- 7 hours ago
Emergency - Season 6 (AU) - Episode 02
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00:00John started dodging a coming car.
00:03It's then resulted in him actually hit another park car
00:06and landed about five metres away.
00:09When your motorbike stops and you don't stop,
00:11you can have any number of injuries.
00:15He cannot feel his legs.
00:18Usually when we see this,
00:19it means that they're going to be a paraplegic.
00:22It's a disaster.
00:23Alright, let's go.
00:30Look inside my eyes and help me try to ease the pain.
00:34You're my lifeline.
00:36It's gonna be right.
00:41You're my lifeline.
00:44Reach out your hand.
00:47Take mine.
00:50Very worried for you, my friend.
00:52The blinds drink smashed abuse.
00:55He's actually stopped breathing.
00:57Oh, it's serious.
00:59Without intervention, he's likely to die.
01:01That's better.
01:03I need you to save me now.
01:20Royal Melbourne's newest recruit emergency registrar,
01:23Dr. Ruth, is juggling two big life changes.
01:27In the six months that I've been at Royal Melbourne Emergency Department,
01:30I've also got married.
01:33My husband, Jordan,
01:35we've been together for over ten years
01:37and I wouldn't have been able to do any of it without him.
01:41So I don't like working completely without one of my rings on.
01:44So I've found a necklace that I can wear
01:47that will safely hold my wedding band or my engagement ring
01:51while I'm doing anything particularly messy.
01:54No matter how hard the shift is,
01:56knowing that I'll be able to go home to Jordan is invaluable.
02:01But today, in a non-stop ED, the honeymoon is over and the pressure is on.
02:08Royal Melbourne receiving.
02:10An ambulance is minutes away with Dr. Ruth's first case.
02:14I've got a 54-year-old male that's been on a motorbike
02:17and it is a witness to strike the bonnet of an oncoming car.
02:22He has no sensation or movement,
02:24sort of distally or probably his locker region.
02:28MBA, deformed wrist, lower limb reflex loss.
02:31When you hear no sensation, no movement in the legs after a motorbike crash,
02:35you're very worried about spinal cord injury.
02:38But there are other things we need to rule out
02:39that could be more immediately life-threatening.
02:4254-year-old John was only three minutes from home
02:45when a collision with a parked car
02:48catapulted him over the handlebars of his bike.
02:51We think maybe he's got a broken spine and a broken wrist.
02:55So who's doing what?
02:57With the countdown to the man's arrival on,
02:59it's all hands on deck with Dr. Jonathan taking the lead.
03:03Hi. Come on in.
03:05Hi, John.
03:06We're going to get you over to the bed next door
03:07and then we'll all do a lot of things around you at once.
03:10One, two, three.
03:13John started dodging a coming car.
03:15It's then resulted in him actually hitting another parked car.
03:21He's then flipped over the top of it
03:23and landed about five metres away.
03:25He had significant sternal pain.
03:27From there down, he cannot feel any sensation whatsoever.
03:31This is pretty bad.
03:32When your motorbike stops and you don't stop
03:34and then strikes something,
03:36you can have any number of injuries.
03:38He's got pain in his chest and pain in his back.
03:41John, can you feel me touching both sides?
03:43He can't feel anything from there down.
03:45I've got a really bad feeling that he's got a spinal cord injury.
03:48Can you try to wiggle your toes again for me?
03:51I'm trying.
03:52The team immediately check for any sensation in John's legs.
03:56Can you feel it in here?
03:58Can you feel it down here?
04:00Can you feel it down here?
04:00Can you feel it down here?
04:01Can you feel it down here?
04:01It feels like ice.
04:02John saying that it feels like ice when his lower legs are touched
04:06is suggestive that there is damage to his spinal cord.
04:10Ready for x-ray when you are.
04:13If he has a really serious spinal injury, he may never fully recover.
04:19He will be a paraplegic.
04:21John, who's your next of kin?
04:24Facing the grim prospect of never walking again,
04:28John urgently needs his family.
04:31Our sister, who's that?
04:33Your sister.
04:34It's crucial.
04:35Nurse Eliza tracks them down.
04:37Oh, you just have to keep holding the light too late.
04:40Yeah.
04:41Oh, she's old school.
04:43Yeah.
04:44He needs to have his best people by his side immediately
04:48because he's terrified because he cannot feel his legs.
04:52I need my brother.
04:54I'm not just a you, please.
04:56I'm straight away, please.
04:57John shares a close bond with his older brother, Patrick.
05:02John's a pretty amazing person.
05:04He is really kind and giving and patient.
05:10He's the type of person that would give the shirt off his back
05:12for someone else.
05:14John is very, very important to me.
05:16You think the worst in these types of situations.
05:20How's the ultrasound route?
05:21Lungs are good.
05:22So lungs are good.
05:23I think he's got a sternal fracture.
05:24First tests reveal John doesn't have a punctured lung,
05:27but Dr. Jonathan is worried his chest pain could be critical.
05:32That's a big problem.
05:33There's many reasons why he'd have pain in his chest.
05:36He could have broken ribs, broken breastbone,
05:38but he might have done something even worse.
05:40Are you happy with the chest, or do you want me to do another one?
05:43Powerless as well?
05:44Yeah, yeah.
05:45There's lots of important structures in your chest,
05:48and it's never good when you've got chest pain in a trauma.
05:51Hmm, what's going on there?
05:53That's not normal.
05:54Like he's got a mass or a hematoma or an aorta or something.
05:58See that?
06:00That's not bad.
06:00That's bad.
06:01The x-ray reveals John's heart is in extreme danger.
06:05That's not good.
06:07Hello.
06:08I'm just going to look at your heart again.
06:10There's a widening around his thoracic spine.
06:12That might be there because he's got a fracture in that area,
06:15but his heart sitting there as well could be damaged.
06:19Your stomach feels sore?
06:20Under the chest.
06:22Under the chest.
06:22I'm looking for fluid or blood around the heart,
06:25which will cause him to have a cardiac arrest.
06:28In your chest, is it the middle part?
06:30Oh, under the chest plate.
06:32Oh, yeah, yeah.
06:39OK.
06:41When Director of Emergency Training Dr Cheung is on shift...
06:45Check out some of the bees. Hello.
06:46The nurses know a game of trivia could strike at any time.
06:51It's the talk of emergency.
06:53Really?
06:54I like to keep everyone on their toes,
06:57so I like to imagine the worst-case scenario
06:59that could happen to the patient,
07:00and if it does, there'll be no surprises.
07:04And today's contestants are nurses Abby and Ruby.
07:09I've got a 60-year-old female
07:10who's fainted maybe seven times since last night.
07:13She's got a low blood pressure,
07:14but heart rate is pretty quick.
07:16What should we give her?
07:18What's your pain?
07:20Anything else?
07:21It starts with I.
07:23I said front of them.
07:24They knew the answer.
07:30As Dr Cheung's next patient arrives,
07:33the questions turn to an injury rarely seen in the ED.
07:37So I've been told that there's a female patient coming
07:41who's been transferred from the Middle East
07:45with shrapnel wounds to her face.
07:47So she's relaxed.
07:49The patient, Ronim, is an Australian student
07:52who was studying dentistry in the West Bank
07:54when shrapnel from a bullet tore through her eye.
07:58To be honest, I'm still, you know, shocked by the event.
08:02I'm still trying to cope with it.
08:04I feel like I'm seeing, but I'm not.
08:06After unsuccessful eye surgery in Jerusalem,
08:10Ronim flew home to Melbourne for further treatment.
08:13How are you feeling? Are you okay?
08:16I'm still...
08:18Her mum, Rana, hasn't left her side.
08:25Hello.
08:27Hello.
08:28Hello.
08:29I'm sure nice to meet you.
08:30I'm one of the doctors here.
08:31How are you going?
08:32Yeah?
08:33It could be better.
08:34Yeah.
08:35I'll come around this way.
08:36Can you tell me what happened?
08:39So I was in my apartment in Abu Dhabi, Jerusalem.
08:42Mm-hm.
08:43The West Bank side.
08:44And out of the blue, we heard sound bombs.
08:48Yeah.
08:48My friend, she decided to take a look out the window.
08:52And we got shot at.
08:54The bullet hit the corner of the window.
08:57Mm-hm.
08:58And her face was covered in blood.
09:01But it wasn't her injuries.
09:03It was actually...
09:03Blood was actually coming out of my eye.
09:05The shrapnel.
09:06Yeah, the shrapnel hit my face.
09:08Yeah.
09:08My eye.
09:09And they did an operation on my eye.
09:10In Jerusalem?
09:12Yeah, to maintain the structure of the globe.
09:15Okay, yep.
09:15Uh, I was in contact with the Australian embassy regarding moving to Australia to continue with
09:21my treatments.
09:22So they helped me cross the borders from Palestine to Jordan.
09:26Okay.
09:27You've flown back from there.
09:28So tell me, have you got vision out of the eye?
09:31The minute I got hit, I...
09:33You've lost vision.
09:34No light, no light.
09:35Nothing.
09:35All right.
09:36So when I look at the eye, it is sunken.
09:38I'm very worried that she will not regain her vision.
09:41Any problem with the facial bones?
09:43No fracture?
09:44I do still have shrapnel in my face, so I don't know anything.
09:48That's all right.
09:48You lie back.
09:51Any pain on your cheekbones?
09:53Yeah, yeah, yeah.
09:53This side?
09:54Yeah.
09:54From the shrapnel?
09:55I think it's shrapnel.
09:56Yeah.
09:56A few other things on up here.
09:58Up there too.
09:59Just that I don't feel the side of my head.
10:01Okay.
10:02She tells me that she can't feel the side of her head.
10:04I'm worried that it's going to be permanent nerve damage.
10:07Also, there's potential for the shrapnel to penetrate the skull.
10:11If there's shrapnel in the brain, operating on the shrapnel could potentially kill her.
10:15We'll do another scan.
10:17In particular, we want to see where these shrapnels are in relation to the skull.
10:22So it must have locked the nerve.
10:24Anyway, the scan will tell us where they are.
10:27Any questions?
10:28Rana is fearful her daughter may lose her eye completely.
10:33The most important thing is that, you know, she has hope to save her eye.
10:40Yeah.
10:41So I'll speak to the eye surgeons.
10:44This is the most important thing that, you know, she has.
10:48Anyway, we'll go slow, all right?
10:52I don't want to give you false hope, okay?
11:02The most important thing is that, you know, she has hope to save her eye.
11:09Yeah.
11:10Dentistry student Raneem has lost vision in her right eye after a bullet hit the window of her apartment in
11:17the Middle East, pelting her with shrapnel.
11:20So I'll speak to the eye surgeons.
11:23After eye surgery in Jerusalem failed, she's desperate to know if Dr Cheung can save her eye.
11:31I'm not sure.
11:33Okay.
11:34All right.
11:34Okay.
11:40So I have to speak to the eye surgeons.
11:42I don't think she'll be able to ever see out of that eye again.
11:45So the next step now is whether she can preserve her eye.
11:50And then there is a patch of numbness to the right side of the scalp.
11:53It could be that one of the shrapnel's severed the nerve.
11:57What are you, sir?
11:57Take a moment now.
11:59I want to stay.
12:00I want to stay.
12:00Absolutely.
12:01Still in shock from her daughter's ordeal, Rana was at home in Melbourne when family broke the news.
12:10At first we didn't know it's a bullet.
12:14It was really, really a very horrific woman to hear.
12:19I have never imagined that her injury was so severe.
12:25I think we should give a formal history handover.
12:28Neurosurgeon Dr Mohamed's expertise is needed.
12:31I'm assuming at the moment, can you see how to have that eye on the doctor?
12:34No.
12:35Anywhere else?
12:36I think I got one in my ear, but it's really small.
12:39But it's just when I, you know, kind of like touch it, I feel it's sting.
12:43Yeah, okay.
12:44All right.
12:45Well, we'll get you a CT scan.
12:46Let's see what's going on first and take a minute.
12:50The team act quickly to get Ranaim scanned.
12:53Oh, yeah. CT is fine.
12:55Oh, yeah.
12:55She will have a CT scan now, which will identify all the metal fragments, how deep they are,
13:01how extensive they are, or whether there's any shrapnel inside her head or any neurological injuries,
13:06that may be something that we need to deal with.
13:08See you soon, alright?
13:10She's a dental student.
13:11She may not be able to go back to studying dentistry.
13:15This is an extremely significant, life-changing injury for her.
13:27As the day wears on in the emergency department, case numbers continue to climb.
13:33Royal Melbourne receiving.
13:35Good afternoon, Royal Melbourne.
13:37This is a patient with a left shoulder dislocation.
13:40We've had quite a delay in extricating this patient as he was under a house.
13:44He has a very altered sensation through his left hand, with reduced sensation in fingertips.
13:51With the patient's arrival imminent, emergency doctor Manny springs into action.
13:58We know very little about the story at the moment, other than he's been found underneath a house,
14:02and the ambulance crew think that he has dislocated his shoulder.
14:05There can be potentially serious injuries, and they're definitely extremely painful.
14:1129-year-old Radisson, an apprentice electrician, was working under a house when he reached back to grab a cable
14:18and felt his shoulder pop.
14:21He was trapped for an hour as fireys removed Briggs to get him out.
14:26Couldn't have happened in a worse place.
14:30Hey guys, Radisson?
14:32Hi Radisson, my name is Manny, I'm one of the emergency doctors.
14:35I'll let my ambulance colleagues here get you across and then we'll hear the story.
14:38Every movement the young Sparky makes causes him excruciating pain.
14:44So this is Radisson, this is his fifth dislocation.
14:47Right, so you happy considering this is already pretty much cut, if I cut the rest of the shirt off?
14:50Yeah, it's a lot of work shit.
14:51He's also got some numbness and tingling in his fingers.
14:54Yeah, looking at his sort of left hand.
14:57And he's had 7.5 of IV morphine.
15:01The ambulance is concerned not just with the altered sensation in the patient's hand,
15:05but also the fact that it's changing colour.
15:07There may be damage on one of the major arteries in the armpit, which is a medical emergency.
15:11Can you feel me touching on the outside of that hand?
15:14Yeah.
15:14And on the inside?
15:15Less so, yeah.
15:16So it's a less so along the thumb.
15:17Yeah.
15:18How about just around the shoulder?
15:19So it's very dull around there.
15:22You've clearly got an off-ended shoulder.
15:24The things that we're worried about sometimes when shoulders come out is not just the bony
15:28injury, but sometimes it can also stretch nerves around the shoulder joint, which is why you're
15:32still a little bit numb over there.
15:34So I think we should just crack ahead, get that shoulder back in in the next rate and see
15:37what we're dealing with.
15:38After five shoulder dislocations, this is a procedure the young Sparky knows well.
15:45I think given your past experience, probably just go straight to sedation.
15:49I agree.
15:49My priority in this situation is to get the shoulder joint back into its normal place as
15:54soon as possible.
15:55And certainly giving a sedative anaesthetic does help us make this experience a little
16:00bit better for him.
16:01I'm going to get one of my colleagues to assist me with that.
16:04Yep.
16:04Any questions about that at all?
16:05Nah.
16:06Oh, I do have pliers in my pocket.
16:08Oh, here we go.
16:08Pliers.
16:09Okay.
16:10I don't know if you guys need any.
16:10We're not going to need it to put the shoulder back in.
16:14Good on you.
16:14No worries.
16:16With Radisson on board with the plan, emergency nurses Georgia and Chris gather the proper
16:21tools for the job.
16:23Radisson, what are you going to do?
16:24Start giving you some oxygen before we put you off to sleep.
16:27Yep.
16:27Dr Scott arrives to help with sedation.
16:30Hi mate, I'm Scott.
16:32Hi mate.
16:32Have you had a general anaesthetic before?
16:35Yeah, first time in the hospital they gave me something, put me under.
16:38Yep.
16:38I don't remember it.
16:39That's okay.
16:40That's probably a good thing.
16:41They were surprised that it's so much.
16:43Okay.
16:43There are risks of any sort of anaesthetic.
16:46We want to find a sweet spot where they're asleep enough that they're not aware of the
16:50procedure and they're not suffering any discomfort.
16:53Giving more medications can increase the risk of side effects.
16:57In a lot of cases it will make them stop breathing.
16:59Alright, no objections to a starting.
17:02This is a high risk procedure and a team must follow a strict protocol.
17:07So we'll just run through the checklist.
17:10So departments, airway doctor, airway nurse, proceduralist, scribe.
17:15Alright, so I'm going to give 50 of propofol to start and we'll work up from there.
17:25Have you got feeling in your fingers or not?
17:27Yeah, you can move them.
17:28Yeah.
17:29I'm just going to look at your heart again.
17:30An horrific motorbike accident has left John paralysed from the waist down.
17:37Yeah, I've got a good view of his heart.
17:38But an x-ray has led Dr. Jonathan to a potentially bigger problem.
17:43A life-threatening injury to John's heart.
17:47With the ultrasound, we're looking for fluid or blood around the heart.
17:50So that's really serious.
17:58Heart's perfect.
17:59That looks fine.
18:00So there's no...
18:01I don't see a big aorta.
18:03So maybe that's something else.
18:04Yeah.
18:05You're doing well, mate.
18:06So I do the ultrasound and there's no fluid around the heart, which is great.
18:10And just confirming still loss of sensation.
18:12But for Dr. Jonathan, the relief is short-lived.
18:16We're going to have to turn to the real problem, which is why John can't move his legs.
18:20We're going to roll you on your side.
18:22Just want to have a feel down your back and see where it hurts.
18:25What I think I saw in that x-ray is a fracture.
18:27It's a bad one.
18:28If you hang on to your sore hand.
18:31All right.
18:31Oh, wow.
18:32Because his spinal cord's going to be injured probably around that area.
18:35One, two, three.
18:38Hi, John.
18:39Is there any pain where I'm pushing?
18:40No.
18:41No?
18:41Any pain down here?
18:43No.
18:44What about down here?
18:45Yeah.
18:46Yeah?
18:46Yeah.
18:47What is that?
18:48This is upper thoracic.
18:51Yeah.
18:54Where the x-ray looks funny.
18:56Yeah.
18:56Can you feel me touching down here?
18:58Near your bottom?
19:00Nothing.
19:01He's now tender in his spine, as well as not moving his legs.
19:04They are the classic signs of a spinal injury.
19:06Three and two.
19:08One.
19:09Terrified, he still has no feeling in his lower back.
19:12I need my brother or my sister, you please.
19:15John urgently needs the support of his family, who are on their way.
19:20Hello.
19:20How are you feeling?
19:21You're not moving your legs.
19:23Is that right?
19:23They don't move?
19:24Yeah.
19:24Yeah.
19:24Yeah.
19:25So we're going to get a scan and have a look and see what's going on.
19:29All right?
19:29Yeah.
19:31Well, we're going to try and work that out.
19:34Do you have any...
19:36Can you move them at all or not?
19:39I'm trying.
19:40Yeah.
19:41Yeah.
19:41Well, they've sort of all gone numb.
19:43Yeah.
19:43Okay.
19:48The main thing here is going to be that he can't move his legs properly, and that's
19:52the devastating injury.
19:53We can fix rib fractures and sternal fractures, but we can't fix spinal cord injuries.
19:57We've got high likelihood of a spinal fracture, but not everyone has a permanent injury.
20:02Some people have an incomplete injury, and some people actually recover.
20:06So we don't actually know what's going to happen.
20:09There's always hope.
20:10All right.
20:11Let's go.
20:2120-year-old Raneem has just been scanned to see if shrapnel from a bullet is dangerously
20:28close to her brain.
20:30If there's shrapnel in the skull, there's also a potential risk of the shrapnel breaking
20:34through the skull into the brain.
20:36So I'm hoping that there is no permanent brain injury.
20:39And also the CT will show me whether she's going to lose vision in her eye completely.
20:44When the shooting happened, Raneem was studying in the West Bank.
20:48Unable to get the treatment she urgently needed, Raneem was evacuated to Melbourne in a desperate
20:54bid to save her eye.
20:58As radiologists review her scans, emergency nurse Emma tackles Raneem's other injuries.
21:05I'll be able to just get the sutures out.
21:06Is it going to hurt?
21:08Look, I don't think so.
21:10It's just the skin's sort of grown over them a little bit.
21:16Raneem, she's a very brave girl.
21:20My biggest worry that the doctors will say, yeah, no, we can't save her eye.
21:27And how this will leave an impact on her life.
21:32I'll pop a little dressing room over there.
21:38The final report on Raneem's CT paints a confronting picture.
21:43I've been working in emergency for over 20 years and I've not seen an injury like this.
21:49Not in Australia.
21:50You can see more shrapnel on the nose, on the cheek and that's on the side of her scalp.
21:57There is so much shrapnel everywhere in the eye, in the face.
22:00It's just catastrophic how much these weapons cause these sort of effects on the body.
22:06That one's pretty close to the skull, but I don't think it's gone past the skull,
22:11so she hasn't got a broken skull.
22:12If the shrapnel had gone a couple of centimetres further into the brain,
22:17you could have died.
22:18This is the main concern.
22:20There's a large piece of shrapnel lodged within the right eye itself.
22:25That's the end of the eye.
22:27Might have to give her a prosthetic eye.
22:31Dr Cheung must now deliver the shattering news.
22:36Now, the thing with the eye, I don't think we'll be able to preserve their sight.
22:43I'll speak to them about the eye itself, but I think the vision itself could be lost.
22:49There goes my life.
23:01So it's a long journey for her from here.
23:03She's going to go up to the ward and she's going to be seen by multiple surgical units.
23:08So for her, the immediate question is, do we have to take the eye out?
23:13And then shrapnel on the rest of the body, it's almost impossible to remove every piece of shrapnel.
23:18There'll be a piece of metal in her for the rest of her life.
23:21A daily constant reminder of what happened to her.
23:24I thought I'd be honest with you.
23:26But we'll see about the eye itself.
23:29Yeah.
23:29She has a dream to become a dentist like her mother.
23:33But unfortunately, with the vision loss, I doubt that she will be able to.
23:37So this is a great tragedy.
23:41Raneem's hopes of keeping her eye now lie in the hands of eye surgeons.
23:47I'm thankful that I'm with my family, but it still does break my heart that my eye, my
23:55dreams, my vision, they didn't come along the trips, sadly, you know.
24:03Yeah.
24:18How are you doing there, Addison?
24:20How are you doing there?
24:21We'll try and get on top of that as best we can, but hopefully we'll have you nice and
24:24sleepy fairly soon.
24:25Hopefully.
24:26Dr. Manny and Dr. Scott are about to sedate Radisson so they can quickly relocate his
24:31shoulder.
24:33It's always busy here.
24:35It's amazing how you're thinking about us right now.
24:37Yeah, I'm thinking about that.
24:38The young Sparky's hand is tingling and turning blue, suggesting a bigger threat.
24:45I'm going to give 50 of propofol to start.
24:47We're worried about a nerve injury or a vessel injury.
24:49The safest and most appropriate thing is putting them to sleep and get the joint back into
24:53place as quick as possible to avoid that injury from progressing.
24:56This one sometimes stings a little bit as it goes in.
24:59Dr. Scott gives the first dose of the powerful sedative.
25:05Just try and keep your eyes open for us as long as you can.
25:08It doesn't work instantly.
25:10I can feel it.
25:12It doesn't work.
25:13No one's...
25:15All the secrets come out now.
25:19Man, there's nothing left to give, man.
25:23With the propofol, we'd usually give it in small doses.
25:26In this circumstance, we still haven't quite got the effect that we want.
25:29We often end up with a patient in what we call the twilight zone, where they're not quite
25:33asleep.
25:34We might need to think about reaching for a second vial.
25:37I'm going to give another 50 of propofol.
25:39Bro, this is going to ruin my D&D painting session.
25:43Or make it.
25:45Well, we'll try not to keep you here too long.
25:47Radisson's worry about his D&D painting has left the doctors totally bamboozled.
25:53What was the D&D plan, do you know?
25:56It was the first we're hearing of it.
25:5840K plans.
25:5940K?
26:00What's that?
26:01I don't know.
26:02Young people.
26:04Oh, Warhammer.
26:05I don't know young people things anymore.
26:08Warhammer's been around for years.
26:10I'm not single enough for embracing.
26:12But Radisson's off-the-wall chat is nothing new to Nurse Chris.
26:17You were not a nerd in school?
26:18That's 50 in.
26:20I was, but in a different way.
26:22Different kind of nerd.
26:23Warhammer 40K is a tabletop game with miniature figurines.
26:26Dr Scott and Manny don't seem to have an idea of what we're talking about.
26:29But Radisson and I, I know that we're speaking the same language.
26:33Happy if we try to lie flat?
26:35Yeah, go for it.
26:38Still with us there?
26:40With the sedation kicking in, the team make an attempt to get Radisson's shoulder back into place.
26:46You need anything from me?
26:48Not at the moment.
26:52I think I'm going to need more sedation from you.
26:55In fact, quite a lot.
26:56You're okay, mate.
26:58Just trying to get that arm into a better spot, okay?
27:01With Radisson's shoulder still not in place...
27:04I'll just get the traction on.
27:06Oh, no.
27:07Dr Scott gives more sedation so Dr Manny can try again.
27:11So, George, I'm going to give you another 50.
27:14This will be 250 so far.
27:20You're okay, mate.
27:22You're still resisting me quite a bit, this guy.
27:25Yeah.
27:29Radisson has had a really high dose of sedative medication.
27:32We do run the higher risk of causing problems with breathing.
27:36I'm still getting a little bit of resistance.
27:38But I'm desperately hoping that we're successful with this attempt.
27:42Oh.
27:47There you go.
27:50Oh.
27:51Well done, mate.
27:52Finally, Radisson's shoulder is back in place.
27:56So, this is usually the risky part.
27:58But now, there's potentially an even bigger problem.
28:02So, once we've stopped giving him a painful stimulus,
28:04all that anaesthetic catches up to them,
28:07so they often stop breathing now.
28:09That's exactly what happened.
28:10Radisson, big breaths for us, mate.
28:12Usually, we can tolerate about 30 seconds of a patient not breathing.
28:15Anything beyond that, the oxygen levels can drop very, very quickly.
28:18We might need to hook them up to a ventilator to support their breathing.
28:22Big breaths.
28:23Big breaths.
28:24Take some deep breaths for us.
28:2629-year-old Tradie Radisson is not breathing.
28:30Radisson.
28:31After he was heavily sedated,
28:33so Dr Manny could pull his dislocated shoulder back into place.
28:38I'm just going to go bed down, Chris.
28:39Yep.
28:40Radisson.
28:40Big breaths, mate.
28:42Come on.
28:42All done.
28:43If he doesn't start breathing within 30 seconds,
28:46the team will need to take urgent action and put him on a ventilator.
28:51Hey Radisson.
28:52Open your eyes for us.
28:54All done.
28:54Take some nice big breaths, yeah?
28:57There you go.
28:58Big breaths for us.
28:58Well done.
28:59Back we go.
29:00Still got a pulse.
29:01We can rotate.
29:02Yep.
29:03Once he's starting to show signs of breathing on his own, it's usually a sign that the anaesthetic's wearing off
29:07and that we're out of the danger zone.
29:10Hey Radisson, open your eyes.
29:11It's all finished.
29:12You're slowly waking up.
29:13It all went really, really well.
29:15We're just going to get an x-ray now and make sure that it's all good.
29:18Okay.
29:19Thanks, Manny.
29:20We're going to head around for x-ray now.
29:22I hear if you get to 10 dislocations, you get a superpower.
29:26Well...
29:27The x-ray will show if Radisson's shoulder is in exactly the right spot and there's no nerve damage.
29:34So if you hold nice and still we'll take that first picture, okay?
29:37Yep.
29:37With Radisson all smiles, Dr Manny can finally see if the procedure has worked.
29:45We've got the shoulder successfully back in position.
29:47Very happy with that.
29:49We'll get him home shortly.
29:51Hey Radisson.
29:52Hey mate.
29:52How's the hand feeling?
29:54Better.
29:55Better?
29:55Basically it looks like everything's okay.
29:57It's back in position.
29:58What we'll do is we'll move you to our rapid stay area just to keep an eye on you for
30:01another
30:01half hour or so and I'll organise your discharge paperwork, okay?
30:05Thanks, Manny.
30:05But before Radisson can leave, Dr Manny is curious about Radisson's mysterious D&D plans.
30:12What do you remember about what you may have told to us while you were under?
30:16What did I say?
30:17Something D.
30:18Oh, you know, Dungeons and Dragons.
30:20Dungeons and Dragons, thank you very much.
30:22At the end of the work today I was gonna meet up with like five friends of mine and paint
30:26our little miniatures.
30:28Luckily I paint with the right hand, so hopefully I can keep a steady hand today.
30:32Should be fine.
30:34Pleasure.
30:35See ya.
30:46John, we're gonna do the rolly thing again, okay?
30:48Where you stay still and we move you, okay?
30:51Just onto the CT scanner bed.
30:53A motorbike accident has left 54-year-old John with potentially devastating injuries.
30:59You might be able to walk again.
31:01We'll see from the scans.
31:02Don't think about that now.
31:04We don't know.
31:04We need to get the scan and we'll find out, okay?
31:07John is starting to realise the gravity of the injuries he might have.
31:12It's hard to know the best way to answer these questions when I don't have all the answers.
31:17John, I'm just about to start that injection.
31:19Warm feeling coming.
31:21Yeah.
31:31It's got a big hematoma and a fracture, hasn't it?
31:34Yeah.
31:35Yeah.
31:36Hmm.
31:37What's impacted?
31:39Well, I don't know what it is, but it's probably T2 or something like that.
31:43Yeah.
31:43Let's see, huh?
31:45So he's got a fracture.
31:46It looks like where we saw it on the plane film.
31:48So high up on his thoracic spine.
31:50Looks like the bone's shattered.
31:52And that would explain why he's not moving his legs.
31:55One, two, three.
31:56Down, two, three.
31:59Oh.
31:59On three.
32:00One, two, three.
32:01Exactly.
32:02Good job.
32:03Good job, John.
32:04As John is taken back to the trauma bay, Dr Jonathan stays behind, waiting for the specialists
32:10to confirm just how badly John's spine is injured.
32:17Did my back break when I fell down from the air?
32:20Yeah.
32:21Yeah.
32:22It's been bad news.
32:24It's not great.
32:24It's not great.
32:25But we'll know more what they can do about it when their specialists have had a look.
32:28And they'll come soon.
32:29Okay?
32:31Maybe you can't speak to you.
32:33Not necessarily.
32:34Don't think about it now.
32:36We'll know more in a bit.
32:37Okay?
32:40I'm going to see my face back burning.
32:42Yeah.
32:43She's coming.
32:45As we get more and more of the results of the scans, it's hard to work out what to tell
32:50John.
32:51We can't know what the injuries are for certain.
32:54So until that, there is still hope that these injuries aren't as serious as they seem.
33:10We'll see what the rest of the film looks like.
33:1654-year-old John has survived an horrific motorbike accident that has left him with a fractured spine.
33:23To find out if he'll ever walk again, Dr. Jonathan has called in specialists to review the CT scans.
33:30Is there a bit in the spinal canal?
33:32Yeah, so he's just got a burst fracture.
33:34There's a bit of bone that's just sticking into the canal.
33:36Into the canal.
33:37The whole thing is disrupted.
33:39Yeah.
33:39Yeah.
33:40Usually when we see this, it means that the person's not going to be walking again.
33:44They're going to be a paraplegic.
33:45This is something that we can't fix.
33:48It's a devastating thing.
33:50What else can I say?
34:01John, I've had a look.
34:03You do have a really bad fracture in your T4 vertebrae.
34:09So about sort of this level in the back.
34:11Your legs, they're not working now.
34:13And that's probably because your spinal cord's been damaged.
34:17Living in the leg.
34:19I'm worried that you won't walk again from what I'm seeing.
34:22Is that bad?
34:23Yeah, it's bad.
34:24That's why you're not moving your legs.
34:27All right?
34:28Yeah.
34:29Yeah, I'm sorry.
34:30That's what we're worried about.
34:32Yeah.
34:33All right.
34:38Oh, it's awful.
34:39I mean, you know, we have to get bad news very often, unfortunately.
34:45It's what happens in emergency.
34:47John?
34:48John's older brother, Patrick.
34:50Patrick here.
34:52And sister, Roselle, finally arrive.
34:55Very good to see you.
34:57Well, hopefully God will be the same acute.
35:01You know, we're praying for you to storm in heaven.
35:03There's a whole team now that will look after John.
35:06He'll go to intensive care.
35:08The surgeons will decide whether he needs an operation or not.
35:11And then he'll usually go to one of the spinal units to be looked after there.
35:28I'm just gonna take a little break.
35:30As one of only five nurse practitioners in the ED, nurse Meredith's specialist skills are often in high demand.
35:37Oh, hello.
35:40How are we?
35:42An emergency nurse practitioner is a nurse who has had a number of years' experience in the emergency specialty and
35:51the master's degree.
35:52That means we can actually independently diagnose illnesses and conditions.
35:58I do sometimes, you know, give my little family a call.
36:02Nurse Meredith juggles her fast-paced job with being a mum.
36:06Yeah, so this is Eleanor, our daughter's six, daddy and daughter.
36:12She loves performing.
36:17Nurse Meredith is urgently called back to the ED.
36:21I'm two hours of sleep.
36:23Oh, you poor thing.
36:24Oh, you literally just flew back in.
36:25Yeah.
36:2626-year-old Brianna has rushed to the ED straight from the airport after cutting short an overseas holiday with
36:34mates.
36:34So, what's happened?
36:36Oh, I got bitten by a dog.
36:38Oh, dear.
36:40Okay, in Vietnam, sure.
36:42And where was the bite?
36:43Yeah, okay.
36:45Yep.
36:46Not too bad.
36:47Sure, sure.
36:48But they obviously got their teeth in.
36:50We don't know that that was a rabid dog, but we're gonna assume that it was.
36:53This bite wound we would consider as a category three exposure, which means it's the highest risk.
36:59So, even though this looks like such a small, innocent wound, if Brianna were to develop rabies, unfortunately, her chances
37:07of survival would be pretty much zero.
37:10So, did you sort of get attention immediately for the bite?
37:13Um, no.
37:15I went to sleep, so I was a bit drunk.
37:16Yeah.
37:17And then it was like bleeding, but I just kind of covered it up.
37:20Okay.
37:20Had you had a rabies vaccine in the past?
37:23Knowing rabies can be fatal, Nurse Meredith needs to quickly understand how at risk Brianna is.
37:30In 2019, but I don't know.
37:32Okay.
37:32I don't think I had the full amount.
37:34I'm gonna go and do a bit of hunting around on the computer and see what I can find about
37:38your vaccine record and sort of see what we need to do in terms of treatment to stop you from
37:43getting rabies.
37:44All right.
37:47While Nurse Meredith goes in search of her health records, Brianna's own research has sent her into a spiral of
37:55anxiety.
37:56I didn't know much about rabies at all.
37:59I didn't get vaccinated for it before Vietnam.
38:02My worst fear is I guess I could die from it.
38:09It's deadly.
38:10Yes.
38:11Nurse Meredith is worried 26-year-old Brianna could have contracted the fatal virus rabies after she was bitten by
38:18a dog while on holiday in Vietnam.
38:22Brianna's come back early from her trip to make sure that she can get the right treatment and it's a
38:27category three.
38:28It's a high risk exposure.
38:29Nurse Meredith is urgently checking Brianna's vaccination record.
38:34So she has her My Health record activated.
38:38To be fully protected against the virus, Brianna needs to have had three rabies shots.
38:44And I can see she's actually had one, two, three doses.
38:52So she's actually had a full course, which is great.
38:55Armed with all the information, Nurse Meredith updates a very anxious and sleep deprived Brianna.
39:02Poor thing.
39:03Hello.
39:04Sorry.
39:05Good news.
39:06I've checked.
39:06I managed to check your vaccination record.
39:08So you did have the full course.
39:10You had three rabies vaccines in 2019.
39:13So all you need is one more vaccine today.
39:16Wow.
39:16And then you're actually good.
39:18Yeah.
39:18So you'll be well protected.
39:19That's awesome.
39:19So we'll grab that for you now.
39:21And that's done.
39:22Yeah.
39:22Awesome.
39:23Yeah.
39:23So I can really understand Brianna's anxiety today.
39:26This is a really scary thing to have happen.
39:28And we see a lot of people returning from their travels.
39:32And even if they've sought the treatment that they should, there's still that unknown.
39:35And there's still that fear that something bad's really going to happen.
39:39All right.
39:40Try and relax your arm as best as you can.
39:43Okay.
39:44Sharp scratch.
39:45Emergency nurse Rob gives Brianna the booster.
39:49The one vaccine I didn't bother to do this time around, and I got bitten by a dog,
39:55but it looks like the 2019 one got me, saved me, pulled me through.
40:01Very happy.
40:02Very relieved.
40:03Have a good night's sleep tonight.
40:12Apprentice Sparky Reddison was rushed to the ED after he became trapped under a house
40:18with a dislocated shoulder.
40:20Couldn't have happened in a worse place.
40:21Fearing the 29-year-old's dislocation had caused nerve damage, Dr. Manny and Dr. Scott
40:28sedated him to rapidly relocate his shoulder.
40:32There we go.
40:33After a short stay in hospital, Reddison was discharged in time to make it to his Dungeons
40:38and Dragons painting session.
40:41Australian student Raneem was left with extensive shrapnel wounds after a bullet hit the window
40:47of her student accommodation in the West Bank.
40:50Have you got vision out of the eye?
40:52The minute I got hit, I lost my vision.
40:55CT scans confirmed the 20-year-old would never regain vision to her right eye.
41:01But questions remained about whether her eyeball could be saved.
41:05I'd have to give her a prosthetic eye.
41:10After multiple surgeries to remove shrapnel from Raneem's face, neck and chest,
41:15surgeons turned their attention to her eye.
41:19Before I used to be actually a lot faster, but now because of the vision thing, sometimes
41:24I just poke it in and it just doesn't land where it's supposed to.
41:27The most impactful surgery was the removal of my eye.
41:30There was a piece of shrapnel 2.9 millimetres long.
41:35It basically cut my eye in half, so they just took out the whole thing.
41:41Here's the thing.
41:42Now they have got both offers, one at Griffith University and one at Melbourne University.
41:48It's not an easy decision.
41:49Now recovering at home with the support of her mum Rana, Raneem is focused on her future.
41:57My main objective, which is to be a dentist, that's not going to change.
42:01If I'm going to be like, this is too hard for me, I've admitted that I have been defeated
42:06and I'm not going to do that, no matter what.
42:09I'm not going to let it define me.
42:11I'd like to thank everyone who has helped me throughout this journey.
42:1654-year-old John was rushed to the ED after an horrific motorbike accident
42:21left him unable to move his legs.
42:24Can you feel me touching down here?
42:26Nothing.
42:27CT scans confirmed a fracture to John's spine had damaged his spinal cord,
42:33leaving doctors doubting he would ever walk again.
42:36I'm worried that you won't walk again, from what I'm seeing.
42:39Is that bad, Doctor?
42:40Yeah, it's bad.
42:42After spinal surgery, doctors could finally confirm
42:45the true extent of John's injury.
42:48Hi, John, how are you?
42:49Hi, Paulina, how are you, darling?
42:51I'm good.
42:52Oh, that's good.
42:52I'm ready to get in my chair.
42:54Alright, lovely.
42:55I remember the doctor's face coming to tell me,
42:59sorry, John, but you've got about a 3% chance to walk again.
43:04That's when I knew that I'd be in a wheelchair for the rest of my life.
43:08How's that?
43:08Good?
43:09Yeah, how are you feeling?
43:10Yeah, good, darling.
43:11In one way, I do thank my lucky stars, because I guess it could have been lights out.
43:19Despite the months of rehab ahead, John is determined to live his life to the full.
43:25I'm blessed, really.
43:26They have such a beautiful family.
43:28They do love me.
43:29I'm a paraplegic now.
43:31More than ever, it's important to have that support.
43:34There's not too many bad days in rehab, I'll be honest, because the people in the front line,
43:39such as the nurses, incredible.
43:41They've given me the confidence and encouragement to be able to get out into the public on my own.
43:48So I can do most things most able people can do.
43:51Hey, Daryl.
43:52Hey, John.
43:52How's it going?
43:53Yeah, good, Daryl.
43:54Yourself?
43:55Yeah, good.
43:56I went with your beard, anyway.
43:58I had to come off, mate.
43:59It's bloody hot.
44:00Yeah, you look 10 years old now.
44:01I feel 10 years old.
44:03But you missed a bit.
44:04If you have a whole life after an injury like this, it's going to be okay.
44:08And I'm going to make the most of my new life.
44:10I'm not going to let this get me down.
44:13That's not me.
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