- 20 hours ago
A and E After Dark - Season 7 - Episode 02
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00:03after dark while the nation sleeps 16 year old male who was shot the A&E night shift begins
00:11can be very dangerous we deal with a lot of aggressive patients things can escalate
00:18can be quite scary when it's just you and one violent position across the UK we join the staff
00:26of three of the most challenged emergency departments it's always busy it's always under
00:31pressure time is of the essence and the medics who face danger each shift most shifts I see more
00:38place than nurses with the amount of drugs and alcohol admissions rising have you been drinking
00:43today the risk of violence and abuse looms large every night please don't swear like that they try
00:50to attack and stuff calm yourself down people can become aggressive you've been punched okay
00:59you see the good bad and the ugly yeah we'll get security the emergency department is like a
01:05battlefield it's like organized chaos every night staff and patients in any waiting rooms across
01:23the UK are subjected to the abusive behavior of intoxicated patients it's estimated that up to 15
01:32percent of A&E attendances are alcohol related so do you understand the reason why you're arrested
01:37we always have disruptive patients or aggression there's been times where I have felt frightened
01:43you don't know what to do in that exact moment there there's nothing you can do other than hope you
01:48don't get really hurt and at weekends after dark that percentage can rocket to a massive 70 percent
01:55gentlemen who assaulted outside of pub today high numbers coming through a lot of them obviously
02:02under the influence of drugs alcohol every single shift there will be somebody arrested
02:20in Belfast royal Victoria A&E the security team are attending a disturbance in the waiting room
02:50with the woman clearly under the influence of alcohol deputy sister Rebecca and the security team are
02:56worried about her upsetting the rest of the patients she was shouting all around the place she made a few
03:18racist comments
03:19to many people in the waiting room and was very loud and aggressive about it
03:24this is absolutely
03:26f**k
03:27f**k
03:27f**k
03:28f**k
03:29f**k
03:29f**k
03:30f**k
03:30f**k
03:31f**k
03:31f**k
03:31f**k
03:32f**k
03:33f**k
03:33f**k
03:33f**k
03:34f**k
03:34f**k
03:35f**k
03:39f**k
03:48f**k
03:49f**k
03:52f**k
03:53f**k
03:53f**k
03:54f**k
04:18f**k
04:19and get you seen by a doctor, but, you know,
04:22we can't tolerate that kind of behavior.
04:24Wait, what are you doing?
04:26So, um, one more chance, really,
04:29and then it's just to be removed, okay?
04:30Are you gonna get to the same bad doctor?
04:31What do I do?
04:33Right, what do I do?
04:33You tell me.
04:44I'm sitting here with a shoulder hanging right here.
04:50Also in Belfast, 21-year-old Roberta
04:53has been rushed in by her father and sister
04:56after a high-impact fall at home.
04:59No, slow, slow, deep breaths, they said.
05:02Hey, that's not a cigarette. Ow!
05:05She's already been x-rayed
05:06and given a Penthox inhaler for the pain.
05:10It's actually still not working.
05:12Well, it's not working.
05:13Argh!
05:15Could we get another one of those?
05:17Probably not, in the waiting room.
05:19So, let me check.
05:22I need some nigh.
05:24I know.
05:25I know.
05:26The Penthox inhaler needs to be used constantly.
05:29If it runs out, the pain-killing effects
05:31wear off quickly.
05:32Oh!
05:36Please!
05:37I know.
05:38Please.
05:39I know, darling, there's nothing to do.
05:41Absolutely nothing I can do, I'm sorry.
05:43Ugh!
05:47It won't be long.
05:48It won't be too much longer.
05:49It won't be too much longer.
06:03Are you running?
06:13Please.
06:14All right, sweet kids.
06:34Let's go.
06:34The next step is we're going to get Mike and he's going to get the green whistle again,
06:37okay?
06:38And we're going to try and settle you down and relax you a bit.
06:40Ugh!
06:41Have you checked the skull?
06:43Is it okay?
06:43So, just showing your shoulders dislocated, okay?
06:47So, the ball of the humerus bone has just popped out, okay?
06:52So, what we're going to do is just try and put it back in place, okay?
06:55And you see the most important thing?
06:56See if you can keep really relaxed.
06:57Obviously, you're in a lot of pain, then we're going to try and relax you.
06:59But the more relaxed you are, the easier it is for us to do.
07:02Okay.
07:03Just take some deep breaths, okay?
07:05I'm going to try and make it easier to calm.
07:06All right.
07:07Ugh!
07:08There's a lot of ligaments in that joint that are being stretched and in the wrong position.
07:13The longer the joint is out of socket, the longer it is very, very painful.
07:18Ah!
07:19Roberta fell over four hours ago.
07:21If the shoulder is not put back into position soon,
07:24there's a risk of permanent nerve damage and ongoing severe pain.
07:29Ugh!
07:30Ugh!
07:33Ugh!
07:36Ugh!
07:46No!
07:47No!
07:47No!
07:47No!
07:47I'm going straight up!
07:49Police are an almost permanent fixture in A&Es up and down the UK.
07:53Oh!
07:54Ah!
07:55I do not have an issue ringing 999 to try and get police and escalating my concerns that
08:00I have staff to look out for, I have myself to look out for and I have other vulnerable
08:04patients to look out for as well.
08:06Oh!
08:10Officers spend an estimated 800,000 hours in the department every year.
08:15Just stay nice and calm. Thank you.
08:17I think an ED often feels like a bit of a police station.
08:21Normally in resus it is quite chaotic anyway. Add police, add nurses, add radiologists, add all
08:29your needs.
08:30What points are you reading, mate?
08:38Come here, f*****g. I'm here so I can make up all your needs.
08:43In Belfast, Deputy Sister Rebecca has given a drunken disruptive patient one more chance
08:49to behave before she's removed.
08:52Please, what can you do, Rebekah?
08:54I do love my job but there's easier ways to make money. I'm just like what am I doing
08:59with my life?
09:00But, you know, it doesn't really kind of limit to just the weekends anymore.
09:05It's all of the time really. Monday to Sunday, every night of the week is just the same.
09:10Alcohol, drugs, and then, oh, there's something happening out here.
09:18Sorry, excuse me.
09:23Right, we'll move you out.
09:29Sweetheart, we can't have you getting involved, okay?
09:32I want your name. I want your name. I want your name. I want everybody's name. I came here
09:37for treatment and you took me in the sack of glass.
09:40Sweetheart, we need to get you to leave.
09:42No, no, no. I want names.
09:45You do?
09:45See what you're saying to me? It's disgusting.
09:48Well, you're standing in the waiting room just harassing other people. There's a full
09:51waiting room here of people who are afraid.
09:53What are you doing?
09:54Right, come on. Let's talk outside.
09:56No!
09:58Patients who are being fairly aggressive, we'll have to approach them in a calm manner,
10:02explaining to them why they can't behave like that. You know, it is obviously putting
10:05other patients at risk, scaring the staff.
10:08Listen, there's been times where I have felt a bit frightened. Recently, I was assaulted.
10:14You don't know what to do in that exact moment. It is quite frightening.
10:18You're being fairly, fairly aggressive to everybody in this waiting room, okay?
10:21You're frightening.
10:22You're lying?
10:23Right, we can't have that in this department.
10:25You treat me like I'm a sacking bastard.
10:28No.
10:28And I don't like it.
10:29We're not. We treat everybody here the same, okay?
10:32We're not going to be able to let you back in whenever you're behaving like this.
10:35Okay.
10:35I don't care.
10:36All right.
10:38That's fine.
10:38You don't want that.
10:40That's okay.
10:40Right?
10:41Yeah.
10:42That's okay.
10:44Right, we're going around in circles here.
10:45She's not really looking to listen to what I have to say.
10:48Right, he's happy enough to support art.
10:55The intoxicated woman will have to leave the hospital untreated due to her behaviour.
11:02I always like to give people a chance.
11:04However, there is a line and you can't cross it.
11:07We just can't allow that kind of behaviour, you know.
11:10Patients are leaving our department to go home because they can't bear to watch what's going on anymore.
11:15They feel threatened, they feel unsafe, so therefore they leave.
11:19These are normally the people who actually need to be there and treated for something really wrong
11:24and then they go home and deteriorate, which is not ideal at all.
11:44Hi.
11:44I'm speaking to Newham A&E.
11:46Can I better seat up the pelvis, please?
11:48In Newham A&E...
11:49I want to be wrong.
11:51I want to be wrong.
11:51A midwife has been taken seriously ill in the hospital at the end of her evening shift.
11:55So, she had some right iliar fossa pain this morning with a bit of vomiting in the past hour.
12:00She's now 10 out of 10 pain in the right iliar fossa.
12:04We've done the bloods, but they're not back yet.
12:07Dr Karl is trying to help 33-year-old Agnes, who has had extreme stomach pain for over 12 hours.
12:13I think there is a mentality of still coming to work even when you're feeling unwell within the NHS.
12:18Unfortunately, you can push yourself too hard and then you end up here.
12:23Obviously, you're in a lot of pain when you came in.
12:25And the first things we did is we just got some blood tests from you, OK?
12:29And we're giving you some fluids and some painkillers as well.
12:32I've already spoken to the radiologist to give you a scan.
12:35So, we're going to scan your tummy and down into the pelvis.
12:38I'm a bit worried that your appendix might either burst or be very, very angry at me.
12:46Intravenous morphine has reduced Agnes' pain, but her condition could be deadly if her appendix has burst.
12:56I thought I could manage my shift and then go home so that I could get some painkillers as well.
13:02I realised I couldn't.
13:04Then my colleagues put me here.
13:06I've not experienced this kind of thing before.
13:11My biggest concern for Agnes right now is that she might have a ruptured appendix,
13:15but we can't rule out other causes.
13:18And in young females, you always need to think about things like ectopic pregnancies,
13:22or ovarian torsion, or ruptured ovarian cysts.
13:25So, the next step is to wait for the blood to come back and to get her into the CT
13:29scanner
13:30to see if we can find what's going on and to see whether or not it's the appendix that's causing
13:33this problem.
13:35The longer it takes to diagnose the source of Agnes' pain,
13:39the higher the risk of life-threatening complications like peritonitis and sepsis.
13:45How bad is the pain out of 10?
13:47How will you grade it?
13:49It's 9 or 10.
13:51So, can I have it look at your tummy, please?
13:54Yes.
13:56Surgeon, Mr. Shahzad, has come to assess Agnes before her scan, as she may require surgery.
14:03Is it sore here?
14:05No.
14:07Is it sore here?
14:08No.
14:08Sore here?
14:09No.
14:10Is it sore here?
14:11Yes.
14:12If you make a big cough for me, please.
14:15Cough.
14:17It hurts when you make a cough?
14:19Just slightly.
14:20Okay, that's fine.
14:23On examination, she's tender in righty leg fossa with a little bit of guarding.
14:28Let's see what CT shows.
14:30So, if it's appendicitis, we'll apply it on her.
14:34With surgeon Mr. Shahzad unsure,
14:37a CT scan may be the only way to know if Agnes' appendix or an ovarian cyst has ruptured
14:43and her life is in jeopardy.
14:45I was in CPAPN before.
14:47I don't know what it was.
15:02It's six in recess at the moment, and one is going to ITU.
15:06Four and intoxicated.
15:07I'll assess it when it arrives.
15:10In Newham recess, a man is arriving who fell while intoxicated, causing a head wound.
15:16You can come to this bed.
15:18Well done.
15:19He was found unresponsive.
15:21Members of the public tried to wake him.
15:23So, he's got a laceration there.
15:25Yeah.
15:25It's bumped to his head there.
15:27Clearly happened with his hat on.
15:28Yeah.
15:28He's still got a bit of blood in there.
15:30Okay.
15:30Unknown to any members of the public.
15:32No one knows where he's come from.
15:34They've just literally found him lying on the floor.
15:37We don't know much about this gentleman.
15:39His last historic case was at the beginning of January,
15:43where he had a fall down stairs, sustaining a head injury,
15:47and that was after being intoxicated again.
15:49Okay.
15:51Do you know where we are at the minute?
15:55No?
15:56We're in the hospital.
15:59Do you know what day it is today?
16:02No?
16:02Do you think you might have had a few drinks?
16:07Yeah?
16:08How much would you drink normally?
16:09What do you think you might have drank today?
16:11Just one?
16:13Yeah.
16:14One beer.
16:15Okay.
16:16All right.
16:16Nothing else?
16:18You got any pain anywhere?
16:22No pain?
16:24Normal.
16:26All right.
16:27Because what you've done is you've got a bang on your head there.
16:29You've been bleeding a bit on your head.
16:31Did you not notice that?
16:33So you don't remember falling over?
16:35No?
16:36Nothing like that?
16:39You don't remember?
16:40Okay.
16:44So there's a problem with the housing?
16:47Okay.
16:49He's drunk quite a lot tonight.
16:51He's already explained that he's having some trouble
16:53paying his rent for next month,
16:55and now he's also telling my colleague
16:57that he's also been fired from work.
17:00So it starts to make sense why he's here in the middle of the night,
17:03very heavily intoxicated and having fallen over and injured himself.
17:08I'm going to get a CT of his head.
17:10Would you mind just to clean up the wound and see?
17:13Right side of the head.
17:14Just a little bit.
17:15See if it needs a drop of glue.
17:16Okay.
17:16We're going to get a scan of your head to make sure everything is okay.
17:19All right?
17:20Yeah.
17:22With the patient under the influence of alcohol,
17:24Dr Sarah requests a CT scan to make sure his behaviour isn't related to a brain injury.
17:29So we're going to clean up your head a bit.
17:31All right?
17:32We're going to come back and see you after you've had your scan.
17:35Okay?
17:36Okay.
17:50She's screaming the place down here.
17:54Dr Mike and Dr Dara are about to attempt to get 21-year-old Roberta's painfully dislocated shoulder back into
18:00its socket.
18:02Please give me something.
18:04Come on.
18:05I think we can maybe get you onto this bed.
18:07No!
18:08I need something please!
18:09Can she have any pain relief before?
18:11Is this just an absolute agony?
18:14The problem with it is once it kicks in you'll be very relaxed and it's safer to get you onto
18:19the bed first.
18:21I mean, I can't.
18:23It took me 20 minutes to get into the car.
18:25I can't.
18:27Does she need to be on the bed before she can have that?
18:29Ideally, yes, because the problem is we're going to do your deduction on the bed.
18:33Sorry.
18:35We'll go slow.
18:36We'll go at your pace.
18:37Watch it.
18:37Watch it.
18:37Watch it.
18:37Watch it.
18:37Watch it.
18:38Watch it.
18:38Watch it.
18:38Watch it.
18:38Watch it.
18:38Watch it.
18:39Watch it.
18:40Watch it.
18:40Watch it.
18:40Listen to me.
18:41Listen to me.
18:41Hey, come on.
18:43Too much pain medication within 24 hours carries a risk of kidney and liver damage.
18:48So Roberta's last dose is being reserved for manipulating the bone back into its joint.
19:04Put your feet on the ground.
19:05Right?
19:06And we're going to do it.
19:07One, two, three.
19:08Stand up.
19:09Stand up.
19:09That's it.
19:10That's it.
19:10That's it.
19:10You're off.
19:11You're off.
19:11Pull it away.
19:12Pull it away.
19:13Stop.
19:13Stop.
19:13Stop.
19:14You're pulling it on your bed.
19:17That's what she's...
19:18Great.
19:18Here you go.
19:19There you go.
19:19Back on it.
19:20Just like the car.
19:36now in position she can be prepped for the arm to be manipulated into its socket but this will
19:42be even more painful do you think you can release this hand because it's best that you're in control
19:47of this no I can use my teeth before she did after a couple of breaths the first time she
19:53had it in her
19:54hand she was like she was smoking it after about two or three puffs she was fine the Penthox inhaler
20:00is a fast-acting pain medication that can be self-administered nice big deep breaths I'll get
20:07you as comfortable as possible for about your job now is just to keep taking that green whistle for
20:12me lovely slow big deep breath we see a lot of patients with shoulder dislocations and it is
20:19very very painful the muscles that are used to usually keep it in the socket essentially are
20:25in high tension and high force and are keeping it now out of socket because the pain and is causing
20:32the patient to be so tense keep taking that part of keep taking the muscle roberta needs consistent
20:52pain relief to ensure her muscles are as relaxed as possible keep going big deep breath through
21:02ah come on big breath even with the inhaler working it will only dull the pain so the doctors
21:08need to work quickly to slip the arm back into position oh well it's going in that sector good girl
21:22well done keep going Roberta's arm has been out of its socket for four hours and the shoulder muscles
21:29have become incredibly tense keep breathing love
21:36where the joint has been out for longer can be sometimes a bit trickier and often that's because
21:41the muscle has maybe gone into spasm and the patient's in a lot more pain we don't get it under
21:46control until we've got that joint back in place we're nearly there okay nearly there just another
21:51wee bit love you'll be okay hold on to me
22:10he was collapsed and was in cardiac arrest over two and a half million people attend a and e at
22:17night every year
22:21which is particularly challenging for the reduced night shift staff
22:38how are you doing donning how are you feeling an intoxicated patient has just returned from the ct scanner
22:44after being found unresponsive on the floor with a gash on his head we had we did we got the
22:49ct result
22:50was okay all right we did a ct of your head do you remember no you don't remember we might
22:58have to
22:58wait until he's sober enough to go when he arrived the man explained he's been having money trouble
23:04after losing his job can you just turn over so i can see your head again just to see to
23:09see if we cleaned
23:10it up all right it's really unfortunate that it's it's a bit of a downward spiral isn't it that you
23:14know
23:14you're having problems then you drink then you hurt yourself and it goes round and around we can step
23:19him out and then i think we just keep him somewhere until he's awake enough to go home yeah i'm
23:25gonna
23:25take you to a room there and clean the wounds okay is that all right we need to keep him
23:35safe and so
23:36we're going to keep him in the department really until he's sober enough to go home safely because at
23:40the minute he's not really remembering everything that's going on and things so we just want to keep
23:44safe here for uh until probably till the morning now you want to sit up a bit yeah sit up
23:50i need
23:50to clean this side so i can clean your head yeah when you're working in the night the problem is
23:55that
23:55no one else is working in the night and so we don't get much support from other services that's a
23:59real
23:59bit of a gap really that we're just doing a bit of patching up and then sending people home without
24:03really giving any long-term solutions anything and everything is what a and e stands for
24:25doctors mike and dara are struggling to manipulate 21 year old roberta's arm back into its shoulder
24:30socket sit back at you good girl despite being medicated with strong pain relief
24:36out come on the muscles in her shoulder remain tight making it incredibly hard to move the bones
24:43into the correct position sometimes when reductions are particularly tricky then we have to apply counter
24:48traction just try traction horizontally this is essentially where we use a sheet and to apply
24:58a force in the opposite direction and that just gives us greater force in order to try and get the
25:04shoulder into joint that's when you're getting in the brute force territory you don't really want
25:11that you want them relaxed come on i know i know i know the counter traction should allow the doctors
25:18to pull the ball at the end of the arm bone around the edge of the joint and back into
25:22position
25:24but they're fighting against extremely strong tense muscles in the shoulder
25:55the longer it takes to get roberta's shoulder joint back into
25:58position the more chance she has of permanent nerve damage and potential corrective surgery
26:04come on roberta oh breathe breathe breathe in come on roberta breathe in breathe
26:12stop on this come on
26:17out that's it that's it that's it that's it that's it that's it that's it that's it
26:23oh god did you see it happen i heard it so we'll just need to get it in a sling
26:28and get another x-ray
26:29okay
26:29and then we'll take it from there
26:32no problem no problem absolutely no problem there good you are well done proud of you yes
26:39yeah so it focuses it's incredibly satisfying when a joint just falls into joint and you get a nice
26:45satisfying clunk you probably have to take that off you know you've had your fun
26:51sorry don't upset her i'm so sorry don't be upsetting her okay can i have one more one last puff
26:57because it's it's really sore isn't it that's why you're taking one more puff then that's it away
27:04while roberta's shoulder appears to be now in the correct position there's no way of knowing
27:09without a follow-up x-ray should i have to go back around the action then i can go home
27:12yeah
27:13yeah if you're if you pass if the joint isn't in the correct position you take it easy okay yes
27:20mom
27:20it could be causing further damage to her shoulder or become dislocated again it's hard it's hard to watch
27:26your child you know in pain um and it's you feel sorry for her and really really your heart goes
27:33out then just gotta just gotta take it off this move that is what it is
27:41this is where our humerus was this is where we are back in joint we had to use a little
27:46bit more
27:47force than we had hoped we would uh but thankfully it did work the joint is perfectly back where it
27:54should be and patients get to go home how do you feel now you feel a lot better it just
27:59feels a
28:00a wee bit like muscle pain but i can it's there okay and you'll be followed up in the fracture
28:04clinic obviously if it you hear popper it seems to go back out of place obviously come back to any
28:09hopefully that won't happen okay all right yeah thank you very much worries at all there we go let's get
28:26you home
28:27new come any good evening hello
28:32in newham resus a patient who is on a fancy dress night out has arrived after collapsing at a train
28:37station this is celeste she's 27 years old she was on her way out tonight dressed up um she had
28:45a
28:45passion fruit alcoholic drink 13 minutes later she started feeling a very dry throat but then
28:50progressively got more itchy and then she felt like it started swelling
28:55passion fruit is an allergen and can trigger a serious allergic response
29:01heart attack my throat suddenly felt like very dry and like my tongue like my mouth area felt very dry
29:07and then i started having trouble breathing and like that freaked me out my breathing was like
29:13like that and i could it felt like i couldn't get enough like air in um they gave me the
29:20injection
29:20when i was on like the floor and i was able to kind of like set up a bit more
29:24after that and they were able
29:25to like move me you know i don't think so with adrenaline administered at the scene to combat the
29:32immediate reaction dr muhammad needs to make sure celeste's breathing and heart rate are back under control
29:38so your heart will get down with time normally if you had an adrenaline you should have six hours of
29:46monitoring
29:50either celeste's fast pulse is because of the adrenaline she was given or the allergic reaction
29:56so she still might be in serious danger
30:02okay let's have a look
30:04got her attached to our monitoring over here typically for an allergic reaction anaphylaxis you monitor them
30:11for a period of like six hours just to see if there's lack of reaction
30:15fingers crossed
30:17it's terrifying like to to not be able to like breathe properly you're like
30:22because you start getting lightheaded and you start feeling like you're gonna like pass out
30:26or like something's really wrong and it's just it's really scary
30:32i was like am i gonna die here on the g platform
30:42accident and emergency good evening how can i help 64 year old male with a high high bm
30:50also in newham midwife agnes is being taken for an emergency ct scan after having severe abdominal
30:57pain while on shift don't worry it's a quick scan won't take too long yeah doctors need to establish
31:04as if her appendix as if her appendix has burst which could be deadly
31:08keep your both hands above your head
31:11like that get same over here there you go hold like that
31:16like the cushion is gonna say breathe in and hold your breath okay
31:47okay
31:49metallic taste in their mouth and you might feel like you're going to vomit yourself.
31:56The vomiting could be due to the contrast but it's also a symptom of a burst appendix.
32:01You have to explain to the patients why this is happening and these
32:05symptoms so that they are aware of it and a bit more calmer.
32:10Surgeon Mr Shuzad has been monitoring Agnes's case and reviewing her scans.
32:15So we had a CT scan. It showed that your appendix is normal.
32:22So it means you don't need surgery. So there was a concern whether you have some
32:29infection of your kidneys on CT scan. But it's not very clear.
32:34So what we'll do, we'll give you some antibiotics. Good night.
32:41Agnes is out of danger but her suspected infection is still extremely painful.
32:48We will keep her overnight and we'll reassess in the morning with our consultant on call team
32:54and we'll discuss her scan with our own radiologist and so that we can have some more clarity about
33:02her kidneys.
33:15Sorry I've lost you I think. Oh yeah sorry can I just confirm GCS?
33:20That's all right. Yes please.
33:2566 year old Terry has come into A&E after crashing his motorbike.
33:29Things happen so quickly and I'm not exactly sure what happened. But a deer came from the left hand
33:36side and crossed my path. I then hit it and I was away. You know I was flying.
33:43His daughter Jessica and her partner Daniel rushed into A&E when they heard about the collision.
33:49Do you feel dizzy or nauseous at all anymore?
33:51No, not really. But that feels the least of my problems, my head. This wrist is painful.
33:59Dr Eniola is treating Terry after his accident.
34:03He was riding a bike and a deer popped up from the view. He hit the deer, he fell down
34:10off the bike.
34:11There are deers around the area so and they pop up from time to time.
34:16Deer are more common at night and early morning and headlights cause a freeze reaction making them
34:22deadly obstacles.
34:24Any headaches now?
34:26No.
34:26No headaches. Any hand pain, any foot pain?
34:29Yeah, this is quite painful and that too is quite painful.
34:34We're trying to look out for other injuries that may be marked by the more obvious one. So it could
34:40be a broken bone but there could be an abdominal injury. It could be a fracture in the chest, in
34:48the ribs.
34:49Any head pain anywhere?
34:51No.
34:52No.
34:52Not your tongue?
34:52No.
34:53Can you open your mouth? Bring out your tongue. Okay.
34:58So we try to make sure that we don't miss out on any other
35:02injuries which may be potentially life-threatening.
35:12Some abdominal injury but it doesn't look worrying because his observations are also fine.
35:18But he sustained some injuries on the right wrist and on the left toe as well.
35:26Being reassured by Terry's vital signs, his abdomen is likely okay.
35:31Dr Eniola turns his attention to potential broken bones.
35:34So if I can just get you to face that wall there and then you roll up your galaxy.
35:40Like that?
35:40You're fine. That's it, perfect.
35:46Okay, a few holes still there.
35:50Over half of the bones in the human body are in the hands and feet combined.
35:55So you're just going to bend his leg knee because you want them to slap like that.
35:58Making them incredibly vulnerable to breaks.
36:03And one more for your toes.
36:05The worst case scenario, if it's untreated, the patient could have crippling pain, chronic pain,
36:11throughout the years if that area isn't treated on time.
36:17Yeah, I won't be sleeping on that side tonight, though.
36:19The worst case scenario, if it's untreated, the patient could have been treated on time.
36:39The worst case scenario, if it's untreated, the patient could have been treated on time.
36:49So I think I'll share the x-rays.
36:51He's been x-rayed, as there are suspected breaks in his hands and feet.
36:55So the big toe, you can see there's a fracture, and it's fractured in two places.
37:01Oh, bloody hell.
37:04I can't understand that. Big milk with both boots.
37:07That's right. The wrist looks fine.
37:10The wrist looks fine?
37:11Yeah.
37:11Oh, my goodness.
37:13Even though there seems to be no breaks in Terry's hand, he could still have a fracture of the scaphoid,
37:18a collection of small bones in his wrist.
37:21It can be easy to miss things on the x-ray.
37:23There are some fractures that are a bit small and subtle,
37:26so physical examinations are quite important.
37:31The x-ray can only show so much.
37:33Of course.
37:34It really show everything.
37:36So, well, because of the bruising, yeah, I'm suspecting there may be a little bone break.
37:43If Dr. Eniola doesn't find all the fractures,
37:46there's a chance he could heal in the incorrect position,
37:48which could lead to chronic pain for the rest of Terry's life.
37:52The pain has a touch.
37:54Yeah, a little bit painful, yeah.
37:57It appears that there's a fracture, yeah.
38:01Yeah, there's a fracture.
38:02Yeah, there's a fracture.
38:04Okay.
38:04Dr. Eniola has spotted a scaphoid fracture not clear on the x-ray.
38:09But for this, we put a strap around here to make sure the fracture heals.
38:15Yeah.
38:15Same thing with this.
38:17Okay.
38:17In about two to three weeks' time, we'll do a repeat x-ray.
38:21Okay.
38:21So that everything is okay.
38:23Yeah.
38:28Before Terry can go home, his breaks will need to be given temporary orthopaedic support
38:32to help them heal.
38:33Oh, I'm a little bit surprised that I've got a slight fracture of the two
38:40and this section of the thumb, it could have been a lot worse.
38:44So, yeah, I'm pretty lucky, really, I think.
38:46And it's been really good service tonight.
38:49I've been really looked after.
38:51I can tell people have been on a skiing holiday.
38:55This is your fashionable shoes.
38:59It's doing okay, considering the mechanism of the injury.
39:03Okay, I expected something a bit more drastic.
39:07The purpose, sir, is to immobilize your thumb.
39:10Keep it still.
39:11Keep it still, so it will reduce the swelling, reduce the pain.
39:15I'm recovering time for him, considering his age.
39:19It may be between about six weeks to ten weeks.
39:24Much appreciate it.
39:26Terry will need to return to the fracture clinic in the day,
39:29once the hospital is completely open for permanent treatment.
39:34It really could have been a lot worse, so I think that he's quite a lucky chap.
39:40Yeah, not too bad.
39:51Hello, Rizos.
39:52In Newham, 27-year-old Celeste is being closely monitored
39:56to see if she'll have any further potentially lethal anaphylactic reactions.
40:01Yeah.
40:01You're going to take up the wires on your chest.
40:03Mm-hmm.
40:04Um, the quality is going to take you somewhere near the main waiting.
40:08Yeah.
40:09Yeah.
40:10With the hospital needing to free up space and her condition remaining stable,
40:14she's moved to an observation area.
40:16I don't know where they've put like more of those.
40:24Come on, see you, bro.
40:26You doing all right?
40:28Come on.
40:29Oh my God.
40:30Celeste is joined by a partner, Ori, who is with her on the way to the fancy dress party
40:34when she had a reaction and her airway started to close.
40:38Isn't like anaphylactic shock, like, can't it kill you?
40:41I guess it depends how much her throat closes.
40:44You can Google it.
40:44It's a severe, potentially life-threatening allergic reaction that requires immediate
40:50emergency treatment.
40:51Mm-hmm.
40:57Dr. Mohamed has been monitoring Celeste for signs of further allergic reaction.
41:05Her heart rate, um, last time I checked it was 19, which is, which is good.
41:09One of the most concerning thing about anaphylaxis is, um, your airway is closed.
41:14So you've been suffocated, basically.
41:17But she was quite lucky.
41:19The ambulance came there early.
41:21What you need to know is, um, you need to go home with EpiPen.
41:24Mm-hmm.
41:25Okay, so EpiPen have, um, adrenaline on it.
41:29If you have, um, symptoms that you think your, your throat is closing,
41:33you can't talk in false sentences, you're very wheezy, you're unwell, you're about to collapse.
41:39Yeah.
41:39This is a red flag that you're looking for before you're injecting yourself with that.
41:44EpiPens are essential, as 2.4 million people have food allergies in the UK,
41:49and could die of fatal reactions.
41:51And you swing.
41:53Fuck.
41:54Okay.
41:55You, that's not, that's real?
41:57You actually have to, like...
41:59You swing and push it.
42:00Oh, snap.
42:01I thought that was, like...
42:02I've only ever seen that, like, um, movies and stuff like that.
42:07Any questions?
42:08Did I almost die from this?
42:11Like...
42:12You, you have a reaction, okay?
42:14You, yeah, you're lucky.
42:16Um, and the ambulance found you in a good time.
42:20They were very fast, they were so fast.
42:22Yeah, yeah, yeah.
42:23They saved your life, basically, did they?
42:25With no further signs of anaphylaxis, and equipped with an EpiPen, Celeste can go home.
42:30I need that, man.
42:31Taxi.
42:32Taxi, taxi.
42:34We can take the train.
42:45We're happy to get you seen by a doctor, but we can't have that behaviour here, here, so...
42:49Fuck behaviour!
43:06You would think desiccating the shoulder wouldn't be as sore.
43:09Oh, it's sore, love.
43:11And then putting it back in is going to be even sore.
43:32Have you been well done?
43:33That sounds embarrassing.
43:36So, have you been well done?
43:38Have you only got to the hospital?
43:47Well, luckily I'm retired, so I don't have to go to work.
43:56I'll just do a bit more reading, I suppose.
44:16Excuse me.
44:22Bye.
44:34Find out good.
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