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Would you like to inspect the original subtitles? These are the user uploaded subtitles that are being translated: 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 Sync & corrections by wilson0804 www.Addic7ed.com 709 00:42:45,776 --> 00:42:50,326 Repair and Synchronization by Easy Subtitles Synchronizer 1.0.0.0 51489

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