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A and E After Dark - Season 7 - Episode 05
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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:10It can be very dangerous.
00:13We deal with a lot of aggressive patients.
00:16Things can escalate.
00:18It can be quite scary when it's just you and one violent patient.
00:24Across the UK, we join the staff of three of the most challenged emergency departments.
00:29It's always busy, it's always under pressure.
00:31Stop CPR.
00:32Time is of the essence.
00:34And the medics who face danger each shift.
00:37Most shifts, I see more place than nurses.
00:40With the amount of drugs and alcohol admissions rising.
00:43Have you been drinking today?
00:44The risk of violence and abuse looms large every night.
00:48Please don't swear like that.
00:50They try to attack and stop.
00:51I am not possible.
00:53Calm yourself down.
00:54People can become aggressive.
00:56What are you going to do?
00:57You've been punched, kicked.
00:59You see the good, bad and the ugly.
01:00I don't give a ****.
01:02Yeah, we'll get security.
01:03The emergency department is like a battlefield.
01:05It's like organised chaos.
01:19After dark, violence against NHS staff is at a record high.
01:26And doctors and nurses face it every time they're on shift.
01:30You've got to call the police.
01:38You've got to call the police.
01:39You've got to call the police.
01:40You've got to call the police.
01:40They can attack the security, they can attack nurses.
01:44I don't think the public is aware.
01:45They don't understand what we're going through.
01:47****
01:49Violence and aggression doesn't just stop at our doors.
01:52It continues on the streets.
01:54That can be quite scary for us and for everybody.
01:58You all right there?
01:59Have better days, haven't you?
02:00Got into a fight.
02:01This is how this might be?
02:10No, you're right.
02:14You're going to fight for it.
02:1736 year, Nisarg is in Riesos.
02:22One moment.
02:24After being assaulted outside his home,
02:26he's just minutes away from losing his vision.
02:30So I'm going to make an injection of low-part intercepted.
02:32I'm going to feel a scratch on your skin.
02:36Emergency doctor Fraser will be treating him.
02:41We see a lot of patients come in who are victims of assault.
02:43Being punched in the face can be fatal.
02:46With this patient, he had bleeding behind his eye.
02:49The pressure that that bleeding causes can squash the nerve,
02:55and so you can go blind in the space of an hour.
02:58It's a real time-critical emergency.
03:01This is just oxygen.
03:03You have to do a procedure called a lateral canthotomy,
03:06where you cut the ligaments that keep the eyeball in place
03:11and essentially relieve the swelling that's squashing the nerve
03:15that goes into the back of the eye.
03:18With the pressure building behind his eye,
03:20they have just minutes to act.
03:24Edelman's going in, right?
03:26I'm going to make you feel funny.
03:28Just have nice dreams.
03:30Dr. Ed administers a fast-acting sedative.
03:33Hey, buddy. You there?
03:35So the night team can fight to save his vision.
03:44That looks like the ligament there.
03:47Yep.
03:48So that's the superior ligament.
03:49Let's cut the superior first.
03:52Cut the superior because it's advisable to cut both
03:54in this circumstance,
03:55so it'll give us some room to maneuver.
03:57That's all right.
04:02I'm on the...
04:04I'm on the next, yep.
04:06Oh, there.
04:08Should we try it in the superior?
04:10Mm-hmm.
04:11And...
04:11Oh!
04:13I'm going to give a little soft-up
04:15of the cat in there.
04:19Sorry, are you touching?
04:20Yeah.
04:20I'm touching.
04:21Oh!
04:25The swelling is making the next cut much more difficult.
04:30Oh!
04:33Oh!
04:35Patient had bleeding under the surface of their eye.
04:38So it was particularly swollen.
04:41It made it quite difficult to see exactly what we were supposed to be cutting.
04:47It's a better grip.
04:48I feel as if it goes to the skin as well.
04:49And then I don't know what else we can cut.
04:53Consultant Dr Susie is also on shift.
04:56When someone has increasing pressure on the back of the eye,
05:00you will start to get compression of the nerve fibers that provide the sensation of vision.
05:05So if you don't release that pressure, that person will lose their sight, and they will become blind, and it
05:12will be permanent.
05:25This lady's new.
05:26She can probably step down, but not to the corridor.
05:29Also working the weekend in Newham's recess is Dr Ella.
05:41A patient drifting in and out of consciousness is being brought in by ambulance.
05:47We're at hospital now, okay?
05:50Give us two minutes and then we'll come in, all right?
05:51Yeah, one, two, three.
05:55She's going to vomit again.
05:57Stand on your side, okay?
06:03Hi, my love.
06:05My name's Ella.
06:05I'm one of the doctors.
06:07I'm just going to hear what's going on and then we're going to make you feel better, okay?
06:11I was witnessed by bystanders to collapse on the side of the pavement tonight outside of her address.
06:17Complaining of abdominal pain has defecated herself and had five vomits with us.
06:22Okay.
06:22I'm still complaining of abdominal pain.
06:24She's been in and out of an altered conscious state with GCS14 as her best with us.
06:29What do we think it is?
06:30She has said that for the last three days she's been having crack and heroin.
06:36I do see drug overdoses all the time and it's an enormous part of our workload.
06:41Pupils?
06:41Pupils are size two, even reactive, but they may be size one now.
06:46The main questions to ask are what have they overdosed on?
06:49Do we need to reverse that drug?
06:51Do they need any life support for that overdose?
06:54Can you open your eyes for me?
06:57Have you got any pain anywhere?
06:59There, in your stomach?
07:02Sorry, honey.
07:03It's going to feel something here, okay?
07:05Vomiting and a painful hard stomach can indicate life-threatening internal bleeding.
07:10Oh!
07:12I want to have a little listen to your breathing.
07:16So, Gretchen, let's do some fluids, clean her up a little bit.
07:20I don't think we need to do any scans or anything now.
07:23Currently, we're going to give her some fluids, some anti-sickness, so she can tell us a bit more about
07:27why she's vomiting, how she feels.
07:29Her tummy's nice and soft, so I'm not in a rush to do any scans right now. She's quite young.
07:33Sharp scratch. Sorry.
07:36Oh!
07:38My main concern for her is, is she withdrawing from crack and heroin and it's making her feel really miserable?
07:43It's going to be quite hard to manage that, so we might need to give her some other things to
07:46make her feel a little bit better.
07:48Can we clean her up a bit? Thanks, guys. I know it's not the nicest.
07:52Well, be quick, don't worry.
07:54Be quick, don't worry.
07:55Patients who are using drugs, they often have an untold story.
08:00A non-confused, well person doesn't allow themselves to be covered in excrement.
08:06It shows that this person is clearly in need of help.
08:11Yes, it does add burden to the NHS, but that is what we're here for.
08:14We're here for accidents and emergencies and drug overdoses or emergencies.
08:32Shut the f*** up!
08:34Security? Oh!
08:36No! No! Shut up!
08:39What?
08:39Alcohol-related emergencies are on the rise.
08:43You were a lot drunker when you first came in to me.
08:45Now you were out of Israel!
08:47Obviously, drugs and alcohol are a big problem.
08:50I've been witnessing violence and aggression.
08:52It is difficult to be on the receiving end.
08:54I think that's definitely gotten worse.
08:57From 2023 to 24, the NHS saw over one million alcohol-related admissions.
09:04Many arriving after dark.
09:07So you, and you, and you can f*** off.
09:10At night, everything gets worse.
09:13At night, everything gets worse.
09:13When you mix in alcohol and violence and aggression against our staff.
09:17And it can feel like a police station sometimes.
09:20F*** that we f*** for, right, f***ing f***!
09:32No!
09:37Nooooo!
09:46Nooo!
09:48He's at imminent risk of losing his sight.
09:50The night team are performing an emergency procedure.
09:53We made a small lab real cut through the skin
09:55so you need to just try and buy yourself through the window.
09:58The procedure we need to do is called the natural camphotomy.
10:01It's not something that we do very often.
10:04It is a time-critical intervention.
10:08Identified a bit of the pigment,
10:09but we couldn't get enough of it clamped to cut.
10:12He's got quite a large swelling to the globe itself.
10:15To relieve the pressure on his optic nerve,
10:18the night team have to cut the ligament inside his eye socket.
10:22If I take away the upper leg with the two forceps, then...
10:26Now, Dr. Susie needs to work around the swelling to cut a second one.
10:31Oh!
10:33Just kill me, though.
10:36I'm going to give him another 20.
10:38I'll give him a little bit.
10:41Yeah.
10:42It's talented.
10:43Yes!
10:44Pop out, though, isn't it?
10:46Oh!
10:48See if we get any of three.
10:52I'm just going to hold it for a little bit.
10:55Respond!
11:00Got it.
11:00Stop.
11:02I don't know.
11:02I'm a bit of a man.
11:04I'm trying.
11:04Feels a lot better.
11:09Well done, my friends.
11:12The eye's more forward, so it's not good.
11:15Trying to find a very small piece of anatomy to cut was really challenging.
11:21We will see if we've been successful.
11:24The team must wait to see if Nisarg's site is saved,
11:28and if the damage goes any deeper.
11:31We're going to do a CT just to assess the bones and see if there's any fractures in the socket
11:36itself.
11:36I'm sure that there's nothing beyond that and into the brain.
11:41You OK?
11:43It's coming round from your sedation, my friend.
11:45When someone is punched in the face with significant force,
11:50there are all sorts of complications.
11:52You would be thinking about significant brain injury, facial fractures.
11:57These things can happen in an instant and change that person's life forever.
12:01And it's something that we need to do some other investigations.
12:16A&E North for Norwich, medical trauma.
12:19I've got some IV fluids up.
12:21Nearly 3am in Norwich.
12:23So it's been going at this rate since midnight, really.
12:28Dr Lucia is looking after a patient whose heart is racing out of control.
12:33It's still going fast, isn't it?
12:35His heart rate on the monitor was 200 beats per minute.
12:39The normal rate is 60 to 100.
12:42He can't maintain that heart rate of 200 for a long time.
12:46Eventually, it will become tired and potentially stop.
12:50All right, sweetheart.
12:51So if you could pop your hands straight for me.
12:53That's fine.
12:54It is unusual. It's rare.
12:56But sometimes people do have this condition
12:59where they go into the spontaneous fast rhythm.
13:03In the slightest, jolt drove his heart into this fast rate.
13:08Dr Lucia consults the cardiology department
13:11for the first critical move in his treatment.
13:15I've given him a bladder syringe
13:17and he's tried about four or five attempts
13:20and basically it's not really changed.
13:23So we're going to give you 6mg of adenosine.
13:25Yes, yes.
13:27Adenosine is a little bit like a jump-starting for heart again.
13:30You give it quite fast into a vein.
13:34It stops the heart and then restarts it.
13:37And hopefully it comes back at the right rhythm
13:41between 60 to 100 beats per minute,
13:44which is the normal rate.
13:45All right, sweetheart.
13:46So adenosine going in now.
13:49And the flush.
13:51The first time I did it a number of years ago
13:53when I gave the adenosine, it was quite scary.
13:56When you didn't see the heart rhythm on the monitor.
14:00Lift your arm up.
14:04Raising his arm helps the drug hit his heart in seconds.
14:10Still going fast, isn't it?
14:12It is, yeah.
14:14It's not done it, has it?
14:16With the heart still racing at 200 beats per minute,
14:20the adenosine has failed.
14:23So, once we're ready...
14:26Dr Lucia tries again, with double the dose.
14:3012mg of adenosine going through and a big flush.
14:35There we go.
14:36Lift his arm up.
14:37Beautiful.
14:39Nice breathing.
14:41Can we get a little bit of oxygen on?
14:44If that's all right, two litres.
14:46Extra oxygen supports the patient's heart
14:48as the night team fight to slow it down.
14:51The rate hasn't made a blind bit of difference, has it?
14:55So, um, I'm going to do 18 now.
14:59Dr Lucia administers a third and final dose.
15:03Any more could stop his heart altogether.
15:06OK, so we're going to do 18.
15:10So...
15:11Adenosine gone through.
15:13Flush gone through.
15:14Lift it up.
15:17Oh, that was awful.
15:19Sorry, sweet.
15:22Adenosine acts fast,
15:23triggering an overwhelming wave of nausea and breathlessness.
15:28During that episode, when the heart is racing,
15:31it is scary.
15:32They feel terrible.
15:33They tell us that they feel terrible.
15:37We're looking promising.
15:39We're looking promising.
15:48We're looking promising.
15:50The final dose has failed.
15:53The patient's heart is still stuck in critical overdrive.
15:57The fact that we've done the third one and it hasn't worked,
16:00I'll just give her a ring now so she's fully aware.
16:03Basically, the heart's beating differently and there's no set pattern.
16:09If you don't intervene, ultimately, the outcome can be for it to stop.
16:28On average, ambulance crews respond to nearly 3,000 falls every 24 hours,
16:33bringing some of the most life-changing emergencies into A&E after dark.
16:42In the middle of his night shift,
16:44Dr. Aditya has been called to see 40-year-old delivery driver Akram.
16:50You can feel my heart?
16:51Yeah.
16:52Who was brought in by ambulance after falling down the stairs.
16:56It's really quite swollen here.
16:58Yeah, here's the bed.
16:59Are you able to bend your elbow?
17:02Oh, I don't think.
17:03No.
17:03I can't believe.
17:04Okay.
17:05We'll get you some x-ray sorted.
17:07Thank you, but before you do it, just give me any pain.
17:10Oh, we'll get you some pain relief.
17:11I've already prescribed it to you, okay?
17:13Do you need some help getting up?
17:14No, I can't.
17:15Okay.
17:16Getting an x-ray as quick as possible is really crucial
17:19because the further we delay the x-rays,
17:22it can lead to nerve damage, can lead to vessel damage.
17:25To reveal the impact of Akram's fall,
17:28Dr. Aditya needs to check all the bones in his arm,
17:31from shoulder to wrist.
17:33Yeah, forearm's fine.
17:36Forearm's okay, yeah.
17:39Desiccated, yeah.
17:42Oh, yeah.
17:43Not for man.
17:44Dislocation is serious, can lead to nerve damage,
17:48making the lymph unusable for the patient.
17:50With Akram's mobility and his job on the line,
17:53Dr. Aditya and the team need to urgently realign his elbow.
17:58This part of your bone should be in this socket,
18:01so we need to put it back in the right place.
18:05Oh!
18:18Yeah, we've got the lady who's just been in a road traffic collision.
18:24She's been crossing the road, driver hasn't seen her,
18:27he's turned the corner and hit her.
18:28Okay.
18:29Any, um, past mitochondria, any blood thinners she's on?
18:32Clipidogrel.
18:32Clipidogrel, okay.
18:33Tonight in Newham, Dr. Rosie's in charge of the Rhesus team.
18:37We've got a head injury, a pedestrian versus car.
18:40Rhesus can be often the most chaotic place in the whole hospital.
18:44Can you tell me if you're in pain there?
18:46Often, the patients are really sick,
18:49especially when it's a pedestrian hit by a car,
18:50we're super careful about those
18:52because the risk of injuries is really high.
18:55After dark, pedestrians are over twice as likely to be struck,
19:00and the consequences can be life-threatening.
19:03I see you, he's here.
19:05Okay.
19:05Yeah.
19:08And vomit bottles in the back, aren't they?
19:10Get some dishes for her.
19:17You're okay.
19:18Okay, here we go.
19:19Well done, well done.
19:23Our main concern is she's got a significant head injury,
19:26especially given that she's vomited now two times,
19:29especially when she's lying flat,
19:31which can suggest a raise in her intracranial pressure.
19:33Yes.
19:34Okay.
19:35Hello, my name is Tosin, one of the A&E doctors.
19:38You can just lie your head back for me, okay?
19:41The night team must run urgent neurological checks
19:44in case 63-year-old Paramuswari
19:46has a critical bleed on the brain.
19:49Deep breath.
19:51Big breath.
19:53Very good.
19:55Okay, my dearie, that's fine.
19:57I'm just going to shine this in your eyes, okay?
19:59There's a light coming in your eyes, okay?
20:01There's a light coming in your eyes, okay?
20:03Good.
20:07Okay.
20:08PP is equal and reactive, two millimetres.
20:13Any pain in your legs?
20:16Just the hand, okay, and your head.
20:18Brilliant.
20:19Let's leave the wrist for now, because we'll get it x-rayed,
20:21so we don't want to...
20:22Yeah.
20:22And then there's this obvious...
20:24Is it boggy?
20:26It is.
20:27It is?
20:28Okay, all right.
20:28Okay.
20:29There's a particular type of boggy swelling
20:31that you can get on the head.
20:34They're fairly rare, but it can suggest a skull fracture.
20:39Sorry, my dear.
20:40We're going to keep her in that position.
20:42We've got a sort of CT trauma series for her.
20:46We're going to get you some scan for your head, okay?
20:49Okay, we'll get you some...
20:50And some painkillers, okay.
20:52Hopefully, we can get her into a scan fairly quickly
20:54so we'll know exactly what we're dealing with.
21:01Following the crash,
21:03Paramuswari's sons called for an ambulance.
21:06I was in shock when I quickly came,
21:07and I saw my mother on the floor.
21:10It was the last thing I wanted to see, but I'm seeing it.
21:14Strongest woman I've made in my life.
21:18Hi, how are you doing?
21:19So, I'm Rosie, one of the doctors.
21:20I'm worried about her head at this point,
21:22so I definitely want to make sure there's nothing in her head.
21:24She vomits in the place as well, isn't it?
21:24Yeah.
21:25There's lots of reasons people vomit,
21:27including if they are shocked from an injury,
21:29but having something worrying in the brain
21:30is a reason why people vomit as well.
21:32So, we're going to sit see everything
21:33and then X-ray the wrist as well.
21:36If you have bleeding on the brain, it can expand.
21:39All that blood expands.
21:41It has nowhere to go.
21:42The skull can't expand,
21:43so it just compresses the really critical areas of the brain,
21:47the ones that control your motor function or your speech.
21:52And what do you mean to translate for her?
21:54Yeah.
21:55In obviously the worst case is your ability
21:58to regulate your breathing and your heart rate as well.
22:01It can lead to disabilities
22:04and possibly death in really severe cases.
22:28I'm going to turn out your last police station right here.
22:33What's going on?
22:34Everyone seems to be coming in for a fight.
22:37After dark, A&Es across the country
22:39are facing more aggressive patients than ever before.
22:44The night shift can be a bit chaotic, a bit crazy.
22:49It can suddenly make the department feel very unsafe.
22:52It can really ramp everyone's anxiety levels up.
22:57It don't minding why you can handle me, I'm sorry.
23:01But many patients on the night shift
23:03are also the victims of aggression and assault.
23:21Oh, my God.
23:23Well done, my friend.
23:24You're coming around.
23:24In Newham, Dr. Fraser is looking after 36-year-old Nisarg.
23:30He was attacked outside his home
23:32and rushed into emergency eye surgery.
23:35I'm just going to pop this off.
23:36We don't need the oxygen anymore, OK?
23:38Now the pressure around his eye has dropped.
23:41The night team need to check
23:43whether they were able to save his eyesight.
23:45Can I just have a look at your vision again?
23:47Are you awake enough for me to look at your vision?
23:50Here you go.
24:01Oh, my God.
24:03OK.
24:04Now I can see.
24:06That's good.
24:07Cover your left eye.
24:08Yeah.
24:08Can you see my face?
24:10I can see your face.
24:11How many fingers?
24:12Four.
24:14Music to my ears.
24:16He's had a punch that's forceful enough
24:20to give him bleeding behind his eyes.
24:22So what else might that have done?
24:23Has that broken any bones in his face?
24:25Make sure he's not got any bleeding in his brain.
24:27What we need to do now
24:28is just because you've had
24:29a quite significant head injury,
24:31we're going to do a scan of your head.
24:33OK?
24:36Nisarg is taken for an urgent head scan.
24:39Nisarg will take about two to three minutes, OK?
24:42To check for any life-threatening injuries.
24:50He waits in majors
24:52while the night team examine the scans.
24:54The thing is, I'm celebrating a festival
24:57with my two-year-old daughter.
25:00The guy came, you know, he's arguing me,
25:03like, I have my daughter in my hand,
25:05and he's trying to punch me,
25:07and I just pulled her back
25:10and that's why my face is like this
25:13and he just punched me in my face and my eyes.
25:21Is your eye painful?
25:23Yes.
25:24And now it's paining here as well.
25:26Yes, the CT scan showed
25:28that there's a broken bone in your face
25:30and around your eye.
25:33What we're going to need to do
25:34is get you followed up by the facial surgeons
25:37as well for an appointment
25:38to see whether they need to do anything.
25:40Sometimes when you've got, you know,
25:41a fractured eye socket,
25:42then the muscles that move your eye
25:44can squish through the gaps in the broken bones,
25:47and that can mean that you can't move your eyes properly.
25:50But the immediate priority for him
25:52was getting him seen by an eye doctor.
25:55We're going to get you seen
25:56by the ophthalmologist in the morning.
25:57All right.
25:58Some of the most dramatic cases
26:01of, you know, injury and trauma
26:02from violence in the community
26:04will happen at night.
26:06It was a pretty horrible assault.
26:08It's what sounds like a completely trivial argument
26:10and someone ends up punching him in the face.
26:11So it's a pretty horrible thing to happen.
26:29He's still in SVT.
26:30He did revert back five cyberspeaks,
26:33but then just went straight back into SVT.
26:36On the night shift,
26:38Dr Lucia is looking after a patient
26:40whose heart is beating around double the speed it should be.
26:44We give six milligrams at 246, no effect.
26:49And then at 250,
26:50I gave 12 milligrams of adenosine, no effect.
26:55With the first treatment failing to calm his heart,
26:58Dr Lucia calls the cardiology specialist.
27:01So we just need to DC.
27:04Well, I'll have a word with Dania
27:05because obviously she needs to be in resources
27:07if we're going to do that as well.
27:08They devise a new treatment plan.
27:12So, I've spoken to cardiologist.
27:14So what he's recommended is actually DC cardioversion.
27:18Oh, no.
27:19I really don't want to do that.
27:21OK.
27:22The quickest way to get the heart back to the normal rhythm
27:26is we put defibrillator pads on
27:29and jolt the heart with electricity back into the normal rhythm.
27:35But you can imagine
27:38that situation not being very, very, you know, pleasant.
27:43So you have to put yourself in the position of the patient.
27:48It makes people really, really, really frightened.
27:51It's more than one way to skin a cat.
27:54So don't worry.
27:55It's all good.
27:57Dr Lucia refers back to the cardiology specialist
28:00on what else can be done.
28:03Give him metoprolol.
28:06What dose would you recommend?
28:08There is one other medication they can try.
28:12Metoprolol is a beta blocker.
28:14This works in a different way
28:17and slows the heart down.
28:20They're metoprolol now.
28:22Yeah, so give that a 312.
28:25Unlike adenosine, which resets the heart,
28:28metoprolol works the opposite way,
28:31blocking adrenaline to gently calm the heart rate.
28:35It's coming down.
28:37It's getting there slowly.
28:39And then once you go back to normal,
28:41get your nice cup of tea.
28:45Nearly.
28:46Yeah.
28:47Nearly.
28:52Get out of it.
28:53The rate is better than what it was.
28:56Whereas before, you were sort of like about 200.
28:59You feel better?
29:01Much better.
29:03Good.
29:05A sigh of relief.
29:06A sigh of relief.
29:07As soon as you get the rate back to the normal rate,
29:12the patient just feels miraculously better.
29:15And that's what we're here to do.
29:18Do an ECG,
29:19and then unfortunately you're going to have to look at our ugly faces for a couple of hours now.
29:23Ha ha ha ha ha ha.
29:26Ha ha ha ha.
29:38In Newham,
29:4063-year-old Paramaswari is having urgent scans,
29:44after she was hit by a car while walking to temple after dark.
29:54her sons are translating for the night team
30:05my brother called me saying mom's had an accident you need to come and she was still regaining
30:11consciousness she didn't know what was happening and then gcs is 15. leading her care dr rosie
30:22is reviewing the scans hello hello how are you doing yeah i've just come to explain about the scan
30:35are you guys happy to translate or do you want a translator here no no are you sure okay so
30:40obviously we've scanned um head neck and all the body here what it does show which is what we were
30:47suspecting unfortunately there is a bleed on the brain okay there's a bleed over where she's got
30:54the bump but there's also a little bit on the back um she does have a fracture of her wrist
30:58as well
30:59unfortunately but that that is very manageable we can sort that out okay so unfortunately the
31:05ct scan has showed that she has a bleed on the brain ct scan only shows exactly what's happening
31:14at one point in time so it's really really important we monitor her carefully um that means doing
31:19neurological observations regularly keep your head nice and still for me just follow finger with
31:26your eyes okay there's lots of things that can happen after you have a bleed on the brain the main
31:36concern is that if you have bleeding it can expand it can compress certain areas of the brain can you
31:45squeeze my hand for me and this side can you pull my hand into you very good and pull out
31:53push out
31:56so then neurology is assessed in various ways for example the power of your limbs the coordination
32:02your ability to feel on your skin these are all things that can be affected by the bleed on the
32:09brain
32:10if i touch her there does she feel that i feel the same on both sides
32:19she can feel it less on that side or more on this side what about here
32:23less on this side okay okay what about here
32:33the same feels the same yeah here
32:43on that side she doesn't feel anything this side okay okay okay that's right so we'll have to
32:49have a chat with the neurosurgeons obviously i'm one of the a&e doctors but one of the neurosurgeons
32:52will have to have a look at all the scans and decide what's what's best for her okay thank you
33:00at the moment her neurological assessment is actually pretty good but my biggest concern is the risk of
33:06further bleeding she's on a blood thinner as well clopidogrel for a previous stroke which makes it
33:13a little bit more concerning blood thinning medication protects paramuswari from a stroke
33:19by preventing her blood from clotting but with the bleed on the brain it could make things far worse
33:26i have spoken to the hematologist at the london and they have suggested to give the platelets yes one
33:32pool of platelets given the risk dr rosie speaks to out of hours blood specialists
33:39the platelets are a component you get in your blood so we all have platelets just swimming around in our
33:44blood to help us clot when we bleed this patient is on a anti-platelet agent called clopidogrel and so
33:50we've
33:50asked the hematologist and we are giving her some extra platelets sort of help that clotting process
33:57the main concern if she re-bleeds is that we get a big collection of blood in the brain that
34:02then
34:02compresses the brain including a lot of the the major areas that are you know in control of our you
34:08know
34:08speech our movements our breathing with the emergency treatment on its way paramuswari stays in
34:14resus under close monitoring giving her the best possible chance of survival it's a shock it's a
34:22massive shock but fingers crossed praying to god that everything will be fine again
34:39no grant i'll try to prioritize him okay thanks let me know thanks in belfast 83 year old ian is
34:46brought into resus hello taking the lead on his care is dr alice what's brought you in tonight
34:59okay do you have trouble with the tummy before not really no can i have a failure tummy grab some
35:07gloves there's a severe pain except see there no not there no just there ah there what came first the
35:19pain or the vomiting well the pain the pain came first a bit of a stiffness itself okay the pain
35:25was
35:25okay became intense is your health usually good it's reasonable yes yeah i'm a farmer i always worry
35:36whenever a farmer comes in because you don't come to see us with nothing no no he's coming with tummy
35:43pain he's got a high lactate he's tender and he's been vomiting his bowels aren't opening so i'm worried
35:49he's either got a blockage in his bowel or a blockage in an artery supplying the boil
35:58ian's wife has arrived to sit with him i've been married since 1967 a long time and
36:06uh we don't really have arguments he has a heart problem he has a pacemaker fitted quite some time
36:15but this is different this is around the tummy area he just felt poorly after he had his evening meal
36:23really sick and was actually vomiting it it happens with age or as i say too many birthdays
36:35so here we are the right place hi keeva it's alice one of the ed regs in the royal could
36:41i talk to you
36:42about ct abdomen pelvis i can only feel his tummy and look at him i can't see what's going on
36:47on the
36:48inside whereas the ct can give me good images of the abdomen and they can tell us a bit more
36:53about
36:53what's going on uh what did you farm
36:59cattle sheep beef or dairy beef well rare breeds oh still on the farm are you still live on the
37:10chest
37:10yeah all right we'll give you a little bit this morphine okay and then if you need more i can
37:15give
37:15you some more in a wee bit okay i was just hoping that you weren't scared of needles because it's
37:21always the big strong men that cope on me whenever i put a needle into them and they do a
37:26lot of
37:26shooting this needle like do you do a lot of shooting oh i know i snuck in while you were
37:32distracted
37:32there ah ah you did do a bit of shooting there i did yes but you're gonna go up for
37:49your scan now
37:50so we are going for the ct scan okay this gentleman i'm worried about a bowel obstruction i'm worried
37:59about an aortic aneurysm i'm worried about mesenteric ischemia i'm worried about pancreatitis
38:05any older gentleman that presents with tummy pain it can be potentially fatal
38:29so you can feel my heart yeah it's fine everywhere in the middle of the night 40-year-old delivery
38:35driver akram has blown his elbow out of its socket so clearly from the x-rays okay it shows that
38:42you
38:42have to stick it to the elbow but it's going to be a difficult procedure to put it back to
38:45care we'll
38:46try to sedate you as much as possible with his ability to drive on the line it needs to be
38:51realigned urgently a treatment that requires two senior doctors dr aditya and dr zoe so i'm going to
39:00use a mask just because it makes it a little bit easier for you to get gas and air into
39:04your system
39:05the night team use penthrox for fast-acting pain relief
39:10deep breaths
39:12doing well it will relax akram's muscles within minutes deep breaths at night
39:19okay it's quite physically intensive procedure both for the patient and for the doctors who are
39:31performing the procedure
39:35it requires traction and counter traction and put the bone back in place keep you taking deep breaths
39:43still awkward to bend is it the procedure needs extra force while zoe anchors akram's elbow in place
39:52dr aditya pulls the forearm further from the socket giving the joint more opportunity to slot back into
40:00natural alignment
40:01where did i think it is it's all right you know okay you've done so well there looks better how's
40:14it
40:14feeling well now the next bit's getting this cast on so falling down the stairs can be quite serious
40:21it can result in head traumas and other severe traumas like chest trauma how does your elbow feel
40:27this is pain still p.m we'll keep you in here for now okay until the next day are ready
40:32to come and
40:32get you okay so all in all yeah he was pretty lucky to just have a dislocated elbow rather than
40:38any other
40:38traumas did you like that pain really
40:54on the other side of the hospital
41:00emergency doctor alice wants to diagnose 83 year old ian's severe abdominal pain breathe in and hold your
41:11breath he waits for his ct results with wife joan is this still as painful as it was all right
41:18hold up there oh that's right you have a right selection of stuff here as long as you don't move
41:24all right yeah and have you felt sick again no your report's back
41:32you reported your scans back so it's not actually the tummy at all it's the pancreas
41:40right it's not very happy right now it's got a bit inflamed right your pancreas can cause loads of
41:48issues it's really important in regulating a lot of things including the sugar levels in your blood but
41:53can be incredibly sore it can also become necrotic so it can die um and then that can make you
41:59really
41:59really sick and his hasn't reached that stage yet it's just inflamed um but he needs careful
42:05observation and pain management do you have any questions for me no no we're gonna be here yeah
42:10oh well i would say you're coming in for bed and breakfast he doesn't need to go for theater he
42:15can
42:15be managed conservatively which is good because in somebody his age going for a big operation
42:21can be very difficult you might want to get yourself home i'm here okay if you need me
42:28most people with pancreatitis you can tell from the front door because they are screaming
42:33and they're writhing in agony he is like just very stoic okay see you in the morning bye-bye
42:45okay sorry about all that classic farmer yeah um yeah it's farmers
42:54three dollars thank you you're very welcome
43:05what's really important is that we continue to check your vision
43:18so we're going to do a few scans for you for the head and the neck
43:31i have check bags right it's perfect do you feel less pain now it's less pain yeah oh very good
43:46and remember what's next what's next is that the surgeons will come and see you
43:51so
43:54so
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