All language subtitles for Critical s01e09 The Purest Evil

You'll be charged with serious
professional misconduct.

You'll destroy my career?

Changing room fire, someone
trapped. Member of staff.

It's definitely Lorraine.

She died en route.

She didn't even get there.
You bastard!

There's something I need you to see.

The guy doing the shooting is
meant to be one of ours.

We shot him three times.
He was your friend?

He was. I thought I knew him.

You couldn't save him.

I wasn't trying to save him.
It was completely the opposite.

Male, 30s, drowner,
two minutes. Yep, got it. Thanks.

OK, male, 30s,
got into difficulty

while swimming in the river.
Probably some pisshead.

Ground escort via TAS.
That's all we've got so far.

12 cans of Super - ten quid.

Helicopter and a week
on ITU - 10,000 quid.

PA: 'Major Trauma, ETA one minute.'
Justin.

Yeah, run it off, mate.

What's up with Justin?

Orthopaedics night out.

Is there a date for Lorraine's
funeral?

I haven't heard from the family.

I'd like to be able to
pay my respects.

I'll make sure you get
the information. Thank you.

SIREN

Oh, God. Uh. Follow me!

The call was for a 30-year-old.

13.
Oh, right. This way!

We know, mate.

Nice and controlled.

This way.

Wild guess he's pulseless.

They really ought to stop
pumping on his chest.

Oh, God.

Oh, shit. Paeds trolley!
I thought he was meant to be 30.

Well he's not.
I'll fast-bleep paeds.

Starting the clock.

Can you fast-bleep the on-call
Paediatrician to resus, please. Thank you.

How old is this patient?
Year eight, he's about 13.

I suggest on my count you stop CPR,
we transfer on the scoop, and we then resume CPR.

OK.

Justin, are you OK for chest
compressions? Yeah. Great. Ready to transfer.

Yeah I've got the head.

Off the chest.
Transfer on three. One, two, three.

This marks the first cycle of CPR.

We're 28 seconds in.

Help yourselves to some
new blocks, boys. Cheers.

Scoop out. Yep, top.

Justin, off the chest.

Brace to the patient's left on
three. One, two, three.

Brace right on three,
everyone ready? One, two, three.

Justin, back on the chest.

We're bagging on 100% O2
at 15 litres a minute.

Struggling to auscultate chest
cos of compressions.

Justin, on my order,
pause compressions.

No not now! I said on my order.
Sorry.

Well, you've stopped now
so you might as well stop.

Sorry.

Thanks, man.

Restart compressions, please.

SINGS QUIETLY: Well, you can tell
By the way I use my walk

? I'm a woman's man... ?

Decent enough ventilation
on both sides.

Monitor's showing asystole.

Let's get the bear hugger on
and get him cabled up.

Already done it.
Thank you.

Have we got any of his next of kin
yet? He needs his parents with him.

We'll get to that.

Could you hold that there, please?
Yeah.

Patient size, 157cm.
Calculating approximate weight.

1.57 squared is about 2.5. BMI looks
lower level of normal, say 18.

18 multiplied by 2.5
gives us 45 kilos.

Yeah. Well done, Harry.

Let's make sure we've got some
warmed liquids, please?

Yes, Mr Boyle.
Thank you, sister.

Oh, shit.
Justin! You bloody idiot!

Nerys. I'm really sorry.

OK, just take it easy.

MOUTHS: I'm really, really sorry.

Sorry. I shouldn't have shouted.

Can I borrow a light, please?
Yeah.

Pupils very sluggish.

Coming up to three minutes.

Amiodarone and adrenaline?
Adrenaline only.

There's no point doing anything
if the core temperature's below 30.

Let's get a temperature.
Who's going to do that?

I can do that. Thank you.
Starting primary survey?

Please. Paeds.

Perfect timing.
Sorry to keep you guys waiting.

Everybody, nice and quiet and give
our full attention to TAS, please.

Thank you. Patient is Ryan Curtis,
13 years of age.

At just after 1400, a couple
of younger lads got into some difficulty swimming in the river.

We understand that Ryan swam
against strong currents to get them to the bank,

where they were helped by
bystanders, but Ryan got pulled under,

and was in the water
for close to ten minutes.

Bystanders administered CPR.
Helicopter on scene at 1425.

Patient showed no signs of trauma.

Patient was not breathing
spontaneously,

had absent carotid and femoral
pulses, and was cold and blue.

The portable monitoring
showed asystole.

Patient was intubated at the scene
and bagged with 100% oxygen.

Chest compressions given
continuously.

Bilateral thoracostomies.
IV cannulation of left ACF.

0.4mg of adrenaline given
at 1430. Bubble wrapped.

Due to the ongoing CPR,
we made the decision to escort him here via ground ambulance.

Thank you. Any questions for TAS?
Any alcohol ingestion?

Denied by everyone at scene,
and no evidence of alcohol at scene.

Come and sign, please.
OK, let's get these blocks off.

Primary survey completed. Surgical
scar on the right lower quadrant.

No clinical evidence of trauma.
Thank you.

To me, Dr Bennett-Edwardes.

We should borrow an IVC probe
from ITU.

Happy to get that for us,
Dr Bennett-Edwardes?

It'd be my pleasure, Dr Chandramohan.
Billy, do you mind? Yes, Miss Bennett-Edwardes

OK, boss, that should give us
a more accurate core temperature.

Fluids are warming. Thank you.

Temperature is below 30.
No drugs to be given.

I believe you've got a Lucas.
We do.

I'm fine. I love this bit.

Let's get it, please.
Coming right up, Mr Boyle.

Thank you, Sister.

Anything more for TAS?

No. It's good to meet you.

Thanks, guys.

I'll call later. My Boyle -
fingers crossed with this one.

We're going to start warming
this patient up.

I want a femoral line.
I want an NG Tube.

I want pleural irrigation.
I want a urinary catheter. Now, please.

Femoral line.
Pleural irrigation. Pleural Fluids should be warm by now.

NG Tube.

You OK to do the catheter?

Sure. Thank you.
Want to vent this kid, boss. Do it.

You know, I've got this
if you need to get a coffee.

I'm fine.

I'm here.

I'm on this.

OK.

Beep, beep, beep, beep, beep.

You OK, Justin? Yeah.

Breathe in, boys.

Acidic gastric contents.
NG Tube is in position.

(She seems to be taking it all
right. Harry. The break-up.)

(Is it over, then?)

(Got to be professional.

(Thing is, at my level, you can't be
seen to mess about with...)

(So she's single now?)

Left thoracostomy patent.

Warm saline running into
the pleural cavity. Good.

Warm saline filling bladder.

Right thoracostomy patent.
Warm saline running in. Got it.

Justin, off the chest,
help me lift him.

Don't fire that up till
I get there. OK.

Yep.

Warm saline now running in
via the femoral line.

I won't re-connect to the ventilator
straight away

in case there's still some
water in the lungs. OK.

How we doing?
Ready to go.

OK. Justin, off the chest.

Better out than in.

Hi, boss. It's Jenny.

The trauma call is
a 13-year-old drowner,

asystolic at a
core temperature sub-30.

How's it going?

We've just started warming him up.

The optimal rate for rewarming
a quick hypothermic

is one degree every five minutes.

Yes, that's very helpful, thank you.

No trauma. No significant PMH.

No drugs. No interventions below 30.

The way you treated Lorraine
was disgusting.

God only knows how you can
live with yourself.

What Lorraine did to herself was
a shock to us all.

Did to herself? You drove her to it!

Lorraine's death is a tragedy
that affects us all,

but we must remain professional.

Now, this situation seems to
be under control.

You're needed
back in the ED, Sister Campbell.

Fine.

Clive? Mm-hmm?

Sorry about that.

Not your fault. Only to be expected.

OK.

ITU's miles.

Great. Dr Bennett-Edwardes,
can you assist me, please?

Certainly, Dr Chandramohan.

ITU used to be called
Intensive Care...

Till they realised nobody did.

Connect up, please.

Connected. OK.

Temperature 28.5.

Yeah, it's got to come up faster.

We're going to move to bypass.

Someone fast-bleep the
trauma theatre, please.

I'll fast-bleep the perfusionist.

Someone fast-bleep the
theatre trauma staff.

I'll do it. Thank you.

Fiona Lomas, trauma fellow.
Can you fast-bleep the perfusionist to trauma theatre, please?

Hello, this is trauma resus.
Can we fast-bleep the theatre staff to trauma theatre, please?

Thank you.

Dead eyes.

He's not dead
until I pronounce him dead.

Sorry.

Right. If you're going to theatre,
I'll leave you to it.

My consultant said
she's happy with your management

and to contact us
if anything changes.

OK.

And thank you.

Is this a bad time?
I've got a relly in.

It's the dad.

Harry,
can you print out a consent form two

and bring it to the relatives' room?

Thank you.

We'll be a good five minutes here.

See you in theatre. Yeah.

Is there something you want
to say to me?

A combat surgeon overcome
by the stress of the moment? No?

Oh, OK.
So you don't want to hear from me.

You just want to judge me.
You showed me something shocking.

The man I saw in that film
isn't the man I know.

It's the man
standing in front of you now.

Well, that scares me.
Yeah, and it scares me too.

I want to understand.

He was bleeding internally
and I went to him to save his life.

And then...

And it was in that moment,

with my fist
wrapped around his heart.

I just...

I just squeezed.

Till I was squeezing
the life out of him.

I hope that's understandable
enough for you.

This is Mr Curtis, Ryan's father.

Glen Boyle, I'm the consultant.

Fiona Lomas, I'm the registrar.

Please.

Mr Curtis, what I'm about to say will
be difficult to hear

but I have to be straight with you.

You should understand that I think
Ryan still stands a chance.

We haven't given up on him,

and we are still
doing our very best for him,

but so far we've been able unable to
get his heart pumping again.

Ryan's hypothermic,

which means his body can survive
longer without a heartbeat.

When will you know?

We're taking him
to an operating theatre now,

to try and accelerate
the rewarming process.

We're going to put him on a bypass
machine that will warm up his blood.

It's only when his temperature's
nearer normal that we'll

know for sure whether or not we're
going to be able

to get his heart pumping again.

Do you have kids?

No.

You?

No.

It's OK, it's OK.

It's OK, Mr Curtis.

I'm sorry he asked about kids.

It's OK.

I don't fall apart every time
someone shows me a baby photo.

No. Still, I'm sorry.

I've told you why
I think you came here.

One way or another,
you thought it would fix things.

I don't know.

Including between you and me.

Like I said, I don't...

I don't know.

Constance?

The bastard.

No. Go to theatre.

Go.

You people. God, you make me sick.

You're emotional, which is

why you're failing to consider
your own professional security.

I think it would be
in your best interests

if I were to disregard your remark.

Clive will pay for this.

Take his side,
you'll pay for it too.

It didn't happen just
because I was off my face.

You're a sweetie, Justin.

But let's be sensible, yeah?

Oh.

Right.

Cheers, Billy. No worries.
See you in a bit. TEXT MESSAGE CHIMES

Sister Campbell's been suspended.

Right. You take that.

Mrs Hicklin. You know
this reshuffle in orthopaedics?

Yeah, I heard something about...
They offered me a band seven post

and I'm going to take it.
This'll be my last trauma call.

Before you ask, yes, it does
have something to do with

the way that this department is run.

Nerys...
Save your breath, love.

I won't be here next week,
and that's that.

I should lead.

Vascular procedure.

Of course.

Patient remains asystolic on Lucas.

Been undergoing CPR for nearly
half an hour in hospital.

And, including pre-hospital care,

patient has shown no
signs of life for 45 minutes.

Baseline ACT...

This patient is not dead until he is
warm and dead, do you understand?

Erm, yeah. That's fine.

The baseline ACT's normal.

Blade.

Give a bolus of heparin.

Swab. Diathermy.

Thank you.

Forceps, please.

Sorry.

Yes, Harry?

I got your form signed, no problem -

but the dad's asking
all sorts about the bypass?

We're inserting
tubes into the femoral artery

and vein at the top of the thigh,

so we can divert circulation
through the bypass machine.

So when it flows
back into the patient,

it increases the temperature
throughout the entire body.

Thanks.

Harry?

I'm also going to put in a
perfusion cannula

to stop the leg becoming ischaemic.

Got it.

I'll get the form.

Erm, I can take the consent form,
if you like.

Oh, it's OK.
Better safe than sorry.

How's the operation going?

All right.

Yeah. It's...

It's all right.

We look alike.

What?

I mean, you're, like,
a much prettier version. And a girl.

Obviously.

OK.
They say that, don't they,

they say that people fancy people
who look like them.

I'm not sure they do say that.

It's like brother and sister,
separated at birth, meeting up,

like, 20-odd years later
and getting off with each other.

Not that you're like my sister.

I wouldn't want to go out
with my sister.

See you later.

See ya.

Travis.

Forceps and Lahey, please.

Sling.

Haemostat.

Thank you.

Sling.

Haemostat.

11 blade, please.

Cannula.

Clamp, please.

Artery cannulated.
Moving on to the vein.

That's good.

Did you get a bite yet?

Erm, what do you mean?

Any takers for the Fiesta? Oh.

Oh, no, just tyre kickers.

It's a good runner though.

Why, are you interested?

Me? No.

My motor's not in the same
league as your motor,

is that what you're saying?

I'm happy with the one that I've
got, that's what I'm saying.

Cannula, please.

Hey, want to buy a car?

PERSON ON PHONE LAUGHS

Sorry.

Vein cannulated.

Perfusion cannula.

Clamps and tubing shears, please.

20mls.

Clamp off.

Thank you.

Clamps off.

OK to go onto bypass?

OK - heparin IVI is going,
ACT is good.

Go for it.

Onto bypass, please.

Going on bypass.

Happy for the Lucas to go off?
Yeah, happy.

Lucas off.

Vent on standby.

Patient's circulation is
now on the bypass pump.

28.5.

29.2.

29.7.

Threshold.

As of now,
we shock any shockable rhythm. Yeah.

Temperature coming up steadily.

OK.

TANNOY:
'Trauma call, ETA 15 minutes. Trauma call, ETA 15 minutes.'

There's timing.

Someone go and
find out what that is, please.

Ventricular complexes.

And again.

Come on.

Another.

Come on.

Picking up a rhythm.

Temperature rising steadily.

Motorcyclist,
bullseyed a windscreen.

Injuries? Critical.

Well, this guy's under,

so can you see if
Dr Busby can cover me, please?

I'll see what I can do,
Dr Chandramohan.

FLATLINE TONE

Lost rhythm. Yeah.

Back to asystole.
So, adrenaline straight away. Yeah.

I've got this.

You should see to the motorcyclist.

No.

This one's mine.
If you need me, I'll be right here.

OK.

Still nothing.

Let's keep the
temperature going up, please.

34 degrees.

Let's hold the temperature there,
to protect the brain.

Boss. Yeah?

OVER INTERCOM: 'Sorry, Glen.
He's been down a long time.'

His temperature's just
passed 34 degrees, so...

It's Fiona. I need information on
the incoming motorcyclist, please.

Bloods?

There is nothing
in the blood profile to support

a treatable cause
of cardiorespiratory arrest.

Here we go again.

FLATLINE TONE

They're saying the
motorcyclist is very bad.

I see nothing
but agonal rhythms.

This is my case.

And we're going to keep going.

OK, Glen and I need to talk.

Please do.

Glen?

I'm not giving up on this one.

Don't make the mistake
of thinking it helps,

if for every one you lose,
you save one.

I need to be here,

I need to be doing my job right.

We'll assess the motorcyclist
when he arrives,

but I don't even know if there's
an available theatre upstairs yet.

Fine. There's a possible incoming.

If so we go to recovery or
we go back to resus.

I'd rather you didn't.

He stays here.

If you can't get a pulse,
you pronounce him.

You've got five minutes.

Coming up to 46 minutes, the patient
is still down, no signs of life.

Yes. We'll keep you informed, yes.

What's the incoming?

Motorcyclist. Major trauma.

What's going on with the
hypothermia?

I asked you a civil question.

Still down. We wanted to move him
but Clive said no.

That's not right. We'll need
theatre for the motorcyclist.

Exactly.

Clive, hi. Yep.
I'm puzzled.

What about?
We need to clear theatre.

We will do, once the hypothermia's
been pronounced dead.

Maybe I'm being thick...
You know, we used to be the best performing unit in the region.

Now we have the highest mortality
rate. You want to know why?

Because we take all the
critically injured patients.

Now, the worse your injuries,
the greater the likelihood you'll succumb to them.

Try broaching that statistical
no-brainer with the DoH.

That patient cannot be an ED death.

He has to be a trauma death.

He has to be pronounced in theatre.

And the motorcyclist,
should he succumb to his injuries,

should also do so, not in resus,
but in theatre.

Tick-tock.

DOOR SLAMS

Incoming Major Trauma,
ETA now nine minutes.

Mrs Hicklin, I just had a call
through from the chief exec's office.

What was the message?
There's no message, but she wants you to call her back ASAP.

Thank you.

That's 48 minutes.

Give adrenaline.

No.

It's time to call this off.

Get out of my theatre.

Point of information,
it's not your theatre.

Stop resuscitation
and pronounce him.

He's not dead until he's...
He's dead.

Warm and dead.

Well, I haven't pronounced him
and no-one is going to pronounce him

until we have exhausted
all of our options.

They are exhausted. That's my point.

Adrenaline, 0.4mg

IV, given.

Clive.

Oh, good. You can talk some sense
into these two.

Clive, you're relieved.

The chief executive has made me
acting clinical lead.

You?

How?

She asked me and I said yes.

No way.
Check your e-mails.

Someone from HR will take you
through your exit protocol.

Manage this case as you see fit.

I've secured
space in theatre upstairs

for the incoming major trauma.

Thank you.

You're welcome.

Get in there if you want.

Really? You've been
champing at the bit for weeks.

Ventricular complexes.

Come on.

Harry.

No output.
Pulseless VT.

Harry, defib.

Yes!

150? Yes.

DEFIB UNIT: '150 Joules selected.
Charging.

'Warning. Stand clear.'

Everyone OK to clear?

Shocking in three, two, one...

Shocking.

No output.

51 minutes.

Let's defib
and try again in two minutes.

Can we have 0.4mg
of adrenaline and 200mg

of amiodarone ready to
go in for the next cycle, please?

Coming right up.
On it, Debs.

Rhythm's becoming less organised.

Don't do this. Don't do this.

Come on!

SVT.

Strong output. Good output.

Sync shock, 50.

DEFIB: 'Synchronised 50 Joules
selected. Charging. Charged.

'Prepare to cardiovert.
Warning. Stand clear.

'Warning. Stand clear.'

Shocking.

Refractory SVT. Output fading.
Losing output.

Hit him with 100. Quickly, please.

Synchronised 100 Joules selected.
Charging. Just do it!

Shocking.

Output dropping.

150, hit him, fast as you can.

Shocking.

Sinus!

OK. OK,
what've we got with that?

Good output. Sinus holding.
Got a good blood pressure.

We've got Rosc. I want to see
if his heart can hold its own.

Pump to three-quarter
flow, please, now.

Three-quarter flow.

Back on vent.

Three-quarter flow.

Sinus holding. BP...

..dropping.

Holding.
Half flow.

Half flow.
Half flow. Sinus holding.

BP...

holding.

Yep. Quarter flow.

Quarter flow.

Quarter flow.

Sinus holding.

BP...

..holding.

Clamp and fully off.

Do it.

OK. Bypass off.

BP dropping.

Dropping.

Holding.

BP holding.

Patient in normal sinus rhythm.

TANNOY: 'Major trauma patient
ETA now one minute.'

Pupils contracting.

Sluggish, but contracting.

Well, we should
get this kid an ITU bed. GLEN LAUGHS

If, when the cannulae are out,
that's job done here?

It's a job done.

Our trauma team have managed to
restart Ryan's heart.

It's beating strongly.

Hi, I'm after a Picu
bed for a post-arrest hypothermic

recovered to sinus after
59 minutes' CPR.

Let's have the other Dardik, then
a 4-0 Prolene, round-bodied, please.

Yeah, it's Ryan Curtis,
06-3-02. OK, thanks.

I'm grateful you're here.

I'm grateful you came running,

when I called.

Cannula out.

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