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Would you like to inspect the original subtitles? These are the user uploaded subtitles that are being translated: 1 00:00:04,052 --> 00:00:05,540 HEARTBEAT PUMPS 2 00:00:05,541 --> 00:00:06,501 I'm not leaving. 3 00:00:06,621 --> 00:00:07,701 But you will, 4 00:00:07,821 --> 00:00:09,421 because that's what you do. 5 00:00:09,581 --> 00:00:12,341 WOMAN ON PHONE: 'It's official, you can return to active service.' 6 00:00:14,101 --> 00:00:15,941 Don't. Glen Boyle's in there. 7 00:00:19,061 --> 00:00:20,781 We couldn't have gone back to yours. 8 00:00:20,901 --> 00:00:22,501 It wasn't that I didn't want to. 9 00:00:22,621 --> 00:00:23,541 Didn't? 10 00:00:25,861 --> 00:00:27,101 This can't be easy for you. 11 00:00:30,941 --> 00:00:32,501 If anyone even sees us... 12 00:00:32,621 --> 00:00:35,301 FAST-PACED MUSIC PLAYS 13 00:00:45,941 --> 00:00:48,461 ALARM BELL RINGS 14 00:00:56,061 --> 00:00:58,981 'Trauma call to Thames lower ambulance bay. 15 00:00:59,141 --> 00:01:01,421 'Trauma call to Thames lower ambulance bay.' 16 00:01:24,981 --> 00:01:26,661 Are you stuck? Yeah, I'm stuck. 17 00:01:26,821 --> 00:01:29,021 SHE LAUGHS Help me. 18 00:01:29,141 --> 00:01:30,341 OK. 19 00:01:31,421 --> 00:01:32,381 Yeah. Yeah. 20 00:01:57,021 --> 00:01:59,741 OVER SPEAKER: The lower ambulance bay is a restricted area. 21 00:01:59,861 --> 00:02:02,581 Essential personnel only. 22 00:02:02,741 --> 00:02:05,461 The lower ambulance bay is a restricted area. 23 00:02:05,581 --> 00:02:07,741 Essential personnel only. 24 00:02:18,061 --> 00:02:19,661 Not exactly in a hurry, are they? 25 00:02:19,781 --> 00:02:21,461 Must be a slow bleed. Huh. 26 00:02:32,101 --> 00:02:33,541 You OK? Yeah. 27 00:02:36,541 --> 00:02:38,821 Can we get these sides down, please? Yeah. 28 00:02:40,381 --> 00:02:43,301 POLICEMAN SHOUTS INSTRUCTIONS 29 00:02:47,461 --> 00:02:49,341 You're the one who found him? Yeah. 30 00:02:50,661 --> 00:02:51,621 He's my son. 31 00:02:53,901 --> 00:02:55,581 I'm Glen Boyle. Frank Howker. 32 00:02:55,701 --> 00:02:57,061 I'm the trauma consultant. 33 00:02:57,181 --> 00:02:58,501 Frank... 34 00:02:58,621 --> 00:03:00,181 I need you to stay here, please. 35 00:03:01,701 --> 00:03:02,861 Thank you. 36 00:03:02,981 --> 00:03:03,941 Stepping up. 37 00:03:11,021 --> 00:03:12,381 Fiona. 38 00:03:12,501 --> 00:03:13,421 Yeah. 39 00:03:36,941 --> 00:03:39,821 Oh... Patient is impaled at three points. 40 00:03:46,061 --> 00:03:47,501 He's got a pulse. 41 00:03:47,621 --> 00:03:49,981 Somebody start the clock, please. 42 00:03:50,141 --> 00:03:52,581 We can't move him until the fire team get here... 43 00:03:52,741 --> 00:03:54,901 So we're going to have to stabilise him where he is. 44 00:03:55,021 --> 00:03:56,701 Let's set up the kit on the trolley. 45 00:03:58,221 --> 00:04:00,061 Constance, scissors, please. 46 00:04:01,221 --> 00:04:02,301 Here you go. 47 00:04:04,501 --> 00:04:06,381 All right to come up, boss? One at a time. 48 00:04:11,381 --> 00:04:14,221 Mark, I need you to make some room for me here, please. OK. 49 00:04:14,341 --> 00:04:15,261 Yep. 50 00:04:15,421 --> 00:04:18,101 LORRY CLANGS Whoa. 51 00:04:18,221 --> 00:04:19,861 Be careful, guys. 52 00:04:19,981 --> 00:04:21,341 Excuse me. 53 00:04:21,501 --> 00:04:23,541 Thank you. SHE LAUGHS 54 00:04:30,701 --> 00:04:32,621 Shit a brick. 55 00:04:32,741 --> 00:04:33,861 Going to need to RSI. 56 00:04:34,021 --> 00:04:35,821 Definitely going to need some volume as well. 57 00:04:35,981 --> 00:04:38,061 An RSI kit, please. O positive on the blood, please. 58 00:04:38,221 --> 00:04:41,221 Constance, a Venflon, please. On its way. 59 00:04:41,381 --> 00:04:42,381 Thank you. 60 00:04:47,981 --> 00:04:50,141 No chest movement on the right side. 61 00:04:50,301 --> 00:04:54,861 I'm doing a needle decompression to relieve the tension pneumothorax. 62 00:04:56,981 --> 00:04:59,061 FRANK BREATHES HEAVILY Oh, God. 63 00:05:00,261 --> 00:05:03,461 Frank. Is there any way you can stabilise this lorry? 64 00:05:03,621 --> 00:05:05,861 I can bring the legs down. That would help, please. 65 00:05:05,981 --> 00:05:07,461 OK. Thank you. 66 00:05:09,181 --> 00:05:12,981 So heart rate's 125, BP is 78/56. 67 00:05:13,101 --> 00:05:14,741 Sats are 80%. 68 00:05:14,861 --> 00:05:16,861 ENGINE STARTS 69 00:05:17,021 --> 00:05:19,261 Going to need to tube him and he definitely needs volume. 70 00:05:19,421 --> 00:05:21,261 Harry, IV access on the left for RSI drugs. 71 00:05:21,461 --> 00:05:24,461 I'm Dr Chandramohan, can you hear me? Blood out. 72 00:05:24,621 --> 00:05:28,341 O pos through the Venflon and a trauma line in, please. 73 00:05:28,461 --> 00:05:31,261 No eye opening, E1. 74 00:05:31,421 --> 00:05:33,581 No verbal response, E1. 75 00:05:33,741 --> 00:05:36,861 Abnormal flexion in response to pain, so that's M3. 76 00:05:36,981 --> 00:05:38,861 GCS is five. 77 00:05:38,981 --> 00:05:41,021 SUCCS 100mg 78 00:05:41,181 --> 00:05:44,701 and let's play it safe and give him 250mg of thiopentone as well. 79 00:05:47,461 --> 00:05:48,861 Sharps bin, please. 80 00:05:54,221 --> 00:05:56,461 OK... MACHINE WHIRS 81 00:05:58,541 --> 00:06:01,581 Can you fill these up and run them? 82 00:06:03,821 --> 00:06:04,861 Whoa, whoa! 83 00:06:04,981 --> 00:06:05,981 Frank. 84 00:06:06,141 --> 00:06:08,421 It's really important that this lorry doesn't move. 85 00:06:08,541 --> 00:06:10,821 I know. It's OK. 86 00:06:10,941 --> 00:06:13,461 SIREN RINGS 87 00:06:28,021 --> 00:06:30,181 OK, let's get that vehicle stabilised. 88 00:06:32,181 --> 00:06:33,781 Nice and gently, please, guys. 89 00:06:35,541 --> 00:06:37,541 OK, I'm going to do a formal thoracostomy. 90 00:06:37,701 --> 00:06:39,381 Can I have the kit, please, Constance? Yes. 91 00:06:39,501 --> 00:06:41,341 I'm doing a trauma line. 92 00:06:41,501 --> 00:06:42,781 On VET. 93 00:06:42,901 --> 00:06:44,341 Curtis Taylor, station manager. 94 00:06:44,501 --> 00:06:47,021 Glenn Boyle, trauma team leader. Aw, shit. 95 00:06:47,181 --> 00:06:49,381 We need to get him off this lorry... Are you OK? Yeah. 96 00:06:49,541 --> 00:06:52,341 ..and our priority is that these spikes don't move inside him. 97 00:06:52,461 --> 00:06:54,141 BPGs! 98 00:06:54,261 --> 00:06:57,101 Lactate 12, pH 7.19. 99 00:06:57,261 --> 00:06:59,661 Dismantling it would be best, but those bolts are rusted in. 100 00:06:59,781 --> 00:07:00,741 That's 15 minutes. 101 00:07:00,901 --> 00:07:02,741 We can cut, but there could be some movement. 102 00:07:02,861 --> 00:07:03,941 He doesn't have 15 minutes. 103 00:07:04,101 --> 00:07:06,061 You're going to have to cut. Get the cutting gear! 104 00:07:06,181 --> 00:07:08,701 I want one of O pos, one of FFP 105 00:07:08,861 --> 00:07:11,181 to go straight in as soon as Harry's ready. I'll go. 106 00:07:18,341 --> 00:07:19,341 Where are we? 107 00:07:19,501 --> 00:07:23,301 OK, sats at 84%, heart rate is 102... 108 00:07:23,421 --> 00:07:25,661 BP is 89/65. 109 00:07:27,021 --> 00:07:29,541 Need to hurry, please. Thoracostomy's completed. 110 00:07:31,661 --> 00:07:33,461 FFP and blood in. Good. 111 00:07:37,861 --> 00:07:39,101 Frank... 112 00:07:39,221 --> 00:07:40,861 You should go inside. 113 00:07:40,981 --> 00:07:42,461 Nicola? Yeah. 114 00:07:42,621 --> 00:07:45,261 I want to stay. We're going to do our very best for him. And they are. 115 00:07:45,421 --> 00:07:47,621 Lydia, can you get him into the relatives room, please? 116 00:07:47,741 --> 00:07:49,461 Make him comfortable. 117 00:07:49,581 --> 00:07:50,821 Let's make some space. 118 00:07:52,541 --> 00:07:53,901 Over to you. 119 00:07:54,021 --> 00:07:55,261 OK, we need to get on with this. 120 00:07:56,581 --> 00:07:58,501 Can somebody help me here, please? 121 00:08:00,581 --> 00:08:03,621 OK. Spikes that have penetrated. 122 00:08:03,741 --> 00:08:06,781 One, two, three. Yes? 123 00:08:08,381 --> 00:08:09,541 Yep. 124 00:08:14,781 --> 00:08:16,261 Steady. 125 00:08:22,981 --> 00:08:25,701 Ready. Watch your eyes. Cutting. Cutting. 126 00:08:25,821 --> 00:08:27,821 MACHINE STARTS 127 00:08:32,701 --> 00:08:34,741 METAL CLANGS 128 00:08:36,301 --> 00:08:38,781 Fiona, can you get a hand on that spike, please? Yeah. 129 00:08:40,061 --> 00:08:41,021 He's stable. 130 00:08:43,861 --> 00:08:45,061 Ready. 131 00:08:45,181 --> 00:08:46,381 Cutting! 132 00:08:49,341 --> 00:08:51,701 METAL CLANGS 133 00:08:52,981 --> 00:08:54,061 Yeah, stable. 134 00:08:57,821 --> 00:08:59,221 Cutting. 135 00:09:02,461 --> 00:09:05,061 METAL CLANGS 136 00:09:05,181 --> 00:09:06,101 Pulse check. 137 00:09:13,141 --> 00:09:14,301 OK, stable. 138 00:09:14,421 --> 00:09:16,021 Release the spikes, please. 139 00:09:16,141 --> 00:09:17,901 Just in. 140 00:09:18,021 --> 00:09:19,421 Scoop in now. 141 00:09:19,541 --> 00:09:21,301 That's it? Yes. 142 00:09:22,421 --> 00:09:23,381 Thank you. 143 00:09:25,461 --> 00:09:28,261 So we are bracing to the patient's right on three. 144 00:09:28,381 --> 00:09:30,421 One, two, three. 145 00:09:30,541 --> 00:09:32,661 Back on three. One, two, three. 146 00:09:32,781 --> 00:09:34,381 That's great. 147 00:09:34,501 --> 00:09:35,461 Coming in. 148 00:09:35,621 --> 00:09:37,381 Bracing to the patient's left this time. 149 00:09:37,501 --> 00:09:38,741 One, two, three. 150 00:09:42,261 --> 00:09:43,861 OK, we're in. Back on three. 151 00:09:43,981 --> 00:09:45,701 One, two, three. 152 00:09:45,821 --> 00:09:47,421 Great. 153 00:09:47,581 --> 00:09:50,381 Next step is a short lift just to the foot of the truck. 154 00:09:51,661 --> 00:09:53,861 On three. One, two, three. 155 00:09:55,861 --> 00:09:58,141 Whoa. MONITOR BEEPS 156 00:09:58,261 --> 00:10:01,061 Put him down. Put him down. 157 00:10:01,181 --> 00:10:03,101 Don't go back any further. 158 00:10:03,261 --> 00:10:06,781 Heart rate's through the roof. BP's 53/46. He's losing blood. 159 00:10:06,901 --> 00:10:07,821 Get blood in, please. 160 00:10:07,981 --> 00:10:09,741 OK, there's no bleeding from the chest area. 161 00:10:09,861 --> 00:10:10,781 It must be lower down. 162 00:10:10,941 --> 00:10:13,341 Do a left anterolateral thoracotomy and clamp the aorta. 163 00:10:13,461 --> 00:10:14,981 Get me the kit, extra gloves! 164 00:10:15,101 --> 00:10:16,301 Quick as we can! 165 00:10:18,261 --> 00:10:19,221 Mr Boyle. Yes. 166 00:10:29,981 --> 00:10:30,981 Give me the blade. 167 00:10:32,301 --> 00:10:33,781 Give me the blade, please! Yes, yes. 168 00:10:35,541 --> 00:10:36,541 Thank you. 169 00:10:37,701 --> 00:10:39,421 Good to cut? Yeah, yeah, yeah. Cutting. 170 00:10:50,301 --> 00:10:51,301 Scissors. 171 00:10:56,261 --> 00:10:58,061 Thank you. Blood going. Ready. 172 00:11:00,101 --> 00:11:01,061 Give me that. 173 00:11:04,941 --> 00:11:06,221 Let's get the aortic clamp. 174 00:11:09,381 --> 00:11:10,701 Thank you. 175 00:11:13,781 --> 00:11:15,661 Aorta...is clamped. 176 00:11:17,221 --> 00:11:20,181 OK, let's cover him up, keep him warm. BP's stabilising. 177 00:11:20,341 --> 00:11:22,541 OK, we're on the clock, we need to go. 178 00:11:22,661 --> 00:11:24,021 Ramakrishna, on your call. 179 00:11:24,141 --> 00:11:26,021 One, two, three, lift. 180 00:11:26,181 --> 00:11:29,581 Bring the trolley in, please. Stop there, down. Down. 181 00:11:29,701 --> 00:11:30,821 Reposition. 182 00:11:33,061 --> 00:11:34,141 Sort these lines out. 183 00:11:34,261 --> 00:11:35,661 Mind your backs there. Heads. 184 00:11:38,061 --> 00:11:39,701 Got it? Yeah. 185 00:11:39,821 --> 00:11:41,421 On three. One, two, three. 186 00:11:46,461 --> 00:11:48,061 Ania, Justin, Constance. 187 00:11:48,221 --> 00:11:50,781 You manage the spikes, please. ALL: Yeah. 188 00:11:50,901 --> 00:11:51,861 OK, let's go. 189 00:11:53,501 --> 00:11:55,341 Guys. Thank you very much. 190 00:11:55,461 --> 00:11:57,501 Our pleasure. Yes, thank you. 191 00:12:00,301 --> 00:12:02,021 Good luck with this one. Thank you. 192 00:12:04,821 --> 00:12:05,781 On the spikes... 193 00:12:17,421 --> 00:12:19,461 Hit the button, please. 194 00:12:19,581 --> 00:12:20,861 LIFT ANNOUNCER: Doors closing. 195 00:12:23,261 --> 00:12:25,181 MONITOR BEEPS We've lost the output. 196 00:12:25,301 --> 00:12:26,421 Check the LV, please. 197 00:12:30,981 --> 00:12:32,421 We've got something here. Blood in. 198 00:12:32,541 --> 00:12:33,861 Let's try and get some volume. 199 00:12:36,581 --> 00:12:37,941 LIFT ANNOUNCER: Ground floor. 200 00:12:39,141 --> 00:12:40,101 Jesus Christ. 201 00:12:40,261 --> 00:12:42,981 Harry, keep the blood going. Go away! 202 00:12:43,101 --> 00:12:44,421 Nice and easy, please. 203 00:12:50,581 --> 00:12:52,981 Keep it steady, please. 204 00:12:53,141 --> 00:12:55,181 Harry... Tom? ..stay on the blood. Hi. 205 00:12:56,381 --> 00:12:58,741 Yeah, I was just wondering about tonight. 206 00:12:58,901 --> 00:13:00,861 But I didn't know we'd anything planned. 207 00:13:00,981 --> 00:13:02,541 I'm going to take you for dinner. 208 00:13:15,347 --> 00:13:17,267 Seems like a bit of a long shot. 209 00:13:22,627 --> 00:13:24,307 I've seen people survive worse. 210 00:13:34,907 --> 00:13:36,307 How's Tom? 211 00:13:36,467 --> 00:13:38,547 What do you mean? You know what I mean. 212 00:13:38,667 --> 00:13:40,067 Tom isn't your concern. 213 00:13:41,427 --> 00:13:43,067 You need to tell him what's going on. 214 00:13:43,227 --> 00:13:45,267 And frankly... Glenn, I... ..you need to tell me. 215 00:13:45,427 --> 00:13:47,787 SPEAKING ON PHONE: And I love you too, Danny. Bye-bye. 216 00:14:04,027 --> 00:14:05,227 Let's do the hoops. 217 00:14:05,387 --> 00:14:07,667 I'm Glen Boyle, I'm the trauma consultant. 218 00:14:07,787 --> 00:14:09,507 Fiona Lomas, trauma fellow. 219 00:14:09,667 --> 00:14:11,867 Ramakrishna Chandramohan, anaesthetics registrar. 220 00:14:11,987 --> 00:14:13,507 Bruce Corby, rapid infuser operator. 221 00:14:13,627 --> 00:14:15,707 Billy Finlay, anaesthetic ODP. 222 00:14:15,827 --> 00:14:17,307 Debbie Wong, scrub nurse. 223 00:14:17,467 --> 00:14:19,827 Patient is major trauma, Edward Howker. 224 00:14:19,947 --> 00:14:22,507 Date of birth is 17/07/77. 225 00:14:22,667 --> 00:14:25,187 Aorta has been clamped for... eight minutes 30. 226 00:14:25,347 --> 00:14:28,307 Consent form four signed to do a thoracotomy, a laparotomy 227 00:14:28,427 --> 00:14:29,547 for haemorrhage control. 228 00:14:43,267 --> 00:14:44,227 Good. 229 00:14:44,347 --> 00:14:45,707 16 minutes gone. 230 00:14:45,867 --> 00:14:48,427 I'm going to complete the clamshell to find and fix the bleed. 231 00:14:50,107 --> 00:14:51,187 Blade, please. 232 00:14:56,627 --> 00:14:57,587 Cutting. 233 00:14:58,827 --> 00:14:59,947 Ready to cut. 234 00:15:24,347 --> 00:15:26,267 Vacuum those, please. 235 00:15:26,387 --> 00:15:27,307 Thank you. 236 00:15:41,147 --> 00:15:42,227 Shears. 237 00:15:45,227 --> 00:15:46,187 Thank you. 238 00:15:50,187 --> 00:15:52,387 BODY PART CRUNCHES 239 00:15:57,467 --> 00:15:58,587 Spreaders. 240 00:16:02,467 --> 00:16:04,787 And let's be really careful placing these, please. 241 00:16:20,947 --> 00:16:23,467 A spike has gone through the diaphragm 242 00:16:23,587 --> 00:16:25,547 and is crushing the IVC. 243 00:16:25,707 --> 00:16:28,107 Sats dropping, end tidal CO2 is dropping. 244 00:16:29,187 --> 00:16:31,587 There's a small tear in the IVC. 245 00:16:31,707 --> 00:16:32,707 Satinsky, please. 246 00:16:33,827 --> 00:16:34,987 I'll try and clamp it. 247 00:16:39,707 --> 00:16:41,987 MONITOR BEEPS Christ. 248 00:16:42,107 --> 00:16:43,587 Sats level to 79%. 249 00:16:44,707 --> 00:16:46,787 This spike's in the way, I'm going to have to pack it. 250 00:16:46,907 --> 00:16:47,827 Hit me. 251 00:16:51,467 --> 00:16:52,427 Hit me. 252 00:16:53,627 --> 00:16:55,187 Two packs in. 253 00:16:55,347 --> 00:16:57,547 OK, the pack's controlling the bleed... 254 00:16:57,667 --> 00:16:59,747 but keep the blood going, please. 255 00:16:59,907 --> 00:17:02,467 The aortic clamp's been on for...? 11 minutes. 11 minutes. 256 00:17:02,627 --> 00:17:05,427 Right, I'm going to do a laparotomy to control the haemorrhage 257 00:17:05,587 --> 00:17:08,427 so we can take the clamp off and reperfuse his lower half. 258 00:17:08,547 --> 00:17:09,507 Blade, please. 259 00:17:10,907 --> 00:17:11,947 Thank you. 260 00:17:13,507 --> 00:17:15,347 OK to cut, Mr Boyle. 261 00:17:15,467 --> 00:17:16,827 Thank you. 262 00:17:45,747 --> 00:17:46,907 McIndoes, please. 263 00:17:49,667 --> 00:17:50,867 Thank you. 264 00:17:54,147 --> 00:17:55,907 Forceps in bleed, please. 265 00:18:00,627 --> 00:18:05,067 MACHINES BEEP STEADILY 266 00:18:05,187 --> 00:18:06,387 Sutures, please. 267 00:18:10,907 --> 00:18:12,987 Just hold it here. Thank you. 268 00:18:26,027 --> 00:18:27,587 Scissors, please. 269 00:18:31,467 --> 00:18:32,987 HE SIGHS 270 00:18:33,107 --> 00:18:34,267 Cut. 271 00:18:37,067 --> 00:18:38,147 Thank you. 272 00:18:40,667 --> 00:18:42,107 Cut, please. 273 00:18:42,227 --> 00:18:43,827 Balfour retractors, please. 274 00:18:47,027 --> 00:18:48,227 Thank you. 275 00:18:55,947 --> 00:18:57,067 Oh. 276 00:19:06,867 --> 00:19:08,107 I need suction. 277 00:19:15,947 --> 00:19:17,267 Where are we? 278 00:19:17,427 --> 00:19:21,627 The heart rate is 109. Sats 87. BP's 88/64. 279 00:19:27,987 --> 00:19:31,707 The top spike has gone through the liver on its way to the diaphragm. 280 00:19:33,227 --> 00:19:34,987 No sign of haemorrhage from the liver. 281 00:19:37,267 --> 00:19:39,427 That's cardiothoracics coming in now. 282 00:19:43,227 --> 00:19:46,627 The middle spike has perforated the hilum of the left kidney. 283 00:19:46,747 --> 00:19:48,867 Evidence of extensive bleeding. 284 00:19:48,987 --> 00:19:50,827 BBG. 285 00:19:50,947 --> 00:19:54,547 Lactate 18, pH 7.13. 286 00:19:54,707 --> 00:19:57,227 We've got to get this clamp off and reperfuse his organs. 287 00:19:57,387 --> 00:19:59,667 OK, we will take in the kidney, tie off the renal vessels 288 00:19:59,787 --> 00:20:01,307 and we'll bin it later, yes? 289 00:20:03,387 --> 00:20:05,667 There is no access with the spike in place. 290 00:20:08,067 --> 00:20:12,027 Let's disinfect the middle spike please, Billy. Get ready to pull it. 291 00:20:12,147 --> 00:20:14,147 Me? Scrub up, please. 292 00:20:15,147 --> 00:20:16,187 All right. 293 00:20:16,307 --> 00:20:17,507 (Get in.) 294 00:20:19,027 --> 00:20:19,987 No pressure. 295 00:20:30,187 --> 00:20:31,747 D-do I need to gown up? 296 00:20:31,907 --> 00:20:34,187 No, that's not sterile. It's covered in cow shit. 297 00:20:34,307 --> 00:20:35,227 Let's go. 298 00:20:41,027 --> 00:20:42,747 HE EXHALES 299 00:20:54,947 --> 00:20:56,427 Hey. Look at me. 300 00:21:05,267 --> 00:21:06,507 Nice and gently. 301 00:21:07,747 --> 00:21:09,307 Like... 302 00:21:09,427 --> 00:21:10,947 Excalibur. 303 00:21:11,067 --> 00:21:12,307 Yeah. 304 00:21:12,427 --> 00:21:14,187 Pull. 305 00:21:14,307 --> 00:21:17,187 HE STRAINS 306 00:21:17,307 --> 00:21:18,387 Harder. 307 00:21:19,547 --> 00:21:21,067 Harder. 308 00:21:21,227 --> 00:21:25,427 Stop. He can't move. Yeah, I know but it's not bloody shifting. 309 00:21:25,547 --> 00:21:27,547 HE GROANS 310 00:21:30,400 --> 00:21:31,600 Step, please. 311 00:21:37,840 --> 00:21:39,480 This one sounds interesting. 312 00:21:42,200 --> 00:21:46,240 The thoracic aortic clamp has been in place for... 16 minutes. 313 00:21:46,400 --> 00:21:49,480 The middle spike has perforated the hilum of the left kidney. 314 00:21:49,640 --> 00:21:52,360 We need to ligate the left renal vessels before we can take 315 00:21:52,480 --> 00:21:53,720 the aortic clamp off. 316 00:21:53,880 --> 00:21:55,760 But in order to get access to the vessels 317 00:21:55,920 --> 00:21:58,520 we need to pull this middle spike. Better get on with it. 318 00:21:58,680 --> 00:22:00,920 The spike is firmly embedded so if you could monitor 319 00:22:01,080 --> 00:22:03,920 the tissues at the top spike while we pull the middle one, please. 320 00:22:04,040 --> 00:22:05,400 Thank you. 321 00:22:05,520 --> 00:22:06,560 Just pull it out. 322 00:22:09,160 --> 00:22:10,520 Harder. 323 00:22:12,760 --> 00:22:15,000 Stop! Bleed from the IVC. 324 00:22:15,120 --> 00:22:16,160 Pack! 325 00:22:22,400 --> 00:22:23,880 Packs are controlling the bleed. 326 00:22:24,000 --> 00:22:25,440 One pack in. 327 00:22:25,600 --> 00:22:29,000 Go, Billy. No, don't move it at all. We have to pull it out. 328 00:22:29,160 --> 00:22:32,160 I understand but the movement made the tear open. 329 00:22:32,320 --> 00:22:34,160 Any more movement could extend the tear. 330 00:22:34,280 --> 00:22:35,840 We can leave the clamp where it is. 331 00:22:36,000 --> 00:22:38,720 In which case, he dies in the ITU tonight of organ failure. 332 00:22:38,880 --> 00:22:40,920 Or we give him a chance and take a risk. 333 00:22:45,600 --> 00:22:46,840 OK. Thank you. 334 00:22:48,080 --> 00:22:49,040 Billy? 335 00:22:50,200 --> 00:22:51,440 Pull it out. 336 00:22:53,120 --> 00:22:54,840 But... 337 00:22:54,960 --> 00:22:56,200 I don't want to kill him. 338 00:22:59,520 --> 00:23:00,920 OK, I'll take over. 339 00:23:04,120 --> 00:23:05,080 Sorry. 340 00:23:07,320 --> 00:23:10,840 STEADY BEEPING CONTINUES 341 00:23:24,280 --> 00:23:25,320 Be ready. 342 00:23:26,960 --> 00:23:28,040 OK. 343 00:23:35,920 --> 00:23:36,880 Thank you. 344 00:23:49,440 --> 00:23:52,280 Packs are controlling the bleed. You can relax now. 345 00:23:52,400 --> 00:23:55,400 He's no worse. Heart rate is 105. 346 00:23:55,520 --> 00:23:58,800 Sats are 88. BP is 87/63. 347 00:23:58,960 --> 00:24:01,880 Gloves. Size eight, please. And then let's sort out that kidney 348 00:24:02,000 --> 00:24:03,920 and reperfuse his organs. ASAP. 349 00:24:09,080 --> 00:24:13,960 Coming up to 26 minutes. I'm going to ligate the renal vessels. 350 00:24:14,080 --> 00:24:16,000 We're a pair of hands short. 351 00:24:16,160 --> 00:24:18,720 Can you retract the small bowel for me? 352 00:24:18,840 --> 00:24:20,640 Under the circumstances. Hmm. 353 00:24:20,760 --> 00:24:21,760 Thank you. 354 00:24:25,160 --> 00:24:26,200 Excuse me. 355 00:24:29,680 --> 00:24:31,280 Forceps and McIndoes, please. 356 00:24:44,880 --> 00:24:45,840 Clamp. 357 00:24:52,120 --> 00:24:53,880 Renal artery is clamped. 358 00:24:55,400 --> 00:24:56,360 Clamp. 359 00:25:03,800 --> 00:25:05,280 The renal vein is clamped. 360 00:25:07,600 --> 00:25:08,760 Forceps. 361 00:25:27,600 --> 00:25:28,640 Scissors, please. 362 00:25:33,720 --> 00:25:36,240 The renal artery is ligated. 363 00:25:36,360 --> 00:25:38,000 Tie, please. 364 00:25:41,160 --> 00:25:42,240 Forceps, please. 365 00:25:53,440 --> 00:25:57,480 27 minutes gone. That's 20 minutes now with the aortic clamp on. 366 00:25:59,320 --> 00:26:00,360 Scissors, please. 367 00:26:05,520 --> 00:26:06,720 The renal vein is ligated. 368 00:26:06,840 --> 00:26:08,640 Nice work. 369 00:26:08,800 --> 00:26:12,040 I'm going to move the aortic clamp infrarenally. 370 00:26:12,160 --> 00:26:13,320 Thank you. 371 00:26:20,480 --> 00:26:22,720 OK, the aorta has been clamped infrarenally. 372 00:26:22,880 --> 00:26:26,280 Fiona will remove the thoracic aortic clamp on my say so. 373 00:26:26,440 --> 00:26:29,080 Let's get ready, please. And let me know when you are. 374 00:26:29,200 --> 00:26:30,320 Increase the blood. Yep. 375 00:26:40,600 --> 00:26:41,760 Yep. 376 00:26:44,920 --> 00:26:47,520 OK, BP rising. 102/85. Ready. 377 00:26:47,680 --> 00:26:49,960 Good. Let's release the clamp by half. 378 00:26:55,840 --> 00:26:57,640 Unclamped by a half. Thank you. 379 00:27:02,600 --> 00:27:04,920 BP dropping. MACHINES BEEP RAPIDLY 380 00:27:05,040 --> 00:27:06,880 Bleed from the IVC. Shit! 381 00:27:07,000 --> 00:27:08,800 Pack. Increase the blood, Billy. 382 00:27:11,360 --> 00:27:12,440 Pack. 383 00:27:15,200 --> 00:27:16,320 Two packs in. 384 00:27:16,440 --> 00:27:18,040 Five packs total. 385 00:27:18,200 --> 00:27:21,920 Packing isn't controlling the bleed. We have to reclamp the aorta. 386 00:27:22,080 --> 00:27:25,360 That's a long time for the aorta to be clamped. Better than being dead. 387 00:27:25,520 --> 00:27:28,000 Let's fully re-clamp the aorta, please. 388 00:27:29,240 --> 00:27:30,640 Fully re-clamped. 389 00:27:30,760 --> 00:27:32,240 Reduce the blood pressure. 390 00:27:34,520 --> 00:27:38,600 Tear is slightly bigger. I'm going to clamp the IVC and fix it. 391 00:27:38,720 --> 00:27:40,200 Vascular clamp. 392 00:27:40,360 --> 00:27:42,920 I'll pull the top spike, give you a little bit more room. 393 00:27:46,560 --> 00:27:49,160 OK, I'm going to pull it out my half a centimetre. 394 00:27:49,280 --> 00:27:50,880 Are you ready? Ready. 395 00:27:51,000 --> 00:27:52,120 Pulling. 396 00:27:54,080 --> 00:27:56,920 I can't quite see what's happening. Slowly. 397 00:27:57,040 --> 00:27:58,240 Yeah. 398 00:27:58,400 --> 00:28:01,160 It seems to be pulling the IVC. Back up. 399 00:28:01,280 --> 00:28:02,440 Stop. 400 00:28:03,520 --> 00:28:04,680 Swab and forceps. 401 00:28:14,160 --> 00:28:15,120 It's hooked. 402 00:28:17,200 --> 00:28:18,960 It's torn the IVC. 403 00:28:19,080 --> 00:28:20,080 Shit. 404 00:28:21,960 --> 00:28:25,080 The tear is approximately 2cm. 405 00:28:25,200 --> 00:28:27,320 MACHINE BEEPS RAPIDLY 406 00:28:27,440 --> 00:28:28,800 Oh, come on! BP crashing. 407 00:28:28,920 --> 00:28:30,440 The aortic clamp is in place. 408 00:28:33,320 --> 00:28:35,800 There's back bleeding into the liver. Pack. 409 00:28:41,240 --> 00:28:42,640 One pack in. 410 00:28:42,760 --> 00:28:45,000 Six packs total. Billy? Yes. 411 00:28:45,160 --> 00:28:48,240 Mrs Murkherjee, I need you to compress the IVC 412 00:28:48,400 --> 00:28:51,000 to stop the back bleeding. I can close the tear 413 00:28:51,160 --> 00:28:53,440 but I can't compress the IVC with the spike in the way. 414 00:28:53,600 --> 00:28:55,320 I can't pull it out and I can't clamp it. 415 00:28:55,480 --> 00:28:57,840 I can't pull the hook through the liver. It will destroy it. 416 00:28:58,000 --> 00:29:01,000 There is no possibility of him getting a liver transplant tonight. 417 00:29:02,360 --> 00:29:05,200 Maybe you can open the liver and lift the spike. No. 418 00:29:05,320 --> 00:29:06,440 He'll bleed to death. 419 00:29:09,840 --> 00:29:13,160 Let's face it, we can't proceed surgically. 420 00:29:13,280 --> 00:29:14,480 We've reached the end. 421 00:29:19,822 --> 00:29:20,822 Hello. 422 00:29:22,662 --> 00:29:24,182 Please take a seat. 423 00:29:29,342 --> 00:29:31,622 One of the spikes went through Edward's liver. 424 00:29:32,942 --> 00:29:36,182 In order to save his life, obviously we need to remove the spike. 425 00:29:37,422 --> 00:29:40,462 But pulling it out will almost certainly destroy his liver. 426 00:29:42,822 --> 00:29:47,222 I'm afraid there's no tissue match for an available donor liver. 427 00:29:47,382 --> 00:29:50,502 And any further efforts we make run the risk of killing him, Frank. 428 00:29:55,862 --> 00:29:57,102 Y-you're giving up? 429 00:29:58,422 --> 00:30:01,262 It's an impossible dilemma for a surgeon. 430 00:30:04,062 --> 00:30:05,262 So you're giving up?! 431 00:30:09,582 --> 00:30:11,542 All we can do is tidy this up. 432 00:30:19,182 --> 00:30:21,622 'Dr Green... Please leave a message.' Shit. 433 00:30:23,502 --> 00:30:26,142 Hi, boss. If you get this message in the next few minutes, can you 434 00:30:26,302 --> 00:30:28,502 come down to trauma theatre cos I think this one's going 435 00:30:28,622 --> 00:30:29,862 to go tits up on the table. 436 00:30:35,902 --> 00:30:37,302 Glen? 437 00:30:37,462 --> 00:30:41,062 I'm going to need tying. Orthopaedic instrument set. 438 00:30:41,182 --> 00:30:42,862 OK. What are we going to do? 439 00:30:43,022 --> 00:30:45,462 I'm going to try and cut the tip off of the spike. 440 00:30:48,422 --> 00:30:50,942 Largest K-wire cutter you've got, please! 441 00:30:51,062 --> 00:30:52,142 OK. 442 00:30:56,662 --> 00:30:57,982 Look, I'm sorry to interrupt 443 00:30:58,142 --> 00:31:00,022 but that is not a healthy colour for bowel. 444 00:31:01,382 --> 00:31:03,982 Look, we are losing the bowel. We need to get a move on. 445 00:31:13,862 --> 00:31:15,502 Thank you. 446 00:31:15,622 --> 00:31:17,462 I need space on your left, please. 447 00:31:17,582 --> 00:31:19,422 There is no space. 448 00:31:19,582 --> 00:31:23,182 Stick a hand in. Retract the liver and the diaphragm, please. 449 00:31:23,342 --> 00:31:25,502 If you damage the IVC, he will die on the table. 450 00:31:25,622 --> 00:31:26,742 Mind your fingers. 451 00:31:26,862 --> 00:31:28,382 This is pointless! 452 00:31:28,502 --> 00:31:29,782 Just hold on a few seconds. 453 00:31:29,942 --> 00:31:32,822 His organs have had no profusion for a protracted period. 454 00:31:32,942 --> 00:31:34,422 Do you think we have a few seconds? 455 00:31:35,862 --> 00:31:36,982 Come on! 456 00:31:39,822 --> 00:31:41,582 Fiona, help me, please. 457 00:31:46,182 --> 00:31:47,302 Come on. 458 00:31:57,942 --> 00:31:59,062 Dish. 459 00:32:01,902 --> 00:32:03,262 Let's pull the spike. 460 00:32:03,382 --> 00:32:05,902 Can you see if I damaged the IVC? 461 00:32:06,022 --> 00:32:06,982 Thank you. 462 00:32:11,622 --> 00:32:12,702 Good. 463 00:32:15,062 --> 00:32:16,022 Got it. 464 00:32:25,702 --> 00:32:27,022 Someone take this. 465 00:32:28,822 --> 00:32:30,302 We've got a bleed in the liver. 466 00:32:30,422 --> 00:32:31,622 Hit me. 467 00:32:36,182 --> 00:32:37,142 Hit me. 468 00:32:39,462 --> 00:32:41,302 Two packs in. Eight packs total. 469 00:32:41,462 --> 00:32:44,702 The IVC is clamped. We've got control of the hepatic bleed. 470 00:32:44,822 --> 00:32:46,222 OK, let's fix the tear 471 00:32:46,382 --> 00:32:48,862 and finally get this bloody aortic clamp off, eh? 472 00:32:48,982 --> 00:32:50,022 I can't. 473 00:32:52,182 --> 00:32:55,582 Cutting off the hook made a 3cm diameter hole in the IVC. 474 00:32:56,982 --> 00:32:59,622 Stitching it would only stenos the IVC completely. 475 00:33:06,102 --> 00:33:07,062 Patch it. 476 00:33:10,862 --> 00:33:12,862 I honestly don't think I could do it in time. 477 00:33:23,942 --> 00:33:25,262 We've come this far. 478 00:33:26,942 --> 00:33:28,342 Can we at least try? 479 00:33:35,902 --> 00:33:38,102 20mm vasa tunica sheet. 480 00:33:38,222 --> 00:33:39,302 Thank you. 481 00:33:41,302 --> 00:33:43,542 I'll need more access to the chest, please. 482 00:33:44,742 --> 00:33:46,142 It's a contaminated wound. 483 00:33:46,302 --> 00:33:49,222 We'll need to revise later to a full autologous graft. 484 00:34:00,942 --> 00:34:03,342 Double-ended fibro-prolene and forceps. 485 00:34:12,942 --> 00:34:14,182 Help me guide it down, please. 486 00:34:25,022 --> 00:34:26,062 APGs. 487 00:34:39,222 --> 00:34:41,782 Lactating 19, pH 6.97. 488 00:34:41,902 --> 00:34:43,982 OK, it's down to minutes, at best. 489 00:34:46,942 --> 00:34:48,382 Does anyone have a condom? 490 00:34:51,342 --> 00:34:55,022 I'm going to improvise a balloon tamponade for the liver. 491 00:34:55,142 --> 00:34:56,102 Anyone? 492 00:34:56,262 --> 00:34:58,662 (Give him the one you've had in your wallet since school.) 493 00:34:58,782 --> 00:35:00,422 (Can't. Used it on your girlfriend.) 494 00:35:00,542 --> 00:35:02,742 Locker 54. The key is in my pocket. 495 00:35:12,942 --> 00:35:14,262 Did you get all that? 496 00:35:14,382 --> 00:35:17,102 Locker 54. Miss Lomas' condoms. 497 00:35:17,222 --> 00:35:18,422 Now, please! 498 00:35:23,302 --> 00:35:24,662 ETA, please? 499 00:35:24,782 --> 00:35:25,902 Three minutes. 500 00:35:26,022 --> 00:35:27,622 I need you to do it in two. 501 00:35:29,342 --> 00:35:31,862 I can't do it. You can do it. 502 00:35:31,982 --> 00:35:32,942 You can. 503 00:35:37,622 --> 00:35:40,582 Miss Lomas' condoms for Mr Boyle. 504 00:35:40,702 --> 00:35:42,542 Billy. Quick as you can, please. 505 00:35:46,462 --> 00:35:49,502 Not my size. I use extra large. 506 00:35:49,622 --> 00:35:51,262 Billy! Never mind. 507 00:35:53,342 --> 00:35:55,222 Nice flowers, by the way, Miss Lomas. 508 00:36:02,302 --> 00:36:04,422 Fold the catheter, please. 509 00:36:04,542 --> 00:36:07,182 Put a syringe in sterile water. 510 00:36:07,302 --> 00:36:08,582 Just here, Billy. Yeah. 511 00:36:17,542 --> 00:36:18,742 Tie. 512 00:36:22,662 --> 00:36:23,782 Thank you. 513 00:36:31,182 --> 00:36:32,182 Cut. 514 00:36:43,862 --> 00:36:45,622 Three packs out. 515 00:36:45,742 --> 00:36:46,902 Five packs total. 516 00:36:47,022 --> 00:36:48,662 Balloon going in. 517 00:36:55,182 --> 00:36:56,302 Syringe, please. 518 00:37:00,222 --> 00:37:02,062 With any luck, the condom will expand 519 00:37:02,182 --> 00:37:03,702 and seal the tear in the liver. 520 00:37:06,342 --> 00:37:07,542 There you go. 521 00:37:09,582 --> 00:37:12,022 Beep the hepatobiliary surgeon, please. 522 00:37:14,822 --> 00:37:16,182 Hi, this is trauma theatre. 523 00:37:16,342 --> 00:37:18,942 Could you beep the hepatobiliary surgeon, please? 524 00:37:19,062 --> 00:37:21,502 OK, I need to get this clamp off. 525 00:37:21,622 --> 00:37:22,542 Now! 526 00:37:27,502 --> 00:37:28,822 Scissors, please. 527 00:37:37,462 --> 00:37:38,622 Done. 528 00:37:38,742 --> 00:37:40,022 Good work. 529 00:37:40,142 --> 00:37:41,342 If it doesn't come apart. 530 00:37:41,502 --> 00:37:45,222 OK, I'm going to take the clamps on the IVC off first. 531 00:37:45,342 --> 00:37:46,462 You ready? 532 00:38:00,022 --> 00:38:01,022 Yeah. 533 00:38:03,982 --> 00:38:06,742 Balloon seems to be holding. 534 00:38:06,862 --> 00:38:09,102 Be ready for the aortic clamp. 535 00:38:09,222 --> 00:38:11,262 Ready. OK. 536 00:38:11,422 --> 00:38:14,022 I'm going to take it off by a half. Ready? 537 00:38:17,062 --> 00:38:18,262 Here. 538 00:38:31,222 --> 00:38:32,262 BP dropping. 539 00:38:33,422 --> 00:38:35,262 Fill 'em up, Billy. Blood and FOP. 540 00:38:38,142 --> 00:38:39,262 Holding. 541 00:38:41,342 --> 00:38:43,342 Climbing slightly. 542 00:38:43,502 --> 00:38:46,022 OK. I'm going to take it three quarters. 543 00:38:47,302 --> 00:38:48,342 Now. 544 00:38:51,742 --> 00:38:53,982 MACHINE BEEPS RAPIDLY 545 00:38:54,102 --> 00:38:55,302 Dropping. 546 00:38:58,102 --> 00:38:59,142 Come on. 547 00:38:59,302 --> 00:39:01,782 IRREGULAR BEEPS Shit. 548 00:39:01,942 --> 00:39:04,662 Broadening QRS complex. We've got to get his potassium down, 549 00:39:04,822 --> 00:39:07,982 otherwise he's going to arrest. Need 10ml of 10% calcium chloride. 550 00:39:08,102 --> 00:39:09,022 Yep. 551 00:39:10,222 --> 00:39:14,382 Thank you. And 20ml of 50% glucose solution with ten units of insulin. 552 00:39:14,502 --> 00:39:15,422 Yep. 553 00:39:16,982 --> 00:39:18,382 Slow bolus, Billy. 554 00:39:18,542 --> 00:39:20,662 Let's get some bicarb for his acidosis. 555 00:39:23,702 --> 00:39:27,742 RAPID BEEPING CONTINUES 556 00:39:30,142 --> 00:39:31,502 Yeah? Yep. 557 00:39:33,342 --> 00:39:34,542 Ten seconds, boss. 558 00:39:37,542 --> 00:39:39,302 OK, glucose-insulin solution is running. 559 00:39:39,462 --> 00:39:41,902 OK, I'm going to take the clamp fully off. Go. 560 00:39:46,902 --> 00:39:48,782 The aorta is fully unclamped. 561 00:39:52,822 --> 00:39:53,902 Dropping. 562 00:39:55,582 --> 00:39:56,782 Dropping. 563 00:40:01,582 --> 00:40:02,542 Dropping. 564 00:40:12,942 --> 00:40:13,902 Dropping. 565 00:40:24,702 --> 00:40:25,702 Holding. 566 00:40:33,742 --> 00:40:34,782 Holding. 567 00:40:40,662 --> 00:40:41,702 Climbing. 568 00:40:44,662 --> 00:40:47,342 BEEPING SLOWS 569 00:40:48,742 --> 00:40:50,262 ECG returning to normal. 570 00:40:50,422 --> 00:40:55,222 Maintaining BP 88/53. Heart rate 112. Sats 97. 571 00:40:57,982 --> 00:40:59,462 Is it me or did we just save him? 572 00:41:03,142 --> 00:41:04,302 Well done. 573 00:41:07,862 --> 00:41:09,302 That's good work, everyone. 574 00:41:13,142 --> 00:41:14,142 Really. 575 00:41:19,502 --> 00:41:20,582 It's great work. 576 00:41:22,422 --> 00:41:25,702 Let's have a full set of bloods, please, ABG... 577 00:41:26,822 --> 00:41:30,582 Dionysus Stematelayos. Consultant hepatobiliary surgeon. 578 00:41:34,382 --> 00:41:35,822 Let's do the swap. 579 00:41:35,982 --> 00:41:37,822 Is that...a condom? 580 00:41:41,022 --> 00:41:42,262 CAMERA CLICKS 581 00:41:50,142 --> 00:41:53,462 What's his haemo-dynamic? He's stable. He's looking good. 582 00:41:55,342 --> 00:41:56,302 Thank you. 583 00:42:00,342 --> 00:42:01,302 I need to see you. 584 00:42:03,622 --> 00:42:04,902 Now, if I can. 585 00:42:06,662 --> 00:42:07,782 I can't. 586 00:42:09,342 --> 00:42:11,182 Because of Tom? 587 00:42:11,302 --> 00:42:12,622 Because you're leaving. 588 00:42:17,342 --> 00:42:19,102 I'm going to need some eyes, please. 589 00:42:24,462 --> 00:42:25,582 Hey. 590 00:42:28,542 --> 00:42:29,942 You saved him. 591 00:42:30,062 --> 00:42:31,262 Yes. 592 00:42:31,382 --> 00:42:32,342 Wow. 593 00:42:39,382 --> 00:42:41,182 Lieutenant Colonel Bryan, please. 594 00:42:43,222 --> 00:42:46,222 Um... Can you put me through to her answering machine? 595 00:42:47,382 --> 00:42:50,462 Hi, Tom. Thank you for the flowers. 596 00:42:50,582 --> 00:42:51,542 They're lovely. 597 00:42:53,022 --> 00:42:56,182 So, what's the big occasion? 598 00:42:58,262 --> 00:43:00,062 Yes, Jane. This is Glen Boyle. 599 00:43:00,222 --> 00:43:02,622 I just wanted to talk to you about my redeployment. 600 00:43:03,862 --> 00:43:06,342 I'm not absolutely sure I'm ready to come back. 601 00:43:07,582 --> 00:43:10,742 I've been offered a chance to extend my contract at City General and... 602 00:43:19,062 --> 00:43:20,542 ..I have decided to stay. 603 00:43:51,982 --> 00:43:54,942 Subtitles by Ericsson 604 00:43:55,062 --> 00:43:57,982 accessibility@bskyb.com 605 00:43:58,032 --> 00:44:02,582 Repair and Synchronization by Easy Subtitles Synchronizer 1.0.0.0 40885

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