- 24 minutes ago
Emergency - Season 6 (AU) - Episode 01
Category
📺
TVTranscript
00:01A 41-year-old gentleman was out in front, and then suddenly collapsed, headstrike right
00:07on the concrete from standing high.
00:09Hit the buzzer, someone.
00:11This is a life-threatening emergency.
00:14We're going to need to ventilate him.
00:16On three, one, two, three.
00:18He's stopped breathing.
00:20We've got about four minutes before Jared might die.
00:24Have we got a pulse, guys?
00:25I can't feel a pulse.
00:27Can someone else feel it on the other side?
00:29All right, I've got a pulse.
00:41Oh!
00:41All my life, life, life, life, it's gonna be right.
00:49All my life, life, reach out your hand, take my hand.
00:57I'm very worried to you, my friend.
01:00The Bones drink smashed abuse.
01:02He was like, she's not breathing.
01:04Oh, yeah.
01:06Without intervention, he's likely to die.
01:09That's better.
01:10I need you to save me now.
01:24When you're open 24 hours a day, seven days a week,
01:28there's little quiet time for staff
01:30at one of the busiest emergency departments in Australia.
01:34The CAMS 5 are clear to land.
01:37Yeah.
01:38Thanks, bye.
01:39Today is only emergency nurse Attilo's second day
01:43coordinating the whole ED floor.
01:47Rob moment received.
01:49I just got the kicking and there's blood coming out of his ears.
01:56And radio problems with air ambulance
01:58are making it a baptism of fire for the 26-year-old.
02:02Can you please repeat that?
02:04Radio is cutting out.
02:08It's a super steep learning curve.
02:10Today we've had helicopters arriving,
02:13there's crane crews up there
02:14that I need to tell to get down from the roof.
02:17Right now I have 38 patients under my care.
02:20It's really exciting.
02:21It's fun and challenging.
02:24And...
02:24Yeah.
02:25I've got to pick up this call.
02:28Royal Melbourne receiving.
02:30Oh, yeah.
02:31So surfing with headstrike.
02:37Surfer Andre has been choppered in from Cape Patterson,
02:42150 kilometres down the south coast of Victoria.
02:46Hamstreet.
02:47Yeah.
02:48The 53-year-old was surfing with mates
02:51when he came off his board,
02:53hitting his head on a sandbank.
02:55And nurse Attilo is on the case,
02:57finding him a spare trauma bay.
03:00Naomi, where are they now?
03:01With the ED bursting at the seams,
03:04Trauma Registrar Dr Alex has arrived to help.
03:08Oh, here's the hands.
03:09Good morning.
03:10G'day, mate.
03:11This is Andre.
03:11Hello. I'm Alex.
03:12I'm one of the trauma doctors.
03:14Where are you saw, mate?
03:15The neck.
03:16The neck, hey?
03:18Got a bit of sand in situ.
03:20Yeah.
03:22Hello.
03:23My name's Ebony.
03:23I'm one of the nurses.
03:24I'll be looking after you on the other side.
03:26One, two, three.
03:28Up.
03:28Okay.
03:29The team is so concerned about the potential
03:32for serious spinal injury,
03:34they're keeping him strapped rigid
03:36to the paramedic's inflatable stretch heart.
03:39Okay, guys, this is 53-year-old Andre.
03:43He was surfing with friends this morning.
03:45He's gone to catch a wave and he's dumped.
03:47The sound is only just underneath the water.
03:49He's collided with his forehead.
03:51Yeah.
03:52He found himself in waves upside down,
03:54but he felt no movement or sensation in all four limbs
03:58for about 15 minutes.
04:00Footage shot from the beach by Andre's mates
04:03show his paralysed body floating face down in the water.
04:08It was only when a wave flipped him onto his back
04:11he could breathe and call out for help.
04:15His friends were able to assist him in a supine position
04:18up the beach to safety
04:20where he still had no movement of legs and arms.
04:24His predominant symptom is complaining of high cervical neck pain.
04:29My biggest concern for Andre is that he has a high neck injury.
04:33It rings big alarm bells for me
04:35that he's been paralysed for 15 minutes.
04:38You clearly hit your head.
04:39Did you black out?
04:40No.
04:40No.
04:41I just couldn't move afterwards.
04:44Yeah.
04:44It was pretty bloody scary.
04:45Yeah, absolutely.
04:46You feel weak in your hands at your moment?
04:48It's a head killing me.
04:50It's like pins and needles that doesn't go away.
04:52Pins and needles.
04:53Sorry.
04:55Who do you live with?
04:57My wife.
04:57I've got three kids.
05:00Andre's wife Helen was on the beach when the chopper arrived.
05:06When I arrived on the beach I was crying because Andre looked terrified.
05:10It was very hard to see someone you love like that.
05:13He was in a lot of pain and couldn't move his hands and feet.
05:16He was paralysed.
05:18Do you work?
05:19Yeah.
05:19What do you do?
05:21Groundskeeper.
05:22Groundskeeper.
05:23With such a physical life that he lives, injuries like this could be absolutely life-changing.
05:29I'm definitely worried that there's a possibility Andre might never walk again.
05:33Is it sore up there?
05:34Well, I can't really feel much.
05:37You can't really feel much.
05:44Emergency doctor Sarah is completing her usual walk into work after having said goodbye to
05:50an excited youngster at home.
05:54A lovely morning this morning.
05:56My nine-year-old is just turning ten.
05:58So, birthday weekend.
05:59I try and walk or run in before a shift.
06:04Today I've listened to my favourite podcast.
06:06It's time that I really love.
06:08It helps kind of separate home from work because once you walk through those doors, it's all
06:14happening and you've just got to be ready to go.
06:20Morning, morning, morning.
06:21Are you back here or are you...?
06:22Yeah, I'm out here.
06:23Yeah, cool.
06:24Alright.
06:25As Dr Sarah hits the main floor, she's unaware her first case of the day is happening outside
06:31the hospital's main entrance.
06:34Usually the best way to do this is to go on either side.
06:37Absolutely.
06:38A man has unexpectedly collapsed, smashing his head on the pavement.
06:43And the hospital's emergency response team has raced to the scene.
06:47He just started spinning and collapsed.
06:50Are the brakes on the band?
06:51Yep.
06:52Right, let's go.
06:53As Jared crashed to the ground, wife Nomi was unable to catch him.
07:00All of a sudden, he just collapsed and smacked his head.
07:05I've got no idea what's fully going on.
07:07We're just going to get this really uncomfortable board out from underneath you, okay?
07:11One, two, three, four.
07:13The 41-year-old is semi-conscious.
07:15Dr Sarah is quickly brought up to speed by emergency registrar, Dr Mitchell.
07:21The 41-year-old gentleman just suddenly collapsed.
07:24Headstrike right on the concrete from standing high.
07:26And did anyone see what happened?
07:28The whole time.
07:28And did he have a seizure or no?
07:29One of the things that I'd worry about is, has he had a seizure or a heart attack
07:34or some other medical complication that's caused him to fall?
07:39Because it's unusual to be standing outside the hospital on the footpath
07:43and suddenly have a fall and hit your head.
07:46Leave it completely.
07:48I know it's sore.
07:49You need to leave it.
07:50Hello, sir.
07:51I'm Dr Whitelaw.
07:52I'm Sarah.
07:52I'm one of the emergency doctors here.
07:55And are you the lovely gentleman's wife?
07:56I am.
07:57Okay.
07:57Is that painful, sir?
07:59Is it sore when I press?
08:01Yeah.
08:01That's a bit sore, is it?
08:02Yeah.
08:03Okay.
08:03So I think we should put a drip in and we'll go from there.
08:07Yeah.
08:07Do you have good bands both sides, mate?
08:10I'm just going to pop a needle in, okay?
08:12Good luck.
08:12Dr Sarah immediately starts looking for the cause of Jared's mysterious collapse.
08:18You were outside.
08:19All of a sudden he started to spin.
08:21Really hard.
08:22Before I could even get him, he went down and hit his head.
08:25Okay.
08:25He does have epilepsy.
08:27Okay.
08:27He was diagnosed at 11 with it.
08:29And how long was it before he started to wake up?
08:32Only a couple of minutes.
08:35His wife tells me that he has epilepsy and she thought he actually had a seizure.
08:41I'm thinking now that's actually why he's fallen and hit his head.
08:45He was unconscious for two minutes.
08:48I'm really concerned that he's hit his head so hard that it's caused him to be unconscious, potentially, from bleeding
08:55in the brain.
08:56I know he got tired.
08:57I know he got tired that his veins were thin.
08:59Right.
09:00If Jared does have a bleed on the brain, another epileptic seizure could be catastrophic.
09:06It's critical Dr Sarah gets medication into him immediately.
09:11It's not going to be easy.
09:13It's too easy.
09:14The angle of it is a little bit difficult.
09:16It does look quite little.
09:18But his veins are proving hard to find, even using an ultrasound.
09:24My gosh, sir.
09:26You are definitely a challenge.
09:34We're going to have one more go.
09:36Let's have a look down here.
09:39Okay, hon.
09:40You're just going to try once more.
09:42Can I get you to make a fist there for me?
09:44Oh, that's good.
09:45So good.
09:46Maybe if you just hold it.
09:48Oh, oh, oh.
09:49Suddenly, Dr Sarah's worst fear is happening.
09:52Jared's having a seizure.
09:54Jared!
09:55Jared!
09:55Do you want to pop the side of the bed up there?
09:58Yeah.
09:59Okay.
10:00That's all right.
10:01Okay.
10:01How's it going there?
10:06I've just hit the emergency buzzer.
10:08I'm really worried that as part of the seizure, he's obstructed his airway and stopped breathing.
10:14This is a real acute emergency.
10:28Okay.
10:29Hit the buzzer, someone.
10:34Dr Sarah is trying to save the life of 41-year-old Jared, who's having a seizure after collapsing
10:42and hitting his head on the pavement outside the hospital.
10:45We're going to need to give him some oxygen and a bag mass valve.
10:48Jared!
10:49Yeah.
10:50The seizure has closed Jared's airway and now he's stopped breathing.
10:55The team is desperately trying to stabilise him.
10:58We're giving Ian Medaz and then we'll need to give him support his airway.
11:02We need to open up his airway.
11:05I don't have IV access, so we're going to have to give the anti-seizure medication through
11:11his muscle.
11:12That takes longer to work, but in Jared's situation, this is a life-threatening emergency.
11:18So hook up the oxygen to the wall.
11:20If we can turn him over, that would be terrific.
11:23And then we will, yeah, turn him over.
11:25You are so helpful.
11:27We might get you to pop out though.
11:30I'm hanging out now.
11:30We're going to need an oxygen mask, peeps.
11:33And then have we got a resus bed to go to?
11:36Yeah, which one?
11:37Resus one.
11:38Perfect.
11:39Dr Sarah fears Jared needs an urgent procedure to take over his breathing.
11:44They need to get him to a specialised bay immediately.
11:48We're going to need a bag valve mask.
11:50Yeah.
11:50Get him in a good airway position.
11:52Let's go to resus one.
11:53Just as they're moving Jared, his mum Carol arrives.
11:57Are you ready to transit?
11:59Yeah.
11:59Have we got an oxygen cylinder?
12:01Yeah.
12:02Okay, let's go.
12:03Many people do die from epilepsy and just one seizure.
12:07My worst fear at the moment is that Jared could die.
12:11Get someone to plug the bed in so we can manage his airway.
12:14Craig and Maria, we're going to need to ventilate him.
12:18Trying to get oxygen into Jared, the team manually pump air into his lungs.
12:24Have we got nasopharyngeals?
12:26Yeah.
12:27Perfect.
12:27Pop it in.
12:28Have we got a pulse, guys?
12:31Is he breathing?
12:34You guys got a pulse?
12:36I can't feel a pulse.
12:37Okay.
12:38Okay.
12:38If Jared's heart has stopped as a result of him not breathing, this isn't a life-threatening
12:44situation.
12:46We only have seconds to turn this around.
12:48Can someone else feel on the other side?
12:50Okay.
12:50I don't think I can pull a hole.
12:58How much is your pain out of ten?
13:01At the moment, probably five.
13:02Five out of ten?
13:03Okay.
13:04Groundsman and surfer Andre has a suspected broken neck and spinal injury after he came
13:11off his board and violently head-planted into a sandbar.
13:15He's shivering, he's cold, the poor thing.
13:18We should cut the wetsuit off.
13:20Wetsuit off?
13:21The 53-year-old's life was saved when he was dragged, paralysed from the surf by his
13:26mates.
13:27Bend, bend, bend.
13:29Oh.
13:29What hurt?
13:30That hurt back up.
13:32In your back?
13:32Top of my neck.
13:34When you moved your arm?
13:35When you moved my shoulder, yeah.
13:36Oh, yeah.
13:37The main thing that we're thinking about at the moment is your neck, which I'm sure you've
13:41already figured out.
13:42Yeah.
13:43That's the thing I'm worried about, too.
13:44Yeah, so basically the aim of that is keeping you nice and still, alrighty, and we're
13:49gonna get some scans done to have a look.
13:51Alrighty.
13:52Gonna go for a drive to CT.
13:53How's your pain now to 10?
13:56Getting back up.
13:59Oh my goodness.
14:00You've got clumps of sand on ya.
14:03Knowing that Andre's incredibly anxious over what could be a devastating injury, Nurse
14:09Ebony does her best to distract him.
14:12I just don't know how you're gonna get it out of your dreads.
14:15Stand locked.
14:15I'm sure it is.
14:17I'm just having a chat to Andre just to try to keep his mind off these scans, because
14:22we both know that this could be really, really scary.
14:25I've been an emergency nurse for 13 years, and I've seen very similar cases where it's
14:31been catastrophic.
14:32So anything to keep his mind off that.
14:35On three, one, two, three.
14:42They should have just called the ambulance.
14:45Being on the front line in emergency medicine wasn't the first career Registrar Dr. David
14:51tackled.
14:52So she'll need to go to recess.
14:53About five minutes.
14:54Yeah, easy.
14:55In my 20s, I was a professional rugby player.
14:58I played for the Wallabies.
15:00It was definitely the peak of my career in the game.
15:03Because she has radiological tension, I don't want her to tension.
15:06Like all sports, you can't really do it forever.
15:09So I had to think about a long-term career, and I was initially interested in medicine
15:15through my exposure to sports doctors, and the mindset is very similar to the mindset
15:21of a high level in sport.
15:23Where's Jay Pat?
15:24With the ED almost at full capacity, Dr. David's next case is already waiting.
15:31It's all happening.
15:3249-year-old vet, Kristen, is on a working holiday with her family.
15:37Yes.
15:38Yes.
15:38Thank God.
15:40She was about to board a plane for Sydney when continuous chest pain and shortness of
15:45breath rang alarm bells.
15:47It becomes odd for me.
15:48Okay.
15:49I love you.
15:50Bye.
15:51After getting an x-ray of her chest, Kristen brought it into ED.
15:56This is the lungs, the chest.
15:58Like, see that's all lung there, that's on the right.
16:01And that's all free gas, so that it's pushed the lung out.
16:05It's called pneumothorax, where the bit of the lungs popped.
16:08And that's like the heart and the mediastinum.
16:10That should be here.
16:11Yeah.
16:12So it's pushed across.
16:14It's not good.
16:15They can become unstable and can die if it's not fixed.
16:19Hello.
16:20How's it going?
16:21So what's happened?
16:21We flew from London to Perth two weeks ago.
16:26Flew to Melbourne on Sunday night.
16:28And Monday I felt pain from the shoulder.
16:31Yes.
16:31Tuesday I felt breathless.
16:33Yes.
16:34Today, frankly, I would have gone on the plane.
16:36Yeah.
16:36But I'm a vet and carrying my own stethoscope.
16:38So I listened to my lung and I could hear no breath sounds.
16:42Yeah.
16:42And that freaked me out.
16:43It was definitely the right call.
16:46Luckily, Kristen's medical knowledge as a vet stopped her getting on the plane.
16:50The change in air pressure could have caused a fatal heart attack.
16:55So obviously like the air is basically pushed the lung.
16:58Yeah.
16:59That's your heart and your heart should be there.
17:01I'm going to have to put a tube in.
17:03A collapsed lung or a pneumothorax can happen spontaneously.
17:06The cavity within her chest can keep feeling full of air.
17:11We have to get the air out of the chest cavity so that the lung can reinflate properly.
17:16The way we've chosen to do it is by putting what's called a tube into her chest cavity.
17:20There are significant risks to this.
17:23You can collapse and you technically could arrest.
17:26Right.
17:26OK, so it's not...
17:27OK, I just let you...
17:28I don't want to minimize.
17:28You're here in the right place, OK?
17:29No, I know. OK.
17:30But, you know, this is an x-ray that someone would see and get pretty worried about.
17:35Kristen calls her husband.
17:38They're going to sedate me and put the tube in.
17:40She was very lucky because she's a vet and she had to listen to her own chest.
17:45And if she had just ignored it, she could have got onto a plane and got herself into trouble.
17:49Right now, if it's not fixed, this is a life and death situation.
17:53If anything goes wrong, I'm not you.
17:57How long have you had your dreads for?
18:0020 years.
18:0220 years.
18:04Surfer Andre has just been scanned for what could be a catastrophic injury to his neck after he smashed his
18:11head into a sandbank.
18:13I'm going to try to get some of this sand off you.
18:16As they wait for the scan report, Nurse Ebony continues to distract him.
18:21I think there's some seaweed as well in here.
18:23Oh, there's probably everything in there.
18:26The wait to get these scans and to get the results are sometimes agonising.
18:31And to have a high neck injury can be absolutely life-changing.
18:35We're all holding our breath at this moment.
18:39My brother used to have dreadlocks.
18:41And one day he started smelling something and then he chopped open his dreadlock and he had mould all through
18:47it.
18:47I do actually wash mine regularly.
18:50Yeah, but he's got like water locked.
18:52He did have cool dreadlocks, but then they very quickly got chopped off.
18:56Finally armed with all the results, Dr Alex gives Andre the news he's dreading.
19:02There is at least one break where the spinal cord goes.
19:06The break's actually at the front.
19:08Okay.
19:09Yeah.
19:10A little bit.
19:10So that's a fractured vertebrae.
19:13Correct.
19:13Yeah.
19:14And then we think maybe what's happened is some bony projections have sort of knocked against your spinal cord.
19:19And that's what's caused that sort of shock where everything went numb and stuff.
19:23Yeah.
19:24Andre has broken his neck and one of those bones is out of place.
19:28And that can be really serious because the bony fracture could pierce the spinal cord.
19:32So the picture is that this is staying on for now.
19:36Yeah.
19:36Okay.
19:37And definitely you're going to need an MRI scan.
19:39An MRI as well.
19:40It's imperative that Andre stays very still whilst we keep him in hospital and wait for the MRI scan.
19:47I was quite scared at the time.
19:49Absolutely.
19:49Yeah.
19:50For sure.
19:50But we'll just take it step by step.
19:52Yeah.
19:52But this is going to be on for a bit longer.
19:53Okay.
19:54As he waits to leave ED, knowing that an MRI may deliver even more bad news, Andre is trying to
20:02count his blessings.
20:03Just lucky that there was people there today.
20:08Or else I probably wouldn't be a scary thought.
20:12So quick, so easy.
20:14We're pretty fragile, aren't we?
20:16Really.
20:24You guys got a pulse?
20:26I can't feel a pulse.
20:27Right.
20:27So we might have to start CPR.
20:30Pull that towel out.
20:32Yep.
20:32Good.
20:33Pull the collar out.
20:34Yep.
20:3541-year-old Jared's life is on the line after suffering a massive seizure.
20:41Dr. Sarah urgently needs backup from another senior doctor.
20:45Can we get another, one of the other consultants in here?
20:49Yeah.
20:49I've got a pulse.
20:49You've got a pulse?
20:50Okay, great.
20:51Perfect.
20:51Well done.
20:52The team need to get anti-seizure medication into him fast.
20:57Veteran emergency doctor George is on his way.
21:00So, George, George, we need access.
21:03He's really difficult.
21:05He might need an IO.
21:06He's got a small vein in that right.
21:09If you're in this much trouble, should we just do an IO while we do an IV?
21:13Yeah, yeah, yeah.
21:13Somebody grab me the IO, please.
21:15Okay.
21:15I need a way to get medication into Jared immediately.
21:19We still don't have intravenous access, so an IO is a blast resort
21:25and that's where we put the needle directly into the bone marrow.
21:29Guys, the other possibility is that he has another seizure.
21:32So, can we make sure that we've got that other five of IO?
21:36Do you want to draw it up?
21:37No one wants a cannula drilled directly into their bone,
21:41but it's Jared's best option.
21:43We need to get that medication in.
21:45We don't have any access, so George is going to get an IO.
21:51Okay.
21:52Dr. George is about to drill straight into Jared's shin bone
21:56so they can deliver the medication.
21:58All right.
22:02Okay, so you got an IO?
22:04Well done.
22:06The IO is in and the team now also have IV access.
22:11There we go. Good job.
22:12So, guys, I think we are going to have to scan this gentleman's head,
22:15but I think we just go ahead and secure his airway.
22:18Jared's condition is so precarious,
22:21Dr. Sarah makes the decision to take over his breathing
22:24before scanning for a bleed on the brain.
22:27Yeah, hi, George from ED.
22:28Would we be able to get some anaesthetic support down in resus one?
22:32It's a nerve-wracking wait for wife Noni,
22:35who could lose the love of her life.
22:37Fourteen years ago, we bumped into each other.
22:40I was...
22:42We bumped into each other down the street
22:44and just rolled from there.
22:47Twelve months later on our first year anniversary,
22:49we were married.
22:50My life now, if he wasn't there...
22:53I don't know.
22:54I really don't know.
22:56I'd hate to think.
22:57Family to him is everything.
22:59That's really important to the both of us.
23:02His wife is outside.
23:04She wants the same way.
23:06Yeah, yes.
23:07Hi.
23:08How are you?
23:09With the support of consultant anaesthetist Dr. Alex,
23:12the team can begin to put a breathing tube
23:15down Jared's throat and into his lungs.
23:18You can obviously see he's got a few factors
23:20that make him difficult.
23:22Do you want to get a seal there?
23:24Yep.
23:24To get the breathing tube into Jared,
23:27we need to make sure that he's not conscious
23:30and that he's paralysed.
23:33If we don't, his vocal cords,
23:35they could shut completely,
23:37that would mean that we won't be able
23:39to put that tube into his lungs.
23:42Well, we've got pads on the monitor.
23:44We've got pads on.
23:45Yeah, all right.
23:46I'm going to go with a D blade to start.
23:48Straight from the D blade.
23:49OK.
23:50OK.
23:51A hundred of fentanyl again.
23:52Yes.
23:53Rock is going in.
23:54Yep.
23:54The team must wait 60 seconds for Jared to be fully paralysed
23:59before they can insert the breathing tube.
24:02OK.
24:03When your second hand comes back to number six.
24:05OK.
24:06Before we put that tube into his lungs,
24:09I'm going to have to take this bag valve mask off
24:11and Jared's not going to be getting any oxygen
24:14into his lungs or to his brain.
24:1613 seconds.
24:18Yeah.
24:1930 seconds.
24:20The brain only has four minutes being without oxygen
24:24before we have permanent brain damage and even death.
24:29So there's no room for error here.
24:31Five.
24:34Three.
24:35Two.
24:36One.
24:4715 seconds.
24:49OK.
24:50Dr. Sarah and the team are at a crucial point
24:54taking over Jared's breathing after he collapsed,
24:57hit his head and started convulsing outside the hospital.
25:00Five.
25:02Four.
25:02Three.
25:04Three.
25:04One.
25:05Have a look.
25:08Jared's breathing has been completely stopped.
25:11They only have seconds left to get the tube into his lungs.
25:16Pull it in.
25:18Pull it up.
25:19If we don't get oxygen to Jared's brain very, very quickly,
25:24then that potential for permanent brain damage is very, very real.
25:28It's one of our most life-threatening emergencies that we see.
25:34OK.
25:35What are you up?
25:37First thing.
25:38First thing.
25:57First thing.
25:58Now we can move him to CT because I'm still really worried about bleeding in his brain.
26:05The aim is that we go to CT as soon as possible.
26:08Can we tilt the bed?
26:09We'll bring the bed up.
26:11We know this heavy gentleman's had a head injury and I'm hoping that's just a cut and a bruise on
26:16his head rather than a bleed in the brain.
26:19But that's really important to make sure that that wasn't the cause of his second seizure.
26:24You know, this is obviously a pretty critical situation.
26:27He's had two seizures in the space of about half an hour.
26:32So we're just going to go halfway across on three.
26:35One, two, three.
26:37Great.
26:38OK.
26:38As Jared is scanned, Mum Carol and wife Noni are coming to terms with just how serious the news could
26:46be.
26:46Worry Jess.
26:47Absolutely stressing.
26:49I'm worried about the head.
26:50If he has a bleed on the brain or something like that, it could really affect him.
26:56The scan results have just come in.
27:00We can see there's a lot of swelling outside of that skull and some bleeding underneath there.
27:07But luckily that skull underneath is nice and thick and I can't see any big bleeds in the brain, which
27:14is reassuring.
27:15And down the bottom of the base of his brain, that looks pretty normal.
27:20Jared needs to be transferred to intensive care for more tests on his brain.
27:26When you guys are ready.
27:28All right, let's go.
27:30Thanks, thanks.
27:32This heavy gentleman is still in a pretty critical condition.
27:35Until we get that EEG, we're really not going to know how his brain is going to be functioning.
27:41So it's a bit of a wait and see situation at the moment.
27:52I'm just going to have a quick listen if that's all right.
27:54Yeah.
27:55Dr David is preparing to do an emergency procedure on 49-year-old vet Kristen's collapsed lung.
28:02Big breath in.
28:04The mother of two's condition is so serious, they need to immediately release the build-up of pressure pushing on
28:11her heart and lungs.
28:13You hear anything?
28:13You're not wrong.
28:14Kristen's quickly moved to a specialist recess room.
28:18There are quite a lot of risks.
28:19There's a risk of bleeding.
28:20There's the risk of injuring a nerve, hitting another organ by accident, like the heart.
28:27Two doctors are required for such a delicate procedure.
28:31And emergency doctor Jonathan is on hand.
28:34You guys are at Emerge.
28:36You put the tube in and then you transfer me to a respiratory.
28:38Yeah, I use a needle to get into the spot through the ribs.
28:42Once I feel air, insert a wire, then insert the device in, stitch it all up and then we connect
28:48it to an underwater seal pretty quickly.
28:51Complications?
28:52Complications.
28:54Infection.
28:55Right.
28:55Failed procedure.
28:56We don't quite get it in the right spot and we've never seen what your chest looks like.
29:01And we'll just sort of troubleshoot as we go along.
29:03There is a rare complication that as the lung re-expands, you can get sort of fluid on the lungs.
29:09What should I be aware of if I start to feel?
29:11Well, you'll still, in that particular case, you'll start to feel quite breathless.
29:15Hello.
29:17Hello.
29:17He's the man of the moment.
29:19Kristen's husband, Jonathan, has made it just in time.
29:26Look over there.
29:27Look over there.
29:29See the black lip?
29:30It should look like it's in the right.
29:32Oh.
29:34That's what you thought, wasn't it?
29:36The couple take a minute to pray.
29:40All right, good.
29:41OK, nice to see you.
29:43Nice to see you.
29:44OK, I'll see you.
29:45See you shortly.
29:46All right.
29:48As Dr David prepares to make a cut into Kristen's chest wall, Dr Jonathan starts sedation.
29:55Look, I'll tell you a little story.
29:56I have one of these once, pneumothorax.
29:59Yeah.
29:59Yeah.
30:00And it hurts when they put this thing in.
30:03That's why you're having this, because it'll make you feel better.
30:05Trust me.
30:07How's that feel?
30:08Come on.
30:10Come on.
30:10With Kristen now sedated, Dr David begins to delicately insert a guide wire through her
30:16ribs and into her chest.
30:19Wire's going.
30:20It's crucial he avoids any vital blood vessels.
30:24Oh.
30:25What happened there?
30:26Can I get another wire?
30:28Can you pull it back?
30:29Nah.
30:31Dr David's having difficulty inserting a wire to release air stuck in vet Kristen's collapsed
30:38lung.
30:42If you can re-thread it into the wire guide.
30:45I should be able to.
30:46Yeah.
30:49Yeah, that's feeding in there.
30:51Yeah.
30:51Perfect.
30:53That's right.
30:54And the wire's moving effectively in the dilator.
30:56That's good.
30:57Yep.
30:57Take the dilator out.
30:58Yep.
31:00Dilator's coming out.
31:01And that's the tricky bit, remember?
31:03That is the tricky bit.
31:04There's some wire.
31:05I've controlled the wire here.
31:06I'm going to insert the device.
31:09Dr David now inserts a special tube along the guide wire.
31:15All the way?
31:16Go all the way.
31:17Okay.
31:18Wire's out.
31:18Everyone.
31:20And then the stiffener.
31:21Stiffener.
31:21And that'll curl in the chest and then you want to cap it off.
31:25Yep.
31:25Stiffener's out.
31:26Okay.
31:26Ready to connect.
31:29Done.
31:29I've got to stitch it in.
31:30With the tube successfully positioned, the air trapped in Kristen's chest can now escape.
31:36Final connection.
31:39That's in.
31:40Good.
31:41This is called an underwater seal.
31:42It's like an S-ben in a toilet, basically.
31:44It means that the gas can't come back through the S-ben.
31:48And there's a bubble.
31:49That's the bad air coming out.
31:52But it won't come back in.
31:53So the lung will inflate with each breath.
31:55The air can't get back in.
31:57And collapse the lung.
31:58Old technique.
31:59Works well.
32:01Kristen starts to wake up.
32:04How are you going there?
32:05You alright?
32:05Oh my gosh.
32:06All the painful bits done.
32:08David's just going to put a couple of stitches in to hold them in place.
32:11But you did really well.
32:13And are you okay if I leave you from here?
32:15Yeah, thank you.
32:15Thanks, J.P.
32:16Jonathan?
32:17Yeah.
32:17Are you happy?
32:18Yeah.
32:19Is it okay?
32:20We'll see what your x-ray looks like.
32:21Make sure it's all sitting in the right spot.
32:23But it should be.
32:24It looks like it is.
32:25Alright.
32:26I'm coming back.
32:27Thanks, J.P.
32:28Get an x-ray.
32:29We probably should see it pretty quick.
32:31Dr. David orders a fast x-ray to make sure the tube is in the right position before he
32:38can let Kristen leave the ED.
32:40Small breath in there.
32:43Good job.
32:44A big anomaly.
32:45So as you can see here, you can see the position really nicely inside her chest through her
32:50ribs there.
32:51And what that does is help drain the air out of the space where the air shouldn't be.
32:57And the heart has actually shifted back into its normal position.
33:01She'll be coming in under the respiratory team.
33:03Tomorrow morning she'll be getting another chest x-rayed because we've got to make sure
33:07it's completely resolved and she's completely safe to travel on an aeroplane.
33:17There's no rest for Dr. Jonathan, whose next case is already waiting.
33:24Hi.
33:24G'day.
33:25Hi.
33:26Alright.
33:26How are you feeling?
33:2759-year-old Darren came into ED when his heart started racing dangerously at twice the
33:34normal speed.
33:36You've been in hospital a couple of weeks ago.
33:38Yeah, yeah.
33:39What was that for again?
33:40What was the...
33:40AF.
33:40I was in AF.
33:42Had a sort of mild heart attack.
33:43Yeah.
33:44And went into AF.
33:45Darren's got atrial fibrillation, so the top chambers of the heart are just doing this.
33:50They're just flicking around.
33:51They should be pumping.
33:52And the upshot of that is your heart rate's going a million miles an hour and skipping
33:55beats.
33:56But it's just really not a good way to be.
33:59Worried Darren could have another heart attack, Dr. Jonathan gets more information.
34:05And have you had chest pain?
34:06Do you feel palpitations or...?
34:08No.
34:08No.
34:09More like really loss of breath.
34:11Mm.
34:11Not being able to breathe.
34:12Yeah.
34:12Okay.
34:13Yeah.
34:13Mild pain.
34:16And...
34:16Yeah.
34:18And a bit of numbness in my arm.
34:20Yeah.
34:20Okay.
34:21It's not good to be in atrial fibrillation.
34:23He's getting symptoms that he's not getting enough blood supply to his heart.
34:27The best thing in this situation is we run a shock through the heart.
34:31That'll put him back in the normal rhythm.
34:33So you're gonna zap me?
34:34I think it's probably the right thing to do.
34:35So you've been zapped before.
34:37Yeah.
34:38And it was perfect.
34:40Yeah.
34:40Yeah.
34:4165.
34:42And we'll give you some medicine to make you go sleepy.
34:44We'll give you a zap.
34:45We'll give you up to three zaps if we need to.
34:48Yeah.
34:48But usually we'll work with one zap.
34:50And hopefully that'll sort you out.
34:52Okay?
34:53Cool.
34:53Thank you, Doctor.
34:54No problem.
34:56Hello.
34:56How are you?
34:57All right.
34:58Are you partner?
34:59Partner.
35:00This guy, I'm Jonathan, one of the doctors.
35:01Nice to meet you.
35:02Chelsea rushed Darren into AD.
35:05He works in the construction industry and he was made redundant.
35:10And that caused him a lot of stress and anxiety.
35:15I think he's bottled up this stress.
35:17He's had heart palpitations before, but this time it's different.
35:22It's really scary.
35:23Have you had like a whole lot to drink?
35:26No.
35:26In the last couple of days or anything like that?
35:28No.
35:29No.
35:29No.
35:30Dr Jonathan tries to work out what has triggered this latest episode.
35:35As far as you know, with your heart, the reason that it's not so good, is that
35:40because you've had the heart attack?
35:41I went through a pretty stressful time.
35:43Yeah.
35:43Suffered extreme amount of anxiety.
35:46Okay.
35:46And that's sort of put a strain on things.
35:49Yeah.
35:50Extreme anxiety.
35:52Darren's about to be wired up to the defibrillator pads, which will deliver the electric shock
35:57to his heart.
35:58We're going to put the pads on so you sit up.
36:00Come forward, sorry.
36:02We'll have to sedate Darren because running the defibrillator current through you really
36:07hurts.
36:08We have SATs.
36:09We have DP just cycling.
36:10It gives you a thump.
36:11And you don't want to remember that.
36:13Or feel it.
36:15The plan will be sedation with ketamine, propofol.
36:19Singles out at 200 joules.
36:21200 joules.
36:22200 joules.
36:24Go hard or go home, yeah?
36:26High voltage.
36:29Men go home.
36:30Because the heart's made up of cells.
36:32They've got electric currents going through them.
36:34We're actually stunning those cells.
36:36Turn them off for a moment.
36:37Then they'll reset.
36:39And hopefully they'll start contracting the way they should.
36:41Anyone have any questions?
36:43No.
36:43The risk is that when we restart the heart, a blood clot can fly through your circulation
36:48and cause a stroke.
36:49That's the thing we worry about.
36:51What are you going to think about?
36:52You've got to pick your dream for the most important part.
36:55I'm going to see my son's toe.
36:58Yeah?
36:58Oh, the rock band on Sunday night.
37:00Yeah.
37:00Before they can start, Darren's about to be given a powerful sedative called ketamine,
37:06which can give some patients bad hallucinations.
37:09What does he play?
37:11Both.
37:11Base?
37:12So the team try to keep him thinking of his son's rock band.
37:16Are they good?
37:17Yeah.
37:18Are you just saying that?
37:19Right.
37:19Come back.
37:21Everything is in place.
37:23Everyone happy?
37:24Yeah.
37:24Good.
37:26And as Dr. Daniel starts to inject the sedative ketamine...
37:30That's a 50-5-0 of ketamine.
37:3450.
37:35I was in a row of five.
37:36Emergency nurse Caitlin keeps Darren thinking positive thoughts.
37:42You're walking in now.
37:43You're in the venue.
37:44You're seeing your ticket.
37:45Yeah.
37:45Front row.
37:47Do my back's on.
37:49Bear with your son.
37:50Josh is there too.
37:52How you going, mate?
37:53Good.
37:54Good?
37:54Yeah.
37:55What's your favourite song that they play?
37:57Going off the grid.
37:59How does it go?
38:00Going off the grid.
38:01Going off the grid.
38:05Okay, it looks like we're sinking.
38:08Darren, how you going?
38:11Good to go.
38:12Good to go.
38:13Yeah.
38:14Do it.
38:26Darren, how you going?
38:2859-year-old Darren is about to have his dangerously racing heart shocked back into a
38:34normal rhythm.
38:35Good to go?
38:36Yeah.
38:36Good to go.
38:37All right.
38:37All right, everyone.
38:38So we're happy.
38:38We've checked for sync.
38:39So we've synced with EFID.
38:41All others clear.
38:43So hands off the patient.
38:45Evaluating rhythm.
38:47Everyone happy?
38:49Do it.
38:51Shocking the patient.
38:54Big deep breath.
39:00You're under 100, Darren.
39:02If Darren's heart rhythm doesn't return to normal, they'll need to shock him again.
39:07We'll see what the next blood pressure is.
39:09Getting there, mate.
39:10Big deep breath.
39:1169.
39:12Come.
39:13Four to go.
39:13Four to go.
39:15You're almost there.
39:16Big deep breath.
39:20Looking good.
39:21All right.
39:22All right.
39:22So that's all gone really nicely.
39:23Yeah.
39:25This is the best part.
39:26When you can see someone who's in a lot of trouble, do something fairly quick and make
39:31them feel a million dollars.
39:32That's the best part of the job.
39:38How long does it take to wear off?
39:40It'll take about 15 minutes.
39:41No, I don't?
39:42Yeah.
39:43Darren's taking so long to wake up from the sedation.
39:46Nurse Caitlin's playing his favourite track from son Xavier's band.
39:51Darren.
39:52Darren.
39:54Can you hear it?
39:56The blood cells are funny.
40:00The not-so-gentle tune has caught Dr Jonathan's attention.
40:05Is that to wake him up?
40:08Is that our new wake-up therapy?
40:11That'd make me go insane if I'd heard ketamine.
40:15How are you going there?
40:16How are you feeling?
40:17Tripping out.
40:18You're tripping out.
40:19Okay.
40:19All right.
40:20Keep the music going if that helps.
40:23Doesn't that make you trip out?
40:24Yeah.
40:27If I was running the show, which I should be, I'd be turning that off.
40:31Each to their own.
40:35Seriously?
40:36He's having a great time.
40:37Gosh.
40:38Oh my God.
40:45Okay.
40:46Okay.
40:46Hit the buzzer, someone.
40:49When Jared suffered a massive epileptic seizure in ED, after falling and smashing his
40:55head outside the hospital, his life was on the line.
40:59Is he breathing?
41:00You guys got a pulse?
41:02I can't feel a pulse.
41:03Dr. Sarah suspected a life-threatening bleed in the brain.
41:07And the 41-year-old was put on a ventilator when he stopped breathing.
41:12This is obviously a pretty critical situation.
41:17After a CT scan found no bleeding, Jared was kept in intensive care for two days until
41:23they cleared him of a brain injury.
41:30Time for tablets.
41:32Really?
41:32Yes, tablets.
41:34Now home and under the watchful eye of wife Noni, Jared's getting used to his new medication
41:40regime.
41:41Here's all your epilepsy medication and everything else.
41:45I could have died that day.
41:47I do feel very lucky that I had the right doctors and nurses at the right time.
41:53It saved my life.
41:55Don't go to hospital again, please.
41:58Epilepsy is part of me and I take life day by day.
42:02I'm just looking forward to the next day and the next day after that and the next day
42:06after that.
42:0749-year-old vet Kristen was on a working holiday from the UK when she rushed into ED
42:13after diagnosing herself with a collapsed lung.
42:18Right now, if it's not fixed, this is a life or death situation.
42:21Dr. David had to perform a delicate operation to reinflate her lung.
42:27Final connection.
42:28That's in.
42:30Hello, everybody.
42:31The mother of two spent three weeks in the Royal Melbourne to have two operations to
42:38fix her lung.
42:39And now she's back at home in the UK recuperating.
42:45After battling months of stress due to losing his job, Darren came to ED with a dangerously
42:51racing heart.
42:53I've suffered an extreme amount of anxiety and that's sort of put a strain on things.
42:58Dr. Jonathan diagnosed the father of two with atrial fibrillation and after sedating
43:04him, shocked his heart back into a normal rhythm.
43:08Shocking the patient.
43:12Now on new medication to control his AF, he's made huge changes in his life and is back
43:19to watching Son Xavier's band playing local gigs.
43:23Yeah, this is going off the grid, yeah.
43:26I'm feeling a lot better.
43:28It's amazing I can dash up a flight of stairs and not feel exhausted.
43:33What you doing now?
43:35I've made a pretty radical change.
43:38I've moved into the public sector from the construction industry and it's a lot less stressful.
43:44I think my future is pretty stable now.
43:46Things are good.
43:48So surfing with headstrike.
43:51Surfer Andre was choppered into ED after he came off his surfboard and violently head
43:57planted into a sandbar.
43:59He felt no movement or sensation in all four limbs for about 15 minutes.
44:04Just couldn't move.
44:05Yeah.
44:06Yeah.
44:06It was pretty bloody scary.
44:07Dr. Alex's fears he had a broken neck were confirmed by a CT scan.
44:13The brake's actually at the front and we think some bony projections have sort of knocked
44:17against your spinal cord.
44:20Andre spent three days in hospital after an MRI found bruising to the spinal cord.
44:27After six weeks and a collar, the groundskeeper now faces an 18 month wait to see if the numbness
44:35in his arms will disappear.
44:36I'm getting better.
44:38I'm looking forward to going back to work.
44:39Even though doctors have told him his surfing days are over, the father of two sees each
44:45day as a blessing.
44:47I love surfing.
44:47It's kind of like heartbreaking not to be able to do it anymore, but I'm grateful for
44:52every day I have really.
44:54And I'd like to say a big thank you to all the emergency staff at the hospital and the
44:59paramedics and all the boys on the beach because I'm here today and I'm still walking
45:03because of all you guys.
Comments