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00:02Ben was the driver of a truck traveling a hundred kilometers per hour he's then
00:08run into the back into a stationary vehicle there's a pelvic fracture the
00:11pelvic injury it's one of the most life-threatening injuries that you can
00:15get in trauma blood pressure 78 okay he looks
00:22fail team so we're upgrading to a trauma call he's at risk of dying right now in
00:27front of me you okay
00:57very worried see you must say the buying strength smashed to bits he was
01:02actually stopped breathing
01:06without intervention he's likely to die
01:08it's better
01:29hello hi I'm Jasmine I'm the medical students ah medical soon we've got
01:34another medical student that's coming as well it's veteran emergency doctor Emma's
01:38first day back in the thick of it after taking a six-month study sabbatical from
01:43the ED so you want to do the assessment okay perfect yep yeah have you um good
01:50yeah that's fine and today she's putting her new skills into practice with
01:56registrar dr. Matt who's on his first day in emergency have you done the
02:01ultrasound I've done a little bit of fast just good normal patients but not much
02:06that's all right I've been going to university studying how to teach young
02:10doctors how to be emergency specialists and I get a lot of joy from that role
02:15Yaakov is the trauma registrar and he might go through the primary survey with
02:21you
02:23Dr. Emma's barely got her feet under the desk when she learns her first case is
02:28being rushed in by ambulance we're doing a really quick team huddle yeah the
02:33reports of truck driver Ben's injuries are so serious Dr. Emma gathers her team
02:39including trauma registrar Dr. Yaakov we've got a unknown age young male who's
02:45coming in truck versus truck at a hundred k's an hour what I'm worried about is he
02:48could have a pelvic fracture that could cause deterioration by the time he's
02:52arrived here so Matt is going to do the primary survey thanks Matt we don't have a
02:57met pack but their obs are normal what am I missing what do you think about that I
03:01should have covered we're in a binder find out good so we need to make sure we're in a
03:05binder in a critical condition the 37 year old cable hauler was trapped in the
03:12wreckage of his truck until emergency services were able to cut him out hearing
03:17this story about a truck this is a truck you worry about that transfer of force
03:22pelvic injuries can cause severe bleeding and that can be a risk to
03:25someone's life anything change no we're all good what's your major concern
03:31pelvis hell that's okay another problem Emma he's just got slippery underwear
03:35underwear should we put a pelvic binder on to put over the top yeah might be a
03:39good idea it's just that it's been slipping yeah the slippery material of
03:42Ben's underwear is causing a problem when you have a pelvic injury veins and
03:47arteries can bleed a huge amount in a very short period of time and that's one of
03:52the most life-threatening injuries that you can get in trauma the pelvic
03:56binder closes the pelvis and stops bleeding that binder is slipping and
04:02I'm not comfortable at all it's a greater trochanter binder so we'll make
04:06sure it sits across the top dr. Jonathan is called in to help just in time
04:12mostly worried about pelvis and sleepy from a lot of pain relief yeah do you
04:18just turn him so that we can get the public blinding and further getting the
04:21sheets all of it yeah a lot of pain okay ready one two three go ahead and start
04:32your primary survey now I'd love to hear hand over thanks Ben is 37 years of age
04:38he was mechanically trapped by the dashboard for approximately 30 minutes that
04:43was sort of sitting on his waist and below suspect that pelvis is fractured Ben's
04:47wife Jasmine was at home when she heard the terrifying news I had to sit on the
04:52floor in the kitchen when I received the phone call I don't think I've ever had
04:56that much fear striking me with anything really he's in a lot of pain so he
05:03received 10 milligrams of IV morphine and he had 70 milligrams of IV ketamine
05:07during extrication yeah ketamine and 10 of morph great when I spoke to the kids
05:12that was the hardest point trying your hardest to not cry on the phone he really
05:21is the shining star of the girls world because it's their dad he's always been
05:26there so it hurts sorry mate I'm Jackie I'm just going to pop this one on your arm
05:32can you lift your arm up for me Ben was trapped from his waist down for a period of
05:38about 30 minutes that's highly concerning I'm worried that he's bleeding right in
05:43front of me our priority now is really getting a blood pressure cuff on because
05:48if his blood pressure drops that's a real sign of a very significant injury sorry
05:55man so can I get a team into log roll Jonathan can you direct the roll Ben needs
06:01to be carefully rolled onto his side so the team can slide the binder under his
06:06pelvis okay so we maybe got a broken pelvis so let's be careful everyone in
06:11position all right team we're gonna roll on three one two three just keep your
06:17head still keep your head still it's okay it's okay keep your head still as the
06:21binder is straightened the first crucial blood pressure reading comes through
06:27initial blood pressure says 87 we might cycle that again does he yeah to a
06:34trauma call yeah Ben's blood pressure is crashing dr. Emma needs to act fast
06:40honey just grab a met pack blood pressure 87 a blood pressure below 100 in
06:45a man like this is totally abnormal so seeing 87 I'm very very concerned team
06:52so we're upgrading to a trauma call I've activated a trauma call that means
06:56surgeons theater CT blood will arrive at the moment his condition is life or death
07:04it's okay okay
07:14as emergency doctors are here finishes his regular commute to ED his thoughts have
07:19been focused on a momentous day coming up I'm getting married in three weeks time
07:25which is super exciting I'm getting married to my best friend she's also a
07:29doctor she works in ICU yeah couldn't be more excited just to have someone who
07:34understands and someone that I can talk to but also someone who motivates me and
07:37and drives me to be better as doctors are here hits the ED floor he's needed
07:43immediately so we've got a young female who's got a severe asthma attack I reckon
07:51this one's a sick one so respirate 40 she's been on Ventolin all night can you come with me we'll
07:57get
07:57the drugs yeah we'll go get them adrenaline infusion yeah ketamine and some mag as
08:01well thank you she's been up all night with this asthma attack I mean she's on
08:06an adrenaline infusion which very quickly makes us worry that this is going to be
08:11a life-threatening event alrighty I've got adrenaline the most beneficial thing
08:16would be for us to on arrival essentially have back start back-to-back
08:20salbutamol lipotropium nebs oh you want nebs I'm setting up for a nebulizer which is a
08:26mask that humidifies the medicine and oxygen or air which helps open up those
08:32airways which are currently constricting I've not had a sick asthma in yeah the
08:38problem with that though is that lets off lots of mist into the atmosphere and
08:42we'll be breathing that in so we need to protect ourselves as well but not a
08:46sound machine will have x-ray on arrival more or less key inks breathing is so
08:51dangerously labored the paramedics bring her in sitting up she could have had
08:57flu covered that might not be like pollen or pollution induced asthma attack the
09:0328 year olds flatmate Gemma called the ambulance and is waiting anxiously
09:08you got any concerning numbers about just the heart rate Keying looks sick she said bolt uprights we
09:15call that tripodding you're leaning forward to try and get your lungs to expand as much as they can
09:20but it's like breathing through a straw and that makes me really worried one two three hello darling
09:28my name's Ebony I'm one of the nurses oxygen so this is Keying yes she has a history of asthma
09:36and has
09:37had a respiratory tract infection for the last couple of days it was quite febrile and chivalry
09:42overnight very drowsy and fatigue yeah so I've started an adrenaline infusion thank you so much
09:48she's got an infection that to us is a concern because it means that in addition to her having
09:55difficulty breathing she likely has pneumonia pneumonia can itself be quite dangerous in effect
10:01we've got life-threatening asthma on an adrenaline infusion Keying has been started on some adrenaline
10:11adrenaline is a last-ditch medication it helps you get more air in and it gets your blood pressure
10:17pumping but it can lead to heart failure that can lead to an arrest
10:35I think from a priorities perspective given that we're still febrile we should get some early
10:40antibiotics in Keying is being tested for infection as she battles a fever in the middle of a life
10:47threatening asthma attack we're going to do some COVID and flu swabs hey all right we'll pop this
10:53one down sorry sweethearts to give you a summary Jason on EV arrival was drowsy seems to have
11:04responded to the adrenaline infusion doctors are here quickly consults with emergency dr. Jason trying
11:11to work out the cause of the attack I wonder whether she's been underlying pneumonia she was febrile
11:16we'll give her some keftriax and then azithro we could give her a magnesium infusion is there
11:20anything else you can think of that we should consider give some mag carry on with the nervous
11:26yeah yeah like HD yeah yeah their adrenaline's still running okay my greatest concern asthma can
11:36deteriorate quickly so if she does head that way then might require us to put on a ventilator so
11:42that a machine can breathe and we take control of it completely sorry we're coming at you from all
11:47angles here but a patient who's got a severe asthma attack who ends up on a ventilator the odds of
11:53them
11:53having a bad outcome I'm incredibly high so we'll try to do everything we can to avoid her needing a
12:00ventilator do you still feel short of threat who's here with you my family is all in Malaysia I'm just
12:09here with my house your housemate okay I think it's good that you called the ambulance that must have
12:15been quite scary are you working on studying at the moment what do you study I'm quite worried about you
12:25what we'll do from here is we'll speak to our colleagues in the intensive care unit I think
12:29that you've probably got an infection that's the cause of case and so we're going to do an x-ray
12:34of
12:34your lungs to have a look could you lean forward for us for just a second as the team x
12:43-ray keying's
12:44chest to check for pneumonia just a big breast in and hold breathe away nurse Ebony has concerning
12:53blood results potassium is 3.3 glucose is up lactate 3.7 so I think those are probably driven by
13:01the adrenaline her potassium levels are low and that can lead to cardiac arrest at its worst the cause of
13:08that is likely the adrenaline however we need to continue the adrenaline it's absolutely critical
13:14to her ability to breathe we're sort of stuck between a rock in a hard place x-ray wise that
13:21looks good she's hyperinflated but other than that that's pretty good the x-ray hasn't solved the
13:27mystery of what triggered keying's asthma attack I can't see any signs of pneumonia what we're looking
13:33for is any sign that she can't fight anymore and that she needs us to support her breathing
13:39Dr. Zaheer wants to avoid putting keying on a ventilator at all costs but there's a problem
13:48what would you like the adrenaline to be running at we can't keep it running at high
13:52lows indefinitely because Dr. Zaheer is a massive tech idea ICU's Dr. Bin is concerned the prolonged
14:00use of adrenaline is now putting too much strain on keying's heart yeah I'm in touch with the
14:08respiratory specialists her heart rate is through the roof there's a delicate balance with adrenaline
14:13on the one hand it helps open up our airways which is what we want but the worst case scenario
14:18is that
14:19the strain on our hearts becomes too much and that can lead to an arrest thank you so much I
14:26really
14:26appreciate your help cheers bye their advice has been that we wean down the adrenaline dose okay darling
14:33we are going to put a hood over the top of you okay because if you have an infective cause
14:39for your
14:39asthma we want to suck it out of here okay my concern is things could change in seconds as we
14:47wean it down
14:48things might get worse there we go team so we're upgrading to a trauma call because of hypotension
15:04Dr. Emma has called for emergency backup after truck driver Ben's blood pressure plummeted to a dangerously
15:11low level initial blood pressure says 87 blood pressure is recycling thank you very much the father
15:19of three has a suspected broken pelvis and internal bleeding after the truck he was driving crashed at
15:27high speed into the rear of a semi trailer let's get the feet together turned inwards together we're
15:35almost there we're getting the binder on we're almost there okay nice and tight for the middle strap if
15:40the pelvis is broken a binder is vital to keep the bones from causing catastrophic internal bleeding
15:48are you okay no you're sort of holding a position like there's a right-hand side of pelvic injury isn't
15:55it looks like a like a hip just the hip maybe blood pressure of 85 on 54 Jonathan can I
16:02get you to focus on
16:04IV access Ben's second blood pressure is also low in fact it's worse I'm very worried that he's got
16:09both a fractured pelvis a dislocated hip that'll cause his pain but mostly that he's bleeding
16:15internally from that fracture net pack is on the way and Jackie when blood comes I'm going to get you
16:23to
16:23start blood I've called for a met pack the massive transfusion pack of blood I need an x-ray urgently
16:29to know what kind of pelvic injury that we're dealing with x-rays here so we're going to
16:35prioritize getting an x-ray all right can we take an x-ray everyone who doesn't have a leg he
16:40looks kind
16:41of ashen yeah I know and a blood pressure very looks like he's actually shocked x-ray while they wait
16:49for
16:49x-ray results dr. Matt make sure Ben stays awake keep talking Matt yeah I'm gonna get you to stay
16:59in
16:59airway now so your job is to make sure he's conscious his airways patent protected we're gonna start blood
17:05when blood arrives I'll look at the x-ray thank you oh no it's just okay so he's got a
17:15right dislocated hip
17:16yeah maybe an acetabular fracture can't tell that's a bit but won't completely account for the shot
17:22yeah okay yeah I'll put a rick in on that side what we thought was right Ben's got a dislocated
17:28hip and
17:29he's broken the socket that the hip sits in the acetabulum the actual part that's supposed to hold
17:34it in has been smashed apart blood pressure 78 met pack Ben's blood pressure is now critical can I just
17:43have a blood clinician ready with the warmer primed and ready and we're going to start with blood yeah
17:48Ben's a shock trauma patient it means there's less blood in your system being pumped around to your
17:54vital organs we really need to focus on getting a big cannula into the veins of Ben that we can
18:00pour blood in and keep him alive he's at risk of dying right now in front of me so Jonathan
18:06you're
18:06going to do a rick line in the left upper limb yeah blood pressure 78 net pack we're going to
18:22start
18:23with blood yeah truck driver Ben's blood pressure is so low Dr. Emma is worried if they don't get blood
18:30into him he could go into organ failure there's a pelvic fracture there's a right dislocated hip so
18:38there may be some significant bleeding in there yeah our hopeful plan is to get to CT but we'll see
18:45the blood for an emergency transfusion has arrived here's the med pack here's your med thanks goody you
18:53watch what happens are you a med student I'm good now one of the floor coordinators as emergency nurse
19:00Goony prepares the blood this will sting a little bit Dr. Johnson inserts a line ready for the life
19:08saving infusion our focus is this pelvic bleeding and we're going to start blood try and resuscitate him
19:15and get into CT okay the rick line is in thanks Jonathan so given his hypotensive at 79 Alex I
19:24might
19:24get a second bag going into the rick line what we're doing now is focusing on blood resuscitation
19:30we're trying to drive that blood pressure up keep Ben alive keep his organs perfused and find out where
19:36the bleeding is that's the blood ready you can put the blood in straight away that's away I just want
19:42to
19:42see some hemodynamic stability it's a tense moment as the team wait to see if Ben's blood pressure
19:49increases how's he going there is he alright next blood pressure is coming up blood pressure 90 now
19:57so we're getting better okay recap team airway Nat patent protected and circulation last blood
20:05pressure is 90 heart rate 68 next blood pressure is popping up at 107 Ben's blood pressure is finally
20:12moving in the right direction we've had one unit of blood second units going okay so our blood pressure
20:19is 116 on 70 we're perfect for going to CT as they rush Ben to the scanner Dr. Emma is
20:26still on high
20:27alert I'm very worried about this man low blood pressure pelvic injury huge forces you know that's
20:34that's a critical condition for him he's having a scan and we'll try and figure out what the next
20:39steps are to keep him alive alrighty let's get ready to roll running study wrong the ED team is preparing
20:54a
20:54trauma bay for dr. Scott's first case of the morning so no word it's three minutes closer now but nobody's
21:01heard anything yet we think so yeah expect me a 74 year old man who's been working under a car
21:10that
21:11sounds like it's fallen off the jack and crushed him these oxygen levels are pretty low we know that
21:15he's got lung disease based on the story we're worried about significant injury to his chest I might just get
21:20a couple things ready if we need if we run into an access dilemma expecting life-threatening chest
21:28injuries emergency registrar dr. David and trauma registrar dr. Harriet are on hand we always just
21:36like to have everything kind of ready to go because sometimes people come in and it's a lot worse than
21:40you expected we're worried they might have popped a lung which is called a pneumothorax if you pop your
21:46lung it stops the blood from getting into your heart and can have a cardiac arrest so something that's
21:50really time critical to treat here we go all right hello there what's your name no no no I'm Scott
21:59one of the doctors I'll be looking after you a team of people here to help you out okay John's
22:05in a lot
22:05of pain he's struggling to get a full breath of air in if his pain is not very well controlled
22:10he can
22:10go into respiratory failure we're gonna need to give him some very strong pain relief so that he can get
22:15his oxygen levels high enough to support his organs we may have to lay you down a little bit all
22:20right
22:21all right without John okay all right that's good man that's good on three one two three oh the pain
22:29back two three and cross on three one three three guys this is John he had a single cab jacked
22:39up when
22:39one of the jacks has given way and he was pinned underneath the sill bystanders have lifted the car
22:45off him John's wife Brenda was inside the house when she heard her daughter crying for help Sherry came
22:53screaming into the sewing room and said dad's trapped under the car and I couldn't believe what she was
23:01saying he had the car jacked up but it was the straps on the hoist that broke it was horrible
23:07it was
23:08horrible on our arrival complaining of significant pain to the right-hand side of his thorax as far as
23:15background history goes emphysema okay how's your fast scan going Dave you know he's got emphysema with
23:22a possible false positive but I'm not seeing lung sliding okay so I'm concerned about a female thorax on
23:27the right side when I'm looking at John's scan I can see that he's not getting air into his lungs
23:33however
23:34we're not quite sure whether or not this represents a pneumothorax or whether this represents his
23:40pre-existing lung disease the emphysema he's been like flat the chest x-ray kind of the birds going
23:46down to the x-ray guys all right x-ray all right big pneumothorax on the right or is it
23:56oh yeah it's a
23:58fun shape though is it just a is it just a pull up yeah we're not sure whether we're dealing
24:04with a
24:04punctured lung or whether he's got a like a big bleb on his lung like a bubble from his emphysema
24:09it
24:10can be really hard to tell on the x-ray CT is a like a three-dimensional x-ray so
24:14it gives everything
24:14in a lot more detail sorry he's got a fair amount of pain in his chest which is not surprising
24:19given
24:20that he's had a 1500 kilo car drop on his chest how's your pain at the moment it's getting worse
24:29okay get you some pain relief let's get you through the scanner and see what injuries you've got getting
24:36him through the CT scan is now a time-critical thing apart from his likely punctured lung I'm
24:41really worried that John's got at least a couple of broken ribs and maybe other injuries to his spine
24:46or his belly these things can go pear-shaped pretty quickly so COVID negative flu negative all things
24:56to get there so I'm just taking the hood up sure yeah sounds good yeah the cause of Keying's asthma
25:02attack
25:03is still a mystery after blood tests have cleared her of a serious viral infection apparently on three
25:10yeah of adrenaline we've got the magnesium still running saline running I've seen that we've just got an
25:16insulin infusion charter right so because of her she was like 16 but even with her adrenaline dose
25:25lowered to reduce the risk of a heart attack the 28 year old is still walking a tightrope
25:33Keying is still working a little bit hard doctors are here fears her asthma is coming back just when the
25:40cookery student is at her most exhausted do you reckon you'd be able to lean forward for me for a
25:48second
25:48that'd be all right take some nice big breaths in and out for me we wean down the adrenaline and
25:58Keying
25:58she looks worse she looks tired and I'm worried doctors are here has to make an important decision
26:06it still sounds really really wheezy I reckon we tolerate the tachycardia and we just go back up to
26:14five for the moment okay back to five yeah what we need to do is put her on the adrenaline
26:19infusion
26:19again and she needs to go to ICU she's going to ICU she'll be in a monitored environment for it
26:27yeah she's not improving with the adrenaline dose increased again the ED team prepare to transfer
26:34a thankful Keying to ICU I feel I almost died because I couldn't breathe at all but yeah luckily
26:45the ambulance came really quick I wish my mom was here because she's my closest one yeah but now I
26:54feel
26:54like yeah better she she's not here I don't want her to worry about me do you want a red
27:01bag or
27:01anything you've got yours Keying is certainly not out of danger just yet she could very well
27:07deteriorate from here if the paramedics had not gotten there when they did Keying would have been in
27:12a very bad position now what could have at its worst happened is that she could have died
27:25I'm just waiting for his blood pressure to drop Alex that's all Dr. Emma and new ED Dr. Matt are
27:33watching for any sign that truck driver Ben's blood pressure will crash again when you roll someone
27:39that's when they come unstuck so sometimes they'll have a little clot sitting on a vessel roll them it
27:45comes at mobilizers and then they bleed yeah 125 that's good another normal blood pressure that's
27:54great news Ben's blood pressure holds for now and just as he returns to ED his wife Jasmine arrives
28:01hi hi what's up well I'm looking a lot better than you okay you are you need me to do
28:10telling hey hey
28:12your hips just kind of broken yeah Ben and I matched back end of 2011 we just kind of hit
28:20it off
28:20straight away and have been together ever since really one moment you think everything's fun and
28:25your world can be completely flipped upside down with one phone call as Ben's parents join Jasmine the CT
28:37scan results are in the arse and broken bones there this is the head of the femur and that's the
28:44cup
28:44or the acetabulum and they're not in the right spot so there's lots of damaged tissue and tendons it
28:50should look like that but instead it looks like this out of position you just need to rest or even
28:58sleep okay he's also got a break across the top of the hip where there's a broken bone associated
29:07with the dislocation the worry is the head would come off the best plan of action for him is to
29:12go
29:12to the operating theater with the orthopedic surgeons try to pull it back in and then if they need to
29:17do an
29:17operation for the pelvic fracture he's in the right space with the right people before Ben heads to
29:24surgery he's keen to reassure his kids still a bit of a mystery as to why his blood pressure was
29:42low
29:43it's almost unbelievable that at the end of the day it's really just about his hip Ben is now being
29:48taken to theater for an operation to rebuild his hip Ben's injuries are quite significant and he's got a
29:56huge recovery ahead of him but ultimately I'm so pleased that despite having an awful injury that
30:02he's here with us and can speak with us 74 year old John is about to be scanned after a
30:151500 kilo
30:17ute fell onto his chest when he was underneath fixing the engine well he looks okay we're hoping that he
30:26doesn't have a punctured lung because I think that would be terrible for him with his lungs so one
30:30two sort of a couple of ribs there the CT is already showing several broken ribs he was moving his
30:39hips
30:39all right wasn't he yeah and then the sheer extent of John's injuries becomes clear unfortunately it
30:48looks like he does have a pretty big punctured lung he's got half a dozen broken ribs as well so
30:53we're
30:53going to need to put a tube in his chest unfortunately okay the scans have confirmed what we were most
31:00worried about John's got broken ribs and punctured lung with his underlying lung disease that's a
31:06really bad combination so we're going to need to put a tube in his chest to evacuate that air and
31:11allow
31:12his lung the space to reinflate again lots of space six ribs can't imagine how much they must hurt
31:18all right let's go back the build-up of air in John's chest is so severe Dr. Scott is worried
31:25he could have a heart attack if it's not released immediately so John you've broken six ribs and you
31:35got a big puncture of your right lung a really big puncture your emphysema complicates things so I'm
31:40worried about the extent of these injuries we do need to get rid of the air that's accumulating in
31:46your chest because that's something that's very very dangerous and to do that we need to put a drain
31:51in your chest at all suck all that air out you okay okay what I can do now though is
32:02we inject some
32:02numbing medicine into the wall of the chest take me about five minutes all right this is a really broken
32:11man broken ribs severe lung disease low oxygen levels and the punctured lung this is something
32:18that there's a very high likelihood that John might die from there's gonna be a little sting in your chest
32:23here okay doing really well John you're all right
32:35that's 10 mils that's a lot okay 74 year old John is about to have a life-saving procedure to
32:44release a
32:45build-up of air trapped in his chest we've just done what's called a nerve block into John's chest the
32:50area around his broken ribs John's pre-existing lung disease makes this already risky procedure even more
32:58dangerous all right you let me know if it's too sore yep that's sore is it it's really important that
33:07we reinflate the lungs so the trauma doctors are about to put a what's called a chest drain in so
33:12that'll help reabsorb all the air that's accumulated in his chest from his punctured lung how's that is
33:17that painful knowing good you're not you're doing really well you have a pressure okay dr. Harriet
33:27painstakingly feeds the tube into John's chest I'm doing well good job that's a big kiss the tube now in
33:38place the trapped air starts escaping deep breaths John that's the western you're doing really well the
33:47tube is in almost done John I find it really important to talk John through this procedure
33:54to give him hope that it is going to end soon and that he can get through this just popping
34:00in some
34:00stitches now okay guys doing okay yeah we're just doing chest x-ray any drums will be going in no
34:08blood
34:08but yeah big kiss and we'll pop in on high flow oh thank you thanks even though the ears come
34:16out
34:16John's still in a lot of pain the pain control he's really important for John he needs to be able
34:21to
34:21take lots of deep breaths so these lungs can inflate properly that's going to reduce the likelihood of
34:27him going into respiratory failure especially in the next 48 hours is that still really hurting you
34:32is it based on my experience he's looking at a week or so in hospital at a minimum and that's
34:38provided
34:39that everything goes to plan all right we're going to take all this stuff off you I'll get you sorry
34:43about your arm John can now leave ED to be closely monitored in a ward he's definitely not out of
34:56the
34:56woods about one in ten patients that comes through our hospital will unfortunately die within 28 days
35:01if they've got any broken ribs for John his risk is higher than that given that he's in his 70s
35:07he's got
35:07lung disease and he's got multiple broken ribs he's been crushed by 1,500 kilo car to be alive now
35:15where at least we've got the opportunity to help him I think is is barely short of a miracle
35:29whereabouts is the patient in the plaster room as dr. Jonathan is reaching the end of this shift his last
35:35case of the
35:36day is Nick who's been brought in by girlfriend Olivia after he dislocated his shoulder playing sport
35:42so what happened it's playing squash yep overhand shot then very quickly came out yeah your shoulders
35:52vulnerable when it's up like that yeah and your x-ray was what we wanted to look at yeah it
35:58was
35:58definitely out that's wrong this bit should be sitting back here so it's popped forwards okay it doesn't
36:04look broken I think so that's good and everything else looks all right take this off having your
36:12shoulder out of place is really painful and the only way you can actually relieve the pain is to get
36:17it
36:17back in the socket the maneuvers we do they hurt because you're just scraping the the humoral head
36:23back into the capsule it's really painful to start with can you straighten your elbow yeah that's good
36:31that's good so what I find uh often works is if we just lift it up dr. Jonathan's about to
36:41try a
36:41very simple method to get Nick shoulder back into place and I'm not going to do any tricky jerky
36:47maneuvers we're just going to go up all right yep that's a bit uncomfortable there isn't it
36:55how are we going it's getting more sore yeah just put your shoulders back yeah that's good just let
37:01it all go floppy bit sore isn't it yeah so we're just going to come back down again the other
37:10thing
37:10we can sometimes do is just come out this way too sore yeah yeah sorry oh ah so we're just
37:23going to pop it
37:23back down again so you want to grab hold of your arm again yeah yeah yeah okay so we need
37:31to do
37:32something else which means we need to get a whole lot of friends to help I'll be back with shoulders
37:38you can often get them to be relocated without having to give heavy sedation it didn't work it's
37:44too sore so the next step is we just try some nitrous oxide some gas that'll take away the pain
37:50we're just going to gently try the same maneuver and see whether it works do you want me to hold
37:54it
37:54for you sure the 27 year old's girlfriend Olivia is supporting him as he waits for what he knows
38:02will be a painful procedure I've dislocated my left uh several times it's something I've learned to live
38:08with but pain was pretty excruciating for a bit there at the moment I'm in construction so it might
38:13affect the work for a short period but yeah we'll see how we go as nurses Lucy and Georgia set
38:19up the
38:19nitrous oxide for pain relief dr. Jonathan explains what's going to happen the nitrous oxide it'll make
38:27you feel a bit dizzy it's laughing gas but you won't be laughing because it'll be pulling on your arm
38:31but it
38:32should take the pain away and you suck on it and if it hurts you suck some more okay okay
38:39let's do it
38:39so this is the little snorkelly scuba thing and you're going to you're going to hold that with
38:44your your left arm stick that in your mouth yeah all right yeah and just breathe on it yeah that's
38:50the way all right so we'll give you a bit of a gas I'm just going to lay the bed
38:54down a bit
38:57are you feeling any funny gas effect no that just means you need more whenever we relocate a joint
39:04there's a possibility we can cause damage as we do it so we have to do it gently and with
39:10a technique
39:10that won't cause any more harm we're just going to gently come up see what happens dr. Jonathan
39:17begins his second attempt to get Nicholas's shoulder back in place and remember anything that hurts big
39:25breaths you can't just yank on things or whack them back in like you know Mel Gibson does in
39:30um lethal weapon you can't do that kind of thing big breaths
39:36there we go good work well done the shoulder has popped back into place what's it feel like thank
39:44you feel okay yeah yeah good all right shouldn't hurt it's back in place so we'll get another x-ray
39:50yeah um you did well all right good after an all clear from the x-ray Nick will be able
40:01to go home
40:02with instructions of no squash for at least two weeks how it felt was weird I've never actually had
40:09uh laughing gas before it's pretty tingly but felt a big clunk and just like that it's back in place
40:16and
40:17now it's a bit painful so so here we go tomorrow tomorrow's gonna be sore
40:28sorry man when cable hauler Ben was rushed into ED after his truck crashed into the back of a semi
40:35trailer his life was on the line blood pressure 78 net pack he looks pale scans revealed the 37 year
40:44old had serious pelvic injuries and needed urgent surgery where there's a broken bone associated with
40:51the dislocation the worry is the head would come off finally back home after a nine-hour operation and
41:00eight weeks in hospital the father of three still has a long recovery ahead I had to break my hip
41:07to get
41:07the leg back out from inside the hip and back into place I'm still in pain nearly every day most
41:14days
41:15yeah well thank you but Ben is looking at life with fresh eyes looking at the photos I've worked
41:22out how lucky I was to be alive I'm looking forward to just being able to go out and kick
41:27the footy with
41:27the kids and go fishing kids and then I'll walk around and not be in pain so much cookery student
41:37Ki Ying could barely breathe when she came into emergency suffering a life-threatening asthma attack
41:43I'm quite worried about you the 28 year old was given an urgent adrenaline infusion to keep her airways
41:50open before being transferred to intensive care should be in a monitored environment for it yeah she's not
41:58improving Ki Ying spent two days in ICU and was well enough to go home a few days later
42:07how's your pain at the moment it's getting worse 74 year old John was in a critical condition after
42:16his 1500 kilogram ute fell onto his chest as he lay underneath fixing it oh that's huge he does have
42:24a pretty big punctured lung he's got half a dozen broken ribs as well after a successful procedure to
42:30fix John's collapsed lung dr Scott was still worried this is a really broken man broken ribs severe lung
42:38disease and a punctured lung this is something that there's a very high likelihood that John might die
42:48from incredibly after five days in intensive care and only ten days on the ward John was able to
42:55return home to wife Brenda I still get a little bit of twins from two of the ribs if I
43:07over exert a
43:08little bit but that's that's as far as it goes John puts his miraculous survival down to the extra couple
43:15of inches given to his chest because it was lying in a hole dug by best mate Koda my dogs
43:21are going to
43:22have a diggin holes in the yard and I just happen to have the car over the top of that
43:26particular particular
43:27hole right I'm showing you the hole now that Koda dug which saved my life because she hadn't had dug
43:35it I
43:36would not be here now and I'm very very grateful to her I was a hair's breath away and that's
43:42all it
43:43is a hair's breath away from killing myself the staff at the hospital they really really really looked after
43:50you know it shouldn't be it's as simple as that
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