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A and E After Dark - Season 7 - Episode 08 Eng Sub
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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 stuff.
00:51Calm yourself down.
00:54People can become aggressive.
00:56You've been punched, kicked.
00:58You see the good, bad and the ugly.
01:00I don't do a ****.
01:02Yeah, we'll get security.
01:03The emergency department is like a battlefield.
01:05It's like organised chaos.
01:23Emergency doctors and nurses are not the only ones working the night shift in A&E.
01:28The police play a massive role in A&E.
01:31They're near enough always in the department.
01:34**** this!
01:36There's always going to be something happening in A&E where they're needed.
01:40It's sad to say, but we always have disruptive patients or aggression.
01:44There's always going to be something that's going to happen in A&E.
01:47There's always going to be something that's going to happen.
01:47Patients are unpredictable.
01:53So many things can escalate very quickly.
01:58That's it.
01:59We managed to get through the night and we see it as another night in A&E.
02:24It's Friday night in A&E.
02:27Yeah, **** you, **** you.
02:31Paramedics bring in a man in extreme distress.
02:34Police are physically restraining him on the ambulance stretcher.
02:42Consultant Nick is leading the team.
02:45Help me.
02:46He is known to police.
02:48Police have gone out to him tonight and have actually arrested him.
02:50No, no, no, no, no.
02:51Because he's going to appear at court.
02:52This is actually fair to the Utah.
02:55That is pretty much the story.
02:56I haven't really been able to get much out of him.
02:58He's got three laps to his head.
03:00So he's got one above his eyebrow, which is the one that's actively bleeding.
03:03**** you.
03:04When patients just shout at you and they require a lot of team members
03:11to restrain them often and to keep them calm and safe.
03:15**** come, keep my room.
03:17So can we get him onto that bed?
03:18Yeah, yeah, yeah.
03:21Listen.
03:21Listen.
03:22Two now.
03:23Take pressure.
03:24Don't pitch me.
03:25OK.
03:26It's broken.
03:27Hey, hey, hey.
03:28Will you sit quietly and talk to me or not?
03:30No.
03:31When patients withdraw any opportunity for you to do any clinical care,
03:38sometimes it can be impossible to treat patients
03:41until you've calmed the patient down.
03:44Oh, **** me!
03:46Can I have ketamine, please?
03:49Do you want to just get the ketamine ready for me?
03:51280 milligrams total.
03:53To keep them calm and safe, sometimes that ends with chemical restraint,
03:59using drugs to sedate them.
04:02OK, I'm going to put an injection in this arm, OK?
04:05Don't put.
04:06I'm going to have to.
04:07I'm going to have to.
04:08To then enable us to do the things we need to do to check they're OK.
04:12Can you hold him still for me, please?
04:16Just keep still for now.
04:23Once the sedation takes hold,
04:25Dr Nick can safely examine the patient's injuries.
04:28It's important that we keep people safe.
04:31We need to keep them under observation,
04:34to do the things we need to do to get them back on their feet.
04:48Staff announcement, we've got a priority call.
04:50ETA, five minutes.
04:53Also working the weekend shift is Dr Sarah in Resos.
04:5836-year-old gentleman who has been assaulted outside a pub today.
05:03Been assaulted multiple times in the face.
05:05Yeah. Is he under arrest or why is he accompanied?
05:07They're here for a statement gathering.
05:09In 2024, over 145,000 victims of violence attended A&E.
05:16The peak come in on the weekend.
05:19Do you want to come with me? We're just going to go around the corner.
05:22Outside a pub in Newham, police were called to an assault.
05:26I'm one of the emergency consultant doctors.
05:29You all right there?
05:30You had better days, haven't you?
05:31You got into a fight.
05:33And were you hit with fists or did you see anything else
05:36that you might have been hit with?
05:37No, I don't know.
05:38You just come with fists. I don't know if they had anything in there.
05:42OK. I just wanted to have a quick look at your eye.
05:45I'm just going to peek it open a little bit, all right?
05:47Can you see me all right?
05:49Yeah.
05:49Yeah? Not blurry or anything like that if I cover this eye? Grand.
05:53Can I get you to open your mouth as much as you can?
05:55Can I do this?
05:57Yeah.
05:58I can do crackling of it.
06:00Yeah. OK.
06:01Can I have a gentle feel around there and just see?
06:04Oh, yeah. OK.
06:06All right.
06:07And it's in my ear.
06:08OK.
06:08There's a good likelihood that you have a fracture
06:12at the base of where your eye sits.
06:14If you do have a break there, then you've probably got a bit of air
06:17kind of coming up and that's what we can feel.
06:19It feels a bit like bubble wrap or something like that.
06:22Don't blow your nose or anything like that, OK?
06:25Just resist the temptation to blow it.
06:28All right.
06:29So what we're going to do, we're going to get a CT scan
06:32of your head and your face, all right?
06:36We can see straight away that he's taken a lot of punches to the face
06:39and also his eyes not moving properly, which is a bit of concern.
06:43When we have injuries to the head, we always have to be mindful
06:46of that there might be brain injuries.
06:50Dr. Sarah fast-tracks David for a head scan.
06:54Just lay down your head there for me, please.
06:57Try to stay still as much as we can, OK? Don't move.
07:02You can't assume anything for the safety of that patient.
07:05You have to make sure that you are absolutely sure
07:08they don't have a brain injury.
07:12Then the face itself has quite a number of complicated bones involved,
07:17and so it will tell us exactly what bones are broken
07:20and exactly what kind of bleeding there might be in or around the brain.
07:24It could be very dangerous.
07:27OK, that's all nine.
07:30All right, nice and quick, thank you very much.
07:35Waiting for the results is David's partner, Michelle.
07:39I just went into hysterics.
07:41I was just uncontrollably shaken.
07:47Would you like to provide a signal for those who call
07:50if we find out who's done this?
07:52Yeah, yeah, yeah.
07:54Do you know the guy's name and all that?
07:56No.
07:59The severity of his injuries could determine legal action.
08:05We've had forensics already arrive on scene.
08:08Then we'll go from there.
08:11Dr. Sarah receives the CT images.
08:15Is there a petrol or hemorrhage?
08:16No.
08:17I don't know, Robbie.
08:18I don't have to report back yet.
08:22What's the point of the test?
08:22When we do scans, we often find things that we're not expecting to find
08:27and it might not always be very clear straight away what they are.
08:30So there's one suggestion that there might be a small area of bleed on the brain,
08:34which can happen when you've been punched.
08:37It might need to refer the patient to the neurosurgeons.
08:42Anyone with any building pressure in their brain from bleeding,
08:46if that wasn't relieved, they might slip into a coma and ultimately be at risk of death.
09:14The
09:15Alcohol fuels some of the most serious cases in A&E.
09:24And at night, its impact is impossible to ignore.
09:29Honestly, it's that war zone right there.
09:31You don't know what you're ever going to walk into.
09:32It will get in your face. They will get aggressive.
09:38The situation can get really ropey, really, really quickly.
09:41I need you to calm down.
09:45Sometimes they're erratic and they're unpredictable.
09:48It's quite difficult to contain on those kind of nights the whole of the emergency department.
10:02It's not going to take off of the emergency department.
10:05It's going to take off of the emergency department.
10:08Staff of the announcement. I don't priority call. ETA, five minutes.
10:13We don't have all the full OBS yet, but they are definitely going to recess.
10:18Under blue lights, a patient is rushed in.
10:22After a suspected overdose has stopped her breathing.
10:26It's okay, it's okay.
10:36It came in as an overdose, they found a sort of unresponsive.
10:43Pals for poor breathing, she wasn't responsive.
10:47She's taken lorazepam, zoplicone and heroin as well.
10:52And heroin as well.
10:58Emergency doctor Andrea takes the lead on her care.
11:03A few of these tablets here, I'm not clear what's in those.
11:09We have no idea what this could be.
11:11So probably she took like a multi-drug overdose.
11:16But now she's having this response.
11:21I'll give you some oxygen, okay?
11:22This is oxygen, okay?
11:24Try to breathe.
11:29Do you remember what happened?
11:33This picture is not fully clear, that's the thing.
11:35We don't know what's going on.
11:38She took a known amount of drugs and probably a regular medication.
11:42She was basically in respiratory arrest when the ambulance came.
11:47What have you taken? Any drugs?
11:49I told you my parents.
11:52Heroin intoxication is a life-threatening condition.
11:55The opioid basically is a very strong sedative and can cause respiratory arrest.
12:02Opioid overdoses become fatal when the drugs switch off the part of the brain that controls breathing.
12:10The ambulance, they've given naloxone two doses. They have a good effect.
12:18Naloxone, known as the life-saving antidote to heroin, restores breathing within minutes.
12:24When you give the antidote, you can have this rebound response, severe agitation.
12:30This is just an heroin intoxication.
12:33But it's not clear because we go like a...
12:36It was this in her pocket, so...
12:39Could be there's prometazine, catapin, borfarin in it, so...
12:43The story is not fully clear.
12:46The patient's oxygen levels appear low, and her behaviour is unpredictable.
12:52Let's do our full assessment, like A, B, C, D, E, and then...
12:57In order to safely assess her, the night team used sedation to calm her symptoms.
13:04Nice deep breaths.
13:06That's it. Breathe in and lay out.
13:09It's hard to see sometimes to their clinical needs,
13:12especially if they are confused or aggressive.
13:16So it's important to speak to them in a gentle tone,
13:20and just really try to get to the root cause of the problem.
13:24That's it. Well done.
13:26So I've given some lorazepam, a sedative agent,
13:30and she's more calm now compared when she arrived, so...
13:34How was it falling a little bit?
13:36How was it falling a little bit?
13:38I broke her chest x-ray because she had a very low respiratory rate,
13:44and she was unconscious.
13:45You have to stay nice and calm for us.
13:48I'll be quick, okay?
13:52Dr Andrea needs to check if there's any life-threatening damage to her lungs...
13:59..before she could fall back into respiratory arrest.
14:03It's not clear if she has vomited or not,
14:05so we're gonna check if there's any consolidation in the lungs.
14:09There's a risk of dying.
14:16In the UK, around 400 victims of assault end up at A&E every day.
14:22With around 80 of them injured so badly, they have to be admitted.
14:26I see quite a number of injuries that are due to assault.
14:32Unfortunately, I'm more likely to come in at the weekend
14:35and more likely to come in late at night.
14:41I mean, it's pretty impressive, surgical lymphosema.
14:44That's for sure.
14:45On the night shift, Dr Sarah and Dr Robbie are reviewing the CT images
14:51of 36-year-old David, who's been violently assaulted outside a pub.
14:56What we saw on the CT was basically there are lots of fractures
14:59and we just want a response back from the maxillofacial surgeons
15:03about when they want to see you for follow-up and all of that.
15:06All right?
15:07The police were wanting to know a bit more about the fractures and things on your face.
15:11Do you mind if I explain what they are?
15:14OK.
15:15We often see patients who are accompanied by the police.
15:18Often the police want to know from us, you know, what the outcome would be for the patient
15:21because that will have an influence on their investigation.
15:24So we'll have to try to work together.
15:26It's about around his nose and his sinus and around his eye.
15:30Multiple complicated fractures.
15:32Is it going to be life-threatening?
15:34Until we get a bit more information, it's a bit hard to answer that question.
15:39With serious facial fractures and the possibility of a bleed on the brain,
15:44Dr Sarah needs to consult with specialists to determine the next steps.
15:49I've got a 36-year-old man.
15:51He's got massive swelling and surgical emphysema to the right side of his face.
15:55Why don't I speak to your consultant?
15:56All right, thanks.
15:58David's partner, Michelle, raises concerns that his pain is getting worse.
16:04Are you all right there? What's happening?
16:05Oh, my neck's gone tight and all.
16:08Okay, let's have a little feel.
16:11Sorry, darling.
16:12Are you feeling like your nostrils are blocked?
16:15Yeah.
16:16Both sides?
16:17Yeah, don't stop bleeding.
16:20The cheek.
16:20Is it getting bigger?
16:21Yeah, and it's irritable in me.
16:25If you haven't blown your nose at all?
16:27Yeah.
16:27Okay, so that will make it worse.
16:30So what it is, is there's air coming out
16:34and where you do have some breaks around your nose and around your sinuses,
16:39that means that air can come out from the sinus, kind of under the skin in your face.
16:44And unfortunately, if you blow your nose, you're just pushing the air out, you see.
16:48It will get a bit worse, all right?
16:50Can I have another look in your eye just to see how we're getting on?
16:53If you blow your nose, you can increase the pressure there and it can actually interfere with the blood supply
16:59to that eye and then compromise the eye itself.
17:02All right.
17:03Every time you blow, it's going to get a bit, a bit worse, all right?
17:06So you've got really got to not do it and just kind of catch the drips if you can.
17:14He's got surgical emphysema coming all round the neck now as well.
17:18So you need to keep an eye on it.
17:20OK.
17:21What we need to know from the maxillofacial surgeons is if that's going to need some kind of operation
17:25and what kind of follow-up it is and when they're going to see him.
17:29The specialists call the night team with a treatment plan.
17:33So plan as per neurosurgery, but from a MaxFax perspective, you go to have me.
17:37Thank you very much. Cheers, bye.
17:42Hi, David. I just got off the phone with the maxillofacial surgeons and their plan is not to admit you
17:52to hospital
17:54and to wait for the swelling to go down and make a decision about the operation.
17:59We have communicated with the neurosurgeons.
18:02There is, on your CT scan as well, there is a tiny area which might represent bleeding in the brain
18:12and there is ambiguity in the report, so we're not sure if it actually is a bleed.
18:17So I think for your purposes at the moment, I think we're going to be observing you.
18:21That's what we're doing. We have communicated with the neurosurgeons when we have a response from them
18:27about what they would like to do with this possible injury and we'll let you know.
18:30How long do I have to wait?
18:32You'll be here for, I would say, probably 24 hours.
18:36I want to go home.
18:37You want to go home?
18:38Yeah, I want to go home. I feel fine.
18:42Let's just take it one step at a time, okay?
18:44Okay.
18:44All right, cheers.
18:46It's such an ordeal they're going through and they just want to get home.
18:50The problem is we often will see patients who do deteriorate
18:55and their bleed is something that becomes a life-changing injury.
19:01Until the lasting impact of the assault becomes clear, David needs to remain under close observation.
19:09All right. Come on. I'm just in here. Okay?
19:16A huge part of our job is treating patients who have been the recipients of violence and it can be
19:24traumatizing when we see nasty life-changing injuries.
19:26It's really distressing to see what people do to each other.
19:37After dark, a crash on the roads is around 80% more likely to be fatal.
19:43And at higher risk of a collision are motorcyclists.
19:57At the Royal Victoria, consultant Chris is leading the team in recess.
20:03Remember, did you bang your eye or get punched or anything like that?
20:07A red trauma is on its way.
20:10This gentleman has crashed his motorbike into a tree.
20:12So, who's the on-call consultant, Don?
20:14He said he would, like, come down.
20:15Could you ring thoracics?
20:16Do we need to ring the ICU?
20:19As soon as you get wind through the phone that there's a motorcyclist on the way, it just raises alarm
20:24bells.
20:25You generally worry about significant head injuries as people are often throwing quite long distances because they can be travelling
20:31at very high speed.
20:34Trauma team specialists are called to recess, ready for 18-year-old Jack.
20:39Can I just put gamma out here?
20:41Yeah.
20:42So, as soon as they can get gamma, we put it in.
20:45Including fracture expert, Dr Ali.
20:48Incoming.
20:52Gamma?
20:53Yep.
20:53Hi.
20:54All right.
20:55You're 18, is it?
20:57And you're on a motorcycle?
20:59Yeah.
20:59All right, what happened?
21:02Um...
21:02Well, no, there was only one left in the position.
21:04That's my left in the position.
21:05Not the best.
21:06Oh.
21:07Well, you were in, um, protective gear, everything?
21:09Everything.
21:10Everything.
21:10All right. How fast do you think you're going, roughly?
21:12Cooking power.
21:13Okay, that one.
21:14All right.
21:14I don't know.
21:14I don't know after that.
21:15I don't know about the crash.
21:17You mind if I just give y'all once over?
21:20Okay.
21:22You feel me touching you?
21:24No.
21:25No?
21:25No.
21:26Can you lift this leg up?
21:29No.
21:30Can't lift my legs at all.
21:31This one either?
21:32Nothing?
21:32Can't see anything with my legs.
21:35Are you feeling me?
21:36Feeling all right, yeah.
21:38All right, okay.
21:38All right.
21:39You're in the right place.
21:40You have the right people around you.
21:41We'll figure out where we're going from there.
21:43I don't know what it is.
21:44Hmm?
21:45I don't know what it is.
21:46What is that?
21:47Tell me.
21:48It's a lot of places.
21:49All right.
21:50All right.
21:51But before you think about anything, let's get all the information first and then we'll see where we're going.
21:57All right.
21:57All right, good man.
22:00To reveal the extent of Jack's crash, Dr. Chris takes him for a CT scan.
22:06Okay, everyone ready?
22:08Yep.
22:08One, three.
22:09One, two, three.
22:13This is a young man, you know, he's only 18.
22:17Breathe in and hold your breath.
22:20There's already signs with this gentleman of what we call spinal shock.
22:23So his blood pressure is down, it's dropping because of the damage to the spine.
22:29Spinal shock is the body's response to severe spinal trauma.
22:34Breathe.
22:35Nerve activity below the injury is temporarily shut down, causing loss of movement, sensation and reflexes.
22:43The best case scenario is that this is some transient injury rather than something permanent.
22:50That's the scan all finished.
22:53All right, I'm going to have this scan on the MC.
22:57It's really okay.
23:00I can actually go straight to your theatre and there's something needed to be compressed or to play.
23:04We need those theatre held ready to go.
23:06Grant.
23:11Back in Reisus, the CT results have arrived.
23:14So it's a three column fracture of T5.
23:16Okay.
23:17It's a lot of bony retropulsion.
23:20We're all fairly concerned that this is going to be a serious spinal injury with potential of damage to the
23:25spinal cord.
23:27It's already looking like this is probably going to be something fairly long-standing for this young man.
23:56It's in the cubicle five.
23:57The patients you see on a Friday and Saturday night, you know, you've just got lots of like bars and
24:01clubs nearby.
24:02So the number of presentations relating to like alcohol.
24:05So you and you and you can fuck off.
24:09And substance violence or drugs will be a lot higher.
24:13A 16-year-old male who was shot.
24:15That can become quite overwhelming.
24:17Stop it.
24:18You know life.
24:26The pressures of the night shift don't always look the same.
24:39An agitated patient is in Reisus after a multi drug overdose.
24:45You just keep still.
24:47Her oxygen levels are low and breathing is fragile.
24:51So Dr. Andrea needs to do a full assessment to determine her level of risk.
24:57She took some not known medication and she smoked some heroin too.
25:03So yeah, definitely is a very complex case of a multi drug intoxication.
25:08While being sedated with a low dose of lorazepam.
25:11Nearly down there.
25:13Nurse Vastin checks the patient's heart in case the low oxygen levels have triggered a dangerous rhythm.
25:20So I'm doing an ECG, just taking the electroactivity of her heart.
25:25This is something that we do frequently with patients with chest pain.
25:29Use the bone contact.
25:30Realise.
25:31Remember you're having an ECG, remember?
25:33Keep still.
25:36It's very difficult to manage.
25:40We want to get ECGs done quite quickly.
25:43But it's difficult for them to keep still.
25:48So you just relax.
25:50Relax.
25:51Because you're a little bit agitated at the moment.
25:54It causes a delay just simply because of what they're going through.
25:58They are actually going through a crisis.
26:04She's got a very high heart rate because she's agitated.
26:08The concern right now is the respiratory rate.
26:12The patient's agitation is rapidly worsening her condition.
26:17So the night team need to increase her sedation.
26:21You always have to balance the sedation and agitation in this patient and it's not easy.
26:27She's more drowsy.
26:30Feeling better, right?
26:32Well, I don't feel...
26:33Yeah, I think so.
26:35Okay, it's not good. Try to relax.
26:39That patient needs taken care of just like any other patient.
26:45Often if people have experienced traumatic experiences, it will impact on their life.
26:51Dr. Andrea reviews the patient's x-ray.
26:56It's completely fine.
26:57But it's important to rule out any significant aspiration.
27:01It's fine.
27:03The patient's vitals are stable.
27:06But with the drugs in her system still unknown, she's not out of risk yet.
27:11You have to actively monitor her and to eyeball her.
27:15Like every five billions.
27:18You have to run into the respiratory rate to avoid, of course, the respiratory arrest.
27:23So she's in a safe place.
27:25She's going to stay racist probably for the next three, four hours.
27:28And I will see what's going to happen next.
27:46Also in Newham Resus, emergency registrar Dr. Fraser is just starting his night shift.
27:53We have got a 61-year-old woman who's got Addison's disease, which is an autoimmune disease
28:03where you don't produce any of the necessary steroids that your body needs.
28:06And so you can be ticked to become unwell very quickly.
28:12Tracy was diagnosed with Addison's disease five years ago.
28:16A rare but deadly condition that can turn any minor infection into a medical emergency.
28:23The past two days, she's been experiencing vomiting.
28:26She says she hasn't been able to tolerate her medications.
28:29Today, she's developed dizziness and also a frontal headache,
28:33which she says are sort of her crisis symptoms.
28:36Addison's disease is a life-threatening problem.
28:40If they deteriorate further, they can become very unwell.
28:45Tracy, my name's Fraser. I'm one of the doctors.
28:47How are you feeling right now?
28:48Um, not good.
28:51Not good. In what way?
28:52I just feel disorientated, like.
28:56And the ambulance was saying that you weren't able to take your normal medicines
29:00because of vomiting, is that right?
29:02I kept vomiting, yeah. I was vomiting a lot.
29:05Tracy takes daily steroid tablets in order to remain well,
29:09but obviously when she's vomiting and unwell, she's not able to swallow those tablets
29:13and therefore can become very sick quite quickly.
29:17Are you having any difficulty with your breathing?
29:19Yeah.
29:20When did that start?
29:21Um, my breathing has not been too great.
29:26Um, since yesterday.
29:28Since yesterday, yeah.
29:31You know, it may be that there was an underlying infection that was causing her breathlessness.
29:35Is that right to have a listen to your breathing?
29:38So we need to do some investigations to try and work out why that is.
29:41Deep breaths in and out.
29:45Dr. Fraser uses ultrasound to scan Tracy's chest for signs of infection.
29:55Have I had any breathing problems in the past?
29:58No. It's my heart.
29:59What's that with your heart?
30:01Um, it's enlarged. That's why I think I've got the breathing problems.
30:05Mm-hmm.
30:06I'm just going to pop you back on a tiny bit of oxygen,
30:08because your oxygen levels are just ever so slightly low.
30:10Yeah.
30:11Not entirely sure why, yeah.
30:14When you have a weaker heart, your heart can't pump the blood forward through your body
30:20as it needs to, and that can cause fluid to accumulate in your lungs.
30:26Yeah, with shortness of breath and, um, like, vomiting and, um, like, disorientated.
30:34I was, like, really disorientated, so that's why I called the ambulance.
30:38For a patient with Addison's, infection can overwhelm the body within hours.
30:44Having fluid in your lungs untreated, because it can make your oxygen levels drop dangerously,
30:47can be fatal.
31:01You okay, Jack?
31:03Yeah.
31:03Are you comfortable enough?
31:04Just my hair's still being pink.
31:05Oh, your hair's being pulled?
31:07Aye, at the back of my hair.
31:09At the Royal Victoria, the night team in Resus are treating 18-year-old Jack.
31:14He was found in a grass verge after a high-speed motorbike crash.
31:19With this young man, he doesn't seem to have any movement or any feeling below the kind of nipple line.
31:23If he's lost movement and lost feeling below a certain level, um, so this is something we have to take
31:29seriously.
31:31What were the throstic injuries?
31:33T5, 6 and 7 are all gone, but 5 is the significance.
31:37That's pressure on?
31:38Yeah, yeah, it's a big bony fragment.
31:41So spinal pain, I think, were contacted?
31:43They're looking at the images as we speak.
31:45Okay.
31:48As Chris, looking at the scan, you definitely look like you've broke at least three bones in your back.
31:55One of them looks like it might be pressing on your spinal cord.
31:58And that might be what's causing your issues in terms of the fact you can't feel difficulty moving, okay?
32:04You're probably going to need an operation for that.
32:06So we're waiting to hear back from our colleagues in the spinal team about what they might plan to do
32:09for that, okay?
32:10Are you happy enough if I go and tell your mum all that?
32:12Brilliant.
32:15Spinal specialists will review the CT to determine Jack's treatment.
32:20The spine is very complex.
32:22There's all different parts of the spine for us to assess.
32:25And obviously worry about spinal cord injury.
32:28Our biggest concerns when it comes to spinal injuries is, well, paralysis.
32:33Will the person be able to walk again?
32:35Especially somebody who is so young, has his whole life ahead of him.
32:39You've got some head of hair on you, don't you?
32:41I know.
32:41Unfortunately, I can't move the hair at the back because of the way you're lying.
32:44I can't move her neck.
32:45Yeah.
32:46Okay.
32:47When young people come in, it's definitely something closer to home for me.
32:50I'm a mother too.
32:51I have boys, you know.
32:53The first thing I do is say to that person, tell them they're safe.
32:57We're here to look after them.
32:58Is it sticking to the tape here?
33:01I don't know what I'm saying.
33:03Okay.
33:03Just being pulled and that.
33:05I know.
33:05Are you okay every other way, though?
33:07No.
33:08You're not in pain anywhere else?
33:09No, just that.
33:10No.
33:11Then I'm thinking straight away, what about the mum?
33:14Liam, can I support you?
33:15He is so close.
33:17All things to support him.
33:19Reassured the best we can.
33:21You know, me being a mum as well, I find that very important.
33:26The night team have consulted with the spinal specialists.
33:30So, here's what's happened, right?
33:32You had the scan just now, and it showed quite a lot of spinal injuries.
33:38All right?
33:39Specifically at the upper part of your spine, all right?
33:42As wide as you can't move anything.
33:44Rib fractures.
33:45You do have some.
33:46The nature of this injury shows me the lungs are not going to be happy.
33:50Yeah.
33:50I mean, over the next few hours, I expect them to become more and more unhappy.
33:54Yeah.
33:54Because I think overnight, we're going to have to keep a very close eye on that.
33:58Yeah.
33:59What we're going to do, we're going to get an MRI of your whole spine.
34:02They're going to take you up there for it now.
34:03Yeah.
34:04If we're going to need to do something tonight, or if it's stable enough to wait till tomorrow.
34:08But either way, I need to make sure that you're breathing properly and you're stable
34:12before we do anything else.
34:14Sound okay?
34:15Yeah.
34:16Hello, MRI.
34:17Hiya.
34:18We have a jack.
34:19He'll be coming up to you.
34:20Yeah.
34:21Yeah.
34:21We're ready now.
34:22Lovely.
34:22Perfect.
34:22Okay.
34:23All right.
34:23We're ready.
34:24Okay.
34:24On three.
34:25One, two, three.
34:28Although we could tell on the CT scan that there's a fracture in his spine.
34:32In fact, some of the bits of bone were potentially pressing on the spinal cord.
34:35We couldn't necessarily tell the significance of the damage on the spinal cord itself.
34:41All right.
34:42Yeah.
34:43That's good.
34:43Yeah.
34:43I'll just take a mark from the MRI.
34:45Yeah.
34:50An MRI will reveal the true impact on Jack's spinal cord.
34:56We're already concerned that this is going to be a fairly long lasting injury.
35:01And that those symptoms are going to be something that can take a very, very long time for any
35:05recovery for him.
35:06If there's going to be any at all.
35:10The plan of action depends on MRI results.
35:14We don't know at this stage if he's going to be paralyzed yet.
35:17Hopefully it's just spinal shock.
35:20This case in particular, it's something that'll never leave me.
35:23This young fella was out riding his motorcycle and now he's wondering, is he ever going to
35:28walk again?
35:29It's a very daunting thought.
35:45Are you happy if number one went to trolley bay one while they weight the CT spine?
35:49Yep.
35:50Sunday night in Norwich.
35:52Hello.
35:53I'm Dulcie.
35:54Nice to meet you.
35:55Oh, it's all been a bit dramatic.
35:59Paramedics have brought in 77-year-old RAF veteran, Michael.
36:04And we had a nasty fall, caught up with a cabinet.
36:07I remember being a bit straight.
36:12Next thing I knew I was just picked up and put on the side.
36:16Quite a lot of blood loss, about 200 mls.
36:19It was Michael's daughter who called for an ambulance.
36:22It was all very square.
36:24Must have been less than a minute.
36:25Gosh, a bit of a shock for you as well.
36:28He's had the trimmer for a long time, but it's escalated quite a lot in the past couple
36:34of years.
36:35Do anything?
36:36No.
36:37All right, Mike, you ready?
36:38Mm-hmm.
36:38Let's go.
36:45Parkinson's can really affect your balance and mobility.
36:49Obviously, more prone to falls.
36:51And with a bash like his head, we need to get that CT scan.
36:56Michael is in urgent need of a head scan.
36:58He's brought into majors.
37:00You're going to be sick.
37:01He's going to be sick.
37:02Oh, OK.
37:03He's going to be sick.
37:05OK.
37:07Vomiting is a major warning sign.
37:09It can signal dangerous pressure building inside the brain.
37:13OK.
37:14Great thing.
37:14Rough.
37:15Rough.
37:16Is your head feeling worse?
37:18It's throbbing.
37:18It's throbbing now, is it?
37:21Do you feel like you're going to be sick again?
37:23No.
37:23You don't know.
37:24Hello, Michael.
37:25Hello.
37:26My name's Laura.
37:27Just going to give you some anti-sickness, all right?
37:30The fastest way to ease Michael's symptoms is through an IV.
37:34There we go, darling.
37:35All done.
37:36This should work quite quickly.
37:40With the anti-sickness relieving Michael's symptoms, nurse Nathan takes him to the scanner
37:45to reveal if there's any lasting impact from his fall.
37:49Hello, my darling.
37:50So, we're going to have a seat at the head now.
37:52Good.
37:53We'll move on to that board, right, from here to there.
37:56Everybody?
37:58All right.
37:59When a person has had a fall and has had a head injury, there's quite a lot of concerns.
38:04Firstly, first, you want to, you know, rule out that they haven't got a brain bleed.
38:08We need to move you on to our scanning bed, okay?
38:12Having a brain bleed is serious in itself.
38:15Potentially, I'm having a stroke.
38:16One, two, three, seven.
38:21Hello, hello.
38:23Hello.
38:23Hello.
38:24Hello.
38:24Hello.
38:25Hello.
38:25Hello.
38:37Hello.
38:47In Rhesus, Dr Fraser is investigating 61-year-old Tracy's symptoms.
38:53We're just waiting for your blood test results, OK?
38:55You've got to come around here to do a chest x-ray, OK?
38:58OK.
38:59At high risk of a dangerous infection, she was rushed in under blue lights.
39:04Tracy, she's got a fever, she's got a cough, she's been vomiting.
39:08And importantly, she's got a background of Allison's disease, which is an autoimmune condition.
39:14Where the adrenal glands stop producing the main, like, steroid hormones that our bodies need to function normally.
39:23And that is a life-threatening problem.
39:26X-rays.
39:29We're going to take a chest x-ray.
39:30Her oxygen level is a little bit low, so we need to do some investigations to try and work out
39:34why that is.
39:35Hold and rebound.
39:49There's nothing really on it, to be honest.
39:50It looks fairly normal.
39:51So it doesn't really explain why her oxygen saturations are slightly low.
39:58Yeah, I'm not sure.
40:00We'll need to keep her in hospital for a bit more time of observation.
40:04There's no signs of an infection yet.
40:06But for Tracy, the threat isn't over.
40:10A lot of emergency medicine is dealing with uncertainty.
40:12And in particular, we need to not be afraid to not make a diagnosis, because, you know, jumping to a
40:19final diagnosis, if that's the wrong answer, can be very dangerous.
40:39In Norwich, 77-year-old Parkinson's patient Michael, who came into A&E after a fall, is in urgent need
40:47of a brain scan.
40:48Hi, buddy.
40:49Hi, buddy.
40:49Relax a bit.
40:50Relax.
40:51Okay, you got you.
40:52Michael needs to be still for the scan to be accurate.
40:55So nurse Nathan gives him oxygen to help calm his tremors.
40:59Hi, buddy.
41:00Relax.
41:00Okay?
41:01A patient who has Parkinson's already has allergic concerns because of his chemists.
41:07All right?
41:07It's time to relax.
41:09Just try and keep your head still.
41:13Having had a fall, and with Parkinson's, we're going to be sure to rule out any concerns of a brain
41:21bleed.
41:22Do it again.
41:23Let's try.
41:28His jaw's just never quite still, is it?
41:30And also, I don't think his fist can be more central than what it is.
41:33Right.
41:34Let me just have a quick look.
41:36Yeah, actually, it's quite still.
41:38Oh.
41:39Done?
41:40Yep.
41:40Bye.
41:42Well done, Michael.
41:43Well done.
41:45Can you take care, Michael?
41:47In majors, emergency Dr. Babajid has the results of Michael's CT.
41:52Michael, so because of the fall, you've had some bit of bleeding in your brain.
42:01So what that simply means is we need to send the images to Addenbrook's hospital,
42:07where they do the brain surgeries and all of that.
42:10A lot of times, they might ask us to bring you over for some surgery, but the decision is entirely
42:17dears.
42:18And I've written a request for them to advise on what we need to do for you.
42:23If you need me, just let you know.
42:25All right?
42:43Anything that we need to do is make him comfortable and make sure he's not in pain.
42:56Michael stays under close observation, while the specialists decide on his best course of treatment.
43:10The nose is definitely broken, all right, but we just need to see what else is broken as well, okay?
43:24I'm guessing you've had this done a million times.
43:36Jack, have you got any metal in you anywhere?
43:38Have you ever had to have an operation, put any plants or something like that?
43:41No.
43:42Grants.
43:57Michael, what did you do in the RAF?
44:00Special plane, good boy.
44:02Nice.
44:03What's your favourite plane?
44:05747.
44:06747?
44:10747.
44:19847.
44:21848.
44:22948.
44:2315 empieza.
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