All language subtitles for Critical s01e04 The Weakness of Mankind.eng

Clive and Nicola,
they're, um, defensive.

I'd like to discuss
the major transfusion protocol.

You run the trauma call,
I run the entire department.

He mentioned Lorraine's illness.

I was just wondering
where you got that from.

Hmm?

Seven, eight, nine.

Arsehole.

- BOYLE: Blade.
- Glen.

Just do as you're told.

You called, told me you needed me,

and I came running.

(THEME SONG PLAYING)

Ripped By mstoll

(GUNFIRE)

(SCREAMING)

(SCREAMING AND GUNFIRE CONTINUE)

(SIGHS)

(MOBILE RINGING)

AUTOMATED VOICE:
Attend emergency department.

Trauma call,
attend emergency department.

(BUTTON BEEPS)

(BEEPS)

DEVLIN: Five minutes.

WOMAN: Will you get him out?
DEVLIN: I'm not staying in that...

Starting the clock.

DEVLIN: I'm not a bloody cripple,

- so stop treating me like one.
- You got your hands full here.

- DEVLIN: You bunch of pricks!
- That's the spirit, my friend.

Patient hypotensive at the scene
with a suspected fractured pelvis.

I've activated a Code Red.

No ID, so he's in the system

- as Mike Oscar.
- BOYLE: What mechanism?

He was found bound and gagged
with a ligature around his neck.

NERYS:
Let's get ready to transfer, please.

- Slide one, two, three.
- (GRUNTING)

Giles will liaise with the police.

A gen surgeon
cardiothoracic's been fast bleeped.

Yeah, it's all done.

One minute hatred,
the next minute dogs on heat.

- (CHUCKLES)
- BOYLE: And where's orthopaedics?

Uh, afternoon off, sir, baby's birthday.

Can we fast bleep
the other orthopod, please?

REBECCA: No, I don't care.

No nuts on the table,
no nuts in the party bags.

Just no nuts, Magda!

Oh, I forgot that bloody clown.

(MONITOR BEEPING)

Okay, great.

Sorry.

I'm still here, but then
three more hours and I'm gone.

Part-timers.

Suspected fractured pelvis.

- Remove the scoop on your count.
- Okay.

So, unclip top and bottom.
Go on three. One, two, three.

Brace, one, two, three.
Go on three. One, two, three.

Thank you.

I'd prescribe a nice chest drain.

- What's this smell?
- Really?

Not keen on his perfume.

- I think it's from an animal.
- His jacket's covered in crap, too.

- That's cows.
- Oh...

Everyone got goggles?
You might wanna double glove.

You requested a general surgeon.

Appreciate you coming.

Situation understood?

(HEAVES)

BOYLE: Let's do the handover.

- Nerys, will you scribe please?
- NERYS: Yeah, of course.

- Harry, Venflon, please.
- Yup.

You and her back on then?

"Male, estimate early 20s.

"Call was made at 12:28.
Ambulance arrived on scene at 12:40.

"Patient was found by a worker
on a landfill site.

"Hands tied, ligature marks around neck
and gagged. Unknown mechanism."

Best guess, violent assault.
Blunt instrument, whack.

"Semiconscious at scene,

"multiple soft tissue injuries and
lacerations, grazes, haematomas.

"Airway blocked with
a piece of fabric, which we cleared."

Yeah, old bit of rag stuffed down there.
I brought it out.

Oh, good thinking, Bob.

WOMAN: "Trachea deviated to the right.

"Diminished breath sounds on both sides.

"Left side tension pneumothorax.

"Abdomen is soft,
suspected pelvic fracture.

"Pulse 110. BP 89 over 59.

"GCS, eight.

"Needle decompression
and oxygen for potential pneumothorax,

"and pelvic binder.

"500 mil bag of normal saline
running in."

- Thank you.
- NERYS: Go on, bugger off, please.

FIONA: I'll do the primary.

Cardiothoracics attending if needed.

Your presence is appreciated.

I hope this is a good use of my time.

(SCOFFS)

Airway.

CHANDRAMOHAN:
Ligature marks around the neck.

- (MAN BREATHING SHAKILY)
- Breathing is noisy.

Um...

- There's no surgical emphysema.
- Sats are low.

FIONA: Pulses are bounding,
but his pressure is well down.

Let's get him a Bair Hugger, please.

Poor expansion on right,
percussion dull.

Poor expansion on left, percussion dull.

His airway's compromised.
There's something in the oropharynx.

No, we cleared what was in there.

- Well, I think he may have...
- (MAN COUGHING)

- (ALL GROAN)
- Swallowed some.

- (CONTINUES COUGHING)
- (ALL GROAN)

MALE PARAMEDIC: Better out than in.

CHANDRAMOHAN: Well...

I can't see anything with this blood
pouring down his throat.

- Get a tampon for the epistaxis, please.
- Yeah.

JUSTIN: He coughed something up.

- Excuse me, ladies.
- JUSTIN: Looks like a piece of cloth.

The police will need to see it.

Bag that up, stick it with his clothes.

I'll take it through
when there's a minute.

- JUSTIN: Okay.
- It appears I'm not needed,

bleep me if that changes.

Hey, we haven't even done the CT yet!

I'm surprised she lasted this long.

Yeah, we're good to go, Nerys?

Yeah, you go get cleaned up, Bob.
I can smell you from here.

Can we complete the primary, please?

There's a number on the skin
under his arm.

"3-6-5-9-9-5."

Like cattle branding.

Just make sure
we mention that to the police.

NERYS: Yeah, of course.

Abdomen is soft.

Pelvis feels unstable
on stress assessment.

Possibly SIJ instability.

No other major limb trauma.

Six units of blood, O positive,

four units of FFP
plus two units of platelets, please.

FIONA: Justin.
JUSTIN: On it.

Sats are still low.

BOYLE: Sats are below 90%,

let's get bilateral
chest drains in, please.

- Me.
- I'll do the other.

Slow and steady wins the race.

Rebecca, can I have
a hand, please? Just...

I'm not happy with his airway.
I need to RSI.

Okay.

- CHANDRAMOHAN: Thio, Sux, 250, 100.
- Yeah.

NERYS: Justin, can you sort
that side for me, please, love?

Thiopental, 250 milligrams.

Suxamethonium, 100 milligrams.

- Tie us, please.
- One second.

250 Thio...

Justin, ties, please.

BILLY: Flush.

Sux, 100.

BILLY: Flush.
CHANDRAMOHAN: Thanks.

BOYLE: How long before we can intubate?

Uh, in about a minute.

Everyone, stand by.

I'd like an image of his pelvis.
It sounds like a fracture.

We will get straight to CT as soon as.

So, uh, you and her...

- How'd you pull it off?
- Shut up.

Um, get the GlideScope ready,
in case we need it.

BILLY: Yup, on it.

(GRUNTING) Yeah.

He is good, but...

(SQUELCHING)

- Okay, that's time.
- Okay.

(GRUNTS)

Sats are still falling.

Well, that's not working.
Can we try the GlideScope, please?

(GLIDESCOPE BEEPING)

There's loads of oedema.

I can't get a view.
Can't see much of the epiglottis.

Hmm. Let's try plan bougie.

Thank you.

Excuse me.

(SIGHS) It's not going in the trachea.

- (GAGGING)
- No, it's not going in the trachea.

- Course of action?
- Bagging.

Tell me how the chest drains are.

- Swinging and bubbling.
- (DEVICE BEEPING)

Sats are below 60%.

- Let's try two person.
- Yeah.

- Anything?
- No, it's not going in.

Well, no. Okay, let's try
and get that out of the way, please.

(DEVICE CONTINUES BEEPING)

Come on!

Can I have a gown, please?

Okay. Done. Done.

FIONA: Sats below 50%.

Come on!

- It's also not happening.
- FIONA: Okay.

- I don't think you're moving any air.
- Can't intubate, can't ventilate.

- He needs a crike.
- Yeah.

I'll need a crike kit now, please.

Yes!

Harry, ties, please.

Thank you.

There's lots of swelling and bruising.

It's okay.

Got it.

Can I please the blade?

(SQUELCHING)

A set of forceps.

There we go.

Let's have the bougie.

Thank you.

Trach.

- Okay, bougie out.
- Okay, got it?

Okay, hold to be secure?

Safe hands.

- Good form.
- Thanks.

CHANDRAMOHAN: Cup.
BILLY: Yup.

- Breath.
- (BAG BLOWING)

- Breath.
- (BAG BLOWING)

- (SIGHS) Patient's ventilated.
- BILLY: Sats are rising.

BOYLE: Good.

(DEVICE STOPS BEEPING)

I'll do a subclavian line.

- Yup.
- BOYLE: Thank you.

Suture, please.

- Could you?
- Yup.

FIONA: He's warmed up.

That was fast.

Let's get the Bair Hugger off him,

and then we'll give him
a 250 mil bolus of saline, please.

Yeah.

And when the subclavian line is ready,
let's do the usual bloods.

So that's, FBC, U&E, ETOH,
cross-match TEG,

LFTs and BBGs.

Lots of blood on that blanket.

BOYLE: Let's clean up
these lacerations and compress.

Pulse 113. BP 88 over 58, falling.

BOYLE: Okay, we need to get blood in.

We will transfuse through
the subclavian line when it's clear.

So that's platelets, FFPs,
and let's get in one gram of TXA.

And please, let's move on this.

BBG's and samples ready to go.

- Nerys.
- I'll sort it.

Harry, will you put
the blood on for me, please?

Uh, yeah, these are flushed.

TXA going in through the Venflon.

Tachycardic. BP 80 over 50.

It's too low.

And he's clammy.

Tell me his temperature, please.

- (THERMOMETER BEEPS)
- 39.7.

(EXHALES)

- He's cooking.
- Yeah, bollocks.

Looks like he's septic.

(INDISTINCT ANNOUNCEMENTS OVER PA)

What's your instinct?

Is he septic or
is it internal haemorrhaging?

Probably both.

But that would be me being pessimistic.

Not like you then.

So, uh, how did you get her back then?

Trade secrets, Billy.

Right.

- (DOOR BEEPING)
- (BILLY CHUCKLES)

BOYLE: Thank you.

CHANDRAMOHAN: Sliding up on three.

One, two, three.

- (BILLY GRUNTS)
- Thanks very much.

And please be careful with the drips.

Non-essential people may leave us.

Hmm. That's me, you and you.

CHANDRAMOHAN: That's harsh.

(DOOR BEEPING)

(DEVICE BEEPING)

Control scan.

(MACHINE WHIRRING)

- (MOBILE RINGING)
- Oh...

What is it?
Yes, I have loads of Wotsits.

Control scan complete.

- Scanning head.
- (MACHINE WHIRRING)

I don't care how much make-up he's got,

he can get changed
in the downstairs toilet.

He's a clown.

- TECHNICIAN: Head scan complete.
- Sorry.

There's no obvious
intracranial haemorrhage.

Nobody touch any buttons.

Sorry.

(DEVICE BEEPING)

Does Clive know anything
about the other consultants

down for the trauma call?

He's fine with it.

Clive's all right.

Is he?

Ask Lorraine.

I don't know her.

I do know him.

Be careful.
You don't know what he's like.

Oh, come on.

You said you wanted this
to be just about work.

So can we focus on the patient
in front of us, please?

Okay.

Excuse me.

(DOOR BEEPING)

NERYS: I've got the VBG results.

- (MUMBLING)
- How did he get in here?

- Who's him?
- Uh, stopping scan.

- NERYS: He followed me in.
- Get him out of there!

DEVLIN: I'm not lying in a bed...

Security to CT Scan room.

- (KNOCKING)
...Not that bucket.

Mr Devlin, you've got to stay
off this fracture.

Haematology results will be ready,

but I'm looking at it now
and there's nothing.

Oh, yeah, I see it. Thanks.

Conscious patients
are a pain in the arse.

Unpleasant! Unprofessional!
Uh, just a moment, please.

- VBG results and scan from Haematology.
- Thank you.

INR four,
and he's also thrombocytopenic.

And there's a leucocytosis.

Let's try again, shall we?

So, apparently, this is where
all the action is.

TECHNICIAN: Starting contrast run.

(MACHINE WHIRRING)

The abdomen is clear.
Well, that's me off the hook.

- Bleep me if anything changes.
- BOYLE: Thank you.

- We'll be in touch.
- Just a minute.

There it is.

That's an open book
pelvic fracture confirmed.

It's a pelvic haematoma
but there's no active extravasation.

Thank you.

So, how are we doing?

Well, we have fractured pelvis
so we're going to theatre.

- Mmm-hmm.
- REBECCA: I'll go prep.

Nurse medic trauma, nurse practitioner
could you fast bleep trauma theatre.

No abdominal complications?

No. I'm a precautionary measure.

But happy to attend.
Glen will do a first-class job.

- Hmm.
- I better push off.

Could we get ready for theatre, please?

Can I get 30 seconds?

Absolutely.

(DOOR BEEPING)

Mrs Mukherjee from Cardiothoracics
has been complaining to her line manager

about the new policy.

Now, he's phoned me

and I've told him,
"There is no new policy."

I just asked for
a gen surgeon, cardiothoracics,

to routinely attend
all major trauma calls.

Yeah, so I see.

You didn't run it past me.

We can wait months for a rubber stamp

or we implement it
and we start saving lives now.

I know where you're coming from,

but this is the stuff of
nightmarish hospital politics.

It's best left to me.

It just seems obvious.

Doesn't it?

Look, I'll handle it this time but, uh,

next time talk to me.

You know where I am.

(INDISTINCT CHATTERING)

Mr Boyle, before you go

I have an admin query for our files,
about your CV.

We're having difficulty verifying your
dates of deployment in Camp Bastion.

Oh, I really don't have time for this.

Did you come straight to us
from active service?

Glen, we need you in here.

Whatever it says on the form.
Sorry, dying man waiting for me.

He's sweating buckets!

- Check his temperature again, please.
- NERYS: Yeah.

(THERMOMETER BEEPS)

NERYS: Up to 40.
FIONA: He looks flushed.

Face and neck.

- Pulse 114. BP 86 over 56.
- It's still low.

I've ordered more pack "B" bloods,

but I'm not sure he's responding
to bloods or fluids.

High temp, low BP.

We need to get him open
and deal with the haematoma ASAP.

It may not be the cause of his problems.

- Okay.
- I think we need further investigations.

- I agree.
- Police update.

- What have you got for us?
- I've passed on the information

about the unusual branding marks
on the patient's arms.

And what did they say?

Well, it can be characteristic
of trafficking from East Africa.

- Mark of ownership.
- Okay.

People get brought over
for slave labour,

often in agriculture.

So, someone's exploited this guy
and then they tried to kill him.

We don't know how long
he's been in the country.

The police are anxious for any news.

BOYLE: Tell them they're in the loop.

And if anything comes up about his ID?

- You'll be the first to know.
- Thank you.

We shouldn't rule out
and important, existing condition.

I think we need to get him
back into resus.

BOYLE: The fracture is the priority.

This patient needs to go
to the theatre now.

We'll put an ex fix over his pelvis,
and see how he responds.

If he's unstable,
then we'll need to pack the pelvis.

Okay, then. Let's go.

Oh, nursing my same doubt.

You minges!

- Mr Devlin, I thought we'd sorted this.
- Please, step aside, please.

If that's what you want.

- NERYS: That's enough now.
- Come on.

HARRY: You have to watch that fracture.

Mr Devlin, this isn't helping anyone.

- Up yours.
- (BONE CRACKING)

(GROANING)

Your problem, Harry.
Let's move around him.

HARRY: Would you stay still, Mr Devlin?

It's all right.

Cheers, Nerys.

What was all that?

Gin-breath man.

Twat. Right, let's take him through.

It's changing.

Lesions are becoming confluent.

The rash in his arm is looking purpuric.

Pulse 114. BP 86 over 56.

Can we lift him up to look at his back?

- No more than 20 degrees.
- Okay.

We're rolling on three.
One, two, three.

Thank you.

CHANDRAMOHAN:
Back on three. One, two, three.

It's spreading very fast.

Right, they're ready to
get him on the table.

No. Could we just wait a moment?

(DEVICE BEEPING)

Everybody take a step back.

Check his eyes.

He's bleeding in the sclera.

So, if he's recently arrived...

I've got a house full of kids
this afternoon.

We need to call a microbiologist.

We need them here right away.

You think it's a haemorrhagic virus?

What's the procedure?

This is Mrs Hicklin,
we need full barrier precautions.

With immediate effect
we are locked down.

(BEEPING)

The on-call microbiologist,
put me through, please.

I need to know where we stand
on the possible haemorrhagic virus.

What our risk of infection is.

And the expert will tell us.

But right now,
you need to operate on his pelvis.

- Okay?
- MRS HICKLIN: Trauma theatre.

This is urgent!

Dr Howe? Where is he?

Yes, I do! Immediately, please.

(SIGHS)

The microbiologist serves
three different centres.

He's at a different hospital.

- That could be 60 minutes plus.
- BOYLE: Well, we're not waiting.

Dr Howe is Wes Howe, isn't he?

That's what the technician called him.

Uh, Justin's friendly with Wes.

FIONA: Okay.

I'll find Justin.

WOMAN: (ON P.A. SYSTEM) You have
entered an infection control area.

Strictly authorised personnel only.

(BEEPS)

- Have you seen Justin?
- No.

(BEEPS)

So in the light of
a possible haemorrhagic virus,

surgery is a clear
health and safety issue.

I'm not willing to participate.

Yeah, you've got two hours
left on your shift so...

I'll catch up with some admin off site.

Rebecca, where are you going?

Look, Giles will inform my department
superior, he will get you a substitute.

We're just about to start the operation.

I can't take the risk.

- Not with kids.
- Look,

I understand where
you're coming from...

No offence, but you don't.

- I'm sorry.
- Mrs Osgood...

- Call upstairs.
- Have you seen Justin?

(BEEPS)

WOMAN: (ON P.A. SYSTEM)
Strictly authorised personnel...

Justin, do you know Wes Howe?

What? (CHUCKLES)
Look, we're just into the same music.

- Wes is...
- It doesn't matter. We need a favour.

We urgently need a clinical picture
for the trauma patient.

Can you call Wes, please?

- Yeah, okay.
- Thank you.

(BEEPS)

We're an orthopod short.

Tell me you're joking.

Part-timer just became a no-timer.

Oh, great.
So how long for a replacement?

Calls have been made. Can you postpone?

No time. No choice.
He needs his ex fix immediately.

This is life-saving.

He needs us to start now.
Where's Rebecca?

We will be proceeding without her.

Yummy mummies who you can't sack.

I need a pelvic external fixator set
and a major O tray, please.

Let's do the who. I'm Glen Boyle,
I'm the trauma consultant.

Fiona Lomas, trauma fellow.

Ramakrishna Chandramohan,
anaesthetics registrar.

Billy Finlay, anaesthetic ODB.

Debbie Wong, theatre scrub nurse.

Heather Dooley, staff nurse.

Jason Marshall, staff nurse.

Shelley Imms, radiographer.

Bruce Colby, rapid infuser operator.

Patient's name is Mike Oscar,
date of birth 1-1-1900.

BOYLE: The patient has
an unknown infection

that may or may not be
a haemorrhagic virus.

We have all been exposed.

But if there's anyone else here

who feels they can't take part in
this operation and they need to leave,

you should do so now.

Thank you.

Drapes, please.

This operation is to perform
a external fixation of the pelvis,

for which I have signed
a Consent Form Four.

Patient has been given one gram
of tranexamic acid in resus.

The critical step in the operation
will be placing of the ex fix.

There should be minimal blood loss,

but if the patient is still unstable
he'll need packing.

He's got no urine output,
so I'm gonna put in the vas cath,

which I can use as
a volume line afterwards.

He's being transfused
blood and blood products,

and we're expecting cross-match
from blood bank.

JUSTIN: I've got
Dr Howe on Skype.

Thank you.
Put on a hat and come through.

Can we try and patch him up

- to one of the monitors, please?
- JUSTIN: Yeah.

My name is Fiona Lomas.
Do you know where we're at, Dr Howe?

Uh, "Wes".
Mrs Hicklin has given me the basics.

Apologies for the virtual presence,
I am off site.

It'd be really great to get your take.

Let me have a look at the rash.

It's evolving quickly.

Closer, please.

Okay. Yeah.

Patient is shocked,
has leucocytosis and thrombocytopenia.

Okay, can I see the TEG?

Yeah, it should be up now.

Yeah.

- Okay. And, Fiona?
- Yes.

- Are you taking barrier precautions?
- Yes.

Good. Worst-case scenario
is a haemorrhagic virus.

It could be a staph sepsis
or a pneumococcus.

I can short-cut with a sample.

Okay, what do you need?

I need you to scrape the skin lesion
with the point of a sterile needle

until blood starts to appear.

Then, blot the blood onto
a microscopic slide and allow it to dry.

Sterile needle and slide, please.

- We've got slides.
- BOYLE: Thank you.

Get it straight out to the lab

and I'll process it
as soon as I get there.

What else should we be doing?

Usual supportive measures,

give him ceftriaxone
and, um, two grams IVstat.

And I can't be sure what it is yet,

so give him a slug
of vancomycin as well.

Let's get two grams of ceftriaxone,

IV stat and one gram
of vancomycin IV, please.

How about fluids?

Fluids as usual. Keep 'em
coming same with blood products,

but we will need to start inotropes
if the fluids don't pick things up.

Let that dry.

Which personnel should we list
for prophylactic antibiotics?

Sorry, I didn't catch that.

Who else needs prophylactic antibiotics?

Anyone exposed to
bodily fluids or aerosols directly,

who wasn't wearing
personal protective equipment.

Give them Ciprofloxacin 500 milligram,
one dose.

Not perfect, but it helps.

I've called the paramedics in.

The cardiothoracic and general surgeons
were exposed to aerosols and resus.

And Rebecca.

I'll contact them.
Nerys will distribute the Cipro.

Okay, well, it sounds good,
let's see the next stage.

And I'll report this to
the Health Protection Unit, okay?

- Thank you.
- Pulse 120. BP 80 over 60.

He's pyrexial, over 40.

Justin. Hi, Wes, I'm Glen Boyle.

The patient has a pelvic fracture
with contained haemorrhage

requiring urgent surgery,
and we were just about to get started.

Coagulopathy means that any bleed
could lead to exsanguination.

- Yeah.
- Let me see what bugs I can find

- and get back to you, okay?
- Okay. I appreciate it.

The minute you hear
anything back from him

- you bring the news straight in here.
- Sure.

He's burning up.
Nothing is improving it.

Okay, let's get the C-arm in, please.

- What do you think?
- It's the ex fix or we lose him.

Can we arc it, please?

That's good.

- Okay to raise?
- Yeah.

Raise.

(DEVICE BEEPING)

Raise off.

Thank you. Play it, please.

- (KNOCK ON DOOR)
- BOB: Glen, you got a sec?

No.

It's not Ebola, is it?

Might be. Might not be.

Well, I can fight most infections but...

CHANDRAMOHAN: Talk to Nerys
about prophylactic antibiotics.

Now piss off, Bob.

BOYLE: And focus.

A Spencer Wells, please.

Thank you.

Okay.

I'm gonna need a drill with a 150 pin
and a drill sleeve, please.

Give me your hand.

Just there.

Thank you.

Let's take a shot, please.

SHELLEY: Raise.

- (DEVICE BEEPING)
- Raise off.

BOYLE: Okay. Thank you.

(DRILLER WHIRRING)

Let's get the T-handle, please.

Thank you.

Let's have another shot.

Okay. Raise.

- (DEVICE BEEPING)
- Raise off.

Good. I'm gonna need another pin.

Okay, need you again.

Open. Just there.

Thank you.

- Let's have another shot.
- Raise.

- (DEVICE BEEPING)
- Raise off.

Thank you.

(DRILLER WHIRRING)

Let's have the T-handle, please.

Pulse is rising.

BP dropping.

BOYLE: Another shot.
SHELLEY: Raise.

Push the Belmont, please.

BILLY: Yup.

- (DEVICE BEEPING RAPIDLY)
- (SIGHS) Okay, he's crashing.

- Is it blood loss?
- Yes, we're losing a lot of blood, fast.

Can you see where these
cross-match bloods have got to, please?

Hey, let's repeat the TEG.

BOYLE: We need to open him up.

Blood bank?

- This is the ODP in trauma theatre.
- Come on.

We need pack C ASAP.

(DEVICES BEEPING)

Still crashing.

Let's prep for
a full laparotomy for PPP.

Come on!

BP still very low. His numbers are crap.

Blade.

Cutting.

Mayo.

Balfour, please.

Thank you.

Morris retractors, please.

- Suction, please.
- (BOYLE GRUNTS)

It's no better.

Okay, I can see the pelvic haematoma.

(SUCTION GURGLING)

Receptor, please.

Here.

Suction.

I'm gonna need swabs, one at a time.
Hit me.

Hit me.

Hit me.

Hit me. Oh, shit!

Hmm.

Glen, the glove is torn.

It's just a nick.

See to it.

Gloves.

(GRUNTS)

Okay to proceed?

Hit me.

Hit me.

Five packs in.

BOYLE: Any improvement?

No, I've given him a second doze
of tranexamic acid.

And he's still crashing.

Bleeding is continuing
through the packs.

We've got an active arterial bleed
in a branch of the internal iliac.

It didn't show in CT scan.

He must've blown-off a clot,
it's a rupture.

- I'm gonna need some...
- Press the...

BOYLE: Get some suction in here, please.

New take should be on the system.

Let's see it.

It's a previous one and the new one...

- Lazy.
- BILLY: Old.

- (BEEPING)
- New.

Old.

- New.
- (SOFTLY) Oh, my God.

He's doing really well.

It's much more deranged.

Two are vital, please.

BP's still falling.

We need to reverse
this man's coagulopathy,

otherwise, he's gonna
bleed out very, very quickly.

He needs cryoplate. It's an FFP.

We're in pack C.

- It's not here.
- Oh!

Where the hell is pack C?

Blood bank, please...

Yes, this is the ODP
in trauma theatre again.

We're still waiting for pack C.

Oh, they're refusing to bring it.

They're waiting for advice
from the line manager

whether should go
near an infection area.

Joking.

Tell them you'll meet them
at the infection barrier.

(ELEVATOR BELL DINGS)

(BREATHING HEAVILY)

WOMAN: (OVER PA) The trauma department
is an infection control area.

Strictly authorised personnel only.

The trauma department is
an infection control area.

Strictly authorised personnel only.

Do you want me to sign for it?

- (BEEPS)
- Knob-head.

Suction, please. And packs.

- I got it.
- Well done. Hit me.

I'm your other pod consultant.

Joseph Whitnell.

Substitute for the reluctant Mrs Osgood.

BOYLE: We've abandoned the ex fix
at the moment.

We've got an internal iliac bleed
and some other issues.

- I'll come through.
- Oh, no, listen, Joseph.

We've got a pathogen in here and there's
no point in exposing anyone else to it.

We'll need to fix the fracture.
I'll take full precautions.

Microbiology results.

Come on through.

What can you tell us, Wes?

WES: Okay, so I found the bugs.

Good news. Ruled out Haemorrhagic virus.
It's only meningococcal sepsis.

- Great news.
- But we should treat this seriously.

Continue the cataracts
and two grams BD

and make sure that someone's
getting those prophylaxes sorted.

Once you're done, get him up to ITU and
I'll be there as soon as I can, okay?

- Okay.
- BOYLE: Scissors.

Ligation is completed.

Seems as if the bleeding's
under control.

- Pulse rate, 110.
- Large swabs, please.

- Thank you, Wes.
- Yeah.

- Thanks for doing that.
- No problem.

Give me the Robinson tube.

Numbers are improving slowly.

A Spencer, please?

Systolic up to 100.

Come on!
That's it, my friend.

I think the coagulopathy's been
corrected by the blood products.

Morris out.

(SIGHS)

He's stabilising.

- Piece of piss, this game.
- That's terrific news.

I'll finish the ex fix for you.

Yeah, I'll just go and organise
a side room in ITU.

Thank you.

Listen, everyone.

I think we got there.

We saved him and...

I just wanted to say thank you.

Hi, it's Ramakrishna calling
from trauma theatre.

Can I have a side room
for Mike Oscar, please?

WHITNELL: Bring up
the CT image onscreen, please.

(INDISTINCT CHATTERING)

Bring up the CR.

Thank you.

FIONA: It's blood.

Is it yours or the patient's?

Is it cut?

Not my blood.

Got a result?

Yes. He's come through it.

Pre the diagnosis, we had
to take both the general

and the cardiothoracic consultants
temporarily off duty.

Down to possible exposure.

They both missed their clinics.

That's down to unnecessary trauma
attendance. It's not ideal, is it?

No.

I suppose not being...

You know, you left me right in
the middle of the schedule manager.

(CLEARS THROAT)

But the most important thing is
that the patient didn't die.

That's down to your intervention
and the team's hard work.

Thanks.

Fiona?

Glen's just a locum.

He's here one day, he's gone tomorrow.

You know how we do things here.

But he has a point.

Sorry, excuse me.

It's your career.

So, he's doing well,

and Ramakrishna will take
him to ITU when they're done.

I'll let Dr Harry know. Mr Boyle?

We rechecked the Camp Bastion dates.

There's a three-month gap between
your deployment and your arrival here.

Is there?

For the records,
can you account for the time?

I can. Yes!

We need to write up our notes.

Good.

You all right?

The patient will live to testify
against the people who did that to him.

I'm very all right.

Remember to take the Cipro.

Yes.

- Thanks.
- And I wanted to apologise.

For what?

You've been dealing with
the hospital protocols, all that crap.

And I don't want you
to feel compromised,

I don't want it to be
professionally difficult for you.

But it's working.

You're making the team a unit.

It seems so.

Look...

Maybe I've been a bit defensive,

but there's no reason why we
can't talk to each other more.

Good.

I'm actually heading back to my digs.

Yeah.

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