- 6 hours ago
A and E After Dark - Season 7 - Episode 05
Category
📺
TVTranscript
00:03after dark while the nation sleeps 16 year old male who was shot the A&D night shift begins
00:10it can be very dangerous he has a knife with him we deal with a lot of aggressive patients
00:16things can escalate this gentleman has been punched it can be quite scary when it's just
00:21you and one violent patient across the UK we join the staff of three of the most challenged
00:27emergency departments it's always busy it's always under pressure time is of the essence
00:33and the medics who face danger each shift most shifts I see more place than nurses with the
00:40amount of drugs and alcohol admissions rising have you been drinking today the risk of violence and
00:45abuse looms large every night please don't swear like that they try to attack and stuff
00:51calm yourself down people can become aggressive you've been punched cake you see the good bad
01:00and the ugly yeah we'll get security the emergency department is like a battlefield it's like
01:05organized chaos
01:18after 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
01:49violence and aggression doesn't just stop at our doors it continues on the streets that can be quite
01:55scary for us and for everybody you're right there a better day than me put into a fight
02:1836 year old miss arc is in resource
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
02:45with 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
03:01this 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
03:18with the pressure building behind his eye they have just minutes to act
03:24element's going in right we're going to 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
03:44vision
03:44that looks like ligament there yeah that's the superior ligament let's cut it's supposed to cut the
03:50inferior first cut this superior because it's advisable to cut both in this circumstance so it'll
03:56give us some real to mini but
03:57on the left
04:05right
04:06oh that
04:08should we tighten the inferior
04:11oh
04:13i'm gonna give a little soft apple
04:24the swelling is making the next cut much more difficult
04:30oh
04:35patient had bleeding under the surface of their eye so it was particularly swollen it made it quite difficult to
04:42see exactly what we were supposed to be cutting
04:52consultant dr susie is also on shift
04:56when someone has increasing pressure on the back of the eye you will start to get compression of the nerve
05:02fibers that provide the sensation of vision
05:05so if you don't release that pressure that person will lose their sight and they will become blind and it
05:12will 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
05:41a patient drifting in and out of consciousness is being brought in by ambulance
05:47we are at hospital now okay
05:49give us two minutes and then we'll come in all right
05:51yeah
05:54She's going to vomit again.
05:57Staying aside, okay?
05:58Okay?
06:03Hiya, my love.
06:04My name's Ella. I'm one of the doctors.
06:07I'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 to collapse
06:13on the side of the pavement tonight outside 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 GCS14 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.
06:40Pupils?
06:41Pupils are size 2, even reactive,
06:44but they may be size 1 now.
06:46The main questions we'll ask are,
06:47what have they overdosed on?
06:48Do 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
07:06can 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,
07:19clean 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,
07:25some anti-sickness,
07:26so she can tell us a bit more about why she's vomiting,
07:28how she feels.
07:29Her stomach's nice and soft,
07:30so I'm not in a rush to do any scans right now.
07:32She's quite young.
07:33Drop, scratch.
07:35Sorry.
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.
07:48Can we clean her up 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
08:07is 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.
08:32Shut the f*** up!
08:34Security?
08:35Oh!
08:36No, no!
08:37Shut up!
08:39Alcohol-related emergencies are on the rise.
08:43You were a lot drunker when you first came in to me.
08:45Now you're an animal!
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.
08:56You're a dick!
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 when you mix in alcohol and violence and aggression against our staff,
09:17and it can feel like a police station sometimes.
09:20F*** down, we're part four, I f***ed.
09:45F*** down, we're part four, I f***ed.
09:50The night team are performing an emergency procedure.
09:53We've made a small lateral cut through the skin, so you need to just try and buy yourself through the
09:57window.
09:58Procedure we need to do is called the lateral canphotomy.
10:01It's not something that we do very often.
10:04It is a time-critical intervention.
10:07We've 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, then...
10:26Now Dr Susie needs to work around the swelling to cut a second one.
10:31Oh!
10:33Just kill me, Doc.
10:36I'm going to give him another 20-inch area.
10:40I'm going to give him another 20-inch area.
10:42It's pelted.
10:44Pop out, though, isn't it?
10:48See if we get any of it.
10:52I'm just going to hold it for a little bit.
10:54It's f***ing!
11:00Got it.
11:00What's up?
11:02I don't know.
11:02How's it done, man?
11:04I'm sure.
11:04It feels a lot better.
11:09Well done, my friend.
11:12Yeah, it's more forward.
11:13So, no, it'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 sight 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.
11:36Make sure that there's nothing beyond that and into the brain.
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.
12:27Dr 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.
12:38The 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.
12:51So if you can 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 the spontaneous fast rhythm.
13:03In the slightest, jolt drove his heart into this fast rate.
13:08Dr 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 and 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.
13:44All right, sweetheart.
13:46All right, sweetheart.
13:47So, 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.
14:10Still 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.
14:3012 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?
14:43If 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, 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.
15:06OK, so we're going to do 18.
15:09So...
15:11Adenosine gone through.
15:13Flush gone through.
15:14Lift 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.
15:48We're looking promising.
15:49The 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.
16:09If 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, bringing some of the most life-changing
16:36emergencies 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.
16:56It's really quite swollen here.
16:58Yeah, here's the beard.
16:59Are you able to bend your elbow?
17:00Oh, I don't think.
17:03No.
17:03I can't.
17:04Okay.
17:05We'll get you some x-ray sorted.
17:07Thank you, but before you do it, just give me any pain.
17:10Oh, we'll get you some pain relief.
17:11I've already prescribed it to you, okay?
17:13Do you need some help getting up?
17:14No, I can't.
17:15Okay.
17:16Getting an x-ray as quick as possible is really crucial because the further we delay the x-rays, it
17:22can 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, forearm's fine.
17:36Forearm's is okay, yeah.
17:38Ah, that's dislocated.
17:42Oh, yeah.
17:43That's not her mask.
17:44Dislocation 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 maid 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.
18:29Any, um, past medical history, any blood thinners she's on?
18:32Clopidogrel.
18:32Clopidogrel, 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, yeah.
19:06Um, bullet balls in the back, aren't they?
19:11Dishes for her.
19:17Okay.
19:18Okay, here we go.
19:19Well done, well done.
19:23Our main concern is she's got a significant head injury,
19:26especially given that she's vomited now two times,
19:29um, especially when she's lying flat,
19:31which can suggest a raise in her intracranial 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
19:44in case 63-year-old Paramuswari has a critical bleed on the brain.
19:49Deep breath.
19:51Big breath.
19:52Very good.
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?
20:02Good.
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,
20:21so I don't want to...
20:22Yeah.
20:22And then there's this obvious...
20:24Is it boggy?
20:26Yeah, it is.
20:27It is? Okay.
20:28All right.
20:28Okay.
20:29There's a particular type of boggy swelling
20:31that you can get on the head.
20:34They're fairly rare,
20:35but it can suggest a skull fracture.
20:39Sorry, my dear.
20:40We're going to keep her in that position.
20:42We're going to sort of CT trauma series for her.
20:46We're going to get you some scan for your head, okay?
20:49Okay.
20:49We'll get you some...
20:50And some painkillers, okay?
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,
21:11but I'm seeing it.
21:14Strongest woman I've met in my life.
21:18Hi, how are you doing?
21:19So I'm raising one of the doctors.
21:21I'm worried about her head at this point,
21:22so I definitely want to make sure there's nothing in her head.
21:24She wanted to bite as well, isn't it?
21:24Yeah.
21:25There's lots of reasons people vomit,
21:27including if they are shocked from an injury,
21:28but having something worrying in the brain
21:30is a reason why people vomit as well.
21:32So we're going to CT everything
21:33and then X-ray the wrist as well.
21:36If you have bleeding on the brain,
21:38it 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.
21:52Yeah.
21:52Would you need to translate for it?
21:54Yeah.
21:54I'll be able to do it.
21:55In, obviously, the worst case is your ability
21:58to regulate your breathing and your heart rate as well.
22:02It can lead to disabilities
22:04and possibly death in really severe cases.
22:25Oh, we're turning on your last police station right here.
22:32What's going on?
22:34Everyone seems to be coming in for a fight.
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.
22:57Ain't no matter why, we can handle me, I'm sorry.
23:01But many patients on the night shift
23:03are also the victims of aggression and assault.
23:19Oh, 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, OK?
23:38Now the pressure around his eye has dropped.
23:41The night team need to check
23:43whether 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
24:18that'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
24:24to make sure he's not got any bleeding in his brain?
24:27What we need to do now
24:28is just because you've had
24:29a quite 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.
24:47Yep.
24:48Yep, got her.
24:50He waits in majors
24:52while the night team examine the scans.
24:55The thing is,
24:56I'm celebrating a festival
24:57with my two-year-old daughter.
25:00The guy came, you know,
25:02he's arguing 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
25:28that 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, you know,
25:41a fractured eye socket,
25:42then the muscles that move your eye
25:44can squish through the gaps
25:46in the broken bones
25:47and that can mean
25:48that 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
25:55by the ophthalmologist in the morning.
25:57All right.
25:58Some of the most dramatic cases
26:00of, you know, injury and trauma
26:02from violence in the community
26:04will happen at night.
26:06It was a pretty horrible assault.
26:08It's what sounds like
26:08a completely trivial argument
26:10and someone's punching him in the face.
26:11So it's a pretty horrible thing to happen.
26:28It's still in SVT.
26:30He did revert back five times.
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
26:41double the speed it should be.
26:44We give six milligrams at 246,
26:47no effect.
26:49And then at 250,
26:50I gave 12 milligrams of adenosine,
26:53no effect.
26:55With the first treatment
26:56failing to calm his heart,
26:58Dr Lucia calls the cardiology specialist.
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.
27:11So, spoken to cardiology.
27:14So what he's recommended
27:16is actually DC cardioversion.
27:18Oh, no.
27:19Not really.
27:20We don't really do that.
27:21The quickest way to get the heart
27:24back to the normal rhythm
27:26is we put defibrillator pads on
27:29and jolt the heart with electricity
27:33back into the normal rhythm.
27:34But you can imagine
27:38that situation
27:39not being
27:40very, very,
27:41you know, pleasant.
27:43So you have to
27:44put yourself
27:45in the position of
27:47the patient.
27:48It makes people
27:49really, really, really frightened.
27:51It's more than one way
27:52to skin a cat.
27:54So don't worry.
27:55It's all good.
27:57Dr Lucia
27:58refers back
27:59to the cardiology specialists
28:00on what else can be done.
28:03Give him
28:04metoprolol.
28:05What dose
28:06would you recommend?
28:08There is one other
28:09medication
28:10they can try.
28:12Metoprolol
28:12is a
28:13beta blocker.
28:14This works
28:15in a different way
28:17and
28:17slows the heart down.
28:20They're metoprolol now.
28:22Yeah.
28:22So give that
28:23a 312.
28:25Unlike
28:26adenosine
28:26which resets
28:27the heart
28:28metoprolol
28:29works the opposite way
28:31blocking
28:32adrenaline
28:32to gently
28:33calm the heart rate.
28:35It's coming down.
28:37It's getting there
28:38slowly
28:39and then
28:40once you go back
28:40to normal
28:41get your nice
28:41cup of tea.
28:45Nearly.
28:47Nearly.
28:52Get out of it.
28:53The rate
28:54is better
28:55than what it was
28:56whereas before
28:57you were sort of like
28:58about 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
29:09the rate
29:10back to
29:10the normal rate
29:12the patient
29:13just feels
29:14miraculously better
29:15and that's what
29:16we're here to do.
29:18Do an ECG
29:19and then
29:20unfortunately
29:20you're going to have to
29:21look at our ugly faces
29:22for a couple of hours now.
29:38In Newham
29:3963-year-old
29:41Paramuswari
29:42is having
29:42urgent scans
29:43after she was
29:45hit by a car
29:45while walking
29:46to temple
29:47after dark.
29:54Her sons
29:55are translating
29:55for the night team.
29:59How's pain
29:59at the minute?
30:00It's terrible.
30:01We'll give her
30:01some morphine.
30:02No.
30:03We'll give morphine
30:04when you're on the room.
30:06My brother
30:06called me
30:07saying
30:07mom's had an accident
30:08you need to come
30:09and she was still
30:10regaining
30:11consciousness.
30:12She didn't know
30:13what was happening.
30:15And then GCS
30:17is 15?
30:18GCS is 15.
30:20Leading her care
30:21Dr. Rosie
30:22is reviewing
30:22the scans.
30:27Hello.
30:28Hello.
30:31How are you doing?
30:33Yeah.
30:34I've just come
30:34to explain
30:34about the scan.
30:36Are you guys
30:36happy to translate
30:37or do you want
30:37a translator here?
30:38No.
30:38Are you sure?
30:40Okay.
30:40So obviously
30:40we've scanned
30:42head, neck
30:43and all the body
30:44here.
30:44What it does show
30:46which is what
30:46we were suspecting
30:47unfortunately
30:48there is a bleed
30:49on the brain.
30:52Okay.
30:52There's a bleed
30:53over where
30:53she's got the bump
30:54but there's also
30:55a little bit
30:55on the back.
30:56She does have
30:57a fracture
30:57of her wrist
30:58as well
30:58unfortunately
30:59but that
31:00is very manageable.
31:02We can sort
31:02that out.
31:03Okay.
31:04So unfortunately
31:05the CT scan
31:06has showed
31:06that she has
31:07a bleed
31:07on the brain.
31:12CT scan
31:13only shows
31:14exactly what's
31:14happening
31:14at one point
31:15in time
31:15so it's really
31:16really important
31:17we monitor
31:17her carefully.
31:18That means
31:19doing neurological
31:20observations
31:21regularly.
31:22Keep your head
31:23nice and still
31:24for me.
31:24Just follow
31:25finger with your eyes
31:26okay?
31:27Kind of okay.
31:32There's lots
31:33of things
31:33that can happen
31:34after you have
31:35a bleed
31:35on the brain.
31:36The main concern
31:36is that
31:37if you have
31:37bleeding
31:38it can expand
31:39it can compress
31:41certain areas
31:42of the brain.
31:44Can you squeeze
31:45my hand for me?
31:47And this side
31:47can you pull
31:48my hand
31:49into you?
31:51Very good
31:52and pull out
31:53push out.
31:54Out, out, out.
31:56So the neurology
31:57is assessed
31:58in various ways
31:59for example
31:59the power
32:00of your limbs
32:01the coordination
32:02your ability
32:04to feel
32:05on your skin
32:05these are all
32:06things that can
32:07be affected
32:08by the bleed
32:08on the brain.
32:10If I touch
32:10her there
32:11does she feel
32:11the same
32:12on both sides?
32:19She can feel
32:20less on that
32:20side
32:21or more
32:21Less on this
32:22side?
32:22What about here?
32:23Less on this
32:23side?
32:24Less on this
32:24side?
32:25Okay.
32:25Okay.
32:25What about
32:26here?
32:33The same?
32:35Feels the same
32:36yeah?
32:37Here?
32:44On that side
32:44she doesn't
32:45feel anything
32:45This side?
32:46Okay.
32:46Okay.
32:47Okay.
32:47That's right.
32:48So we'll have
32:48to have a chat
32:49with a neurosurgeon
32:50obviously I'm
32:50one of the
32:50A&E doctors
32:51but one of
32:51the neurosurgeons
32:52will have
32:52to have a look
32:53at all the
32:53scans
32:54and decide
32:54what's best
32:55for her.
32:56Okay.
33:00At the moment
33:01her neurological
33:01assessment
33:02is actually
33:02pretty good
33:03but my biggest
33:04concern
33:05is the risk
33:05of further
33:06bleeding.
33:08she's on
33:09a blood
33:10thinner as
33:10well
33:10clopidogrel
33:11for a
33:11previous
33:12stroke
33:12which makes
33:12it a little
33:13bit more
33:13concerning.
33:14Blood
33:15thinning
33:15medication
33:16protects
33:16Paramuswari
33:17from a
33:18stroke
33:18by preventing
33:19her blood
33:20from clotting
33:21but with
33:22the bleed
33:22on the
33:22brain
33:23it could
33:24make
33:24things
33:24far worse.
33:26I have
33:26spoken to
33:27the
33:27haematologist
33:28at the
33:28London
33:28and they
33:29have
33:30suggested
33:30to give
33:30the platelets
33:31yes
33:32one pool
33:32of platelets.
33:34Given
33:34the risk
33:35Dr Rosie
33:36speaks to
33:37out-of-hours
33:37blood
33:37specialists.
33:39Platelets
33:40are a
33:40component
33:41you get
33:41in your
33:41blood
33:42so we
33:42all have
33:42platelets
33:43just swimming
33:43around in
33:43our blood
33:44to help
33:44us clot
33:45when we
33:45bleed.
33:46This
33:46patient
33:47is on
33:47an
33:47anti-platelet
33:48agent
33:48called
33:49clopidogrel
33:49so we've
33:50asked the
33:51haematologist
33:51and we are
33:52giving her
33:53some extra
33:53platelets
33:54to help
33:55that clotting
33:55process.
33:57The main
33:58concern
33:59if she
33:59re-bleeds
34:00is that
34:00we get
34:00a big
34:01collection
34:01of blood
34:02in the
34:02brain
34:02that
34:02then
34:02compresses
34:03the
34:03brain
34:03including
34:04a lot
34:04of the
34:05major
34:05areas
34:06that
34:06are
34:06in
34:07control
34:07of
34:07our
34:07speech
34:08our
34:08movements
34:09our
34:09breathing.
34:10With
34:11the
34:11emergency
34:11treatment
34:12on its
34:12way
34:13Paramuswari
34:14stays
34:14in
34:14resus
34:15under
34:15close
34:16monitoring
34:17giving
34:18her
34:18the
34:18best
34:18possible
34:19chance
34:19of
34:19survival.
34:20It's
34:21a shock
34:21it's
34:22a massive
34:22shock
34:22but fingers
34:24crossed
34:24praying
34:25to
34:25God
34:25that
34:25everything
34:26will
34:26be
34:26fine
34:26again.
34:41In
34:43Belfast
34:4483-year-old
34:45Ian is
34:46brought
34:46into
34:46resus.
34:49Hello.
34:50Taking
34:50the lead
34:51on his
34:51care
34:51is
34:52Dr
34:52Ellis.
34:54What's
34:54brought
34:54you
34:55in
34:55tonight?
34:56Pain
34:57in
34:57the
34:57stomach
34:58and
34:58vomiting.
34:59Okay.
35:00Have you
35:00had trouble
35:01with the
35:01tummy
35:01before?
35:02Not
35:03really,
35:03no.
35:05Can
35:05I
35:05have
35:05a
35:06failure
35:06tummy?
35:07Grab
35:07some
35:07gloves.
35:09There's
35:09a
35:09severe
35:09pain
35:10except
35:11see
35:12there.
35:13Ah!
35:14Not
35:14there,
35:14no.
35:15Just
35:15there?
35:16Ah!
35:17There.
35:17What
35:18came
35:18first,
35:18the
35:18pain
35:19or
35:19the
35:19vomiting?
35:20Well,
35:20the
35:20pain.
35:21The
35:21pain
35:21came first.
35:22There's a bit
35:22of a
35:23stiffness
35:23itself.
35:24Okay.
35:25The pain
35:25was.
35:26Okay.
35:26It became
35:27intense.
35:28Is your health
35:28usually good?
35:30It's reasonable,
35:32yes.
35:32Yeah.
35:33I'm a
35:34farmer.
35:35I always worry
35:36whenever a farmer
35:37comes in,
35:38because you don't
35:39come to see us
35:39with nothing.
35:40No.
35:41No.
35:42He's come in with
35:43tummy pain,
35:44he's got a high
35:44lactate,
35:45he's tender,
35:46he's been vomiting,
35:47his bowels aren't
35:48opening.
35:48So I'm worried
35:49he's either got
35:49a blockage in
35:50his bowel
35:50or a blockage
35:51in an artery
35:51supplying the
35:52bowel.
35:53Here you go.
35:58Ian's wife
35:58has arrived
35:59to sit with
35:59him.
36:01We've been
36:01married,
36:01well,
36:02since 1967,
36:03a long
36:04time,
36:06and we
36:07don't really
36:08have arguments.
36:09He has a
36:10heart problem,
36:11he has a
36:11pacemaker,
36:12fitted quite
36:13some time,
36:14but this
36:15is different,
36:16this is
36:16around the
36:17tummy area.
36:19He just
36:20felt poorly
36:21after he had
36:21his evening
36:22meal,
36:23really sick
36:24and was
36:26actually
36:26vomiting.
36:27It happens
36:29with age,
36:31or as I
36:32say,
36:32too many
36:32birthdays.
36:35So here
36:35we are,
36:36the right
36:37place.
36:38Hi,
36:39Keeva,
36:39it's Alice,
36:39one of the
36:40ED regs in
36:41the Royal.
36:41Could I
36:42chat to you
36:42about CT
36:42abdomen
36:43pelvis?
36:44I can
36:44only feel
36:45his tummy
36:45and look
36:46at him,
36:46I can't
36:47see what's
36:47going on
36:47on the
36:48inside,
36:49whereas a CT
36:49can give
36:50me good
36:50images
36:50of the
36:51abdomen
36:52and they
36:52can tell
36:52us a bit
36:53more about
36:53what's
36:53going on.
36:55What did
36:56you farm?
36:59Cattle,
36:59sheep.
37:00Beef or
37:00dairy?
37:02Beef,
37:03well,
37:04rare breeds.
37:06Oh?
37:06Still on
37:07the farm,
37:07are you?
37:09Still live
37:09on the chest.
37:10Yeah.
37:11All right,
37:12we'll give you
37:12a little bit
37:12of this morphine,
37:13okay?
37:14And then
37:14if you
37:14need more,
37:15I can
37:15give you
37:15some more
37:16in a wee bit,
37:16okay?
37:19I was just
37:19hoping that
37:20you weren't
37:20scared of
37:21needles,
37:21because it's
37:21always the
37:22big strong
37:22men that
37:23cope on me
37:23whenever I
37:24put a needle
37:24into them.
37:25And they do
37:25a lot of
37:26shouting,
37:26this needle.
37:27They do
37:27do a lot
37:28of
37:28shouting.
37:31And I was
37:31snuck in while
37:32you were
37:32distracted there.
37:33aah.
37:35Ah.
37:37Ah.
37:37Oh.
37:39Ah.
37:44You did
37:45do a bit
37:45of shouting
37:45there.
37:46I did,
37:47yes.
37:48You're
37:48going to go up
37:49for your
37:49scan now.
37:50So we are
37:51going for a
37:51safety scan,
37:52okay?
37:55For this
37:56gentleman,
37:56I'm worried
37:56about a
37:58bile obstruction,
37:59I'm worried
37:59about an
38:00aortic aneurysm,
38:01I'm worried
38:01about mesenteric
38:02ischemia,
38:03I'm worried
38:04about pancreatitis.
38:05Any older gentleman
38:07that presents
38:07with tummy pain,
38:08it can be
38:09potentially fatal.
38:28you can
38:29feel my
38:29heart?
38:30Yeah.
38:30It's fine.
38:31Yeah.
38:31Everywhere?
38:32In the
38:32middle of the
38:33night,
38:3440-year-old
38:34delivery driver
38:35Akram has
38:36blown his
38:36elbow out
38:37of its
38:37socket.
38:39So clearly
38:40from the
38:41x-rays,
38:41it shows
38:42that you
38:42have dislocated
38:43the elbow,
38:44but it's
38:44going to be
38:44difficult
38:44procedure to
38:45put it
38:45back to
38:45care.
38:46We'll
38:46try to
38:46sedate you
38:46as much
38:47as possible.
38:48With his
38:48ability to
38:49drive on
38:50the line,
38:50it needs
38:51to be
38:51realigned
38:52urgently.
38:53A treatment
38:54that requires
38:54two senior
38:55doctors,
38:56Dr. Aditya
38:57and Dr.
38:58Zoe.
39:00So I'm
39:00going to use
39:00a mask
39:01just because
39:01it makes
39:02it a little
39:02bit easier
39:02for you to
39:03get gas
39:03and air
39:04into your
39:04system.
39:05The night
39:06team use
39:06Penthox for
39:07fast-acting
39:07pain relief.
39:10Deep breaths.
39:11Doing well.
39:13It will
39:14relax Akram's
39:15muscles within
39:15minutes.
39:17Deep breaths
39:18and nice
39:19breath.
39:21Good man.
39:23Let's move on
39:24on that one.
39:25Go on.
39:27It's quite
39:28physically
39:28intensive
39:29procedure,
39:29both for the
39:30patient and
39:31for the doctors
39:31who are
39:31performing the
39:32procedure.
39:34It requires
39:36traction and
39:37counter-traction
39:37and put the
39:38bone back in
39:39place.
39:39Keep you
39:40taking deep
39:41breaths.
39:43Still awkward
39:44to bend,
39:45is it?
39:46The procedure
39:47needs extra
39:47force.
39:49While Zoe
39:50anchors Akram's
39:51elbow in
39:52place,
39:52Dr. Aditya
39:54pulls the
39:54forearm
39:54further from
39:55the socket,
39:57giving the
39:58joint more
39:58opportunity to
39:59slot back into
40:00natural alignment.
40:06It's all right,
40:07I don't know.
40:08You okay?
40:09You've done so
40:10well there.
40:12Looks better.
40:13How's it
40:14feeling?
40:15Well, I know
40:16the next bit's
40:17getting this cast
40:18on.
40:20Falling down the
40:20stairs can be
40:21quite serious.
40:22It can result in
40:23head traumas and
40:24other severe
40:24traumas like
40:25chest trauma.
40:26How does your
40:26elbow feel?
40:27Still being?
40:29We'll keep you
40:30in here for now,
40:30until the next
40:31day are ready to
40:32come and get
40:32you, okay?
40:34So all in all,
40:35yeah, he was
40:35pretty lucky to
40:36just have a
40:36dislocated elbow
40:37rather than any
40:38other traumas.
40:39Yeah, you feel it
40:40pretty, that was
40:41stupid.
40:42Did you like
40:42that pain, really?
40:43No, I'd like it.
40:54On the other side of
40:56the hospital,
40:59emergency doctor Alice
41:01wants to diagnose
41:0283-year-old Ian's
41:04severe abdominal pain.
41:06Breathe in and hold
41:08your breath.
41:12He waits for his CT
41:13results with wife
41:14Joan.
41:15Is this still as
41:16painful as it was?
41:18Very painful up
41:19there.
41:20Oh, that's right.
41:21You have a right
41:22selection of stuff
41:22here, as long as
41:23you don't move.
41:25All right, yeah.
41:26And have you felt
41:27sick again?
41:29No.
41:30Your report's back.
41:32Your report, your
41:33scan's back.
41:34So it's not
41:35actually the tummy
41:36at all, it's the
41:36pancreas.
41:39Right.
41:40It's not very happy
41:41right now.
41:42It's got a bit
41:43inflamed.
41:45Right.
41:46Your pancreas can
41:47cause loads of
41:48issues.
41:49It's really important
41:50in regulating a lot
41:51of things, including
41:52the sugar levels in
41:53your blood, but can
41:53be incredibly sore.
41:55It can also become
41:56necrotic, so it can
41:57die, and then that
41:59can make you really,
41:59really sick.
42:00His hasn't reached
42:01that stage yet.
42:02It's just inflamed.
42:04But he needs careful
42:05observation and pain
42:06management.
42:07Do you have any
42:08questions for me?
42:09No, I'm not going to
42:09be here.
42:10Yeah.
42:11Well, I would say
42:11you're coming in for
42:12bed and breakfast.
42:13He doesn't need to go
42:14for theatre.
42:15He can be managed
42:15conservatively, which
42:16is good because in
42:18somebody his age, going
42:19for a big operation
42:21can be very difficult.
42:23You might want to get
42:24yourself home.
42:25I'm here, okay, if you
42:26need me.
42:29Most people with
42:30pancreatitis, you can
42:31tell from the front
42:31door, because they are
42:32screaming.
42:32They are writhing in
42:34agony.
42:35He is, like, just
42:38very stoic.
42:40Okay.
42:41See you in the
42:42morning.
42:44Bye-bye.
42:45Bye-bye, love.
42:47Sorry about all that.
42:49Classic farmer.
42:50Yeah.
42:52Yeah, it's farmers.
42:55Great, Alice.
42:56You're very welcome.
43:05What's really important
43:06is that we continue to
43:07check your vision.
43:18So we're going to do a few
43:19scans for you for the head
43:20and the neck.
43:31I have to check the x-ray.
43:33It's perfect.
43:33Do you feel less pain?
43:35Now it's less pain, yeah.
43:36Oh, very good.
43:46What's next?
43:47What's next is that the
43:48surgeons will come and see you.
Comments