All language subtitles for Critical s01e06 No Place to Be Sick

I thought she was still off sick.

I don't know if you know, but
I teach an intubation tutorial...

What did you tell him?
"There's a slapper in the ED,

"just give her a bit of teaching
and she'll feel your tube."

It's Clive. He's gunning for you.

And this could
turn into a shit storm.

When Clive told me
that you were under my supervision

I assumed that he had told you too.

Bastard wants us
to fight for the same job.

I was mad to call you.

Lorraine's back. You should go.

We don't need you.

PHONE RINGS

What do you want?
'You in yet?'

Missing me?
'Always. Get us a coffee, will you?'

Why don't you ask your paramedic
friend, I'm sure she'd love to.

'Triple shot capp, no sugar. Go on.'

I've just been past the
coffee place

and I haven't got any hands free.

'No bloody heart.' Well,
it's comments like that that mean...

THUMP

SCREAMING

'Harry? What was that? What's going
on? Harry?'

There's been an accident, you should
come. 'What accident? Are you OK? What's happened?'

Oh, God.

Hello.

Can you hear me?

Can you... ?

Oh, my God. Nuala? Nuala?
Are you OK?

Oh, God. Oh, God.

She's Harry and I'm Justin
and we're going to take care of you.

Yeah?

Airway. Airway.

What?

She's got an airway.

OK. I'll check the pulse, yeah?

She's breathing.
What?

She's... Take them...

Be careful!

What are you doing? Get back!

Back!

Moving back please.
Yeah. Would you mind?

Come on, give them some room to...
Oh, my word.

Mind out,
doctor coming through. Harry?

13.
Look, I'll take it from here.

26 resps. She's breathing? Yes.

Is this the cardiac arrest?

No, she just fell, from up there.

We need suction, O2,
a guedel and NPs.

It's not us, it's not an arrest.
Put out a trauma call.

Leave the kit, leave the kit.

Right, there's a suction
pump in there and a green guedel.

Harry? You OK?
It's not a cardiac arrest.

Did you put out a trauma call?
Yes. She's breathing.

Pulse 120.

You taking it?
It's not an arrest, and if you're on call...

What's going on?
Trauma call, prep for an RSI.

And tell someone to bring a scoop.
Might need a binder too.

All right.

If you feel you can't handle
it... Fine, I'll take it.

Thanks, Harry.

I'm sure Doctor Busby's got to
rush off and give another SHO an

intubation tutorial(!)

Have you done a primary?
I'm trying to get an adjunct in.

Harry?
Not complete.

OK. Doesn't look like you need this.

Just bleep me
if you get into trouble, yeah?

High flow O2 please.
Yep, coming.

Cheers.

Nicola, is there anything I can do?
You could book her in.

Yeah, yeah, I'll leave you to it.

It's not going in.

OK, we need to roll her.
Harry, come on.

Yeah, so we're rolling
gently on three. One, two, three.

OK. Are we there?
OTHERS: Yeah.

OK. Well done.

O2 ready? Yeah.

Tolerating a guedel.
Pulse 120, resps 24.

I need everybody to take a step
back, please.

All of you, right now, take a step
back so we can do our jobs.

We need a scoop.
Billy's on it. Should be bringing a binder too.

Primary? Already doing it. Airway
clear with a guedel.

Pulse 120, resps 24.

Can you hear me? My name is Fiona.

We're going to help you.

Patient has an obvious head injury.

Pupils equal and reactive,
a little sluggish, possibly a four.

She fell from up there, yes?
Anyone know who she is?

No?

E1, V1, no response from trap pinch.
M1, GCS3.

Who was first on scene?

Me.
You see it happen?

Yep.
Need to know how she landed.

Feet first, and then
she hit her head on the floor.

OK. There's a slight
fullness in the abdomen.

So she's fallen from height,
onto marble, feet first.

She's got a serious head wound
and possible spinal fractures

and intra-abdominal injuries,
and there's an open tib-fib.

So we'll be doing scoop and binder,
resus, repeat primary and then CT.

Everybody clear?
ALL: Yeah. I'll grab a trolley

and I'll let CT know
that we're on our way.

Bleep me if you need me.
What in heavens...?!

Harry, collar and blocks.

Fiona, can you take the pelvis?

Harry, I need you on the shoulders,
and I've got the legs.

Sorry, bloody lifts, I was just...

Ohh, nasty-looking tib-fib.

Can you do the scoop first, please?

From the head.

Rolling on three - one, two, three.

Tell me when. Yep.

Back on three - one, two, three.

Let's reverse, please.

Rolling on three - one, two, three.

Ready. OK, back on three -
one, two, three.

I know this girl!
Haven't we seen her before?

She's not staff, is she?

No, a patient.

There's no vascular compromise.

Thank you.

I started the clock.
We're just over three minutes in.

We need the trolley.

Ow!

You been lying on that?

I didn't expect to find glass on the
floor! You should sue, mate.

I will. Ow!

Can we focus, please? I need the BP.

104 over 65. Pulse 113.

OK, let's get ready
for the transfer, please.

Everybody ready? Yep.

One, two, lift.

And down.

CT's occupied at the moment.
Excellent(!)

Come on. Resus, go. Brakes off, go.

Under the circumstances,
I'll let you off about the coffee.

Almost four minutes.
Could do better.

What are you doing here?

I'm leading the trauma call.

You know what I mean.

Am I supposed to give you a call
and ask permission?

I thought you'd have gone.
Why's that?

I don't think either of us
wants history to repeat itself.

Nuala. That's it.
I knew I had the name.

Nuala Barrington.

You remember her, Harry?

I need to change.

GLEN: Has the patient's identity
been established?

CONSTANCE: Yes, Nuala Barrington.

Trachea central.

Thanks, Harry. What?

You just volunteered
to be the scribe.

Oh. Right.

Good bilateral chest expansion.

Breathing symmetrical,
resps rate 16.

You were also the first on the scene,

so you'll have to do
the handover as well.

Er...sure.

Patient's name is Nuala Barrington.

IV's in. What bloods do you want?

FBC, U and Es, LFTs,
give me glucose, a VBG,

clotting and crossmatch, please.

Ramakrishna? Pretty much there.

Can we see if CT's free, please?

Harry? Is she on the system?

Ah, yeah,
Major Trauma Foxtrot Charlie.

Resus, are you ready for patient
Nuala Barrington,

Major Trauma Foxtrot Charlie,
in the system?

Thanks.
They've got someone in there.

(Excellent...)

Harry?

Harry! You're up.

Er, right, right...

Em... This is Nuala Barrington.

She fell about 30 feet
onto the Atrium floor

about 13 minutes ago.

GCS three,
she has a likely head injury,

a possible pelvic fracture
and an open tib-fib.

Haemodynamically, she's...stable.

Trauma call?

Yes, Lorraine.

It's good to have you with us.

Look at that.

Blood. You guys are witnesses
for my personal injury claim, right?

Got to be worth
a fortnight in Ibiza at least.

Nice pants.

Yeah. Your dad got them for me.

BILLY SNIGGERS

The abdo's tight.

Where's the Fast scanner?

Justin, the Fast!
Yeah, I'm there, I'm there.

She's lost the dorsalis pedis.
Let's get the scoop off.

Unclip top and bottom.

One, two, three.

I've got it.

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

Justin, give us a hand, please?
Yeah.

No.

We really need to pull this tib-fib,
or she'll lose her foot.

OK. But quick as you can, yes?

Thank you.

Sorry, would you mind...?

Lift to 30 degrees when I say.

Ready, brace...

lift.

WHISPERS: Is it me,
or is this really arousing?

BONES CRUNCH

(Ooh!) Sorry, could I have a hand,
please?

Ready, brace...down.

I'm ready to go.

We have dorsalis pedis.

Excellent.

RSI now, please.

Harry, can I get cricoid, please?

Er...sure.

I'll do this. No, I...I got it.

Thio, 200.

Thiopentone, 200 milligrams.

Can we give Neuro a shout, please?
Sure.

Head injury from this height,

it'd be nice if they came
and looked at her CT wouldn't it?

You'd think.

Mrs Hicklin, Trauma.

We need an opinion
on a serious head injury.

Major Trauma Foxtrot Charlie,
she's on the system.

We'll be in CT.

Free fluid in the abdomen
and the pelvis.

Sorry.

Shit.

BOTH: She needs to...

CT and then we need to get her
to theatre, fast.

Ready to intubate.

BP 152/79, pulse 99.

Sats 82. Alert Theatre.

Tell them
we could be there on the run.

Mrs Hicklin, Trauma.

We have Major Trauma Foxtrot Charlie
for you. She is on the system.

Thank you.

Scope.

There you go.

WHISPERS: Billy!

OK, that's time.

Hello, CT? Mrs Hicklin, Trauma.

Are you ready for
Major Trauma Foxtrot Charlie yet?

Bougie.

Thank you.

CT. They'll call us when it's free.

Right...!

Tube.

Sorry, who's scribing?

There we go. That's me.
That's through.

- No rush.
- Bougie out.

Got it.

Breath.

Breath.

We're in.

Cricoid off, thanks.

There you go.

Regarding Major Trauma
Foxtrot Charlie...

Tell me about her pupils, please.
I'm concerned about the head.

Nuala Barrington.

Her medical files
are on the system already.

They should be linked?!

Pupils equal,
but much slower to react.

Yep, there we are.
Regular, apparently.

Just so we're all up to speed.

Come on, back to work!

CT? They'll call us.

OK, I'll take the head,
you get the blocks on.

You've never been a first responder
before, have you?

She made it to resus, Harry.

You did fine.

Numbers, please?

BP 156/81, pulse 78, sats 81.

That's really pushing the ICP.

Could be Cushing's response.
We should get a catheter in.

Yep, let's do that.

Constance?

Right away, Mrs Rappaport.

Stow lines and prep for a move
to CT now, please.

PHONE RINGS

Mrs Hicklin.

CT's ready.

Forget the catheter and let's go.

Now, please.

Lines attached, brakes off.
Let's go.

Let's do it.

I'm sorry. Sorry.

Have you been involved
in an accident at work? I have.

Oooh, no...

Justin! Door, please.

Glen? Yes?

This incident,
Major Trauma Foxtrot Charlie,

it's probably going to be
declared an SI.

I thought you should know,
so you can document everything,

make sure those files are buffed.
Not that I actually said that!

Thanks, Giles.

I just thought you should know.

Pupils unequal.

Can we chase Neurosurgery, please?
Yep.

It's not working. You're making it
very difficult for Lorraine.

Mrs Hicklin, CT.
We need that opinion.

Yes.

Everybody ready?

So, yeah, we'd appreciate... Yes.
Yes. Thank you.

Very good. Control scan.

I must apologise for not clearing
the previous patient more quickly.

This was due to unfortunate
but understandable technical errors.

I'm still here.

Control scan complete.

Major Trauma cases
need to be prioritised.

Neurosurgeon needs more information.

Like what? Her hat size? What?

This is something I've learned in my
CBT sessions that I've been taking.

Starting head scan.

LORRAINE: Right-sided extradural,

midline shift

and associated contusions
on the right.

And fractures to the right-side
occipital and parietal bones.

This brain looks really tight.

Let's fast bleep Theatre, please.

Head scan complete.

No, no, put me back through
to Switchboard.

I would appreciate it if you would
avoid touching any buttons.

Who replaced Brian with
a friendly robot?

Mrs Hicklin, CT. Can you fast bleep
the trauma theatre team, please?

Stepford Radiographers.
I, Radiographer.

Rise Of The Radiographers.

HE MAKES ROBOT NOISES

ROBOT VOICE: Robot radiographers.
Oi!

Sorry.

Mrs Hicklin, CT.

(That was our best material.)
We need an ETA on the neurosurgeon.

Contrast connected,
I think we can continue.

Starting contrast run.

Rib fractures.
That's the least of her worries.

Jesus Christ.

What the hell's that? Some kind
of foreign material. Brian?

I wouldn't like to say without
more information. I'm uploading

these images for the
radiologist's report.

PHONE RINGS
Mrs Hicklin, CT. Thank you.

Trauma theatre's ready.

MACHINE BEEPS, THEY GROAN

She's blown a pupil
and she's coning.

I need neurosurgery
down here, right now!

Gently on three. One, two, three.

Quick as you can, folks.

Brakes off.

Hypertonic's going in.

Is the intra-abdominal fluid
due to extravasation?

Yeah, there's bleeding. What is the
material in her stomach? God knows.

Get the Radiologist to report to me
in theatre, please. I'll go ahead.

Right.

You're welcome.

Lorraine didn't create this
situation. Neither did I.

She's a good surgeon.

But maybe we need better
than good right now.

SHE SCOFFS

You're incredible.

I'll see you in there.

Patient is Major Trauma
Foxtrot Charlie,

AKA Nuala Barrington.

Consent, please.

We need to prep for a laparotomy
and a craniotomy, please.

Someone from neurosurgery may or
may not be on his way.

CLOCK BEEPS
Thank you.

Have you seen Fiona?

Changing.

What's the numbers?

156 over 78, pulse is 61.

Hypertonic's bought us some time.
Yeah, not long.

Keep checking her pupils, please.
Yep.

Fiona, can I have a word?

If you're quick.

I saw her in the ED yesterday.
Who?

Nuala.

She came in complaining
of stomach pains.

I've seen her before, everyone
knows her, she's a regular...

Did you examine her?

Yes. I palpated her abdomen,
BP, heart rate -

I even did bloods
just to keep her happy.

Did you assess her mental state?

She seemed normal at first.
Normal for Nuala.

But she did kick up more than usual,
and I did... Yeah?

I did think she needed
a psych assessment.

Did you discuss this with anyone?

The duty consultant.
Doctor Archerfield.

Clive.

I told him her history,

and that I thought she should
see a psych liaison nurse.

But he said she was about to
breach the four hour rule

and to discharge her.

Does it say this in your notes?

Just says I discussed it with him.

OK.

Don't worry.

I've got this.

Radiologist has just
uploaded her report.

There's free fluid in the abdomen
with active bleeding.

Any news on the material in her gut?

Take a look.

"Dense foreign bodies within the
stomach and the small bowel

"suggesting recent ingestion.

"The largest measures 1.9 by 2.4cm."

So, not prepared to risk an opinion
about what it actually could be?

There's an active
bleed in the abdomen.

We need to unzip her now.
Right behind you.

I'll do this unless...

OK. Numbers, please.

158 over 80, pulse 60.
SATS could be better.

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

Lorraine Rappaport, consultant
vascular surgeon.

Khaali Osman, scrub nurse.
Heather Dooley, support nurse.

Ramakrishna Chandramohan, gas reg.
Billy Finlay, anaesthetic ODP.

Jason Marshall, support nurse.

Fiona Lomas, trauma fellow.
Armeh Khalor, ODP.

Daniel Insalaco,
rapid infuser operator.

Patient is Major Trauma Foxtrot
Charlie. Date of birth 17/4/1988.

She fell from a height, there's
a right-sided extradural haematoma,

intra-abdominal bleeding
plus foreign bodies.

I've signed a consent form four
for laparotomy plus proceed.

Any word from neurosurgery?

No.

Packs to me, please.

OK, let's have the blade.

Am I OK to cut?
OK.

Cutting.

Standby Suction, please.

Give me two clips, please.

Let's have the mayo.

You do the other side.

OK, there's plenty of blood there.

Let's get ready to flush with warm
saline, please. Everybody ready?

Yeah. Yeah. Yeah.

Cutting.

Oh!
Jesus Christ.

Thank you very much(!)

Was that you, Billy?
No.

Take this, please.

There's generalised peritonitis
with loculated pus just everywhere -

the pelvis...

..paracolic gutters...

Is it caused by the foreign bodies?
I don't know. Just a mess in here.

We should get Gen Surg
to have a look at it.

Yeah, that's not a bad idea.
OK. Fast bleep Gen Surg, please.

Balfour and Morris retractor, please.

The bleeding's mostly in the left
upper quadrant. Let's have a look.

Yep, ruptured spleen.

We're gonna have to have that.
Packs, please.

Hit me.

Again.

Let's move down, again.

Hit me. Keep 'em coming.

Hit me.

Again.

How many's that in?
Eight.

Hit me.

Yep.

Ten in the abdomen.
Ten packs in. How we doing?

Better, but let me catch up with some
volume before you go any further.

Two units of blood, two FFP.
Yep.

Left eye looking very sluggish.

Two dardik, please.

Thank you.

Mayo.

Dish.

Here comes the spleen.

Let's have 2-0 VICRYL, please.

Thank you.

I'm ligating the artery.

What are the numbers?
She's looking a little better.

This pus has been here a while.

There's got to be a perforation in
there somewhere. Shall I flush it?

Yeah, just let me finish off
these ties first, please.

Shit.
What?

You really don't wanna hear this,
but she's blown the other pupil.

Come on! Where the
bloody hell is neuro?!

Pressure's killing her.
Prep for a burr hole.

That means you need to go
and rescrub and I need someone

to hold the head, now, please.

Is there anyone here who's been
cleared to scrub in?

Maybe call someone down from
Theatres? Not enough time.

What about Harry?
Yes. Harry.

Fast bleep Doctor Bennett-Edwards.

Have you done a burr before?

Twice in the field. Once at Brum.
When was that?

It was a few years back.
Cut, please.

I'd prefer it if you waited
for neurosurgery.

And I'd prefer neuro were here right
now with their fingers in her head,

but they're not,
and if we wait we lose her.

I'm not happy with you
doing a burr hole.

But if I don't do it, she dies.

Look, I know this puts you
in a difficult situation.

It puts us all in
a difficult position.

Yes.

It does.

I know you're concerned about the
mess you're in with management.

But my only concern is I've got
a patient who's going to die

unless someone cracks her skull.

And that someone should be
a neurosurgeon.

OK.

You know I'm right.

So do you.

What is it?

We're opening up the head.
You need to scrub in.

Short back and sides, boys.

Let's have a couple of swabs
ready as well, please.

Harry, hurry up.

Pressure right here, please.

Blade.

Retractor.

Brace with the cutter burr, please.

I need you to hold the head here
and here, please. Saline, please.

I'm going to have to run this bowel
through to find the perforation.

Thank you.
How's she doing?

I'm worried she's gonna arrest.

OK.

HE EXHALES

Whatever you do, Harry...

..don't sneeze.

HE EXHALES

I can't see. I need
some light here, please.

How's that?
Yep.

OK.

Let's get some irrigation here.
Suction.

Pass me the burr, please.

Thank you.

Come on.

Let's have some more irrigation,
please.

OK.

The flush.

Pressure is released.

Ramakrishna?

Shock versus ICP, these numbers
are impossible to interpret.

Yeah. Let's lift the drape, please.

Yeah.

OK.

It's slow, but it's reactive.

Nice work.
Thank you.

The burr hole did the job.

Brains.

Here we go.

What the hell's going on?
Burr hole. She was coning.

Not bad. For an amateur.

We're just so happy
to have you with us.

At last.

Prep the power perforator.

It's not the 18th century.

HE MOUTHS

Help them to scrub in, please.
And, Harry...

good job.

I can finish this if there's
somewhere else you need to be.

Sure.

I'll just...rescrub.

Seems like you two make a good team.

Torvill and Dean.

Let's tidy up this mess, shall we?

Knife.

Raney clips.

Retractor.

Perforator.

Shit!

There's a tear in this
splenic flexure.

Drilling second burr.

I've located one of
the foreign bodies.

What's that?
Glass.

She swallowed glass.
Radical approach to dieting.

Well, at least we found
the perforation.

Got it.
Last burr.

All yours.

Linear stapler, please.

How are the OBS now?

Uh, not good.

Curette.

Flush.

So, who was that
supporting the head?

The ED SHO.

Not Harry, by any chance?

Yeah, that's right.
Heard all about her.

One of our Reg's
smashed it last month.

Craniotome.

DRILL WHINES

Gen Surg. Got held up in theatre.

What's the situation?

We're sealing the perforation
in the splenic flexure.

We did a splenectomy.
And a burr hole.

Well, leave some for me.
Be right with you.

Almost there.

Mayo.

Let's have a dish, please.

Thank you.

Yes.

Elevator.

Here's the boy.
Malleable retractor.

Suction.

You gonna pull the clot
or you gonna frame it?

Spend as much time
as I do in the brain,

and you'd know you don't
wanna rush things.

Swab.

Bipolar diathermy.

BP 141 over 74, pulse 72, SATS 95.

It's going the right direction.
She won't be Einstein after this,

but as she jumped 30 feet
on to a marble floor

I'm guessing she wasn't that before.

I'm sure he's got the wrong
end of the stick. About Harry.

There's another perforation
in the D-colon. Right.

Well, let's have a look.

I think we've got this now.
Yes?

Fine.

Thank you.

Is she out of the woods?
Seems so.

She's stable.
Tickety-boo.

Hi.
Hi.

Oh, God, I'm gonna stink
all day now.

I'm sorry about Glen.

Well, I'm sorry you got
caught in the middle.

You did your Gen-Surg up
in Birmingham, didn't you?

At the QE, yeah.

With Glen?

I wouldn't say "with."

It didn't end well.

Well enough for you to get him
to come here and take my job.

Sorry.

I didn't know what to do.

Clive gave me the impression
that you weren't coming back.

You know she came in to
the ED yesterday? Who did?

Nuala.

Harry wanted to do a psych assessment
but Clive insisted

that she be discharged
to meet the four hour target.

Thank you.

PA SYSTEM: 'Trauma call,
attend emergency department.

'Trauma call, attend
emergency department.'

Hi. Is the next case coming in here?

ETA three minutes.
CT available?

Here. Holding for us.
How's Nuala?

Oh, she's fine, yeah,
it's looking good.

Great. Listen...

Nuala Barrington is one case that
you don't need to worry about, OK?

Hi!

Yep?

What can I do for you, Lorraine?

I hear you're going to
call it an SI?

Yes, it's a very unfortunate
incident. Very sad.

How's the patient?

Looks like she's going to make it.
Which is probably just as well. Mmm.

Y'know HSE are going to be
all over us. Yes.

I'm sure they'd be particularly
interested to learn that she was

discharged from the ED last night,
with a stomach full of glass.

When she should have had
a psych assessment.

Yes, well, I see how that might raise
questions about the member of staff

who examined her. I can see
how it might raise questions

about the duty ED consultant who
puts targets before patient welfare.

Oh, you know what?

I can take this one.

OK.

Thank you.

So, with everything going on, you
really think she's up to the job?

That isn't fair.
I'm making this work.

You said so yourself. Whatever's
going on between me and you,

that's what's really important
is that I am making this unit work.

Yes, of course, but you have to
understand - I'm not going anywhere.

I'm not leaving.

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