
21:17Her daughter Melanie has been with her since she came in.
21:21Yeah.
21:22Yeah.
21:23Only go home.
21:25You can't go home.
21:26I'm sorry.
21:29Not well enough.
21:32Well, I'm a six.
21:33I'm a six.
21:34You're quite poorly, yeah.
21:37Not very well.
21:39Dr Farragher has come to check in on Jane.
21:43Can I borrow this arm for a blood test?
21:46A few more bloods from you.
21:51You are very, very warm.
21:56Can we go home?
21:58No.
21:59No.
21:59No, you're very poorly, Jane.
22:00You can't go home.
22:01We need to keep you.
22:03I don't think you're going to do very well if you go home.
22:06Sorry.
22:06I think we've fluctuated because I thought that we'd had a bit of a breakthrough.
22:11She's had the hydrocortisone.
22:12She seemed a bit more lucid.
22:13Yeah.
22:14And then she's kind of gone again.
22:17I'm going to check whether her sugars have dropped or anything like that.
22:19She looks worse from the end of the bed than she did earlier.
22:21And her GCS, so her consciousness level, is a little bit lower.
22:27And that's just a bit concerning for other things, not just her Addison's,
22:31that there might be something going on inside her brain that we need to make sure is OK.
22:36Because Jane has deteriorated so rapidly, Dr Farragher has ordered a scan of her head.
22:43Where are we going now?
22:46You're having a scan on your head because it's been quite sore.
22:51I don't want to scan.
22:54You've got to.
22:56Find out what's going on.
23:02I know you want to go home, but you can't.
23:05Not yet.
23:11That's what we're trying to find out.
23:17This is a particularly bad bit of confusion.
23:23There's only one time it's been slightly worse than this where it's been unconsciousness.
23:27But this is a particularly bad episode.
23:39Mum, where's your pain?
23:42Jane's rapid decline could indicate a much more serious condition than originally thought.
24:02It's 4.30pm and Sister Georgia hasn't stopped since she clocked on.
24:08Oh, Lisa, you're here.
24:10And even with 92 patients in the department, she's embracing the challenge.
24:16I do enjoy being a sister and I'm glad that I went for this job role.
24:20I do feel like I'm ready for the next chapter in my career and the next step.
24:24When Adam gets back, obviously if there's no one else that comes in here, you can go back onto walk
24:31-ins if that's alright.
24:33You're managing all the staff, you're managing the department when you're in charge.
24:38You need to make sure all your staff are happy and then it's really good teamwork then when you've got
24:43a good team.
24:46So Lisa, a walking nurse that I sent down to help on walk-ins, but we've got a patient in
24:51resource now.
24:52So I've had to swap her because Adam's on his break, so she's going to cover resource.
24:57So we're still a nurse shot on walk-ins now, so we're going to have to wait for Adam to
25:01get back and then we can swap again.
25:15In resource, John came in after falling from a ladder.
25:21He's with wife Muriel and daughter Beverly.
25:24I'm taking a photo of that bad boy.
25:39Oh, I got married in there with minors because it used to be August holidays.
25:45August holidays for minors, we got the double wages in there for two weeks.
25:50And we used to go to the doctors and get a sick note, right?
25:54And get two more weeks sick note and all.
25:57And that was the only time you could afford to get married.
26:00And that's when we got married when we were 20.
26:03It's true, that. It's true, isn't it?
26:06When I come out of church, I stood on the steps, down Lay's Lane near, on the steps outside.
26:12And she took that.
26:15When you used to step in the car.
26:16What is it? Street out of me, and she slashed it straight out of me when I got out of
26:20the door.
26:20I don't think you've seen it since.
26:21I've never seen it since.
26:22I think, no deal.
26:26Dr Price, who's been caring for John, has his final scan results.
26:31Sounds like we're having a good time in here.
26:33I've just gone quiet.
26:34You've gone quiet?
26:36I'm feeling a bit tired, yeah.
26:37Are you in pain?
26:38No.
26:39Right, we've got you some pain relief coming.
26:41Good.
26:41Now, a bit of an update from the rest of the scan that we've had done.
26:45Yeah.
26:46Okay.
26:47It shows that you've got some fractures in your spine.
26:50New fractures.
26:52So they've been reported.
26:53We know about the fracture here.
26:54Yeah.
26:55But with the fractures being new in your back, we have to keep you on your back.
26:59Okay?
26:59And we have to get you into hospital.
27:01Okay?
27:02Excuse me, I can't get out of it.
27:03I've got to stop in bed, really.
27:04At the moment, until we've had the full report, and it's been looked into by detail by the orthopaedic doctors.
27:09Yeah.
27:10So, unfortunately, we're going to have to keep you flat on your back for the minute.
27:14But we're going to clean this up, give you a fresh pillow, and get you comfortable, and you can have
27:18a nap.
27:18I think you're quite a strong cookie.
27:20I'm not.
27:21Never.
27:21All right.
27:23Right, thank you very much.
27:27John was taken up to the orthopaedic ward, and stayed in hospital for eight weeks.
27:38Back in the paediatric department, three-year-old Leo is waiting to have the burn on his hand treated after
27:46he caught it on the iron at home.
27:48He's with his mum, Jess, and dad, Craig.
27:54Charge nurse Greg is ready to treat him.
27:57I think we're going to have some tears on this, to be honest, guys.
28:00Yeah.
28:01Hello, dude.
28:03I'm surprised you're not tired, but they might have you been running up and down.
28:05He's never done.
28:06We just need to hold his hand still.
28:08Ah!
28:08It might be one of you that gives him a hug.
28:10If they're really young, and you're there, obviously, trying to have a look at the wound, trying to clean it,
28:15poke around, obviously, it's causing them pain.
28:17One.
28:18Two.
28:19Three.
28:20Done.
28:21Yeah!
28:23Yay!
28:25Yay!
28:27Yay!
28:27Yay!
28:28You need to be kind and compassionate.
28:30You need to be understanding.
28:32Because if you're medical, to you, that's just a standard, ordinary day for you.
28:36But to that child, it could be one of the worst days you've ever, ever had.
28:39So you've got to put yourself in other people's shoes, I think.
28:42So if you hold him at his elbow, mum, if that's all right, like that.
28:45Yay!
28:45Last bit.
28:50All sorted, Leo heads home with mum and dad.
28:55He's soon recovered, and hasn't touched the iron since.
29:04It's late afternoon in Barnsley Casualty, and it's still chock-a-block.
29:09Sarah, has Kube 13 gone?
29:12To 36, she's gone.
29:17I'll take her off.
29:20Sometimes you might come on to shift and have, like, 20 patients waiting for beds, but there's
29:25no beds in the hospital, so it's like, where do these patients go?
29:28We haven't got no beds, have we?
29:30What have you got?
29:30We were on a minus seven in A&E, but there were nine beds, which...
29:34Nine.
29:38So it's a case of waiting for discharges on the ward for us to be able to move out of
29:42A&E, and that's what makes A&E so crowded, because there's no beds in the hospital.
29:47They're going to try and move some of the patients back across from medical.
29:56You just need to make sure that them patients are safe, they've had all the treatments, medications, make sure that
30:03they're clean, make sure that they've been fed, get them a drink, just look after them really.
30:17Over in radiology, Jane is having an urgent CT scan of her head.
30:23The team are worried her confusion is being caused by an abnormality in her brain.
30:34Because she's deteriorated so rapidly, the team are sending her back to Rhesus, so they can keep a closer eye
30:41on her.
30:42Right, darling, I'm just going to pop them stickers on.
30:45Jane?
30:46Yeah.
30:46Hello, sweetheart.
30:48Hello.
30:48I'm back again.
30:49You're back with me and Olivia now, OK?
30:53Newly qualified nurse Olivia and nurse Adam take over.
30:57Where's your pain, Jane?
31:02All over.
31:05Dr Farragher has the results from Jane's CT scan.
31:09Hi.
31:12I think we're going to give you some different antibiotics, because you've got this headache and you've been feeling sick.
31:18And you're a bit confused.
31:21We're a bit worried you might have an infection in your head.
31:25In my head?
31:26Yeah.
31:28Because you're a lot sicker than I would expect you to be.
31:31From all your results.
31:34Because of her fever and how unwell she's been and how confused she is, we're going to cover her for
31:39an infection in the brain called encephalitis.
31:43We don't know for sure that she's got this. It's just that with her presentation this is a concern and
31:49it's really important to cover for it.
31:58Do we know what the cause for, like if there's an infection in the brain, what can cause that?
32:04I don't really know the report of what's come back from her scan. I know they're just thinking it's infection
32:09on the brain.
32:11Main thing is we're going to get it sorted.
32:16We'll get you sorted.
32:17We'll get you sorted.
32:17You're not a nuisance.
32:19Won't be sat here if you're a nuisance.
32:23You're alright.
32:25We're going to take you to the ward now Jane, is that alright?
32:30I'm going to the way home.
32:32AMU.
32:34Jane was taken to the acute medical unit where she stayed for two days.
32:39She's now back at home, fully recovered.
32:49The next walking patient to be seen is 59-year-old Maxine.
32:55I've come in because I had a really bad acute pain overnight in my, between my shoulder blades.
33:02And it was radiating down both arms and legs.
33:05And I tried to see my GP but couldn't.
33:08So they suggested I had to come to Wayne in.
33:12Advanced clinical practitioner Chantel takes over her care.
33:17Maxine, my name is Chantel. I'm one of ACPs in A&E.
33:21So Maxine, tell me about you. Tell me what's been going on.
33:24I started with a sudden onset pain.
33:26I started Friday.
33:28I worked Friday and as the afternoon went on I was getting more and more pain in my left shoulder.
33:33And then last night it just started but it was central, like between my shoulders.
33:39But then it's actually been my legs as well.
33:42With this pain, any shortness of breath?
33:46Not specifically unless I got, if I was lying flat, yes.
33:49But so long as I'd kept propped up on a couple of pillars.
33:51What about when you're walking around?
33:52I do get a bit breathless anyway.
33:55My initial thoughts with Maxine is could this be a chest infection?
33:59So she's come in breathless, she's got an oxygen requirement, she's got a pain to her back.
34:05Any other medical history?
34:08Yeah, I've got, erm, I've got the sarcoidosis, high blood pressure, I'm on medication for.
34:16I've just, like I said, a couple of weeks ago got tipped over into type 2 diabetes.
34:21OK.
34:22Which I'm not surprised at.
34:25Maxine's got a complicated health history, so it's harder to get to the root cause of her pain.
34:33Let me have a listen to the back of your lungs first. So nice, big deep breaths.
34:39Let me just have a feel down your spine and tell me if there's any pain or anything.
34:43Oh, it's sore there.
34:44And what about here?
34:46Yeah.
34:47Sorry, I'm really sorry.
34:48And have you noticed this pain before?
34:51Erm, no, nothing intense like that, no.
34:53OK.
34:54Let's get you some strong painkillers, get a chest x-ray as well, and Steve sent your bloods off.
34:59Yeah.
34:59The part will take you round, OK?
35:02It's OK.
35:03The chest x-ray will hopefully give advanced clinical practitioner Chantelle more of an idea of what's causing Maxine's pain.
35:11And she's trying to stay as positive as she can.
35:14I'm hoping that they say, yes, you've pulled a muscle and let me go home.
35:19That's what I'm hoping for.
35:24Sister Georgia is ten hours into her 12-hour shift.
35:28I mean, we've got 73 patients in the department at minute.
35:32Erm, we're on a three-hour, eleven-minute doctorate.
35:35Erm, beds are coming up slowly but surely.
35:41Sometimes you do feel like you want to just, like, stop patients coming in,
35:45but obviously that's not anything that you can ever do in an emergency department.
35:49You can never close the doors and just say,
35:51oh, we're not taking any more patients.
35:55It's always a 24-hour service.
36:01And a new patient is on their way in.
36:0965-year-old Ken has a large wound on his head after a serious car crash.
36:17He's taken straight to an ambulance bay.
36:20It's just been driving on from work.
36:23And he says, he can't really remember what happened.
36:25Paramedic Jack hands over.
36:27It's gone through a concrete fence and down about, I'd say, about three or four-foot ditch.
36:33There's nobody else involved.
36:35So these are the pictures of the actual RTC.
36:43There's the wall that has come down.
36:45He's done three of those concrete posts.
36:51He's climbed through from the driver's side.
36:53He climbed out the passenger side.
36:54I was slightly worried about the car like that.
36:57I feel the old mind.
36:58I thought, if time's gone, it'll be petrol all over.
37:02That's why I wanted to get out of the car.
37:06Yeah, I didn't want to get burned till I got out.
37:08Dr Heather White comes to do an initial assessment on Ken's injuries.
37:12So you've been in a car crash?
37:15Yeah.
37:15What's happened?
37:16Just walking through it.
37:17There's like a gap in me, hadn't there?
37:19I was driving along and, I don't know, the next thing I know, I've been thrown all over.
37:25And do you remember before the crash, if that makes sense?
37:29No, just before the crash.
37:31If you saw a picture of the car, I'd be quite lucky, really.
37:35Have you been sick at all?
37:37No.
37:37No.
37:38Any pain anywhere?
37:40No, just...
37:41I'm just getting a channel light in your eye, if that's okay.
37:44Yeah.
37:48And then I'll just press on your neck.
37:50Any pain there?
37:52No.
37:53Obviously, someone will see you a bit more thoroughly.
37:55Yeah.
37:55And go over what happened before.
37:58It might have worked out before, but I think there's nothing that's worrying me right now.
38:03It seems on the surface, Ken has had a lucky escape.
38:07But he can't go anywhere until the team investigate what has caused his memory loss.
38:22Hiya, it's Sister in Edie. I'm just wondering if you're ready for a mail.
38:25No.
38:26In casualty, Sister Georgia is in the last hour of her shift.
38:31And finally, making progress.
38:33We've got 67 patients in department.
38:35We've got an hour and seven minute doctor wait, which is better than what it was earlier.
38:40Assessment time's looking better.
38:41So, it's a 33 minute wait for assessment nurse.
38:47So, yeah, it's looking better to hand over to at 19.
38:55Over in cubicle 12,
38:59Ken is waiting for another assessment after he crashed his car into some concrete posts.
39:05I'm lucky to be alive, really.
39:09I mean, I don't know if you're going to black out or what.
39:13Dr. Fenula Sherbert comes to investigate further what caused him to crash.
39:20So, you don't remember what happened pre-axing the car?
39:23No.
39:23Have you ever had a blackout before?
39:26No.
39:27Any problems with your heart?
39:29No, not that I'm aware of.
39:32And when you were in the car, did you have any chest pain?
39:36No.
39:37We just wanted to make sure that there wasn't anything related to your heart that could cause this.
39:42I'm going to get some glue to see if we can just glue that up.
39:51That's the worst bit.
39:57An artist will work.
39:59We're going to get a scan of your head to make sure that there's not a reason that you can't
40:04remember it.
40:04We're going to see if something's happened before the crash.
40:08Or if the reason you can't remember it is because you've bopped your head before the crash.
40:12And then I will come back in and I'll let you know what the report says and then we'll go
40:18from there.
40:19OK. Sounds good to me.
40:22Dr. Sherbert wants to find out if Ken's memory loss is due to a bleed on the brain.
40:27So sends him down to have a CT scan.
40:37Already in radiology is Maxine.
40:40Maxine, breathe in.
40:42Hold your breath.
40:44Breathe normally.
40:47She's just had a chest x-ray after coming in with pain in her shoulder and legs.
40:55Hi, I'm back.
40:57Advanced clinical practitioner Chantel comes to give her the results.
41:01Erm, so let me tell you the plan.
41:07So, we're going to keep you in hospital.
41:09So, the blood clot test that we do, it's not specific for blood clot but it could signify a blood
41:15clot has come back a little bit raised.
41:17So, we need to keep you in and do a scan of your lungs.
41:21Yeah.
41:21Something's going off and you're not a simple patient as well, you're on a lot of medication and special ones
41:26too.
41:27Not simple and special.
41:29So, when patients come in and they've got, they either present with lots of weird and wonderful symptoms or they
41:34have a long medical history, generally it can be quite difficult to sieve out certain symptoms and get to the
41:42root emergency.
41:43Any questions?
41:45No, I think you're fairly comprehensive. I understand why you've got to keep me in.
41:49Right. Just come and get me if you need me. I've seen okay.
41:53And then you'll be going up onto the acute medical unit which is Ward 2728.
41:57Yeah, okay. Thank you.
42:00It's always a little bit difficult because of my underlying health conditions and all of them together sort of complicate
42:07a lot of things.
42:08So, yeah, I'm not happy about it but it is what it is that I've got to stay in.
42:13It's very good on the wards so I can't quibble.
42:16Maxine spent eight days in hospital where she learnt she had a compressed fractured vertebrae.
42:22Now back at home, she's on the mend.
42:27Back in radiology, Ken is having a CT scan to rule out a bleed on the brain.
42:33All right, what you do is keep your head still, all right?
42:45So, send your results to your doctor, okay?
42:49Armed with the new information, Dr. Sherbert updates him.
42:53Good news. No bleeding, which is what we're worried about.
42:56It's not, so the inside is fine, so we couldn't see any reason from a brain point of view why
43:01you had the loss of consciousness.
43:03So, you're okay to leave the hospital today but I'd like you to come back into medical estec.
43:09You shouldn't drive until you've had that appointment.
43:11Have you got any questions about anything?
43:13No, no, it makes sense.
43:14Is that all right?
43:14Yeah.
43:19Ken's still not driving and is undergoing tests to find out if he blacked out.
43:29It's home time for Sister Georgia.
43:33We had a busy afternoon but we got it back and we've left it quite a nice hot night.
43:42Going home and just relaxing and sticking telly on, having your tea and being with your family, like, just chills
43:50you out.
43:50And although each shift brings a new challenge.
43:54I just, I don't know where else I'd want to work.
43:57Yeah, I do enjoy it. I love it.
44:00She goes home happy and ready to do it all again the next day.
44:23I don't know where else I've got to work, I'mmind America.
44:23Yeah, I do enjoy it.
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