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1
00:00:06,788 --> 00:00:10,748
Hi, Tom. Thank you for the flowers.
They're lovely.
2
00:00:10,868 --> 00:00:12,988
What's the big occasion?
3
00:00:13,188 --> 00:00:18,708
You need to tell him
what's going on. And, frankly, you need to tell me.
4
00:00:18,828 --> 00:00:21,828
I need to see you. I can't.
5
00:00:21,988 --> 00:00:25,988
Because of Tom?
Because you're leaving.
6
00:00:35,948 --> 00:00:40,028
'Major traffic incident. Multiple
critical injuries. Imminent.
7
00:00:40,188 --> 00:00:45,228
'Trauma call...'
Rhythm check. BF. No pulse.
8
00:00:45,348 --> 00:00:48,188
Back on. Charging?
9
00:00:48,348 --> 00:00:52,468
Yeah. Everyone
except Justin stand clear.
10
00:00:52,628 --> 00:00:58,228
We need to open his chest.
'150 joules selected. Charging.'
11
00:01:01,668 --> 00:01:04,548
'Charged.'
Justin, stand clear.
12
00:01:04,668 --> 00:01:08,028
Shock in three, two, one. Shocking.
13
00:01:08,148 --> 00:01:10,788
Back on the chest.
14
00:01:14,668 --> 00:01:18,868
Rebecca, gown up. What size gloves?
15
00:01:18,988 --> 00:01:21,628
Em, six, please.
16
00:01:24,228 --> 00:01:29,908
You ever done this before? Er, no.
OK, we cut fast and we cut deep. OK?
17
00:01:30,028 --> 00:01:32,428
You follow my lead.
18
00:01:36,348 --> 00:01:38,428
I'm not shaking. It's cramp.
19
00:01:38,628 --> 00:01:44,828
Harry, what are you doing? Checking
for signs of life. No, he's dead. Move on. Harry...
20
00:01:44,988 --> 00:01:49,348
We did everything we could.
Time of death: 17.31.
21
00:01:49,508 --> 00:01:53,588
And get the mortuary technicians
up here straight away.
22
00:02:00,948 --> 00:02:02,788
Ties.
23
00:02:09,628 --> 00:02:13,948
Carry on with the CPR. I'm going to
work around you. 'Trauma call.
24
00:02:14,148 --> 00:02:19,588
'An estimated further 6-8
critically-injured patients due within the hour.'
25
00:02:19,748 --> 00:02:25,148
Can you give us some more room
in here? Blade.
26
00:02:25,268 --> 00:02:27,948
Off the chest.
27
00:02:29,268 --> 00:02:31,348
Ready to go?
28
00:02:31,468 --> 00:02:33,468
Fast and deep.
29
00:02:37,428 --> 00:02:43,148
'Due to a major incident,
we're experiencing severe delays in all departments.
30
00:02:43,308 --> 00:02:47,468
'We apologise for any inconvenience
or distress this may cause.'
31
00:02:51,228 --> 00:02:53,788
The shears, please.
32
00:02:59,388 --> 00:03:00,628
Yeah?
33
00:03:07,228 --> 00:03:11,388
Asystole now. Shit.
Get an aortic clamp ready.
34
00:03:13,948 --> 00:03:16,308
No outputs.
35
00:03:18,468 --> 00:03:20,108
Tractor.
36
00:03:23,068 --> 00:03:26,468
OK, as soon as we're open, get
in there, compress the aorta. Yeah?
37
00:03:26,588 --> 00:03:29,028
Yeah. Go, now.
38
00:03:33,268 --> 00:03:38,908
Harry, in my pocket is my mobile.
Call Fiona, tell her we need more hands down here.
39
00:03:39,028 --> 00:03:41,268
Other pocket.
40
00:03:45,668 --> 00:03:47,548
OK, clamp it up.
41
00:03:52,068 --> 00:03:54,548
I need her on the phone immediately.
42
00:04:00,548 --> 00:04:02,508
Nice.
43
00:04:07,348 --> 00:04:09,308
PHONE BUZZES
44
00:04:22,948 --> 00:04:24,988
No nagging doubts?
45
00:04:25,148 --> 00:04:29,628
No, it's time.
It makes sense for us.
46
00:04:33,028 --> 00:04:36,508
I'll get our coffees. OK.
47
00:04:46,588 --> 00:04:50,828
'You have one saved message.
Fiona, we need you in Resus.'
48
00:04:51,028 --> 00:04:57,148
'Due to a major incident,
there are severe delays in all departments. We apologise...'
49
00:04:57,348 --> 00:05:02,948
Constance, how are we doing?
Well, there's three for Resus and plenty more coming.
50
00:05:03,108 --> 00:05:07,348
Let's just start getting them
moved through.
51
00:05:11,268 --> 00:05:15,748
OK, motorcyclist pulled under
a lorry, which started a pile-up.
52
00:05:15,948 --> 00:05:21,948
De-gloving injuries to his limbs
and thorax. He was given needle decompression at the scene.
53
00:05:22,068 --> 00:05:25,268
OK. Obs? Rests 24.
54
00:05:25,388 --> 00:05:27,868
Pulse 116. BP 102 over 70.
55
00:05:27,988 --> 00:05:30,108
And low GCS.
56
00:05:30,308 --> 00:05:36,268
Any extra staff here yet?
Leave it with me! Where's the receiving team, then?
57
00:05:36,388 --> 00:05:38,428
Er...
58
00:05:38,628 --> 00:05:44,308
It's just me for now.
We've been through triage. That's just a queue. Who's this?
59
00:05:44,508 --> 00:05:50,148
P1 from major incident.
Coach passenger - leg fractures and chest pain.
60
00:05:51,388 --> 00:05:56,108
OK, in here, please. Er, right.
I'll try and get some extra hands.
61
00:05:56,268 --> 00:06:00,468
'Staff please ensure that
all walking wounded are held...'
62
00:06:00,628 --> 00:06:04,388
Anybody free to give me a hand,
please?
63
00:06:05,468 --> 00:06:08,068
You OK? Let me get to it.
64
00:06:25,668 --> 00:06:30,868
The quickest way to get his heart
started is to get blood in fast.
65
00:06:49,068 --> 00:06:52,028
OK, you just hold this, please.
66
00:06:56,708 --> 00:06:59,948
Thank you. Just cut there, please.
67
00:07:01,348 --> 00:07:03,548
Thank you.
68
00:07:07,188 --> 00:07:09,388
Thank you.
69
00:07:09,508 --> 00:07:10,428
OK...
70
00:07:10,548 --> 00:07:12,988
Thank you.
71
00:07:13,148 --> 00:07:15,868
Can you just take that top off,
please?
72
00:07:16,068 --> 00:07:21,708
OK, I'm going to run the blood
straight into this line and, hopefully...
73
00:07:21,908 --> 00:07:29,388
..the volume will get his pulse
back up. Connected. Get back on the heart massage, please.
74
00:07:32,468 --> 00:07:37,268
Let's get some more O Pos
from the fridge, please.
75
00:07:37,428 --> 00:07:41,948
No O Pos left. Crossmatch?
No, he'll take longer to match.
76
00:07:42,108 --> 00:07:46,868
OK, let's get Nicola. We need
to find some O Pos from somewhere.
77
00:07:47,068 --> 00:07:53,108
First major incident, Justin? Er...
Aww, we've got a Maj Acc virgin. Don't worry. This won't hurt much.
78
00:07:53,228 --> 00:07:56,028
He's no virgin.
79
00:07:58,828 --> 00:08:03,068
Ready for rays. Stand clear, please.
Billy... Don't tell, Billy...
80
00:08:06,308 --> 00:08:09,108
Rays in three.
81
00:08:10,788 --> 00:08:16,228
One, two, three, rays.
How's it going? Looks like it'll be a busy evening.
82
00:08:16,388 --> 00:08:20,748
Anything I should know?
They're heading for theatre.
83
00:08:20,908 --> 00:08:25,668
What happened to you on Wednesday?
It wasn't possible.
84
00:08:25,828 --> 00:08:30,908
There's something I need to speak to
you about. Yes. I need to talk, too.
85
00:08:31,068 --> 00:08:36,068
I've been offered a post. Sorry.
I don't know what to do next.
86
00:08:36,188 --> 00:08:38,148
OK. I'll take this one.
87
00:08:38,308 --> 00:08:42,588
Sure. We'll talk later.
Yes, let's.
88
00:08:42,788 --> 00:08:48,348
He's got bilateral femoral fractures
and chest pain. OK. Is he stable? Yes, but in a lot of pain.
89
00:08:48,548 --> 00:08:55,588
25 seconds to pulse check.
I called the medical registrar, but there's no doctor to see him. OK.
90
00:08:55,788 --> 00:09:00,868
I'll come as soon as I can.
Let's get him started on morphine and fluid.
91
00:09:01,028 --> 00:09:05,108
Let me know if anything changes.
OK? OK. Thanks.
92
00:09:13,028 --> 00:09:19,268
This is the last of the O Pos from
theatre. That's not enough. We don't know how long crossmatch will take.
93
00:09:19,468 --> 00:09:26,428
I'll send Giles for more. And the
chances of moving that body are...? Heart's contracting. Let me see.
94
00:09:29,628 --> 00:09:34,588
As soon as I can. Thank you. There's
a pulse. Give me BP. 77 over 48.
95
00:09:34,708 --> 00:09:36,468
Do we have him? Yes.
96
00:09:36,668 --> 00:09:42,868
OK, let's get that blood into him
fast, Harry. And then package him for transfer.
97
00:09:43,028 --> 00:09:47,668
'Clinical Lead please contact Head
of Human Resources immediately.'
98
00:09:47,828 --> 00:09:51,708
Blood.
Can you chase CT? Mm-hm.
99
00:09:54,788 --> 00:09:57,508
You're in there, mate. Think so?
100
00:09:57,668 --> 00:10:01,388
There's only one way to find out.
It's CT.
101
00:10:01,588 --> 00:10:07,308
We'll be there in five minutes.
Harry, get started on the patient in A, please. He's for Theatre 7.
102
00:10:07,468 --> 00:10:11,548
Rebecca, cardiothoracics, general
surgery and your boss'll take over.
103
00:10:11,668 --> 00:10:13,588
Thank you.
104
00:10:14,628 --> 00:10:16,988
On vents. Sats are good.
105
00:10:18,148 --> 00:10:22,068
15 minutes 'til CT. Book it.
..We'll take it.
106
00:10:22,228 --> 00:10:25,828
We'll do an extended fast.
Can you get the ultrasound, please?
107
00:10:25,948 --> 00:10:28,468
Coming through.
108
00:10:29,668 --> 00:10:33,548
Harry, start the primary.
I'll be back in a sec.
109
00:10:33,708 --> 00:10:38,388
Justin, keep going with what's
prescribed. I need another ECG.
110
00:10:38,548 --> 00:10:43,508
OK, tell me the story. This one,
asthma attack, resp 33. Thank you.
111
00:10:43,668 --> 00:10:48,108
A head injury, lost consciousness,
GCS 14 with neck pain.
112
00:10:48,228 --> 00:10:51,268
Pulse 104, but otherwise he's stable.
113
00:10:51,428 --> 00:10:55,388
And this one? Em...
Needs a tube.
114
00:10:55,548 --> 00:10:59,788
Spinal injury, GCS 8.
OK. He goes to ED.
115
00:10:59,988 --> 00:11:05,148
The other two stay here. Harry,
leave him, I need you here now. Justin... Yeah.
116
00:11:05,308 --> 00:11:10,268
This guy goes to Bay B. Constance
will help you. I've got him sorted.
117
00:11:10,468 --> 00:11:15,508
We're going to double bed.
The spinal in there. I'll start, Rebecca can take over.
118
00:11:15,668 --> 00:11:18,748
We really need more hands down here.
Enough!
119
00:11:18,948 --> 00:11:25,188
Glen, everybody's asking me
about this. I've chased it and they're on their way, OK?
120
00:11:29,444 --> 00:11:34,684
Abdomen's distended.
Get more O Pos, please. Yeah.
121
00:11:34,804 --> 00:11:37,684
They're full for half an hour. Shit.
122
00:11:37,804 --> 00:11:41,524
Yeah. OK, book it. Yes, please.
123
00:11:41,684 --> 00:11:45,324
We'll have to manage him here
until then.
124
00:11:46,924 --> 00:11:49,764
Weak radials.
125
00:11:54,284 --> 00:12:00,924
Right ankle pulses are absent.
Right's cold compared to left. Billy, Doppler, please. Yeah.
126
00:12:02,844 --> 00:12:07,524
The calf is hard and dull.
This guy needs an urgent fasciotomy and theatre.
127
00:12:07,684 --> 00:12:11,444
This can't wait 30 minutes.
Can you call them again? Thank you.
128
00:12:11,604 --> 00:12:16,684
Yeah, Resus.
We now need urgent fasciotomy.
129
00:12:16,804 --> 00:12:19,444
Yes, now.
130
00:12:19,564 --> 00:12:22,164
No DP or PT flow.
131
00:12:23,364 --> 00:12:25,204
Knee...
132
00:12:31,364 --> 00:12:36,084
Try fascic flow. Billy, can you see
if the x-rays are up yet? Yeah.
133
00:12:37,844 --> 00:12:40,484
They're up.
134
00:12:42,404 --> 00:12:48,564
And no fractures.
Compartment syndrome? Yes. About 90 minutes post-injury.
135
00:12:48,724 --> 00:12:53,724
No luck with the theatres. OK,
you're right. He'll lose a leg.
136
00:12:53,924 --> 00:12:58,964
So you'll do it here and...you,
Anna, you'll assist. Scrub up, please.
137
00:12:59,844 --> 00:13:01,724
Now.
138
00:13:03,564 --> 00:13:07,644
OK, Ania, come on. Are you sure
about this? Absolutely.
139
00:13:07,804 --> 00:13:11,404
I'm not prepared to accept
an ischemic leg. Time is muscle.
140
00:13:11,564 --> 00:13:15,444
(You don't see this every day,
do you?)
141
00:13:16,804 --> 00:13:19,884
Billy, Ramakrishna, get him set up.
142
00:13:22,884 --> 00:13:28,444
Just have a feel of your chest.
A lady outside is looking for her husband. He's been in half an hour.
143
00:13:28,564 --> 00:13:30,924
It's Jim Waters.
144
00:13:31,084 --> 00:13:34,364
Er...that's Jim Waters.
Oh, God.
145
00:13:34,484 --> 00:13:37,084
OK...can you talk to her?
146
00:13:37,244 --> 00:13:40,924
Er, no. No, I can't leave
this patient. I'll bring her here.
147
00:13:41,084 --> 00:13:45,364
No...! Give us a minute
to get rid of him. Shit.
148
00:13:45,484 --> 00:13:48,844
Guys, you need to go away. Now.
149
00:13:49,004 --> 00:13:53,044
Let's move it, please. Constance,
can you hook up the oxygen? Yes.
150
00:13:53,244 --> 00:14:00,404
OK, we're just going to put a clean
sheet on and then we'll move you straight over.
151
00:14:01,484 --> 00:14:04,844
Billy, my ties. Thanks.
152
00:14:12,764 --> 00:14:15,644
Antiseptic, please, Billy. Yeah.
153
00:14:24,284 --> 00:14:27,004
Drapes. Yeah.
154
00:14:32,524 --> 00:14:35,164
I need you to lift up the leg.
155
00:14:35,284 --> 00:14:38,084
Here we are.
156
00:14:40,604 --> 00:14:43,044
Another drape, Billy. Yeah.
157
00:14:51,604 --> 00:14:56,244
Ania, I need you to hold the ankle.
I need you to keep it steady. OK.
158
00:14:56,404 --> 00:15:00,244
Billy, will you support the thigh?
Yeah.
159
00:15:00,364 --> 00:15:02,204
OK?
160
00:15:02,364 --> 00:15:06,804
I'm going to expose the lateral
intermuscular septum.
161
00:15:08,924 --> 00:15:10,564
Cutting.
162
00:15:17,924 --> 00:15:20,204
BEEP
Shit!
163
00:15:20,364 --> 00:15:25,764
OK, airway's secure.
Chest is...
164
00:15:28,324 --> 00:15:33,764
Clear. But BP's in his boots.
He needs a laparotomy, boss. Rapid infuser to maximum.
165
00:15:33,924 --> 00:15:37,444
Can I get some blood?
At maximum. Thank you.
166
00:15:37,564 --> 00:15:40,084
Billy? Yeah, I'm here!
167
00:15:45,164 --> 00:15:47,844
Pulse is really weak.
168
00:15:48,004 --> 00:15:52,604
BP's gone. Let's squeeze some blood
in through this vent.
169
00:15:54,284 --> 00:15:58,004
He needs to be in theatre, boss.
I know! Billy, on the chest.
170
00:16:00,484 --> 00:16:05,644
Are you OK? Dr Bennett Edwardes?
This is Mrs Waters.
171
00:16:09,844 --> 00:16:11,684
Take these.
172
00:16:18,124 --> 00:16:23,964
I'm very sorry, but I have
some bad news for you. We did our very best,
173
00:16:24,124 --> 00:16:29,124
but your husband's injuries were
too severe for us to help him.
174
00:16:29,284 --> 00:16:33,004
I'm afraid he died
a short while ago.
175
00:16:33,124 --> 00:16:35,924
I'm terribly sorry for your loss.
176
00:16:41,044 --> 00:16:44,684
Let's get you a seat.
177
00:16:46,324 --> 00:16:50,844
SOBBING
We'll get you sat down. It's all right.
178
00:16:57,844 --> 00:16:59,484
There.
179
00:17:03,084 --> 00:17:06,484
Pulse check, please.
180
00:17:08,124 --> 00:17:14,244
BP's back. It's weak, but
it's there. Good. Let's keep going on the rapid infusion. Yeah.
181
00:17:15,324 --> 00:17:18,764
Another one for you. OK.
182
00:17:22,404 --> 00:17:26,444
I don't have another reg.
And all the trauma bays are busy.
183
00:17:26,604 --> 00:17:31,524
Congratulations on your news,
by the way. Thank you.
184
00:17:31,684 --> 00:17:37,164
And we're sure ED can't take her?
She needs to be in here. OK.
185
00:17:43,284 --> 00:17:45,444
This way, please.
186
00:17:50,764 --> 00:17:52,044
Harry?
187
00:17:53,764 --> 00:17:57,404
OK, let's hear it.
OK, Mavis, 82.
188
00:17:57,564 --> 00:18:01,924
Just discharged from ED
at four hours to keep beds free.
189
00:18:02,084 --> 00:18:06,084
Collapsed in the car park
with difficulty breathing.
190
00:18:07,644 --> 00:18:14,804
OK, Harry, I need you to take care
of her for me, please. Yes? Of course. Thank you. Hi.
191
00:18:16,724 --> 00:18:19,684
Tell me. BP rising. 88 over 44.
192
00:18:19,804 --> 00:18:22,724
Let's get back to the fasciotomy.
193
00:18:27,444 --> 00:18:30,484
I'm starting the medial incision.
194
00:18:30,604 --> 00:18:32,764
Cutting.
195
00:18:33,884 --> 00:18:36,724
Could you just sign this? Yeah, sure.
196
00:18:36,924 --> 00:18:43,164
Is this the guy?
Er, yes. Known asthmatic. Thanks. Brought in from the incident.
197
00:18:43,364 --> 00:18:49,804
Tachynoeaic, tachycardic on arrival
and unable to speak. He's been given nebs, steroids and...
198
00:18:50,004 --> 00:18:57,284
Yes, this one. Ipratropium.
Just started on magnesium, but his obs have worsened.
199
00:18:57,484 --> 00:19:03,924
Why wait so long to give him
magnesium? That turns these around. He might have avoided a tube.
200
00:19:04,124 --> 00:19:09,804
The line was really difficult.
I was drawing stuff up myself. Sorry. I should have done better.
201
00:19:09,924 --> 00:19:12,124
Get over here and help.
202
00:19:14,124 --> 00:19:18,764
Mavis, I'll be back in just one
minute, OK? Could you watch her?
203
00:19:24,924 --> 00:19:28,484
Can we get some help here? Help!
204
00:19:29,844 --> 00:19:32,204
Some help, please.
205
00:19:33,244 --> 00:19:36,004
Go. I'll be fine here.
206
00:19:39,044 --> 00:19:43,964
Can't you find an alternative route?
All right. See you when we see you.
207
00:19:44,164 --> 00:19:49,724
'Due to a major incident,
we're experiencing severe delays in all departments.
208
00:19:49,884 --> 00:19:54,124
'We apologise for any inconvenience
or distress this may cause.'
209
00:19:56,000 --> 00:59:00,000
Major incident's shut the motorway.
Extra staff are stuck in gridlock.
210
00:19:59,000 --> 00:20:05,160
What's he doing here? Oh, yeah.
Turns out he refused to go quietly. So they had to promote him.
211
00:20:09,200 --> 00:20:10,480
Clive.
212
00:20:10,680 --> 00:20:17,080
Nicola. I hope you don't mind us
commandeering your office. David, Ruth, this is Mrs Hicklin.
213
00:20:17,280 --> 00:20:22,520
We're struggling to move patients
to CT, theatres or the wards. It's in hand.
214
00:20:22,680 --> 00:20:27,640
I'm trying to clear the decks
elsewhere. Do we not have any space?
215
00:20:27,840 --> 00:20:33,960
All I can see is that you're coping
admirably, especially after all the marvellous changes you brought in.
216
00:20:40,200 --> 00:20:44,520
..and after all that, it turns out
I had it on me all along.
217
00:20:44,720 --> 00:20:50,640
You're so funny.
You make me laugh so much. Lovely Billy.
218
00:20:50,840 --> 00:20:57,760
Well, what do you say to a night out?
You, me, some dinner, lots of laughs?
219
00:20:57,960 --> 00:21:02,480
Yeah, that would be lovely.
But as friends. You know I have a boyfriend.
220
00:21:02,600 --> 00:21:05,760
Y-Yeah. Of course.
221
00:21:05,920 --> 00:21:10,480
You thought I meant...
Nah, just as friends. Cool.
222
00:21:10,600 --> 00:21:11,600
OK.
223
00:21:11,720 --> 00:21:14,280
'Due to a major incident...'
224
00:21:15,360 --> 00:21:19,000
Billy... Billy! With me - now.
Please. Bay C.
225
00:21:26,840 --> 00:21:32,080
BP's still dropping.
Systolic 84, pulse is 120 and MAT is getting worse.
226
00:21:32,200 --> 00:21:34,760
Look, this is new. This bruising.
227
00:21:37,160 --> 00:21:40,720
Retroperitoneal bleed's
more extensive.
228
00:21:40,920 --> 00:21:47,880
Ania, can you chase theatre again?
We need to move him now. Don't bother. I'll check trauma theatre.
229
00:21:53,480 --> 00:21:58,120
Excuse me, sorry. Coming through.
Mind your backs, please! Sorry.
230
00:21:58,280 --> 00:22:02,560
Mind your back. Sorry.
I've got to get through.
231
00:22:08,880 --> 00:22:14,680
Sorry to disturb, Mr Street.
How long will you be? You're the third person to ask.
232
00:22:14,800 --> 00:22:17,280
It takes as long as it takes.
233
00:22:17,480 --> 00:22:23,320
Don't know what his problem is.
At least he regularly gets his digits inside a bird.
234
00:22:23,440 --> 00:22:24,520
Here.
235
00:22:34,400 --> 00:22:40,880
I got a three-month contract
to continue working here. What about your army deployment?
236
00:22:41,000 --> 00:22:43,920
I've deferred it.
237
00:22:45,800 --> 00:22:48,240
There's her bloods.
238
00:22:49,880 --> 00:22:56,880
Right, her potassium's not helping.
OK, 10ml of calcium chloride, then magnesium and insulin dextrose.
239
00:22:57,040 --> 00:23:01,000
She's still in VT with output.
Can I have help with her airway?
240
00:23:01,120 --> 00:23:03,400
I'm busy with your other patient.
241
00:23:03,520 --> 00:23:07,000
Calcium chloride, 10ml going in.
242
00:23:09,720 --> 00:23:16,440
OK, can we have another synchronised
shot, please? Shouldn't we wait until that's gone through?
243
00:23:18,840 --> 00:23:24,920
It's nearly run through and the
calcium should stabilise her heart temporarily.
244
00:23:26,880 --> 00:23:32,520
Yes, this is Glen Boyle,
Trauma Consultant. I need a theatre for an emergency laparotomy, please.
245
00:23:32,640 --> 00:23:34,920
Maj Acc. MO 0005.
246
00:23:35,080 --> 00:23:39,760
Well, it's an emergency so, yes,
I need it now. OK, understood.
247
00:23:39,920 --> 00:23:43,840
News? Another 15 minutes at best,
but Street knows about him
248
00:23:44,040 --> 00:23:49,360
and Nicola's trying to find
a theatre upstairs. BP's still abysmal.
249
00:23:49,520 --> 00:23:53,920
OK, let's keep transfusing him.
Aim for 90 systolic.
250
00:23:54,080 --> 00:23:58,600
CT and theatre are busy, so let's
get Shelley to redo the x-rays.
251
00:23:58,720 --> 00:24:01,040
Justin, you can do that. Call X-ray.
252
00:24:01,200 --> 00:24:04,160
- Em, Billy can you...?
- I'm busy.
253
00:24:07,480 --> 00:24:13,960
Thank you.
'Due to a major incident, we're experiencing severe delays.
254
00:24:14,160 --> 00:24:18,800
'We apologise for any inconvenience
or distress.' Justin here. Hi, Shelley.
255
00:24:19,920 --> 00:24:24,040
Yeah, fine. Can we get more x-rays
in Resus Bay C, please?
256
00:24:24,160 --> 00:24:25,880
Thanks.
257
00:24:30,440 --> 00:24:32,040
Glen?
258
00:24:33,120 --> 00:24:37,640
We have a prolonged entrapment
on its way. Low GCS.
259
00:24:37,840 --> 00:24:44,080
They intubated him on scene.
I've cleared an ED cubicle for an extra Resus bay.
260
00:24:44,280 --> 00:24:49,040
And what about those extra hands?
Clive won't reallocate onsite staff. Clive?
261
00:24:49,160 --> 00:24:51,640
He's been moved up to management.
262
00:24:51,800 --> 00:24:55,920
I know. What I need is you to cope
until people start arriving.
263
00:24:56,120 --> 00:25:01,960
I've got the on-call surgical SHO
coming and we can ask Dominic after he hands over the asthma patient.
264
00:25:02,120 --> 00:25:04,680
Can you spare anyone?
BEEP
265
00:25:04,840 --> 00:25:08,880
Oh, shit.
Do I have a choice? Thanks, Glen.
266
00:25:09,080 --> 00:25:14,800
BP's dropping again.
It's 68 over 34... Shit! He's oozing from his lines.
267
00:25:14,960 --> 00:25:19,560
Give him calcium and more clotting
factors. He's cold. Bair Hugger!
268
00:25:19,720 --> 00:25:22,960
Yeah, switch,
give me theatres, please.
269
00:25:23,120 --> 00:25:28,360
OK, this is Glen Boyle.
Maj Acc MO 0005.
270
00:25:28,520 --> 00:25:32,280
He's deteriorated.
I really need to bring him up now.
271
00:25:32,440 --> 00:25:37,600
Coagulopathic, yes.
Transfusing, yes.
272
00:25:37,760 --> 00:25:41,640
OK, thank you.
OK, let's prep for transfer.
273
00:25:41,840 --> 00:25:48,160
They'll be another five. We'll
continue transfusions as we go. I need to check the other bays.
274
00:25:48,320 --> 00:25:52,320
Give me a shout if anything changes.
Carry on with x-rays? Yes, please.
275
00:25:52,480 --> 00:25:57,320
Harry? Update, please.
Er, yeah. This one is medical
276
00:25:57,480 --> 00:26:02,120
and this lady,
the medics are taking her. Good.
277
00:26:03,240 --> 00:26:09,760
I heard your news. Well done.
I hope you have more luck than I did choosing the right one. Thank you.
278
00:26:09,920 --> 00:26:14,200
Harry, Constance, with me, please.
Anna, here.
279
00:26:14,400 --> 00:26:21,200
I need you to go with Harry and
Constance to ED. There's a surgeon and I'll send Dominic over ASAP. Go.
280
00:26:22,600 --> 00:26:24,680
Em...it's Ania.
281
00:26:24,800 --> 00:26:26,280
Right.
282
00:26:27,400 --> 00:26:32,800
Harry? Hm? I need you to take the
lead on the prolonged entrapment. No, I...
283
00:26:32,920 --> 00:26:35,400
If there's a problem, call me. Yes?
284
00:26:35,520 --> 00:26:38,200
Yes. And thank you.
285
00:26:39,960 --> 00:26:42,880
I'm ready for rays. Thanks.
286
00:26:52,920 --> 00:26:55,120
Rays in three.
287
00:26:55,240 --> 00:26:58,400
One, two, three, rays.
288
00:26:59,440 --> 00:27:02,520
Cubicle four, please.
289
00:27:03,720 --> 00:27:08,440
Hi. Handover first,
then we'll put him on the trolley.
290
00:27:08,600 --> 00:27:12,760
Shouldn't we wait for the Trauma Team
leader? That's me. Oh.
291
00:27:12,920 --> 00:27:17,360
OK, I've got a male in his late-30s,
came off his motorbike.
292
00:27:17,520 --> 00:27:22,240
He was trapped in a lateral position
between two vehicles for an hour.
293
00:27:22,440 --> 00:27:29,480
He told me he hadn't been KO'd and he
had a pain in his chest. Tubed at the scene due to difficulty breathing.
294
00:27:29,640 --> 00:27:33,640
We needed a high flow of oxygen
to keep his sats acceptable.
295
00:27:33,840 --> 00:27:39,400
Equal air entry,
but bilateral surgical emphysema and rib fractures.
296
00:27:39,560 --> 00:27:43,240
Surgical emphysema has extended
to his upper chest and neck.
297
00:27:43,440 --> 00:27:49,720
He had bilateral thoracostomies.
Circulation is stable. Pelvis and leg seemed to escape major damage.
298
00:27:49,880 --> 00:27:53,840
OK, great, thanks. Move him across
and I'll manage him on vent.
299
00:27:54,000 --> 00:27:57,200
- Sorry.
- Can you help us?
300
00:27:57,320 --> 00:28:00,440
On three. One, two, three.
301
00:28:00,640 --> 00:28:06,480
I've got it. That was trauma
theatre. Street's been delayed. You'll have to start on your own.
302
00:28:06,640 --> 00:28:10,720
You're not coming?
I can't. I'm needed in Resus.
303
00:28:10,920 --> 00:28:17,880
You'll be OK from here? I will.
About extending your contract. Yeah. Make sure it's the right move.
304
00:28:18,040 --> 00:28:21,160
Don't mess up your army career.
Need to go.
305
00:28:21,280 --> 00:28:22,720
Yeah.
306
00:28:31,800 --> 00:28:34,120
Equal bilateral air entry.
307
00:28:36,600 --> 00:28:43,200
That feels weird.
Er...I mean surgical emphysema and...
308
00:28:44,600 --> 00:28:47,240
..bilateral rib fractures.
309
00:28:48,320 --> 00:28:51,360
The abdomen is not distended.
310
00:28:51,520 --> 00:28:55,640
BEEP
Why are his sats dropping?!
311
00:28:55,800 --> 00:29:00,960
Oh, shit! The tube's come out.
I'll go get help!
312
00:29:03,120 --> 00:29:05,560
Got it? C-spine immobilisation here.
313
00:29:05,680 --> 00:29:08,200
Bag and mask, please.
314
00:29:20,800 --> 00:29:22,760
(Come on...)
315
00:29:23,880 --> 00:29:26,280
Guedel!
316
00:29:29,200 --> 00:29:31,840
Come on...
317
00:29:46,040 --> 00:29:50,520
His chest's not moving
and his sats aren't going up.
318
00:29:50,680 --> 00:29:54,840
Check the thoracostomies,
see if they're open.
319
00:29:55,000 --> 00:30:00,040
And then a laryngoscope and a tube,
please. ..Shit.
320
00:30:01,560 --> 00:30:04,600
Come on, come on. Sats are dropping.
321
00:30:16,560 --> 00:30:19,240
I can't see anything.
322
00:30:19,360 --> 00:30:22,840
Surgical emphysema... Tube.
323
00:30:24,400 --> 00:30:26,880
OK, I think I can...
324
00:30:27,000 --> 00:30:29,520
Come on.
325
00:30:30,600 --> 00:30:32,760
Oh, shit... I can't.
326
00:30:32,880 --> 00:30:35,360
Oh, shit! I've made him bleed.
327
00:30:48,240 --> 00:30:51,000
BEEPING INTENSIFIES
Constance... Hang on! Easy.
328
00:30:51,000 --> 00:30:56,480
Let's try and get this tube in him.
Here, let me. Look, his sats are 61!
329
00:30:56,680 --> 00:31:02,080
One sec. He needs an airway,
Dominic! Hang on! This is in the way.
330
00:31:02,280 --> 00:31:07,200
His sats are still falling!
If you don't stop, he's going to die! Damn it!
331
00:31:07,360 --> 00:31:11,760
Stop! He can't ventilate. Move.
We do this now. Blade.
332
00:31:11,880 --> 00:31:14,480
CONSTANT BEEPING
333
00:31:41,120 --> 00:31:45,000
We're in.
Cuff up and ventilate.
334
00:31:45,120 --> 00:31:48,240
Hold this, please.
335
00:31:58,040 --> 00:31:59,720
Ventilating.
336
00:32:02,320 --> 00:32:04,280
Sats rising.
337
00:32:10,920 --> 00:32:13,560
Roberts out. Scissors.
338
00:32:17,720 --> 00:32:20,800
Splenectomy is complete. Packs.
339
00:32:26,920 --> 00:32:30,280
- Two in.
- Two in, eight in total.
340
00:32:30,400 --> 00:32:32,920
BP still dropping, systolic is 70.
341
00:32:33,080 --> 00:32:37,800
OK, moving on to the retroperitoneal
bleed. Um, hang on.
342
00:32:38,000 --> 00:32:43,640
Yes? Shouldn't we examine the rest
of the abdomen first? We have to address this bleed. But...
343
00:32:43,800 --> 00:32:47,800
We don't have a consultant present.
Someone has to lead. Yes?
344
00:32:50,880 --> 00:32:53,480
Thank you.
345
00:32:58,080 --> 00:33:04,680
Evidence of an expanding
retroperitoneal haematoma. BP still dropping, systolic now 67.
346
00:33:04,800 --> 00:33:07,680
Let me see the pelvic x-rays. Yup.
347
00:33:08,960 --> 00:33:11,240
- Four out.
- Four out, four in.
348
00:33:11,440 --> 00:33:18,240
OK. No pelvic fractures in evidence.
So the haematoma is... probably venous in origin.
349
00:33:18,360 --> 00:33:20,480
Agreed? Agreed.
350
00:33:21,560 --> 00:33:23,880
Forceps, McIndoes.
351
00:33:24,080 --> 00:33:30,000
Can I just say something? Quickly!
Shouldn't we be treating this a bit more conservatively?
352
00:33:30,200 --> 00:33:36,040
His BP is still falling. He can't
wait. If the bleed is venous, why risk opening him up further?
353
00:33:40,440 --> 00:33:46,000
OK, I'll do some extraperitoneal
packing to stabilise him until Street gets here.
354
00:33:46,120 --> 00:33:48,520
Mains forceps.
355
00:33:49,720 --> 00:33:51,800
Pack.
356
00:34:06,560 --> 00:34:11,080
- Six in.
- Six in, ten in total. OK...
357
00:34:11,200 --> 00:34:13,840
BP? It's holding.
358
00:34:17,120 --> 00:34:18,880
Holding.
359
00:34:20,920 --> 00:34:22,680
Holding.
360
00:34:23,920 --> 00:34:26,880
BEEP
Oh! Come on!
361
00:34:27,040 --> 00:34:30,640
Forceps, McIndoes - now!
Dropping. Systolic is 64.
362
00:34:35,200 --> 00:34:39,880
Massive arterial bleed. Suction.
Billy, whack it in! Yes!
363
00:34:42,240 --> 00:34:46,240
I can't see a thing here. I need
another suction. Suction, quickly!
364
00:34:46,360 --> 00:34:49,280
I can't see anything here! Quickly!
365
00:34:53,520 --> 00:34:59,040
I can't locate the bleed.
It's got to be in the pelvis. There's no fracture!
366
00:34:59,240 --> 00:35:02,920
BEEPING
Shit! BP's dropping! Billy! Yes, we're on it!
367
00:35:03,040 --> 00:35:05,880
Packs! And again.
368
00:35:06,000 --> 00:35:09,120
Where's Street? Systolic is 60!
369
00:35:09,280 --> 00:35:14,640
Billy, faster with the blood!
Going full pelt! Systolic is 57.
370
00:35:14,800 --> 00:35:20,040
It's dropping. 53.
Shit, he's crashing.
371
00:35:21,566 --> 00:35:23,286
Fiona?
372
00:35:23,486 --> 00:35:29,606
Glen, I need your help. I can't
control this retroperitoneal bleed. Where's Street? He's not here.
373
00:35:29,726 --> 00:35:32,126
I need you in theatre now.
374
00:35:32,326 --> 00:35:38,566
Bay B, please. I've got seven
patients here, three are unstable. There's no way I can leave. Sorry.
375
00:35:38,726 --> 00:35:42,246
Glen, I'm losing him.
Tell me exactly what's happening.
376
00:35:42,406 --> 00:35:47,326
OK, I've packed him, but his BP is
still falling. Systolic's around 50.
377
00:35:47,526 --> 00:35:54,126
It doesn't make any sense -
there are no torn vessels and the pelvis is intact.
378
00:35:54,246 --> 00:35:56,526
And we're sure it's not a fracture?
379
00:35:56,686 --> 00:36:01,166
I'm looking at the x-ray right now.
Hold on, hold on. Glen...
380
00:36:01,326 --> 00:36:05,206
Stop. Where are we taking him?
OK, in there. We're double bedding.
381
00:36:05,366 --> 00:36:09,326
The x-ray,
is the pelvic binder on?
382
00:36:10,406 --> 00:36:13,326
Yes. OK, listen...
383
00:36:13,486 --> 00:36:17,206
Put me on speaker.
You heard him.
384
00:36:19,486 --> 00:36:23,126
OK, go ahead.
OK, everybody listen to me.
385
00:36:23,326 --> 00:36:28,926
If this is what I think it is,
the chances are the pelvis is fractured.
386
00:36:29,126 --> 00:36:33,926
The binder has reduced it,
so we can't see the break, but it is there.
387
00:36:34,086 --> 00:36:38,166
X-rays are too low-res to reveal it.
Shit. We skipped CT. Yeah.
388
00:36:38,326 --> 00:36:43,446
Analgesic? Er, morphine. 10mg?
Yeah. 2.5 at a time, yes?
389
00:36:43,566 --> 00:36:45,966
Go. This is what you need to do.
390
00:36:46,126 --> 00:36:50,606
You need to unpack, get in there
and clamp off one of the arteries.
391
00:36:50,766 --> 00:36:54,846
If you can't determine which one,
well, you'll have to do both.
392
00:36:55,006 --> 00:36:58,766
Both of them? Yeah, I know.
It's crap, but yes.
393
00:36:58,926 --> 00:37:03,086
OK, got it. Good.
Take me off speaker, please. ..Stop.
394
00:37:03,206 --> 00:37:05,246
Go. You're off speaker.
395
00:37:06,606 --> 00:37:11,246
You're more important to me
than the army. OK?
396
00:37:12,286 --> 00:37:14,846
That's why I'm staying.
397
00:37:14,966 --> 00:37:17,406
I have to go.
398
00:37:17,526 --> 00:37:20,086
I'll speak to you later. Good luck.
399
00:37:21,446 --> 00:37:23,406
Thank you.
400
00:37:29,966 --> 00:37:31,806
Right.
401
00:37:31,966 --> 00:37:36,046
We're unpacking.
And this is going to be fast.
402
00:37:36,166 --> 00:37:38,206
Is everybody ready?
403
00:37:38,366 --> 00:37:41,766
- Yes, Miss Lomas.
- Ready.
404
00:37:41,926 --> 00:37:45,686
Ramakrishna?
Yeah, let's do this.
405
00:37:49,206 --> 00:37:51,126
Unpacking.
406
00:37:55,046 --> 00:37:56,806
Four out.
407
00:37:56,926 --> 00:37:59,926
Four out, ten in. Shit.
408
00:38:00,046 --> 00:38:02,646
OK, get in there with suction.
409
00:38:05,646 --> 00:38:10,166
I can't get to it. The vessels have
collapsed. Get me another suction.
410
00:38:13,406 --> 00:38:18,886
I have the common iliac bifurcation.
I'm searching for the internal iliacs.
411
00:38:19,046 --> 00:38:23,126
OK, let's be ready
with McIndoes, Dardicks, sling.
412
00:38:29,446 --> 00:38:31,406
How's it going? What happened?
413
00:38:31,606 --> 00:38:36,766
He was can't intubate,
can't ventilate. Needed a cric. Otherwise stable.
414
00:38:36,926 --> 00:38:41,246
OK, well done, Dominic. Is he going
to CT? Yes. I need to book him in.
415
00:38:41,446 --> 00:38:47,646
Then get him booked in!
Then get him to Resus Bay C, OK? Yes, Mrs Hicklin.
416
00:38:55,486 --> 00:38:57,246
Dardick.
417
00:38:59,646 --> 00:39:04,606
That's the right
internal iliac artery clamped.
418
00:39:06,046 --> 00:39:10,166
No good. He's still hosing. Give me
another suction. Blood, please.
419
00:39:12,246 --> 00:39:18,126
Systolic's 50. It's no good.
OK, I'll have to clamp the other artery. Sling.
420
00:39:23,206 --> 00:39:24,566
Quick!
421
00:39:24,686 --> 00:39:26,846
Ta.
422
00:39:33,606 --> 00:39:35,966
Got it.
423
00:39:38,766 --> 00:39:43,926
OK, clamps. Let's get his volume up.
It's happening.
424
00:39:53,766 --> 00:39:55,926
Systolic still 50.
425
00:40:12,206 --> 00:40:14,326
Rising. 55.
426
00:40:18,686 --> 00:40:21,166
Systolic still rising.
427
00:40:21,286 --> 00:40:23,326
Now 60.
428
00:40:30,966 --> 00:40:32,046
65.
429
00:40:33,526 --> 00:40:37,566
Mr Street, Gen Surgery consultant.
Scrubbing in.
430
00:40:45,646 --> 00:40:49,566
Thank you.
We've got another P1 coming in now.
431
00:40:49,726 --> 00:40:55,086
I found you an anaesthetist
and a gen surg reg. Good. This way.
432
00:40:55,206 --> 00:40:57,846
Go and get ready in Bay A, please.
433
00:40:58,046 --> 00:41:05,686
Em, two theatres are clear
and a CT list has been cancelled, so we can start moving patients. OK.
434
00:41:05,886 --> 00:41:11,206
Thank you very much for today.
You're welcome. I'm glad you're staying.
435
00:41:17,606 --> 00:41:21,806
Is there any news on his ITU bed?
It's free. A team's coming now.
436
00:41:22,006 --> 00:41:27,566
Great. OK, everyone happy?
It's easy to manage patients that are completely stable.
437
00:41:27,726 --> 00:41:31,726
At least I did something when he
lost his airway. You did the cric?
438
00:41:36,966 --> 00:41:39,566
I threw a lot at you today.
439
00:41:39,686 --> 00:41:42,006
Very impressed.
440
00:41:42,126 --> 00:41:45,006
Yeah, well done, Harry.
441
00:41:46,966 --> 00:41:48,966
Did we win? Yes.
442
00:41:49,086 --> 00:41:51,006
Good.
443
00:41:51,166 --> 00:41:55,446
Can we talk? I hear congratulations
are in order. When's the big day?
444
00:41:58,046 --> 00:42:02,206
I asked him not to say anything.
Have you got the ring? Can we see?
445
00:42:02,326 --> 00:42:05,486
Go on, show the ring.
446
00:42:07,046 --> 00:42:10,206
Oh! Put it on. Let's see it. Go on.
447
00:42:10,326 --> 00:42:12,646
Aww, it's beautiful.
448
00:42:12,766 --> 00:42:15,926
That is gorgeous. Congratulations.
449
00:42:16,086 --> 00:42:20,366
We've got another patient coming in.
ETA is five minutes.
450
00:42:20,526 --> 00:42:24,806
If we could go and get prepared
in Bay A, please.
451
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Please.
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I'm so... Yeah.
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