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A and E After Dark - Season 7 - Episode 02
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Short filmTranscript
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 he has a knife with him we deal with a lot of aggressive patients
00:17things can escalate this gentleman has been punched kicked can't be quite scary when it's
00:21just you and one violent vision across the UK we join the staff of three of the most
00:27challenged emergency departments it's always busy it's always under pressure time is of the essence
00:34and the medics who face danger each shift most shifts I see more police than nurses
00:39with the amount of drugs and alcohol admissions rising have you been drinking today the risk of
00:45violence and abuse looms large every night please don't swear like that they try to attack and stuff
00:52calm yourself down people can become aggressive you've been punched
00:58you see the good bad and the ugly yeah we'll get security the emergency department
01:04is like a battlefield it's like organized chaos
01:20every night staff and patients in A&E waiting rooms across the UK are subjected to the abusive
01:26behavior of intoxicated patients it's estimated that up to 15 percent of A&E attendances are alcohol
01:34related so do you understand the reason why you're arrested we always have disruptive patients or
01:39aggression there's been times where I have felt frightened you don't know what to do in that exact
01:45moment there's nothing you can do other than hope you don't get really hurt and at weekends after dark
01:52that percentage can rock it to a massive 70 percent there's been here that's assaulted outside of
01:59public today high numbers coming through a lot of them obviously under the influence of drugs alcohol
02:03every single chef there will be somebody erected
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
02:56are worried about her upsetting the rest of the patients
03:15she was shouting all around the place she made a few racist comments to many people in the waiting room
03:21and was very loud and aggressive about it
03:29yeah
03:35dude
03:36you can do the
03:43you can do the
03:51Hi, I'm ready for the war, what are you going to do?
03:54Bye, bye, bye, what are you going to do?
03:57The fight nearly broke out, but they've been separated.
04:00We've removed the alcohol and we have explained to her
04:04that we'll give it back to her whenever she leaves any.
04:08The woman can only stay and be seen by a doctor
04:11if she gives up her alcohol.
04:12But she's already asking for it back.
04:15I've explained, look, if you're willing to sit here
04:17and behave yourself, you know, we will see you
04:20and get you seen by a doctor, but, you know,
04:22we can't tolerate that.
04:23We have your hair.
04:24Wait, well, what are you doing?
04:26So, um, one more chance, really,
04:29and then she has to be removed, okay?
04:30Do you want to get you seen by a doctor?
04:32What am I doing?
04:33Right.
04:33You tell me.
04:44I'm sitting here with a shoulder hanging right here.
04:56No, slow, slow, slow, deep breaths, they said.
05:02Hey, that's not a cigarette.
05:05She's already been x-rayed and given a Penthox inhaler for the pain.
05:26The penthox inhaler needs to be used constantly.
05:29If it runs out, the pain-killing effects wear off quickly.
05:32Oh!
05:36Please!
05:37I love you.
05:38Please.
05:39There's nothing to do.
05:41Absolutely nothing to do.
05:42I'm sorry.
05:47It won't be long.
05:48It won't be too much longer.
05:51Are you, Roberta?
05:53Dr. Dara has been alerted that Roberta's extreme pain has returned and needs immediate attention.
05:58What we're going to do is give you some good pain relief, okay?
06:00Okay, we're going to get you nice and relaxed.
06:01Give a go, putting this back in place, okay?
06:03Please, please.
06:06Right, sweet kids, let's go.
06:09Dr. Mike will be working with Dr. Dara and has just received the images of Roberta's shoulder.
06:15Looking at the x-ray here, this big bone, her humerus, should be within the joint here.
06:22It's quite clearly out of position, so we need to try and get that back in the joint sooner rather
06:29than later.
06:31Oh!
06:32All right, so 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, okay?
06:41Have you checked the skull?
06:43Is it okay?
06:44So just showing that 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 is see if you can keep really relaxed.
06:57After 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.
07:02Yeah.
07:02Okay, just take some big deep breaths, okay?
07:05I'm going to try and make it easier to come, all right?
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.
07:19Roberta fell over four hours ago.
07:21If the shoulder is not put back into position soon, there's a risk of permanent nerve damage and ongoing severe
07:28pain.
07:29Are you looking at it?
07:46Oh.
07:47No, no, no.
07:47I'm a straight-up.
07:49Police are an almost permanent fixture in A&E's up and down the UK.
07:55I do not have an issue ringing 999 to try and get police.
07:59And I ask my concerns that I have staff to look out for,
08:02I have myself to look out for,
08:03and I have other vulnerable patients to look out for as well.
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 E.D. often feels like a bit of a police station.
08:21Normally in resus, it is quite chaotic anyway.
08:23Add police, add nurses, add radiologists, add all of this into the mix,
08:28and, yeah, it does get quite chocker.
08:31What points are you reading, mate?
08:38Come here, f***ing.
08:40I can't, so I can make up all your meals.
08:43In Belfast, deputy sister Rebecca has given a drunken, disruptive patient
08:48one more chance to behave before she's removed.
08:52Please, please do the back, Ray.
08:54I do love my job, but, like, there's easier ways to make money.
08:58I'm just like, what am I doing with my life?
08:59But, you know, it doesn't really kind of limit to just the weekends anymore.
09:05It's all of the time, really.
09:07Monday to Sunday, every night of the week is just the same.
09:11Alcohol, drugs, and then...
09:13Oh, there's something happening out here.
09:18Sorry, excuse me.
09:23Right, we'll move you out.
09:26No, you're not moving me, no word.
09:28Sorry.
09:29Sweetheart, we can't have you getting involved.
09:31I want your name, I want your name.
09:36I came here for treatment,
09:38and you sort of take 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?
09:45Do you know what you're saying to me?
09:47It's disgusting.
09:48Well, you're standing in a waiting room just addressing other people.
09:50There's a full waiting room here of people who are afraid.
09:53What about me?
09:54Right, come on, let's talk outside.
09:56No!
09:58Patients who are being fairly aggressive,
10:00we'll have to approach them in a calm manner,
10:02explaining to them why they can't behave like that.
10:04You know, it is obviously putting other patients at risk,
10:07scaring the staff.
10:09There's been times where I have felt a bit frightened.
10:12Recently, I was assaulted.
10:14You don't know what to do in that exact moment.
10:16It is quite frightening.
10:18You're being very verbally aggressive
10:19to everybody in this waiting room, okay?
10:21You're frightened.
10:22Oh, you're lying!
10:23Right, we can't have that in this department.
10:25Please, you treat me like I'm a sack of glasses.
10:28No.
10:28And I don't like it.
10:29We're not.
10:30We treat everybody here the same, okay?
10:32We're not going to be able to let you back in
10:34whenever you're behaving like this.
10:35It's okay.
10:36Will you make them your name?
10:38That's fine.
10:38I'm going to hold your name.
10:39You don't want that.
10:40That's okay.
10:40Right?
10:41Yeah, that's okay.
10:42Do you make them?
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.
10:50Yeah.
10:50Yeah.
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
11:12because they can't bear to watch what's going on anymore.
11:15They feel threatened, they feel unsafe, so therefore they leave.
11:18These are normally the people who actually need to be there
11:21and treated for something really wrong
11:24and then they go home and deteriorate,
11:26which is not ideal at all.
11:44Hi, I'm speaking from Newham A&E.
11:46Can I get a CTL pelvis, please?
11:48In Newham A&E...
11:49I want to be well.
11:51..a midwife has been taken seriously ill in the hospital
11:54at the end of her evening shift.
11:56So she had some right illiofosser pain this morning
11:59with a bit of vomiting in the past hour.
12:00She's now 10 out of 10 pain in the right illiofosser.
12:04We've done the bloods, but they're not back yet.
12:07Dr Karl is trying to help 33-year-old Agnes,
12:10who has had extreme stomach pain for over 12 hours.
12:13I think there is a mentality of still coming to work,
12:15even when you're feeling unwell within the NHS.
12:19Unfortunately, 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?
12:28And we're giving you some fluid and some painkillers as well.
12:32I've already spoken to the radiologist to get you a scan.
12:36So we're going to scan your tummy and down into the pelvis.
12:38I'm a bit worried that your appendix might either burst
12:43or be very, very angry at the moment.
12:46Intravenous morphine has reduced Agnes' pain,
12:49but her condition could be deadly if her appendix has burst.
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.
13:26So the next step is to wait for the blood to come back
13:28and to get her into the CT scanner to see if we can find what's going on
13:31and to see whether or not it's the appendix that's causing this problem.
13:35The longer it takes to diagnose the source of Agnes' pain,
13:39the higher the risk of life-threatening complications
13:41like peritonitis and sepsis.
13:56Surgeon Mr. Shahzad has come to assess Agnes before her scan
14:00as she may require surgery.
14:04Is it sore here?
14:05No.
14:07Is it sore here?
14:08No.
14:08Sore here?
14:09No.
14:10Is it sore here?
14:11Yeah, a bit.
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.
14:34With surgeon Mr. Shahzad unsure,
14:37a CT scan may be the only way to know
14:40if Agnes' appendix or an ovarian cyst has ruptured
14:43and her life is in jeopardy.
14:45I was in CPAP before.
14:47I don't know what it was.
15:02It's six in recess at the moment,
15:04and one is going to ITU.
15:06Four in intoxicated.
15:07I'll assess it when it arrives.
15:10In Newham recess,
15:12a man is arriving who fell while intoxicated,
15:15causing a head wound.
15:16You can come to this bed.
15:18Well done.
15:19He was found.
15:21Unresponsive.
15:21Members of the public tried to wake him.
15:23So he's got a wound.
15:24That's the wound to his head there.
15:27Okay.
15:27Clearly happened with his hat on.
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 downstairs,
15:45sustaining 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?
16:03Do 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?
16:14One beer.
16:15Okay.
16:16All right.
16:16Nothing else?
16:18You got any pain anywhere?
16:22No pain?
16:24Normal.
16:24Normal.
16:25Normal.
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?
16:37You don't remember?
16:40Okay.
16:44So there's a problem with the housing?
16:46Yes.
16:47Okay.
16:49I think he's drunk quite a lot tonight.
16:51He's already explained that he's having some trouble paying his rent for next month.
16:55And now he's also telling my colleague that 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?
17:12CT.
17:13Right side of the head.
17:14Just a little bit.
17:15See if it needs a drop of glue.
17:16We're going to get a scan of your head.
17:18To make sure everything is okay.
17:19All right?
17:20Yeah.
17:21Yeah, all right.
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.
17:30So we're going to clean up your head a bit.
17:31All right?
17:33We're going to come back and see you after you've had your scan.
17:35Okay?
17:36Okay.
17:36Okay?
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.
18:05Come on, Mom.
18:06I think we could maybe get you onto this bed.
18:08No, I 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 safely get you onto the bed
18:20first.
18:21Oh, I mean, I can't.
18:23It took me 20 minutes to get into the car.
18:25God.
18:27Does she need to be on the bed before she can have that?
18:29Ideally, yes.
18:30Because the problem is we're going to do your bedroom bed.
18:34Sorry.
18:35We'll go slow, we'll go at your pace, but the quicker you get on here, the quicker you can have
18:39that pain relief, okay?
18:40Listen to me, listen to me.
18:42Hey, 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.
18:54Watch your fingers, don't touch her head.
18:58I can't let go, I can't let go.
19:00Right, I'll hold you here.
19:02Take your feet off this.
19:03Right, put your feet on the ground.
19:05Right, and we're going to get another one, two, three, stand up, stand up, that's it, that's it, that's it,
19:10you're up.
19:11You're up, pull it away, pull it away.
19:13Stop, stop, stop.
19:14Nobody's...
19:14You're putting on a different...
19:15Don't touch it, don't touch it.
19:17That's what she's...
19:18Right, there you go.
19:19Back on it, just like the car.
19:23You're okay, you're okay.
19:25You're okay.
19:26Right?
19:27Right, see me and lie back.
19:28I'll take your legs, come on.
19:29I can't lie.
19:30You'll be okay, you'll be fine.
19:36Now in position, she can be prepped for the arm to be manipulated into its socket, but this will be
19:42even more painful.
19:44Do you think you can release this hand, because it's best that you're in control of this?
19:48No, I can use my teeth, that's what I've done before.
19:51She did, after a couple of breaths the first time, she had it in her hand, but she was...
19:55It was like she was smoking it, but after about two or three puffs, she was fine.
19:59The Penthox inhaler is a fast-acting pain medication that can be self-administered.
20:04Nice, big, deep breaths for us.
20:06And we'll get you as comfortable as possible.
20:09Robert, your job now is just to keep taking that green whistle for me.
20:14Lovely, slow, big, deep breaths.
20:16We see a lot of patients with shoulder dislocations, and it is very, very painful.
20:21The muscles that are used to usually keep it in the socket, essentially, are in high tension and high force,
20:28and are keeping it now out of socket, because the pain is causing the patient to be so tense.
20:35We're going to sleep on you one, but I'm going to do your licker.
20:42I'm going to lie a little bit flatter, and keep taking nice, big, deep breaths.
20:46Keep taking it, Bert.
20:47Keep taking that.
20:48Bert, keep taking it, love.
20:49Keep taking the muscle.
20:51Roberta needs consistent pain relief to ensure her muscles are as relaxed as possible.
20:55Keep puffing.
20:56Keep sucking the muscle, love.
20:59Keep going, big, deep breaths, Bert.
21:01Ah!
21:02Come on, big, big.
21:04Even with the inhaler working, it will only dull the pain,
21:07so the doctors need to work quickly to slip the arm back into position.
21:11Big, big.
21:11Ah!
21:13Stop!
21:14You're okay.
21:15You're okay.
21:15You're okay.
21:15You're okay.
21:16You're okay, okay?
21:17Ow!
21:19Ow!
21:20Come on, it's going in that set, girl.
21:21Good girl.
21:23Well done.
21:24Keep going.
21:25Roberta's arm has been out of its socket for four hours,
21:28and the shoulder muscles have become incredibly tense.
21:31Keep breathing, love.
21:33Ah!
21:34Keep going.
21:36Big, deep breath.
21:37Where the joint has been out for longer can be sometimes a bit trickier,
21:40and often that's because the muscle has maybe gone into spasm,
21:43and the patient's in a lot more pain.
21:45We don't get it under control until we've got that joint back in place.
21:49We're nearly there, okay?
21:51Nearly there.
21:51Just another wee bit, love.
21:53You'll be okay.
21:53Hold on to me.
21:56Ow!
22:10He was collapsed and was in cardiac arrest.
22:14Over two and a half million people attend A&E at night every year.
22:18Bring it on, bring it on, bring it on, bring it on.
22:20You can't make no permission.
22:22Which is particularly challenging for the reduced night shift staff.
22:26I don't give a fuck.
22:27Yeah, we'll get security.
22:28Fuck you, man.
22:38How are you doing, Donny? How are you feeling?
22:40An intoxicated patient has just returned from the CT scanner
22:44after being found unresponsive on the floor with a gash on his head.
22:48We got the CT result. It was okay, all right?
22:52We did a CT of your head.
22:54Do you remember?
22:56No, you don't remember?
22:57We might have to wait until he's sober enough to go.
23:01When he arrived, the man explained he's been having money trouble
23:04after losing his job.
23:05Can you just turn over so I can see your head again,
23:08just to see if we've cleaned it up all right?
23:11It's really unfortunate that it's a bit of a downward spiral, isn't it?
23:14That you're having problems, then you drink, then you hurt yourself,
23:17and it goes round and round.
23:19We can step him out, and then I think we just keep him somewhere
23:22until he's awake enough to go home.
23:24I'm going to take you to a room there
23:26and clean the wounds, okay?
23:28Is that all right?
23:34We need to keep him safe,
23:36and so we're going to keep him in the department really
23:37until he's sober enough to go home safely,
23:39because at the minute he's not really remembering everything that's going on
23:42and things, so we just want to keep him safe here
23:45until probably until the morning now.
23:46You want to sit up a bit, yeah?
23:49Sit up, I need to clean this side, yeah?
23:51So I can clean your head, yeah?
23:53When you're working in the night,
23:54the problem is that no one else is working in the night,
23:56and so we don't get much support from other services.
23:59That's a real bit of a gap, really,
24:00that we're just doing a bit of patching up
24:01and then sending people home without really giving any long-term solutions.
24:05And anything and everything is what INA stands for.
24:20Help!
24:23Help!
24:24Let's do it!
24:25Doctors Mike and Dara are struggling to manipulate
24:2821-year-old Roberta's arm back into its shoulder socket.
24:31Sit back.
24:32That's you. Good girl.
24:34Despite being medicated with strong pain relief...
24:36Ah!
24:38Come on.
24:39..the muscles in her shoulder remain tight,
24:41making it incredibly hard to move the bones into the correct position.
24:44Sometimes, when reductions are particularly tricky,
24:47then we have to apply counter-traction.
24:50If you just apply traction horizontally...
24:53..this is essentially where we use a sheet
24:57to apply a force in the opposite direction,
25:00and that just gives us greater force
25:02in order to try and get the shoulder into joint.
25:05Ow!
25:06Stay still, stay still.
25:07That's when you're getting into brute force territory.
25:09Ow!
25:10You don't really want them relaxed.
25:12Ow!
25:13Come on, I know, I know, I know.
25:15The counter-traction should allow the doctors
25:18to pull the ball at the end of the arm bone,
25:20around the edge of the joint and back into position.
25:23Roberta.
25:23Come on, breathe.
25:24But they're fighting against extremely strong,
25:27tense muscles in the shoulder.
25:29Oh, help, stop, stop, everyone, stop.
25:32Stay still, stay still.
25:33The key is you keep taking this medication.
25:36Of course, keep taking one of the big, deep breaths.
25:38Big, deep breaths.
25:39Don't swap sides.
25:40Come on.
25:41Stop down.
25:41Put your leg down, Roberta.
25:43Stop, stop your head moving.
25:44Stop your head moving.
25:45You're doing super.
25:46Put your leg down, Roberta.
25:47Put your leg down.
25:49Roberta, put your leg down.
25:50Some more big, deep breaths.
25:51Come on, come on.
25:52Try and get us real relaxed.
25:53Breathe it in.
25:55The longer it takes to get Roberta's shoulder joint
25:58back into position,
25:59the more chance she has of permanent nerve damage
26:01and potential corrective surgery.
26:04Come on, Roberta.
26:06Oh.
26:06Breathe.
26:07Breathe.
26:07Breathe in.
26:08Come on.
26:09Roberta, breathe in.
26:11Breathe.
26:12It's up on this.
26:13Come on.
26:15It's up there.
26:16Oh.
26:17Oh.
26:17That's it, that's it, that's it.
26:20That's it, that's it, that's it.
26:22Oh, my God.
26:23Pop, did you hear Pop?
26:24I heard it.
26:25So we'll just need to get it in a sling
26:28and get another x-ray.
26:29Okay.
26:30And then we'll take it from there.
26:32No problem.
26:33No problem.
26:35Absolutely no problem.
26:36There, good girl.
26:37Well done.
26:38Proud of you, yes.
26:39Yeah.
26:41It's incredibly satisfying
26:42when a joint just falls into a joint
26:45and you get a nice, satisfying clunk.
26:47We'll probably have to take that off, you know.
26:49You've had your fun.
26:50Sorry.
26:51Don't, don't upset her.
26:53I'm sorry.
26:54Don't be upset now.
26:55Okay, here we go.
26:56Can I have one more?
26:57One last puff, because it's really sore, isn't it?
26:59That's why you're taking it.
27:00One more puff, then that's it away.
27:05While Roberta's shoulder appears to be now
27:07in the correct position,
27:08there's no way of knowing without a follow-up x-ray.
27:10Should I have to go back her knee, actually,
27:12and then I can go home?
27:13Yeah.
27:13Yeah, if you're, if you're past.
27:16If the joint isn't in the correct position...
27:19Can you take it easy, okay?
27:20Yes, Mom.
27:20...it could be causing further damage to her shoulder
27:23or become dislocated again.
27:25It's hard, it's hard to watch your child,
27:27you know, in pain.
27:29Um, and it's, you feel sorry for her,
27:32and really, really, your heart goes out to them.
27:34Just gotta, just gotta take it off of this move.
27:36That is what it is.
27:41This is where our humerus was.
27:42This is where we are, back in joint.
27:45We had to use a little bit more force
27:47than we had hoped we would,
27:48but thankfully, it did work.
27:52The joint is perfectly back where it should be,
27:55and patients get to go home.
27:57How do you feel now?
27:58You feel a lot better?
27:59It just feels a wee bit like muscle pain,
28:01but I can, it's there more.
28:02Okay.
28:03You'll be followed up in the fracture clinic.
28:05Obviously, if it, you hear a popper,
28:07it seems to go back out of place.
28:08Obviously, come back to any.
28:09Hopefully, that won't happen.
28:10Okay.
28:11All right.
28:11Yeah, thank you very much.
28:13No worries at all.
28:14There we go.
28:14Let's get you home.
28:27Good evening.
28:28Hello.
28:32In Newham Resus,
28:33a patient who is on a fancy dress night out
28:36has arrived after collapsing at a train station.
28:38This is Celeste.
28:40She's 27 years old.
28:41She was on her way out tonight, dressed up.
28:44She had a passion fruit alcoholic drink.
28:4713 minutes later,
28:48she started feeling a very dry throat,
28:50but then progressively got more itchy,
28:52and then she felt like it started swelling.
28:55Passion fruit is an allergen
28:57and can trigger a serious allergic response.
29:01My throat suddenly felt, like, very dry
29:03and, like, my tongue, like, my mouth area felt very dry.
29:07And then I started having trouble breathing
29:09and, like, that freaked me out.
29:11My breathing was, like,
29:13like that.
29:15It felt like I couldn't get enough, like, air in.
29:19They gave me the injection
29:20when I was on, like, the floor.
29:22And I was able to, like,
29:23set up a bit more after that
29:24and they were able to, like, move me.
29:26Do you know how to flash or something?
29:28I don't think so.
29:30With adrenaline administered at the scene
29:32to combat the immediate reaction,
29:34Dr. Mohammed needs to make sure
29:35Celeste's breathing and heart rate
29:37are back under control.
29:38So, your heart will get down this time.
29:42Normally, if you had an adrenaline,
29:45you should have six hours of monitoring.
29:50Either Celeste's fast pulse
29:52is because of the adrenaline she was given
29:53or the allergic reaction.
29:55So she still might be in serious danger.
30:02OK, let's have a look.
30:05Got her attached to our monitoring over here.
30:07Typically, for an allergic reaction,
30:09anaphylaxis, you monitor them
30:10for a period of, like, six hours
30:12just to see if there's lack of reaction.
30:14Fingers crossed.
30:17It's terrifying, like,
30:18to not be able to, like, breathe properly
30:21or, like...
30:22Because you start getting lightheaded
30:23and you start feeling like
30:25you're going to, like, pass out
30:26or, like, something's really wrong
30:28and it's just... it's really scary.
30:32I was like,
30:33am I going to die here on the tube platform?
30:43Accident, an emergency.
30:44Good evening. How can I help?
30:4564-year-old male
30:47with a high, high BM.
30:51Also in Newham,
30:52midwife Agnes is being taken
30:54for an emergency CT scan
30:55after having severe abdominal pain
30:58while on shift.
30:59Don't worry. It's a quick scan.
31:01Won't take too long, yeah?
31:03Doctors need to establish
31:04if her appendix has burst,
31:06which could be deadly.
31:08Now, you're going to keep
31:09your both hands above your head.
31:11Like that.
31:12Same over here.
31:14There you go.
31:14More like that.
31:16Like, the patient's got to say,
31:17breathe in
31:17and hold your breath, okay?
31:24There you go.
31:26There you go.
31:30There you go.
31:30Sit down.
31:32I'm going to sit you up now, yeah?
31:35You're okay?
31:36As part of her scan,
31:38radiographer Jan has given Agnes
31:40an injection of contrast
31:41to help show her appendix.
31:43When a patient comes,
31:44we tend to say it's like
31:45they feel a hot flush
31:47going through their body,
31:49a metallic taste in their mouth
31:50and you might feel like
31:51you're going to vomit yourself.
31:53Can you feel the hot flush?
31:55Yeah, it's normal.
31:56Don't worry, don't worry.
31:57The vomiting could be due
31:58to the contrast,
31:59but it's also a symptom
32:00of a burst appendix.
32:01You have to explain
32:02to the patients
32:03why this is happening
32:04and these symptoms
32:05so that they're aware of it
32:07and a bit more calmer.
32:10Surgeon Mr Shuzad
32:11has been monitoring Agnes' case
32:13and reviewing her scans.
32:15So, we had a CT scan.
32:19It showed that
32:20your appendix is normal.
32:22Okay?
32:22So it means
32:23you don't need surgery.
32:26So, there was a concern
32:28whether you have
32:29some infection of your kidneys
32:30on CT scan.
32:32But it's not very clear.
32:34So what we'll do
32:35will give you
32:36some antibiotics, right?
32:41Agnes is out of danger,
32:42but her suspected infection
32:44is still extremely painful.
32:48We will keep her overnight
32:49and we'll reassess in the morning
32:52with our consultant on Carl's team
32:54and we'll discuss her scan
32:56with our own radiologist
32:58and so that we can have
33:01some more clarity
33:02about our kidneys.
33:15Sorry, I've lost you, I think.
33:17Oh, hi, yeah, sorry.
33:18Can I just confirm GCS?
33:20That's all right.
33:21Yes, please.
33:2566-year-old Terry
33:26has come into A&E
33:27after crashing his motorbike.
33:29Things happen so quickly
33:31and I'm not exactly sure
33:33what happened,
33:35but a deer came
33:36from the left-hand side
33:37and crossed my path.
33:38I then hit it
33:39and I was away.
33:42You know, I was flying.
33:43His daughter Jessica
33:45and her partner Daniel
33:46rushed into A&E
33:47when they heard
33:48about the collision.
33:49Do you feel dizzy
33:50or nauseous at all anymore?
33:51No, not really.
33:52But that feels
33:53the least of my problems,
33:55my head.
33:56This wrist is painful.
33:59Dr. Eniola
34:01is treating Terry
34:02after his accident.
34:03He was riding a bike
34:04and a deer popped up
34:06from the view.
34:08He hits the deer.
34:09He fell down
34:10off the bike.
34:11There are deers
34:12around the area,
34:13and they pop up
34:14from time to time.
34:16Deer are more common
34:18at night and early morning
34:19and headlights
34:20cause a freeze reaction,
34:22making them
34:22deadly obstacles.
34:24Any headaches now?
34:26No.
34:26No headaches.
34:27Any hand pain,
34:28any foot pain?
34:29Yeah, yeah,
34:29this is quite painful.
34:31And that too
34:32is quite painful.
34:34We're trying to look out
34:36for other injuries
34:36that may be marked
34:37by the more obvious one.
34:40So it could be
34:41a broken bone,
34:42but there could be
34:43an abdominal injury.
34:45It could be
34:46a fracture
34:47in the chest,
34:48in the ribs.
34:49Any head pain?
34:51Anywhere?
34:51No.
34:52Not at all?
34:52No.
34:53Can you open your mouth?
34:55Bring it out
34:55to your tongue.
34:57Okay.
34:58So we try to make sure
34:59that we don't miss out
35:01on any other
35:02injuries which may be
35:04potentially life-threatening.
35:08Okay?
35:10Okay, relax.
35:12Some abdominal injury,
35:13but it doesn't look
35:14worrying
35:15because his observations
35:17are also fine.
35:18He sustained some injuries
35:20on the right wrist
35:22and on the left toe
35:24as well.
35:26Being reassured
35:27by Terry's vital signs,
35:29his abdomen
35:29is likely okay.
35:31Dr. Eniola
35:31turns his attention
35:32to potential broken bones.
35:34So if I can just get you
35:35to face that wall there,
35:38and then you roll up
35:39your galaxy.
35:40Like that?
35:40You're fine.
35:41That's it, perfect.
35:46Okay, a few bones
35:47still there.
35:50Over half of the bones
35:51in the human body
35:52are in the hands
35:53and feet combined.
35:55So you're just going to
35:56bend his leg knee
35:56because you want him
35:57to slap like that.
35:58Making them incredibly
35:59vulnerable to breaks.
36:03And one more
36:03for your toes.
36:05The worst case scenario,
36:06if it's untreated,
36:07the patient could have
36:09crippling pain,
36:09chronic pain
36:11throughout the years
36:12if that area
36:14isn't treated
36:16on time.
36:17Yeah, I won't be sleeping
36:18on that side tonight though.
36:20Oof.
36:43Dr. Eniola is treating
36:4566-year-old Terry
36:46who crashed his motorbike
36:48into a deer.
36:51He's been x-rayed
36:52as there are
36:53suspected breaks
36:54in his hands and feet.
36:55The big toe.
36:56Yeah.
36:57You can see
36:57there's a fracture
36:59and it's fractured
37:00in two places.
37:01Oh, bloody hell.
37:04I don't understand that.
37:05Big, big motorbike boots.
37:07That's right.
37:08The wrist looks fine.
37:10The wrist looks fine?
37:11Yeah.
37:11Oh, goodness.
37:13Even though there seems
37:14to be no breaks
37:15in Terry's hand,
37:16he could still have
37:17a fracture of the scaphoid,
37:18a collection of small bones
37:19in his wrist.
37:21It can be easy
37:22to miss things
37:22on the x-ray.
37:23There are some fractures
37:24that are a bit small
37:25and subtle,
37:26so physical examinations
37:28are quite important.
37:31The x-ray can only show
37:33so much.
37:33Of course.
37:34It really show everything.
37:36So, well, because of the bruising,
37:38yeah, I'm suspecting
37:40there may be a little bone break.
37:43If Dr. Eniola doesn't find
37:45all the fractures,
37:46there's a chance he could heal
37:47in the incorrect position,
37:48which could lead to chronic pain
37:50for the rest of Terry's life.
37:52Any pain as a touch?
37:54Yeah, a little bit painful, yeah.
37:56It appears that there's
37:57a fracture, yeah.
38:01Yeah, there's a fracture.
38:02Yeah, there's a fracture.
38:04Okay.
38:05Dr. Eniola has spotted
38:06a scaphoid fracture
38:07not clear on the x-ray.
38:09But for this,
38:11we put a strap around here
38:13to make sure the fracture heals.
38:15Yeah.
38:15Same thing with this.
38:17Okay.
38:17In about two to three weeks' time,
38:19we'll do a repeat x-ray.
38:21Okay.
38:21So that everything is okay.
38:23Yeah.
38:28Before Terry can go home,
38:29his breaks will need to be given
38:31temporary orthopedic support
38:32to help them heal.
38:34Oh, I'm a little bit surprised
38:36that I've got a slight fracture
38:39of the two
38:40and this section of the thumb.
38:42It could have been a lot worse.
38:44So, yeah, I'm pretty lucky, really,
38:46I think.
38:46And it's been really good service tonight.
38:49I've been really looked after.
38:51I can tell people
38:52I've been on a skiing holiday.
38:55This is your fashionable shoes.
38:59He's doing okay
39:00considering the mechanism
39:02of the injury.
39:02Okay, I expected something
39:04a bit more drastic.
39:07The purpose, sir,
39:08is to immobilize your thumb.
39:10Keep it still.
39:11Keep it still.
39:12So it will reduce the swelling,
39:14reduce the pain.
39:16Recovery time for him,
39:18considering his age,
39:19it may be between
39:21about six weeks
39:22to ten weeks.
39:23Thank you very much.
39:25Appreciate it.
39:26Terry will need to return
39:27to the fracture clinic
39:28in the day
39:29once the hospital
39:30is completely open
39:31for permanent treatment.
39:34It's really could have been
39:35a lot worse.
39:37So I think that he's
39:38quite a lucky chap.
39:41Yeah, not too bad.
39:51Hello, Jesus.
39:52In Newham,
39:5427-year-old Celeste
39:55is being closely monitored
39:56to see if she'll have
39:57any further potentially
39:58lethal anaphylactic reactions.
40:01You'll take off the wires
40:02on your chest.
40:04The cold case
40:05is going to take you
40:06somewhere near
40:07the main waiting.
40:09Yeah.
40:10With the hospital
40:11needing to free up space
40:12and her condition
40:13remaining stable,
40:14she's moved
40:15to an observation area.
40:30Celeste is joined
40:31by a partner, Ori,
40:32who is with her
40:33on the way
40:33to the fancy dress party
40:34when she had her reaction
40:36and her airway
40:37started to close.
40:38Isn't like
40:39anaphylactic shock
40:40like, can't it kill you?
40:41I guess it depends
40:42how much her throat closes.
40:44You can Google it.
40:45It's a massive severe.
40:46potentially life-threatening
40:48allergic reaction
40:49that requires
40:49immediate emergency treatment.
40:59Dr. Mohamed
41:00has been monitoring Celeste
41:02for signs of further
41:03allergic reaction.
41:04Her heart rate,
41:06last time I checked,
41:07it was 90,
41:08which is good.
41:09One of the most
41:10concerning things
41:11about anaphylaxis
41:12is your airway is closed,
41:14so you've been suffocated
41:16basically.
41:17But she was quite lucky.
41:19The ambulance
41:19found her early.
41:21What you need to know
41:21is you need to go home
41:23with EpiPen.
41:25Okay, so EpiPen
41:26have adrenaline on it.
41:28If you have symptoms
41:30that you think
41:31your throat is closing,
41:33you can't talk
41:34in false sentences,
41:35you're very wheezy,
41:36you're unwell,
41:37you're about to collapse,
41:38this is a red flag
41:40that you're looking for
41:41before you're injecting yourself.
41:43Okay.
41:44What's that?
41:44EpiPens are essential
41:46as 2.4 million people
41:47have food allergies
41:48in the UK
41:49and could die
41:50of fatal reactions.
41:51And you swing.
41:54Okay.
41:55You...
41:56That's not...
41:57That's real?
41:57You actually have to, like...
41:59You swing and push it.
42:01That's...
42:01Well, that was like...
42:02I've only ever seen that
42:03in, like,
42:04movies and stuff like that.
42:07Any questions?
42:08Did I almost die
42:09from this?
42:11Like...
42:12You...
42:12You have a reaction, okay?
42:14You...
42:15Yeah, you're lucky.
42:16No.
42:17And the ambulance
42:18found you
42:19in a good time.
42:20They were very fast.
42:21They were so fast.
42:22Yeah, yeah.
42:23They saved your life,
42:23basically, today.
42:25With no further signs
42:26of anaphylaxis
42:27and equipped with an EpiPen,
42:29Celeste can go home.
42:31Taxi?
42:32Taxi, taxi?
42:34We can take the train.
42:45We're happy to get you seen
42:46by a doctor,
42:47but we can't have that behaviour
42:47here, so...
42:49What behaviour?
43:05What behaviour?
43:06You would think
43:07desiccating a shoulder
43:08wouldn't be as sore.
43:09Oh, it's sore, love.
43:11And then putting it back in
43:11is going to be even sore.
43:36Have you been built out?
43:53Luckily I'm retired so I don't have to go to work. I'll just do a bit more reading I suppose.
44:35I don't have to go to work.
44:35You
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