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1
00:00:04,520 --> 00:00:06,158
This is Mrs Rappaport.
2
00:00:06,240 --> 00:00:08,196
I'm the consultant on call
for major trauma.
3
00:00:09,360 --> 00:00:10,475
Resources are stretched.
4
00:00:10,880 --> 00:00:13,348
Well, then, some of us
need to raise their game.
5
00:00:13,440 --> 00:00:14,759
Where is this going exactly?
6
00:00:16,000 --> 00:00:17,115
What's happened to Lorraine?
7
00:00:17,880 --> 00:00:19,199
Who's covering?
8
00:00:19,280 --> 00:00:21,236
It's in your best interest
to stay out of this,
9
00:00:21,320 --> 00:00:23,231
so stay out of this.
10
00:00:24,040 --> 00:00:25,519
You're the last person
I want to call, but...
11
00:00:25,680 --> 00:00:27,398
You're the only one who can help.
12
00:00:27,480 --> 00:00:29,550
I think my boss just got suspended.
13
00:00:30,360 --> 00:00:32,396
(THEME SONG PLAYING)
14
00:00:35,300 --> 00:00:43,300
Ripped By mstoll
15
00:00:44,760 --> 00:00:46,398
(SIREN WAILING)
16
00:00:48,400 --> 00:00:50,755
AUTOMATED VOICE: Trauma call,
attend emergency department.
17
00:00:50,960 --> 00:00:53,758
Trauma call,
attend emergency department.
18
00:01:01,000 --> 00:01:02,672
(CONTINUES WAILING)
19
00:01:09,040 --> 00:01:10,553
She went off a couple of minutes ago.
20
00:01:10,720 --> 00:01:12,517
(RAPID BEEPING)
21
00:01:16,040 --> 00:01:17,155
Shit!
22
00:01:18,480 --> 00:01:20,869
Let's get her inside. Move. Move!
23
00:01:21,160 --> 00:01:23,833
Right. Mid-forties female.
Next-door neighbour at 4:30...
24
00:01:24,040 --> 00:01:25,473
Not now, lovey. Wait till we're inside.
25
00:01:25,560 --> 00:01:27,073
- Sorry, Nerys.
- Is this the...
26
00:01:27,240 --> 00:01:28,275
Yes.
27
00:01:29,040 --> 00:01:30,439
Have you got who's
trauma consultant, today?
28
00:01:30,520 --> 00:01:32,875
Uh, that information's
not come through yet.
29
00:01:32,960 --> 00:01:33,949
Call Clive, please.
30
00:01:34,200 --> 00:01:35,189
Colleague call.
31
00:01:35,280 --> 00:01:37,714
Dr Archerfield, please attend
trauma resus, urgently.
32
00:01:38,160 --> 00:01:40,879
- Starting the clock. Critical airway.
- (BEEPS)
33
00:01:40,960 --> 00:01:43,269
Okay, uh, straight into the bay.
No handover.
34
00:01:43,880 --> 00:01:45,279
Where's Dr Chandramohan?
35
00:01:45,360 --> 00:01:47,078
- On study leave, today.
- Who's covering?
36
00:01:47,160 --> 00:01:48,309
- Dr Busby.
- Fast bleep him.
37
00:01:48,400 --> 00:01:49,628
- We need an anaesthetist.
- PARAMEDIC: On three...
38
00:01:49,720 --> 00:01:51,756
One, two, three.
39
00:01:54,240 --> 00:01:55,958
What's with the whole
Elephant Man thing?
40
00:01:56,040 --> 00:01:58,110
- (GASPS) Right.
- Oh, my God.
41
00:01:58,360 --> 00:01:59,429
JUSTIN: Bloody hell.
42
00:01:59,520 --> 00:02:01,431
Can you fast bleep
Dr Busby for me, please.
43
00:02:01,520 --> 00:02:04,193
- FIONA: And Dr Archerfield.
- Hmm?
44
00:02:04,680 --> 00:02:06,796
All right, 100% oxygen and bag
as best you can.
45
00:02:06,960 --> 00:02:08,109
I don't know if you can hear me,
46
00:02:08,200 --> 00:02:10,077
but we're going to do something
to help you breathe.
47
00:02:10,520 --> 00:02:12,476
Thio, sux, 'scope, bougie, narrow tube.
48
00:02:12,680 --> 00:02:14,193
Don't be daft.
You'll never get a tube in.
49
00:02:14,640 --> 00:02:16,551
- MRS HICKLIN: Cannot intubate.
- Okay.
50
00:02:16,640 --> 00:02:17,834
Fiona!
51
00:02:17,920 --> 00:02:19,558
DR HARRY: Uh, could you
fast bleep Dr Barnby, please?
52
00:02:19,920 --> 00:02:22,115
- Busby.
- Busby, sorry and Dr Archerfield.
53
00:02:22,280 --> 00:02:23,315
To trauma resus.
54
00:02:23,520 --> 00:02:24,748
- Well?
- DR HARRY: Thanks.
55
00:02:26,000 --> 00:02:27,035
Yep. Put the call out.
56
00:02:27,320 --> 00:02:29,436
- FIONA: Getting any in?
- The wood's in the way.
57
00:02:29,520 --> 00:02:31,078
- What is it?
- Fence post.
58
00:02:31,560 --> 00:02:32,834
She fell out a window.
59
00:02:35,720 --> 00:02:37,517
Poor ventilation
across both lung fields.
60
00:02:37,600 --> 00:02:39,431
- Cannot ventilate.
- Give me a sat.
61
00:02:39,520 --> 00:02:40,794
Yeah, just in a second.
62
00:02:44,880 --> 00:02:46,233
Okay. Okay?
63
00:02:46,600 --> 00:02:47,999
(MONITOR BEEPING)
64
00:02:48,080 --> 00:02:49,195
Yep.
65
00:02:50,480 --> 00:02:52,789
Oxygen saturation 60%. Shit.
66
00:02:53,120 --> 00:02:54,758
Fence post. 60%.
67
00:02:54,840 --> 00:02:57,229
This is a situation,
cannot intubate, cannot ventilate.
68
00:02:57,520 --> 00:02:58,839
She needs a tracheotomy.
69
00:02:58,920 --> 00:03:00,956
Nerys, can you write that down,
as stated by me.
70
00:03:01,040 --> 00:03:02,871
And the time is...
71
00:03:02,960 --> 00:03:05,520
- One minute, twenty seconds.
- Yeah.
72
00:03:05,600 --> 00:03:09,229
BILLY: Oxygen saturation now 50%%,
and falling.
73
00:03:09,640 --> 00:03:12,552
- Cannot intubate, cannot ventilate.
- (BEEPING RAPIDLY)
74
00:03:12,840 --> 00:03:14,558
You've covered your arse.
Now let's do it.
75
00:03:14,920 --> 00:03:16,478
DR HARRY: Looks like Clive
isn't joining us.
76
00:03:16,560 --> 00:03:18,278
Nerys, nice and calmly,
77
00:03:18,800 --> 00:03:21,314
- please, get a QuickTrach ready to go.
- Well, yeah.
78
00:03:21,760 --> 00:03:23,910
BILLY: Uh, thiopentone
and suxamethonium doses?
79
00:03:24,240 --> 00:03:26,356
- 200, 100...
- BILLY: Got it.
80
00:03:26,960 --> 00:03:29,235
MRS HICKLIN: Let's get the blocks off.
Harry, can you give me a hand?
81
00:03:29,320 --> 00:03:31,072
- I'll give inline immobilisation.
- (JUSTIN GRUNTS)
82
00:03:31,160 --> 00:03:32,593
(MONITOR BEEPING)
83
00:03:44,040 --> 00:03:45,029
Thiopentone.
84
00:03:48,560 --> 00:03:50,073
Flush. Sux.
85
00:03:50,720 --> 00:03:52,438
Thiopentone 200 milligrams,
86
00:03:52,520 --> 00:03:54,954
suxamethonium 100 milligrams, given.
87
00:03:56,760 --> 00:03:57,909
Flush.
88
00:04:01,080 --> 00:04:02,798
QuickTrach to me right now, please.
89
00:04:03,080 --> 00:04:04,559
Shitting shit!
90
00:04:07,280 --> 00:04:09,555
It's coming up to two minutes thirty,
no airway.
91
00:04:09,640 --> 00:04:11,790
- Anyone heard from the anaesthetist?
- It's just us.
92
00:04:13,480 --> 00:04:16,074
Okay. Step away.
93
00:04:18,440 --> 00:04:20,510
- (PATIENT GROANING)
- FIONA: Shit, she's not under.
94
00:04:21,240 --> 00:04:23,390
Ketamine 30 milligrams, now, Billy!
95
00:04:23,480 --> 00:04:26,119
- BILLY: Yep, yep, yep.
- It's all right. It's okay, yeah?
96
00:04:26,360 --> 00:04:28,112
BILLY: I'm drawing it.
FIONA: Billy! Come on, quicker!
97
00:04:28,200 --> 00:04:30,509
I'm coming, I'm coming, I'm drawing.
One second.
98
00:04:30,600 --> 00:04:32,238
FIONA: Come on, Billy! Come on!
99
00:04:32,320 --> 00:04:33,594
- (GROANING)
- FIONA: Come on...
100
00:04:34,280 --> 00:04:36,316
- Come on, Billy. Give it!
- MRS HICKLIN: Stay still, stay still.
101
00:04:36,400 --> 00:04:39,870
Now coming up to three minutes.
Still no airway.
102
00:04:39,960 --> 00:04:41,837
MRS HICKLIN: Good girl,
come on, that's it.
103
00:04:41,920 --> 00:04:43,717
You'll be fine. It's okay, it's okay.
104
00:04:43,920 --> 00:04:48,198
- Come on, darling, here we go.
- BILLY: Ketamine 30 milligrams, given.
105
00:04:48,400 --> 00:04:50,595
FIONA: Okay, she's under. Step away.
106
00:04:56,680 --> 00:04:58,716
You have done this before?
107
00:05:04,840 --> 00:05:05,875
I have now.
108
00:05:08,800 --> 00:05:10,074
I'm getting air.
109
00:05:10,240 --> 00:05:12,196
(MONITOR BEEPING RAPIDLY)
110
00:05:19,520 --> 00:05:21,556
Thanks, Billy. Sorry.
111
00:05:21,880 --> 00:05:23,029
Water off a duck's back.
112
00:05:23,440 --> 00:05:24,589
I'll hold the trach in place.
113
00:05:24,840 --> 00:05:26,876
Attach the strap and loop it
around her neck, will you?
114
00:05:26,960 --> 00:05:28,313
BILLY: Bagging.
115
00:05:29,760 --> 00:05:31,113
It's okay.
116
00:05:32,440 --> 00:05:35,750
JUSTIN: Oxygen and saturation climbing,
now 70%.
117
00:05:36,240 --> 00:05:37,878
Yeah, yeah, under the hood. That's it.
118
00:05:38,040 --> 00:05:39,792
- Strap's on.
- Okay.
119
00:05:42,840 --> 00:05:43,909
Sats now 80%.
120
00:05:48,040 --> 00:05:50,031
MRS HICKLIN: 90%. Good.
121
00:05:50,440 --> 00:05:52,271
Airway secure. Scoop out.
122
00:05:53,560 --> 00:05:55,073
Thanks, Justin.
123
00:05:56,120 --> 00:05:57,473
Brace.
124
00:05:58,560 --> 00:05:59,959
Brace.
125
00:06:00,040 --> 00:06:01,712
FIONA: Okay, let's get
the blocks back in, Justin, please.
126
00:06:01,800 --> 00:06:03,028
- JUSTIN: Yep, I'll do blocks.
- (SIGHS)
127
00:06:03,120 --> 00:06:04,235
DR HARRY: Yeah,
I'll help with the blocks.
128
00:06:06,240 --> 00:06:07,559
Well done.
129
00:06:07,880 --> 00:06:09,029
I'm not covering my arse,
130
00:06:09,120 --> 00:06:11,350
I'm helping my colleagues make
the right decision at the right time.
131
00:06:11,440 --> 00:06:12,429
Stress of the moment.
132
00:06:12,960 --> 00:06:14,188
Mmm-hmm.
133
00:06:14,280 --> 00:06:15,349
- Blocks in?
- They're in.
134
00:06:15,440 --> 00:06:17,749
MRS HICKLIN: Can someone
cut her out of her clothes, please?
135
00:06:17,840 --> 00:06:18,909
Yep. Excuse me, love.
136
00:06:19,000 --> 00:06:20,035
Oi, oi, oi...
137
00:06:20,120 --> 00:06:21,314
Airways secure.
138
00:06:23,720 --> 00:06:25,517
MRS HICKLIN:
We have a female, mid-forties...
139
00:06:28,160 --> 00:06:30,151
Ventilating both lungs.
140
00:06:31,360 --> 00:06:33,191
Strong pulses. Good blood pressure.
141
00:06:36,520 --> 00:06:37,794
If only it was always this easy.
142
00:06:38,720 --> 00:06:40,233
(ALL CHUCKLING)
143
00:06:42,240 --> 00:06:43,355
Oh! Here he is.
144
00:06:44,760 --> 00:06:47,877
Ah. Good of you to join us, Dr Busby.
145
00:06:48,120 --> 00:06:49,951
Shit. The call said 10 minutes.
146
00:06:50,040 --> 00:06:51,553
MALE PARAMEDIC: She went off,
in the back of the truck.
147
00:06:51,680 --> 00:06:53,238
It didn't get updated
till the last minute.
148
00:06:53,320 --> 00:06:54,389
I never got the update.
149
00:06:54,480 --> 00:06:57,313
- Well, let's not discuss it now.
- BUSBY: Okay. Ah...
150
00:06:57,520 --> 00:07:01,069
The trach will tide us over
until we get ENT involved.
151
00:07:01,960 --> 00:07:05,077
Sats normalising.
Nice job on the QuickTrach.
152
00:07:05,480 --> 00:07:06,799
Thank you.
153
00:07:08,480 --> 00:07:10,789
Can we have the handover now, please?
154
00:07:10,880 --> 00:07:13,348
PARAMEDIC: The patient is female,
believed to be mid-forties,
155
00:07:13,520 --> 00:07:15,238
but we don't have an ID yet.
156
00:07:15,360 --> 00:07:16,998
999 call was made
by the next-door neighbour,
157
00:07:17,080 --> 00:07:18,638
but he couldn't ID the patient.
158
00:07:18,720 --> 00:07:20,950
Said he didn't know her name.
She kept herself to herself.
159
00:07:21,040 --> 00:07:22,712
This was at 4:30.
160
00:07:22,800 --> 00:07:26,395
Neighbour heard a crash
and saw her lying in her back garden.
161
00:07:26,480 --> 00:07:27,833
Ah, first-floor window was open
162
00:07:27,920 --> 00:07:30,275
and he thinks
she was cleaning the windows.
163
00:07:30,440 --> 00:07:33,512
She landed on a fence post,
hence the penetrating mandibular injury.
164
00:07:33,720 --> 00:07:35,915
No other major injuries
apparent on examination.
165
00:07:36,000 --> 00:07:38,673
Uh, she was semiconscious
at the scene, GCS 11.
166
00:07:39,040 --> 00:07:41,508
En route, she started to have
difficulty with the airway.
167
00:07:41,600 --> 00:07:43,795
She wouldn't take a Guedel
and there was difficulty bagging.
168
00:07:43,880 --> 00:07:46,269
- Primark.
- Important medical information, that is.
169
00:07:46,360 --> 00:07:48,237
- Don't be silly. Concentrate.
- Sorry.
170
00:07:49,000 --> 00:07:50,399
MRS HICKLIN: Thank you. Any questions?
171
00:07:50,480 --> 00:07:52,550
- Any analgesia given?
- No, due to the GCS.
172
00:07:52,640 --> 00:07:54,596
No, she's been given
30 milligrams of Ketamine here.
173
00:07:54,880 --> 00:07:55,915
She has stuff in her pockets.
174
00:07:56,000 --> 00:07:57,911
All right, let's do a BA3, then.
175
00:07:58,000 --> 00:08:01,470
BILLY: She's also had 200 of thio
and 100 of sux.
176
00:08:01,560 --> 00:08:02,959
BUSBY: Thanks, Billy.
177
00:08:03,040 --> 00:08:04,951
- Mobile phone.
- Mobile phone.
178
00:08:05,040 --> 00:08:06,951
Anything with a name?
179
00:08:07,120 --> 00:08:08,997
- No, no credit cards.
- Tesco Club Card?
180
00:08:09,680 --> 00:08:11,636
- Oh! Dry cleaning ticket.
- Dry cleaning ticket.
181
00:08:14,560 --> 00:08:15,549
- Fruit...
- Fruit pastilles.
182
00:08:17,360 --> 00:08:19,078
BOTH: Fruit pastilles.
183
00:08:19,160 --> 00:08:21,549
Can you sign off on the paperwork
with Nerys for me, please?
184
00:08:25,560 --> 00:08:28,120
- Sorry, she needs to complete a PS20.
- Huh?
185
00:08:28,200 --> 00:08:31,954
- Major Trauma Patient Experience Survey.
- She's unconscious.
186
00:08:35,400 --> 00:08:37,118
Right, can someone do bloods? Harry?
187
00:08:37,200 --> 00:08:39,111
Yeah. Sure, no problem.
188
00:08:43,320 --> 00:08:45,709
- So, you're Harry?
- Yep, that's me.
189
00:08:46,800 --> 00:08:48,313
Dominic. Dom.
190
00:08:48,680 --> 00:08:49,669
(CLEARS THROAT)
191
00:08:50,840 --> 00:08:51,829
Hi, Dom, nice to meet you.
192
00:08:53,880 --> 00:08:55,029
So, you're trauma team leader now?
193
00:08:55,720 --> 00:08:57,950
- Now? No.
- Instead of Lorraine.
194
00:09:04,680 --> 00:09:05,669
Shall I do these?
195
00:09:06,280 --> 00:09:07,713
Billy can do those for you.
196
00:09:08,520 --> 00:09:10,078
(SIGHS) All right.
197
00:09:14,040 --> 00:09:16,998
This fullness in the abdomen
could be fluid.
198
00:09:17,080 --> 00:09:19,548
Let's get O-neg on standby
and G&S and TEG,
199
00:09:19,640 --> 00:09:21,312
- as well as the usual bloods.
- Yeah.
200
00:09:21,400 --> 00:09:22,958
- Can you run off a VBG?
- Yep.
201
00:09:23,040 --> 00:09:24,917
And can someone call CT
straight away, please?
202
00:09:25,000 --> 00:09:25,989
I'll call them.
203
00:09:26,080 --> 00:09:29,356
Uh, I'd love images
of her pelvis and legs.
204
00:09:29,480 --> 00:09:30,469
X-rays now?
205
00:09:30,920 --> 00:09:32,797
If the scanner's free, I'd prefer a CT.
206
00:09:36,640 --> 00:09:38,835
MRS HICKLIN: Time is coming up
to eight minutes.
207
00:09:38,920 --> 00:09:41,229
- Eight minutes, Mark.
- (BILLY WHISTLING)
208
00:09:46,480 --> 00:09:48,550
- That's you done. Thank you, bye.
- BOTH: Thanks, Nerys.
209
00:09:48,880 --> 00:09:50,438
CHANDRAMOHAN: (ON ANSWERING MACHINE)
Leave a message for
210
00:09:50,520 --> 00:09:52,750
Dr Ramakrishnan Chandramohan,
Anaesthetics Registrar.
211
00:09:52,840 --> 00:09:53,829
- (SIGHS DEEPLY)
- You know you want to.
212
00:09:53,920 --> 00:09:56,115
- (BEEPS)
- Hey. It's me, Harry.
213
00:09:56,200 --> 00:09:58,668
Um, what's this about study leave?
214
00:09:58,960 --> 00:10:00,109
This is Mrs Hicklin.
215
00:10:00,200 --> 00:10:02,873
Uh, we've got major trauma
Foxtrot Bravo for a top-to-toe.
216
00:10:02,960 --> 00:10:03,949
No major limb trauma.
217
00:10:05,200 --> 00:10:07,031
Thank you.
Yeah, they can take her right away.
218
00:10:07,120 --> 00:10:09,554
Great. I'll see you there.
219
00:10:10,880 --> 00:10:12,154
Yeah.
220
00:10:13,560 --> 00:10:15,710
Yes. Well, well,
let's just keep at it, shall we?
221
00:10:21,280 --> 00:10:22,474
(BEEPS)
222
00:10:34,360 --> 00:10:36,157
- Clive.
- Hi, Fiona.
223
00:10:36,520 --> 00:10:38,317
They put out a call for you.
224
00:10:38,400 --> 00:10:41,597
Yep, I'm sorry, I'm snowed under.
How's it going?
225
00:10:41,680 --> 00:10:43,557
- Patient's stable.
- Mmm-hmm.
226
00:10:43,640 --> 00:10:44,629
Uh, I saw earlier,
227
00:10:44,720 --> 00:10:46,870
Lorraine's name's not
on the rota for today.
228
00:10:46,960 --> 00:10:48,439
- No.
- I tried calling her in the week
229
00:10:48,520 --> 00:10:50,556
but she hasn't got back to me.
230
00:10:50,640 --> 00:10:53,359
Yes, well she's still feeling
under the weather, poor thing.
231
00:10:53,440 --> 00:10:55,032
If you speak to her,
give her my best, will you?
232
00:10:55,120 --> 00:10:56,678
Yeah... Okay.
233
00:10:56,760 --> 00:11:00,150
So, we haven't got a trauma consultant.
234
00:11:00,240 --> 00:11:03,835
No, there is, uh, somebody coming in.
Isn't he here yet?
235
00:11:03,920 --> 00:11:05,114
No.
236
00:11:05,800 --> 00:11:08,633
A major trauma case needs
a trauma team leader.
237
00:11:08,720 --> 00:11:11,234
Yep, well I'm here if you need me.
238
00:11:11,320 --> 00:11:14,278
- I'm sure you can cope.
- Okay.
239
00:11:30,800 --> 00:11:34,076
(ECHOES) Trauma call,attend emergency department.
240
00:11:35,760 --> 00:11:37,352
Fiona! You better come quick.
241
00:11:46,240 --> 00:11:48,356
Stop messing about with the blood gas
and get back over here.
242
00:11:50,280 --> 00:11:52,953
FIONA: Let's keep filling her up
and try to get her BP back.
243
00:11:53,040 --> 00:11:54,792
Surgical airway is established,
244
00:11:54,880 --> 00:11:56,950
there's apparent haemostasis
in the mandible,
245
00:11:57,120 --> 00:12:00,908
so I propose we leave for
a MaxFax opinion once she's stable.
246
00:12:04,960 --> 00:12:05,995
As I've said,
247
00:12:06,080 --> 00:12:09,311
once we have a CT
we can send to MaxFax and ENT,
248
00:12:09,400 --> 00:12:11,789
but right now our priority
is addressing the low BP
249
00:12:11,880 --> 00:12:14,314
- by pushing the blood transfusion.
- NERYS: Agreed.
250
00:12:22,440 --> 00:12:23,793
Uh, did we get gases?
251
00:12:23,880 --> 00:12:25,871
- Uh...
- I'm the trauma consultant.
252
00:12:25,960 --> 00:12:27,871
Most likely,
this is an internal haemorrhage,
253
00:12:27,960 --> 00:12:30,872
so we need to find the bleeding
and stop it before it kills her.
254
00:12:31,280 --> 00:12:34,352
Let's run a unit of O-neg
into each of the Venflons, please.
255
00:12:34,440 --> 00:12:35,919
- MRS HICKLIN: We're doing that.
- Then have another one
256
00:12:36,000 --> 00:12:37,194
ready to go up straight after.
257
00:12:37,600 --> 00:12:41,673
Plus two units of FFP,
continuing at a ratio of 3:2.
258
00:12:41,760 --> 00:12:43,557
And let's give her a gram of TXA.
259
00:12:44,480 --> 00:12:47,040
We're already 20 minutes
into our golden hour, so...
260
00:12:48,040 --> 00:12:49,678
Right now, please.
261
00:12:50,040 --> 00:12:51,109
Who's he?
262
00:12:51,200 --> 00:12:52,758
Nerys, uh, get another
263
00:12:52,840 --> 00:12:54,273
- two units of O-neg from the fridge.
- Yep.
264
00:12:54,360 --> 00:12:56,157
- Get them running ASAP.
- Who are you, please?
265
00:12:56,920 --> 00:12:59,388
Glen Boyle, locum trauma consultant.
266
00:12:59,960 --> 00:13:01,439
Pleased to meet you. You are?
267
00:13:01,920 --> 00:13:03,911
Nicola Hicklin. Nurse consultant.
268
00:13:04,040 --> 00:13:06,429
I'm the Deputy Clinical Lead
in this department.
269
00:13:06,520 --> 00:13:07,919
You should've introduced
yourself earlier.
270
00:13:08,960 --> 00:13:10,712
Uh, BP's still down.
271
00:13:10,920 --> 00:13:13,992
So, let's get the transfusions going.
Pressure bags, please.
272
00:13:14,240 --> 00:13:15,992
- Yep.
- GLEN: Anyone called a Code Red?
273
00:13:16,720 --> 00:13:18,631
- No.
- Well, let's make the call,
274
00:13:18,720 --> 00:13:19,948
or call Blood Bank
275
00:13:20,120 --> 00:13:23,078
and request 12 units
of cross-match or O-neg,
276
00:13:23,160 --> 00:13:24,832
whichever is most quickly available,
277
00:13:24,920 --> 00:13:28,037
eight of FFP
and four of platelets, please.
278
00:13:28,480 --> 00:13:30,038
Okay. You need to sign in.
279
00:13:31,520 --> 00:13:32,589
There?
280
00:13:36,120 --> 00:13:37,519
Do we have the bloods yet?
281
00:13:37,600 --> 00:13:39,431
Uh, sent off about five minutes ago.
282
00:13:39,520 --> 00:13:40,555
MRS HICKLIN: This is Mrs Hicklin.
283
00:13:40,760 --> 00:13:43,433
I need the following to trauma resus,
re-patient...
284
00:13:43,520 --> 00:13:44,748
...EtOH and TEG.
285
00:13:44,840 --> 00:13:47,479
Christ, EtOH, I'd forget me head, me.
286
00:13:48,000 --> 00:13:49,115
Tranexamic acid.
287
00:13:49,200 --> 00:13:51,509
NERYS: One gram IV bolus.
Infusion to follow.
288
00:13:51,600 --> 00:13:53,955
- Need more access. Yep.
- I'll do a trauma line.
289
00:13:54,320 --> 00:13:56,231
And let me know
when that's done, please.
290
00:13:56,320 --> 00:13:59,153
Hello, this is William Finlay, ODP,
I would like to request an EtOH.
291
00:13:59,240 --> 00:14:00,559
- GLEN: I can't...
- lf you're not on the system yet,
292
00:14:00,640 --> 00:14:02,312
just choose "temporary staff"
from the dropdown list.
293
00:14:02,520 --> 00:14:03,555
- Temporary?
- Yep.
294
00:14:15,400 --> 00:14:16,753
Excuse me.
295
00:14:17,040 --> 00:14:18,678
You were going to show us her VBGs?
296
00:14:18,840 --> 00:14:19,955
Oh.
297
00:14:23,400 --> 00:14:24,719
Thank you.
298
00:14:25,880 --> 00:14:27,199
Who's he?
299
00:14:30,720 --> 00:14:31,709
Glen Boyle.
300
00:14:34,920 --> 00:14:36,319
FIONA: Thanks.
301
00:15:05,520 --> 00:15:06,919
- Trauma line's in.
- Thank you.
302
00:15:07,000 --> 00:15:09,673
Let's run two more units of O-neg
through the trauma line
303
00:15:09,760 --> 00:15:11,716
and two of FFP through the Venflons,
304
00:15:11,800 --> 00:15:13,552
once the first two units
of O-neg are through.
305
00:15:13,800 --> 00:15:15,791
- More or less through now.
- GLEN: Crack on.
306
00:15:16,080 --> 00:15:17,593
- You are?
- Justin.
307
00:15:23,040 --> 00:15:25,190
Blood pressure's moved up
now 100 over 80.
308
00:15:25,280 --> 00:15:26,395
Sats remain good.
309
00:15:26,480 --> 00:15:28,232
GLEN: Airway stable pending ENT?
310
00:15:28,320 --> 00:15:30,231
- JUSTIN: Just about.
- Then...
311
00:15:30,320 --> 00:15:31,309
Let's get her a CT.
312
00:15:32,280 --> 00:15:34,475
- Okay, but I'd rather...
- Then...
313
00:15:34,560 --> 00:15:36,312
Let's get her a CT.
314
00:15:37,160 --> 00:15:39,230
- I'll call them.
- Thank you.
315
00:15:40,160 --> 00:15:41,513
- Who's he?
- I...
316
00:15:43,200 --> 00:15:44,633
Glen Boyle.
317
00:15:45,480 --> 00:15:47,072
Miss Lomas, trauma fellow.
318
00:15:47,280 --> 00:15:48,554
We've got a major for you.
319
00:15:48,640 --> 00:15:49,709
MRS HICKLIN: Thank you.
320
00:15:49,800 --> 00:15:50,994
Thanks.
321
00:15:51,880 --> 00:15:53,199
CT can take her now.
322
00:15:53,280 --> 00:15:55,555
- JUSTIN: Blood running in fast now.
- Cheers.
323
00:15:55,720 --> 00:15:58,518
BP's coming up a little more. Now 105.
324
00:15:59,240 --> 00:16:00,514
Then let's get her a CT.
325
00:16:00,600 --> 00:16:02,556
- Harry, take the drip stand, will you?
- Yep, on it.
326
00:16:02,640 --> 00:16:03,914
MRS HICKLIN: Justin.
327
00:16:04,000 --> 00:16:05,035
Finish that for me.
328
00:16:05,120 --> 00:16:07,998
- JUSTIN: Reconnect the ventilator...
- When did you start?
329
00:16:08,080 --> 00:16:09,399
GLEN: Today.
NERYS: Justin, grab this, please.
330
00:16:09,480 --> 00:16:11,311
MRS HICKLIN: So, you're not
Lorraine Rappaport's replacement?
331
00:16:11,400 --> 00:16:13,709
Who? No. Temporary.
332
00:16:13,800 --> 00:16:15,995
- How long are you here for?
- Not sure. Just filling in.
333
00:16:16,280 --> 00:16:18,157
You do know that
we're a centre of excellence?
334
00:16:18,720 --> 00:16:20,597
- Absolutely.
- We're the referral centre
335
00:16:20,680 --> 00:16:22,238
for major trauma for the whole region.
336
00:16:24,120 --> 00:16:25,394
I got it.
337
00:16:27,400 --> 00:16:28,389
Get a move on, please.
338
00:16:57,480 --> 00:17:00,358
- How's it going?
- Great.
339
00:17:01,440 --> 00:17:03,237
These trauma calls!
340
00:17:04,480 --> 00:17:05,993
Yeah, I know.
341
00:17:14,400 --> 00:17:17,198
- You'll have to back up.
- You'll have to back up.
342
00:17:20,920 --> 00:17:22,148
(BEEPS)
343
00:17:24,320 --> 00:17:26,356
We're here, Brian, if you could
open the doors for us, please.
344
00:17:28,240 --> 00:17:29,229
(BEEPS)
345
00:17:38,360 --> 00:17:40,032
BILLY: Get it right here. That's it.
346
00:17:40,240 --> 00:17:42,595
You looked as if you'd seen a ghost.
347
00:17:42,680 --> 00:17:45,319
- Could've warned me.
- I should have.
348
00:17:47,280 --> 00:17:49,430
- I should've called.
- No. Really?
349
00:17:51,120 --> 00:17:52,269
Sorry.
350
00:17:53,640 --> 00:17:57,235
I thought you would have grown out
of trying to catch me off guard.
351
00:18:02,160 --> 00:18:03,798
It's good to see you.
352
00:18:06,280 --> 00:18:07,679
You too.
353
00:18:08,640 --> 00:18:09,868
(DOOR LOCK BEEPS)
354
00:18:11,760 --> 00:18:14,991
- Sorry. Um, scan's about to start.
- Thank you.
355
00:18:15,680 --> 00:18:18,911
We've been trying to enact
a major transfusion protocol,
356
00:18:19,000 --> 00:18:22,356
but some of the haematology consultants
insist on it going through them.
357
00:18:22,440 --> 00:18:23,714
Well, then someone needs to speak up.
358
00:18:23,800 --> 00:18:25,950
Someone already did.
359
00:18:26,040 --> 00:18:27,678
Lorraine Rappaport.
360
00:18:28,880 --> 00:18:31,519
Hence the vacancy you've just filled.
361
00:18:37,880 --> 00:18:39,108
(BEEPS)
362
00:18:46,840 --> 00:18:48,034
(BEEPS)
363
00:18:51,040 --> 00:18:52,314
The orthopod, where is she?
364
00:18:52,480 --> 00:18:54,994
- Rebecca? Must've gone back to the ward.
- (CHUCKLES)
365
00:18:55,240 --> 00:18:56,593
(WHISPERING) Back in a mo. I'm busting.
366
00:18:56,680 --> 00:18:58,159
FIONA: Usual story, once we reach CT,
367
00:18:58,240 --> 00:19:00,231
they start catching up
with their normal jobs.
368
00:19:00,360 --> 00:19:01,873
Small subdural.
369
00:19:02,280 --> 00:19:03,599
We're going to need a neuro opinion.
370
00:19:03,800 --> 00:19:06,314
- (BOTH CHUCKLING)
- You really are new, aren't you?
371
00:19:09,240 --> 00:19:10,275
BRIAN: Are you chewing?
372
00:19:11,760 --> 00:19:13,398
(SWALLOWS) No.
373
00:19:15,760 --> 00:19:18,433
I'm going to connect up the contrast
and start the body scan.
374
00:19:18,680 --> 00:19:20,079
Nobody press any buttons.
375
00:19:25,800 --> 00:19:27,552
Don't worry about Brian.
His bark's worse than his bite.
376
00:19:29,240 --> 00:19:30,514
What a relief.
377
00:19:30,600 --> 00:19:32,113
BRIAN: Patient secure.
Let's get ready to scan.
378
00:19:32,200 --> 00:19:35,829
I don't know if you know,
but I teach an intubation tutorial.
379
00:19:35,920 --> 00:19:39,310
- Really?
- BRIAN: Starting contrast run.
380
00:19:46,760 --> 00:19:48,671
- Stop the scan!
- Uh, stopping.
381
00:19:50,800 --> 00:19:52,791
What's going on in there?
382
00:19:54,200 --> 00:19:57,351
He's heard that
if he gives you extra teaching,
383
00:19:57,720 --> 00:19:59,790
you're bound to put out.
384
00:20:00,440 --> 00:20:03,477
- BRIAN: Dr Busby.
- Keep your hair on, Brian.
385
00:20:05,520 --> 00:20:07,238
BRIAN: I... I cannot work like this.
386
00:20:07,320 --> 00:20:09,436
- (STAMMERING) This is anarchy.
- Sorry.
387
00:20:13,960 --> 00:20:15,837
- What happened to blondie?
- BRIAN: Scanning.
388
00:20:19,400 --> 00:20:20,389
The police just called.
389
00:20:20,480 --> 00:20:22,311
They went to the house
and obtained an ID on the patient,
390
00:20:22,400 --> 00:20:24,675
but on the system
she'll still be Foxtrot Bravo.
391
00:20:24,920 --> 00:20:27,514
- Okay.
- Small contrast extravasations.
392
00:20:27,760 --> 00:20:30,797
FIONA: No tamponade
or thoracic aortic rupture.
393
00:20:30,880 --> 00:20:33,189
- Fruit pastille?
- No.
394
00:20:33,400 --> 00:20:36,153
GLEN: Okay, so now we know,
if there is a haemorrhage,
395
00:20:36,240 --> 00:20:37,878
it's in the abdomen.
396
00:20:37,960 --> 00:20:39,075
I'll go and see if there's any progress
397
00:20:39,160 --> 00:20:40,354
- on tracking down next of kin.
- Thanks.
398
00:20:40,560 --> 00:20:41,993
What's that around the liver?
399
00:20:42,080 --> 00:20:43,672
GLEN: It's a bit of this,
it's a bit of that,
400
00:20:43,920 --> 00:20:45,399
nothing major.
401
00:20:48,520 --> 00:20:50,511
Shit, she's haemorrhaging!
402
00:20:50,840 --> 00:20:53,195
FIONA: Left renal tear plus
various intraperitoneal
403
00:20:53,280 --> 00:20:54,269
extravasations.
404
00:20:54,360 --> 00:20:55,588
Fast bleep the trauma theatre.
405
00:20:55,760 --> 00:20:57,113
I want her ready to cut in 10 minutes.
406
00:20:57,200 --> 00:20:59,555
- I'll fast bleep the general surgeons.
- GLEN: And chase the blood bank.
407
00:20:59,640 --> 00:21:00,629
Excuse me?
408
00:21:00,840 --> 00:21:03,479
This patient needs to go to theatre
to stop the internal bleeding.
409
00:21:03,560 --> 00:21:05,437
I'd be more comfortable
if it went through Clive.
410
00:21:05,640 --> 00:21:08,108
- Clive?
- Clive Archerfield. He's in the ED.
411
00:21:09,480 --> 00:21:10,708
Right.
412
00:21:12,040 --> 00:21:13,393
Fiona Lomas, trauma fellow.
413
00:21:13,480 --> 00:21:15,630
Would you kindly fast bleep
the trauma theatre staff
414
00:21:15,720 --> 00:21:18,188
and the general surgeon on-call,
straight away please?
415
00:21:18,640 --> 00:21:20,232
And put me through to blood bank again.
416
00:21:21,440 --> 00:21:23,237
MAN: (OVER PA)
Would the on-call general surgeons
417
00:21:23,320 --> 00:21:24,878
please report to trauma theatre.
418
00:21:25,200 --> 00:21:28,192
That's on-call general surgeons
to trauma theatre, please.
419
00:21:28,960 --> 00:21:30,109
CLIVE: Yeah, as well as the Nof,
420
00:21:30,200 --> 00:21:32,316
I want your X-ray with Jessica,
her blood's done.
421
00:21:32,400 --> 00:21:34,595
So there's no delay, when the orthopods
take her up to the ward.
422
00:21:34,680 --> 00:21:35,908
She's been here two hours already so...
423
00:21:36,160 --> 00:21:37,957
Sorry, I'm in a hurry. Glen Boyle.
424
00:21:38,120 --> 00:21:40,918
- Trauma locum.
- Ah, Clive Archerfield.
425
00:21:41,000 --> 00:21:42,877
My patient needs an urgent laparotomy
426
00:21:42,960 --> 00:21:44,632
and, apparently,
I need to ask for your approval.
427
00:21:45,000 --> 00:21:47,116
- That hasn't come from me.
- Good. Thanks.
428
00:21:47,200 --> 00:21:50,397
But also, I'd like to discuss
the major transfusion protocol.
429
00:21:50,480 --> 00:21:52,311
Yep, sure. I'll fix a time.
430
00:21:52,400 --> 00:21:56,234
No, it's not working today
so it needs fixing today.
431
00:21:56,320 --> 00:22:00,029
Look, uh, you run the trauma call,
I run the entire department,
432
00:22:00,280 --> 00:22:02,271
so, leave it with me.
433
00:22:03,760 --> 00:22:04,988
Thanks.
434
00:22:06,240 --> 00:22:09,437
REGISTRAR: We're receiving a pleomorphic
xanthoastrocytoma from the Children's.
435
00:22:10,040 --> 00:22:12,634
It's an acute neurosurgical referral.
436
00:22:12,720 --> 00:22:16,315
Someone just needs to tell me
if the patient is in transit or not.
437
00:22:16,400 --> 00:22:19,073
- You're the neurosurgical reg?
- Guilty.
438
00:22:19,160 --> 00:22:20,991
Any chance you could take
a look at a CT for me?
439
00:22:21,200 --> 00:22:22,758
(CHUCKLES) No.
440
00:22:22,840 --> 00:22:25,559
I'm the consultant on-call
for major trauma.
441
00:22:25,640 --> 00:22:27,870
You could be George Clooney.
You'd still have to email it.
442
00:22:27,960 --> 00:22:28,949
- DR HARRY: Uh...
- Hey!
443
00:22:29,040 --> 00:22:30,678
He's new. Hi!
444
00:22:30,960 --> 00:22:32,029
Hi.
445
00:22:33,480 --> 00:22:35,675
We're the tertiary
referral centre for neuro.
446
00:22:36,240 --> 00:22:37,958
The other hospitals
complain of favouritism
447
00:22:38,040 --> 00:22:40,429
if we provide a faster service
for intramural referrals.
448
00:22:40,880 --> 00:22:42,757
- Uh...
- The thing is, hombre,
449
00:22:43,400 --> 00:22:44,799
we're not that into head injuries.
450
00:22:46,480 --> 00:22:47,754
(CHUCKLES)
451
00:22:48,600 --> 00:22:49,828
Oh, you're taking the piss.
452
00:22:49,920 --> 00:22:52,036
I couldn't help but overhear,
453
00:22:52,120 --> 00:22:53,235
let me get you on a system
454
00:22:53,320 --> 00:22:56,039
and, uh, let's find
this patient of yours.
455
00:22:56,120 --> 00:22:57,599
Oh, thanks.
456
00:22:58,200 --> 00:23:00,191
Okay, let's get moving.
We're taking her to theatre.
457
00:23:00,280 --> 00:23:01,395
Yeah.
458
00:23:02,600 --> 00:23:03,953
MRS HICKLIN: I am not happy
with this at all.
459
00:23:04,040 --> 00:23:05,632
- With what?
- Him!
460
00:23:06,040 --> 00:23:07,393
Well, he's the trauma consultant.
461
00:23:07,480 --> 00:23:08,549
Locum consultant.
462
00:23:08,640 --> 00:23:10,312
Breezes in and we don't know
the first thing about him.
463
00:23:11,680 --> 00:23:14,069
This patient needs opening up right away
464
00:23:14,160 --> 00:23:16,594
or she's going to bleed to death.
465
00:23:17,880 --> 00:23:19,154
BUSBY: Let's get the blood
delivered to theatre.
466
00:23:19,240 --> 00:23:20,275
Yep.
467
00:23:22,200 --> 00:23:24,475
BUSBY: Okay, one, two, three.
468
00:23:24,840 --> 00:23:27,229
FIONA: Come on, let's get moving.
469
00:23:33,640 --> 00:23:35,870
(ALL TALKING INDISTINCTLY)
470
00:23:59,000 --> 00:24:00,479
FIONA: Hello, Switch, this is Theatre.
471
00:24:00,560 --> 00:24:02,790
We have fast bleeped
the general surgeons.
472
00:24:02,880 --> 00:24:05,110
Can you chase them, please?
473
00:24:26,680 --> 00:24:30,229
MAN: (ON PA) On-call general surgeonsplease report to trauma theatre.
474
00:24:30,320 --> 00:24:34,154
That's on-call general surgeons
to trauma theatre, please.
475
00:24:37,080 --> 00:24:38,513
Re next of kin,
476
00:24:38,600 --> 00:24:40,431
there's a grown-up daughter,
name of Rachel,
477
00:24:40,520 --> 00:24:41,919
coming up from London.
478
00:24:42,000 --> 00:24:43,069
Thanks.
479
00:24:56,480 --> 00:25:00,359
JUSTIN: I've not had a good day.
MAN: Good shot. Straight through.
480
00:25:01,520 --> 00:25:04,318
How far away is general surgery, please?
481
00:25:04,400 --> 00:25:05,389
It's a big hospital.
482
00:25:06,280 --> 00:25:09,431
Can you fast bleep
the general surgeons again, please?
483
00:25:09,520 --> 00:25:10,919
Thank you.
484
00:25:16,680 --> 00:25:18,591
(INDISTINCT MURMURING)
485
00:25:23,960 --> 00:25:25,279
BP's still dropping.
486
00:25:36,560 --> 00:25:38,073
No. Can't wait.
487
00:25:38,760 --> 00:25:41,957
Scrub in, please.
We need to stop the haemorrhage.
488
00:25:43,320 --> 00:25:45,356
DALISAY:
Would you like me to prep?
489
00:25:45,440 --> 00:25:46,714
GLEN: Please do.
490
00:26:04,720 --> 00:26:06,676
Is it always like this?
491
00:26:07,000 --> 00:26:08,433
Lorraine told Clive, over and over
492
00:26:08,600 --> 00:26:11,194
that other specialities should
automatically come to the trauma calls.
493
00:26:11,680 --> 00:26:15,195
And you think I can change things
when this Lorraine couldn't?
494
00:26:15,280 --> 00:26:16,508
You...
495
00:26:17,560 --> 00:26:19,835
You're a bull in a china shop.
496
00:26:27,160 --> 00:26:30,994
Um, the neurosurgical registrar
just reviewed the CT scans for us.
497
00:26:31,280 --> 00:26:33,635
- You're kidding.
- I have my moments.
498
00:26:33,720 --> 00:26:35,153
- GLEN: Let's hear it.
- Uh...
499
00:26:35,240 --> 00:26:37,310
Insignificant subdural haematoma.
500
00:26:37,400 --> 00:26:39,550
No gross brain injury visible on the CT.
501
00:26:39,640 --> 00:26:41,392
No other morphological changes visible.
502
00:26:41,640 --> 00:26:44,234
No neurosurgical intervention
is indicated at this time.
503
00:26:44,320 --> 00:26:46,550
Good. Thanks. Well done.
504
00:26:46,640 --> 00:26:47,709
Do my ties, please.
505
00:26:50,440 --> 00:26:52,476
Gen surg are operating on another...
506
00:26:54,000 --> 00:26:56,355
You shouldn't be here.
Return to seeing patients in the ED.
507
00:26:56,440 --> 00:26:57,634
Yes, sorry, Mrs Hicklin.
508
00:26:57,960 --> 00:26:59,279
It's okay.
509
00:27:00,360 --> 00:27:02,476
May I ask, what on earth are you doing?
510
00:27:03,280 --> 00:27:05,350
If we do not stop
the internal haemorrhage,
511
00:27:05,680 --> 00:27:08,069
organ damage will be
irreversible and fatal.
512
00:27:08,800 --> 00:27:10,950
There's a reason why
this is called the Golden Hour.
513
00:27:11,040 --> 00:27:12,393
So, I'm going to get started
514
00:27:12,480 --> 00:27:15,233
and the general surgeons
can muck in when they get here.
515
00:27:15,400 --> 00:27:17,834
- I'm not happy.
- And why are you not happy?
516
00:27:17,920 --> 00:27:19,148
What exactly do you mean
517
00:27:19,240 --> 00:27:20,912
when you've described yourself
as a "trauma surgeon"?
518
00:27:21,440 --> 00:27:24,591
What I mean is
I've practised all over the world,
519
00:27:24,680 --> 00:27:27,148
in the Forces and civilian hospitals.
520
00:27:27,240 --> 00:27:30,118
I specialise in critical injuries.
521
00:27:30,880 --> 00:27:33,792
Unfortunately, too many
trauma services in this country
522
00:27:33,880 --> 00:27:37,634
are formed from a jumble
of general surgeons and orthopods.
523
00:27:37,760 --> 00:27:39,637
MRS HICKLIN:
We provide a major trauma service
524
00:27:39,720 --> 00:27:41,039
of dedicated professionals
525
00:27:41,120 --> 00:27:43,588
in which the general surgeons
perform the laparotomies.
526
00:27:43,680 --> 00:27:45,511
I'm comfortable in the abdomen.
527
00:27:46,080 --> 00:27:47,308
We've only got your word for that.
528
00:27:47,680 --> 00:27:49,671
Then you should write in
the patient's notes
529
00:27:49,760 --> 00:27:52,991
that you are blocking
a lifesaving procedure.
530
00:27:57,040 --> 00:27:58,712
MRS HICKLIN: You're very quiet.
531
00:28:00,880 --> 00:28:02,279
I hope the procedure goes well.
532
00:28:03,280 --> 00:28:05,919
Call me if there is anything you need.
533
00:28:12,200 --> 00:28:13,519
Thank you.
534
00:28:16,080 --> 00:28:18,514
Bull one, china shop nil.
535
00:28:25,120 --> 00:28:26,269
Where to?
536
00:28:26,360 --> 00:28:28,430
I'm Glen Boyle.
I'm the trauma consultant.
537
00:28:28,520 --> 00:28:31,432
- Sister Dalisay Guinto, Scrub Nurse.
- Dominic Busby, gas reg.
538
00:28:31,520 --> 00:28:33,590
Billy Finlay, anaesthetic ODP.
539
00:28:33,880 --> 00:28:35,472
Armin Khular, ODP.
540
00:28:35,640 --> 00:28:37,119
Alex Badger, staff nurse.
541
00:28:37,200 --> 00:28:39,077
Clara Lloyd, staff nurse.
542
00:28:39,160 --> 00:28:40,878
Polly Mason, documentation nurse.
543
00:28:41,120 --> 00:28:43,270
Fiona Lomas, trauma fellow.
544
00:28:43,560 --> 00:28:45,152
Charlotte Grace, circulating.
545
00:28:45,480 --> 00:28:47,755
And can we confirm
who the patient is, please?
546
00:28:47,840 --> 00:28:50,195
Major trauma Foxtrot Bravo.
547
00:28:50,320 --> 00:28:52,470
Date of Birth 1-1-1900.
548
00:28:53,680 --> 00:28:55,033
GLEN: Thank you.
549
00:29:00,800 --> 00:29:03,439
Okay, I've signed a consent form four.
550
00:29:03,520 --> 00:29:07,229
I'm performing a laparotomy to arrest
a life threatening haemorrhage.
551
00:29:07,320 --> 00:29:09,788
- Everyone good with that?
- ALL: Yes.
552
00:29:16,520 --> 00:29:18,795
- GLEN: Are we ready?
- Ready, Mr Boyle.
553
00:29:19,360 --> 00:29:20,509
Blade.
554
00:29:22,800 --> 00:29:23,789
Is she okay to cut?
555
00:29:24,400 --> 00:29:25,515
Okay.
556
00:29:31,200 --> 00:29:32,474
Cutting.
557
00:30:07,480 --> 00:30:09,311
- (MONITOR BEEPING)
- Shit. Suction.
558
00:30:09,400 --> 00:30:11,834
- Vacuum.
- Pressure's dropping like a stone.
559
00:30:12,040 --> 00:30:14,110
Packs. I can't see a thing.
560
00:30:14,200 --> 00:30:16,714
FIONA: I'm trying.
BOYLE: Then try harder!
561
00:30:23,280 --> 00:30:24,349
Here.
562
00:30:24,440 --> 00:30:26,635
FIONA: Five packs in the abdomen.
Five in.
563
00:30:27,880 --> 00:30:29,154
Ring.
564
00:30:29,760 --> 00:30:31,557
(SUCTION GURGLING)
565
00:30:42,800 --> 00:30:43,915
You know what I'm going to say...
566
00:30:45,040 --> 00:30:46,871
- So don't say it.
- I've got to say it.
567
00:30:49,880 --> 00:30:51,472
BP's dropping, sats are dropping.
568
00:30:51,800 --> 00:30:53,552
(RAPID BEEPING)
569
00:30:55,520 --> 00:30:58,512
Okay. Okay. I need an aortic clamp.
570
00:30:58,960 --> 00:31:00,393
I, don't, uh...
571
00:31:00,560 --> 00:31:03,313
- I need an aortic clamp.
- Right, uh, yes...
572
00:31:03,400 --> 00:31:04,594
I need an aortic clamp.
573
00:31:04,680 --> 00:31:06,511
- We don't have...
- I need an aortic clamp.
574
00:31:10,040 --> 00:31:11,871
Upstairs theatres! Go!
575
00:31:13,800 --> 00:31:15,074
- (GRUNTS)
- Careful!
576
00:31:15,160 --> 00:31:17,993
- BP's 65 over 38.
- More packs, please. Now.
577
00:31:25,160 --> 00:31:29,278
Hands. Get your hands in there,
press down on the bleed.
578
00:31:32,880 --> 00:31:34,598
(BEEPING CONTINUES)
579
00:31:39,680 --> 00:31:40,795
Okay.
580
00:31:41,920 --> 00:31:43,273
- BP...
- We can see.
581
00:31:43,520 --> 00:31:44,839
Five more in the abdomen.
582
00:31:44,960 --> 00:31:45,949
Ten in.
583
00:31:46,440 --> 00:31:47,668
(CONTINUES BEEPING)
584
00:31:50,840 --> 00:31:52,478
(PHONE RINGING)
585
00:31:53,840 --> 00:31:54,829
Turn it off!
586
00:32:02,440 --> 00:32:04,715
- Shit, sorry.
- It's okay.
587
00:32:07,480 --> 00:32:08,959
(RAPID BEEPING)
588
00:32:10,080 --> 00:32:13,117
BUSBY: Pressure's falling.
Packs not working.
589
00:32:18,400 --> 00:32:20,311
We unpack quadrant by quadrant
590
00:32:20,480 --> 00:32:22,118
and we deal with the bleeds
as we get to them.
591
00:32:22,960 --> 00:32:24,439
Starting with the left upper quadrant.
592
00:32:24,560 --> 00:32:25,629
Okay?
593
00:32:37,400 --> 00:32:38,389
Spleen's haemorrhaging.
594
00:32:38,560 --> 00:32:41,199
There's an expanding
retroperitoneal haematoma.
595
00:32:41,360 --> 00:32:42,475
Shit! Repack.
596
00:32:42,560 --> 00:32:43,879
Pressure's dropping again.
597
00:32:46,400 --> 00:32:47,833
The spleen is controllable.
598
00:32:48,400 --> 00:32:49,913
It's the renal bleed that's killing her.
599
00:32:51,680 --> 00:32:53,511
I really need that clamp.
600
00:32:54,160 --> 00:32:56,674
BUSBY: She's going down.
BOYLE: Here, pressure.
601
00:32:57,320 --> 00:32:59,550
- BUSBY: We're losing her!
- (SIGHING)
602
00:33:02,200 --> 00:33:04,270
GLEN: Okay, she needs more blood.
Let's fill her up.
603
00:33:04,640 --> 00:33:06,119
Code was called 30 minutes ago.
604
00:33:06,200 --> 00:33:08,555
This is trauma theatre,
for patient Foxtrot Bravo.
605
00:33:08,640 --> 00:33:10,676
We are still waiting on...
606
00:33:11,000 --> 00:33:13,878
Twelve units, eight of FFP,
four of platelets.
607
00:33:14,160 --> 00:33:16,913
12 units of cross-match,
eight units of fresh frozen plasma
608
00:33:17,000 --> 00:33:18,718
and four units of platelets.
609
00:33:18,800 --> 00:33:19,835
Thank you.
610
00:33:20,320 --> 00:33:21,514
I've got the aortic clamp.
611
00:33:21,600 --> 00:33:24,910
To me! Quickly! To me. Quickly!
612
00:33:26,840 --> 00:33:28,592
Okay, so we can clamp off the aorta
613
00:33:28,680 --> 00:33:30,159
and stop all the bleeding
in the lower body.
614
00:33:30,680 --> 00:33:32,591
That means unpacking her
to get the clamp on.
615
00:33:33,440 --> 00:33:34,873
Yes, it does.
616
00:33:36,600 --> 00:33:38,192
- (PHONE RINGING)
- Oh, for Christ's sake!
617
00:33:38,280 --> 00:33:40,475
- Whose phone is that?
- BILLY: Uh, must be the patient's.
618
00:33:45,040 --> 00:33:46,109
Uh...
619
00:33:47,080 --> 00:33:48,513
There's a text trail here.
620
00:33:49,040 --> 00:33:50,951
- Later.
- You ought to know what it says.
621
00:33:52,400 --> 00:33:54,470
The last text she sent was
to someone called Rachel.
622
00:33:54,720 --> 00:33:56,631
- That's her daughter.
- Can we do this later?
623
00:33:56,720 --> 00:33:58,119
No, we do it now, quickly.
624
00:33:58,240 --> 00:34:01,038
"I'm sorry. I miss him so much.
625
00:34:01,600 --> 00:34:03,955
"I love you with all my heart,
but he was my baby.
626
00:34:04,400 --> 00:34:07,597
"I thought one day I'd get over it,
but I never will.
627
00:34:07,680 --> 00:34:11,275
"I'm sorry. I love you. Mum."
628
00:34:15,840 --> 00:34:17,193
She jumped.
629
00:34:21,480 --> 00:34:22,799
GLEN: When I say "go",
we rip out the packs
630
00:34:22,880 --> 00:34:25,553
and we open up
the retroperitoneal space.
631
00:34:25,640 --> 00:34:28,029
- You got it?
- Yes.
632
00:34:31,120 --> 00:34:32,678
GLEN: Pressure.
633
00:34:37,640 --> 00:34:39,676
GLEN: Shit. Go.
BUSBY: Pressure dropping.
634
00:34:39,840 --> 00:34:41,478
(RAPID BEEPING)
635
00:34:42,840 --> 00:34:45,229
BOYLE: Suction!
FIONA: Five packs out, two in.
636
00:34:46,720 --> 00:34:48,278
(SUCTION GURGLING)
637
00:34:51,360 --> 00:34:54,079
GLEN: I need more suction
if I'm going to see what I'm doing here.
638
00:34:54,160 --> 00:34:55,149
BUSBY: Still falling.
639
00:34:57,200 --> 00:34:58,599
Okay.
640
00:35:02,040 --> 00:35:04,918
Doing a medial rotation
to access the aorta.
641
00:35:05,040 --> 00:35:06,951
(SUCTION GURGLING)
642
00:35:13,760 --> 00:35:15,512
GLEN: Shit! Where is it?
643
00:35:15,640 --> 00:35:17,119
Let's get the blood
out of there, please.
644
00:35:17,200 --> 00:35:18,679
Clear the blood.
645
00:35:22,240 --> 00:35:24,310
I can't locate the aorta!
646
00:35:24,400 --> 00:35:25,913
No, I can't do this blind.
647
00:35:26,080 --> 00:35:29,231
I need you to clear the field
with suction.
648
00:35:33,760 --> 00:35:36,115
- Okay, clamp.
- FIONA: Have you got it?
649
00:35:36,760 --> 00:35:38,239
GLEN: Yes, I've got it.
650
00:35:39,120 --> 00:35:40,553
Okay, clamp.
651
00:35:55,480 --> 00:35:57,198
- Clamp on.
- Is it on?
652
00:35:57,320 --> 00:35:59,356
Yeah. Numbers? Quickly.
653
00:36:00,040 --> 00:36:01,871
BUSBY: Still falling, 50 over 20.
654
00:36:12,400 --> 00:36:13,719
Hold on, wait a minute.
655
00:36:18,000 --> 00:36:19,433
BP climbing.
656
00:36:21,640 --> 00:36:22,959
Good work.
657
00:36:23,400 --> 00:36:24,992
BP 70 over 45.
658
00:36:25,160 --> 00:36:28,152
Okay, let's mop up,
suction and swabs, please.
659
00:36:30,760 --> 00:36:32,716
Okay, we've got haemostasis.
660
00:36:32,840 --> 00:36:35,354
Okay, BP now 100 over 70.
661
00:36:36,160 --> 00:36:37,354
Good.
662
00:36:37,960 --> 00:36:40,599
(SIGHS) I'm going to ligate
the left renal artery.
663
00:36:41,200 --> 00:36:42,758
Dardik.
664
00:36:44,160 --> 00:36:45,957
- Thank you.
- (CHUCKLES)
665
00:36:48,160 --> 00:36:51,152
GLEN: Renal artery clamped
above the rupture.
666
00:36:52,440 --> 00:36:54,032
Hold that clamp.
667
00:36:55,240 --> 00:36:57,276
FIONA: Got it.
GLEN: 2-0 tie, please.
668
00:36:58,680 --> 00:36:59,749
Thank you.
669
00:37:05,440 --> 00:37:07,271
ROBERT: Sorry,
we had someone on the table.
670
00:37:07,360 --> 00:37:08,395
GLEN: Are you the general surgeon?
671
00:37:10,240 --> 00:37:11,673
- Robert Street.
- Glen Boyle.
672
00:37:11,840 --> 00:37:16,072
The abdominal aorta is cross-clamped.
673
00:37:16,160 --> 00:37:19,311
The left renal artery has been ligated.
674
00:37:19,480 --> 00:37:23,792
The patient is currently awaiting
a splenectomy and a nephrectomy.
675
00:37:24,360 --> 00:37:25,713
Hemodynamically stable.
676
00:37:25,800 --> 00:37:28,519
- The patient's settled.
- Okey dokey.
677
00:37:28,600 --> 00:37:31,068
- Thanks, I'll take it from here.
- Are we done?
678
00:37:31,360 --> 00:37:32,679
You're done. Good work.
679
00:37:34,680 --> 00:37:35,795
Thank you very much, everybody.
680
00:37:37,240 --> 00:37:38,559
BUSBY: Thanks, guys.
681
00:37:42,520 --> 00:37:45,557
BILLY: That's Haematology.
ROBERT: Good, we can fill her up.
682
00:37:45,640 --> 00:37:47,232
Thanks, mate.
683
00:37:47,320 --> 00:37:49,038
ROBERT: Let's get those
transfusions running.
684
00:37:49,120 --> 00:37:51,350
Let's run him. Three, two, one.
685
00:38:49,760 --> 00:38:51,034
(BEEPS)
686
00:39:06,120 --> 00:39:08,315
Do you want to grab a coffee?
687
00:39:09,360 --> 00:39:13,239
Thanks for what you did, but best not.
688
00:39:15,600 --> 00:39:18,433
- No one knows you called me, do they?
- No.
689
00:39:20,040 --> 00:39:23,635
Clive and Nicola,
they're, um, defensive.
690
00:39:25,320 --> 00:39:27,231
Well, it's a state-of-the-art unit
and no-one thought
691
00:39:27,320 --> 00:39:29,151
to stock the theatre
with an aortic clamp.
692
00:39:30,520 --> 00:39:33,114
Every speciality under the sun
and not one of them are available
693
00:39:33,200 --> 00:39:34,394
to attend the trauma call.
694
00:39:34,480 --> 00:39:36,789
I'd say they've got a lot
to be defensive about.
695
00:39:36,880 --> 00:39:38,632
Now you might understand
why I called you.
696
00:39:38,720 --> 00:39:41,029
Yeah, now you don't think
that was such a good idea.
697
00:39:41,120 --> 00:39:42,951
- I didn't say that.
- No?
698
00:39:43,480 --> 00:39:44,833
(BEEPS)
699
00:39:53,040 --> 00:39:55,031
Let's set aside the you-and-me part.
700
00:39:56,400 --> 00:39:57,469
As a registrar,
701
00:39:58,680 --> 00:40:02,434
receiving critically injured patients
on a day-to-day basis,
702
00:40:02,760 --> 00:40:04,432
I'm glad you came.
703
00:40:18,400 --> 00:40:19,549
(BEEPS)
704
00:40:25,920 --> 00:40:28,559
The set-up here,
the NHS politics, it's...
705
00:40:28,640 --> 00:40:30,358
It's difficult.
Give me Helmand any time.
706
00:40:30,440 --> 00:40:32,556
So, why did you come, then?
707
00:40:32,640 --> 00:40:33,675
I thought you needed me.
708
00:40:33,760 --> 00:40:36,115
- This unit needs you.
- Right.
709
00:40:36,200 --> 00:40:38,998
- I should think this through.
- You own me.
710
00:40:39,880 --> 00:40:41,677
You mean, I "owe" you.
711
00:40:42,600 --> 00:40:43,919
That's what I said.
712
00:40:48,480 --> 00:40:50,516
- Good work. Well done.
- Thank you.
713
00:40:50,600 --> 00:40:52,955
- Thanks.
- Yeah, she's in trauma theatre.
714
00:40:53,040 --> 00:40:55,793
That's MaxFax and ENT.
Here to take care of the fence post.
715
00:40:56,920 --> 00:40:59,878
I'd better get in there and make sure
they don't step on each other's toes.
716
00:41:01,000 --> 00:41:02,638
- ARCHERFIELD: Very good work.
- Cheers.
717
00:41:03,320 --> 00:41:06,915
Have you got a moment to speak
to the patient's daughter?
718
00:41:07,000 --> 00:41:08,991
- You're Rachel?
- Yes.
719
00:41:09,280 --> 00:41:11,999
Mr Boyle and Ms Lomas
are the trauma surgeons.
720
00:41:12,200 --> 00:41:13,679
Hello, Rachel.
721
00:41:13,760 --> 00:41:15,796
So we've done our part successfully.
722
00:41:15,880 --> 00:41:18,997
Your mum was in a bad way,
but now she's stable.
723
00:41:19,080 --> 00:41:21,753
All being well,
she should make a full recovery.
724
00:41:22,400 --> 00:41:24,675
We'll show you to our relatives' room.
725
00:41:24,920 --> 00:41:26,717
- Thank you.
- If you wouldn't mind, Natasha...
726
00:41:27,760 --> 00:41:30,354
Sorry, Fiona,
can you complete the trauma record?
727
00:41:30,840 --> 00:41:32,193
No problem.
728
00:41:33,720 --> 00:41:34,994
Thank you.
729
00:41:35,480 --> 00:41:37,232
- Good outcome.
- Yeah.
730
00:41:37,960 --> 00:41:40,155
There's a motorcyclist
on his way into us,
731
00:41:40,960 --> 00:41:43,030
severe lower limb injuries,
732
00:41:43,400 --> 00:41:44,913
ETA 15.
733
00:42:13,760 --> 00:42:15,716
Mmm-hmm. Yeah...
734
00:42:39,640 --> 00:42:42,632
WOMAN: (OVER PA)
Trauma call, ETA 14 minutes.
735
00:42:42,720 --> 00:42:45,598
Trauma call, ETA 14 minutes.
736
00:42:46,680 --> 00:42:47,795
Well?
737
00:42:51,120 --> 00:42:52,553
Bring it on.
738
00:42:55,400 --> 00:43:03,400
Ripped By mstoll
739
00:43:10,560 --> 00:43:12,596
(THEME SONG PLAYING)
740
00:43:12,646 --> 00:43:17,196
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