- 14 hours ago
A&E After Dark - Season 7 Episode 5
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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 he has a knife with him we
00:14deal with a lot of aggressive patients things can escalate this gentleman has
00:19been punched it can't be quite scary when it's just you and one violent
00:22patient across the UK we join the staff of three of the most challenged emergency
00:28departments it's always busy it's always under pressure yeah time is of the
00:33essence and the medics who face danger each shift most shifts I see more place
00:39than nurses with the amount of drugs and alcohol admissions rising have you been
00:43drinking today the risk of violence and abuse looms large every night please
00:48don't swear like that they try to attack and stuff
00:53calm yourself down people can become aggressive
00:56you've been punched cake you see the good bad and the ugly yeah we'll get security
01:03the emergency department is like a battlefield it's like organized chaos
01:22violence 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
01:43nurses I don't mean the public is aware they don't understand what we're going through violence and
01:50aggression doesn't just stop in our doors it continues on the streets that can
01:54be quite scary for us and for everybody you're right there better days
02:13need to enter fight 36-year-old nissark is in resus or a service that could affect me
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 who are victims of assaults being punched in the face can be
02:45fatal
02:46with this patient he had bleeding behind his eye the pressure that that bleeding causes can squash
02:54the nerve and so you can go blind in the space of an hour it's a real time-critical emergency
03:00you have
03:04to do a procedure called a lateral canthotomy the way you cut the ligaments that keeps the eyeball in
03:11place and essentially relieve the swelling that's squashing the nerve that goes into the back of the eye
03:18with the pressure building behind his eye they have just minutes to act
03:24edamins going in right I'm gonna make you feel funny just have nice dreams
03:30dr. ed administers a fast-acting sedative hey buddy you there so the night team can fight to save his
03:37vision
03:44that looks like ligament there yep that's the superior ligament let's cut the superior first
03:52cut this the superior because it's advisable to cut both in this circumstance so it'll give us some room to
04:08the
04:24the swelling is making the next cut more
04:27It was much more difficult.
04:35The patient had bleeding under the surface of their eye,
04:38so it was particularly swollen.
04:41It made it quite difficult to see exactly
04:43what we were supposed to be cutting.
04:53Consultant Dr Susie is also on shift.
04:56When someone has increasing pressure on the back of the eye,
05:00you will start to get compression of the nerve fibres
05:02that provide the sensation of vision.
05:05So if you don't release that pressure,
05:08that person will lose their sight
05:10and they will become blind and it will be permanent.
05:25This lady's new. She can probably step down, but not to the corridor.
05:28Also working the weekend in Newham's recess is Dr Ella.
05:34GCS.
05:35GCS, 14.
05:37Okay.
05:37Who can step down? Bed five is three.
05:39Bed two can step down.
05:42A patient drifting in and out of consciousness
05:44is being brought in by ambulance.
05:47We're at hospital now, okay?
05:50Give us two minutes and then we'll come in, all right?
05:52Yeah.
05:52One, two, three.
05:54She's going to vomit again.
05:57Staying aside, okay?
05:58Staying aside.
06:03Hiya my love.
06:05My name's Ella, I'm one of the doctors.
06:06I'm just going to hear what's going on
06:08and then we're going to make you feel better, okay?
06:11I was witnessed by bystanders
06:13to collapse on the side of the pavement tonight
06:15outside of her address.
06:17Complaining of abdominal pain has deprecated herself
06:19and had five vomits with us.
06:22Okay.
06:22I'm still complaining of abdominal pain.
06:24She's been in and out of an altered conscious state
06:26with GCS 14 as her best with us.
06:29What do we think it is?
06:30She has said that for the last three days
06:32she's been having crack and heroin.
06:36I do see drug overdoses all the time
06:38and it's an enormous part of our workload.
06:41Pupils?
06:41Pupils are a size two, even reactive,
06:44but they may be a size one now.
06:46The main questions to ask are,
06:47what have they overdosed on?
06:49Do we need to reverse that drug?
06:51Do they need any life support for that overdose?
06:54Can you open your eyes for me?
06:57Have you got any pain anywhere?
06:59There, in your stomach?
07:02Sorry, honey.
07:03It's going to feel something here, okay?
07:05Vomiting in a painful, hard stomach
07:07can indicate life-threatening internal bleeding.
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.
07:20I don't think we need to do any scans or anything now.
07:23Currently, we're going to give her some fluids, some anti-sickness,
07:26so she can tell us a bit more about why she's vomiting,
07:28how she feels.
07:29Her tummy's nice and soft,
07:30so I'm not in a rush to do any scans right now.
07:32She's quite young.
07:38My main concern for her is,
07:39is she withdrawing from cracking heroin
07:41and it's making her feel really miserable?
07:43It's going to be quite hard to manage that,
07:45so 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.
07:51I know it's not the nicest.
07:52Well, be quick, don't worry.
07:54Be quick, don't worry.
07:55Patients who are using drugs,
07:58they often have an untold story.
08:00A non-confused, well person
08:02doesn't allow themselves to be covered in excrement.
08:06It shows that this person is clearly in need of help.
08:11Yes, it does add burden to the NHS,
08:13but that is what we're here for.
08:14We're here for accidents and emergencies
08:16and drug overdoses are emergencies.
08:32Shut the f*** up!
08:34Security?
08:35Oh!
08:36No, no!
08:37Shut up!
08:39What?
08:39Alcohol-related emergencies are on the rise.
08:43You're a lot drunk when you first came in to me.
08:45Now you're not in Israel.
08:47Obviously, drugs and alcohol are a big problem.
08:50I've been witnessing violence and aggression.
08:52It is difficult to be on the receiving end.
08:54I think that's definitely gotten worse.
08:58From 2023 to 24,
09:00the NHS saw over one million alcohol-related admissions,
09:04many arriving after dark.
09:06So you and you and you can f*** off.
09:11At night, everything gets worse.
09:13When you mix in alcohol and violence and aggression against our staff,
09:17and it can feel like a police station sometimes.
09:20The s***-
09:34nooo..
09:39In East London, 36-year-old Nisarg has been violently assaulted outside his home.
09:45Hold on, my father.
09:48He's at imminent risk of losing his sight.
09:50The night team are performing an emergency procedure.
09:53We made a small lateral cut through the skin so you can just try and buy it out of the
09:57window.
09:58Procedure we need to do is called the lateral camphotomy.
10:01It's not something that we do very often.
10:03It is a time-critical intervention.
10:07Identified 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, the night team have to cut the ligament inside his eye socket.
10:22If I take away the upper lid with the two forceps, then...
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!
10:37I'm going to give him another 20-year-old character.
10:39What?
10:40Thank you, Ricky.
10:43It's counter.
10:43Yes!
10:45Pop out, right, isn't it?
10:47Owww!
10:48See if we get anything.
10:50Yeah.
10:52I'm just going to hold it for a little bit.
10:54It's fine!
11:00It's fine!
11:01It's fine!
11:02It's fine!
11:02It's fine!
11:02It's fine.
11:02It's fine.
11:04It feels a lot better.
11:09Well done, my friend.
11:12Yeah, it's more forward, so it's not good.
11:15Trying to find a very small piece of anatomy to cut was really challenging.
11:21We will see if we've been successful.
11:24The team must wait to see if Nisarg's site is saved, and if the damage goes any deeper.
11:31We're going to do a CT, just to assess the bones and see if there's any fractures in the socket
11:36itself.
11:36I'm sure that there's nothing beyond that and into the brain.
11:41Okay?
11:43It's coming round from your sedation, my friend.
11:45When someone is punched in the face with significant force, there are all sorts of complications.
11:52You would be thinking about significant brain injury, facial fractures.
11:57These things can happen in an instant and 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.
12:23So it's been going at this rate since midnight, really.
12:28Dr 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.
12:41He 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.
12:51So if you could pop your hands straight for me.
12:53That's fine.
12:54It is unusual.
12:55It's rare.
12:57But sometimes people do have this condition where they go into this spontaneous fast rhythm.
13:02In the slightest, Jolt drove his heart into this fast rate.
13:08Dr Lucia consults the cardiology department.
13:11For the first critical move in his treatment.
13:15I've given him a bladder syringe.
13:17And 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.
13:37And hopefully, it comes back at the right rhythm between 60 to 100 beats per minute, which is the normal
13:44rate.
13:45All right, sweetheart.
13:46So, adenosine going in now and the flush.
13:51The first time I did it, a number of years ago, when I gave the adenosine, it was quite scary.
13:56When 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.
14:10It's still 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.
14:3012 milligrams 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?
14:44If that's all right, two litres.
14:46Extra oxygen supports the patient's heart as the 19 fight to slow it down.
14:52The rate hasn't made a blind bit of difference, has it?
14:55So, I'm going to do 18 now.
14:59Dr. Lucia administers a third and final dose.
15:03Any more could stop his heart altogether.
15:07Okay, 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, I'll just give her a ring now so
16:01she'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 lift here. I'm okay.
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 really quite swollen here.
16:58Yeah, he has a beard.
16:59Are you able to bend your elbow?
17:01No.
17:02I don't think...
17:03No.
17:03I can't...
17:04Okay.
17:05We'll get you some...
17:06Thank you, but before you do, just give me any pain.
17:10Oh, we'll get you some pain relief. I've already prescribed it to you, okay?
17:13Do you need some help getting up?
17:14Yeah, okay, good. Thank you.
17:15Okay.
17:16Getting an x-ray as quick as possible is really crucial,
17:19because the further we delay the x-rays, it can lead to nerve damage, can lead to vessel damage.
17:25To reveal the impact of Akram's fall, Dr. Aditya needs to check all the bones in his arm,
17:31from shoulder to wrist.
17:33Yeah, forearm's fine.
17:36Forearm's is okay, yeah.
17:38Ah, that's dislocated.
17:40Desiccated, yeah.
17:42Oh, yeah.
17:43Not for a man.
17:45Dislocation is serious, can lead to nerve damage, making the lymph unusable for the patient.
17:50With Akram's mobility and his job on the line, Dr. Aditya and the team need to urgently realign his elbow.
17:58This part of your bone should be in this socket, so we need to put it back in the right
18:03place.
18:18Yeah, 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.
18:28Okay.
18:29Any past medical history, any blood thinners she's on?
18:32Clipidogrel.
18:32Clipidogrel, okay.
18:33Tonight in Newham, Dr. Rosie's in charge of the Rhesus team.
18:37We've got a head injury, a pedestrian versus 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, especially when it's a pedestrian hit by a car.
18:50We're super careful about those because the risk of injuries is really high.
18:56After dark, pedestrians are over twice as likely to be struck.
19:00And the consequences can be life-threatening.
19:03I see you, he's here.
19:05Okay.
19:05Yeah.
19:07What?
19:08Bobbit balls in the back, aren't they?
19:10They're in the back.
19:10Yeah, yeah.
19:11I'll get some dishes for her.
19:17Are you okay?
19:19Okay, here we go.
19:19Well done.
19:20Well done.
19:23Our main concern is she's got a significant head injury, especially given that she's vomited now two times, especially when
19:30she's lying flat, which can suggest a raise in her intracranial pressure.
19:41The night team must run urgent neurological checks in case 63-year-old Paramuswari has a critical bleed on the
19:48brain.
19:49Deep breath.
19:51Deep breath.
19:53Big breath.
19:53Very good.
19:53Good.
19:56Okay, my dearie.
19:57That's fine.
19:57I'm just going to shine this in your eyes, okay?
19:59There's a light coming in your eyes, okay?
20:03Good.
20:07Okay.
20:08PPU is equal and reactive, two millimetres.
20:13Any pain in your legs?
20:16Just the hand, okay?
20:17And your head.
20:18Brilliant.
20:19Let's leave the wrist for now, because we'll get it x-rayed, so we don't want to...
20:22Yeah.
20:22And then there's this obvious...
20:24Is it boggy?
20:26Yeah, it is.
20:27It is?
20:28Okay, all right.
20:29Okay.
20:29Yeah.
20:29There's a particular type of boggy swelling that 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, okay?
20:49Okay.
20:50We'll get you some...and some painkillers.
20:51Okay.
20:52Hopefully we can get her into a scan fairly quickly, so we'll know exactly what we're dealing with.
21:01Following the crash, Paramuswari's sons called for an ambulance.
21:06I was shocked when I quickly came, and 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 met in my life.
21:17Yes.
21:18Hi, how are you doing?
21:19Hi.
21:19I'm Rosie, one of the doctors.
21:21I'm worried about her head at this point, so I definitely want to make sure there's nothing in her head.
21:24She vomited twice as well, isn't it?
21:24Yeah.
21:25There's lots of reasons people vomit, including if they are shocked from an injury,
21:29but having something worrying in the brain is a reason why people vomit as well.
21:32So we're going to sit see everything and then x-ray the wrist as well.
21:36If you have bleeding on the brain, it can expand.
21:39All that blood expands, it has nowhere to go, the skull can't expand,
21:44so 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 and your heart rate as well.
22:01It can lead to disabilities and possibly death in really severe cases.
22:11Oh, my God.
22:28I was in the last police station right here in Melbourne.
22:33What's going on? Everyone seems to be coming in for a fight.
22:36Go!
22:37Go!
22:37After dark, A&Es across the country are 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.
22:53It can really ramp everyone's anxiety levels up.
23:01But many patients on the night shift are also the victims of aggression and assault.
23:20Oh, my God.
23:23Well done, my friend. You're coming around.
23:24In Newham, Dr. Fraser is looking after 36-year-old Nisarg.
23:30He was attacked outside his home and rushed into emergency eye surgery.
23:35I'm just going to pop this off. We don't need the oxygen anymore, OK?
23:38Now the pressure around his eye has dropped.
23:41The night team need to check whether they were able to save his eyesight.
23:46I'm just having a look at your vision again. Are you awake enough for me to look at your vision?
23:50Yeah.
23:50Here you go.
24:01Oh, my God.
24:03OK.
24:04Now I can see.
24:06That's good. Cover 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 to give him bleeding behind his eyes.
24:22So what else might that have done? Has that broken any bones in his face?
24:25Make sure he's not got any bleeding in his brain.
24:27What we need to do now is just because you've had quite a significant head injury,
24:31we're going to do a scan of your head, OK?
24:36Nisarg is taken for an urgent head scan.
24:39This scan will take about two or three minutes, OK?
24:42To check for any life-threatening injuries.
24:47Yeah.
24:50He waits in majors while the night team examine the scans.
24:54The thing is, I'm celebrating festival with my two-year-old daughter.
25:00The guy came, you know, he's arguing me, like,
25:03I have my daughter in my hand and he's trying to punch me
25:07and I just pulled her back and 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 is get you followed up by the facial surgeons
25:37as well for an appointment to see whether they need to do anything.
25:40Sometimes when you've got, you know, a fractured eye socket,
25:42then the muscles that move your eye can 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 was 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 injury 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 and someone's punching him in the face.
26:12It's a pretty horrible thing to happen.
26:29It's still in SVT.
26:30He did revert back five cyber speeds.
26:33But then just went straight back into SVT.
26:36On the night shift, Dr Lucia is looking after a patient
26:40whose heart is beating around double the speed it should be.
26:45We give six milligrams at 246, no effect.
26:49And then at 250, I 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, we just need to DC.
27:04Well, I'll have a word with Dania
27:05because obviously she needs to be in resource if we're going to do that as well.
27:08They devise a new treatment plan.
27:12So, spoken to cardiology.
27:14So what he's recommended is actually DC cardioversion.
27:18Oh no, probably we don't really do that.
27:21Okay.
27:21The quickest way to get the heart back to the normal rhythm
27:26is we put defibrillator pads on and jolt the heart with electricity
27:33back 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. It's all good.
27:57Dr Lucia refers back to the cardiology specialists
28:00on what else can be done.
28:03Give him metoprolol.
28:06What 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 and slows the heart down.
28:20Yeah, metoprolol now.
28:22Yeah, 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.
28:47Nearly.
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,
29:13the patient just feels miraculously better.
29:15And that's what we're here to do.
29:18Do an ECG and then unfortunately you're going to have to look at our ugly faces for a couple of
29:22hours now.
29:23A sigh of relief.
29:27A sigh of relief.
29:31A sigh of relief.
29:38A sigh of relief.
29:39A sigh of relief.
29:39A sigh of relief.
29:39In Newham,
29:4063 year old Paramaswari is having urgent scans.
29:44After she was hit by a car while walking to temple after dark.
29:48A sigh of relief.
29:54her sons are translating for the night team
30:05my brother called me saying mom's had an accident you need to come and she was still regaining
30:11consciousness she didn't know what was happening and then gcs is 15. leading her care dr rosie
30:22is reviewing the scans hello hello how are you doing yeah i've just come to explain about the scan
30:35are you guys happy to translate or do you want a translator here no no are you sure okay so
30:40obviously we've scanned um head neck and all the body here what it does show which is what we were
30:47suspecting unfortunately there is a bleed on the brain okay there's a bleed over where she's got
30:54the bump but there's also a little bit on the back um she does have a fracture of her wrist
30:58as well
30:59unfortunately but that that is very manageable we can sort that out okay so unfortunately the
31:05ct scan has showed that she has a bleed on the brain
31:13ct scan only shows exactly what's happening at one point in time so it's really really important
31:17we monitor her carefully um that means doing neurological observations regularly
31:22keep your head nice and still for me just follow finger with your eyes okay
31:32there's lots of things that can happen after you have a bleed on the brain the main concern is
31:37that if you have bleeding it can expand it 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
31:51so very good and pull out push out out out out so then neurology is assessed in various ways for
31:59example the power of your limbs the coordination your ability to feel on your skin these are all things
32:06that can be affected by the bleed on the brain if i touch her there does she feel that i
32:12feel the same
32:12on both sides she can feel it less on that side or more on this side what about here less
32:23on this side
32:25okay okay what about here the same feels the same yeah here
32:44on that side she doesn't feel anything this side okay okay okay that's right so we'll have to have
32:49a chat with the neurosurgeons obviously i'm one of the a&e doctors but one of the neurosurgeons will
32:52have to have a look at all the scans and decide what's what's best for her okay all right thank
32:57you
33:00at the moment her neurological assessment is actually pretty good but my biggest concern
33:05is the risk of further bleeding she's on a blood thinner as well clopidogrel
33:11for a previous stroke which makes it a little bit more concerning blood thinning medication
33:16protects paramuswari from a stroke by preventing her blood from clotting but with the bleed on
33:22the brain it could make things far worse i have spoken to the hematologist at the london
33:29and they have suggested to give the platelets yes one pool of platelets given the risk
33:35dr rosie speaks to out of hours blood specialists the platelets are a component you get in your blood
33:42so we all have platelets just swimming around in our blood to help us clot when we bleed
33:46this patient is on a anti-platelet agent called clopidogrel so we've asked the hematologist and
33:52we are giving her some extra platelets sort of help that clotting process the main concern if she re-bleeds
34:00is that we get a big collection of blood in the brain that then compresses the brain including a
34:04lot of the the major areas that are you know in control of our you know speech our movements our
34:09breathing with the emergency treatment on its way paramuswari stays in resus under close monitoring
34:17giving her the best possible chance of survival it's a shock it's a massive shock
34:22but fingers crossed praying to god that everything will be fine again
34:39no grant i'll try to prioritize him okay thanks for letting me know thanks
34:43in belfast 83 year old ian is brought into resus
34:53the pain in the stomach and vomiting okay have you had trouble with the tummy before
35:02not really no can i have a feel of your tummy grab some gloves there's a severe pain
35:10and i said to see there no and then no no just there ah there what came first the pain
35:19or the
35:19vomiting oh the pain the pain came first there's a bit of a stiffness or something where the pain
35:25was became intense is your health usually good it's reasonable yes yeah i'm a farmer i always worry
35:36whenever a farmer comes in because you don't come to see us with nothing no no he's coming with tummy
35:43pain he's got a high lactate he's tender and he's been vomiting his boils aren't opening so i'm worried
35:49he's either got a blockage in his bile or a blockage in an artery supplying the boil
35:58ian's wife has arrived to sit with him i've been married well since 1967 a long time
36:05and uh we don't really have arguments he has a heart problem he has a pacemaker
36:12fitted quite some time but this is different this is around the tummy area
36:19he just felt poorly after he had his evening meal really sick and uh was actually vomiting
36:27it uh it happens with age or as i say too many birthdays so here we are the right place
36:38hi keeva it's alice one of the ed regs in the royal could i chat to you about ct abdomen
36:43pelvis
36:44i can only feel his tummy and look at him i can't see what's going on in the inside
36:48or as a ct you can give me good images of the abdomen and they can tell us a bit
36:53more about
36:53what's going on uh what did you farm
36:59cattle sheep beef or dairy beef well rare breeds oh still on the farm are you still live on the
37:10chest
37:10yeah all right we'll give you a little bit of this morphine okay and then if you need more i
37:15can
37:15give you some more in a wee bit okay i was just hoping that you weren't scared of needles because
37:21it's always the big strong men that cope on me whenever i put a needle into them and they do
37:26a
37:26lot of shooting this needle they do do a lot of shouting i know i snuck in while you were
37:32distracted there
37:33ah you did do a bit of shouting there i did yes you're gonna go up for your scan now
37:50so we are
37:51going for the ct scan okay this gentleman i'm worried about a bowel obstruction i'm worried about an aortic
38:00aneurysm i'm worried about mesenteric ischemia i'm worried about pancreatitis any older gentleman
38:07that presents with tummy pain it can be potentially fatal
38:28you can feel my heart yeah it's fine everywhere in the middle of the night
38:3440 year old delivery driver akram has blown his elbow out of his socket
38:39so clearly from the x-rays it shows that you have to stick it to the elbow but it's going
38:44to be a
38:44difficult procedure to put it back to care we'll try to sedate you as much as possible
38:48with his ability to drive on the line it needs to be realigned urgently
38:53a treatment that requires two senior doctors dr 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
39:04into your system the night team use penthrox for fast acting pain relief
39:10deep breaths
39:12doing well
39:13it will relax akram's muscles within minutes
39:27it's a quite physically intensive procedure both for the patient and for the doctors who are
39:31performing the procedure
39:35it requires traction and counter traction and put the bone back in place keep you taking deep breaths
39:43it's still awkward to bend is it the procedure needs extra force
39:49while zoe anchors akram's elbow in place dr aditya pulls the forearm further from the socket
39:57giving the joint more opportunity to slot back into natural alignment
40:06so
40:07are we okay you've done so well there
40:11looks better how's it feeling well now the next bit's getting this cast on
40:19so falling down the stairs can be quite serious it can result in head traumas and other severe
40:25traumas like chest trauma how does your elbow feel this is being still being we'll keep you in here for
40:30now okay until the next three are ready to come and get you okay so all in all yeah he
40:35was pretty
40:35lucky to just have a dislocated elbow rather than any other traumas
40:41did you like that
40:54on the other side of the hospital
40:56oh
40:57oh
41:00emergency 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 is this still as painful as it was very painful up
41:19there
41:20oh that's right you have a right selection of stuff here as long as you don't move
41:25all right yeah and have you felt sick again no your report's back
41:32you reported your scans back so it's not actually the tummy at all it's the pancreas
41:40right it's not very happy right now it's got a bit inflamed right
41:46your pancreas can cause loads of issues it's really important in regulating a lot of things
41:51including the sugar levels in your blood but can be incredibly sore it can also become necrotic so it
41:57can die um and then that can make you really really sick and his hasn't reached that stage yet
42:02it's just inflamed um but he needs careful observation and pain management do you have
42:08any questions for me no i'm gonna be here yeah oh well i would say you're coming in for bed
42:12and breakfast
42:13he doesn't need to go for theater he can be managed conservatively which is good because
42:17in somebody his age going for a big operation can be very difficult you might want to get yourself
42:24home i'm here okay if you need me most people with pancreatitis you can tell from the front door
42:32because they are screaming and they're writhing in agony he is like just very stoic okay
42:40okay see you in the morning bye bye okay sorry about all that classic farmer yeah um yeah it's farmers
42:55praise all us thank you you'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 check the x-ray is perfect do you feel less pain now is less pain yeah oh very
43:37good
43:46so what's next what's next is that the surgeons will come and see you
43:51so
44:05so
44:06so
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