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A and E After Dark - Season 7 - Episode 05
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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:10It can be very dangerous.
00:13We deal with a lot of aggressive patients.
00:16Things can escalate.
00:18It can be quite scary when it's just you and one violent patient.
00:24Across the UK, we join the staff of three of the most challenged emergency departments.
00:29It's always busy, it's always under pressure.
00:31Stop CPR.
00:32Time is of the essence.
00:34And the medics who face danger each shift.
00:37Most shifts, I see more place than nurses.
00:40With the amount of drugs and alcohol admissions rising.
00:43Have you been drinking today?
00:44The risk of violence and abuse looms large every night.
00:48Please don't swear like that.
00:50They try to attack and stop.
00:51I am not possible.
00:53Calm yourself down.
00:54People can become aggressive.
00:56What are you going to do?
00:57You've been punched, kicked.
00:59You see the good, bad and the ugly.
01:00I don't give a ****.
01:02Yeah, we'll get security.
01:03The emergency department is like a battlefield.
01:05It's like organised chaos.
01:19After dark, violence against NHS staff is at a record high.
01:26And doctors and nurses face it every time they're on shift.
01:30You've got to call the police.
01:38You've got to call the police.
01:39You've got to call the police.
01:40You've got to call the police.
01:40They can attack the security, they can attack nurses.
01:44I don't think the public is aware.
01:45They don't understand what we're going through.
01:47****
01:49Violence and aggression doesn't just stop at our doors.
01:52It continues on the streets.
01:54That can be quite scary for us and for everybody.
01:58You all right there?
01:59Have better days, haven't you?
02:00Got into a fight.
02:08****
02:11Stop on the mouse.
02:13Come on, my help.
02:14Switch dogs to Reisos please.
02:1836-year-old Nisarg is in Reisos.
02:21Or is there a stick of a grip in your hand?
02:24after being assaulted outside his home he's just minutes away from losing his vision
02:36emergency dr fraser will be treating him
02:41we see a lot of patients come in who are victims of assault 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
02:53can squash the nerve and so you can go blind in the space of an hour it's a real time
03:00-critical
03:00emergency this is just oxygen you have to do a procedure called a lateral canthotomy
03:06where you cut the ligaments that keep the eyeball in place and essentially relieve the swelling
03:14that's squashing the nerve that goes into the back of the eye with the pressure building behind his
03:20eye they have just minutes to act
03:24element's going in right i'm gonna make you feel funny just have nice dreams
03:30dr ed administers a fast-acting sedative
03:32hey buddy you 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
03:51cut this the superior because it's advisable to cut both in this circumstance so it'll give
03:56us some room to mini but oh i'm gonna give a little top-up okay no sorry you can see
04:19yeah
04:25the swelling is making the next cut much more difficult
04:34the swelling is making the next cut much more difficult
04:35patient had bleeding under the surface of their eye so it was it was particularly swollen
04:41it made it quite difficult to see exactly what we were supposed to be cutting
04:46something
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
05:06don't release that pressure that person will lose their sight and they will become blind and it will
05:21be permanent
05:25this lady's new she could probably step down but not to the corridor also working the weekend in Newham's recess
05:31is Dr. Ella
05:41a patient drifting in and out of consciousness he's 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
05:54she's gonna vomit again
05:57stay on your side okay okay
06:03hi my love my name's Ella I'm one of the doctors
06:06I'm just gonna hear what's going on and then we're gonna make you feel better okay
06:11okay
06:11was witnessed 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 okay
06:22I'm still complaining of abdominal pain
06:24she's been in and out of a altered conscious state with GCS 14 as her best with us
06:29what do we think it is?
06:30she 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 a size two even reactive but they may be a size one now
06:45the main questions to ask are what have they overdosed on
06:49do we need to reverse that drug
06:50do 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 gonna feel something here okay
07:05vomiting in a painful hard stomach
07:07can indicate life-threatening internal bleeding
07:12I wanna have a little listen to your breathing
07:16so Gretchen let's do some fluids
07:18clean 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
07:24some 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 so I'm not in a rush to do any scans right now
07:32she's quite young
07:33sharp scratch
07:35sorry
07:35oh
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 gonna be quite hard to manage that
07:45so we might need to give her some other things to
07:46make 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
07:52we'll be quick don't worry
07:54we'll be quick don't worry
08:02she doesn't allow themselves to be covered in excrement
08:06it shows that this person is clearly in need of help
08:10yes 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
08:31shut the f*** out
08:34security?
08:35oh
08:35no
08:36no
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 a lot drunker
08:46obviously drugs and alcohol are a big problem
08:49I've been witnessing violence and aggression
08:51it is difficult to be on the receiving end
08:54I think that's definitely gotten worse
08:57from 2023 to 24
09:00the 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***ing every f***ing fluoride f***ing
09:39In East London 36 year old Nassar has been violently assaulted outside his home
09:45what a high five
09:48He's at imminent risk of losing his sight. The night team are performing an emergency
09:52procedure.
09:53We made a small lateral cut through the skin so you need to just try and buy yourself
09:57through the window.
09:58The procedure we need to do is called the natural camphotomy. It's not something that
10:02we do very often. It is a time-critical intervention.
10:07We identified a bit of the pigment 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
10:20his eye socket.
10:22If I take away the upper leg with the two forceps, then...
10:27Now Dr. Susie needs to work around the swelling to cut a second one.
10:31Oh!
10:33It does kill me, though.
10:36I'm going to give him another 20.
10:52I'm just going to hold it for a little bit.
10:54I'm just going to hold it for a little bit.
10:59I've got it.
11:02I've got it done now.
11:03I've got it done now.
11:04I've tried.
11:04Feels a lot better.
11:09Well done, my friend.
11:12The eye's more forward, so that's 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
11:35the socket itself.
11:36Make sure that there's nothing beyond that and into the brain.
11:41You OK?
11:43Just 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.
12:19We'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.
12:38The 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 can pop your hands straight for me.
12:53That's fine.
12:54It is unusual.
12:55It's rare.
12:56But sometimes people do have this condition where they go into this spontaneous fast rhythm.
13:03In 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 the 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.
13:49And the flush.
13:51The first time I did it, a number of years ago, when I gave the adenosine, it was quite scary.
13:55When 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.
14:23So, once we're ready.
14:26Dr Lucia tries again, with double the dose.
14:3012 milligrams of adenosine going through.
14:32And 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 liters?
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, erm, 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.
15:17Oh, that 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 and there's no set pattern.
16:08If 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.
16:42In 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.
17:15Getting an x-ray as quick as possible is really crucial because the further we delay the x-rays,
17:21it 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, from shoulder
17:32to wrist.
17:33Yeah, her arm's fine.
17:36Her arm's okay, yeah.
17:39Desiccated, yeah.
17:42Oh, yeah.
17:43Her arm.
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.
18:16Yeah, we've got the lady who's just been in a road traffic collision.
18:24She's been crossing the road, driver hasn't seen her, he's turned the corner and hit her.
18:28Okay.
18:33Tonight in Newham, Dr. Rosie's in charge of the recess team.
18:37We've got a head injury, a pedestrian versus car.
18:40Recess can be often the most chaotic place in the whole hospital.
18:44Can you tell me if you're in pain there?
18:47Often 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.
18:55After dark, pedestrians are over twice as likely to be struck and the consequences can be life-threatening.
19:03I see you, he's here.
19:05Okay, lovely.
19:07What?
19:08Vomit bottles in the back, aren't they?
19:10In the back, yeah.
19:11Get some dishes for her.
19:17Okay.
19:17You're okay.
19:18Okay, here we go.
19:19Well done, well done.
19:23Our main concern is she's got a significant head injury, especially given that she's vomited now two times,
19:29especially when she's lying flat, which can suggest a raise in her endocrinial pressure.
19:34Okay.
19:35Hello, my name is Tosin, one of the A&E doctors.
19:38You can just lie your head back for me, okay?
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.
19:51Big breath.
19:53Good.
19:53Again?
19:55Okay, my dearie, that'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.
20:08PP is equal and reactive, two millimetres.
20:13Any pain in your legs?
20:16Just the hand, okay, and 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.
20:28All right.
20:28Okay.
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.
20:49Okay.
20:50We'll get you some...
20:50And some painkillers.
20:51Okay.
20:52Hopefully we can get her into a scan fairly quickly, so we'll know exactly what we're dealing
20:55with.
21:10Yeah.
21:22Yeah.
21:22So I definitely want to make sure there's nothing in her head.
21:24She's vomited in tight as well, isn't it?
21:24Yeah.
21:25There's lots of reasons people vomit, including if they are shocked from an injury, but having
21:29something 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.
21:41It has nowhere to go and the skull can't expand.
21:44So it just compresses the really critical areas of the brain, the ones that control your
21:48motor function or your speech.
21:55And obviously the worst case is your ability to regulate your breathing and your heart rate
22:00as well.
22:01It can lead to disabilities and possibly death in really severe cases.
22:11It can lead to disabilities.
22:12It can lead to disabilities.
22:28It can lead to disabilities.
22:32It can lead to disabilities.
22:34It can lead to disabilities.
22:36It can lead to disabilities.
22:37It can lead to disabilities.
22:37After dark, A&Es across the country
22:39are facing more aggressive patients than ever before.
22:44The 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.
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. You're coming around.
23:25In Newham, Dr. Fraser is looking after 36-year-old Nisarg.
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, okay?
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.
24:03Okay.
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 to give him bleeding behind his eyes.
24:22So what else might that have done?
24:23Has 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 a quite significant head injury,
24:31we're going to do a scan of your head, okay?
24:36Nisarg is taken for an urgent head scan.
24:39Nisarg will take about two or three minutes, okay?
24:42To check for any life-threatening injuries.
24:47Yep.
24:48Yeah, got it.
24:50He waits in majors while the night team examine the scans.
24:55The thing is, I'm celebrating festival with my two-year-old daughter.
25:00The guy came, you know, he's arguing me, like, I have my daughter in my hand,
25:05and he's trying to punch me, and 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, and now it's peening here as well.
25:26Yes, the CT scan showed that there's a broken bone in your face and 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.
25:50But 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, you know, 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,
26:10and someone ends up punching him in the face.
26:11So it's a pretty horrible thing to happen.
26:29He's still in SVT.
26:30He did revert back five cyberspeaks,
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.
26:44We 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 need to DC.
27:04Well, I'll have a word with Dania,
27:06because obviously she needs to be in resources if we're going to do that as well.
27:09They devise a new treatment plan.
27:12So, I've spoken to cardiology,
27:14so what he's recommended is actually DC cardioversion.
27:18Oh, no. I really don't want to do that.
27:21OK.
27:21The 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, so 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 and slows the heart down.
28:19Yeah, 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 you a 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.
29:00You 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.
29:16And that's what we're here to do.
29:18Do an ECG,
29:19and then unfortunately you're going to have to look at our ugly faces
29:22for a couple of hours now.
29:23HE LAUGHS
29:38In Newham,
29:4063-year-old Paramaswari is having urgent scans
29:43after she was hit by a car while walking to temple after dark.
29:51There, Captain.
29:52Okay.
29:54Her sons are translating for the night team.
29:59How's pain at the minute?
30:00It's terrible.
30:01We'll give her some morphine.
30:02No.
30:03Morphine on the other room.
30:06My brother called me saying,
30:07Mum's had an accident.
30:08You need to come.
30:09And she was still regaining consciousness.
30:12She didn't know what was happening.
30:16And then GCS is 15.
30:18GCS is 15.
30:20Leading her care,
30:21Dr. Rosie is reviewing the scans.
30:27Hello.
30:29Hello.
30:31Hello.
30:31How are you doing?
30:33Yes.
30:33Yeah?
30:34I've just come to explain about the scan.
30:36Are you guys happy to translate,
30:37or do you want a translator here?
30:38No.
30:39Are you sure?
30:39Okay.
30:40So, obviously, we've scanned head, neck, and all the body here.
30:45What it does show, which is what we were suspecting,
30:48unfortunately, there is a bleed on the brain.
30:52Okay.
30:52There's a bleed over where she's got the bump,
30:54but there's also a little bit on the back.
30:56She does have a fracture of her wrist as well, unfortunately,
30:59but that is very manageable.
31:02We can sort that out.
31:03Okay.
31:04So, unfortunately, the CT scan has showed
31:06that she has a bleed on the brain.
31:12CT scan only shows exactly what's happening
31:14at one point in time.
31:16So, it's really, really important
31:17we monitor her carefully.
31:18That means doing neurological observations regularly.
31:22Keep your head nice and still for me.
31:25Just follow finger with your eyes, okay?
31:32There's lots of things that can happen
31:34after you have a bleed on the brain.
31:36The main concern is that if you have bleeding,
31:38it can expand.
31:40It can compress certain areas of the brain.
31:44Can you squeeze my hand for me?
31:46And this side, can you pull my hand into you?
31:51Very good.
31:52And pull out, push out.
31:54Out, out, out.
31:56So, their neurology is assessed in various ways.
31:59For example, the power of your limbs,
32:01the coordination, your ability to feel on your skin.
32:06These are all things that can be affected
32:08by the bleed on the brain.
32:10If I touch her there,
32:11does she feel the same on both sides?
32:19She can feel it less on that side or more on the side.
32:21Less on this side?
32:22No, less on this side.
32:24Less on this side?
32:25Okay, okay.
32:25What about here?
32:33The same?
32:35Feels the same, yeah?
32:37Here?
32:44On that side, she doesn't feel anything.
32:45This side?
32:46Yeah.
32:47Okay, okay.
32:47Okay, 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,
32:51but one of the neurosurgeons
32:52will have to have a look at all the scans
32:54and decide what's best for her.
32:56Okay, fine.
33:00At the moment,
33:01her 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,
33:11for a previous stroke,
33:12which makes it a little bit more concerning.
33:15Blood thinning medication protects Paramuswari
33:17from a stroke by preventing her blood from clotting.
33:21But with the bleed on the brain,
33:23it could make things far worse.
33:26I have spoken to the haematologist at the London
33:29and they have suggested to give the platelets.
33:32Yes, one pool of platelets.
33:34Given the risk,
33:36Dr Rosie speaks to out-of-hours blood specialists.
33:40Platelets are a component you get in your blood,
33:42so we all have platelets just swimming around in our blood
33:44to help us clot when we bleed.
33:46This patient is on a anti-platelet agent,
33:49it's called clopidogrel,
33:50so we've asked the haematologist
33:51and we are giving her some extra platelets
33:54to help that clotting process.
33:57The main concern if she re-bleeds
34:00is that we get a big collection of blood in the brain
34:02that then compresses the brain,
34:04including a lot of the major areas that are in control of our speech,
34:08our movements, our breathing.
34:10With the emergency treatment on its way,
34:13Paramuswari stays in recess 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,
34:24praying to God that everything will be fine again.
34:43In Belfast, 83-year-old Ian is brought into recess.
34:49Hello.
34:50Taking the lead on his care is Dr. Alice.
34:54What's brought you in tonight?
34:56Pain to the stomach and vomiting.
34:59Okay.
35:00Have you had trouble with the tummy before?
35:02Not really, no.
35:05Can I have a feel of your tummy?
35:07Just grab some gloves.
35:08There's a severe pain.
35:11See there?
35:13Ah.
35:14And there, no.
35:15Just there?
35:16Ah.
35:17There.
35:18What came first, the pain or the vomiting?
35:20Oh, the pain.
35:21The pain came first.
35:22There's a bit of a stiffness or something.
35:24Okay.
35:25The pain was.
35:26Okay.
35:26Became intense.
35:28Is your health usually good?
35:31It's reasonable, yes.
35:32Yeah.
35:33I'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.
35:41No.
35:42He's come in with tummy pain.
35:44He's got a high lactate.
35:45He's tender.
35:46He'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.
35:53Here you go.
35:58Ian's wife has arrived to sit with him.
36:01We've been married, well, since 1967.
36:03A long time.
36:06And we don't really have arguments.
36:09He has a heart problem.
36:11He has a pacemaker.
36:12He's fitted quite some time.
36:14But this is different.
36:16This is around the tummy area.
36:19He just felt poorly after he had his evening meal.
36:23Really sick and was actually vomiting.
36:28It happens with age.
36:31Or as I say, too many birthdays.
36:35So here we are.
36:36The right place.
36:38Hi, Keefa.
36:39It's Alice, one of the ED regs in the Royal.
36:41Could I chat to you about CT abdomen pelvis?
36:44I can only feel his tummy and look at him.
36:46I can't see what's going on in the inside.
36:48Whereas the CT can give me good images of the abdomen.
36:52And they can tell us a bit more about what's going on.
36:55What did you farm?
36:59Dattle, sheep.
37:00Beef or dairy?
37:02Beef, well, rare breeds.
37:06Oh?
37:06Still on the farm, are you?
37:09Still live on it, yes.
37:10Yeah.
37:11Right, we'll give you a little bit of this morphine, okay?
37:14And then, if you need more, I 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 that cope on me
37:23whenever I put a needle into them.
37:25And they do a lot of shouting with needles.
37:27They do do a lot of shouting.
37:31And I snuck in while you were distracted there.
37:33Ah!
37:35Ah!
37:37Oh!
37:38Ah!
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?
37:55This gentleman, I'm worried about a bowel 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,
38:08it can be potentially fatal.
38:28You can feel my heart?
38:30Yeah.
38:30It's fine?
38:31Yeah.
38:31Everywhere?
38:31Okay.
38:32In the middle of the night, 40-year-old delivery driver Akram
38:36has blown his elbow out of his socket.
38:40So clearly, from the x-rays, it shows that you have just
38:43to kick the elbow.
38:44But 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, 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
39:03and air into your system.
39:04The night team use Penthrox for fast-acting pain relief.
39:10Deep breaths.
39:11Doing well.
39:13It will relax Akram's muscles within minutes.
39:17Deep breaths.
39:18Good night, sir.
39:19Let's go and see.
39:21Good, man.
39:25Keep going.
39:27It's quite a physically intensive procedure,
39:29both for the patient and for the doctors who are performing the procedure.
39:35It 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.
40:04How did I take it, Chris?
40:06I think it feels alright.
40:07How are we doing?
40:08You okay?
40:09You've done so well there.
40:12Looks 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.
40:22It can result in head traumas and other severe traumas like chest trauma.
40:26How does your elbow feel?
40:28This is big.
40:29Still PM?
40:29We'll keep you in here for now, OK?
40:31Until the next day are ready to come and get you.
40:33OK?
40:34So all in all, yeah, he was pretty lucky
40:35to just have a dislocated elbow
40:38rather than any other traumas.
40:40Did you like that?
40:43No, I liked it.
40:51All right?
40:55On the other side of the hospital...
41:00Emergency doctor Alice wants to diagnose
41:0283-year-old Ian's severe abdominal pain.
41:06Breathe in and hold your breath.
41:12He waits for his CT results with wife Joan.
41:16Is 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
41:23as long as you don't move.
41:25All right, yeah.
41:26And have you felt sick again?
41:29No.
41:30Your report's back.
41:32Your report to your scan's back.
41:34So it's not actually the tummy at all, it's the pancreas.
41:39Right.
41:40It's not very happy right now.
41:43It'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
41:51including the sugar levels in your blood
41:53but can be incredibly sore.
41:55It can also become necrotic so it can die
41:58and then that can make you really, really sick.
42:00His hasn't reached that stage yet, it's just inflamed.
42:04But he needs careful observation and pain management.
42:07Do you have any questions for me?
42:09No, I'm not going to be here.
42:10Yeah.
42:11Oh, 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
42:17because in somebody his age going for a big operation
42:22can 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
42:32because they are screaming and they are writhing in agony.
42:34I, he is like just very stoic.
42:39Okay.
42:41Yes.
42:42See you in the morning.
42:44Bye-bye.
42:45Bye-bye.
42:47Sorry about all that.
42:49Classic farmer.
42:50Yeah.
42:52Yeah, it's farmers.
42:55Great dollars, 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 bags, right? It's perfect.
43:33Do 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.
43:59We're gonna love on the chin.
44:06The engineers will come and see you.
44:08The surgeons will come and see you.
44:08Then they're going to call you, baby.
44:08Now I am, I'm sure you've heard about it.
44:11What are you guys saying?
44:13The surgeons will come and see you guys.
44:14They're all in the Advisors.
44:14They'll be different.
44:14They're all in the house that is a crazy place.
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