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00:03after dark while the nation sleeps 16-year-old male who was shot the A&E
00:09night shift begins it can be very dangerous we deal with a lot of
00:15aggressive patients things can escalate it can be quite scary when it's just you
00:22in one violent position across the UK we join the staff of three of the most
00:27challenged emergency departments it's always busy it's always under pressure
00:31time is of the essence and the medics who face danger each shift most shifts I
00:38see more place than nurses with the amount of drugs and alcohol admissions
00:42rising have you been drinking today the risk of violence and abuse looms large
00:47every night please don't swear like that they try to attack and stuff
00:51calm yourself down people can become aggressive
00:56you've been punched cake you see the good bad and the ugly
01:01yeah we'll get security the emergency department is like a battlefield it's like organized chaos
01:19after dark violence against NHS staff is at a record high and doctors and nurses face it every time
01:29they're on shift sometimes we have to call the police they can attack the security they can they attack
01:42nurses I don't think the public is aware they don't understand what we're going through violence and
01:50aggression doesn't just stop at our doors it continues on the streets that can be quite scary for us and
01:57for
01:57everybody you're right there better days than you got into a fight
02:1836 year old miss arc is in resus
02:24after being assaulted outside his home he's just minutes away from losing his vision
02:36emergency doctor Fraser will be treating him
02:41we see a lot of patients come in here victims of assaults being punched in the face can be fatal
02:45with this patient he had bleeding behind his eye the pressure that that bleeding causes can squash
02:54the nerve and so you can get blind in the space of an hour it's a real time-critical emergency
03:00this is just oxygen you have to do a procedure called a lateral canthotomy where you cut the
03:07ligaments that keep the eyeball in place and essentially relieve the swelling that's squashing the nerve that
03:15goes into the back of the eye with the pressure building behind his eye they have just minutes
03:21to act elements going in right I'm gonna make you feel funny just have nice dreams dr. Ed administers
03:31a fast-acting sedative everybody there so the night team can fight to save his vision
03:44that looks like ligament there yep that's the superior ligament let's cut the superior first cut this
03:52the superior because it's advisable to cut both in this circumstance so it'll give us some room to maneuver
04:24the swelling is making the next cut more
04:27much more difficult
04:34oh patient had bleeding under the surface of their eye so it was it was particularly swollen it made
04:41it quite difficult to see exactly what we were supposed to be cutting
04:52consultant dr susie is also on shift when someone has increasing pressure on the back of the eye you
05:00will start to get compression of the nerve fibers that provide the sensation of a vision so if you don't
05:07release that pressure that person will lose their sight and they will become blind and it will be permanent
05:25this lady's new she can probably step down but not to the corridor also working the weekend in newham's recess
05:31is dr.
05:32ella
05:41a patient drifting in and out of consciousness is being brought in by ambulance
05:47you're at hospital now okay give us two minutes and then we'll come in all right
05:51yeah
05:52yeah
05:52she's gonna vomit again
05:57seeing your sight okay
06:03hi my love my name's ella i'm one of the doctors i'm just gonna hear what's going on and then
06:08we're
06:09gonna make you feel better okay
06:11i was witness by bystanders to collapse on the side of the pavement tonight outside of her address
06:17complaining of abdominal pain has defecated herself and had five vomits with us
06:22okay i'm still complaining of abdominal pain she's been in and out of her altered conscious state
06:26with gcs 14 as her best with us
06:29what do we think it is
06:30oh she has said that for the last three days she's been having crack and heroin
06:36i do see drug overdoses all the time and it's an enormous part of our workload
06:40pupils
06:41pupils are size two even reactive but they may be size one now
06:45the main questions to ask are what have they overdosed on
06:48do we need to reverse that drug do they need any life support for that overdose
06:54can you open your eyes for me
06:57have you got any pain anywhere there in your stomach
07:02sorry honey
07:03it's gonna feel something here okay
07:05vomiting in a painful hard stomach can indicate life-threatening internal bleeding
07:10oh
07:12i want to have a little listen to your breathing
07:16so gretchen let's do some fluids clean her up a little bit
07:19i don't think we need to do any scans or anything now
07:23currently we're gonna give her some fluids some anti-sickness
07:25so she can tell us a bit more about why she's vomiting how she feels
07:29her tummy's nice and soft so i'm not in a rush doing any scans right now
07:32she's quite young
07:33drug scratch
07:35sorry
07:36oh
07:38my main concern for her is is she withdrawing from cracking heroin and it's making her feel
07:42really miserable
07:43it's going to be quite hard to manage that so we might need to give her some other things
07:46to make her feel a little bit better
07:49can we clean her off a bit
07:50thanks guys i know it's not the nicest
07:52we'll be quick don't worry
07:54we'll be quick don't worry
07:55we'll be quick don't worry
07:56patients who are using drugs they often have an untold story
07:59a non-confused well person doesn't allow themselves to be covered in excrement
08:06it shows that this person is is clearly in in need of of help
08:11yes it does add burden to the nhs but that is what we're here for we're here for accidents
08:15in emergencies and drug overdoses are emergencies
08:31shut the f*** out
08:33security
08:34oh
08:35no no
08:37shut up
08:38what
08:39alcohol related emergencies are on the rise
08:43you're a lot drunker when you first came in to me
08:45now you're around as well
08:47obviously drugs and alcohol are a big problem
08:49i can witness the violence and aggression
08:51it is difficult to be on the receiving end
08:54i think that's definitely gotten worse
08:58from 2023 to 24 the nhs saw over 1 million alcohol related admissions
09:04many arriving after dark
09:06so you and you and you can f*** off
09:10at night everything gets worse
09:12when you mix in alcohol and violence and aggression against our staff
09:17and it can feel like a police station sometimes
09:20f*** every part of fluoride f***
09:39in east london 36 year old nissarg has been violently assaulted outside his home
09:48he's at imminent risk of losing his sight the night team are performing an emergency procedure
09:53you made a small lab will cut through the skin so you need to try and buy yourself through the
09:57window
09:58the procedure we need to do is called the natural camphotomy
10:01it's not something that we do very often
10:04it is a time critical intervention
10:07it identified a bit of the ligament but we couldn't get enough of it clamped to cut
10:12he's got quite a large swelling to the globe itself
10:15to relieve the pressure on his optic nerve
10:18the night team have to cut the ligament inside his eye socket
10:22if i take away the upper lid with the two forceps
10:26now dr susie needs to work around the swelling to cut a second one
10:31oh
10:33it does kill me though
10:36oh
10:36i'm going to give him another 20 there
10:38okay
10:38what
10:39what
10:40what
10:40what
10:40what
10:41what
10:42what
10:43what
10:43what
10:43what
10:43what
10:44what
10:45what
10:45what
10:45what
10:45what
10:45what
10:45what
10:45what
10:48what
11:00what
11:00what
11:01what
11:02how's it done now
11:03I'm sure
11:04i'm sure
11:04it feels a lot better
11:09well done my friend
11:12the eyes more forward so
11:13no it's good
11:14that's good
11:15trying to find him
11:17a very small piece of anatomy to cut
11:19that's good
11:20was really challenging
11:21we will see if we've been successful
11:24the team must wait to see if Nisarg's sight is saved
11:27and if the damage goes any deeper.
11:31We're going to do a CT just to assess the bones
11:33and see if there's any fractures in the socket itself.
11:36Make sure that there's nothing beyond that and into the brain.
11:41OK? It's coming round from your sedation, my friend.
11:46When someone is punched in the face with significant force,
11:50there are all sorts of complications.
11:52You would be thinking about significant brain injury, facial fractures.
11:57These things can happen in an instant
11:58and change that person's life forever
12:01and it's something that we need to do some other investigations.
12:16A&E North for Norwich, medical trauma.
12:19We've got some IV fluids up.
12:21Nearly 3am in Norwich.
12:23It's been going at this rate since midnight, really.
12:27Dr Lucia is looking after a patient whose heart is racing out of control.
12:33Still going fast, isn't it?
12:35His heart rate on the monitor was 200 beats per minute.
12:39The normal rate is 60 to 100.
12:42He can't maintain that heart rate of 200 for a long time.
12:46Eventually, it will become tired and potentially stop.
12:50All right, sweetheart, so if you can pop your hands straight for me, that's fine.
12:55It is unusual, it's rare, but sometimes people do have this condition
12:59where they go into the spontaneous fast rhythm.
13:03In the slightest, jolt drove his heart into this fast rate.
13:07Dr Lucia consults the cardiology department for the first critical move in his treatment.
13:15I've given him a bladder syringe and he's tried about four or five attempts
13:20and basically it's not really changed.
13:22So we're going to give you six milligrams of adenosine.
13:25Yes, yes.
13:27Adenosine is a little bit like a jump-starting for heart again.
13:30You give it quite fast into a vein.
13:34It stops the heart and then restarts it and hopefully it comes back at the right rhythm
13:41between 60 to 100 beats per minute, which is the normal rate.
13:45All right, sweetheart, so adenosine going in now and the flush.
13:50The first time I did it a number of years ago where I gave the adenosine,
13:54it was quite scary when you didn't see the heart rhythm on the monitor.
14:00Lift your arm up.
14:04Raising his arm helps the drug hit his heart in seconds.
14:10Still going fast, isn't it?
14:12It is, yeah.
14:14It's not done it, has it?
14:16With the heart still racing at 200 beats per minute, the adenosine has failed.
14:22So, once we're ready...
14:26Dr Lucia tries again with double the dose.
14:3012mg of adenosine going through and big flush.
14:35There we go.
14:36Lift his arm up.
14:37Beautiful.
14:39Nice breathing.
14:41Can we get a little bit of oxygen on?
14:43If that's all right, two litres?
14:46Extra oxygen supports the patient's heart as the night team fight to slow it down.
14:51The rate hasn't made a blind bit of difference, has it?
14:55So, um, I'm going to do 18 now.
14:59Dr Lucia administers a third and final dose.
15:03Any more could stop his heart altogether.
15:06Okay, so we're going to do 18.
15:09So, adenosine gone through, flush gone through, lift it up.
15:17That was awful.
15:19Sorry, sweet.
15:22Adenosine acts fast, triggering an overwhelming wave of nausea and breathlessness.
15:28During that episode, when the heart is racing, it is scary.
15:32They feel terrible.
15:33They tell us that they feel terrible.
15:37We're looking promising.
15:39We're looking promising.
15:43Oh, hang on.
15:47And then it kicks in again.
15:50The final dose has failed.
15:53The patient's heart is still stuck in critical overdrive.
15:57The fact that we've done the third one and it hasn't worked,
16:00I'll just give her a ring now so she's fully aware.
16:03Basically, the heart's beating differently.
16:07There's no set pattern.
16:09If you don't intervene, ultimately, the outcome can be for it to stop.
16:28On average, ambulance crews respond to nearly 3,000 falls every 24 hours,
16:33bringing some of the most life-changing emergencies into A&E after dark.
16:40I'm just going to have a look at your arm, OK?
16:42In the middle of his night shift, Dr. Aditya has been called to see 40-year-old delivery driver Akram.
16:50You can feel my heart?
16:51Yeah.
16:52Who was brought in by ambulance after falling down the stairs.
16:56It's clearly quite swollen here.
16:58Yeah, here's the bed.
16:59Are you able to bend your elbow?
17:02Oh, I don't think.
17:03OK.
17:05We'll get you some x-ray sorted.
17:07Thank you, but before you do, just give me any pain.
17:10Oh, we'll get you some pain relief.
17:11I've already prescribed it to you, OK?
17:13Do you need some help getting up?
17:14No, I can't get it.
17:15OK.
17:16Getting an x-ray as quick as possible is really crucial
17:19because the further we delay the x-rays,
17:22it can lead to nerve damage, can lead to vessel damage.
17:25To reveal the impact of Akram's fall,
17:28Dr. Aditya needs to check all the bones in his arm,
17:31from shoulder to wrist.
17:33Yeah, forearm's fine.
17:36Forearm's is OK, yeah.
17:38Ah, that's desiccated.
17:39Desiccated, yeah.
17:42Oh, yeah.
17:43Not her mask.
17:44This location is serious, can lead to nerve damage,
17:47making the lymph unusable for the patient.
17:50With Akram's mobility and his job on the line,
17:53Dr. Aditya and the team need to urgently realign his elbow.
17:58This part of your bone should be in this socket,
18:01so we need to put it back in the right place.
18:16Yeah, we've got the lady who's just been in a road traffic collision.
18:24She's been crossing the road.
18:26Driver hasn't seen her.
18:27He's turned the corner and hit her.
18:28OK.
18:29Any past mitochondria, any blood thinners she's on?
18:32Clopidogrel.
18:32Clopidogrel, OK.
18:33Tonight in Newham, Dr. Rosie's in charge of the Rhesus team.
18:37We've got a head injury, a pedestrian bus car.
18:40Rhesus can be often the most chaotic place in the whole hospital.
18:44Can you tell me if you're in pain there?
18:46Often, the patients are really sick,
18:49especially when it's a pedestrian hit by a car.
18:50We're super careful about those
18:52because the risk of injuries is really high.
18:55After dark, pedestrians are over twice as likely to be struck,
18:59and the consequences can be life-threatening.
19:03I see you, he's here.
19:05OK.
19:05OK, lovely.
19:08Vomit balls in the back, aren't they?
19:11Some dishes for her.
19:17OK.
19:18OK, here we go.
19:19Well done.
19:20Well done.
19:23Our main concern is she's got a significant head injury,
19:26especially given that she's vomited now two times,
19:29especially when she's lying flat,
19:31which can suggest a raise in her intracranial pressure.
19:33Yes.
19:34OK.
19:35Hello, my name is Tosin, one of the A&E doctors.
19:38You can just lie your head back for me, OK?
19:41The night team must run urgent neurological checks
19:44in case 63-year-old Paramuswari
19:46has a critical bleed on the brain.
19:49Deep breath.
19:51Big breath.
19:53Very good.
19:53Again?
19:55OK, my dearie, that's fine.
19:57I'm just going to shine this in your eyes, OK?
19:59There's a light coming in your eyes, OK?
20:01There's a light coming in your eyes, OK?
20:03Good.
20:07OK.
20:08PP is equal and reactive, two millimetres.
20:13Any pain in your legs?
20:16Just the hand, OK?
20:17And your head.
20:18Brilliant.
20:19Let's leave the wrist for now, because we'll get it x-rayed,
20:21so we don't want to...
20:22Yeah.
20:22And then there's this obvious...
20:25Is it boggy?
20:26Yeah, it is.
20:27It is? OK.
20:28All right.
20:28OK.
20:29There's a particular type of boggy swelling
20:31that you can get on the head.
20:34They're fairly rare, but it can suggest a skull fracture.
20:39Sorry, my dear.
20:40We're going to keep her in that position.
20:42We've got a sort of CT trauma series for her.
20:46We're going to get you some scan for your head, OK?
20:49OK.
20:49We'll get you some...
20:50And some painkillers, OK.
20:52Hopefully, we can get her into a scan fairly quickly
20:54so we'll know exactly what we're dealing with.
21:01Following the crash,
21:03Paramuswari's sons called for an ambulance.
21:06I was in shock when I quickly came,
21:07and I saw my mother on the floor.
21:10It was the last thing I wanted to see, but I'm seeing it.
21:14Strongest woman I've made in my life.
21:18Hi, how are you doing?
21:19So I'm Rosie, one of the doctors.
21:20I'm worried about her head at this point,
21:22so I definitely want to make sure there's nothing in her head.
21:24She vomited the place as well, isn't it?
21:24Yeah.
21:25There's lots of reasons people vomit,
21:27including if they are shocked from an injury,
21:29but having something worrying in the brain
21:30is a reason why people vomit as well.
21:32So we're going to sit see everything
21:33and then X-ray the wrist as well.
21:36If you have bleeding on the brain, it can expand.
21:39All that blood expands.
21:41It has nowhere to go.
21:42The skull can't expand,
21:43so it just compresses the really critical areas of the brain,
21:47the ones that control your motor function or your speech.
21:55And obviously the worst case is your ability to regulate your breathing
21:59and your heart rate as well.
22:01It can lead to disabilities
22:04and possibly death in really severe cases.
22:28I'm going to turn on your last police station right here.
22:37After dark, A&Es across the country
22:39are facing more aggressive patients than ever before.
22:43The night shift can be a bit chaotic, a bit crazy.
22:49It can suddenly make the department feel very unsafe.
22:52It can really ramp everyone's anxiety levels up.
22:57Ain't no man alive, you can handle me, I'm sorry.
23:01But many patients on the night shift
23:03are also the victims of aggression and assault.
23:20Oh, my God.
23:23Well done, my friend.
23:24You're coming around.
23:25In Newham,
23:26Dr. Fraser is looking after 36-year-old Miss Arg.
23:30He was attacked outside his home
23:32and rushed into emergency eye surgery.
23:35I'm just going to pop this off.
23:36We don't need the oxygen anymore, OK?
23:38Now the pressure around his eye has dropped.
23:41The 19 need to check whether they were able to save his eyesight.
23:45Can I just have a look at your vision again?
23:47Are you awake enough for me to look at your vision?
23:50Here you go.
24:01Oh, my God.
24:03OK.
24:04Now I can see.
24:06That's good.
24:07Cover your left eye.
24:08Yeah.
24:08Can you see my face?
24:10I can see your face.
24:11How many fingers?
24:12Four.
24:14Music to my ears.
24:16He's had a punch that's forceful enough
24:19to give him bleeding behind his eyes.
24:22So what else might that have done?
24:22Has that broken any bones in his face?
24:24Make sure he's not got any bleeding in his brain.
24:27What we need to do now
24:28is just because you've had a quite significant head injury,
24:31we're going to do a scan of your head, OK?
24:36Miss Arg is taken for an urgent head scan.
24:39This scan will take about two to three minutes, OK?
24:42To check for any life-threatening injuries.
24:47Yep.
24:48Yep, got it.
24:50He waits in majors
24:52while the night team examine the scans.
24:55The thing is, I'm celebrating festival
24:57with my two-year-old daughter.
25:00The guy came, you know, he's arguing with me, like,
25:03I have my daughter in my hand
25:05and he's trying to punch me
25:07and I just pulled her back
25:10and that's why my face is like this
25:13and he just punched me in my face and my eyes.
25:21Is your eye painful?
25:23Yes.
25:24And now it's been here as well.
25:26Yes, the CT scan showed that there's a broken bone in your face
25:30and around your eye.
25:33What we're going to need to do
25:34is get you followed up by the facial surgeons
25:37as well for an appointment
25:38to see whether they need to do anything.
25:40Sometimes when you've got a fractured eye socket,
25:42then the muscles that move your eye
25:44can squish through the gaps in the broken bones
25:47and that can mean that you can't move your eyes properly.
25:49But the immediate priority for him
25:52was getting him seen by an eye doctor.
25:55We're going to get you seen by the ophthalmologist in the morning.
25:57All right.
25:58Some of the most dramatic cases of, you know,
26:01injury and trauma from violence in the community
26:04will happen at night.
26:06It was a pretty horrible assault.
26:08It's what sounds like a completely trivial argument
26:10and someone's punching him in the face.
26:12It's a pretty horrible thing to happen.
26:28He's still in SVT.
26:30He did revert back five sinus peaks
26:33but then just went straight back into SVT.
26:36On the night shift,
26:37Dr Lucia is looking after a patient
26:40whose heart is beating around double the speed it should be.
26:44We give six milligrams at 246, no effect.
26:49And then at 250,
26:50I gave 12 milligrams of adenosine, no effect.
26:55With the first treatment failing to calm his heart,
26:58Dr Lucia calls the cardiology specialists.
27:01So we just need to DC.
27:04Well, I'll have a word with Dania
27:05because obviously she needs to be in resources
27:07if we're going to do that as well.
27:09They devise a new treatment plan.
27:12So, spoken to cardiology,
27:14so what he's recommended is actually DC cardioversion.
27:18Oh, no.
27:19I really don't want to do that.
27:21OK.
27:22The quickest way to get the heart back to the normal rhythm
27:26is we put defibrillator pads on
27:29and jolt the heart with electricity back into the normal rhythm.
27:35But you can imagine that situation not being very, very, you know, pleasant.
27:43So you have to put yourself in the position of the patient.
27:48It makes people really, really, really frightened.
27:51It's more than one way to skin a cat.
27:54So don't worry.
27:55It's all good.
27:57Dr Lucia refers back to the cardiology specialists
28:00on what else can be done.
28:03Give him metoprolol.
28:05What dose would you recommend?
28:08There is one other medication they can try.
28:12Metoprolol is a beta blocker.
28:14This works in a different way
28:17and slows the heart down.
28:21Yeah, so give that a 312.
28:25Unlike adenosine, which resets the heart,
28:28metoprolol works the opposite way,
28:31blocking adrenaline to gently calm the heart rate.
28:35It's coming down.
28:37It's getting there slowly.
28:39And then once you go back to normal,
28:41get your nice cup of tea.
28:45Nearly.
28:46Yeah.
28:47Nearly.
28:52Get out of it.
28:53The rate is better than what it was,
28:56whereas before you were sort of like about 200.
28:59You feel better?
29:01Much better.
29:03Good.
29:05A sigh of relief.
29:06A sigh of relief.
29:07As soon as you get the rate back to the normal rate,
29:12the patient just feels miraculously better.
29:15And that's what we're here to do.
29:18Do an ECG and then, unfortunately,
29:20you're going to have to look at our ugly faces
29:22for a couple of hours now.
29:23Ha, ha, ha, ha, ha, ha.
29:26Ha, ha, ha, ha, ha, ha.
29:29Ha, ha, ha, ha, ha, ha.
29:31Ha, ha, ha, ha, ha, ha, ha.
29:38In Newham, 63-year-old Paramaswari is having urgent scans
29:44After she was hit by a car while walking to temple after dark
29:54Her sons are translating for the night team
29:59I was pain at the minute terrible. We'll give it some more thing. No more the morphine on the durum
30:06My brother called me saying mom's had an accident. We need to come and she was still regaining consciousness
30:12She didn't know what was happening
30:15And then GCS is 15 15
30:20Leading her care dr. Rosie is reviewing the scans
30:27Hello
30:31Hello, how are you doing?
30:33Yeah, I've just come to explain about the scan. Are you guys happy to translate or do you want a
30:37translator here?
30:38No, are you sure? Okay, so obviously we've scanned
30:42Head neck and all the body here
30:45What it does show which is what we were suspecting unfortunately, there is a bleed on the brain
30:52Okay, there's a bleed over where she's got the bump, but there's also a little bit on the back
30:56She does have a fracture of her wrist as well
30:58Unfortunately, but that that is very manageable. We can sort that out. Okay
31:04So unfortunately the CT scan has showed that she has a bleed on the brain
31:12The CT scan only shows exactly what's happening at one point in time. So it's really really important. We monitor
31:17her carefully
31:18And that means doing neurological observations regularly
31:22Keep your head nice and still for me. Just follow finger with your eyes, okay?
31:26Kind of okay
31:32There's lots of things that can happen after you have a bleed on the brain. The main concern is that
31:37if you have bleeding it can expand
31:40It can compress certain areas of the brain
31:44Can you squeeze my hand for me and this side can you pull my hand into you?
31:51Very good and pull out to push out
31:55So the neurology is assessed in various ways. For example the power of your limbs the coordination
32:02Your ability to feel on your skin. These are all things that can be affected by the bleed on the
32:09brain
32:09If I touch her there does she feel that feel the same on both sides?
32:19You can feel it less on that side or more on this side or less on this side. Less on
32:24this side. Okay. Okay. Okay. What about here?
32:33The same feels the same. Yeah, yeah
32:44On that side she doesn't feed anything. This side? Yeah. Okay. Okay. Okay. That's right
32:48So we'll have to have a chat with the neurosurgeons
32:50Obviously, I'm one of the A&E doctors, but one of the neurosurgeons will have to have a look at
32:53all the scans and decide what's what's best for her. Okay. All right. Thank you
33:00At the moment her neurological assessment is actually pretty good
33:03But my biggest concern is the risk of further bleeding
33:08She's on a blood thinner as well clopidogrel for a previous stroke
33:12Which makes it a little bit more concerning
33:14Blood thinning medication protects paramuswari from a stroke
33:18By preventing her blood from clotting
33:21But with a bleed on the brain it could make things far worse
33:26I have spoken to the hematologist at the London and they have suggested to give the plate
33:31Yes, one pull of platelets
33:34Given the risk
33:35Dr. Rosie speaks to out-of-hours blood specialists
33:40Platelets are a component you get in your blood so we all have platelets just swimming around in our blood
33:44to help us clot when we bleed
33:45This patient is on a antiplatelet agent called clopidogrel
33:49And so we've asked the hematologist and we are giving her some extra platelets sort of help that clotting process
33:57The main concern if she re-bleeds is that we get a big collection of blood in the brain that
34:02then compresses the brain
34:03Including a lot of the the major areas that are in control of our speech our movements our breathing
34:10With the emergency treatment on its way paramuswari stays in resus under close monitoring
34:17Giving her the best possible chance of survival
34:20It's a shock. It's a massive shock
34:23But fingers crossed praying to god that everything will be fine again
34:40No, I'll try to prioritize him. Okay. Thanks to let me know. Thanks
34:43In Belfast 83 year old Ian is brought into resus
34:49Hello
34:50Taking the lead on his care is dr. Alice
34:54What's brought you in tonight?
34:59Okay, do you have trouble with the tummy before?
35:02Not really, no
35:05Can I have a failure tummy?
35:07Can I grab some gloves?
35:09There's a severe pain
35:11See there
35:15Just there?
35:16There
35:17What came first the pain or the vomiting?
35:20Well the pain
35:21The pain came first
35:22And a bit of a stiffness or something
35:24Where the pain became intense
35:27Is your health usually good?
35:30That's reasonable, yes
35:32Yeah
35:32I'm a farmer
35:35I always worry whenever a farmer comes in
35:38Because you don't come to see us with nothing
35:40No
35:40No
35:42He's coming with tummy pain
35:43He's got a high lactate
35:45He's tender
35:45He's been vomiting
35:47His bowels aren't opening
35:48So I'm worried he's either got a blockage in his bowel
35:50Or a blockage in an artery supplying the bowel
35:52Here's Joe
35:58Ian's wife has arrived to sit with him
36:00We've been married since 1967
36:04A long time
36:06And we don't really have arguments
36:09He has a heart problem
36:11He has a pacemaker
36:12Fit it quite some time
36:15But this is different
36:16This is around the tummy area
36:19He just felt poorly after he had his evening meal
36:23Really sick
36:24And was actually vomiting
36:27It happens with age
36:31Or as I say too many birthdays
36:35So here we are
36:36The right place
36:38Hi Keeva, it's Alice
36:39One of the ED regs in the Royal
36:41Could I chat to you about CT after my father's office?
36:44I can only feel his tummy
36:45And look at him
36:46I can't see what's going on on the inside
36:48Whereas the CT can give me good images of the abdomen
36:52And it can tell us a bit more about what's going on
36:55What did you farm?
36:59Dattles, sheep
37:00Beef or dairy?
37:02Beef, well, rare breeds
37:06Oh?
37:06Still on the farm, are you?
37:09Still live on the chest
37:10Yeah
37:11Right, we'll give you a little bit of this morphine, okay?
37:14And then if you need more
37:15I can give you some more in a wee bit, okay?
37:19I was just hoping that you weren't scared of needles
37:21Because it's always the big strong men
37:22that cope on me whenever I put a needle into them
37:25And they do a lot of shouting
37:27They do do a lot of shouting
37:30I know I snuck in while you were distracted there
37:33Ah
37:35Ah
37:37Oh
37:39Ah
37:44You did do a bit of shouting there?
37:46I did, yes
37:48You're going to go up for your scan now
37:50So we are going for a CT scan, okay?
37:55For this gentleman, I'm worried about a
37:58bowel obstruction
37:59I'm worried about an aortic aneurysm
38:01I'm worried about mesenteric ischemia
38:03I'm worried about pancreatitis
38:05Any older gentleman that presents with tummy pain
38:08and it can be potentially fatal
38:29You can feel my heart?
38:30Yeah
38:30It's fine, everywhere
38:32In the middle of the night
38:3440-year-old delivery driver Akram has blown his elbow out of its socket
38:39So clearly from the x-rays
38:41It shows that you have dislocated the elbow
38:43But it's going to be a difficult procedure to put it back to care
38:46We'll try to sedate you as much as possible
38:48With his ability to drive on the line
38:50It needs to be realigned urgently
38:53A treatment that requires two senior doctors
38:56Dr. Aditya and Dr. Zoe
39:00So I'm going to use a mask just because it makes it a little bit easier for you to get
39:03gas and air into your system
39:05The night team use Penthox for fast-acting pain relief
39:10Deep breaths
39:11You're doing well
39:13It will relax Akram's muscles within minutes
39:17Deep breaths
39:18And now it's a rough
39:19Let's go and see
39:21Good man
39:27It's quite physically intensive procedure
39:29both for the patient and for the doctors who are performing the procedure
39:34It requires traction and counter traction and put the bone back in place
39:39Keep you taking deep breaths
39:43Still awkward to bend is it?
39:46The procedure needs extra force
39:49While Zoe anchors Akram's elbow in place
39:52Dr. Aditya pulls the forearm further from the socket
39:57Giving the joint more opportunity to slot back into natural alignment
40:04I think it feels
40:05I think it feels all right
40:07You okay? You've done so well there
40:11Looks better
40:13How's it feeling?
40:15Well now the next bit's getting this cast on
40:19So falling down the stairs can be quite serious
40:21It can result in head traumas and other severe traumas like chest trauma
40:26How does your elbow feel?
40:28This is big
40:28Still p.m.
40:29We'll keep you in here for now okay?
40:31Until the next day are ready to come and get you
40:32Okay
40:34So all in all yeah he was pretty lucky to just have a dislocated elbow rather than any other traumas
40:39Yeah I didn't feel it
40:40It was stupid
40:42Did you like that in your language?
40:44Yeah I liked it
40:54No
40:55On the other side of the hospital
40:59Emergency doctor Alice wants to diagnose 83 year old Ian's severe abdominal pain
41:06Breathe in and hold your breath
41:12He waits for his ct results with wife Joan
41:15Is this still as painful as it was?
41:18Very painful up there
41:20Oh that's right
41:21You have a right selection of stuff here as long as you don't move
41:25All right
41:25Yeah
41:26And have you felt sick again?
41:29No
41:29Your report's back
41:32Your report your scan's back
41:35So it's not actually the tummy at all it's the pancreas
41:39Right
41:40It's not very happy right now
41:42It's got a bit inflamed
41:45Right
41:46Your pancreas can cause loads of issues
41:49It's really important in regulating a lot of things including the sugar levels in your blood
41:53But it can be incredibly sore
41:55It can also become necrotic so it can die
41:58And then that can make you really really sick
42:00And his hasn't reached that stage yet
42:02It's just inflamed
42:04But he needs careful observation and pain management
42:07Do you have any questions for me?
42:09No
42:09I'm not going to be here
42:10Yeah
42:10Oh well I would say you're coming in for bed and breakfast
42:13He doesn't need to go for theatre
42:15He can be managed conservatively which is good because
42:17In somebody his age going for a big operation
42:21Can be very difficult
42:23You might want to get yourself home
42:25I'm here okay if you need me
42:29Most people with pancreatitis you can tell from the front door because they are screaming
42:32And they're writhing in agony
42:35He is like just very stoic
42:39Okay
42:41See you in the morning
42:44Bye bye
42:45Bye bye
42:46Okay
42:46Sorry about all that
42:49Classic farmer
42:50Yeah
42:51Yeah it's farmers
42:54Praise Alice thank you
42:56You're very welcome
43:05What's really important is that we continue to check your vision
43:18So we're going to do a few scans for you for the head and the neck
43:31I have checked the x-ray is perfect do you feel less pain?
43:35No it's less pain yeah
43:36Oh very good
43:46What's next?
43:47What's next is that the surgeons will come and see you
44:01F
44:24What's next?
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