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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
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604
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605
00:43:58,032 --> 00:44:02,582
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