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1
00:00:05,175 --> 00:00:06,575
You'll destroy my career?
2
00:00:06,695 --> 00:00:08,935
Clive will pay for this.
3
00:00:09,095 --> 00:00:11,055
Take his side,
you'll pay for it too.
4
00:00:14,175 --> 00:00:16,975
Harry! The break-up.
Is it over then?
5
00:00:17,135 --> 00:00:19,295
Got to be professional.
So she's single now?
6
00:00:21,135 --> 00:00:23,255
Clive, you're relieved.
7
00:00:23,415 --> 00:00:28,815
The Chief Executive has made me
Acting Clinical Lead.
8
00:00:28,935 --> 00:00:31,095
I'm grateful you're here.
9
00:00:31,255 --> 00:00:34,135
I'm grateful you came running,
when I called.
10
00:00:41,215 --> 00:00:44,455
'The lower ambulance bay is
a restricted area.
11
00:00:44,575 --> 00:00:47,575
'Essential personnel only.
12
00:00:47,735 --> 00:00:50,215
'The lower ambulance bay is
a restricted area.
13
00:00:50,335 --> 00:00:52,175
'Essential personnel only.'
14
00:00:52,335 --> 00:00:53,855
- This way, quick!
- What've we got?
15
00:00:54,015 --> 00:00:57,175
Dog attack. And one of the dogs,
he won't let go!
16
00:00:57,335 --> 00:01:00,495
Dog. We've been in transit
for 15 minutes.
17
00:01:00,655 --> 00:01:04,775
Is the dog still alive?
Yeah. Bob, you OK?
18
00:01:04,895 --> 00:01:06,175
Just about.
19
00:01:06,335 --> 00:01:09,055
The dog, where is it exactly?
Pinned to the floor.
20
00:01:09,175 --> 00:01:10,615
You need to hurry, though.
21
00:01:10,775 --> 00:01:13,575
Yeah, OK. Listen,
we're going to open the door now.
22
00:01:15,175 --> 00:01:17,575
ALL EXCLAIM
23
00:01:25,255 --> 00:01:27,735
All we had was Diazepam,
If this bastard thing wakes up...
24
00:01:27,855 --> 00:01:31,535
OK. Give me the ketamine, please.
25
00:01:31,655 --> 00:01:34,455
Justin, ketamine. Now, please.
26
00:01:39,615 --> 00:01:41,095
Thank you.
27
00:01:47,255 --> 00:01:50,255
Easy, boy.
Why doesn't someone just kill it?
28
00:01:50,415 --> 00:01:52,455
Shoot it
when it's this close to the guy?
29
00:01:52,615 --> 00:01:54,735
You don't have to shoot it, just...
DOG SNARLS.
30
00:01:54,895 --> 00:01:56,855
Shi...
Just be careful, please.
31
00:01:57,015 --> 00:02:00,335
Sorry. Just be careful.
Sorry. Any sign of the vet?
32
00:02:00,455 --> 00:02:02,335
Yeah, he's called. He's on his way.
33
00:02:02,495 --> 00:02:06,095
Call him back, tell him
we need access to a vein, hind leg,
34
00:02:06,215 --> 00:02:08,175
if that's at all possible, yes?
35
00:02:08,295 --> 00:02:10,495
We'll need an ETA. I wouldn't.
36
00:02:10,615 --> 00:02:12,975
I was just... switching it off.
37
00:02:13,095 --> 00:02:14,335
Good.
38
00:02:14,495 --> 00:02:17,375
The ketamine by itself is going to
make it hold on tighter.
39
00:02:17,535 --> 00:02:20,095
You've got to give it diazepam
to counter muscle rigidity.
40
00:02:20,255 --> 00:02:22,735
No, don't give any more diazepam -
if it relaxes and let's go,
41
00:02:22,895 --> 00:02:24,295
matey's going to
bleed like stink.
42
00:02:24,455 --> 00:02:27,655
His brachial artery's been torn
open. That's why we didn't kill it.
43
00:02:27,815 --> 00:02:30,935
Its jaws are like a clamp.
Soon as it releases... peeow.
44
00:02:31,095 --> 00:02:33,415
We're going to stick to
50mg of ketamine for now,
45
00:02:33,575 --> 00:02:35,495
that should make him
nice and happy.
46
00:02:35,615 --> 00:02:36,775
I'd double it.
47
00:02:36,935 --> 00:02:40,455
OK, he says the best vein's
on the lateral aspect of the hock.
48
00:02:40,615 --> 00:02:42,495
Hock, what the
bloody hell's the hock?
49
00:02:42,655 --> 00:02:45,935
Don't ask me. Well, I'm not asking
you, am I, Giles!
50
00:02:46,095 --> 00:02:48,935
Oh, yeah. What's the...?
He can hear.
51
00:02:49,095 --> 00:02:52,095
It's halfway up the back of the
leg, it's the bit that sticks out.
52
00:02:53,895 --> 00:02:56,015
Yeah, it's what she said.
53
00:02:56,135 --> 00:02:58,975
Fiona, butterfly cannula, please?
54
00:02:59,135 --> 00:03:01,015
Yeah.
Sure you've got it?
55
00:03:01,135 --> 00:03:02,575
Got it.
56
00:03:02,735 --> 00:03:05,495
Now, if someone constricts
the stifle... No...
57
00:03:05,615 --> 00:03:07,135
It's the next joint up,
58
00:03:07,295 --> 00:03:10,375
its knee, then the vein can be
palpated. Thank you.
59
00:03:10,495 --> 00:03:11,575
GROWLING
60
00:03:19,535 --> 00:03:20,535
OK?
61
00:03:21,855 --> 00:03:23,135
I think. Here.
62
00:03:27,255 --> 00:03:28,415
OK, there, I've got it.
63
00:03:32,375 --> 00:03:33,935
SNARLING
64
00:03:34,055 --> 00:03:35,095
It's OK, boy.
65
00:03:39,695 --> 00:03:44,215
OK. That's 50mg of
ketamine going in now.
66
00:03:44,375 --> 00:03:47,015
OK, he says his ETA's five,
six minutes. Thank you.
67
00:03:47,135 --> 00:03:48,415
We need a resus trolley.
68
00:03:49,775 --> 00:03:51,215
The patient, any pain relief?
69
00:03:51,375 --> 00:03:54,055
10mg morphine.
We couldn't get a line in.
70
00:03:54,215 --> 00:03:56,935
OK. He's called Charlie Walton
and he's blind.
71
00:03:57,135 --> 00:04:00,375
Apparently it was his guide dog they
went for and he was trying to save it.
72
00:04:00,495 --> 00:04:01,655
They?
73
00:04:01,775 --> 00:04:02,775
Three of them.
74
00:04:03,855 --> 00:04:05,575
The dog is now sedated.
75
00:04:05,695 --> 00:04:07,335
We ready to transfer?
76
00:04:07,495 --> 00:04:09,975
They're not coming inside.
Er, what?
77
00:04:10,135 --> 00:04:12,095
A live dog? With patients
and staff all about? No.
78
00:04:12,215 --> 00:04:13,575
Management has spoken.
79
00:04:13,735 --> 00:04:16,055
If you can hear me, Charlie,
my name's Glen,
80
00:04:16,175 --> 00:04:17,575
I'm a trauma consultant.
81
00:04:17,735 --> 00:04:20,375
We need to stabilise you,
before we can sort out the dog.
82
00:04:20,495 --> 00:04:23,175
OK? Manage to get a GCS?
83
00:04:23,295 --> 00:04:25,175
Best we could tell, five or six.
84
00:04:25,295 --> 00:04:27,415
GCS five or six.
85
00:04:29,735 --> 00:04:31,535
OK, we've got
to secure the airway.
86
00:04:31,655 --> 00:04:33,615
Yes, we do. Around the side, please.
87
00:04:38,615 --> 00:04:40,415
Radial and brachial pulse absent.
88
00:04:40,535 --> 00:04:41,735
Thank you.
89
00:04:41,895 --> 00:04:44,175
I'm going to put
a cuff around the leg.
90
00:04:45,575 --> 00:04:46,695
Harry, can you help me?
91
00:04:46,815 --> 00:04:48,655
Yeah. OK to come up?
92
00:04:48,775 --> 00:04:50,815
I'm not making any promises.
93
00:04:50,975 --> 00:04:54,615
Great, so I'll just stay and let it
chew the F out of me, shall I?
94
00:04:54,735 --> 00:04:56,015
GROWLING
95
00:04:56,135 --> 00:04:57,975
Calm down, boy, calm down.
96
00:05:19,215 --> 00:05:22,615
We need to tube him
sooner rather than later.
97
00:05:22,735 --> 00:05:24,815
Oxygen sats at 90%.
98
00:05:24,935 --> 00:05:26,615
Thank you. BP?
99
00:05:27,975 --> 00:05:29,735
It's cycling -
I'm not getting a read.
100
00:05:29,895 --> 00:05:31,975
We'll need to give him
volume before we tube him,
101
00:05:32,135 --> 00:05:34,855
otherwise he might
arrest on induction. We need access.
102
00:05:36,055 --> 00:05:38,975
Well, good luck with that -
no chance of a subclavian.
103
00:05:39,135 --> 00:05:43,255
Justin, can you get me an I/O kit,
some O pos,
104
00:05:43,375 --> 00:05:44,855
and I need scissors, please.
105
00:05:44,975 --> 00:05:46,255
Yep.
106
00:05:54,975 --> 00:05:56,375
Thank you.
107
00:06:00,015 --> 00:06:02,615
Can someone prime two
three-ways for me, please?
108
00:06:02,735 --> 00:06:04,095
Got it.
109
00:06:05,535 --> 00:06:07,095
Hey, Charlie.
110
00:06:07,255 --> 00:06:10,175
Listen, you hang in there,
we're doing the best we can.
111
00:06:16,455 --> 00:06:19,815
In case it can, I'm going to let
the dog hear the sound of the drill.
112
00:06:19,935 --> 00:06:21,615
That's a good idea.
113
00:06:21,735 --> 00:06:23,175
DRILL BUZZES / DOG GROWLS
114
00:06:23,295 --> 00:06:24,815
Steady.
115
00:06:24,935 --> 00:06:26,655
No, leave it, don't wake it up!
116
00:06:26,775 --> 00:06:28,775
Harry, swab.
117
00:06:28,935 --> 00:06:32,095
Look, forget about the vet. Just
sux, paralyse the shit out it,
118
00:06:32,255 --> 00:06:34,175
then send it on its merry
way once you've...
119
00:06:34,335 --> 00:06:37,615
If we have to, yes, with a massive
dose of thio so it doesn't suffer.
120
00:06:37,735 --> 00:06:39,695
Suffer? After what it's done?
121
00:06:39,815 --> 00:06:41,175
There's no need to be cruel.
122
00:06:41,295 --> 00:06:42,775
Yeah, Ramakrishna!
123
00:06:42,935 --> 00:06:47,335
OK, Charlie,
my name is Fiona Lomas.
124
00:06:47,455 --> 00:06:49,175
We're going to take care of you.
125
00:06:49,335 --> 00:06:51,415
I'm afraid this is going to
hurt a little.
126
00:06:51,575 --> 00:06:54,615
Listen, Charlie, you've lost
a lot of blood so we need to get
127
00:06:54,775 --> 00:06:58,895
some fluids into you before we send
you off to sleep, OK?
128
00:06:59,055 --> 00:07:01,175
Unfortunately, we have to do that
through your shin
129
00:07:01,295 --> 00:07:02,375
and your shoulder.
130
00:07:02,495 --> 00:07:03,975
OK?
131
00:07:04,095 --> 00:07:05,775
WOMAN: Yeah.
132
00:07:09,295 --> 00:07:11,655
MUFFLED CRIES It's all right,
Charlie, they've got you.
133
00:07:11,815 --> 00:07:14,375
I'm sorry, Charlie, I'm sorry.
You're all right, mate.
134
00:07:16,575 --> 00:07:19,095
It's all right.
135
00:07:19,215 --> 00:07:20,935
You're doing really well, mate.
136
00:07:21,095 --> 00:07:23,895
I'm with you, mate. You're OK.
I'm not going anywhere. You're OK.
137
00:07:31,335 --> 00:07:34,455
OK, Charlie, I need to do the same
again to your shoulder.
138
00:07:35,775 --> 00:07:36,935
OK?
139
00:07:37,055 --> 00:07:38,255
CHARLIE WHIMPERS
140
00:07:39,775 --> 00:07:41,175
SNARLING
141
00:07:42,735 --> 00:07:43,735
It's OK.
142
00:07:47,095 --> 00:07:49,175
OK, Charlie, it's done now.
That's it.
143
00:07:59,935 --> 00:08:00,935
C02 sats?
144
00:08:02,295 --> 00:08:04,215
Er, 75 and dropping.
145
00:08:04,375 --> 00:08:06,295
We can't wait, I've got to intubate.
Do it.
146
00:08:09,055 --> 00:08:11,215
Billy,
this port's looking a bit ropey.
147
00:08:11,415 --> 00:08:13,455
Can you administer the RSI
drugs into the tibia?
148
00:08:13,575 --> 00:08:15,255
Yeah.
149
00:08:15,415 --> 00:08:18,735
'The lower ambulance bay is
a restricted area.
150
00:08:18,855 --> 00:08:20,935
'Essential personnel only.
151
00:08:21,095 --> 00:08:23,215
'The lower ambulance bay is
a restricted area.
152
00:08:23,335 --> 00:08:25,415
'Essential personnel only.'
153
00:08:25,575 --> 00:08:28,575
Thank you for, you know,
sticking up for the dog.
154
00:08:33,175 --> 00:08:34,535
Cricoid?
155
00:08:34,655 --> 00:08:35,655
Er, yeah, thanks.
156
00:08:37,615 --> 00:08:39,495
Listen, Charlie, you're going
to feel me
157
00:08:39,655 --> 00:08:41,975
pushing gently down on your throat,
OK?
158
00:08:42,095 --> 00:08:43,815
But it's nothing to worry about.
159
00:08:43,935 --> 00:08:46,255
Thiopentone, 250mg.
160
00:08:51,295 --> 00:08:52,975
Just sending you off to sleep, mate.
161
00:08:53,095 --> 00:08:55,335
Suxamethonium 100mg.
162
00:09:01,495 --> 00:09:02,815
MOBILE PHONE RINGS
163
00:09:02,975 --> 00:09:05,455
SNARLING He's waking up!
164
00:09:05,575 --> 00:09:08,415
Easy there, boy, easy boy.
165
00:09:08,535 --> 00:09:11,135
It's OK.
166
00:09:11,255 --> 00:09:13,695
Just keep going.
167
00:09:13,855 --> 00:09:16,495
There's a good dog. It's OK.
Good boy.
168
00:09:16,615 --> 00:09:18,135
I said give it double!
169
00:09:18,255 --> 00:09:19,895
And I did.
170
00:09:21,415 --> 00:09:23,295
OK, sats down to 55.
171
00:09:23,415 --> 00:09:25,015
RAPID BEEPING
172
00:09:38,615 --> 00:09:40,095
OK.
173
00:09:55,615 --> 00:09:57,255
SNARLING
174
00:09:57,415 --> 00:10:01,695
Mind your hands there, guys.
Just keep bagging.
175
00:10:01,815 --> 00:10:04,175
OK, oxygen sats rising to 65.
176
00:10:04,295 --> 00:10:06,695
Billy, sux, please.
177
00:10:06,855 --> 00:10:10,215
Pass that over.
OK.
178
00:10:10,415 --> 00:10:15,175
I need you to hold on to him bloody tight
and don't let go until I say so, yes? Yes.
179
00:10:15,335 --> 00:10:18,695
OK, boy.
I'm really sorry I have to do this.
180
00:10:18,815 --> 00:10:21,215
I really love dogs, me.
181
00:10:22,975 --> 00:10:24,415
What are you doing?
You're not killing it?
182
00:10:24,575 --> 00:10:27,495
Too right. No, no, no.
The vet'll be here any minute.
183
00:10:27,655 --> 00:10:30,495
Giles, Giles.
We need to get this dog off him now.
184
00:10:30,655 --> 00:10:33,095
No, no, no. Dangerous drugs cannot
be given to a dog
185
00:10:33,255 --> 00:10:36,335
on hospital premises without a vet's
prescription. For Christ's sake!
186
00:10:36,495 --> 00:10:39,655
No, we don't have the
authority to... It's on mine,
187
00:10:39,775 --> 00:10:41,615
as acting clinical lead, OK?
188
00:10:47,295 --> 00:10:49,095
Management has spoken.
189
00:10:49,255 --> 00:10:51,935
Right, we've lost far too much time
so we dispatch this dog
190
00:10:52,095 --> 00:10:54,655
and get this man upstairs quickly.
Thiopentone.
191
00:10:54,775 --> 00:10:57,535
Pass that. Thank you.
192
00:10:59,935 --> 00:11:03,255
Let's get a field dressing ready,
please, and hit me again.
193
00:11:03,375 --> 00:11:05,175
Ta. Thank you.
194
00:11:08,495 --> 00:11:10,295
It's going in.
195
00:11:14,255 --> 00:11:15,575
Here.
196
00:11:15,695 --> 00:11:17,135
Ta.
197
00:11:25,015 --> 00:11:26,615
It's dead.
198
00:11:26,735 --> 00:11:29,015
THEY EXHALE
199
00:11:31,135 --> 00:11:32,775
Never mind.
200
00:11:34,615 --> 00:11:36,335
Oxygen sats back up to 90.
201
00:11:36,495 --> 00:11:38,575
OK, let's get him
out of here, please.
202
00:11:38,735 --> 00:11:41,135
O2 bottle, please, Billy.
Yeah.
203
00:11:44,095 --> 00:11:46,535
OK, I need to get major
control of this artery.
204
00:11:46,695 --> 00:11:50,415
Where are your tourniquets? Fiona,
I know we've had our difficulties,
205
00:11:50,575 --> 00:11:54,255
but I'm hoping things are going
to be better now... Eurgh!
206
00:11:54,375 --> 00:11:55,655
Whoa, whoa, whoa, whoa, whoa!
207
00:11:55,775 --> 00:11:57,495
Let me get it.
208
00:11:59,000 --> 00:12:03,040
Hold the doors, please.
I've still got haemorrhage control.
209
00:12:04,120 --> 00:12:05,520
Move, please.
210
00:12:05,640 --> 00:12:06,800
Move!
211
00:12:06,920 --> 00:12:08,665
THEY GROAN
212
00:12:08,866 --> 00:12:11,946
No, don't stop.
We have to keep going. Keep going!
213
00:12:12,106 --> 00:12:14,386
I've got... I've got it!
Any news on the agency nurse?
214
00:12:14,546 --> 00:12:17,266
Um, no. Then get on it.
Yeah, I have.
215
00:12:18,506 --> 00:12:21,546
Sorry, we're still a nurse down.
Fast-bleep the theatre staff.
216
00:12:21,706 --> 00:12:24,586
Say we'll have him
there in five minutes, please. Yep.
217
00:12:26,346 --> 00:12:28,226
Up there.
218
00:12:28,386 --> 00:12:31,386
This is Mrs Nicola Hicklin,
acting clinical lead.
219
00:12:31,546 --> 00:12:33,986
On the ventilator now. Let's remove
the scoop on your count.
220
00:12:34,146 --> 00:12:37,226
Can you fast-bleep the trauma
theatre staff and general surgery?
221
00:12:37,386 --> 00:12:40,226
On three, everyone ready?
Yeah. It's all re: Charlie Walton.
222
00:12:40,386 --> 00:12:42,866
One, two, three...
Major trauma Mike Papa. Easy.
223
00:12:43,026 --> 00:12:45,866
On three - one, two, three.
And brace left on three.
224
00:12:46,026 --> 00:12:48,906
One, two, three.
Just check the back.
225
00:12:49,026 --> 00:12:50,226
No, that's not good enough.
226
00:12:50,386 --> 00:12:52,466
We need to get him
there in about five. OK.
227
00:12:52,626 --> 00:12:54,386
It's over half an hour
since the attack.
228
00:12:54,546 --> 00:12:57,426
Well done. Harry, can you take over
from Bob, please?
229
00:12:57,586 --> 00:12:59,546
They're getting
someone off the table now.
230
00:12:59,706 --> 00:13:02,306
It's going to be about 10,
15 minutes. Come on.
231
00:13:02,426 --> 00:13:03,626
It's the best they can do.
232
00:13:03,746 --> 00:13:06,306
PHONE RINGS
233
00:13:08,146 --> 00:13:10,066
Setting elapsed time.
234
00:13:10,226 --> 00:13:12,386
Hi, I'm Ania Wasenska,
the agency nurse.
235
00:13:12,546 --> 00:13:16,706
Nice of you to come(!) Sorry, I was
sent to the wrong hospital.
236
00:13:16,866 --> 00:13:20,146
This tourniquet is doing nothing.
The injury's too high.
237
00:13:20,266 --> 00:13:23,386
Can someone get me some shears...
238
00:13:23,506 --> 00:13:24,746
(Thank you.)
239
00:13:24,866 --> 00:13:26,426
Scribe, please.
240
00:13:26,546 --> 00:13:29,106
Me? OK.
241
00:13:29,226 --> 00:13:31,226
You need to sign in first.
242
00:13:31,346 --> 00:13:32,946
Keep the pressure on the neck.
243
00:13:33,106 --> 00:13:35,546
Temporary staff,
and just drag that over to there.
244
00:13:35,666 --> 00:13:36,946
Thanks.
245
00:13:37,066 --> 00:13:38,266
Thank you.
246
00:13:42,906 --> 00:13:43,986
Hey.
247
00:13:44,146 --> 00:13:49,746
We're in luck. Yeah? Yeah. He's on
night shift, custody duty. Ah, great.
248
00:13:51,906 --> 00:13:53,746
Formal handover now, please.
249
00:13:53,906 --> 00:13:57,266
OK, this is Charlie Walton, 29.
He was attacked at, er...
250
00:13:57,386 --> 00:13:59,426
Approx 10.40.
251
00:14:01,026 --> 00:14:04,026
..by three dogs.
Considerable blood loss at scene.
252
00:14:04,186 --> 00:14:08,226
No BP, no vital stats,
GCS was approximately 5 to 6.
253
00:14:08,346 --> 00:14:09,666
I'm just going to get an apron.
254
00:14:09,826 --> 00:14:14,746
We put him on high-flow oxygen,
and gave him 10mg of IM morphine,
255
00:14:14,906 --> 00:14:17,186
got him here as fast as we could,
basically.
256
00:14:17,346 --> 00:14:20,946
He was brought in with one of
the dogs still alive and attached.
257
00:14:21,106 --> 00:14:23,666
Further defence wounds to
both forearms,
258
00:14:23,826 --> 00:14:26,706
tear to the right side of the
neck... Got this for you.
259
00:14:26,866 --> 00:14:29,266
..and large wound lower left
side of his abdomen.
260
00:14:29,386 --> 00:14:30,786
The presence of the dog hampered
261
00:14:30,946 --> 00:14:33,586
any further effective
treatment of the patient.
262
00:14:33,746 --> 00:14:36,146
Delivery from blood bank
for Mike Papa.
263
00:14:36,266 --> 00:14:37,906
Lovely fit, that.
264
00:14:38,026 --> 00:14:39,546
Did he touch your arse?
265
00:14:44,226 --> 00:14:47,146
Whoa. He's been torn right open.
266
00:14:48,986 --> 00:14:50,746
Patient needs to get to theatre.
267
00:14:50,906 --> 00:14:53,826
If I'm not back in ten minutes,
just bring him in.
268
00:14:53,946 --> 00:14:55,986
So let's not waste any more time.
269
00:14:56,146 --> 00:14:58,946
Anyone got questions
for Tessa or Bob?
270
00:14:59,066 --> 00:15:01,346
No? Thank you. You can sign off.
271
00:15:02,986 --> 00:15:04,786
Rapid infuser operator is here.
272
00:15:04,946 --> 00:15:08,506
Hello. Prime the Belmont, six
units of blood, six of FFP, please.
273
00:15:08,666 --> 00:15:11,266
He's also going to need
1g of TXA bolus
274
00:15:11,386 --> 00:15:13,346
and then 1g infusion to follow,
275
00:15:13,506 --> 00:15:17,786
Augmentin 1.2g,
and a tetanus booster, please, Billy.
276
00:15:17,906 --> 00:15:19,706
Good air entry bilaterally.
277
00:15:22,666 --> 00:15:24,946
There's no surgical emphysema.
278
00:15:25,066 --> 00:15:26,746
I'm leaving the abdomen for now.
279
00:15:26,906 --> 00:15:29,346
OK, as I'm here,
I might as well do the left arm.
280
00:15:29,466 --> 00:15:31,586
Oh, those can be nasty.
281
00:15:32,906 --> 00:15:35,386
Anything with teeth,
you can't trust.
282
00:15:35,506 --> 00:15:37,146
I won't let my Immy have a hamster.
283
00:15:37,306 --> 00:15:40,506
Obviously, no peripheral or even
brachial pulse.
284
00:15:40,626 --> 00:15:42,506
Sorry, do I know you?
285
00:15:42,626 --> 00:15:44,466
No. I'm Ania. Oh...
286
00:15:46,226 --> 00:15:47,306
OK.
287
00:15:53,066 --> 00:15:57,146
Ragged wound to the right-hand
side of the neck.
288
00:15:57,306 --> 00:16:00,426
Active bleeding
from superficial vessel.
289
00:16:00,546 --> 00:16:01,946
BLOOD POURS
290
00:16:02,106 --> 00:16:05,786
Shit. Must've been a spasm.
We need to ligate this in theatre.
291
00:16:05,906 --> 00:16:07,826
No, we ligate it here.
292
00:16:07,946 --> 00:16:09,586
Got it.
293
00:16:10,946 --> 00:16:13,066
Harry, continue with the primary.
294
00:16:13,226 --> 00:16:16,146
Justin? Yep. IO's too slow,
I'll do a femoral line.
295
00:16:16,306 --> 00:16:19,986
Do it. Justin. Yep.
Harry, let's hear it, please.
296
00:16:20,106 --> 00:16:22,146
Multiple bite wounds.
297
00:16:22,306 --> 00:16:25,106
Superficial shredding to the
forearm.
298
00:16:25,226 --> 00:16:27,186
Heavily soiled.
299
00:16:27,346 --> 00:16:30,546
More defensive
wounds to the hand and wrist.
300
00:16:30,706 --> 00:16:33,506
Extensor tendons exposed.
He must've fought like hell.
301
00:16:33,626 --> 00:16:35,226
And imagine you can't see a thing.
302
00:16:35,346 --> 00:16:37,026
I'm a cat person from now on, me.
303
00:16:37,146 --> 00:16:38,946
I love dogs, me.
304
00:16:39,106 --> 00:16:42,946
Thready radial pulse. With small,
ring and middle fingers missing.
305
00:16:43,066 --> 00:16:44,706
Oh, any sign of them? No.
306
00:16:44,866 --> 00:16:47,226
OK. I'll still need
imaging of what's left.
307
00:16:47,346 --> 00:16:49,026
Won't be able to get it here.
308
00:16:49,186 --> 00:16:51,946
So, is that me out, then? Yeah.
Yeah, but she's...
309
00:16:52,066 --> 00:16:54,066
No, we're going to wait till theatre.
310
00:16:54,226 --> 00:16:56,466
But if you could interest
the plastic surgeon, please?
311
00:16:56,586 --> 00:16:57,586
OK. Thank you.
312
00:16:59,186 --> 00:17:01,786
Justin, I'll call you later.
313
00:17:01,906 --> 00:17:03,226
OK. Yeah.
314
00:17:03,346 --> 00:17:05,706
INDISTINCT CHATTER
315
00:17:11,306 --> 00:17:14,666
Whoa! Bollocks. I think you meant to
say that in the singular.
316
00:17:14,826 --> 00:17:17,986
Yep, he's a man down. OK, let's just
swab and dress it for now, please.
317
00:17:18,146 --> 00:17:22,346
Yep.
We also need blood, FBC, U&E, VBGs,
318
00:17:22,466 --> 00:17:26,106
cross-match and coag, please... Yep.
319
00:17:34,826 --> 00:17:36,146
It's clamped.
320
00:17:36,266 --> 00:17:38,186
Blood coming up.
321
00:17:46,626 --> 00:17:48,786
Justin, scissors, please.
322
00:17:53,666 --> 00:17:54,946
Thank you.
323
00:17:55,106 --> 00:17:59,546
Let's have a Foley as well, please.
Say what you see, Harry.
324
00:17:59,706 --> 00:18:02,706
Oh, shitting shit.
Oh, I mean, sorry.
325
00:18:02,866 --> 00:18:05,426
That doesn't look good. The abdomen
is filling up with blood.
326
00:18:05,626 --> 00:18:08,666
It's everywhere. OK, pack it for
now. We'll be in theatre soon.
327
00:18:08,786 --> 00:18:09,786
Packs!
328
00:18:09,866 --> 00:18:11,266
They're over there.
329
00:18:11,386 --> 00:18:14,026
Foley. Can you open it, please?
330
00:18:14,146 --> 00:18:16,066
Thank you.
331
00:18:17,986 --> 00:18:21,626
Hopefully, this'll inflate enough to
stem the bleeding from the arm
332
00:18:21,746 --> 00:18:23,506
until we're in theatre.
333
00:18:25,426 --> 00:18:28,146
Justin, I need
you on the syringe, please. Yep.
334
00:18:29,306 --> 00:18:30,666
Now, please. OK.
335
00:18:34,346 --> 00:18:36,746
OK, squeeze gently...
336
00:18:39,346 --> 00:18:40,946
Good.
337
00:18:42,826 --> 00:18:43,986
That is good.
338
00:18:45,066 --> 00:18:46,506
Thank you.
339
00:18:46,626 --> 00:18:49,186
OK, let's see if this holds.
340
00:18:50,466 --> 00:18:53,346
That should do
until we get to theatre. Good.
341
00:18:53,506 --> 00:18:56,026
So he needs blood, so as soon
as the femoral line is up,
342
00:18:56,146 --> 00:18:58,226
whack it in, please. Ah...
343
00:18:59,466 --> 00:19:01,266
Harry, reapply pressure. Swabs.
344
00:19:02,700 --> 00:19:06,699
I'm sorry.
We need to get to theatre now!
345
00:19:06,700 --> 00:19:08,380
Pack. Hit me.
346
00:19:08,500 --> 00:19:09,900
Hit me.
347
00:19:12,020 --> 00:19:13,460
Yes.
348
00:19:13,580 --> 00:19:15,260
Clear for theatre.
349
00:19:15,420 --> 00:19:17,460
OK, let's get him
ready to move, please.
350
00:19:17,620 --> 00:19:20,780
OK, not yet, I'm still suturing.
Sorry, can't wait.
351
00:19:21,980 --> 00:19:25,020
Done. OK, let's go. Move, please!
352
00:19:37,100 --> 00:19:38,860
Oh! Whoa!
353
00:19:38,980 --> 00:19:40,940
AINA EXCLAIMS
354
00:19:41,100 --> 00:19:42,980
You got it?
Yeah, yeah, I think so.
355
00:19:43,140 --> 00:19:45,340
Good job, Harry.
Let's keep going, please.
356
00:19:45,500 --> 00:19:48,580
Forget the Foley,
keep the pressure on it. (Well done.)
357
00:19:50,380 --> 00:19:53,940
Daisy, we're going to need hats on
these guys. Grey and green, please.
358
00:19:54,060 --> 00:19:55,260
Yep.
359
00:20:00,660 --> 00:20:02,180
Side down.
360
00:20:02,340 --> 00:20:04,860
Right, we need to get him across
very carefully
361
00:20:04,980 --> 00:20:06,580
so that Harry can maintain...
362
00:20:08,140 --> 00:20:09,980
Maintain what? Pressure.
363
00:20:10,100 --> 00:20:11,700
Very carefully, please.
364
00:20:11,860 --> 00:20:14,140
Everyone ready? Harry, you happy?
Happy.
365
00:20:14,260 --> 00:20:16,860
OK, on three. One, two, three...
366
00:20:16,980 --> 00:20:18,940
PHONE BEEPS
367
00:20:23,140 --> 00:20:25,620
Are you OK to stay here
while we scrub in? Mm-hm.
368
00:20:25,780 --> 00:20:28,100
You two go on. I'll sort this.
Thank you.
369
00:20:28,260 --> 00:20:30,940
Where shall we prep him?
Neck to knee, please.
370
00:20:31,100 --> 00:20:33,860
We'll need arm boards.
And we need a cell saver.
371
00:20:33,980 --> 00:20:35,460
Brian, arm boards, please.
372
00:20:35,580 --> 00:20:36,980
PHONE BEEPS
373
00:20:37,140 --> 00:20:39,060
Guys, let's do an instrument
check.
374
00:20:45,260 --> 00:20:48,300
'Glen, it's Jane Bryant.
Call me when you get a chance.'
375
00:20:48,460 --> 00:20:52,500
Did you know that was invented
by a doctor in the Victorian times?
376
00:20:52,620 --> 00:20:54,180
I'm serious.
377
00:20:54,340 --> 00:20:58,980
Because he was embarrassed about
putting his ear near to your...
378
00:21:02,740 --> 00:21:04,660
Spoils the fun, though, eh?
379
00:21:04,820 --> 00:21:07,220
Not if you warm
up your bell-end first.
380
00:21:07,340 --> 00:21:09,340
Could you get me a wipe, please?
381
00:21:09,460 --> 00:21:10,820
Yep.
382
00:21:13,420 --> 00:21:15,260
(You have GOT to tell him.)
383
00:21:19,500 --> 00:21:20,900
I had to get back.
384
00:21:22,580 --> 00:21:24,260
I just had to.
385
00:21:24,380 --> 00:21:26,060
Tom was waiting.
386
00:21:26,180 --> 00:21:28,260
Did he say anything?
387
00:21:29,980 --> 00:21:33,740
No, but you understand why
I couldn't.
388
00:21:33,860 --> 00:21:36,500
We couldn't have gone back to yours.
389
00:21:39,780 --> 00:21:42,220
(It wasn't that I didn't want to.)
390
00:21:42,340 --> 00:21:44,220
Didn't?
391
00:21:44,340 --> 00:21:46,380
What about now?
392
00:21:57,700 --> 00:22:01,740
Oh, look! A souvenir.
That's another for the black museum.
393
00:22:01,940 --> 00:22:04,500
No, no, that might
look nice on a chain.
394
00:22:04,620 --> 00:22:05,940
The police'll need it.
395
00:22:06,100 --> 00:22:09,140
Oh. Well,
in that case you'd better, um...
396
00:22:09,260 --> 00:22:10,940
Thank you.
397
00:22:11,100 --> 00:22:13,620
I'll find out where this
general surgeon is.
398
00:22:16,100 --> 00:22:17,660
Thank you.
399
00:22:22,780 --> 00:22:24,540
Fiona...
400
00:22:28,580 --> 00:22:30,260
It's not that simple.
401
00:22:35,300 --> 00:22:36,940
It is for me.
402
00:22:45,580 --> 00:22:49,100
OK, let's do the WHO. I'm Glen
Boyle, I'm the trauma consultant.
403
00:22:49,260 --> 00:22:51,940
Fiona Lomas, trauma fellow.
Khaali Osman, scrub nurse.
404
00:22:52,100 --> 00:22:54,740
Ramakrishna Chandramohan,
anaesthetic reg.
405
00:22:54,860 --> 00:22:56,340
Billy Finlay, anaesthetic ODP.
406
00:22:56,460 --> 00:22:57,900
Harry, get the arm, please.
407
00:22:58,060 --> 00:23:00,780
Brian Austin, support nurse.
Sandra, support nurse.
408
00:23:00,940 --> 00:23:02,700
Daisy Macdonald,
documentation nurse.
409
00:23:02,860 --> 00:23:05,660
Scott, rapid infuser operator.
Come round this side.
410
00:23:08,140 --> 00:23:10,580
Do you need any extra help?
Has your shift finished?
411
00:23:10,700 --> 00:23:12,300
Mm-hm. Glen?
412
00:23:12,460 --> 00:23:16,340
Suits me. Great, thanks.
Harry Bennett-Edwardes, EM SHO.
413
00:23:18,460 --> 00:23:20,500
Can we identify the patient, please?
414
00:23:20,660 --> 00:23:22,580
Yeah,
patient is major trauma Mike Papa.
415
00:23:22,700 --> 00:23:24,940
Date of birth 18/10/1985.
416
00:23:25,100 --> 00:23:28,500
The right external
jugular has been ligated.
417
00:23:28,660 --> 00:23:33,220
Defect in the abdominal wall,
eviscerated omentum and bowel.
418
00:23:33,380 --> 00:23:35,500
There's significant blood loss
419
00:23:35,620 --> 00:23:38,260
through left brachial artery injury,
420
00:23:38,380 --> 00:23:39,900
which Fiona has her finger on -
421
00:23:40,060 --> 00:23:42,860
it's the only way we've been able to
control it so far.
422
00:23:43,020 --> 00:23:46,380
Consent form four signed for
damage-control laparotomy,
423
00:23:46,540 --> 00:23:48,860
haemorrhage and contamination
control
424
00:23:49,020 --> 00:23:51,740
with a laparostomy,
and limb revascularisation.
425
00:23:51,900 --> 00:23:55,140
OK to start?
All set. Number 10 blade.
426
00:23:55,300 --> 00:23:57,860
And I need the cell saver
suction around here, please.
427
00:23:57,980 --> 00:24:00,020
I'll take the suction.
428
00:24:08,980 --> 00:24:10,620
Arterial clamp.
429
00:24:20,460 --> 00:24:21,660
Good.
430
00:24:21,780 --> 00:24:23,500
Clamp's holding for now.
431
00:24:23,660 --> 00:24:27,540
OK, I need to access the axillary
artery below the clavicle.
432
00:24:27,700 --> 00:24:31,500
OK. We'll open him up
and see what we can do.
433
00:24:31,620 --> 00:24:33,300
22 blade, please.
434
00:24:33,420 --> 00:24:34,700
10 blade, please.
435
00:24:36,220 --> 00:24:37,580
Thank you.
436
00:24:38,700 --> 00:24:39,860
Am I OK to cut?
437
00:24:39,980 --> 00:24:41,340
Yep, OK.
438
00:24:41,460 --> 00:24:42,700
Cutting.
439
00:24:44,340 --> 00:24:45,820
Cutting.
440
00:24:50,940 --> 00:24:54,100
Do we have a temperature?
Yes, 35.0.
441
00:24:54,260 --> 00:24:58,100
Heart rate? 140. BP holding
at 75 over 45.
442
00:24:59,260 --> 00:25:01,860
Topping him up as fast as we can.
443
00:25:01,980 --> 00:25:03,220
Mayo, please.
444
00:25:08,020 --> 00:25:10,220
More FFP, cryo, platelets.
445
00:25:10,340 --> 00:25:12,100
Thanks.
446
00:25:18,460 --> 00:25:20,540
I'll take the ring, please.
447
00:25:20,700 --> 00:25:25,380
Hi, yeah. This is Billy Finlay ODP
in trauma theatre... Thank you.
448
00:25:25,540 --> 00:25:29,140
Yeah. Can we order more FFP,
platelets and cryo
449
00:25:29,260 --> 00:25:31,340
for patient Mike Papa, please?
450
00:25:31,460 --> 00:25:32,780
Yes.
451
00:25:37,180 --> 00:25:40,860
Yep. I'm going to need warm saline.
Jugs of it, please.
452
00:25:40,980 --> 00:25:42,780
Warm saline, please.
453
00:25:44,060 --> 00:25:45,580
Packs, please.
454
00:25:47,100 --> 00:25:48,140
One.
455
00:25:50,940 --> 00:25:52,540
Hit me. Two.
456
00:25:54,300 --> 00:25:55,580
Hit me. Three.
457
00:25:55,700 --> 00:25:57,660
Three in. Three in.
458
00:26:01,380 --> 00:26:03,460
(Um, look mate, about Harry...
459
00:26:05,260 --> 00:26:07,060
(She and I... We're...
460
00:26:07,180 --> 00:26:09,100
(It's back on.
461
00:26:11,380 --> 00:26:13,380
(Sorry.
462
00:26:13,500 --> 00:26:14,580
(It's...
463
00:26:14,700 --> 00:26:16,460
(It's early days
464
00:26:16,620 --> 00:26:19,220
(so we're trying to keep it
under the radar.)
465
00:26:19,340 --> 00:26:20,820
No worries.
466
00:26:20,940 --> 00:26:22,780
Thanks for the heads-up.
467
00:26:24,220 --> 00:26:27,060
It's good to know before I make
a right tit of myself. Oh...
468
00:26:31,540 --> 00:26:32,980
If you could assist.
469
00:26:33,100 --> 00:26:34,860
Course.
470
00:26:34,980 --> 00:26:36,380
Retractor, please.
471
00:26:40,980 --> 00:26:43,100
Scissors and forceps, please.
472
00:26:43,260 --> 00:26:45,980
I thought it was only
the brachial that was torn.
473
00:26:46,140 --> 00:26:50,860
We need proximal control first
and then to explore the injury.
474
00:26:51,020 --> 00:26:54,980
As it's so high up,
it's easier to clamp the axillary.
475
00:26:55,140 --> 00:26:57,740
As well as the clamp,
I'm also going to put
476
00:26:57,860 --> 00:26:59,980
a vascular sling around the artery -
477
00:27:00,140 --> 00:27:03,340
it's easier to control later on
if we run into any problems.
478
00:27:04,780 --> 00:27:06,940
Clamp, please. Hit me.
479
00:27:08,380 --> 00:27:09,500
One.
480
00:27:11,260 --> 00:27:13,180
Hit me. Two. Two more in.
481
00:27:13,300 --> 00:27:15,020
Sling, please. Five in the abdomen.
482
00:27:16,700 --> 00:27:20,700
Voila - success. Middle and ring
fingers recovered from the scene.
483
00:27:20,820 --> 00:27:22,980
Where's the plastic surgeon?
484
00:27:23,100 --> 00:27:25,460
Be waiting for the drumroll.
485
00:27:25,620 --> 00:27:28,820
Reckon they're saveable.
Well, one, maybe.
486
00:27:28,940 --> 00:27:30,940
Take a picture, send it to Nicola.
487
00:27:31,100 --> 00:27:33,820
Tell her we need
plastics down here now, please.
488
00:27:33,940 --> 00:27:35,780
In fact, you should use my phone.
489
00:27:35,940 --> 00:27:38,060
That way she'll think it's
coming from me.
490
00:27:38,180 --> 00:27:39,940
It's over here in my pocket. Yep.
491
00:27:42,780 --> 00:27:44,300
Over on this side.
492
00:27:47,700 --> 00:27:51,460
No, sorry, you're going to have to
go up from under. Um... sorry.
493
00:27:54,460 --> 00:27:55,980
Got it?
494
00:27:56,100 --> 00:27:57,980
Yep. Cheers.
495
00:28:01,740 --> 00:28:06,860
OK, so now we unpack and clean out
each section at a time.
496
00:28:07,020 --> 00:28:10,340
If it was me,
and he could repair one thing,
497
00:28:10,500 --> 00:28:12,980
I'd rather have a scrotum
than a finger.
498
00:28:13,140 --> 00:28:16,420
I don't think most of us
in here would necessarily agree.
499
00:28:17,740 --> 00:28:20,740
I'm going to need more. Much more.
500
00:28:20,860 --> 00:28:22,180
More saline, please.
501
00:28:23,980 --> 00:28:25,620
Do you have a Javid shunt?
502
00:28:25,740 --> 00:28:27,860
Sorry I... There wasn't time.
503
00:28:28,020 --> 00:28:30,420
Mr Simpson had his carotid list
this morning.
504
00:28:30,540 --> 00:28:32,820
We haven't any left on the shelf.
505
00:28:32,940 --> 00:28:34,500
OK...
506
00:28:34,620 --> 00:28:35,900
Um...
507
00:28:36,020 --> 00:28:37,500
A giving set.
508
00:28:37,660 --> 00:28:40,340
I'll need... I'll
need about a foot of it, please.
509
00:28:40,500 --> 00:28:42,740
Nurse, a giving set, please.
Yep.
510
00:28:44,500 --> 00:28:46,620
And I'll need a sterile field.
Sure.
511
00:28:46,740 --> 00:28:48,300
Blade, please.
512
00:28:51,740 --> 00:28:53,060
Here.
513
00:28:53,180 --> 00:28:54,340
Hit me.
514
00:28:54,500 --> 00:28:57,060
Blood's going in
but BP's still falling.
515
00:28:57,220 --> 00:29:00,700
This bowel's a mess.
Severed in multiple places.
516
00:29:04,820 --> 00:29:07,500
Come on.
Where's your friend?
517
00:29:07,620 --> 00:29:09,420
OK, I need...
518
00:29:09,580 --> 00:29:14,260
Get me a TLC stapler
and more gauze, please. Hit me.
519
00:29:15,980 --> 00:29:17,500
One more in.
520
00:29:17,620 --> 00:29:19,060
Four in the abdomen.
521
00:29:19,180 --> 00:29:20,580
Retractor, please.
522
00:29:25,540 --> 00:29:27,060
Not those, darling.
523
00:29:29,460 --> 00:29:30,980
BP's still dropping.
524
00:29:39,940 --> 00:29:41,580
Now the shunt.
525
00:29:44,580 --> 00:29:47,300
Khaali, I need heavy
Vicryl ties or silk.
526
00:29:47,420 --> 00:29:48,900
Two of them, please. Sure.
527
00:29:50,260 --> 00:29:53,060
I've got one end
and I cannot find the other.
528
00:29:53,220 --> 00:29:56,780
This bowel is a bloody mess,
and we're running out of time.
529
00:29:56,900 --> 00:29:58,660
Clamp, please.
530
00:30:02,380 --> 00:30:04,140
And I'll take the stapler.
531
00:30:04,300 --> 00:30:06,660
I've still got an odd
number of ends.
532
00:30:06,820 --> 00:30:09,820
For now, I'm just going to have to
staple them. Thank you.
533
00:30:12,420 --> 00:30:14,260
BP's still dropping.
534
00:30:24,660 --> 00:30:26,300
Reload.
535
00:30:29,220 --> 00:30:32,540
And I'll take saline and suction,
please.
536
00:30:34,860 --> 00:30:36,340
Thank you.
537
00:30:37,980 --> 00:30:39,420
Cut, thank you.
538
00:30:39,580 --> 00:30:43,380
Thank you. Photos sent and plastics
called. Is that me done?
539
00:30:43,500 --> 00:30:44,700
Yes.
540
00:30:44,860 --> 00:30:47,860
OK, do you want me
to put your phone back in your...
541
00:30:47,980 --> 00:30:49,580
No. Thank you.
542
00:30:49,700 --> 00:30:51,340
Cut. Thank you.
543
00:30:55,140 --> 00:30:57,580
OK, shunt's in.
Let's see how it holds.
544
00:31:01,220 --> 00:31:02,820
Will you check his pulse?
545
00:31:04,500 --> 00:31:06,660
Thready.
OK, it will spasm a bit.
546
00:31:06,820 --> 00:31:08,980
But the capillary return's
much better.
547
00:31:09,100 --> 00:31:10,700
Right, I have control.
548
00:31:10,860 --> 00:31:14,220
I'm glad someone does.
I've now got three bloody ends.
549
00:31:14,340 --> 00:31:16,820
MACHINE BEEPS
550
00:31:16,980 --> 00:31:19,620
BP dropping - 60 over 40.
Billy, whack it in.
551
00:31:19,780 --> 00:31:22,340
It could be a
revascularisation bleed?
552
00:31:23,940 --> 00:31:28,100
Axillary NAD, brachial NAD.
Show me the jugular.
553
00:31:30,300 --> 00:31:32,100
There's nothing here.
554
00:31:32,220 --> 00:31:33,860
Jugular NAD. Shit.
555
00:31:34,020 --> 00:31:36,660
Whole sections have been torn away
from the mesentery.
556
00:31:36,780 --> 00:31:39,020
Dish. Glen... Yes?
557
00:31:40,820 --> 00:31:43,860
Oh, Christ! He's bleeding out!
558
00:31:44,026 --> 00:31:45,000
BEEPING
Let's keep filling him up, please.
559
00:31:45,000 --> 00:31:47,880
I am, but as fast as I'm topping him
up, it keeps on pissing out of him.
560
00:31:48,040 --> 00:31:49,776
This goes on much longer,
we're looking at DIC,
561
00:31:50,400 --> 00:31:52,320
and then he's buggered. Tie.
562
00:31:56,760 --> 00:31:58,080
Thank you.
563
00:32:02,920 --> 00:32:05,040
And release, please.
564
00:32:07,240 --> 00:32:08,680
Thank you.
565
00:32:14,600 --> 00:32:16,000
Cut.
566
00:32:20,600 --> 00:32:22,680
He's still bleeding like a sieve.
567
00:32:22,840 --> 00:32:25,440
I'm going to have to
start at the upper abdomen
568
00:32:25,600 --> 00:32:28,360
and work my way down,
haemorrhage control as we go.
569
00:32:28,480 --> 00:32:30,680
Morris retractor.
570
00:32:35,080 --> 00:32:36,680
The liver...
571
00:32:37,880 --> 00:32:40,720
The liver's OK,
let's go to the spleen, please.
572
00:32:42,960 --> 00:32:45,120
BP is continuing to fall.
573
00:32:45,240 --> 00:32:48,520
Spleen... is also good.
574
00:32:51,320 --> 00:32:53,800
The stomach is OK.
575
00:32:55,480 --> 00:32:57,920
Jejunum is well perfused.
576
00:32:58,080 --> 00:33:00,280
Be easier to take
the rest of it out.
577
00:33:00,440 --> 00:33:03,160
Yes. OK. We're going to need
more warm saline
578
00:33:03,320 --> 00:33:06,120
and more gauze -
both wet and dry.
579
00:33:06,240 --> 00:33:08,600
Lay them out here and here, please.
580
00:33:08,720 --> 00:33:11,720
BEEPING CONTINUES
581
00:33:16,160 --> 00:33:17,640
Thank you.
582
00:33:19,280 --> 00:33:22,120
BP's still dropping. More saline.
583
00:33:25,760 --> 00:33:27,560
Here.
584
00:33:27,680 --> 00:33:29,200
One.
585
00:33:29,320 --> 00:33:31,040
Here.
586
00:33:31,160 --> 00:33:32,360
Two.
587
00:33:32,480 --> 00:33:34,640
Here. Three out. One left.
588
00:33:34,800 --> 00:33:37,360
OK, he needs Metaraminol.
I've got to get his pressure up.
589
00:33:37,520 --> 00:33:39,440
He's full of holes.
I've got no choice.
590
00:33:39,600 --> 00:33:42,280
He'll just pump out blood.
If I don't give him some perfusion,
591
00:33:42,440 --> 00:33:45,040
there's going to be nothing to
salvage... Glen!
592
00:33:46,960 --> 00:33:49,960
Let's just run the bowel. Please.
593
00:33:56,800 --> 00:33:58,840
Billy, Metaraminol.
594
00:34:03,640 --> 00:34:05,480
Shit, we haven't got any.
595
00:34:05,600 --> 00:34:07,040
Billy!
596
00:34:07,160 --> 00:34:08,960
OK, retract.
597
00:34:10,760 --> 00:34:12,320
Need you to flush.
598
00:34:12,440 --> 00:34:14,240
And suction.
599
00:34:16,920 --> 00:34:19,480
Where the hell is this bleed?
600
00:34:22,600 --> 00:34:24,600
Here, please!
601
00:34:30,640 --> 00:34:34,320
OK, a number of mesenteric vessels
are severed.
602
00:34:36,320 --> 00:34:38,160
Give me a clamp!
603
00:34:42,280 --> 00:34:43,800
And again.
604
00:34:46,840 --> 00:34:48,320
Tie.
605
00:34:58,480 --> 00:34:59,880
And release.
606
00:35:01,200 --> 00:35:02,760
Thank you.
607
00:35:02,880 --> 00:35:04,240
Cut it.
608
00:35:05,640 --> 00:35:07,280
Sorry.
609
00:35:07,400 --> 00:35:08,840
Thanks.
610
00:35:11,600 --> 00:35:13,160
Thank you.
611
00:35:18,000 --> 00:35:19,360
And release.
612
00:35:20,480 --> 00:35:22,080
Thank you.
613
00:35:24,320 --> 00:35:25,720
Cut.
614
00:35:25,840 --> 00:35:27,920
Metaraminol going in.
615
00:35:31,640 --> 00:35:33,600
That should push up his BP.
616
00:35:40,800 --> 00:35:43,000
OK, we're winning up here.
617
00:35:43,120 --> 00:35:44,680
Well, we're losing in here.
618
00:35:44,840 --> 00:35:47,480
Blood is increasing
and we need to pack. Hit me.
619
00:35:50,360 --> 00:35:52,640
General Surgeon Mr Street's here.
620
00:35:52,760 --> 00:35:54,200
Another two in, Daisy.
621
00:35:54,320 --> 00:35:55,600
Back to three.
622
00:35:55,760 --> 00:35:58,560
The dogs have played tear and share
with his small intestine,
623
00:35:58,720 --> 00:36:01,720
and his mesentery's been
ripped to shreds.
624
00:36:01,840 --> 00:36:04,680
OK, I'll be right with you.
625
00:36:07,440 --> 00:36:09,960
Plastics is on his way.
I need to isolate the bleeding.
626
00:36:10,120 --> 00:36:13,880
You want me to cancel?
No. No, we live in hope.
627
00:36:14,040 --> 00:36:17,120
Well, it shouldn't be a problem
in the future,
628
00:36:17,240 --> 00:36:19,160
co-ordinating the specialities.
629
00:36:19,280 --> 00:36:20,800
Thanks.
630
00:36:20,960 --> 00:36:25,200
OK. Let's keep going,
one section at a time.
631
00:36:28,160 --> 00:36:29,440
Here.
632
00:36:31,160 --> 00:36:34,040
Can you retract, please?
One out.
633
00:36:35,240 --> 00:36:36,400
OK.
634
00:36:36,560 --> 00:36:39,760
Yeah. It's venous bleeding
from the root of the mesentery.
635
00:36:39,880 --> 00:36:41,600
Roberts, please.
636
00:36:44,240 --> 00:36:47,000
And I'm going to
need a transfixion stitch.
637
00:36:47,160 --> 00:36:52,160
If this is the main source of the
bleed, he might stand a chance.
638
00:36:52,280 --> 00:36:53,640
Scissors, please.
639
00:36:56,000 --> 00:36:58,600
Forceps.
640
00:36:58,720 --> 00:37:00,040
Thank you.
641
00:37:25,080 --> 00:37:26,240
OK, let's cut.
642
00:37:26,360 --> 00:37:28,040
Mr Doughty, plastics, here.
643
00:37:28,160 --> 00:37:29,480
I think we're there.
644
00:37:30,800 --> 00:37:32,800
Not exactly keyhole surgery(!)
645
00:37:35,080 --> 00:37:38,600
We thought you'd like to see a
proper operation for once, Henry.
646
00:37:38,720 --> 00:37:40,000
Hit me.
647
00:37:41,920 --> 00:37:43,360
And again, please.
648
00:37:44,600 --> 00:37:46,520
Yep. Two more in.
649
00:37:46,680 --> 00:37:49,360
Back to five.
So how long ago did this happen?
650
00:37:49,520 --> 00:37:52,480
Just over an hour ago.
Fingers are over there.
651
00:37:52,640 --> 00:37:57,560
8� gloves. And can you open the bag
for me, please?
652
00:38:01,760 --> 00:38:03,520
OK.
653
00:38:03,640 --> 00:38:05,520
Let's scoop.
654
00:38:12,240 --> 00:38:13,840
Think you can save them?
655
00:38:14,000 --> 00:38:16,640
Yeah, the fingers are in pretty
decent shape, actually,
656
00:38:16,760 --> 00:38:19,200
but that's only half the story.
657
00:38:19,320 --> 00:38:22,080
I'll need to assess the hand.
658
00:38:22,200 --> 00:38:23,800
Thank you.
659
00:38:26,240 --> 00:38:28,000
How's Tom?
660
00:38:29,720 --> 00:38:31,240
Yeah, he's fine.
661
00:38:33,120 --> 00:38:35,720
OK, the arm looks pretty decent
662
00:38:35,880 --> 00:38:39,080
but I'll need to scrub before I make
a definitive assessment.
663
00:38:39,200 --> 00:38:41,280
OK, can you call up a microscope?
664
00:38:41,440 --> 00:38:44,520
And I'll need an arm board, drapes
and a stool, please.
665
00:38:44,640 --> 00:38:47,000
Brian, help the plastic, please.
666
00:38:52,680 --> 00:38:54,560
Ohh! Oh, sorry!
667
00:38:56,560 --> 00:39:00,880
We need the microscope
in trauma theatre for Mr Doughty.
668
00:39:01,000 --> 00:39:02,000
Thank you.
669
00:39:03,760 --> 00:39:06,640
What's up? One sec.
670
00:39:06,800 --> 00:39:10,000
OK, so his small intestine -
no wonder it doesn't all match up
671
00:39:10,120 --> 00:39:12,520
and the mesentery's so badly torn -
672
00:39:12,680 --> 00:39:15,080
there are huge sections missing.
Missing?
673
00:39:15,200 --> 00:39:16,880
And not all accounted for.
674
00:39:17,040 --> 00:39:19,760
I would say we're about
a metre-and-a-half down.
675
00:39:19,920 --> 00:39:22,280
Somebody won't need to
feed his dog tonight.
676
00:39:22,440 --> 00:39:24,360
Can he survive it?
Yes, he's got enough.
677
00:39:24,520 --> 00:39:26,880
And at least
he won't end up on home TPN.
678
00:39:27,040 --> 00:39:29,200
But you've found
and stapled all the ends? Yes.
679
00:39:29,360 --> 00:39:33,520
Haemorrhage control? All bleeding
mesenteric vessels have been ligated.
680
00:39:33,640 --> 00:39:35,080
Where are we?
681
00:39:35,240 --> 00:39:39,080
Yeah, he's responding to filling.
BP is 100 over 60.
682
00:39:39,200 --> 00:39:40,920
So, he'll make it, then? Oh, yes.
683
00:39:41,080 --> 00:39:44,160
Look, there's just a few serosal
tears I need to deal with...
684
00:39:44,320 --> 00:39:46,720
I think I can manage, mate.
It won't take me that long.
685
00:39:46,880 --> 00:39:49,120
Glen, go. Give a poor general
surgeon a chance.
686
00:39:49,240 --> 00:39:51,680
He'll be fine. Go.
687
00:39:56,440 --> 00:39:59,280
Oh, Harry, can you assist?
Yes, Mr Street.
688
00:39:59,400 --> 00:40:00,880
Until my registrar turns up.
689
00:40:01,000 --> 00:40:02,520
We need to get more blood in him
690
00:40:02,680 --> 00:40:05,480
and warm him up before Mr Doughty
performs his magic.
691
00:40:05,640 --> 00:40:08,640
OK, I'll need the micro-vascular
and handsets, please.
692
00:40:08,800 --> 00:40:12,080
Actually, why don't you just
call up to theatre five
693
00:40:12,240 --> 00:40:14,840
and get them to send
my whole trolley down.
694
00:40:14,960 --> 00:40:17,000
I'll need an assistant, too,
695
00:40:17,160 --> 00:40:19,000
but I'm all right to carry
on for now,
696
00:40:19,120 --> 00:40:20,840
just need a knife and fork, please.
697
00:40:21,000 --> 00:40:25,040
Need someone to push your stool in
for you, Mr Doughty? Ha-ha(!)
698
00:40:25,200 --> 00:40:28,440
'Hi, Glen, thanks for calling back.
It's good news.'
699
00:40:28,560 --> 00:40:30,160
It's, um... yeah?
700
00:40:30,320 --> 00:40:33,280
'Re: our last session,
I passed on my recommendation
701
00:40:33,400 --> 00:40:34,840
'and it's been approved.
702
00:40:35,000 --> 00:40:37,800
'It's official - you can
return to active service.'
703
00:40:37,920 --> 00:40:39,640
That's great. That's, um...
704
00:40:39,760 --> 00:40:41,520
'So well done.'
705
00:40:41,640 --> 00:40:44,280
Thanks. Thanks for everything, Jane.
706
00:40:44,440 --> 00:40:47,920
'Deployment papers should come
through in about ten days, OK?'
707
00:40:48,080 --> 00:40:50,480
Yeah, yep, bye.
'See you soon. Bye.'
708
00:42:41,241 --> 00:42:45,726
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