All language subtitles for Critical s01e08 Scrambled Eggs Go Back in the Shell.eng

Should've been there for you.
I messed up.

We both did.

It's not that terrible
having me here, is it?

(What if she has?)
(Has what?)

(Shagged the neuro reg.)
(Ask her.)

Mr Boyle, before you go,
I have an admin query.

Did you come straight to us
from active service?

Sorry, dying man waiting for me.

You were in breach
of your supervisory directive.

You'll be charged with serious
professional misconduct.

You'll destroy my career?

FIRE ALARM SOUNDS

VOICES IN BACKGROUND

We're evacuating patients,
but no-one's telling us

where the fire is.
I need information now.

Yes, this is Giles Dhillon,
trauma manager.

Do we have a location
for the fire alarms yet?

This way.

Theatre changing rooms.
Changing rooms!

Staff changing rooms. This way.

Connie... Me, too? Let's go.

Yes! You, too!

Staff changing rooms - on the right.

All clear.

I'm personally leading a trauma team
down to the incident now.

Resus trolley straight away, please!

Not until we've cleared it, please.

Quickly! She's in a bad way.

Sister, let's get that trolley,
please. Yes, Mr Boyle.

And a scoop, Harry. Giles,
make sure there's an anaesthetist

on their way down,

and have the rest of the
trauma call divert to Resus.

Yes, Mr Boyle. Thank you.

You OK? Yeah.

All clear.

The fire's out, but it's
still a bit smoky in there.

If anyone starts with any problems
breathing, let me know

and we'll get out straight away.
Got it.

TANNOY: 'Exercise extreme caution

'and report evidence
of fire or smoke at once.'

Oh, my God!

Who is she? Don't know.

Hello?

Can you tell me your name?

'Evacuate immediately.

'Alarm areas sounding an
intermittent tone.'

Yeah, I thought of that.

Right,
we're going to take care of you.

We're going to give
you something for the pain.

Give her morphine. Yep.

Controller. Control.

Theatre one changing room fire out.

One serious casualty,
medics in attendance.

OK. Roll to the left first.

To the right on "roll".

Ready, set, roll.

Designate theatre area Red Zone,

rest of Emergency Department Amber.

Lift on "lift".

Ready...set...

lift.

'Alarm areas sounding
an intermittent tone.

'Exercise extreme caution.

'Report evidence of fire or smoke.'

Let's go.

'Alarm areas sounding a continuous
tone, evacuate immediately.'

Oh, my God.

Giles.

Get security to check CCTV
and find out who this is, please.

Yes, yes, of course.

Gangway!
Major trauma coming through.

Gangway.

Changing room fire, someone
was trapped. Member of staff.

Who? Don't know. Mrs Hicklin's
asked me to check the CCTV.

Male or female? Female.

CCTV, you show me first.

Yeah, OK...

ALARM CONTINUES

Starting the clock.

Does anybody recognise her?

There's not much to recognise.

Ramakrishna,
I'm leaving you to the airways,

Fiona will do primary survey,

Harry will give us venous access,

via a large-bore cannula,

and then we will immediately
give 30 milligrams of ketamine,

one gram of paracetamol

and one litre
of warmed Hartmann's, please.

I've got the ketamine.

I've got the paracetamol
and Hartmann's. Justin?

Yep.

We're going to need cold swabs.
Yeah, I'll get them.

That's it. Just open up.

'Evacuate immediately.

'Alarm areas
sounding a continuous tone.

'Exercise extreme caution
and report evidence of a fire...'

I'm Dr Chandramohan,
the anaesthetics registrar.

Can you tell us your name?

FAINT MURMUR

Name?

We need to check your airway.

Let's get that scoop out. Yeah.

Make her more comfortable, please.

Unclip top and bottom. Unclipped.

OK. Brace and to the patient's left.
Very gently on three.

One, two, three.

OK, I need to look at her back.

OK. Back on three. One, two, three.

Brace right on three.

MACHINES BEEP RAPIDLY

One, two, three.

Back on three. One, two, three.

All right, my love. Well done.

I'm Fiona Lomas, trauma reg.

I need to examine you.

Let's keep the non-burnt
areas warm, please.

Right you are.

'Alarm areas sounding
a continuous tone...'

I'll scribe.

'Alarm areas
sounding a continuous tone.

'Exercise extreme caution

'and report evidence
of fire or smoke at once.'

Look, we don't know who she
is yet, so clear off, please.

Thank you, Nerys.

Can you understand me?

What's your name?

FAINT GROANS

Facial burns, partial-thickness.

Soot in mouth.

Small amount...

Suctioned.

Carbonaceous sputum.

Again, small amount...suctioned.

Singeing of nasal hairs.

Good peripheral perfusion.

OK, someone has got to have seen
her go into the changing room?

Giles is checking the CCTV.

Has anybody seen Lorraine today?

Oh, my God. It's Lorraine?
We don't know who it is.

That's right. We don't.

I'm calling the Burns Unit.

Excuse me.

Look, everyone,
I know this is not easy,

but please can we just treat
her like any other patient.

Yeah, this is Mrs Hicklin.

Can you put me through
to the consultant on call for Burns?

Can you open your mouth
for me, my sweet?

I can't get anything. Keep trying.

Any intra-oral burns, oedema?

No signs of either.
Upper airway appears clear.

I need to give you some oxygen,
my love.

The mask might be
a bit uncomfortable

while the painkillers kick in.

OK, well done.

100% O2, 15 litres a minute.

Just waiting
for the sats reading to come up.

Vitesh, Nicola Hicklin.

We have a woman over here
at CGH with greater than 50%

full and partial-thickness burns.

No, we've no ID yet.

I'll let you know.

OK, cheers, Vitesh.

Reasonable ventilation
across both lung fields.

Good carotid and femoral pulses.

Widespread full

and partial-thickness burns
across the chest.

Can you upload the referral form
to the Central Infirmary Burns Unit

once we've got
all the necessary information?

Yeah.

Adding to that, that we believe
it may be a member of staff.

Of course, Fiona.

Oxygen saturation?

100.

We'll confirm that with ABGs.

OK, so better iv access first,

tube second, ABGs third.

Let's do it. Subclavian line.

'Alarm areas sounding a continuous
tone, evacuate immediately.'

Can you do us a favour

and bleep the consultant
anaesthetist on call. It's Molloy.

What did your last slave die of?

That's a bit racist.

Go away, please!

I'm pausing the primary survey
till the patient gets something for the pain.

I've done you 30
of ket, Lomas. It's in there.

Thank you.

You'll feel a sharp scratch
just underneath your collar bone.

OK, we're going to take care of you.

We're going to give you
something for the pain.

Yes, I'm calling
on behalf of Dr Chandramohan.

Could you fast bleep Dr Molloy?

So, this will be
the sequence of events.

Once Ramakrishna has cannulated
the subclavian vein,

he'll take a syringe of blood.

Harry, you'll receive that syringe
and you'll send it for FBC,

U and E's, G&S,

TEG, EtOH,

beta-HCG and drug screen.

And don't forget the drug screen.

ABGs to follow,
including carboxyhaemoglobin.

Yes. Yes.

No...MOLLOY.

Consultant anaesthetist.
Yes. Yeah, that's it. Thanks.

FIRE ALARM ENDS

Thank God for that.

Send those straight off,
come back for an ABG.

(What's going on?)

SHE GROANS

Can someone prep me for an
art line, please? I'll get it.

Mrs Hicklin,
can we catheterise the patient

so we can monitor her urine output,
and start a fluid chart, please?

OK.

Sister, let's prepare
some sterilised gauze

to remove any loose flesh
or burnt clothing.

And let's source
some clingfilm please.

Yes, Mr Boyle. Justin, burns kit.

We haven't had the handover yet.

I was in the male changing room.

Heard shouting and ran over
to the female side.

She'd barricaded herself in,

so it was hard work getting to her,

but luckily, there was an
extinguisher in the corridor, so...

You put the fire out?

Yes.

Well done.

Yes.

Well done.

We're going to give you something
to make you comfortable.

Ketamine and paracetamol given.

Thank you.

Hartmann's running in.

You're going to feel a strange
feeling at the top of your chest.

That's just the fluid running in.

OK.

Resuming the primary survey.

Bloods have gone.

Cheers.

Harry, ABG.

(You bastard.)

She's very pink.

Whoa, whoa, whoa!

Cherry.

She was in an enclosed space.

She's hypoxic.

Can't be. Her sats are still 100.

Guedel, oxygen. Yep.

Diazemuls.

Need to oxygenate.

But what about the sats?
Shut up, Billy.

Come on, Justin, come on.
JUSTIN: Coming, coming, coming!

GLEN: She's asphyxiating.

It's OK... Shit!

Come on!

Shit!

Shit! Come on, Justin, come on.
Coming, coming!

Yep.

Diazemuls ten milligram iv, given.

It's OK, you're OK.

(OK.)

Good.

What's her carboxyhaemoglobin?

30% and her CO2 is 12 point...

Whatever, she's got severe CO
toxicity. I need to tube her now.

We. Thio 125, sux.

Get the GlideScope ready. Yep.

Ready for the cricoid? Yeah.

Done it before? Yeah. Great.

Thiopentone, 125...in.

Come on, Billy, come on!

You'll have it. You'll have it.

Breath sounds diminishing...

Come on!

Sux, 100... Yeah.

..in.

Bougie at the ready.

Lady wand.

Not the time or the place, Billy.

(Shit!)

Not liking what I'm seeing...

ALARM BEEPS
(Shit!)

Bougie.

Tube.

She's on the bougie. Yep.

Subglottic oedema.

OK.

Shit.

Shit.

It's closing off the airway.

Can we get the tube in?

I need you to tell me
what's happening.

Laryngeal mask.

Yeah, copy that.

Backs!

Mini-Trach,
gloves and gown, please, now.

Need an answer, Ramakrishna.

I NEED an ANSWER.

There you go.

Yeah, OK.

OK, LMA in place.

Oh, Godsake, why me?

VF arrest.

Get me gloves, please.

Femoral absent, carotid absent.

Compressions and defibrillation.

OK, so we're bagging via LMA,
so it's 30:2. Go.

CONTINUOUS ALARM

OK, go.

150 biphasic. 150 biphasic.

DEFIBRILLATOR:
'150 joules biphasic shock.

'Charging.

'Charged. Prepare for shock.

'Warning. Stand clear.

'Warning. Stand clear.'
Shocking in three.

Everybody off.

Oxygen away, Justin off the chest.

One, two, three...

shock.

Back in. Come on.
Restart compressions.

Two minutes of CPR, please.

I'm not happy with this ventilation.

I'm going to try and tube her
again at the end of this cycle.

OK. What's the smallest tube
you've got there?

6.0.

So what's the story with the sats?

Pulse ox misreads
carbon monoxide poisoning

as a normal oxygen saturation.

I knew that. Yeah.

Radiographer.

Sorry.

Well done for rescuing her
from that fire.

30 seconds gone, 90 to go. Thanks.

I want to apologise for badgering
you over apparent discrepancies

in your CV.

An Army contact
told me what happened.

Right.

No wonder you needed some time off.

Your actions in Afghanistan
were admirable.

Thank you.

60 seconds gone, 60 to go.

OK, let's use this time
to calculate surface area of burns.

Anyone?

By rule of nines

and with visual estimation,
it's 65%.

OK.

Using the Parkland formula,
with estimated weight of 60 kilos

that gives us four times 60 times 65

which equals 15.6 litres

over the first 24 hours

with 50% given over
in first eight hours,

ie 7.8 litres.

Good.

65% of body surface area is burned.

Gives her a 50% chance of survival.

As per Harry's calculation,

that's one litre per hour
for the first eight hours.

Did you really work that out
for yourself or did you cheat?

Five seconds.

We weren't even going out
properly at the time

and you were acting like an arse.
So no change there, then.

Time. I need to get in
during the pulse check. OK.

Need quick hands, Billy.
Yep. Charging.

DEFIBRILLATOR: 'Shock charging.

'Charged. Ready to shock.
Warning, stand clear.'

I need to get in.
It's oxygenation that she needs.

GLEN: Delay shock.
Justin, off the chest.

Femoral absent, carotid absent.

OK, let's go.

OK, tube in! Get in!

DEFIBRILLATOR: 'Ready to shock...'
Shocking after three. Everybody clear.

Oxygen away.

One, two, three.

Compressions, come on.

Another two minutes of CPR.

Time is 22 minutes and 30 seconds.

Let's be ready with adrenaline
for after this cycle, please.

OK, we can go asynchronous now.

That Mini fell through.

The black one
with the 20 thou on the clock.

Guy got a better offer.

I'm gutted.

OK, we're moving more air now.

We've got ROSC.

Can we stop CPR, please?

Sinus.

Carotid output, femoral output.

OK, OK, that's well done,
everybody.

Let's get a plain chest film, please,

and then we're going to transfer
her to the Burns Unit. OK.

Portable machine's in use.

OK to move the patient
down to the overhead?

OK, let's go. Quick as we can
please, quick as we can.

Go. Get going.

NICOLA: Harry,
you should be back in ED.

TANNOY: 'Will all staff please
return to their stations?' HE KNOCKS

'Will all staff return
to their stations? Thank you.'

Security sent me the CCTV footage.

MACHINE BEEPS

Rays in three.

One, two, three...rays.

Patient is intubated and ventilated.

Tonic-clonic seizure
and VF arrest due to CO toxicity,

but she's stable now. All clear.

Get in there and finish
the clingfilm, please.

OK. Thanks, boss.

Image on screen.

Doesn't look good.

MACHINE BEEPS RAPIDLY
Got a problem.

Move, please.

Chest compliance is down.

Poor oxygenation.

The burns
are constricting her chest.

She needs escharotomies.

Right now, please. OK.

This is Fiona Lomas, trauma reg.

Could you fast-bleep Trauma theatre
staff urgently, please.

What's that she's got there?

Sanitizer gel.

Highly flammable.

After she barricades herself in,
nothing happens for some time.

Oh, God.

HE SIGHS

I'd best tell the trauma team.

I don't think that's a good idea.

They need to know
who their patient is.

I don't think that's going
to help anybody right now.

MACHINES BEEP
Diathermy, please.

Thank you. Swabs, please.

Chest compliance is even worse.

Her lungs are getting
really badly compressed.

OK.

That loosened the chest.

Lung compliance and tidal volumes
are still way down.

Hi, boss. We've some real issues
with ventilation here.

Emergency escharotomies
are in progress. Right.

It's definitely Lorraine.

I thought you should know.

You don't have to do this.

Yes, I do.

It's not changing.

It's not enough.

You need to release
more scar tissue.

OK, we'll do transverse incisions.

I can do it if you want.

I'm doing it.

Chest compliance improving,

tidal volumes increasing.

Tidal volume continues to improve.

End tidal CO2 is dropping,
sats now rising.

I'm happy to do the transfer.

I'll call my opposite number in the
Burns Unit. All right. Cheers, boss.

Let's get her a face mask.

Prep her for the Burns Unit, please.

Face mask, burns box, resus.

Cheers, Billy.

She stands a decent chance.

Of what?

A lifetime of pain
and disfigurement?

She was misguided.

I had to challenge her,
for the good of the department.

(Yeah.)

There are HUNDREDS of members
of staff whose careers, livelihoods

and families depend
on the success of this unit.

I couldn't let one person
derail that. No, you couldn't.

DOOR OPENS

Anything to say? Who told you?

Doesn't matter. I've been told.

If I ever thought Lorraine would
do something like this... What?

Then you wouldn't
have ruined her career?

The only thing Lorraine ever did
was challenge the way you run this department.

We don't yet know the range
of emotions that motivated her.

No?

Someone should inform
the next of kin.

Well, not you.

There's a husband
and two young children.

Joshua's six, Olivia's four.

PHONE RINGS

'John Rappaport.'

Mr Rappaport...

My name's Fiona Lomas.

I'm one of Lorraine's
junior colleagues.

'Yes?'

I have very bad news.

I'm afraid Lorraine's been involved
in an accident at work.

She has sustained severe burns.

'My God.'

We're transferring her to the Burns
Unit at the Central Infirmary...

..and I think it would be best
if you made your way there directly.

'Yes, I will.'

I am so sorry to have to
give this news over the phone.

Mr Rappaport...

Fiona...

I've got it.

Mr Rappaport,

it's Giles Dhillon.

I'm very sorry.

Sats are still dropping.
Have you checked the circuit? Yep.

Ramakrishna, what's happening?

MULTIPLE MACHINES BEEP RAPIDLY

No.

No, there's no leaks, no.

Must be the tube. Yeah.

Another 6.0. Yeah.
No, make it a 5.5.

Tell me.
We're not ventilating the lungs.

Sats are now 80%. Yeah, I can read.

(Come on.)

Facial oedema's
pulling out the bloody tube!

Off the vent. Yeah. Crike set!

Crike, over here. Yes, got it.

Come on, move.

No, bougie. There you go.

Ties!

Tube.

Get it out. Yep.

OK.

Sats are now 60%.

Ramakrishna,
I'm giving you ten seconds.

Nine. Eight.

Seven. Six.

Five. Four.

Three. Shit. Two.

One.

Blade, please. Clear, clear.

Haemostat.

Trach.

Inflate, please.

SINGLE MACHINE BEEPS

Ventilating. Good.

Thanks.

Patient back on vent. Sutures.

Cut it.

OK.

We keep her warm and then we
transfer her to the Burns Unit.

Yep.

Let's make sure
she gets there this time.

Brake on.

Moving on three,
everyone ready? Yep.

One, two, three.

I'll call as soon as I hand her
over to the Burns Team.

RADIO COMMUNICATION
IN BACKGROUND

Transit time is five,
ten minutes right?

Nearer five. OK, good.

MACHINE BEEPS

I need to unstrap.

HE SIGHS
You got 200mg of hydrocortisone?

Great, thank you.

We've got a bit of a problem back
here, we need to get down ASAP.

RADIO: 'En route to City General...'

Shit. Got suction? Yep.

Sorry.

Oh, shit.

Come on.

CONTINUOUS BEEP
Shit.

Oh, shit!

Can you do compressions?
I need to bag her.

Not enough room.
We're going to be landing ASAP.

I should bag... We're going to be
landing. You need to be strapped...

I need to bag her! ..in!

Locked and tight in the front.

Locked and tight to the back.
Patient is secure.

Down.

Ambubag and adrenaline.

Get on the chest, mate. Right.

Adrenaline given.

She's drowning.

Massive ARDS reaction
to smoke inhalation.

We're done.

This is a coroner job, so we need
to leave everything attached.

Sorry, mate.

We'll take her in.

Thanks.

Mate, it's Billy.

All right.

HE SIGHS

I've got it.

Billy?

It's Giles again.
Ramakrishna, stay where you are

and I'll organise
some transport for you. Billy.

She died en route.

Yes, she's here.

Dr Bennett-Edwardes,
he wants to talk to you.

Er, yeah, tell him I'll ring him.

She's going to give you a call.

It must have been a terrible ordeal

and we're all thinking of you.

Yep. I'll call you back
when I know who's coming to get you.

Fiona...

Fiona! She didn't even get there.

You bastard!
I'm terribly, terribly sorry.

Stop!

You will stop!

I'm so sorry, baby.

No.

There's something I need you to see.

Please.

OK.

I wasn't on active service
when you called me.

My last deployment
finished months ago.

I've been on...

I've been on long-term leave.

SOLDIERS SHOUT

What is this?

It's a helmet camera. It's not mine.

It's our...

forward operating base
in Afghanistan.

GUNFIRE AND SHOUTING

The guy shooting at us is Afghan.

He's meant to be one of ours.

We shot him three times.

He was your friend? He was.

I thought I knew him.

SOLDIER: 'I need a medic!'

Why didn't you tell me? What?

I...

Because I'd have known?

Known?

Known what?

That this is why you're here.

Another chance to save lives.

And now look. Lorraine...

Lorraine wasn't anyone's fault...

..but Clive's. Hah! OK.

And your friend...

..you did the best you could
for him.

You don't understand.

OK.

I can't...

..pretend to understand
what you've been through...

..but it wasn't your fault.

You couldn't save him.
I wasn't trying to save him!

I wasn't trying to save him.

It was completely the opposite.

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